1. Transition to Practice Karin Sherrill Laura Crouch Carol Cheney

2. Arizona Simulation Network http://azsimnet.com

3. Practice Gap • First article in 1930 (Townsend, 1931) discussed Practice Gap • Benner novice to expert • Kramer’s “Reality Shock” from 1974

4. Problem: NCSBN Employer Study (2002 & 2004) Are novice graduates being prepared to provide safe and effective care? http://www.ncsbn.org

5. Problem: Advisory Board Company Survey (2008) • 5,700 frontline nurse leaders • 400 nursing deans/directors/chairs http://www.advisoryboardcompany.com

6. Problem: Advisory Board Company Survey (2008) • Concerns: • Initiative • Quality improvement • Time management • Tracking multiple responsibilities • Conflict resolution • Delegation http://www.advisoryboardcompany.com

7. Turnover Rate • Research varies • Kovner (2009) found 26% in two years • Others as high as 35 – 60%

8. Transition/Residency Programs United States (more?) International Australia Canada Ireland Portugal Scotland • California’s New Grad RN Transition Program • North Carolina Transition to Practice Initiative • Vermont’s Nurse Internship Project

9. Pass NCLEX Separate Orientation Hospital Policies Includes all levels of Nursing Entry 5 Online Modules 6 Month Preceptorship (w/preceptor training)

10. Simulation Study http://www.ncsbn.org

11. Standardized Patients vs. High-fidelity Patients • Finding standardized patients • Scenario Reality • Script development time vs. ad lib • Objectives and Outcomes • Cost Sleeping vs Sleeping

12. Simulation Hours • How many simulation hours in a nursing program? • How much time for simulation in each course? • Placement of simulation within the semester • How do we measure/ evaluate simulation effectiveness r/t time?

13. Healthcare Reform Changes • As funding reduces so will amount of education

14. 56% of all Medication Errors do to improper IV Administration Patient Safety and Quality Healthcare 06/05

15. Central Venous Catheter Insertion • CVC statistics- In US over 5mil/year placed • ≥15% patient complications • 5-19% mechanical • 5-26% infectious • 2-26% thrombotic • Need to reduce errors

16. Virtual and Hands-on Simulations

17. With Proven Outcomes • 92% decrease in pneumothorax • 83% decrease in infections

18. Revision of Traditional Training • Weighted Checklists • Train to errors • High fidelity simulation

19. With Proof of Learning and Generalization Increases learning by 300%

20. Focus on Quality and Safety • Reduce Errors • Increase Quality • Increase safety • Improve efficiencies • Reduce Costs • Reduce Costs • Reduce Costs

21. Nursing On-boarding • Highest rate of attrition is in 1st yr • New nurses are overwhelmed when placed into patient care

22. It costs a Banner facility $1,000,000 just in wasted OR time to train 14 surgeons in robotic surgery.

23. Formative Evaluation • Aimed at course/simulation improvement • Asks learners for feedback to improve • All along the way you look at ways to improve, make changes

24. Summative Evaluation • Provides info whether someone or something did what it is designed or supposed to do • Associated with number scores or letter grades

25. Formative and Summative • The same information can be used for either

26. “Audit”ive Assessment • Audits provide “reasonable assurance” that something is error free or that quality standards are being met • Measurement rather than to express an opinion about the fairness of statements or quality of performance (leave this assessment to peer reviews and boards)

27. Evaluations Assessments and Audits… Oh My! • Simulation is a practical application • Look at knowledge, skills, critical thinking, interpersonal relations • All of which bridge the gap from transition to practice • Help to guide us to meet both the learner needs and needs of the healthcare system • Gives us data…

28. Let’s Debrief…..