Levels Of Nursing Practice

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Nursing Preceptor Workshop.

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  • The purpose of this presentation is to give preceptors the resources and tools they need in order to precept any level orientee.
  • Level I: Novice A GN or RN with less than one year experience. • No experience with situations for which they are in • Need rules to guide actions • May be asked to perform tasks without any situational experience • Unable to use discretionary judgment, works better with rules than with guidelines • Must be backed up by a competent nurse • Has no rule about which tasks are most relevant in a real-world situation or when an exception to the rules is necessary Level II: Advanced Beginner An RN with one to three years experience: A Level I nurse may advance to Level II status after a minimum of one year experience and recommendation by a Clinical Manager. • Demonstrates marginally acceptable performance • May shift from teaching rules to teaching guidelines • Is gaining experience with real situations and able to note meaningful patterns • Needs assistance in prioritizing (or have priorities pointed out by preceptor) • Must be backed up by a competent nurse • Can formulate guidelines for actions in terms of patterns and attributes • Has difficulty identifying important aspects; treats all attributes as equally important Level III: Competent Nurse An RN with a minimum of three years experience may be hired into the level if he/she shows evidence of meeting specified criteria. A Level II RN can advance to Level III after a minimum of two years experience and recommendation by a Clinical Manager. All required unit-specific certification must be completed in order to advance to Level III. • Begins to see his or her actions in terms of relevance • May focus on improving decision-making of long-term goals or overall plan and ways to improve • Begins to distinguish relevance of care and of multiple, complicated care needs • Feels the ability to cope and manage the interdisciplinary needs of patients • A good preceptor for a novice nurse, can see unforeseen events • Lacks the speed and flexibility of a proficient Nurse Level IV: Proficient Nurse A Level III RN may advance to Level IV status after a minimum of three years or specialty experience. The nurse must meet specified criteria and be recommended by a Clinical Manager. Level IV requires the nurse to maintain his/her status by performing additional activities. A candidate for Level IV is usually approved by a Clinical Ladder Committee. • Can discern situations as wholes rather than concentrating on selected parts • Use complex case studies to facilitate learning rather than single pieces of information • Uses past experiences to judge situations rather than rules or guidelines alone • A good preceptor for a competent nurse guide • Can recognize when the expected normal picture is absent • Considers fewer options and hones in on accurate elements of a problem Level V: Expert Nurse A Level IV nurse may advance to Level V after a minimum of five years or specialty experience. The nurse must meet the specified criteria and be recommended by a Clinical Manager. Level V requires the nurse to maintain his/her status by performing certain activities. A candidate for Level V must be approved by a Clinical Ladder Committee. • Practices holistic rather than fractionated care • Grasps situations intuitively and correctly identifies processes and solutions without wasting time • Encourage other nurses in advance practice • Demonstrates excellent practice with extraordinary management of clinical problems • Considered an expert by others • A good preceptor for a competent nurse   Benner, P. (1984) "From Novice to Expert: Excellence and Power in Clinical Nursing Practice." Addison-Wesley Publishing Company, Nursing Division, Menlo Park, California. Additional Data from Benner, P. (1982). From novice to expert. American Journal of Nursing, 82, 402-407.    
  • Children start with no preconceived ideas They have no knowledge about the subject to begin with They have a natural curiosity Adults are autonomous and self-directed Adults have accumulated a foundation of life experiences and knowledge Adults need to be given rationales for why they are learning what they are learning. Adults learn what is necessary for them. Adults are problem-centered vs. subject-centered Most adult learners have specific expectations of a learning experience. Adults learn in supportive and positive environments.
  • Be realistic Set your orientee up to Succeed Be specific Don’t make people have to guess Make expectations clear Don’t leave your orientee wondering what you want from them
  • Record progress towards meeting goals Establish basic competence and compliance with ORHS standards Keep it to the point
  • Critical Checks (Clinical) Think Link (Education & Training) Patient Care Education (Clinical) Pharmacy Services (Departments) MRSA (Education & Training) SLP (Education & Training) CAI (Education & Training GN Roundtables (Education & Training) HR Resources for job description and personal stuff Policy & Procedures Incident Reporting - How to (Education & Training) Trach Care (E-Learning) UBE Corporate Education
  • Orientee Self Assessment (Adults can often determine their own learning needs) PBDS Report (Good indicator of orientation needs)
  • Critical Checks (Clinical) Think Link (Education & Training) Patient Care Education (Clinical) Pharmacy Services (Departments) MRSA (Education & Training) SLP (Education & Training) CAI (Education & Training GN Roundtables (Education & Training) HR Resources for job description and personal stuff Policy & Procedures Incident Reporting - How to (Education & Training) Trach Care (E-Learning) UBE Corporate Education
  • Daily & Weekly Goals Take 1 minute a day Take 5 minutes weekly Give Ongoing Expectations SMART Goals: Specific Measurable Attainable Realistic Time Bound
  • Plan Exactly what you want Daily & Weekly Goals Take 1 minute a day Take 5 minutes weekly Give Ongoing Expectations SMART Goals: Specific Measurable Attainable Realistic Time Bound
  • Did you accomplish the goals? If not, what do you need in order to do so? Assess daily and weekly.
  • Document, document, document Document Daily & Weekly
  • Look for common ground
  • Plan Exactly what you want Daily & Weekly Goals Take 1 minute a day Take 5 minutes weekly Give Ongoing Expectations SMART Goals: Specific Measurable Attainable Realistic Time Bound
  • Complete all initial assessments by 0800 and have them documented by 1000; all medications must be given within 30 minutes of scheduled time S pecific M easurable A ttainable R ealistic T ime Bound
  • Critical Checks (Clinical) Think Link (Education & Training) Patient Care Education (Clinical) Pharmacy Services (Departments) MRSA (Education & Training) SLP (Education & Training) CAI (Education & Training GN Roundtables (Education & Training) HR Resources for job description and personal stuff Policy & Procedures Incident Reporting - How to (Education & Training) Trach Care (E-Learning) UBE Corporate Education
  • Levels Of Nursing Practice

    1. 1. Preceptor Workshop Part I
    2. 2. Objectives: <ul><li>Define 3 principle roles and responsibilities of a preceptor. </li></ul><ul><li>Distinguish how a preceptor’s role differs from that of regular staff. </li></ul><ul><li>Define Benner’s Levels of Nursing Practice. </li></ul><ul><li>List 5 available resources for the preceptor. </li></ul><ul><li>List 3 principles of adult education. </li></ul>
    3. 3. <ul><li>Unit Based Workshop </li></ul><ul><li>Review Preceptor Tools </li></ul><ul><li>Discuss Available Resources </li></ul><ul><li>Make the job easier </li></ul><ul><li>Make the preceptor more effective </li></ul><ul><li>Make efficient use of the preceptor’s time </li></ul><ul><li>Optimize the orientation process </li></ul>Purpose:
    4. 4. <ul><li>What is a Preceptor </li></ul><ul><li>Preceptor Responsibilities </li></ul><ul><li>Orientee Responsibilities </li></ul><ul><li>Levels of Practice </li></ul>The Preceptor Role
    5. 5. <ul><li>A preceptor instructs, teaches and supports an individual who is learning a new skill or is in a new position…. </li></ul><ul><li>A preceptor works closely with the learner, and will watch and coach him/her in skill application. </li></ul><ul><li>A person may be precepted by a number of individuals simultaneously </li></ul>What is a Preceptor?
    6. 6. Protector Educator Coach ROLE MODEL Judge Mentor Friend Supervisor Roles of a Preceptor
    7. 7. LEVELS OF NURSING PRACTICE Advanced Beginner Novice Competent Proficient Expert
    8. 8. <ul><li>To ask questions </li></ul><ul><li>Talk openly </li></ul><ul><li>Prepare </li></ul><ul><li>Follow through on agreements </li></ul>Responsibilities of a Preceptor
    9. 9. <ul><li>To ask questions </li></ul><ul><li>Talk openly </li></ul><ul><li>Prepare </li></ul><ul><li>Follow through on agreements </li></ul>Responsibilities of a Orientee
    10. 10. <ul><li>Adults need to know why they need to know </li></ul><ul><li>Adults have the need of Self Importance </li></ul><ul><li>Adults are problem-centered vs. subject-centered </li></ul><ul><li>Adults often know how they learn best </li></ul><ul><li>Adults usually actively participate in their learning </li></ul>Adult Learners
    11. 11. Preceptor Effective? What makes a?
    12. 12. Desire Knowledge Experience Organization Teaching Skills People Skills What does it take? Yes Yes Yes Yes Yes Yes
    13. 13. What else do you need? Objectivity People Skills Concrete Goals Evaluation Tools Effective Documentation
    14. 14. What works? Goals & Agreements Timeframes Checklists Evaluation Tools Progress Notes Resources
    15. 15. Goals are the single most important factor in achieving success Why make Goals?
    16. 16. Goals & Agreements <ul><li>Turn Goals into Agreements </li></ul><ul><li>Make goals specific </li></ul><ul><li>Take one minute per day </li></ul><ul><li>Try 3-5 minutes a week </li></ul><ul><li>Evaluate daily </li></ul>
    17. 17. Timeframes <ul><li>Be realistic </li></ul><ul><li>Be specific </li></ul><ul><li>Make expectations clear </li></ul>
    18. 18. Checklists <ul><li>Use the checklists </li></ul><ul><li>Checklists are made to help </li></ul><ul><li>Write in additional needs </li></ul><ul><li>Review list weekly </li></ul>
    19. 19. Evaluation Tools <ul><li>Refer to your goals </li></ul><ul><li>Be flexible </li></ul><ul><li>Keep notes (progress notes) </li></ul><ul><li>Keep up weekly </li></ul>
    20. 20. Progress Notes <ul><li>Document progress </li></ul><ul><li>Record progress towards meeting goals </li></ul><ul><li>Keeps orientation plan on track </li></ul><ul><li>Gives credit for what you do </li></ul><ul><li>Covers yourself legally, good or bad </li></ul><ul><li>Establishes basic competence and compliance with Orlando Health Standards </li></ul>
    21. 21. Resources <ul><li>Learn your resources </li></ul><ul><li>Seek out opportunities </li></ul><ul><li>Think and plan what you need </li></ul><ul><li>Don’t go it alone </li></ul><ul><li>Use your policies </li></ul>
    22. 22. <ul><li>The Change </li></ul><ul><li>Transition from staff to preceptor </li></ul><ul><li>Training </li></ul><ul><li>Working with tools </li></ul><ul><li>Value Systems </li></ul><ul><li>Results </li></ul>Becoming Effective
    23. 23. EVALUATE NEEDS How to be Effective
    24. 24. USE RESOURCES How to be Effective
    25. 25. USE THE TOOLS How to be Effective
    26. 26. PLAN GOALS How to be Effective
    27. 27. S pecific M easurable A ttainable R ealistic T ime Bound Plan SMART Goals
    28. 28. ASSESS DAILY How to be Effective
    29. 29. KEEP NOTES   How to be Effective
    30. 30. SEEK OUT OPPORTUNITIES How to be Effective
    31. 31. THE EFFECTIVE PRECEPTOR <ul><li>Possesses and demonstrates broad knowledge </li></ul><ul><li>2)    Explains actions and decisions </li></ul><ul><li>3)      Answers questions clearly and precisely </li></ul><ul><li>4)     Is o pen to conflicting ideas and opinions </li></ul><ul><li>5)      Connects information to broader concepts </li></ul><ul><li>6)      Communicates clear goals and expectations </li></ul><ul><li>7)      Captures learners attention </li></ul><ul><li>8)      Makes learning fun </li></ul>
    32. 32. Part II Preceptor Workshop
    33. 33. <ul><li>Describe how to assist orientees in identifying of their own learning needs and in setting appropriate goals. </li></ul><ul><li>Describe SMART Goals. </li></ul><ul><li>List 2 important steps used by the effective preceptor. </li></ul><ul><li>Explain how to apply principles of adult education as a preceptor. </li></ul>Objectives:
    34. 34. TEACHING STRATEGIES
    35. 35. Teaching Principles <ul><li>Build in active participation </li></ul><ul><li>Build in successful goals </li></ul><ul><li>Build in self-directed approaches (does not mean learning in isolation) </li></ul><ul><li>Tap into learner’s life experiences </li></ul><ul><li>Vary the methodology </li></ul><ul><li>Offer mutual learning between participant and presenter. </li></ul><ul><li>Keep it simple </li></ul>
    36. 36. Assessing Learning Needs <ul><li>Observation </li></ul><ul><li>Skills orientation checklist (unit specific) </li></ul><ul><li>PBDS findings </li></ul><ul><li>Progress Notes </li></ul>Ways to assess learning needs:
    37. 37. <ul><li>Frequently asked questions (by the orientee) </li></ul><ul><li>Questioning the orientee about previous work experiences </li></ul><ul><li>Ask (the orientee): what are your learning needs? </li></ul>Assessing Learning Needs Ways to assess learning needs: (cont..)
    38. 38. <ul><li>Don’t handle it all alone </li></ul><ul><li>Know your options </li></ul><ul><li>Communicate </li></ul><ul><li>Document </li></ul><ul><li>Find the silver lining </li></ul>Dealing with Frustration
    39. 39. Making Goals TAKE ONE MINUTE
    40. 40. Making Weekly Goals TAKE FIVE (or less) MINUTES
    41. 41. <ul><li>Give everyone direction </li></ul><ul><li>Generate measurable tools </li></ul><ul><li>Allow for multiple successes </li></ul><ul><li>Keep an ongoing record </li></ul><ul><li>Help guide the orientee </li></ul><ul><li>Encourage regular evaluation </li></ul><ul><li>Keep everyone on track </li></ul>Why Goals Work
    42. 42. S pecific M easurable A ttainable R ealistic T ime Bound Use SMART Goals
    43. 43. Sample Goals <ul><li>Complete self assessment portion of competencies, outlined in orientation notebook, during the first week of orientation. </li></ul><ul><li>Demonstrate good time management by documenting assessment and vital signs within one hour of assessment. </li></ul><ul><li>Coordinate care and management of one low acuity patient independently by “anticipated date”. </li></ul><ul><li>Effectively coordinate and manage care of 2 patients of intermediate acuity by “anticipated date”. </li></ul><ul><li>Perform admission history and assessment and document completely in Sunrise within 1 hour of admission. </li></ul><ul><li>Complete Interpretation of ABG’s & Mechanical Vent SLP’s by “anticipated date”. </li></ul><ul><li>Complete real time charting within 1 hour of assessment </li></ul>
    44. 44. Making Agreements <ul><li>Explain Roles and Responsibilities </li></ul><ul><li>Discuss Skills to be acquired </li></ul><ul><li>Determine Start Date and End date </li></ul><ul><li>Review Outcomes </li></ul><ul><li>Use Methods of Feedback </li></ul><ul><li>Use Methods of Evaluation </li></ul>
    45. 45. PBDS <ul><li>Performance Based Development System </li></ul><ul><li>Measures critical thinking </li></ul><ul><li>A proven evaluation tool </li></ul><ul><li>Guides orientation </li></ul><ul><li>Makes your job easier </li></ul>
    46. 46. Using PBDS <ul><li>Make goals simple and specific </li></ul><ul><li>Evaluate according to goals </li></ul><ul><li>Adjust goals according to results </li></ul><ul><li>Make your job easier </li></ul>
    47. 47. PBDS Progress Notes Examples From PBDS Department
    48. 48.                    0 of 6     Resp. Neuro 1. Admit and manage 2 respiratory patients independently by 10/29/06 2. Give 4 organized reports to physicians by 10/29/06 10/20/06 - Admission for pneumonia with preceptor 10/22/06 - Admission for COPD done independently. Followed appropriate protocol. 10/23/06 – Managed PE pt. independently. Followed appropriate protocol. Participated in successful code. 2. 10/20/06 - Dr. Jones (+) 10/20/06 - Dr. Smith (+) 10/22/06 - Dr. Green (+ w/urgency) 10/23/06 - Dr. Davis (+)    1 4 DE Ima Newtoyou  10/16 -10/29/06
    49. 49.                 2 of 6     Neuro    2 4 DE Ima Newtoyou   1. Admit and manage 2 neuro patients independently by 11/12/06 2. Complete all charting by end of shift by 11/12/06 1. 10/31/06 - Admission for closed head trauma done independently. Followed appropriate protocol. 11/6/06 - Admission for r/o CVA, followed protocol for thrombolytics. 2. 10/31/06 - All completed 11/6/06 - 20 min. OT 11/7/06 - All completed 11/9/06 - All completed  10/30-11/12/06
    50. 50. 11/13-11/26/06                   3 of 6         3 4 DE Ima Newtoyou Consistently manage 6 patients independently by 11/26/06 11/17/06 - 4 11/20/06 – 5 11/22/06 – 6 (w/little help) 11/23/06 - 6
    51. 51. 11/27-12/3/06                   6 of 6         Orientation complete UBE reviewed reassessment video #107 CTA class scheduled 12/4/06 PBDS Reassessment scheduled 12/11/06 4 4 DE Ima Newtoyou
    52. 52. <ul><li>Keep everyone on the same track </li></ul><ul><li>Don’t take long to do (1-5 minutes) </li></ul><ul><li>Help determine what else is needed </li></ul><ul><li>Generate tools for making further plans </li></ul><ul><li>Makes the preceptor’s job easier </li></ul><ul><li>Gives feedback to the orientee </li></ul><ul><li>Makes it easy to follow progress </li></ul>Evaluations
    53. 53. Evaluate Daily <ul><li>Take a moment everyday to evaluate </li></ul><ul><li>Give Continual Feedback to your orientee </li></ul><ul><li>Complete all documentation forms </li></ul><ul><li>Keep Leadership Informed & Up-To-Date </li></ul><ul><li>Complete Regular Progress Notes </li></ul><ul><li>Share Concerns with Leadership and/or Educators </li></ul>
    54. 54. How to Evaluate the Orientee <ul><li>Use Effective Communication </li></ul><ul><li>Use Preceptor/Orientee Agreements </li></ul><ul><li>Make Observations & Give Feedback </li></ul>
    55. 55. <ul><li>Offer additional information </li></ul><ul><li>Protect nursing licenses </li></ul><ul><li>Open additional doors for staff </li></ul><ul><li>Encourage self-sufficiency </li></ul><ul><li>Give preceptors a break </li></ul><ul><li>Expand nursing knowledge </li></ul><ul><li>Encourage staff involvement </li></ul>Use Resources
    56. 56. <ul><li>Keeps and ongoing record of progress </li></ul><ul><li>Backs up the preceptor </li></ul><ul><li>Provides proof of orientation </li></ul><ul><li>Establishs basic competence and compliance with Orlando Health standards </li></ul><ul><li>Records progress towards meeting goals </li></ul><ul><li>Create a historic record of orientation </li></ul>Documentation
    57. 57. Document Daily <ul><li>Complete Skills Check List </li></ul><ul><li>Review and plan Goals/Agreements </li></ul><ul><li>List daily achievements </li></ul><ul><li>Evaluate if goals were achieved </li></ul><ul><li>Adjust plan accordingly </li></ul>
    58. 58. Giving Feedback <ul><li>Deliver it in a timely manner </li></ul><ul><li>Focus on behavior and learning objectives </li></ul><ul><li>Present the facts, be specific </li></ul><ul><li>Avoid feedback overload (concentrate on one thing at a time) </li></ul><ul><li>Maintain positive body language </li></ul><ul><li>Be culturally sensitive </li></ul><ul><li>Strive for win/win situation </li></ul><ul><li>Encourage self-assessment </li></ul><ul><li>Encourage Critical Thinking skills </li></ul><ul><li>Always include positive comments </li></ul><ul><li>Learn from one’s mistakes </li></ul>
    59. 59. Role Modeling We learn by example
    60. 60. Goals can make winning easy and give us measurable tools Winning Goals
    61. 61. Make it easy to win Set reasonable goals Make it Easy
    62. 62. A standard procedure for teaching a task that a student finds difficult is to break it down into smaller units. Breaking it Up
    63. 63. Evaluate daily (were the goals met?) Adjust new goals accordingly Make Adjustments
    64. 64. Adjust goals according to your evaluations Turn ideas into plans for your orientee Be Flexible
    65. 65. SHARE IDEAS ?

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