Supporting Learners: Regulatory and an Acute Care Practice Perspective

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1 Supporting Learners: Regulatory and an Acute Care Practice Perspective Ashley Graat RN, BScN, M.Ed(c) Professional Practice Leader - Evidence Based Practice Murray Krock RN, BScN, MN Corporate Nursing Education Leader, Professional Practice 1

2 Presentation Pathway Overview of St. Michael s Hospital (SMH): Who we are Why we developed a preceptorship workshop Introduce & review key components of SMH nursing preceptorship workshop Demonstrate the application of the College of Nurses of Ontario s (CNO) Supporting Learners Guideline to preceptorship 2

3 St. Michael s Hospital: Who we are Academic health sciences centre affiliated with the University of Toronto, and a major tertiary and quaternary referral centre $500M+ operating budget 475 acute adult inpatient beds 5,368 staff 1,800 nurses 713 physicians 537 volunteers 71,951 emergency visits 29,549 surgical cases 466,631 ambulatory visits 26,406 inpatients 3, 357 students trained Source: Community Report

4 Supporting Learners Nurses have a professional obligation to support learners to develop and refine the competencies needed for safe, ethical and effective practice, and to support the development and socialization of colleagues who are learning. (Supporting Learners Practice Guideline, College of Nurses of Ontario) As preceptors, nurses support the transition and integration of new nurses and nursing students into the organization and practice setting. This workshop (preceptorship)will prepare nurses with the knowledge and skills to function effectively in a preceptor role. (St. Michael s Hospital, Preceptorship Workshop) 4

5 Preceptorship Workshop: Components Differentiate preceptorship and mentorship Benefits of preceptorship programs Qualities of an ideal preceptor Adult learning theory and principles VARK learning style preferences Promoting critical thinking Factors that affect the preceptorship experience Providing effective feedback Conflict resolution strategies Evaluating the preceptorship Roles & responsibilities of the preceptor, preceptee, educator/administrator 5

6 Preceptorship is A frequently employed teaching and learning method using nurses as clinical role models. It is a formal, one to one relationship of predetermined length between an experienced nurse (preceptor) and a novice nurse (preceptee) designed to assist the novice in successfully adjusting to a new role. The novice may be a student, a new graduate nurse, or an already practicing nurse moving into a new, domain or setting. Preceptorship is a partnership between the preceptor who is responsible for teaching, evaluating and providing feedback to the preceptee. Canadian Nurses Association,

7 Exercise: Preceptorship versus Mentorship Definition: Purpose: Type of Relationship: Role Model Characteristics: Participant Characteristics: Assessment and Evaluation: Time Frame: Preceptorship Mentorship 7

8 Qualities of an Ideal Preceptor Demonstrates professionalism and competence Interested and committed to the preceptor role and life long learning Strong leadership and conflict-resolution skills Role model, teacher, coach and provides ongoing feedback Trusting, caring, patient and enthusiastic Demonstrates strong interpersonal and communication skills Strong knowledge, skills and judgment (CNO Professional Standards, hospital policies and procedures, unit specific competencies/routines etc.) 8

9 Preceptor & Preceptee Interview Getting to know your preceptee Purpose: To foster the preceptor/preceptee relationship & to tailor the preceptorship to maximize the preceptee s experience. 1. Describe the types of clinical experiences you have had. 2. What do you expect to gain from the preceptorship? 3. Describe the best way you learn. 4. What do you see as your major strengths? 9

10 Preceptor & Preceptee Interview Getting to know your preceptee..cont d 5. What do you see as your greatest challenges? 6. What are your future aspirations? 7. Is there anything else you would like your preceptor to know and understand about you/your professional needs? 8. How can your preceptor further assist you during the preceptorship experience? 9. What questions do you have for your preceptor? Adapted from: Swihart, D. (2007). Nurse Preceptor Program Builder: Tools for a Successful Precptor Program (2 nd ED). Danvers: HCPro 10

11 Adult Learning Theory & Principles: Malcolm Knowles Six Principles of Adult Learning 1. Adults are internally motivated and self-directed 2. Adults bring life experiences and knowledge to learning 3. Adults are goal oriented 4. Adults are relevancy oriented 5. Adults are practical 6. Adult learners like to be respected 11

12 VARK Learning Styles KINESTHETIC 12

13 One Minute Preceptor Step 1: Get a commitment Have your preceptee present their plan of care or intervention plan for the problem. Step 2: Probe for supporting evidence Establish the knowledge basis for decisions in step 1. Step 3: Teach general rules Provide correct information or provide location of resources. Step 4: Reinforce what was right Provide positive feedback to promote confidence and self-esteem. Step 5: Correct mistakes Provide specific information regarding necessary improvement. 13

14 Preceptees want and value feedback Builds confidence Can accelerate learning Feedback: is the sharing of specific information related to a learner s performance in order to help him/her continue or modify a behaviour. Without feedback, incorrect assumptions about performance may be made Without feedback, learners may discontinue positive behaviours Promote self reflection and independent study 14

15 Tips for Providing Effective Feedback Self-Assessment Balanced Well-Timed Based on Observation Descriptive and Specific Regularly Provided 15

16 Sources of Conflict Between Preceptor & Preceptee Role expectations CONFLICT: A clash or struggle when a real or perceived threat or difference exists in the desires, thoughts, attitudes, feelings or behaviours of two or more people. Different learning/working styles Inadequate skills/knowledge Personal/personality issues 16

17 Dealing with Conflicts 1. Provide positive feedback on performance. 2. Focus on the observed behaviour that could be improved. 3. Describe impact of behaviour. 4. Work together to identify solutions. 5. Develop an action plan. 6. Set a date for evaluation. 17

18 Lessons Learned 1. Preceptors want to support preceptees 2. Planning & development of education to support preceptorship development is critical to secure corporate support 3. Education is a recognized a strategy 4. Participants need an opportunity to share and discuss their experience 18

19 Preceptor Resources: College of Nurses of Ontario. (2009). Practice Guidelines: Supporting Learners. Toronto, ON. College of Nurses of Ontario. (2011). Entry to Practice Competencies. Toronto, ON. College of Nurses of Ontario, (2002). Professional Standards. Toronto, ON. College of Nurses of Ontario. (2006). Practice Standard: Decisions About Procedures and Authority. Toronto, ON. 19

20 Preceptor Resources: College of Nurses of Ontario. (2010). Developing SMART Learning Goals. Toronto, ON College of Nurses of Ontario. (2006). Practice Standard: Decisions About Procedures and Authority. Toronto, ON. Preceptor Education Program (PEP), The Faculty of Health Sciences at the University of Western Ontario, a project funded by The Ministry of Health and Long-Term Care. VARK Learning Style Questionnaire. Retrieved from 20

21 References Altier, M.E., & Kresk, C.A. (2006). Effects of a 1-year residency program on job satisfaction and retention of new graduate nurses. Journal for Nurses in Staff Development, 22(2), American Association of Critical Care Nurses. (2000). A Preceptor Training Program. Ammon-Gaberson, K.B. (1987). Adult Learning Principles: Application for Preceptor Programs. AJORN journals, 45(4), Baker, D. (2003). Clinical Teaching Matters-A Bulletin on Clinical Teaching Topics. Retrieved from Bastable, S.B. (2003). Nurse as Educator: Principles of teaching and learning for nursing practice. Boston: Jones and Bartlett. Beecroft, P. C. et al. (2004). Bridging the gap between school and workplace: Developing a new graduate nurse curriculum. JONA, 34(7/8), Beecroft, P.C. et al. (2001). RN internship: outcomes of a one year pilot program. Journal of Nursing Administration, 31(12), Benner, P. et al. (2010). Educating Nurses: A Call for Radical Transformation. San Francisco California: Jossey-Bass. 21

22 References Benner, P. (1982). From Novice to Expert. American Journal of Nursing, 82, Benner, P. (2001). From Novice to Expert: Excellence and Power in Clinical Nursing Practice, Commemorative Edition. Prentice Hall. Black, J. et al. (2008). Competencies in the context of entry-level registered nurse practice: a collaborative project in Canada. International Nursing Review, 55, Blanzola, C. et al. (2004). Nurse internship pathway to clinical comfort, confidence, and competency. Journal for Nurses in Staff Development, 20(1), Bossers, A., et al. (2007). Preceptor Education Program (PEP), The Faculty of Health Sciences at the University of Western Ontario, a project funded by The Ministry of Health and Long-Term Care. Retrieved from ttp:// Brunit, B.A., & Kopp, D.J. (2007). Impact of Preceptor and Orientee Learning Styles on Satisfaction. Journal for Nurses in Staff Development, 23(1), Boychuk Duchscher, J. (2008). The process of becoming: The stages of new nursing graduate professional role transition. The Journal of Continuing Education in Nursing, 39(10),

23 References Canadian Nurses Association. (2004). Achieving Excellence in Professional Practice: A guide to preceptorship and mentoring. Ottawa: Author. Canadian Nurses Association. (1995). Preceptorship resource guide: Teaching and learning with clinical role models. Ottawa: Author. College of Nurses of Ontario. (2009). Practice Guideline: Supporting Learners. Toronto: Author. College of Nurses of Ontario. (2010). Developing SMART Learning Goals. Toronto: Author. Dibert, C., & Goldenberg, D. (1995). Preceptors perceptions of benefits, rewards, supports, and commitment to the preceptor role. Journal of Advanced Nursing, 21(21), Duncan, B. (2005). The communication cycle. Retrieved October 30, 2012 from Dwyer, J (2009). The business communication handbook, 8th edition, Pearson, Frenches Forrest, NSW. Types of communication. Retrieved from 23

24 References Evans, T. (2008). Preparing to teach in the clinical setting. Department of Nursing Education and Health Studies, Grande Prairie Regional College. Ferguson, L.M. (2007). Challenges for new nurses in evidence-based practice, Journal of Nursing Management, 15, Fleming, N. (2011). VARK. A guide to learning styles. Retrieved from Frankel, A. (2009). Nurses learning styles: promoting better integration of theory into practice. Nursing Times, 105(2), Goode, et al. (2009). Nurse residency programs: an essential requirement for nursing. Nursing Economics, 27(3), Hardyman, R. & Hickey, G. (2001). What do newly-qualified nurses expect from preceptorship? Exploring the perspective of the preceptee. Nurse Education Today, 21, HcPRO. (2005). Nurse Precepting. A Video Guide to Effective Mentoring. [Motion Picture]. Marblehead, MA: The Healthcare Compliance Company. Kertis, M. (2007). The One-Minute Preceptor: A five-step tool to improve clinical teaching skills. Journal for Nurses in Staff Development, 23(5),

25 References Krugman, M. et al. (2006). The national post-baccalaureate graduate nurse residency program. A model for excellence in transition to practice. Journal for Nurses in Staff Development, 22(4), Learning Styles. (2009). The Student Development Center at University of Western Ontario. Retrieved from Levett-Jones, T. & Fitzgerald, M. (2005). A review of graduate nurse transition programs in Australia. Australian Journal of Advanced Nursing, 23(2), Lyons, T. F. (1971). Role clarity, need for clarity, satisfaction, tension and withdrawal. Organizational Behavior and Human Performance, 6, Matsumura, G. et al. (2004). Staff nurse perceptions of the contributions of students to clinical agencies. Nursing Education Perspectives, 25(6), Mamchur, C., & Myrick, F. (2003). Preceptorship and interpersonal conflict: a multidisciplinary study. Journal of Advanced Nursing, 43 (2), Morton-Cooper, A. (1993). Mentoring and Preceptorship: A Guide to Support Roles in Clinical Practice. London: Blackwell Scientific. Mueller, C. W. & McCloskey, J. C. (1990). Nurse Job satisfaction: a proposed measure. Nursing Research, 39(2),

26 References Myrick, F. (2002). Preceptorship and critical thinking in nursing education. Journal of Nursing Education, 41(4), Myrick, F. & Yonge, O.J. (2005). Nursing preceptorship: Connecting practice & education. Philadelphia: Lippincott Williams & Wilkins. Myrick, F., & Yonge, O.J. (2004). Enhancing critical thinking in the preceptorship experience in nursing education, Journal of Advanced Nursing, 45 (4), Myrick, F., & Yonge, O.J. (2001). Creating a climate for critical thinking in the preceptorship experience. Nurse Education Today, 21, Myrick, et al. (2012). Putting the Evidence into Preceptor Preparation. Nursing Research and Practice, 2012, 1-7. O Brien-Pallas, L. et al. (2006). The impact of nurse turnover on patient, nurse and system outcomes: a pilot study and focus for a multicenter international study. Policy, Politics & Nursing Practice, 7(3), O Connor, A. B. (2006). Clinical instruction and evaluation: A teaching resource (2nd Ed.). Toronto: Jones and Bartlett. Owens, D.L. et al. (2001). New graduate RN internship program: A collaborative approach for system-wide integration. Journal for Nurses in Staff Development, 17(3),

27 References Paton, B. (2008). Preceptors matter: Supporting, extending and legitimizing the role of the nurse preceptor. Centralized Preceptor Education Project. Image Printing, University of Calgary. Red Deer College/Alberta Health Services. (2011). Preparing to be a Preceptor. Author. Registered Nurses Association of Ontario. (2006). Preceptorship and Mentorship. Retrieved from Russel, S.S (2006). An Overview of Adult Learning Process. Urologic Nursing, 26(5). Ryerson University. (2010). Preceptor Information: Guiding, Teaching & Supporting. Retrieved from Salt, J. et al. (2008). Increasing retention of new graduate nurses. JONA, 38(6), Sorensen, H.A.J., & Yankeh, L.R. (2008). Precepting in the fast lane: Improving critical thinking in new graduate nurses. The journal of Continuing Education in Nursing, 39 (5),

28 References Tanner, C.A. (2005). What have we learned about critical thinking in nursing? Journal of Nursing Education, 44(2), The Clinical Educator s Resource Kit. (2007). Queensland Occupational Therapy Fieldwork Collaborative. Retrieved from Ulrich, B. et al. (2010). Improving retention, confidence and competence of new graduate nurses: Results from a 10-year longitudinal database. Nursing Economic$, 28(6), Williams, C.A. et al. (2007). Postbaccalaureate nurse residency 1-year outcomes. JONA, 37(7/8), Wolfensperger Bachford, C. (2002).false Breaking into orthopaedic nursing: Preceptorship for novice nurses, Orthopaedic Nursing, 21(3), Yonge, O., et al. (2007). Preceptorship and mentorship: Not merely a matter of semantics. International Journal of Nursing Education Scholarship, 4(1). Yonge, O., Krahn, H., Trojan, L. Reid, D., & Haase, M. (2002). Supporting preceptors. Journal for Nurses in Staff Development, 18(2),

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