1. Supporting Transition: Lessons learned from Nurse Internship & Residency © 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net 1 Vermont Nurses In Partnership Susan A. Boyer, RN, M.Ed., FAHCEP

2. VNIP Collaborative approach © 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net 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

3. Transition to practice © 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net 3 3 levels of internship were needed 1. New graduate transition 2. New to specialty 3. Undergraduate

4. What we have learned from:  Twelve years of statewide program implementation  Serving the full continuum of care  With ongoing data collection, analysis, and program revision based on evidence  Using formative & summative research  An evolving project, product and process © 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net 4

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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 © 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net 9

10. Why mentorship? © 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net 10  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

11. Transition to practice  Nurse Residency program  Requires core competency development  Extension of basic Internship Program  Addition of specific learning modules to support development during clinical mentorship period  Preceptors are the single most crucial element for successful development © 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net 11

12. © 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net 12 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 value s Preceptors – to develop Clinical capability with emphasis on Nursing Judgment Targeting: Analyze – Evaluate - Synthesize

13. Preceptor Development What's the goal? © 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net 13  How do we determine “what to teach” in regards to development of preceptors and clinical coaches?

14. Establish our goal © 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net 14  Preceptors will collect evidence of clinical capability of the novice care provider.  Must effectively develop capability, wherever it is missing

15. Goal: To effectively develop & collect evidence of capability © 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net 15  Preceptors will require:  Effective Communication  Supportive Interpersonal Skills  Core teaching/learning principles  Foster critical thinking skills  Team process:  Relationship-based care  Relationship-based development

16. To develop capability © 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net 16  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

17. To validate capability © 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net 17  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

18. © 2009 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt- nurses@earthlink.net

19. Preceptor development © 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net 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

20. Core Concepts © 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net 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

21. Program Outcomes: © 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net 21  Competence expectations standardized  Logical, simplified, consistent, objective  Same expectations for all staff  Targets critical thinking, judgment, reasoning  Clinical performance outcomes instead of traditional grocery list of “tasks & procedures”  Prioritizing evaluation, caring relationships, leadership, management & critical thinking  Concept-based vs. case or task-based

22. Program Outcomes: © 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net 22  Concepts & framework applicable across continuum of care  Suitable 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

23. VNIP: Collaborative Outreach © 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net 23 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

24. VNIP: Collaborative Outreach © 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net 24 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

25. VNIP: Collaborative Outreach © 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net 25  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