Preceptor’s Coaching and Development

Overview

As expert practitioners, preceptors have a solid understanding of clinical practices, so they use their skills to help students develop their own. Essentially, a preceptor  is usually an advanced-practice nurse who “juggles the roles of teacher and clinician” (Burns et al. 2006). Preceptors supply students with valuable learning experiences, so they will afford students opportunities to observe or participate in a safe and positive learning environment. In collaboration with Nurse Managers and Clinical Instructors, preceptors tailor each learning experience according to the individual. The student nurse has to meet his or her course objectives, so the preceptor takes those into consideration when planning activities. Because preceptors supervise students’ actions, they are invaluable at offering objective reports and articulate evaluations. In other words, preceptors teach skills, assess skills, give feedback, evaluate skills, identify criteria, and create specific expectations when necessary. Overall, preceptors are facilitators of a student’s success. 

Initially, preceptors conduct orientation sessions with each nursing student and address medical surgical unit policies and procedures, identify individual learning styles, and explain evaluations, feedback, and interactions. First of all, preceptors inform students of dress codes and unit protocol in order to reduce any first day angst. Secondly, it is important to review students’ previous learning experiences and identify students’ learning styles. We all learn in different ways, so preceptors need to be familiar with the various learning styles. In this way, the preceptor is able to implement appropriate unit experiences and reveal learning strengths and weaknesses in order to provide students with optimal education. Thirdly, preceptors assure students that they will receive specific guidance and detailed feedback. Preceptors supervise and evaluate students’ performances and supply students with daily feedback. Evaluations are an integral tool because they offer support and let students know how to maintain progress or correct mistakes. After the orientation, it is helpful to take the student on a tour of the unit and make introductions. Incidentally, preceptors should always encourage students to network with other staff members or professionals in the community. 

One-on-One Guidelines

Preceptors use a competency based approach in their one-on-ones with students. Researchers in Ireland established 5 domains: “professional/ethical practice, holistic approaches to care and the integration of knowledge, interpersonal relationships, organization and management of care, and personal and professional development” (Cassidy et al., “Introduction” 2012). Specifically, professional/ethical practices involve moral decision making. Essentially, we know what is morally right or wrong. In addition, preceptors encourage students to use critical thinking and consider subjective, objective, primary, and secondary data when caring for patients. At the same time, a holistic approach to care utilizes our critical thinking skills. Nurses must know how to apply their knowledge to different scenarios in a fast-paced environment. Explicitly, each patient is different, thus, his or her care will differ as well.  Delegations of nursing activities depend on an individual’s location, but for the most part, preceptors should make a valid effort to assess students’ competence and base their assessments on a student’s knowledge, skills, and experience level. In that way, a preceptor assures that the student is following his or her instructors’ guidelines and educational goals. 

Legal and Ethical Issues

Preceptors supervise their students with ethical and legal issues in mind. The American Nurses Association (2011) dictates that it is a nurse’s professional duty to embrace a code of ethics because ethics is “an integral part of the foundation of nursing” ("Preface| code of ethics for nurses with interpretive statements," para. 1). There are always ethical issues in clinical nursing. When supervising students, preceptors extend compassion and respect, but, at the same time, preceptors have to establish professional boundaries. While it is not likely students would take advantage of preceptors, it is important to clearly establish guidelines. Most importantly, preceptors are accountable for their own actions and their students’ supervision. Ultimately, students do not work under a preceptor’s licensure. Preceptors must maintain that they are there to supervise, but each student is responsible for his or her actions. By emphasizing personal accountability, the preceptor instills working ethics in the students. At times a preceptor may assign students’ learning experiences to other qualified preceptors, but, they still must supervise the students to offer their feedback. Essentially, the assigned students remain the original preceptor’s responsibility. 

Reporting Requirements

Assessments are an instrumental portion of the day and they should be objective in nature. For example, if students correctly identify a patient’s aliment, preceptors consider that information to be free of judgment because it relies on facts. On the other hand, evaluations allow preceptors to interject personal reactions, but only to a certain extent. Preceptors evaluate new learners’ four developmental levels as follows (Stone & Gillmour-Kahn, 2010): 

• D1 Enthusiastic and ready to learn

• D2 Some disillusionment and decreased commitment as they learn that the task is more difficult than they expected

• D3 Learning continues with increased knowledge and skills. Commitment fluctuates from excitement to insecurity

• D4 High level of competence, motivation, and commitment (Clinical Teaching Strategies in Nursing,  p. 271)

Using the scale, preceptors assess students’ abilities. In addition, preceptors gauge students’ motor skills and rate their professionalism. Basically, preceptors aim to discover if students have professional attitudes and practice accountability. If the student has a weakness, preceptors consider what they want the student to adjust in order to betterment that particular skill. Specifically, feedback must be specific and articulate. For example, instead of telling students they did “a good job,” preceptors can say “I liked that you collected your data while maintaining small talk with the patient.” Furthermore, preceptors will add time frames to performance. As an illustration, if a student has difficulty with data collection, preceptors will provide a time frame in which the student must improve. Moreover, preceptors will offer a percentage. Nursing involves lifelong learning, so the student can focus on perhaps obtaining the 90% range of improvement. Either way, preceptors should incorporate both negative and positive feedback. Overall, feedback allows the preceptor to identify a student’s weaknesses and strengths, and they are an essential component because daily feedback allows the learner to address performance issues as they come along. 

Preceptor Performance Appraisal

Faculty assesses a preceptor’s performance as well. Explicitly, a professional nurse should exemplify the American Association of Colleges of Nursing’s five values (2008): altruism, autonomy, human dignity, integrity, and social justice (Beth, p. 9). Preceptors should treat their students with respect and provide individual assessments and instructions. Any activities must have a sound pedagogical basis and ultimately teach students to become competent professionals. Using Benner’s Novice to Expert Scale (English, 1993), preceptors will be evaluated based on the following: 1 = Novice/rarely, 2 = Advanced Beginner/Sometimes, 3 = Competent/Regularly, 4 = Proficient/Most of the time, and 5 = Expert/Always (p. 388). Essentially, preceptors should strive for excellence. In the case that a preceptor falls under the scale’s 3, faculty or managers, or both, will sit down with the preceptor and identity problem areas and the best way to solve problems or strengthen weaknesses.  Preceptors should continue to have goals for their professional developments, so appraisals will include goal making. 

Incentive Program

Preceptors are at risk for anxiety, or they become disillusioned with the reality of the work; therefore, faculty should reward preceptors for excellent performance. Consequently, recognition or rewards encourage preceptors to continue with their work ethics. Some examples of rewards include: pay differentials, educational offerings, such as subscription to journals, and tuition reimbursement, or opportunities to attend conferences (Biggs & Schriner 2010). However, hospitals rarely offer student preceptors any form of monetary awards. On the other hand, most hospitals have online subscriptions to various medical journals. If a preceptor has access to journals, he or she will realize we appreciate their efforts and encourage their goals.

At the same time, because we have limited funds, often gifts will have to be inexpensive tokens of appreciation, but nonetheless, each preceptor should have some sort of recognition. Ultimately, it is likely to make preceptors feel needed if incentives are personable. Therefore, faculty will implement its own version of the PRIDE program (Biggs & Schriner 2010) in order to provide preceptors with well-deserved recognition and as an incentive program. The acronym PRIDE stands for professionalism, recognition, individual, dedication, and education. Each preceptor who exhibits each trait will receive public recognition for their achievements.  Every year we will hold a preceptor appreciation gathering that includes refreshments and a small award ceremony that hands out certificates, preceptor pins or badges, engraved pens, or tote bags. In this way, the reward is an individual award and it is feasible when faced with limited budgets. Subsequently, small rewards or recognition may entice other staff members to act as preceptors.

Scenario One

Tardiness and mishandling of students puts the unit at risk for legal issues, so it is important to schedule a one-on-one meeting with the preceptor. In that meeting, we can find out if there are any issues that are affecting the preceptor’s job performance. We cannot assume their tardiness is due to a personal problem. Perhaps, it is a communication issue and the preceptor does not realize that he or she is responsible. Similar to a problem identification form that a preceptor would use with a student, faculty can have the same identification sheet to use with a preceptor. 

If a preceptor arrives late three days in a row, we should ask to privately speak with the preceptor because we have to communicate with the preceptor. We have to understand the preceptor’s style and competence and understand the bigger picture. First, we would commit on the issue at hand. For example, I would ask the preceptor what he or she thinks is going on. In that way, there is a clear agreement of the said problem. Secondly, in regards to the students, I would ask the preceptor what led him or her to conclude that students were able to work alone. In this way, I find out if there was any miscommunication during the preceptor’s initial orientation.  Afterwards, I would let the preceptor know that we would fill out a problem identification sheet. 

We would fill out the sheet separately, and after we were through, we would compare our answers. In this way, we both identify the problem. Next, we will ascertain appropriate preceptor behaviors and agree upon what measures the preceptor must take. In this case, it is two issues, so we would expect the preceptor to rectify the issues in one week. Either way, communication plays a vital role. In this case, I would emphasize that it is a liability issue and could potentially become a high risk situation. Moreover, I would be able to let the preceptor know that it is ultimately his or her accountability that is at stake. 

Scenario Two

The healthcare industry realizes that continuing education allows a hospital and its workers growth. However, many cannot attend school because nurses are working adults. In this scenario, I would commend the preceptor for wanting to further his or her education. In light of their interest, I would propose they seek out an accredited online university. In this way, a preceptor does not have to go to a traditional class meeting, so a preceptor can continue his or her education without taking time off work or limiting family obligations. Knowing the inevitability of the working nurse dilemma, faculty and managers should devote an amount of time to seeking out such educational opportunities in order to offer viable solutions or advice. While some preceptors may not have had any experience with online distance education, I would reassure them that they are practiced critical thinkers and would be able to handle the curriculum. 

In addition, I can offer to adjust his or her patient care assignments by assigning an associate preceptor. In a way, this allows other staff members to work with students. While it is important to keep a student’s preceptor the same throughout his or her schooling, we must think of other means to allow busy professionals time to devote to their education. After all, educational growth remains a goal for a professional nurse’s lifelong learning. 

References

Biggs, L., & Schriner, C. L. (2010). Recognition and Support for Today’s Preceptor. The Journal of Continuing Education in Nursing, 41(7), 317-322. doi: 10.3928/00220124-20100401-05

Burns, C., Beauchesne, M., Ryankrause, P., & Sawin, K. (2006). Mastering the preceptor role: Challenges of clinical teaching. Journal of Pediatric Health Care, 20(3), 172-183. doi: 10.1016/j.pedhc.2005.10.012

Cassidy, I., Butler, M., Quillinan, B., Egan, G., McNamara, M. C., Tuohy, D., ... Tierney, C. (2012). Preceptors’ views of assessing nursing students using a competency based approach. Nurse Education in Practice, 12(6), 346-351. doi: 10.1016/j.nepr.2012.04.006

English, I. (1993). Intuition as a function of the expert nurse: A critique of Benner's novice to expert model. Journal of Advanced Nursing, 18(3), 387-393. doi: 10.1046/j.1365-2648.1993.18030387.x

Preface | code of ethics for nurses with interpretive statements. (2011). Preface | Code of Ethics for Nurses with Interpretive Statements. Retrieved from http://www.nursingworld.org/Mobile/Code-of-Ethics/code-of-ethics-preface.html

Stone, S. E., & Gillmour-Kahn, M. (2010). Quality clinical education for graduate students at a distance. In Clinical teaching strategies in nursing (pp. 255-285).