Beth Ulrich

Transition to Practice Study in Hospital Settings

This multisite study of transition to practice included 105 hospitals in three states. Hospitals volunteered to participate and were randomly assigned to either the study group or the control group, and all new graduate registered nurses hired between July 1 and September 30, 2011, were invited to participate. The study hospitals adopted the National Council of State Boards of Nursings Transition to Practice model program; control hospitals continued using their existing onboarding programs, which ranged from simple orientation procedures to structured transition programs with preceptorships. The new graduate nurses who volunteered for the transition to practice study ( n = 1,088) filled out surveys at baseline, 6, 9, and 12 months after beginning their first nursing position. Competence was reported by both the new nurses and their preceptors. New nurse self-reported data included the number of errors, safety practices, work stress, and job satisfaction. The hospitals provided retention data on the all the new graduates hired during the study period. Though the results showed few statistically significant differences between the two groups, when the hospitals in the control group were categorized as having established or limited programs, differences were detected. Hospitals using established programs had higher retention rates, and the nurses in these programs reported fewer patient care errors, employed fewer negative safety practices, and had higher competency levels, lower stress levels, and better job satisfaction. Structured transition programs that included at least six of the following elements were found to provide better support for newly graduated RNs: patient-centered care, communication and teamwork, quality improvement, evidence-based practice, informatics, safety, clinical reasoning, feedback, reflection, and specialty knowledge in an area of practice.

Critical Care Nurses’ Work Environments 2008: A Follow-Up Report

Summary The American Association ofCritical-Care Nurses continues itsleading role in advocating for thefundamental need for healthy workenvironments, not only in highacuity and critical care areas, butacross all of health care. The 2008follow-up survey enabled us toevaluate the status of work environ-ments 2 years after the originalbaseline survey and nearly 4 yearsafter release of the AACN Stan-dards for Establishing and Sustain-ing Healthy Work Environments.Although the 2008 survey did notreveal dramatic improvements, nei-ther did it show backsliding, evenas the American health care systemcontinues to be severely strained. The AACN healthy work envi-ronment standards affirm that“adequately addressing the reput-edly ‘soft’ issues that involve rela-tionships is the key to halting theepidemic of treatment-related harmto patients and the continued ero-sion of the bottom line in health-care organizations.” 12(p12) It is criticalto maintain a relentless focus onensuring healthy work environmentsto retain nurses in high acuity andcritical care areas and ultimatelyimprove the quality of care affordedto patients and their families. With-out implementing the fundamental

Patient falls: profile for prevention.

&NA; Patient falls are common in the hospital or long‐term care setting In a large Southwestern teaching hospital. patient falls have been monitored on an ongoing basis. A multidisciplinary task force developed a method of identifying patient fall risk factors A survey was used concurrently as falls were reported during the month of July. Forty‐seven falls were reported Of this sample, neurological patients accounted for 12 (25.5%) of the incidents. The neurological patient fall profile was identified as a high‐risk profile, and interventions were taken to prevent falls in this group. A second data collection was conducted six months later with this population. While the number of patients on the neurological services remained constant, the incidence of falls decreased (25%). By using a comprehensive approach of data collection and assessment, education, and follow‐up, the institution has decreased neurological patient falls.

Transition to Practice in Nonhospital Settings

Two surveys found that fewer than 50% of employers thought newly licensed nurses (hereafter referred to as “new nurses”) were safe and effective in practice (National Council of State Boards of Nursing [NCSBN], 2002, 2004). These concerning findings caused NCSBN to begin to examine transition to practice (TTP) in nursing, developing an evidencebased model program (see Figure 1) and studying its effectiveness in hospital and nonhospital settings. After completion of the TTP study in hospitals with registered nurses (RNs) (Spector et al., 2015), a study was conducted in nonhospital facilities with licensed practical nurses (LPNs) and RNs to determine if NCSBN’s TTP program could be used effectively across settings. This article presents the findings of that study.

Preceptor support in hospital transition to practice programs

Objective: The aim of this study was to describe newly licensed RN (NLRN) preceptorships and the effects on competency and retention. Background: Preceptors are widely used, but little is known about the benefit from the perspective of the NLRN or about the models of the relationships. The National Council of State Boards of Nursing added questions about the preceptor experience in a study of transition-to-practice programs. Methods: Hospitals were coded as having high or low preceptor support in regard to scheduling NLRN on the same shifts as their preceptors, assignment sharing, and preceptor release time and a low number of preceptors per preceptee. Results: Half of the 82 hospitals were classified as high, and half as low preceptor support. NLRNs and their preceptors in high-support hospitals evaluated the preceptor experience and NLRN competence higher. In addition, NLRN retention was higher in the high-support hospitals. Conclusions: To improve NLRN competence and retention, preceptors should have adequate time with each NLRN, share shift and patient assignments, and have few preceptees assigned to each preceptor concurrently.

Gender Diversity and Nurse-Physician Relationships

Gender and cross-professional perceptions affect nurse-physician relationships. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Newly Licensed RN Retention: Hospital and Nurse Characteristics

OBJECTIVES The aims of this study were to examine the relationship between 1-year retention of newly licensed RNs (NLRNs) employed in hospitals and personal and hospital characteristics, and determine which characteristics had the most influence. METHODS A secondary analysis of data collected in a study of transition to practice was used to describe the retention of 1464 NLRNs employed by 97 hospitals in 3 states. Hospitals varied in size, location (urban and rural), Magnet® designation, and university affiliation. The NLRNs also varied in education, age, race, gender, and experience. RESULTS The overall retention rate at 1 year was 83%. Retention of NLRNs was higher in urban areas and in Magnet hospitals. The only personal characteristic that affected retention was age, with younger nurses more likely to stay. CONCLUSION Hospital characteristics had a larger effect on NLRN retention than personal characteristics. Hospitals in rural areas have a particular challenge in retaining NLRNs.

Franklin A. Shaffer, EdD, RN, FAAN

Abstract Frank Shaffer, EdD, RN, FAAN, began his nursing career as the first male graduate from the Mercer Hospital School of Nursing. Today, he is the chief executive officer (CEO) of The Commission on Graduates of Foreign Nursing Schools (CGFNS) International, expanding and diversifying their scope of services and influencing healthcare on a global level. Along the way, Franks career has been filled with unique experiences, all guided and influenced by his passion for learning (learning for himself and helping others learn), collaboration at all levels (one to one, between organizations, and between healthcare professions), building relationships, and moving nursing forward in all practice settings.