T Competence And Innovation In Preceptor Development .
J O U R N A L F O R N U R S E S I N S T A F F D E V E L O P M E N T Volume 24, Number 2, E1–E6 Copyright A 2008 Wolters Kluwer Health l Lippincott Williams & WilkinsTo meet the challenges inherent to the 21st.century healthcare environment, preceptors.require specific preparation for their. Competence and.teaching/mentoring role, as well as resource.and policies that support this. Innovation in Preceptor materialsinstructionalwork. One of the challenges. Development: Updating facing the Vermont nurse leaders wasteaching direct care providers how to.develop critical thinking skills in novice staff. Our Programsmembers. The Vermont Nurse Internship.Project approached this challenge in a.collaborative manner and has ‘‘raised the. Susan A. Boyer, MEd, RNbar’’ for preceptor development with.statewide, standardized, research- and.theory-based preceptor instruction and.support. Based on 7 years of intensive work.with preceptor development, the nurse.leaders have added to the role and.responsibilities of the preceptor by.delineating the Protector and Evaluator.components of the role and specifying critical.thinking development, documentation of.evidence, and team leading responsibilities.PROJECT FOUNDATIONThe Vermont Nurse Internship Project (VNIP) is a statewide nurse leadership initiative that includes representation from academia, various practice settings, andregulatory agencies. This coalition has developed anurse internship model that supports the transitionfrom school to practice in diverse settings. With 6 yearsof experience in working with interns and their preceptors, the nurse leaders who developed the VNIPhave learned many lessons and have establishedevidence-based practices related to intern and preceptor development. Two unique features of this projectinclude the collaboration between education, practice,and regulation and statewide standardization of anexpanded preceptor curriculum.THE VNIP—A STATEWIDE NURSINGWORKFORCE DEVELOPMENT PROJECTIn 1998, the Vermont Organization of Nurse Leaders(VONL) recognized that there was a nursing shortage.Susan A. Boyer, MEd, RN, is Executive Director, Vermont Nurses inPartnership, Inc., Windsor, Vermont.They commissioned research to determine the futureimpact on health care in Vermont (Vermont NursingReport, 2006) and then developed strategies for addressing it. The strategic goals that resulted from thiswork include the following:V. Create a formal nursing internship program thatprovides adequate practical clinical experience for novicenurses to function at a competent level when they enterthe work force. This would force a marriage of schoolsof nursing and fields of practice that could strengthenboth institutions, while promoting the preparationof nurses able to handle the currently complex anddemanding field of health care.VI. Expand clinical opportunities for students by increasingthe use of clinical staff as preceptors in specialty areas(Current State of Nursing in Vermont, 1999, p. 10).In the fall of 1999, the VNIP was initiated with grantfunds for a 1-year, part-time position that wouldspearhead the development and pilot test of an internship that could be implemented in multiple agenciesacross the state. Seven years later, it continues with afull-time director and specific clerical support. Theproject now works to serve strategic goals throughcontinued collaborative work with schools and agencies. A key component of the VNIP work is preceptorJOURNAL FOR NURSES IN STAFF DEVELOPMENTCopyright @ 2008 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.E1
TABLE 1Outcomes—Transition Process.development. Preceptors are the delivery agents forthe internship, and they shape the culture of theworkplace as one of nurture and support. . .or not.Vermont is the only state in the nation that hasstandardized preceptor and intern development on astatewide basis. The VNIP has also expanded the development of preceptors to include how to developcritical thinking capability in others, the protector role,and application of the Competence Outcomes and Performance Assessment (COPA) model and clearly definedexpectations for evaluation or competence validation.Research- and theory-based educational preparationfor the preceptor role is essential to success for boththe intern and preceptor. As of May 2006, the VNIP hasdelivered preceptor education to over 1,300 Vermontemployed healthcare providers. Feedback from programparticipants has been used to shape the educationaldelivery, modify the content, and evaluate the effectiveness of agency support/resources for preceptors.Anecdotal feedback assures us that we have beensuccessful in changing the workplace culture to one ofsupport and nurture for the new graduate and new-tospecialty nurse. Managers, educators, and colleagues report marked improvement in the ‘‘transition-to-practice’’process (see Table 1). Quantitative data show thepositive impact on recruitment, retention, and vacancyrates (see Table 2).21ST CENTURY PRECEPTOR DEVELOPMENTTo ensure that preceptor development is effective for21st century healthcare needs and demands, VNIP reE2evaluated the approach to preceptor education andsupport. In 2001, academic educators joined the preceptor development team in evaluating and revisingthe educational preparation for preceptors. They workedwith staff development specialists to modify the curriculum to fit the existing position requirements andbrought an approach that teaches the foundations ofresearch and theory behind the ‘‘skills’’ or ‘‘tools’’used. This approach is in direct contrast with the traditional staff development process that provided a ‘‘justenough, just in time’’ type of preparation. One of thefindings in the ‘‘Novice-to-Expert’’ Theory (Benner, 1984)was that nurses often knew about ‘‘how to do’’ something without knowing ‘‘why to do’’ it. With this inTABLE 2Outcomes—Recruitmentand Retention.For the initial pilot test, 49% of the nurse interns camefrom out-of-state residence and/or schools.Retention data from tertiary care center—Retention ofthose who completed their orientation in 1999 was75%, whereas the new graduates who completed aninternship showed a 93% retention rate for each ofthe following 2 years.Position vacancy rate—At one participating agency, themedical–surgical unit had suffered an unrelentingvacancy rate of 20%. This agency credits the internship/preceptor program with the current vacancy rate of0% for the entire nursing department.March/April 2008Copyright @ 2008 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
mind, instead of teaching preceptors how to use formsand tools, we instruct about why/how (or why not)these forms, tools, and approaches are effective. We arebuilding a cadre of care providers and educators whouse this comprehension of communication, teaching/learning process, and interpersonal relationships in allof their interactions with clients and colleagues.Experiential LearningWhen educating preceptors, the roles of socializer, educator, and role model (Alspach, 1988) have traditionallybeen considered as the core responsibilities. Thesecomponents are fundamental but do not include themost important roles of the preceptor. Along with thetraditional expectations, preceptors fill the functions ofprotector, evaluator, and team leader/builder. To support these additional roles, we have added educationalcontent specific to the foundation components ofsafety administrator (protector) and competency validator (evaluator), in addition to focusing attention onhow the preceptor’s team leadership skills are essentialto the socializing and protecting roles (see Figure 1).With healthcare systems focused on the preventionof errors, the role of protector, or safety administrator,is the essential foundation of the preceptor’s job.The preceptor protects safety for the client, novice,and, sometimes, colleagues of the new hire. Being a‘‘protector’’ is not a new role. As professional nurses,we are constantly on guard to ensure safe and effectivecare for clients. At the same time, the preceptor needsto provide a safe learning environment, one where thenovice feels safe to learn, to ask questions, and to evenmake mistakes and learn from them. A safe learningenvironment includes a teaching/learning approach thatbuilds simple to complex, encourages independent practice, plans for success, ensures consistent observation,provides ongoing feedback/encouragement and monitors to protect the safety of both novice care providersand clients. In the protector role, the preceptor mustestablish a team approach to the development of novices. This requires the preceptor to be a team leader,communicator, and conflict resolver. The preceptor recruits the full healthcare team to support both the development and evaluation of the novice. After assessing thelearning needs, team members provide support andinstruction as the novice develops and practices specificskills and tasks. To ensure safe and effective care forclients, the preceptors will not allow the novice to practice independently until basic capability or ‘‘competence’’is demonstrated. Competence evaluation is another aspect of evidence-based care. Demonstration of capablepractice is the ‘‘evidence’’ that is collected that validatesthat this person can provide care in a safe and effectivemanner. The preceptors are challenged to respond tothe question, ‘‘What evidence do you have that thisFIGURE 1 Preceptor roles and responsibilities.JOURNAL FOR NURSES IN STAFF DEVELOPMENTCopyright @ 2008 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.E3
person can do this in a safe and effective manner?’’When preceptors have the answer to this question, theyhave fulfilled their protector role as it relates to providing safe and effective care. When the novice has beenable to provide evidence of his or her capability to provide safe, effective care in a supportive environment, thepreceptor has fulfilled his or her protector role as itrelates to protecting the novice.Defining competence is the first step in any evaluation process. In the VNIP, performance scoringguidelines are based on the performance categoriesdelineated in the Novice-to-Expert Model (Benner,1984). This requires further exploration and discussion for preceptors because the competent level ofpractice within ‘‘Novice to Expert’’ often requires 2 to 3years of development. For use in an orientation orinternship, the capability level for independent practice is actually that of advanced beginner. The VNIPcoalition defined this basic level of competence as‘‘Capable’’—familiar with skill/equipment but mayneed assistance and seeks help when unfamiliar withprocess/skill. The evaluation assessment avoids theterm competent while building on the link between theminimum requirements for safe and effective care andthe Novice-to-Expert Model (see Table 3).The ongoing emphasis on competency assessmentbrings into focus the role of evaluator or competencevalidator. This role highlights the evaluation and examination aspects of the preceptor’s responsibilities.The preceptor must determine and communicate thetransition in his or her role between being the educator who teaches and nurtures and being the competency validator who is there to evaluate performanceinstead of assisting. Evaluation is an essential component of ensuring safe and effective care for patients.The evidence of capability is documented and retainedin the employee record. This is also the evidence thatmay be used to determine that this novice is not suitable for the setting within which he or she is a noviceTABLE 3Performance and Self-AssessmentScoring Key.1. Identified limitation—requires direct guidance andsupport; little or no experience with skill2. Capable—familiar with skill/equipment but may needassistance; seeks help when unfamiliar with process/skill3. Performs independently—knowledgeable to performthese tasks safely as a result of training and experience4. Proficient—extensive experience in this area/skill; ableto teach and mentor others5. Expert—develops the capability/thinking of colleaguesand ensures evidence-based practiceE4practitioner. To accomplish this effectively, the competence assessment tool needs to be based on ‘‘clearlydefined expectations,’’ which are specific, measurable,performance-based criteria. The VNIP has accomplished this through use of the framework establishedby Lenburg (1999): the COPA Model. Within thismodel, each care provider has competency outcomesand performance criteria statements identified thataddress specific behaviors representing each of theeight core practice competencies: assessment and intervention, communication, critical thinking, humancaring and relationship skills, teaching, management,leadership, and knowledge integration. This frameworkshifts the focus away from the traditional ‘‘grocery list’’of tasks and procedures and instead highlights thedirect care behaviors that comprise the critical thinking, organization, leadership, and interpersonal skillsthat are essential to effective practice in health care. Anadditional advantage of using this framework includesits applicability for all direct care providers. Having auniversal approach for both the preceptor instructionand the resulting competency assessment fosters ateam approach to development and support for preceptors and staff.Team leading is a factor within all the work that thepreceptor undertakes. In the role of team leader, thepreceptor recruits colleague support and assistance forthe development and observation of the novice. Thepreceptor builds the communication, teamwork, andinterpersonal interactions that provide for successfulteaching/learning, while creating a workplace cultureof support and nurture. The preceptor ensures communication among manager, novice, and/or educatorand resolves conflicts if they arise. Ensuring colleaguesupport for the novice is often the greatest challenge.Too often, the attitude of colleagues has been, ‘‘Thereare two of them, and they can take that extra admissionand the post-op patient!’’ Instead, we need a workplace culture that recognizes the additional work involved in precepting and the time investment requiredfor success, one that views the success of the novice asa joint responsibility rather than ‘‘the preceptor’s job.’’The African proverb, ‘‘It takes a village to raise a child’’is an appropriate axiom for this role, because it takesthe entire work team to create the workplace cultureand socialization that ensures safe, effective practiceand the retention of novice nurses.In updating the ‘‘educator role,’’ we need to teachpreceptors how to develop critical thinking skills in thenovices and colleagues with whom they work. Often,the selected preceptor has been in practice longenough that he or she did not receive any instructionspecific to critical thinking within basic nurse education. Thus, there is a need to teach on three differentlevels: What is critical thinking? How do you do it? HowMarch/April 2008Copyright @ 2008 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
do you foster it in others? Preceptors report that it isfar more difficult to develop the right question to askthan to give the novice an answer from their more‘‘expert’’ experience base. It is crucial to rememberthat answering the question for the novices is equal todoing their critical thinking for them.Another critical thinking challenge that preceptorsface is evaluation. Some find it hard to visualize how tomeasure this vital skill in a colleague or novice. TheVNIP competency tool identifies some of the criticalthinking behaviors with critical element statementssuch as the following: Practices within limits of experience/capabilitySeeks assistance/information correctlyIntegrates data obtained from multiple sourcesExplains diagnostic reasoningPrioritizes care needs and tasks correctlyApplies population- and disease-specific considerations in planning and providing careInitiates/supports discharge planning throughout careThis list of behaviors provides clearly defined expectations for both the preceptor and the novice inrelation to critical thinking in daily practice. The otherseven core practice competencies are defined withbehavioral outcomes in the same manner, and theyoutline the entire role of the nurse in the identifiedsetting. Each specialty area has additional pages thatoutline the practice that is unique to the specialty.INSTRUCTIONAL PROCESSFor the initial preceptor development, a preassignmentand a 2-day workshop lay the foundation for instruction. Content areas include roles/responsibilities, noviceto-expert theory, competency development/assessment,delegation and accountability, teaching/learning theory,communication, personality styles and generational/cultural barriers to communications, critical thinking,preceptor program experiences, team building, anddevelopment of clinical coaching plans. The teachingmethod for each topic includes small group work, casescenarios, and/or individual surveys, thus addressingdifferent learning styles and maintaining interactivelearning throughout the sessions. The self-learningmodule and workshop are approved for a total of 18.6contact hours of continuing education, yet workshopparticipants consistently request more time and moreinstruction related to communication, conflict management, and working with ‘‘problem’’ learners. Otherrequested topic areas include change theory, emotionalintelligence, and more on reflective practice.Along with standardizing the educational preparationand competency expectations, the VNIP has createdstandardized clinical coaching plans. These coachingplans provide a guideline for the educational processfor novices who have specific learning needs. They areteaching plans that are based on specific learning goals,and the concept is similar to that of using standardizedpatient care plans. These coaching plans simplify theprocess for preceptors and the novices with whomthey work by offering specific learning activities andmeasurable, behavior-based outcomes that serve theparticular performance goal. Each page starts with bulleted reminders to ensure follow-through on documentation, computer skills, planning of learning experiences,and discussion time. The coaching plans require specific documentation that supports critical thinking development, encourages case scenario exploration and‘‘what ifs,’’ and fosters the feedback cycle.Preceptor education participants have consistentlyrequested practice with the tools with which they willbe working. Prior to implementation of the internshipproject, there was no consistency in forms or approach. In fact, different units within an agency oftenused different systems and format. Basing the VNIPcompetency assessment on the COPA model framework and the establishment of clinical coaching planshas standardized the approach for both the development and evaluation of competence. Within Vermont,all the acute care, public health, and most of the visiting nurse and long-term care agencies are using thesame competency expectations for new-graduate internships. Most of these sites use the same form and processfor all orientation of new staff.The VNIP has standardized preceptor developmentstatewide. All preceptor education is taught from thesame teaching plan and outcome objectives. Presentation resources are developed by content experts andshared with colleagues across the state. This vitalinstruction is offered in all regions of the state and forall direct care providers—from across the co
critical thinking capability in others, the protector role, and application of the Competence Outcomes and Per-formance Assessment(COPA)model and clearly defined expectations for evaluation or competence validation. Research- and theory-based educational preparation for the preceptor role is essential to success for both the intern and preceptor.
UNI 1 NATURA CIENC LEARN TOGETHER PRIMARY 3 33 LIN Competence in linguistic communication MST Competence in mathematics, science and technology DIG Competence in the use of new technologies LTL Competence in learning to learn SOC Competence in social awareness and citizenship AUT Competence in autonomous learning and personal initiative CUL Competence in artistic and cultural awareness
2. Self-assessment 2 Metacognition and self-regulation 2 Self-assessment of competence 4 Self-assessment accuracy 4 Self-assessment of driver competence 5 3. Assessing perceived competence 8 Constructs of perceived competence 8 A construct for perceived driver competence 9 Instrument development 10 4. Validity theory 12
orientations and perceived competence, and goal orientations and intrinsic motivation, how these constructs interrelate is still in question. Theory and research suggest that task and ego goal orientations are linked to perceptions of competence, intrinsic motivation, and effort and that perceptions of competence and intrinsic
The Effectiveness of Mind Mapping and Brainstorming Techniques to Teach Writing to Visual and Read Write Learning Style Students Syntax Literate, Vol. 4, No. 5 Mei 2019 65 competencies derived from language system (linguistic competence, sociolinguistic competence, discourse competence and strategic competence), macro-skills (productive; speaking and writing, and receptive skills; listening .
Intercultural Competence Intercultural competence . is the capability to accurately understand and adapt behavior to cultural difference and commonality. Intercultural competence . reflects the degree to which cultural differences and commonalities in values, expectations, beliefs, and practices are effectively bridged, an inclusive .
the root of all competitive advantages lies core competence (Torkkeli and Tuominen, 2002). Therefore core competence is a critical strategic tool in understanding the foundation of competitive advantage. According to Prahalad and Hamel (1990) competence and core competence are actually different concepts.
clinical, non-clinical, and interpersonal standards. Measuring competence is essential for determining the ability and readiness of health workers to provide quality services. Although competence is a precursor to doing the job right, measuring performance periodically is also crucial to determine whether providers are using their competence on .
Cultural competence needs to be seen as a continuum from basic cultural awareness to cultural competence; effort must be made to move beyond knowledge towards cultural sensitivity and competence (Adams, 1995). Developing sensitivity and understanding of another ethnic group Cultural awareness must be
