Abstract
Background: The ECRI recognized transition to practice (TTP) as 2024’s top patient safety concern. Challenges newly licensed nurses (NLNs) face during TTP and orientation (TTP/O) include: developing competence in managing patient care complexities and integrating into interprofessional teams. Job satisfaction, retention rates, nurse well-being, and patient outcomes are affected by the TTP/O periods.
Purpose: Our goal is to support NLNs with TTP challenges. A TTP/O pathway including nurse competencies with measurable performance outcomes (POs) and essential knowledge, skills and abilities (KSAs), and digital knowledge assessment tools was developed and implemented.
Methodology: A staged orientation to assess overall competency and a psychometrically sound nursing knowledge assessment tool (KAT) was developed. Pre/post-orientation KAT scores were measured to ensure identified gaps were met. A competence model with content validated POs and KSAs was implemented. Preceptor education included how to: implement staged competency validation, assess overall competence, provide actionable feedback and promote nurse well-being. Competency assessments provided objective data to identify nurses who were succeeding and those not attaining competency. Pre- and post-orientation outcome surveys were conducted to evaluate TTP/O approach. First year turnover was measured and reasons for nurses leaving were identified.
Outcomes: Preceptors and NLNs evaluated POs and KSAs weekly during TTP/O.To be deemed competent and ready for independent practice, NLNs needed to attain a PO score of applying or achieving. Performance improvement plans (PIPs) were implemented if these scores were not achieved. After PIPs, NLNs who were unable to score applying or achieving were counseled and assisted to find a position where they could excel. Post-orientation outcomes showed improvements from pre- in: knowledge and confidence in ability to recognize and intervene for changes in patient stability and assessment of the ability to provide safe patient care. 7.7% turnover at one year. The Nursing Solutions, Inc. National Health Care Retention Report found 18.4% of all newly hired RNs in 2022 left within a year; $56,300 average turnover cost.
Implications for Nursing Practice: Implementing TTP/O with content validated criteria ensures NLNs are confident, knowledgeable and competent for practice. This staged approach helps NLNs’ overcome TTP challenges and improve retention rates and nurse well-being.
Notes
References:
1. AACN’s competence framework for progressive and critical care: Initial competency 2022. (2022). American Association of Critical Care Nurses.
2. American Association of Critical-Care Nurses. (n.d.). AACN synergy model for patient care. AACN. https://www.aacn.org/nursing-excellence/aacn-standards/synergy-model accessed October 10, 2024.
3. Beamer, J. C., Kromer, R. S., & Jeffery, A. D. (2019). Imagining an orientation built on trust. Journal for Nurses in Professional Development, 36(1), 2–6. https://doi.org/10.1097/nnd.0000000000000602
4. Cain, C., & Miller, J. (Eds.). (2019). AACN scope and standards for progressive and critical care nursing practice. American Association of Critical-Care Nurses.
5. Collins, R. (2020). Clinician cognitive overload and its implications for nurse leaders. Nurse Leader, 18(1), 44–47. https://doi.org/10.1016/j.mnl.2019.11.007
6. ECRI’s Top 10 Patient Safety Concerns for 2024. 2024 ECRI https://home.ecri.org/blogs/ecri-blog/ecri-s-top-10-patient-safety-concerns-for-2024 accessed October 10, 2024
7. Elias, C. E., & Day, T. (2020). Experiences of newly qualified nurses in critical care: A qualitative systematic review. Journal of the Intensive Care Society, 21(4), 334–343. https://doi.org/10.1177/1751143720926794
8. McDermott, C. (2023). Supporting competency-based time-variable orientation of newly licensed RNS.Nurse Leader, 21(2), 169–173. https://doi.org/10.1016/j.mnl.2022.12.005
9. Mortenson, M., Naustdal, K.,I., Uibu, E., Magi, L., Kangasniemi, M., Polluste, K., and Moi, A., L. (2022) Instruments for measuring patient safety competencies in nursing: a scoping review. BMJ Open Quality Review, 11(e001751).
10. Miller, C. M., Meyer, K., Riemann, L. A., Carter, B. T., & Brant, J. M. (2023). Transition into practice: Outcomes of a nurse residency program. Journal of Continuing Education in Nursing, 54(1), 32–39. DOI: 10.3928/00220124-20221207-08
11. NSI Nursing Solutions, Inc. (2023). 2023 NSI National Health Care Retention & RN Staffing Report. https://www.nsinursingsolutions.com/Documents/Library/NSI_National_Health_Care_Retention_Report.pdf and https://www.wpchange.org/resources/2023-nsi-national-health-care-retention-rn-staffing-report
12. Sampson, M., Knupp, A., Chignolli, H., Dhakal, K., et.al. (2024) Strategies for incorporating evidence-based practice into nurse residency programs: A scoping review. World Views on Evidence-Based Nursing, 21(4), 407 - 414.
13. Ulrich, B., Cassidy, L., Barden, C., Varn-Davis, N., & Delgado, S. A. (2022). National nurse work environments - October 2021: A status report. Critical Care Nurse, 42(5), 58–70. https://doi.org/10.4037/ccn2022798
Sigma Membership
Iota Nu at-Large
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Other
Keywords:
Transition to Practice, Onboarding, Competence, Precepting, Clinical Practice, Workplace Culture, Newly Licensed Nurses, Novice Nurses
Recommended Citation
Miller, Julie and Grieshop, Sara, "Promote a Healthy Learning Environment by Responding to Transition to Practice Safety Concerns" (2025). Biennial Convention (CONV). 32.
https://www.sigmarepository.org/convention/2025/presentations_2025/32
Conference Name
48th Biennial Convention
Conference Host
Sigma Theta Tau International
Conference Location
Indianapolis, Indiana, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2025-11-18
Promote a Healthy Learning Environment by Responding to Transition to Practice Safety Concerns
Indianapolis, Indiana, USA
Background: The ECRI recognized transition to practice (TTP) as 2024’s top patient safety concern. Challenges newly licensed nurses (NLNs) face during TTP and orientation (TTP/O) include: developing competence in managing patient care complexities and integrating into interprofessional teams. Job satisfaction, retention rates, nurse well-being, and patient outcomes are affected by the TTP/O periods.
Purpose: Our goal is to support NLNs with TTP challenges. A TTP/O pathway including nurse competencies with measurable performance outcomes (POs) and essential knowledge, skills and abilities (KSAs), and digital knowledge assessment tools was developed and implemented.
Methodology: A staged orientation to assess overall competency and a psychometrically sound nursing knowledge assessment tool (KAT) was developed. Pre/post-orientation KAT scores were measured to ensure identified gaps were met. A competence model with content validated POs and KSAs was implemented. Preceptor education included how to: implement staged competency validation, assess overall competence, provide actionable feedback and promote nurse well-being. Competency assessments provided objective data to identify nurses who were succeeding and those not attaining competency. Pre- and post-orientation outcome surveys were conducted to evaluate TTP/O approach. First year turnover was measured and reasons for nurses leaving were identified.
Outcomes: Preceptors and NLNs evaluated POs and KSAs weekly during TTP/O.To be deemed competent and ready for independent practice, NLNs needed to attain a PO score of applying or achieving. Performance improvement plans (PIPs) were implemented if these scores were not achieved. After PIPs, NLNs who were unable to score applying or achieving were counseled and assisted to find a position where they could excel. Post-orientation outcomes showed improvements from pre- in: knowledge and confidence in ability to recognize and intervene for changes in patient stability and assessment of the ability to provide safe patient care. 7.7% turnover at one year. The Nursing Solutions, Inc. National Health Care Retention Report found 18.4% of all newly hired RNs in 2022 left within a year; $56,300 average turnover cost.
Implications for Nursing Practice: Implementing TTP/O with content validated criteria ensures NLNs are confident, knowledgeable and competent for practice. This staged approach helps NLNs’ overcome TTP challenges and improve retention rates and nurse well-being.
Description
A transition to practice (TTP) orientation pathway including nurse competencies with validated performance outcomes and digital knowledge assessment tools to support nurses with TTP challenges was implemented. Post-orientation outcome measures showed improvements from pre- in: knowledge and confidence in ability to recognize and intervene for patient stability changes and provide safe patient care. First year turnover was 7.7%.