TTP & APP Issue - December 2023

In November 2011, the Veterans Health Administration (VHA) started a mandatory RN Transition-to-Practice (TTP) program. The purpose was to support and retain new graduate registered nurses as they transitioned from nursing school to practice. The goal was to have 100% of all VA medical facilities hiring new RNs with less than one year of professional RN experience to have an RN TTP residency program or collaborate with a VA medical facility with such a program.

The RN TTP program consists of a comprehensive 12-month curriculum built upon standards related to clinical nursing, leadership, and professional dimensions. Additionally, Veteran-centric content is reviewed during the RN TTP program. The program may contain didactic and experiential learning components. Each post-graduate RN is assigned a preceptor who is an experienced RN and who has completed preceptor training.  

Throughout the program, the RNTTP residents develop an evidence-based practice or Quality Improvement (QI) project where they focus on a topic of interest and work with stakeholders to impact change. This project exposes the resident to many of the processes within the VA as well as individuals who may assist with continued process improvement efforts during their nursing careers. The final meeting is a graduation ceremony where residents share about their projects. It is an inspiring and impressive view into the future of nursing!

A Nursing Professional Development Specialist with VHA interviewed TTP program educators and RNs who completed the TTP program about their experiences. What follows are some excerpts from those interviews. The program educators described their passion for the TTP program, their beliefs about the importance of transition programs, and how invigorating it is to watch the nurse residents evolve and develop the skills necessary for success in nursing.

“I find the residents’ fresh energy and new ideas invigorating. I try to be a resource to the residents. I am someone they can bring a problem or an idea to and together we work through next steps. I watch them learn some hard lessons throughout the year, and they grow a lot. I find a lot of joy in watching their evolution!”

“I also get excited when I see the ‘light bulb light up’ in a residents face. I had a group of RNTTP residents in the Simulation Center and we were doing the First 5 Minute Code Drill. It was clear they were very nervous. One person was asking questions like “have you really ever been in a code?”, “how often does it really happen?” I could see she was extremely uncomfortable. We worked through the first code and it did not go so well. We debriefed, more questions like those above. We did the code a second time and it went well. When we started that debrief this person said to me (I could see the genuine relief, excitement all over her face) “I CAN DO THIS! I COULD SAVE SOMEONE’S LIFE!  I FEEL LIKE I CAN GO BACK TO MY AREA AND IF SOMEONE CODES, I KNOW EXACTLY WHAT TO DO, AND I COULD TOTALLY DO IT!!”  That is what it is all about!”

The nurses who completed the transition program described how the TTP program prepared them for their roles as competent and independent nurses.

“When I entered this program in September of 2022, I had been in healthcare for 16 years and had practiced as an LPN for 9 years. The RN TTP program not only introduced the new RNs to the VA standards and culture but also covered significant areas of nursing. The topics covered would take a healthcare professional a much longer timeframe to learn than only a year.”

“The registered nurse transition-to-practice (RNTTP) program has been an invaluable experience. …I was fortunate to be paired with a dedicated preceptor and mentor. My preceptor provided guidance and assistance with daily nursing tasks on the unit, while my mentor served as a reliable resource for any questions or concerns I encountered during my first year of nursing.”

“… having the support of a mentor and preceptor throughout my initial year provided me with a sense of security and comfort. I was able to carry out nursing duties independently, knowing that I had someone to turn to if I required guidance. This positive experience instilled in me the confidence to ask questions as needed, without any concern about being judged or unsupported.”

“…the RNTTP program has been a transformative experience for me, both personally and professionally. It has equipped me with comprehensive support, invaluable mentorship, exposure to diverse clinical settings, and the opportunity to engage in evidence-based research and education. This program has played a crucial role in shaping my development as a competent and confident professional nurse during my initial year in the field.”

“My experience as a resident in the RN Transition to Practice program was slightly different than most as I had already worked as an RN at the VA for about eight months prior to joining. Having the opportunity to interact with different specialties and RNs serving in different roles than my own helped me to better understand what resources are available. Having other residents to discuss our experiences with helped me to see that I shared similar feelings with other new RNs around me and allowed me to feel more secure in my new role.”

The class associated with the TTP program explored “…many topics, including the most current, evidence-based practices, critical thinking exercises, journaling about their experiences, and introductions to resources available to them at their VA locations. At the end of the class, nurses are charged with making a presentation that includes research usually reserved for higher education. This introduction is a confidence building exercise through research and public speaking, but also allows fresh ideas to flow which may be a catalyst for change in their areas. Sometimes these fresh ideas identify gaps in care that go unnoticed…”

“I never felt ‘thrown to the wolves,’ as it were, as many former students feel when first jumping into a civilian establishment. Even if some aspects did not directly benefit me, I can see the value in this approach because so many nurses come out of school still not knowing what to expect. Everyone will get different things out of the program, but all will feel supported.