Transition to Practice Study in Hospital Settings

The need for an effective transition to practice program in nursing has been documented for more than 80 years (e.g., Townsend, 1931). Yet, comprehensive study of transition to practice in nursing did not begin until the 1970s. Marlene Kramer published her seminal work, Reality Shock, in which she proposed and assessed strategies to ameliorate that shock (Kramer, 1974). Patricia Benner also began studying the nurse’s transition from novice to expert (Benner, 1984, 2004) based on the Dreyfus model of skill acquisition (Dreyfus & Dreyfus, 1986). Today, the transition of new nurses to practice is even more important. Health care is becoming increasingly complex, and the need for systems thinking continues. The patient population is more diverse, sicker, and older, and patients have multiple conditions. Technology is growing exponentially, and nurses are working at a “staccato pace” (Wiggins, 2006). Patients are discharged so quickly that they go home with complex medical, social, and economic issues. Moreover, McMenamin (2014) has issued a “tsunami warning” regarding the looming nursing shortage that will be triggered by massive nurse retirements. Soon there will be fewer seasoned nurses and more novice nurses in the workplace. Along with the complexity of health care and the projected increase of the proportion of novice nurses, medical errors continue to be a pervasive problem. Recent estimates are that between 210,000 and 400,000 premature deaths occur each year from preventable harm (James, 2013). A survey of 400 nursing school deans and 5,700 nurse leaders showed a wide gap between perceptions of the deans and the practicing nurse leaders regarding the preparation of newly graduated nurses (Berkow, Virkstis, Stewart, & Conway, 2008). Focusing on 36 competencies, 90% of the deans and directors believed their nursing students were fully prepared to provide safe, effective care to patients, but only 10% of the nurse leaders believed they were fully prepared. Despite the increased complexity of health care, the alarming number of medical errors, and the expertise gap, nurses, unlike other professionals, often have no comprehensive transition programs to support them as they enter the profession. The Joint Commission, the Institute of Medicine (IOM), and the Carnegie Study of Nursing Education have called for robust transition to practice, or residency, programs for nurses (Benner, Sutphen, Leonard, & Day, 2010; Institute of Medicine [IOM], 2011; The Joint Commission, 2002). Yet, comprehensive, evidence-based nurse residencies are offered by only a minority of employers. A Transition to Practice Study in Hospital Settings