The Development of the Evidence-Based Nurse Internship Program

The impetus for developing the Nurse Internship program was the growing deficit of nurses, with projections anticipating a supply of  36% fewer than needed by 2020.  Vermont is a small, rural state that does not reimburse nurses as well as some of the larger neighboring states.  While recruitment endeavors were ongoing over the course of the project, the nurse leaders targeted retention for the initial collaborative effort.  The work was funded by grants and hospital association support until 2003, when the Health Resources Services Administration funded expanded implementation. 

The internship framework is founded upon research and theories that include current studies & data collection, literature search results, consults and queries to the ‘experts’ in various specialties, Dreyfus model of ‘skills acquisition, Benner’s novice to expert theory.  It also utilizes Teaching/Learning, Critical Thinking, group dynamics, communication, leadership, team building, training & development theories and ‘best practices’.   The workgroup that designed the framework included representatives from academia, regulation and practice settings from across the continuum of care.  Thus the foundational requirements of the Vermont Nurse Practice Act, Standards of Practice for specialty services and various Accreditation organizations are incorporated within program structure.  Its major components and concepts include Preceptor delivery - with a focus on preceptor development and support; Clearly defined expectations – performance outcomes based on Lenburg’s Competency Outcomes Performance Assessment (COPA) model; and Evidence based – data collection, evaluation, and foundational protocols.   The core work of the internship was developing competencies and a manner to assess them.  Benner’s novice to expert designations structured the process.  All practice areas contributed specific subskills for each of Lenburg’s eight core competencies, with the result of a universal competency tool that could be used in nearly all direct care settings.