Transition to Practice Regulatory Model: Implementing Change

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Transition to Practice Regulatory Model
Implementing Change

• Nancy Spector, Director of Regulatory Innovations
• NM Statewide Nursing Faculty Conference
• June 4, 2009, 100-230 p.m.

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Mission of NCSBN

• The National Council of State Boards of Nursing
  (NCSBN), is composed of Member Boards, provides
  leadership to advance regulatory excellence for
  public protection.

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Resources for Educators

• www.ncsbn.org/ Go to programs services
• For Transition https//www.ncsbn.org/363.htm
• Leader to Leader
• nspector_at_ncsbn.org

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Background of the Problem
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Background of the Problem

• Benners work over 20 years
• Kramers Reality Shock, from 1974

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Background

• NCSBN delegates voted in 2002 to
• Identify and promote effective models to
  facilitate a successful transition of new nurses
  from education to practice. and Participate in
  strategies for retention of the new graduate.

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Background

• NCSBN 2002 2004 Employer Studies
• Yes definitely to survey question regarding
  novice graduates being prepared to provide safe
  and effective care
• 45 (2002) 48.8 (2004)-diploma graduates
• 40 (2002) 41.9 (2004)- BSN graduates
• 35 (2002) 41.9 (2004)- ADN graduates
• 30 (2002) 32.9 (2004)- PN graduates

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Background

• Advisory Board Company (2008) Surveyed
• 5,700 frontline nurse leaders
• 400 nursing deans/directors/chairs

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Background

• 90 academic leaders believe their new students
  are prepared.
• 10 of health system nurse leaders believe new
  nurses are prepared.

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Advisory Board Study

• Biggest Improvement Needed
• Follow up
• Initiative
• Quality improvement
• Time management
• Tracking multiple responsibilities
• Conflict resolution
• Delegation

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Transition to Practice A Missing Piece in Nursing
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Background

• Turnover rates (2006 Nurse Executive Center
  Transitioning New Graduates to Hospital
  Practice)
• One Year- 36
• Two Years- 75
• Three Years- 50

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Background

• NCSBN hosted the Transition Forum February 22,
  2007
• Speakers from other disciplines and countries all
  came together.
• Various research findings showed need for
  transition programs.
• Stakeholders agreed to a standardized regulatory
  model (AACN, AONE, ANA, NAPNES, NLN)

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Background

• Computerized NCLEX, allowing for almost immediate
  licensure
• Context of practice frenzy
• Health care becoming more complex
• Nursing shortage
• IOM and other studies on patient safety

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Transition to Practice Work

• Goals To promote public safety by supporting
  newly licensed nurses during their critical entry
  period and progression into practice.
• Premises
• Definitions

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Transition to Practice Model
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Description of Model

• Pass NCLEX
• Separate Orientation
• Flexible and robust
• 6 month preceptorship

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Description of Model

• 1 year institutional support
• Feedback and reflection
• License renewal

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Description of Model

• Website plans for modules
• Preceptorship training
• QSEN for RNs

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Transition to Practice Fact Sheet

• The problem
• The impact
• The solution

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Transition to Practice Evidence Grid

• International Work
• National Work
• Individual Work

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FAQs

• Why should this be implemented through
  regulation?
• How was the model designed?
• Are you seeing this as a failure of education
  and/or practice?

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FAQs

• Are the modules just re-teaching?
• What about cost?
• How can this be implemented in rural areas?

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FAQs

• Will NCSBN mandate transition to practice in all
  boards?
• What about the current climate of job shortages?

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Its a Collaborative Model
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Collaborative Input

• Formally with 14 organizations as well as our
  membership
• Pilot before mandating through regulation
• Consider costs

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Collaborative Input

• Outcomes from pilots will be important
• Successful national programs are being
  implemented
• Be sure LPN needs are met
• Tightening of job market

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Collaborative Input

• Preceptor training
• Several states are interested in piloting
• Timeframe needed
• Embraced the model for being inclusive
• Willingness for collaboration

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Transition Dashboard

• Pilots (June 2011)
• Modules
• Marketing
• Business Plan

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Transition Dashboard

• Preceptor Development
• Research
• Funding

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Transition Tool Kit

• Available at
• httpswww.ncsbn.org/363.htm

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Transition Tool Kit

• Evidence grid
• Fact sheet
• FAQs
• Most recent article
• Dashboard

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Transition Tool Kit

• Goals/definitions/premises
• Model description
• Example of model rules for Boards
• Example of Transition to Practice Verification
  form (TPV form)

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Timeline

• 2009-10
• Business plan
• Content outline for nurse (LPN and RN) modules
• Convene research advisory panel
• Develop specifics of pilots
• Identify funding sources
• stakeholder collaboration

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Timeline

• 2010-11
• Develop nurse (LPN and RN) modules
• Develop preceptor modules and online connections
• Establish pilot sites
• Identify funding sources
• stakeholder collaboration

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Timeline

• 2011-12
• Implement pilots
• Collect data
• Identify funding sources
• stakeholder collaboration

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Transition to Practice

• the one goal that unifies us all improvement
  both in individual patient care and in the health
  care delivery system might be achieved.
• -Marlene Kramer, 1974

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The Future!!