Project Director Peggy Hawkins RN PhD peggyhawkins1creightonedu SheilaExstromnebraskagov Statistics June Smith RN PhD Grant from Center for Regulatory Excellence to study educational needs of RNs and LPNs in rural and urban Nebraska including both longterm care and acute care faci ID: 783373
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Slide1
Adaptation of a Transition to Practice Program for New Graduates in Acute and Long-term Care Facilities in Urban and Rural Nebraska
Project Director: Peggy Hawkins, RN, PhD
peggyhawkins1@creighton.edu
Sheila.Exstrom@nebraska.gov
Statistics: June Smith, RN, PhD
Slide2Grant from Center for Regulatory Excellence to study educational needs of RNs and LPNs in rural and urban Nebraska including both long-term care and acute care facilities.Project launch Spring 2010
Conclusion Spring 2012
Background
Slide3Phase One: Determine educational needsPhase Two: Quasi-experimental study of new graduates
Purpose to determine whether educational modules and preceptor development made a difference in new graduate transition to practice
Phase Three:
Analysis of data
Three Phases to Project
Slide4Representatives from the 5 nursing organizationsNebraska Board of NursingNebraska Assembly of Deans and Directors
Licensed Practical Nursing Association of Nebraska
Nebraska Organization of Nurse Leaders
Nebraska Nurses Association
Task Force as Oversight
Slide5Baseline data: 2009 new nursing graduates by mailed questionnaires plus interviews and expert panel Delphi study
Determined which modules to develop for the educational intervention
Phase One Activities
Slide6Do new nursing graduates who have online educational modules and preceptors who attended a preceptor development program have greater satisfaction, higher confidence, and less errors than new graduates who have regular orientation programs? Secondary question was to estimate costs.
Phase Two: Primary Research Question
Slide7Control Surveys
Managers
Preceptors
New nursing graduates
Observational studiesInterventions introduced
Educational Modules
8 Preceptor programs (n = 239 at 22 facilities)
Treatment
Surveys
Managers,
Preceptors
New grads
Observational studies
Phase Two
Slide8Control Group
Treatment Group
New Graduate
Interim
Conclusion
97
40
60
45
Preceptors
Interim
Conclusion
118
81
5657Managers3029
Results - Sample
Slide9Significant Items <.05
Control
Treatment
New
Graduate:
%
Satisfied
Assigned classes
Length of transition
83%
85%
96%
97%
New
Graduate: % Prepared Make patient care decisions76%93%Preceptor perception: % of new grads prepared Delegate Tasks Make patient care decisions Administer meds to large groups Provide care to 6 or more
35
%43%54%25%46%75%77%*17%
Results –
Perceptions about New Grads
Slide10Preparedness
Items <.05
Control
Treatment
Felt prepared to precept
68%
81%
Develop coaching plans
47%
58%
Develop new grad critical thinking
54%
78%
Understand learning styles
55%78%Evaluate new grad competence59%81%Utilize variety of teaching strategies56%65%Assuring new grad gave safe care86%92%Results – Preceptors Preparedness
Slide11Items <.05
Control
Treatment
Development of critical thinking in new grads
83%
93%
Resolution of issues/conflicts
92%
*80
%
Acting as a role model for my facility
100%
*98
%
Evaluating the competency of new graduates81%92%Planning meaningful experiences for new graduates each work day78%92%Results – Satisfaction of Preceptors
Slide12Items <.05
Control
Treatment
Satisfied with new
grads
88%
96%
Manager
satisfaction with
self
60%
100%
Results – Manager Satisfaction
Slide13Percentages of Control Group Rating New Grads ‘Prepared’ or ‘Very Prepared’
Slide14Percentage of Treatment Groups Rating New Graduates as ‘Prepared’ or ‘Very Prepared’
Slide15Control
Treatment
New Graduates
n=47
n=45
Number and % of new graduates reporting errors
32 (68%)
29 (64%)
Total
errors reported by new grads
97
88
Preceptors
n=84
n=66 Number and % of preceptors reporting new grad errors51 (61%)34 (52%) Total errors reported by preceptors258120
Managers
n=30n=29 Number and % of managers reporting new grad errors19 (63%)17 (59%)
Total errors
reported by managers
206
144
Results - Errors
Slide16Control
Treatment
Estimated cost per manager
$1128
$634
Estimated cost per preceptor
$5900
*$3932
Estimated total cost:
$7028
$4566
Results – Costs
*does not include preceptor conference fee
Slide17Control Group
Treatment Group
New Graduate
Rural
Urban
48
56
27
33
Preceptors
Rural
Urban
54
64
3438
Managers
RuralUrban1811919
Rural Urban Comparison: Sample
Slide18Item
Control
Treatment
Preparation documenting care
Urban
Rural
72.7%
81.3%
77.8%
*30
%
Preparation of preceptors (major/minor issue)
Urban
Rural
45.6%*93.4%58.9%55.5%Satisfaction with transition program Urban Rural90%*40% 100%
100%
Client falls Urban Rural*80% 40% 57.1%25.0%
Treatment delays
Urban
Rural
77.8%
*26.7%
46.2%
37.5%
Costs estimate per new grad
Urban
Rural
$417.65
*$
1754.6
$546.59
$799.92
Comparison of Control and Treatment Manager Groups by Location: Items with Significance
Slide19Item
Control
Treatment
Yes, enough time in transition
Urban
Rural
71.7%
*93.5
%
93.9%
88.5%
Yes, each day unofficial preceptor
Urban
Rural
7.3%*27.7% 9.7%0%Yes, courses improved general nursing knowledge in program Urban Rural87.0%*68.9%
87.9
%80.0%Yes, courses improved specialty nursing knowledge in program Urban Rural76.9%
61.9%
87.9
%
*60.0%
Dissatisfaction with length of time
Urban
Rural
20.0%
*6.5
%
3.0%
3.8%
Comparison of Control and Treatment New Graduate Groups by Location: Items with Significance
Slide20Item
Control
Treatment
Very satisfied with preceptor
classes Urban
Rural
31.3%
*8.1%
33.3%
19.0%
Very satisfied with ability to assist new grad decision
making Urban
Rural
54.7%*34.0%54.5%43.5%Very satisfied with developing critical thinking in new grad Urban Rural31.5%*10.0 %48.5%20.8%
Very satisfied with collegial
support Urban Rural42.3%*17.8 % 40.6%*27.3 %
Comparison of Control and Treatment Preceptor Groups by Location: Items with Significance
Slide21Control (n = 7)
Treatment (n = 10)
Category
f
Field
Note Examples
f
Field Note Examples
Safety
52
Lack of proper identification (n=23)
Lack of infection control (n=19)
Improper hand hygiene (n=8)
Hazards (n=2)
56Lack of proper identification (n=16)Lack of infection control (n=22)Improper hand hygiene (n=10)Hazards (n=8)Medications16Prep (n=12)Administration (n=4)10Prep (n=7)Administration (n=3)
Privacy
4Enter without knocking (n=3)Patient information left out (n=1)3Patient information left out (n = 3)Cares4Missed weight ac (n=1)
Omitted bruise assessment (n=1)
Improper technique BG (n=1)
Did not know how to transfer (n=1)
4
Omitted assessment (n=2)
Improper technique BG (n=2)
Communication
10
Failed to inform or report (n=10)
7
Fail to inform, report or chart timely manner (n=7)
Total
86
M
=12
80
M
=8
Observational Studies
Slide22New graduates Higher satisfactionMore PreparedFewer errors
Preceptors
More prepared to precept
Managers
Higher satisfactionCosts estimates reduced
Findings
Slide23New graduates need mentoringEducation assists in transitionModules and trained preceptors reduce errorsInternships in programs of study are valued and positively impact transition
Preceptors educated in role are essential
Financial opportunities exist
Rural and urban patients deserve an equal opportunity to receive safe care
Implications
Slide24The likelihood to provide safe, timely, effective, efficient, equitable, and patient-centered care to Nebraska patients during new graduate transition to practice improves when focused, standardized, and evidence-based educational modules are available/mandated for new graduates, and new graduates are paired with a consistent, formally educated preceptor.
Implications
Slide25Lack of LPNsLong-term care underrepresented
Limited generalization as pilot study
Limitations