TEAM PRECEPTOR MODEL: TRANSITIONS TO PROFESSIONAL DEVELOPMENT

TEAM PRECEPTOR MODEL:TRANSITIONS TO PROFESSIONAL DEVELOPMENT Susan F. DePasquale, CGRN, MSN, CNS St. James Healthcare Sisters of Charity of Leavenworth Health System (SCLHS) Butte, Montana

Objectives Define Team Preceptor Model (TPM) Recognize importance of TPM or “collaborative development” to nursing role development Identify new TPM processes and tools within SJH and SCLHS Education Collaborative

Background: emerging nursing roles New evolving regulatory and professional standards of practice: New grad training levels vary – associate / tech training and transition programs, i.e. RN to BSN and BSN to MSN Health reform & incentives for APRN role development - varying pathways and levels, i.e. DNP Clinical nursing role development (IP, OP, Triage & all levels of nursing administration) - certification highly encouraged and continuing competency mandatory most jurisdictions in U.S. and internationally. Nurses at all levels are required to demonstrate a learning plan, professional reflection and peer feedback. Nursing state / national regulatory levels – increasing focus is on transition to practice / continuing competency (novice to expert)

Background: health reform & nursing An expanding potpourri of new nursing pathways with specific standards and best practice guidelines to support role development in a milieu of widespread health care reform.

Background: choosing a nursing pathway Pathways & Standards of Practice: Acute Care Clinical Specialties, Subspecialties (i.e. HIV/AIDS, Addictive Behaviors, EOL Care…), Advanced Practice (multiple pathways), Women’s / Children’s Health, Genetics, Research … EBN (evidence-based nursing) standards are professionally monitored and regulated at many levels

Background:Team Preceptor Model • Team Preceptor Model (TPM) also termed “Collaborative Preceptor Model” is well entrenched in the nursing literature and more recently at a regulatory level • Is considered essential in any organization committed to: • collaborative practice • continuing competency • professional role development • high quality health care standards

Team Preceptorship: why is it important? TPM is important to nursing professional development because it helps new nurses transition: • from theory into every day practice • from classroom or prior work group into new practice setting (socialization) • into applied learning and internalizing a new role within a professional health affiliate or organization • into learned values of their profession within nurturing and supportive relationships – circle of support

Team Preceptorship: defined When we talk about TPM we are referring to: A one-to-one relationship between RN Preceptor(s) / Mentor(s) and a new RN, new grad or nursing student (in a transition to practice program) Involvement of an intense, time-limited clinical experience to facilitate learning (3 months – 1 year, depending on jurisdiction and level of nursing experience) Existing support by a clinical education department, organizational policy and values / mission Liaisons between a health organization and institutions of learning; i.e. incorporates community nursing education for student placements and initial phases of transition to practice

Benefit to patient care & to a health organization TPM is discussed in the literature in terms of: • Brief review of the literature • Patient Safety initiatives (EBN, Collaboration / Communication, Team Culture of Safety … ) • Nursing recruitment & retention • Nursing role development • Team satisfaction • Accreditation & funding (is a focus of ongoing surveys) • Others (based on experience)?

TPM: where are we at? • First Step: review of the literature • Description of collaborative development of the TPM • Methods of evaluating TPM and success - benchmarking: • Seattle - Virginia Mason Medical Center (VM) & Swedish Healthcare (benchmarking) • Exempla and SCLHS Education Collaborative (system hospitals and networking) • Montana – SJH staffing and collaborative model (self-reflection), local and regional networking, i.e. small metropolitan / rural hospital programs and MNA transition to practice state program

TPM: review of literature • The Future of Nursing: Focus on Education (2011). Institute of Medicine. Retrieved online 10/04/2011 at Future of Nursing. • National Council of State Boards of Nursing (2011). Transition to Practice. Retrieved online 09/28/2011 at NCSBN. • College of Registered Nurses of British Columbia (2011). Retrieved online 08/01/2011 at CRNBC Practice Support • Preceptors Development and Support (2011). BC Academic Health Council: British Columbia, Canada. Retrieved online 08/01/2011 at Preceptor Development • Cooper Brathwaite, Angela and Lemonde, Manon (2011). Team Preceptorship Model: A Solution for Students’ Clinical Experience. Toronto, Canada. ISRN Nursing: Vol. 2011, Article ID 530357. • Royal Children’s Hospital (2011). RCH Nursing Preceptorship Model. Melbourne, Australia. • Transition into Practice – A Proposal for a Pilot Study in Ohio. Retrieved online 09/28/2011 at Ohio Pilot Transition to Practice.

TPM: review of literature Joint Commission (2011). Health Care at the Crossroads: Strategies for Addressing the Evolving Nursing Crisis. Warshawsky, N.E. and Sullivan-Havens, D. (2010). Global Use of the Practice Environment Scale of the Nursing Work Index. Nursing Research: 2010. Spector, Nancy (2009). A Transition to Practice Regulatory Model: Changing the Nursing Paradigm. Dean’s Notes: Vol. 31, No. 2; Nov/Dec 2009. Beecroft, P., McClure-Hernandez, A., Reid, D. (2008). Team Preceptorships: A New Approach for Precepting New Nurses. Journal for Nurses in Staff Development: July/Aug. 2008: Vol. 24, No. 4; p. 143-148. Bolten Health Trust (2008). Policy and Frameworks for the Implementation of Preceptorship for AHPs, HCSs, Nurses, Assistant Practitioners and Support Workers: London, United Kingdom. NCSBN’s Transition to Practice Model: A Multi-Site Study Comparing Patient Outcomes (2003). Retrieved online 10/04/2011 at Transition To Practice International Study Health Care Provider Preceptor Training Program: Model Curriculum (2003). Chancellors Office California Community Colleges: Sacramento California Queensland Health Preceptor Program for Transition Support (2001). Queensland Nursing Council: Australia

TPM: collaborative development TPM is a synergistic and dynamic process, involving: • an innovative model based on the premise of collaborative mentoring - the conceptual framework • nurses working together with several team members where each mutually coach and facilitates each others personal and professional growth - to promote a spirit of team • each individual in the TPM being recognized for unique experiences, skills, and knowledge that he or she brings to another’s learning experience - individualized and inclusive of diversity and creativity

TPM: collaborative development Each member of the health team participates in the following during the course of a preceptorship: a direct or supportive role (example: orientation to unit) coaches the new nurse in dynamic processes that support the acquisition of new skills, interactions, and activities leading to professional growth and development (example: documenting a learning plan and peer feedback, professional practice support) models a team approach that fosters a reciprocal relationship between all stakeholders of the health team or collaborative (example: standardization of learning tools; includes education, leadership, interdisciplinary and community liaisons)

TPM: methods of evaluating Actual Study Analysis (2011) – Framework: • Community Health Nurse Preceptor / Student Group • Data collected - using a focus group format to enhance information recall and robust data • An interview guide was created to help in facilitating two focus groups – separate interview questions specifically for students and for preceptors • Focus Groups interviewed at 12 weeks of placement; included 9 students and 14 preceptors

TPM: methods of evaluating Actual Study Analysis (2011) – Evaluation Points: Support for preceptors and students Collaboration among team members Good communication among team members Feeling overworked for preceptors (delay in work flow) and for students (perception of delay in work) Accessibility of preceptors for students Expertise of preceptors for students

TPM: Methods of evaluating Actual Study Analysis (2011) – Findings: Preceptors and students faced different challenges during implementation of the TPM Preceptors felt overworked and students perceived the delay in workflow These results have implications for clinical practice Opportunities existed for participatory planning, i.e. student’s learning from one or more preceptors (not necessarily a nurse) to develop competencies

TPM: methods of evaluating About Feedback: “You identify in your learning plan that your preceptor is there to highlight learning experiences for you that correspond with your learning plan, to help you accomplish your goals. For me, it was a very effective approach”. Clinical StudyTeam Preceptorship Model: A Solution for Students’ Clinical Experience (2011).

TPM: methods of evaluating Benchmarking Other’s Successes: VM & Swedish Models – Shared Leadership, Unit Practice Councils, Team Projects / Project Reports, Professional Recognition SCLHS Model – is an Education Collaborative that engages all sister hospital sites; the sharing of standard work to develop: Team Engagement – i.e. shared leadership councils Evaluation Method – i.e. nursing economics, nursing quality Evidence Based Learning (to promote a continuous learning environment and culture of safety) – i.e. TEAM STEPPS, shared teaching tools and resources Professional Recognition of all team members at varying levels of experience and learning plans To help identify stakeholders, nursing and non-nursing – i.e. Aspiration Risk Lean Project (interdisciplinary team)

SJH: what’s our team model? A few models were reviewed before visioning our own:

SJH: an evolving team model Red = New Structures Green = New Language (theory) SCLHS Education Collaborative The Placement Coordinator – role & new tools, i.e. motivational interviewing, change models, etc… [HR and Staffing share this role] Lessons Learned: is interdisciplinary Lessons Learned: Tools used is part of an evolving process within SCLHS and new changes affecting standardization, i.e. electronic portfolio Lessons Learned: EP roles often start sooner and can cross over, i.e. charge duty, quality, or others and this can be a bridge or a detriment depending on staffing and preceptorship needs Lessons Learned: SJH leadership wears “many hats”; SCLHS standardization and transparency of information is purported to help support LT participation Lessons Learned: TPM includes assumptions re: NP role that we approach more cautiously; i.e. NP educational curriculum and preparation? Exempla – Culture of Safety, LEAN, EPIC, New Leadership (Councils) National Board of Nursing – White Paper (Joint Commission) “Future of Nursing”

SJH: professional planner & feedback tools SJH Model – Includes all levels of nursing experience starts with the nurse performing a self assessment and forming a professional plan utilizes peer feedback to support reflection, identify and meet practice goals, a performance evaluation (starts with milestone meetings during orientation) and as part of a growing CV SCLHS Model – pending (in early formative stages, goal to standardize across the system) Benchmarking – Shared Leadership and Professional Recognition Program (PRP), i.e. magnet hospitals utilize a career ladder format that includes a standard learning planner / continuing competency journal

SCLHS: evaluation tools Exempla Collaborative – shared the Practice Environment Scale of the Nursing Work Index (4 score); national measure for associate engagement adopted from the “striving to be heard” study SCLHS – survey monkeys, i.e. Press Ganey, Culture of Safety Surveys, etc … Can you think of any others? How do we evaluate our education for nursing and all associates?

Measuring engagement: practice environment scale Examples of questions (Scale 1 – 4) Career development / clinical ladder opportunity Active staff development or continuing education program for nurses Praise and recognition of job well done Enough time and opp0rtunity to discuss patient care problems with other nurses Collaboration (joint practice) between physicians and nurses. {1 = strongly agree, 2 = agree, 3 = disagree, 4 = strongly disagree}

Recognition moment SJH Nursing Preceptors SJH Nursing Leadership and Education Collaborative SCLHS Education Collaborative Silver Bow and Montana (a rich regional body of nursing collaboration and knowledge sharing) Nationally and Internationally

Finally ~ Thanks for listening!

TEAM PRECEPTOR MODEL: TRANSITIONS TO PROFESSIONAL DEVELOPMENT