Preceptorship Handbook by linzhengnd


									           Preceptorship Handbook

                         Preceptor Edition

                                Revised 2009

Skagit Valley College  Bellingham Technical College  Whatcom Community College
Increasing attention has been given by both nursing service and nursing education to the preparation of the new
nurse. The clinical preceptorship program has been developed to provide a stronger clinical experience in the final
quarter of the Registered Nursing Program.

The basic concept of the preceptorship program is the pairing of a student preceptee with an experienced,
competent registered clinical preceptor over a five to six week period. The preceptorship experience is designed to
provide a "bridge" for the graduating nurse, a bridge between the student role and the staff nurse role. This
transition time not only helps the student preceptee refine their technical skills but also practice and develop skills
in priority setting, problem solving, making clinical judgments and working within a team. The clinical preceptor
provides a role model for the student preceptees as they refine their skills and prepare for the transition to a
Registered Nurse.

Increased stability in the student preceptee’s assignment will result as she/he works on a unit with one nurse over
the course of 10-15 shifts (or the equivalent to 120 hours), develops competency in providing holistic
comprehensive nursing care and develops managerial skills necessary to competently care for patients. We believe
this approach with increased collaboration between nursing service and education will result in a new graduate who
will have a smoother transition from student to staff nurse and who will be better prepared to provide quality patient

However, most of them will have limited experience in responsibilities as a team leader or primary nurse. They
must satisfactorily complete the objectives of the preceptorship in order to complete the program. You will be
directly involved in assisting them in this period and in providing feedback about their performance.

Preceptor Role
Responsibilities of the clinical preceptor include:
   1. Complete the preceptor preparation by reading the preceptor handbook.
   2. Serve as resource person, involved in the teaching and supervision of one student preceptee
   3. Establish a mentor type rapport with the student preceptee.
   4. Share usual assigned workload with the student preceptee, providing quality client care and an opportunity
       for the student preceptee to meet learning objectives.
   5. Let the preceptee help set the pace.
   6. Give the preceptee increasing responsibility as the experience progresses.
   7. Give the preceptee feedback on a daily basis.
   8. Assess learning needs of the student preceptee and discuss those needs with the preceptee as well as the
       faculty liaison.
   9. Provide someone to answer questions when you are off the unit.
   10. Arrange a substitute clinical preceptor in the even of absence.
   11. Take breaks together, and meals if mutually agreeable.
   12. Evaluate the student preceptee’s clinical competency, using the tools provided, throughout the
   13. Meet with the faculty liaison a minimum of three times during the preceptorship.

Thank you for volunteering to be a clinical preceptor. For our purposes the clinical preceptor is seen as an
experienced and prudent advisor who can coach, trust, and than let go of the preceptee as she/he assumes the role of
a beginning registered nurse. Obviously, it takes a special person to be a clinical preceptor. According to student
preceptees in past preceptor programs, the most durable quantities in a preceptor are: a good role model, open,
honest, supportive, calm, confident, relaxed, organized, humorous, and concerned.

                  Skagit Valley College  Bellingham Technical College  Whatcom Community College
How can I help the student preceptee feel a part of the unit where I work? What’s the best way to let my co-
workers know what the student preceptee is doing and how my role has changed?
In other settings this has been a problem for the preceptor, preceptee and other staff on the unit. Well into the
experience, staff still didn’t know what the preceptee was doing, how she/he was different from other student
preceptees, or why she/he was working on a one-to-one basis with an RN. This situation may cause confusion as
well as frustration on the part of all persons concerned. Here are some steps to alleviate this confusion:
    1. Introduce the preceptee to the entire staff.
    2. Clarify roles and expectations if necessary.
    3. Make rounds with the preceptee.
    4. Give the preceptee a tour of the unit.
    5. For the first shift, let the student preceptee follow you to learn the routines.
    6. Identify stressors that may be present, for you or the student preceptee.

Why do I have to confer with the preceptee on a daily basis? How can I possible fit it into my busy schedule?
First, acknowledge that becoming a clinical preceptor is an additional responsibility. Manager/directors have been
asked not to increase your patient care responsibilities with the rationale that “there are two of you doing the work”.
Because there never seem to be enough hours in the day, planning is the key to establishing, fostering, and
maintaining the preceptor/preceptee relationship. Therefore, it is important that you and your preceptee agree on a
daily time to talk over the events of the day, discuss future plans, review objectives, and share feelings. These
meetings may be longer in the beginning of the preceptorship while you are establishing rapport, and only five to
ten minutes in the end when your trust in each other is established.

The preceptee will be anxious; and unsure of her/his abilities. In school she/he receives positive and negative
feedback on a regular basis. At this point in the preceptee’s growth and development she/he needs daily feedback
from you. This feedback provides the preceptee with a clear picture of how she/he is doing, what areas need
improvement, and what areas are strong.

Besides giving daily feedback, what other things can I do to let the preceptee know that I have confidence in
her/his abilities?
According to past preceptees, daily feedback is the top of the list, but other things you can do include:
    1. Once you’re reasonably sure she/he can function safely, you can discontinue checking everything (except
        those skills on the student limitations list below) the preceptee does.
    2. Let the preceptee take on responsibilities that she/he feels capable of handling and you feel comfortable
    3. Refer staff members to the preceptee for direction, assistance, and/or consultation.
    4. Toward the end of the experience, step back and let the preceptee handle the workload, particularly when
        things get a little hectic.

Do I make the preceptee’s daily assignment?
After a shift, or maybe two, of which the student preceptee being a shadow, you can jointly plan an assignment
which will consist of the preceptee in meeting her/his personal goals, clinical skills, objectives, and the course
objectives. Keep in mind that preceptee’s abilities vary as do staff members’. Assignments should increase in levels
of difficulty as the preceptee masters each skill. It is anticipated that by the end of the clinical experience the
preceptee will be able to function safely as a beginning nurse in a team leading or primary nursing position.

The faculty liaison will assist you in assessing the preceptee, identifying learning needs, and planning learning
experiences. This is particularly true in the first few days of the experience when you and the preceptee may both
be feeling anxious about your new roles. The faculty liaison is always available by phone or pager whenever the
preceptee is on the unit for questions or concerns.

                 Skagit Valley College  Bellingham Technical College  Whatcom Community College
I’m not sure what kinds of issues I can or should discuss with the faculty liaison.
   Faculty liaisons have identified a variety of areas that they feel are important for you to share.
   1. It is important to establish rapport early in the experience, and let the faculty liaison know what is
       happening with the student preceptee and how things are going even if there are no problems.
   2. Don’t ignore your intuition-the faculty liaison is a good person which whom to validate those hunches
       about a student preceptee.
   3. Being a teacher is a demanding role, so share your feelings with another teacher, the faculty liaison, another
       preceptor (remember to maintain confidentiality about your preceptee) or your supervisor.
   4. The faculty liaison needs to know about mundane things like schedule changes, floating to other units, or
       working double shifts.
   5. Interactions with the faculty liaison are confidential, so feel free to discuss; strong feelings concerning the
       student preceptee, problems the preceptorship may be causing, or anything about the experience. Give
       yourself permission to get support and feel better about a situation.
   6. Remember the main function of the faculty liaison is to solve problems with you. If the time the faculty
       member makes rounds is not convenient for you to talk, identify a more convenient time for her/him to
       return and discuss issues.
   7. If the faculty liaison is not available to discuss an issue with her/him it is important to speak to someone, so
       do not hesitate to discuss problems with the faculty liaison’s Director. Do not let a problem get out of hand.

What if the student preceptee makes a mistake, for example a medication error or is not performing up to
the standards of practice?
First, assess the patient’s condition. Then follow agency protocol for paperwork and informing the physician. If the
client was harmed as a result of a student preceptee’s act, call the faculty liaison as soon as possible. If no harm
occurred, notify the faculty liaison the next time you see her/him.

Am I responsible for the student preceptee’s actions?
As a registered nurse, you are responsible for others under your supervision. If you have worked with student
preceptees before as a team leader or primary nurse, you have had some responsibility for them. While serving as a
clinical preceptor, you will probably know more about your preceptee’s ability and supervise her/him more closely
than you have with student preceptees previously. The faculty liaison is also responsible for the student preceptee’s
actions, even when she is not in the hospital. Student preceptees are provided with malpractice insurance. This is
encouraged but not required for clinical preceptors.

What if I am absent?
We realize you may be absent from work during the preceptorship either for personal reasons or low census. An
alternate clinical preceptor should be selected to be your substitute. If you anticipate an absence, assist in arranging
for the preceptee to work with the alternate or another staff RN, if the alternate is not available. This may not be
appropriate in all cases/settings, in which case rescheduling may be necessary. Student preceptees will be told they
may have to deal with last minute changes in case of emergency or your absence. If they are assigned an alternate
preceptor the student preceptee should share their goals and progress with the clinical preceptor alternate or staff
RN and jointly plan an assignment.

Student Preceptee Role
The student preceptee is expected to arrive on their assigned unit at least 15 minutes prior to the beginning of the
shift in order to get a head start. They should be prepared with your assignments, patient reports, and their
organization tool.

Responsibilities of the student preceptee include:
   1. Identify in writing specific clinical objectives and share them with you.
   2. Develop plans with you in order to meet these objectives.
   3. Work under your supervision or designees.
   4. Achieve the clinical objectives at a satisfactory level.
   5. Participate in evaluation of the experience.

                  Skagit Valley College  Bellingham Technical College  Whatcom Community College
Student Preceptee Limitations
RN supervision is required for:
    1. Venipuncture, phlebotomy; conversion to/from IV to saline lock
    2. IV fluids and medications including saline/Heparin lock flush
    3. Blood transfusions
    4. Transferring a patient to or from OR, PACU, ICU, or ED
    5. Verbal or phone orders from physician (see verbal order sheet, next page).
    6. Transcribing orders
    7. Signature in narcotic book, consent forms, admission and discharge sheets and on blood transfusion sheets
        must be countersigned
    8. Changing dressings on central lines or other complex procedures
    9. TPN
    10. All pediatric medication dosage calculation and administration
    11. All parenteral medication calculations
    12. All insulin preparation
    13. All Heparin preparations
    14. Any procedure the student has not previously performed

Student preceptees may not do*:
     1. Arterial sticks or draw arterial blood from arterial catheters
     2. Defibrillation or cardioversion
     3. Administration of antineoplastic agent
     4. Administration of medication via intrathecal catheter
     5. Verbal orders from a physician
     6. Continuous epidural marcain infusion and sedation procedures
     7. PICC line insertion and dressing change
     8. Intraaortic balloon pump
     9. Accessing AV grafts
     10. Burn dressing changes
     11. Suturing
     12. Prostaglandins Gel (and any new derivatives of same) administration
     13. Intrauterine catheter placement
     14. Amniotomy
     15. Scalp lead insertion/removal
     16. Cardiac sheath removal
*If there are “do not” skills that are performed regularly in the area in which the student preceptee is assigned
they may be addressed in the weekly goals statement. Permission from you and faculty is necessary prior to
performing any of the skills on this list.

Taking Phone Orders
Students are still legally unable to take orders alone until they are hired by the institution.
   1. Try a three-way phone conversation.
           a. Verify that you will be present for clarification and assistance during phone order.
           b. Have the student clearly present patient condition, situation, concern to physician with
                corresponding data or assessment information.
           c. Repeat the order back to the physician, for full clarification of order.
           d. Write down the order as physician phone order
           e. Write the order, order date and time, the physician’s name and your name on the Physicians’ order
                sheet. Then co-sign the sheet. You must be present, listening and verify the physician’s order
                through your signature.
   2. Before calling the MD, make sure the student preceptee has:
           a. Chart and med sheets
           b. Recent vital signs or other data, if pertinent

                 Skagit Valley College  Bellingham Technical College  Whatcom Community College
    3. Know what the goal of the conversation is and what results are necessary.
          a. Collaborate and problem solve with preceptee regarding purpose or goal for phoning physician
             about patient condition.
          b. Prepare and gather all potential assessment and necessary information related to patient prior to

Signing Off Orders
    1. The unit secretary will take off orders and put into the computer.
    2. S/he will update Kardex according to the new orders.
    3. The student preceptee will then double-check everything.
    4. Sign your name, title, time, and date.
    5. You will check and co-sign the orders (you have the legal responsibility for the orders).

Faculty Role
Responsibilities of the faculty liaison include:
   1. Work with faculty to identify clinical preceptors.
   2. Work with you in planning, implementing, and evaluating student preceptee learning experiences and
   3. Acting as a resource and facilitator to the preceptee learning experience as well as the preceptor mentoring
   4. Distribute the clinical competence evaluation tool and preceptor packet.
   5. Meet with you and student preceptees
   6. Serve as trouble shooter and problem solver with you and the student preceptee.
   7. Maintain attendance and other administrative records.
   8. Assign grades for the course.

Preceptorship Objectives
   1. Demonstrate critical thinking, reflection, and problem-solving skills.
   2. Embrace and exhibit personal ethics of social responsibility and service.
   3. Practice preventative health care.
   4. Explore the interdisciplinary team approach to nursing care.
   5. Take responsibility for quality care and excellent health outcomes.
   6. Practice relationship-centered care with individuals and families.
   7. Provide culturally-sensitive care.
   8. Contribute to continuous improvement in your health care practice environment.
   9. Use communication and information technology effectively and appropriately.
   10. Continue to learn and encourage others to learn.
   11. Assess the individual with a holistic approach, including physiological, psychological, sociological,
       cultural, spiritual and developmental aspects understanding that the internal and external environment
       influences the individual.
   12. Apply scientifically based knowledge a) to assess adaptation to actual and potential alterations in health
       function and b) to explain access to health care delivery resources and treatment.
   13. Provide care safely and competently utilizing the nursing process in a variety of community health care
       settings for diverse individuals, families and groups by implementing cognitive, psychomotor and affective
   14. Diagnose human response to actual and potential health problems and/or life process.
   15. Plan individualized client outcomes and nursing care that will promote, maintain or restore optimal health
       and support a dignified death.
   16. Initiate therapeutic nursing interventions including but not limited to: a) pharmacology (including dosage
       calculations), b) nutritional support, c) health education, and d) psychomotor skills.
   17. Evaluate and revise the plan of care in relation to individual responses and outcomes.
   18. Manage and coordinate care as an interdisciplinary team member to solve problems, make decisions,
       organize and delegate appropriately and advocate for the client.

                 Skagit Valley College  Bellingham Technical College  Whatcom Community College
You will complete a course evaluation that will be shared with the student preceptee and the faculty liaison at set
times during the preceptorship. Grades are assigned by the faculty liaison and are based on your evaluation, their
observations, and all evidence of student preceptee behavior (including turning in required assignments).

The student preceptees are required to develop their own goals as steps toward meeting course objectives. They
must demonstrate satisfactory performance for each competency to pass the course. Evaluation involves your
professional opinion as to the student preceptee’s success. One of the faculty liaison’s primary responsibilities is to
be a resource for you in clarifying the objectives and in working with you in evaluation, both on an informal, daily
basis and at formal mid-preceptorship and final evaluations.

Sometimes a student preceptee seems to be doing poorly at first. It is important to remember when this happens that
the preceptee is still a student, but is rapidly approaching the ranks of a nurse. They will be decidedly slower than
you are in both skill and decision-making. They may need to talk over steps in a procedure or options for a decision
with you. Stop them before a patient’s safety is endangered if necessary, but otherwise let them “try it out”. Some
struggles and failures along the way are expected; this does not mean the student preceptee won’t meet the terminal
objectives. While evaluation is more or less a continuous process, it is more objective to look at overall
performance rather than individual specific events on a day-to-day basis.

Unfortunately, sometimes a student preceptee’s performance seems to be unsatisfactory. If your student preceptee’s
performance seems unsatisfactory, do not wait until the formal evaluation time. Consult with the faculty liaison as
soon as the problem becomes apparent. She/he can help you assess specific weaknesses and learning needs as well
as assist you in giving constructive feedback to the student preceptee. Remember, student preceptees may
occasionally fail in the last quarter, and failure on the part of the student preceptee is not failure on the part of the
clinical preceptor.

If the student preceptee has serious clinical deficiencies and/or fails to improve after counseling, the faculty liaison
will follow the process for evaluation set forth in the Student Handbook and syllabi. As nurses, we also have a
responsibility to protect the public, our present and future patients.

After working closely together, you may find your student preceptee has become a good friend and saying “good-
bye” may be difficult. The student preceptee may want to give you a card, bring cookies to the unit, or have coffee
together- these are all appropriate. An elaborate or expensive gift is not expected. And you are not expected to do
anything for the student preceptee upon completion.

You have the experience and knowledge needed to make this experience a real success. Students feel both excited
and nervous to meet and work with you. This is a very pivotal time in their lives and your support and
professionalism are appreciated. The faculty liaison, the facility staff, and your supervisor are all available to give
guidance and support, and it’s your responsibility to use these supports to your advantage. So good luck!

                  Skagit Valley College  Bellingham Technical College  Whatcom Community College

To top