1. No category

Expanding the Evidence for New
Graduate Transition
Best Practices: A Provincial
Perspective
Dr. Kathy Rush, UBCO
Ms. Monica Adamack, IHA
Presentation Objectives
 Introduction of Project
 Salient results
 Challenges
 Recommendations
Background
 Partnerships
 Michael Smith Research Foundation
 Academia and Practice
 Provincial
Project Overview
 Three Phase Project
 Foundational framework
 Phase 1: Literature Review
 Phase 2: Current Practices in BC / Mixed Methods
 Phase 3: Toolkit Development
EDUCATION
WORKPLACE
ENVIRONMENT
SUPPORT
COMPETENCY
CRITICAL THINKING
Literature Review
Literature Review - Findings
Education / Competency
 Educational components were not described in detail
 NGs prefer fewer formal classes
 Dedicated time for specific skill practice results in higher levels of NG comfort
Support
 Preceptor training improved outcomes
Workplace Environment
 Work environment impacts transition
 6-9 months post-hire stress
 Increased retention, decreased turnover
Other
 No standardized tools
 Lack of consistency and clarity within terminology
Qualitative - Method
 Focus group categories
 Interviews
Health Authority
Total # of Sessions
Total # of New Graduate
Participants
Total # of Nurse Manager
Participants
Fraser
6
8
7
Interior
6
18
23
Northern
2
5
2
Providence
3
0
10
Provincial Health
2
2
8
Vancouver Coastal
6
9
4
Vancouver Island
6
6
15
Total
31
48
69
Qualitative - Findings
 Role ambiguity/role confusion.
Education
 ESN program valuable but contentious
 Desire more practical skill focus and less classroom
learning
Qualitative Findings
Competency/Critical Thinking
 NGs expressed lack of practical skills;
 Dependent on education program/institution
 Casualization
Support/Satisfaction
 Extremes
 Networking
Qualitative Findings
Workplace Environment
 Consistency / inconsistencies
 Advocacy
 Feedback
 ‘Culture of the NG‘
 Transition indicators
 Variability of funding
Quantitative - Survey
 Demographics
 Orientation
 Transition generically / specifically
 Education approaches
 Casey-Fink Graduate Nurse Experience Survey
Quantitative
Health Authority
# of New Graduates receiving survey
invite
# of New Graduates who
participated
Response Rate
Fraser
307
23
7%
Interior
152
72
47%
Northern
122
39
32%
Providence
90
24
27%
Provincial
21
12
57%
Vancouver-Coastal
124
41
21%
Vancouver Island
192
46
24%
1008
257
26%
 Survey
Total
Quantitative - Findings
 60% in Transition Programs
 NGs who participated in a formal transition
program had significantly higher transition
scores then those who did not participate!
EDUCATION
What is the relationship between the helpfulness of different
education methods of delivery and transition experience?
Type of Educational Opportunities
Very
Helpful/ Moderately helpful
Not very helpful
N/A
helpful
Written Materials
18.8
62.5
11.8
6.9
Classroom/Theory
13.9
63.2
6.2
16.7
Simulation/Lab
13.2
34.0
2.8
50.0
Hands-on/Bedside Learning
57.6
23.6
1.4
17.4
Inservices/Workshops
29.9
59.0
0.7
10.4
Website/Online Materials
13.2
54.9
9.0
22.9
What is the relationship between the timing of New Graduate
specific education and New Graduates transition experience?
Is there a relationship between their total transition scores and
their ability to access support when needed?
SUPPORT
What is the relationship between length of orientation and
transition?
What is the relationship between percentage of New
Graduate shifts that are preceptored during the orientation
and transition?
Variable
Orientation
Frequency
Percentage
167
7
94.89
3.98
No
Length of Orientation (Weeks)
2
1.14
2
2 but < 4
>4
% Preceptored Shifts
78
48
48
44.83
27.59
27.59
18
19
21
25
91
10.34
10.92
12.07
14.37
52.30
Yes
From Previous Employment
None
25
26-50
51-75
>75
What are the most helpful perceived supports for New
Graduates who participated in a New Graduate transition
program? Which people supports are related to transition?
WORKPLACE ENVIRONMENT
When do BC New Graduates feel the greatest need for
support during their transition to practice? Are they able to
access support when they feel the greatest need?
What is the prevalence of self-reported bullying among New
Graduates?
What is the relationship between the total transition score
and the predictors “transition program participation”,
“bullying/harassment” and “ability to access
support when most needed”?
ToolKit Development
 Methodological Triangulation
 Two categories of Tool-Kit Best Practice's
Recommendations':
 Strongly Recommended, and Recommended
 Macro level
Competency/Critical Thinking
Strongly Recommended
 Ensure all NGs
participate in a formal
transition program as
this assists in skill
consolidation
 Strive to provide NGs
with at least 49 hours of
work in a two week
period during their first
year of practice
Education
 Strongly Recommended
 NG education delivered
during a formal transition
program should be of a
practical nature such as
hands-on/bedside
learning opportunities
and
inservices/workshops.
Formal classroom type
learning should be limited
 Recommended
 Encourage
undergraduate programs
to increase the
opportunities for practical
skill focus
Support
Strongly Recommended
 Use of mentors to
support NGs during
their transition
 Provide formal
preceptor education and
make this training a
requirement
 Provide formal support
to NGs for at least 6 to
9 months post-hire
Recommended
 Unit orientation at least
4 weeks in length
Workplace Environment
Strongly Recommended
 Strive to ensure clinical
unit work environments
are ‘Healthy’
 Provide training and
resources
 Enforce zero tolerance
for bullying policy
Challenges
 Conceptual
 Interchangeable use of terms
 Ethical
 5 different research ethics review boards
 Methodological
Recommendations
 Need to have more flexible timelines
 Longitudinal Study benefits
 Harmonized research / ethics
 Publishing in open access
 Future work
 Development of toolkit to micro level
 Build provincial repository
 Future studies
Publications
 Expanding The Evidence For New Graduate Nurse Transition
Best Practices: MSFHR website:
http://www.msfhr.org/expanding-evidence-new-graduatenurse-transition-best-practices
 Rush, K.L., Adamack, M., Gordon, J., Janke, R., & Ghement, I.
(2015). Orientation and Transition Program Component
Predictors of New Graduate Workplace Integration. Journal of
Nursing Management, 23(2), 143-55.
 Adamack, M., & Rush, K.L. (2014). Disparities in New
Graduate Transition to Practice from Multiple Stakeholder
Perspectives. Nursing Leadership, 27(3), 16-28.

 Rush, K.L., Adamack, M., Gordon, J., Janke, R., &
Ghement, I. (2014). New Graduate Transition
Programs: Relationships With Access to Support and
Bullying. Contemporary Nurse, 48(2), 219-228.
 Rush, K.L., Adamack, M., Janke, R., Gordon, J., &
Ghement, I. (2013). The helpfulness and timing of
education: Relationships with new graduate transition.
Journal for Nurses in Professional Development, 29(4),
191-196.
 Rush, K.L., Adamack, M., Gordon, J., Lilly, M., & Janke,
R. (2013). Best Practices of Formal New Graduate
Transition Programs: An Integrative Review. International
Journal of Nursing Studies, 50 (3), 345-356.

 Acknowledgements and Appreciation
 Questions