Vermont Nurses In Partnership Susan A. Boyer, DNP, M.Ed., RN VNIP’s Clinical Transition Framework: Lessons learned from statewide/regional Nurse Internship & Residency Programs Vermont Nurses In Partnership Susan A. Boyer, DNP, M.Ed., RN © 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net

VNIP Collaborative approach Origins: Nurse leadership group Inclusive of various practice settings, specialty services, academia, & regulation Goal: To Implement a statewide nurse internship Supports “transition to practice” Applicable in multiple HC settings Environment of nurture & support Process: Preceptor Delivery Model Requires preceptor development/support VNIP started as a nurse internship project in 1999. It has evolved into a collaborative non profit business structure that provides staff development consulting within and outside Vermont. © 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net

Transition to practice Identified need for 3 levels of nurse internship New graduate transition New to specialty Undergraduate Collaborative endeavor Nurses working with nurses to support transition to practice Non-profit organization Ongoing outreach to others © 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net

This PP gives an overview of what we’ve learned from: Nearly two decades of statewide program implementation & evaluation Serving the full continuum of care Ongoing data collection, analysis, and rapid cycle quality improvement Using formative & summative data analysis An evolving project, product and process © 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net

© 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved © 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net

Why Preceptorship? Builds one on one relationship Improves satisfaction, retention, and orientation process Provides bridge between theory and reality Develops capability Protects and ensures safety for patient, new care provider and organization Collects evidence of competence © 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net

Why mentorship? Ongoing development of clinical capability Support through 2nd & 3rd phases of Boychuk’s “Transition Stages” Development of nursing judgment Development towards proficient practice Transition within the profession Deciding how and where you fit within the nursing profession © 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net

Transition to practice Clinical Transition Framework (CTF) Requires core competency development Extension of new grad Internship Program Addition of specific learning modules to support development during clinical Preceptors are the single most crucial element for successful development © 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net

Targeting: Analyze – Evaluate - Synthesize VT Nurses In Partnership, Inc Susan A Boyer, RN, MEd, FAHCEP, Executive Director 3/11/2018 Preceptors – to develop Clinical capability with emphasis on Nursing Judgment Targeting: Analyze – Evaluate - Synthesize Psychomotor Develop Precision Articulation Become automatic Integrate related skills Naturalization Technical skills Affective Act upon Attitudes Develop value system Organize own values Adopt behavior Internalize values Does your current ‘transition support system’ develop the novice’s ability to perform above the basic level or “receiving phase”? © 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net © 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net

Preceptor Development What's the goal? How do we determine “what to teach” in regards to development of preceptors and clinical coaches? © 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net

Establish our goal Preceptors will collect evidence of clinical capability of the novice care provider. Must effectively develop capability, wherever it is missing While maintaining safety for patient, learner, and self © 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net

Goal: To effectively develop & collect evidence of capability Preceptors require: Effective Communication Supportive Interpersonal Skills Core teaching/learning principles Foster critical thinking skills Team process: Relationship-based care Relationship-based development © 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net

To develop capability Preceptor roles & responsibilities Teaching and learning theory Learning styles, Novice to expert, Simple to complex, Principles of adult learning Story-telling, Use of case scenarios, and/or practice with difficult situations Collaborative team approach Relationship-based process, Interpersonal issues, conflict management, Socialization © 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net

To validate capability Define “competent practice” Delegation, accountability, liability Nurse practice act, job descriptions, P & P Performance management Communication & feedback Assessment & evaluation of capability Data collection Validating performance, collecting evidence, complete documentation tools © 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net

© 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved © 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net

Preceptor development Preceptor Development & Support Multi-disciplinary approach Need to: Revise/update the preceptor model Develop high level preceptor workshops Consider recognition and reward Prioritize protector role Delineate evaluator or competence validator role Establish protocols © 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net

Core Concepts - VNIP’s CTF Theory and evidence-based Clearly defined expectations Competency-based – COPA model Concept focus rather than task, procedure, case-based Preceptor development and support Protector and Evaluator roles Critical thinking development Data collection/evaluation = Evidence based Clinical coaching plans – “roadmap” for teaching & evidence collection that is based in the clinical setting © 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net

Program Outcomes: Clearly Defined Expectations – for both Preceptor and each newly hired nurse Competency tools that address orientation, annual performance appraisal & ongoing competence development/evaluation Coaching plans to guide the work of the preceptor/preceptee team Protocols that define the responsibilities, roles, process and tools to use © 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net

Program Outcomes: Standardized competence expectations Logical, simplified, consistent, objective Clinical performance outcomes instead of traditional grocery list of “tasks & procedures” Concept-based vs. case or task-based Engages sampling and accountability theories Prioritizing evaluation, caring relationships, leadership, management, critical thinking, judgment, reasoning Universal performance expectations for all © 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net

Program Outcomes: Preceptor program impacts workplace culture Evidence-based, standardized preceptor development / support for allied healthcare team Concepts & framework are applicable across the continuum of care Focus on Preceptor’s role of ‘Protector’ for the patient and new graduate Concept-based vs. case or task-based Guides performance data collection – Competency Validator © 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net

VNIP Alliance membership Includes resource manuals Proprietary rights to all tools and forms Roles, survey tools and protocols Teaching tools - how to foster critical thinking Tools for competency assessment Tools for clinical coaching PowerPoint Presentations, activities, notes, and more for preceptor development Same for intern development © 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net

VNIP: Collaborative Outreach Consulting services & collaborative workgroup Explanation of VNIP framework, core concepts, and key processes Instruction specific to use & roles of various resource materials Cyber-communications network Expert contributors adding to resource pool Web-based updates as they occur Linkages for shared workshop delivery/participation © 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net

VNIP: Collaborative Outreach Key processes Preceptor development and support Critical thinking & critical thinking development Data collection/evaluation of process change &/or effectiveness Clinical coaching with outline of standardized knowledge for each specialty Competency based evaluation – COPA model Concept focused rather than case-based © 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net

© 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved © 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net

References Boyer, S. (2011a). Preceptorship: Pathway to Safe Practice and Clinical Reasoning. In P. Joseph, & H. Feldman, Nursing leadership: A concise encyclopedia 2nd Edition (pp. 29-31). New York: Springer Publishing. Boyer, S. (2011b). VT Nurses in Partnership: Developing nurses competence within a complex, high-acuity healthcare environment. In A. M. Bushy, Rural Nurse: Transition to Practice (pp. 147- 158). New York: Springer Publishing Company. Boyer, S. (2016). Core Curriculum for Clinical Coaching: A Preceptor Workbook, 5th. Windsor: Vt Nurses in Partnership. Boyer, S. (2017). Clinical Transition Framework: Efficient solutions for transitional support systems. Nurse Leader , Doi: 10.1016/j.mnl.2017.o3.013. . Boyer, S., Valdes-Delgado, K., Huss, J., Barker, A., & Mann-Salinas, E. (2017). Impact of a Nurse Residency Program on Transition to Specialty Practice. Journal for Nurses in Professional Development, 33 (5), 220–227. doi. 10.1097/NND.0000000000000384. Lenburg, C., Abdur-Rahman, V., Spencer, T., Boyer, S., & Klein, C. (2011). Implementing the COPA model in nursing education and practice settings: Promoting competence, quality care, and patient safety. Nursing Education Perspectives,, 32 (5), 290-296. PMID: 22029239. © 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net

References Mann-Salinas, E., Hayes, E., Robbins, J., Sabido, J., Feider, L., Allen, D., & Yoder, L. (2014). A systematic review of the literature to support an evidence-based Precepting Program. Burns, 40(3), 374-387. DOI: http://dx.doi.org/10.1016/j.burns.2013.11.008. Palumbo, M. V., Rambur, B., & Boyer, S. (2012). Education and employment characteristics of nurse preceptors. Journal of Continuing Education in Nursing, 43(10):472-80. doi: 10.3928/00220124-20120716-29. Epub 2012 Jul 23. . Robbins, J., Valdez-Delgado, K., Caldwell, N., Yoder, L., Hayes, E., Barba, M., . . . Mann-Salina, E. (2017). Implementation and outcomes of an evidence-based precepting program for burn nurses. Burns, DOI: http://dx.doi.org/10.1016/j.burns.2017.04.017. VNIP. (2009, May). Vermont Nurse Internship Project Research Plan Report . Retrieved from Vermont Nurses in Partnership (VNIP): http://www.vnip.org/documents/Report-NCSBN.pdf VNIP. (2017, 9 7). Clinical Transition Framework: Core Components and Evidence Base. Retrieved from Vermont Nurses in Partnership (VNIP): http://www.vnip.org/documents/VNIP- CTF_EvidenceBase2017.pdf Wierzbinski-Cross, H., Ward, K., & Baumann, P. (2015). Nurses’ Perceptions of Nurse Residency: Identifying Barriers to Implementation. . Journal for nurses in professional development, 31(1), 15-20. © 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net

For more information: Explore VNIP web site & white papers: www.vnip.org Query VNIP Director at: sboyer@vnip.org or sb.vnip@gmail.com © 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net