The Impact of Transition Experience on Practice of Newly Licensed Registered Nurses Suling Li, PhD, RN Associate Directo

1. The Impact of Transition Experience on Practice of Newly Licensed Registered Nurses Suling Li, PhD, RN Associate Director of Research NCSBN

2. Background • New RNs struggling with transition into practice • Shortened gap between taking NCLEX and being licensed • High job stress and high turnover rates in new RNs • Complexity of health care environment • Increased workload due to acute nursing shortage

3. Goals • To describe the transition experience of newly licensed RNs • To identify factors that influence transitions into practice • To examine the impact of the transition experience on clinical competence and safe practice issues of newly licensed RNs

4. Conceptual Framework on Transition • Structure of transition • Content of transition • Characteristics of preceptors • Characteristics of the new nurse • Partnerships between the new nurse and the preceptor • Institutional support for both the new nurse and the preceptor

5. Outcomes Primary Outcomes • Clinical competency • Practice errors and risks for practice breakdown Secondary Outcomes • Stress level • Job turnover

6. Assessing Outcomes Two perspectives: • Perspective of the new RN • Perspective of his/her preceptor/mentor

7. Outcome Measures • Clinical competence (35 items): • Clinical reasoning and judgment • Pt care delivery and management skills • Communication and interpersonal relationships • Recognizing limits and seeking help • Practice errors and risks for practice breakdown

8. Design • Survey of nurse-preceptor dyad

9. Sample Profile – Demographics New RNs Preceptors N: RN 560 231 BSNs 32.8% 31.5% ADNs 60.7% 49.7% Age (yrs) 32.4 42.2 Female 94.4% 92.2% White 81.2% 88%

10. Characteristics of the New RNs • Hospital 86.4% • Full time 91.2% • English first language 92.6% • Graduates of USA programs 99.0% • With LPN experiences 19.9% • Employed in urban area 47.3% • Months of working experience 11.4

11. Characteristics of Preceptors

12. Workload of Preceptors Client care assignment: • Yes, regular load 45.8% • Yes, reduced load 31.7% • No 22.5%

13. Pre-Graduation Synthesis Experience ADNs BSNs (n=335) (n=181) Synthesis course required 33.8% 68.2% Length of the course (wks) 7.0 9.9

14. Transition Experience

15. Internship Experience

16. Duration of Transition

17. Preceptor Involvement

18. Content of Transition Programs

19. Days Before First Patient Care Assignment

20. Patient Care Assignment

21. Patient Care Assignment

22. Clinical Competence: Overall

23. Clinical Competence: Subconcepts

24. Most Competent Areas

25. Least Competent areas

26. Clinical Competence During 1st YearOverall New RNs Preceptors

27. Clinical Competence During 1st YearSubconcepts

28. Clinical Competence and Work Setting

29. Transition and Clinical Competence During first 3 months of practice, those who had a primary preceptor performed at a higher competent levels (B=0.45), especially in the areas of communication and interpersonal relationships (B=.51), as well as recognizing limits and seeking help (B=.49).

30. Practice Errors

31. Practice Errors Index

32. Transition and Practice Errors

33. Clinical Competence and Practice Errors • New nurses who were more competent (r= -.35), especially in the areas of clinical reasoning ability (ß=-.38) and communication and interpersonal relationships (ß=-.33), made less practice errors.

34. New RN Turnover* *Either changed position or plan to leave, 40.0%

35. Transition and Turnover

36. Perceived Stress

37. Perceived Stress During 1st Year

38. Clinical Competence and Stress

39. Transition and Stress • The longer the work experience the less the fear experienced by graduates about harming the patients (B=-.11) • Graduates who had an internship (B=-.11) were less likely to feel expectations were unrealistic • Graduates who had a transition programs that addressed specialty knowledge (B=-.10) were less likely to feel expectations were unrealistic

40. Stress and Practice Errors

41. Summary of Findings • Transition experiences of new RNs vary across practice settings • New RNs are more competent in the areas of pt care delivery and management, compared to the areas of clinical reasoning and judgment skills, as well as recognizing limits and seeking help • During the first 3 months of practice, new RNs who had a primary preceptor practiced at higher competent levels • Without the assistance of preceptors, new RNs practiced at less competent levels during their initial phase of independent practice

42. Summary of Findings • New RNs with preparation for specialty practice in transition programs made less errors • Less competent and/or stressed new RNs made more practice errors • New RNs who had an internship experience were less likely to leave their current position within the next 6 months

43. Acknowledgements Advisory Group: 2006 & 2007 NCSBN PR&E Committee • Nancy Spector, NCSBN Director of Education • Gino Chisari (Chair, 2006) • Brenda S. Jackson (Chair, 2007) • Mary Blubough (Board Liaison) • Connie Brown • Barbara Knopp • Barbara Newman • Cynthia Van Wingerden • Debra Werner • Lepaine McHenry • Marcy Echternacht • Therese Shipps • Mary Calkins • Mary Doherty, NCSBN Practice, Regulation, & Education Associate Research Support • Data Collection: Lindsey Gross • Statistical Support: Richard Smiley

44. Contact Information Suling Li, PhD, RN Tel: (312) 525-3658 sli@ncsbn.org