Preceptorship Period Research Articles

Content Analysis of Feedback Journals for New Nurses From Preceptor Nurses Using Text Network Analysis.

This study aimed to identify keywords, core topic areas, and subthemes by analyzing feedback journals written by preceptor nurses to new nurses during the preceptorship period and to derive implications through word clustering. A total of 143 preceptor nurses' feedback journals for new nurses from March 2020 to January 2021 were converted into a database using Microsoft Office Excel. Text network analysis was performed using the NetMiner 4.4.3 program. After data preprocessing, simple frequency, degree centrality, closeness centrality, betweenness centrality, and community modularity were analyzed. In the feedback journals, the most central words were "study," "medication," "practice," "nursing," "method," "need," and "effort," whereas frustration, "new nurses" had low centrality. Five subthemes were derived: (1) learning necessity to strengthen new nurses' competency, (2) independence of new nurses, (3) emphasis on accuracy in nursing skills, (4) difficulties in understanding the nursing tasks expected of new nurses, and (5) basic competency of new nurses. The results of this study highlighted the experiences of new nurses and allowed for an assessment of journal feedback content provided by preceptor nurses. As such, the study provides basic data to develop a standardized education and competency empowerment program for preceptor nurses.

The Impact of COVID-19 on the Clinical Experience and Training of Undergraduate Student Radiographers internationally: The Clinical Tutors’ perspective

IntroductionThe impact on the clinical training and education of healthcare students by COVID-19 has been documented. However, the thoughts and experiences of clinical tutors (CTs) about radiography students attending for clinical training and education during this now elongated period beyond first recognition of the virus has not been explored. This paper will discuss data collected from CTs in the UK Devolved Nations (UKDN) and the United Arab Emirates (UAE) who were compared because of their similarities in delivery based on individual ‘rules of engagement’ devised by their various health departments. AimThe purpose of this study was to examine the clinical tutors' thoughts and experiences of supervising radiography students attending clinical placement during the COVID-19 pandemic. MethodsThe UK Devolved Nations (UKDN) and the United Arab Emirates (UAE) were selected for comparison on an international level as they are geographically distinct with a comparable population and education accredited/acknowledged by the Society and College of Radiographers (SCoR). Data was collected data from CTs across the UKDN and the UAE. The study used an online questionnaire (Google Forms) with closed questions in four themes including: students' experiences, impact on students' clinical placement, attitude of the clinical staff and the potential effects of COVID-19 on future graduates’ skills and competencies. Further data was gathered on the experience of CTs mentoring students during the COVID-19 pandemic. ResultsData were collected from 59 CTs (81%, n = 48) from UKDN and (19%, n = 11) UAE. Twenty-seven (46%) respondents reported that COVID-19 had a negative impact on clinical practical experience. However, 32 (54%) identified that COVID-19 had no impact on student supervision/feedback or on clinical achievements. Eleven (19%) respondents thought that students should not have been on clinical placement during the pandemic but a further 51% (n = 30) were happy with the students on placement and expressed willingness to delegate work to students. Interestingly, 58% (n = 34) of CTs suggested that future graduates may need a longer preceptorship after they graduate due to receiving decreased clinical experience during the pandemic. Overall, 78% (n = 46) of respondents thought that students improved their clinical confidence by working directly with COVID-19 positive patients. ConclusionThe current study has identified conflicting opinions across CTs in different clinical departments. Whilst some felt that students should not be in the hospital during the pandemic, others reported that working directly with COVID-19 patients had a positive impact on students as it improved their clinical confidence. Despite the challenges presented by COVID-19, CTs were able to provide direct clinical supervision and feedback to students on clinical placement throughout the pandemic. Nevertheless, future graduates may need a longer preceptorship period due to decreased clinical experience during the pandemic. Implications for practiceClinical placements should continue during subsequent COVID-19 waves of infection or future pandemics to ensure development of skills in resilience and adaptability. Underdeveloped skills due to a decreased range of examinations can be rectified when any wave of the infection subsides by providing tailored training based on individual student's needs.

Clinical Transition Framework: Nurse Competence and Preceptor Development

Preceptorship is currently high on the policy agenda with recommendations for a mandatory period of preceptorship for nurses emanating from the Next stage review of the NHS (DH 2008) and from the Nursing and Midwifery Council's consultation on pre-registration education (NMC 2008, 9). It is heralded as a means of improving patient care by assisting new practitioners in developing clinical skills and encouraging workforce retention by supporting students in the transition to registered practitioner.

A preceptorship toolkit for nurse managers, teams and healthcare organisations.

The transition from student to newly qualified nurse can be challenging. A period of preceptorship is recommended to support newly qualified nurses in their new work environment, and to give them time to adapt and gain confidence. Researchers have developed a toolkit based on previous research that contains several resources that nurse managers, teams and organisations can use to develop and improve preceptorship for newly qualified nurses. The toolkit includes an organisational support tool, a managerial support framework, a supernumerary time tool and a local culture of support tool. This article describes these resources and gives an example of how the toolkit can be adapted locally.

Changing preceptorship to achieve better quality training and less attrition in newly qualified nurses.

The preceptorship period is of great importance in the career of a nurse, as he or she moves from being a student to a competent, accountable professional. Problems with the current preceptorship system for preceptors include not receiving adequate training-particularly in providing constructive feedback to preceptees. In addition, when a small number of nurses are repeatedly assigned preceptees to mentor, this can lead to burnout. Preceptees can feel overwhelmed by their first months as a newly qualified nurse (NQN) and can feel unsupported if a preceptor's teaching style or personality is unsuited to them. This can lead to attrition in the nursing workforce, a current problem. This article suggests a new way of organising preceptorship, by allowing preceptors to opt in to the scheme, providing a pool of energised and enthusiastic preceptors. In turn, NQNs could initially work with the pool of nurses before being given the choice of which preceptor to work with individually.

COVID-19 and student nurses: A view from England.

COVID-19 and student nurses: A view from England.

A multisite evaluation of readiness to transition to newly qualified nurse in a cohort of children's nursing students.

The post-qualifying and preceptorship period in nursing has been well-researched, however, there is limited evidence about the immediate period before qualifying. To explore the experiences of role transition of London-based final placement (FP) children's nursing students and to identify what support is required for future cohorts of students. Four London universities circulated an online questionnaire to FP students. The questionnaire content included FP student experiences, preparation for role transition and employability. Seventy seven students responded (27%). Twenty seven students (35%) felt well-prepared to transition. The main concerns included: becoming an accountable practitioner, employers' expectations and availability of support in the newly qualified period. Students wanted more employability support and the opportunity to talk to newly qualified nurses and prospective employers. Universities and clinical partners need to do more to develop better education and support for FP students and deliver it in a timely way.

Putting knowledge to work in clinical practice: Understanding experiences of preceptorship as outcomes of interconnected domains of learning.

To explore how preceptor support can assist newly qualified nurses to put knowledge to work across interconnected forms of knowledge when delegating to healthcare assistants. Current literature on preceptorship in nursing has failed to explore how competence is underpinned by knowledge frameworks in clinical practice. An ethnographic case study in three hospital sites in England (2011-2014). Data collection included participant observation, interviews with 33 newly qualified nurses, 10 healthcare assistants and 12 ward managers. Data were analysed using thematic analysis. A tool to assist newly qualified nurses to delegate and supervise newly qualified nurses during the preceptorship period was developed and piloted with thirteen newly qualified nurses in the same sites. A process evaluation was undertaken. Focusing on a key task for newly qualified nurses, delegation to healthcare assistants, we argue that preceptorship can support newly qualified nurses as they put knowledge to work in the transition from qualifying student to newly qualified nurses. In supportive ward cultures, limited access to formal preceptorship can be bolstered by team support. newly qualified nurses in less supportive ward cultures may have both a greater need for preceptorship and fewer compensatory mechanisms available to them when formal preceptorship is not available. We argue that organisational learning contexts and individual learning styles (interconnected domains of learning) are key to understanding effective preceptorship. We suggest that putting knowledge to work early in their careers with preceptorship support may assist newly qualified nurses to develop confidence and competence in delegation and supervision of healthcare assistants. Our findings suggest that newly qualified nurses need to be supported by effective preceptorship in their learning as they transition from undergraduate to post graduate. Preceptorship programmes at ward and organisational level need to recognise the intensity of the learning required during this transition phase.

Midwifery preceptorship: The next chapter

At the point of registration, the Nursing and Midwifery Council (2009: 23) states that student midwives should be able to ‘practise safely and effectively without the need for direct supervision’. However, newly qualified midwives should have a preceptorship period where knowledge and skills are consolidated while confidence in practice is developed. This period is not designed to meet shortfalls in pre-registration education; rather, it is to support registrants during the transition from student to autonomous and accountable practitioner ( Department of Health, 2010 ); in other words, the journey from novice to expert ( Benner, 2001 ). This article describes preceptorship in the context of midwifery practice and summarises the roles and responsibilities of the ‘new registrant’, the preceptor and the employer. It discusses a case study preceptorship programme, with comments from current preceptees and the practice development midwife.

Ultrasound clinical progress monitoring: Who, where and how?

Prior to assessment of final ultrasound clinical competency it is important to monitor clinical progress, provide high quality feedback and encourage skills development. The role of the supervisor, mentor and assessor are fundamental to the on-going progress monitoring of ultrasound trainees. This article forms the second part of a larger project which was to elicit ultrasound practitioners' opinions on how progress should be monitored, where and by whom. An on-line questionnaire was used to gain opinions from ultrasound practitioners. Totally, 116 responses were received from professionals with an interest in ultrasound assessment. Results suggested that experienced, qualified ultrasound practitioners should undertake the role of supervisor and assessor, having been prepared for that role by the training centre. Formative monitoring should take place both within the clinical department and possibly the training centre, using a range of methods. Following completion of the training, practitioners should have a preceptorship period to consolidate their knowledge and skills for 3 to 6 months or until further competencies have been demonstrated. Formative progress monitoring should be a recognised part of ultrasound training. Essentially, staff undertaking supervision and assessor roles should be supported and trained to ensure a high quality, consistent learning experience for ultrasound trainees. Additionally, they should provide appropriate feedback to the trainee and education centre.

Newly qualified nurses' experiences of a preceptorship.

What was the experience of preceptorship like for newly qualified registered nurses in a healthcare trust? A qualitative approach was used with data collected using semi-structured one-to-one interviews with eight participants who had recently completed their preceptorship period. The data was analysed using Newell and Burnard's (2011) Pragmatic Approach to Qualitative Data Analysis, which involved a six-stage analysis process. Two main categories emerged from the data. These were Support Requirements and Expectations of Preceptorship. Support was further broken down into two themes: time and build confidence. Expectations of preceptorship was further broken down into two themes; understanding the process and understanding the preceptor's role. The participants felt that preceptorship offered support and helped them in developing their confidence in the transition to registrant. It would appear that consistency of provision of preceptorship is a key issue that would warrant further study.

An audit into supervisors of midwives experience of supervision

An audit of supervisors of midwives' (SoMs') experience of supervision and their understanding of their role as leaders in clinical practice was undertaken. Particular attention was paid to their experiences as newly appointed SoMs during the preceptorship period. The amount of protected time that SoMs have to undertake the role was explored, including how the SoMs achieved the expectations of being leaders in clinical practice. An online audit questionnaire was sent to all the SoMs within the local supervising authority. The findings of the audit demonstrated that a significant number of SoMs did not have preceptorship or supernumerary time as newly-appointed SoMs. The audit results confirmed the findings of previous research illustrating that SoMs had inadequate time to undertake their role. There was a variation in engaging with different leadership aspects of supervision depending on the SoM's substantive post. The SoMs participating in the audit gave examples of factors that impede them in achieving the standards for their role as set out by the Nursing and Midwifery Council. The SoMs participating in the audit expressed the empowering effect of being able to facilitate women's birth choices and supporting midwives to provide high quality midwifery care.

The value of preceptorship for newly qualified midwives

The aim of the study was to examine the views and learning needs of student midwives at the point of registration in order to inform the development of a new preceptorship programme for newly qualified midwives using a qualitative phenomenological approach. Ten third year student midwives enrolled on an undergraduate BSc Midwifery programme were included in the study. Questionnaires and a focus group session were employed to collect data. Eight students returned the questionnaire and nine attended the focus group. Data were thematically analysed using an inductive approach. The results suggest that preceptorship is highly valued by the students questioned and a period of preceptorship in a maternity unit they are familiar with was highlighted as being important in building confidence. It was also suggested that preceptorship programmes should focus on clinical skills enhancement, ward management and socialisation into the workplace.

The role of healthcare support workers in providing palliative and end-of-life care in the community: a systematic literature review

Despite the widespread use of Health Care Support Workers (HCSWs) in providing palliative and end-of-life care, there is little information available about their contributions towards supporting patients who want to be cared for at home or to die at home. Between January and April 2011, a systematic review was conducted to address two questions: (i) What particular tasks/roles do HCSWs perform when caring for people at the end of life and their families to comply with their desire to remain at home?; (ii) What are the challenges and supporting factors that influence HCSWs' ability to provide palliative and end-of-life care in the community? Databases searched for relevant articles published between 1990 until April 2011 included CINAHL, EMBASE, PsychINFO, British Nursing Index, Web of Science, Medline and ASSIA. In total, 1695 papers were identified and their titles and abstracts were read. Ten papers met the eligibility criteria of the study. After the methodological quality of the studies was appraised, nine papers were included in the review. Judgements regarding eligibility and quality were undertaken independently by the authors. The findings indicate that HCSWs invest a great deal of their time on emotional and social support as well as on assisting in the provision of personal care. They are also involved in providing care for the dying, respite care for family members and offer domestic support. Although it is important to acknowledge the many positive aspects that HCSWs provide, the findings suggest three challenges in the HCSWs role: emotional attachment, role ambiguity and inadequate training. Support factors such as informal peer grief-support groups, sense of cohesiveness among HCSWs and task orientation enabled HCSWs to overcome these challenges. To conclude, induction and training programmes, a defined period of preceptorship, appropriate support, supervision and clearly defined role boundaries may be helpful in reducing the challenges identified in HCSWs' roles.

‘SINK or SWIM’: The experience of newly qualified midwives in England

Objective to explore newly qualified midwives' and preceptors' view of the preceptorship period. Design qualitative design utilising focus groups as a means of collecting data. Setting hospital trusts partnered with three Universities in England. Participants in total there were 62 participants; 40 newly qualified midwives, 20 preceptors and two practice development midwives participated in focus group interviews. Findings the findings suggested that newly qualified midwives and preceptors found it difficult to meet due to time constraints and either working different shifts or in different clinical areas. In addition three main themes emerged in relation to what affected effective preceptorship. The most important areas to improve the preceptorship period were to appoint midwives responsible for the organisation and support of newly qualified midwives. In addition, each new midwife should have a programme tailored to their needs which avoids repetitive learning. Conclusions the transition period causes anxiety for newly qualified midwives, especially when there is a long delay between qualification and taking up their first post. There appears to be some confusion over induction and preceptorship paperwork. The majority of midwives described their initial experience of working as a qualified midwife as ‘SINK or SWIM’.

Oncological outcomes of laparoscopic colon resection for cancer after implementation of a full-time preceptorship

The learning curve for laparoscopic colectomy (LC) is considered long and difficult. The presence of a preceptor may shorten the learning curve of LC and ensure adequate oncologic and short-term results. City of Hope implemented a full-time LC preceptorship between September 2004 and March 2006 with one experienced surgeon assisting other surgeons. We review our outcomes with laparoscopic colon resection for colon adenocarcinoma after implementation of this preceptorship. All cases of laparoscopic colon resection for adenocarcinoma performed from September 2004 to April 2009 were retrospectively reviewed. We compared the patients in two groups: group 1 had surgery performed during the preceptorship period from September 2004 to March 2006 (n=39) and group 2 had procedures done between April 2006 and April 2009 (n=74). Clinical characteristics evaluated included sex, age, body mass index (BMI), ASA level, and history of previous abdominal surgery. Postoperative variables evaluated included type of operation, conversion to open surgery, estimated blood loss (EBL), operation time, stage, number of harvested lymph nodes, time to liquid diet, postoperative stay, complications, and 30-day mortality rate. Kaplan-Meier survival curves were constructed based on disease-free survival (DFS) and overall survival (OS). One hundred thirteen patients underwent LC for adenocarcinoma during the study period. Mean age and BMI were similar between the groups. There was also no significant difference in conversion rates (10.3% vs. 13.5%, p=0.77) or total complications (25.6% vs. 41.9%, p=0.088) between groups 1 and 2, respectively. There was a significantly greater number of lymph nodes removed in the post-preceptor period (20.3 vs. 15.8, p=0.007). The 3-year DFS rate was 96.5%, with a mean follow-up of 22.8months, and the 3-year OS rate was 88.9%, with mean follow-up of 22.1months, for the entire cohort. Implementation of a program with a full-time preceptorship can help institutions overcome the challenges of laparoscopic colectomy and achieve acceptable postoperative and oncologic outcomes.

Fitness for practice in nursing and midwifery education in Scotland, United Kingdom

The aim of this paper is to report findings from a major study that evaluated the Fitness for Practice nursing and midwifery curriculum in Scotland, UK. The competence of student nurses and midwives at the point of registration has been the focus of debate and research. However, no major study, on such a large scale, had specifically evaluated pre-registration programmes to determine whether they enabled students to achieve 'fitness to practice'. The study had a broad evaluation design conducted in three phases using a mixed methodology. Phase 1 involved questionnaires, Objective Structured Clinical Examination's (OSCE) and curriculum evaluation. Phase 2 involved semi-structured interviews (some telephone) and focus groups across main stakeholders: students (n = 78), mentors (n = 78), practice-education facilitators (n = 24), academics (n = 59), senior clinical (n = 46) and education managers (n = 16), service users and carers (n = 10). The findings suggest that the Fitness for Practice curriculum model in Scotland has on the whole been successful. The key finding is the predominant opinion of stakeholders that newly qualified nurses and midwives are perceived as being fit for practice at the point of registration. A perceived lack of confidence is, as with all transitions to new roles, an understandable outcome. Previous concern that student nurses and midwives are not 'fit for practice' has focused on the perceived lack of clinical skills at the point of registration, not on competence to practice in general. This study demonstrates that this is an important distinction and recognises that registration is only the beginning of a life long learning experience. Students need to be supported to develop their confidence following registration as well as additional skills in their chosen field of practice. Appropriate mentorship and a period of preceptorship should be in place to accommodate this.

Building Reflective Practice through Preceptorship: The Cycles of Professional Growth

A preceptorship process for newly qualified occupational therapists is presented, highlighting the importance of reflective practice within the preceptorship period to extend the skills of new practitioners and to promote professional growth. Models drawing on the learning cycle (Kolb 1984) are used to explore links between the processes of reflective practice, continuing professional development and preceptorship. This opinion piece introduces the National Health Service Knowledge and Skills Framework (Department of Health 2004) as a development tool and summarises the findings of a pilot study to show how preceptorship supports graduates in maintaining good habits of reflective practice and continuing professional development.

Calls for support system to counteract discrimination faced by overseas staff

Overseas nurses should undergo a period of preceptorship after registering with the Nursing and Midwifery Council (NMC), an independent study has recommended.

There for us': Exploring preceptorship among newly qualified Child Branch staff nurses

A qualitative study (N=6) was undertaken examining the experiences of newly qualified staff nurses following Project 2000 Child Branch education, within which the experience of preceptorship was explored. All staff had an allocated preceptor, but experienced the process with varying degrees of success. In-depth interviews were undertaken at five months post-qualifying: content analysis of the data revealed a number of themes relating to the process of preceptorship, and the staff nurses' views of factors which either promoted or hindered its effectiveness. Factors contributing to successful preceptorship appeared to be: the availability of the preceptor; planning of learning objectives; ongoing feedback regarding progress; the enthusiasm and commitment of the preceptors for their role. In no case did preceptorship appear to have a formal structure and it was unclear what criteria would be used to assess staff performance at the end of the preceptorship period. This paper examines the background to preceptorship and the debate concerning its structure and intended outcomes. The experiences of the study participants are then examined in the light of this discussion. The study identifies some fundamental questions about the nature and process of preceptorship.