NURS FPX 6085 Assessment 2 Problem Statement (PICOT)

Problem Statement (PICOT)

The shift-to-practice phase is a stressor for the new graduate nurses employed in a large urban hospital, that is, in the unit of women’s services, where high acuity and rapid clinical situations are common.

Despite some developed orientation and preceptor ship models, there remains a gap in the training of new nurses to be in a qualified position to handle complicated cases involving patients with confidence and safety, which leads to a strain, fluctuations in practice, and the likelihood of patient safety. Significant considerations in this project are identified needs, population to be targeted, intervention, anticipated outcomes, and schedule and quality improvement model.

Among new graduate nurses, making a transition to practice in the women services unit of a busy urban hospital (P), does a structured and evidence-based educational intervention (including simulation-based education and specific orientational activities) (I) versus the standard process of orientation (C) improve clinical readiness, confidence, and the ability to safely manage common and high-acuity situations (O), in a 6-12-week orientation period (T)?

Population (P): Just recently graduated nurses starting in a unit of a large metropolitan hospital servicing women.

Intervention (I): Evidence-based educational intervention (structured): Simulation-based education and orientation activities.

Comparison (C): Orientation process that is in place.

Outcome (O): Being more equipped to deal with common and high-acuity clinical situations clinically, more confident, and safer.

Time (T): Six to twelve weeks

Problem Statement

• Need Analysis

The need identified through this project would focus on quality enhancement, education of nurses, and patient safety through offering a structured and evidence-based educational intervention to the new graduate nurses, including simulation-based learning and particular orientation activities. New graduate nurses are often working in highly acute units of women’s services or high-work neonatal units of major urban hospitals, but are not properly trained on how to deal with complex obstetric, gynecologic, and neonatal cases.

Such gaps in knowledge in the preparation stage put patients and nurses at a higher risk of clinical errors, low confidence, and poor quality of care. The existing literature states that stress, burnout, and unsafe clinical practice in novice nurses are caused by a lack of transition-to-practice programs (Reebals et al., 2021).

As of the organizational data, internal quality reports of the related units of women’s services show that new graduate nurses are more likely to engage in near-miss medication errors, delayed maternal deterioration identification, and failure to escalate care during obstetric emergencies in the first three months of their practice. Besides, nurse educators report uneven preceptor evaluation, in which, in most cases, there is a record of the absence of emergency response, interpretation of fetal monitoring, and interdisciplinary communication during the orientation phase (Ibrahim et al., 2024).

Although the formal simulation competency scores are not actively followed, the present orientation completion is based more on time-related aspects than on clinical competency, which limits objective evaluation of independence of practice preparedness. In this project, the assumption made is that the simulating resources and teaching facilities needed to support the intervention would be available in the organization.

The issues that could potentially have led to this problem include variability in the orientation structure, clinical simulation of high-acuity cases, and absence of an early transition to mentored clinical decision-making (Elendu et al., 2024).

The lack of preparedness in facing emergency or high-threat situations is reported to be widespread among women in the services of women among new graduate nurses, and this negatively impacts patient safety and retention of nurses. These types of educational gaps introduce the potential of adverse patient outcomes, staff turnover, and decreased care quality.

The current unit-level statistics also show that there is a higher turnover rate of the less than one year of experience in the women’s services, which means that it is not only a safety risk, but also a rotating workforce. These trends can demonstrate that not only is it educational, but it is also operational and financial in character and that quality improvement in transition-to-practice is not only immediate, but also desperate (Gautam et al., 2023).

It is also assumed that the unit nurse educators, preceptors, and the leadership will have a positive impact in terms of integrating the concept of simulation-based learning with an evidence-based approach of improving clinical competence and confidence during the transition-to-practice process.

• Population and Setting

The specific group in the project being targeted is new graduate nurses who are starting their careers in a busy hospital in an urban environment in the unit of women’s services. This group is especially vulnerable during the first stage of transition, as they do not have much clinical experience, the workload is high, and the process of maternal and neonatal patient care is rather complex (Mohammed et al., 2025).

The services of women require rapid clinical decision-making, a high level of technical skills, and effective communication between professionals, and, therefore, proper preparation of education is needed so that women can work safely.

Other issues that this population may face are performance anxiety, fear of making errors, failure to prioritize care in case of an emergency, and lack of confidence in dealing with physicians and senior nurses in case of an emergency. In addition, varying education and exposure to obstetric and neonatal crises during nursing education may result in varying levels of baseline competency disparities among new graduate nurses during orientation. These factors could affect readiness to study, involvement in simulators, and success at the transition, in general.

The environment where the intervention will be implemented will be an acute care hospital that facilitates nurse residency training and education using simulation. The orientation process can incorporate realistic clinical situations and practice-guided and structured feedback due to such an environment.

To be more specific, the targeted setting is an inpatient unit of women’s services in a large urban hospital that has labor, delivery, postpartum, and neonatal services, where the patient acuity is high, and clinical degradation might occur rapidly. Some obstetric emergencies that such units usually address are, but are not limited to, postpartum bleeding, preeclampsia, and neonatal resuscitation; hence, competency-based training is vital in patient safety.

The potential barriers are time constraints in the orientation procedures, the shortage of staff, and the dissimilarity in the assistance offered by the preceptors, though institutional commitment to nurse education and patient safety must add to the successful implementation and sustainability.

Other environment-related problems may also include the unavailability of the simulation laboratories due to conflicting educational needs, incompatible time schedules between the clinical shift and the training, and the unequal support of the leadership based on the staffing demands (Park et al., 2025). To eliminate these challenges, the nursing educators, the unit managers, and the hospital administration will be forced to liaise their efforts to ensure that the training hours are not sacrificed and that the preceptors are utilized frequently.

• Intervention Overview

The proposed intervention, based on the current project, is a structured and evidence-based educational intervention among new graduate nurses in the women’s services unit that integrates simulation-based education and orientation training. Our program will focus on developing clinical preparedness, confidence, and safe decision-making in common and high acuity maternal and neonatal scenarios.

Facilitated simulation practices, case-based learning processes, and formal clinical skill validation practices will be provided to the new graduate nurses by nurse educators and preceptors. The orientation process will use feedback, self-reflection, and performance evaluation after 6-12 weeks to measure the progress and help trainees to develop their skills (Salem et al., 2025). It is a methodology that views experiential learning, critical thinking, and long-term educational support at the transition-to-practice level.

The nurses of the new graduate group in a busy urban unit in women’s services are particularly well positioned to receive this intervention since they face the issue of lack of exposure to clinical practice, high patient acuity, and performance anxiety typical of the first years of professional practice. Simulation-based education gives nurses a chance to practice in emergency response, communication, and technical skills in a secure and controlled environment that does not cause any harm to patients (Kavakli and Konukbay, 2024).

The structured orientation model also provides similarity in training experience and promotes gradual autonomy. Furthermore, such an educational paradigm can be realized on a huge scale and be economical as it is viable in terms of broader application in such inpatient units. The primary and direct goal of the intervention is the reduction of readiness and confidence as the key factors, and the increase in clinical competence, as well as standardized care delivery.

Potential obstacles to implementation could include the inability to find time in orientation schedules, varying levels of engagement with a preceptor, and the inability of the staff to conduct simulation operations. The remaining problems may include the learning styles of the new graduate nurses, including intolerance to the unorthodox forms of learning.

The following barriers will need to be overcome with the institutional support, the input of the leadership, and the provision of the appropriate resources that will assist in sustaining the regular involvement and continuity of the program.

• Comparison of Approaches

Typically, the classical framework of orienting new graduate nurses relies on the unit-based preceptorship, classroom instruction, and learning within the framework of normal patient care (Valdes et al., 2021).

Whereas this model can be utilized to achieve real-time exposure to clinical practice, this model does not necessarily offer standardized exposure to high-risk and low-frequency clinical events such as obstetric emergencies or neonatal complications. By this, new nurses may graduate oriented and be unaware of how to be critical and be capable of being confident enough to handle high-acuity situations independently.

The alternative interventions include other interprofessional training based on simulation, extended nurse residency, and other transition programs led by advanced practice educators. These approaches provide more clinical assistance, professional socialization, and confidence through the assistance of long-term guidance and systematization of skills.

However, such programs may be costly to finance; they may require extra staff, increase time and money, which are not always available to invest in the entire hospital system (Pradhan et al., 2024). The interprofessional models are generalized in terms of nursing competencies rather than in offering women-specific service care.

In comparison, a simulation-based orientation program, which is created and facilitated by nurses, is balanced as it offers flexibility, realism, and uses fewer resources. This model promotes experiential learning, critical thinking, and practice of high-acuity situation repetition, interdisciplinary collaboration between nurse teachers, preceptors, and other individuals on an interdisciplinary team.

Even though such a program should not be hindered by the possible barriers, namely the availability of simulation, the experience of the educator, and the modified policies regarding the training requirements, this is one of the most feasible and permanent approaches in the environment of high acuity women’s services, rather than the traditional way of orientation.

• Initial Outcome

The primary output of this project will be to enhance clinical preparedness, confidence, and safe management of common and critical scenarios among new graduate nurses by the project completion date, as well as the post-orientation program.

Baseline data will also be collected at the outset of orientation, and these data will entail the initial scores on the simulation, the preceptor competency ratings on the standardized evaluation tools, as well as the self-reported confidence levels on the validated confidence scales. The safety events and near-miss reports in the last three months involving new graduate nurses will also be used to determine the pre-intervention safety trends (Yang and Liu, 2021).

Some of these secondary results include the enhanced clinical competence measured via simulation performance tests, preceptor tests, and self-reports of confidence regarding the new graduate nurses (Alkhelaiwi et al., 2024).

Here, it is envisaged that these findings will reveal that an educational intervention that entails an organized, simulated training will be suitable in order to improve the outcomes of transition-to-practice by improving the performance of the technical skills and professional confidence of the women in the service.

SMART outcomes

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

The criteria that the evaluator will use to ascertain the attainment of these outcomes will entail:

(1) quantifiable change in scores of simulation-based clinical performance before and after the post-intervention assessment;

(2) enhancement of the degree of self-reported confidence in relation to the capability of managing the high-acuity women in services scenarios;

(3) enhanced score of preceptor evaluation based on better clinical judgement, communication, and technical skills performance; and

(4) a decreased number of clinical error incidents, near miss incidents or safety events incidents among new graduate nurses at the end of the Addressed as a set of outcome measures, they are the signs of an improved quality of care and patient safety and a more favorable transition-to-practice experience that involves a well-structured educational preparation.

• Time Estimate

The creation and the execution of educational intervention based on training of the new graduate nurses under the structured and simulation-based method is projected to occur within four to five months. The first month will be dedicated to program planning and design, during which the simulation scenarios, structured orientation information, assessment tools, and communication with nurse educators and unit leadership will be created (Lysfjord and Skarstein, 2024).

In the second month, educator and preceptor preparation will be conducted to ensure that there is consistency in the facilitation of simulations, providing feedback, and competency assessment among all the participants. This intervention will then be implemented within three months in accordance with the 6-12-week orientation model of the PICOT question. The planned simulation, mentored clinical practice, and planned feedback will engage new graduate nurses throughout the transition to independent practice.

The potential challenges, which may affect the proposed schedule, may be the postponement of the educator training, time scheduling problems related to the workforce, or a lack of resources in the simulation laboratory and clinical units.

Quality Improvement Method

The quality improvement cycle, which will be implemented on this project, is the Plan-Do-Study-Act (PDSA) cycle. The given model would be a particular fit, as it is aimed at trial and error, a fixed result of the tests, and real-time adjustment, based on the results. These attributes are important in the analysis of the effectiveness of the structured educational intervention regarding simulation-based learning that will be implemented for new graduate nurses in a high-acuity women’s unit.

The PDSA cycle will also help introduce incremental changes to the orientation processes and deliver the feedback to the educators and preceptors in due time, and be able to refine the intervention and introduce the maximum benefit to the nurse readiness, confidence, and patient safety (Abuzied et al., 2023).

It is assumed that the process of education of nurses and unit leadership will facilitate and assist the whole intervention process and that the new graduate nurses will also be actively engaged in the simulation and learning process to achieve meaningful outcomes.

Four phases will be applied in the implementation of the PDSA cycle. During the Plan stage, the educational modules, simulation situations, and orientation workflows would be developed, as well as assessment tools and evaluation criteria.

The application of the program to the unit of women’s services among the new graduate nurses will occur in the Do stage, whereby guided simulations, structured clinical practice, and preceptor feedback will be applied. The monitoring of the performance indicators, self-rated levels of confidence, and the evaluation of the preceptors are going to be included in the study phase so that the effectiveness of the intervention in increasing the clinical readiness and competence could be assessed (Alhejaili et al., 2025).

Finally, the stage of Act will use the findings to implement necessary changes to the orientation program to render it scalable, sustainable, and aligned with the organizational goals to succeed in the practice of nurses.

Literature Review

The transition of new graduate nurses to a high-acuity unit in women’s services is a transitional period that has significant issues relating to clinical preparedness, confidence, and safe patient care. The acuity of those challenges is that, in case of the lack of appropriate preparation, the possibility of making mistakes will be risky, patient safety will be affected, and nurse stress and turnover will happen.

It was stated that the structured educational sessions, including the simulation-based learning and the special orientation sessions, can increase the clinical competence and confidence during the transition-to-practice period to achieve the improvement of the staff and patient outcomes (Elendu et al., 2024). The interventions assist in learning skills, thinking, and professional socialization in high acuity nursing facilities.

According to Elendu et al. (2023), simulation-based education provides a safe and controlled environment where to practice work with emergency and high-risk scenarios and make nurses experience and feel confident without compromising patient safety. Similarly, Kavakli and Konukbay (2024) indicated that structured orientation programs are efficient in the context of clinical judgment development, procedural skills, and interprofessional communication development since they are the key competencies in complex care settings. All these works allow concluding that the need for a certain intervention is justified through educational activities that must be responsive to the needs of the women’s services unit.

Additional research identified the barriers as the issue of the new graduate nurses limiting their exposure to uncommon high-acuity events, inconsistency of the preceptor assistance, and the absence of formal feedback as a component of the orientation (Joseph et al., 2022).

It was noted by Mohammed et al. (2025) that new nurses in the process of dealing with obstetric and neonatal emergencies may lack confidence, experience anxiety, and make more erroneous decisions without any specific interventions. It is also demonstrated that repeated practice, directed debriefing, and competency validation are all useful in overcoming these barriers and ensuring that one is prepared to practice independently.

Finally, the new nurse transition programs have been accompanied by improved outcomes of interprofessional and evidence-based orientation strategies. Altinbas et al. (2025) undertook a review of simulation and structured mentorship studies, and they determined that simulation programs and structured mentorship programs led to improvement in self-efficacy, improved performance of skills, and also improved professional satisfaction.

Guerrero et al. (2022) have pointed out that frequent exposure to high-fidelity scenarios and assessments with the help of structured methods supports the competence and safety outcomes. Generally, the literature highlights the fact that the gaps existing in the readiness, confidence, and safe practice of new graduate nurses in the women’s services units are significant and need a well-organized educational intervention based on simulation to handle the gaps.

In the study of the effect of the organized simulation-based learning on the acute care clinical competence of the new graduate nurses, Ahmed et al. (2025) discovered that the skills performance and the confidence improved significantly, although they also advised that they should be self-supplemented with further orientation.

Similarly, Hernawaty et al. (2024) established the relationship between the specified orientation initiatives and the clinical errors, which hints at the fact that the evidence-based instructional interventions could potentially be used to ensure perfect preparedness during the transition-to-practice period.

The connection between low preparation and high levels of stress, in addition to the lack of confidence and inadequate patient safety in novice nurses, was outlined in a recent study by Casia et al. (2025), thus the necessity to provide high-intensity educational programs with guided practice, feedback, and simulation.

Another point that was made by Wang et al. (2025) is that because of the constant exposure to stressful circumstances, followed by reflection debriefing, clinical judgment and decision-making are increased, which is a wonderful argument that can be made in favor of the orientation interventions that are rooted in simulation.

To conclude, the literature shows that the suggested educational intervention grounded in simulation and organized structure will be helpful to novice graduate nurses who operate in the women’s service unit, as the outcomes of the study point to the increased rates of clinical preparedness and higher confidence levels, as well as reduced patient care outcomes. Guidance, learning, and simulation offer effective, convenient, and scalable means of competence development in high acuity situations.

In addition, the systematic orientation, simulation, and feedback activities are combined, which is consistent with the available recommendations, best practices in education, and internal policies, as they demonstrate this form of intervention to apply to the target audience and the clinical setting.

• Evaluation of Relevance and Currency

The chosen literature can be highly applied to the problems of transition-to-practice in new graduate nurses operating in high-acuity units related to women’s services, the methods of education, simulating learning, and organized orientation to improve clinical competence and confidence (Elendu et al., 2024; Kavakli and Konukbay, 2024). Most of the sources date back to 2022- 2025 to provide the latest evidence on the topic of simulation, guided practice, and competency development in a complex clinical setting (Joseph et al., 2022; Mohammed et al., 2025).

The findings are grounded in the existing nursing education practice and high-acuity environment that will be useful in the practical design of structured and evidence-based orientation programs (Altinbas et al., 2025; Guerrero et al., 2022). The literature describes both systemic and individual factors that contribute to readiness and safe practice and can be utilized to intervene at the orientation gaps and high-acuity exposure (Ahmed et al., 2025; Ernawaty et al., 2024).

Overall, it may be observed that the evidence is timely, applicable, and informative on how the readiness, confidence, and safe patient care of the new graduate nurses in the women’s services units can be improved (Casia et al., 2025; Wang et al., 2025).

Health Policy

The considerations related to health policies and regulations are relevant to the success of implementing a structured and simulation-based educational intervention among the new graduate nurses in the women’s services units. The institutional policies on orientation programs, staffing ratios of the nurses, and competence evaluation provide a model that ensures the sustainability of the program, quality, and adherence to the organizational standards.

The evidence-based criteria of transitions-to-practice programs are also provided by the national nursing education principles and accreditation standards, such that the intervention may contribute to safe, effective, and consistent treatment of patients (Brunt and Morris, 2023). The discussion of such legal and ethical facets as the scope of practice and professional accountability is also needed to make the implementation easier and make sure that the regulatory standards are not breached.

The patient-safety standards of the Joint Commission, especially the standards associated with competence validation, high-risk clinical conditions, and reduction of preventable maternal morbidity, also demand that organizations provide adequate training to staff and continuously assess them, which is why simulation, formal orientation, and standardized competency assessments are required.

Also, nurse practice acts and BON (Board of Nursing) regulations require nurses to practice within their scope and competence levels and mandate employers to offer proper orientation and supervision, which determine the way training should be provided and recorded. Regulations of the Occupational Safety and Health Administration (OSHA) regarding occupational-related hazards and risks associated with exposure also support the need to prepare nurses by simulating to handle the obstetric and neonatal emergencies safely. Protecting patients from any harm, ensuring safe and evidence-based practice are the ethical norms that include the Code of Ethics of ANA, and making thorough preparation is ethically vital.

A policy dealing with simulation-based education, recording of competency assessment, as well as safe handling of learner information, should be followed so as to give the students confidentiality, professional integrity, and safe learning conditions.

The points of equity and accessibility are also urgent, as new graduate nurses may have diverse past clinical experiences, learning styles, and simulation-based learning comfort. The loopholes in the current policies could be linked to the standard ways of high-acuity orientations, interprofessional collaboration within the context of the transition programs, and frequent measurement of outcomes, that is, the institutional support and policy changes are needed to promote fair access to quality educational resources (Geese & Schmitt, 2023).

Conclusion

A transition-to-practice phase of new graduate nurses working in high-acuity units in women’s services is a critical period of time that should be used to ensure safe and competent clinical practice. The lack of continuity in the systematic orientation and working in the high-acuity environment can compromise the readiness, self-confidence, and safety of the nurse.

An educational intervention in the form of a planned intervention, which will be a structured and simulation-based intervention, provided by nurse educators, will enhance clinical competence, confidence, and skill to manage increasingly complicated patient scenarios. Maximizing the learning outcomes and clinical performance with the application of the Plan-Do-Study-Act (PDSA) cycle can be incorporated through continuous assessment and cyclic improvements.

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