Preceptorship and Pre-Registration Nurse Education, Term Paper Example

Introduction

Preceptor is a concept applied mainly to a teaching experience, but can be used in any other disciplines. Importantly the practice makes teachers or instructors more effective role models by upholding the principles of their practice. In higher education some students are ascribe a preceptor position being held responsible for function within the laws of the anticipated professional endowment. Medical students at universities such as Harvard, Cambridge and Oxford offer preceptorship opportunities to their students (Myrick & Yonge, 2005).

With reference to nursing a preceptor is a registered practitioner who has been given the responsibility of supporting a newly registered practitioner through preceptorship (Department of Health, 2010). This assignment is a reflection of my preceptorship activities as a professional nurse. The discussion will embrace outlining roles and responsibilities of a 10 preceptor and factors that contribute to effectiveness of a preceptor. Next, listing twenty (20) factors that are barriers to effective preceptorship will be undertaken. These listed features will be supported by offering five (5) examples from my personal clinical experiences. Possible strategies for overcoming 12 barriers to effective preceptorship being referenced from appropriate literature will be discussed. In concluding my experiences of being a /8 preceptee and how this has informed the type of preceptor characteristics that would be emulated by me, will be embraced in a discussion.

Roles and responsibilities of a preceptor

Roles and responsibilities of a level 10 preceptor are unique. They encompass developing appraisals, supervising and mentorship of preceptees. Preceptors must demonstrate the skills to successfully support the preceptees during the transition journey from new graduate practitioner into professional practitioner. They show potential to initiate progress through AfC gateways.. The responsibility of orienting preceptees into organizational values during their placement is mandatory. The same values are communicated to patients. A preceptor’s role also entails identifying professional commitment qualities in the preceptee. This is expected to influence development of professionalism and adherence to regulatory requirements. After training and transition are completed the preceptor is expected to initiate his/her lifelong learning experiences for enhancement of future career (DeWolfe, Laschinger & Perkin, 2008).

Factors that contribute to effectiveness of a preceptor

An effective preceptor must be willing to accept the responsibility of maintaining an outstanding performance/deportment in relation to persons found in the same environment who use him/her as a role model. Another important quality that enhances the preceptor experience is when one finds trust and confidentiality in the relationship between preceptor and preceptee. When the experience is designed to produce learning and goals are achieved during the process the interaction can be considered effective (Sedgwick & Harris, 2012).

More importantly, when a preceptor establishes precise goals roles and responsibilities this facilitates transition from one task to the other. It is also important to work out a schedule outlining specific times when precept activities are conducted and engagement occurs. Besides, an effective preceptor would function according to goal expectations and measurable outcomes. This means that each day must be embraced knowing that specific tasks are being undertaken and plans accomplished (Bolderston, Palmer, Feuz & Tan, 2010).

Preceptorship is an adult learning application. As such, adult learning approaches would enhance the experience. Structured learning techniques encourage the utilization of critical thinking skills along with independent clinical judgment. Communication between preceptor and preceptee significantly impacts the preceptorship process. Therefore, relevant feedback must be encouraged because it improves clarity of function increasing favorable outcomes. Students must feel same in the preceptor’s environment, which must be created by the preceptor. Ultimately, the learning culture must be accepted between preceptor and preceptee for effective interactions (Kieng, Feuz & Bolderston, 2011).

Twenty (20) factors that are barriers to effective preceptorship. (Supportive 5 examples from personal clinical experiences)

Preceptorship is expected to be barrier free. However, from its inception barriers to effective execution of preceptorship have been identified. Essentially, preceptorship is a period of transition whereby the newly graduated nurse moves from functioning in the capacity of a student into a full practitioner or professional status. As such, in discussing barriers it would e worthwhile classifying them into two broad categories. First barriers can be associated barrier program design itself, which limits efficient implementation of relevant structures that facilitate a smooth process. A second category is identified as being associated with executers of the preceptorship program (Council of Deans of Health, 2009).

Ten barriers to effective preceptorship linked to the program design are identified as limited learning methods; few opportunities to demonstrate self-learning; poorly structured clinical practice days; privileges to demonstrate reflective practice are obscure; web-based learning programs are inaccessible; preceptorship program is not supported by stakeholders or partnerships; funding is limited to execute all features of the program; portfolio building is not included in the curriculum;   there is no evidence of cost-effective investment and the program offers few opportunities for mixing skills during task execution (Currie & Watts, 2012).

Ten barriers applicable to the implementation process are identified as executors of the process misunderstandings goals of the program; obvious conflict between what is delivered as program content and the executors intentions; issues of human rights violations ; demonstrating unprofessional attitudes during learning process interaction; communication difficulties in transmitting information while giving instructions; disregard for individual differences; limited individual support from executors;  inequitable access to resources offered by executors; executors failure to adequately stimulate learners’ towards their highest potential and limited use of a theoretical approach in  content delivery (Proctor, Beutel, Curren, Crespigny & Simon,  2011).

Five (5) examples from personal clinical experiences

With respect to program design on many occasions it was identified that the program funding might have been limited because some resources were not available to complete assignments which were expected to be provided through the program. For example, some web support was missing from online resources and not current. A second barrier experience could be cited as my preparation to interact with patients effectively. It would appear that how the program was designed that aspect of the training came a little too soon. There was not enough time interval  between content delivery and application for me to build a portfolio and enter into this learning experience confidently. Supporting literature shows where this can reflect both program design and implementation discrepancy (Morgan & Medows, 2012).

A third experience is identified during interactions with program executors while they were exceptionally supportive my unique learning difficulties were not addressed at an individual level. It could have been their misunderstanding of program goals in relation my learning needs. My personal limitation lay in the preconception concerning mental health. It is the stigmatization of this disease.  From the outset, undertaking a mental health placement made me very anxious. The experience of interacting with patients who suffer from mental health illnesses or conditions was minimal. Therefore, for me my exposures had to be guided into where it was most appropriate for me to encounter the exposure. From relevant literature it shows where this is very important technique (Morton, Howes, Leech, Smith, 2011).

A fourth experience that relates to program implementation strategies was my readiness for the exposure given in the clinical setting. My supervisor was effectively aligning the theoretical knowledge with my current mental health experience. While the exposure was welcomed the facility environment released immense feelings of anxiety for which my preparation did not allow me to readily manage appropriately. This was a real barrier to me functioning effectively. Here again the individuality of student learning might have been overlooked as well as my right to being ready for the exposure. Relevant literature supports this as being a barrier to the smooth transition of the preceptorship experience (Maxwell, Brigham, Logan & Smith, 2011).

The fifth and final experience also relates to barriers perceived from executors’ roles   communication difficulties in transmitting information. In expressing my discomfort being exposed to a situation it seemed as though my concern was either not represented correctly to the supervisor or the response was mingled with sensitivity. It did not resolve my difficulty while the problem was not intensified. However, while identifying my supervisors’ limitation of communicating a feasible resolution to the irregularities being experienced by me interacting with mental health clients my own communication skills were explored. A self introspection was conducted when told that all new students in the clinical setting act that way. This was hard to believe. For me my situation was different. There is relevant literature referencing these challenges experienced by nurses during their preceptorship exposure (Maxwell et.al, 2011).          

Possible strategies from the literature for overcoming 12 barriers to effective preceptorship.

The twelve (12) barriers that will be discussed are limited funding to execute all features of the program; portfolio building is not included in the curriculum; no evidence of cost-effective investment and the program offers few opportunities for mixing skills during task execution.  Other applicable barriers are identified as executors of the process misunderstandings goals of the program; obvious conflict between what is delivered as program content and the executors intentions; issues of human rights violations ; demonstrating unprofessional attitudes during learning process interaction; communication difficulties in transmitting information while giving instructions; disregard for individual differences; limited individual support from executors;  inequitable access to resources offered by executors (Giallonardo, Wong & Iwasiw, 2010).

These twelve barriers in some instances will be addressed individually as well as collectively. From a collective perspective, strategies applicable to breaking down barriers between preceptorship administration and its execution process begins by establishing a democratic forms of governance of the program. In a general sense conducting a process evaluation could be a very effective strategy in approaching resolution of these barriers. Process evaluation is assessing the implementation strategies contained in a program. It is also termed process analysis (Borland & Tseng, 2011).

Process evaluation conducted over a period of time being repeated. Specific measures are designed to collect the relevant data in assessing whether the program was effectively implemented. This is critical to education where because various innovations, and public policy create complex chains of action. As such, correct implementation procedures are key to successful outcomes (Borland & Tseng, 2011).

In adapting a democratic process in leadership can facilitate resolution of all twelve barriers. Be,low is a diagram showing how democracy functions to eliminate barriers to attaining successful preceptorship. The important steps pertain to developing an effective decision making  process in asserting control over both program dysfunctions as well as those emerging from preceptorship executors. It begins with identifying the issue; designing the decision making; criteria; evaluating the criteria; implementing it and evaluating the implementation process. The diagram below is a representation of the process.

Conclusion

These are my experiences which have informed me into the preceptor I would like to become This reflection is based on my experiences as a second year graduate student during myclinical placement at Graylands Hospital, Claremont, WA, while completing my Masters of Nursing Science postgraduate qualification. This reflection will explore stigmatising attitudes of nursing students and the feelings I experienced during this time and the subsequent reflective process.

My preceptor experiences began after being assigned comfort and activity duties, whilst out in the common room during lunch time when I was approached by a patient, I introduced myself and explained that I was a second year nursing student working on the ward for 2 weeks. He acknowledged me but mainly directed his conversation to my preceptor. I recalled from handover that patient X was a33-year-old involuntary patient who had been admitted with paranoid schizophrenia he was suffering from auditory hallucinations and delusions. I was conscious of upholding a professional standard and providing non-judgemental nursing care. However I felt very anxious as I had very little experience in dealing with patients who had mental health illnesses or conditions.I became veryself-conscious of my stance, posture and body language. I was closely observing my preceptor to see the way he interacted with patient X. Even though I was feeling distressed by what I was hearing, I tried to copy my preceptors body language and interaction with patient X while not allowing my feelings to show.

The aspects of this experience that affected me the most were my own ignorance and the realisation that I too have a perceived stigma towards mental health. From the outset, undertaking this mental health placement, I was very anxious as I have had minimal experience in dealing with patients who suffer from mental health illnesses or conditions, and the thought of being placed in a mental health facility induced a range of anxiety producing feelings within me. Although I was theoretically trained, and able to fulfil this task in providing mental health care, I realised I felt afraid and anxious about ability my to actually help patients.

I was so busy thinking about the textbook way of dealing with the situation that I forgot to use my own experience and common sense to guide me. During the initial confrontation I felt taken aback and unprepared I was consciously aware of my own limitations and lack of clinical knowledge and experience in these situations and I was afraid to say the wrong thing, I was also well aware of my scope of practice but in this case I realised that there were situations here that I hadn’t enough experience to deal with.

I noticed that I was blushing and wringing my hands anxiously, the helpless feeling inside me was getting worse and as the panic set in I realised that I felt quite afraid, I was consciously looking for the exit and ensuring my back was against the wall. I was no longer engaged in conversation with the patient and was looking for a way to escape I felt a wave of relief when my preceptor asked me to go inside the reception area and look up a form 1. As I arrived in the safety and comfort of the secluded reception area I had time to reflect on the situation and collectmy thoughts. According to Gibbs (1988) a vital part of effective nursing is reflective practice and reflection. I suddenly realised that I was being extremely judgemental and biased towards this patient who clearly wasn’t well. He was suffering from an illness and had little to no control over his own thoughts and actions, A high level of discrimination does exist in the general population and I had entered this placement with these shared feelings and emotions and had a negative view on engaging with mental health patients.

During the incident I had found it extremely difficult to overcome my fear of interacting with people living with a mental health illness.

My clinical facilitator came to visit me on the ward and we discussed the incident, I explained my fears with her and she reassured me that at some point all nurses feel this way. She advised me not to read the patients files and to use my own observations to create an assessment of the patients mental health condition in the here and now to prevent me from being judgemental. I realised that I was viewing patient X as a mental illness not a person living with mental illness and judged him accordingly, and that my own stigma towards my patient was preventing me from building up a therapeutic relationship. Stigma is associated with a nurse’s inability to show understanding to the client because of her pre-judgmental attitudes (Webster, 2009).

The next morning I came in with a completely different mind set no more hiding in the enclosed reception area I needed to engage with the patients to have a clearer understanding about mental health disorders. I started playing basketball and some of the patients joined in and starting talking to me about their childhoods, what sports they liked to watch /play, their families and how their illness started and how long they had been living with their disorders. It was then that I felt feelings of compassion and empathy kicked in and I knew that while I didn’t have the knowledge or expertise to offer clinical advice or determine the correct treatment plan for these Both the Clinical facilitator and clinical nurse supervisorencouraged me to interact and engage with the patients and I happily did so without working outside my scope of practicein accordancewith the national competency standards 2.2 for the registered nurse (ANMC, 2006).Gopee (2011) suggests that a positive mentor-mentee relationship can help make the mentor and the mentee feel more comfortable with each other and this facilitates the smooth interaction and communication between them.

On the last day of my placement I felt a sense a gratitude that I had been encouraged to participate and communicate with the patients and had a greater knowledge of mental health disorders and empathy and respect for all the patients. These qualities of encourage I admire and would like to become a preceptor of this quality.

References

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