289 County Road, Windsor, VT 05089

802-674-7069

Proposal – Contracting Agency July 20, 2009

Vermont Nurses In Partnership (VNIP) welcomes the opportunity to collaborate with ‘the agency’ in building a ‘transition to practice’ framework that protects client safety while supporting new nurse transition with the least amount of organizational and personal pain as possible.

VNIP has successfully addressed this need through development and implementation of a nurse internship that has evolved over the last 10 years with both summative and formative evaluation. The foundational models used for the VNIP Nurse Internship include the Competence Outcomes Performance Assessment (COPA) model(Lenburg, 1999) and evidence-based preceptor development(Boyer, 2008). VNIP uses continuous data collection to increase the value, safety, and effectiveness of the program. Our qualitative data gives testimony from clinical staff regarding the positive impact of the program, and quantitative outcomes show a reduction in the turnover rate during the initial year of employment. The VNIP program has evidenced less than 10% loss of all new graduates that complete the VNIP Nurse Internship, statewide. This compares favorably to the report from the American Nurses Association (ANA) House of Delegates (Wheeler, 2008), which states,“Over half of new graduate nurses leave their first professional nursing assignment in less than one year. Neophytenurses chose to leave the nursing profession due to role overload, job dissatisfaction, stress, low self-efficacy, and physician-staff relationships. It has been projected that approximately six percent of new graduate nurses become so discouragedduring the first year of practice that they choose to leave the nursing profession completely.”

The VNIP Nurse Internship addresses this issue with clearly defined expectations stated in performance outcomes terminology, clinical coaching plans to support the development of new graduates, and evidence-based preceptor development and support. The strength and quality of VNIP’s preceptor development/support is based on current research and evolving theory. The Vermont Nurse Internship is the only initiative with a ten (10) year track record of statewide development, implementation and data collection. VNIP has successfully standardized the new graduate competency development/assessment in both acute care and across the continuum of care. A single preceptor instructional plan is used statewide with mixed audiences from the full allied healthcare team. VNIP recognized from the start that the preceptor program was foundational to new nurse development, and as a result, no other initiative matches their focus, resource dedication, practice influence, and evolving data collection related to evidence-based preceptor development and support.

In 2003, our initial new graduate internship was expanded statewide and across the continuum of care with assistance from a Project Grant from Human Resource & Service Administration (HRSA). Our continuing commitment to research is evidenced by several years of collaboration with the National Council of State Boards of Nursing (NCSBN), as we develop and evaluate the program and its impact. VNIP has just completed an extensive research project that was funded by the NCSBN and the findings support the focus on preceptor development and support. There is growing evidence that the relationship that preceptors establish with students, new graduates, orientees and other colleagues is a key factor in the development of safe and competent practice(Evidence- Based Transition to Nursing Practice Initiative in North Carolina; Summary of Phase 1 findings, 2009). While several articles will be forthcoming from the VNIP research, summary data from our work is available on request. Please see the bibliography for other publications and presentations from the ongoing intern/preceptor development work. These include recognition of our excellence in practice by the National Nursing Staff Development Organization with the award of 2008 Excellence in Precepting Award.

The fundamental values of Vermont Nurses In Partnership include Continuous Development, Collaboration, and Evidence-based practice. With this in mind, we welcome the opportunity to collaborate with ‘the agency’ as we continue to develop and evolve both resources and data collection.

VNIP Services:

VNIP provides the framework, forms, teaching tools, and consulting services that support immediate implementation of an evidence-based ‘transition to practice’ model that supports the development and assessment of new nurse competence. The VNIP transition model is based upon a preceptor delivery process, thus preceptor development and support are a core component of the framework.

All tools and forms are effective, tested, templates that have been utilized in multiple agencies across the nation, and across the continuum of care. Each template can be customized by the educators and managers from the contracting agency. VNIP consulting staff will assist with the customization to ensure that your agency benefits fully from the ‘lessons learned’ via statewide framework implementation over the last ten (10) years. (All tools are proprietary property of VNIP, but agencies are invited to contribute their ongoing development of the tools back to the project to allow all partners to benefit from updates, revisions, and additions to the resource collection. )

VNIP consulting services will instruct educators and managers regarding the development, research, implementation needs, and utilization of tools, framework, and teaching materials. On completion of the 5 day intensive course, the participating educators and managers will be ready to finalize a work plan for internship, orientation and/or preceptor programs. The program participants will have received the electronic resources, along with instruction in their use, which allows them to start teaching Basic Preceptor Development Courses as immediately as “the agency” scheduling allows. VNIP provides tested tools and process for internship and preceptor programs which support a framework for competence development and evaluation. The framework and resources can be implemented immediately or customized to the specific needs and challenges of “the agency”. “the agency” can contract for additional ‘on site’ work from VNIP staff or customized tools can be sent to VNIP for review and recommendations via cyber-consulting and teleconference meetings.

Each contracting agency will receive a CD-Rom with electronic files as detailed below. Most forms are saved in Word format, presentations saved in PowerPoint, so they can be easily customized or adapted. Minimal hardware requirements include: Computer with CD-Rom drive, Windows XP or later version, MS Office 2003 or later version, and printer. Internet access is required for survey data entry and web-based information access.

Available Deliverables include:

  • Tools for both development and assessment of competence
  • A universal competence assessment tool that can be used for all direct care nurses
  • At least 12 unit specific competency tools that are used with the universal form
  • Clinical coaching plans that address at least 6 different specialty areas
  • Other tools as developed for various VNIP partners
  • Templates for intern and preceptor program structure/foundation
  • Examples of protocols used to support effective program delivery
  • Guidelines for “transition to practice” model based upon 10 years of implementation, research, and formative evaluation in multiple agencies across the continuum of care
  • Recommendations for transition & preceptor support programs based on learnings from multiple agencies; multiple healthcare settings
  • Summative and formative evaluation
  • Survey tools for evaluation of preceptor, learner, and program
  • Tracking documents and process for new hire nurse retention
  • Workplace Impact assessment tool – seeks data on workplace support for transition process
  • Electronic access to VNIP web-based survey tools
  • Benchmarking of results against outcomes from sites across the nation
  • Inclusion in evolving research and data collection process
  • References and feedback based on VNIP experience with project and data collection
  • Framework and resources for teaching preceptors via an evidenced-based model
  • Teaching plan and supporting documents for 18.8 contact hours of basic preceptor instruction – delivered via self-learning module and 2 day workshop
  • PowerPoint presentations for 11 topic areas that have been found necessary for preceptor role preparation – includes: Roles/Responsibilities; Novice to Expert Theory; Competency Assessment and Performance Outcomes; Delegation, Liability, & Accountability; Teaching/Learning Theory for Precepting; Communication skills; Interpersonal relationships; Experiences of Precepting; Preceptor Toolkit; Fostering Critical Thinking Skills; Team Building/Teamwork.
  • Teaching Plan and supporting documents for pre-assignment
  • Advanced Preceptor Development resources and materials
  • Instruction in how to implement all of these within a proven, effective framework
  • Five day consulting sessions that will include at least the Course on Competency Program Implementation (5 days) and additional agency-based work as needed
  • Monthly teleconference meetings for problem-solving, customization, and updates as indicated
  • Ongoing cyber-consulting for feedback on changes, implementation and customization of forms – how many hours per month to a maximum of X hours per month. $300/hour
  • Bi-annual updates on framework, model, tools and the evolving concepts behind them
  • Bi-annual 2 day workshops to review progress, address challenges, receive updates on the evolving framework and concepts and complete agency-based work as needed
  • Linkage with broader network through VNIP newsletters and cyber-communications

Competency Tools

With statewide implementation, data collection and formative adaptation of the internship framework, VNIP has developed a universal competence evaluation tool that can be used across the continuum of care, for all nurse hires that provide direct care. This tool is based on the COPA model and VNIP has developed samples of unit specific tools that are used in conjunction with the universal document. The process is simplified when the agency adopts this same tool for assessment of all new staff they employ and this tool/process has been proven effective in settings statewide, across the continuum of care, with nurses that range from new graduate to traveler. These tools are constantly evolving, as other agencies customize, adapt, and add new specialty content.

Preceptor Development and Support

A unique feature of the VNIP Nurse Internship is the focus on Evidence-based Preceptor Development and support. The preceptor program lays the foundation for new graduate success. This success targets the development and evaluation of critical thinking capability with prioritization of nursing judgment. Preceptors need to be taught how to foster critical thinking and they need the resources that allows them to engage in this core activity. They also require specific instruction in their role and responsibilities as a preceptor.

VNIP’s preceptor development has shifted the focus from task to clinical judgment, from cases to concepts, from test results to integrated affective/psychomotor skills, from orientation to clinical coaching, and from procedures to performance-based expectations. The focus must target the development of nursing judgment rather than a task-based orientation. To make this transition, the instruction and support for preceptors must be analyzed and structured in a pro-active manner. VNIP is leading the nation with their preceptor development framework and utilizes formative data collection for ongoing improvement of the model and resources. The VNIP Electronic Resource Manual includes preceptor program teaching plans, PowerPoint presentations, handouts, activities and instruction in their utilization. There is content that addresses both basic and advanced preceptor education, some of which could be administered in independent-learning modules.

Resources for preceptor/intern team

VNIP has learned that successful new graduate transition is dependent on preceptors, who are dependent on the development and support systems that we establish for them. These must include clearly defined competencies and clinical coaching plans which provide a guideline for experiential learning and concrete documentation of critical thinking development. The preceptor/intern teams also require protocols related to competence development, preceptor program, and orientation. The VNIP evaluation tools are provided as Word documents, so that your organization may change and modify them as desired. At the same time, VNIP’s web-based survey tools provide an opportunity to benchmark against a wider pool of data collection. Other necessary resources include the Preceptor Course Workbook which allows agencies to print and bind course texts as needed. This text is provided in pdf format or you may purchase printed copies from the VNIP office. The Clinical Competency Program Implementation (CCPI) Course is supported by the 77 page, proprietary VNIP workbook, CLINICAL COACHING PROGRAM IMPLEMENTATION. This is the authoritative manual for implementation of evidence-based Internship and Preceptor programs.

Consultation and Instruction

In addition to the site license, implementation consultation is required. This consulting will include: preparatory cyber/telephone consulting as requested, participant pre-assignments for the intensive course, VNIP faculty presenters, workbooks for each of the instructional sessions, monthly telephone conference meetings as needed, ongoing cyber consulting for customization of tools, and 5 to 8 days of intensive instructional sessions repeated at three different times/locations within year one.

Evolving Concepts

VNIP’s experience with internship and preceptor programs has demonstrated that this work is a journey rather than a destination. These concepts are introduced with the initial intensive course, but will require annual updates and reinforcement of “Does it fit?” “How applied” “How utilized” and “How to customize”.

Core concepts that apply to both intern and preceptor development and support include:

  • Using a standardized approach to competency assessment – the same ‘orientation checklist’ being used in all acute care settings and the same concepts and systems applied across the continuum of care (including allied health colleagues).
  • Tracking progression via the achievement of goals and competencies, instead of being “time oriented”.
  • Utilizing clinical coaching plans to provide the ‘roadmap’ for the intern/preceptor team.
  • Promoting a “Concept based” approach rather than a “case-based” competence development process
  • Prioritizing competence assessment for critical thinking, leadership, management, human caring relationships, teaching and knowledge integration. - Built upon Lenburg’s COPA framework.
  • Standardizing preceptor development with a universal teaching plan that addresses the core communication, interpersonal and teaching/learning theory and skills.
  • Utilization of preceptor education across the continuum of care and for the full allied healthcare team.
  • Systems and framework that target nursing judgment, critical thinking, and professional role competencies; rather than a task or procedure based orientation.
  • Concept based instruction and competence development; rather than case-based
  • Utilization of a single competency assessment tool, process, and expectations for validation of capability for both new graduate and traveler nurses
  • Adopting systems that can be applied across the full allied healthcare team; rather than nursing working within a ‘silo’ of nursing unique systems.

With a contract for the VNIP framework, model and the electronic resources, ‘the agency’ will benefit from 10 years of program development, implementation and ongoing qualitative and quantitative research. Your organization can immediately implement a research and theory-based program that has been adopted by several other regional or statewide initiatives (IHS – Navajo and Phoenix area service units; Hawaii Center for Nursing, Alaska Hospital Association, and New York State Nurses Association are some of our partners that utilize regional influence and benefits for participating agencies.)

With contract acceptance, VNIP will provide electronic resources, face-to-face instruction, and ongoing consulting services to customize the program and tools to the unique needs and challenges of ‘the agency’. VNIP will share their experience, tools and resources through a site licensing and consulting agreement that is based in a “train the trainer” model, thus increasing its impact exponentially.

At a minimum, ‘the agency’ will need to purchase site licenses for each of the participating facilities. Immediate utilization of these tools and resources requires an intensive instructional course that is offered over a 5 period. The first two days of each course role model the instruction for the basic development course, then the subsequent days target the role of the educator/manager in program implementation.