Abstract
Concerns have been raised about the adequacy of newly licensed Registered Nurses' (NLRNs') preparation for hospital-based practice. The Institute of Medicine (2010) and The Joint Commission (2005) call for innovative educational strategies to be developed in order to improve professional education and increase focus on the achievement of competence. The intentions of hospital-based Transition to Practice Programs (TPPs) are to support and facilitate NLRNs transition to clinical practice. A TPP based on quality and safety competencies is one innovative strategy to promote targeted education in quality and safety. The content, length, and structure of TPPs vary to meet the levels of participant's pre-licensure preparation as well as roles ultimately to be obtained by the NLRNs. The purpose of this study was to evaluate the effectiveness of a TPP on NLRN self-assessment of quality and safety competency development in the hospital setting. A quasi-experimental design was used to determine if the NLRNs' self-assessment of quality and safety knowledge, skills, and attitudes changed significantly over time and by type of TPP. The research questions were: (1) which TPP is more effective in increasing NLRNs' self-assessment of confidence in attaining quality and safety knowledge over time; (2) which TPP is more effective in increasing NLRNs' self-assessment of confidence in attaining quality and safety skills over time; (3) which TPP is more effective in increasing NLRNs' self-assessment of confidence in attaining quality and safety attitudes over time; (4) is there a significant difference in the NLRNs' self-assessment of confidence in attaining quality and safety knowledge, skills, and attitudes based on the NLRNs' previous patient care experiences outside of their educational program; and (5) is there a significant difference in the NLRNs' self-assessment of confidence in attaining quality and safety knowledge, skills, and attitudes by the type of pre-licensure educational program the NLRN completed? The sample included 151 NLRNs from 3 different hospitals. Sixty-four participants completed a pretest and post test. There was a statistically significant increase in knowledge scores from Time 1 (M = 33.6, SD = 4.25) to Time 2 (M = 35.9, SD = 5.49), t(59) = 2.704, p = .009. There was a statistically significant increase in skills scores from Time 1 (M = 33.2, SD = 4.06) to Time 2 (M = 35.7, SD = 5.42), t(59) = 3.138, p = .003. There was no statistically significant increase in attitude scores from Time 1 (M = 36.9, SD = 3.31) to Time 2 (M = 37.9, SD = 5.68), t(59) = 1.265, p = .211. There was no statistically significant difference between TPP for knowledge, skills or attitudes scores. This study found no significant difference in quality and safety knowledge, skills, and attitudes over time for NLRNs with previous patient care experiences, although mean NQSSI scores did increase over time. When investigating whether there was a significant difference in the NLRNs' self-assessment of confidence in attaining quality and safety knowledge, skills, and attitudes by type of pre-licensure educational program, there was no significant difference in mean scores over time or by type of pre-licensure program. However, the ADN prepared group had a decrease in mean NQSSI scores over time, whereas the BSN prepared group of NLRNs had increased mean NQSSI scores over time. This is the first study to explore NLRNs' confidence in attainment of quality and safety knowledge, skills, and attitudes. The findings of this study indicate TPPs are effective strategies to advance NLRNs' skills towards a self-assessed higher level of confidence in quality and safety competencies, therefore it can be argued that there is a need for NLRNs to participate in TPPs. TPPs should continue to be studied regarding the effect of NLRNs' preparation on their transition to practice. The positive impact TPPs make on NLRNs' confidence in quality and safety knowledge, skills, and attitudes can lead to more confident nurses and have a positive effect on patient outcomes..