Coaching Clinical Preceptors

Overview

Entering the nursing field can be a daunting task for a new nurse. They have the burden of caring for individuals who are facing difficulty in their healthcare as well as being surrounded by professionals who know their roles. The role of a preceptor is vital in preparing a nurse for a career in healthcare.  Baltimore outlines what the role of the preceptor is in the hospital setting. “Preceptors are accountable for providing bedside instruction to and competency evaluation of new nurses on a daily basis. Hospital have the responsibility to provide preceptors with the knowledge and skills required to meet the orienteers multifaceted needs” (Baltimore, 2004, p. 133). Preceptors must juggle the difficult tasks of having to teach new nurses while at the same time maintaining a role as a clinician in the hospital setting. Baltimore also states the hospital’s responsibility to ensure that preceptors have clear guidelines on how preceptors can manage their roles.

Guidelines

The hospital’s guidelines for preceptors should be based on a competency based model in order to achieve the best outcomes when working with their staff on a one on one basis. Mallette discovered that the implementation of a competency based approach was the optimal way to improve performance for both the nursing staff and preceptors. “Implementation of the model has resulted in individualized, population-focused experiences for students based on the principles of service-learning, empowered preceptors who are able to increase their scope of service, and increased productivity for the faculty in research and scholarship” (Mallette, 2005, p. 21).  The guidelines would establish the protocols for not only following the hospital’s policies and procedures but also how to follow the competency based guidelines of the nursing profession as a whole.  

The preceptor would need to review the basic policies and procedures of the hospital as it pertains to administrative policies such as clocking in and out or taking breaks. They would then review the various units within the hospital. Once the basics have been reviewed the preceptor would need to develop a learning plan with their nurse trainee. The trainee’s learning style as well as the evaluation procedures will be discussed so that the plan is individualized to the trainee’s needs. It would need to be established whether the trainee prefers an independent learning style or supervision that micromanages their performance. The preceptor would then move onto the professional nursing guidelines. The preceptor would review the standards of nursing practice and how they apply to the hospital setting the nurse works within especially in patient care.

Ethical and legal issues

The preceptor would review ethical and legal issues when working with patients in their discussion of maintaining professional nursing practice. However the preceptor would also need to establish any ethical issues that may arise during the course of supervision, and consistently conduct ethical reviews of the nurse. Throughout the course of supervision the nursing trainee may develop a relationship with the preceptor. However clear boundaries between professional and personal relationships would need to be established to avoid the occurrence of a dual relationship. Preceptors must also ensure that they are regularly meeting with their trainees to address any issues that they may be having. Without regular supervision a trainee could make a mistake that would place liability on both the preceptor and trainee. The actions of the trainee’s reflect on the preceptor and the organization as a whole. The preceptor would need to stress this to the trainee to ensure that their work ethic is strong. Through addressing these issues at the start of the supervision and orientation process the preceptor can prevent any issues from arising that may occur throughout the course of the employment.

Reporting requirement

The evaluation and reporting process are key to the success of the nurse trainee. Through the use of feedback forms and assessments a preceptor can gauge the performance of the nurse trainee in a number of different areas. The evaluation tools are key in determining areas of improvement for the nurse trainee. They would then be able to develop plans to improve the areas. The reporting methods allow a preceptor to determine whether a nurse trainee is knowledgeable in the topics presented in textbooks as well as how the trainee works with patients. Being able to evaluate the bedside manner of a trainee is just as valuable as evaluating just the knowledge gained through their education. The reporting should occur on a daily basis and the trainee must be provided with the feedback on a regular basis as well to continue the trainee’s improvement.

Performance appraisal

The nurse trainee is not the only one whose performance is evaluated. The clinician’s performance as a preceptor must be evaluated as well in order ensure the strength of the competence based model. The preceptor will be evaluated on trainee feedback, performance of the trainee as well as supervisor evaluations. The trainee will provide feedback on how available the preceptor was to them. The preceptor will also be evaluated on the strength of their supervision as well as how well they could provide constructive feedback to their trainees. The preceptor will also be judged upon the performance of their trainees. If a nursing trainee does well this demonstrates that the preceptor has done a good job on providing training. Conversely is a trainee is not managing the responsibilities of her position it may indicate that the preceptor needs to make improvements in their supervisory style. The feedback of the preceptor’s supervisors is valuable as well in the performance appraisal process. A preceptor can go to their supervisor to discuss issues that arise with the trainees. A preceptor’s supervisor would be able to provide constructive feedback as to how well the preceptor managed the difficulties that occurred. 

Results of performance appraisal process

The performance appraisal process for the preceptor provides opportunities for improvement just as it does for the nurse trainee. If the appraisal process demonstrates certain areas of improvement for the preceptor a plan could be developed in conjunction with a supervisor to improve these areas. Resolving the issues is an important step in the appraisal process. The preceptor plays a valuable role in the learning process for the nurse trainees, which is why addressing areas of improvement for the preceptor is a crucial role in the appraisal process. It could even be determined through the appraisal process that the clinician may not be the right person to be in a preceptor position. This may be based on the feedback that the preceptor was inattentive to the needs of the trainee or that they do not have the time to fulfill the responsibilities required of them. Being able to recognize when an individual is not able to fill the position of preceptor to the best of their ability improves the appraisal process. It also hold the preceptor and their supervisor accountable to the goals of providing a learning environment for nurse trainees.

Incentive Program

Being able to recognize good preceptors is also a result of the appraisal process. In order to be able to maintain these preceptors who know how to motivate and teach trainees an incentive needs to be provided to preceptors. As Weismann has found quality nursing preceptor’s can be difficult to find. “Due to the time demands and economic pressures of contemporary medical practice, talented and dedicated teaching faculty staff are becoming more difficult to find” (Weismann, 2006, p. 1140). The hospital administration would need to do the best that they can to maintain these preceptors in their positions as a preceptor position can be very stressful. Not only do they have to manage working two positions but they also have to take on the stresses of the trainee’s they supervise. Preceptors may become more likely to have higher burnout rates than their coworkers who do not have the responsibility to supervise a trainee. The incentive program could provide preceptors with the recognition and acknowledgement that is needed to continue doing their hard work. 

The incentive program that is developed with limited funding would rely more on providing praise and recognition rather than just monetary rewards. The preceptor’s input would also be taken into account to develop a program that would be beneficial to everyone. Blum found that this is essential as nurse preceptors are often not included in the decision making aspects of developing programs. “Although nurse preceptors are frequently used to assist in practice education of nursing students, their contribution to the creation of these programs has not been explored” (Blum, 2009, p. 29). Allowing preceptors to take part in developing their recognition program would provide preceptor’s with some control. A recognition program could be developed in that nurse trainees would be able to provide praise to their preceptors. This could be done through a bulletin board where positive praise is posted for all of the hospital staff to see. This would require the preceptors to be internally motivated. For those preceptors who are extrinsically motivated a small monetary incentive could be provided in the form of gift cards for preceptors with the highest performing nursing trainees. The combination of both approaches could provide valuable incentives for the preceptors. 

Scenario 1

Issues of constant tardiness and lack of supervision of trainees could be grounds for dismissal of a preceptor. Before these steps are taken the issues would need to be addressed first on a one on one basis with the preceptor. They would be reminded of the hospital’s policies on tardiness and what that specifically means for the preceptor. The preceptor’s role would then be discussed especially in regards to monitoring the activities of the trainees. The liability that could occur for the preceptor and the hospital would be discussed. The fact that the rotation is the first experience of the trainees would also be addressed with the preceptor as they are laying the foundation for work in the health care field for these trainees. This would occur in the hopes of stressing the importance of ensuring their trainees are receiving the supervision they need. Once these issues were addressed a plan would be drawn up in these areas so that the preceptor could demonstrate improvement.  The preceptor would be required to check in with the supervisor when they arrived to work. The preceptor would also be required to provide notes of the monitoring activity that was completed with their trainees. If the issues continue to be a problem the preceptor would need to address higher levels of the hospital administration that could possibly result in dismissal of the preceptor.

Scenario 2

Within this scenario the administrator should work together with the RN so that she can achieve both her professional and educational goals. I would work with the RN to develop a work schedule where she would be able to attend school part time and continue to work full time. The nurse would be provided with information on online schools that she could attend at home. The nurse would also be provided with information of financial aid or loan options that she could pursue. It would be important to validate and support the nurse’s desire to continue her education. If the hospital is seen as not being supportive of education they may find that other preceptor’s choose to work in a setting that would be more supportive of their decision to further themselves.  

References

Baltimore, J. J. (2004). The hospital clinical preceptor: Essential preparation for success. Journal of Continuing Education in Nursing, 35(3), 133-140.

Blum, C. A. (2009). Development of a clinical preceptor model. Nurse Educator, 34(1), 29-33.

Mallette, S., Loury, S., Engelke, M. K., & Andrews, A. (2005). The integrative clinical preceptor model: A new method for teaching undergraduate community health nursing. Nurse Educator, 30(1), 21-26.

Weissman, M. A., Bensinger, L., & Koestler, J. L. (2006). Resident as teacher: Educating the educators. Medical Education, 40(11), 1140-1140.