Clinical Transition Framework Lessons learned from statewideregional Nurse

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Clinical Transition Framework: Lessons learned from statewide/regional Nurse Internship & Residency Programs Vermont Nurses

Clinical Transition Framework: Lessons learned from statewide/regional Nurse Internship & Residency Programs Vermont Nurses In Partnership Susan A. Boyer, DNP, M. Ed. , RN 1 © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip. org

VNIP Collaborative approach • Origins: Nurse leadership group • Inclusive of practice settings, specialty

VNIP Collaborative approach • Origins: Nurse leadership group • Inclusive of 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 2 © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip. org

Transition to practice Identified need for 3 levels of nurse internship 1. New graduate

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 Non-profit organization Ongoing outreach to others 3 © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip. org

This PP gives an overview of what we’ve learned from: • Nearly two decades

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 © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip. org 4

Protocols and Data collection Clearly Defined Roles Preceptor Instruction & Support Intern, Student, Orientee

Protocols and Data collection Clearly Defined Roles Preceptor Instruction & Support Intern, Student, Orientee Development © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip. org 5

Protocols & Surveys Clearly Defined Expectations Preceptor Support • Evidence-base • Evaluation • Support

Protocols & Surveys Clearly Defined Expectations Preceptor Support • Evidence-base • Evaluation • Support systems • Policies – orientation, student, preceptor, competency • Performance criteria • Competency Tools • Coaching Plans • Instructional Strategies • Basic Instruction • Resources to support role • Ongoing skill and • Critical Thinking Development 6 © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip. org

7 © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No

7 © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip. org

8 © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No

8 © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip. org

Why Preceptorship? • Builds one on one relationship • Improves satisfaction, retention, and orientation

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 9 © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip. org

Why mentorship? • Ongoing development of clinical capability • Support through 2 nd &

Why mentorship? • 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 10 © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip. org

Transition to practice • Clinical Transition Framework (CTF) • Requires core competency development •

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 11 © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip. org

Preceptors – to develop Clinical capability with emphasis on Nursing Judgment Targeting: Psychomotor Analyze

Preceptors – to develop Clinical capability with emphasis on Nursing Judgment Targeting: Psychomotor Analyze – Evaluate - Synthesize Develop Precision Articulation Become automatic Integrate related skills Naturalization Technical skills Affective n Act upon Attitudes n Develop value system n Organize own values n Adopt behavior n Internalize values 12 © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip. org

Preceptor Development • How do we determine “what to teach” in regards to development

Preceptor Development • How do we determine “what to teach” in regards to development of preceptors and clinical coaches? What's the goal? 13 © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip. org

The goal statement: Preceptors will collect evidence of clinical capability of the novice care

The goal statement: 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 14 © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip. org

To develop capability • Preceptor roles & responsibilities • Effective Communication and Interpersonal Skills

To develop capability • Preceptor roles & responsibilities • Effective Communication and Interpersonal Skills • Use of case scenarios, story-telling, practice with difficult situations • Collaborative team approach • Relationship-based process, Interpersonal issues, conflict management, Socialization • Teaching and learning theory • Learning styles, novice to expert • Principles of adult learning, simple to complex, success builds success • Fostering critical thinking skills 15 © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip. org

To validate capability • Outline and define “competent practice” • Nurse practice act, job

To validate capability • Outline and define “competent practice” • Nurse practice act, job descriptions, orientation tools • Delegation, accountability, liability • Procedures, protocols & policy statements • Providing safe and effective care – protection • Performance management • Communication & feedback • Assessment & evaluation of capability • Data collection • Validating performance, collecting evidence, complete documentation 16 © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip. org

Preceptor Roles and Responsibilities © 2003 - 2019 Vermont Nurses In Partnership, Inc. All

Preceptor Roles and Responsibilities © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip. org 17

Preceptor development Preceptor Development & Support Multi-disciplinary approach Need to: Revise/update the preceptor model

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 18 © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip. org

Core Concepts: Clinical Transition Framework • Theory and evidence-based • Competency-based – COPA model

Core Concepts: Clinical Transition Framework • Theory and evidence-based • Competency-based – COPA model • Concept focus rather than task, procedure, system-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 © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip. org

Program Outcomes: • Clearly Defined Expectations – for both Preceptor and each newly hired

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 define responsibilities, roles, process & tools 20 © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip. org

Program Outcomes: • Standardized competence expectations • Logical, simplified, consistent, objective • Clinical performance

Program Outcomes: • Standardized competence expectations • Logical, simplified, consistent, objective • Clinical performance outcomes instead of traditional grocery list of “tasks & procedures” • Concept-based vs. task-oriented • Engages sampling and accountability theories • Prioritizing aspects of professional practice: caring relationships, leadership, management, critical thinking, judgment, clinical reasoning 21 © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip. org

Program Outcomes: • Preceptor program impacts workplace culture • Evidence-based, standardized preceptor development /

Program Outcomes: • Preceptor program impacts workplace culture • Evidence-based, standardized preceptor development / support for allied healthcare team • Concepts & framework applicable for full continuum of care • Universal performance expectations for all • Focus on Preceptor’s role of ‘Protector’ for the patient and new graduate • Guides performance data collection – Competency Validator 22 © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip. org

Alliance for Clinical Transition Support (ACTS): Agency membership provides & delivers Competency & Preceptor

Alliance for Clinical Transition Support (ACTS): Agency membership provides & delivers Competency & Preceptor Program tools, templates and teaching resources Proprietary rights to all tools and forms Defining roles, survey tools and protocols Teaching tools - how to foster critical thinking Tools for competency assessment & clinical coaching Power. Point Presentations, activities, notes, and more for preceptor development 23 © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip. org

ACTS Collaborative Outreach Consulting services & collaborative group • Guidance related to framework, core

ACTS Collaborative Outreach Consulting services & collaborative group • Guidance related to framework, core concepts, & process • Instruction specific to use 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 24 © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip. org

Clinical Transition Framework: Tools, theory and process • • • Preceptor development and support

Clinical Transition Framework: Tools, theory and process • • • Preceptor development and support Competency based evaluation – COPA model Clinical coaching tools • • • Outline of standardized knowledge for each specialty/goal Clear, concrete, & concise performance criteria Learning strategies for accomplishing performance goals Critical thinking & Clinical Judgment development Concept focused rather than task-oriented 25 © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip. org

Clearly Defined Roles Protocols and Data collection Preceptor Instruction & Support CTF Supports development

Clearly Defined Roles Protocols and Data collection Preceptor Instruction & Support CTF Supports development of: Intern, Student, Orientee Development 26 © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip. org

References • Boyer, S. , Mann-Salinas, E. , Valdez-Delgado, K. , & Van. Fosson,

References • Boyer, S. , Mann-Salinas, E. , Valdez-Delgado, K. , & Van. Fosson, C. (2019). Using the Delphi technique to determine core components of a Nurse Competency Program. Journal for Nurses in Professional Development , Pending. JNPD-19 -017 • Boyer, S. (2018). Core Curriculum for Clinical Coaching: A Preceptor Workbook, 6 th. Ascutney: Vt Nurses in Partnership. • Boyer, S. (2017). Clinical Transition Framework: Efficient solutions for transitional support systems. Nurse Leader , Doi: 10. 1016/j. mnl. 2017. o 3. 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. 1097/NND. 0000000384. • Boyer, S. (2011). VT Nurses in Partnership: Developing nurses competence within a complex, high-acuity healthcare environment. In A. M. Bushy, Rural Nurse: Transition to Practice (pp. 147158). New York: Springer Publishing Company. • 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, 27 and patient safety. Nursing Education Perspectives, , 32 (5), 290 -296. PMID: 22029239. © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip. org

For more information: Explore VNIP web site & white papers: www. vnip. org Query

For more information: Explore VNIP web site & white papers: www. vnip. org Query VNIP Director at: sboyer@vnip. org or sb. vnip@gmail. com 28 © 2003 - 2019 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. sboyer@vnip. org

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