- Email: [email protected]
New Careers in Nursing Scholar Alumni Toolkit: Development of an Innovative Resource for Transition to Practice
NEW CAREERS IN NURSING SCHOLAR ALUMNI TOOLKIT: DEVELOPMENT OF AN INNOVATIVE RESOURCE FOR TRANSITION TO PRACTICE ANN MARIE P. MAURO, PHD, RN, CNL, CNE*, LORI A. ESCALLIER, PHD, RN, CPNP-PC†, AND MARIA G. ROSARIO-SIM, EDD, PPCNP-BC, RNC-OB‡ The transition from student to professional nurse is challenging and may be more difficult for underrepresented minority nurses. The Robert Wood Johnson Foundation New Careers in Nursing (NCIN) program supported development of a toolkit that would serve as a transitionto-practice resource to promote retention of NCIN alumni and other new nurses. Thirteen recent NCIN alumni (54% male, 23% Hispanic/Latino, 23% African Americans) from 3 schools gave preliminary content feedback. An e-mail survey was sent to a convenience sample of 29 recent NCIN alumni who evaluated the draft toolkit using a Likert scale (poor = 1; excellent = 5). Twenty NCIN alumni draft toolkit reviewers (response rate 69%) were primarily female (80%) and Hispanic/Latino (40%). Individual chapters' mean overall rating of 4.67 demonstrated strong validation. Mean scores for overall toolkit content (4.57), usability (4.5), relevance (4.79), and quality (4.71) were also excellent. Qualitative comments were analyzed using thematic content analysis and supported the toolkit's relevance and utility. A multilevel peer review process was also conducted. Peer reviewer feedback resulted in a 6-chapter document that offers resources for successful transition to practice and lays the groundwork for continued professional growth. Future research is needed to determine the ideal time to introduce this resource. (Index words: Diversity; Leadership development; Mentoring; New graduate nurses) J Prof Nurs 32:S59–S62, 2016. © 2016 Elsevier Inc. All rights reserved.
Background *Assistant Dean & Professor, Director, Center for Educational Research and Innovation, Rutgers, The State University of New Jersey, School of Nursing, Newark, NJ 07107. †Professor & Associate Dean for Assessment, Evaluation, and Outcomes, School of Nursing, Stony Brook University, Stony Brook, New York 11794–8240. ‡Professor & Director, Nurse Practitioner Programs, SUNY Downstate Medical Center, College of Nursing, Brooklyn, NY 11203. Funded by a Robert Wood Johnson Foundation (RWJF) Innovation Award Grant and published by agreement between RWJF and the American Association of Colleges of Nursing for the RWJF New Careers in Nursing (NCIN) program. Conflicts of interest: None. Address correspondence to Dr. Mauro: Assistant Dean & Professor, Director, Center for Educational Research and Innovation, Rutgers, The State University of New Jersey, School of Nursing, 65 Bergen Street, Room 1123A, Newark, NJ 07107. E-mail: [email protected] (A.M.P. Mauro), [email protected] (L.A. Escallier), [email protected] (M.G. Rosario-Sim) 8755-7223
The transition from student to professional nurse is challenging and may be more difficult for underrepresented minority nurses. The latest national data show that men and ethnic minorities are underrepresented in the U.S. nursing workforce (HRSA, 2010); therefore, it is important to support their success. It is well documented that the transition from student to registered professional nurse is challenging (Barnett, Minnick, & Norman, 2014; Cleary, Horsfall, Jackson, Muthulakshmi, & Hunt, 2013; Missen, McKenna, & Beauchamp, 2014; Philips, Kenny, Esterman, & Smith, 2014). New registered nurses (RNs) must adjust to a high-demand institutional culture, which may place the nurse, the patient, and the agency at risk for adverse events. The number of new graduate nurses entering the workforce following graduation from RN programs has increased from 68,000 in 2001 to more than 150,000 in
Journal of Professional Nursing, Vol 32, No. 5S (September/October), 2016: pp S59–S62 © 2016 Elsevier Inc. All rights reserved.
S59 http://dx.doi.org/10.1016/j.profnurs.2016.02.002
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2013 (HRSA, 2014). However, approximately 17.5% of new nurses leave their first job within 1 year, and 33.5% leave within 2 years (Kovner, Brewer, Fatehi, & Jun, 2014). Studies show that there are a multitude of reasons for new nurse turnover: lack of mentorship, inadequate emotional and moral support, technical challenges, bullying, and difficulties with professional socialization (Loftin, Newman, Dumas, Gilden, & Bond, 2012; Vogelpohl, Rice, Edwards, & Bork, 2013). Because underrepresented minority nursing students have reported these challenges as barriers to their success (Escallier & Fullerton, 2013), their transition to practice may be even more difficult. As described in a previous article in this issue, the Robert Wood Johnson Foundation (RWJF)/American Association of Colleges of Nursing New Careers in Nursing (NCIN) program has increased the number of men and ethnic minorities in the workforce by providing leadership development and mentoring resources. There is more diversity among NCIN scholars than among nursing students overall in bachelor of science in nursing (male 40.6% vs. 12.5%; White 37.7% vs. 69.9%) and master of science in nursing (male 33.9% vs. 10.8%; White 29.7% vs. 68.1%) programs (NCIN, 2015). An NCIN innovation award funded the development of a transition-to-practice toolkit for new nurses by our team of expert educators from NCIN programs at three large universities in the New York metropolitan area. The purpose of the toolkit is to provide the necessary resources for successful transition to practice and to lay the groundwork for continued professional growth. As a result, the toolkit may be useful in promoting the retention of new nurses, particularly those from underrepresented racial, ethnic, and gender minorities. This article provides an overview of the toolkit and describes the process used to establish its utility, comprehensiveness, and content validity for others who wish to develop similar resource documents.
Objectives of the Toolkit The toolkit objectives were to (a) offer information and suggestions throughout the job search process, (b) provide guidance for establishing and sustaining successful mentoring relationships, (c) suggest strategies for successful socialization into the nursing profession, (d) provide information for defining career goals and a path for professional growth, (e) guide pursuit of advanced education in nursing, and (f) facilitate growth as a nurse leader.
Toolkit Overview The NCIN Scholar Alumni Toolkit is designed to provide nursing students and newly licensed nurses with the necessary leadership development and mentoring resources for successful transition from the student to professional role and to lay the groundwork for continued professional growth. Benner's (1984) novice to expert model conceptually informed the toolkit
development. Benner maintains that expert nurses develop skills and understanding of patient care over time through a sound educational base and a multitude of experiences. Support resources can provide insight into the experiences of newly licensed RNs as they begin their nursing career and help to guide them during this complex transition to practice. The NCIN Scholar Alumni Toolkit is comprised of six chapters containing information on selected topics identified in the literature and by newly licensed NCIN scholar alumni, faculty, and other experts as important for successful transition to professional nursing practice. An overview of each toolkit chapter, its content, and its subtopics is presented in Table 1. A variety of resources and helpful tips is included in each chapter. Examples include résumé templates; recommendations, such as reflective journaling and interviewing tips; evidence-based Web sites; references to articles, texts, and videos; professional organizations; and more. Topics can be reviewed in any sequence based on reader interest and are presented in a questionand-answer format to enhance usability. Hard copies of the final toolkit were distributed to all 130 NCIN grantee schools at the national Grand Finale Summit in September 2015. An open access, electronic version of the transition-to-practice toolkit is currently available and can be downloaded on the NCIN Web site at http:// www.newcareersinnursing.org/node/31674. Students and new nurses may find these resources to be helpful as they begin their nursing career and as they continue to advance their education and professional growth. Faculty may also wish to utilize this toolkit as a resource during the nursing curriculum and prior to graduation.
Toolkit Development Process Institutional review board approval was not required as the project focused solely on the evaluation of resource materials and not human subjects. Our project team worked collaboratively via regularly scheduled conference calls. The initial steps included (a) development of a content outline based on the specific toolkit objectives forming the foundation for each chapter and (b) implementation of a user-friendly toolkit structure. Thirteen recent NCIN scholar alumni from the three partner schools provided feedback on the preliminary content (54% male, 23% Hispanic/Latino, 23% African Americans, 15% Asian). Using this alumni feedback, the content of each chapter was revised and reorganized. Several scholars provided poignant personal observations and advice. Permission from these scholars was obtained to incorporate their direct quotes anonymously within each chapter. To enhance its utility, the toolkit's six chapters were constructed using key questions posed from the first person point of view of a new nurse. The corresponding responses were designed to offer evidence-based guidance, expert advice, and credible on-line resources. Each project team member researched and developed two chapters, which were
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Table 1. NCIN Scholar Alumni Toolkit: Resources for Successful Transition to Professional Nursing Practice Chapter title
Objective
Sample topics
The Job Search: Resources for a Successful Provide resources and guidance Transition to Nursing Practice throughout the job search process
Establishing and Sustaining Successful Mentoring Relationships Starting Your Nursing Career: Strategies for Success
Resources for Defining Career Goals and a Path for Professional Growth
Advancing Your Nursing Education
Growth as a Nurse Leader
How to begin; creating a résumé, cover letter, and thank-you note; on-line applications; Nurse Career Battery Test; interview tips; deciding about a job offer Give information for establishing Defining mentorship; where to find a mentor; successful mentoring partnerships establishing, engaging in, sustaining, and changing the mentoring partnership Offer strategies for success when What to expect, managing ethical dilemmas, time beginning the nursing career management, setting priorities, delegation, documentation, cultural competence, patient satisfaction, adjusting to shift work, bullying, managing personal finances Provide information for defining career Progressing from novice to expert; moving from goals and a path for professional growth generalist to specialist; engaging in research, publication, and presentation; global engagements; nursing career paths Give information about advanced Importance of advanced nursing education, nursing education doctoral education, graduate degrees in other disciplines, financial support for graduate education Offer guidance for continued leadership Importance of reflection, networking, NCIN development Scholars Network, professional organizations, nonprofits, volunteer opportunities, leadership development programs, professional journals
then reviewed and revised collaboratively as a group by telephone. The next step was to establish the utility and comprehensiveness of the toolkit by distributing selected toolkit chapters and an e-mail of an author-developed survey to a convenience sample of 29 recent NCIN scholar alumni from the three partner schools. NCIN scholar alumni were asked to rate the quality of specific chapters using a 5-point Likert scale ranging from poor (1) to excellent (5) and the toolkit's overall content, usability, relevance, and value. Twenty respondents completed some or all of the elements of the rating tool (69% response rate). These respondents were female (80%), Hispanic/Latino (40%), Asian (25%), and African/ American (25%). Fifteen respondents completed all elements of the rating tool and gave the chapters a mean overall rating of 4.67 with scores ranging from 4 to 5 (0 = poor; 5 = excellent), demonstrating strong validation that the chapter objectives were met. The mean scores for the toolkit's content (4.57), usability (4.5), relevance (4.79), and overall quality (4.71) were also excellent. In addition, qualitative feedback was solicited from the NCIN scholar alumni through informal meetings, e-mail correspondences, notations on the draft document, and comments from the evaluation survey. Revisions were made based on this feedback. Written comments on the rating tool (n = 10) reflected careful review and scrutiny of the content of the specific chapters, for example, inclusion of résumé templates (Chapter 1), time management tips (Chapter 3), how to delegate (Chapter 3), and networking advice (Chapter 6). Overall, the NCIN alumni feedback was very positive, as reflected by a scholar's comment that the toolkit is “a
great resource to get vitally important information quickly from reliable sources.” Following these revisions, the draft toolkit was peer reviewed by an internationally recognized expert nurse educator for its content validity. The project team made additional editorial, content, and structural changes that incorporated the expert's suggestions. A final review by the expert nurse educator was conducted prior to forwarding the toolkit to the NCIN Deputy Program Director, two professional editors, and the printing team for further review and input. After reading the revised manuscript, the expert nurse educator favorably commented that the toolkit was “very informative - a great asset!” Final editing and proofreading by the project team, NCIN Deputy Program Director, editors, and printing team resulted in further edits and “callouts,” or boxed text that highlighted key chapter themes and notable quotes, were added to the layout. The cover was designed using photographs of the project team members and their most recent NCIN scholar alumni who signed photograph release consent forms.
Lessons Learned Several key lessons were learned as a result of the project. One of the most significant benefits gained was the synergy of the collaborative process among the project team, which was further enhanced by input from the scholar alumni, expert nurse educator peer reviewer, NCIN Deputy Program Director, editors, and printing team. Scholar alumni feedback added significant value and made a meaningful contribution to the toolkit because of their unique perspectives on transition to practice and its challenges. While the project team was committed to the development
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of a user-friendly toolkit format, we believe that the rigor of the multilevel peer review process enhanced the scholarliness of the final product. The diversity of thought and open exchange of ideas at all project phases resulted in the depth, richness, and quality of the toolkit. Weekly assessment of the project timeline, activities, and evaluation plan was extremely important to keep the project team on track given competing demands and busy work schedules. Throughout the project, there was a need to anticipate potential challenges, maintain flexibility, and revise implementation strategies as needed. For example, the original plan was to have scholar alumni from each school evaluate the full draft toolkit; however, it was quickly recognized that this would not be feasible because of scholar alumni time constraints. Therefore, it was decided that each project team member would enlist scholars from her school to evaluate the two draft chapters for which she led the development. The biggest challenge faced by the project team was the coordination and scheduling of conference calls on a regular basis. Even though meeting times were carefully planned, there were often delays or disruptions before or during calls. The lesson learned was that working in collaborative partnerships from a distance using technology requires patience, flexibility, creativity, a sense of humor, and the need for continuous assessment and evaluation of the project outcomes, timeline, and shared responsibilities. Input from the small number of NCIN scholar alumni from the New York area may limit some aspects of the toolkit's generalizability. New graduate nurses from other areas in the United States may face different transitionto-practice challenges depending on their location and employment trends in the region. However, we believe that our scholars and alumni are likely very similar to others across the nation based on our participation in annual NCIN summits and long-standing interactions with our colleagues from all geographic regions. It is our hope that the wide variety and scope of information in the toolkit will help new graduate nurses in all settings.
Conclusion The project was well intentioned and systematically designed, resulting in a validated and useful resource for all new nurses, especially those from underrepresented minorities. We believe that the toolkit has the potential to facilitate the transition to practice and to assist new nurses on their journey of professional growth. Further research is needed to determine (a) the ideal time to introduce this resource, for example, early in the nursing curriculum or prior to graduation and (b) the perceptions of new nurses regarding the utility of the toolkit resources. Input from clinical partners, administrators, and recruiters from various settings may provide a broader perspective on transition-to-practice challenges. Clearly, further efforts are needed to facilitate a successful transition from the student to professional role, particularly for new nurses from underrepresented groups.
Acknowledgments Funded by a RWJF Innovation Award Grant and published by agreement between RWJF and the American Association of Colleges of Nursing for the RWJF NCIN program.
References Barnett, J. S., Minnick, A. F. & Norman, L. D. (2014). A description of post-graduation nurse residency programs. Nursing Outlook, 62, 174–184, http://dx.doi.org/10.1016/ j.outlook.2013.12.008. Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park, CA: AddisonWesley. Cleary, M., Horsfall, J., Jackson, D., Muthulakshmi, P. & Hunt, G. E. (2013). Recent graduate nurse views of nursing, work and leadership. Journal of Clinical Nursing, 22, 2904–2911, http://dx.doi.org/10.1111/jocn.12230. Escallier, L. & Fullerton, J. (2013). An assessment of leadership and mentorship activities within an accelerated baccalaureate nursing program. Journal of Research in Nursing and Midwifery, 2, 84–88, http://dx.doi.org/10.14303/ JRNM.2013.058. Kovner, C. T., Brewer, C. S., Fatehi, F. & Jun, J. (2014). What does nurse turnover rate mean and what is the rate? Policy, Politics & Nursing Practice, 15, 64–71, http://dx.doi.org/ 10.1177/1527154414547953. Loftin, C., Newman, S. D., Dumas, B. P., Gilden, G. & Bond, M. (2012). Perceived barriers to success for minority nursing students: An integrative review. ISRN Nursing, 2012, http:// dx.doi.org/10.5402/2012/806543. Missen, K., McKenna, L. & Beauchamp, A. (2014). Satisfaction of newly graduated nurses enrolled in transition-to-practice programmes in their first year of employment: A systematic review. Journal of Advanced Nursing, http://dx.doi.org/10.1111/jan.12464 (Advance online publication). Philips, C., Kenny, A., Esterman, A. & Smith, C. (2014). A secondary data analysis examining the needs of graduate nurses in their transition to a new role. Nurse Education in Practice, 14, 106–111. Robert Wood Johnson Foundation New Careers in Nursing Program [NCIN] (2015). 2014–2015 Annual report. Washington, DC: Author. U.S. Department of Health and Human Services, Health Resources and Services Administration [HRSA] (2010). The registered nurse population: Findings from the National Sample Survey of Registered Nurses. Retrieved from http://bhpr.hrsa. gov/healthworkforce/rnsurveys/rnsurveyfinal.pdf. U.S. Department of Health and Human Services, Health Resources and Services Administration [HRSA] (2014). The future of the nursing workforce: National- and state-level projections, 2012–2025. Rockville, MD: Author (Retrieved from http://bhpr.hrsa.gov/healthworkforce/supplydemand/ nursing/workforceprojections/nursingprojections.pdf). Vogelpohl, D. A., Rice, S. K., Edwards, M. E. & Bork, C. E. (2013). New graduate nurses’ perception of the workplace: Have they experienced bullying? Journal of Professional Nursing, 29, 414–422, http://dx.doi.org/10.1016/ j.profnurs.2012.10.008.
Background *Assistant Dean & Professor, Director, Center for Educational Research and Innovation, Rutgers, The State University of New Jersey, School of Nursing, Newark, NJ 07107. †Professor & Associate Dean for Assessment, Evaluation, and Outcomes, School of Nursing, Stony Brook University, Stony Brook, New York 11794–8240. ‡Professor & Director, Nurse Practitioner Programs, SUNY Downstate Medical Center, College of Nursing, Brooklyn, NY 11203. Funded by a Robert Wood Johnson Foundation (RWJF) Innovation Award Grant and published by agreement between RWJF and the American Association of Colleges of Nursing for the RWJF New Careers in Nursing (NCIN) program. Conflicts of interest: None. Address correspondence to Dr. Mauro: Assistant Dean & Professor, Director, Center for Educational Research and Innovation, Rutgers, The State University of New Jersey, School of Nursing, 65 Bergen Street, Room 1123A, Newark, NJ 07107. E-mail: [email protected] (A.M.P. Mauro), [email protected] (L.A. Escallier), [email protected] (M.G. Rosario-Sim) 8755-7223
The transition from student to professional nurse is challenging and may be more difficult for underrepresented minority nurses. The latest national data show that men and ethnic minorities are underrepresented in the U.S. nursing workforce (HRSA, 2010); therefore, it is important to support their success. It is well documented that the transition from student to registered professional nurse is challenging (Barnett, Minnick, & Norman, 2014; Cleary, Horsfall, Jackson, Muthulakshmi, & Hunt, 2013; Missen, McKenna, & Beauchamp, 2014; Philips, Kenny, Esterman, & Smith, 2014). New registered nurses (RNs) must adjust to a high-demand institutional culture, which may place the nurse, the patient, and the agency at risk for adverse events. The number of new graduate nurses entering the workforce following graduation from RN programs has increased from 68,000 in 2001 to more than 150,000 in
Journal of Professional Nursing, Vol 32, No. 5S (September/October), 2016: pp S59–S62 © 2016 Elsevier Inc. All rights reserved.
S59 http://dx.doi.org/10.1016/j.profnurs.2016.02.002
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2013 (HRSA, 2014). However, approximately 17.5% of new nurses leave their first job within 1 year, and 33.5% leave within 2 years (Kovner, Brewer, Fatehi, & Jun, 2014). Studies show that there are a multitude of reasons for new nurse turnover: lack of mentorship, inadequate emotional and moral support, technical challenges, bullying, and difficulties with professional socialization (Loftin, Newman, Dumas, Gilden, & Bond, 2012; Vogelpohl, Rice, Edwards, & Bork, 2013). Because underrepresented minority nursing students have reported these challenges as barriers to their success (Escallier & Fullerton, 2013), their transition to practice may be even more difficult. As described in a previous article in this issue, the Robert Wood Johnson Foundation (RWJF)/American Association of Colleges of Nursing New Careers in Nursing (NCIN) program has increased the number of men and ethnic minorities in the workforce by providing leadership development and mentoring resources. There is more diversity among NCIN scholars than among nursing students overall in bachelor of science in nursing (male 40.6% vs. 12.5%; White 37.7% vs. 69.9%) and master of science in nursing (male 33.9% vs. 10.8%; White 29.7% vs. 68.1%) programs (NCIN, 2015). An NCIN innovation award funded the development of a transition-to-practice toolkit for new nurses by our team of expert educators from NCIN programs at three large universities in the New York metropolitan area. The purpose of the toolkit is to provide the necessary resources for successful transition to practice and to lay the groundwork for continued professional growth. As a result, the toolkit may be useful in promoting the retention of new nurses, particularly those from underrepresented racial, ethnic, and gender minorities. This article provides an overview of the toolkit and describes the process used to establish its utility, comprehensiveness, and content validity for others who wish to develop similar resource documents.
Objectives of the Toolkit The toolkit objectives were to (a) offer information and suggestions throughout the job search process, (b) provide guidance for establishing and sustaining successful mentoring relationships, (c) suggest strategies for successful socialization into the nursing profession, (d) provide information for defining career goals and a path for professional growth, (e) guide pursuit of advanced education in nursing, and (f) facilitate growth as a nurse leader.
Toolkit Overview The NCIN Scholar Alumni Toolkit is designed to provide nursing students and newly licensed nurses with the necessary leadership development and mentoring resources for successful transition from the student to professional role and to lay the groundwork for continued professional growth. Benner's (1984) novice to expert model conceptually informed the toolkit
development. Benner maintains that expert nurses develop skills and understanding of patient care over time through a sound educational base and a multitude of experiences. Support resources can provide insight into the experiences of newly licensed RNs as they begin their nursing career and help to guide them during this complex transition to practice. The NCIN Scholar Alumni Toolkit is comprised of six chapters containing information on selected topics identified in the literature and by newly licensed NCIN scholar alumni, faculty, and other experts as important for successful transition to professional nursing practice. An overview of each toolkit chapter, its content, and its subtopics is presented in Table 1. A variety of resources and helpful tips is included in each chapter. Examples include résumé templates; recommendations, such as reflective journaling and interviewing tips; evidence-based Web sites; references to articles, texts, and videos; professional organizations; and more. Topics can be reviewed in any sequence based on reader interest and are presented in a questionand-answer format to enhance usability. Hard copies of the final toolkit were distributed to all 130 NCIN grantee schools at the national Grand Finale Summit in September 2015. An open access, electronic version of the transition-to-practice toolkit is currently available and can be downloaded on the NCIN Web site at http:// www.newcareersinnursing.org/node/31674. Students and new nurses may find these resources to be helpful as they begin their nursing career and as they continue to advance their education and professional growth. Faculty may also wish to utilize this toolkit as a resource during the nursing curriculum and prior to graduation.
Toolkit Development Process Institutional review board approval was not required as the project focused solely on the evaluation of resource materials and not human subjects. Our project team worked collaboratively via regularly scheduled conference calls. The initial steps included (a) development of a content outline based on the specific toolkit objectives forming the foundation for each chapter and (b) implementation of a user-friendly toolkit structure. Thirteen recent NCIN scholar alumni from the three partner schools provided feedback on the preliminary content (54% male, 23% Hispanic/Latino, 23% African Americans, 15% Asian). Using this alumni feedback, the content of each chapter was revised and reorganized. Several scholars provided poignant personal observations and advice. Permission from these scholars was obtained to incorporate their direct quotes anonymously within each chapter. To enhance its utility, the toolkit's six chapters were constructed using key questions posed from the first person point of view of a new nurse. The corresponding responses were designed to offer evidence-based guidance, expert advice, and credible on-line resources. Each project team member researched and developed two chapters, which were
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Table 1. NCIN Scholar Alumni Toolkit: Resources for Successful Transition to Professional Nursing Practice Chapter title
Objective
Sample topics
The Job Search: Resources for a Successful Provide resources and guidance Transition to Nursing Practice throughout the job search process
Establishing and Sustaining Successful Mentoring Relationships Starting Your Nursing Career: Strategies for Success
Resources for Defining Career Goals and a Path for Professional Growth
Advancing Your Nursing Education
Growth as a Nurse Leader
How to begin; creating a résumé, cover letter, and thank-you note; on-line applications; Nurse Career Battery Test; interview tips; deciding about a job offer Give information for establishing Defining mentorship; where to find a mentor; successful mentoring partnerships establishing, engaging in, sustaining, and changing the mentoring partnership Offer strategies for success when What to expect, managing ethical dilemmas, time beginning the nursing career management, setting priorities, delegation, documentation, cultural competence, patient satisfaction, adjusting to shift work, bullying, managing personal finances Provide information for defining career Progressing from novice to expert; moving from goals and a path for professional growth generalist to specialist; engaging in research, publication, and presentation; global engagements; nursing career paths Give information about advanced Importance of advanced nursing education, nursing education doctoral education, graduate degrees in other disciplines, financial support for graduate education Offer guidance for continued leadership Importance of reflection, networking, NCIN development Scholars Network, professional organizations, nonprofits, volunteer opportunities, leadership development programs, professional journals
then reviewed and revised collaboratively as a group by telephone. The next step was to establish the utility and comprehensiveness of the toolkit by distributing selected toolkit chapters and an e-mail of an author-developed survey to a convenience sample of 29 recent NCIN scholar alumni from the three partner schools. NCIN scholar alumni were asked to rate the quality of specific chapters using a 5-point Likert scale ranging from poor (1) to excellent (5) and the toolkit's overall content, usability, relevance, and value. Twenty respondents completed some or all of the elements of the rating tool (69% response rate). These respondents were female (80%), Hispanic/Latino (40%), Asian (25%), and African/ American (25%). Fifteen respondents completed all elements of the rating tool and gave the chapters a mean overall rating of 4.67 with scores ranging from 4 to 5 (0 = poor; 5 = excellent), demonstrating strong validation that the chapter objectives were met. The mean scores for the toolkit's content (4.57), usability (4.5), relevance (4.79), and overall quality (4.71) were also excellent. In addition, qualitative feedback was solicited from the NCIN scholar alumni through informal meetings, e-mail correspondences, notations on the draft document, and comments from the evaluation survey. Revisions were made based on this feedback. Written comments on the rating tool (n = 10) reflected careful review and scrutiny of the content of the specific chapters, for example, inclusion of résumé templates (Chapter 1), time management tips (Chapter 3), how to delegate (Chapter 3), and networking advice (Chapter 6). Overall, the NCIN alumni feedback was very positive, as reflected by a scholar's comment that the toolkit is “a
great resource to get vitally important information quickly from reliable sources.” Following these revisions, the draft toolkit was peer reviewed by an internationally recognized expert nurse educator for its content validity. The project team made additional editorial, content, and structural changes that incorporated the expert's suggestions. A final review by the expert nurse educator was conducted prior to forwarding the toolkit to the NCIN Deputy Program Director, two professional editors, and the printing team for further review and input. After reading the revised manuscript, the expert nurse educator favorably commented that the toolkit was “very informative - a great asset!” Final editing and proofreading by the project team, NCIN Deputy Program Director, editors, and printing team resulted in further edits and “callouts,” or boxed text that highlighted key chapter themes and notable quotes, were added to the layout. The cover was designed using photographs of the project team members and their most recent NCIN scholar alumni who signed photograph release consent forms.
Lessons Learned Several key lessons were learned as a result of the project. One of the most significant benefits gained was the synergy of the collaborative process among the project team, which was further enhanced by input from the scholar alumni, expert nurse educator peer reviewer, NCIN Deputy Program Director, editors, and printing team. Scholar alumni feedback added significant value and made a meaningful contribution to the toolkit because of their unique perspectives on transition to practice and its challenges. While the project team was committed to the development
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of a user-friendly toolkit format, we believe that the rigor of the multilevel peer review process enhanced the scholarliness of the final product. The diversity of thought and open exchange of ideas at all project phases resulted in the depth, richness, and quality of the toolkit. Weekly assessment of the project timeline, activities, and evaluation plan was extremely important to keep the project team on track given competing demands and busy work schedules. Throughout the project, there was a need to anticipate potential challenges, maintain flexibility, and revise implementation strategies as needed. For example, the original plan was to have scholar alumni from each school evaluate the full draft toolkit; however, it was quickly recognized that this would not be feasible because of scholar alumni time constraints. Therefore, it was decided that each project team member would enlist scholars from her school to evaluate the two draft chapters for which she led the development. The biggest challenge faced by the project team was the coordination and scheduling of conference calls on a regular basis. Even though meeting times were carefully planned, there were often delays or disruptions before or during calls. The lesson learned was that working in collaborative partnerships from a distance using technology requires patience, flexibility, creativity, a sense of humor, and the need for continuous assessment and evaluation of the project outcomes, timeline, and shared responsibilities. Input from the small number of NCIN scholar alumni from the New York area may limit some aspects of the toolkit's generalizability. New graduate nurses from other areas in the United States may face different transitionto-practice challenges depending on their location and employment trends in the region. However, we believe that our scholars and alumni are likely very similar to others across the nation based on our participation in annual NCIN summits and long-standing interactions with our colleagues from all geographic regions. It is our hope that the wide variety and scope of information in the toolkit will help new graduate nurses in all settings.
Conclusion The project was well intentioned and systematically designed, resulting in a validated and useful resource for all new nurses, especially those from underrepresented minorities. We believe that the toolkit has the potential to facilitate the transition to practice and to assist new nurses on their journey of professional growth. Further research is needed to determine (a) the ideal time to introduce this resource, for example, early in the nursing curriculum or prior to graduation and (b) the perceptions of new nurses regarding the utility of the toolkit resources. Input from clinical partners, administrators, and recruiters from various settings may provide a broader perspective on transition-to-practice challenges. Clearly, further efforts are needed to facilitate a successful transition from the student to professional role, particularly for new nurses from underrepresented groups.
Acknowledgments Funded by a RWJF Innovation Award Grant and published by agreement between RWJF and the American Association of Colleges of Nursing for the RWJF NCIN program.
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