Nursing Preceptors - Literature review Example

Preceptor is a practice which is quickly becoming more common and frequent. Nurses who are experienced and have seniority in the field are the preceptors, and they help new nurses or student nurses by guiding them, sharing their experience and knowledge and integrating them in the new position and place. The exact definition of a preceptor is a person, who is generally a nurse from the staff, that "teaches, counsels, inspires, serves as a role model, and supports the growth and development of an individual (the novice) for a fixed and limited amount of time with the specific purpose of socializing the novice into the new role" (Morrow, 1984, as cited in OMalley, Cunlitte & Breeze, 2000. This definition describes the many roles or functions the preceptor fills, and illustrates how difficult and complex it is to be a preceptor. Furthermore, being a preceptor is especially important since it affects the quality of care given by preceptees (the new nurses or student nurses which are taught and guided by the preceptors) to patients. As highlighted in the analysis of the available literature on the subject, preceptorship is an "essential part of the socialization and professional development of nurses with a new registerable qualification" (OMalley, Cunlitte & Breeze, 2000. It was also found by Davis (2003) that the professional development of nurses, which is incorporated in the preceptorship program, is linked to high quality service provision (as cited in Davidson, Glasper & Donaldson, 2005). Hence, it is obvious that the preceptorship improves the quality of care being given to patients. A preceptor has many responsibilities, which can be divided into two groups- fundamental responsibilities and procedural responsibilities. The ones of the former group are: commitment to the role of the preceptor and desire to teach and share expertise with co-workers. The responsibilities of the latter group, the procedural responsibilities, include: orientation and socialization or the preceptees to the unit, assessment of the developing objectives of the preceptees, being a role model, observing and evaluating the preceptees, giving constructive criticism and supporting, facilitating preceptees development, supervising patient care provided by the preceptees to ensure it is safe and competent nursing, documenting a summary of the preceptees performance and maintaining strict confidentiality of all preceptee-related information (OMalley, Cunlitte & Breeze, 2000, Smith, 2006). The complexity and multiplicity of the preceptors responsibilities were recognized by Cerinus and Ferguson (1994), and were compared by Shamian and Inhaber (1985) to the process of nursing: the preceptor needs to assess the preceptees, plan the preceptorship, implement the teaching and role modeling, and evaluate preceptees evaluations (as cited inOMalley, Cunlitte & Breeze, 2000. The entire process of the preceptorship is long and demands much thought and planning. All of the above show what an important part the preceptor has, and how much the preceptorship is important. Accordingly and expectedly, there are various qualifications and skills needed in order for a nurse to be a preceptor. The preceptor needs to be a competent and confident person with experience and expertise in the clinical field hes teaching; he has to have critical thinking and problem-solving skills, as well as an ability of decision-making, qualities which were described by Shamian and Inhaber (1985) as essential for a preceptor (as cited inOMalley, Cunlitte & Breeze, 2000; the preceptor also has to be interested in personal growth and in the process of teaching and learning; he needs to be someone who doesnt have a judgmental attitude; he needs to be able to adapt to individual teaching needs; other characteristics a preceptor needs, the willingness and desire to teach and the flexibility to provide an individualized experience of learning, are ones Hill and Lowenstein (1992) focused on as imperative to being a preceptor (as cited inOMalley, Cunlitte & Breeze, 2000; finally, a preceptor needs to be assertive. Be that as it may, no matter how qualified and potent the preceptor is, he needs the support of the organization in order to carry out a successful preceptorship program. Generally speaking, there needs to be collaboration between managers of hospitals (or other health care facilities), preceptors, doctors, preceptees and even patients in order to achieve the maximum results possible, something which will benefit all concerned. Still, for a preceptorship program to succeed and achieve its goals, several things are required, in addition to collaboration between all factors involved. First and foremost, the planners of the preceptorship program should stick to certain guidelines which will be established after careful consideration of all aspects of the matter. Among these guidelines are the following: identifying aims and measurable objectives, identifying training requirements, establishing available support and resources, organizing practice updates (likes resuscitation lectures, fire lectures, etc.), introducing policies and procedures, discussing about the professional development and introducing the clinical supervision. These guidelines will help ensure the programs effectiveness. Second, it is advisable that the atmosphere in the medical facility be good and positive, since it is bound to the preceptees mood and content. If preceptees feel more at ease and happier, their progress and development of learning and internalizing the things they are being taught is bound to be much better. Along with a positive atmosphere, it is recommended that preceptors be supportive and welcoming towards preceptees. The term "critical companionship" was used by Titchen (2003) to describe the relationship between preceptors and preceptees. This is because the period of transition from student nurse to a registered practitioner is the most arduous of all; therefore a companion who is experienced and knowledgeable would be of great assistance to preceptees. Furthermore, in a study examining 18 newly registered nurses, Charnley (1999) found that almost all of them were stressed of the change in status they are going through, and most of them expressed a need for support to help them with the transition (as cited in "staff nurse development…"). This proves that the relationship between preceptors and preceptees is needed and can be very positive. In spite of this, the relationship can take a turn for the worse if it is enforced, as Howatson-Jones found out in 2003 (as cited in "staff nurse development…"). If the requirements above are being met, the preceptorship program is supposed to succeed and good results should be seen both in the success rates and in the positive influence on the performance of nurses. In the Royal Aberdeen Childrens Hospital in the UK, a preceptorship program was initiated and implemented in 1998. It included 113 nurses, only 9 of which failed to complete the program. This is an example which bodes well in terms of success rates, since more than 90% completed the program successfully. As for the positive influence to nurses performance, there is existent research that proves that it occurs when the nurses are trained by preceptors. One example of this is that of a medical center called the CJW Medical Center, in which a preceptorship program was created and implemented, alongside changes in the location and arrangement of wards. Qualitative and quantitative data revealed success of the units in many levels. A survey conducted in 2004 demonstrated a high level of satisfaction and engagement of the staff. The survey also compared the achievements and performance of the medical centers with other hospital and health care facilities, and revealed that the scores of the CJW medical center were consistently high in almost every item. The only item with a relatively low score was one which wasnt connected to nurse performance, but to equipment supplies. These remarkable scores achieved by the CJW medical center are quite extraordinary, especially given the fact that the units were new and just began their activity, while trying to adapt to the transition in location and procedures (Torres, 2006). This really enhances the claim that preceptorship has a positive effect on inexperienced nurses. Its been established that both novice nurses and patients benefit from programs of preceptorship, but the preceptors themselves also benefit from it. Among the "rewards" preceptors receive are: having the satisfaction of making a positive impact on new nurses, adding the experience in the education of other nurses to the résumé and work record, growing and developing the career, sharpening clinical skills while teaching and supervising others, and being able to climb up the clinical ladder, something which will increase the salary and status of the preceptor. It also contributes the experienced nurses who are constantly looking for opportunities to grow, evolve and learn new things within their position. Additionally, nurses who took on the role of preceptor in another preceptorship program in the US stated that they were "overwhelmingly positive about the experience"(Torres, 2006). So actually, preceptorship is extremely beneficial for preceptors as it helps them gain more experience, feel gratification by helping others, improving the skills and also possibly gaining a better status and maybe even a raise. Therefore, it is safe to say that being a preceptor is very rewarding. There is, however, one more side that tremendously benefits from preceptorship programs- the managers of the medical facilities. Preceptorship programs solve two big problems for them- staffing the medical facility with good and competent nurses, and retention of nurses for a long time. New nurses or student nurses lack practical knowledge gained by experience, though having gained the traditional and theoretical knowledge. Preceptorship equips them with more knowledge, making them more competent and better at the job. It also helps to evaluate individuals talent and qualifications, and assess his potential for being a good employee. Moreover, preceptorships help retain nurses in the institution on a permanent basis. It does so by introducing them to the institution or facility, familiarizing it to them, and teaching them well while also supporting them. This creates a positive image of the place and makes it seem as a good and welcoming place to work at. It makes basically attracts the nurses to stay there past their preceptorship program and remain there. This is especially important since there are shortages in staff lately in different places, and efficient new nurses are very much needed. A preceptorship workshop was offered in the CJW medical center in December 2003 and June 2004, and equipped the preceptor with strategies and tools to orient new employees successfully. The result was that by May 2004, the units in the medical center were 89% staffed, and later on they were 100% staffed with no open positions available at all! Also, the use of agencies to help find nurses was less than 1%, and this means that the program was also useful in directing the new nurses or student nurses straight from school to the job (Torres, 2006). Furthermore, it was found that about half of the nurses who undergo preceptorship opt to stay in the company and work there (Smith et al., 2006). As for the ones that arent interested to stay, managers are coming up with incentives and strategies to convince new nurses to stay. These contain programs giving preference in hiring to those who underwent a preceptorship within the institution, encouraging nurses to stay in their current field of expertise, better orienting and socializing them into the workplace and more (Smith et al., 2006). Either way, managers benefit from having more nurses also because when there are more nurses, they perform better and have less work for each one (Torres, 2006). Despite the many benefits and contributions achieved by preceptorship to all involved, some still criticize it by saying that it fails sometimes, and also places a heavy burden on preceptors, who have to do their nurse work as well as precepting the new nurses. It is in fact true that the burden of preceptors has increased, as revealed by Edmund, 2001, Pulsford et al., 2002, Northcott, 2000 (as cited in Davidson, Glasper & Donaldson, 2005). However, no existing research claims that it decreases the performance of the preceptors. In conclusion, preceptorship encompasses the training, guiding, teaching, reviewing, supporting and assessing the preceptees as they arrive while also being student nurses or just having finished learning nursing. It evolves them in many ways by granting them knowledge they hadnt received in their education up until then, as well as offering advice and support given by an experienced nurse. Not only do preceptorship programs help preceptees, but they are also very rewarding for preceptors and conducive for patients, who get better care, and to managers, who train the nurses and improve their skills, and also retain them longer in the company or institution. As shortages in qualified and competent staff increase, so will the preceptorship practice grow further and further. Its current scope is quickly growing, and this is a positive sign, considering the fact that it positively affects everyone involved. Though there is some criticism about preceptorship, there is no proof that it is detrimental to the performance of preceptors or that it can damage anything else. Given all this, it is safe to say that any new preceptorship programs, and the increase in them, are welcome and positive things, which will improve and enrich everyones lives. References Davidson, Julie, Glasper, Edward & Donaldson, Pauline (2005).Staff nurse development program: evaluation. Pediatric Nursing, Vol. 17 (Issue 8). p. 30-33. OMalley C, Cunlitte S & Breeze J (2000).Preceptorship in practice. Nursing standard, Vol. 14. Retrieved January 24, 2007 from http://www.nursing-standard.co.uk/archives/ns/vol14-28/pdfs/p45-49_w28_s1.pdf Smith, Linda S. (2006). The joys and responsibilities of preceptors. Nursing, Vol. 36. p.9-10. Smith, D., Rizzo, D., Carter, N., Miller, K., Dubry, K., Hitchcock, J., et al. (2006). Nurses "gamble" on nurses to provide staffing solutions. Nursing Management, Vol. 37 (Issue 5). p. 10-12. Torres, Beth (2006). A blueprint for success. Nursing Management, Vol. 36 (Issue 5). p. 45-49. Read More