Rapid review on healthcare preceptorship in the UK. Rachel Heathershaw Abril Tejedor Benítez

Transcription

1 Rapid review on healthcare in the UK Rachel Heathershaw Abril Tejedor Benítez 22 nd October

2 Contents EXECUTIVE SUMMARY... 2 BACKGROUND... 3 METHODOLOGY... 4 IDENTIFYING REVIEW QUESTIONS... 4 IDENTIFYING RELEVANT STUDIES... 4 INFORMATION SOURCES... 5 SEARCH... 5 STUDY SELECTION... 5 DATA EXTRACTION... 6 SYNTHESIS OF RESULTS... 8 CONCLUSION REFERENCES APPENDIX Authors Rachel Heathershaw is a Senior Lecturer at the Department of Nursing Studies in University Campus Suffolk Abril Tejedor Benítez is a Lecturer in Adult Nursing at the Department of Nursing Studies in University Campus Suffolk Page 1

3 Executive Summary The period is an important stage that commences at the point of practitioner qualification. Newly qualified practitioners require support in making the transition from student to competent practitioner. This rapid review identified 29 papers which met inclusion criteria; these were subject to scrutiny and data extracted in line with review aim. Preceptorship is one aspect of continuous professional development which is vital to support healthcare professionals in the delivery of safe, effective, person centred care. It is also considered a key factor in recruiting and retaining newly qualified staff. Newly qualified practitioners consider that programmes should be structured and that individualised support could improve the experience and help them develop their confidence and consolidate their clinical skills and knowledge. They would like to have qualified preceptors, to get protected time for completing programmes and to be able to obtain feedback on the development of their practice. They also consider that the relationship with their preceptor plays an important role in their transition to being qualified practitioners. Preceptors agree on the importance of having structured programmes and of providing support to newly qualified professionals to promote their confidence in the development of their new roles. They also find the lack of allocated time is a barrier together with a lack of support for developing their role and the increased workload that this entails. They highlight the importance of providing feedback to newly qualified professionals and of having appropriate support and training to provide effective. Preceptorship programmes vary in length, approach, engagement between the preceptor and preceptee and service context. Standardised, structured and collaborative programmes seem to promote the development of confidence and clinical skills among newly qualified practitioners. Increasing organisational commitment to collaborative programmes seems to help newly qualified practitioners feel more comfortable during their transition period and this might have an impact on retention. Preceptor preparation is variable and is determined by local factors. Page 2

4 Background Recruitment and retention of newly qualified healthcare professionals is essential in order to meet the current staffing requirements in the NHS today. The Directors of Nursing Forum Norfolk and Suffolk Workforce Partnership recognise that is one aspect of continuous professional development which is vital to support healthcare professionals in the delivery of safe, effective, person centred care. It is also considered a key factor in recruiting and retaining newly qualified staff. A programme that maximises the benefits of clinical nursing education in terms of knowledge and skills acquisition, confidence and professional socialisation has the potential to positively impact the overall healthcare community. A structured approach to would benefit all the organisations in the workforce partnership. Preparation of preceptors for this role is essential in order to achieve the outcomes identified above. Therefore this review will focus on the preceptor role, development programmes and the ongoing supervision of preceptors to ensure the sustainability of the programme. The Directors of Nursing would like to ensure any developments in are underpinned with an up to date evidence base. The period is an important stage that commences at the point of practitioner qualification. Newly qualified practitioners require support by a competent role model in making the transition from student to competent practitioner (Wigens and Heathershaw, 2013). At present, there are no Nursing and Midwifery Council standards for. The latest guideline on this issue was published in 2006, and it strongly recommended that all new registrants have a period of on commencing employment. The Department of Health (DH) issued the Preceptorship framework for Newly Registered Nurses, Midwives and Allied Health Professionals (2010) that included definitions and elements of, citing retention rates as an outcome measure. The importance of further developing current programmes for newly registered nurses has also been highlighted recently in Raising the Bar Shape of Caring; A Review of the Future Education and Training of Registered Nurses and Care Assistants (Willis, 2015). Recommendations are linked to collaborative working around guaranteed employment, advanced skills acquisition and revalidation (Willis 2015). In order to examine the most contemporary evidence a review of literature published after the 2010 Department of Health Preceptorship Framework was undertaken to account for any implementation of their recommendations. The review objective was agreed: Page 3

5 To identify the latest evidence on nursing and analyse core emerging themes within the literature Methodology A scoping review of the literature was undertaken on the subject of non medical professions in the UK since the publication of the latest DH framework (2010). The scoping review used the framework developed by Arksey and O Malley (2003) consisting of five stages: Stage 1: identifying the research question Stage 2: identifying relevant studies Stage 3: study selection Stage 4: charting the data Stage 5: collating, summarising and reporting the results Identifying review questions What different types of programme exist? How are registered nurses prepared for the role of preceptor? What impact does a programme have? Identifying relevant studies Inclusion criteria: Papers published in the UK or international studies relevant to the UK context English language time frame to reflect the publication of Preceptorship Framework (DH, 2010) All care settings Exclusion criteria: News article Medical profession / pharmacy Undergraduate students Mentorship (not ) Reflection / opinion piece Evaluation of teaching Page 4

6 Refworks was utilised for the management of references. Information sources The electronic databases Medline and CINAHL were searched. Search The search terms applied were: Preceptor* newly qualified newly registered As the term has a slightly different definition internationally, papers outside of the UK were scrutinised for applicability and were selected on this basis. Study selection The inclusion and exclusion criteria were applied to all papers retrieved (n=911) from the searches. Each study title and abstract was then independently screened against the inclusion and exclusion criteria (please see figure 1 below). Full text copies of the studies selected were obtained for data extraction. Regular team meetings were conducted to discuss decisions on study inclusion and exclusion at each stage of the scoping process. Page 5

7 Figure 1 PRISMA flow chart of the study selection process Data extraction All papers were scrutinised and relevant data were extracted (please see Appendix 1). The following table shows title, authors and year for the 29 studies that were finally included in the review. Page 6

8 'Practising under your own Pin' a description of the transition AVIS et al., experiences of newly qualified midwives. Flying Start NHS : easing the transition from student to registered BANKS et al., health professional. Perceptions and experiences of nurse preceptors regarding their CHANG et al., training courses: a mixed method study. A different world? The transition experiences of newly qualified DARVILL et al., children's nurses taking up first destination posts within children's community nursing teams in England. Supporting New Zealand graduate midwives to stay in the profession: DIXON et al., An evaluation of the Midwifery First Year of Practice programme. A systematic review of the effectiveness of strategies and interventions EDWARDS et al., to improve the transition from student to newly qualified nurse. Stabilizing and retaining a quality nursing work force through the use of FIGUEROA et al., the Married State Preceptorship Model. Entry to nursing practice preceptor education and support: could we do HAGGERTY et al., it better? Preceptorship: ensuring the best possible start for new nurses. HARRISON WHITE and SIMONS, The lived experiences of newly qualified children's nurses. HOLLYWOOD, Care and compassion: the experiences of newly qualified staff nurses. HORSBURGH and ROSS, Evaluation of work stress, turnover intention, work experience, and HU et al., satisfaction with preceptors of new graduate nurses using a 10 minute preceptor model. SINK or SWIM : The experience of newly qualified midwives in HUGHES and FRASER, England. Provision of training and support for newly qualified nurses. JONES et al., The clinical practice collaborative support model for the graduate nurse. KRAMER et al., Newly qualified nurses experiences of a. LEWIS and MCGOWAN, Preceptors views of : an interpretative phenomenological MARINGER and JENSEN, analysis. A programme for newly qualified nurses: A study of MARKS MARAN et al., preceptees' perceptions. Implementing structured in an acute hospital. MORGAN et al., Preceptors' perceptions of a programme for newly MUIR et al., qualified nurses. Are preceptors adequately prepared for their role in supporting newly PANZAVECCHIA and PEARCE, qualified staff? Using group to support novice nurses. PARKER et al., The theory of organisational socialisation and its potential for PHILLIPS et al., improving transition experiences for new graduate nurses. A programme for health visitors and school nurses: a PHILLIPS et al., pilot study. Fairy tale midwifery fact or fiction: The lived experiences of newly REYNOLDS et al., qualified midwives. Best practices of formal new graduate nurse transition programs: An RUSH et al., integrative review. How first experiences influence newly qualified nurses. TAPPING et al., Nurse preceptor training needs assessment: views of preceptors and TSAI YM et al., new graduate nurses. Supporting newly qualified nurses in the UK: A systematic literature WHITEHEAD et al., review. Table 1. Studies included in the review Page 7

9 Synthesis of results After carrying out data extraction, four key themes were identified within the literature. These are: perceptions of preceptees; perceptions of preceptors; types of programmes; and preparation of preceptors. Please see figure 1 below for a summary of the process. Figure 1. Literature review process and results Perceptions of preceptees Preceptees express a variety of factors in regard to how they feel about. These can be associated with the transition into their new role, important aspects of the process and the relationship and engagement with their preceptor. Harrison White and Simons (2013) found that newly qualified children s nurses find the transition from student to staff nurse traumatic, adding pressure to being newly qualified. In a study with 35 qualified midwives in 18 work sites in the UK, Avis et al. (2013) reported that newly qualified midwives identified themselves as competent to deliver care but lacking confidence, especially in clinical skills, complex cases and prioritising care when workload was high. A phenomenological study (Reynolds et al. 2014) exploring the lived experiences of newly qualified midwives (NQM) throughout their first post identified two interpretive themes Fairy tale midwifery fact or fiction and Submissive empowerment between a rock and a hard place. NQMs identified an idealistic perception of the role of the midwife generated by the self, causing a degree of scepticism about preparation as time moved on. Confidence was lost as a result of a perceived lack of personal autonomy. Tsai et al. (2014) found that the preceptees identified a lack of confidence, anticipation of a caring learning atmosphere, concrete explanation of the reasons for an error and time to grow. They also expressed freezing in embarrassment during interactions and experiencing stress and frustration when facing a preceptor. Page 8

10 Support and structure was considered to be crucial in a study about transition experiences of newly qualified children s nurses (Hollywood, 2011). Participants pointed out support as the most important aspect of the process, the level of support required depending on previous experiences. Harrison White and Simon s (2013) study participants advocated for a degree of informal support outside the programme s guidelines. Darvill et al. (2014), in a study of newly qualified children s nurses working in the community, report that they valued the presence of a preceptor and formal support, but they needed a more individual approach to support and they found that some accepted practices affected the transition process. The midwives in Avis et al s (2013) study valued where it was a structured programme, adding that they need to work in an environment where they can develop their practice by being able to ask questions and obtain feedback. Preceptees would like clear processes and to receive more individualised support to develop confidence and clinical skills. They would like to have qualified preceptors, to get protected time for completing programmes and to obtain feedback Horsburgh and Ross (2013) found that newly qualified nurses (NQNs) felt that support received was eclectic rather than systematic. They perceived some staff were resistant to change and that they were left to manage by themselves when facing first work experiences. In a systematic review of the published research related to the development of to support NQNs in the UK, Whitehead et al. (2013) found that all papers agreed that NQNs require a period of support following qualification. This stems from the fact that although competent, NQNs can lack the confidence to be autonomous practitioners. If done well, structured can improve recruitment and retention for all. Preceptees need support both from preceptors and peers and they require feedback on objective assessment. There was consensus that the relationship is most important and that this is enhanced if supported by formal structures. Being able to choose their preceptor was expressed by participants in Marks Maran et al. (2013) evaluative study. Impact was measured in terms of increased communication skills, personal development, professional development and clinical skills development. Preceptees positively evaluated the programme, which was a collaborative initiative developed in conjunction with the local HEI. Preceptees pointed out that whilst making time was a challenge, it should be a high priority. They felt that preceptors should have the appropriate expertise, felt able to bring problems to their preceptor and liked the style of facilitation. A small percentage identified some difficulties Page 9

11 with personality clashes and securing time. Access to preceptors in terms of time issues was reported by Hughes and Fraser (2011). Participants in their study felt that an individualised approach would avoid repetition of contents. Banks et al. (2011) found that those that had protected time to do the Flying Start NHS programme were most likely to complete it and assess the support received as useful. Taking into account the preceptees perspective, Lewis and McGowan (2015) report that elements of the programme should include clarity around support requirements and expectations of, time to engage and build confidence, as well as being able to understand the process and the role of the preceptor. They recommend developing a clear timeline to help participants plan and providing guidance in regard to the role and context of the relationship. The newly qualified midwives in Reynolds et al s (2014) study also experienced challenges with workload, support and a lack of ability to consolidate their knowledge and skills when working in both hospitals and the community. Preceptors value training for the role and structured programmes. They highlight the importance of support from management, preceptees organisation skills and the relationship between preceptor and preceptee. Perceptions of preceptors Preceptors perceptions centred on their attitude towards, its impact and its effectiveness. Harrison White and Simons (2013) found that preceptors recognised the importance of programmes when newly qualified nurses start work and that they required a formal establishment and structure of the programme. Their goal was to assist the preceptees feel confident and comfortable in their new role. They also highlighted the importance of providing feedback. Muir et al. (2013) reported on the preceptors perceptions from a wider evaluation study in which quantitative results were confirmed by qualitative findings. Preceptorship was generally viewed as positive and having a beneficial impact on preceptee and preceptor development whilst acknowledging that making time was difficult. Tsai et al. (2014) identified themes from preceptors that included: a commitment to teaching; building a caring learning atmosphere; drafting clinical instruction plans; providing feedback and evaluation; and giving support and guidance. Maringer and Jensen (2014) undertook a qualitative study exploring the views of therapists as preceptors with the identification of three key themes: valuing structured learning and reflection; the requirements of the preceptor preceptee relationship and the perceived impact of on the services. Overall the process was valued and the link between Page 10

12 and reflection was viewed positively. In addition to this, paperwork was highlighted as an issue and different learning styles acknowledged as a consideration. There was a connection noted between the individual s own experiences and the effect on their motivation towards providing good. The capability of the preceptee was also seen as having an impact on the success of. Preceptors considered that organised, hardworking, self directed preceptees who demonstrated initiative were more likely to develop successfully through. They acknowledged that they needed more training in the roles, responsibilities and skills of being a preceptor and valued a constructive supportive supervisory relationship between preceptor and preceptee. Panzavecchia and Pearce (2014) carried out a study that aimed to ascertain the support provided to preceptors and the qualities they require to carry out their role. Staff reported a lack of formal preparation for the role and being unaware of available training. However they did report taking the role seriously and were keen to ensure preceptees were supported. The role s attributes identified were: support; guides; facilitators; advisors; and role models similar to mentorship a proportion of the participants were already acting as mentors. Among the difficulties identified, preceptors pointed out time limitations, workload and general lack of support from management. Type of programmes A variety of different programmes are identified in the papers, these are detailed in the table below Programme Author Flying start NHS web based resource Banks et al. (2011) Standardised approach UK preceptor coordinator, core standards and Morgan et al. (2012) competency framework Collaborative support model USA married state whereby the Kramer et al (2012) preceptor stays with the preceptee plus weekly support meeting Married state model USA Figueroa et al. (2013) Signal post development scheme UK integrates, clinical Tapping et al. (2013) supervision, role development and leadership development, incorporated with four periodic review points Local development approach Avis et al. (2013) Group programme to support UK Parker et al. (2014) Nurse foundation programme UK 13 days that span the first year Jones et al. (2014) centrally designed and co ordinated approach 10 minute model Taiwan designed to guide preceptors Hu et al. (2015) to dedicate 10 minutes, twice per day to structurally communicate, interact and discuss problems and issues with new graduate nurses in the first three months Midwifery First Year of Practice Programme NZ Structured support Dixon et al. (2015) during clinical practice, a funded mentor chosen by the new graduate, financial assistance for education and assessment at the end. Table 2. Different types of programmes Page 11

13 Programmes vary in length, approach, engagement between the preceptor and preceptee and service context. In a study by Banks et al. (2011) most practitioners using the web based resource to support newly qualified staff Flying Start NHS reported that it was useful to develop their clinical skills and their confidence. Morgan et al. (2012) described the implementation of a standardised approach to in one large UK NHS foundation Trust whose previous approach had been a little inconsistent with difficulties identifying NQNs in a timely way and the existence of specific courses in some areas e.g. critical care. Local evaluation was positive with preceptees stating that the programme was relevant to their practice, helped them to settle in more quickly and would recommend it to other NQNs. Kramer et al. (2012) evaluated a collaborative support model for newly graduated registered nurses in the USA. This programme consisted of an 18 week education and training system designed specifically to transition inexperienced orientees to safe, competent professional practitioners. One of the aims was to increase organisational commitment and thereby increase retention. This included the institution of a married state whereby the NQN and their preceptor stayed together at all times inclusive of a collaborative support model with weekly support meetings. This was positively evaluated by NQNs who reported that their confidence and skill level increased, rating the weekly support session favourably for enhanced knowledge, collaboration, critical thinking and organisational skills. Preceptors reported that they gained confidence in their role. The issues of resource provision were identified including expansion to other units and preparation of preceptors. In their study, Figueroa et al. (2013) found that new newly qualified nurses and preceptors perceived the Married State Preceptorship Model as promoting safety and reducing anxiety. The signal post development scheme integrates, clinical supervision, role development and leadership development and it incorporates four periodic review points (Tapping et al. 2013). Participants in the evaluation found it to be largely positive. They felt that it assisted NQNs to reflect on their strengths and weaknesses and that it helped them devise their own strategies to enhance strengths and address weaknesses as well as reflect on their role. In a study with 35 qualified midwives in 18 work sites in the UK, Avis et al. (2013) found that the majority of participants reported that was not structured and that they had to initiate meetings with preceptors. Preceptorship programmes seem to be determined by local factors. Parker et al. (2014) shared the experiences of ward leaders who devised and facilitated a group programme to supplement the of newly qualified nurses (NQNs). Overarching group aims included providing NQNs with access to senior leaders to support their professional Page 12

14 development, maintain wellbeing, facilitate access to peer support, support the ward preceptors, and achieve fully staffed competent ward teams capable of providing high quality care within six months; this was evaluated favourably. Jones et al. (2014) carried out a study in which nurses and managers assessed the Nurse Foundation Programme. It was highly valued by attendees, as it offered knowledge and support to new staff. Managers thought the programme made it easier to release time for new staff to do the training and that it helped with skill mix decision in clinical areas. There was some reference to the impact of and this is linked to retention of staff in the papers. Rush et al. (2013) aimed to identify best practice of formal new graduate nurse transition programmes in Canada by carrying out an integrative review in which 47 papers were examined according to four themes: education; support/satisfaction; competency and critical thinking; and workplace environment. They considered that the stronger evidence suggests that: new graduate education should focus on practical skill development; preceptors should receive a formal training; formal support should be available at least through the first difficult 6 9 month period; opportunities for peer discussion should be provided; and organisations should strive to ensure clinical units with healthy work environments. There was a specific section on retention and cost benefit. An overwhelming majority of papers made specific reference to the importance of and dedicated preceptored shifts. Rush et al. (2013) acknowledge however that because of the variability in research designs and sample sizes coupled with the fact that few of the studies had designs with a degree of control necessary to rule out competing explanations, drawing conclusions is limited. Despite a lack of outcome measures, evidence demonstrated benefits in selected areas of new graduate transition. Figueroa et al. (2013) report a statistically significant decrease in turnover rates with the married state model. Hu et al (2015) evaluated the effects of a 10 minute preceptor model in Taiwan and found that those nurses in the 10 minute preceptor model group reported lower turnover intention and higher satisfaction. In a study carried out by Dixon et al., (2015) about retention of newly qualified midwives in New Zealand, they found that the retention rate for those that had participated in the Midwifery First year of Practice Programme was of 83% with 358 midwives still practising in This programme is structured and individualised and it is organised nationally and provided in all care settings. A systematic review of transition strategies to support newly qualified nurses carried out by Edwards et al. (2015), found that they have an overall positive impact on new staff regardless of the type of support provided. Page 13

15 Preparation of preceptors Preparation of preceptors is present in the literature. New Zealand s Nursing Entry to Practice programme was evaluated by nurses and preceptors in a study by Haggerty, Holloway and Wilson (2012). Results highlighted the need for developing national preceptor training standards and to provide access to preceptors for appropriate training. Rush et al. (2013) suggest that new graduate education should focus on practical skills development with preceptors having formal training Tsai et al. (2014) undertook a naturalistic enquiry to explore the training needs of preceptors from both the viewpoints of preceptors and preceptees. The Taiwanese Joint Commission on Hospital Accreditation stated that preceptors should have 3 years experience in a teaching hospital and attend at least 10 hours of preceptor training. The programme concerned covered six topics but had no underpinning evidence base and did not include how to support new graduates. Chang, Lin, Chen et al. (2015) in a study on perceptions of preceptors about their training in Taiwan, found that preceptors reported that their learning needs were not fulfilled by current training and that they were not clinically practical. They receive at least 8 hours training and take a post training exam to become preceptors the content of the exam is determined locally. Participants found that communication skills training is the most useful part of their training for practice and that the least useful part was about adult learning theory. Issues such as receiving inadequate training previous to start their role, courses focusing on theory rather than practice and stress emerged as problems identified by the participants in this study. Conclusion Due to the variability in research methodologies and reporting stances this review can broadly deduce that is viewed as a positive entity based on the evidence. As shown on Table 2, there are a range of different models for programmes. These vary in regards of length, components and roles. There is a suggestion that models should encompass a supportive aspect with some of the programmes clearly incorporating this. There are some innovative approaches which also offer a new perspective such as the married state where the preceptor spends time directly with the preceptee. There is also reference to preceptored shifts. Preceptees appear to prefer a structured model that includes embedded support but also identify the challenges that need to be addressed such as access to preceptors and availability of protected time. The relationship with the preceptor is pivotal and how this is modelled in practice. Page 14

16 This review found that preparation of preceptors is very variable and is dependent on local context. Nevertheless, preceptees and preceptors identify the importance of this to achieve successful. The benefits for the preceptee are expressed in terms of skills development, increased confidence, knowledge, critical thinking, communication, collaborative working, personal and professional development. There is also an indication that recruitment and retention are improved through simple measures put in place for staff in post at fixed points. There is not a clear measure for impact on patient care beyond the expectations of increasing the efficacy of newly qualified staff. References AVIS, M. MALLIK, M. and FRASER, D. M. (2013) Practising under your own Pin' a description of the transition experiences of newly qualified midwives. Journal of Nursing Management 21(8) pp BANKS, P. ROXBURGH, M. KANE, H. LAUDER, W. JONES, M. KYDD, A. and ATKINSON, J. (2011) Flying Start NHS : Easing the transition from student to registered health professional. Journal of Clinical Nursing 20(23) pp CHANG, C.C. LIN. L.M, CHEN. I.H. KANG, C. M. and CHANG, W.Y. (2015) Perceptions and experiences of nurse preceptors regarding their training courses: a mixed method study. Nurse Education Today 35(1) pp DARVILL, A. FALLON, D. and LIVESLEY, J. (2014) A different world? The transition experiences of newly qualified children's nurses taking up first destination posts within children's community nursing teams in England. Issues in comprehensive pediatric nursing 37(1), pp DEPARTMENT OF HEALTH (2010) Preceptorship Framework for Newly Registered Nurses, Midwives and Allied Health Professionals. London. Department of Health DIXON, L. CALVERT, S. TUMILTY, E. KENSINGTON, M. GRAY, E. CAMPBELL, N. LENNOX, S. and PAIRMAN, S. (2015) Supporting New Zealand graduate midwives to stay in the profession: An evaluation of the Midwifery First Year of Practice programme. Midwifery, 31(6), pp EDWARDS, D. HAWKER, C. CARRIER, J. and REES, C. (2015) A systematic review of the effectiveness of strategies and interventions to improve the transition from student to newly qualified nurse. International Journal of Nursing Studies 52(7) pp Page 15

17 FIGUEROA, S. BULOS, M. FORGES, E. and JUDKINS COHN, T. (2013) Stabilizing and retaining a quality nursing work force through the use of the Married State Preceptorship Model Journal of Continuing Education in Nursing 44(8) pp HAGGERTY, C. HOLLOWAY, K. and WILSON, D. (2012) Entry to nursing practice preceptor education and support: could we do it better? Nursing Praxis in New Zealand 28(1) pp HARRISON WHITE, K. and SIMONS, J. (2013) Preceptorship: ensuring the best possible start for new nurses. Nursing Children & Young People 25(1) pp HOLLYWOOD, E. (2011) The lived experiences of newly qualified children's nurses. British Journal of Nursing 20(11) pp HORSBURGH, D. and ROSS, J., Care and compassion: the experiences of newly qualified staff nurses. Journal of Clinical Nursing, 22(7), pp HU, Y.C. CHEN, S.R. CHEN, I.H. SHEN, H.C. LIN, Y.K. and CHANG, W.Y. (2015) Evaluation of work stress, turnover intention, work experience, and satisfaction with preceptors of new graduate nurses using a 10 minute preceptor model. Journal of Continuing Education in Nursing, 46(6), pp HUGHES, A. J. and FRASER, D. M. (2011) SINK or SWIM : The experience of newly qualified midwives in England. Midwifery 27(3) pp JONES, A. BENBOW, J. and GIDMAN, R. (2014) Provision of training and support for newly qualified nurses. Nursing Standard, 28(19), pp KRAMER, D.S. LINDGREN, C.L. HIGH, C. OCON, S. and SANCHEZ, R. (2012) The clinical practice collaborative support model for the graduate nurse. Journal of Continuing Education in Nursing, 43(7) pp LEWIS, S. and MCGOWAN, B. (2015) Newly qualified nurses experiences of a. British Journal of Nursing 24(1) pp MARINGER, T. and JENSEN, J. (2014) Preceptors views of : an interpretative phenomenological analysis. British Journal of Occupational Therapy, 77(8), pp MARKS MARAN, D. OOMS, A. TAPPING, J. MUIR, J. PHILLIPS, S. and BURKE, L. (2013) A programme for newly qualified nurses: A study of preceptees' perceptions. Nurse Education Today, 33(11), pp MORGAN, A. MATTISON, J. and STEPHENS, M. (2012) Implementing structured in an acute hospital. Nursing Standard, 26(28), pp MUIR, J. OOMS, A. TAPPING, J. MARKS MARAN, D. PHILLIPS, S. and BURKE, L. (2013. Preceptors' perceptions of a programme for newly qualified nurses. Nurse Education Today 33(6) pp Page 16

18 PANZAVECCHIA, L. and PEARCE, R., Are preceptors adequately prepared for their role in supporting newly qualified staff? Nurse Education Today, 34(7), pp PARKER, J. CLEVELAND, N. and AH THION, C Using group to support novice nurses. Nursing Times 110(36) pp PHILLIPS, C., ESTERMAN, A. and KENNY, A., The theory of organisational socialisation and its potential for improving transition experiences for new graduate nurses. Nurse Education Today, 35(1), pp PHILLIPS, S. TAPPING, J. OOMS, A. MARKS MARAN, D. and GODDEN, R A programme for health visitors and school nurses: a pilot study. Community Practitioner 86(1) pp REYNOLDS KITSON, E. CLUETT, E. and LE MAY, A. (2014) Fairy tale midwifery fact or fiction: The lived experiences of newly qualified midwives. British Journal of Midwifery, 22(9), pp RUSH, K. L. ADAMACK, M. GORDON, J. LILLY, M. and JANKE, R. (2013) Best practices of formal new graduate nurse transition programs: An integrative review. International Journal of Nursing Studies, 50(3), pp TAPPING, J. MUIR, J. and MARKS MARAN, D. (2013) How first experiences influence newly qualified nurses. British Journal of Nursing, 22(2), pp TSAI, Y.M. LEE HSIEH, J. TURTON, M.A. LI, S.Y. TSENG, H.L. LIN, H.C. and LIN, H.L. (2014) Nurse preceptor training needs assessment: views of preceptors and new graduate nurses. Journal of Continuing Education in Nursing, 45(11), pp WHITEHEAD, B. OWEN, P. HOLMES, D. BEDDINGHAM, E. SIMMONS, M. HENSHAW, L. BARTON, M. and WALKER, C. (2013) Supporting newly qualified nurses in the UK: A systematic literature review. Nurse Education Today, 33(4), pp WIGENS, L. and HEATHERSHAW, R (2013) Mentorship and Clinical Supervision Skills in Healthcare. 2 nd ed. Andover. Cengage WILLIS, P. (2015) Raising the Bar. The Shape of Caring A review of the future education and training of registered nurses and care assistants. HEE <online> Available at Shape of caring review FINAL.pdf. <Accessed 9 October 2015> Page 17

19 Appendix 1 Data Extraction chart Data extraction chart Authors Date Country and care setting Aims of paper Type of participants and sample size Methods Key subject and outcomes measured Key findings AVIS, M., MALLIK, M. and FRASER, D., M 2013 UK Maternity units. To examine transition experiences of newly qualified midwives 35 newly qualified midwives (NQM) in 18 work sites in the UK (and their preceptors and supervisors) Semi structured diaries (midwives); questionnaires (preceptors and supervisors); semi structured interviews (midwives with their preceptors). Data on transition experiences during initial 6 months of first employment. Preceptorship schemes available are rarely structured or offer NQM the kind of support needed. NQM primarily obtained transition support from members of the midwifery team. Formal contact with supervisors minimal. At the point of registration they lack confidence in performing their new responsibilities. BANKS, P., ROXBURGH, M., KANE, H., LAUDER, W., JONES, M., KYDD, A. and ATKINSON, J UK Acute care and community. To evaluate the impact and effectiveness of Flying Start NHS on the confidence, competence and career development of newly 547 NQP (nurses, midwives and allied health professionals AHPs); 22 mentors; 21 Flying Start NHS Leads and Online survey; telephone interviews; focus groups. Evaluation of impact of programme. Satisfaction with support from mentors; impact on clinical skills development, Undertaking Flying Start NHS in their first year of employment increases clinical skills development and confidence. Support received was good. NQPs and mentors reported a lack of time. Mentors require training and time to enable them to provide support. 18

20 qualified practitioners (NQP). Coordinators. confidence and career development. CHANG CC, LIN LM, CHEN IH, KANG CM and CHANG WY Taiwan Acute care hospitals. To explore nurse preceptors' perceptions of their training courses 386 nurse preceptors (survey) plus other 36 (focus groups interviews) in 8 hospitals Cross sectional questionnaire survey and focus group interviews Preceptors perceptions about their training courses Most courses did not fulfil the learning needs of nurse preceptors and were clinically impractical. Most useful course was on communication skills and least useful course was on adult learning theory and principles. Three themes identified as problems: inadequate training before being appointed as nurse preceptors; courses more theoretical than practical; preceptors experienced stress from multiple sources. DARVILL A, FALLON D, LIVESLEY J UK Community children s nursing teams. A qualitative study about the experiences of a group of newly qualified children s nurses (NQN). 8 newly qualified children s nurses. Semi structured interviews, fieldwork observation; thematic analysis. Experiences of transition. Thematic analysis of fieldwork. Formal support and the physical presence of a preceptor are valued by NQNs. Some accepted practices inadvertently reduced confidence and inhibited a smooth transition. A more individual approach is needed allowing for different rates of progression. No reality shock reported. DIXON, L., CALVERT, S., TUMILTY, E., KENSINGTON, M., GRAY, E., CAMPBELL, N., LENNOX, S. and 2015 New Zealand All work settings. To explore retention of NQMs after Midwifery First Year of Practice (MFYP) 415 newly qualified midwives Analysis of longitudinal observational data from cohorts. Effects of MFYP programme on retention The overall retention rate for new graduate midwives who had participated in the MFYP programme was 83% with 358 midwives still practising in 2012 Page 19

21 PAIRMAN, S. programme. EDWARDS, D., HAWKER, C., CARRIER, J. and REES, C., 2015 Studies from: UK, USA, New Zealand, Australia, Thailand. To determine effectiveness of the main strategies to support NQNs during transition into clinical workplace and evaluate their impact on individual and organisational outcomes. n/a Systematic review Effectiveness of transition strategies. Overall impact of support strategies appears positive, irrespective of the type of support provided. This may suggest that it is the organisation s focus on NQNs that is important, rather than simply leaving them to acclimatise to their role themselves. FIGUEROA S, BULOS M, FORGES E and JUDKINS COHN T USA Acute hospitals. To explore 1 st year turnover rates of NQNs and NQNs and preceptors perceptions of the Marries State Preceptorship Model 108 NQNs and 100 preceptors. Focus groups, surveys. Effects of MSPM on turnover; perceptions of MSPM Four themes emerged for NQNs: partnership, critical thinking, learning, and transition. A statistically significant decrease in turnover rates was seen with MSPM versus traditional precepting. NQNs and preceptors perceived the MSPM as promoting safety and reducing anxiety. HAGGERTY C, HOLLOWAY K and WILSON D 2012 New Zealand All work settings. To identify best practice on preparation of, and support for, registered nurses (RNs) undertaking 841 nurses after 6 months in the programme; 182 nurses after the programme; Questionnaires; interviews following baseline data collection from a longitudinal study on the Evaluation of nurses and preceptors experiences of the NETP programme. Participants Overall, the evaluation reinforced benefits of quality on the development of NQNs confidence and competence. Three key issues were identified: selection process for preceptors; need for collaboratively developed national preceptor training standards; creative solutions needed to support preceptors to access appropriate training. Page 20

22 preceptor roles. 187 preceptors; 16 coordinators. Nursing Entry to Practice programme (NETP). Case studies. perceptions in questionnaire and analysis of interviews, focus group and case studies. HARRISON WHITE, K. and SIMONS, J 2013 UK Acute care To investigate the experience of a local programme from the perspective of NQ children s nurses and preceptors. 6 nurses (3 preceptees and 3 preceptors). Questionnaires; focus groups. Perceptions of participants; evaluation of programme. Thematic analysis of data. Traumatic transition from student to staff nurse. Need for proper accessibility and support from preceptors and of meaningful feedback. Need for a programme that is clinically focused, structured and formally established, enabling preceptees to feel confident and comfortable in their new role and environment. HOLLYWOOD, E., 2011 UK Acute care To explore the transitions of newly qualified RCNs from postgraduate student nurse to staff nurse. 6 newly qualified children s nurses Interviews Experiences of newly qualified nurses. Thematic analysis of interviews Support is the most important aspect of the transition experience. Mentorship and programmes facilitate support and previous experiences prescribe the amount of support required. HORSBURGH, D. and ROSS, J UK Acute care To explore newly qualified staff nurses perceptions of compassionate care and factors that facilitate and inhibit its 42 newly qualified nurses Focus groups Experiences and perceptions of newly qualified nurses. Analysis of data from focus groups Support for newly qualified staff was eclectic rather than systematic. Some staff were perceived as resistant to change, creating a negative environment. Page 21

23 delivery. HU YC, CHEN SR, CHEN IH, SHEN HC, LIN YK and CHANG WY 2015 Taiwan Acute care To evaluate the effects of a 10 minute preceptor (10MP) model for assisting NQNs in their professional development and increasing their retention in hospitals. 107 new graduate nurses Questionnaires (work experience, stress and satisfaction with preceptors) Evaluation of experiences and impact of model. Work experience scores; work stress scores; turnover intentions; satisfaction with preceptors. The program showed significant differences between groups regarding work stress at months 2 and 3 and work experience at months 1, 2, and 3. The 10MP group reported lower turnover intention and higher satisfaction with the preceptors than the traditional PM group. HUGHES, A., J. and FRASER, D., M., 2011 UK Acute care To explore NQMs and preceptors view of the period 62 participants: 40 newly qualified midwives, 20 preceptors and two practice development midwives Focus groups interviews. Perceptions of period. Analysis of data from focus groups. NQMs and preceptors found it difficult to meet due to time constraints.. The most important areas to improve the period were to appoint midwives responsible for the organisation and support of NQMs. In addition, each NQM should have a programme tailored to their needs which avoids repetitive learning. JONES, A., BENBOW, J. and GIDMAN, R 2014 UK Acute care To evaluate nurses and ward managers experience of the Nurse 212 NQNs (evaluation forms). 15 nurses and 5 ward managers (semi Evaluation forms; semi structured interviews. Evaluation of standardised programme. Participants perceptions (evaluation The NFP was highly valued by attendees, offering timely knowledge and support for NQNs. Ward managers reported that the NFP made it easier to release time for newly qualified nurses to participate in training, while helping with skill mix decisions on the ward. Page 22

24 Foundation Programme (NFP) in Cardiff and Vale University Health Board structured interviews). forms). Thematic analysis of data from interviews and evaluation forms. KRAMER DS, LINDGREN CL, HIGH C, OCON S and SANCHEZ R, 2012 USA Acute care. Report on the evaluation of a collaborative support model by RN residents and preceptors RN residents, preceptors and managers and clinicians in 6 hospitals. Case studies, survey, feedback meetings. Evaluation of programme. Data from survey (married state model, shift reports, assessments, medications, goals for the week, weekly goal follow up and plans for the next week). More than 95% of the residents rated the married state as helping them a great deal. RN residents reported that their confidence and skill level grew. 75% of preceptors rated the married state as helping them a great deal and reported gained confidence in their role. LEWIS, S. and MCGOWAN, B., 2015 UK To gain insight into what it was like for NQNs who had finished. 8 registered nurses who had direct experience of Semi structured interviews and field notes (recorded). Experience of preceptees. Data from semistructured interviews and Recommendations: clear mapped timeline may help participants to plan; clarity about what is entailed in terms of their roles and the context of the relationship; further research exploring confidence; add intro to in 3 rd year of programme. Page 23

25 field notes. MARINGER, T. and JENSEN, J 2014 UK Acute care. To explore the views of therapists on their roles as preceptors 6 3 Occupational therapists (OT) and 3 Physiotherapis ts (PT) Semi structured interviews Experiences of at a large acute NHS Trust. Interpretative phenomenologi cal analysis. Three themes emerged: valuing structured learning and reflection; the requirements of the preceptor preceptee relationship; and the perceived impact of on the services. MARKS MARAN, D., OOMS, A., TAPPING, J., MUIR, J., PHILLIPS, S. and BURKE, L., 2013 UK Acute care. Evaluation of a programme for NQNs to determine engagement, impact, value and sustainability of the programme from the preceptees perspective. 90 NQNs Questionnaires, reflective journals and personal audio recordings. Evaluation of a programme. Engagement; Impact; Value; Sustainability. 82% NQNs found making time a challenge; 93% said that meetings should be a high priority; 97% preceptors had appropriate expertise 70% choose own preceptor; 80% comfortable to bring problems ; 84% liked the style of facilitation; 75% intro given by p to the team helped Sustainability from a preceptee perspective 90% would consider becoming a preceptor; 80% recommending it to a colleague MORGAN, A., MATTISON, J. and STEPHENS, M 2012 UK Acute care. to evaluate course 90 staff from three intakes 60 completed local evaluation Local evaluation after course completion. Evaluation of programme. Data from evaluation forms. Identified barriers obtaining protected time, to attend course, big Trust therefore difficult to identify NQNs soon enough, some areas e.g. critical care already have some type of course so they don t always do. Generally feedback is positive Page 24

26 MUIR, J., OOMS, A.,TAPPING, J., MARKS MARAN, D., PHILLIPS, S. and BURKE, L., 2013 UK Acute care. To evaluate preceptors perception of programme 40 Nurse preceptors Questionnaires and one to one interviews Preceptors perceptions of programme. Data from questionnaires and interviews. Key themes identified: development of preceptees; value of the programme to the organisation; value of being a preceptor in terms of their own professional development. Generally viewed positively difficulty making time, positive impact on preceptee and preceptor development PANZAVECCHIA, L. and PEARCE, R., 2014 UK Acute care. To ascertain the support provided to preceptors and the qualities they require to carry out their role supporting NQ professionals 30 preceptors in 3 hospitals. Questionnaires. Closed questions with an opportunity to include qualitative comments. Semistructured interviews. Support provided to preceptors. Data from questionnaires and interviews. Three themes emerged: 1. Lack of prep for the role 2. Expectations of a preceptor and how they perceive the role (Attributes and perception of the role of a preceptor) 3. Limitations and difficulties PARKER J, CLEVELAND N and AH THION C 2014 UK Acute care. Sharing experience of ward leaders in devising and facilitating a group programme to supplement the of NQNs 82 responses Evaluation Evaluation of experience of ward leaders in devising and facilitating a group programme to supplement the of NQNs Evaluated favourably Page 25