SE11d
Transition to Practice SE11
Provide one example, with supporting evidence, that demonstrates the effectiveness of the transition to practice program of a nurse transferring within the organization to a new nurse practice environment.
- Narrative must include a description of the five domains of the transition to practice program that facilitates effective transition.
- Evidence must include quality outcomes that demonstrate the effectiveness of the transition to practice program.
Note: The five domains of the transition to practice program must include
- Program Leadership
- Organization enculturation
- Development and design
- Practice-based learning and
- Quality outcomes
Example d: Transition to Practice Program for Nurse Transferring within the Organization: Nurse Transition from Medical/Surgical Unit to Labor/Delivery/Recovery/Postpartum
Program Leadership
At Catholic Health Initiatives (CHI) St. Vincent Hot Springs (SVHS), there is a transition to practice program in place for Labor/Delivery/Recovery/Postpartum (LDRP) that orients an experienced nurse in the organization into the new clinical nursing environment. Amy Gates, BSN, RN, LDRP Nurse Manager, oversees the LDRP nurse orientation program, a multi-faceted program designed as a blended experience of lecture, demonstration, and simulation.
Gates is accountable for the process of assessing, planning, implementing, and evaluating the activities and quality outcomes for nurses who transition from one practice environment to the LDRP. Upon transferring to LDRP, the transferring nurse begins a 90-day orientation phase.
Gates assigns the transferring nurse a preceptor upon hire and creates a schedule to mirror the preceptor. Once orientation has started, Gates meets with the preceptor and transferring nurse weekly to gain feedback and assess needs for any additional orientation.
This gives Gates, the transferring nurse, and the preceptor multiple opportunities to review what is going well and where the transferring nurse has opportunities for improvement. Gates also has an open-door policy to discuss any needs or concerns at any time for a two-way communication system to take place any time it is needed.
Organizational Enculturation
The transferring nurse is paired with a preceptor. The preceptor is proficient in all skills, so the transferring nurse can stay with one preceptor for the entire orientation. For example, LDRP preceptors demonstrate proficiency in Labor/Delivery/Recovery, Transition Nursing/NICU, and Couplet Care. During orientation unit-specific policies, the new coworker reviews procedures and order sets and is introduced to the physicians and other coworkers that are working each shift.
Development and Design
After transferring nurses participate in unit-specific nursing orientation, they are then required to attend additional EPIC courses for the perinatal navigator, OB suite log, and surgery suite documentation. The transferring nurse then completes three unit competency-based orientation (CBO) tools about LDRP, including Labor/Delivery/Recovery (LDR), Transition/NICU, and Couplet Care.
These CBO tools provide guidance for the transferring nurse on what skills they must be proficient in before being able to move to the next skill. The transferring nurse completes one skill set at a time. For a nurse transitioning from a Medical/Surgical unit to the LDRP unit, the LDR orientation is 12 to 18 weeks, Baby Postpartum Transition/NICU orientation is six to 10 weeks, and the Baby/Mom Postpartum Couplet Care is four weeks.
The CBO tool is reviewed and signed off at the end of each week during the transferring nurse and preceptor debrief. At the end of each skill, the CBO tool is signed off by the transferring nurse, precepting nurse, and nurse manager. This shows a consensus that the transferring nurse is proficient in all the skills in that CBO tool. At this time, if any deficiencies or weaknesses are noted on the CBO tool, Gates and the preceptor will work with the transferring nurse to provide additional orientation and education.
During the LDRP orientation, a fetal monitoring class is required, including online modules and a test that must be completed before the in-person class. In addition to Basic Life Support and Advanced Cardiovascular Life Support, a Neonatal Resuscitation Program is also required. This is completed during the Transition/NICU orientation. It also requires online modules and tests to be completed before the
two-hour hands-on check-off class.
In collaboration with the education team, the nurse manager prepares and updates the CBO tools. On a biannual basis, LDRP unit-specific CBO tools are reviewed and evaluated by Gates and the LDRP Unit Base Council. The group also annually reviews the Elsevier annual clinical competencies and updates them based on nursing needs for the unit before assigning competency to the nurses. All updates are also discussed with the education team, who assigns the competencies to the nurses.
Practice-Based Learning
Nurses who transition from one practice environment to another in the organization will have an individualized orientation plan. A nurse transferring to LDR is typically oriented to the unit during the first 12 weeks.
During this time, the transferring nurse and preceptor take care of laboring patients, mothers from delivery to two hours postpartum (recovery phase), and high-risk antepartum patients. They also circulate in cesarean sections and triage patients. The transferring nurse attends a fetal monitoring class during this time.
Once the transferring nurse and preceptor complete the CBO tool and feel that the transferring nurse is proficient, the transferring nurse moves into the NICU/Nursery/Transition Care. This orientation is 10 weeks.
During this time, the transferring nurse learns to care for newborns from birth to two hours of age. The transferring nurse skills include every 30-minute transition checks, Apgar scoring, newborn medication administration, and newborn vital signs, including length and weight. The transferring nurse also becomes NRP-certified.
Once the transferring nurse and preceptor complete the CBO tools and feel that the transferring nurse is proficient, they move on to Couplet Care. This orientation is four weeks in length. During this time, the transferring nurse learns how to care for postpartum mothers and newborns. This includes newborn hearing tests, bilirubin lab work, critical congenital heart defects screening, and newborn genetic screening.
Postpartum skills include breast or formula feeding education, discharge education, and assessing for any post-delivery complications. Once the transferring nurse and preceptor complete the CBO tool and feel that the transferring nurse is proficient, the transferring nurse is off orientation and able to care for LDRP in all phases of care and recovery.
Quality Outcomes
During orientation, transferring nurses are set up for success by having the transferring nurse and their preceptors guide the amount of orientation in each skill set. The transferring nurse’s confidence is built in nursing skills with daily debriefs about what went well and what they can improve on or what skill they have not had a chance to complete.
In general, for nurses transferring to a new practice environment, program effectiveness is measured through turnover rates, retention rates, pre- and post-test knowledge, ongoing professional development and engagement, coworker engagement results, and/or evaluations by transferring nurses, preceptors, and/or others on the unit.
The overall RN turnover rate average on LDRP for fiscal year 2023 (January to December) was 1.76%. Quality outcomes for the nurse transitioning from Medical/Surgical units to the LDRP unit include having a 0% nurse turnover rate for CY2021 and CY2022. Five nurses transitioned from the Medical/Surgical units to the LDRP during this time, and all five nurses still work in the LDRP Unit (December 2023).
There were not any nurses who transitioned from Medical/Surgical Units to LDRP in CY2023. (Evidence SE11d-1, LDRP Unit Nurse TTP for Nurse Transferring within the Org Turnover Rate Graph) Additionally, all five nurses continue to grow professionally as they are all involved in the CHI SVHS Clinical Ladder program and work as charge nurses and preceptors on the LDRP unit.