• Creation of an Evidence-Based Program Evaluation Design for Preceptor Programs

      Bindon, Susan L. (2011)
      The role of the preceptor in orientation and the use of preceptor development programs to teach preceptors to be effective during the orientation process are supported by the literature. The characteristics of effective preceptor programs are outlined and studied in the literature. The literature supports the use of pre and post tests to evaluate knowledge and nurse retention rates to evaluate outcomes. However, these are only two measures which provide limited information to evaluate preceptor program effectiveness. A comprehensive evaluation for a preceptor program is needed, which includes measures from the participant, stakeholder, and organizational perspectives. The purpose of this capstone project was to develop a comprehensive preceptor evaluation using Donabedian’s Structure-Process-Outcome framework (1966) combined with the theory of Nursing Intellectual Capital (Covell, 2008) as an evaluation blueprint. The goal of the project was to develop a useful comprehensive evaluation design for hospital-based preceptor programs. Method: A survey-based quality improvement project was completed to determine the usefulness of an evidence-based Preceptor Program Evaluation Blueprint. Guided by the blueprint, surveys were used to gather data regarding the Structure, Process, and Outcomes of the LifeBridge Health Preceptor Development program from four different participant perspectives. These convenience samples included twenty-two new graduate nurses, nineteen nurse educators, twenty nurse leaders, and one hundred fifty preceptors. Results: Data from stakeholders revealed an overall satisfaction with the preceptor development program from all key stakeholder groups, yet also revealed uneven perceptions regarding other outcomes such as cost savings and impact on overall new graduate nurse retention, despite data to support positive changes in these organizational metrics. As predicted by the theoretical framework used for the project, weaknesses identified in Structure (identification of individuals responsible for follow-up) were also present in the Process and Outcomes feedback. The same held true for strengths in the Structure elements (preceptor workshop design), which also were consistent throughout the Process and Outcomes data. Changes to the program will be made based on the data from four key participant groups across all three elements of the LBH preceptor program. Conclusion: The evaluation blueprint was extremely helpful in guiding a comprehensive program evaluation and highlighting strengths, weaknesses, and inconsistencies of the program. Using the blueprint, staff development educators can identify, modify, and measure, and monitor key areas both during and after preceptor programs, to help support changes and lead to further enhancements and improvement. Streamlining and simplification of the blueprint is recommended to make it more accessible and usable for educators evaluating preceptor programs.
    • Implementation of a Nurse Preceptor Simulation to Foster Feedback Skills

      Murray, Toni; Hammersla, Margaret (2019-05)
      Background: Effectual feedback is an essential skill crucial to the preceptor role; preceptors are often hesitant and uncomfortable with providing feedback. Inadequate preceptorship is a consistent problem that has continued to affect the onboarding and retention of a qualified registered nurses. In a national survey, timely and effective feedback was ranked the most critical preceptor skill by new nurses entering the practice. The provision of timely constructive feedback is one of the core competencies of nurse preceptors. Feedback education is successfully provided through simulated crucial conversations by using standardized actors in communication learning activities. The use of simulation in training can provide a safe and effective learning environment where new skills can be acquired. The use of standardized actors, role-playing, scripted responses, and simulation has the potential to improve communication skills by offering its participants life-like experiences. Nurse preceptors can benefit from educational activities that can improve feedback skills in the clinical setting during preceptorship Local Problem: Nursing leadership and nurse preceptors at a community hospital in Baltimore, Maryland identified preceptor development as an institutional priority. During the fall of 2017, preceptors (n=260) completed a needs assessment survey. In the survey results that over 44% of the nurse preceptors had no formal training for preceptorship; of those who had training, 42% of them received it over three years ago. Additionally, almost one-third of the preceptors perceived they were not proficient in feedback skills to new nurses and many were unsure if they were previously taught the skill during their program. The purpose of this Doctor of Nursing Practice (DNP) quality improvement project was to implement a feedback simulation into a current preceptor program, to foster preceptors’ skills for providing constructive feedback to new to practice nurses. Intervention: A quality improvement project with a simulation workshop was implemented to incorporate standardized feedback strategies. The simulation workshop included the use of standard actors, video-vignettes, and classroom learning activities to foster feedback skills. Results: Twelve experienced nurse preceptors from a 64-bed medical-surgical-telemetry unit participated in the project. The preceptors’ perception of their knowledge before the simulation was rated as good (3.33 =/- 1.15) and very good post-simulation (4.5 +/- 0.52) on a 5-point Likert scale. Using a specially designed feedback assessment form two Nursing Professional Development Specialists observed and scored the preceptors’ feedback behavioral skills during the pre and post-simulation. A paired t-tests and repeated-measures ANOVA statistical method was used to measure the trend in preceptor scoring. All preceptor scores showed statistical significance (p <= 0.5) in all categories post simulation (establishing an engaging learning environment, maintains an engaging learning environment, structure the feedback conversation in an organized way, provokes an engaging discussion, identifies and explores performance gaps, and helps the learner achieve good future performance). Conclusions: The results of this project can be used to inform educational activities to support preceptor development in feedback skills. Simulated educational activities is a useful teaching strategy that can improve nurse preceptor feedback skills in the clinical setting during preceptorship with the new nurse entering practice.