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

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The Impact of Transition Experience on Practice of Newly Licensed Registered Nurses Suling Li, PhD, RN Associate Director of Research NCSBN. Background. New RNs struggling with transition into practice Shortened gap between taking NCLEX and being licensed

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The Impact of Transition Experience on Practice of Newly Licensed Registered Nurses

Suling Li, PhD, RN

Associate Director of Research

NCSBN

background
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
goals
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
conceptual framework on transition
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
outcomes
Outcomes

Primary Outcomes

  • Clinical competency
  • Practice errors and risks for practice breakdown

Secondary Outcomes

  • Stress level
  • Job turnover
assessing outcomes
Assessing Outcomes

Two perspectives:

  • Perspective of the new RN
  • Perspective of his/her preceptor/mentor
outcome measures
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
design
Design
  • Survey of nurse-preceptor dyad
sample profile demographics
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%

characteristics of the new rns
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
workload of preceptors
Workload of Preceptors

Client care assignment:

  • Yes, regular load 45.8%
  • Yes, reduced load 31.7%
  • No 22.5%
pre graduation synthesis experience
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

transition and clinical competence
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).

clinical competence and practice errors
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.
new rn turnover
New RN Turnover*

*Either changed position or plan to leave, 40.0%

transition and stress
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
summary of findings
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
summary of findings42
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
acknowledgements
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
contact information
Contact Information

Suling Li, PhD, RN

Tel: (312) 525-3658

[email protected]

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