Supporting Nurse Practitioner Preceptor Development

The 1-minute preceptor to improve diagnostic reasoning in a primary care nurse practitioner residency program

BACKGROUND

The One-Minute Preceptor (OMP) model to teach diagnostic reasoning and Reporter, Interpreter, Manager, and Educator (RIME) framework to measure progress are used in physician training. Little is known about the use of these tools in nurse practitioner (NP) training.

LOCAL PROBLEM

Precepting NP trainees at the Veterans Affairs (VA) is not standardized. A standardized approach to precepting NP residency trainees using the OMP model and RIME scoring was evaluated for improvement and helpfulness.

METHODS

A quality-improvement project with two Plan-Do-Study-Act (PDSA) cycles were conducted over a 12-week period. Mean RIME scores, preceptor self-efficacy, and use of teaching skills were measured preintervention and postintervention. Data were analyzed using a paired sample t-test and descriptive statistics.

INTERVENTIONS

A convenience sample of preceptors and trainees was recruited from a large VA medical center. A 1-hour workshop educated preceptors with role playing and return demonstrations on OMP techniques and RIME scoring. The teachings were applied to standardize precepting and assess diagnostic reasoning. Trainee self-scoring and results triggered conversations to fulfil the identified gaps.

RESULTS

Mean RIME scores improved (1.62 [0.17] vs. 2.23 [0.38], p < .001) post 12-week intervention. Mean RIME scores improved between PDSA cycle 1 and cycle 2 (2.07 [0.25] vs. 2.48 [0.39], p < .001). Preceptors (91%) and trainees (100%) found the OMP model and RIME framework helpful.

CONCLUSION

Use of the OMP improved diagnostic reasoning in NP trainees. The OMP and RIME framework provided standardization of precepting and trainee discussions on improvements.

Preceptor Boot Camp: Basic Training for Novice Preceptors

BACKGROUND

A clinical preceptor (CP) provides the vital link to apply didactic learning in clinical practice for nurse practitioner (NP) students. A nationwide shortage of CPs continues. The goal of this pilot project was to evaluate a model for developing preceptors from the school of nursing alumni that addressed modifiable academic barriers to precepting.

METHOD

Six NP alumni from the school of nursing participated in a comprehensive novice CP training program based on Kolb's experiential learning theory and unparalleled faculty support through regularly scheduled contact. Pre- and posttests, site visits, and focus groups were used to assess the participants' progress.

RESULTS

Participants' self-reported ability to teach and manage time when working with NP students improved, and 83.9% showed improved knowledge of precepting skills.

CONCLUSION

Foundational skills and communication are essential elements to support novice CPs. This support may enhance both student and CP experience as well as increase retention of CPs. [J Contin Educ Nurs. 2024;55(6):283-288.].

Clinical Preceptor Development and the Benefit of Structured Teaching Techniques: A Scoping Review

INTRODUCTION

Physician assistant (PA) education in the clinical year is dependent on clinical preceptors. Recruitment of preceptors has been identified as a significant barrier for programs. As a result of the preceptor shortage, evaluation of the barriers to recruitment and retention has been considered. The lack of development and training was identified as a barrier to recruitment and retention of preceptors.The aim of this scoping review article was to identify structured teaching strategies to reduce the development and training barrier and improve preceptor efficacy and efficiency. Structured teaching techniques, such as the One-Minute Preceptor and Summarize, Analyze, Narrow, Probe, Plan, and Select (SNAPPS), are proven to be effective and efficient ways to train learners.

METHODS

Online databases were used to identify articles published from 2014 to 2022 using the following terms: "physician assistant" or "nurse practitioner," "preceptor development," "preceptorship," "teaching methods," "pedagogy," "clinical teaching," and "medical education." Seventeen articles formed the basis of the scoping review of the literature. A singular author reviewed the articles.

RESULTS

Training resources help ease student instruction burden that preceptors experience. Many preceptors rely on clinical experience to guide their teaching methods. Introducing formal, structured teaching strategies can improve preceptors' effectiveness. By implementing preceptor training using structured teaching strategies, PA programs can decrease barriers for preceptors and potentially increase preceptor effectiveness and efficiency.

CONCLUSIONS

Training preceptors on using structured teaching strategies through workshops, asynchronous learning modules, and podcasts could provide preceptors with the support needed to educate clinical phase PA students. Physician assistant programs must explore best practices in clinical teaching and the associated education and operational outcomes.

A systematic review: Clinical education and preceptorship during nurse practitioner role transition

BACKGROUND

The demand for nurse practitioners (NP) is growing; however, the NP role transition is difficult. NP role transition starts with NP student entering the program and can last for as long as two years post-graduation. NP clinical education and preceptorship model is outdated and is in need of restructuring.

PURPOSE

The purpose of this literature review was to describe and explain the issues and resources within the NP clinical education and preceptorship that is used to support NPs' role transition both before and after graduation.

METHODS

The search years included 2010-2022. The following search terms were used: graduate nurse, advanced nursing, nurse practitioner, APRN, masters prepared, advanced nurse, nursing student, practicum, residency programs, residencies, school, program, clinical, clinical education, nursing education, health education, training, clinical site, student, preceptor, preceptorship, apprenticeship, mentor, mentorship, transition, role transition, role change, nurse's role, primary care, qualitative research, collaboration, and clinical competence.

RESULTS

In this review pre-graduation persistent issues with availability of clinical sites and preceptors as well as lack of consistency in competency based clinical education assessment practices were identified. Difficult transition to practice post-graduation showed inconsistent and limited support available to further develop the newly graduated entry level NPs' clinical skills.

CONCLUSION

Restructuring the old clinical education and preceptorship model used during the pre-graduation NP role transition stage is necessary to improve NP role transition process and graduate the required number of practice ready NPs.

Preceptors and the New Neonatal Nurse Practitioner Educational World

The need for neonatal nurse practitioner (NNP) preceptors has never been greater. Precepting is a professional responsibility with both rewards and challenges. The recent pandemic has brought about new challenges, not the least of which is burnout from clinical, learner, and environmental demands. A new educational model from the American Association of Colleges of Nursing and the National Task Force outlines educational and preceptor requirements aimed at improving the advanced practice educational experience for students and preceptors. Available research provides evidence of what preceptors value and how to develop best practices with academic institutions to advocate for their students. This article will discuss new nursing educational models and the role of the NNP preceptor and analyze current best practices in preceptor recruitment and retention while discussing national trends impacting personal and professional NNP practices.

Perceptions of motivating factors and barriers to precepting

BACKGROUND

Advanced practice registered nurses (APRNs) and physician assistants (PAs) are integral to health care delivery in the United States. However, the cultivation of APRNs and PAs relies heavily on the model of precepting. Advanced practice registered nurses and PAs frequently precept students or new hires, yet limited data are available to describe the motivations, incentives, and barriers associated with precepting.

PURPOSE

The purpose of this mixed-method, cross-sectional study was to better understand APRN and PA preceptors' perceived levels of support during precepting, facilitating factors, and barriers to the precepting process.

METHODS

An electronic survey was distributed via REDCap to a convenience sample of APRN and PA preceptors at an academic medical center. Data collected from the survey were analyzed using both descriptive statistics and qualitative thematic analysis.

RESULTS

One hundred fifty-four participants completed the survey. Motivating factors for precepting included "giving back" to the profession, and barriers included inadequate time to precept while in the clinical role. Participants indicated that financial incentives, heightened communication, protected teaching time, preceptor training, meaningful recognition, and organizational support could enhance the precepting process.

CONCLUSION

This study demonstrated that altruistic intentions frequently motivate APRN and PA preceptors, however, navigating multiple clinical responsibilities while precepting serves as a barrier to the precepting process. Preceptor training, ongoing education, dedicated time for precepting, enhanced communication, and organizational or professional incentives may optimize the APRN and PA precepting process.

IMPLICATIONS

Further research should focus on how to optimally incorporate education, professional development, support, and incentives into the APRN and PA preceptor role.

Nurse practitioner preceptor resource needs and perceptions of institutional support

BACKGROUND

Nurse practitioner (NP) preceptors encounter stress when balancing clinical responsibilities with mentoring. Support can decrease role stress and promote preceptor resilience.

PURPOSE

Characterize NP preceptor resource needs and their perception of support for the clinical preceptor role.

METHODS

A cross-sectional, mixed-methods study used a web-based survey to identify preceptor resource needs. A convenience sample from a large, academic Midwestern university was recruited by email, with reminder emails 1 and 2 weeks after initial invitation. Survey tools included researcher-designed questions about preceptor-desired resources, an adapted Preceptor's Perception of Support Scale, and qualitative questions of preceptor needs. Data were analyzed using descriptive statistics and qualitative thematic analysis.

RESULTS

Two hundred thirty-nine of 784 surveys (30.48%) were returned. Preceptors valued free mentoring resources, desired access by "smartphone app," and identified mentoring topics of interest. They perceived adequate role preparation, clearly defined roles, supportive and knowledgeable colleagues, committed supervisors, and appropriate workload. Respondents noted the following insufficiencies: time for normal duties while precepting, preceptor resources, opportunities to share with colleagues, faculty-student time, and faculty assistance to identify student's performance problems. Qualitative data highlighted faculty-preceptor communication and compensation as preceptor concerns.

IMPLICATIONS FOR PRACTICE

Preceptors feel a need for specific supports identified in this study. Preceptor insights inform strategies to build clinical preceptor resilience and well-being, strengthen the academic-practice partnership, and facilitate positive education outcomes. Faculty should increase communication-based support individualized to specific student needs. Resources should be developed that more fully support specific competencies and skills within NP student clinical education.

Nurse practitioner students' observations of preceptor engagement in obesity management and weight bias: A mixed-methods approach

BACKGROUND

Obesity is considered a growing epidemic in the United States. Nurse practitioners (NPs) have the opportunity to serve as leaders in addressing concerns related to disease management, particularly obesity. Currently, we lack an awareness of how NP students are learning obesity management from their preceptors.

PURPOSE

Thus, the current study sought to explore how NP students perceive preceptors' behaviors when managing patients with obesity.

METHODOLOGICAL ORIENTATION

This study used a mixed-methods design. Participants were asked to report how often they observed their preceptors engage in different strategies when interacting with patients with obesity (e.g., calculate body mass index, identify goals). Students were then asked to respond to the statement: "share observations you made of how patients with obesity were treated in this environment." Students completed 2 clinical rotations during this period and, thus, were asked to answer the questions twice to capture experiences at both clinical sites.

SAMPLE

Researchers surveyed 225 NP students completing clinical rotations in 3 settings (Family Practice, Pediatrics, and Obstetrics/Gynecology).

CONCLUSIONS

Quantitative results revealed significant differences in the frequency of observed obesity management behaviors by all preceptors. Qualitative results revealed that NP students most often observed preceptors displaying interpersonal warmth without weight bias when working with patients with obesity. Contrary to current literature, this sample of NP students observed their preceptors engaging in positive interactions with individuals with obesity.

IMPLICATIONS FOR PRACTICE

Educators must continue to teach students to engage in unbiased behavior toward patients. It is critical to continue to improve obesity management content offered in NP programs.

Improving Nurse Practitioner and Physician Assistant Preceptor Knowledge, Self-Efficacy, and Willingness in a Hospital Medicine Practice: An Online Experience

BACKGROUND

A hospital medicine practice experienced an increased demand for additional nurse practitioner (NP) and physician assistant (PA) preceptors.

METHOD

An online preceptor education course was developed that included eight modules: communication and feedback, expectations for assessment and evaluation, pedagogy, time management and efficiency, goal setting and coaching, working with struggling or at-risk students, legal and ethical considerations, and teaching procedures. Knowledge, self-efficacy, and willingness to precept were examined in a precourse and postcourse format.

RESULTS

Postcourse, knowledge improved from 69.4% to 90.6%. Self-efficacy improved by 35.2%, and willingness to precept also improved. Qualitative themes emerged, including excitement to precept, helpful course, and time constraints.

CONCLUSION

An online NP and PA preceptor training program increased preceptor knowledge, self-efficacy, and willingness to serve as a preceptor. Additional research is needed to explore the time constraints to serving as an NP or a PA preceptor in the inpatient environment. [J Contin Educ Nurs. 2020;51(6):275-279.].

Implementation of an educational program to improve precepting skills

BACKGROUND

Educating health care providers is dependent on developing high-quality clinical preceptors, yet preceptors face widespread challenges to precepting, such as time constraints and lack of formal preceptor training.

LOCAL PROBLEM

Our college of nursing conducted a needs assessment survey of our preceptors to better understand the barriers to and incentives for precepting. Formal preceptor training was identified as an intervention to support preceptors.

METHODS

Based on survey responses and a literature review of best practices, a preceptor training program was developed and delivered to local health care partners. Posttraining surveys were used to measure the effectiveness of the training.

INTERVENTION

We developed a one-hour formal preceptor training program. The main components included 1) orienting a student, 2) applying the Recorder/Reporter-Interpreter-Manager-Educator (RIME) framework for clinical evaluation, 3) One-Minute Preceptor (OMP) methodology for clinical teaching, 4) strategies for giving students feedback, and 5) communicating with the university.

RESULTS

Preceptor training was delivered to health care providers (N = 58) at eight clinics and one nurse practitioner (NP) professional group. Most participants (86%) had never received training in the RIME framework or OMP method (80%). The participants rated the following aspects of training as very useful or moderately useful: Orientation checklist (100%), RIME framework (96%), and OMP (100%).

CONCLUSIONS

We found that training preceptors on evidence-based, time-efficient strategies for precepting is feasible and valuable. If continued and expanded, this training may positively affect retention and recruitment of preceptors for our university's NP students. This training may be transferable to other geographical settings.

Clinical Nurse Specialist Preceptor Protocol

PURPOSE

Develop an evidence-based clinical nurse specialist (CNS) preceptor protocol to enhance preceptor's skills and effectiveness and strengthen the preceptor-preceptee relationship and outcomes.

DESCRIPTION

An effective CNS preceptor is a key variable to quality, timely, and fiscally responsible CNS transition and retention. Most preceptors receive no formal education or skill development. Literature searched from the previous 10 years explored CNS preceptor, preceptee, and preceptorship process.

OUTCOMES

Protocol key components are development of the mutual collaborative relationship, shared meaning, understanding, goal setting, timelines, and evaluations. The planning phase of the protocol includes face-to-face meeting to identify overarching goals and establish a trusting collaborative relationship. The mutual iterative learning and growing phase includes identification of learning needs, goals, and strategies such as debriefing, reflective journaling, and mutual ongoing evaluation. The concluding phase includes formal evaluation. The outcome phase includes safe autonomous CNS practice, along with mutual growth and satisfaction.

CONCLUSIONS

The literature informed the CNS preceptor protocol development. The protocol may be evaluated within a preceptor-preceptee relationship across multiple settings. Higher levels of CNS research are vital to identify evidence-based CNS preceptorship strategies. As CNSs are integrated into advanced practice roles, a structured preceptor protocol and education program is critical to provide quality outcomes.

Deliberate teaching tools for clinical teaching encounters: A critical scoping review and thematic analysis to establish definitional clarity

PURPOSE AND METHOD

We conducted a scoping review of tools designed to add structure to clinical teaching, with a thematic analysis to establish definitional clarity.

RESULTS

Six thousand and forty nine citations were screened, 434 reviewed for eligibility, and 230 identified as meeting study inclusion criteria. Eighty-nine names and 51 definitions were identified. Based on a post facto thematic analysis, we propose that these tools be named "deliberate teaching tools" (DTTs) and defined as "frameworks that enable clinicians to have a purposeful and considered approach to teaching encounters by incorporating elements identified with good teaching practice." We identified 46 DTTs in the literature, with 38 (82.6%) originally described for the medical setting. Forty justification articles consisted of 16 feedback surveys, 13 controlled trials, seven pre-post intervention studies with no control group, and four observation studies. Current evidence of efficacy is not entirely conclusive, and many studies contain methodology flaws. Forty-nine clarification articles comprised 12 systematic reviews and 37 narrative reviews. The most number of DTTs described by any review was four. A common design theme was identified in approximately three-quarters of DTTs.

CONCLUSIONS

Applicability of DTTs to specific alternate settings should be considered in context, and appropriately designed justification studies are warranted to demonstrate efficacy.