Preceptorships Erin Kibbey, BS, RN, CCRN

Learning Objectives Define a preceptorship Describe the benefits of preceptorships Recognize the characteristics of preceptorships with positive outcomes Distinguish between the current preceptorship program at Munson/A2 to current research Evaluate a plan for improvement

Definition Organized instructional programs that facilitate the integration of newly employed nursing staff into their role responsibilities in the work setting Not mentoring GOAL: Training nurses while still maintaining competence and ensuring highest quality of care (Alspach, 2000)

Preceptor Characteristics Role model Facilitator Socializer Communicator Teacher Evaluator Provider of feedback What is the least comfortable aspect of the preceptor role? Wear many hats Answer: Evaluating employee performance Above all else – honest and open communication will establish a positive learning environment (Moore, 2008)

Benefits Contribute to ability to adapt to change Retention Recruitment Fosters better prepared nurses and increased confidence Increased efficiency and time management skills Improved problem-solving Advantages to preceptor 2 shortages have prompted an increased use of precepted experiences: nursing faculty, professional nurses Turnover is costly and affects quality of care - health care organizations have been challenged to design effective programs that offer support for new nurses to ease their transition Nurses leaving profession within 2 years of graduation – 30-61% 1st year, nurse with less than a year of experience can cost an organization almost $50,000. Does not factor in negative influence on staff morale and patient satisfaction. One study shows change of 50% retention rate before implementation of nurse resident program to rates of 79% to 97%. Preceptor advantages Increased job satisfaction, new dimension to work - stimulation Motivation to maintain skills Learn from students Contributes to professional growth (Bratt, 2009; Moore, 2008; Ullrich & Haffer, 2009; Wright Shpritz & O’Mara, 2006)

What Makes a Good Preceptorship? Preceptor preparation in the form of a workshop or class identified as most important prerequisite Process of selecting individuals Time for preparation, resources, practice Creating a climate conducive to learning Adult centered Consistency Feedback that is timely, provided in an encouraging manner, and related to identified goals Ongoing recognition & support Selection process for preceptors – Clinical nursing characteristics, professional characteristics, personality Most important personality characteristic - *Willingness and desire to be a preceptor* Adequate preparation for helping preceptors identify strategies for balancing multiple demands. Factors that contribute to climate: preceptor (ability to value, work with, and support) and staff acceptance of orientees as part of team, how preceptor gets along with staff Adult centered: Variety of learning methods, Self-direction when possible, Constant opportunity for assessment and evaluation (Baltimore, 2004; Moore, 2008; Morris et al., 2007; Myrick & Yonge, 2001; Wright Shpritz & O’Mara, 2006 )

Example Model for Critical Care Builds on learners experiences, provides a variety of learning methods, uses task-oriented problem-solving approaches to learning, and uses self-directed learning (Morris et al., 2007)

How Does Munson/A2 Measure Up? Preceptor workshop Varying preceptor eligibility requirements Inconsistent preparation to the precepting role Outdated/lack of resources for preceptors to guide orientation Skills checklists Lack of instruction on how to promote higher order cognitive skills during bedside teaching ECCO - Online learning Munson’s Strategic Plan for Nursing Services 2013-2016 Ask how many have gone to this out of those that have precepted? Goal 4: Nurses grow professionally as preceptors, mentors, and leaders within the organization. Tactics: • Standardize preceptor eligibility, education, support, and incentives, including structures for organizational and unit oversight, scheduling, and evaluation. • Develop preceptor committees, both unit-based and hospital-wide. • Incorporate simulation learning opportunities as able.

Plan for Improvement Combined self-study and team based approach Software/training modules and books http://www.aacn.org/WD/Elearning/Content/preceptor/preceptor.content Precepting in Nursing: Developing an Effective Workforce by Ullrich & Haffer More resources http://a2ccnursingeducation.weebly.com/critical-care-topics.html Development of a case study guide for preceptors Educator blog http://cardiothoracicnursingeducation.blogspot.com/ Simulation training for both orientees and preceptors AACN’s Preceptor Challenge Module – 3.5 CNE’s – Interactive simulation based. Precepting different learning styles and levels of proficiency. Practice constructive feedback, complete an evaluation and learning plan. Maximum benefit from orientation if preceptor is able to refer them to appropriate learning resources Case study guide—a collection of case studies, with increasing levels of complexity, developed for use by the preceptors. Simulation could provide opportunity to learn better feedback techniques in addition to assessment techniques that can stimulate higher order thinking. – Article about CATs

Outcome Measures Revise preceptor program by end of 2013 Decreased new graduate RN turnover Safety culture survey increases in “this organization does a good job in training new staff" Increase in employee engagement question “this organization provides opportunity to improve professional knowledge and skill” Increase in the number of hours where the simulation lab is used Exit evaluation/survey of orientation experience specific to A2. (Munson Medical Center, 2013)

Review One minute paper What was the most important thing you learned in this teaching session? Purpose: To assess comprehension of major concepts covered during session

Conclusion “You cannot hope to build a better world without improving the individuals. To that end each of us must work for his own improvement, and at the same time share a general responsibility for all humanity, our particular duty being to aid those to whom we think we can be most useful.” - Marie Curie

References Alspach, J. G. (2000). The educational process in nursing staff development. Annapolis, MD: American Association of Critical Care Nurses. Baltimore, J. J. (2004). The hospital clinical preceptor: Essential preparation for success. Journal of Continuing Education in Nursing, 35(3), 133-140. Bratt, M. (2009). Retaining the next generation of nurses: the Wisconsin Nurse Residency Program provides a continuum of support. Journal of Continuing Education in Nursing, 40(9), 416-425. doi:10.3928/00220124-20090824-05 Fulmer, T. (2006). Foreword. In J. P. Flynn & M. C. Stack (Eds.), The role of the preceptor: A guide for nurse educators, clinicians, and managers (2nd ed.). (pp. xi-xii). NY: Springer Publishing Company, Inc. Munson Medical Center. (2013). Strategic plan for nursing services: 2013-2016. Retrieved from Munson Medical Center’s intranet. Moore, M. L. (2008). Preceptorships: Hidden benefits to the organization. Journal for Nurses in Staff Development, 24, E9-E15. Morris, L. L., Pfeifer, P. B., Catalano, R., Fortney, R., Hilton, E. L., McLaughlin, J., . . . Goldstein, L. (2007). Designing a comprehensive model for critical care orientation. Critical Care Nurse, 27(6), 37-60. Myrick, F., & Yonge, O. (2001). Creating a climate for critical thinking in the preceptorship experience. Nurse Education Today, 21(6), 461-467.

References Continues Ullrich, S. and Haffer, A. (2009). Precepting in nursing: Developing an effective workforce. Sudbury, MA: Jones and Bartlett Publishers. Wright Shpritz, D. and O’Mara A. M. (2006). A model preceptor program for student nurses . In J. P. Flynn & M. C. Stack (Eds.), The role of the preceptor: A guide for nurse educators, clinicians, and managers (2nd ed.). (pp. 28-53). NY: Springer Publishing Company, Inc