Supporting Transition for New Graduate Nurses : via a Statewide Nurse Internship Model © Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. 1 Vermont Nurses In Partnership Susan A. Boyer, RN, M.Ed., FAHCEP

Collaborative approach © Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. 2  Origins: N urse 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: Based in Preceptor Program (Clinical Coaching)  Requires preceptor development/support

Transition to practice © Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. 3 3 levels of internship were needed 1. New graduate transition 2. New to specialty 3. Undergraduate

Program Outcomes: © Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. 4  Statewide use of single competency tool  Same expectations for all staff  Performance outcomes vs grocery list of “tasks & procedures”  Concept-based vs. case or task-based  Foster critical thinking development  Prioritizing evaluation, caring relationships, leadership, management & critical thinking

Program Outcomes: © Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. 5  Concepts and framework fit across continuum of care  Applicable for full allied healthcare team  Statewide standardization of preceptor development and support  Evidence-based preceptor development  Focus on Preceptor’s role of ‘Protector’ for the patient and new graduate

What we have learned from:  10 years of program implementation  Across the continuum of care  Across the state  With ongoing data collection and analysis  With formative and summative research application  An evolving project, product and process © Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. 6

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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 © Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. 11

Why mentorship? © Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. 12  Ongoing development of clinical capability  Support through 2 nd & 3 rd 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

Determining content? What's the goal? © Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. 13  How do we determine “what to teach” in regards to development of preceptors and clinical coaches?

Establish our goal © Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. 14  Preceptors will collect evidence of clinical capability of the novice care provider.  Must effectively develop capability, where it is missing

© Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. 15 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 Clinical capability with emphasis on Nursing Judgment Analyze – Evaluate - Synthesize

Goal: To effectively develop & collect evidence of capability © Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. 16  Preceptors will require:  Effective Communication  Supportive Interpersonal Skills  Core teaching/learning principles  Foster critical thinking skills  Team process:  Relationship-based care  Relationship-based development

To develop capability © Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. 17  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

To validate capability © Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. 18  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

Preceptor development © Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. 19  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/validator role Establish protocols

Core Concepts © Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. 20  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

VNIP: Collaborative Outreach © Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. 21 Electronic manuals with site license,  Roles, JD, survey tools and protocols  How to teach, how to foster critical thinking development  Tools for competency assessment  Tools for clinical coaching  PowerPoint Presentations, activities, notes, etc. for preceptor development  Same for intern development

VNIP: Collaborative Outreach © Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. 22 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

VNIP: Collaborative Outreach © Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. 23  Key processes  Preceptor development and support  Critical thinking & critical thinking development  Data collection/evaluation of process change &/or effectiveness  Clinical coaching with instruction specific to various learning styles  Clinical Coaching plan development & use  Competency based evaluation – COPA model  Concept focused rather than case-based

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Protector - Safeguards patient & preceptee Facilitator - Role model, Socializer & Team leader Educator - Teacher, Coach, Evaluator Preceptor © Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. 25