Evaluation of clinical nurse transition program at US Army Hospitals

Abstract

Introduction: The purpose of this evaluation was to determine the effectiveness of the clinical nursetransition program (CNTP) for newly commissioned Army nurses. This is one of the first evaluations conducted to document the outcomes of the Army Nurse Corps (ANC) transition-to practice residency program. Materials and Methods:This project was a prospective pre-test/post-test design evaluation of newly licensed registered nurses (RNs) enteringthe military health system from Fall 2017 to Fall 2018 using Casey-Fink Readiness for Practice Survey and the NewGraduate RN Transition Program Competency Assessment Tool. Data were analyzed using SAS 9.4. All tests weretwo-tailed as applicable and p-values less than 0.05 were considered significant. Missing data were treated as missingfor individual items; their values were not imputed. No participant was excluded due to missing items. This evaluationwas determined to be exempt from human subject protection regulations by the Human Protections Administrator atWomack Army Medical Center. Results: A total of 92 pre-test surveys were sent to the nine CNTP training sites whichactively trained RNs during the study timeframe. Due to a shipping error, 6 of the 92 completed pre-test surveys fromone CNTP site were not received, for an overall response rate of 93.4% (86/92), from eight CNTP sites. Of the 86 participants from whom pre-tests were received, all 86 successfully returned their post-test survey, for a 100% responserate pre-to post-survey. The participants were predominately white (73.3%) and female (70.9%) with a median age of23 years (IQR: 22-24 years) and an undergraduate GPA of 3.5 (IQR: 3.4-3.7, Table II). Quantitative data analysisrevealed that after the training, all participants reported a significant improvement in providing safe (p < 0.0001) andquality care (p < 0.0001) for an average workload of in-patient patients. It also showed a significant improvement inteam leading (p < 0.0001), effective decision making (p < 0.0001), incorporating evidence into practice (p < 0.0001),and demonstrated professionalism (p < 0.0001). The overall clinical competence and readiness to practice (p < 0.0001)also improved. Data shows that participants perceive significant improvement in all the objectives set by the ANC forthe transition program. Conclusion: The results of this program evaluation provide evidence that the CNTP has been asuccess in meeting the intended objectives. Participants showed a significant improvement in their perceived readinessand level of competency in clinical, technical, and leadership skills performance at the end of the program, as well asimproved communication and teamwork. The CNTP experience provides an effective means to facilitate the development of newly licensed Army nurses' clinical competence and confidence in practice. The study limitation includes theCasey-Fink Readiness for Practice Survey had relatively low reliability, but it was chosen as it was better aligned tothe specified CNTP objectives. And also, with any self-reported evaluation, there is potential bias regarding the accuracy of participants' self-perception. Follow-up study may include examining the demographics of the incomingnurses, such as their source of commission. To determine if and how the comfort and confidence self-reported by thenew graduate nurses is reflective of actual ability, nurse preceptors may be asked to complete skills assessments or simulations with objective measurements may be used.