Transition to PracticeKarin 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)

Diploma BSN ADN PN0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

20022004

http://www.ncsbn.org

Are novice graduates being prepared to provide safe and effective care?

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?)• California’s New Grad

RN Transition Program• North Carolina

Transition to Practice Initiative

• Vermont’s Nurse Internship Project

International• 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

Sleeping

vs

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 5mil/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

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0.9Correlation with Experts

Increases learning by 300%

With Proof of Learning and Generalization

Focus on Quality and Safety

• Reduce Errors• Increase Quality• Increase safety• Improve efficiencies• Reduce Costs• Reduce Costs• Reduce Costs

Nursing On-boarding

• Highest rate of attrition is in 1st yr

• New nurses are overwhelmed when

placed into patient care

It costs a Banner facility $1,000,000

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…..