Preceptor skills and characteristics: considerations for preceptor education

How early clinical experiences in rural communities influence student learning about rural generalism considered through the lens of educational theory

Introduction

Rural communities have poorer health compared to urban populations due partly to having lesser healthcare access. Rural placements during medical education can equip students with the knowledge and skills to work in rural communities, and, it is hoped, increase the supply of rural physicians. It is unclear how students gain knowledge of rural generalism during placements, and how this can be understood in terms of place-based and/or sociocultural educational theories. To gain insight into these questions we considered the experiences of pre-clerkship medical students who completed two mandatory four-week rural placements during their second year of medical school.

Methods

Data was collected using semi-structured interviews or focus groups, followed by thematic analysis of the interview transcripts.

Results

Rural placements allowed students to learn about rural generalism such as breadth of practice, and boundary issues. This occurred mainly by students interacting with rural physician faculty, with the effectiveness of precepting being key to students acquiring knowledge and skills and reporting a positive regard for the placement experience.

Discussion

Our data show the central role of generalist physician preceptors in how and what students learn while participating in rural placements. Sociocultural learning theory best explains student learning, while place-based education theory helps inform the curriculum. Effective training and preparation of preceptors is likely key to positive student placement experiences.

Implementation of an Evidence-Based Onboarding Program to Optimize Efficiency and Care Delivery in an Intensive Care Unit

Nationally, nurse turnover is 18.7%, and 24.1% of nurses leave their organization within a year of hire. Onboarding is a key component of a nurse's intent to stay and job satisfaction. This article describes the implementation and results of an onboarding program in a large intensive care unit.

Preceptor Course Structures and Processes Contributing to Newly Licensed Nurse Outcomes

BACKGROUND

This article describes a preceptor program implemented across a health care system with standardized structures and processes that contribute to newly licensed nurse outcomes, including role satisfaction and retention.

METHOD

A quantitative design used two psychometrically tested instruments with data collected through Internet-based surveys.

RESULTS

Newly licensed nurses' perceptions of their preceptors were consistently favorable. Newly licensed nurse retention from 2019 through 2022 was 93% at 1 year.

CONCLUSION

Preceptor programs are a critical element in facilitating the transition of newly licensed nurses to professional practice. The success of the program is dependent on the quality of preceptors, who must be carefully selected, educated, and evaluated for the role. [J Contin Educ Nurs. 2023;54(10):448-453.].

Design, Implementation, and Outcomes of an Interprofessional Mobile Web Application for Preceptors for Challenging Issues

OBJECTIVE

The purpose of this study was to develop and assess an easily accessible interprofessional mobile web application to assist preceptors with challenging teaching and learning situations.

METHODS

Phase 1 was a modified Delphi process of 48 advanced practice nursing, dentistry, medicine, and pharmacy preceptors to determine the content of the application. Phase 2 consisted of 12 preceptors from the 4 disciplines piloting a prototype to refine the tool using design-thinking principles. Feedback was analyzed using inductive coding and thematic analysis. Phase 3 evaluated the impact of the final tool on 80 preceptors' satisfaction, knowledge, self-efficacy, and perception of behavior change.

RESULTS

Consensus on 10 topics was reached in the following 3 themes: feedback and communication, clinical and professional development of learners, and precepting efficiency. Preceptors rated the tool as efficient and applicable. Features perceived as useful included concise and applicable content that was easy to navigate with practical video examples. Features to improve included academic jargon, length of content, and lack of connectivity with other preceptors. Knowledge and self-efficacy improved after the use of the refined tool. Change in perceptions of behavior after 1 month was mixed, with a significant change in accessing resources to address challenging situations and regularly reflecting on challenging situations and no significant change in awareness, frequency, or success in managing challenging situations.

CONCLUSION

An interprofessional mobile web application for challenging teaching and learning situations developed through a modified Delphi process was deemed efficient and relevant and demonstrated positive knowledge and self-efficacy change.

Effectiveness of a critical reflection competency program for clinical nurse educators: a pilot study

BACKGROUND

Critical reflection is an effective learning strategy that enhances clinical nurses' reflective practice and professionalism. Therefore, training programs for nurse educators should be implemented so that critical reflection can be applied to nursing education. This study aimed to investigate the effects of a critical reflection competency program for clinical nurse educators on improving critical thinking disposition, nursing reflection competency, and teaching efficacy.

METHODS

A pilot study was conducted using a pre- and post-test control-group design. Participants were clinical nurse educators recruited using a convenience sampling method. The program was conducted once a week for 90 min, with a total of four sessions. The effectiveness of the developed program was verified by analyzing pre- and post-test results of 26 participants in the intervention group and 27 participants in the control group, respectively. The chi-square test, independent t-test, Mann-Whitney U test, and analysis of covariance with age as a covariate were conducted.

RESULTS

The critical thinking disposition and teaching efficacy of the intervention group improved after the program, and the differences between the control and intervention groups were statistically significant (F = 14.751, p < 0.001; F = 11.047, p < 0.001). There was no significant difference in the change in nursing reflection competency between the two groups (F = 2.674, p = 0.108).

CONCLUSION

The critical reflection competency program was effective in improving the critical thinking disposition and teaching efficacy of nurse educators. Therefore, it is necessary to implement the developed program for nurse educators to effectively utilize critical reflection in nursing education.

Establishing the Need for Standardized Clinical Educator Training Programs for Medical Laboratory Professionals

BACKROUND

There is minimal, if any, training for clinical educators in medical laboratory professions. This leads to challenges with teaching, assessment and workload/training balance. Hence, the need for standardized clinical educator training.

METHOD

A survey was developed, validated and deployed to medical laboratory professionals. Responses were analyzed using SPSS. Responses from two open-ended questions-is clinical educators' training important and how is this training beneficial?-were analyzed using thematic analysis.

RESULTS

Most participants indicated that clinical educator training is important (99.4%). However, 72.4% received no formal training prior to training student. Themes from the importance of training include: Equip clinical educators, body of knowledge, standardize training and quality of training. Themes that emerged from the benefits of clinical educators training involve Training content, logistics, professional behavior and technical skills.

CONCLUSION

Clinical educators' training is crucial and valuable. Standardized training on pedagogy and other success strategies are warranted for successful clinical experiences.

Evidence-based practices in developing and maintaining clinical nurse preceptors: An integrative review

OBJECTIVES

This integrative review of literature explores the best practice for establishing and maintaining a hospital-based nurse preceptor program. The intent is to provide nurse leadership and educators with guidance for optimizing preceptor programs in order to improve patient, staff, and organizational outcomes.

DESIGN

The project team conducted an integrative review of literature to inform best practice using the Johns Hopkins Evidence-Based Practice Model and Guidelines.

DATA SOURCES

Data sources included the PubMed, CINAHL, and Cochrane databases.

REVIEW METHODS

Each applicable article underwent a rigorous review and appraisal by the project team. The team used the Johns Hopkins Evidence-Based Practice Model to guide the appraisal process and to synthesize results to generate a comprehensive list of recommendations.

RESULTS

The search yielded 115 unique articles that answered the evidence-based practice question. What are best practices for establishing and maintaining a hospital-based nursing preceptor program? Due to the abundance of data, the practice question was divided into three separate sub questions that explored preceptor development, continuous preceptor support, and essential competencies of preceptors. Relevant evidence included one level I article, seven level II articles, and one level IV article. Most of the evidence was found in articles ranking as level III (n = 54) and level V (n = 52).

CONCLUSIONS

Many preceptorship themes and recommendations resonate throughout multiple levels of evidence. Recommendations include implementing an evidence-based, standardized curriculum that features diverse teaching modalities, critical thinking, and clinical reasoning. Common themes in the literature echo that preceptors need ongoing education, training, and support to improve nursing satisfaction, retention, and the quality of nursing care.

Evaluating the impact of integrating SMART goal setting in preceptor development using the Habits of Preceptors Rubric

DISCLAIMER

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

PURPOSE

The impact of goal setting in pharmacy preceptor development was evaluated using the Habits of Preceptors Rubric (HOP-R), a criterion-referenced assessment developed to assess, quantify, and demonstrate growth across 11 preceptor habits.

METHODS

This study retrospectively evaluated initial and follow-up survey responses from the 2019-2020 Clinician Educators Program cohort at Midwestern University College of Pharmacy, Glendale Campus. Enrollees in this teaching and learning curriculum (TLC) were invited to assess their precepting habits using the HOP-R after attending the first seminar and again toward the end of the longitudinal program. Using online surveys, participants rated their precepting capabilities as developing, proficient, accomplished, or master level for each habit. In the initial survey, each participant selected a habit of focus for deliberate development and established an individualized goal using the specific, measurable, achievable, relevant, and time-bound (SMART) framework. In the follow-up survey, participants indicated their satisfaction with and progress toward accomplishing their precepting goal.

RESULTS

Initial survey results from 55 study participants identified developing as the most frequently self-reported habit level (53%; n = 605 ratings), while master was the least frequently reported (1%). In the follow-up assessment, accomplished (45%) was the most frequently self-reported habit level, while master (5%) remained the least reported. The cohort reported a median progress in SMART goal accomplishment of 69% (range, 12% to 100%; n = 54).

CONCLUSION

Preceptors and resident pharmacists reported perceived advancement in precepting capabilities within the conceptual framework of the HOP-R encompassing both their self-selected habit of focus and adjacent habits while enrolled in a TLC. SMART goals facilitated qualitative and quantitative assessment of development.

Nursing Students' Perceptions of Staff Nurse Instructors' Characteristics in a Dedicated Education Unit

BACKGROUND

The dedicated education unit is a model that has been used for clinical experiences in recent years. The importance of effective staff nurse instructors (SNIs) is paramount in nursing students' development of nursing skills and critical thinking.

PURPOSE

This study examined nursing students' perceptions of positive and negative characteristics of SNIs.

METHOD

During a 3-year period, an estimated 265 nursing students evaluated SNIs using an optional two question survey. Qualitative data were retrieved and reviewed by researchers to analyze common themes delineated by students.

RESULTS

Various themes were noted in which students identified exemplary SNI characteristics as well as barriers to learning.

CONCLUSION

Data revealed positive and negative attributes that promoted student learning by the SNIs. Areas for improvement in training of the SNIs became evident through analyzing data, which can be used by clinical faculty to improve the experiences for both students and SNIs. [J Nurs Educ. 2021;60(8):459-461.].

Factors that influence the preceptor role: a comparative study of Saudi and expatriate nurses

OBJECTIVES

The aim of this study was to compare expatriate and Saudi nursing staff's perceptions of factors that influence their role as preceptors of nursing students.

METHODS

Descriptive comparative study using a self-administered survey was completed by a convenience sample of eligible nurses (n=285). It was conducted in five different hospitals within the Ministry of Health in the Kingdom of Saudi Arabia.

RESULTS

Most preceptors were expatriate nurses (70.5%), while Saudi preceptors represented only 29.5%. The findings show that there is a difference between Saudi and expatriate nurses in their perception of the role, that cultural factors influence the role of expatriate preceptors and that organisational factors influence both groups.

CONCLUSIONS

Expatriate preceptors felt that there were cultural obstacles that hindered their role. These findings will contribute to the development of a more contemporary and culturally sensitive preceptorship model.

Developing a process to manage challenges encountered by experiential education administrators

INTRODUCTION

This study explored preceptor and student related issues reported in pharmacy experiential education settings and solutions that experiential education administrators (EEAs) applied to inform a process to manage these challenges.

METHODS

This mixed-methods study was conducted in two phases. In phase one, five EEAs from three schools of pharmacy collected quantitative and qualitative data over a two-year period on issues reported by students and preceptors and the solutions EEAs employed. Descriptive statistics and content analysis were used to analyze quantitative and qualitative data, respectively. Interviews with six EEAs from four schools were completed in phase two. An additional school was added in phase two. Open coding, pattern coding, and summative analysis were completed on interview data.

RESULTS

Preceptors and students reported 156 and 65 issues, respectively. The most common issues reported were student reliability/responsibility (22, 14%) and preceptor communication (13, 20%). The most frequently applied solutions were coach preceptor (51, 24%) and meet with student (20, 24%). Interviews revealed more information about the strategies EEAs used. Approaches included reactive responses such as talking to and coaching preceptors or students. Preventative strategies were desired, such as tracking data and training.

CONCLUSIONS

Results informed two approaches that EEAs can employ to resolve student and preceptor issues. In the proactive process, issues are tracked to inform student and preceptor development. The reactive approach involves meeting with the preceptor or student, gathering information from both parties, coaching the preceptor or student, and involving other administrators as needed for serious concerns.

Development of an advanced practice preceptor evaluation tool

BACKGROUND

Preceptors are essential in advanced practice registered nurse (APRN) and physician assistant (PA) fellowships; however, no tools exist for fellows to evaluate their preceptor.

PURPOSE

The study's purpose was to examine the use of a modified preceptor evaluation tool (PET) in a new population APRNs and PAs who participated in a formalized postgraduate fellowship program.

METHODOLOGICAL ORIENTATION

A qualitative study involving cognitive interviewing methods was used to evaluate original and modified items of the PET as a means to determine face validity. Over a period of 19 months, five different focus groups were conducted. Study participants completed an independent analysis of the tool prior to engaging in a focus group discussion. Further testing of new items was performed using the last two focus group cohorts and achieved data saturation.

SAMPLE

The sample included 23 fellows who had completed an acute, ambulatory, or primary care yearlong fellowship. More than half of the fellows ranged in age from <30 to 40 years.

CONCLUSIONS

All original 19 items were retained, with the majority (79%) requiring slight modifications. Using feedback from fellows, 10 items were added to the final version, including two open-ended questions. The new items added a focus on preceptors' ability to foster domains of professional growth in the fellows' provider role.

IMPLICATIONS FOR PRACTICE

This newly developed tool with face validity provides a new mechanism for preceptor evaluation by APRN and PA fellows. Additional research is needed with larger groups of fellows as a means to establish the tool's psychometric properties.

Developing a Perioperative Nurse Residency Program to Address Planned Nurse Retirements

Many perioperative nurses are nearing retirement age, which requires hospital and other surgical facility leaders either to compete for experienced perioperative nurses or to find educational solutions to prepare qualified nurses for the perioperative nurse role. Facing the upcoming retirement of several perioperative nurses, leaders at the Sacramento Veterans Affairs Medical Center needed to be proactive. This article describes the leaders' exploration of possible solutions to the shortage, the development of attainable goals, and the steps to provide a successful perioperative nurse residency program. It discusses the required human and material resources, the candidate screening process, and information related to classroom and clinical experiences. The first nine-month perioperative nurse residency program concluded with three graduates who are now working full-time as RN circulators and scrub persons. This facility's administrative leaders immediately approved a second cohort that ran from February 2019 to November 2019.

Family Integrated Care for Preterm Infants

Parent-infant separation is a major source of stress for parents of hospitalized preterm infants and has negative consequences for infant health and development. Family Integrated Care (FICare) uses a strengths-based approach, based on family-centered care principles to promote parental empowerment, learning, shared decision making, and positive parent-infant caregiving experiences. Outcomes of FICare include increased self-efficacy upon discharge and improved parent-infant relationships and infant developmental outcomes. In this article, the authors describe the FICare model and emerging evidence regarding outcomes of FICare for infants and families and discuss challenges and opportunities in implementing and maintaining high-quality FICare.

2019 Continuing Education and Professional Development: Important Milestones

This article provides an annual recap of key issues affecting continuing education and professional development during the past year. [J Contin Educ Nurs. 2019;50(12):534-536].

Community health learning experiences that influence RN to BSN students interests in community/public health nursing

BACKGROUND

As a result of national initiatives reforming the United States' healthcare delivery system, nurse education must emphasize population health and wellness outside of acute care facilities. Bachelor of Science in Nursing (BSN) programs implement innovative strategies and partnerships to provide students with community health clinical experiences to learn the professional practice role of the Community/Public Health (C/PH) nurse. This qualitative research explored the community health learning experiences that influenced postlicense nursing students' interests in a professional role change-from an acute care hospital setting to a community health setting.

METHODS

Data collection, analysis, and dissemination methods found in basic qualitative research designs were used in this study. A purposive sample of Registered Nurse (RN) to BSN students (N = 15) completed semi-structured interviews.

FINDINGS

RN to BSN students sought a professional role change from a hospital to a community-based setting after favorable community health learning experiences that included (a) a supportive C/PH nurse preceptor, (b) identification of desirable nurse role characteristics, (c) special learning activities, (d) and faculty engagement with students.

IMPLICATIONS

Findings provide nurse educators and other consumers of nursing practice with information regarding specific learning contributors that engage and provide transformative learning for RN to BSN students.

Implementation of a Standardized Evaluation Tool to Improve Preceptor Confidence

Preceptors guide the transition of new graduate nurses into practice. Having access to evidence-based tools for evaluation of new graduate nurses promotes preceptor confidence and consistent measures of performance. The Norwegian Nurse Competence Scale was implemented across three acute care organizations for evaluation of new graduate nurse performance. After implementing a standardized process to evaluate new graduate nurses, individual summary scores ranged from 17-25 (preintervention) to 20-25 (postintervention), indicating mid to high levels of preceptor confidence.

The art of preceptorship. A qualitative study

In the clinical nursing practice preceptorship is a widespread method to improve patient care by assisting nurses in developing the right clinical skills. However, little is known about how preceptorship should be practiced to achieve a positive learning outcome. The aim of the study was to investigate how preceptorship can be used in clinical practice to create learning and facilitate competence development. A qualitative study guided by a hermeneutic phenomenological approach and inspired by ethnographic fieldwork included 28 participant observations and 58 interviews. Data were analysed according to Steinar Kvale's three interpretation contexts. The findings showed three themes: Being together: Preceptee and preceptor were physically present in the same room optimising the learning situation with focus on complexity, use of senses and patient safety. Doing together: Preceptee and preceptor performed nursing together to obtain skills focusing on independence, practical skills and communication. Getting along together: Preceptee and preceptor together focused on the patient, relation, comfort and managing how to keep the balance between a professional and a personal relation. Precepetorship is situated learning where knowledge and skills are generated through participation in clinical practice. In this way, nurses develop clinical judgement and independence.