289 County Road, Windsor, VT 05089

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Proposal options for “agency”June 8, 2010

Vermont Nurses In Partnership (VNIP) welcomes the opportunity to collaborate with “agency” in adopting 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 concern through implementation of a model that has evolved over the last 10 years with both summative and formative evaluation. In the process of serving new graduate and new to specialty nurses with the original VNIP internship, we learned that the concepts are equally essential for the development of students and other staff in transition. The core concepts and resources developed by VNIP support the development of critical thinking, core technical skills, clinical judgment and professional competencies. These are vitally important for developing nurse students as well as for practicing RNs seeking to transition into professional roles and new specialties. The single most important resource the transitioning nurse has is the preceptor that is prepared via evidence-based preceptor instruction and support.

Vermont Nurses In Partnership, Inc. (VNIP) is a not-for-profit public charity that develops programs and resources for supporting nurse development. The programs developed by VNIP promote a workplace culture of nurture, support and professional growth for new graduates and those in transition to a new specialty.

The strength and quality of the VNIP framework is based on current research and evolving theory. VNIP is the only initiative with a ten (10) year track record of statewide development, implementation, data collection and standardization of both new graduate and preceptor development. VNIP recognized from the start that the preceptor program was foundational to new nurse development, and as a result, no other initiative matches the focus, resource dedication, practice influence, and evolving data collection related to evidence-based preceptor development and support. A standardized, evidence-based, preceptor instructional plan is used statewide with mixed audiences from the full allied healthcare team. The content, delivery approach and program structure have been validated through delivery to over 7,000 clinical care providers, with ongoing formative evaluation and revision.

Use of the VNIP framework is simplified by its adaptability as a single framework for all orientation, development of capability and competency validation. The framework fits for both students and temporary staff, those receiving the maximum support as well as those receiving the minimum. With that foundation, VNIP has expanded the definition of “Intern” to include Nurse Students as well as those making transitions into new roles or specialties. VNIP is unique in offering evidence-based framework and resources that support development and data collection for all direct care providers from the learning phase, through orientation, to transition to new specialty services.

BackgroundIn 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). This support fostered an increased focus on data collection and outcomes reports. 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 recently completed an extensive research project that was funded by the NCSBN and the findings support a 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 related to intern/preceptor development work; including recognition of our excellence in practice by the National Nursing Staff Development Organization with the award of 2008 Excellence in Precepting Award.

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). The VNIP framework and the theoretical application of the COPA model work synergistically (Armstrong, Spencer, & Lenburg, 2009) with other nurse competency models such as Quality and Safety Education for Nursing (QSEN) or the Nurse of the Future initiative. VNIP uses continuous data collection to increase the value, safety, and effectiveness of the both the Internship and Preceptor Programs. Our qualitative data gives testimony from clinical staff regarding the positive impact of the framework and quantitative outcomes show a significant reduction in the turnover rate during the initial year of employment. VNIP has achieved nearly 90% year one retentionof all new graduates that complete the VNIP Nurse Internship, statewide. This compares very 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. 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 Framework 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. VNIP has also standardized the approach to competency assessment with statewide utilization of evidence-based forms for both development and evaluation of competence.

Serving the unique needs and challenges of the “agency”
Through this proposal, VNIP offers the “agency” immediate implementation of the VNIPevidence-based framework for preceptor and nurse intern development and support. The VNIP preceptor or clinical coaching program is an essential supporting structure for the nurse internship program that “agency” offers its new graduate nurses. The structured support for new graduates and those transitioning to new specialties is provided by preceptors or clinical coaches. These key care providers require specific, intensive preparation for their roles in coaching and evaluating new staff. VNIP has brought preceptor development into the 21st century with emphasis on evidence-based instruction, the protector role and evaluator responsibilities. The tools, resources, protocols and teaching materials from this research-based clinical coaching program are shared via a ‘train the trainer’ model, thus multiplying its impact exponentially. Formative and summative evaluation of VNIP programs has demonstrated that clearly defined expectations and clinical coaching plans provide guidance to the preceptor/preceptee team. Delivery of intensive Clinical Competence Program Development(CCPD) courses with various regional and statewide initiatives havevalidated the need for all components of the five (5) day course. The instruction provided for “agency” will include preceptorprogram development, development of a formal “Clinical Mentoring Program”and the competency assessment/coaching plans that support the work of the clinical coaching team.

VNIP encourages agencies to shift the title from ‘preceptor’ to ‘clinical coach’ because the role and expectations within the VNIP framework are far advanced from the traditional view of precepting. Clinical Coaches require specific instruction in the ‘protector’ and ‘evaluator’ roles along with other progressive concepts that are unique to the VNIP program.

Distinctive features of the VNIP framework include:

  • content requirements determined via evidence-based development
  • instruction delivered via a research and theory-based framework
  • teaching preceptors &/or clinical coaches how to foster Critical Thinking development
  • targeting nursing judgment over tasks and procedures
  • concept-based instruction, development, evaluation (as opposed to task or case- based)
  • delving into individual learning styles vs. a limited view of“principles of adult learning”
  • reflective practice, reflective learning frameworks
  • content and delivery that is appropriate for multi-disciplinary target audiences
  • using standardized competence forms and process
  • targeting clinical “performance outcomes” seen in actual practice settings
  • “raising the bar” as relates to development and performance by seeking the highest level of action verbs when describing performance expectations.
  • establishing clinical coaching tools that provide a roadmap for the learning team
  • evaluation tools and process that have the potential for regional/national benchmarking

VNIP will customize the course curriculum for “agency”to address the full continuum of transition. Boychuk’s Transition Stages Model (Boychuk-Duchscher, 2008) shows the progression of new nurse development over the initial twelve (12) months of practice. During the first three (3) months or “transition shock” period (Boychuk-Duchscher, May 2009), the Clinical Coach protects the patient and the novice care provider while developing and validating basic competent practice in the new nurse. Once basic competency is established, Clinical Mentoring offers continuedsupport, development and validation of capability. This ongoing support establishes a firm foundation upon which sound nursing judgment is built. By ensuring structured support through the full continuum of transition, “agency” will advance the level of practice of the new graduate along Benner’s novice to expert framework (Benner, 1984). This progression is dependent upon the workplace culture and the preparation of the ‘clinical coach’. VNIP will adjust the consulting contract, work plan and fees to customize this contract to the specific needs and challenges as defined by the “agency” Project Management Team. The CCPD course outline includes writing clinical practice competency expectationsthat are the foundation of performance outcomes expectations. The courseincludes resources and framework for both nurse intern and preceptor development. Participants willdelve into the clinical mentoring role and the programming needs required for supporting new graduates through a full year of practice.

Initial contract This section lists the potential services that VNIP can and does provide. What is included in the pricing proposal for your agency will be determined through discussion with the VNIP Executive Director and detailed in the final summary proposal.

Contract development

Core components of a contract proposal will include:

1. A site license which gives access to, and the right to reproduce, the tested tools and resources developed and validated by VNIP. Data collection, benchmarking and reporting services is included with the site license. VNIP makes available data collection and benchmarking via web-based survey tools. These tools provide for ongoing data collection related to satisfaction, competence development, workplace impact, etc. Periodic reports are provided with comparison to benchmarks from regional and demographic groups.

Licensingfees for the VNIP electronic manual and data collection vary according to the size of agency. Thefee schedule is based on RN Full Time Equivalency (FTE) numbers. We do not count per person impacted, although that is the actual benefit of the site license. Using the FTE count for the cost calculation allows two half time employees to count as one FTE. This FTE number does include managers, educators and RNs in other nursing support roles.

When calculating cost benefit, you would divide the total cost by all those that benefit from the preceptor and intern development resources and tools. This number includes all new hires, current staff and students from the full allied healthcare team. The impact of the framework is felt by patients, their families and the communities as these staff members apply the core communication, interpersonal and teaching/learning theory and practices to support safety and quality of care.

Annual Site license renewalbrings benefits that include: a selection from at least two new advanced development workshops each year; structured frameworks for specialty unit or undergraduate internships; access to newsletter articles pertaining to training and development; web availability of all updated materials as they are completed or added to the resource files; and models for formal electronic, clinical and professional mentoring programs.

2. Project management assistance includesteleconference and cyber-consulting that offers individualized support, and the opportunity to bypass the ‘speed bumps’ experienced by VNIP and/or other adopting agencies. This is best accomplished with a monthly fee that includes project management, work plan development, monthly teleconference meetings as scheduled and ongoing cyber-consulting wherein participating sites can send questions and/or revised documents for review and recommendations from VNIP Faculty. This work allows agencies to develop a project work plan, reinforce their understanding of the framework, receive advisement during customization of tools, and benefit from the multitude of “lessons learned” via project implementation across the continuum of care, across the nation.

3. The Basic Preceptor Development, Intensive CCPD Course, &/or individualized consulting serviceswhich are essential for understanding how the framework components fit and work as an integrated framework. This coursework includes research-based staff development concepts and educational theory. You may choose to contract for annual intensive courses which bring newly- assigned and transferring educators and managers into an understanding of the concepts, theory and implementation of program components. Annual updatesalso provide memory re-activation regarding concepts that are core to the programs; introduce new and evolving concepts related to experiential learning; provide instruction regarding advanced preceptor courses; discuss implementation issues of electronic, clinical and professional mentoring; address problem-solving for issues faced within your agency and review other annual renewal components.

The contracted consulting and/or instructionvaries based on specific request, number of faculty required, incidental costs/requirements & contract agreement.

Travel Expenses - Consulting travel expenses can be calculated into the final contract price or paid upon submission of receipts. Travel includes transportation, meals, lodging, parking & mileage reimbursement.

The fundamental values of Vermont Nurses In Partnership includeContinuous Development, Collaboration, andEvidence-basedpractice. With this in mind, we have established a national forum of nurse leaders who target ‘transition to practice’ support and resources. We welcome your“agency” within this network as we continue to develop and evolve both resources and data collection.

Each contracting agency will receive a CD-Rom with electronic files as detailed below. Most forms are saved in MS Office Word format, presentations saved in PowerPoint, so they can be easily customized or adapted. Contents of CD may not be printed or copied unless site license is purchased.

The minimal hardware requirements include: Computer with CD-Rom drive, Windows XP or later version, MS Office 2003 or later version, and printer. Basic Internet access is required for survey data entry and web-based information access.

Available Deliverables include all items listed below. Each underlined section needs to be delineated within the contract that is developed for your agency.

1. ELECTRONIC FILES - RESOURCE MATERIALS FOR COMPETENCE DEVELOPMENT

  • Tools for both development and assessment of competence
  • A proven system for competence assessment that fits for orientation of all new hires while providing the support needed for new graduate or new-to-specialty care providers.
  • A universal competence assessment tool that is used for all direct care registered 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 competency/coaching tools as developed for various VNIP partners
  • Templates of foundational resources such as policies, job description, and performance appraisal documents that are based on the same competence assessment expectations.
  • Guidelines for “transition to practice” model based upon VNIP implementation, research, and formative evaluation in multiple agencies across the continuum of care
  • Templates for clinical coachingand mentoring program structure/foundation
  • Examples of protocols used to support effective program delivery
  • Templates forpreceptor job description, performance evaluation tools, teaching plans and other contact hour application documents
  • Guidelines for “preceptor development and support”model based upon 8 years of utilization and formative evaluation via statewide standardized instructional model.
  • Recommendations for transition & preceptor support programs based on learnings from multiple agencies; multiple healthcare settings across the continuum of care
  • Summative and formative evaluation
  • Survey tools for evaluation of preceptor, learner, and program
  • Tracking documents and process for new hire nurse retention
  • References and feedback based on VNIP experience with project and data collection
  • Workplace Assessment tool – seeks data on workplace support for transition process
  • Framework and resources for teaching preceptors via an evidenced-based model
  • Teaching plan and supporting documents for 18.5 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
  • Differentiation between the role/responsibilities of the coach and the clinical mentor.

2. INSTRUCTION IN HOW TO IMPLEMENT WITHIN A PROVEN, EFFECTIVE FRAMEWORK