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

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
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.

5. Intern, Student, Orientee Development
Preceptor Instruction & Support
Protocols and Data collection
Clearly Defined Roles
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6. 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
© Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission.

7. © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved
© Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission.

8. © 2003 - 2019 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
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”?
© 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?
© Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission.

14. 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
© Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission.

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

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

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

18. 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.

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

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

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

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

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

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

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

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

27. 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
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: /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
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 ). 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), PMID:
© Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission.

28. 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.