The VA Learning Opportunity Residency (VALOR) program is a prelicensure experience with a nurse preceptor for rising senior students enrolled in a bachelor of science in nursing program. Students must have a minimum 3.0 grade-point average to apply. The program provides 800 hours of paid learning experiences in diverse didactic and hands-on clinical situations. The first 400 hours of the program (10 weeks) occur over the summer, and the second 400 hours take place during the fall and spring semesters of the student’s last year of school.1 During the last 400 hours, students are placed in the areas they are interested in working as new graduate nurses.
The aim of the Salem VALOR program is to develop the next generation of VAMC nurses by recruiting new graduate nurses. The Salem VAMC structures the VALOR program to meet the needs of both the students and the facility. According to Glenda Fuller, the student programs manager for the VA, national VALOR retention rates from 2007 to 2011 have averaged 38%. However, more applicants apply for new graduate nurse positions than are available. Included in the VHA Directive 2011-039, facilities that hire a nurse with ≤ 1 year of experience must enroll them in a yearlong transition-to-practice program.2 Therefore, facilities may limit the number of new graduate nurse positions.
On entry into the VALOR program, participants write a journal entry regarding their fears and concerns about becoming a new graduate nurse. In addition, each student turns in a written reflection about their experiences each week and participates in daily group discussions with the program coordinator. The last day of the summer portion of the program, students again write about their fears and concerns about becoming a new graduate nurse. After reviewing the VALOR journals, conducting focus groups, and taking notes during the daily meetings, the authors describe the following VALOR experience from the summer of 2013 at the Salem VAMC.
Preparing New Graduates
Hospitals are under pressure to provide high-quality nursing care despite hiring new graduate nurses who are unfamiliar and inexperienced in caring for patients’ complex health care needs. New graduate nurses currently make up more than 10% of hospital nursing staff, and that number is expected to grow as baby boomers retire.3 Boswell and colleagues suggest that those new graduate nurses are unprepared for the registered nurse role.4 Identifying strategies to facilitate the transition from student to the new graduate nurse role will likely decrease attrition rates and increase the effectiveness and the quality of patient care. Nursing programs, such as the VALOR, can ease the transition from the classroom to the working environment.5
This result is evident when observing how VALOR students enhance their nursing skills after the 10-week summer program. VALOR participant Andrea King published her summer experience at the Salem VAMC in The Torch, the Virginia Nursing Students’ Association newsletter.6 “I had so much practice and eventually confidence in my nursing skills,” she wrote, “that I had the autonomy and independence to feel like I was working as an actual nurse.”6
The VALOR Experience
During the summer months, senior nursing students have the opportunity to go on rounds with the chaplain, work with nurse practitioners, attend outings with mental health patients, participate in home health visits, interact with patients in groups, and rotate to different hospital units. Students attend FranklinCovey classes (which specialize in employee performance improvement), participate in an evidence-based practice (EBP) project (which helps them to learn about teamwork), and collaborate with interdisciplinary health care professionals. At the end of the summer, students present their team EBP project to the nurse executive committee. Presentation experience assists students in acquiring public speaking skills. Students are nervous about presenting to a room full of executives. However, they learn to depend on one another and to strengthen weaknesses and build on strengths.
When high-performing students come together as one cohort, this dynamic poses challenges for the VALOR participants. One student described her vulnerability in relation to her VALOR peers as “the hardest hit to my self-confidence has been working with such intelligent and accomplished cohorts.” Another student found that even though she was at the top of her class, working with the other VALORs “challenged her self-confidence” because all the program participants were high-performing students. She found it pushed her to perform better. One person reflected, “I feel the VALOR experience has really given all of us the opportunity to unleash our full potential. I have no doubt that these students will become future health care leaders.”
Building Skills