Bridging the Preparation-Practice Gap, Volume I

Quantifying New Graduate Nurse Improvement Needs

A guide for assessing competency of new graduate nurses in order to create a strategy for enhancing the practice-readiness of those nurses.

Executive Summary

Establishing shared priorities

At a time when it is critical for hospitals and nursing schools to work even more closely together to prepare the next generation of nurses, the viewpoints of their respective leaders seem to be diverging. The generational shift of the nation’s nurse workforce has begun in earnest. New graduate nurses now comprise more than ten percent of a typical hospital’s or health system’s nursing staff, and this number is certain to grow.

However, at the very same time we are increasingly relying on such inexperienced staff, hospital-based nursing leaders are increasingly questioning new graduates’ practice readiness, a perspective that academic leaders by and large do not seem to share. According to recent Nursing Executive Center research, nearly 90 percent of academic leaders believe their nursing students are fully prepared to provide safe and effective care compared to only ten percent of hospital and health system nurse executives. The aim of this report is to move beyond such broader disagreement and to isolate the specific nursing competencies that are driving what has become to be known as nursing’s preparation-practice gap—with the hope of focusing academic and industry efforts to bridge it.

Capturing academic and industry perspectives

To move to a more grounded assessment of new graduate nurses’ greatest improvement needs, the Center deployed a novel dual-survey methodology. More specifically, the Center developed parallel survey tools for academic and frontline nursing leaders based on input from a broad cross-section of more than 100 nursing experts from nursing schools, hospitals, health systems, and nursing education associations. At the heart of both survey tools is a common set of 36 discrete nursing competencies. Nursing school leaders were asked to assess the relative emphasis their schools place on each of the 36 competencies, while frontline nursing leaders were asked to rate their level of satisfaction with new graduate proficiency on each one.

In total, we received valid responses from over 400 nursing school leaders (including deans, directors, and department chairs) and from over 3,500 hospital-based nursing leaders (including directors, managers, clinical nurse specialists, nurse educators, and charge nurses). Such a large respondent pool not only contributes to greater accuracy of the findings discussed in this report, but allows for more detailed analysis of a host of different demographic subgroups.

Triaging new graduate improvement needs

Not surprisingly, results from the Center’s dual surveys reveal ample room for improvement across all surveyed competencies. Investment in improving new graduate nurse proficiency on all 36 competencies however, is neither feasible nor efficient for most. Amidst today’s resource constraints, the Center strongly recommends that nursing leaders deliberately prioritize the most pressing and promising opportunities for enhancing new graduate performance. To that end, this report assesses meaningful differences in performances across the 36 competencies among all new graduate nurses as well as various subgroups such as specific unit specialties and degree types, rank orders the competencies by level of new graduate proficiency, examines the relative weight nursing school curricula place on each of the competencies, and explores the impact of increased curricular emphasis on practice readiness.

The report also includes a Competency Prioritization Tool to help hospital and nursing school leaders open a more grounded dialogue about new graduate practice readiness and to translate our national findings to unique local circumstances. Perhaps most promising, while performance levels among different new graduate subgroups does vary somewhat, there is remarkable consistency in how all types of frontline nurse leaders rank order there new graduates’ improvement needs—meaning that nursing leaders should be able to pursue a relatively consistent approach for bridging the preparation-practice gap.

We have codified the competencies of new graduate nurses in response to broad analyses of these competencies that are not readily actionable.

By reading this study, members can:

  • Assess member survey results and analysis on a common set of 36 critical nurse competencies
  • Open a more grounded dialogue in creating a collaborative plan of action for enhancing the practice readiness of new graduate nurses

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