C. A. R. I. N. G.

for new nurses: Preceptor Training

Rebecca Totzke, RN, BSN, CMSRN

CNL Master’s Candidate August 2015

University of Pittsburgh

Introduction

Issue:

• 14% 4S RN turnover rate, highest of M-S units (8/14)

• PEC- RN “pull” survey- 29% of pulls to 4S (8/14)

• 4S preceptor interviews: No formal training

• Gap analysis: Hospital preceptor course last offered 4/13

Why does it matter?

• RN turnover demand on/for preceptors, burnout if

preceptor does not feel prepared or confident in role

• Quality of preceptorship experience directly impacts

satisfaction & retention of new RNs

• Patient care suffers-poor outcomes

Literature Review

• RN turnover=better outcomes & mortality (JC, 2001)

• Orientation$ = 100% RN salary; turnover = cost (JC, 2001))

• 1st yr new RN turnover = 35-65% (Figueroa, 2013)

• 65-76% of inexperienced RNs do not meet entry-level clinical judgment expectations. (delBueno, 2005)

• Preceptors impact job satisfaction & competency of new RN (Sandau et al., 2011)

• New RNs will change to less acute setting or leave nursing if don’t feel competent (NCSBN, 2008)

• Preceptors feel prep & understanding of role confidence (Panzavecchia & Pearce, 2014)

• “Live” class is best- shares info with discussions & learning (Horton et al., 2012)

Project Barriers

• Class room availability: 4S class 3 hrs vs. 4hrs

• Overwhelming amount of resources

• 100 hrs planned for course development, well exceeded

• Time limit of project: Inability to time teaching & then

pairing newly trained preceptor with new orientee to

observe preceptorship

Project Facilitators

• Very engaged staff: attendance & participation

• Beth Cancilla, Clinician 4S, assisted to recruit 4S staff to

participate in class based on schedule

• 100% of 4S preceptor attendance-9 total

• Leadership support for recruitment of participants

• MICU- 5 participants

• ED-2 participants

• Nurse leader residents-2 participants

• Support from education dept. to rewrite course

Methods

Objectives Short term

• Preceptor competence &

confidence

Long term

• Preceptors satisfaction with

role (3 & 6 mos )

• Satisfaction of new RNs with

newly trained preceptors

• Competence of new RNs at

end of preceptorship

• Retention of new RNs

Tools: PowerPoint handouts, discussions, feedback

handouts, recognition gifts

Classes:

4S: March 25th(2) &27th(1)

Hospital: April 2nd (2)

Total attendance: 9+12=21

Applying Hamot’s

Core Nursing Values

to Precept New Nurses

• C-ompassion for the preceptee

• A-dvocacy to promote learning & communication

• R-espect & Dignity to increase satisfaction and retention

• I-ntegrity & Honesty when providing feedback

• N-ew technology & Innovation to promote safe practice

• G-uidance & Mentoring to enhance the team

PRECEPTORS…

…you are the

ships that carry

our new nurses

through choppy

waters to the end

of the rainbow!

Course Outline

• Compassion • New RN reality shock

• Preceptor roles and responsibilities

• Adult learning

• Preceptor reflective practice/beliefs

• Advocacy • Creating a good learning/work

environment

• Communication skills-Dialogue skills

• Shift report/ISBAR

• Handling stressors-Dealing with difficult situations

• Respect & Dignity • Developing objectives

• Granting independence & autonomy

• Inspiring peers

• Dignity & respect to customers

• Integrity & Honesty • Just culture

• Providing feedback

• Changing behavior

• Debriefing

• New technology & Innovation • Organization, prioritization,

situational awareness

• Clinical teaching techniques

• Resources –human & electronic

• Patient safety & Magnet

• Guidance & Mentoring • Developing critical thinking

• Teamwork & Socialization

• Competency & confidence

• Self-care

RESULTS Pre/post survey & Overall Course Evaluations

1

1.5

2

2.5

3

3.5

4

4.5

5

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Str

on

gly

Dis

agre

e S

tron

gly

Agre

e

Survey Question

Preceptor Class Survey Results

Pre-survey Post-survey

4.44

3.84

4.22 4.22 4.44

3.78

4.83 4.78 4.67

4.28 4.47

4.00

0

1

2

3

4

5

1 2 3 4 5 6 7 8 9 10 11 12

Str

ongly

Dis

agre

e

Str

ongly

Agre

e

Question #

Overall Course Evaluation

Magnet matters:

Structural Empowerment

Structural Empowerment

• The organization provides educational activities to improve the nurse’s expertise as a preceptor.

• Describe the organizations preceptor educational program (s) and how each program is evaluated on an ongoing basis.

Source of Evidence

1. Meeting minutes with 4S leadership for course planning

2. 2014 New RN survey-satisfaction with preceptorship, learning environment, preceptor

3. Course outline

4. Meeting agenda UD/Council & PP slides

5. Program evaluation

CNL Role Functions in

Micro-System Project

Educator

• Class developed with latest evidence to benefit preceptor-orientee relationship to enhance communication, feedback quality provided to the orientee, & the learning environment

Outcomes Manager

• Monitor outcomes to assure meeting of objectives & fulfilling needs of preceptors, new RNs, UD, organization, & patients

Advocate

• Give support to preceptors by providing them with resources, ways to learn more info, and format to ask questions /share experiences.

• Patients outcomes depend on well trained RNs.

Team Manager

• Work with preceptors, orientees, educators/dept, Magnet coordinator, and nurse leadership to ensure program meets strategic goals

Recommendations

• Update slides to incorporate staff input/ideas

• “Example pool” from specialties

• “Basics” class for RNs with no experience as 1o preceptor

• Offer in April & October

• Build in time for more skills practice-”Deeper dives”

• Advanced class/modules to further education after Basics

• Reevaluate preceptee feedback tool & update

• Increase recognition

Who are your 2 recruits?

Next classes:

May 5

June 11th

7-11 & 12-4

Future of “ Preceptor Program”

• Magnet document SOE

• Use newly trained preceptors with interns/new RNs

• Survey all new RNs post preceptorship for satisfaction

• Survey attendees at 3 & 6 months after-did practice change?

• Fall 2015 -Survey UD-satisfaction with skills of preceptors?

• Complete development of “Preceptor Program”

• Define selection criteria

• “Preceptor Support” services via online tools

• Enhance recognition of efforts-Develop criteria for

Preceptor Sr. Pro. Contributions

WHAT DO YOU FIND

AT THE END OF C. A. R. I. N. G.

PRECEPTORSHIPS? A pot o’ competent, confident, new nurses!

CARING Pot o’

competent,

confident, nurses

References

• delBueno, D. (2005). Why Can’t New Registered Nurse Graduates Think Like Nurses? Nursing Education Perspectives, 26(5), 278-82.

• Figueroa, S., Bulos, M., Forges, E., & Judkins-Cohn, T. (2013). Stabilizing and Retaining a Quality Nursing Work Force Through the Use of the Married State Preceptorship Model. The Journal of Continuing Education in Nursing, 365-372.

• Horton, C., DePaoli, S., Hertach, M., & Bower, M. (2012) Enhancing the Effectiveness of Nurse Preceptors. Journal for Nurses in Staff Development 28 (4), E1-E7.

• Joint Commission on Accreditation of Healthcare Organizations (2001). Health Care at the Crossroads: Strategies for Addressing the Evolving Nursing Crisis [White paper]. Retrieved October 18, 2014, from Joint Commission: http://www.jointcommission.org/assets/1/18/health_care_at_the_crossroads.pdf

• National Council of State Boards of Nursing, (2008). Toward an Evidence-based Regulatory Model for Transitioning New Nurses to Practice. Chicago, IL: Author. Retrieved from https://www.ncsbn.org/Pages_from_Leader-to-Leader_FALL08.pdf

• Panzavecchia, L. & Pearce, R. (2014). Are Preceptors Adequately Prepared for Their Role in Supporting Newly Qualified Staff? Nurse Education Today, 1119-1124.

• Sandau, K. & Halm, M. (2011). Effect of a Preceptor Education Workshop: Part 2. Qualitative Results of a Hospital-wide Study. The Journal of Continuing Education in Nursing 42(4), 172-181.