Preceptorship Handbook

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Copyright © 2010 by University of Ontario Institute of Technology/ Durham College, Faculty of Health Sciences, Oshawa, ON, CA

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Table of Contents Message to Preceptors ............................................... 4 Preceptorship Program ............................................... 5 “Caring to Shape the Future of Nursing” .................. 5 Mission .............................................................. 5 Goals ................................................................ 5 Preceptorship Model (APEM) ........................................ 8 6C’s of Preceptorship Model ........................................ 9 Novice to Expert ...................................................... 10 Summary of Preceptorship Roles and Responsibilities ... 11 Student ............................................................ 11 Preceptor .......................................................... 12 Faculty Advisor .................................................. 13 Decision Tree .......................................................... 14 Important Links ....................................................... 15 Student and Advisor Contact Information .................... 16

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Message to Preceptors Dear Preceptors, We would like to take this opportunity to express to you how thrilled we are at your commitment to Nursing Education. Your enthusiasm for education and willingness to share your expertise with our stu-dents is appreciated both by the University and the College. Students continually speak of the importance of learning from “real” clinicians in the field of Nursing. The role modeling which students receive from you will help them to pursue their own identity as a nurse and to develop the respect and attitudes they need to commit to life-long learning. While you will be working closely with our students and professors over the next 2 terms, we look forward to celebrating with you at the end of the academic year during our annual Preceptor Recognition Celebration. Again, thank you so much for sharing your knowledge and skills with our students. We are indeed privileged to have you working on our team. Sue Coffey, RN, PhD Amanda Laird, RN, BScN, MN Director of Nursing Coordinator, RPN and RN to BScN Programs Faculty of Health Sciences Faculty of Health Sciences University of Ontario Institute of Technology

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Preceptorship Program

“Caring to Shape the Future of Nursing” Supported by the Year 4 team, the BScN preceptorship program strives to recruit, retain, recognize, & reward our local community and hospital clinical practice volunteers whose exemplary knowledge and expertise will provide the foundation for senior level practice education. Mission To create a spirit of student centered cooperation and collaboration among academic and practice participants. The triad of individuals will work reciprocally to foster individual growth of the preceptor while strengthening the quality of senior level practice education in preparation for entry into professional nursing. Goals • Building partnerships and communication strategies which look

respectfully and consistently at issues • Empowering advisors & preceptors to effectively role-model and

help students find and express their passion for nursing • Educating advisors, preceptors and students about: 1. their role in this collaborative relationship 2. the UOIT/DC caring curriculum and year level objectives 3. a positive and effective support network, and 4. evaluation methods for course competencies and personal individual learning goals • Supporting student learning by emphasizing the value of nursing

and it’s all encompassing role in health care through a variety of diverse placement opportunities

• Providing an experience for advisors, preceptors, and students

that rewards their commitment to nursing and professional prac-tice education

• Evaluation of the program and preceptorship experience by all

members of the triad, to promote positive changes on individual and program levels

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Caring Concept Within the context of Nursing knowledge, caring is defined somewhat differently by various theorists but the common feature is that caring is an essence, a way of being, fundamental to the relationship nurses have with patients and their families Four common theoretical definitions of caring are:

Leininger’s Theory of Culture Care Madeline Leininger developed a theory of culture care based on her interest in the culture dimension of human caring. She identified care as being the essence of nurs-ing with a goal of providing care that is cul-turally acceptable to the patient (client, family, community). “Care refers to actions and activities directed towards assisting, supporting, or enabling another individual or group with evident or anticipated needs to ameliorate or improve a human condition or life-way, or to face death” (Leininger, 1991, p. 46).

Watson’s Theory of Human Care Jean Watson developed a theory on car-ing which has evolved over the years. She bases her theory on a form of hu-manism and metaphysics (the philosophy of being and knowing). Watson describes nursing as a human science with a goal of helping people gain a higher degree of harmony with the mind, body and soul; achieved through caring transactions. “A value and an attitude that has to be-come a will, an intention or a commit-ment that manifests itself in concrete acts” (Watson, 1985, p. 32).

Boykin & Schoenhofer’s Theory of Nursing as Caring This work attempted to establish nursing as an academic discipline and to create a nursing curriculum grounded in caring. This theory views caring as a mode of being, and that everyone is caring. However, being a caring person requires the knowledge of oneself and of another during a shared experience. “Caring is the intentional and authen-tic presence of the nurse with another who is recognized as a person living caring and growing in caring” (Boykin & Schoenhofer 1993, p. 25).

Roach’s Conceptualization of Caring

Although not formerly described as a theory, Simone Roach articulates a set of values and be-liefs about caring in nursing. Her work focuses on caring as “not unique to nursing, but unique in nursing”(McCance, McKenna, & Boore, 1999; p. 1390). She describes five C’s of caring as a broad framework of human behaviour on how caring can be expressed: Compassion, Competence, Confi-dence, Conscience, and Commitment. “Caring is not simply an emotional or attitudinal response; caring is a total way of being, of relat-ing, of acting; a quality of investment and en-gagement in the other– person, idea, project, thing or self” (Roach, 1984, p.2).

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At DC/UOIT the Caring Curriculum was developed from the belief that caring is the essence of practice and can be modeled, acquired, practiced, enhanced and evaluated. The philosophy of our BSCN program incorporates: “...the concept of caring into the curriculum with the natural sciences inform-ing those dimensions of caring, which are technical and biomedical. The be-liefs, values and assumptions underlying the concept of caring are reflected in the program’s conceptualization of people, health and healing, as well as in the teaching-learning process” (UOIT/DC, 2007, p. 5). Caring is embedded in each of our courses and therefore in our course goals. Each course goal is further aligned with appropriate College of Nurses of On-tario (CNO) Entry to Practice Competencies (2008). Students are evaluated using these CNO Entry to Practice competencies. As a preceptor you will receive a copy of the practicum evaluation document from the student at the start of the placement. It is important that you review the competencies within the document that you will be evaluating the student on. These will also help you to select appropriate learning experiences for the student, and to guide your student in achieving the competencies.

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Preceptorship Model

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6 C’s of the Preceptorship Model

Core Process Explanation

Collaboration

Definition– Refers to the consistent interdependence amongst stakeholders and members, which is necessary to engage and involve members to act. Application– Shared vision, information sharing, mutual trust are outcomes of collaboration, which contribute to sustaining members. (e.g., recruiting RN’s to be precep-tors; fulfilling student requests for clinical experiences)

Conscience

Definition– Refers to the values and guiding principles embodied in “service, trust and mutual respect...which translates into daily actions.” Application– Ethical values and principles guide the daily practice of nurses. Preceptors role model this behaviour for others. (e.g., role model openness, respect, and car-ing toward clients and learners)

Capability

Definition– Refers to knowledge, skills and professional values. Application– Capability through preceptorship is the en-couragement of learning and improvement (e.g., experi-enced preceptor, with a variety of clinical skills facilitate, encourage and support students in clinical practice set-tings)

Commitment

Definition– Refers to taking an active role in creating something of value together. Application– Willingly making a mutual commitment and contribution to the value of preceptorship. A tangible outcome is recruitment and retention of nurses. (e.g., preceptors commit to teaching, fostering professional growth and acceptance of learners as colleagues)

Contribution

Definition– Refers to the desire to contribute a wide vari-ety of time and talents to something that is of value to serve the common good. Application– Volunteering to act as a preceptor for stu-dent and other learners in order to develop and sustain the future of the profession

Continuity

Definition– Refers to future growth and survival as a profession. “Institutional memory is one of the most critical factors for community continuity.” Application– Expert knowledge is transferred through preceptorship (e.g., preceptors available to students for variety of learning experiences)

Adapted from:RNAO(2004). Achieving a Preceptorship Excellence Model: Core Processes of Community.

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Novice to Expert

Stage Student Characteristics Preceptor Implications

Novice

No experience with situations in which they are asked to perform tasks Inability to use discretionary judgment No rule about which tasks are most rele-vant in a real-world situation or when an exception to rules is necessary

Teach rules to guide actions that can be recognized without situ-ational experience Must be backed up by a compe-tent nurse

Advanced Beginner

Demonstrates marginally acceptable per-formance Is gaining experience with real situation to note meaningful patterns and attributes (or have them pointed out by preceptor) Can formulate guidelines for actions in terms of patterns and attributes Difficulty identifying important aspects; treats all attributes as equally important

Shift from teaching rules to guide-lines Help to recognize patterns and their meanings Assist in prioritizing Must be backed up by a compe-tent nurse

Competent

Begins to see his or her actions in terms of long-term goals or overall plan Begins to distinguish between relevant and irrelevant attributes Feels the ability to cope and manage the unforeseen event Lacks the speed and flexibility of a profi-cient nurse

Focus on improving decision-making skills and ways to improve coordination of multiple compli-cated care needs of patient as-signments A good preceptor for a novice nurse

Proficient

Can discern situations as wholes rather than single pieces Uses past experiences rather than rules to guide practice Can recognize when the expected normal picture is absent Considers fewer options and hones in on accurate elements of problems

Use complex case studies to facili-tate learning A good preceptor for a competent nurse

Expert

Practices holistic rather than fractionated Grasps situation intuitively and correctly identifies solutions without wasting time Extraordinary management of clinical prob-lems Considered an expert by others

Often not possible to recapture mental processes Encourage exemplars and descrip-tions of excellent A good preceptor for a competent nurse

Data from Benner, P. (1982). From novice to expert. American Journal of Nursing, 82, 402-407

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Preceptorship Roles & Responsibilities: Student

Pr

ecep

tors

hip

Triad

Phas

e I

Initia

tion &

Ass

essm

ent:

Cla

rify

ing a

nd C

om

munic

ating

Exp

ecta

tions

and n

eeds

Phas

e II

W

ork

ing &

Im

ple

men

tations:

M

ovi

ng t

hro

ugh t

he

Prec

epto

rship

Exp

erie

nce

Phas

e II

I Eva

luation &

Ter

min

ation:

Pr

ovi

din

g F

eedbac

k Continued

Guid

ance

S

tud

en

t

√ D

emonst

rate

s ac

counta

bili

ty

for

lear

nin

g b

y cl

arifyi

ng w

ith

the

pre

cepto

r: (

1)

reci

pro

cal

expec

tations

for

pre

cepto

r-sh

ip,

(2)

studen

t pra

ctic

e st

andar

ds

and c

om

pet

enci

es,

(3)

the

sched

ulin

g o

f pla

ce-

men

t hours

acc

ord

ing t

o a

ca-

dem

ic r

equir

emen

ts a

nd (

4)

the

mid

-ter

m a

nd f

inal

eval

uation p

roce

sses

√

Com

ple

tes

DC

/UO

IT P

raxi

s Sel

f-Ass

essm

ent

of

lear

nin

g

nee

ds,

and s

hare

s th

is w

ith

the

pre

cepto

r

√ Rev

iew

s sk

ills

and c

urr

ent

know

ledge

as a

foundat

ion f

or

furt

her

dev

elopm

ent

√ D

evel

ops

a le

arn

ing p

lan in

colla

bora

tion w

ith t

he

pre

cep-

tor

whic

h r

elate

s to

the

pra

c-tice

set

ting a

nd is

bas

ed o

n

per

sonal an

d c

ours

e obje

c-tive

s

√ Pr

epare

s co

nsi

sten

tly

in a

n

appro

priat

e m

anner

for

the

pra

ctic

um

exp

erie

nce

√ Enac

t nurs

ing r

ole

s under

di-

rect

or

indirec

t su

per

visi

on in

the

conte

xt o

f co

urs

e an

d

lear

nin

g p

lan o

bje

ctiv

es

√ D

emonst

rate

s re

sponsi

venes

s to

lea

rnin

g b

y vo

lunte

erin

g t

o

par

tici

pate

in a

var

iety

of

pra

ctic

um

opport

unitie

s

√ Consi

sten

tly

mai

nta

ins

reflec

-tive

note

s th

at a

ccura

tely

re-

flec

t le

arnin

g e

xper

ience

√ D

ocu

men

ts p

rogre

ss t

ow

ard

achie

ving c

om

pet

enci

es

thro

ugh f

eedbac

k pro

vided

by

pre

cepto

r an

d f

aculty

advi

sor

√ Com

ple

tes

a m

id-t

erm

writt

en

self-e

valu

ation f

or

revi

ew a

nd

verifica

tion b

y pre

cepto

r

√ Com

ple

tes

a final

sel

f-ev

aluation b

ased

on p

rogre

ss

in a

chie

ving p

erso

nal

and

acad

emic

lea

rnin

g o

bje

ctiv

es

and g

oal

s

√ Pa

rtic

ipat

es in a

fin

al c

olla

bo-

rative

mee

ting o

pport

unity

with p

rece

pto

r an

d f

aculty

advi

sor

to d

iscu

ss p

rece

pto

r-sh

ip e

xper

ience

√ Com

ple

tes

an e

valu

ation o

f th

e pre

cepto

r, a

dvi

sor

and

ove

rall

pre

cepto

rship

pro

cess

bas

ed o

n a

cadem

ic a

nd o

r-gan

izational

sta

ndar

ds

√ Fo

llow

ing t

he

pre

cepto

rship

ex

per

ience

, pro

vides

eva

lua-

tion,

feed

bac

k an

d r

ecom

-m

endat

ions

for

futu

re d

evel

-opm

ent

and c

han

ge

to t

he

Prec

epto

r Pr

ogra

m a

t D

C/

UO

IT

12

Preceptorship Roles & Responsibilities: Preceptor

Pr

ecep

tors

hip

Triad

Phas

e I

Initia

tion &

Ass

essm

ent:

Cla

rify

ing a

nd c

om

munic

atin

g

Exp

ecta

tions

and N

eeds

Ph

ase

II

Work

ing &

Im

ple

men

tation

Movi

ng t

hro

ugh t

he

Prec

epto

rship

Exp

erie

nce

Ph

ase

III

Eva

luation &

Ter

min

ation:

Provi

din

g F

eedbac

k Continued

Guid

ance

P

rece

pto

r

√ Rev

iew

s w

ith t

he

studen

t:

(1)

Org

aniz

ational polic

ies,

pro

cedure

s an

d c

ode

of

con-

duct

(2)C

olle

ge

of

Nurs

es

stan

dar

ds

rela

ted t

o t

he

area

of

pra

ctic

e (3

)Rec

ipro

cal ex

-pec

tations,

incl

udin

g s

ched

-ule

s an

d r

equir

ed m

eeting

tim

es (

4)P

roce

ss f

or

acce

ss-

ing t

he

pre

cepto

r outs

ide

of

the

pra

ctic

e se

ttin

g a

nd (

5)

Met

hod f

or

pro

vidin

g e

valu

a-tion a

nd f

eedbac

k √

Orien

tate

s st

uden

t to

the

pra

ctic

e se

ttin

g

√ Rev

iew

s ac

adem

ic c

ours

e obje

ctiv

es

√ G

uid

es t

he

studen

t to

dev

elop

a le

arnin

g p

lan w

hic

h inco

r-pora

tes

cours

e obje

ctiv

es

rela

ted t

o t

he

pra

ctic

e se

ttin

g

√ Tea

ches

and r

ole

model

s, s

afe

and

ethic

al ca

re r

elat

ed t

o t

he

pra

ctic

e se

ttin

g

√ Fa

cilit

ate

s th

e opport

unity

for

com

-pet

ency

dev

elopm

ent

thro

ugh a

va

riet

y of

div

erse

lea

rnin

g o

pport

u-

nitie

s √

Support

s th

e st

uden

t by

bei

ng

acce

ssib

le o

n a

consi

sten

t bas

is

√ Ass

esse

s and r

evie

ws

studen

t co

m-

pet

ency

for

safe

and e

thic

al pra

ctic

e √

Mai

nta

ins

open

, hones

t co

mm

unic

a-tion a

nd f

eedbac

k w

ith s

tuden

t an

d

facu

lty

advi

sor

thro

ughout

the

ex-

per

ience

√

Coord

inat

es w

ith f

aculty

advi

sors

at

mid

term

to a

sses

s st

uden

t pro

gre

ss

and e

nsu

re c

ours

e an

d indiv

idual

obje

ctiv

es a

re b

eing m

et

√ Com

ple

tes

a fo

rmal

wri

tten

ev

aluation b

ased

on a

cadem

ic

and o

rgan

izational

sta

ndar

ds

√ Pa

rtic

ipat

es in a

fin

al c

olla

bora

-tive

mee

ting o

pport

unity

with

studen

t an

d f

acu

lty

advi

sor

to

dis

cuss

the

pre

cepto

rship

ex-

per

ience

√

Rec

om

men

ds

a pas

s/fa

il gra

de

for

the

studen

t to

the

facu

lty

advi

sor

√ Fo

llow

ing t

he

pre

cepto

rship

ex-

per

ience

, pro

vides

eva

luation,

feed

bac

k and r

ecom

men

dations

for

futu

re d

evel

opm

ent

and

chan

ge

to t

he

Prec

epto

r Pr

o-

gra

m a

t D

C/U

OIT

13

Preceptorship Roles & Responsibilities: Faculty Advisor

Pr

ecep

tors

hip

Triad

Phas

e I

Initia

tion &

Ass

essm

ent:

Cla

rify

ing a

nd c

om

munic

atin

g

Exp

ecta

tions

and N

eeds

Phas

e II

W

ork

ing &

Im

ple

men

tation:

Movi

ng T

hro

ugh t

he

Prec

epto

rship

Exp

erie

nce

Phas

e II

I Eva

luation &

Ter

min

ation:

Pro

vidin

g F

eedbac

k

Continued

Guid

ance

Facu

lty

A

dvis

or

√ Rev

iew

s w

ith t

he

pre

cepto

r an

d s

tuden

t pri

or

to t

he

pla

cem

ent:

(1)A

cadem

ic p

oli-

cies

, pro

cedure

s, a

nd

pra

c-tice

sta

ndar

ds

(2)A

cadem

ic

requir

emen

ts a

nd c

om

pet

en-

cies

(3)R

ecip

roca

l ex

pec

ta-

tions

for

pre

cepto

rship

incl

ud-

ing s

ched

ule

s an

d r

equired

m

eeting t

imes

and (

4)T

he

eval

uation p

roce

ss

√ Act

s as

a r

esourc

e fo

r su

p-

port

ing lea

rnin

g a

nd d

evel

op-

men

t of

the

pre

cepto

r an

d

studen

t

√ Li

nks

with p

rece

pto

rs a

nd s

tuden

ts

on r

egula

r in

terv

als

as r

equired

for

com

munic

atio

n r

elat

ed t

o p

ract

i-cu

m s

tandar

ds

and e

xpec

tations

of

the

studen

t

√ Support

s th

e st

uden

t by

resp

ect-

fully

and c

onsi

sten

tly

addre

ssin

g

issu

es r

elat

ed t

o a

chie

ving lea

rnin

g

obje

ctiv

es

√ M

ainta

ins

open

com

munic

ation w

ith

the

pre

cepto

r an

d o

ther

sta

ff in-

volv

ed in t

he

exper

ience

√ Eva

luate

s re

flec

tive

pro

gre

ss n

ote

s an

d lea

rnin

g o

bje

ctiv

es a

s nee

ded

√ Ass

esse

s and e

valu

ate

s st

uden

t ac

adem

ic c

ours

e re

quirem

ents

th

roughout

the

term

√ Consu

lts

with p

rece

pto

r an

d s

tu-

den

t to

dev

elop s

ucc

ess

pla

ns

for

studen

ts f

aili

ng t

o m

eet

obje

ctiv

es

by

mid

term

√ Com

ple

tes

a fo

rmal

wri

tten

aca

-dem

ic e

valu

atio

n a

nd a

ssig

ns

a pas

s/fa

il gra

de

bas

ed o

n t

he

pre

-ce

pto

r’s

eval

uative

com

men

ts

and t

he

deg

ree

to w

hic

h a

ll le

arn-

ing a

nd c

ours

e obje

ctiv

es h

ave

bee

n m

et

√ Fa

cilit

ates

a f

inal

colla

bora

tive

m

eeting o

pport

unity

with t

he

studen

t an

d p

rece

pto

r to

dis

cuss

th

e pre

cepto

rship

exp

erie

nce

√ Fo

llow

ing t

he

pre

cepto

rship

ex-

per

ience

, pro

vides

eva

luation,

feed

bac

k and r

ecom

men

dations

for

futu

re d

evel

opm

ent

and

chan

ge

to t

he

Prec

epto

r Pr

ogra

m

at D

C/U

OIT

14

Controlled act authorized to nursing

Not a controlled act

Controlled act not authorized to nursing

NO

Proposed procedure

If an order is required, is it in place?

Do not perform

Delegation in place?

Do not perform

YES

NO

YES

YES

NO

Do not perform

Do not perform

YES NO

Do you have the knowl-edge, skill and judgment to manage all possible outcomes of performing procedure?

YES

NO

May perform

NO

YES

Appropriate care provider?

Decision Tree Decision Tree for Performance of Procedures

Emergency?

Initiated*?

*Only applies to controlled act procedures authorized to nursing, as identified in Appendix D

College of Nurses of Ontario. Practice Standard: Decisions About Procedures and Authority, Revised 2006

15

Important Links

College of Nurses of Ontario (CNO) www.cno.org/ ⇒ CNO Supporting Learners document: www.cno.org/docs/prac/44034_SupportLearners.pdf ⇒ CNO Entry to Practice Competencies: www.cno.org/docs/reg/41037_EntryToPracitic_final.pdf Registered Nurses’ Association of Ontario (RNAO) www.rnao.org/ ⇒ RNAO Preceptorship Resources Kit: www.rnao.org/prk Faculty of Health Sciences– UOIT www.healthsciences.uoit.ca/ Nursing Handbooks http://www.healthsciences.uoit.ca/nursinghandbooks.html

Suggested Readings

Diekelmann, N., & McGregor, A. (2003). Students who fail clinical courses: Keeping open a future of new possibilities. Journal of Nursing Education, 42(10), 433-436. Thomas, S.P. (2003).Handling anger in the teacher-student relationship. Nursing Education Perspectives, 24(1), 17-25 Warelow, P., Edward, K-L., & Vinek, J. (2008). Care: What Nurses Say and What Nurses Do. Holistic Nursing Practice, 22(3). Watson, J. (2003). Love and Caring: Ethics of Face and Hand– An Invitation to Return to the Hearth and Soul of Nursing and our Deep Humanity. Nursing Administration Quarterly, 27(3).

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Student Contacts Student Name: E-mail Address:

Phone Number:

Student Name: E-mail Address:

Phone Number:

Student Name: E-mail Address:

Phone Number:

Faculty Advisor: E-mail Address:

Phone Number:

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Notes