Supporting Transition: Lessons learned from Nurse Internship & Residency © 2003 - 2008 Vermont...

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

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Vermont Nurses In PartnershipSusan A. Boyer, RN, M.Ed., FAHCEP

VNIP Collaborative approach

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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: Based in Preceptor Program (Clinical Coaching) Requires preceptor development/support

Transition to practice

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3 levels of internship were needed 1. New graduate transition2. New to specialty3. Undergraduate

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

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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© 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved.

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Why mentorship?

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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

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

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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

Preceptors – to develop Clinical capability with emphasis on Nursing

Judgment

Targeting: Analyze – Evaluate - Synthesize

Preceptor Development

What's the goal?

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How do we determine “what to teach” in regards to development of preceptors and clinical coaches?

Establish our goal

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Preceptors will collect evidence of clinical capability of the novice care provider.

Must effectively develop capability, wherever it is missing

Goal: To effectively develop & collect evidence of capability

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Preceptors will require: Effective Communication Supportive Interpersonal Skills Core teaching/learning principles

Foster critical thinking skills Team process:

Relationship-based careRelationship-based development

To develop capability

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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

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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

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Preceptor development

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Preceptor Development & Support Multi-disciplinary approach Need to:

Revise/update the preceptor modelDevelop high level preceptor workshopsConsider recognition and reward Prioritize protector role Delineate evaluator/validator role Establish protocols

Core Concepts

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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

Program Outcomes:

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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

Program Outcomes:

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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

VNIP: Collaborative Outreach

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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

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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

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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