Transition to Practice
Regulatory Model:
Implementing Change
Nancy Spector, Director of Regulatory
Innovations
NM Statewide Nursing Faculty Conference
June 4, 2009, 1:00-2:30 p.m.
Mission of NCSBN
The National Council of State Boards of
Nursing (NCSBN), is composed of Member
Boards, provides leadership to advance
regulatory excellence for public protection.
Resources for Educators
 www.ncsbn.org/ Go to: programs & services
 For Transition:
https://www.ncsbn.org/363.htm
 Leader to Leader
 nspector@ncsbn.org
Background of the Problem
Background of the Problem
 Benner’s work over 20 years
 Kramer’s “Reality Shock,” from 1974
Background…
NCSBN delegates voted in 2002 to:
“Identify and promote effective models to
facilitate a successful transition of new
nurses from education to practice.” and
“Participate in strategies for retention of the
new graduate.”
Background…
NCSBN 2002 & 2004 Employer Studies:
“Yes definitely” to survey question regarding
novice graduates being prepared to provide
safe and effective care:
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45% (2002) & 48.8% (2004)-diploma graduates
40% (2002) & 41.9% (2004)- BSN graduates
35% (2002) & 41.9% (2004)- ADN graduates
30% (2002) & 32.9% (2004)- PN graduates
Background…
Advisory Board Company (2008)
Surveyed
 5,700 frontline nurse leaders
 400 nursing deans/directors/chairs
Background…
 90% academic leaders believe their new
students are prepared.
 10% of health system nurse leaders believe
new nurses are prepared.
Advisory Board Study
Biggest Improvement Needed:
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Follow up
Initiative
Quality improvement
Time management
Tracking multiple responsibilities
Conflict resolution
Delegation
Transition to Practice: A Missing
Piece in Nursing
Background…
 Turnover rates (2006 Nurse Executive
Center: “Transitioning New Graduates to
Hospital Practice”)
 One Year- 36%
 Two Years- 75%
 Three Years- 50%
Background…
 NCSBN hosted the Transition Forum
February 22, 2007
 Speakers from other disciplines and countries all
came together.
 Various research findings showed need for
transition programs.
 Stakeholders agreed to a standardized
regulatory model (AACN, AONE, ANA, NAPNES,
NLN)
Background…
 Computerized NCLEX, allowing for almost
immediate licensure
 Context of practice: “frenzy”
 Health care becoming more complex
 Nursing shortage
 IOM and other studies on patient safety
Transition to Practice Work
 Goals: To promote public safety by
supporting newly licensed nurses during
their critical entry period and progression
into practice.
 Premises
 Definitions
Transition to Practice Model
Description of Model
 Pass NCLEX
 Separate Orientation
 Flexible and robust
 6 month preceptorship
Description of Model
 1 year institutional support
 Feedback and reflection
 License renewal
Description of Model
 Website plans for modules
 Preceptorship training
 QSEN for RNs
Transition to Practice Fact
Sheet
• The problem
• The impact
• The solution
Transition to Practice Evidence Grid
 International Work
 National Work
 Individual Work
FAQs…
 Why should this be implemented
through regulation?
 How was the model designed?
 Are you seeing this as a failure of
education and/or practice?
FAQs…
 Are the modules just re-teaching?
 What about cost?
 How can this be implemented in rural
areas?
FAQs…
 Will NCSBN mandate transition to
practice in all boards?
 What about the current climate of job
shortages?
It’s a Collaborative Model
Collaborative Input…
Formally with 14 organizations as well
as our membership:
 Pilot before mandating through
regulation
 Consider costs
Collaborative Input…
 Outcomes from pilots will be important
 Successful national programs are
being implemented
 Be sure LPN needs are met
 Tightening of job market
Collaborative Input…
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Preceptor training
Several states are interested in piloting
Timeframe needed
Embraced the model for being
inclusive
 Willingness for collaboration
Transition Dashboard
 Pilots (June 2011)
 Modules
 Marketing
 Business Plan
Transition Dashboard
 Preceptor Development
 Research
 Funding
Transition Tool Kit
 Available at:
https:www.ncsbn.org/363.htm
Transition Tool Kit
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Evidence grid
Fact sheet
FAQs
Most recent article
Dashboard
Transition Tool Kit
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Goals/definitions/premises
Model description
Example of model rules for Boards
Example of Transition to Practice
Verification form (TPV form)
Timeline
2009-10
 Business plan
 Content outline for nurse (LPN and RN)
modules
 Convene research advisory panel
 Develop specifics of pilots
 Identify funding sources
 stakeholder collaboration
Timeline
2010-11
 Develop nurse (LPN and RN) modules
 Develop preceptor modules and online
connections
 Establish pilot sites
 Identify funding sources
 stakeholder collaboration
Timeline
2011-12
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Implement pilots
Collect data
Identify funding sources
stakeholder collaboration
Transition to Practice…
“…the one goal that unifies us all –
improvement both in individual patient
care and in the health care delivery
system – might be achieved.”
-Marlene Kramer, 1974
The Future!!