• 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.
    • Simulation to Improve Confidence and Competence of the Neonatal Nurse Practitioner

      Williams, Julie E.; McComiskey, Carmel A. (2019-05)
      Background: Neonatal nurse practitioners must maintain competence in low-volume, high-risk procedures to provide timely, high-quality, and safe care. In institutions with multiple providers e.g. fellows, residents, and neonatal nurse practitioners, the number of procedures available per provider may be very low. Simulation education provides an opportunity to practice procedures without compromising the care of patients or competition. Local Problem: The project institution is an academic center with a high level of procedural competition due to the presence of physicians, physician trainees, and nurse practitioners. The purpose of this quality improvement project was to implement and evaluate the impact of a needle thoracentesis simulation on the confidence and competence of neonatal nurse practitioners. Interventions: A simulation was implemented for 15 full-time neonatal nurse practitioners in the Neonatal Intensive Care Unit. A pre-simulation survey to assess each neonatal nurse practitioner’s perception of procedural confidence and competence was conducted. Subsequently, each neonatal nurse practitioner received PowerPoint slides with an embedded video on the correct performance of a needle thoracentesis. Following the pre-survey and PowerPoint slides, each neonatal nurse practitioner participated in the needle thoracentesis simulation. Utilizing a procedural checklist adapted from the National Association of Neonatal Nurse Practitioner Competency and Orientation Toolkit for Neonatal Nurse Practitioners, the nurse practitioners needle chest thoracentesis skills were assessed. After completing the simulation, the nurse practitioners received an identical post-simulation survey to re-evaluate their perception of their procedural confidence and competence. Results: Neonatal nurse practitioners reported an increase in confidence in their 1) ability to determine when a needle thoracentesis was necessary versus allowing spontaneous resolution (p<0.01); 2) and in their ability to perform an emergency needle thoracentesis competently without or with minimal procedural guidance (p=0.04). They also reported an increase in confidence in their ability to troubleshoot unexpected problems that might occur during the procedure (p<0.01) and an increase in confidence in their ability to incorporate patient safety measures in the event of an emergency thoracentesis (p=0.03). Conclusions: This quality improvement project provided support for the use of simulation to increase the confidence and competence of the neonatal nurse practitioner in performing a chest needle thoracentesis and to assist neonatal nurse practitioners in maintaining competency in low volume high risk procedures.