Phase I of the Transition to Nursing Practice Project

Critical funding in the form of a two-year grant from the BlueCross BlueShield of North Carolina Foundation in 2006 supported the implementation of Phase I of this multi-year project to determine the significant elements in current transition programs across the state that support the newly licensed nurse’s competence and confidence development while decreasing the risk for errors during the early months of one’s transition into the work setting. Such findings will add to the body of evidence needed to build a statewide orientation model based on best or promising practices. Data were collected from newly licensed registered nurses and their preceptors in twenty-nine hospitals across North Carolina during the newly licensed nurses’ first six months of employment between August 2007 and February 2008 at approximately two month intervals.
Participating hospitals were divided into three comparison groups according to the general type of transition program being utilized as follows:
Group1 - agencies using a standardized national competence assessment and development system;
Group 2 – individual employer-developed formal transition-to-practice programs for newly licensed nurses; and
Group 3 – employer-developed general orientation programs that do not include special programming for newly licensed nurses.

Results of Phase I Survey

  • The average length of time that a newly licensed nurse reported spending in a transition/orientation program was eight weeks.
  • The key finding across all three rounds of data collection was the significant correlation between self reported competency scores and the relationship between preceptors and new nurses. The quality of the new nurse/preceptor partnership had a direct relationship with how competent a new RN felt about his/her nursing practice. Of equal importance was the finding that a higher competency score reported by a new RN correlated with fewer practice errors at both four and six months. 
  • In terms of competence development over the first six months of employment and type of transition program for newly licensed nurses, no one type of program was found to be superior overall. However, statistically significant differences occurred among the three comparison groups in specific areas of competence development including self-reported ability to perform technical skills safely and accurately at two months into practice. By six months into practice, significant differences occurred in the following areas: recognizing when care demands exceed new RN’s capability; managing time and organizing workload effectively; recognizing implications of clinical  presentation of clients; appropriately utilizing research findings in providing care; and fully understanding assignments, including physician orders. In all three rounds of data collection, new nurses felt relatively less competent in the area of clinical reasoning and judgment than in the areas of patient care delivery, communication, and recognizing limits/seeking help. 
  • More than 75% of the responding new RNs in all three rounds of data collection reported that risks for practice breakdown occurred at least once in their practice in the previous thirty days. In terms of reported errors, those who were still in transition programs when completing the surveys reported significantly fewer errors compared to those who were no longer in the structured transition framework. 
  • More than 27% of the new nurses at both two and six months into practice reported feeling “often” or “always” overwhelmed by client care responsibilities.
  • In this study, 29 newly licensed nurses resigned their position and left the agency and another 15 were terminated within their first six months of employment. 
  • NOTE: To review a full report of the data analysis for this study, please click on the link in the following section.

Phase I Findings Summary

Phase 1 Findings Summary