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Associate and Bachelor Degree Graduates National Council of Powered By Docstoc
					Maja Djukic, PhD, RN
New York University, College of Nursing

Chris Kovner, PhD, RN, FAAN
New York University, College of Nursing

Carol Brewer, PhD, RN, FAAN                       2012 NCSBN Scientific Symposium
University at Buffalo, School of Nursing
                                                                      Arlington, VA
                                                              September 11, 2012



Funded by:
National Council of State Boards of Nursing Center for Regulatory Excellence
Robert Wood Johnson Foundation
           RWJF funded                           NCSBN funded
       RN Work Project Team                       Project Team

                                           •   Maja Djukic,
•   Christine Kovner, PhD, RN, FAAN (PI)
                                           •       PhD, RN (PI)
    • Maja Djukic, PhD, RN (Co-I)
                                           •   Christine Kovner,
    • William Greene, PhD (Co-I)           •       PhD, RN, FAAN (Co-PI)
    • Sean Corcoran, PhD (Co-I)            •   Carol Brewer,
    • Jason Nembhard                       •       PhD, RN, FAAN (Co-PI)
    • Farida Fatehi                        •   Farida Fatehi
    • Nell Selander                        •   Ilya Bernstein
    • Carina Katigbak                      •   Joanna Seltzer

•   Carol Brewer, PhD, RN, FAAN (Co-PI)
    • Ying-Yu Chao
    • Eman Abu Sabbah
   Provide data on current
    practice role expectations
    and educational preparation
                                                   Pre-
    for QI and safety for entry-                Licensure
                                                Education
    level RNs

   Inform design of NCLEX-RN      Regulation

    licensure exams and the                             Nursing
    Transition to Practice                             Practice &
                                                       Continuing
    regulatory model                                   Education




                                                                    3
1.   Magnet Recognition

2.   Transforming Care at the
     Bedside (TCAB)

3.   IHI Open School

4.   Nursing Schools Accreditation

5.   Quality & Safety Education for
     Nurses (QSEN)

                                      4
Centers for Medicare and Medicaid Services
Reimbursement Reforms

        2008                     2010             Today
 CMS expands the list    CMS adds participation
 of hospital acquired,       in a Database of
   nursing-sensitive          Nursing Quality
  conditions that no         Indicators to the
   longer qualify for    reporting requirements
    reimbursement          for annual payment
                                  update

                                                          5
   Little is known about changes over time in practice role
    expectations, pre-licensure, and employer-sponsored
    educational preparation for entry-level RNs related to QI and
    safety

   QI Definition
     a range of formal approaches to the analysis of patient
      care quality and systematic efforts to improve it




                                                                    6
   Examine differences between two cohorts of entry-level RNs
    in:
    a. frequency of participation in QI at work
    b. preparedness in QI and safety from pre-licensure nursing
       education programs
    c. preparedness in QI and safety from employers




                                                                  7
   Cross-sectional, descriptive, comparative design

   Sample included RNs working in hospitals who were licensed to
    practice between:
     August 2004 and July 2005 (Cohort 1) surveyed in 2008
     August 2007 and July 2008 (Cohort 2) surveyed in 2010


   Sample included RNs in 15 U.S. states (27 sites) randomly drawn
    from a larger sample, gathered using a two-stage sample of RNs
    nested in 34 states and DC

   Dillman Tailored Design method mixed-mode (US Mail and Web-
    based) 95-item survey
                                                                      8
   Examined responses to each question using descriptive
    statistics

   Used Fisher’s exact chi-square test for categorical variables
    and independent sample t-tests for non-categorical
    variables

   Key QI variables
    based on QSEN framework


                                                                    9
 Panel Wave 1            Wave 2        Wave 3       Wave 4               Wave 5    Wave 6
Survey January            January      January      January              January   January
          2006              2007        2009          2011                 2013      2015




                                       New                     New
   New                                Cohort 1                Cohort 2
Cohorts                                 January                January
                                         2009                    2012




                    Quality            Quality
     QI          Improvement 1      Improvement 2
Surveys             October            October
                     2008               2010
   How prepared or             1. Identified good care from scientific
    unprepared by basic             evidence
    nursing education           2.Measured current performance
    program/employer were       3. Assessed gaps in current practice
    you in the following        4. Systematically applied tools and
    topics…?                        methods to improve performance
    Not at all prepared;        5. Repeated steps 1-4 until desired
    Somewhat prepared;              performance is achieved
    Very Prepared               6. Measured resulting changes
                                7. Monitored sustainability
   During the last 12 months   8. Participated in QI processes such as root
    how often have you              cause analysis
    personally…?                9. Worked in a team to improve processes
    Never; Once; >1 but <1          and systems of care
    per/month; 1/month;         10. Been involved in a specific clinical
    >1/month                        effort to improve a system or pattern
                                    of patient care on your unit
                                                                          11
   Response Rate
     Cohort 1 (72%), N=115
     Cohort 2 (47%), N=424

   Power
     Based on combined N=539, 80% power to detect small
      effect size




                                                           12
Variable                                         Cohort 1 (N=115)         Cohort 2 (=424)           p
Age                                               36.1 years (SD = 10)     34.4 years (SD = 9)     .103

Gender (Female)                                          83.3%                   93.2%             .003

Marital status (Married)                                 55.7%                   52.9%             .673

First basic nursing degree (Diploma/Associate)          60.9%                    58.6%             .748

Ethnicity (White)                                        81.3%                   80.1%             .987

Work Status (Full Time)                                 88.7%                    92.5%             .189

Work setting (Hospital)                                 93.9%                    93.4%             1.000

Unit Type (General Medical-surgical)                     31.3%                   35.9%             .939

Position/Job title (Staff/general duty nurse)           82.6%                    94.3%             .000

Opportunity to work since passing NCLEX-RN       42.5 months (SD = 3.8)   30.3 months (SD = 3.8)   .000
                                                                                                           13
100
                Cohort 1
90

80              Cohort 2

 70

60

 50

40

 30

20

 10

 0
      I have Never Heard of Very Poorly Preapared   Poorly Prepared   Reasonably Well   Very Well Prepared
           QI Processes                                                  Prapared


                                                                                                      14
100
 90   Cohort 1 (04-05) "%Never"
 80   Cohort 2 (07-08) "%Never"
 70
 60
 50
 40
 30
 20
 10
  0




                                  15
100
90           Cohort 1 (04-05) "% Never"

80           Cohort 2 (07-08) "%Never"
 70
60
 50
40
 30
20
 10
 0
       Using strategies to improve   Communicating concerns         Participate in analyzing    Developing strategies to
       hand washing compliance      about the risk of spreading nosocomial infection rates in     prevent and control
            across all clinical    antibiotic resistant bacteria in         your unit         nosocomial infections in your
       professionals who care for       your unit to reduce                                               unit
         patients in your unit to      nosocomial infection
      reduce nosocomial infection

                                                                                                                     16
                                Monitor sustainability

Repeat processes until desire performance is achieved

                           Measure resulting changes

   Systematically apply tools and methods to improve…

                       Assess gaps in current practice

                        Measure current performance

                               Flowcharting processes

    Use of QI data analysis or project monitoring tools

                              Project Implementation

                                        Measurement
                                                                                   Cohort 2 (07-08) "% Not At All
                                        Data Analysis                              Prepared"
                                                                                   Cohort 1 (04-05) "% Not all
                                       Data Collection                             Prepared"

                                                          0   10   20   30   40   50   60    70    80    90    100
                                                                                                               17
          Monitor sustainability

   Repeat processes until desire…

      Measure resulting changes

  Systematically apply tools and…

  Assess gaps in current practice

  Measure current performance

         Flowcharting processes

Use of QI data analysis or project…

        Project Implementation

                  Measurement                     Cohort 2 (07-08) "% Not At All
                                                  Prepared"
                  Data Analysis                   Cohort 1 (04-05) "% Not all
                                                  Prepared"
                 Data Collection

                                    0   20   40   60            80             100
                                                                                     18
   Little improvement is noted
    in early-career RNs’ QI
    participation at work over 2
    years and educational
    preparedness over 3 years




                                   19
                                    The healthcare workforce*




                                              RNs                    MDs          Everyone else


*Included in the healthcare workforce are: counselors, social workers, dieticians, nutritionists, pharmacists, physicians, surgeons,
physician assistants, RNs, clinical laboratory techs, emergency medical techs, paramedics, practical and vocational nurses (BLS, 2008).
                                                                                                                                          20
   NCLEX- RN Exam
     Based on practice trends, but practice trends in QI may
      not be optimal
     Follow practice trends or set trends for practice and
      education?

   Transition to Practice Model
     May fill the gap in early career RNs knowledge of and
      participation in QI



                                                                21
   Maja Djukic, PhD, RN
    Assistant Professor
    New York University
    College of Nursing

    (w) 212-992-9440
    md1359 @nyu.edu




                           22

				
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