Determining Practice Readiness with Davis Advantage

Studies have validated that health care is riddled with medical errors resulting in negative patient outcomes, including death. Medication errors involve the largest percentage of safety threats to hospitalized clients, with nurses as the most common offenders of these errors. Over half of novice nurses report being involved in a medication error in their first year of nursing; however, hospital administrators feel these estimates are low (Goekcimen et al., 2023, Huston et al., 2018, Meulenberg, 2020, Hamed & Konstantinidis, 2022). Making the leap from graduating student to novice nurse is a considerable transition, especially when students are underprepared for practice. In 2021, it was reported by Kavanagh & Sharpnack at the Cleveland Clinic that only 9% of new nurses met entry level competencies when using PBDS (Performance-Based Development System). Performance measurement using this tool has shown a downward trend over several decades. Determining Practice-Readiness with Davis Advantage ARE NEW GRADUATES PRACTICE READY?

Meeting Entry Level Competency

30-35%

23%

14%

1990 to 2005

2011 to 2015

2016 to 2020

2020 YTD

Del Bueno (2005) Kavanagh & Szweda (2017)

Kavanagh & Sharpnack (2021)

What Does Practice-Readiness Mean? Practice-readiness is difficult to define because it is complex, multifaceted, and varies depending on the individual person and situation. Two new graduates with the exact same education will show different levels of practice-readiness. Researchers have attempted to quantify practice-readiness by identifying the qualities needed. These include a person’s ability to problem solve, provide safe practice, communicate, prioritize, and use clinical judgment, to name a few. A curriculum that is built on these qualities can provide the foundation necessary to produce practice-ready nurses.

Responses from Strategies to Create Practice-Ready Nurses Webinar, Spring 2024

Building Practice-Ready Nurses For a nursing program to build practice-ready nurses, strategies must be used that include developing definitions for progression and establishing benchmark outcome achievements. Practice-readiness begins with the end in mind, so first consider what the student will look like upon graduation, then work backwards. Use these steps to form a pathway to success. 1. Re-visit your end-of-program student learning outcomes (EOP-SLO). Be sure they are consistent with the needs of today’s novice nurse. 2. Affirm that course outcomes are leveled to achieve the EOP-SLOs. This creates a framework for what needs to be accomplished to meet these goals. 3. Align all classroom assessment and clinical evaluations with the course outcomes. This identifies that you are measuring what you need to teach. 4. Determine clear, measurable definitions of assessments and evaluation. For example, “Provide patient-centered care to a group of pediatric patients” is not measurable. Here is a sample of clear, measurable, progressing definitions for students throughout the program.

Semester 1

Semester 2

Semester 3

Semester 4

Recognizes changes in condition, reports when appropriate; intervenes safely with guidance; and evaluates outcomes Rephrases into lay terms for patient/family when teaching medical information Identifies the relationship of lab data, medications, and pathophysiology as it relates to patient care Safely implements routine nursing actions and evaluates effect; lacks ability to delegate

Distinguishes between normal and abnormal assessment findings Explains procedures & performs teaching to the patient/family using textbook descriptions Distinguishes between abnormal and abnormal but anticipated findings Recognizes active patient problems requiring assistance when identifying priority actions.

Performs complete assessment with guidance/prompts

Organizes relative importance of multiple assessments over time

Assessment

Modifies teaching based on patient/family response, cultural and language variations and learning barriers. Analyzes trends in lab data and compares to patient response Safely implements appropriate nursing actions in a timely manner; consistently delegates

Seeks guidance to answer patient/family questions

Patient Teaching

Lab Data & Diagnostics

Reports abnormal lab data

Performs basic nursing actions with prompts

Nursing Actions

Draws conclusions based on available information for

Repeats basic information

Summarizes available

Prioritizes available information for

Semester 2 Explains procedures & performs teaching to the patient/family using textbook descriptions Distinguishes between abnormal and abnormal but anticipated findings Distinguishes between normal and abnormal assessment findings Explains procedures & performs teaching to the patient/family using textbook descriptions Distinguishes between abnormal and abnormal but anticipated findings Semester 2 Distinguishes between normal and abnormal assessment findings Explains procedures & performs teaching to the patient/family using textbook descriptions Recognizes active patient problems requiring assistance when identifying priority actions. Follows all safety procedures when delivering care; identifies unsafe situations and reports Summarizes available information for documentation and communication with health care team Semester 2 Explains procedures & performs teaching to the patient/family using textbook descriptions Distinguishes between abnormal and abnormal but anticipated findings Recognizes active patient problems requiring assistance when identifying priority actions. Distinguishes between normal and abnormal assessment findings

Semester 4 Modifies teaching based on patient/family response, cultural and language variations and learning barriers. Organizes relative importance of multiple assessments over time Analyzes trends in lab data and compares to patient response documentation and communication. Uses a standardized handoff/report form, but able to move away from it to answer questions. Semester 4 Semester 4 Modifies teaching based on patient/family response, cultural and language variations and learning barriers. Analyzes trends in lab data and compares to patient response Safely implements appropriate nursing actions in a timely manner; consistently delegates Organizes relative importance of multiple assessments over time Draws conclusions based on available information for Follows all safety procedures when delivering care; identifies unsafe situations, corrects then reports Organizes relative importance of multiple assessments over time

Semester 3 Rephrases into lay terms for patient/family when teaching medical information Recognizes changes in condition, reports when appropriate; intervenes safely with guidance; and evaluates outcomes Rephrases into lay terms for patient/family when teaching medical information Identifies the relationship of lab data, medications, and pathophysiology as it relates to patient care Safely implements routine nursing actions and evaluates effect; lacks ability to delegate Follows all safety procedures when delivering care; identifies unsafe situations; reports then corrects Semester 3 Semester 3 Recognizes changes in condition, reports when appropriate; intervenes safely with guidance; and evaluates outcomes Identifies the relationship of lab data, medications, and pathophysiology as it relates to patient care Rephrases into lay terms for patient/family when teaching medical information Safely implements routine nursing actions and evaluates effect; lacks ability to delegate

Seeks guidance to answer patient/family questions

Patient Teaching

Semester 1

Lab Data & Diagnostics

Reports abnormal lab data

Performs complete assessment with guidance/prompts

Assessment

Performs basic nursing actions with prompts

Nursing Actions

Semester 1 Seeks guidance to answer patient/family questions Performs complete assessment with guidance/prompts Reports abnormal lab data Repeats basic information with prompting for documentation and health care team communication Semester 1 Performs complete assessment with guidance/prompts

Patient Teaching

Recognizes changes in condition, reports when appropriate; intervenes safely with guidance; and evaluates outcomes Rephrases into lay terms for patient/family when teaching medical information Identifies the relationship of lab data, medications, and pathophysiology as it relates to patient care Prioritizes available information for documentation and communication with team. Uses a standardized handoff/report form

Assessment Communication

Assessment Lab Data & Diagnostics

Modifies teaching based on patient/family response, cultural and language variations and learning barriers. Analyzes trends in lab data and compares to patient response Draws conclusions based on available information for Safely implements appropriate nursing actions in a timely manner; consistently delegates documentation and communication. Uses a standardized handoff/report form, but able to move away from it to answer questions. Safely implements appropriate nursing actions in a timely manner; consistently delegates Draws conclusions based on available information for documentation and communication. Uses a standardized handoff/report form, but able to move away from it to answer questions. Follows all safety procedures when delivering care; identifies unsafe situations, corrects then reports Follows all safety procedures when delivering care; identifies unsafe situations, corrects then reports Draws conclusions based on available information for documentation and communication. Uses a standardized handoff/report form, but able to move away from it to answer questions. Follows all safety procedures when delivering care; identifies unsafe situations, corrects then reports Modifies teaching based on patient/family response, cultural and language variations and learning barriers. Analyzes trends in lab data and compares to patient response Safely implements appropriate nursing actions in a timely manner; consistently delegates

Seeks guidance to answer patient/family questions Performs basic nursing actions with prompts

Seeks guidance to answer patient/family questions Follows all safety procedures when delivering care

Patient Teaching Nursing Actions Safety

Patient Teaching

Distinguishes between abnormal and abnormal but anticipated findings

Identifies the relationship of lab data, medications, and pathophysiology as it relates to patient care

Lab Data & Diagnostics

Reports abnormal lab data

5. Identify benchmarks for all classroom and clinical assessment and evaluation. If benchmarks are not achieved, a remediation plan should be in place. Davis Advantage Analytics Davis Advantage analytics allows for students, faculty, and administration to obtain evaluation and feedback at the individual, classroom, and institutional level. Performs basic nursing actions with prompts Recognizes active patient problems requiring assistance when identifying priority actions. Safely implements routine nursing actions and evaluates effect; lacks ability to delegate Repeats basic information with prompting for Summarizes available information for documentation and communication with health care team Prioritizes available information for documentation and communication with team. Uses a standardized handoff/report form Nursing Actions Performs basic nursing actions with prompts Recognizes active patient problems requiring assistance when identifying priority actions. Safely implements routine nursing actions and evaluates effect; lacks ability to delegate Communication Repeats basic information with prompting for documentation and health care team communication Summarizes available information for documentation and communication with health care team Prioritizes available information for documentation and communication with team. Uses a standardized handoff/report form Repeats basic information with prompting for documentation and health care team communication Summarizes available information for documentation and communication with health care team Prioritizes available information for documentation and communication with team. Uses a standardized handoff/report form Safety Follows all safety procedures when delivering care Follows all safety procedures when delivering care; identifies unsafe situations and reports Follows all safety procedures when delivering care; identifies unsafe situations; reports then corrects Student Evaluation & Feedback Faculty Evaluation & Feedback Administration Evaluation & Feedback • Results • Correct answers • Rationales • Clinical judgment cognitive skill • Book page references • Test-taking tips • Classroom performance • Average time spent • Participation • Strengths • Weakness • Curriculum usage • Class averages • Aggregate data • Performance by assignment type • Data trends • Overall usage documentation and health care team communication

Nursing Actions Communication

Communication

• Visual feedback dashboard • Time-stamped completion • Quick review

Follows all safety procedures when delivering care; identifies unsafe situations and reports

Follows all safety procedures when delivering care; identifies unsafe situations and reports • Classroom performance • Average time spent • Participation

Follows all safety procedures when delivering care; identifies unsafe situations; reports then corrects

Follows all safety procedures when delivering care Student Evaluation & Feedback Safety Student Evaluation & Feedback • Results • Correct answers • Rationales • Clinical judgment cognitive skill • Book page references • Test-taking tips • Results • Correct answers • Rationales • Clinical judgment cognitive skill • Book page references • Test-taking tips • Visual feedback dashboard • Time-stamped completion • Quick review Personalized Learning • 70% performance score • 25 minutes time spent per activity • 100% participation score Clinical Judgment • Results • Correct answers • Rationales • Clinical judgment cognitive skill • Book page references • Test-taking tips Semester 1

Faculty Evaluation & Feedback

Administration Evaluation & Feedback

Follows all safety procedures when delivering care

Safety

Administration Evaluation & Feedback • Curriculum usage • Class averages • Aggregate data • Performance by assignment type • Data trends • Overall usage Semester 4 • Curriculum usage • Class averages • Aggregate data • Performance by assignment type • Data trends • Overall usage Personalized Learning • 100% performance score • 10 minutes time spent per activity • 100% participation score Clinical Judgment • Curriculum usage • Class averages • Aggregate data • Performance by assignment type • Data trends • Overall usage • 70% performance score • 15 minutes time spent per activity • 100% participation score Quizzing

Semester 2

Semester 3

• Strengths • Weakness

Student Evaluation & Feedback

Faculty Evaluation & Feedback

Administration Evaluation & Feedback

• Strengths • Weakness Personalized Learning • 80% performance score • 20 minutes time spent per activity • 100% participation score Clinical Judgment • 50% performance score • 25 minutes time spent per activity • 100% participation score Quizzing

Personalized Learning • 90% performance score • 15 minutes time spent per activity • 100% participation score Clinical Judgment • 60% performance score • 20 minutes time spent per activity • 100% participation score Quizzing

• Classroom performance • Average time spent • Participation

• Strengths • Weakness

• 40% performance score • 30 minutes time spent per activity • 100% participation score Quizzing

Using Davis Advantage to Set Benchmarks A benchmark is a pre-identified criteria that serves as a standard of measurement. When benchmarks are established with reflective thought, they are effective in measuring progressing outcomes. If benchmarks are unrealistic, students feel they are being set up to fail. Here is an example of how to level benchmarks with Davis Advantage. • Visual feedback dashboard • Time-stamped completion • Quick review • Visual feedback dashboard • Time-stamped completion • Quick review Semester 1 Semester 2 Semester 3 Semester 4 • 70% performance score • 120 minutes time spent • 100% participation score • 80% performance score • 120 minutes time spent • 100% participation score • 90% performance score • 120 minutes time spent • 100% participation score • 100% performance score • 120 minutes time spent • 100% participation score

Semester 1 Personalized Learning • 70% performance score • 25 minutes time spent per activity • 100% participation score Clinical Judgment Personalized Learning • 70% performance score • 25 minutes time spent per activity • 100% participation score Clinical Judgment • 40% performance score • 30 minutes time spent per activity • 100% participation score Quizzing • 70% performance score • 120 minutes time spent • 100% participation score Semester 1 • 40% performance score • 30 minutes time spent per activity • 100% participation score Quizzing • 70% performance score • 120 minutes time spent • 100% participation score

Semester 2 Personalized Learning • 80% performance score • 20 minutes time spent per activity • 100% participation score Clinical Judgment Personalized Learning • 80% performance score • 20 minutes time spent per activity • 100% participation score Clinical Judgment • 50% performance score • 25 minutes time spent per activity • 100% participation score Quizzing • 80% performance score • 120 minutes time spent • 100% participation score Semester 2 • 50% performance score • 25 minutes time spent per activity • 100% participation score Quizzing • 80% performance score • 120 minutes time spent • 100% participation score

Semester 3 Personalized Learning • 90% performance score • 15 minutes time spent per activity • 100% participation score Clinical Judgment Personalized Learning • 90% performance score • 15 minutes time spent per activity • 100% participation score Clinical Judgment • 60% performance score • 20 minutes time spent per activity • 100% participation score Quizzing • 90% performance score • 120 minutes time spent • 100% participation score Semester 3 • 60% performance score • 20 minutes time spent per activity • 100% participation score Quizzing • 90% performance score • 120 minutes time spent • 100% participation score

Semester 4 Personalized Learning • 100% performance score • 10 minutes time spent per activity • 100% participation score Clinical Judgment Personalized Learning • 100% performance score • 10 minutes time spent per activity • 100% participation score Clinical Judgment • 70% performance score • 15 minutes time spent per activity • 100% participation score Quizzing • 100% performance score • 120 minutes time spent • 100% participation score Semester 4 • 70% performance score • 15 minutes time spent per activity • 100% participation score Quizzing • 100% performance score • 120 minutes time spent • 100% participation score

Personalized Learning • 70% performance score • 25 minutes time spent per activity • 100% participation score Clinical Judgment • 40% performance score • 30 minutes time spent per activity • 100% participation score Quizzing • 70% performance score • 120 minutes time spent • 100% participation score

Personalized Learning • 80% performance score • 20 minutes time spent per activity • 100% participation score Clinical Judgment • 50% performance score • 25 minutes time spent per activity • 100% participation score Quizzing • 80% performance score • 120 minutes time spent • 100% participation score

Personalized Learning • 100% performance score • 10 minutes time spent per activity • 100% participation score Clinical Judgment • 70% performance score • 15 minutes time spent per activity • 100% participation score Quizzing • 100% performance score • 120 minutes time spent • 100% participation score

About the author Karin Sherrill, MSN, RN, CNE, ANEF, FAADN has been a nurse educator for over 30 years. She works as a nursing education consultant, supporting faculty in creating better nurses. References Goekcimen, K., Schwendimann, R., Pfeiffer, Y., Mohr, G., Jaeger, C., & Mueller, S. (2023). Addressing patient safety hazards using critical incident reporting in hospitals: A systematic review. Journal of patient safety, 19 (1), e1–e8. Hamed, M. & Konstantinidis, S. (2022). Barriers to incident reporting among nurses: A qualitative systematic review. Western Journal of Nursing Research, 44, 506-523. Huston, C.L., Phillips, B., Jeffries, P., Todero, C., Rich, J., Knecht, P., Sommer, S., Lewis, M.P. (2018). The academic-practice gap: Strategies for an enduring problem. Nursing Forum, 53, 27-34. Kavanagh, J.M. & Sharpnack, P.A. (2021). Crisis in competency: A defining moment in nursing education. Online Journal of Issues in Nursing, 26 (1), Manuscript 2. Meulenberg, A. (2020). Shifting perceptions of error reporting among newly licensed nurses. Journal for Nurses in Professional Development, 36 (4), 243-245.

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