Research Team 5/22/2012. Disclosure Information. Transitioning New Nurses into Practice: Evaluation of a Year Long Professional Development Program

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1 Transitioning New Nurses into Practice: Evaluation of a Year Long Professional Development Program Alice V. Stonek, MS, BSN, CPN-BC Carolyn Ziebert, MS, RN Children s Hospital of Wisconsin. All rights reserved. Disclosure Information For: Alice V. Stonek, MS, BSN, CPN-BC & Carolyn Ziebert, MS, RN Transitioning New Nurses into Practice: Evaluation of a Year Long Professional Development Program Learners must fill out and turn in evaluations to successfully complete this program. WNA CEAP or ANCC does not endorse any products within this presentation/program. There are no relevant financial relationships related to this presentation/program. There is no sponsorship/commercial support of this presentation/program. There is no Off-label drug use described in this presentation/program. The content being presented will be fair, well-balanced and evidence-based. Children s Hospital of Wisconsin. All rights reserved. Research Team Principal Investigator: Carol Klingbeil, RN, MS, CPNP (CHW) Co-Investigators: Lynn Doyle, MS, APNP (Tufts Medical Center) Norah Johnson, PhD, RN (Marquette) Rachel Schiffman, PhD, RN, FAAN (UWM) Catherine A. Schmitt, MSN, RN, CNOR (UWM) Alice V. Stonek, MS, BSN, CPN-BC (CHW) Joan Totka, MSN, RN (CHW) Carolyn Ziebert, MS, RN (CHW) 1

2 Purpose of the Study Evaluate a 12-month professional development program for newly hired nurses at a pediatric hospital. Included both new graduates and experienced nurses. Evaluation focused on nurses perceived stressors and supports during the program. Background of the Professional Development Day (PDD) Program Literature supports the need for multi-level 12 month transition program for new graduates. Further supported by the recent Institute of Medicine (IOM) The Future of Nursing: Leading Change, Advancing Health report calling for a nurse residency program. Structure of the PDD Program Central Orientation 4 days in Educational Services Unit Orientation 2-6 months depending on unit Professional Development Days PDD 1: 2-4 months post hire PDD 2: 5-8 months post hire PDD 3: months post hire 2

3 Central & Unit Orientation Central Orientation Focused on core institutional competencies. Blended learning combining instructor-led and online education. Unit Orientation Focused on development of the unique skills needed to care for the unit populations. PDD Content PDD 1 Ethics Dealing with sorrow & grief Boundaries Debrief PDD 2 Crucial Conversations Debrief PDD 3 Principles of Being a Preceptor Debrief Transition Study IRB approved Setting: 296 bed pediatric hospital Sample: All RNs newly hired into the organization from January 2010 February 2011 were invited to participate. 118 consented to the study Method: Mixed method study 3

4 Framework Meleis Transition Theory focuses on transitions as diverse, complex and multidimensional. Reflective practice focuses on processing experiences with trained facilitators and is linked to improved retention. Method/Design Mixed method study: Used a repeated measures design with data collected at 3, 6 and 12 months post hire. Quantitative data Gathered using the Casey-Fink Graduate Nurse Experience Survey (revised) Qualitative data Gathered through structured debriefing sessions during three educational offerings. Demographics of Participants N = 118 Predominantly female (92.4%) and Caucasian (89.0%). More that 75% under 30 years of age. Majority (64.4%) had less than one year of experience with a range of 1-39 years. Education was 75.2% BSN & 18.8% ADN. 54.7% were working in an intensive care unit. Over 50% had prior health care experience most commonly in nursing assistant or intern roles. 4

5 Quantitative Data Casey-Fink Graduate Nurse Experience Survey (revised) Five sub-scales Support Organizing/Prioritizing Communication/Leadership Professional Satisfaction Experiencing Stress Casey, K., Fink, R., Krugman, M., & Propst, J. (2004). The Graduate Nurse Experience. Journal of Nursing Administration, 34, Quantitative Data Quantitative Data 5

6 Qualitative Data Structured debriefing sessions at each of the PDD offerings. Guiding questions based on Studer Model: Reflecting back since you have started: What is going well? What hasn t gone so well? Thinking about your expectations, any surprises? If there was one thing you could change that would make your transition easier what would it be? Studer, Q. (2003). Hardwiring Excellence: Purpose, Worthwhile Work, Making a Difference. Fire Starter Publishing, Gulf Breeze, FL Going Well? PDD 1(2-4 months) Preceptors Number of preceptors appropriate. Preceptors were advocates for orientees. Teaching learning Balanced approach with various methods. Staged orientation. Going Well? PDD 2 (5-8 months) Role transition Feeling independent and confident. Trusting intuition and seeing the big picture. Resources People resources are critical. Mentors are mentioned for the first time. 6

7 Going Well? PDD 3 (10-12 months) Resources Mentoring, co-worker support, teamwork Able to self-identify the resources. Role Transition Increased confidence and comfort in new situations. Application of critical thinking. Appreciation of different perspectives and strategies for care. Not Going Well? PDD 1 (2-4 months) Preceptors Too many preceptors hindered learning and interfered with progression. Timely and constructive feedback is needed. Preceptor preparation is variable. Teaching learning Assignments for orientees should take precedence over primary patients. Taking prior experience into account. Not Going Well? PDD 2 (5-8 months) Communication with leadership team Need more structured and timely communication. Role transition Struggles with time management. Anxiety about transition from dependent to independent practice. Self-identified need to take more difficult patients during orientation. 7

8 Not Going Well? PDD 3 (10-12 months) Floating Non-standardized approach. Organizational change Affects perceptions and feelings of security. Conclusions/Implications New hires identified PDDs as relevant to their learning and helpful in the transition to their new roles. The debrief provides a safe outlet for new hires to express their concerns, receive support and feel valued. Important issues are de-identified & shared with leadership in the affected areas. Use of debrief is valuable in helping an organization identify systems issues & new hire needs. The impact of organizational changes on new hires perceptions and feelings of security cannot be underestimated. Recommendations for Future Research Comparison of different models of onboarding IOM residency programs versus PDD, which is our model. Depends on organizational needs and ability to support. 8

9 Next Steps at CHW Results to be shared with leaders and participants. Revision of PDDs based on course evaluations and research results. Questions?? Thank you! Children s Hospital of Wisconsin. All rights reserved. 9