Supporting preceptors

Clinical Instructors' Experiences Working with and Assessing Students Who Perform below Expectations in Physical Therapy Clinical Internships

Purpose: Clinical education is an integral component of the curriculum of all physical therapy (PT) entry-to-practice programmes in Canada. The literature indicates that working with and assessing students performing below expectations (SPBE) can be procedurally and emotionally difficult. Our study aimed to explore the experiences of clinical instructors (CIs) and the decision-making process involved when supervising SPBE in PT. Method: A total of 19 in-depth, semi-structured interviews were conducted with CIs, transcribed, and coded using qualitative thematic analysis. Results: Four factors appeared to be important for CIs when they were deciding how to assess SPBE: (1) features of student performance, (2) factors related to the CIs, (3) academic and clinical facility influencers, and (4) strategies and available resources. Concerns about safety and professional behaviour, a student's clinical reasoning skills, and a lack of progression were key factors that CIs considered in recommending a final grade. CIs were more likely to recommend a failing grade if there was a series of repeated incidents rather than an isolated incident. Conclusions: We make several recommendations for the student, CI, and facilities to consider to better support and facilitate the process of working with SPBE in PT clinical education.

Evaluating the preceptor-preceptee relationship among Pharm D students at the King Saud University School of Pharmacy

OBJECTIVE

To evaluate preceptee satisfaction concerning preceptorship and the preceptor-preceptee relationship among pharmacy students.

METHODS

A cross-sectional study was conducted from May 2017 to August 2017 on senior Pharm D students at King Saud University (KSU) College of Pharmacy. A survey instrument was used to get feedback from students regarding their clinical rotations and internships and to evaluate their satisfaction toward preceptorship to meet the goals of the curriculum. Data were entered into SPSS, version 24.

RESULTS

Of the 52 students surveyed, 36 (69.2%) were female. More than half of respondents were somewhat satisfied with their preceptors and 11.5% were satisfied. Additionally, only 17% of students rated their preceptors as having excellent clinical teaching skills; about 19% of students rated them as "needs improvement." About 40% of students rated their preceptors as very good, concerned, competent, and safe in their care for persons living with serious co-morbidities and diseases. About half of students (48.1%) rated their non-faculty KSU preceptors' teaching behavior as not satisfactory compared with only four respondents with respect to KSU faculty preceptors' teaching behavior.

CONCLUSION

Pharm D students were somewhat satisfied with their preceptors' teaching behaviors in communication skills, practice, and teaching skills as well as feedback and evaluation to students. To enhance the quality of experiential education, preceptors should be trained to develop programs that direct and energize advancement.

Assessing the impact of academic-practice partnerships on nursing staff

Background

The ‘spillover effect’ of academic-practice partnerships on hospital nursing staff has received limited attention. In 2007, the Department of Veterans Affairs (VA) created the VA Nursing Academy (VANA) to fund fifteen partnerships between schools of nursing and local VA healthcare facilities. In this paper, we examine the experiences of the VA staff nurses who worked on the units used for VANA clinical training.

Methods

We used survey methods to collect information from staff nurses at all active VANA sites on their characteristics, exposure to the program’s clinical training activities, satisfaction with program components, and perspectives of the impact on their work and their own plans for education (N = 314). Our analyses utilized descriptive statistics and bivariate and multivariate regression.

Results

Results show that staff nurses working on VANA units had moderately high levels of exposure to the program’s clinical education activities, and most reported positive experiences with those activities. The vast majority (80 %) did not perceive the presence of students as making their work more difficult. Among those who were enrolled or considering enrolling in a higher education program, over a quarter (28 %) said that their VA’s participation in VANA had an influence on this decision.

The majority of staff nurses were generally satisfied with their experience with the students. Their satisfaction with the program was related to the level or dose of their exposure to it. Those who were more involved were more satisfied. Greater interaction with the students, more information on the program, and a preceptor role were all independently associated with greater program satisfaction.

Conclusions

Our study suggests that academic-practice partnerships may have positive spillover effects on staff nurses who work on clinical education units. Further, partnerships may be able to foster positive experiences for their unit nurses by focusing on informing and engaging them in clinical training activities. In particular, our results suggest that academic-practice partnerships should keep unit nurses well informed about program content and learning objectives, encourage frequent interaction with students, involve them in partnership-related unit-based activities, and urge them to become preceptors for the students.

Electronic supplementary material

The online version of this article (doi:10.1186/s12912-015-0085-7) contains supplementary material, which is available to authorized users.

Text messaging to support off-campus clinical nursing facilitators: a descriptive survey

BACKGROUND

Managing large student cohorts can be a challenge for university academics, coordinating these units. Bachelor of Nursing programmes have the added challenge of managing multiple groups of students and clinical facilitators whilst completing clinical placement. Clear, time efficient and effective communication between coordinating academics and clinical facilitators is needed to ensure consistency between student and teaching groups and prompt management of emerging issues.

METHODS

This study used a descriptive survey to explore the use of text messaging via a mobile phone, sent from coordinating academics to off-campus clinical facilitators, as an approach to providing direction and support.

RESULTS

The response rate was 47.8% (n=22). Correlations were found between the approachability of the coordinating academic and clinical facilitator perception that, a) the coordinating academic understood issues on clinical placement (r=0.785, p<0.001), and b) being part of the teaching team (r=0.768, p<0.001). Analysis of responses to qualitative questions revealed three themes: connection, approachability and collaboration.

CONCLUSIONS

This study demonstrates that use of regular text messages improves communication between coordinating academics and clinical facilitators. Findings suggest improved connection, approachability and collaboration between the coordinating academic and clinical facilitation staff.

Dietitians’ Perceptions of Precepting: Knowledge, Skills, Attitudes, Barriers, and Training

Purpose

The extent to which dietitians agreed or disagreed with key informants’ perceptions of precepting knowledge, skills, and attitudes (KSA), training needs, and barriers was determined.

Methods

A 98-item survey was developed and distributed electronically to Dietitians of Canada members (n=5376).

Results

Of the 750 respondents who completed the survey (14% response rate), more than 95% agreed that preceptors should have knowledge of promoting learning and skills acquisition, and of learner assessment and evaluation. More than 90% of respondents agreed that preceptors should have skills in planning, teaching, coaching, research, facilitation, and evaluation. Differences in respondents’ perceptions of preceptor participation in practice-based research differed with years of experience. Respondents with fewer than five years of experience had a higher level of agreement that preceptors should participate in practice-based research than did those with more experience (P<0.05). Respondents indicated that barriers to precepting training were insufficient time (93%) and work environments not supportive of precepting (64%).

Conclusions

The findings articulate the KSA, training needs, and barriers to precepting considered significant for dietitian preceptors. The results are important for the advocacy for resources to support the training and development of preceptors, upon whom sustainability of the profession depends.

Educator informed practice within a triadic preceptorship model

Preceptorships have long been a subject of scholarship with proven effectiveness in preparing nursing students to transition into beginning graduate nurses. Nursing research has predominantly focused on the dyadic preceptor-student relationship. The triadic pedagogical relationship between educator-student-preceptor has garnered less attention and inquiry. Nurse educators' experience in preceptorships is under reported. Through a process of scholarly inquiry, nurse educators from one western Canada School of Nursing documented their experiences and professional judgment in facilitating preceptorships over one semester. In the context of the anticipated exodus of nursing experts in the midst of rapidly changing healthcare delivery, this paper recommends a reemphasis on preceptorships as a triadic pedagogical relationship. Educator informed practices that foster triadic relationships in preceptorships include attending to distant relationships, being mindful of the influence of continuity, recognizing a preceptor's proficiency, responding to rapidly changing and complex environments, facilitating common understanding through communication, and integrating practice and education performance expectations.

Mission Possible CD ROM: instructional tool for preceptors

Senior student preceptorship is a vital clinical component of many baccalaureate nursing curricula providing a one-on-one partnership with a registered nurse with clinical expertise. Experiential data and literature review support the preceptor's need for guidance with student assessment and evaluation strategies. This article reports on research conducted to assess the perceived increase in a preceptor's knowledge after viewing an author developed instructional CD, Mission Possible CD ROM: Instructional Tool for Preceptors. The results suggest that perceived knowledge increased; however, the lack of time to view the CD was an issue for the majority of the nurse preceptor participants. More research is warranted to build on current literature regarding instructional strategies of benefit to a nurse in the preceptor role.

Preceptorship: using an ethical lens to reflect on the unsafe student

Patient safety has become a worldwide health concern, and health care professionals have a moral and ethical responsibility to promote patient safety. The clinical education of many health care professionals often involves a preceptorship or field experience wherein students are assigned to work one-to-one with a preceptor or field educator so that they can be socialized into the profession and receive a reality-oriented experience. Health care professionals who accept the responsibility of being a preceptor face additional workload and stress, especially when the students to whom they are assigned are not meeting the expectations of safe, professional practice. Taking a stand against unsafe students is an important way for preceptors to promote patient safety. Given the nature of the stress and the inherent ethical issues associated with precepting an unsafe student, it is useful to examine this experience through an ethical lens. Included in this article is a brief overview of preceptorship as a model of clinical education, together with a discussion of the nature of the ethical decisions that preceptors face when precepting an unsafe student. Ethical theories, namely, virtue ethics and utilitarianism, are also explored and serve to provide the ethical lens through which preceptors can reflect upon their experiences with unsafe students.

A pilot study on conducting mobile learning activities for clinical nursing courses based on the repertory grid approach

In clinical nursing courses, students are trained to identify the status of the target patients. The mastery of such ability and skills is very important since patients frequently need to be cared for immediately. In this pilot study, a repertory grid-oriented clinical mobile learning system is developed for a nursing training program. With the assistance of the mobile learning system, the nursing school students are able to learn in an authentic learning scenario, in which they can physically face the target patients, with the personal guidance and supplementary materials from the learning system to support them. To show the effectiveness of this innovative approach, an experiment has been conducted on the "respiratory system" unit of a nursing course. The experimental results show that the innovative approach is helpful to students in improving their learning achievements. Moreover, from the questionnaire surveys, it was found that most students showed favorable attitudes toward the usage of the mobile learning system and their participation in the training program.

Supervising medication administration by undergraduate nursing students: influencing factors

BACKGROUND

The administration of medication is an important skill nursing students need to learn in the clinical setting to develop safe practices. Legally within Queensland, registered nurses are required to provide personal supervision for this process. Research undertaken by the authors suggests the supervision students receive frequently falls short of what is legally required.

AIMS AND OBJECTIVES

The aim of the study was to examine the factors that influence the experiences of final-year undergraduate nursing students when administering medications in the clinical setting.

DESIGN

A grounded theory approach was used with constant comparative analysis to identify categories from the data.

METHODS

The experiences of final-year nursing students were explored using a grounded theory approach. In-depth, semi-structured interviews were conducted with 28 final-year undergraduate nursing students in Queensland, Australia.

RESULTS

Supervision was found to be the central issue influencing medication administration for students. Three main factors were identified as influencing the supervision provided by registered nurses: attitudes of the registered nurse, communication from the university, and busyness and having time.

CONCLUSIONS

The extent to which registered nurses provide direct supervision to nursing students when administering medication is influenced by factors inherent within the clinical environment.

RELEVANCE TO CLINICAL PRACTICE

The factors influencing the supervision provided by registered nurses needs further exploration that effective strategies can be implemented to ensure safe practices in relation to medication administration can be implemented.

Preceptors' perspective on recruitment, support, and retention of preceptors

In this study, the researchers sought consensus among preceptors of senior nursing students about issues key to the preceptors' recruitment, support, and retention. A modified Delphi method with two rounds of questionnaires was used followed by a focus group to explore issues for which consensus was not reached. Preceptors agreed on the importance of personal satisfaction and on a number of tangible benefits of being a preceptors such as receiving information on a need-to-know basis. Topics such as how to help students think critically and how to provide constructive feedback also were considered important. Preceptors agreed that having students well prepared at the beginning of preceptored experiences was important as was receiving a personalized thank you letter to acknowledge their work a the end of the experience, two strategies that could help with retention.

Preceptoring nursing students: registered nurses' perceptions of nursing students' preparation and study approaches in clinical education

Preceptorship influences Registered Nurses' (RNs) daily work to different degrees depending on nursing students' knowledge, and willingness to learn. Consequently, it is of the utmost importance to investigate how RNs assess nursing students in clinical education. The aim of this study was to describe RNs' perceptions of nursing students' preparation and study approaches at hospital workplaces, and to explore relationships between RNs' perceptions and their personal/clinical characteristics. A cross-sectional design was used. In 2006, 142 of 196 RNs at a Swedish hospital answered a questionnaire (response rate 72.5%). The majority of RNs (63-84%) rated students' study approaches highly and thought students comprehended the outcomes of learning. Fewer (45-49%), rated students as having adequate theoretical knowledge highly and were of the opinion that they had acquired knowledge about the unit. Statistically, non specialist nurses rated significantly higher compared with specialist nurses. Significant positive correlations were found between the RNs' perceptions of nursing students and their interest in preceptoring. The extent to which preparation programmes, established in collaboration between a university and a hospital, had improved preceptors and nursing students was not graded. Further descriptive and intervention studies are therefore needed.

Preparation of nurses who precept baccalaureate nursing students: a descriptive study

Clinical preceptorship is employed by baccalaureate nursing education programs as a capstone experience and a means of initiating the professional socialization of senior-level students who will shortly be new graduates. This quantitative, descriptive study explored the perceptions about preceptor preparation among nurses who precept baccalaureate nursing students. Mercer's Role Attainment Theory was the theoretical framework for this study, in which 75 participants from two hospitals in the Midwest completed a survey. Two key findings emerged from the data: All preceptors of senior-level nursing students want to know what their responsibilities are with regard to the student and the preceptorship experience, and nurses in critical care areas identified learning how to teach critical thinking to senior-level students as more essential than did nurses in other areas.

Case study: creating a healthy workplace in a surgical trauma intensive care unit

This case study describes the implementation of the Parsons' Healthy Workplace Theory and Intervention in a surgical intensive care unit in a level 1 trauma facility. This intervention and change strategy was the impetus for the creation of a more positive work environment by developing and empowering staff. The process led to shared decision making and development of action planning teams that subsequently became unit-based committees. The committees have focused goals, action plans, and timelines for achieving those goals. Transforming care and the enculturation of shared decision making at the bedside is essential for improving quality of patient care and for recruitment and retention of nurses.

An outcomes-based approach to improve registered nurse retention

A 230-bed facility determined that 64% of its registered nurse (RN) voluntary turnover rate occurred with newly hired RNs. Inadequate orientation processes and practices were determined to be the root cause. The pilot project's 36% reduction in newly hired RN departures results in an annual savings of over $1 million. Details of the plan, the pilot project, the cost-benefit analysis, and the spread to the system are described. Evaluation of year-end data provides nurse leaders with critical information as RN retention is a priority.

Undergraduate nursing students' preparedness to "go rural"

This article reports on a theme emerging from a focused ethnography examining the professional socialization of undergraduate fourth year nursing students during a rural hospital preceptored clinical experience. Nursing students and preceptors geographically dispersed over a 640,000 square kilometer rural area participated in this study. Students report student preparedness for the rural hospital setting means to "know what you are getting into". Assisting nursing students to prepare for the rural hospital preceptorship facilitates a positive experience thus increasing the effectiveness of the preceptorship model of clinical teaching. Having a positive rural-based experience also has the potential for recruiting new staff. These preliminary findings suggest that student preparation for the rural hospital preceptorship includes cognitive and psychological preparation, as well as the acquisition of common advanced clinical skills.

Precepting an unsafe student: the role of the faculty

According to a recent study, one of the central findings indicated that preceptors require significantly more support than they are currently receiving from faculty especially when precepting a student who is engaging in unsafe practice. In this grounded theory study, 22 preceptors were interviewed. The findings reveal some interesting implications not only regarding the staffing of preceptorship programs but also the process of preparing faculty as to how to provide preceptors with sufficient and appropriate support throughout the preceptorship experience.

Preceptoring a student in the final clinical placement: reflections from nurses in a Canadian Hospital

AIM

To capture personal reflections on being a preceptor and to identify the supports and challenges to enacting the role.

BACKGROUND

Prior to graduation from a nursing programme, students begin the transition in roles from student to practicing health-care professional. To ease this transition, preceptorship programmes have been implemented to foster professional socialization and help students achieve confidence in their practice during their final clinical placement (consolidation experience). Preparation for the preceptor role is dependent upon the information offered by the agency as well as by the educational institution. Nursing staff are requested for much of the calendar year to work with increasing numbers of undergraduate students at various levels, function as preceptors in the final clinical experience (consolidation) as well as be involved in the orientation of newly hired nurses.

METHODS

This qualitative study used one-on-one tape recorded interviews with nurses who had previous experience as a preceptor. Thematic analysis of the transcribed data resulted in the emergence of an overall theme and categories.

RESULTS

Eight nurses were interviewed from a variety of units including medical surgical as well as critical care. The overriding theme from the analysis was 'safe passage'. This safe passage was for the patient and the student and was accomplished through the process of teaching and a clear view of the preceptor role. Challenges to the role were lack of recognition by other nursing staff as well as limited support from some faculty advisors. Supports for the role were the visible presence and ongoing support by faculty advisors as well as the hospital workshop.

CONCLUSION

This study highlighted the importance of support from nursing faculty as well as recognition by fellow nurses of the workload involved when being a preceptor.

RELEVANCE TO CLINICAL PRACTICE

Preceptors play an important role with students prior to graduation. Both the hospital and educational institutions need to ensure that nurses are given the necessary support, recognition and resources.

The One-Minute Preceptor

The One-Minute Preceptor (OMP) is a teaching tool that has been used successfully for over 10 years in family practice residency programs. It was designed to enhance the teaching skills of physicians involved in the clinical education of new residents. This article describes the five steps of the OMP and how it was taught to a group of nurse preceptors and reports their evaluations of the impact that this education had on their ability to instruct and offer feedback to the novice nurse.

Nurses' perceptions of stress and support in the preceptor role

This study was undertaken to examine whether staff nurses experience stress when they are precepting, and the sources of the stress. Another purpose was to describe preceptors' perceptions of support from others, such as coworkers and managers. A convenience sample of 65 registered nurse preceptors completed an investigator-developed questionnaire asking for their views on stress and support in the preceptor role. Most respondents (89%) reported that precepting is stressful to some degree, with the most common reasons being workload, skill level of the preceptee, organizational support, and preceptor confidence. Despite the high levels of stress reported, most subjects described adequate support as preceptors from coworkers and managers. Preceptors are critical for the training and retention of new nurses. It is important that stressors related to precepting be acknowledged and strategies be employed to reduce stress. Recommendations for support and strategies are included.

Preceptor Preparation

Preceptor preparation is critical to the success of all orientation programs. This article focuses on the purposes of preceptor preparation and a series of programs developed for the staff of Surgical Services. The programs are leveled and focus on basic and advanced concepts. The advanced program is a means of reward and recognition for preceptors in the various surgical services areas. The programs are designed for nurses and other staff involved in precepting new employees.