Preceptorship - Training new nurses

1. Gina Granger
PRECEPTORSHIP: WHAT DOES
IT MEAN?

2. LEARNING OBJECTIVES:
At the end of this presentation, attendees should be able
to:
• Define the following concepts:
• Preceptorship
• Onboarding
• Competency assessment
• Discuss the 2 priorities for new staff
• Identify and define the 5 levels of Benner’s Novice to Expert
model of competency
25 February 2017COPYRIGHT © 2015 NEOCONSULT INTERNATIONAL 2

3. INTRODUCTION
• Too many nurses are assigned to become preceptors without
adequate training.
• They are competent nurses and a year or two in the department,
so it’s assumed they will relate to new grads and that is about all
the need.
• Unless they receive training in the phases of reality shock, what
new nurses need, how to role model behavior and expectations,
and how to provide feedback and criticism, they are being set up
to fail
25 February 2017COPYRIGHT © 2015 NEOCONSULT INTERNATIONAL 3

4. 25 February 2017COPYRIGHT © 2015 NEOCONSULT INTERNATIONAL 4
• ‘‘A preceptor is an experienced and competent staff nurse who
has received formal training to function in this capacity
• and who serves as a role model and
• a resource person to new staff nurses’’ (Alspach 2000)
DEFINITION OF PRECEPTOR
http://www.nursingcenter.com/lnc/pdfjournal?AID=733695
&an=00124645-200707000-00010&Journal_ID=&Issue_ID=

5. 25 February 2017COPYRIGHT © 2015 NEOCONSULT INTERNATIONAL 5
• Nurses in face-to-face situations often share informal
knowledge. Such sharing is an important part of experiential
learning (Levine & Gilbert, 1999).
• New nurses receive all kinds of information on a daily basis,
such as input from patients, supervisors, ancillary staff, and the
environment itself.
• The new nurse must decide what knowledge to internalize,
based on training and education, and apply that knowledge
to practice-
• the preceptor plays an important role here.
WHY THE NEED FOR A PRECEPTOR?

6. 25 February 2017COPYRIGHT © 2015 NEOCONSULT INTERNATIONAL 6
Top priorities are to
• 1) “onboard” the new staff to their organization
• and to
• 2) ensure new nurse competency
PRIORITIES FOR NEW STAFF

7. “ONBOARDING”
• Companies spend large amounts of time, effort, and resources on
recruiting new staff;
• the last thing they want is for those new staff to up and leave for
somewhere else, which research shows they all too frequently do.
The onboarding process is crucial for new nurses who face an
enormous change process as they transition from one hospital (+/
country) to another
25 February 2017COPYRIGHT © 2015 NEOCONSULT INTERNATIONAL 7

8. 25 February 2017COPYRIGHT © 2015 NEOCONSULT INTERNATIONAL 8
Onboarding is a business management term that describes
the process of assimilating new employees into the new
organization.
More than simply orientation, onboarding is the process of
 embedding new employees into the culture
 ensuring they not only become productive employees, but
 they also become emotionally invested in the organization.
“ONBOARDING”
Hendren 2010

9. 25 February 2017COPYRIGHT © 2015 NEOCONSULT INTERNATIONAL 9
• Ideally, nurses are provided with orientation upon being hired
regarding their role.
• This orientation should include the transfer of knowledge from
an experienced nurse to the new nurse.
• An experienced nurse may provide training, or “precepting” to
a new nurse to help him or her adjust to the new role.
• The “preceptor” is the knowledge transfer expert in the nursing
arena.

10. 25 February 2017COPYRIGHT © 2015 NEOCONSULT INTERNATIONAL 10
The unit manager and a new nurse rounded the hospital corridor, coming face-
to-face with a preceptor standing next to the bustling nurses' station of a critical
care unit.
Without prelude, an exasperated look on her face, the preceptor launched into
her story. "I tell my preceptees I'm not usually in the business of critizing them, but
this one ...!“
The preceptee claimed to have seen and done it all, showed no desire to do
anything more than once, and reported nothing of personal benefit was taking
place on the assigned unit.
Yet when questioned by the preceptor, the nurse had little understanding of the
nursing care needed for the assigned patients.
The preceptor's frustration was shared by the unit manager, when conversation
turned to burn out and this valuable nurse's desire to give up the responsibility of
precepting
If you were the new nurse, how would you feel?
SCENARIO:

11. 25 February 2017COPYRIGHT © 2015 NEOCONSULT INTERNATIONAL 11
• Competency is defined as “the knowledge, skills, ability and
behaviours that a person possesses in order to perform tasks
correctly and skilfully” (Whelan, L: 2006)
• Common meaning = task dexterity & workplace skills
• It is assessed in terms of knowledge, skills & attitude
• These knowledge, skills and attitude, advance from Novice to Expert
levels of competency
NURSING COMPETENCY

12. NOVICE TO EXPERT COMPETENCY
(BASED ON BENNER MODEL)

13. 25 February 2017COPYRIGHT © 2015 NEOCONSULT INTERNATIONAL 13
Level Characteristics
Novice Cannot perform procedures independently- needs constant assistance
Advanced
Beginner
Demonstrates Marginally Acceptable Performance
Typically new registered nurse up to one year of experience
(1st 3 months of probation)
Competent Able to prioritize plan of care
Efficient delivery of patient care
Speed & flexibility practical situations still lacking
Typically has 2 to 3 years’ experience in area
(2nd 3 months of probation)
Proficient Increased critical thinking skills and decision making skills
Intuitive grasp of the clinical situation based on background knowledge
Enhanced confidence
Can recognize when normal outcomes not achieved
Take responsibility for own professional development (wants to learn more)
Typically has 3 to 5 years’ experience in area
Expert Shows expertise in theoretical and practical knowledge in clinical situations
Other nurses seek their help in problem solving or to identify key aspects of a situation
Become resource & mentor for other nurses (role model)
Is able to compare the similarities and dissimilarities among clinical situations.
Consistently exceeds clinical competence expectations
Motivates other staff to develop themselves
Typically has experience in one clinical area for more than 5 years

14. 25 February 2017COPYRIGHT © 2015 NEOCONSULT INTERNATIONAL 14
• We may think that everyone progresses through all levels of the
model—novice to advanced beginner to competent to proficient
to expert.
• This is not always the case.
• Some nurses stagnate at a level, and their practice does not
advance beyond that point.
• Thus, a phenomenon exists that has been labelled by some as the
“perpetual novice”
www.vnip.org/documents/Mentor-Preceptor-
Novicetoexpert.ppt

15. MOVING BEYOND THE PERPETUAL NOVICE:
A UK STUDY:
• With declining rates of arteriovenous fistula (AVFs) in UK, opportunities to
develop expert cannulation skills have become limited for hemodialysis nurses.
• This study identified factors that hindered skill acquisition.
Personal attributes identified:
• HD nurses' approach to learning and previous experience,
• Emotional reaction to stress, and
• Interpersonal relationships with colleagues.
Environmental/contextual factors identified :
• Limited learning opportunities,
• Attitudes and demands from patients,
• Unit flow and time pressures
25 February 2017COPYRIGHT © 2015 NEOCONSULT INTERNATIONAL 15
Wilson et al 2013

16. 25 February 2017COPYRIGHT © 2015 NEOCONSULT INTERNATIONAL 16
• Allows the nurse to make conclusions about what observations require intervention
and what observations are "within normal limits."
• The expert nurse who detects a slight change in the breathing pattern of a
patient, and knows that the change requires immediate intervention, is attaching
meaning to what is.
• This is why educated, experienced, registered nurses are valuable at the bedside
of the patient.
• Their ability to perceive signals and to determine the relevance of those signals
cannot be matched by nursing assistants taught only to collect and record health
data at prescibed intervals. Such personnel might be able to gather data
accurately, but they do not have the educational preparation and scientific
background needed to attach meaning to those data
• In brief, to recognize patterns is to attach meaning to the assessment of the "what
is." The attachment of meaning leads to making nursing diagnostic statements.
• Stating the diagnosis is not professional vigilance; it is an informed action that
results from that vigilance. It is only through that action, however, that others see
that vigilance has occurred.
ATTACHING MEANING TO OBSERVATIONS: A SKILL OF EXPERT
NURSES

17. 25 February 2017COPYRIGHT © 2015 NEOCONSULT INTERNATIONAL 17
The most important practical lesson that can be given to nurses is to
teach them:
 what to observe —how to observe—
 what symptoms indicate improvement—what the reverse—
 which are of importance —which are of none—
 which are evidence of neglect —and of what kind of neglect.
All this is what ought to make part, and an essential part, of the
training of every nurse
(Florence Nightingale)
NURSING VIGILANCE
Mayer & Levine 2005

18. 25 February 2017COPYRIGHT © 2015 NEOCONSULT INTERNATIONAL 18
• J.K. is a 5-year-old male patient with non-Hodgkin’s
lymphoma (NHL) who has been hospitalized for 10 days while
beginning treatment.
• A tunneled triple-lumen catheter had been placed for
chemotherapy and blood draws. J.K. is neutropenic.
• Today his respiratory rate is 24 breaths per minute, and he has
a rash. He is not as active as he has been and has stayed in
bed most of the day.
• He vomited once this morning. He is afebrile with a heart rate
of 100 beats per minute.
SCENARIO:
NOVICE - EXPERT

19. 25 February 2017 19
• My biggest concern about caring for J.K. was making sure I gave all of his medications on time.
He has been here for a while, and this was my first time taking care of him.
• I was nervous because his mother was usually in the room, and I was told she asked quite a few
questions.
• I did my usual assessment, and he seemed okay and wanted to stay in bed instead of going for a
walk.
• I did ask my preceptor to assess him because he has a little rash that was new today. Shortly
after she assessed him, he vomited 1time. I made sure that his IV was still running, and I let him
get some rest.
• His mother arrived and seemed really concerned that he was in bed and that he had a little rash
and had vomited once. She actually started to cry. I let her talk to him while I got another set of
vital signs. He didn’t have a fever, but his pulse was up a little and so were his respirations.
• I asked my preceptor if there was something else I should check. She called the doctor and got a
bunch of orders. I had to get help to coordinate all the consults and enter the lab orders. I didn’t
know how I was going to comfort the mother and get everything done.
• My preceptor said she thinks J.K. may have an infected catheter. I think they should have put in
an implanted port instead of this kind of tunneled catheter. I went to look for a policy or
protocol to tell me how to proceed with J.K.’s care.
SAME PATIENT- 2 NURSES.... Advanced Beginner

20. 25 February 2017 20
• J.K. was my youngest patient on Tuesday. I was a little surprised to hear his
diagnosis of NHL because the children are usually a little older when they get
that. I looked in the room as soon as I got out of report and noticed his mother
wasn’t here yet. I went right in and introduced myself and told him I would be
his nurse all day.
• I saw a baseball cap next to his bed, and I asked him what kinds of things he
likes to do in summer just to try to get to know him. He seemed pretty
comfortable with me, and I started my assessment.
• His pulse and respirations were higher than I would expect. Even though he was
afebrile, I was suspicious about his vital signs. He has a tunneled catheter for
chemotherapy and he is neutropenic, so you really can’t be too careful. It’s too
bad we need multiple ports for his chemo and blood draws, or he could have
had an implanted port.
• Knowing that he might not show the usual signs of infection and did have a little
rash starting, I was definitely thinking that he may have an infected catheter.
• I wanted to get him out of bed, but he said he was tired and didn’t want to get
up. He just didn’t seem right, so I asked the nurse who cared for him the last 3
days if he had been up and active. She said he had.
SAME PATIENT- 2 NURSES.... Expert

21. 25 February 2017 21
• J.K.’s mother came, and I met her at the door. I asked her if J.K. seemed to
be a little lethargic to her, and she agreed that he did. He vomited once
after she arrived, and she began to cry. I sat with her and answered her
questions about what I thought was happening.
• I excused myself and told her I’d be back in just a few minutes, but I needed
to call the doctor to get orders for labs and x-ray. I assured her she would
have an opportunity to discuss everything with the doctor and asked her if
she would like to accompany J.K. to any tests or diagnostics that may require
him to leave the floor. I could tell it was important to her to participate in
all of the decisions around J.K.’s care.
• I also took a quick look at J.K.’s admission assessment and found that his
mother was a single mom and had been going through some hard times. I
considered calling for a social worker and minister but wanted to wait and
talk to her a bit more before I did that.
SAME PATIENT- 2 NURSES.... Expert

22. 25 February 2017COPYRIGHT © 2015 NEOCONSULT INTERNATIONAL 22
BEING AN EXPERT NURSE, MEANS MORE
THAN JUST SKILLS COMPETENCY. VIDEO
https://www.youtube.com/watch?v=PJX6_0oqI90

23. 25 February 2017COPYRIGHT © 2015 NEOCONSULT INTERNATIONAL 23
• Willing and able in the hectic, challenging hospital environment.
• Positive attitude, patience, and comfort with thinking out loud
• Excitement is contagious, and passion for the profession of nursing is
critical for effective role modelling. These attributes are observable
through a positive attitude.
• Enthusiasm, approachability, self-respect, and the respect of peers
are important in a preceptor
• A personal commitment to learning and an interest in teaching,
• a dash of humour, contribute to success. Humour can be used as a
teaching tool, especially when mistakes occur, to relieve anxiety
and promote growth in the relationship between the preceptee and
preceptor
REQUIREMENTS FOR PRECEPTORS

24. 25 February 2017COPYRIGHT © 2015 NEOCONSULT INTERNATIONAL 24
• Preceptors can play a critical role in how a
new nurse adapts in the new environment
• This also affects the development of
competency ; or the ability of the
preceptee to demonstrate his/ her
competency
CONCLUSION:

25. 25 February 2017COPYRIGHT © 2015 NEOCONSULT INTERNATIONAL 25
http://mummytofive.com/wp-
content/uploads/2012/07/drseussprintable_mummytofive.jpg

26. 25 February 2017COPYRIGHT © 2015 NEOCONSULT INTERNATIONAL 26
• Any Questions?
GROUP DISCUSSION

27. 25 February 2017COPYRIGHT © 2015 NEOCONSULT INTERNATIONAL 27
1. Rebecca Hendren, 'Onboard' new graduate nurses to prevent them jumping ship: for HealthLeaders
Media, September 7th,2010 – in http://www.strategiesfornursemanagers.com/ce_detail/256250.cfm
2. Mayer G. & Levine M., Vigilance: The Essence of Nursing; ANA PeriodicalsOJINTable of ContentsVol
10 - 2005No 3 Sept 05
3. http://www.aultman.org/Aultman-Hospital-
Information/aboutus/OurNurses/TheoreticalFrameworkforNursing.aspx
4. Whelan L., Competency Assessment of Nursing Staff; Orthop Nurs. 2006 May-Jun;25(3):198-202;
5. Hoffecker, C.L. 2011, The Patricia Benner Theory, East Tennessee State University College of Nursing- in
NRSE: 3400 Concepts of Professional Nursing
6. Wilson B, Harwood L, Oudshoorn A. CANNT J. Moving beyond the "perpetual novice": understanding
the experiences of novice hemodialysis nurses and cannulation of the arteriovenous fistula. Source:
Victoria Hospital, London Health Sciences Centre, London, CANNT J. 2013 Jan-Mar;23 (1):11-18
7. Benner’s stages of clinical competence-NSW Health, NaMO-WOW Project tool 2011
8. Critical care Nursing: A Holistic Approach 10th Edition. 2012. Lippincott Williams & Wilkins (p 9-10)
9. Boyer, S. (Vermont Nurses in Partnership) Mentoring and Precepting: Transition from Novice to Expert
accessed on www.vnip.org/documents/Mentor-Preceptor-Novicetoexpert.ppt
REFERENCES: