It is well documented that preceptors play a critical role in the transition of nurses and that preceptor education and support provide the foundation for a successful preceptorship (Foy, Carlson, & White, 2013; Shinners & Franqueiro, 2015; Swihart & Figueroa, 2014). Whether registered nurses are moving from academia to professional practice or from one practice area to another, their preceptor experience plays a critical role in both practice transition and how they socialize into their new work environment. The Transition to Practice Study in Hospitals (Blegen et al., 2012) provided a correlation between successful preceptoring with the satisfaction and retention of new graduate registered nurses.
The nursing professional development (NPD) practitioner is often tasked to design, implement, and evaluate a preceptor program. According to the Nursing Professional Development: Scope & Standards of Practice (Harper & Maloney, 2016) within the role of "partner for practice transitions," the NPD practitioner supports "the transition of nurses and other healthcare team members across learning and practice environments, roles, and professional stages" (p. 17). Thus, it is critical that the NPD practitioner is aware of the key components for a successful preceptor role development program.
PRECEPTOR ROLE DEVELOPMENT
A preceptor is a "specialist in their field and/or areas of practice and performance who facilitate successful orientations, transitions into practice, and role competency[horizontal ellipsis]" (Roth, Figueroa, & Swihart, 2014, p. 83). In addition, preceptors "serve as role models and resource people[horizontal ellipsis]" while "they merge the knowledge, skills, abilities, and roles of both coaches and mentors to help preceptees develop and mature into strong practicing professionals[horizontal ellipsis]" (Swihart & Figueroa, 2014, p. 17).
Just as organizations are using a standardized, systematic approach to onboard new employees, so too should they consider such an approach for preceptor development to ensure consistent, high-quality performance. The use of a competency-based approach to prepare nurses in their role as preceptors includes identification of essential competencies, assessment of preceptor knowledge and behaviors through a gap analysis, providing education and support to address the identified gaps, and observation of competency validation at the point of care.
PRECEPTOR EDUCATION
One example is a purchased program with curriculum developed by certified NPD specialists. Using the results of a preceptor job analysis, the specialists identified the roles and responsibilities of the preceptor. This provided the foundation for the development of five essential preceptor competencies: Orienting the Preceptee to the Healthcare Environment, Orienting the Preceptee to the Clinical Unit/Department, Creating a Safe Learning Environment, Demonstrates Competency in the Role of Preceptor, and Clinical Leadership in the Role of Preceptor. These competencies are the framework for preceptor education, which may be provided as a self-paced learning module or as a live workshop using a variety of learning strategies to prepare preceptors to perform each of the identified competencies. Roth (2015) recommends using engaging learning strategies to prepare preceptors. The preceptor role development program includes articles, self-reflection, group activities, role play, and learner guide questions. Educational resources address each individual preceptor's learning needs as identified through the gap analysis in preparation for competency performance. Continuing education hours are awarded for successful completion of preceptor education that culminates with competency validation.
COMPETENCY VALIDATION AT THE POINT OF CARE
Several theories and practices address competency validation. The Miller (1990) pyramid uses a four-tiered approach to competency acquisition: "knows," "knows how," "shows how," and "does." Each level of the pyramid requires evidence for validation. Miller purports that the demonstration of "knows" (knowledge) is evidenced using objective test methods such as verbal or written tests. Evidence of "knows how" uses Bloom's Taxonomy to create test items that challenge application, analysis, and synthesis. Although this method is accepted and widely used for competency validation (e.g., the use of annual medication or electrocardiogram examinations), there are challenges with item development and psychometrics to ensure validity and reliability as well as concern that good test taking skills do not always equate with the ability to perform. "Shows how" (performance) is evidenced by demonstration with role playing or other strategies in a simulated or practice-like setting. Finally, "does" (action) occurs within the practice setting-at the point of care. Although a variety of evaluation methods may be helpful as a precursor to competency validation, verifying performance of safe practice by direct observation within a practice setting that includes all of the complexity of patient care, interprofessional communication, and environmental distractors is the highest level of performance evaluation.
IMPLEMENTATION AND SUSTAINABILITY
Implementing such a robust and comprehensive program requires thoughtful preparation at all levels of the organization. Communication with leadership on the process, structure, and goals of the preceptor program is essential to gain support. Organizational goals for implementing the program (e.g., improving preceptor satisfaction and retention or increasing the number of preceptors) must be communicated. A review of current and prospective preceptors and assessing their levels of knowledge and performance are also important before program implementation. Current preceptors who do not meet the criteria for preceptoring (having the knowledge, skills, and behaviors) should be removed from the preceptor pool. Finally, preceptor evaluation and observation of performance in the role are necessary to validate competency.
Organizations must also provide ongoing education and support to foster continued preceptor development. Evaluation of the preceptor program is an essential component for continuous improvement. Feedback should be gathered from all stakeholders including preceptors (past and present), and those in supporting roles such as departmental leaders and educators. Preceptor role development programs should undergo continuous evaluation and revision based on these outcomes.
CONCLUSION
Preceptors have identified that preceptor retention and role satisfaction stem from having education, recognition, and support from organizational leadership and peers (Shinners & Franqueiro, 2015). Although there has been tremendous work done to develop and support preceptors, there is still much more that can be done. The American Academy of Preceptor Advancement (http://www.preceptoracademy.com) provides a wide array of resources for preceptor development including the Preceptor Scope & Standards of Practice and the Core Curriculum for Preceptor Advancement. We encourage NPD practitioners to approach preceptor role development in the spirit of collaboration and inquiry, to evaluate preceptor programs and experiences, to recognize and celebrate preceptor achievement, and to share what you have learned through your experiences with others so that they too may experience progress with preceptor development and success.
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