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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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

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Transition to practice
Identified need for 3 levels of nurse internship
1. New graduate transition
2. New to specialty
3. Undergraduate

Collaborative endeavor
 Nurses working with nurses to support
transition to practice
 Non-profit organization
 Ongoing outreach to others

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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

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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
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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
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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

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Preceptors – to develop Clinical capability
with emphasis on Nursing Judgment
Targeting: Analyze – Evaluate - Synthesize

Psychomotor Affective
 Develop Precision  Act upon Attitudes
 Articulation  Develop value system
 Become automatic  Organize own values
 Integrate related skills  Adopt behavior
 Naturalization  Internalize values
 Technical skills

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Preceptor Development

 How do we determine “what to

teach” in regards to development
of preceptors and clinical coaches?

What's the goal?

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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

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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

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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

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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

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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

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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
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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
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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

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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

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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

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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
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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

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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. 29-31). 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. 147-
158). 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: 10.1016/j.mnl.2017.o3.013. .
 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. 10.1097/NND.0000000000000384.
 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), 290-296. PMID: 22029239.

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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), 374-387. DOI: http://dx.doi.org/10.1016/j.burns.2013.11.008.
 Palumbo, M.V., Rambur, B., & Boyer, S. (2012). Education and employment characteristics of
nurse preceptors. Journal of Continuing Education in Nursing, 43(10):472-80. doi:
10.3928/00220124-20120716-29. 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: http://dx.doi.org/10.1016/j.burns.2017.04.017.
 VNIP. (2009, May). Vermont Nurse Internship Project Research Plan Report . Retrieved from
Vermont Nurses in Partnership (VNIP): http://www.vnip.org/documents/Report-NCSBN.pdf
 VNIP. (2017, 9 7). Clinical Transition Framework: Core Components and Evidence Base. Retrieved
from Vermont Nurses in Partnership (VNIP): http://www.vnip.org/documents/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), 15-20.

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For more information:

Explore VNIP web site & white papers:

www.vnip.org
Query VNIP Director at:
[email protected] or
[email protected]

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