Nurse Preceptorship

Overview of Theories, Frameworks, Key

Concepts, and Principles that Influence the
Knowledge, Skills, Abilities, and Judgment for
Becoming a Master Preceptor.

Becky Graner MS, RN 2014 1

Purpose: Provide an overview of theories, frameworks, key
concepts, and principles that influence the knowledge, skills,
abilities, and judgment for becoming a master preceptor.

Objectives
1. Define components for a preceptor program.
2. Review roles and expectations of the preceptor.
3. Review common theories, concepts, and frameworks related to
teaching/learning.
4. Review standards and principles related to becoming a nurse
preceptor.

Becky Graner MS, RN 2014 2

Preceptor education is one part of a
comprehensive preceptor program
Preceptor
resources

Standard
preceptee
instructions and Preceptor
mandatory pre- education
clinical
requirements Full
preceptor
program

Templates
Sustaining and
rewarding individualized by
preceptors facilities and
institutions

Becky Graner MS, RN 2014 3

Possible components for a preceptor program
Preceptor Facility (clinical site) Academic Resources Recruitment &
education retention

Online or face to Contracts, facility Course overview, Library access (if Preceptor
face workshop/ requirements for goals, objectives, applicable), online /preceptee
courses to provide clinical learning, teaching strategies, resources, matching service,
knowledge, skills, identification, student, preceptor, templates for recognition/awards,
attitudes, and passwords, policy and course assignments,
judgment congruent and procedures evaluations. contact info for
for mastering faculty, preceptor,
precepting preceptee

Becky Graner MS, RN 2014 4

Possible components for a preceptor program
Every program needs a basic review and or comprehensive education activity for new and or
experienced preceptors.

Preceptor education Facility (clinical site) Academic Resources Recruitment &

retention

Online or face to face Contracts, facility Course overview, Library access (if Preceptor
workshop/ courses to requirements for goals, objectives, applicable), online /preceptee
provide knowledge, skills, clinical learning, teaching resources, matching service,
attitudes, and judgment identification, strategies, templates for recognition/awards
congruent for mastering passwords, policy and student, assignments,
precepting procedures preceptor, and contact info for
course faculty, preceptor,
evaluations. preceptee

Preceptors will be expected to obtain and review the students program goals and objectives, that
material is provided by the specific educational institution. Students must have legal contracts in place
for clinical site placement and students will need to meet facility requirements (much the same as
employees of that facility).
Becky Graner MS, RN 2014 5
This overview will focus on the advanced practice
registered nurse (APRN) serving as a preceptor.

Becky Graner MS, RN 2014 6

This overview is for those who have some background knowledge in
the principles of teaching/ learning, in nursing education activity
development, the COPA model, and the IOM Core Competency &
QSEN principles.

Through out the presentation you will see the key symbol
This symbol alerts the preceptor of key material that is essential for
becoming a master preceptor. The preceptor is encouraged to explore
these topics fully by using the additional resources for learning
provided through out the presentation.

Becky Graner MS, RN 2014 7

Roles the preceptor plays
Oversight/ supervision
Evaluator
Educator
Socialization
Role model
Protector

Boyer, S.A. (2008). Competence and innovation in preceptor development:

Updating our programs. Journal for Nurses in Staff Development, (24)2, E1-E6.
doi: 10.1097/01.NND.0000300872.43857.0b
Becky Graner MS, RN 2014 8
What is expected of a preceptor?
Patient safety
Safe environment
Over sight Critical
Evaluator thinking/reasoning
Collaboration

Professional Educator / learner

practice Leadership role
Preceptor & Nursing standards of
preceptee practice and performance

Relationship building
Socialization
Role model

Protector
Nurses care
Ethics
for people
Advocacy

Becky Graner MS, RN 2014 9

 Preceptors facilitate the integration of theory and practice
with the learner, while keeping patients safe.

Theory application through evidence-based nursing actions is the

foundation for practice.

In discussing your role as a preceptor the review of theories, concepts, standards, and principles is
necessary to build a shared framework and language in this area of nursing practice.

Nursing education shares a set of theories, concepts, and principles that overlap with other
professions, such as, education, human development, psychology, sociology, and instructional
design.

We will briefly touch on these theories and frameworks related to these topics, resources for
further independent exploration will be provided within the context of the material presented on
the slides.

Becky Graner MS, RN 2014 10

Oversight and evaluator: Patient safety
Evaluation in education is the appraisal of progress or lack of progress the student has achieved
in their quest to reach set goals. Evaluations can be done by the self, the preceptor, the faculty,
the patient/ family. Advanced practice nursing students often co-create learning goals.

Evaluation is Standard 6 in ANAs standards of professional nursing practice. Evaluation in this

context is the appraisal of nursing process/actions in relation to patient/ family/ community
outcomes. There are a number of models that can be used to structure evaluations.

Results of evaluations are used to improve performance, improve outcomes, to change

processes.

To measure or evaluate one must know the expected competencies linked to the standards of
practice and performance for the APRN.
What is Competency?
An expected and measureable level of nursing performance that integrates knowledge, skills,
abilities, and judgment, based on established scientific knowledge and expectations for nursing
practice (ANA, 2010, p. 64).

Becky Graner MS, RN 2014 11

Knowledge, skills, abilities, and judgment
Knowledge
Thinking, understanding of science/humanities, professional standards of practice,
insights gained from context, practical experiences, personal capabilities, leadership
performance
Skills
Psychomotor, communication, interpersonal, diagnostic
Abilities
Capacity to act effectively which requires: listening, integrity, knowledge of ones
strengths and weaknesses, positive self regard, emotional intelligence, openness to
feedback
Judgment
Critical thinking, problem solving, ethical reasoning, decision-making

ANA (2010), p. 12-13.

Becky Graner MS, RN 2014 12
Oversight and evaluator: Safe environment
IOM: Core competencies in Nursing Education
Patient centered care
Interdisciplinary teams
EBP
Quality improvement
Informatics
http://www.iom.edu/Reports/2003/health-professions-education-a-bridge-to-quality.aspx
Quality and Safety in Education for Nurses (QSEN)
Defines the knowledge, skills and abilities needed for each of the competencies
Patient centered care
Teamwork/collaboration
EBP
Quality improvement (QSEN separates IOMs QI into these 2 categories)
Patient safety
Informatics
http://qsen.org/competencies/

Becky Graner MS, RN 2014 13

Evaluation

Who does it?

Faculty
Preceptor
Preceptee
Patients/families
What does it contain?
Competencies
Where does it happen?
In action (if appropriate, reflection in action during patient care)
After action (reflection on action after patient care)
How is it accomplished?
Gap analysis
Formal written
Discussion
Testing
Reflection
When does it happen?
Formative (during the learning process: feedback, modifying instructions, clarifying)
Summative (assessment of learning at the end of a set period: final exams, project, paper)

Becky Graner MS, RN 2014 14

One way to organize evaluation is to use the
COPA Model
A framework and process developed by Carrie Lenburg to promote
initial and continuing competence by integrating:

Competence for contemporary practice

Outcomes to be achieved for practice
Performance of essential competencies
Assessment structured for competence

Becky Graner MS, RN 2014 15

Lenburgs Eight Core Practice Competencies
with Sub-skill Examples (COPA Model)

http://gm6.nursingworld.org/MainMenuCategories/ANAMarketplace
/ANAPeriodicals/OJIN/TableofContents/Volume41999/No2Sep1999/
COPAModel.html

Assessment and Intervention Skills

safety and protection
assessment and monitoring
therapeutic treatments and procedures

Becky Graner MS, RN 2014 16

Communication Skills
oral skills
talking, listening, with individuals
interviewing; history taking
group discussion, interacting
telling, showing, reporting
writing skills
clinical reports, care plans, charting
agency reports, forms, memos
articles, manuals
computing skills (information processing; using computers)
related to clients, agencies, other authorities
related to information search and inquiry
related to professional responsibilities

Becky Graner MS, RN 2014 17

Critical Thinking Skills:
evaluation; integrating pertinent data from multiple sources
problem solving; diagnostic reasoning; creating alternatives
decision making; prioritizing
scientific inquiry; research process
Human Caring and Relationship Skills
morality, ethics, legality
cultural respect; cooperative interpersonal relationships
client advocacy

Becky Graner MS, RN 2014 18

Management Skills
administration, organization, coordination
planning, delegation, supervision of others
human and material resource utilization
accountability and responsibility; performance appraisals and QI
Leadership Skills
collaboration; assertiveness, risk taking
creativity, vision to formulate alternatives
planning, anticipating, supporting with evidence
professional accountability, role behaviors, appearance

Becky Graner MS, RN 2014 19

Teaching Skills
individuals and groups; clients, coworkers, others
health promotion; health restoration
Knowledge Integration Skills:
nursing, healthcare and related disciplines
liberal arts, natural and social sciences, and related disciplines

Becky Graner MS, RN 2014 20

Oversight and evaluator:
Critical Thinking /reasoning
To facilitate growth/sophistication in critical thinking/reasoning a framework
provides the preceptor a guide to use with the learner that fosters thinking/
reasoning/ clinical judgment. It also provides a method for providing
feedback to the learner by establishing a shared language and way to
organize or label ones actions.

One such model is Tanners Integrative Model of Clinical Judgment.

Noticing a perceptual grasp of the situation on hand determined by the
nurses expectations (based on his/her knowledge base)
Interpreting developing a sufficient understanding of the situation to respond
Responding deciding on the course of action deemed appropriate for the
situation, which may include no immediate action
Reflecting attending to the patients responses to the nursing action which in
the process of acting reflecting-in-action and or reflecting-on-action

Becky Graner MS, RN 2014 21

Dr. Christine Tanners Integrative Model of Clinical Judgment
Tanner, C.A. (2007) Thinking Like a Nurse: a research based model of clinical judgment. Journal of Nursing Education, 45(6), 204-211.

Becky Graner MS, RN 2014 22

Collaboration Competencies: The development of
interprofessional competencies by health professions students as part of the
learning process, so that they enter the workforce ready to practice effective
teamwork and team-based care. These competencies provide a basis for actions
that the preceptor is expected to role-model/ evaluate and the preceptee is
expected to assimilate by acquisition of knowledge, skills, abilities, and judgment.

Core Competencies for Interprofessional Collaborative Practice

Competency Domain 1: Values/Ethics for Interprofessional Practice
Competency Domain 2: Roles/Responsibilities
Competency Domain 3: Interprofessional Communication
Competency Domain 4: Teams and Teamwork

http://www.aacn.nche.edu/education-resources/ipecreport.pdf

Becky Graner MS, RN 2014 23

Professional Practice: Educator/ Learner
Adult learning principles
Learning taxonomy
Generational /experience considerations
Learning / teaching styles
Instructional design

Becky Graner MS, RN 2014 24

Professional Practice: Educator/ Learner
Common learning theories
Adult learning theory by Malcolm Knowles (andragogy)
See next slide
Transformative learning theory (Mezirow)
Experience, critical reflection, development
Preceptor help preceptees become aware and critical of assumptions and experiences.
View from different and new perspectives
Social learning theory (Bandura)
Learning through observing and modeling
Attention, retention, reproduction, motivation
Hierarchy of Needs theory (Maslow)
Preceptors awareness of preceptees needs influence learning

Becky Graner MS, RN 2014 25

Professional Practice: Educator/ Learner
Adult learning principles (Knowles)
1. Learners need to know: why what how
2. Self concept of learner: autonomous, self-directed
3. Prior experiences of learner: resource, mental models
4. Readiness to learn: life-related, developmental task
5. Orientation to learning: problem centered, contextual
6. Motivation to learn: intrinsic value, personal pay-off

Becky Graner MS, RN 2014 26

Professional Practice: Educator/ Learner
Learning taxonomy (classification for information or a mechanism
that categorizes how things relate to each other) (Ulrich, 2012, p. 79).

Blooms taxonomy: Objectives and Domains of learning

http://epltt.coe.uga.edu/index.php?title=Bloom's_Taxonomy
Finks taxonomy of significant learning
Fink, L. D., (2003). Creating Significant Learning Experience. San Francisco, CA:
Jossey-Bass

Becky Graner MS, RN 2014 27

 Revised Blooms Taxonomy
evaluation creating

synthesis evaluating

analysis analyzing

application applying

comprehension understanding

knowledge remembering

Bloom, 1956 Anderson & Krathwohl, 2001;

Krathwohl, 2002

Becky Graner MS, RN 2014 28

 Finks taxonomy of significant learning

1. Foundational knowledge: understand and

remember
2. Application: skills, thinking, managing
3. Integration: see and understand connections
among different things
4. Human dimension: learning about oneself
and others
5. Caring: developing new feelings, interests,
values
6. Learning how to learn: becoming a better
student, inquiring, self-directed

For learning to occur there MUST BE some type

of change in the learner no change- no
learning. (Fink, 2003)

Becky Graner MS, RN 2014 29

Professional Practice: Educator/ Learner
Generational /experience considerations
http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAP
eriodicals/OJIN/JournalTopics/TheMultigenerationalWorkforce

Becky Graner MS, RN 2014 30

Professional Practice: Educator/ Learner
Learning styles
How individuals receive and process information, how they store information
in the brain and how they retrieve and use the information.
Kolb http://academic.regis.edu/ed202/subsequent/kolb2.htm
Benners novice to expert
Novice, advanced beginner, competent, proficient, expert
Myer-Briggs Type Indicator
Extroversion
Sensing
Thinking
Judgment

Becky Graner MS, RN 2014 31

Professional Practice: Educator/ Learner
Instructional design is . . .
The practice of creating "instructional experiences which make the
acquisition of knowledge and skill more efficient, effective, and
appealing.
The process consists broadly of determining the current state and
needs of the learner, defining the end goal of instruction, and creating
some "intervention" to assist in the transition. Ideally the process is
informed by pedagogically (process of teaching) and andragogically
(adult learning) tested theories of learning and may take place in
student-only, teacher-led or community-based settings.
There are many models but common parts are: analysis, design,
development, implementation, and evaluation (sound familiar?)

Becky Graner MS, RN 2014 32

Professional Practice: Nursing standards of
practice and performance
ANAs Scope and Standards of Practice and Professional Performance
Standards for Registered Nurses and additional competencies for the
graduate level prepared specialty nurse and the APRN
http://www.nursingworld.org/EspeciallyForYou/AdvancedPracticeNurs
es

North Dakota Standards of Practice

http://www.legis.nd.gov/information/acdata/html/54-05.html

Becky Graner MS, RN 2014 33

Relationship between Educational Competencies,
Licensure and Certification
Competencies Measures of competencies
Identified by Professional
Organizations
(e.g. oncology, palliative
care, CV) Specialty Certification

Specialty

CNP, CRNA, CNM, CNS in Population Foci

Licensure: based
Population context
on Education
And certification**
Role

APRN Core Courses:

Patho/phys,
Pharmacology, APRN
physical/health assess

Becky Graner MS, RN 2014 34

Professional Practice: Nursing standards of
practice and performance
The Consensus Model for APRN Regulation, Licensure, Accreditation,
Certification and Education
https://www.ncsbn.org/4213.htm

Becky Graner MS, RN 2014 35

Professional Practice: Leadership Role
Every nurse in every setting- the expectations of advanced practice

Leadership Standard 12 of ANAs Standards of professional Nursing

Practice adds five (5) competencies for the graduate level nurse.
Influences decision-making bodies to improve the professional practice
environment and healthcare consumer outcomes
Provides direction to enhance the effectiveness of the interprofessional team.
Promotes APN and role-development by interpreting its role for healthcare
consumers, families, and others.
Models expert practice to interprofessional team members and healthcare
consumers.
Mentors colleagues in the acquisition of clinical knowledge, skills, abilities,
and judgment.
(ANA, 2010, p. 56)

Becky Graner MS, RN 2014 36

Socialization: Relationship building
Introductions, expectations, and feedback
Introduces preceptee to team and others
Supports social needs
Supports adjustments to new role
Fosters integration into workplace culture
Helps establish communication between preceptee and management
Helps resolve conflicts
Ensures support of colleagues for socialization and orientation purposes

Becky Graner MS, RN 2014 37

Socialization: Role model
Transition to new role
Transition is the psychological process one goes through to come to terms
with a new situation.
It is not change (change is situational such as a new boss, new team, new
policy).
Change is external and transition is internal.

Stress management may view this process as grieving shock & denial, pain &
guilt, anger & bargaining, depression, reflection & loneliness, upward turn,
reconstruction & working through, acceptance & hope.

Becky Graner MS, RN 2014 38

Nurses care for people. . .Protector
Ethics
http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Codeof
EthicsforNurses/Code-of-Ethics.pdf (ANA Code of Ethics)
http://www.icn.ch/about-icn/code-of-ethics-for-nurses/ (International Code
of Ethics for Nurses)
Advocacy
Fundamental to nursing
nursing is the protection, promotion, and optimization of health and
abilities, prevention of illness and injury, alleviation of suffering through the
diagnosis and treatment of human responses, and advocacy in the care of
individuals, families, communities, and populations (ANA, 2010, p. 3).
The nurse preceptor applies this nursing foundational belief/action to the
relationship with preceptees.

Becky Graner MS, RN 2014 39

Nurses care for people. . . Protector
The preceptor
Protects the patient/family from novice error
Protects the preceptee from making errors that might threaten self and
future.
Provides a safe learning environment for the preceptee to learn and practice
Supports developing skills
Ensures adherence to policy and procedures
Considers licensed scope of practice when assigning and delegating
Protects the preceptee from adverse behaviors of others
Adapted from Boyer, S. A. (2008). Competence and innovation in preceptor development:
Updating our programs. Journal for Nurses in Staff Development, (24) 2, E1-E6.

Becky Graner MS, RN 2014 40

Resources for further learning
COPA Model
http://nursingworld.org/nursingcompetencies

http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodical
s/OJIN/TableofContents/Volume41999/No2Sep1999/COPAModel.html

http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodical
s/OJIN/TableofContents/Volume41999/No2Sep1999

Becky Graner MS, RN 2014 41

Resources for further learning

Becky Graner MS, RN 2014 42