SE8: The organization provides educational activities to improve the nurse s expertise as a preceptor.

Transcription

1 Structural Empowerment: Teaching and Role Development SE8: The organization provides educational activities to improve the nurse s expertise as a preceptor. SE8a: Describe the organization s preceptor education program(s) and how each program is evaluated on an ongoing basis. Provide supporting evidence. Introduction The relationship between a newly-hired nurse and their preceptor is one factor essential to a successful transition into practice at Massachusetts General Hospital (MGH). The preceptor teaches, guides, coaches and provides feedback to the new nurse as he/she learns the clinical practice, the culture and the values of the organization. This relationship helps to integrate the newly-hired nurse into the team where the new nurse learns about each individual discipline and how to communicate and collaborate with them as they work toward the delivery of safe, high-quality, patient-centered care. As important as it is to invest in the onboarding of the new nurse, it is just as important to focus on how preceptors are prepared for this important role. One of the findings of the National Council of State Boards of Nursing study on Transition to Practice (2015) was that new nurse outcomes were significantly better when there was a preceptorship, as well as a preceptor educated for the role. The following example demonstrates Massachusetts General Hospital s (MGH) commitment to assisting nurses to develop expertise in the preceptor role and to evaluate the effectiveness of educational interventions. Preceptor Program Development The education of all clinicians has always been central to the mission of MGH and Nursing & Patient Care Services (N&PCS) (OOD3). In 2014, MGH unveiled its strategic plan which articulated the institution s aspirations for each of its core missions: clinical care, research, education and community. In addressing education, the organization aspired to provide educational programs that will be actively coordinated and advocated for across the continuum and incorporating all disciplines. The Institute of Medicine (IOM) Report on Nursing: Leading Change, Advancing Health (2011) and the Interprofessional Education Collaborative (IPEC) (2011) both reported that healthcare continues to educate its students in silos rather than interprofessionally where they are ready to enter the workplace as a member of a collaborative practice team... a key step to moving health systems from fragmentation to a position of strength (World Health Organization, 2010). The Norman Knight Nursing Center for Clinical & Professional Development (Knight Center) is accountable for creating programs to meet the learning needs of nurses and support staff at MGH. The Knight Center has historically held a Preceptor Development

2 program to support preceptors in developing the skills necessary to successfully transition a newly-hired nurse into clinical practice. However, the existing program did not contain any information about how a preceptor could support the integration of the new nurse into the interdisciplinary team. Cognizant of the findings in the literature as well as the MGH s work on strengthening interprofessional education through the work of the Executive Council on Teaching and Education, Gino Chisari, DNP, RN, RN-BC, the Director of the Knight Center and his team envisioned redesigning the preceptor program where the content would include input from other disciplines. Chisari also hoped to engage members of those disciplines as program faculty to launch this new, interdisciplinary program where clinicians would learn together how to precept newlyhired staff. On January 15, 2015, an interprofessional planning group (attachment SE8a.a) met to begin the work of redesigning the preceptor development program. The planning group recognized that just as experience and theory move clinicians from advanced beginner to expert, a preceptor also has a trajectory of development from initially learning the role to mentoring and coaching other preceptors. The knowledge and skill needed for this transition would then require program content that assisted the preceptor with role development. Following the planning meeting, Chisari and members of the Knight Center developed a document for the planning group to review. Based on the planning group s discussion, Chisari and the Knight Center staff envisioned a three-level preceptor development program with specific goals, themes and curriculum development outcomes (attachment SE8a.b).The planning group approved the following programs: Level 1 Program: focuses on building foundational knowledge, skills and abilities needed to allow the preceptor to facilitate the transition of the newly-hired nurse into practice at MGH. Level 2 Program: builds on the level I program by incorporating content on advanced teaching methodologies, precepting new leadership/advanced practice staff and mentoring beginning preceptors. Level 3 Program: provides the learner with the knowledge, skills and abilities to fulfill an advisory preceptor role designed to promote and advance the preceptor learning environment through leadership, research and evidence-based practice. The Knight Center worked to translate the goals, themes and outcomes from the planning committee into the three new programs. Because planning for the three new programs was concurrent with preparing for the launch of ecare/epic, the new electronic patient record, the Knight Center staff realized that they would only be able to offer Level I and II before the focus of all educational activities would focus on ecare/epic education. The Knight Center plans to name, develop, and offer the Level III program in It was also decided that the Knight Center staff would serve as faculty for the first few programs to provide consistency and identify any needs for modification.

3 Programs to Improve the Nurse s Expertise as a Preceptor In an effort to draw attention to the new preceptor classes and to underscore that changes had been made, the following program names were chosen: Level I program: Practice Partners Gateway to Practice Level II program: Practice Partners Moving Beyond the Basics The level I program, Practice Partners, Gateway to Practice was held on June 29, 2015 and October 16, A total of 46 clinicians attended the two programs and 26 were clinical nurses. The Level I program covered: Education theory Assessing for learning Delivering and receiving feedback Conflict engagement and resolution Reflective practice and self-assessment Identification of preceptor resources The level II program, Practice Partners: Moving Beyond the Basics was held on January 26, 2016 and December 12, A total of 20 clinicians attended the program and 13 were clinical nurses. The Level II program covered: Appreciative inquiry Generational issues Motivation - moving from preceptor to mentor Failure of expectation Debriefing, giving/receiving feedback and peer communication Evaluating the Effectiveness of the Programs Level I Program: Practice Partners Gateway to Practice Following the completion of the June 29, 2015 Level I program, Laura Sumner, RN, MSN, ANP-BC, ONC, Professional Development Specialist, the program planner, met with her colleagues Sheila Golden-Baker, RN, MS, CRRN, and Mary O Brien, RN, MS, RN-BC, both Professional Development Specialists in the Knight Center, to review, evaluate, and discuss the need to modify the program based on participants evaluations and feedback. Sample feedback on important learning points from a participant in this program included recognizing how different individuals have specific learning styles and how I as a preceptor can help and orient my co-workers and new staff. Another participant wrote that the program allowed them to more effectively use active listening. Because of the participants positive evaluations and feedback, as well as the perceptions of the faculty, the Knight Center planning committee did not think that there was a need to change any content in the Level I program. Participants who attended the Level I program held on October 16, 2015 provided positive feedback on their evaluations. Once again, the Knight Center planning committee did not think that any modifications were needed on the Level I program based on participant evaluations and

4 the perceptions of the faculty. The agendas, quality improvement forms and evaluations from the June 29, 2015 and October 16, 2015 programs are included in attachment SE8a.c. Level II Program: Practice Partners Moving Beyond the Basics Pre- and post-assessments were developed for the Level II program as it focused on building upon the fundamental principles of precepting in the Level I program. The preand post-assessments were designed to evaluate the impact of the Level II program on the participants confidence in their knowledge and ability to effectively precept, and it was administered on the day of the program. The Knight Center staff also planned to ask the participants to complete the post-assessment three months after the Level II program to further evaluate the effectiveness of the program. Following the completion of the January 26, 2016 Level II program, Sumner met with the program planning committee from the Knight Center including Chisari, Golden- Baker and Professional Development Specialists Kathleen Larrivee, RN-BC, MSN, Patricia Crispi, RN-BC, MS, and Jennifer Curran, RN, MS, to review, evaluate, and discuss the need to modify the program based on participants evaluations and feedback including the results from the pre-assessment and two post-assessments. While the results of the two post-assessments demonstrated that the program participants believed that the program improved their confidence, knowledge and ability to effectively precept, the planning committee felt they could solidify those improvements by sending out knowledge boosters. A knowledge booster is a concept developed by Art Kohn, PhD, a professor, writer, and consultant, as a way to improve after training knowledge, retention and transfer of information. The planning committee agreed they would attendees from the December 12, 2016 Level II program brief core concepts from the program two days, two weeks and two months post program (attachment SE8a.d). In reviewing the evaluations, the planning committee learned that although participants reported learning information that could be used to improve their practice (e.g., active listening skills, setting expectations, and developing a learning plan), a number of them did recommended that the program include more time for discussion and case study analysis rather than relying primarily on didactic presentations. The Knight Center planning committee used this feedback to modify the Level II program which was subsequently held on December 12, Again, participants reported improved confidence knowledge and ability on the pre- and post-assessments and post-program evaluations from the December program were positive. The agendas, assessment data, quality improvement forms and evaluations from the two Level II programs are included in attachment SE8a.e. The Knight Center planning committee will continue to evaluate and revise its preceptor programs as needed to ensure that preceptors have the knowledge, skill and abilities to effectively transition newly-hired nurses into the organization.

5 Future Plans Regarding the initial goal to promote interprofessional learning, the Preceptor Development Planning Committee will reconvene after the launch of the Level III program in early 2017 to discuss program expansion, development of faculty from the non-nursing health professions and marketing to interdisciplinary team members interested in improving their abilities as a preceptor. As required by ANCC, the program planners will continue to meet after each program to evaluate its effectiveness and discuss ways to improve the content and/or method of delivery as appropriate. References Framework for Action on Interprofessional Education & Collaborative Practice. World Health Organization, Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative. Kohn, A. Learning Solutions website learningsolutionsmag.com/authors/453/art-kohn Spector, N. The National Council of State Boards of Nursing's Transition to Practice Study: Implications for Educators. Journal of Nursing Education, March 2015, Vol. 54 (3) pg The Future of Nursing Leading Change, Advancing Health Institute of Medicine, Washington, DC 2011