1 Preceptor Refresher Course How to Receive Your CE Credits Read your selected course Completed the quiz at the end of the course with a 70% or greater. Complete the evaluation for your selected course. Print your Certificate CE s will automatically be reported to the CE Broker Purpose The purpose of this course will aid in enhancing preceptor skills and confidence for individuals serving as preceptors. A preceptor must demonstrate clinical expertise and competence to be a role model for safe, quality patient care. He or she must also have experience regarding the environment of the health care organization. Nonetheless, precepting is a multifaceted role that demands a diversity of vital important skills. Objectives An effective Preceptor Objectives should include (Spector, 2015): 1. Understand the history of precepting individuals. 2. Assess learning needs of preceptee and set goals. 3. Apply SMART learning goals.
2 4. Developing and implementing a learning plan. 5. List effective time management and prioritization when providing patient care. 6. Describe the importance of teaching effective documentation. 7. Understand how to teach and promote clinical reasoning, critical thinking, and problem solving in the workplace. 8. List way on how to provide constructive feedback and coaching. 9. Describe how to create an effective preceptor checklist. History The role of the preceptor is one that can predict the success of the newly hired graduate nurse, administrator, experienced nurse, or Unlicensed assistive personnel (UAP) during their orientation experience. Evidence states that this success can be attributed to the amount of preparation and support the preceptor receives from an organization to prepare the preceptee for his or her important role. Preparing the preceptee effectively may also decrease the health care organization s turnover rate. An effective preceptor program can lower the turnover rate, reduced costs, and enhance the quality of nursing care, and other services provided to patients (Lee, Tzeng, Lin, & Yeh, 2009). Recruitment, training, turnover, and retention of experienced nursing staff remains an ongoing business issue in many health care organizations. Therefore effective preceptor programs is imperative for positive outcomes. Hospitals with deficiencies in nursing staff tend to have a higher rate of poor patient outcomes (Agency for Healthcare Research & Quality, 2004). In 2015, the turnover rate for bedside RNs increased to 17.2%, up from 16.4% in 2014. In
addition Certified Nursing Assistant (CNA) turnover exceeded all other positions at 23.8% (NSI Nursing Solutions, 2016). 3 One way to decrease turnover is through providing preceptor training programs for the nursing staff. Implementing a preceptor training program can ensure that the preceptor integrates the knowledge, skills, and attitudes necessary for a new hire to function in a their new nursing role. Preceptor training also brings satisfaction to the staff nurse that is taking on the role as a preceptor. One way to decrease turnover, provide quality patient care, and increase job satisfaction in a supportive way is through preceptor training programs. Assessing learning needs of preceptee and setting goals A preceptee that is trained by a knowledgeable preceptor will be able to provide quality care that is compassionate and confident because the he or she has been well-prepared. The following needs of the preceptee should be assessed by his or her preceptor: What does the preceptee already know? What is the preceptee s preferred learning style? What are barriers to learning? What instructional methods are available? The preceptor should then set goals based on the learning assessment needs of preceptee. In addition, the preceptee should write down his or her goals and give them to the preceptor. Research shows that you are more likely to achieve a goal if you write it down. Having a Learning plan allows individuals to write down his or her goals, and track ones learning activities and outcomes. The goals should be SMART goals.
4 A SMART learning goal is structured so that anyone who reads your goal statement will understand what you want to learn. The preceptee can set any amount of goals necessary for the learning experience. 1. S-Specific- A specific goal is detailed, focused and clearly stated. Everyone reading the goal should understand what the individual would like to accomplish. 2. M-Measurable- A measurable goal is quantifiable, meaning you can see the results. 3. A- Attainable- An achievable goal can be achieved based on your skill, resources and area of practice. 4. R- Relevant. A relevant goal applies to your current role and can be linked to key role responsibilities. 5. T- Time-limited. A time-limited goal has An example of a SMART Goal in nursing: I would like to start 5 IV s without having to stick the patient more than once during my first week of orientation. An example of a SMART Goal in Nursing Administration: I would like to send three nurses every three months for skills update training by the end of November.
5 Develop and implementing a learning plan Developing a Learning Plan requires that the preceptee: 1. Reflect back to the learning goals that were agreed, and the ability (i.e. knowledge, skill or attitude) to be accomplished. The preceptee learning plan should be should be directly related to set goals, action-oriented, and achievable. 2. Identify the learning experience needed to achieve his or her set goals. Goalimplementation associated with specific learning plan should be developed from an understanding of the research or evidence base practices. 3. Identify the support required to develop and achieve goals. Implementation of goals is a shared responsibility of the learner, preceptor, and the health care organizations management team. The responsibility of management is to provide the right resources and an environment that supports the growth and development needs of the preceptor, and the preceptee. The preceptor should assist in: a. Managing and implementing the goals b. Agree with goals discuss and sign to show commitment c. Implement the goals and assist the preceptee to achieve goals d. Set time aside to check in with each other to discuss progress and make necessary adjustments or changes. e. Provide ongoing feedback and recognition to help guide and reinforce progress.
6 Teach effective time management and prioritization when providing patient care Effective time management requires individuals to systematically focus on what is the priority and temporally suppress or delegate what is not a priority. The key components of effective time management and prioritization are for the preceptor to help the preceptee identify four components on how to prioritize, organize, delegate and to take a break. 1. Prioritize-the preceptor should teach the preceptee to: a. Identify the most important patient tasks. b. To become familiar with how long it takes to perform different patient task on the unit. c. How to be flexibility. d. Understand how to make an informed decision for accomplishing patient tasks. 2. Organize-the preceptee should observe the preceptor daily routine structure and adopt critical organizational skills. 3. Delegate- delegating responsibility to unlicensed personnel is a effective component of time management and prioritization. Nurses who try to do it all often think other staff won't do their jobs properly. However, it is an expectation of CNA sitting at the desk to do his or her job. Doing the work of another staff at the expense of a patient is not good nursing. Do not be afraid to delegate appropriate task to an Unlicensed assistive personnel (UAP) 4. Take a break- It is important to stress to your preceptee that he or she cannot work efficiently if they are exhausted. Take a moment to hydrate, urinate, and consume food.
Having short periods of rest allows you to collect your thoughts and re-energize yielding positive patient outcomes. 7 Documentation There are standards of care that exist in health care. One of the most important elements that surround theses standard of care is keeping a record of the treatments, procedures, and care provided to patients. Keeping these records requires legal documentation. In the legal system, documentation is regarded as an essential element (Gutheil, 2004). Preceptors should reinforce in his or her teaching that documentation of care is the primary source of reference and communication that tells the entire health care team members: 1. About the patient 2. Patient care and treatments 3. Aids in good decision making for the patient positive outcomes 4. Determines the effectiveness of treatments 5. Tell the health care team about patient facts Below is a chart of Medical Record Guidelines that the preceptor can share with the preceptee.
8 Documenting in the Medical Record Guidelines Activity Write legibly always using black indelible ink. DO not use Blue ink or a pencil Whenever something is documented by you always sign the entry made, list your job title, and date and time your entries using a 24 hour clock. Rationale Writing legibly can prevent miscommunication, and medical errors. Ink must be used because pencil can be erased permitting the record to be altered. Indelible ink will not smudge or become difficult to read. Black ink reproduces more effectively when duplicating records to share only with the health care team. A signature indicates that you have made the entry and should further clarification be required then you can be consulted. Using your title can also make it easier to locate the exact person if further clarification is needed. Dating and timing your entries allow a bystander to note when actions occurred and when observations were made. Only record what you have observed, never make entries for another person based on here say. Care interventions should only be described and documented after they have been provided. You should not falsify your records. Recording should be done in a timely manner. If errors are made and you need to amend or alter your records then you must not erase, use correction fluid or score through an entry. A single line through the error, signed or initialed next to it is needed. When using electronic charting record documentation never share your password or give your smart card to anyone. Always log off when your documentation is completed or Only you can vouch for what you have observed. Documenting care prior to delivery is incorrect and could be seen as fraudulent. Refer to the violations of the Nurse Practice Act Standards on falsifying records. If you wait until the end of the shift you may have forgotten important information that needs to be recorded Erasing or using correction fluid or scoring through an entry can indicate you are trying to hide or cover up an entry, a single line allow the original entry to be audited. If you share your password or fail to log off after an entry has been made others can access the record and alter this, the record will then appear as if you have made the. entry after making an entry. Source: Adapted from: Dimond, 2005; Carter, 2007; Ellis and Bentz, 2007; Nursing and Midwifery Council, 2009
9 Provide Constructive Feedback and Coaching The goal of effective feedback and coaching is for the preceptee to become competent at the organization he or she is hired, deliver effective safe patient care, and be able to independently analyze and solve complicated work situations. Providing effective feedback is one of the most important characteristics of a good preceptor. Feedback, and coaching should be frequent, ongoing, and constructive. Feedback should be given daily. Individuals that receive daily effective feedback and coaching usually perform significantly better, develop better judgment, and learn faster than individuals who do not receive daily feedback. The preceptor should make sure that the feedback is clearly understood. It may be beneficial for the preceptor to have preceptee summarize the provided feedback because mixed messages may be perceived. Because health care is based on evidence based practices, the preceptor should have the evidence needed when providing feedback. Effective Feedback and Coaching can be described as comments that: Let the preceptee know what they have done well Let the preceptee see what they need to improve Let the preceptee plan a course of action for remediation or change Daily Critical Thinking Dr Patricia Benner introduced the concept that expert nurses develop skills and understanding of patient care over time through a sound educational base as well as a multitude of experiences. She proposed that one could gain knowledge and expertise ("knowing how") without ever learning the theory ("knowing that"). In other words the more that you are exposed
10 to clinical experiences the better you get at managing these experiences. Therefore the preceptor should always include the preceptee with the daily planning and patient outcomes. If a patient has a chief compliant both preceptor and preceptee should be present to: 1. Recognize the problems 2. Raise questions 3. Gather data for a possible solution 4. Evaluate current or alternative solutions 5. Finally show your preceptee how to implement solutions for the best possible outcomes. Creating an effective preceptor checklist It is crucial for the organization to create and use an effective preceptor checklist. An effective preceptor checklist will serve as a guide to help the preceptee acclimate to your team and become productive in his/her role more quickly. The checklist should include areas to be covered, descriptions of the areas to be covered, and when completed. According to the Canadian Centre for Occupational Health and Safety (2016) precepting is the process of introducing new, inexperienced, and transferred workers to the organization, their supervisors, co-workers, work areas, and jobs, and especially to health and safety. Providing training and extra assistance during the initial period of employment is critical, regardless of the age of the employee, as they are not familiar with the hazards of the job or the workplace. During this phase, each worker develops the knowledge, skills, and abilities that are necessary to work in a safe and healthy manner. Below is an adopted checklist from the
11 Canadian Centre for Occupational Health and Safety (2016) that can be tailored to your organizational needs. Name of Preceptor: Name of Preceptee: Date of Hire: Date of Completion: Areas to be Covered Company Safety Rules PRECEPTOR CHECKLIST Description Explain safety rules that are specific to your company. Completed Yes No Company Policies Explain the health, safety and wellness policies of your company. Previous Training Ask the employee if she/he has taken any safety training. Training Health and Safety Potential hazards Emergency Procedures Toxic Products Food and Beverages Provide any necessary safety, environmental, compliance or policy/procedural training. Inform the health and safety specialist that a new employee has joined the company who will need safety training. Arrange for this training and education to occur. Tour the work areas and facility and discuss associated work area hazards and safe work practices. Show and explain how to use emergency eyewashes and showers, first aid kits, fire blankets, fire extinguishers, fire exits and fire alarm pull boxes, as applicable. Demonstrate the evacuation procedures. Identify workspaces where hazardous materials are used, stored or disposed. Provide training as necessary. Explain that food and beverages are only permitted to be stored in refrigerators clearly labelled "FOOD ONLY".
12 Emergency Notification Form WHMIS Emergency Evacuation Personal Protective Equipment (PPE) In Case of Injury or Illness Health and Safety Committee General Rights and Responsibilities Emergency Contact Document Have employee complete the Emergency Notification form. Keep a copy for your files and send a copy to your Emergency Coordinator. Provide education about WHMIS. Identify the location of the Material Safety Data Sheets (MSDSs). Review the MSDSs for all hazardous materials to be used by the employee. Explain hazardous material labelling requirements. Conduct job specific training. Review the company's Emergency Evacuation Plan and explain the evacuation signals and procedures, point out proper exit routes and the designated assembly area for your Branch. Review the PPE program if the employee will be required to wear protective equipment. Issue appropriate personal protective equipment (PPE) that must be worn as required by the work being performed. Review the reporting procedures in the event of an injury and/or accident. Supply a copy of the facility telephone list with names of the Health and Safety Committee members highlighted. Identify the location of the safety bulletin board. Explain how the employee can participate in the health and safety process (e.g., report hazards) Explain worker rights and responsibilities as granted by legislation. (See the section of our OSH Answers on Legislation for more details.) Provide a list of names, addresses, phone numbers and fax numbers of the persons who must be contacted in case of emergency. Maintain a record of the orientation.
13 References Benner, P. (2011). From Novice to expert. Retrieved from http://currentnursing.com/nursing_theory/patricia_benner_from_novice_to_expert.html Carter, P.J. (2007). Essentials for Nursing Assistants. A Humanistic Approach to Caregiving. Lippincott, Philadelphia Canadian Centre for Occupational Health & Safety. (2014). Employee Orientation Checklist. Retrieved from https://www.ccohs.ca/oshanswers/hsprograms/orientation.html. Dimond, B. (2005). Abbreviations: The Need for Legibility and Accuracy in Documentation. British Journal of Nursing 14(12), 665 66. Ellis, J.R., Bentz, P.M. (2007). (7th Ed) Modules for Basic Nursing Skills. Lippincott, Philadelphia. Lee, T. Y., Tzeng, W. C., & Yeh, M. L. (2009). Effects of a preceptorship programme on turnover rate, cost, quality, and professional development. Journal of Clinical Nursing, 18, 1217-1225. National Council of State Boards of Nursing. (n.d.). What every nurse needs to know. Retrieved from http://floridasnursing.gov/forms/nurse-need-know-info.pdf. NSI Nursing Solutions. (2016). National Healthcare Retention & RN Staffing Report. Retrieved from. http://www.nsinursingsolutions.com/files/assets/library/retentioninstitute/nationalhealthcarernretentionreport2016.pdf Preceptor Preparation Helps Hospitals Improve Nurse Retention Rates. White Paper. Elsevier. 2013.
14 Spector N. The National Council of State Boards of Nursing s Transition to Practice Study: Implications for Educators. (2015). Editorial. Journal of Nursing Education. 54(3), 119-120.