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To maximize clinical learning and onboarding experiences, APRN preceptors must demonstrate skills in learner assessment and evaluation, interprofessional communication, effective role modeling, and appropriate socialization of individuals to specified roles, practice settings, and organizational culture. In addition to an orientee or students' educational needs, curricular and onboarding requirements and outcomes, preceptors must also balance the rigors and perpetual demands of clinical practice, including productivity, in a face-paced, quality- oriented industry.
Just as preceptors make investments in the professional acclimation and growth of peers, they also need to invest in their own professional development. Consequently, a program was needed that would provide structured training and support to new and experienced APRN preceptors, as well as promote the recruitment, individualized development, continued skillset enhancement, recognition, and retention of quality preceptors.
Based on a needs assessment and gap analysis of advanced practice providers conducted in early 2015, an academic medical center developed and implemented an innovative, structured advanced practice preceptor program. The objective of the program's design was to effectively transition and successfully assimilate students, novice and established clinicians into a diverse, complex healthcare system. The targeted curriculum coaches preceptors to elicit critical thinking, demonstrate effectual communication, facilitate interprofessional team building, apply conflict management skills, model professionalism, and evaluate clinical and social competence.
Launched in late 2015, the program utilizes a three tiered, multi-modal approach to learning and has several participating cohorts of advanced practice providers. An initial intervention is administration of an assessment tool with an evidence-based, nursing process focus. This sixteen question online self-assessment enables participants to reflect and evaluate their current precepting skills and practice using a 4 point Likert scale (1= never, 2 = sometimes, 3 = most of the time, 4 = always). The self-assessment is then repeated at 3, 6, and 12 months post educational interventions and organized according to a modified Benner’s novice to expert theory.
Initial self-assessment of two cohorts (n=34) revealed the majority of practitioners were <90% on “most of the time” or always” completing that portion of the precepting process. Following this self-assessment were two distinct and separate educational interventions. The first is a web-based series of interactive on-line modules called “E-Tips for Practice Education” designed to develop the precepting skills and confidence of healthcare practitioners. E-Tips was developed by an interdisciplinary team of professionals and sponsored by the British Columbia Academic Health Council and permission to use was obtained by the creators of the current APRN preceptor program. The second educational intervention is a series of two group training sessions consisting of discussion and interactive learner activities to support the online learning content. Participants were required to complete four online modules prior to the first 1 hour group session (focusing on assessment and planning) and the remaining four modules prior to the second group 1 hour session (focusing on implementation and evaluation). Both group sessions were developed and facilitated by two Nursing Professional Development Specialists in collaboration with department leadership and educators.
The resulting program accomplishes its objective by yielding fully functioning core team members with preceptors who optimize students' educational experiences and transition and onboard professionals, while serving as a compelling recruitment and retention strategy. Group discussion has stimulated ideas and plans for developing and improving current orientation processes, student coordination, and teamwork. Data extraction from the first two cohorts shows that there was a statistically significant improvement in the assessment and evaluation portions of precepting. Qualitative feedback included comments such as “student shared goals and both of us had a great learning experience” and “I asked the preceptee about her learning style at the beginning of the day and she made note of it in her eval of me that I was the first person to do that!”
The grid below demonstrates participants’ baseline and 3 month self- assessment of individual precepting practices related to key components: learner assessment, planning, implementation and evaluation. Initial self-assessment was completed by 34 individuals, 3 month self-assessment by 26 with notation of a 33% attrition rate. Data for later trained APRN cohorts has not yet been included due to timeframe of training and data extraction.
|
Assessment |
Planning |
Implementation |
Evaluation |
||||
% answered “most of the time” or “always” |
Initial (n=34) |
3 mo (n=26) |
Initial (n=34) |
3 mo (n=26) |
Initial (n=34) |
3 mo (n=26) |
Initial (n=34) |
3 mo (n=26) |
Novice (<1 yrs) |
81% |
100% |
69% |
100% |
94% |
100% |
87% |
100% |
Advanced Beginner (1-3 yrs) |
83% |
96% |
80% |
92% |
75% |
83% |
75% |
92% |
Competent (3-5 yrs) |
92% |
--- |
92% |
--- |
100% |
--- |
83% |
--- |
Proficient (5-10 yrs) |
67% |
67% |
79% |
88% |
75% |
79% |
67% |
71% |
Expert (>10yrs) |
64% |
92% |
82% |
90% |
97% |
95% |
64% |
92% |
By sharing clinical expertise and role modeling professionalism, skilled preceptors provide quality learning experiences, guide transitions to practice, support succession planning, and shape the further of the advanced practice workforce. Using an innovative, e-learning format paired with interactive sessions for integration and application of key concepts and principles of precepting, an academic medical center developed and implemented a preceptor development program focused upon advanced practice. The objective of the program's design was to effectively transition and successfully assimilate students, novice and experienced clinicians into a diverse, complex healthcare system. Mindful of the art and science of precepting, program components prepared novice preceptors and promoted the ongoing development of experienced preceptors. The targeted curriculum coaches preceptors to assess learner needs; plan, implement and evaluate learning effectiveness; elicit critical thinking; demonstrate effectual communication; facilitate interprofessional team building; apply conflict management skills; model professionalism; and evaluate clinical and social competence. The resulting program yields preceptors who optimize the educational experiences, transition and onboard advanced practice students & professionals, and support recruitment and retention initiatives.