Transition form Bedside to Education
What Is Transition Into Practice
Transition into practice is the progression of a new graduate nurse
as he or she advances from the role of a student nurse to a competent
professional registered nurse and a leader at the bedside (Manzano, Rivera,
& Sullivan, 2013)
Nursing Shortage and Educational Demand
As the nursing shortage and the complexity of patient care continue to increase, it is imperative that the new graduate is integrated into practice autonomously and successfully. Evidence from the National Council of State Boards of Nursing demonstrates that there is a gap between nursing education and the application of knowledge to practice.Employers stated that new graduate nurses were not adequately prepared to provide safe care (Spector & Li, 2007).
A successful strategy and a best practice in improving the transition to
practice for new graduate nurses is a formalized nurse residency program (NRP,
Little. Ditmer, & Bashaw, 2013). The Institute of Medicine (IOM, 2011)
strongly recommends the development and implementation of NRPS to improve
retention of nurses and expand existing competencies, in order to foster
improved patient outcomes and quality of care (Little et al. 2013)
Aim of Nursing Education and Outcomes
The aim of an NRP is to “improve a new graduate's organizational ability and technical skills, encourage the use of outcome data to promote patient safety, strengthen commitment to lifelong learning and enhance the commitment to nursing as a profession” (Manzano et al., 2013 , p. 371),A white paper published by The Joint Commission (2005) states that the University Health System Consortium/American Association of Colleges of Nursing (UHC/AACN) NRP “could serve as a critical model for more broadly based nursing residency programs” (Goode, Lynn , McElroy, Bednash, & Murray, 2013).
The UHC/AACN NRP is an evidence-based program consisting of a series of learning seminars and work experiences with a focused curriculum developed in collaboration with the Chief Nursing Officers Council of the UHC and deans from baccalaureate schools of nursing from the AACN (2009) (Goode et al, 2013). The program emphasizes three principal content areas: “leadership, with a focus on managing resources for patient care and collaborating with inter professional teams; patient safety and outcomes, which enhances knowledge of quality, safety and nurse sensitive outcomes; and professional role, which includes professional practice issues, managing changing patient conditions, ethics and end-of-life care” (Goode et al., 2013, p. 24).
Measuring the success of an NRP can be performed using metrics such as a favorable return on investment (ROI) rate and a decreased turnover rate for new graduate nurses in the first year of employment (Anderson, Hair, & Todero, 2012; Pine & Tart , 2007). Many studies have shown a positive ROI and decreased turnover after implementation of an NRP (Casey, Fink, Krugman, & Propst, 2004; Williams, Goode, Krsek, Bednash, & Lynn, 2007). In addition, the Casey Fink Graduate Nurse Experience instrument is widely used to measure the success of the new graduate's transition.
The new graduate completes the online survey at the time of hire, after 6 months, and after 1 year of employment. Progression is measured in five main areas: stress, support, organization and prioritizing, communication with leadership, and professional satisfaction (Goode et al. 2013). Data consistently show that all domains of the Casey Fink demonstrate favorable outcomes after a new graduate nursing completes an NRP (Goode et al, 2013).
Impact of Nursing Education on Nursing Services
Structured NRPS have been effective in assisting the new graduate nurse with the transition into practice (Little et al, 2013) After reviewing the literature, the following recommendations can be made: all new graduate nurses should complete a transition into practice program, such as an NRP that is 1 year in length (Goode et al. 2013: Krugman et al, 2006; Rush, Adamack. Gordon, Lilly, & Janke, 2013; Williams et al. 2007). Second, the NRP's structure should align with the organization's mission. vision, values, and care model to further support the assimilation into the organization's culture (Little et al., 2013).
Third, there should be metrics to measure the effectiveness of the program, such as a favorable ROI (Pine & Tart, 2007). Finally, an advisory board should be established to include inter professional health team members and an academic partner to foster the collaboration between academia and practice to increase organizational buy in and ensure continued evolution of the NRP to meet the needs of the new graduate nurses American Association of Colleges of Nursing (AACN) (2009). Post baccalaureate nursing residency program: Executive summary.
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