Identification of the Problem/Concern
Preceptorship is a practice of supporting novice nurses by experienced nurses in clinical settings for the purpose of assisting in nurses’ adaptation (Duteau, 2012). At New York Methodist Hospital, experienced nurses also work as preceptors. Still, the problem is in the fact that preceptors in the organization are selected because of their experience, but these nurses often lack required skills and resources to work effectively, and they do not receive special training as preceptors.
In clinical settings, it is possible to observe the lack of focus on the preceptors’ orientation. Those preceptors who are not trained for this role during preceptor orientation can experience such problems as poor time management, ineffective communication with preceptees, the decreased quality of care, and inappropriate performance (Shinners, Mallory, & Franqueiro, 2013). Therefore, preceptor orientation in clinical settings is important for nurses who plan to become preceptors.
Summary of Relevant Literature
Preceptorship orientation is widely discussed in the scholarly literature. In her article, Duteau (2012) have described preceptorship programs in Canada. In their research, Watson, Raffin-Bouchal, Melnick, and Whyte (2012) have also analyzed the implementation of the nursing peer preceptorship program in Canadian healthcare facilities. Kalischuk, Vandenberg, and Awosoga (2013) have concentrated on nurses’ expectations regarding their roles as preceptors. According to Borch, Athlin, Hov, and Sörensen (2013), more attention should be paid to group supervision during the process of training preceptors. Carlson (2013) and Hilli, Salmu, and Jonsen (2014) have focused on the idea of developing specific trusting relationships between preceptors and preceptees. Shinners et al. (2013) and Price (2014) have accentuated the necessity of developing preceptors’ skills in relation to the work with patients, clinical reasoning, and socialization. Mann-Salinas et al. (2014) and Bontrager, Hart, and Mareno (2016) have concluded that preceptors need to develop their skills while participating in orientation programs and courses.
In her study, Duteau (2012) provides recommendations on how to improve approaches to developing preceptorship programs while accentuating individual learning needs, responsibilities of skilled nurses, as well as sustainability and flexibility in the working process. Watson et al. (2012) have provided clear recommendations regarding the adaptation of preceptorship programs to the work in clinical settings with the focus on redesigning schedules and teamwork. Borch et al. (2013) recommend focusing on group supervision. Kalischuk et al. (2013) analyze expectations of preceptors regarding the effective course. Shinners et al. (2013) propose the list of activities that should be included in the program for preceptors: adult learning principles, feedback, critical thinking, and goal setting among others. Price (2014), Mann-Salinas et al. (2014), and Bontrager et al. (2016) propose involving team members and educators in the development of effective programs. However, the project does not allow for applying recommendations provided in the studies by Carlson (2013) and Hilli et al. (2014).
The reviewed literature is appropriate to support the current project. In their article, Watson et al. (2012) develop the idea of integrating preceptorship programs into the clinical setting to improve practical skills of both preceptors and preceptees. The ideas of Borch et al. (2013) regarding preceptors’ visions of effective courses are also important to be discussed in the context of the project. Shinners et al. (2013) and Price (2014) also provide practical recommendations regarding the curriculum for the preceptorship program. Mann-Salinas et al. (2014) accentuate the necessity of the proper selection of nurses for the role of preceptors, and this study directly supports the current project. The study by Bontrager et al. (2016) also supports the project while discussing the aspects that can improve the work environment for preceptors and preceptees.
There are also sources that do not support the project in all its aspects. According to Duteau (2012), it is necessary to rely on educational institutions rather than healthcare facilities as appropriate learning environments that can be created only with reference to the support of educators. The development of an independent preceptorship orientation class is not supported by the author directly. Carlson (2013) notes that the effective preceptor preparation is based on the cooperation between educational organizations and healthcare facilities, and he also discusses the idea of symbolic interactionism that cannot be included in the program’s development. Furthermore, in spite of the fact that Kalischuk et al. (2013) and Hilli et al. (2014) provide important conclusions in their work, they do not support this project’s ideas directly, and they cannot be used extensively.
Project Details
Currently, New York Methodist Hospital is in the process of merging with Columbia Presbyterian Hospital that is also known as Columbia University Medical Center. The complex change project includes the development of a preceptorship preparation class to train those nurses who want to become preceptors. It is expected that preceptors will be selected among experienced nurses with reference to their degree (Bachelor of Science in Nursing) and willingness to perform this role. Thus, target recipients include nurses who plan to become preceptors, as well as nurse leaders and educators who will perform roles of instructors. Stakeholders include experienced nurses, novice nurses or preceptees, administrators, and patients.
The staff-training department at New York Methodist Hospital is also in the process of reorganization. Therefore, the project oriented to creating a preceptorship preparation class cannot be implemented until the completion of the final stage in January of 2017.
Currently, the group of specialists working at New York Methodist Hospital and Columbia Presbyterian Hospital continues to develop the curriculum in cooperation with educators from colleges and universities. The project is planned to be implemented in January of 2017, and the focus will be on evaluating the first results. The final stage of the project that includes revising the organization’s policies and standards will be completed in February of 2017.
Summary of Project: Resolution of the Problem/Concern
It has been found that, at New York Methodist Hospital, those nurses who are selected as preceptors demonstrate the lack of knowledge and practical preceptorship skills, and they have no adequate training. The solution to the problem is the development of a preceptorship preparation class. The group of specialists is working on the curriculum. The focus is on creating a specific program for preceptors who work at New York Methodist Hospital. The practice of referring to educators as consultants is advantageous because of saving resources and guaranteeing flexibility (Watson et al., 2012). Topics for the four-week course are selected with reference to researchers’ recommendations and problems experienced by preceptors in the organization, and they include teaching strategies, goals’ setting, communication, and evaluation among others (Mann-Salinas et al., 2014; Shinners et al., 2013). Instructional methods include lectures, presentations, role playing, scenarios, and discussions.
To implement the intervention, Kurt Lewin’s theory of change was selected. The process of change is based on three main stages: unfreezing, moving, and refreezing (Shirey, 2013). During the unfreezing stage, the representatives of a project team were expected to recognize the need for change (Shirey, 2013). This stage has been completed recently. The second stage is moving, and it is based on developing a detailed plan of actions and the curriculum for the program. This stage is planned to be completed in January of 2017. At the stage of refreezing, the effectiveness of the preceptorship preparation class will be analyzed and evaluated, and the organization’s policies will be revised. The main barriers to the project implementation are a complex process of merging New York Methodist Hospital and Columbia Presbyterian Hospital and associated reorganizations in the work of the project team. The barriers are addressed by planning all stages of the process.
The evaluation plan should include four steps. At the first stage, it is necessary to determine areas that are gaps in nursing education, including time management, communication, decision-making, and critical thinking among others. These areas should become targets, and outcomes will be measured in the number of cases and percentages. At the second stage, it is important to develop questionnaires and protocols for administrators, instructors, trained preceptors, and preceptees to focus on changes. The third step is the pre-implementation evaluation of the preceptors and preceptees’ interaction and work. The fourth step is the post-implementation evaluation of preceptors’ skills and outcomes.
Next Steps
The current project oriented to the problem of effective preceptor preparation supports the promotion of evidence-based practice. Thus, it demonstrates how it is possible to use evidence in order to select effective solutions to problems identified in areas of nursing education and administration. The project results will be shared with colleagues in the area of nursing education with the help of presentations and brochures. It is important to post results on professional forums. It is also important to present the project results in the form of a conference paper in order to support the use of evidence in resolving practical issues in clinical settings when they are related to the problem of ineffective preceptorship. This project demonstrates the importance of preceptor orientation not only with the focus on the field of education but also with the focus on clinical settings. Observing the process of the project implementation, it is possible to state that it accentuates the necessity of developing preceptorship programs in healthcare organizations, emphasizes the need for uniting theoretical and practical elements in the preceptor education, and contributes to improving preceptors’ skills in training novice nurses.
References
Bontrager, S., Hart, P. L., & Mareno, N. (2016). The role of preceptorship and group cohesion on newly licensed registered nurses’ satisfaction and intent to stay. The Journal of Continuing Education in Nursing, 47(3), 132-139. doi: 10.3928/00220124-20160218-09
Books[Image]. (n.d.).
Borch, E., Athlin, E., Hov, R., & Sörensen, D. G. (2013). Group supervision to strengthen nurses in their preceptor role in the bachelor nursing education: Perceptions before and after participation. Nurse Education in Practice, 13(2), 101-105. doi:10.1016/j.nepr.2012.07.009
Carlson, E. (2013). Precepting and symbolic interactionism: A theoretical look at preceptorship during clinical practice. Journal of Advanced Nursing, 69(2), 457-464. doi:10.1111/j.1365-2648.2012.06047.x
Duteau, J. (2012). Making a difference: The value of preceptorship programs in nursing education. The Journal of Continuing Education in Nursing, 43(1), 37-43. doi:10.3928/00220124-20110615-01
Hilli, Y., Salmu, M., & Jonsen, E. (2014). Perspectives on good preceptorship: A matter of ethics. Nursing Ethics, 21(5), 565-575. doi:10.1177/0969733013511361
Kalischuk, R. G., Vandenberg, H., & Awosoga, O. (2013). Nursing preceptors speak out: An empirical study. Journal of Professional Nursing, 29(1), 30-38. doi:10.1016/j.profnurs.2012.04.008
Mann-Salinas, E., Hayes, E., Robbins, J., Sabido, J., Feider, L., Allen, D., & Yoder, L. (2014). A systematic review of the literature to support an evidence-based precepting program. Burns, 40(3), 374-387. doi:10.1016/j.burns.2013.11.008.
New York Methodist Hospital[Image]. (n.d.).
Price, B. (2014). Preceptorship of nurses in the community. Primary Health Care, 24(4), 36-41. doi:10.7748/phc2014.04.24.4.36.e858
Shinners, J., Mallory, C., & Franqueiro, T. (2013). Preceptorship today: Moving toward excellence. The Journal of Continuing Education in Nursing, 44(11), 482-483. doi:10.3928/00220124-20131025-91
Shirey, M. R. (2013). Lewin’s theory of planned change as a strategic resource. Journal of Nursing Administration, 43(2), 69-72. doi:10.1097/NNA.0b013e31827f20a9
Two nurses using tablet [Image]. (2016).
Watson, L. C., Raffin-Bouchal, S., Melnick, A., & Whyte, D. (2012). Designing and implementing an ambulatory oncology nursing peer preceptorship program: Using grounded theory research to guide program development. Nursing Research and Practice, 2012(1), 1-15. doi: 10.1155/2012/451354