Transition to Practice Karin Sherrill Laura Crouch Carol

Transition to Practice Karin Sherrill Laura Crouch Carol Cheney

Arizona Simulation Network http: //azsimnet. com

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

Problem: NCSBN Employer Study (2002 & 2004) Are novice graduates being prepared to provide safe and effective care? 60. 0% 50. 0% 40. 0% 2002 30. 0% 2004 20. 0% 10. 0% Diploma BSN ADN PN http: //www. ncsbn. org

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

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

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

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

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

Simulation Study http: //www. ncsbn. org

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

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?

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

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

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

Virtual and Hands-on Simulations

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

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

With Proof of Learning and Generalization 0. 9 0. 8 0. 7 0. 6 0. 5 Correlation with Experts Increases learning by 300% 0. 4 0. 3 0. 2 0. 1 0 Novices Before Training Conventional ACLS Training Low End Simulation with Errors Training High End Simulation with Errors Training

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

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

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

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

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

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

“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)

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…

Let’s Debrief…. .