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 nurse transition 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) entering the military health system from Fall 2017 to Fall 2018 using Casey-Fink Readiness for Practice Survey and the New Graduate RN Transition Program Competency Assessment Tool. Data were analyzed using SAS 9.4. All tests were two-tailed as applicable and p-values less than 0.05 were considered significant. Missing data were treated as missing for individual items; their values were not imputed. No participant was excluded due to missing items. This evaluation was determined to be exempt from human subject protection regulations by the Human Protections Administrator at Womack Army Medical Center. Results A total of 92 pre-test surveys were sent to the nine CNTP training sites which actively trained RNs during the study timeframe. Due to a shipping error, 6 of the 92 completed pre-test surveys from one 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% response rate pre- to post- survey. The participants were predominately white (73.3%) and female (70.9%) with a median age of 23 years (IQR: 22–24 years) and an undergraduate GPA of 3.5 (IQR: 3.4–3.7, Table II). Quantitative data analysis revealed that after the training, all participants reported a significant improvement in providing safe (p < 0.0001) and quality care (p < 0.0001) for an average workload of in-patient patients. It also showed a significant improvement in team 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 for the transition program. Conclusion The results of this program evaluation provide evidence that the CNTP has been a success in meeting the intended objectives. Participants showed a significant improvement in their perceived readiness and level of competency in clinical, technical, and leadership skills performance at the end of the program, as well as improved 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 the Casey-Fink Readiness for Practice Survey had relatively low reliability, but it was chosen as it was better aligned to the 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 incoming nurses, such as their source of commission. To determine if and how the comfort and confidence self-reported by the new graduate nurses is reflective of actual ability, nurse preceptors may be asked to complete skills assessments or simulations with objective measurements may be used.

New graduate nurses’ clinical competence: A mixed methods systematic review

“…(2014) and Oblea et al. (2019) reported a significant increase in competence after 6 months in a transition programme, with Bratt et al. (2014)’s findings being sustained at 12 months.…”

“…The Nurse Competence Scale (NCS) was the most used tool ( N = 10; Kuokkanen et al., 2016; Lima et al., 2016; Lima et al., 2014; Numminen et al., 2014; Numminen et al., 2015a; Numminen et al., 2015b; Numminen, Leino‐Kilpi, et al., 2016; Numminen et al., 2017; Numminen, Ruoppa, et al, 2016; Wangensteen et al., 2012). All other tools were used in four or less research papers each: Six‐Dimension Scale of Nurse Performance (6‐D Scale; Aggar, Bloomfield, Thomas, & Gordon, 2017; Aggar, Gordon, Thomas, Wadsworth, & Bloomfield, 2018), Modified Six‐Dimension Scale of Nurse Performance (M6‐D Scale; Bratt, Baernholdt, & Pruszynski, 2014), Holistic Nursing Competence Scale (HNCS; Jung et al., 2017; Takase et al., 2014), New Graduate Registered Nurse Transition Program Competency Tool (NGRNTPCT; Oblea et al., 2019), Nurse Competence Questionnaire (NCQ; Chen, Chen, Chen, Kuo, Li, & Chiang, 2017; Chen, Chien, et al, 2017), Nurse Professional Competence (NPC; Holowaychuk, 2018) and Overall Competency Tool/Specific Competency Tool (OCT/SCT; Blegen et al., 2015; Spector et al., 2015; Wilson et al., 2018; Woda et al., 2019).…”

COVID-19 Pandemic

“…TPPs also act as a catalyst for professional development through organizational membership drives, assist with certifications, and promote advanced education, which is helpful for job advancements. Likewise, military TPPs allow team building by military nurses as they create and present evidence-based projects (Oblea et al, 2019). These activities encourage esprit de corps and promote lifelong learning through pursuit of advanced nursing degrees, which are beneficial for promotions.…”

“…In 2008, they collaborated with the University of Cincinnati Medical Center to establish the first militarycivilian TPP. In 2009, the U.S. Army Nurse Corps (ANC) initiated the Brigadier General Anna Mae Hays Clinical Nurse Transition Program (CNTP) in lieu of the preceptor program (Oblea et al, 2019). This program shapes newly assigned ANC officers into competent clinicians and effective military leaders.…”

“…The nursing profession is obligated to apply current and historical pandemic lessons learned as strategies to develop future registered nurses (RNs) into practicing clinicians (Labrague et al, 2018). Civilian and military transition-to-practice programs (TPPs) meet this duty by shaping newly licensed RNs into competent RNs (Oblea et al, 2019;Walsh, 2018). The purpose of this article was to explore the evidence about TPPs for newly licensed civilian and military RNs that support averting current and future nursing shortages.…”