Preceptor Information

The role of preceptor requires an investment of time, energy and effort to support a new member of staff in the workplace. This may be a new graduate nurse, a nurse returning to work after a prolonged period of absence or an experienced nurse who is in a new working environment. This handbook is intended to help preceptors fulfil their responsibilities, act as an aide memoir to previous learning and offer templates for recording preceptoring activities. Whilst preceptoring occurs for various reasons as stated previously this guidance and supporting documentation will be of particular relevance to preceptors who are preceptoring newly graduated registered nurses.

Preceptoring programmes have been found to benefit preceptees, preceptors and health care institutions. For preceptees it provides an opportunity to practice in a safe and supported environment and to be socialised into the new team. It provides an environment for successful entry into the nursing profession by facilitating the development of decision making and clinical practice skills. Preceptors benefit by seeing the novice become more confident, their own self esteem becomes more evident as they have increased awareness of the role model they portray. For the organisation preceptorship has been proven to reduce staff turnover, result in fewer resignations, increased staff satisfaction, enhanced knowledge and improve the quality of patient care.

What is a Preceptor?
Preceptor? Mentor? Teacher? Buddy? What's the difference?
Roles & Responsibilities
Establish a routine for giving feedback
Guide your preceptee during clinical practice
Teach and demonstrate practical skills
Increase the workload for your preceptee gradually
Give timely feedback
Act as a role model
Plan learning experiences
Complete Related Documentation
Adult Learning & Teaching Principles

What is a Preceptor?

The terms mentor, preceptor, buddy, coach and teacher are often used to describe a similar role. In essence all are designed to offer a support mechanism; however, there are subtle differences that will be highlighted shortly. There are numerous definitions of the word preceptor and the context of the role will have a bearing on the definition adopted. For the purpose of this handbook the definition of preceptorship is:

“A formal one to one relationship of a pre-determined length between an experienced nurse and a nurse new to that environment. The goal is to assist the new nurse to successfully adjust to, and perform, a new role.”

Preceptor? Mentor? Teacher? Buddy? What's the difference?

Roles & Responsibilities

The Role

Wearing the preceptor hat is not for the faint hearted! The role is demanding and intense but should provide increased job satisfaction and personal growth and development. As a preceptor you will need to be a:

• Facilitator

• Coach

• Cheerleader

• Socialiser

• Evaluator

• Record keeper

• Advocate

• Role model

These role types are not new to you, as a nurse, but you may need to think about applying them in a different way. For example your usual daily focus would have been on applying these concepts with a patient perspective. This will not change but you will need to apply them to your new member of staff as well as to your patients.

There will be times when your workload takes priority or when staffing situations make preceptoring more difficult. Anxiety can be minimised for both the preceptee and the preceptor if the situation is explained and solutions offered as to how it will be managed. Working in a team or as a pair is a great way of learning and of sharing the workload! Be creative.

Responsibilties

The role has many responsibilities the top 11 are listed here:

Orientation of your preceptee to the ward/unit/department.

You should include the layout of the department as well as specific policies and procedures and where these can be found.

A few points to remember when orienting your preceptee:

• Put your self in his or her shoes

• Acknowledge his or her presence

• Talk about what is happening today

• Introduce your preceptee to staff and patients

• Give clear instructions

• Never abandon your preceptee

• Help your preceptee to develop critical thinking skills

• Explain the chain of command to your preceptee

• Be positive

• Practice what you preach!

• Facilitate learning experiences.

A skill such as giving an injection has a series of steps and understanding. It is not enough just to enable the preceptee to do the injection. The preceptee will need encouragement to go through the various stages culminating in the actual administration of the drug.

You need to create an atmosphere where the preceptee comes to work with a positive attitude largely due to your behaviours, skills and attitudes. This can be time consuming, sometimes oppressive, and takes tremendous energy.

Establish a routine for giving feedback.

A requirement for preceptors who are working with participants on the graduate nurse programme is for rostered development time. This has been scheduled by the Graduate Nurse Programme Coordinator (appendix 3a, 3b) and all such meetings must be recorded.

The preceptor and preceptee should share a workload for the first six weeks of the preceptee's placement. However it is also important that informal daily feedback is given, especially in the first few weeks. This may take the form of a discussion reviewing the shift, or perhaps practicing a particular skill on a mannequin. Establishing this type of regular dialogue gives an opportunity both to praise and reinforce positive practice and moderate behaviours that the preceptee needs to change.

If you are absent from work for any reason or you are not rostered the same shifts as your preceptee ensure that you give them another member of staff who will buddy them.

Guide your preceptee during clinical practice.

You will need to demonstrate nursing skills and practice, provide opportunities where the skills can be practiced under supervision and validate competency once the skills has been accomplished to the agreed level. Remember when ascertaining competency your main concern is that the practice is safe.

Try not to intervene if the practitioner is just slow. Practice makes perfect! In the case of recently graduated nurses the level to which you should be assessing is governed by the Nursing Council of New Zealand (NCNZ) and can be accessed via their website: www.nursingcouncil.org.nz/competencies. Once a skill has been performed competently remember to record this using the relevant documentation.

Teach and demonstrate practical skills.

Nursing is a very practical profession and therefore you need to teach in a variety of ways. People learn in different ways � some prefer to learn by reading, others by observing another person and others by actually doing the task. Think about how you prefer to learn and try to ascertain the same of your preceptee.

Increase the workload for your preceptee gradually.

Graduate nurses have never had their own caseload before. A requirement of the graduate nurse programme is that you and your preceptee share a clinical workload for a minimum of 6 weeks. Even after this, good practice would suggest that working with another person is better than working alone.

Working as a team can also be beneficial for the patient. Gradually increase the preceptee's workload as their skills increase. You will need to teach them how to prioritise patient care, how to manage their time effectively and how to communicate with other team members.

Give timely feedback.

The focus on regular communication � daily if possible �cannot be over emphasised. Remember that it should reinforce positive behaviour as well as counter inappropriate behaviour. When giving feedback choose the place carefully � in private.

Whilst poor practice needs addressing try not to destroy your preceptee's self esteem, criticism must be specific and constructive. Don't forget the acronym �B.E.E.R�.

Act as a role model

A few points to remember:

• Ensure you are neat and tidy and adhere to uniform policy

• Have a good attendance record � make arrangements if you will not be at work or not rostered with your preceptee.

• Arrive at work on time and be prepared to take the report.

• Follow TDH policies & procedures.

• Express positive comments in the work place and at meetings.

• Have good manners and act in a courteous way.

• Wear your wings and halo at all times!

Work closely with your Charge Nurse Manager (or equivalent) and the coordinator of the graduate nurse programme. They are there to help and support you.

Plan learning experiences

There are some things that the preceptee needs to learn within the first week of employment such as what to do in an emergency, shift times, various telephone numbers, where certain equipment is kept etc. Other learning needs require different time frames. As a preceptor you should plan and agree learning needs with your preceptee and review these regularly.

You may need to consider the preceptee going to other wards or departments to offer a greater range of practice opportunities. Think of those skills needed for the particular unit. If the skill is practised infrequently but the risk is high to patients if not carried out properly it may be necessary to provide an assimilated experience � e.g cardiac arrest.

Complete Related Documentation

This is vitally important both as evidence of your professional development and when evidence is required to support audit requirements.

N.B:If you are preceptoring a graduate nurse on the Nurse Entry to Practice Programme (NETP) you are required to complete 16 hours of professional development during the programme. This activity is to help you in your role as a preceptor and can be a combination of work relevant study days, conference, preceptor / clinical updates, reflective practice activity or similar.

This information will be required by the coordinator of the NETP programme so please make sure you record the evidence. There is a form included in this handbook for the purpose of recording your professional development (Appendix 5.) Completion of this workbook will require reflective practice and goal setting - the time taken to do this will depend on you � if you ask your CNM or equivalent to verify your work it will contribute towards your professional development.

Also:

• Encourage completion of the ward / unit orientation booklet.

• Ensure appraisals are completed as per policy.

• Record development sessions and sign off.

• Discuss the preceptee / preceptor contract (appendix 4).

Remember these are only the first 11 responsibilities of a preceptor. Read through and discuss the responsibilities of the preceptor role description with your colleagues and ensure you have their support � you cannot do it alone, it requires a team effort.

Attributes of a Preceptor:

A preceptor has to be willing to undertake the role, have a passion for nursing and have many attributes to enable them to undertake the role.

Study the attributes listed above. Which attributes are you confident you possess? Which do you need to work on? How will you do this? Be honest with yourself � you might find it beneficial to do a self-assessment and then repeat the exercise with a colleague.

Be mindful of the attributes that you are less sure of and make an effort to develop them into your behaviours at work. Acknowledging your own strengths and weaknesses will assist in your personal development.

A few attributes to guard against:

Reality Shock

Reality shock occurs to new employees when the reality of the job becomes apparent and it is not what they were expecting. It can happen to both graduate nurses and experienced nurses and at worst the disillusionment can lead to resignation within the first six months. The disparity often occurs when ethical, moral, professional and/or cultural beliefs of the preceptee conflict with those of the nursing and health care professionals within the organisation. The preceptor must consider these contrasting beliefs and assist the preceptee to acclimatise into the new work place.

There are four phases which a new employee may experience and by being aware of these the preceptor can help the preceptee to settle and reduce the reality shock.

The Honeymoon Phase

This period occurs during the first few weeks when the new employee is excited about being in a new job; perhaps happy to be working and out of college; earning money; keen to learn new skills and make new friends. The picture is rosy and everything is going well until

The Shock Phase:

This may happen if any of the following happen:

• The preceptee encounters unprofessional attitudes or behaviours from co-workers.

• The preceptee discovers that equipment is not maintained properly, or that there are a lack of necessary supplies, or breakdown in chains of communication which results in suboptimal standards of care.

• Any other situation that causes anger, frustration or embarrassment can result in the preceptee experiencing the shock phase which if not explored can lead to disillusionment. One of the worst triggers for the shock phase is humiliation by a team member.

The Resolution Phase:

There is a very possible outcome which will result in the preceptee lowering their ideals and standards to accommodate the ethos or culture they are witnessing. To avoid this it is crucial to keep open communication between preceptor and preceptee and to encourage the best beliefs and values to be maintained.

The preceptor needs to gain the trust and respect of the preceptee. This means that if poor practice or malfunctioning equipment is highlighted by the preceptee the preceptor must do something to remedy it. Trust and respect can also be accrued by:

• Not gossiping about other staff

• Not allowing gossip about the preceptee to be perpetuated

• Always give feedback in private

• Giving simple instructions /directions

• Listening to the preceptee

• Do not ask the preceptee to do something that you would not do yourself

• Be the professional role model � uniform, time keeping, appearance, meal /tea breaks.

Adult Learning & Teaching Principles

Each of us has different learning styles and experiences. The 3 main ways of learning are listening, observing and doing. Some people can learn a skill very quickly whilst others will take longer. What is important is that the skill is learned.

Adults tend to learn better when they understand the why behind the activity and when the activity is relevant to their ability to practice at a competent standard. Adults also have a wealth of knowledge and experiences that have been gained in various working and personal contexts. Do not devalue their expertise but do encourage them to transfer their previous experiences into the new environment as far as possible.

You need to determine how your preceptee learns most effectively and gear your teaching to that method. Often nurses learn using a combination of all three styles so you will need to be prepared to offer different techniques.

Principles of Learning

1. We learn by doing. The preceptee must be allowed to undertake and complete a task, no matter how slowly.

2. We learn to do something by focusing on one task. The preceptor should focus on the preceptee learning one task at a time.

3. We need to be ready to learn. The skill or task needs to be relevant to patient care. This helps the preceptee understand why it is necessary to learn. The preceptor will need to assess when the time is right to teach a new skill and this will be dependant on factors such as how the preceptee is settling, how they are coping with the new values and beliefs of the work place, previous learning experiences and the overall environment in which learning will be conducted.

4. We need to be motivated to learn. The preceptor must provide encouragement each time a new skill is accomplished.

5. We need to practice skills. Performing a skill once will not result in competence. Remember that practice makes perfect.

6. Practising a skill must be safe but as real as possible. Role play, scenario learning and the use of mannequins are good substitutes for the real thing.

7. The learning atmosphere will impact hugely on performance and the relationship which develops between the preceptor and the preceptee. Occasionally it is necessary to allow the preceptee to make mistakes � the trick is to talk through the mistake without humiliating the learner.

8. Backgrounds and physical ability will vary. The preceptor will have different dexterity skills than the preceptee.

Assessing Competence

Competency is the ultimate goal of the preceptoring function. Competency will be measured by two indicators:

1. The preceptee has accomplished all the requirements of the unit's orientation programme

2. The preceptee identifies with levels 2 to 4 of NCNZ competencies for Registered Nurses (competent, proficient, expert).

Nurses participating in the Graduate Nurse Programme are expected to reach level 2 � competent �by the end of the programme. Assessment is determined by the submission of a portfolio which is assessed against the competency domains set by the Northern Districts Regional Professional Development and Recognition Programme. Qualified assessors undertake the assessment. However, TDH would not expect an employee to reach the stage of submission of the portfolio if the preceptor had identified practice or conduct deficits.

How do you Deal with Issues of Competency?

Documentation is important throughout the preceptorship contract. However when there are problems particular attention to documentation is important. Ensure you have records of all meetings, goal setting sessions, feedback, teaching / practice sessions. If formal performance management procedures are to be invoked this information will be crucial.

Points to consider:

• Ensure the preceptee understands what is being asked of them.

• Ensure your interpretation of competent is not exaggerated � is their practice safe?

• Have you offered constructive feedback and allowed time for the behaviour to change? Can you prove/show you have done this?

• Have you explained the consequences of the practice or conduct continuing?

• Have you evidence to support your assessment?

• Have you asked for a colleague to work with the preceptee?

• Have you discussed the issue with your Charge Nurse Manager?

• If the preceptee is a new graduate have you discussed the issue with the programme coordinator?

• Have you asked the preceptee if there is a reason for the problem continuing?

If you have carried out all the points above and the problem still persists you must engage help. This may be from your line manager or other senior staff who may well involve the human resource department.