Design: Quantitative

Sample: 738 licensees and their supervisors

Methods: Using a tool developed by the National Council of State Boards of Nursing (NCSBN), a descriptive survey was sent to 738 licensees endorsed under special provisions and to their supervisors. The tool included information on the work environment, clinical and theoretical preparation, orientation, medical errors, and English competency. Results were compared to a national sample.

Findings: Most of the nurses (n=160) and supervisors (n=110) reported no problems in adequacy of clinical preparation. However, the supervisors noted that the rate of problems was about half (5%) of those encountered with other nurses hired during the same time frame (10%).

The percentage of nurses who reported making an error was 18%, while supervisors reported that 11% of the nurses had made an error. Of the 29 nurses in the sample who reported errors, the areas with most errors were medication errors (38%); delays in treatment (26%), and client falls (21%).

In the sample, the majority (62% of the nurses and 73% of the supervisors) reported no problems with communication. Of those who reported problems with communication, the areas were identified as understanding non-English-speaking clients or staff (21%), and/or reading or understanding physician orders (16%).

Conclusions: The nurses endorsed under the special provisions performed better than new graduates in their first 6 months after licensure. The medical error rate was less than half of the error rate for the national sample. No major problems in English competency were encountered.

Implications: Requiring work experience in special endorsement procedures does not compromise patient safety.

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