Nurs FPX 6085 Assessment 2 

The transition-to-practice phase is a stress factor for new graduate nurses working in a busy urban hospital, specifically in the unit of women’s services, where high acuity and fast-paced clinical scenarios are frequent. Although there are established orientation and preceptorship models, there are still gaps in the training of new nurses to be capable of handling complex patient situations with confidence and safety, which increases pressure, inconsistency in practice, and the risk to patient safety. Major aspects in this project deal with needs identified, target population, intervention proposed, expected results, schedule, and quality improvement framework.

In new graduate nurses transitioning into our practice within a busy urban hospital’s women’s services unit (P), does implementing a structured, evidence-based educational intervention that includes simulation-based learning and targeted orientation activities (I), compared with the current standard orientation process (C), improve clinical readiness, confidence, and ability to safely manage common and high-acuity scenarios in women’s services (O), over a 6–12-week orientation period (T)?

Population (P): Nurses who have just graduated and are entering practice in a unit of a busy urban hospital that serves women.

Intervention (I): Structured, evidence-based educational intervention: Simulation-based learning and orienting activities.

Comparison (C): Existing standard orientation process.

Outcome (O): More prepared to clinically, better-confident, and safer handling of common and high-acuity clinical situations.

Time (T): Six to twelve weeks

Problem Statement

The identified need in this project is centered on quality improvement, nurse education, and patient safety by applying a structured and evidence-based educational intervention to the new graduate nurses, comprising simulation-based learning and specific orientation exercises. New graduate nurses are frequently employed in high-acuity units of women’s services or neonatal units with high workloads in major urban hospitals, without adequate training on how to handle complex obstetric, gynecologic, and neonatal cases.

These knowledge gaps during preparation expose patients, nurses to a greater risk of clinical errors, decreased confidence, and diminished quality of care. According to the current literature, insufficient transition-to-practice programs are the source of stress, burnout, and unsafe clinical practice in new nurses (Reebals et al., 2021).

Need Analysis

Regarding the organizational data, internal quality reports in related units of women’s services demonstrate that new graduate nurses are more prone to participate in near-miss medication errors, delayed maternal deterioration identification, and inability to escalate care during obstetric emergencies within the initial three months of their practice. Moreover, nurse educators complain of inconsistent preceptor assessment, where commonly there are records of a lack of emergency response, fetal monitoring interpretation, and interdisciplinary communication in the orientation stage (Ibrahim et al., 2024).

Even though formal simulation competency scores are not actively monitored, the current orientation completion is founded more on time-related factors than on clinical competency, which restricts objective assessment of independence of practice readiness. The assumption in this project is that the organization has the simulating resources and teaching facilities to support the intervention.

Nurs FPX 6085 Assessment 2 

The factors that might have contributed to this issue are variability in the structure of orientation, a lack of clinical simulation on high-acuity cases, and the absence of mentored clinical decision-making at an early period of transition (Elendu et al., 2024). Reports of a lack of preparedness to face emergency or high-risk situations in women’s services are common among new graduate nurses, which adversely affects patient safety and nurse retention. Such educational gaps create the possibility of negative patient outcomes, employee turnover, and reduced quality of care.

The existing unit-level data also indicate an increased turnover of the nurses who have less than one year of experience in women’s services, which indicates that insufficient preparation is also a cause of not only a safety hazard, but also a fluctuating workforce. These trends can prove that it is not only educational, but also operational and financial in nature, and that quality improvement in transition-to-practice is not only immediate, but also desperate (Gautam et al., 2023). It is also presumed that the unit nurse educators, preceptors, and leadership will contribute effectively towards the incorporation of simulation-based learning into an evidence-based strategy of enhancing clinical competence and confidence throughout the transition-to-practice process.

Population and Setting

The targeted population of this project is new graduate nurses joining their profession in a busy hospital of an urban setting within the women’s services unit. This group is particularly susceptible in the initial transition period, as it has little clinical experience, and the workload is high, and the maternal and neonatal patient care is quite complicated (Mohammed et al., 2025). Women’s services units demand quick clinical judgment, a high level of technical skills, and good interprofessional communication, and thus, efficient education preparation is necessary in order to practice safely.

Other challenges that this population might experience include performance anxiety, fear of committing mistakes, having a hard time prioritizing care during emergencies, and a low level of confidence in interacting with physicians and senior nurses during emergencies. Also, different levels of education and inconsistent exposure to obstetric and neonatal crises at nursing school can lead to different levels of baseline competency differences among new graduate nurses attending orientation. These aspects may influence preparedness to learn, participation in simulators, and success in transition, in general.

The setting of the intervention will be an acute care hospital that promotes nurse residency training and education through simulation. Such an environment enables the incorporation of realistic clinical scenarios, guided practice, and structured feedback in the orientation process. To be more precise, the targeted environment is an inpatient women’s services unit in a large urban hospital with labor and delivery, postpartum, and neonatal services, in which the patient acuity is high and clinical degradation may happen quickly. Obstetric emergencies that these units often deal with include, but are not limited to, postpartum hemorrhage, preeclampsia, and resuscitation of newborns, which is why training based on competencies is essential in patient safety.

The possible obstacles are the time limitations during the orientation process, the lack of staff, and the inconsistency in the support provided by the preceptors, but the institutional dedication to nurse education and patient safety should contribute to the successful implementation and sustainability. Other setting-specific issues can also encompass the lack of availability of simulation laboratories because of competing educational requirements, scheduling incompatibilities between clinical shifts and training, and inconsistent support of the leadership based on the staffing demands (Park et al., 2025). To overcome these issues, nursing educators, and the unit managers and the hospital administration will have to coordinate their efforts to guarantee that the training time is not compromised, and the preceptors are engaged regularly.

Intervention Overview

The intervention suggested in this project is a structured, evidence-based educational intervention for new graduate nurses combining simulation-based education and orientation activities in the women’s services unit. The program will be aimed at enhancing clinical preparedness, confidence, and safe decision-making in common and high-acuity maternal and neonatal situations.

New graduate nurses will undergo facilitated simulation practices, case-based learning processes, and formal clinical skill validation practices with nurse educators and preceptors. Feedback, self-reflecting, and performance evaluation will be employed during the orientation process over 6-12 weeks to assess the progress and assist trainees in building their skills (Salem et al., 2025). This methodology focuses on experiential learning, critical thinking, and sustained educational assistance at the transition-to-practice stage.

New graduate nurses working in a busy urban women’s services unit are especially suited to this intervention, as its problem is limited exposure to clinical practice, high patient acuity, and performance anxiety commonly felt in the early years of professional practice. Education based on simulation provides nurses with the opportunity to train in emergency response, communication, and technical skills in a safe and controlled setting, without posing any danger to patients (Kavakli and Konukbay, 2024).

The structured orientation model offers similarity in the training experience, as well as encouraging gradual autonomy. Moreover, this educational model can be implemented on a large scale and be cost-effective since it is feasible in terms of wider application in similar inpatient units. The intervention is directly aimed at addressing the central factors of decreased readiness and confidence, enhancing clinical competence, and supporting standardized care delivery.

The possible implementation barriers might be the lack of time during orientation schedules, differences in engagement with a preceptor, and inadequacies in the staffing to carry out simulation activities. The other issues can be the learning preferences of new graduate nurses, as well as resistance to non-conventional methods of learning. These barriers will be necessary to overcome with institutional support, involvement of the leadership, and allocation of proper resources that will help in maintaining the consistent participation and sustainability of the program.

Comparison of Approaches

The classical method of orienting new graduate nurses is usually based on the unit-based preceptorship, classroom teaching, and learning in the context of regular patient care (Valdes et al., 2021). Although this model can be used to get real-time exposure to clinical practice, this model may not always provide a standardized exposure to high-risk and low-frequency events like obstetric emergencies or neonatal complications. Through this, new nurses might graduate oriented without knowing how to respond critically or be able to be confident enough to handle high-acuity situations on their own.

Initial Outcome

The main deliverable of this project will be to improve the clinical preparedness, confidence, and safe management of typical and critical situations among new graduate nurses by the project completion date, and after the orientation program. At the beginning of orientation, baseline data will also be gathered and this data will include the initial performance scores on simulation, preceptor competency ratings on standardized evaluation instruments, and self-reported confidence levels on the validated confidence scales. The pre-intervention safety trends will also be determined by reviewing safety event and near-miss reports involving new graduate nurses in the past three months (Yang & Liu, 2021).

 Among the secondary outcomes are the improved clinical competence assessed by means of simulation performance tests, preceptor tests, and self-reported surveys of confidence about the new graduate nurses (Alkhelaiwi et al., 2024). These results are expected to show that an educational intervention involving a structured, simulated training is appropriate to boost the results of transition-to-practice by enhancing the performance of the technical skills and professional confidence among women in the service.

SMART outcomes

• At least a 20% change in simulation-based competency scores in baseline versus post-orientation assessment.
• An increase in self-reported confidence scores dealing with obstetric and neonatal emergencies by 25 percent at the end of orientation week 12.
• At least one performance level increase in sub-areas of clinical judgment, communications, and technical skills on preceptor evaluation rubrics.
• A 15% decrease in the reported near-miss or safety events among new graduate nurses in three months of program implementation.

The evaluator criteria used to determine the achievement of these outcomes will involve: (1) measurable improvement in the scores of simulation-based clinical performance between the baseline and post-intervention assessment; (2) increased level of self-reported confidence in relation to the ability to manage high-acuity women in the services scenarios;

(3) improved preceptor evaluation score in terms of improved clinical judgment, communication, and technical skills performance; and (4) reduced clinical error, near miss, or safety event reports involving new graduate nurses during the post-orientation period. Taken together, these outcome measures are indicators of a higher quality of care and patient safety and a more positive transition-to-practice experience with organized educational preparation.

Time Estimate

The development and the implementation of the educational intervention of training the new graduate nurses according to a structured and simulation-based approach is estimated to take place within four to five months. The first month will consist of program planning and design, where simulation scenarios, structured orientation information, assessment tools, and communication with nurse educators and unit leadership will be developed (Lysfjord & Skarstein, 2024).

Nurs FPX 6085 Assessment 2 

During the second month, educator and preceptor preparation will take place in order to guarantee the consistency in the facilitation of the simulations, feedback provision, and competency assessment among all participants. This intervention will then be carried out within three months as per the 6-12-week orientation framework in the PICOT question. New graduate nurses will be involved in planned simulation sessions, mentored clinical practice, and planned feedback during the period of transition to independent practice. The possible obstacles that can influence the suggested schedule are the delay of the educator training, difficulties with time scheduling connected with the workforce, or the shortage of resources in the simulation laboratory and clinical units.

Quality Improvement Method

The quality improvement framework that will be applied to this project is the Plan-Do-Study-Act (PDSA) cycle. This model would specifically suit the situation, as it focuses on trial and error, constant test results, and real-time adaptation depending on the results. These characteristics play a significant role in analyzing the efficacy of the structured educational intervention in terms of simulation-based learning to be applied to new graduate nurses in a high-acuity women’s services unit.

Incremental improvements to the orientation processes can be ensured with the help of the PDSA cycle, along with the delivery of the feedback to the educators and preceptors in a timely manner and the ability to refine the intervention and bring the most benefit to nurse readiness, confidence, and patient safety (Abuzied et al., 2023). The assumption made is that nurse educators and unit leadership will guide and support the entire intervention process, and that new graduate nurses will also be actively involved in simulation and learning processes to obtain meaningful results.

Literature Review

The transitional period of new graduate nurses into the practice in high-acuity units of women’s services poses major challenges associated with clinical preparedness, confidence, and safe patient care. The criticality of those challenges is that without proper preparation, there is a risk of making mistakes, patient safety will be impaired, and nurse stress and turnover will occur. It was indicated that structured educational programs, such as simulation-based education and specific orientation programs, have the potential to enhance clinical competence and confidence in the transition-to-practice period to result in improved staff and patient outcomes (Elendu et al., 2024). These interventions help to acquire skills, think critically, and socialize professionally in high acuity nursing settings.

Elendu et al. (2023) noted that simulation-based education offers a secure and controlled setting in which to train on emergency and high-risk situations and have nurses gain experience and confidence without jeopardizing patient safety. Equally, Kavakli and Konukbay, (2024) pointed out that structured orientation programs are effective in terms of developing clinical judgment, procedural skills, and interprofessional communication as they are critical competencies in complex care environments. All these studies justify the necessity of specific educational interventions that should respond to the needs of women’s services units.

Lastly, interprofessional and evidence-based orientation strategies have shown better results in the new nurse transition programs. Altinbas et al. (2025) conducted a review of the simulation and structured mentorship studies, and they conclude that simulation and structured mentorship programs enhance self-efficacy, demonstrate better skill performance, and enhance professional satisfaction.

Guerrero et al. (2022) have emphasized that regular exposure to high-fidelity situations and evaluations using the structured approaches reinforces the competence and safety outcomes. The literature, by and large, emphasizes the fact that the gaps present in the readiness, confidence, and safe practice of new graduate nurses in the women’s services units are appropriate and require a structured, simulation-based educational intervention to address the gaps.

Conclusively, the literature indicates that the proposed educational intervention based on simulation and organized structure will benefit new graduate nurses who work in women’s services units, as the results of the study evidence the higher levels of clinical readiness and confidence rates, and safer patient care results. Guidance, learning, and simulation provide convenient, scaled, and efficacious methods of developing competence in high acuity scenarios. Moreover, the combination of the systematic orientation, simulation, and feedback activities is in line with the existing recommendations, educational best practices, and the internal policies, as it proves that this type of intervention is relevant to the target audience and the clinical environment.

Evaluation of Relevance and Currency

The selected literature is very applicable to the transition-to-practice issues of new graduate nurses in high-acuity units in women’s services, the strategies of education, simulation-based learning, and structured orientation to enhance clinical competence and confidence (Elendu et al., 2024; Kavakli and Konukbay, 2024). The majority of the sources were published during 2022- 2025 to ensure the most up-to-date evidence about simulation, guided practice, and competency development in a complex clinical setting (Joseph et al., 2022; Mohammed et al., 2025).

The results are based on the current nursing education practice and high-acuity setting that will be valuable in the practical design of structured and evidence-based orientation programs (Altinbas et al., 2025; Guerrero et al., 2022). Both systemic and individual aspects, which influence readiness and safe practice, are highlighted in the literature and can be used to intervene at the orientation gaps and high-acuity exposure (Ahmed et al., 2025; Ernawaty et al., 2024). In general, it can be noted that the evidence is timely, applicable, and informative on how to improve the readiness, confidence, and safe patient care among new graduate nurses in women’s services units (Casia et al., 2025; Wang et al., 2025).

Health Policy

Relevant health policy and regulatory considerations contribute to the success of the implementation of a structured and simulation-based educational intervention for new graduate nurses working in the women’s services units. Policies of the institution concerning orientation programs, staffing ratios of nurses, and competence assessment offer a framework that guarantees the sustainability of the program, quality, and compliance with the organizational standards.

Transitions-to-practice programs also have evidence-based criteria presented by national nursing education guidelines and accreditation requirements, so that the intervention could foster safe, effective, and consistent care of patients (Brunt and Morris, 2023). Such legal and ethical aspects as the scope of practice and professional accountability have to be discussed as well to facilitate implementation and ensure that the regulatory standards are not violated.

The Joint Commission’s patient-safety standards, particularly those related to competence validation, high-risk clinical situations, and reduction of preventable maternal morbidity, require organizations to ensure staff are adequately trained and consistently evaluated, supporting the need for simulation, structured orientation, and standardized competency checks. Additionally, state nurse practice acts and BON (Board of Nursing) rules mandate that nurses practice within their competency levels and require employers to provide appropriate orientation and supervision, shaping how training must be delivered and documented.

Occupational Safety and Health Administration (OSHA) regulations on workplace safety and exposure risks also justify preparing nurses through simulation to safely manage obstetric and neonatal emergencies. Ethical standards such as ANA’s Code of Ethics reinforce the responsibility to protect patients from harm and ensure safe, evidence-based practice, making comprehensive preparation ethically necessary.

In order to provide confidentiality, professional integrity, and safe learning conditions, a policy addressing simulation-based education, documentation of competency assessments, and safe management of learner data should be observed. The issues of equity and accessibility are also imperative, since new graduate nurses might possess a variety of previous clinical experiences, learning preferences, and comfort with simulation-based instruction.

The gaps in existing policies can be associated with the standardized methods of high-acuity orientation, interprofessional collaboration in the framework of the transition programs, and regular assessment of outcomes, meaning that institutional support and policy revisions are required to encourage equitable access to quality educational resources (Geese & Schmitt, 2023).

Conclusion

The transition-to-practice phase of new graduate nurses in high-acuity units in women’s services is a critical period of time to guarantee safe and competent clinical practice. Discontinuity in systematic orientation and exposure to high acuity settings may undermine the nurse’s preparedness, confidence, and patient safety. A planned educational intervention represented by a structured and simulation-based intervention delivered by nurse educators will improve clinical competence, confidence, and skill to handle more complex patient situations. Continuous assessment and cyclic improvements can be used to maximize the learning outcomes and clinical performance through the use of the Plan-Do-Study-Act (PDSA) cycle.

References

Abuzied, Y., Alshammary, S. A., Alhalahlah, T., & Somduth, S. (2023). Using FOCUS-PDSA quality improvement methodology model in healthcare: Process and outcomes. Global Journal on Quality and Safety in Healthcare, 6(2), 70–72. https://doi.org/10.36401/jqsh-22-19.

Brunt, B., & Morris, M. (2023). Nursing professional development evidence-based practice. National Library of Medicine; StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK589676/

Park, Y., Lee, S.-J., & Hur, Y. (2025). Facilitators, barriers, and future direction of high-fidelity simulation in nursing education: A qualitative descriptive study. BioMed Central Nursing, 24(1). https://doi.org/10.1186/s12912-025-03541-8