New Graduate RN Transition Programs California Informational Web Conference Held February 22, 2011 Questions Asked During the Event and Answers Getting Involved in Programs: Which hospitals and which school already have residency programs in the works? We are compiling an inventory of residency/transition to practice programs in California specifically, programs that are not employer-based. On slide 34 of the presentation, we have an initial list across the state. If there are other programs you are aware of, please notify Nikki West (nikki@cinhc.org) or Carolyn Orlowski (carolyn@cinhc.org) at CINHC, so we may continue to build the inventory. In the San Diego area, who is the discussion with regarding starting programs? There is a program already established through CSU-San Marcos in partnership with Palomar Pomerado Health System. There is also a discussion being coordinated by the Hospital Association. In the San Diego region, hospitals are running their own transition programs without being based at a school of nursing? Any suggestions as to how to change this? The Transition Programs can take on different formats. If there are groups of clinical sites that have partnered to offer the programs and they are running smoothly, that is fantastic. Traditional residency programs have been hospital-based, e.g., Versant. If there are schools or additional community partners that want to get involved, please get in touch with the participating hospitals to explore options. I am currently running a hospital based nurse intern program at Cottage Health System Santa Barbara. I would like to connect with other who are running community and hospital based programs. Any suggestions? At CINHC, we would be happy to connect you with leaders from local community healthcare settings, schools, workforce investment boards, local funders, and regional association leaders (such as the Hospital Association of Southern California). 1
I love what you are doing to help new grads. But when will you be implementing these transition programs in southern California? Will you be placing these on your website when they are created? There are already programs in Southern California that are based on our model accepting Transition Program participants. Western University, CSU San Marcos in partnership with Palomar Pomerado Health System, 3 new pilot programs at Saddleback College, Golden West College, and Chaffee College starting May 23. (Mary O Connor is the contact for this 3 college program at moconnor@gwc.cccd.edu) and Rio Hondo College also starting their first course May 23. CSU Fullerton and Mount Saint Mary s College also have pre existing programs. Program Structure and Eligibility: In your view, is there a distinction between "residency" and "transition" programs, or are you using the terms interchangeably? There has been a workgroup discussing the possibility of implementing formal residency programs as a standard practice for all nurses. The group has been led by Dorel Harms of the California Hospital Association and is made up of several nurse leaders across the state. This group has grappled with terminology. Some people advocate residencies while others are in favor of transition programs. Dorel Harms of CHA and Nikki West of CINHC have inquired with two members of the IOM Committee for their input. We understand from them that the IOM Committee actually chose residency/transition-topractice as the term to designate the programs to help new nurses more effectively bridge from education to the workplace. The IOM Committee liked the term residency but wanted to differentiate it from a medical residency, so included transition to practice. Therefore, moving forward, we propose the term RESIDENCY/TRANSITION TO PRACTICE as the umbrella term to define the various types of bridging programs for new graduate RNs. What is the average length of these programs? Do the students have their RN license prior to starting the program? Cost to the participants? As a standard, these programs are 12-18 weeks in length. To be eligible for participation, enrollees must have graduated from nursing school and passed the NCLEX, thus are licensed. Some programs have been grant funded at no cost to the participant, some have requested participants contribute a small application fee or portion of tuition, and others have standard school course costs per unit depending on the school system and program available. Are the transition programs open to all new graduates? How are participants selected? 2
For the CINHC-coordinated programs, preference was given to newly graduated and licensed RNs in the San Francisco Bay Area, as a way to retain the increases in enrollment the Moore Foundation has helped to fund. Additional eligibility requirements were identified by each program and are listed on the CINHC website at http://www.cinhc.org/programs/educational-capacity/collaborative-models/. Each program has its own approach to selecting participants. All require a formal application, and some follow up with in-person interviews. Individual schools and programs also have their own specific criteria often prompted by the school district they are part of, or influenced by funding sources that may designate a target region or group. Have the students who applied for these programs looked for a position as an RN and not been able to find one, or are they entering these programs immediately after graduation? Eligibility differs among the programs, but many programs prefer applicants who have sought employment as an RN. Eligibility requirements for the CINHC-coordinated programs are listed on the CINHC website at http://www.cinhc.org/programs/educationalcapacity/collaborative-models/. How many participants are placed per facility and per unit? This number differs per facility based on availability of preceptors. In many cases, there are only 1-3 participants per facility and/or unit. Therefore, it is important to secure multiple clinical partners to enable programs to place participants. Are any of the programs begun while the student is still in school? Not of the four programs that CINHC is helping to coordinate. However, there is a program that begins during a student s senior year which is being offered in San Diego. This is a partnership between CSU San Marcos and Palomar Pomerado Health System. The program is sponsored by Palomar Pomerado, with help from a federal jobdevelopment grant administered by San Diego Workforce Partnership. Additionally Western University, CSU Fullerton, and Mount Saint Mary s College programs have provided these programs for their newly licensed RN s who are now going on for another degree and still students who are starting their BSN or MSN programs. Is this not the responsibility of the schools of nursing to provide an education that allows nurses to practice nursing? These programs are meant to supplement the education given in nursing schools, and to focus on integrating what was learned in academia into practice through a post-licensure, intensive guided clinical education. As these are licensed RNs, restraints experienced as a student are lifted. The programs provide for development of skills and competencies to allow a new graduate to effectively serve as an RN in the clinical setting. Nursing leaders recognize that the competencies needed for licensure as an RN and the experience needed and gained once practicing in the RN role for the first time are different. There is value to 3
having schools provide the programs from an academic perspective, in close partnership with employers to support the RN role transition. Of the programs accepting both BSNs and ADNs, what was the percentage of each in the program? All Bay Area programs presented in the web conference accept BSN and ADN graduates, with the exception of the USF program, which focuses on community health, which has a minimum requirement of BSN. The percent enrolled by degree can be obtained by each program, but we do not actively track this information across the region. Other programs in the state each have their own criteria including some who offer these programs only to their currently enrolled students. Can you clarify the value of the certificates attached to a specific school as opposed to continuing education? Depending on the program and the way in which the course needs to be run through the school, some schools are able to provide academic credit, whereas other programs offer continuing education. From our perspective, the value is equal. It is simply a matter of how the program can be made available. For those programs who have adopted the core CINHC criteria and evaluation measures we do also provide all participants with a CINHC/New Graduate RN Transition Program certificate of completion, which we hope will become increasingly recognized by the healthcare industry. Can you clarify whether the goal is to prepare for CCNE accredited program or is there an additional goal to create a new industry-recognized certificate? Currently, there is not a goal to prepare for CCNE accreditation, but to offer a new industry-recognized certificate. If you are referencing the UHC/AACN accreditation, this has not yet been identified as a goal, either, but may be worth exploring as we move forward. Why would it be necessary to get IRB approval for a transition program? The evaluation tools are asking for information from human subjects who have been enrolled within a university or community college. Following the program, we ask managers to evaluate the participants in their first employment setting to see how well they transition as an RN. Therefore, certain schools and clinical sites are required to review and approve the evaluation tools and give permission for their data to be utilized We have a small group reviewing the existing IRB documents that were created to approve the evaluation already taking place at schools and clinical sites. We hope to have standard language that can be used as new schools and clinical sites establish similar programs. Did the participants get paid during the program...how many hours a week was required? 4
These are not paid experiences, though a few programs have secured funding to provide small stipends to participants. The programs are a minimum of 24 hours/week, and are 12-18 weeks in length, so a new nurse does have time to work part-time as needed. How does the curriculum differ for ADNs vs. BSNs? The curriculum is not modified for ADNs vs. BSNs. A program accepts a cohort of mixed ADNs and BSNs, and the entire group completes the same program together based on QSEN core competencies for newly licensed RNs. Some programs offer upper division course credit for continuing to a BSN and may add additional assignments for students seeking credit that could be transferable to a masters program. Were there any barriers at the service facilities to starting such a program? i.e Nursing Unions Yes, there have been barriers within service settings. Some clinical sites were not able to identify preceptors within the initial timeframe requested. Other facilities needed to work through conversations regarding unions. The Transition Program participants are students, and are in the facilities in a student capacity, so this helps to minimize union concerns. How are hospitals finding resources (preceptors) to precept these nurses in the transition program when they are probably having to precept their new hires too? I can imagine the preceptors could be burned out. Preceptors are valuable resources and need to be cared for so they aren't overwhelmed with teaching responsibilities. Clinical partner sites are continually recruiting and training new preceptors who are seeking out new opportunities for professional growth. Because of this, their preceptor pool is quite large allowing them to typically have a healthy amount to cover the needs of senior students, transition students, and new hires. Not easy to establish residency program as our clinical facilities are impacted! It is a challenge to initiate programs, due to many clinical sites maximizing preceptors for pre-licensure students. In these situations, you may wish to explore partnerships with other sites that have not traditionally taken students. Transition Programs coordinated through CINHC have partnered with rehabilitation facilities, SNFs, clinics, and school nursing associations. If hospitals in the short term are hiring fewer new grad RN s, there may be options for them to each provide small number of RN Transition Program assignments. It sounds like the design of the USF (ambulatory focus) and the other programs (acute care) were a bit different although there were apparently some similarities. How did you assure the consistency needed to issue an "industry recognized certificate"? The programs are all based on teaching to the QSEN standards, regardless of preceptorship setting in acute or non-acute locations. The principles taught are consistent, 5
and the skills and competencies gained over the course of the program are the same, regardless of which program was attended. All participants are evaluated using the same competency evaluation tool. Therefore, the industry-recognized certificate has common meaning. Do any of the current hospitals doing Transition programs also have an RN Residency program? We have the Versant RN Residency and I am trying to figure out if it is possible to run both. Also, what would be the benefit for the hospital for adding a Transition Program on top of a Residency program? John Muir Medical Center is one of our close clinical partners. They have an RN Residency Program and also partner with two Transition Programs to provide clinical experiences. It is possible to run both programs but you just have to be very clear with the program participants and the preceptor staff that these are not the 'residents' that are hired, these are the 'transition' program participants who are completing this training as a part of the academic based didactic/clinical partnership. The benefit on the service side is that these transition program participants are getting an extended orientation in your facility. If there is an available RN position at the end of the program and the participants wants to apply and is hired, there is potentially a decreased transition/orientation time since they would have already gone through a lot of this process already. Program Funding: What did the funding received by these programs cover? Were faculty expenses covered? Were students paid any type of stipends or was tuition covered? Among the four programs presented that CINHC is coordinating, funding has been applied in slightly different ways. However, the majority of funding has been used to cover faculty expenses. Some programs have provided a student stipend, and some have requested participants contribute a small application fee or portion of tuition. We are currently reviewing program cost, including in-kind, and all funding sources. Our goal is to share with all of you a general structure and general cost information for implementing and sustaining a transition program. Just to clarify, this is for new graduate nurses, correct? Do they need to pay to be part of the program or it is just covered by grant funding? The program is for newly graduated, newly licensed RNs. The four CINHC-coordinated programs presented are currently covered through grant funding from the Moore Foundation and Kaiser Permanente, though some programs do request an application fee. Moving forward, we will create a sustainability plan in order to find ways to continue these 6
programs after the existing funding sources have been depleted. Funding options after the grant period may include charging tuition fees. Are the preceptors compensated? If so, who pays (grant funding or clinical site)? Thanks. Preceptor compensation varies across the clinical partners. Some facilities compensate for the time spent in training and in working directly with the Transition Program participants; others do not. While the funding given to support these programs could be applied toward preceptor compensation, most of the facilities absorb this cost as an in-kind contribution. Program Evaluation/Results: Where were the positions that the RN graduates found employment? The clinical partner sites? Are they within San Francisco Bay Area or elsewhere? New Graduate RN Transition Program participants have found employment in a number of settings, both within the Bay Area and other regions. To date, almost 70% of participants have found employment as RNs, and 33% of those who have secured RN positions have taken them at the place where they had their preceptorship. There are three states and 75 hospitals in those states piloting the NCSBN Transition Programs. Please identify the three states. Yes, the National Council of State Boards of Nursing (NCSBN) has selected three states -- Illinois, North Carolina and Ohio -- to participate in their Transition to Practice pilot. These three states mounted enormous statewide efforts to identify 75 hospitals for phase I of the study. You can learn more about the NCSBN Transition to Practice work at https://www.ncsbn.org/363.htm. What was your goal for "% of those who complete" being hired? We have not set a goal, but of course, would like to have 100% of participants find RN positions. Have student qualities been identified that increase their marketability? The programs were designed as a collaborative effort of local employers and schools. The intent is to have each employer (clinical site) give input as to the skills and competencies that should be taught so as to make participants more marketable or employable. The programs are based on the QSEN competencies. In terms of specific qualities, we are evaluating the four CINHC-coordinated programs to see if there are specific attributes or components of the programs that lead to increased marketability. In general, we are finding that having additional clinical experience, and preferably time within a clinical 7
setting/specialty where there is an FTE opening for new nurses, increases the likelihood of hire. How long are the transition programs? Is the cost different (less or more) than RN Residencies? Would effective Transitions programs replace Residencies? The Transition Programs run 12-18 weeks in length, depending on how each collaborative has structured its specific offering. We are in the process of identifying the fully-loaded cost to implement a Transition Program (including start-up vs. ongoing costs, and direct vs. in-kind contributions) now that programs have been in existence for a little over a year and we have a clearer understanding of the expenses. In terms of cost difference, since clinical sites offer RN residencies of differing lengths and components, and not all clinical sites provide residencies, the cost of a Transition Program compared to an RN Residency would need to be compared on a site-by-site basis. There is currently no standard definition for these programs. The role of Transition Programs in facilities that already have residencies will need to be evaluated. Our hope is that certain aspects of residencies could be covered through a Transition Program, especially if a Transition Program participant becomes hired at the site where they have done their Transition Program preceptorship. An area where residencies may be abbreviated is the length of clinical orientation required. We are in the process of evaluating the benefits of the Transition Programs and comparing this to common residencies. We hope to have data to share later this year. Is there a standard tool to measure QSEN competencies? A California statewide team of nurse leaders assembled to create an evaluation tool to measure participant competencies. This tool is based on QSEN, as well as the work of the ACNL Professional Practice Committee, and The Advisory Board s Nurse Executive Council. This competency tool is used by all Transition Programs as a way to assess participants progress made towards practicing nursing based on QSEN. How did you do your evaluations so that participants actually did evaluations and you received info back, (time frame, method, e vs hard copy) The competency evaluations were administered in hard copy, and were completed by the preceptors at program start, then again at program end. The confidence evaluations (Casey Fink) were administered both electronically as well as hard copy. We did not receive 100% response rate on our surveys. We are looking to automate all of the surveys, so all are distributed electronically. At what point are the post experience data gathered? How soon "post?" 8
We collect participant post data on their competence and confidence during the last week of their program. We compare this information to the same test used to assess them during their first week of the program, which is when the pre data was collected. What is the ROI for service and for academia and how is Transition going to influence Residency programs? That is a big question! We have a team from CINHC and University of San Francisco addressing this very topic. What we hope to show is that transition programs reduce the amount of time it takes for a new nurse to be fully functioning in the nurse staffing, though the programs are not currently meant to replace employer-based residencies once a nurse is hired. Programs such as Versant do not count new graduate employees in the staffing. This would continue to be true in any situation where a new graduate is hired. It is hoped and our evaluation tools are measuring the extent to which -- transition program participants could be held out of staffing for a shorter amount of time following hire, thus making the programs economically attractive to employers. The ROI for academia would be to have additional time to prepare new nurses, and in ways that they do not have opportunities to complete given the many other requirements and restrictions within nursing education. We hope that programs will bridge any education gap between graduation and nurse preparedness for practice. The role of transition programs alongside traditional residency programs still needs to be assessed. General: Are these slides available? Yes, the slides are available on the www.cinhc.org site, under Featured Documents at the bottom of the page. Along with the slides, you can also play a recording of the web conference and access the handouts. Is the standard QSEN competency tool available to us who are listening? Yes, the Brief Transition Program Competency Assessment Tool is definitely available. It is based on QSEN, as well as the work of the ACNL Professional Practice Committee, and The Advisory Board s Nurse Executive Council. This competency tool is used by all Transition Programs as a way to assess participants progress made towards practicing nursing based on QSEN. Please contact Nikki West at www.cinhc.org for a copy of the tool. In addition to the QSEN tool, we are using the Casey-Fink Graduate Nurse Experience Survey (2006 revised) to assess participant confidence. Who is speaking to get access to website? If you would like to gain access to the RN Transition Program wiki site to view documents and learn more about the programs, you may access information at http://rn-transitionprograms.wikispaces.com/. 9
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