Levels Of Nursing Practice

Part IPart I

Objectives:

• Define 3 principle roles and responsibilities of a

preceptor.

• Distinguish how a preceptor’s role differs from that

of regular staff.

• Define Benner’s Levels of Nursing Practice.

• List 5 available resources for the preceptor.

• List 3 principles of adult education.

1. Unit Based Workshop

2. Review Preceptor Tools

3. Discuss Available Resources

4. Make the job easier

5. Make the preceptor more effective

6. Make efficient use of the preceptor’s time

7. Optimize the orientation process

Purpose:

1. What is a Preceptor

2. Preceptor Responsibilities

3. Orientee Responsibilities

4. Levels of Practice

The Preceptor Role

A preceptor instructs, teaches and supports an individual who is learning a new skill or is in a new position….

A preceptor works closely with the learner, and will watch and coach him/her in skill application.

A person may be precepted by a number of individuals simultaneously

What is a Preceptor?

Roles of a Preceptor

LEVELS OF NURSING PRACTICE

Advanced

Beginner

Novice

Competent

Proficient

Expert

1. To ask questions

2. Talk openly

3. Prepare

4. Follow through on agreements

Responsibilities of a Preceptor

Responsibilities of a Orientee

1. To ask questions

2. Talk openly

3. Prepare

4. Follow through on agreements

1. Adults need to know why they need to

know

2. Adults have the need of Self Importance

3. Adults are problem-centered vs.

subject-centered

4. Adults often know how they learn best

5. Adults usually actively participate in

their learning

Adult Learners

Preceptor Effective?

What makes a?

Desire

Knowledge

Experience

Organization

Teaching Skills

People Skills

What does it take?

Yes

Yes

Yes

Yes

Yes

Yes

What else do you need?

Objectivity

People Skills

Concrete Goals

Evaluation Tools

Effective Documentation

What works?

Goals & Agreements

Timeframes

Checklists

Evaluation Tools

Progress Notes

Resources

Goals are the single most important

factor in achieving success

Why make Goals?

Goals & Agreements

1. Turn Goals into Agreements

2. Make goals specific

3. Take one minute per day

4. Try 3-5 minutes a week

5. Evaluate daily

Timeframes

1. Be realistic

2. Be specific

3. Make expectations clear

Checklists

1. Use the checklists

2. Checklists are made to help

3. Write in additional needs

4. Review list weekly

Evaluation Tools

1. Refer to your goals

2. Be flexible

3. Keep notes (progress notes)

4. Keep up weekly

Progress Notes

1. Document progress

2. Record progress towards meeting goals

3. Keeps orientation plan on track

4. Gives credit for what you do

5. Covers yourself legally, good or bad

6. Establishes basic competence and compliance with Orlando Health Standards

Resources

1. Learn your resources

2. Seek out opportunities

3. Think and plan what you need

4. Don’t go it alone

5. Use your policies

A. The Change

B. Transition from staff to preceptor

C. Training

D. Working with tools

E. Value Systems

F. Results

Becoming Effective

EVALUATE

NEEDS

How to be Effective

USE

RESOURCES

How to be Effective

USE

THE

TOOLS

How to be Effective

PLAN

GOALS

How to be Effective

Specific

Measurable

Attainable

Realistic

Time Bound

Plan SMART Goals

ASSESS

DAILY

How to be Effective

KEEP

NOTES

How to be Effective

SEEK

OUT

OPPORTUNITIES

How to be Effective

THE EFFECTIVE PRECEPTOR1) Possesses and demonstrates broad knowledge

2)   Explains actions and decisions

3)    Answers questions clearly and precisely

4)    Is open to conflicting ideas and opinions

5)    Connects information to broader concepts

6)    Communicates clear goals and expectations

7)    Captures learners attention

8)    Makes learning fun

Part IIPart II

• Describe how to assist orientees in identifying of their own learning needs and in setting appropriate goals.

• Describe SMART Goals.

• List 2 important steps used by the effective preceptor.

• Explain how to apply principles of adult education as a preceptor.

Objectives:

TEACHING STRATEGIES

Teaching Principles

Build in active participation

Build in successful goals

Build in self-directed approaches (does not mean learning

in isolation)

Tap into learner’s life experiences

Vary the methodology

Offer mutual learning between participant and presenter.

Keep it simple

1. Observation

2. Skills orientation checklist (unit specific)

3. PBDS findings

4. Progress Notes

Assessing Learning Needs

Ways to assess learning needs:

5. Frequently asked questions (by the orientee)

6. Questioning the orientee about previous work experiences

7. Ask (the orientee): what are your learning needs?

Assessing Learning Needs

Ways to assess learning needs: (cont..)

1. Don’t handle it all alone

2. Know your options

3. Communicate

4. Document

5. Find the silver lining

Dealing with Frustration

Making Goals

TAKE

ONE

MINUTE

Making Weekly Goals

TAKE

FIVE (or less)

MINUTES

Give everyone direction

Generate measurable tools

Allow for multiple successes

Keep an ongoing record

Help guide the orientee

Encourage regular evaluation

Keep everyone on track

Why Goals Work

Specific

Measurable

Attainable

Realistic

Time Bound

Use SMART Goals

Sample Goals•Complete self assessment portion of competencies, outlined in orientation notebook, during the first week of orientation.

•Demonstrate good time management by documenting assessment and vital signs within one hour of assessment.

•Coordinate care and management of one low acuity patient independently by “anticipated date”.

•Effectively coordinate and manage care of 2 patients of intermediate acuity by “anticipated date”.

•Perform admission history and assessment and document completely in Sunrise within 1 hour of admission.

•Complete Interpretation of ABG’s & Mechanical Vent SLP’s by “anticipated date”.

•Complete real time charting within 1 hour of assessment

Making Agreements

Explain Roles and Responsibilities

Discuss Skills to be acquired

Determine Start Date and End date

Review Outcomes

Use Methods of Feedback

Use Methods of Evaluation

PBDS

1. Performance Based Development System

2. Measures critical thinking

3. A proven evaluation tool

4. Guides orientation

5. Makes your job easier

Using PBDS

1. Make goals simple and specific

2. Evaluate according to goals

3. Adjust goals according to results

4. Make your job easier

PBDSProgress Notes Examples

From PBDS Department

0 of 6

Resp.

Neuro

1. Admit and manage 2 respiratory patients independently by 10/29/06

2. Give 4 organized reports to physicians by 10/29/06

10/20/06 - Admission for pneumonia with preceptor10/22/06 - Admission for COPD done independently. Followed appropriate protocol.10/23/06 – Managed PE pt. independently. Followed appropriate protocol. Participated in successful code.

2. 10/20/06 - Dr. Jones (+) 10/20/06 - Dr. Smith (+) 10/22/06 - Dr. Green (+ w/urgency) 10/23/06 - Dr. Davis (+)

1 4

DE

Ima Newtoyou

10/16 -10/29/06

2 of 6

Neuro

2 4

DE

Ima Newtoyou

1. Admit and manage 2 neuro patients independently by 11/12/06

2. Complete all charting by end of shift by 11/12/06

1. 10/31/06 - Admission for closed head trauma done independently. Followed appropriate protocol. 11/6/06 - Admission for r/o CVA, followed protocol for thrombolytics.

2. 10/31/06 - All completed 11/6/06 - 20 min. OT 11/7/06 - All completed 11/9/06 - All completed

10/30-

11/12/06

11/13-11/26/06

3 of 6

3 4

DE

Ima Newtoyou

Consistently manage 6 patients independently by 11/26/06

11/17/06 - 411/20/06 – 511/22/06 – 6 (w/little help)11/23/06 - 6

11/27-12/3/06

6 of 6

Orientation complete

UBE reviewed reassessment video #107

CTA class scheduled 12/4/06

PBDS Reassessment scheduled 12/11/06

4 4

DE

Ima Newtoyou

Keep everyone on the same track

Don’t take long to do (1-5 minutes)

Help determine what else is needed

Generate tools for making further plans

Makes the preceptor’s job easier

Gives feedback to the orientee

Makes it easy to follow progress

Evaluations

Evaluate Daily

Take a moment everyday to evaluate

Give Continual Feedback to your orientee

Complete all documentation forms

Keep Leadership Informed & Up-To-Date

Complete Regular Progress Notes

Share Concerns with Leadership and/or

Educators

How to Evaluate the Orientee

Use Effective Communication

Use Preceptor/Orientee Agreements

Make Observations & Give Feedback

Offer additional information

Protect nursing licenses

Open additional doors for staff

Encourage self-sufficiency

Give preceptors a break

Expand nursing knowledge

Encourage staff involvement

Use Resources

Keeps and ongoing record of progress

Backs up the preceptor

Provides proof of orientation

Establishs basic competence and compliance

with Orlando Health standards

Records progress towards meeting goals

Create a historic record of orientation

Documentation

Document Daily

Complete Skills Check List

Review and plan Goals/Agreements

List daily achievements

Evaluate if goals were achieved

Adjust plan accordingly

Giving Feedback Deliver it in a timely manner Focus on behavior and learning objectives Present the facts, be specific Avoid feedback overload (concentrate on one thing at a

time) Maintain positive body language Be culturally sensitive Strive for win/win situation Encourage self-assessment Encourage Critical Thinking skills Always include positive comments Learn from one’s mistakes

Role Modeling

We learn by example

Goals can make winning easy and give us measurable tools

Winning Goals

Make it easy to winSet reasonable goals

Make it Easy

A standard procedure for teaching a task that a

student finds difficult is to break it down into

smaller units.

Breaking it Up

Evaluate daily (were the goals met?)

Adjust new goals accordingly

Make Adjustments

Adjust goals according to your evaluations

Turn ideas into plans for your orientee

Be Flexible

SHARE IDEAS