Identification of statewide core competencies for new graduate nurses at the beginning of practice and after a 12-month nurse residency program.

AIM: To inform the development of statewide core competencies for new graduate nurses at the beginning of their professional career and after completing a 12-month nurse residency program. BACKGROUND: Although studies have attempted to clarify the expected core competencies of new graduate nurses at the beginning of their professional career, results are mixed. Additionally, nurse residency program competency expectations vary. DESIGN: A retrospective cross-sectional study using a purposive sample of a national nurse residency program database. METHODS: Wilcoxon Signed Rank tests compared retrospective self-report data between January 1st 2017 and December 31st 2019, from 2916 acute care hospital new graduate nurses working in the state of Maryland, USA, to examine their perceptions of competency at hire and after completing a nationally standardized 12-month nurse residency program. The study used six domains from the Casey Fink Graduate Nurse Experience Survey© 2006 and the Vizient/AACN Nurse Residency Program™ Progression survey. RESULTS: New graduate nurses' self-report of competency increased from a mean score of 4.81 at the beginning of a nurse residency program to 6.67 after completion of 12-month nurse residency program (scale of 0-10). At the beginning of a nurse residendy program, new graduate nursesreported a low level of comfort in three of the six survey domains: communication and leadership, high-intensity skills and patient safety. At 12 months, new graduate nurses reported higher levels of comfort in all six survey domains, with statistically significant increases (Wilcoxon Signed Rank test, α =0.05). CONCLUSIONS: Four domains for ongoing competency development were identified for the nurse residency program curriculum-communication and leadership, patient safety, complex patient assignments and end-of-life care-with the expectation that new graduate nurses achieve competency at program completion. New graduate nurses' perceptions corroborated findings from a statewide study of academicians and practice leaders, thus helping to develop realistic core competencies for new graduate nurses entering the workforce and after completing a 12-month nurse residency program.

PubMed4Hh: A Point-of-Care Mobile App for Evidence-Based Clinical Decision Support for Nurse Residents in Maryland.

Evidence-based clinical decision-making is considered a core competency for professional nurses. However, barriers such as lack of time in clinical practice; information overload; restricted access to resources; lack of evidence appraisal skills, awareness, and knowledge; and unreliable resources prevent them from adopting evidence-based practice. This study examined the usefulness of the PubMed4Hh (PubMed for Handhelds) mobile application for clinical decision-making at the point of care among Maryland newly licensed RNs. Using iOS and Android smartphones, 178 newly licensed RNs participated in a 6-month trial from November 2019 to April 2020. Nurses manually entered free-text queries or used voice inputs on the "Patient, Intervention, Comparison, Outcome" or "askMEDLINE" search engines. The results retrieved were presented as journal article abstracts or short summaries called "the bottom line," designed for quick reading at the point of care. Both Patient, Intervention, Comparison, Outcome and askMEDLINE were rated highly for their usefulness, and participants said they would continue using PubMed4Hh and recommend it to others. Newly licensed RNs had a significantly higher perception of the usefulness of PubMed4Hh when the results of "the bottom line" or abstracts confirmed, led, or modified their nursing skills, knowledge, or the patient's care plan.

A Statewide Nurse Residency Program Evaluation.

Across the nation, hospitals are answering the call to action for funding and requiring new-to-practice registered nurses to complete a nurse residency program (NRP). In response, all Maryland acute care hospitals successfully funded, adopted, and implemented a 12-month standardized, commercially available (vendored) NRP. However, although the hospitals use the same curriculum, their administrative practices, content, and deliverables vary. A statewide program evaluation was conducted by the Maryland Organization of Nurse Leaders, Inc./Maryland Nurse Residency Collaborative to understand the NRP structure and process variability, including implementation challenges, and what worked and what did not. Findings from 26 semi-structured interviews with Maryland acute care hospital NRP coordinators showed that leadership support and resources, differences in patient populations, number of nurse residents, and organizational requirements best explained programmatic adaptations. Using lessons learned, best practices are shared, including methods to garner leadership support and reduce adaptations. Although program customization is expected, program replicability and scalability are essential to achieving program outcomes. [J Contin Educ Nurs. 2023;54(9):421-429.].

The Impact of Preceptor Education, Experience, and Preparation on the Role.

Findings from the 2020 Association for Nursing Professional Development National Preceptor Practice Analysis study validated the Ulrich precepting model. This secondary data analysis examines the influence of preceptor training, experience, and education on perceptions of the importance of the preceptor roles, domains (knowledge and practice), and required competencies. Preceptor training compared with education and experience best predict nurses' perceived importance of precepting and its seven roles.

The Association for Nursing Professional Development National Preceptor Practice Analysis Study: An Exploration of Precepting in Perioperative Settings.

Preceptors are an important part of meeting perioperative workforce demands. A secondary analysis of data collected for the 2020 Association for Nursing Professional Development National Preceptor Practice Analysis Study focused on 400 perioperative nurse preceptors and compared their responses to nonperioperative preceptors. Most perioperative respondents had participated in preceptor training; they spent significantly more time orienting experienced nurse preceptees in the perioperative specialty and its diverse settings (eg, orthopedic surgery, open-heart surgery) than preceptors in nonperioperative settings and specialties. Perioperative preceptors spent significantly less time precepting students, suggesting the presence of an opportunity to address the nursing shortage by promoting student exposure to the perioperative setting. To align with the AORN position statements on orientation and nurse residencies, perioperative nurse leaders should ensure that properly educated preceptors are available to assist RNs who are transitioning to perioperative practice. The Ulrich Precepting Model provides an evidence-based framework for preceptor training.

Overcoming the Disruption of Clinical Nursing Education: A Statewide Hospital-Academic Initiative.

Havoc of the COVID-19 pandemic on prelicensure nursing programs caused students to lose precious onsite clinical opportunities to gain competency in basic fundamental skills. A statewide task force of faculty and hospital leaders developed the Transition to Nurse Residency Program to develop new nurses' skills and behaviors routinely learned during onsite clinical experiences. This article describes the program contents and shares its contents for use by nursing professional development practitioners.

Preceptor Practice: Initial Results of a National Association for Nursing Professional Development Study.

In 2020, the Association for Nursing Professional Development commissioned a national preceptor practice analysis study using the Ulrich Precepting Model to identify the roles, knowledge, and activities essential to preceptor practice. In a survey of 3,623 preceptors, the model's seven preceptor roles and their associated domains of knowledge and practice were validated. Findings indicate that nursing professional development practitioners should provide preceptors with initial role preparation in addition to ongoing education.

De-Escalation Training to Medical-Surgical Nurses in the Acute Care Setting.

Violence is increasing on medical-surgical units as a "silent epidemic." This quality improvement project employs a small non-experimental, single-group, pre- and post-test design (N = 11) to determine the effectiveness of de-escalation training on medical-surgical nurses' confidence levels when dealing with agitated patients. Regardless of age, education, or years of experience, scores improved for each question on Thackrey's (1987) Confidence in Coping with Patient Aggression Instrument after implementing Ten Domains of De-escalation by Richmond et al. (2012). A paired-sample two-tailed t-test significantly increased from Time 1 pre-test (M = 49.82, SD = 10.11) to Time 2 post-test (M = 72.82, SD = 14.41), t(10) = 4.46, p <.001. The mean increase was 23.00 [95% CI, 11.51-34.49]; d = 1.84 indicating a large effect size (Pilot, 2010). A sensitivity analysis (Wilcoxon Signed Rank Test) showed a median difference among the matched pairs with a significant increase in confidence levels post-training, z = -2.847, p <.004. The median score increased from the pre-test (Md = 51) to the post-test scores (Md = 71) (Pallant, 2013).

Transforming Roles of Nursing Professional Development Practitioners.

This research was undertaken to delineate the future role of nursing professional development (NPD) specialists. Using a modified e-Delphi technique, seven key roles for NPD (partner for practice transitions, learning facilitator, change agent, mentor, leader, champion of scientific inquiry, and advocate for NPD specialty) and their concomitant competencies evolved. Results of this study informed the update of the NPD Scope and Standards of Practice and may be used to identify competencies for the specialty.

Three-Year Pre-Post Analysis of EBP Integration in a Magnet-Designated Community Hospital.

BACKGROUND: Adoption of evidence-based practices (EBP) by registered nurses (RNs) and nurse leaders continues to be a challenge. Although multiple strategies and substantial resources are being invested to advance nursing practice based on evidence, little is known about the long-term impact of these interventions. AIMS: This study was undertaken to assess nurse leaders' and clinical RNs' beliefs to use EBP, perceptions about organizational readiness for EBP, and frequency of implementing EBP following implementation of multifaceted interventions to achieve and maintain Magnet designation. METHODS: This retrospective descriptive study compared data from two previously administered online surveys (2008 and 2012) at a mid-Atlantic Magnet-designated community hospital. RESULTS: Clinical RNs' self-reported attitudes toward EBP were more positive (2008: M = 53.85, standard error of the mean [SEM] = 0.65; 2012: M = 57.07,SEM = 0.58), as well as their perceptions of organizational readiness (2008: M = 50.72, SEM = 1.20; 2012: M = 81.09, SEM = 0.98), between the two survey years. Contrarily, although nurse leader scores were significantly higher for beliefs (2008: M = 61.15, SEM = 1.23; 2012: M = 60.60., SEM = 0.96), readiness (2008: M = 61.28, SEM = 2.16; 2012: M = 85.18, SEM = 1.64), and implementation (2008: M = 21.35, SEM = 1.72; 2012: M = 19.08, SEM = 1.43) little change was observed in the nurse leader scores between the two survey years compared with clinical RNs. DISCUSSION: Results from this study suggest that the multifaceted interventions have had a positive impact on clinical RNs' beliefs and readiness for EBP, but not for nurse leaders. Albeit low, self-reported implementation of EBP by RNs and nurse leaders has been sustained, but has not improved. LINKING EVIDENCE TO ACTION: Leaders must see their role as not only facilitators of EBP but also as active participants practicing EBP. Actively engaging leaders in EBP by serving on interprofessional EBP teams and role modeling these behaviors to staff is critical to EBP implementation. Realistic expectations of RNs for EBP implementation and clear and accessible resources may enhance RNs' willingness to implement. Going forward, it may be necessary to differentiate the expectations of RNs in EBP implementation by clarifying expectations in the process of identification and analysis of evidence from use of EBP in clinical practice.

Motivating registered nurses to return for an advanced degree.

Master's-prepared nurses are required as faculty and educators in the hospital setting to meet the increasing demands of today's health care environment. A non-experimental, descriptive study design was used to examine nurses' preferences for organizational incentives and rewards that might motivate them to return for an advanced nursing degree. Using findings from this research study, a grant was developed and funded to address the need to both fill expected vacancies in the nursing work force and reduce the clinical nursing instructor shortage through a strategic academia and service partnership. A cohort model and mentorship program to identify nurses and then encourage and assist them in matriculating and completing an advanced degree in nursing was developed. One expected outcome of the proposed collaborative arrangement is to increase the number of registered nurses prepared at the graduate level to create a pool of individuals qualified to serve as clinical instructors, faculty, and preceptors while maintaining their hospital positions. Another expected outcome is to provide a path for nurses to pursue graduate education.