The transition from student to a real-world job setting can be difficult in any arena, and that is certainly true for the nursing profession, where the potential for reality shock among new nurses is significant. In an effort to ease that transition for newly graduated registered nurses (RN) entering the workforce, as well as augment the number of nurses joining the ranks in caring for the nation’s veterans in Department of Veterans Affairs (VA) health care facilities, the VA Learning Opportunities Residency (VALOR) program provides nursing students an opportunity to enhance their skills in a VA health care setting. And, the VA looks for a significant percentage of program participants to stay on and begin their nursing careers in the VA, helping to stem the current and projected nursing shortage.
The VALOR program was initiated in 1990, according to program specialist Glenda Fuller, PHR. “This is a program that provides unique learning opportunities for outstanding students,” she said, adding that participating students must have a 3.0 GPA and have completed their junior year in an accredited baccalaureate nursing program. Selected candidates for this paid internship work in an approved VA facility a total of 400 hours during the summer months, and they can work an additional 400 hours spread over their senior year while accommodating their school schedule. Currently, 124 VA-approved health care facilities participate in the VALOR program, Fuller said, and since 2007, the program has seen 5,197 nursing student participants.
Nursing students in the program engage in didactic or classroom experiences, clinical conferences, and competency-based clinical practice with a qualified RN preceptor. “Each one of the [participating] facilities has a different curriculum,” explained Patrick Youngblood, DBA, SPHR, Health Professional Scholarship program manager and VALOR program manager. The students work with a preceptor on an assigned unit, but also may have the opportunity to rotate to other specialties for additional learning experiences. For example, he said, “Maybe it’s a [medical-surgical unit], or maybe they do some rotations in psychiatry or telemetry, or whatever the other disciplines are at the hospital.”
The students gain valuable experience in the VALOR program, augmenting traditional classroom instruction, Youngblood said. While they learn skills in nursing school, for example, how to start an IV, he said, “By the time you pass the NCLEX [National Council Licensure Examination – a nationwide examination for the licensing of nurses] and go out there, it’s totally a different environment. This [program] brings you into that environment to experience nursing in a real-world setting.”
“The VA affords them the opportunity to get real-life experience with a preceptor and a developed curriculum to hone their skills,” he said. “Not only are they coached and mentored about their bedside [skills], but they also learn and get the experience of being in the different units within the hospital in a training environment.”
Additionally, “Those 800 hours that an individual can add to their resume enhances their hireability,” said Youngblood. “Whether it’s at the VA or in the private sector, it’s just valuable training that they’ve received to make them more marketable.”
A research study reinforces the program’s value to nursing students. In a July 2016 article published in the monthly, peer-reviewed clinical journal Federal Practitioner titled “The Unique Value of Externships to Nursing Education and Health Care Organizations,” study authors Debra Shipman, PhD, RN, Jack Hooten, MHA, MSN, RN, and Linda Lea, MBA, PA-C, “investigated RNs’ experience in the VALOR prelicensure externship during the nurses’ senior year of coursework and the impact of this experience on their nursing practice,” according to the abstract. In their discussion of findings, they wrote, “The present study found that nursing students who had been in the VALOR externship felt confident in their clinical skills when they were transitioning to the RN role. Other studies similarly have found that externship students were self-confident assuming the RN role, owing to their additional clinical experience. … The RNs interviewed in the present study discovered that, unlike nursing school, VALOR provided a realistic view of full-time work as an RN.”
The VALOR program also provides benefits to the VA. “The reason the program was established was to create a pipeline of newly graduating students to fill vacancies throughout the VA,” Youngblood explained. Currently, the retention rate for program participants to stay with the VA after graduation is 47 percent. “Some changes were made probably two to three years ago to increase that number,” he said. “The VA’s point of view is that we would like to see that retention rate exceed 60 percent, so the facilities that participate in the program are encouraged, or almost mandated, to sign a commitment-to-hire letter stating that they will hire their students. Therefore, we anticipate that that retention rate will change over the next couple of years.”
In addition to a source to fill nursing vacancies, Youngblood explained that the VALOR program helps to fulfill the mission of the VA Office of Academic Affiliations. That mission, according to the VA, is to conduct “an education and training program for health professions students and residents to enhance the quality of care provided to veteran patients within the Veterans Health Administration (VHA) healthcare system. In accordance with this mission, ‘To educate for VA and for the nation,’ education and training efforts are accomplished through coordinated programs and activities in partnership with affiliated U.S. academic institutions.” “We mirror their goal in the mission to educate and train those students,” Youngblood said. “Our hospitals that have these affiliations with the universities thrive off of that relationship with the university.”
Moreover, prospective employers at VA health care facilities are able to become familiar with VALOR participants’ skills and strengths while they are students, allowing for the most appropriate hiring and placement decisions, Youngblood added.
One of the specific challenges regarding the VALOR program, Youngblood explained, is that “most of these are in urban locations, where the universities are. So, as with the rest of medicine, we have challenges in the rural locations with this program,” he said.
Additionally, Youngblood said, “Hiring students at VA facilities prior to them passing their NCLEX can be a challenge,” highlighting efforts to educate the facilities about utilizing all the available hiring flexibilities.
“There’s a high turnover in human resources,” he said, “so we always endeavor to inform and advise them of the hiring practices and encourage them to get involved in hiring these individuals.
“The process to credential a newly licensed nurse can sometimes take longer than what a recruiter or a new candidate might want,” he added.
Fuller elaborated, “The facilities now provide the next step for when the students graduate,” she said. “For instance, we have some facilities where [participants] go directly from being a valid student to being a graduate nurse technician until they become licensed. And once they become licensed, then they rotate into whatever that next logical step is at that facility, whether the ‘transition to practice’ program or whatever specific program they have at that facility to help them better become prepared to be an RN.”
Typically, Fuller indicated, there are more applicants than can be accommodated in the program. “I have facilities that will normally say, ‘I have two slots and I have 40 applicants,’” she said. For fiscal year 2020, Fuller noted that 259 nursing students are approved for the VALOR program.
“What I think would surprise someone is that we don’t have to do that much advertising for the VALOR program, because normally word gets out by word of mouth from previous VALOR students. I had gone on an on-site audit last year, and one of the students at the facility, when we interviewed her, said, ‘I told everybody at the school about the VALOR program.’ If they have good, positive experiences, then they have no problem telling other students at their school, or wherever they are, about the VALOR program,” she said.
Fuller added that feedback from participants reflects the positive experiences. “We do an annual satisfaction survey with the students, and 98 percent of VALOR participants would recommend this program to someone else. The most recent one was done in September 2019, and that’s pretty standard,” she said. “They’re always above 95 percent.”
Elaine R. Sherman, MSN, RN, VA nurse professional development specialist and VALOR coordinator, shared her experience as a former VALOR program student participant. Describing her motivation to apply for and participate in the program, she explained, “I am a veteran, and this was an opportunity for me to give back. Also, I had not worked in a hospital before, and I am a visual learner, so this was a chance for me to put together all the information I had learned in nursing school, such as completing a head-to-toe assessment. Or, when seeing a diagnosis of CHF [congestive heart failure], this was an opportunity to see the signs and symptoms in real time.
“It was a great experience,” she continued. “I shadowed nurses and floated to all the units, which provided me an opportunity to see nursing in real time and decide what specialty I would like to choose. I would recommend the VALOR program to every nurse,” she daid, adding that in her position at a teaching hospital, “I promote this to all nursing students who train in our building.”
Sherman summarized the overall value of her participation in the program, asserting that it provided a strong foundation for her ensuing professional nursing career.