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Preceptorship

 

• Welcome
• Preceptorship
• Preceptor
• Preceptee
• Supports for Preceptors
• Becoming a Preceptor
• Learning in the Clinical Environment
• Supernumerary Status
• Clinical Internship/Rostered practice
• Assessing Clinical Practice
• Competency Based Practice
• Clinical Placements Sites Nursing and Midwifery Students NUIG
• Students Experience of Preceptorship
• FAQ
• Contact Us
• References

WELCOME

Welcome to the Preceptors Page

The purpose of this site is to provide a resource to all the preceptors who give of their time and expertise to facilitate learning, supervise and assess students while on clinical placement on the following programmes:

• Bachelor of Nursing Science (General)
• Bachelor of Nursing Science (Psychiatric)
• Bachelor of Midwifery Science

 The programmes are conducted in partnership between the Health Service Executive West and the National University of Ireland, Galway.

 The aim of clinical practice learning is to enable students develop the domains of competence and become safe, caring, competent decision-makers willing to accept personal and professional accountability for evidence-based nursing/midwifery care.

 Your contribution to the education of these students is vital in helping students to reach their potential while on clinical placement.

 Clinical practice experience provides students with:

• The opportunity and privilege of direct access to patients/clients 
• The opportunity to experience the world of nursing and midwifery and to reflect on and to speak to others about what is  experienced
• The reference system for the student to critically evaluate practice, to predict future action and through reflection, reflect the thinking that underpins nursing actions
• The motivation essential to acquire the skills critical to the delivery of quality patient /client care 
• The environment to enable them understand the integrated nature of practice and to identify their learning needs
• Opportunities to take responsibility, work independently and receive feedback on their practice (Lofmark et al 2001)

An Bord Altranais (2003) Guidelines on the key points that may be considered when developing a quality clinical learning environment Dublin: An Bord Altranais

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PRECEPTORSHIP

Preceptorship is a one-to-one educational relationship between an experienced nurse and a nursing student. 

The preceptorship relationship is a purposeful, short term facilitating partnership that provides opportunities for socialization into nursing practice and helps to bridge the gap between theory and practice.

Preceptorship was introduced to undergraduate nursing education in Ireland following the recommendations of the Nurse Education Forum 2001.

The forum also recommended that all nursing staff who supervise students should have preparation for the role. A two day preparation course was recommended by the national implementation committee and learning outcomes were identified to ensure uniformity of preparation.

The guiding principle regarding preceptorship should be that, regardless of the role title, it is the quality of the student staff relationship and the support within that relationship that is the factor that contributes most to student learning.

Successful preceptorship has a significant influence on student development

• The most important factor influencing students’ development of professional knowledge, is the nature of support and guidance from an approachable mentor (Spouse 2001)

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PRECEPTOR

A preceptor is a registered nurse or midwife who has been specially prepared to guide and direct student learning during clinical placement.

The preceptor acts as a role model and a resource for a student who is attached to him or her for a specific time span or experience. It is a purposeful, short-term, facilitating partnership.

When the student is starting the clinical placement the Preceptor will:

• Welcome and orientate the preceptee to the clinical area 
•  Supervise and monitor his/her performance and provide assistance as needed
• Gives constructive criticism and support
• Communicate observations, reviews and problems to clinical nurse/midwife managers, clinical placement co-ordinators, link lecturers
• Supervise patient care provided by the preceptee to ensure safe, competent nursing care
• Evaluate the preceptee’s ability to set and meet learning outcomes and validate her accomplishments
• Document a summary of the preceptee’s performance in the competency assessment booklet at the first, midway and final meeting.
• Check  the preceptee’s level of preparation for assigned patients and ensure that assignments are within his/her scope of practice 
•  Maintain confidentiality of preceptee related information.

  www.nursingboard.ie/en/policies-guidlines.aspx

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PRECEPTEE

The preceptee is the student nurse undertaking an undergraduate nursing/midwifery degree programme and is on clinical placement . The student is assigned a named preceptor.

Roles and Responsibilities of the Preceptee:

When supernumerary it is expected that the student:

• Will complete 35 hours per week. This is inclusive of guaranteed reflective time of six hours each fortnight (or equivalent) plus two hours classroom based workshop each fortnight (or equivalent). Students are expected to negotiate in advance with their preceptor their release for reflective practice. Reflective time should be planned rather than ad hoc.
• Will work, where possible, the same shifts as their preceptor. It is recommended that students are allocated to, in addition to a named preceptor, one or two “alternate” or associate preceptors who will take responsibility for guiding their learning in the absence of the named preceptor. The named preceptor however retains overall responsibility for the student throughout the placement.
• Will negotiate the hours of work in advance with the named preceptor.  In most instances, it is expected that the student will start at the beginning of a shift to facilitate attendance at report
• Will work across the week (including the weekend) provided the preceptor/clinical nurse manager/clinical placement co-ordinator are satisfied that it is possible to provide appropriate supervision.
• Cannot work more than one weekend per allocation. 
•  Is not generally permitted to work more than one twelve-hour shift per week. 
•  Is not generally permitted to work Bank Holidays.
•  Is not generally permitted to undertake night duty until the period of clinical internship in year four. 
•  Is expected to actively participate in providing direct care to a client/group of clients.
• Provides care appropriate to their knowledge and practical experience under the supervision and direction of a registered nurse/midwife.  It is the responsibility of the registered nurse/midwife (preceptor) to ensure that the students are not delegated any task or responsibility beyond their skill or expertise
• Will make known to the preceptor any limitations to their competence and in relation to skills or knowledge. 

An Bord Altranais (2003) Guidance for Nursing Students. Dublin: An Bord Altranais Is available from the An Bord Altranais website http://www.nursingboard.ie/

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SUPPORTS FOR PRECEPTORS 

 Co-ordinators

Clinical Placement Co-ordinators are assigned to each clinical area.  The role of the clinical placement co-ordinator is to guide and support students to achieve the learning outcomes of the clinical placement and meet the requirements of the programme.

The National Evaluation of the Role of the Clinical Placement Co-ordinator (Department of Health and Children 2001 ) described the multidimensional role of the Clinical Placement Co-ordinator which includes

• ·Student support
• Teaching/student assessment and feedback
• Support in external placements
• Practice development
• Pastoral care and counselling

Link Lecturers

Each clinical area that facilitates student’s clinical placements is assigned a named link lecturer from the School of Nursing and Midwifery, NUI, Galway.

The role of the link lecturer is to provide support and guidance to:

•  Students
•  Preceptors
•  Clinical nurse/midwifery managers

on any issue pertaining to students and clinical placements.

Name, phone and email details of the link lecturer assigned to your clinical area are contained in the Bachelor of Nursing Science/ Bachelor of Midwifery Science Clinical Resource Pack.

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BECOMING A PRECEPTOR

A two day training course entitled Teaching/Assessing/Preceptorship is run in the Centre for Nurse Education, Galway University Hospitals.

Learning outcomes of the course

1.       Demonstrate an understanding of the context of the changing nature of nursing and nurse education.

2.       Demonstrate knowledge of the structure and key elements of the four-year degree programme eg. Rostered year, reflective practice.

3.       Demonstrate an understanding of theories of teaching and learning and the principles of facilitating, teaching and assessment of learning as applied to the clinical learning environment.

4.       Identify the characteristics of an effective learning environment and demonstrate awareness of the factors which facilitate or inhibit learning.

5.       Discuss the concept of Perceptorship and define the role and responsibilities of the preceptor in relation to supporting students through their clinical learning experience. Define the role and responsibilities of the preceptee.

6.       Demonstrate an understanding of assessment of competency in clinical practice and the knowledge required for the completion of documentation to reflect the level of competence achieved by individual students.

7.       Demonstrate a working knowledge of the domains of competence documented in the Requirement and Standards for Nurse Registration Education Programmes (ABA, 2 ^nd edition, November 2000).

If you would wish to attend the course contact:

Madge Gilligan
Centre for Nurse Education,
Galway University Hospitals,
Galway.
Phone number: 091 544362

e-learning

An Bord Altranais has produced an e-learning package to assist assessors of student nurses/midwives on clinical placement. The interactive package is available on the An Bord Altranais website http://www.nursingboard.ie/

Another excellent elearning resource for preceptors can be found at http://ucdpreceptors.hseland.ie/

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LEARNING IN THE CLINICAL ENVIRONMENT

The aim of clinical practice learning is to enable students develop the domains of competence and become safe, caring, competent decision-makers willing to accept personal and professional accountability for evidence-based nursing care. Clinical practice experience, whether in the hospital or community care setting, forms the central focus of the profession and is an integral component of the nurse registration education programme.

Learning in the clinical area involves being part of a team while learning nursing/midwifery knowledge and skills. 

Central to the practice of adult learning is the necessity to provide an environment of mutual respect, partnership, support and trust.

Creating a climate conducive to learning in a complex environment such as a ward/unit/community is a challenging task. The learning climate influences how the student experiences practice and positive experiences are essential to learning.

A quality clinical learning environment is influenced by: 

•  Dynamic, democratic structures and processes
•  A ward/unit area where staff are valued, highly motivated and deliver quality patient/client care
•  Supportive relationship, good staff morale and a team spirit 
•  Good communication and interpersonal relations between registered nurse/midwife and student 
•  Acceptance of the student as a learner who can contribute to the delivery of quality patient care

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The following publications are available to download from the An Bord Altranais website

http://www.nursingboard.ie/

• An Bord Altranais (2003) Guidelines on the key points that may be considered when developing a quality clinical learning environment. Dublin: An Bord Altranais.
• An Bord Altranais (2005) Requirements and Standards for Nurse Registration Education Programmes. Dublin: An Bord Altranais.

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SUPERNUMERARY STATUS

All clinical placements are supernumerary during the four year programme with the exception of the 36 week clinical intership/rostered in Semester 1 of Year 4.

Students do not receive any payment while on supernumerary placements.

Supernumerary status means that the student nurses/midwives are surplus to the rostered complement of registered nurses.

Supernumerary status does not mean that students are not expected to take an active role in client care.

An Bord Altranais Requirements and Standards for Nurse Registration Education Programmes (2005) outline the key features of supernumerary status as:

1.       Clinical practice placements provide learning opportunities, which enable the achievement of the learning outcomes. The supernumerary status of the student during the period of clinical placement is an important factor in enhancing the educational value of the experience.

2.       The key feature of supernumerary status are:

2.1    Allocation to a clinical placement is driven by educational needs enabling the student to achieve stated learning outcomes;

2.2    The student actively participates in giving care appropriate to the student’s level of knowledge and practical experience, with the supervision and direction of a registered nurse/midwife;

2.3    The student is surplus to the rostered complement of nurses;

2.4    The clinical placement allows for purposeful/focused learning where the student applies the theoretical knowledge to health care practice and develops the integrated knowledge and skills essential to a professional practitioner;

2.5    The student takes an active role in achieving the learning outcomes whilst acknowledging and respecting the interest/rights of the patient/client.

An Bord Altranais (2005) Requirements and Standards for Nurse Registration Education Programmes (3 ^rd edition) Dublin: An Bord Altranais

An Bord Altranais (2005) Requirements and Standards for the Midwife Registration Education Programe (3 ^rd edition) Dublin: An Bord Altranais is available from the An Bord Altranais website   http://www.nursingboard.ie/

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CLINICAL INTERNSHIP/ROSTERED PRACTICE

The Clinical Internship/rostered practice placement starts in Semester 2 of year 4 and runs for 36 weeks.

During this period of clinical internship the student will be part of the workforce and therefore rostered on the duty roster of the allocated clinical setting.

Each placement will be of six week’s duration. Students will continue to be allocated to a preceptor (a registered nurse/midwife) and will be involved in direct care giving to a group of clients.

PRINCIPLES OF PRACTICE DURING CLINICAL INTERNSHIP/ROSTERED PLACEMENT

During clinical internship/rostered placement the student is an employee of the Health Service Executive West and is accountable to the Director of Nursing and reports to the Clinical Nurse Manager.

Placements are planned in advance by the Allocations Officer, NUI Galway in partnership with the Directors of Nursing.

Hours of work:

• Students work 39 hours per week inclusive of reflective time of 4 hours per week.
• Student will work across the week including the weekend and will work the roster of the clinical area.

Sick Leave: 

•  Students must inform the Clinical Nurse Manager and Nursing Administration in the event of being unable to attend due to illness.
• A Medical Certificate is required when absence is more than 2 days duration.

Night Duty:

• Students should experience night duty during the clinical intership placement.
• The Clinical Nurse Manager may assign the student to a week’s night duty as indicated on the allocation sheet.

Bank Holidays:

• Student may work Bank Holidays if the ward manager is satisfied that there is adequate supervision.
• Time off in lieu of any Bank Holiday worked must be given before the student completes the allocation in a particular  clinical area.
• Bank Holiday entitlements should not be accumulated or carried forward.

Reflective Practice:

• Reflective hours (4 hours per week) must be negotiated with the Clinical Nurse Manager in advance and are recorded as part of the hours of practice. 
•  Reflective hours cannot be accumulated from week to week. 
•  Students leave the clinical area during the allocated reflective time.
• A series of supervised ’Reflection Workshops’ will be organised by the School of Nursing and Midwifery Studies, NUI, Galway during the clinical intership placement. Students are expected to attend these supervised sessions. Details of the reflective workshops will be sent to each clinical area.

Preceptors:

• Students will be assigned a preceptor and are expected to actively participate in providing direct care to patients/clients.
• When participating in care giving the student would be expected to provide care appropriate to his/her knowledge and practical experience under the supervision of a registered nurse.
• Assessment of student’s clinical competence will continue throughout the clinical internship/rostered placement.

Clinical Placement Co-ordinators:

• Clinical Placement Co-ordinators will continue to co-ordinate the students learning activities.

Students are required to display a high standard of professional behaviour in practice, and adhere to the principles outlined in the Code of Conduct of An Bord Altranais (April 2000). The student is subject to the disciplinary procedures which apply to staff within the Health Service Executive West.

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ASSESSING CLINICAL PRACTICE

An Bord Altranais (2000) requires assurance and evidence that the student is competent to practice and demonstrates the skills of a safe, caring and competent decision-making practitioner, willing to accept personal and professional accountability for evidence-based nursing/midwifery practice.

Assessment is a gatekeeper function in that those qualified practitioners who have the authority to assess a student’s competence to practice regulate entry to the Register of Nurses/Midwives.  (An Bord Altransis (2003))

Assessment of clinical practice can:

• Help maintain standards
• Predict the future behaviour and potential of nurses/midwives
• Monitor student progress
• Motivate students
• Identify students’ strengths and areas for improvement
• Increase students' self awareness
• Encourage students to develop the skills of self-assessment
• Measure the effectiveness of teaching

Assessment includes the observable behaviours, interactions, performances and procedures demonstrated by students.

The aim of assessing student’s competency is to ensure that the student acquires:

• The skills of critical analysis
• Problem-solving skills
• Decision-making skills
• Reflective skills
• The abilities essential to the art and science of nursing

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COMPETENCY BASED ASSESSMENT

Competency based assessment is a student-centred assessment strategy designed to elicit performance, potential and evidence of attitudes/values and knowledge.

The integration of knowledge, attitudes/values and skills in practice underpin competency assessment and implies that assessment involves both questioning and the giving of feedback.

Competencies for Entry to the Register

Competence is a complex and multidimensional phenomenon and is defined as the ability of the Registered Nurse to practice safely and effectively, fulfilling his/her professional responsibility within his/her scope of practice.

The five domains of competence represent the level the student must reach on completion of the education programme for entry to the Register held by An Bord Altranais.

The domains of competency:

1.       Professional /Ethical practice

2.       Holistic approaches to care and the integration of knowledge

3.       Interpersonal relationships

4.       Organisational and management of care

5.       Personal and professional development

The Domains of Competence represents a broad enabling framework to facilitate the assessment of pre-registration student nurses’ clinical practice. Each domain consists of performance criteria and their relevant indicators.

The Domains of Competence are detailed in the Requirements and Standards for Nurse Registration Education Programmes 2005

And the Requirements and Standards for the Midwife Registration Education Programme 2005.

The School of Nursing and Midwifery, NUI, Galway have developed a Competency Assessment Booklet based on the competencies of the An Bord Altranais requirements. Learning outcomes have been developed for each of the domains and for each year of the programme.

The learning outcomes describe the performance of the student if they are operating at the required level. The competency requirement become more demanding as the student progresses through the programme (Years 1-4)

Learning to use the Competency Assessment Booklet is part of the 2 day Teaching/Assessing/Preceptorship programme.

e-learning

An Bord Altranais has produced an e-learning package to assist assessors of student nurses/midwives on clinical placement. The interactive package is available on the An Bord Altranais website  http://www.nursingboard.ie/

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  Clinical Placement sites for HSE West NUI,Galway Nursing and Midwifery Students

Bachelor of Nursing Science (General)

Bachelor of Nursing Science (Psychiatric)

Bachelor of Midwifery Science

STUDENTS EXPERIENCE OF PRECEPTORSHIP

What students have said of their experience of preceptorship:

“ My preceptor was great, it didn’t matter if you were a student, an attendant, doctor or staff nurse with ten years experience, everyone had their opinion and she (the preceptor) would listen to you and respect you and she was just so approachable and the staff were lovely, and there was so much to learn and it was a great learning experience”

Eadaoin, Nursing Graduate

“ The hardest part about the clinical placement is just trying to get settled in. Trying to figure out what the staff are like and what the ward is like. A good preceptor guides you through all that very quickly and you can settle in and learn”

Mary , Nursing Graduate

“I learnt so much from my preceptor, the way she could communicate with patients who were upset about their diagnosis, she could listen and ask questions and give information and just be comfortable in a difficult situation. She made it all seem so natural. You become more aware of your gestures and of what you say to people and how to put things.  I really learned a lot from her and watched her every move”

Síle, Nursing Graduate

“The preceptors were great, they keep you on your toes, always asking you ’what is this’, ’do you know why we are doing this’, ’why is this important’ they make you think about practice and you learn all the time”

Marie, Nursing Graduate.

I loved the rostered placement. My preceptor gave me responsibility and I loved being part of the team. The preceptor was always there for you to go back to and check things, but you had some responsibility and it was great and I learnt a lot from him”

John, Nursing Graduate

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FREQUENTLY ASKED QUESTIONS

Do I have to be a preceptor?

The Code of Professional Conduct for each Nurse and Midwife , April 2000, published by An Bord Altranais states, inter alia, that:
"Each nurse has a continuing responsibility to junior colleagues. He/she is obliged to transmit acquired professional knowledge, skills and attitudes both by word and example. The nurse must not delegate to junior colleagues tasks and responsibilities beyond their skill and expertise”

This implies that all nursing and midwifery staff should support and guide junior colleagues as part of their role.

Who decides who will act as a preceptor?

The Clinical Nurse/Midwife Manager will decide in consultation with the Clinical Placement Co-ordinator and staff, who will act as preceptor to students taking into consideration rosters and availability of staff.

What's in it for me?

• Personal and professional growth
• Satisfaction from sharing knowledge and expertise 
•  Increased job satisfaction
• Honour and recognition for contribution to student learning
• Increase in teaching, communication and clinical skills
• Contributing to a better clinical learning environment
• Contributing to future health care by influencing the clinical practice of students
• Can be recorded in your portfolio of professional development
• Could enhance your Curriculum Vitae

If I am unhappy about the performance of a student nurse/midwife, what should I do?

You should explain to the student your concerns about their poor performance and explain what the student needs to do to improve their performance. Giving regular feedback to the student on their performance is important so that they are aware of your concerns. This gives the student an opportunity to improve their performance.

You should discuss your concerns with the Clinical Placement Co-ordinator and or the link lecturer. They will provide support and guidance to both you and the student. Clinical Nurse Managers and other preceptors are also an invaluable resource and should be consulted for advice and support.

What if the student doesn’t agree with my assessment?

Your assessment is based on your professional judgement. The student is expected to understand how or why you came to your judgement. Giving feedback early and often will help the student understand your assessment of their performance.

Giving clear feedback and guidance at the midway interview/meeting, should also help the student to understand your assessment.

If you envisage that there will be a difficulty with the final interview/ meeting with the student, you may have the link lecturer present. The purpose of this is to help both the student and the preceptor.

I have done the 2 day Teaching/Assessment/Preceptorship programme. Can I get more training?

A series of continuing professional development workshops for preceptors is being developed by the Centre for Nurse Education, Galway University Hospitals in partnership with the School of Nursing and Midwifery NUI,Galway. Details will be circulated to each clinical area in the near future.

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CONTACT US

E-mail: nursingstudies@nuigalway.ie

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REFERENCES

An Bord Altranais (2000) Requirements and Standards for Nurse Registration Education Programmes . Dublin: An Bord Altranais.

An Bord Altranais (2000) The Code of Professional Conduct for Each Nurse and Midwife. Dublin: An Bord Altranais.

An Bord Altranais (2003) Guidelines on the key points that may be considered when developing a quality clinical learning environment Dublin: An Bord Altranais

An Bord Altranais (2005) Requirement and Standards for the Nurse Registration Education Programmes. Dublin: An Bord Altranais

An Bord Altranais (2005) Requirements and Standards for the Midwife Registration Education Programme Dublin: An Bord Altranais

Department of Health and Children (2001) National Evaluation of the Role of the Clinical Practice Co-ordinator, Dublin: Department of Health and Children.

Quinn, F. (2000) The Principles and Practice of Nurse Education (4 ^th ed). Cheltenham: Stanley Thomas

Neary, M. (2000) Teaching, Assessing and Evaluation for Clinical Competence A practical guide for practioners and teachers. Stanley Thornes. Cheltenham

Spouse, J (2001) Bridging theory and practice in the supervisory relationship: a sociocultural perspective. Journal of Advanced Nursing  33, (4) pp.512-522

Lofmark,A. Carlsson, M. Wikblad,K. (2001) Student nurses’ perception of independence of supervision during clinical nursing practice. Journal of Clinical Nursing 10: pp.86-93

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