Which place would you choose to work

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Which place would you choose to work?

• Welcoming, nurturing and supportive
• Educated, skilled, interested, and assigned
  preceptor
• Coordinated, clear curriculum and process
• Competency checklist, graduated skills
  demonstration
• Team work and collaboration in a positive
  environment

• Initiation by fire
• Different preceptors every day
• Unclear process
• Assumptions of what skills should be
• Frustrated, irritated, and harried staff

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Vermont Nursing Internship Program
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Goal

• It is the goal of the Vermont Nursing Internship
  Program to support the novice nurses entry into
  practice, their growth along the continuum of
  expertise, and their professional practice within
  the complex and demanding field of healthcare.
  The Vermont Nursing Internship Program is a
  program designed to improve access to quality
  health care and strengthen the nursing work force
  by providing new nurses the clinical and
  leadership skills needed to practice in existing
  and emerging organized health care systems.

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Translation

• Build a nurture chain with a research-based,
  effective process to
• Assess novice nurses needs
• Guide and nurture skills development at an
  accelerated rate
• Attract and retain new nurses

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Problem Statement

• Vermont is a rural state with only one urban
  Medical Center that serves a widely spread,
  medically underserved population.
  Community-based healthcare is delivered through
  the rural community hospitals and home care
  centers. The Vermont Organization of Nurse
  Leaders has identified the following trends,
  which negatively impact the current state of
  nursing practice
• A nursing shortage, which complicates the
  transition of graduate nurses in the workplace
• Increasing patient acuity, complexity and
  demands on nursing and
• An increased need for nurses as elderly
  population increases

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Translation

• Its a sad state of affairs!
• Decreased clinical experience for nursing
  students
• Nursing shortage in clinical practice
• Increased patient acuity in all settings
• Increased need for nurses as population ages

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The Vision

• The Vermont Board of Nursing, schools of
  nursing, and practice sites work in a
  collaborative statewide partnership to maintain a
  nationally recognized Nursing Internship Program.
  The internship is available in multiple settings
  and supports the transition from new graduate
  nurse to a self-confident, adaptable, and
  independent professional

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Background

• Report on Nursing, Toni Keading for the Vermont
  Association of Hospital and Health Systems, Inc.,
  and the Vermont Organization of Nurse Leaders,
  December 1998
• In Vermont
• Average age of nurses 45 in 1997
• 72 of nurses over age 40
• 36 fewer graduating nurses than in 1994
• No growth in RN wages over past 5 years
• Majority of nurses prepared in 2, rather than 3,
  years
• More complex practice environment
• 84 of licensed nurses in practice

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Current State of Nursing in VermontVermont
Organization of Nurse Leaders and the Vermont
Association of Hospitals and Health Systems, May
1999

• Strategic Solutions
• Create a blue ribbon panel to address nursing
  shortage
• Marketing to recruit students into nursing
• Improve workplace environment
• Conduct internship program for new nurses
• Create internship program for new nurses
• Expand clinical educational opportunities for
  students

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Southern Vermont Area Health Education Center
Grant for Pilot Program

• Hired Susan Boyer as Director
• Formed Vermont Nursing Internship Consortium
• Formulated mission and vision
• Formed subcommittees
• Models/Competency
• Preceptorship
• Outcomes
• Funding/Sustainability
• Web page and communications network

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Vermont Nursing Internship Consortium

• 62 Key Nursing Leaders throughout the states of
  Vermont and New Hampshire
• Vermont State Board of Nursing
• Area Health Education Center
• Southern Vermont Health Education Center
• All colleges and schools of nursing in Vermont,
  as well as one (1) school of nursing in New
  Hampshire
• Two (2) VNAs
• Fifteen (15) hospitals

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Committees

• Competency curriculum
• Preceptor education and certification
• Outcomes evaluation
• Funding and sustainability investing in our
  future

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Model

• Internship Curriculum
• Core classroom education
• Precepted clinical experience following the
  foremost competency research by Carnie Lenburge
  in the COPA model
• Preceptor Education, Support and Certification
• Outcomes Evalution
• Statewide Consortium of Nurse Leaders

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Introductory Experiences

• General orientation
• Discharge planning
• Roles and responsibilities of interdisciplinary
  team

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The Nurture ChainRoles and Responsibilities

• Clinical Educator
• Coordinates and/or leads core classroom
  experiences
• Supports, develops, and verifies competence of
  the preceptor
• Coach to preceptor/intern dyad
• Documents readiness for preceptor certification

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The Nurture ChainRoles and Responsibilities

• Preceptor
• Develops goals and objectives in collaboration
  with the intern and clinical educator
• Assesses interns experience level and learning
  style plans learning experience accordingly
• Chooses patient assignment based on educational
  goals and objectives
• Shares patient assignment by progressively
  delegating patient care responsibilities to the
  intern
• Acts as a role model for the intern adheres to
  nursing policies and procedures

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The Nurture ChainRoles and Responsibilities

• Preceptor (cont.)
• Assists the intern in organizing and prioritizing
  daily patient care routines
• Provides daily feedback to the intern and
  documents goal development/achievement weekly
• Collaborates with the clinical educator and nurse
  manager to evaluate progress and address issues
• Provides a written evaluation to the intern at
  the conclusion of the internship
• Completes preceptor educational process to
  prepare for role

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COPA Model developed by Carrie Lenburg, EdD, RN,
FAAN

• Competency
• Outcomes
• Performance
• Assessment

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COPA Model

• 8 Core Practice Competencies
• Assessment and intervention skills
• Communication skills
• Critical thinking skills
• Human caring and relationship skills
• Teaching skills
• Management skills
• Leadership skills
• Knowledge integration skills

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Competence Verification Form
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Initial OutcomesPre and Post Satisfaction Survey

• Pre Post of change
• A support environment was
• Provided for transition to practice 2.26 3.91
  33
• Colleagues, managers, and
• educators were confident in the
• interns competence and capability
• during the first year of practice 2.25 3.67
  28
• Process for transition to practice
• was comprehensive, effective,
• structured, and well communicated 2.37 4.03
  33

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SO WHAT!!!

• Which environment do you work in...

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Watch Us Grow

• Vermont, Michigan, Alaska, Arkansas, Wisconsin,
  New Hampshire, Indian Health Services, Acute
  Care, L.T.C., VNA, Public Health
• Its a model that works and can be translated
  for other disciplines