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Healthcare Competency Management Comparison

Better Preceptors Promote an Engaged and Competent Nursing Workforce

By Traci Hanlon MN, RN, Consultant at Creative Healthcare Management 

There has been plenty written on developing an engaged workforce with recommendations that point to hiring the right people in the first place (Bowen, Ledford, Nathan, 2013, and Kristof, 2006). The importance of manager competence in screening, interviewing, and identifying the personal characteristics and competencies of individuals who will best complement their teams cannot be overstated. However, as a consultant with more than 20 years assisting in the development, implementation, and evaluation of many acute and long term care institution’s orientation programs, I have observed a gap in how many of us facilitate the transition of new staff to practice. If we are not thoughtful in how we transition new staff into practice, we reduce the effectiveness of our teams and decrease job satisfaction in our newly hired staff. On a larger scale, we may unintentionally pose a threat to patient safety by hampering the ability of our new staff members to develop solid critical thinking skills, healthy communication practices, and a collegial interdependence within teams. 

In the healthcare industry, preceptors are used to socialize, mentor, evaluate, and assist in the transition of new staff into the workforce. Traditionally, preceptors were used only for new graduate nurses and students, but since a key role of the preceptor is to supervise, evaluate, and validate a new staff member’s competency, then it makes sense to use preceptors with all new staff as a model to introduce the norms and nuances of a particular unit and to assess and validate a preceptee’s competency. The length of preceptorship should be determined by the level of experience new staff members have with the profession in general, their familiarity with the hiring organization, their familiarity with the role they are being hired for, and their experience in the specific nursing specialty. 

Managers invest a great deal of time and energy in the hiring process with the aim of finding the right combination of skill, attitude, and engagement necessary to add value to their teams. What managers often fail to recognize is that if they do not invest that same time and energy into selecting the right combination of skill, attitude, and engagement in the preceptors who will be transitioning their new hires into the work environment, all of their hard work in finding the right fit for their team may end up going down the drain. Preceptors can make or break the new hire’s experience; in fact, I have seen bad precepting experiences lead to increased stress during the orientation phase, which has the potential to impact the development of good critical thinking skills. Poor critical thinking skills can contribute to poor outcomes, which in the long term can reflect negatively on patient safety. Preceptors set the tone for the level of professional practice expected on a unit and make clear the norms and behaviors that are deemed acceptable in the workplace. In other words, everything your new hire learned in orientation, from behavior standards to infection control policies and best practices, can be undone by a preceptor who does not exemplify best practices in his or her own professional practice or lacks crucial critical thinking or interpersonal competencies.

So what criteria should a manager use to select who will orient and precept new hires?

There is a significant body of literature that provides ample recommendations for determining preceptor selection criteria (Eddy, s. 2010, Altmann, T. 2006, Hartline, C. 1993).  Upon review of the most recent research articles articulating preceptor best practices, several preceptor characteristics and competencies stood out to me as providing the best indicators for preceptor success. They are:

  1. Demonstrates self-directed advancement of professional practice
  2. Demonstrates authentic leadership
  3. Demonstrates exceptional performance  in clinical  and interpersonal competencies
  4. Demonstrates the desire to become a preceptor (self-selection)

Demonstrates Self-directed Advancement of Professional Practice

People demonstrating this characteristic have taken ownership for their own professional development. They are the ones who volunteer for quality improvement projects and participate in life-long learning as evidenced by attending conferences, classes, or in-services that expand their clinical and critical thinking and their interpersonal competency.

Demonstrates Authentic Leadership

Individuals who engage in authentic leadership have a track record of treating others with kindness and respect. They do not engage in gossip, and often these individuals hold others accountable for destructive behaviors by having kind, yet firm peer-to-peer conversations related to observed unhealthy work behaviors.

They have a clear vision and purpose for the work they do and can often articulate how their personal values align or complement the organizational mission, vision, and values. These individuals are engaged and committed to their organization. This is demonstrated by their ability to embrace change with a positive attitude and their early adoption of initiatives, processes, and philosophies that may stretch their current way of thinking and or practice.

Demonstrates Exceptional Performance in Clinical and Interpersonal Competencies

These individuals are self-directed learners who will typically be the first to complete any competency or learning requirements. In other words, they will not be the individuals you have to hunt down, remind, and micro-manage to provide evidence of their competency. These are also individuals who continually seek to improve their current skill levels; they are receptive and value constructive feedback.

Demonstrates the Desire to Become a Preceptor (self-selection)

This characteristic speaks to the importance of choosing only individuals who have an authentic desire to precept and (ideally) who proactively seek the opportunity to do so.  Managers who mandate precepting as an expectation for all staff risk entrusting individuals who are not suited to precepting or lack the skill to undertake such an important and critical role with one of the most important jobs in health care.  

Selecting preceptors who demonstrate competency in the four areas described above to facilitate the transition of new staff into your team is a crucial part of the hiring process.  To neglect this step and allow individuals who lack the necessary desire and skills to precept is setting up the entire team to fail, especially the new person. 

An engaged and competent workforce relies on a solid foundation that begins the first day they step onto their unit. The preceptor plays a vital role in this process and can make or break a new person’s experience.  It is for this reason that managers must focus their attention on the entire continuum of hiring, from the first screening phone call, to the interview, all the way through their orientation of which preceptor selection is a most vital aspect.

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Traci Hanlon MN, RN is a consultant with Creative Healthcare Management and specializes in preceptor, nursing orientation, and transition to practice program development.

References:

Bowen, D., Ledford, G., Nathan, B., (2013). Hiring for the organization, not the job.  Academy of Management Perspectives. 27(3).

Kristof, A.  2006. Person-organization fit: An integrative review of its conceptualizations, Measurement, and Implications. Personal Psychology, 49(1).

Eddy, S. 2010. Lesson learned from formal preceptorship programs.  Creative Nursing, 16(4).

Altmann, T., (2006). Preceptor selection, orientation, and evaluation in baccalaureate nursing education.  Nursing Education. 3(1).

Hartline, C., (1993). Preceptor selection and evaluation: A tool for educators and managers.  Journal of Nurse Staff Development. 9(4).

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