Vermont Nurses In Partnership Susan A. Boyer, DNP, M.Ed., RN Clinical Transition Framework: Lessons learned from statewide/regional Nurse Internship & Residency Programs Vermont Nurses In Partnership Susan A. Boyer, DNP, M.Ed., RN © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip.org

VNIP Collaborative approach Origins: Nurse leadership group Inclusive of 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 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip.org

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 Non-profit organization Ongoing outreach to others © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip.org

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 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip.org

Intern, Student, Orientee Development Preceptor Instruction & Support Protocols and Data collection Clearly Defined Roles © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip.org

Clearly Defined Expectations Preceptor Support Protocols & Surveys Evidence-base Evaluation Support systems Policies – orientation, student, preceptor, competency Clearly Defined Expectations Performance criteria Competency Tools Coaching Plans Instructional Strategies Preceptor Support Basic Instruction Resources to support role Ongoing skill and Critical Thinking Development © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip.org

© 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip.org

© 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip.org

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 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip.org

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 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip.org

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 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip.org

Targeting: Analyze – Evaluate - Synthesize VT Nurses In Partnership, Inc Susan A Boyer, RN, MEd, FAHCEP, Executive Director 7/23/2019 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 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip.org © 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 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip.org

The goal statement: 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 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip.org

To develop capability Preceptor roles & responsibilities Effective Communication and Interpersonal Skills Use of case scenarios, story-telling, practice with difficult situations Collaborative team approach Relationship-based process, Interpersonal issues, conflict management, Socialization Teaching and learning theory Learning styles, novice to expert Principles of adult learning, simple to complex, success builds success Fostering critical thinking skills © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip.org

To validate capability Outline and define “competent practice” Nurse practice act, job descriptions, orientation tools Delegation, accountability, liability Procedures, protocols & policy statements Providing safe and effective care – protection Performance management Communication & feedback Assessment & evaluation of capability Data collection Validating performance, collecting evidence, complete documentation © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip.org

Preceptor Roles and Responsibilities © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip.org © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip.org

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 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip.org

Core Concepts: Clinical Transition Framework Theory and evidence-based Competency-based – COPA model Concept focus rather than task, procedure, system-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 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip.org

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 define responsibilities, roles, process & tools © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip.org

Program Outcomes: Standardized competence expectations Logical, simplified, consistent, objective Clinical performance outcomes instead of traditional grocery list of “tasks & procedures” Concept-based vs. task-oriented Engages sampling and accountability theories Prioritizing aspects of professional practice: caring relationships, leadership, management, critical thinking, judgment, clinical reasoning © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip.org

Program Outcomes: Preceptor program impacts workplace culture Evidence-based, standardized preceptor development / support for allied healthcare team Concepts & framework applicable for full continuum of care Universal performance expectations for all Focus on Preceptor’s role of ‘Protector’ for the patient and new graduate Guides performance data collection – Competency Validator © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip.org

Alliance for Clinical Transition Support (ACTS): Agency membership provides & delivers Competency & Preceptor Program tools, templates and teaching resources Proprietary rights to all tools and forms Defining roles, survey tools and protocols Teaching tools - how to foster critical thinking Tools for competency assessment & clinical coaching PowerPoint Presentations, activities, notes, and more for preceptor development © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip.org

ACTS Collaborative Outreach Consulting services & collaborative group Guidance related to framework, core concepts, & process Instruction specific to use 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 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip.org

Clinical Transition Framework: Tools, theory and process Preceptor development and support Competency based evaluation – COPA model Clinical coaching tools Outline of standardized knowledge for each specialty/goal Clear, concrete, & concise performance criteria Learning strategies for accomplishing performance goals Critical thinking & Clinical Judgment development Concept focused rather than task-oriented © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip.org

Preceptor Instruction & Support Protocols and Data collection Supports development of: Intern, Student, Orientee Development Preceptor Instruction & Support Protocols and Data collection Clearly Defined Roles CTF © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip.org

References Boyer, S., Mann-Salinas, E., Valdez-Delgado, K., & VanFosson, C. (2019). Using the Delphi technique to determine core components of a Nurse Competency Program. Journal for Nurses in Professional Development , Pending. JNPD-19-017 Boyer, S. (2018). Core Curriculum for Clinical Coaching: A Preceptor Workbook, 6th. Ascutney: 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. Boyer, S. (2011). 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. 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 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip.org

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 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip.org