Chris Rust, MSN, RNC-OB, C-EFM Preceptor Workshop Chris Rust, MSN, RNC-OB, C-EFM

The Complex Work Environment Nurses are faced with a chaotic work environment filled with: - Advanced medical technology - Constantly changing procedures and new medications - Computerized charting - Highly complex nursing skills - High patient acuity - Scarce resources - Limited staffing - Increased patient and family partnership in the plan of care (Giallonardo, Wong & Iwasiw, 2010, p.993)

Retention of Nurses How does a new nurse survive in this environment? New graduate nurse turnover rate is between 35-65% within the first year of employment. The transition from student to practicing nurse is widely recognized as a difficult “right of passage” in which new nurses undergo a process of socialization to their working environment. Retention of new graduate nurses and experienced nurses is essential to providing quality patient care. How do we get new graduate nurses and experienced nurses to stay? (Giallonardo, Wong & Iwasiw, 2010, p.993-4)

Provide a Nursing Preceptorship A one-on-one pairing of a practitioner with a less experienced learner who is striving to achieve a set of mutually defined learning objectives. A nurse preceptor provides individualized supervision, support, and teaching to a new graduate or a nurse who is new to the specific care area. For a new graduate, a nursing preceptorship bridges the gap between learned nursing education (theory) and practice in the real world of patient care (clinical application of theory and knowledge). (Giallonardo, Wong & Iwasiw, 2010, p.993)

Preceptorships and Retention Numerous research studies have identified that preceptorships improve retention of new graduate nurses. Work engagement, job satisfaction, and feeling valued as a member of the healthcare team are essential influencing factors on job retention. New graduate nurses identify with the positive professional attitudes and behaviors demonstrated by their preceptors and incorporate this into their practice. “Eating your young” is no longer acceptable.

Preceptor Competencies Preceptors: - Provide an open and positive relationship with their preceptee - Are positive role models even during adverse, critical, or frustrating situations - Demonstrate leadership skills in priority setting and making sound decisions - Demonstrate the use of critical thinking skills

Preceptor Competencies Preceptors: - Have at least one year of nursing experience on the unit in which they are going to be a preceptor - Comfortable as a teacher - Knows where to get things/ Knows who to call to get questions answered - Good sense of humor - Flexible with assignments, willing to negotiate and compromise

Preceptor Competencies Assist preceptees in developing a positive, trusting relationship with their unit and the entire organization. Assist preceptees in learning the culture of their unit and the culture of the entire organization. Introduce orientee to other staff members and physicians. As long as patient safety is not compromised allow orientee to make and learn from their own mistakes.

Preceptor Competencies Active listener. Observes for orientee’s non-verbal behaviors Assesses degree of orientee’s anxiety and channels anxiety to maximize learning. Practices therapeutic and effective communication skills. Demonstrates appropriate non-verbal behaviors. Identify how the orientee likes to learn. Validate orientee’s concerns. Resolve conflict in a positive manner.

Preceptor Responsibilities Describe the routine of the unit – how it really is!!! Explain the “nurse talk” or unit specific “lingo”. Assist orientee in accessing policies and procedures in Mosby’s and St. Elizabeth Policies and Procedures. Demonstrate how to access and print forms in EPIC and Medex. Assist with navigating NetLearning, Intranet (emails), Success Factors. Discusses chain-of-command and delegation duties. Demonstrates proper use of supplies and equipment

Preceptor Responsibilities Provide immediate constructive feedback. Orientation paperwork should document areas of progress and areas that need improvement. Report any performance issues to the Nurse Manager right away. Complete orientation paperwork in a timely manner. If the orientee and you do not work well together let your nurse manager know right away. - Some personalities do not match. - Orientee’s learning style may not match your teaching style.

Benefits to Being a Preceptor Fresh insight that comes from seeing your profession through the eyes of the orientee. Provides an opportunity for personal & professional growth. Review of skills and knowledge base. Increased awareness of self as role model. Demonstrates leadership and teaching skills. Satisfaction from sharing knowledge and expertise. Satisfaction from observing the orientee grow.

Disadvantages of Being a Preceptor Indirectly /directly responsible for orientee’s mistakes. When the orientee is not progressing appropriately this may cause preceptor to look bad, feel guilty, increase stress and conflict. Increased workload Time Consuming Stress Loss of patient contact Difficult to tell someone that they are not working out

Learning Experience Assessment Each week take time to review with the orientee: - What went well - What was learned - What could be improved upon - What goals will be set for the next week If orientee has several preceptors determine a way so that the preceptors can communicate with one another about accomplishments and goals for each week.

Patricia Benner – From Novice to Expert Five Levels of Nurses - Novice Nurse - Advanced Beginner - Competent Nurse - Proficient Nurse - Expert Nurse

From Novice to Expert New graduate nurses transition from novice nurses to advanced beginners. Novice Nurses - Needs assistance to gain necessary experience for developing skills. - Unable to concentrate on the “big picture” until they feel comfortable with skills that are required. - Unable to distinguish which tasks are more important - everything is an emergency. - Easily overwhelmed by what they don’t know.

Working With the Novice Nurse Begin by teaching simple rules that apply to all patients. The novice’s focus is on rule-based activities and the application of theoretical knowledge. (O’Connor, 2006, p. 58) Help Orientee begin distinguishing clinical parameters that are relevant to the whole population.

Working With the Novice Nurse Help them apply “clinical forethought” – If the patient has x, y, or z complaints, the patient is likely to need a, b, or c treatment (O’Connor, 2006, p.58) Experienced RNs’ who float from another area may respond like a novice nurse if unfamiliar with the patient population.

Working With the Advanced Beginner Focus on tasks to be completed and routines to be followed for particular patient populations. Help them establish priorities. Limited connection to patient needs. Still heavy reliance on knowledge of theory as a guide to practice. Encourage them to become active on unit committes.