SE8

SE8 The organization provides educational activities to improve the nurses’ expertise as a preceptor.

Describe the organization’s preceptor educational program(s) and how each program is evaluated on an ongoing basis. Provide supporting evidence.

Consistent with the nursing professional practice model at Homestead Hospital, there are opportunities to foster professional growth and development as well as promote collaboration and teamwork through preceptoring others. The organization provides educational activities to improve nurses’ expertise as preceptors with the following preceptor programs:

New Nurses to Homestead Hospital
Clinical Nurse Educators
Professional Nurse Advancement Program (PNAP)

A. Preceptor Program for New Nurses to Homestead Hospital

Description

In 2008 BSHF moved from a task-based model to a competency-based model founded on Brenner’s framework of Novice to Expert, as a tool in the evaluation process and promotions of nurses in the Professional Nurse Advancement Program (PNAP). In doing so, nurses with 2 years of direct care experience were considered to be a “Proficient RN.” Part of the requirement for the PNAP advancement was to meet the competency behaviors and complete a full day workshop entitled “Nurses as Preceptors/Clinical Coaches”. This requirement addressed the organizational need for having preceptors available for the residency programs. It also promoted the nurse’s professional growth.

To meet this need, the corporate Clinical Learning department designed an 8-hour interactive workshop that, in keeping with adult learning principles, got participants thinking and moving. Clinical Nurse Educator Solimar Figueroa, RN taught it, which laid the foundation towards comprehensive, theory-based education related to interpersonal communication; roles/responsibilities; and principles of teaching/learning, assessment, planning; and feedback skills. The class introduced experienced nurses to theory- and research-based education that included instruction on how to foster critical thinking skills in the preceptee and the development of the preceptor and evaluator roles. (SE8 01 Preceptor Class Flyer and Attendance Roster)

The objectives of the Nurses as Preceptors/ Clinical Coaches workshop were to:

Describe the roles and responsibilities of the preceptor as related to the residency program.
Discuss the concept of transitioning as it relates to safety.
Discuss a learning style assessments tool appropriate for the novice nurse.
Summarize the learning process and the principles of adult learning.
Compare and contrast generational differences in staff learning styles and preferences.
Determine the best practices in fostering critical thinking in the preceptee.
Apply Benner’s Novice to Expert competency development theory to case scenarios.
Explain methods used to verily and document competency and performance.

A unique feature of the workshop was the introduction of the ‘married state’ working relationship between the resident and the preceptor. This involved working side-by-side and sharing the duties in tandem. The couple shared the same schedule for the duration of the residency as much as possible, with the intent to reduce the number of preceptors. This model gave the resident/ new nurse the opportunity to safely assume a full patient assignment and gain experience without being overwhelmed This was a move away from the traditional approach of orientation where a new nurse may start with 1-2 patients and gradually progressed to taking a full patient assignment.

Ongoing Preceptor Education and Support

The Clinical Learning department provided additional ongoing training, education and support for nurse preceptors through a quarterly Preceptor Forum and a Council for Preceptor Nurse Practice (CPNP). The Preceptor Forum was an open meeting for preceptors to discuss issues related to the preceptorship of new graduates and experienced nurses. They met quarterly with the intent to identify critical issues for preceptors and preceptees; discuss new graduate training; and relate experiences in order to provide examples for other members. CPNP met bimonthly. It was opened to any nurse who wished to join. Clinical Learning also offered a 2-hour Refresher Course on the ‘Married State Preceptorship Model’ for those preceptors who needed an update and review of the concepts.

PARTICIPANTS

Name/ Credentials	Title	Department	Role
Solimar Figueroa, RN, MSN, RN-BC (Nursing Professional Development certified)	Clinical Nurse Educator/ Preceptor liaison	Clinical Learning	Presenter on preceptorship/ shared governance “Married State” expert
Judy Bowling, RN, MSN, MHA, BS, RN-BC (Nursing Professional Development certified)	Clinical Nurse Educator II	Clinical Learning	Consultant for system-wide clinical learning and competency development. Led the development of education to support the implementation and integration of standardized evidence- based practice
Marjorie Lima, MBA, MSN, RN	Versant RN Residency Manager	Clinical Learning	Responsible for the coordination and facilitation of residencies with cross-coordination of the Specialty Practice programs

Ongoing evaluation

Since the inception of “Nurses as Preceptors/ Clinical Coaches”, Homestead Hospital has noted a consistent retention of clinical nurses that transition into a new role. Feedback about the preceptor’s education and effectiveness is obtained not only by the unit’s nurse leadership team but is also evaluated by Clinical Learning’s staff through rounding, while preceptors are actively engaged with the new nurses and through the completion of the Slater Nursing Competency Rating Scale by direct observation. These afford opportunities for ‘just in time’ coaching by seasoned clinical educators. Preceptor effectiveness is also reflected in the RN residency online survey. Each RN resident is asked to complete a survey at various points in their residency program. Each question is rated on a 4 point Likert scale (strongly agree to strongly disagree). There are 10 questions specifically related to the preceptors. Results of the survey indicated that preceptors have been successful in achieving the goals of providing an environment that is supportive and conducive to learning and growing. Some of the words the residents used to describe the preceptors included: supportive, innovative, flexible around student needs, good listeners, patient, enthusiastic, empathic, caring, willing to work with beginners, interested in professional growth and continued learning.(SE8 02 Preceptor Effectiveness Evaluation: HH RN Versant Residency Program August 2013, highlighted)

B. Preceptor Process for Clinical Nurse Educators

Description

The clinical nurse educators (CNE) at Homestead Hospital serve as the hub of each nursing unit in providing the structure and education needed for its staff members. However, they too need guidance in growing and developing into their specific roles. Throughout the system and in Homestead Hospital, each unit has a dedicated CNE. These educators are the experts who provide guidance and education to the direct care nursing staff. They are responsible for optimizing staff’s clinical performance as they care for their unique patient populations.

Over the course of several years, CNEs participated in a variety of educational opportunities. Clinical Learning provided education internally on topics such as The Florida Nursing Scope and Standards of Practice; competency development (Donna Wright Model); how to write learning objectives; use of evidence-based tools for program development; and shared governance councils. In addition, sources of information provided through membership in professional organizations or attendance in local conferences/seminars were also available.

Ongoing Education and Support of CNEs

Beginning in 2012, corporate Clinical Learning developed an interactive 2- hour class titled “How to Write Great Learning Objectives “, which Homestead Hospital CNEs attended. The participants received a laminated colored reference to Bloom’s Revised Taxonomy on one side and instructions on verb selection and teaching methods on the other side. Within the Bloom’s Revised Taxonomy was a yellow square, highlighting the levels appropriate for continuing nursing education. Thereafter, Clinical Learning launched a class named “Assessing Staff Learning Needs: The Power of Outcomes-Based Education” in 2013 to improve CNEs’ ability to plan and execute learning needs assessment.

At the system level, Clinical Learning noted that as new CNEs were brought onboard, there was a need to provide some guidance and consistency to their onboarding and help them transition from an expert clinical nurse to a novice CNE. CNEs themselves also identified this as an opportunity area. As a result, Clinical Learning established a planning committee to develop and implement a course for new CNEs. The day-long program titled “New Clinical Educator Practice Development Course” was first offered in February 2013 with 6 ANCC-approved contact hours. Homestead Hospital CNEs who were new to the role have attended the class. (SE8 03 Attendance Roster)This introductory course aimed to provide the new CNEs with the knowledge and tools needed to effectively transition into their new role. Specifically, the class sought to address the following learners’ objectives:

Describe the responsibilities inherent to the role of clinical educator.
Define the key components of educational process and design for adult learners.
Utilize a learning style assessment tool appropriate for staff.
Determine generational differences in staff learning styles and preferences.
Recognize the elements of a measurable and realistic learner objective.
Explain the teaching strategies appropriate to objectives, content, and target audience.

Educators, both experienced and new, identified that they wanted to learn more about staff competency validation and assessment; differentiating compliance problems from true educational needs; and providing outcomes-based education. The issue was discussed at a Clinical Learning quarterly staff meeting, and the Continuing Education (CE) Council was charged with planning and developing a workshop. Lacking in-house expertise, CE Council members launched a nation-wide search for a professional trainer. They decided on the course objectives and interviewed several potential instructors via phone conference. The result was the creation of a workshop named the “3rd Annual Clinical Educator Conference: Cultivating the Capable, Credible, and Confident Educator”, with Terrence Donahue as the speaker in March 2013. This seminar was a hands-on, interactive session that provided both the novice and experienced CNE with evidence-based tools for developing and delivering effective educational programs for high quality outcomes. The program objectives were as follows:

Differentiate between staff learning needs and staff management issues.
Discuss a standardized approach to assessment of basic staff education and training needs.
Describe instruction delivery skills through effective use of vocal techniques, movement, and gestures.
Examine high impact/low effort design and delivery changes that help motivate and improve learner outcomes.
Match your instructional style with group dynamics to meet the needs of the learners.
Generate program evaluations that provide feedback for continuous self-improvement.
Illustrate effective training using a process model and job aids that focus on best practices.

Lastly, Clinical Learning generated a resource guide, called the “Continuing Education Guide.” This was designed to be the “go-to” guide to assist CNEs with some of the common questions and generic responsibilities, such as The Joint Commission requirements and how to meet them.

Clinical Nurse Educator Council

In August of 2013, Homestead Hospital CNEs requested Chief Nursing Officer and Vice President Gail Gordon, RN, for the establishment of a CNE Council within the shared governance structure. Gordon approved their request. Thereafter, Magnet Project Director Julie David MSN, ARNP facilitated their first meeting and provided guidance on moving forward as a new council. By September of 2013, they had held their first meeting and eventually developed a charter and elected a present chair. The CNEs requested to have a nurse leader present to act as a liaison and address any administrative issues or decisions that came up. (SE8 04 CNE Meeting Minutes 9/25/13 and Charter) Since the establishment of the CNE Council in Homestead Hospital, 3 new CNEs have been onboarded. This council became instrumental in facilitating the orientation process for these new educators with several members volunteering as preceptors.

PARTICIPANTS

The Homestead Hospital CNE Council members were:

Name/ Credentials	Title	Department	Role
Rosemary Lee, DNP, ARNP, ACNP-BC, CCNS, CCRN	Clinical Nurse Specialist	Critical Care	Chair
Linda Johnson, MSN, ARNP, WHNP-BC, RNC-OB	Clinical Nurse Educator	Perinatal Services	Chair Elect
Sandy Johnson, BSN, RN, CMSRN	Clinical Nurse Educator	3 South	Member
Aracely Olvera, BSN, RN, CMSRN	Clinical Nurse Educator	MS5	Member
Beverly Johnson, BSN, RN	Clinical Nurse Educator	MS4	Member
Jose Nazario, MSN, RN, CGRN	Clinical Nurse Educator	Surgical Services	Member
Rachael Rodriguez, BSN, RN, CMSRN	Clinical Nurse Educator	MS3/Staffing	Member
Bettina Laier BSN, RN, CEN	Clinical Nurse Educator	Emergency Department	Member
Tamra Da Costa, BSN, RN	Clinical Nurse Educator	Emergency Department	Member
Edda Avila, BSN, RN, RRT-ACCS	Clinical Nurse Educator	Respiratory	Member
Leslie Everett, BSN, RN, CCRN	Patient Care Manager	Critical Care	Nurse leader liaisons
Netonua Reyes, BSN, RN, CCRN	Patient Care Manager	Emergency Department	Nurse leader liaisons

Ongoing Evaluation

In order to facilitate the identification, assessment, and development of education activities to meet the learning needs of this specific target audience, Clinical Learning established a quarterly system-wide Clinical Educator Forum. The Forum provided a learning community for clinical educators from various disciplines committed to improving their practice through collaboration, evidence-based education, resource development and communication. It also established a linkage to educational resources through an e-mail distribution group; an electronic shared educator drive; and quarterly face-to-face contact with educators throughout the system. This provided an ideal venue for the ongoing and periodic assessment and identification of their learning needs through data gathered from focus groups, surveys, new trends in the literature, and the criteria set forth in the Nursing Professional Development Scope and Standards of Practice.

Since the CNE Council was formed in Homestead Hospital, the CNEs were able to accomplish the following:

Implemented Donna Wright Model for ongoing unit-based competencies
Initiated and coordinated quarterly Nursing Grand Rounds

Developed and completed an Educational Survey with bedside nursing staff and nursing leadership

Reviewed policies and procedures to ensure they were evidence-based and consistent with current practice
Led nursing research studies
Revised unit orientation checklists for clinical nurses and clinical partners
Developed CNE-specific initial and ongoing competencies

C. Preceptors for the Professional Nurse Advancement Program (PNAP)

Description

Baptist Health South Florida and Homestead Hospital’s PNAP is based on Patricia Benner's Model of Novice to Expert competency. The program’s 4 levels are: Novice/Advanced Beginner Nurse, Proficient Nurse, Advanced Nurse and Expert Nurse. It contains specific criteria for each level and each level builds on the one before. It differentiates nursing practice based on clinical proficiency, experience and the nurse's ability to set and achieve clinical and professional goals.

All newly hired nurses with less than 2 years of qualified nursing experience are hired at the Novice/Advanced Beginner level while nurses with 2 or more years of qualified experience are hired at the Proficient level. Applications for the Advanced and Expert nurse levels are entirely voluntary. The Advanced and Expert levels are for nurses who meet the specific needs of a practice area and fulfilling role(s) to improve the quality of patient care provided within their particular clinical settings. The PNAP criteria are as follows:

Completes a self assessment utilizing the Competency Model and meets with Supervisor/Manager to discuss professional growth
Functions as a preceptor/mentor
Completes an appraisal of a clinical problem
Serves as a unit based resource of specialty knowledge
Maintains membership in a professional nursing organization
Has earned a BSN or MSN degree or is actively enrolled in an accredited program with completion within three (3) years
Actively participates in entity based or system councils
Maintains National Certification in current specialty
Completion of Leadership Skills for the RN class
Completion of Introduction to Performance Improvement class
Completion of 18 nursing contact hours during the past year

Professional Development Council

Patient Care Managers and CNEs were instrumental in promoting clinical advancement of all nurses. In addition to their support and guidance, the Professional Development Council (PDC) assisted in promoting the clinical advancement for all nurses. The PDC was the shared governance council responsible for defining and directing educational advancement opportunities and clinical competency activities related to clinical nursing. The council’s earlier goals included increasing the number of nurses with their Bachelors in Nursing (BSN) and higher degree, certification and PNAP numbers. In 2010, Homestead Hospital had a total of 3 Advanced Nurses. To realize the goal of increasing PNAP advancement, the PNAP committee, which reviewed the advancement portfolio, became part of PDC. Then, PDC embarked on identifying barriers to PNAP advancement through brainstorming during the meetings and informal surveys. One of the things the council identified was that nurses were confused and needed guidance in navigating the PNAP application process. Thus, PDC committed to mentoring and precepting clinical nurses to become certified, enroll in a RN to BSN program, and advance in the PNAP.

PNAP Advancement Educational Strategies

Since 2011, PDC nurse members have precepted and mentored colleagues in the advancement process using a variety of methods. These included individual one-on-one consultations, hosting PNAP fairs, certification drives, BSN enrollment fairs, and providing guidance in researching evidence-based solutions to clinical practice problems (SE8 05 PDC Minutes 2/1/13).
Specific strategies the PDC implemented in 2013 include:

Extending invitations to nurses ready to advance, such as those certified in their specialty with a BSN or enrolled in a BSN program, sent via email memos and postcards mailed to the nurses’ home address.
Educating Patient Care Managers on the PNAP requirements and their roles and responsibilities using a one-page quick reference guide.
Implementing a grassroots campaign using the “certification cart’ equipped with sample certification examination questions written on flash cards (with answers on the back) for emergency, medical-surgical, critical care, perinatal, endoscopy, and recovery room specialties. The cart also had a poster that showcased the pictures of newly certified nurses as role models. PDC aimed to help nurses realize that certification was an achievable goal and that they have already mastered much of the content required by the certification test through their experience and training.

Ongoing Evaluation

By the end of 2014, Homestead Hospital had 19 Advanced Clinical Nurses. Despite having precepted and mentored 34 nurses in the PNAP process over the past 5 years, PDC noted that the nurses with the drive for excellence often move on to shine in other arenas, such as leadership and education. Since Homestead Hospital is a small and relatively flat organization, there are finite positions for advanced nurses to move into. As a result, these nurses often get promoted and assume a new role; move internally within the organization into another specialty area; or transfer into open positions in sister hospitals. For this reason, Homestead Hospital is often referred to as the university for BHSF. Nurse leaders, CNEs and PDC members are committed in growing and developing nurses to become excellent nurses no matter where they will end up practicing. They will continue reassessing and implementing novel strategies to uphold this thrust. This is Homestead Hospital’s legacy to professional nursing.

Former Advanced/Expert Nurses Who Had Been Further Promoted

Name/Credentials	Department	PNAP Level	Promoted To
Ana C. Cabrera, BSN, RNC-OB	Perinatal Services	Advanced	Clinical Patient Educator in June 2013
Christina Edozie, MSN, RN, CCRN	ICU	Advanced	Bioethics Nurse December 2013
Caroline Gandy, BSN, RN, CMSRN	Endoscopy	Advanced	Patient Care Supervisor December 2013
Mary Montejo, BSN, RN, CWS	Wound Care	Advanced	Wound/Ostomy Coordinator September 2014
Aracely Olvera, BSN, RN, CMSRN	MS5	Advanced	Clinical Nurse Educator in December 2012
Georgina Orozco, MSN, RN, CCRN	PACU	Advanced	Completed Advanced Practice Nurse degree and worked in a physician practice in Aug. ‘13
Cheriese Rawlins, MSN, RN, CCRN	ICU	Expert	Clinical RN Educator August 2013
Mavalee Taylor, MSN, ARNP, CCRN, FNP-BC	ICU	Advanced	House Supervisor in 2011
Derrick Yuhr, BSN, RN, CPAN	PACU	Advanced	Nurse Specialist 2 in March 2013

Summary Attachments/Hyperlinks/Evidences:

SE8 01 Preceptor Class Flyer and Attendance Roster
SE8 02 Preceptor Effectiveness Evaluation: HH RN Versant Residency Program August 2013, highlighted
SE8 03 Attendance Roster
SE8 04 CNE Meeting Minutes 9/25/13 and Charter
SE8 05 PDC Minutes 2/1/13

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Teaching and Role Development