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
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
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
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
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
"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
"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.firstname.lastname@example.org.
© 2004. AMN Healthcare, Inc. All Rights Reserved.