Transcript Karin Sherrill, Maricopa Community Colleges, Laura

Transition to Practice
Karin 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)
Are novice graduates being prepared to provide
safe and effective care?
60.0%
50.0%
40.0%
2002
30.0%
2004
20.0%
10.0%
0.0%
Diploma
BSN
ADN
PN
http://www.ncsbn.org
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?)
International
• California’s New Grad
RN Transition Program
• North Carolina
Transition to Practice
Initiative
• Vermont’s Nurse
Internship Project
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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
vs
Sleeping
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
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
With Proof of Learning and
Generalization
Correlation with Experts
0.9
0.8
0.7
0.6
0.5
Increases learning
by 300%
0.4
0.3
0.2
0.1
0
NOVICES BEFORE
TRAINING
CONVENTIONAL ACLS
LOW END
TRAINING
SIMULATION WITH
ERRORS TRAINING
HIGH END
SIMULATION WITH
ERRORS TRAINING
Focus on Quality and Safety
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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…..