4042 — The Veterans Health Administration Registered Nurse Transition-To-Practice Program: A Qualitative Evaluation of Factors that Affect Implementation

Lead/Presenter: Nicholas Yankey, COIN - Ann Arbor
All Authors: Robinson CH (HSR&D Center for Clinical Management Research, Ann Arbor) Yankey NR (HSR&D Center for Clinical Management Research, Ann Arbor) Couig MP (HSR&D Center for Clinical Management Research, Ann Arbor) Sales AE (HSR&D Center for Clinical Management Research, Ann Arbor)

Objectives:
In November 2011, the VA implemented a mandatory Registered Nurse Transition-To-Practice (RN TTP) program. In collaboration with the Office of Nursing Services (ONS), we assessed implementation of the program as part of a nationwide quality improvement partnered evaluation initiative.

Methods:
We conducted semi-structured telephone interviews with Chief Nurse Executives, RN TTP Coordinators and their teams at 19 purposively selected VA medical centers between June 2015 and February 2016. Interviews averaged 55 minutes, were audio-taped and transcribed, and were member-checked by interviewees. Interviews were designed to understand factors affecting RN TTP implementation at facilities.

Results:
Factors commonly mentioned as affecting implementation fell into four primary domains: materials and support from the national program office, facility level dynamics and resources, program specific requirements, and program outcomes. Interviewees generally felt that curriculum resources, evaluation tools, and other program materials provided by ONS were helpful, but electronically stored in places and on platforms that were difficult to navigate and access. Interviewees described RN TTP as a powerful recruiting tool; however, coordinators were challenged by aligning the schedules of trainees with mentors and preceptors and protecting trainee time for educational components. Nearly all interviewees felt that retention of nurses post-RN TTP was high, although many were not specifically collecting or reporting these data.

Implications:
Implementing RN TTP requires significant time and coordination by program staff and nursing leadership. Having national guidance and support helps to ensure new graduates are able to transition from entry-level to competent professionals.

Impacts:
RNs are the largest single component of the VHA workforce, and their recruitment and retention are essential to ensuring access to inpatient care. Implementation of the RN TTP program will attract new graduate RNs, develop their decision-making and clinical leadership skills, and strengthen their commitment to providing outstanding care to Veterans and their families; leading to a favorable return on investment.