Identifying Entry-Level Nursing Practice Characteristics and Emerging Trends in the United States through Evidence-Based Research

Identifying Entry-Level Nursing Practice Characteristics and Emerging Trends in the United States through Evidence-Based Research

Preferred Presentation Format: Oral or poster presentations

Learner Objectives:

1. The learner will be able to describe entry-level nursing practice characteristics and emerging practice trends in the U.S.
2. The learner will be able to describe demographics, such as nursing experience and work setting, of entry-level nurses in the U.S.

Research Purpose and Target Audience:

The authors aim to identify entry-level nursing practice characteristics through a series of large-scale practice analysis studies.  In addition to practice characteristics, emerging trends in nursing practice are also identified.  As the nursing community becomes increasingly global, the results of this study are of interest to nursing educators, regulators and practitioners.

Abstract Keywords:

Entry-level practice, emerging practice trends, practice analysis

Proposal:

Background

The National Council of State Boards of Nursing (NCSBN) is responsible to its membership for the preparation of psychometrically sound and legally defensible licensure examinations.  The periodic performance of practice analysis studies assists NCBSN in understanding practice characteristics of entry-level nurses and evaluating the validity of its test blueprints.  Due to the ever-changing nature of the U.S. healthcare industry, entry-level nursing practice analyses are conducted on a triennial basis.  In 2006, NCSBN began development of a series of continuous practice analysis studies to be conducted in the three-year gaps among the regular practice analysis cycles.  The purpose of conducting these continuous practice analyses was to discover emerging trends in entry-level nursing and to provide consistent validity evidence for the NCSBN test blueprints.  In the present study, audience will learn the results of these continuous practice analyses and identify any emerging practice trends in the U.S.

A large number of entry-level nurses are randomly sampled every three months to receive an electronic survey on nursing practice.  The sample is defined as candidates who successfully passed the NCLEX, a nursing licensure examination used in the U.S., within the previous six months.  In essence, no individual sampled would have been working as a licensed nurse for more than six months.  The electronic survey contains an extensive list of nursing activities as determined by a subject matter expert (SME) panel, questions about the respondent’s nursing experience and work environment, and respondent’s demographic information.

Study Methodology

To illustrate the continuous practice analysis process, the following sections provide a description of the methodology used to conduct the most recent Registered Nursing (RN) Continuous Practice Analysis study in 2012. Descriptions of subject matter expert panel processes, survey development, sample selection and data collection procedures are provided.  The methodology with which continuous practice analyses have been conducted since 2006 mirrors the process described. Panel of Subject Matter Experts

Nursing activity statements from the 2011 RN Practice Analysis were used in the 2012 Continuous Practice Analysis study. A panel of RNs was assembled to assist with the 2011 RN Practice Analysis. Panel members worked with and/or supervised the practice of RNs within their first six months of practice or were themselves newly licensed RNs and represented all geographic areas of the U.S., all major nursing specialties and various practice settings.

The panel of experts performed several tasks crucial to the success of the practice analysis study. The SMEs asked three newly licensed RNs whom they supervised to submit detailed daily logs describing the activities they performed on the job. Additionally, SMEs were asked to submit job descriptions, orientation and professional evaluations from their work settings. Using activity logs, past activity statements, job descriptions, performance evaluation documents, as well as their own knowledge of newly licensed RN practices, the panel created a category structure describing the types of activities performed by newly licensed RNs. They were careful to create a structure that was clear, understandable and logical.

Once the list of categories was created, the panel members worked to create a list of activities performed within each category. Each activity was reviewed for applicability to newly licensed practice and the relationship to the delivery of safe nursing care to members of the public. Care was taken to create the activity statements at approximately the same level of specificity and to avoid redundancy.

  Survey Development

A number of processes were used to create, evaluate and refine the survey instrument used for the 2012 RN Continuous Practice Analysis study. First, the activity statements created by the SMEs for the 2011 RN Practice Analysis were reviewed and edited by the NCLEX Examination Committee, and oversight group consists of U.S. nursing regulators. The resulting activity statements were incorporated into a survey format. The survey included questions about the RN’s practice settings, past experiences and demographics. Two forms of the survey were created to decrease the number of activity statements contained on each.

The survey contained five sections. Section one focused on RN activity performance needed to safely practice newly licensed nursing. In the second section, questions related to the respondent’s work experience, including months of experience as an RN and type and length of work orientation. Section three contained questions about the respondent’s work environment including questions about work settings, client characteristics and work schedules. Section four requested information on the respondent’s last day of work including numbers of hours worked, number of clients for whom care was provided, and the amount of time spent in various RN activities. Section five asked for basic demographic information.   Survey Mailing Procedure   A sample of newly licensed RNs was selected from the NCSBN database of successful NCLEX-RN candidates over a six-month period. During each quarterly survey administration period, a new group of candidates was selected. Invitations for each of the online surveys were sent via e-mail. One week later, a reminder e-mail was sent to all participants reiterating the importance of the study and urging participation. In the second week of the administration, a second reminder e-mail was sent. The final reminder was e-mailed in the fourth week of the administration.

 

Confidentiality

  All potential participants were assured confidentiality with regard to their participation and their responses. Files containing mailing information were kept separate from the data files. The study protocol was reviewed and approved by NCSBN’s chief executive officer for compliance with organizational guidelines for research studies involving human subjects.   Survey Rating Scales   The 2012 RN Continuous Practice Analysis survey asked responders to answer two questions about each nursing activity. The first question addressed the frequency of activity performance. The scale of frequency ranged from “Never performed in work setting” to “5 or more times.” Responders were instructed to mark “Never performed in work setting” then move to the next activity if an activity did not apply to their work setting. If the activity did apply to their work setting, they were asked to mark a six-point scale (0 to 5 or more times) reflecting the frequency with which they had performed the activity on their last day of work. They were then asked to rate the overall importance of the activity considering client safety and/or threat of complications or distress on a five-point Likert scale with 1 being “Not Important” and 5 being “Critically Important.” Additionally, applicability to practice setting was assessed by analyzing the number of responders not marking the “Never performed in work setting” response.   Responders were asked to rate performance frequency of all activities that were applicable to their work settings. They reported how frequently they performed the activity on the last day they worked on a six-point scale: “0 times” to “5 times or more.” The setting-specific frequency was calculated by averaging the frequency ratings of those responders providing ratings (i.e., responders indicating that the activity applied to their work setting).   Anticipated Results and Practical Implications   In the present research, the authors will compile results of all continuous practice analysis conducted since 2006 to provide a longitudinal picture of nursing practice characteristics in the U.S.  Data depicting nursing demographics will be reported.  Changes in categories of nursing activities performed at the entry-level will be noted, as will changes in time spent in or importance entry-level nursing assigned to these activity categories.  To ensure that the results of this study is beneficial to a larger audience in the nursing community, additional background research will be conducted comparing nursing policies such as the Institute of Medicine Future of Nursing report to results of the current study.    

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