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Nurse Internship Program Uses a Statewide Coalition to Succeed

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By Amy Siroky, contributor

With the goal of alleviating an impending nurse shortage, the creators of the Vermont Nurse Internship Program (VNIP) have created an impressive statewide project that offers gradual clinical experience to new graduates and allows them to transition successfully into a clinical setting.

It All Started With A Report

In 1998, the Vermont Organization of Nurse Leaders [VONL] along with the Vermont Association of Hospitals and Health Systems [VAHHS] commissioned a study to determine nursing issues in relation to health care staffing in Vermont.

What they found gave them little reason to celebrate: "With both increasing demand and decreasing supply combining forces today, a serious nurse shortage is likely in the not-so-distant future," stated the December 1998 Report on Nursing in Vermont.

This led to a further report in early 1999 that was titled The Current State of Nursing in Vermont from which six strategic goals were developed to help ease the anticipated shortage. Two of these goals became the platform for the Vermont Nurse Internship Program (VNIP), which included establishing the internship program and the preceptor, or mentor, program.

The Vermont Organization of Nurse Leaders [VONL] pursued a grant and amazingly received funding fairly quickly through the Southern Vermont Area Health Education Center [SVAHEC] to begin the project.

That's where Susan Boyer, RN, M.Ed., came in-initially hired on a half-time basis. Five years later, she is a more-than-full-time care taker of the program in her role as project director.

Less than a year after the issuance of the Report on Nursing in Vermont, Boyer facilitated the first full task force meeting in November of 1999 with 25 people from a variety of backgrounds-nurse leaders from facilities, nursing schools, and regulatory agencies. While Boyer was initially daunted at the task of managing the group, it worked, she feels, because development and decision-making was by consensus.

"We got everyone's input that we could possibly solicit. Vermont being Vermont, the word got out and people wanted to participate," Boyer said.

The task force met several more times and the next summer the first internship pilots took place. Boyer initially hoped for an initial group of 10-20 interns at two hospitals.

But the overwhelming response provided 55 interns at four hospitals: 26 ADN students, 27 BSN students, and 2 MSN students. Twenty-eight students were from within Vermont, and 27 from other states. The internship proved to be an incentive for out of state students to accept positions with the facilities.

The results helped ensure the program would stay. Comparisons of pre- and post-pilot surveys completed by managers, supervisors, coworkers and preceptors demonstrated that participants felt there were significant improvements [approximately 40 percent improvement] in the competency development process for the new grads.

In addition, retention rates skyrocketed. Pre-internship, retention of new grads was at an acceptable 75 percent rate for year of hire retention. Post internship, the rate was at well above 90 percent, for both the 2000 and 2001 internship programs.

Resources To Make It Work

While the program has been in place for almost five years now, its funding has also made strides to make it more secure. The initial funding from SVAHEC was extended for several months when federal funding was not granted, and then the hospitals covered the expenses for several months.

When the Vermont Department of Employment received an H1B grant-money at a federal level that was for specialty care internships that were to be preceptor-based-it was natural to turn to the group that was already working with preceptor development. The result being that VNIP contracted to develop and deliver the preceptor education for this new initiative. This funding continues to support the expenses of preceptor workshops through the end of 2004.

Typically, staff development and training is often provided in a "just enough and just in time" environment. The H1B funding allowed Boyer and the other VNIP leaders to reflect on what they wanted the preceptor program to be with an understanding of why and how it will work. The result was a model that was thoroughly-and excellently-developed. The VNIP models are now utilized by other organizations desiring to develop mentor/preceptor and nurse internship programs.

Funding has been a significant issue for the program. The preceptor must have educational support in assuming their role, just as does the nurse intern. Because the preceptor's caseload is adjusted based on the fact that they are working one-on-one with a nurse intern, an additional burden is placed on the staff to ensure acuity rates are managed.

More recently, Boyer and VNIP were successful in the pursuit of federal funds, receiving a grant through the Health Resources and Service Administration (HRSA) an agency of the Health and Human Services Department, and the Department of Education. This funding guarantees them that the program will have continuity at least through 2006.

How The Program Works

Under the program's model, a "preceptor," or mentor/teacher, is utilized to partner with the new graduate. The new graduate initially shadows the preceptor, performing some nursing functions. Continued education of the new grad occurs over the internship as well, and the new grad slowly assumes a standard case load of patients. The preceptor receives training in advance of the internship in order to understand the interpersonal, communication and teaching/learning issues that they face. The workload expectations are adjusted so that the preceptor and/or unit educator have the time needed for developing and validating competent practice in the novice nurse.

Boyer clarified some of the original intention of the program: "Would you want a medical school graduate to be the physician caring for you and your family without his having had an internship and/or residency? Shouldn't we provide the same sort of mentored support and experience for Registered Nurses? They carry many similar life-sustaining assessment, treatment, and decision making requirements within their scope of practice."

The interns can include undergraduate and graduate level participants. Effort is now ongoing to expand to specialty care internships in the areas such as ICU, OR, Home Care, Public Health and other fields.

Five Years Later

With the program now in full swing, Boyer remains in touch with all the participating facilities on at least a weekly basis. The project currently includes 15 Vermont hospitals, four nursing homes, six Visiting Nurse Associations and twelve public health offices participating at some level. Many facilities include information on their Web sites or in advertising and utilize this as a draw for new graduates. Before VNIP, one facility had a Med-Surg unit with continued vacancies at the 20 percent rate and they now have a 0 percent vacancy and have eliminated their budget for advertising and recruiting. They attribute this change to the internship/preceptor program.

The greatest challenge, Boyer feels, has been getting people to attend meetings and maintain communications-time and work pressure exists for all of them. They've tried to solve it by creating a strong virtual community and communicating consistently through e-mail and the web site established at VNIP.org. The Internet has expanded their horizons as Boyer's mailing list now includes 80 people internationally who are involved in internships and preceptor development.

But the shared effort of the Vermont nurse leaders throughout the state can't be discounted, Boyer insists. Representatives from academia, practice settings, and regulatory agencies all participated, including nurses from across the care continuum.

"It's been great how the nurse leaders in Vermont are willing to give their all consistently. The air of collaboration is fantastic," Boyer states.

Boyer feels Vermont is a unique place for a statewide program like this to succeed.

"We're small enough to ensure a standardized pilot, but large enough to provide a really significant sampling," she said. "With information about the Vermont project available in cyberspace, she receives frequent requests for sharing the program with facilities or regions or organizations looking for help starting a similar program.

The VNIP is unique as the only program of its sort offered at a statewide level; collaboratively developed with representation from education, agencies, and regulation; and crossing the full continuum of care. Boyer said. "People ask me 'Collaborate with the hospitals in my area? We compete with them. I say how can you not collaborate-it builds strength, value, and quality." With national recognition-the national council of the state board of nursing wants to conduct a research project on the program-Vermont's Nurse Internship Project stretches boundaries beyond the state lines.

For more information on the Vermont Nurse Internship Program, visit their Web site at VNIP.org or contact Susan Boyer at EMAILsusan.boyer@hitchcock.org.

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