Transition-to-Practice: Programs for New Graduate RNs

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Audrey Berman, PhD, RN

(Interview with Audrey Berman)

Research has shown for many years that employers of new nursing graduates find they are not fully prepared to provide safe and effective inpatient care. In this blog post, Audrey Berman, PhD, RN, shares her experience and best practices for creating transition-to-practice programs for new graduate RNs. Read on to learn how you can better prepare graduates for the working world!

Q: You have been involved in creating programs for new graduate RNs called transition-to-practice. What were the drivers of that program?

Audrey: The research has shown for many years that employers of new graduates find they are not fully prepared to provide safe and effective inpatient care. In addition, the 2010 Institute of Medicine report, The Future of Nursing, recommended that all nurses participate in a transition program when newly licensed or changing roles. And, in my geographical region, and many other areas of the nation, RN graduates since 2009 have experienced significant difficulty finding employment. Luckily, the San Francisco Bay area benefitted from a grant from the Betty Irene Moore Nursing Initiative which spearheaded the creation of four innovative transition-to-practice programs.

Q: Were all the programs the same?

Audrey: Each program was a little different but they all involved strong partnerships between academic institutions and service partners – both inpatient and ambulatory care settings. In general, participants enrolled in a special 12-16 week course at the university which provided liability coverage and academic credit and involved one day of class/lab and 2-3 days of precepted clinical per week. We all used the same Casey-Fink Graduate Nurse Experience Survey at the beginning and end of the course plus a New Graduate RN Transition Program
Competency Assessment focused on the six Quality and Safety Education for Nurses (QSEN) competencies. A total of 345 new graduates from many different ADN, BSN, and entry-level MSN programs in the area participated.

Q. Were there any surprises in the program?

Audrey: In my specific program, we assessed the new graduates’ prior to starting clinical. They had a medication math test and had a case study in which they had to identify priority problems, assess, determine interventions, and describe communication with the healthcare team, all demonstrating clinical judgment. They also participated in simulation laboratory testing of selected skills. Most surprising to me was that almost all participants passed the math test without difficulty, only half passed the case study, and most had significant difficulty with the skills assessment. Specifically, they failed to use appropriate communication, infection prevention, body mechanics, and medication rights skills.

So, even though they were recent graduates (less than 18 months), they could not demonstrate some essential nursing care we would normally expect of a new RN. In addition, several of the results of the Casey-Fink survey indicated awareness of the participants that their organizational and prioritizing skills needed development.

As a dean, these findings suggest that schools of nursing could do a better job of insuring that graduating students can demonstrate common basic expectations of the workplace. Most schools probably have a capstone written exam but may not have a final skills/simulation/performance assessment. We should implement these assessments and tweak curricula and clinical experiences now, rather than when the next wave of the nursing shortage hits us hard, which will be soon.

Q. Did these transition programs make a difference?

Audrey: Absolutely! Assessments of the students at the end of the programs showed statistically significant improvements in confidence and competence. Some participants accepted job offers during the program and 84% of those in the first grant-funded programs were employed as an RN within three months of program completion. California now has over 1,500 RNs who have either completed or are planned to enroll in a transition program and there are a total of 23 programs and others in planning or development stages.

Q. Any final advice or suggestions for others?

Audrey: In terms of creating a similar transition program, be sure to find out what other groups have done and not reinvent the wheel. For example, search for residency or transition-to-practice posts on the Future of Nursing Campaign for Action at the Center to Champion Nursing in America http://campaignforaction.org/ where you will find webinars, sample curricula, and many other pieces of wisdom.

Obviously, I am a strong proponent for assessing the skills of graduates entering a transition program and using that data to improve the program (and give feedback to local schools from which they graduated, if possible). Depending on the instruments used and your intended dissemination of the results of your program, you may need IRB or instrument use approval.

For more information, also see:

Berman, A., Beazley, B., Karshmer, J., Prion, S., Van, P., Wallace, J. & West, N. (2014). Competence gaps among unemployed new nursing graduates entering a community-based transition-to-practice program. Nurse Educator, 39, 56-61.

Berman, A., Johnson, T., & West, N. (2014, in press). New license, no job: Nurse leaders’ experience with transition-to-practice programs for unemployed new RN graduates. Nurse Leader.

Jones-Bell, J., Karshmer, J., Berman, A., Prion, S., Van, P., Wallace, J., & West, N. (2014). Collaborative academic-practice transition program for new graduate RNs in community settings: Lessons learned. Journal of Continuing Education in Nursing, 45, 259-264. doi: 10.3928/00220124-20140402-01

West, N., Berman, A., Karshmer, J., Prion, S., Van, P., Wallace, J., (2014). Preparing new nurse graduates for practice in multiple settings: A community-based academic–practice partnership model. The Journal of Continuing Education in Nursing, 45, 252-256. doi: 10.3928/00220124-20140417-03


Audrey Berman, PhD, RN is the dean at the Samuel Merritt Hospital School of Nursing diploma nursing program. Although breast cancer is Audrey’s primary substantive interest, she has taught broadly in medical/surgical nursing with a special interest in legal issues. Audrey serves on several boards including the Bay Area Tumor Institute, American Heart Association East Bay, and is the president of the California Association of Colleges of Nursing. She is also the lead author for Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 9th ed.