Preceptor Orientation and Intervention PlanOrientation and Development Guide for Preceptors

Role of the Preceptor

The role of a preceptor in any student program is paramount to clinical training. The preceptor demonstrates the practical side of the academic program performing procedures and protocols with current evidence-based practice within the confines of the practice protocol of the nursing profession and the policies and procedures of the facility in which he or she works and also allows the student nurse the opportunity to observe a balanced continuum of care.

Within this relationship, the preceptor models the realities of practice for the student and helps guide the student to organize behaviors and strategies for effective and efficient patient care. In addition, a preceptorship provides the student with the opportunity to experience the pressures of day to-day relationships with patients, other professionals, the referral system, local, state, and federal rules and regulations, and the realities of productivity-based practice. Preceptors are the vital link between the concepts and evidence-based approaches to care and the realities of actual practice. (Barker & Pittman, 2010, p. 145)

When the clinical student is then ready to stop observing and begin practice themselves the preceptor acts as the guiding and observing coach that allows the student nurse the opportunity for professional and practical development of skills. In this role the preceptor is expected to demonstrate the utmost of professionalism and skill and aide in the development of the student nurse so he or she may step out on their own with the same professionalism and attention to detail. Nursing instructors are spread very thin in a clinical setting and though the expectation is that they will stand back and observe the work of the preceptor they cannot be present for every procedure and/or training experience of every student nurse. In addition to that nursing instructors rely heavily on preceptors to demonstrate procedures and practices that coincide with the materials they are teaching in theory and coursework. Finally, nursing instructors rely heavily on preceptors to be the eyes and ears of the clinical setting noting the readiness or needs of development on the part of the nursing student so these needs and/or proficiencies can be supported through praise or further clinical training, away from patients. The most important role of a preceptor and as a nurse is that of the patient advocate who will realistically support nursing students in their attempt to become safe providers of care to patients in vulnerable positions of health and wellness. The instructor and student have an obligation to communicate to preceptor the clinical readiness of the student nurse for the experience, and the preceptor has the obligation to make note of this level of skill and utilize it as a starting point for observation and determination of independent skill development opportunities. (Barker & Pittman, 2010)

Guidelines for One-on-one Student interaction with Competency-based Approach

Competency is based upon not only skill of performance but taking into account the safety and comfort of a patient. Student nurses are only considered competent to practice once they have demonstrated appropriate skill to the preceptor and/or the nursing instructor and to a large degree the bulk of this development of clinical skills is in the hands of preceptors who seek to support competency, intervene when they feel the patient may be at some risk of incompetency and report all this back to the nursing instructor who will then communicate with the nursing student to address competency issues and/or triumphs back to the student in the appropriate manner. To accomplish this a student has a comprehensive list of procedures and practices that must first be observed and then applied, to determine the competency and skill they are developing. At no time should the patient, nursing student, preceptor or any other non-preceptor care provider feel unsafe or at risk of harm. The preceptor often has the role of assuring the patient that the nursing student is competent and able to perform the needed procedure safely, effectively and with the patients' health and well-being in mind, sometimes even before this is known to the preceptor. If for any reason the nursing student is compromising the patient with his or her actions, outside of competent the preceptor must be present to take over and advocate for patient well-being above all else.

Ethical and Legal Issues of Supervision of Students

Preceptors supervising students are expected to be present for demonstration as well as to observe when a nursing student is believed to have achieved...

Once a skill set has been demonstrated by the nursing student some tasks can be delegated to him or her without direct observation and with the nursing instructor's awareness and approval of independent care but the preceptor must remain available and reachable in a rapid manner and a nursing instructor must be present in the facility at all times for any student nurse to perform procedures. The legal allowances of the student nurse program demand these standards as does the legal and ethical policies and procedures of the facility that is contracted with the nursing school to provide a safe and productive clinical setting for training. A preceptor cannot delegate any and all responsibilities to another who has not met the conditions of being a preceptor or who is not fully qualified to observe and supervise a student nurse. (Barker & Pittman, 2011, p. 146)
Reporting Requirements for Preceptors

Preceptors must report through standardized means the progress of a student nurse, in conjunction with the nursing instructor and submit such reviews to the nursing instructor without delay, and usually on a daily basis. Any concerns that a preceptor must have regarding the skills or abilities of a particular student nurse or any outward violations of the role they play or safety violation or failing must be reported immediately to the nursing instructor as well as through any necessary channels of incident reporting within the facility. Though preceptors have some discretion regarding this reporting it is essential that the ethical standards of the nursing profession as well as the facility of practice be honored, especially in the case of patient safety, to communicate incidents and points of concern regarding the safety of a student nurse in the clinical setting. Mutual communication between the student, preceptor and the faculty of the source institution as well as established expectations and demands will help mitigate conflicts for preceptors and ensure a smooth demonstration of teaching clinical skill to students, no matter their level of competency. (Barker & Pittman, 2010)

Guidelines for Preceptor Performance Appraisal

Baseline Measures and Parameters for Appraisal

Preceptors will be evaluated by students as well as faculty based on their willingness to teach, allowance of clinical observation where it is appropriate and their willingness to guide the student through an observed independent clinical skill performance. Preceptors will also be evaluated by students and faculty with regard to professionalism. Preceptors will be evaluated for ease of communication, ability and willingness to answer questions proposed by student nurses and an overall level of ease of communication. Finally preceptors will be evaluated based on their willingness and availability for practical teaching. The evaluation scale is demonstrative of a 1-10 scale and will be performed by both student and instructor separately and comments will be encouraged as an addition/amendment to any section of the evaluation. Student/Instructor evaluations of the preceptor will then be transcribed and at the selection of the instructor shared with the preceptor for comment or support in the process and submitted to supervisory staff as desired by the facility. Students and instructors will be expected to remain professional and sincere in all their observations of the preceptor and any evaluations that do not follow this important professional courtesy and standard will be omitted from results, at the discretion of the faculty and/or the precept supervisor.

Consequences of Performance Appraisal

Performance appraisal of preceptors inside the confines of professionalism, will serve as a guide for improvement and/or praise according to the evaluations and may serve as a guide for the removal of a preceptor from the program, in the most dire observed circumstances. It is essential and important that the preceptor earns the professional respect of students and faculty and follows the ethical and practical guidelines of the profession in a transparent manner. A high level of clinical skill must be observably present in the preceptor but almost equally important for the preceptor student partnership is open and honest communication and an observable willingness to teach and share.

Incentive Program

Preceptor performance will be rewarded with a complimentary luncheon that fits into the schedules of preceptors and allows them the opportunity to be rewarded for what might seem like a relatively thankless job, which is nonetheless essential…