HealthNovember 28, 2019

Improving new nurse competency through hospital transition programs

According to the American Nurses Association, almost 500,000 registered nurses are expected to retire by 2022. To avoid a potential nursing shortage, the United States Bureau of Labor Statistics anticipates the need for 1.1 million new nurses to replace retirees and expand care. And while over 2.2 million new nurses will enter the nursing workforce through 2030, there’s still the problem of new nurse competency.

Even though all nurses who practice are expected to be competent, new nurses often need help developing the skills to practice safely and efficiently. Many hospital systems have implemented transition programs to help develop new nurse competency. But what, exactly, is competency in the context of new graduate nurses? And how can transition programs improve new nurse performance and skill level?

Defining competency—what should new nurses know?

Within the nursing profession, competency can be defined as a nurse’s ability to be:

  • Confident
  • Knowledgeable
  • Safe
  • Timely

Additionally, a competent nurse should not rely on supporting cues from co-workers to complete their tasks successfully. But new graduate nurses are usually not proficient in multiple skill areas, even after receiving an education designed to acclimate them to the nuances of nursing practice.

In 2016, an Australian study identified eight skill areas in which a new nurse is expected to be “work-ready” by their colleagues. These areas included:

  • Behavior conductive to learning
  • Communication and documentation
  • Efficient and effective communication
  • Personal care (assessment, planning, and evaluation of care using comprehensive nursing models)
  • Preventing risk and promoting safety
  • Privacy and dignity
  • Professional nursing behaviors
  • Therapeutic nursing behaviors and respect for personal space

While many of these skill areas are critically important to a new graduate nurse, these were just a few of the 30 total skill areas identified by seasoned nurses as contributing to competency. Other skill areas in which experienced nurses identified a lack of new nurse competency included multidisciplinary team working, promoting self-care, medications and IV products, cultural competence, and critical analysis and reflective thinking.

How can transition programs help improve competency?

Hospital transition programs are becoming increasingly popular as nursing educators recognize the need for competency improvement processes. Transition programs generally include orientation, onboarding, nurse residency, and nurse internship programs. In almost all cases, nurse preceptors and the quality of the new nurse/preceptor relationship is critical for competency development.

An integrative review published in the journal Advances in Nursing Science suggests that transition programs help new nurses develop their skill set in several key areas, such as clinical decision making, critical thinking, organizational skills, communication, prioritization of patient care, and leadership. In some cases, competence in these skill areas was measured by testing critical thinking skills and observing new nurse behaviors during patient-simulated assessments.

Compared to limited transition programs, structured transition programs appear to improve new nurse competence more. Also, longer transition programs appear to increase competency based on new nurse self-reporting. New nurses were more likely to self-report feeling more competent and confident with year-long transition programs compared to more traditional three-month orientation programs.

Improved competency among new nurses has another benefit-improved patient safety. New nurses with higher competency scores are less likely to report practice errors. Additionally, in hospitals offering established transition programs, new nurses are less likely to engage in negative safety practices, such as violating safety precautions. This, in turn, leads to fewer patient errors like medication errors.

There’s no one right way to develop or improve a transition program within your hospital. However, making your program as effective as possible starts by identifying primary areas for new nurse competency improvement and then planning strategies to improve performance. You can help develop transition programs to better prepare and support new graduate nurses as they grow in their own nursing practice. Since so many new nurses are expected to enter the workforce, it’s essential to take steps to improve competency.

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