Monday, November 5, 2007

This presentation is part of : Innovations in Clinical Excellence Evidence-Based Practice Contest Winners II
Preceptor as Connoisseur and Catalyst: An evidence based standard for Nurse Preceptors
Deborah A. Raines, PhD, RN, Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
Learning Objective #1: describe the process to develop an evidence-based community standard for preparation of nurse preceptors.
Learning Objective #2: discuss the challenges and triumphs of designing and evidence-based program to meet the needs of health-care facilities through the county.

            Preceptor is a widely used term in nursing.  In the practice environment preceptors work with students to demonstrate nursing care and with new employees to ensure adequate orientation.  The activities of the preceptor are critical to future generations of nurses. Definition of the preceptor’s role and responsibility and the preparation, expectation and recognition of these nurses varies from setting to setting.  Preparation of preceptors for their role is challenging to healthcare facilities, due to limited time, educational and staffing resources. Preceptors are a precious link to the success of today's healthcare institutions.  The nurse preceptor is a vital contributor in the recruitment and retention of new nurses and in the provision of quality care and optimal patient outcomes.  Preceptors must be nurtured through quality programs and standards to prepare and sustain them in this vital role.
            This project’s purpose was to develop and implement an evidence-based community standard for the preparation of preceptors across health care facilities in Palm Beach County.  A systematic review and evaluation of the literature guided the creation of an interactive educational workshop and a series of quarterly “E-TIPS” (e-TIPS: e-Teaching in Practice Strategies).  The goal was to enhance the preparation of preceptors thereby enhancing nurse retention and patient care outcomes and well-being.

            A search in CINAHL (limited to English language publications), using the key words preceptor and precepting, identified 433 articles published since 1964. Approximately half (n=213) of those articles have been published since 2000, reinforcing the interest in and important of the term to the discipline of nursing in today’s chaotic healthcare environment..  Limiting the search to data-based articles revealed 159 research publications including 26 doctoral dissertations.  To focus on recent findings, the search was narrowed to articles from the years 2000 to 2006 and identified a total of 84 data-based publications, including six doctoral dissertations. The doctoral dissertations were eliminated from this review.   The 76 scientific articles based on empiric studies were retrieved and used to construct an evidence table using the U.S. Preventative Services Task Force system to stratify the quality of the evidence.   The majority of the identified publications yielded level III evidence or descriptive studies and a few level II studies were identified.  Most of the level II studies were either longitudinal investigations (level II-3) or cohort studies (level II-2). As each paper was read it was evaluated as to the quality of the research and to identify the contribution of knowledge for nursing practice and education.

            The need for an educational standard for preceptors originated from healthcare leaders in the community.  A synthesis of the practice implications of the reviewed literature was presented to the nurse executives representing health care organization throughout the county.  In collaboration with the Nursing Work Force Initiative of the Palm Healthcare Foundation,  an interactive workshop titled:  Preceptor as Connoisseur and Catalyst was developed based on the knowledge extracted  from the evidence based literature. The title was created to represent the important work of the preceptor as one who “knows nursing” and “stimulates action”.  An interactive format was adopted to facilitate and support the nurse in reflecting and thinking about their precepting behaviors and professional development.  Using the knowledge from the literature, the importance of continuous learning and nurturing of the individual preceptor culminated in the creation of an on-line network with quarterly sharing of strategies for preceptors via the “e-TIPS”. This on-line network is used to disseminate learning resources as well as to facilitate an evolving e-community of preceptors.

            A multimodal method of evaluation is being used.  Following the interactive workshop, participants complete a paper and pencil evaluation of the content, process and facilitator.  The second phase is a behavioral evaluation completed within the healthcare organization, and consists of three parts: a self evaluation of performance as a preceptor, an evaluation of the preceptor by a preceptee and an evaluation of the preceptor by a nurse educator/manager within the facility.  These evaluation use competencies developed from the evidence based literature.  A short online survey accompanies each “e-TIPS” to provide the preceptor an opportunity to give feedback and it identify content for future “e-TIPS”
            The on-going mode of evaluation is a two armed research project.  The first research study, Celebrating the Nurse Preceptor, is a cross-sectional study to develop an understanding and appreciation of the motivations, activities and behaviors of the nurse preceptor. This study uses a structure approach of story as a scholarly endeavor.  The findings of this study will provide validity to the application of the evidence based knowledge in the practice setting and an appreciation of the lived experience of the nurse preceptor.  The second study is a longitudinal study to quantify the outcomes of the program through measurement of the preceptors' activities over time.  The specific foci of this study are to explore:  (1) Role enhancement of the nurse as preceptor, (2) Retention of workshop participants by their employers, (3) Job satisfaction of workshop participants, (4) Activities of the nurse preceptor following participation in the Preceptor of Excellence Program.  Data are being collected via a web-based survey on a quarterly basis for 24 months following completion of the interactive workshop.  The use of the on-line network facilitates continuous contact with participants..

            Attendance at the interactive workshop has been high and has the support of the nursing leadership in the community. A number of organizations have also chosen to adopt this program for preceptor education and development in place of an organizational specific program. The program evaluation of the interactive workshop sessions are overwhelming positive and a large proportion of participants complete the on-unit evaluations within a 3 months period.  The research examining the stories of nurse preceptors is revealing rich data about the motivations and behaviors of the nurse preceptor in action.  The longitudinal study has a high participation rate and is yielding a large amount of data.  After completion of the February 2007 data collection point, analysis of this data will begin and preliminary finding will be available.