Acknowledgement

PreceptorshipDenielle Beardmore, RN, Dip Project M’Ment, Ma Ed, Grad Dip Ed & T, Grad Dip Onco/Pall Care, BA Nursing, Dip App Sci (Nursing), Cert IV WATDirector Nursing Education and Practice DevelopmentBallarat Health Services

Acknowledgement This project was possible due to funding made available by Health Workforce Australia.

www.youtube.com/watch?v=fW8amMCVAJnoredirect=1

Come to the edge’, he said.They said, ‘We are afraid’.‘Come to the edge’, he said.They came.He pushed them…..And they flew!Giullaume Apollinaire

Objectives To provide an understanding of what preceptorship is To develop an awareness of what characteristics and qualities one needs to possess in order to be a successful preceptor To develop an understanding of the theory as it relates the principle foundations of adult learning To develop knowledge in support strategies

Identify methods of assessing performance and providing feedback How to create a positive learning environment

Flying Start Series • http://glm.e3learning.com.au/

Defining Preceptorship Preceptorship is not easily defined and is often interchanged in the literature with the words “mentoring”, “clinical coaching” ‘budding” or “clinical support” it is a word used to describe a means of transition. It involves a paring of one or more experienced clinician (preceptor) with a novice (preceptee). A novice could be an “undergraduate, new graduate or clinician in transition to a new facility or area of practice” (Wright, 2002) For the purpose of the Flying Start Series we consider preceptorship as: .................a period of transition for the undergraduate student or newly registered practitioner “during which time he or she will be supported by a preceptor, to develop their confidence as an autonomous professional, refine skills, values and behaviours and to continue on their journey of life-long learning” (NHS, Preceptorship Framework, 2009)

Defining Preceptorship It is about..................... “an individualised period of support under the guidance of an experienced clinical practitioner which attempts to ease transition into professional practice or socialisation into a new role” (NHS, Preceptorship Framework, 2009)

The preceptorship relationship is usually a “short-term professional relationship with a specific end date, it is often an assigned relationship with preceptors and preceptees seldom involved in the selection with whom they will be paired………….it tends to focus primarily on the development of clinical competencies and involves some sort of judgement or evaluation of the overall clinical performance” (Yonge, Billay, Myrick, Luhanga, 2007)

Preceptors are responsible for evaluating the advancement of learners, ensuring they progress to develop critical thinking skills and evolve into confident and capable nurses Preceptor is the title that is used to describe an expert nursing or medical clinician who is a role model to the learner, demonstrating and personifying a competent nurse The preceptor engages in one-to-one teaching in an actual clinical setting where the information supplied is practical rather than theoretical The preceptor models the appropriate professional behaviours and ensures the development of a safe and competent learner (Baltimore, 2004)

Preceptorship is therefore a framework to ensure transition support processes meet best practice standards in the form of “an educational relationship which is intended to provide access to an experienced and competent role model, a means by which to build a supportive teaching and learning relationship” (Qld Health) • Much of the literature on preceptorship implies that the most appropriate preceptor is one who is experienced however in many settings these choices are not available therefore the Flying Start Series considers that newly graduated practitioners can undoubtedly relate to the experiences of adapting to a new role or workplace • Therefore all levels of staff should be considered as contributing to the preceptorship journey

PRECEPTOR The role of the preceptor is multifaceted

Small fish in a big sea

The aim of preceptorship is to • assist the novice practitioner to adjust to their new role • provide supervision to novice clinicians • aide in the smooth transition of the preceptee to effectively apply and consolidate knowledge and skills delivered in educational programs • act as a role model and effectively manage the identification and promotion of professional behaviours, and • assist in the application of theory to practice with a particular group of patients/clients

The work place as a learning environment Differs from that of the classroom, it has an added dimension………...the patient ‘Reality’ assists the novice to integrate their knowledge into practice The workplace is complex - The physical environment, staffing levels, complexity of patients, how the learners role is viewed, quality of the supervision all have an impact

Finding the right road

Issues in the work place Limited number of clinical placements or rotations Quality and quantity of the preceptors available Current and recency of practice in the speciality areas Variability in expectations from wards, students, staff and the University

First Impressions count The first hours a preceptee spends with you as a preceptor sets the scene for the ongoing relationship you wish to build, it is an important moment in time, appreciate the benefits that can occur with well planned time on the first day or shift. Some practical ideas for making the preceptorship relationship work might be: • to identify when you can work together from a roster point of view • Give the preceptee a tour of ward/dept or work area, go through the routine, and let them know how things are organised for the day • Discuss dress requirements

Refer them to the location and check they have access to your organisational policy and procedures • Introduce the preceptee to key people in the team/area • Discuss transport arrangements – can the preceptee get to the workplace for all shift times? • Identify any resources the preceptee may require, ask if they have any particular support needs • Ask what their concerns are if any with this placement or experience • Ask them what their goals for this experience are • And be sure to discuss feedback processes of how, when and what if any are the processes should they not be satisfied.

So what’s in it for me? There are a number of documented benefits for implementing preceptorship some of your colleagues have said being a preceptor • “challenges you” (CNS) • “It can help your professional development- the students question you” (RN) • “you get to share what you know” (Grad) • “It eventually benefits patient care as working with a preceptee helps you to reflect on your own practice and being asked more questions helps you learn more” (CNS) • “(It) improves morale” (Grade 2 RN) • “it may sound a bit out there but….I do it because I can influence and shape the type of professionals that are going to work here” (CNE) • “new staff see things through fresh eyes we should listen carefully to their observations” (NUM) • “it helps to remind me of some of things I think are important in my profession” (Medical Registrar)

Role of the Preceptor To act as a facilitator, teacher, observer, evaluator and role model Introduce the preceptee to other staff members and inter department personnel, to help integrate them into the social structure of the nursing unit Teach and supervise in connecting the theory to clinical practice

Assist the preceptee to coordinate patient care Share the expectations upon which evaluation will take place Communicate concerns about them to them in the first instance

To be or not to be a Preceptor ??????

Attributes of a Preceptor Considerable literature exists listing the many attributes and characteristics of what makes a successful preceptor, hopefully you will recognise yourself in some of the following: A Preceptor is willing to support others a problem solver a critical thinker patient motivated to contribute to the learning and development of others knowledgeable in the clinical setting enthusiastic committed to quality health care outcomes a promoter of learning able to display insight and empathy to situations an exemplary role model a talent spotter a reflective practitioner able to adapt different learning styles respectful of peers non-threatening and non judgemental able to use see the funny side of things conscience of the level of influence and privilege being a preceptor has

Why be a preceptor? To help another person gain skills you already posses You think you have the personality and enthusiasm to give it a go To increase the number of staff able to complete specific tasks To develop your training and leadership skills

Dual roles With all this in mind we also need to consider that you will be juggling dual roles, although you have offered to be a preceptor and you are seen to be proficient and experienced in your clinical role you will need to consider the balance between the needs of your patients/clients/residents and the preceptee. Differences between a preceptor and preceptee may arise when expectations, roles, learning and communication styles are not made clear

Expectations You are not expected to know everything but that your role is to assist the Undergraduate students, or new staff

Do you still want to do this?????

Adult LearningPrinciples

The principles of adult learning apply a practical approach, with assumptions based on a humanistic conception of self-directed and autonomous learners with teachers as facilitators of learning. The principles believe that: • Adults need to know why they need to learn something before they undertake it. Preceptors’ can facilitate the reasons for knowing things by raising awareness and acting as role models. • The role of the learner’s experience is important to use. As a preceptor consider the volume and quality of the learners experience and background including learning style, motivations, needs, goals and interests. Experiential techniques such as group discussion, simulation, problem solving exercises and case studies can be useful. Care should be taken to ensure that experience hasn’t closed us off to new ideas/fresh perceptions etc. Using preceptees own experience is important for their self-identify. Our experiences contribute to who we are!

Adults have a self-concept of being responsible for their own decisions and lives. There is a deep need to be seen by others as being capable of self direction Preceptors need to act as facilitators, guiding development rather than considering the preceptees as empty vessel that need to be filled • Adults must have a readiness to learn this means we are ready to learn things we need to know in order to function or cope with real life situations. Preceptoring in the workplace does just this, it is learning in the context of reality. • Orientation to learning – Children are subject-orientated and adults are life centred, task-centred or problem-centred. We learn new knowledge, skills and attitudes best in the context of real life application. • Adults respond better to internal motivators rather than external motivators however these internal motivators like job satisfaction, self-esteem, quality of life, growth and development, may become blocked by negative self concept, lack of resources and programmes that defy adult learning principles.

Learning is facilitated when the preceptor has sufficient experience and expertise within an identified clinical practice area to feel confident and competent in clinical nursing skills Learners prefer and learn best from preceptors who understand and appreciate learning and continue to be learners themselves Learning is enhanced by preceptors who appropriately demonstrate empathy, non-possessive warmth, respect for the learner and consistency in their approach to the preceptor/learner relationship.

Each learner is unique, therefore, learning can be influenced by factors such as the individual’s emotional status, motivation and cognitive ability Adults learn best if they are acknowledged as partners in the learning experience, participating fully in the design, implementation and evaluation of the experience Learners have expectations of the experiences to be provided by the organisation by which they are employed Preceptors should ascertain what these expectations are and seek to fulfil them Learners should take primary responsibility for their skill development and take an active role in identifying areas of competency and inability

Learning Styles Each person differs in their preferred learning style and techniques. Learning styles generally group common ways that people learn. Everyone has a mix of learning styles. Some people may find that they have a dominant style of learning, with far less use of the other styles. Others may find that they use different styles in different circumstances. There is no right way. Nor are your styles fixed. You can develop ability in less dominant styles, as well as further develop styles that you already use well.

The literature talks about many different definitions of styles in general the seven most common styles can be considered as: • Verbal (linguistic) – you prefer using words, in both speech and writing • Visual (spatial) – you prefer using pictures, images and spatial understanding • Auditory – you prefer using sound and music • Kinaesthetic (physical) – you prefer using your body, hands, and sense of touch • Mathematical (Logical/theorist) – you prefer using logic, reasoning and systems • Social (interpersonal/activist) – you prefer to learn in groups or with people • Solitary (intrapersonal/reflector) – you prefer to work alone and use self-study

Consider your own learning style, what is your preference when learning a new skill? • In the first few days of working with your preceptee consider their learning style/s, by having some understanding of the different styles or preferred style

Acquisition of professional skills Preceptees will be continuously gaining skills and knowledge by observing you as a role model however sometimes your facilitation of their development will need take on a more formal approach Clinical skills they will need to master will vary from simple to complex and preceptees will vary from novice with a limited range of skills to experts who have developed a wide range of skills A clinical skill should bring together both theory and practice, it is not just being able to do something, but also about Understanding the rationale or theory that underpins the intervention

Strategies for teaching skills • The first thing to consider is what stage of development is the preceptee at, ask questions like what course are they undertaking, what year are they in, have they been in this type of setting before, what skills and knowledge do they already possess that you can build upon? • Consider what resources you have available, what is essential learning to achieve and what is desirable if it is available? You may like to identify core or essential skills pertinent to the clinical area and the preceptees stage of development • If there are any assessment requirements or achievement of competencies these should be identified as a priority. Don’t forget to enlist the assistance of your colleagues to achieve these strategies.

Preparation for teaching skills The first time a preceptee attempts a skills should be as controlled as possible there will obviously be a level of anxiety on their part and patients/clients should be informed Consider if the skill can be attempted away from the patient/client to reduce this stress often this is not possible as a learning opportunity has presented itself Encourage the preceptee to plan out loud, talk through the activity they are going to undertake, can they recount the steps of the process or procedure? This allows you time to anticipate any problems or gaps and potentially correct any errors Preparation time is valuable if it can be made available for both You and the preceptee.

Breaking down the skill Although a skill has to be performed as a whole, there are often many components that you can break it into. Teaching the components in parts gradually integrating these into the whole allows the preceptee time to master each component

Repeat practice • Mastery within different settings is only acquired with repeat practice; the preceptee may have the opportunity to simulate the clinical skill in a safe environment which allows for correction of technique and feedback away from the patient or client

The urge to intervene • No doubt in your time as a preceptor you will feel the urge to intervene this must be resisted for reasons other than putting the patient/client or others at risk • The opportunity to make mistakes is a valuable experience that can be used as a positive point of discussion • Feedback on this level of performance and areas of improvement given consistently will reduce the preceptees feelings of exposure, vulnerability and anxiety

A model for teaching clinical skills • Peyton (1998) described a model for teaching clinical skills that can be used in simulated learning environments and the clinical setting. It is known as the “4-stage approach” • Stage 1 consists of a demonstration of the clinical skill at normal speed with no explanation. This allows the preceptee to see what the skill should look like in real time • Stage 2 is repetition of the skill with clear explanation; the preceptee can ask questions and clarify at any point • Stage 3 is where the preceptor (or another staff member) performs the skill with the preceptee providing the verbal instructions the preceptor can ask questions, clarify points, and challenge the instructions. The stage can be repeated several times in the simulated learning environment or over several days if in the clinical setting. • Stage 4 allows the preceptee to perform the skill under supervision

Remember to consider the risks • As with any learning that occurs in a clinical setting the risks associated with the activity need to be considered, risks to patients/clients and others should be assessed when implementing any teaching of clinical skills. Patients/clients should be advised and given the opportunity to renege on being part of the learning event • Peyton’s model may look time consuming and long winded however opportunity to receive feedback, reflect and practice ensures learning is grounded in best practice

Professional Socialisation ‘‘Who are you?’’ said the caterpillar… ‘‘I – I hardly know, Sir, just at present’’, Alice replied rather shyly, ‘‘at least I knew who I was when I got up this morning, but I think I must have been changed several times since then’’

The ‘in-betweenness’ that occurs when a undergraduate student receives a formal registration number or when a practicing professional starts in a new area can be described as a nonlinear process or journey that moves the new person through developmental and professional, intellectual and emotive, skill and role-relationship changes, and contains within it experiences, meanings and expectations (Duchscher, 2008).

Building a learning culture • Health care environments that support learning are essential if preceptees are to be “effectively orientated, taught to work safely, interact in a proactive manner and contribute to ideas that benefit practice and health outcomes” (Henderson, Walker, Creedy, Boorman & Cooke, 2010) • The literature confirms that health workplaces need to be accepting of different levels of staff with varying degrees of skill sets. With this acceptance comes affiliation, two prerequisites for learning. As a preceptor you can play a part in equipping staff to connect with preceptees.

Connections made between the preceptee and staff in the work area can be promoted and fostered by you in your preceptor role • Consider how you prepare your colleagues for the arrival of the preceptee • Think of ways to ignite curiosity and interest, discover what is known about the preceptee and share it with the team • In the week leading up to the arrival of the preceptee talk about what they can and can’t do and what their scope of practice will be?

A learning culture .................So what is a learning culture and how do you know if you have one? These questions are often asked; the answers are complex and subject to much debate and discussion. • It was Peter Senge’s 1990 book The Fifth Discipline that brought him firmly into the limelight and popularized the concept of the ‘learning organization'. Since its publication, more than a million copies have been sold and in 1997, Harvard Business Review identified it as one of the seminal management books of the past 75 years. According to Senge (1990) learning organizations are: • …organizations where people continually expand their capacity to create the results they truly desire, where new and expansive patterns of thinking are nurtured, where collective aspiration is set free, and where people are continually learning to see the whole together.

Acknowledgement