1. 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
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2. 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 It has evolved into a collaborative non profit business structure that provides staff development consulting within and outside Vermont.
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3. 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
© Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission.

4. 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
© Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission.

6. © 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved
© Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission.

9. 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.

10. 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
© Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission.

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

12. 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”?
© Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission.
© Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission.

13. Preceptor Development What's the goal?
How do we determine “what to teach” in regards to development of preceptors and clinical coaches?
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14. 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
© Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission.

15. 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
© Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission.

16. 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
© Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission.

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

18. © 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved
© Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission.

19. 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
© Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission.

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

21. 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
© Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission.

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

23. 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
© Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission.

24. 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
© Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission.

25. 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
© Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission.

26. 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
© Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission.

27. © 2003 - 2017 Vermont Nurses In Partnership, Inc. All rights reserved
© Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission.

28. 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 ). 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 ). 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: /j.mnl.2017.o
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 /NND
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), PMID:
© Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission.

29. 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), DOI:
Palumbo, M. V., Rambur, B., & Boyer, S. (2012). Education and employment characteristics of nurse preceptors. Journal of Continuing Education in Nursing, 43(10): doi: / 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:
VNIP. (2009, May). Vermont Nurse Internship Project Research Plan Report . Retrieved from Vermont Nurses in Partnership (VNIP):
VNIP. (2017, 9 7). Clinical Transition Framework: Core Components and Evidence Base. Retrieved from Vermont Nurses in Partnership (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),
© Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission.

30. For more information: Explore VNIP web site & white papers:
Query VNIP Director at: or
© Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission.