Unprecedented levels of change in both healthcare and higher education have created a powerful context to reform nursing education. The health of the nation, through improved patient care, has been the ultimate goal of nursing education (National League for Nursing, 2013) with the equally important goal to provide competent nursing practitioners. The primary focus of this mixed method design study was to understand, how did cultivating evaluation skills prepared nurse preceptors to evaluate clinical competencies? Recent evidence revealed that staff nurses had been ill-prepared for the role of preceptor to positively influence student nurses (Hou, Zhu, & Zheng, 2011; Paton, 2010; Thomas, 2014). The information from prior literature also indicated that nursing graduates were not prepared to practice in the current healthcare environment and have not met expected clinical competencies (Pijl-Zieber, Barton, Awosoga, & Konkin, 2015; Rush, Adamack, Gordon, Lilly, & Janke, 2013; Wiles, Simko, & Schoessler, 2013).
Although the observation that novice nurses were not prepared to practice was well reported, the same could not be said about solutions to the problem (Hickerson, Taylor, & Terhaar, 2016). Most importantly, supporting patient safety and quality of care in healthcare environments is paramount (Lim, Weiss, & Herrera-Capoziello, 2016), and schools of nursing have been expected to prepare and grow the nursing workforce to provide the delivery of safe, evidence-based, high-quality care for patients across varied population groups. Therefore, determining if using evaluation competencies developed in the workshop would better prepare nurse preceptors to evaluate student nurse’s clinical performance would provide valuable information for clinical nursing practice.
Background of the Study
Nurse preceptors were defined as professional nurses that primarily work in clinical settings who were responsible for student nurses’ learning during clinical practice (Madhavanpraphakaran, Shukri, & Balachandran, 2014; Martensson, Lofmark, Mamhidir, & Skytt, 2016; Omer, Suliman, & Moola, 2016; Paton, 2010). The clinical environment has been the quintessential place where student nurses learned about nursing, have been acculturated into the nursing profession, and have acquired the skills and knowledge of professional nursing practice. Nurse preceptors have been perceived as knowledgeable and experienced practitioners who assisted in bridging the classroom to the real world of human patients in clinical settings (Varley, McNamara, & MacNamara, 2012; Weston, 2010). Smoker (2018) study revealed nurse preceptors used a hidden clinical curriculum to teach and evaluate clinical skills. Billings and Halstead (2012) argued that the hidden curriculum is known and actively taught by faculty, yet not evaluated because descriptors of the behavior are lacking. A lack of descriptors of behaviors in this curriculum leads to subjective ways of teaching. The need to change and identify a clinical nursing curriculum must happen in order to infuse what could be seen as a registered nurse’s core competencies and to close the practice-theory gap is a feasible resolution based on nurse preceptors’ input into these programs.
Need for the Study
Various studies have highlighted that the teaching and evaluation of nursing students in clinical practice is challenging for instructors, clinical nurses, and nursing students (Msiska, Smith, Fawcett, & Munkhondya, 2015; Rafiee, Moattari, Nikbakht, Kojuri, & Mousavinasab, 2014). Despite drastic advancements in hospital environments over the past 25 years, clinical nursing education has failed to maintain the pace, thus exacerbating teaching and evaluation problems (Beeman, 2001; Msiska et al., 2015). Formal preparation courses for staff nurse preceptors are well documented in the literature. An eight-hour formal workshop conducted by Horton, DePaoli, Hertach, and Bower (2012) in their study of 714 participants who attended an 8-hour preceptor workshop sought to answer the question, did preceptors feel better prepared to precept after attending the nurse preceptor academy? Preceptors reported that they felt better prepared and where more effective at precepting students. Sandau, Cheng, Pan, Gaillard, and Hammer’s (2011) study examined the hospital-wide effect of a mandatory 8-hour nurse preceptor workshop on preceptors and orientees. Three-hundred preceptors completed usable quantitative surveys. Results from this study confirmed preceptor workshops are effective in preparing experienced nurses to precept new nurses. One of the participants from the qualitative portion of the result noted that everyone who acts as preceptors can greatly affect the future practice of the nursing profession. Given the importance of making steady incremental progress toward educating nurse preceptors, these studies provide a background which clearly demonstrates that formal education and collaborative partnerships between care agencies and nursing schools can help to close the gap preceptors have in their teaching and evaluative role of preparing student nurses during clinical training. Cultivating teaching and evaluation skills in preceptors builds upon previous work in the ongoing effort to better prepare nurse preceptors for their role and to retain graduate nurses in the profession of nursing.
Significance of the Study
Nursing education involves both theoretical knowledge and practical clinical experiences. Theory combined with practical experiences offered undergraduate student nurses the chance to integrate and apply multilayered levels of knowledge including theoretical understanding, technological application, and practical skills learned in a classroom, teaching laboratory, and simulation. The nature and quality of applying this knowledge has depended on the preparation of the individual student (Karimi, Ashktorab, Mohammadie, & Abedi, 2014). Therefore, clinical teaching and evaluation must be standardized, at least within institutions, to evaluate students on their progress toward program outcomes. Faculty must take responsibility for preceptor preparation and collaborate with employers and preceptors to identify more efficient and effective ways to enhance the precepting experience for student nurses. Faculty must provide clear expectations to guide the preceptor when working with student nurses. Competence is dynamic and situational; therefore, teaching and evaluating student’s clinical practice should employ a variety of strategies to derive a comprehensive picture of a student’s clinical performance and their readiness to move to the next stage of the novice-to-expert continuum.
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