1  Implementing a QSEN Focused Transition to Practice Program
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1 Implementing a QSEN Focused Transition to Practice Program

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1 Implementing a QSEN Focused Transition to Practice Program




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Presentation on theme: "1 Implementing a QSEN Focused Transition to Practice Program"— Presentation transcript:

Slide1

1

Implementing a QSEN Focused Transition to Practice Program

QSEN Conference - May 31, 2017, Chicago, IL

Slide2

NCSBN

’s Missi

on

Th

e National Council of State Boards of Nursing (NCSBN) provides education, service and research through collaborative leadership to promote evidence-based regulatory excellence for patient safety and public protection.

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Background

2001 NCSBN Employer’s study: Fewer than 50% of employers report newly licensed nurses are “safe and effective” in their practice.

Replicated in 2003 with similar results.

NCSBN BODs convened a TTP Committee, charged to design an evidence-based TTP model

Slide4

Background

Reviewed the evidence for a year (2009-2010)Literature reviewGaps in education/practice

Berkow

(2008)

Benner (2004)Patient safetyStress linked to errors (Elfering, 2007)Discipline reports (MA BON, 2007; Chicago Tribune, 2000)Missed care (Kalisch, 2006)

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Background

Patient safety (cont’d)Ebright, 2004 (near misses)

Del Bueno, 2005 (COPA model)

Competence

Bjork & Kirkvold, 1999Dartmouth Hitchcock transition program, 2007

Slide6

Background

RetentionKovner, 2009

– 26% in two years

Before economic downturn: 35%-60%What’s next? (Auerbach et al., 2011)

Slide7

Reviewed Successful Programs

(2009-2010)UHC/AACN’s Residency (now Vizient

/AACN)

Versant Residency Program

Wisconsin Residency ProgramMississippi Residency Program

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Successful International Programs

(2009 – 2010)Flying Start - Scotland

Canada’s Preceptorship Program

Australia’s Risk Management Program for new nurses

Portugal’s regulatory transition program

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Evidence-Based Model Competencies

Specialty content

Communication

Safety

Clinical reasoning5. Prioritizing/organizingEvidence-based practiceRole socializationDelegating/supervising

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Threads

To be integrated throughout:Feedback

Reflection

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Collaborative Model

More than 35 stakeholders made suggestions on the model, including AACN, NLN, NOADN, ANA, AONE, HRSA, AHRQ, CMS, QSEN, etc.

QSEN suggested

crosswalking

with their competencies with goal of consistent national model.

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QSEN Re-Categorizing

Specialty contentCommunication

Safety

Clinical reasoning

Patient Centered CareCommunication & TeamworkThreaded throughoutThreaded throughout

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Re-Categorizing

Prioritizing/organizingEvidence based practice

Role socialization

Delegating/supervising

Patient Centered CareEvidence Based PracticeCommunication & TeamworkCommunication & Teamwork

Slide14

Four Consistent Threads

Safety

Clinical Reasoning

Feedback Reflection

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15

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Multisite, Randomized, Controlled

Study (JNR, 2015)How effective is NCSBN’s TTP program in terms of safety, competence, stress, satisfaction and retention when compared to control group?

A Post Hoc Question Arose:

2. Do transition programs make a difference in new graduate outcomes in terms of safety, competence, stress, job satisfaction and retention?

16

Slide17

Procedure

State and site coordinators for study integrity

Online modules and surveys in integrated website

All sites either went through their own IRB or Western IRB

All preceptors trained before the study

Slide18

Outcome Measures

Baseline, 6, 9, and 12 months; all established for validity and reliability:Overall Competency (preceptors and nurses)

Specific Competencies (preceptors and nurses)

Safety Practices (nurses)

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Outcome Measures (Cont’d)

Work Stress (nurses)

Job Satisfaction (nurses)

Preceptor Evaluation (preceptors and nurses)

Retention (data directly from the employers)

Slide20

Results

No clear differences – so post-hoc question was asked: Do Transition to Practice Programs make a difference in new graduate outcomes in terms of safety, competence, stress, satisfaction and retention?

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Results: Evidence-Based Components

Patient-centered careCommunication and teamwork

Evidence-based

practice

InformaticsSafetyClinical reasoningFeedbackReflectionPreceptorshipSpecialty content21

Slide22

Results: Categories

TTP Program – n=43 (577 new nurses)Established Program – employ 6 components n=29 (300 new nurses)

Limited Program – employ fewer than 6 components – n=22 (186 new nurses)

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Slide23

Results Summarized

Established programs significantly increased:Overall competency

Job satisfaction

Established programs significantly decreased:

Work stressReports of errorsUse of negative safety practices (did not use universal precautions)TTP in middle; Limited on bottom

Slide24

TTP vs. Established vs. LimitedTurnover

P <.001

24

Transition Program

New Nurses LeavingTTP14.7%Established Programs12.0%Limited Programs24.8%

Slide25

QSEN Competencies

All three groups significantly improved over the yearlong period

Implication: QSEN is being consistently integrated into the academic curriculum

Slide26

TTP Courses

Based on TTP study results:Communication and

Teamwork

Patient and Family-Centered CareEvidence Based PracticeQuality ImprovementInformaticsPreceptor Training

Slide27

Key Features

Assess – Begin courses with branching scenarioLearn – Information on a wide variety of topics is presentedSustain – Real-world scenarios shared for application

Slide28

Key Features (Cont’d)

Interact – Preceptor and peer discussions

Evaluate – Preceptor feedback at every step

Modalities – Scenarios, quizzes, videos, critical thinking activities, discussion opportunities with preceptors and peers

Branching Scenarios – Beginning of each course

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“ The synergy inspired by the Quality and Safety Education for Nursing (QSEN) project over the past decade is leading the transformation of nursing education and practice to improve Quality and safety of health care.” ~ Sherwood & Barnsteiner, 2017

Contact Information:

Nancy Spector, PhD, RN, FAAN:

nspector@ncsbn.org