Chapter 1
Introduction
A functional healthcare system needs to be effective and efficient to achieve optimal healthcare and improve the quality of care. The healthcare industry is fronting a significant shortage of health workers whose scope is complex to understand. According to the World Health Organization (WHO), there is an abrupt global requisite for more than 4.3 million health workers in 57 countries with perilous shortages. Unless these declines are addressed, they will risk the accomplishment of the health-related “Millennium Development Goals (MDGs)” (Simon, 2020). According to new research from the Association of American Medical Colleges (AAMC), the United States risk facing a primary care provider deficit of between 21,400 and 55,200 by 2033. As countries continue to fight the COVID-19 epidemic, the gap between expanding healthcare demands and the supply of doctors to address the healthcare issue has recently grown wider. As the country’s population grows, the problem of having enough primary care providers to service communities become progressively more difficult. According to the US Bureau of Labor Statistics (BLS), the job outlook for advanced practice registered nurses, including nurse practitioners (NPs) is anticipated to expand by 31% in 2026. For surgeons and physicians, this rate is estimated to be 13%. In these modern days, most families need a private nurse (family nurse practitioners) to attend to them given that there is shortage of primary care providers to attend to different families. Thus, the healthcare system requires new grad nurse practitioners trained through preceptorship to become competent and improve healthcare provision. These precepts necessitate training and preceptorship to enhance their supervision and support for skills development and mentorship. In general, preceptorship allows new grad nurse practitioners to quickly adapt to the ever-changing healthcare systems. Through their guidance, the preceptors become an optimal fit within the healthcare field to guide and support new graduates. This supervision allows new grad NPs to easily integrate into healthcare teams without being a hindrance (Bartlett et al., 2020). Healthcare professionals undergo training programs to become effective and competent preceptors. There are many training programs for new FNPS including preceptorship, residency program, etc. however this paper will focus on developing a Family Nurse Practitioner (FNP) Preceptor Training Program. This educational program is designed to help healthcare providers to precept and support RNs to transition into an FNP via residency program. This preceptor education program targets healthcare providers as preceptors and role models for residents. The program employs a range of teaching strategies that promote active learning and hands-on experience that result in the acquisition and integration of new knowledge, skills, and attitudes (Association of Surgical Technology, 2021).
Justification of the Project
Preceptors are necessary for the advancement of the new graduate FNPs’ skills and knowledge. Preceptorship, mentorship, orientation, and residency are common learning methods that healthcare institutions use to introduce new hires to the organization’s policies and procedures. Once new hires are acquired the knowledge and skills needed to function independently or become competent and confident in providing care. Usually, educators and preceptors have trained academically and made experientially qualified to become an extension of the healthcare providers. Their guidance to the new graduate is irreplaceable as it aids their progression and helps them reach their academic goals. However, some of these educators and preceptors are excellent clinicians but lack effective teaching and learning strategies (Knott, Mylrea & Glass, 2020). Currently, little is known about the availability of resources and training materials for these educators and preceptors. A training program is an integral part of becoming a preceptor and preceptors must be able to avail these training programs for their respective fields, so in the case of FNPs who are trying to start or advance their careers; it becomes imperative that they receive formal training (residency) in their respective field. This preceptor training program allows the preceptors to gain an understanding of their responsibilities and develops the knowledge and skills required to perform their role as preceptors successfully. An excellent preceptor training program reviews the clinical skills and offers opportunities to review the policies and procedures in the related field (Piccinini et al., 2018). It equips the potential preceptors with the ability to develop teaching strategies that they may use to train future nurse practitioners. Apart from this knowledge and skill-based training, the preceptor program is also significant in developing certain attitudes which are required to be a successful preceptor. Practicing self-evaluation helps in the identification of individual leadership styles. For this reason, “Adaptive Training”, is provided to preceptors to develop flexibility toward different personalities and teaching styles. Adaptive Training is an interactive training tool that uses machine learning and mediated resources to meet the unique learning requirement of learners. It is a great educational tool to help preceptors complete their training effectively. Moreover, the adaptive training program is provided to develop flexibility toward different personalities and learning styles as the preceptors will be training others in the future (Dingle & Avant, 2018). The preceptor training program for FNP is important in equipping them with the appropriate knowledge, skills, and behaviors required for this mentorship role.
Purpose of the Project
The purpose of this project is to develop educational materials and resources that will equip the FNP Preceptors with the knowledge and skills that will allow them to work effectively with the FNP residents in their field. This training program aims to provide a preceptor with a better understanding of FNP residents’ roles and responsibilities as FNPs as well as assist them in developing the proper skills required for training future FNPs. This preceptor training will develop six modules to provide preceptors with needed resources for effective and saucerful residency programs. This will serve as formal training for FNP’s preceptors as it will be focused solely on the outcomes needed by the FNP in this field. After this training, the preceptors will be able to perform their duties skillfully as they will be equipped with relevant skills and knowledge.
Theoretical Framework
The research aims to provide a clear guideline for FNP preceptors and educate them about the FNP role in the healthcare system. It will help in developing a deep understanding of preceptor responsibilities and utilizing the resources that might aid them in identifying the educational goals and outcomes. There are various criteria and competencies outlined in the literature to become a clinical preceptor. Preceptors must be physicians or advanced practice registered nurses, who are licensed to practice in the state where the preceptorship experience may occur. Moreover, the experience of at least two years as a nurse practitioner or physician is required. This experience includes being proficient in providing patient care following the organization’s policy and procedure as well as national clinical guidelines, fulfilling the assigned duties, and being able to safely operate the equipment. Effective and appropriate use of resources and effective verbal and written communication is also a prerequisite to becoming a preceptor.
Over the years, the number of new nurse practitioners is increasing. In this case, the preceptors have become essential as their training focuses on making them highly skilled in clinical practice and it also increases their preparedness, knowledge, effectiveness, and willingness to play the role of a preceptor (Simon, 2020). The most effective training model for preceptor training is the “One-Minute Preceptor Model”, which aims to provide the preceptors with the capability to take complete advantage of the time given for teaching the students or the NPS. Although this teaching method takes more than one minute to teach, its effectiveness and efficiency make it the most optimized training model. The paper aims to utilize this method in devising the preceptor training program for family nurse practitioners that are trying to augment their skills towards preceptorship (Gatewood et al., 2020).
The training program will be developed using Barnes’ Learning Theory for adults. The theory focuses on providing a competitive learning environment for adults. Through the use of this theory, a training program can be devised that will be effective in educating adults. This theory informs the readers about the differences in the way a child learns in contrast to adults. Children’s brains are developing so it is easy for them to learn new things, however; in adulthood, people are set in their ways and it becomes difficult to learn new things. With the help of Barnes’ Learning Theory for adults, the program developed will be adaptable for each learner’s needs. Learning through the principles of this theory will allow the students to fully grasp the concepts and increase their knowledge base (TEAL, 2011).
Chapter 2
Literature Review
Training nurse practitioners to become preceptors is beneficial as the number of primary care physicians is decreasing. Although many preceptor training programs are provided, there is still a shortage of preceptors so developing an efficient training program and encouraging students to participate in the program is extremely important. For this, the programs need to be centered around one core skill so that the students may choose the one that suits them best. To prove that intensive training in a specific field will make the NPs more capable, the paper is focusing solely on developing a preceptor training program for Family Nurse Practitioners (FNPs). This chapter will review the literature available regarding this topic and use it to build an effective preceptor training program for FNPs.
Previous Preceptor Training Programs for FNPs
There are many preceptor training programs for nurse practitioners (NPs), however; there is not a program that solely focuses on preceptor training for family nurse practitioners (Simamora, 2020). This lack of specific training modules is a gap in the literature. To understand the reason for such a gap, a literature review was conducted. The PubMed, Cochrane Library, Scopus, and CINAHL databases were searched for publications on preceptor training programs for nurse practitioners from 2000 to January 2022. The search was performed with the following keywords: preceptorship, training, NP, FNP, residency program, USA, and Advanced practice nurse. The search was conducted in English and was limited to articles published in English in the USA. A manual search of reference lists from identified papers supplemented the electronic search. We were able to identify preceptor training. Unfortunately, the literature search didn’t retrieve any FNP preceptor training. So, this project aims to develop an FNP preceptor training program.
This literature review identified the number of findings of existing preceptor training programs that focus on the training of nurse practitioners, through this training they become ready to provide specialized care to specific patients, which means they are ready to become a part of a specialized department. They can choose to be FNPs or any other type of nurse practitioner. This means further preceptor training programs are not as widely available that will allow them to expand their skills and knowledge base. If more specialized training programs are provided then this will allow them to train new FNPs and help them adjust to the team seamlessly (Giddens et al., 2014).
Family Nurse Practitioners (FNPs)
FNPs work with physicians in keeping medical records of the patients; these records include the history of diseases in the patients’ family, patients’ medical history, medication administered to a patient over the years, etc. It requires a deep knowledge of each patient and all patients have interacted with FNPs throughout their medical life. FNPs are trained to provide care to patients of every age group. They are responsible for keeping a record of the patients’ medical history and monitoring their health over the years, which helps in detecting early signs of diseases and help in prevention. FNPs are the most needed in the healthcare system but over the years there has been a shortage of family physicians which has led to an increased workload for FNPs. However; the number of FNPs is not enough to compensate for the shortage of family physicians so a preceptor training program must be provided so that new FNPs can be oriented and trained effectively and to manage and treat patients (SGU, 2021).
Available Preceptor Training Programs
Even though there is no published FNP Residency training for Preceptor, the literature review revealed only four. The currently available training programs are for nurse practitioners which include Advanced Practice Registered Nurse (APRN) Preceptor Development Education, One-Minute Preceptor Training Method, NP Concentration Preceptor Guide, FNP Preceptor Program, etc. However, these programs are more of guidance (sheet cheat), They are mainly for NP students while attending nursing school. While the project aims to identify and build a preceptor training program based on literature. Below is an overview of these four programs.
APRN Preceptor Development Education
This program consists of seven training and educational modules that are available online. It focuses on educating the students about their responsibilities as a preceptor, the way the students’ learning styles may differ from others and teaches the preceptors to adapt to their future students’ needs, clinical teaching, facilitation of critical thinking, and effective communication, and cultural awareness. The program provides simulation in which the APRNs apply the skills that they have learned during the training program (Maryland, 2020). However, this program is not tailored to FNP needs in community clinics, especially for the LA County population.
One-Minute Preceptor Model
Many NPs in the healthcare system are individuals of advanced age and although these NPs are highly skilled; their career is or will be coming to an end soon due to their age. With most of the NPs being seniors, there is an impending problem of a shortage of NPs in the coming years so it is becoming more and more necessary to establish and develop NP preceptor programs. The preceptors are trained NPs or physicians that are experienced and skilled as clinicians. They work directly with the NP residents, training them in clinical healthcare settings and enabling them to become independent practitioners in a short time. The demand for NPs is increasing due to population growth so the demand for preceptors has increased as well. However, there is a deficit of preceptors and with the ever-growing demand for more NPs, there is also a shortage of time required for training. To efficiently train preceptors in a limited time; the “One-Minute Preceptor Training Model”, is an optimal choice (Miura et al., 2020). However, future studies should examine the effect of a series of brief interventions to see if they are effective at improving overall teaching ratings.
Recent research by Ong et al. (2017) indicates that although little impact was seen on dental surgery, cross-professional understanding of the OMP model may be improved. Similarly, there is a lack of research on the use of OMP models in nursing and advanced nursing practices. Current evidence supports the value of OMP as an effective clinical training model evaluated by students to improve their training through clinical evaluation, feedback, and corrective support. Although research is limited to most healthcare professionals, it is practical to propose the adoption of this learning model as a tool for NP educators. Further research is needed to assess the effectiveness of the OMP model in NP education. (Gatewood et al., 2020).
NP Concentration Preceptor Guide
This preceptor training program aims to integrate FNPs and physicians into the role of preceptors and make them capable of effectively training future NPs. Through this program, the preceptors learn new teaching strategies and skills as well as their responsibilities for training competent FNPs. After this program, they will be able to teach the resident about different concepts, theories, and their applications. They develop the capability of advancing the skills, knowledge, and proficiency of their residents. They can adapt to different learning styles of their students which is important for the growth of students. This training program is developed using “Andragogy, Knowles’ theory of adult learning”, which theorizes that adults are independent learners and employ self-direction in their learning process so the best way to educate an adult is to allow them to plan and evaluate their learning progress. So, in this training program, the teacher plays the role of a facilitator more than an educator (MSN, 2019).
4- Mennonite College of Nursing-Illinois State University FNP Preceptor Manual
This manual aims to prepare FNP preceptors to explain advanced practice roles and duties to FNP students. It not only trains them to be FNP preceptors but also for nursing system administration. It builds a nursing foundation, then trains FNP students for practice in individual, group, and community settings. This training manual allows FNP students to take on a leadership role and guide other FNPs. It also serves as a foundation for doctoral study, if practicing nurses are looking forward to advancing their careers. Similar to other programs it aims to build an advanced knowledge base, critical thinking, utilization of scientific inquiry, and leadership role (Nursing, 2018).
This preceptor manual has been developed to provide preceptors with information about the graduate program and the clinical courses. It also includes guidelines related to your preceptor role. As it’s descriptive more of policy and procedure for the school of nursing.
Development of Training Program
These training programs provide an extensive base for the development of an effective preceptor training program for the FNPs. The outcomes determined by each program are similar to the rest of the programs, so these outcomes can be adopted into the program that is being developed by the researcher. The most efficient training program is One-Minute Preceptor Training Method, as it aims to achieve the same goals as the other programs but in a short time. This method will permit for the training of more preceptors, in a short time that will combat the shortage of preceptors in the healthcare system.
Based on literature review the authors developed a new FNP residency program that is culturally appropriate for the population of LA County. This program was piloted and refined in a cohort of F9 NP residents that served in different community clinics in LA County.
Chapter 3
Methodology
This chapter will cover the methods employed in the development of the preceptor training program for the FNPs. The process will utilize the One-Minute Preceptor Method as the foundation of the program and explain the modules developed for it.
One Minute Preceptor
This method was developed to utilize the limited time available effectively as precepting in a clinical setting can be difficult due to the busy environment. The schedules of the nurse practitioners may serve as a hurdle for them; making them unable to participate in a formal study session. This method allows the preceptors to utilize a five-step model that helps them in precepting effectively. This approach is extremely structured as it can be easily adapted according to the needs of each learner. The steps defined in this method help the preceptor in determining the effective teaching method for each student by asking them a series of questions that can allow a deep insight into the learning behavior of the students. These steps take minimal effort and are as follows:
- Get a commitment
- Probe for supporting evidence
- Teach general rules
- Reinforce what was done right
- Correct mistakes
This model will provide the basis for the development of an intensive training program.
SUPPORTING FRAMEWORK
Model for Improvement
With approval, an improvement model will be used as the basis for guiding this quality improvement project. The Associates in Process Improvement (API) methodology is a transition model that tries to develop rapid improvements in procedures and results. It is founded on the plan-do-study-act (PDSA) process and system of profound understanding developed by W. Edwards Deming. The improvement model is made up of two parts: three improvement questions and the PDSA cycle. The following are the three improvement questions.
1. What are we endeavoring to accomplish?
2. How will we know if a change is beneficial?
3. What transformations can we make to enhance the problem?
The first improvement question establishes measurable objectives, such as a schedule, target population, and systems affected. The second question asks users to quantify changes to show that they have occurred. The final question encourages users to select variables that have previously proven to be successful. Generally, the questions elicited responses serve as the cornerstone for improvement activities. The trial-and-learn process is best described as the second component of the model for improvement, the PDSA cycle. It is a never-ending cycle of implementation, evaluation, and improvement. The development of a team of involved stakeholders kicks off the planning stage. Each team member is given a specific job and is expected to report regularly. The actual implementation and extraction of data take place in the action stage.
Nurse Knowledge
Compliance with program guidelines
Nurse attitude
Preserve and revise plan to result in measures
reinforcement and close monitoring are required.
Introduce the preceptors program guide.
Emphasize on FNPs advanced eduction.
Identify Concerns
Pre and post-survey to evaluate FNPs understanding.
Education
Plan
Organize training programs.
Study
Act
Figure 1: Model for Improvement: Adapted from Simon (2020).
Framework Application
Identify the Purpose of Improvement Efforts
Nursing preceptors are crucial in assisting new nurses and FNPs in adjusting to the training surroundings and nursing culture. It is estimated that 17% of recently qualified FNPs quit their first occupation within the first year (Simon, 2020). Worse, if new FNPs have inadequate understanding during the transition period, they may depart the field. A new FNP is partnered with a preceptor for a length of time during which the preceptor supports, enlightens, and assists the preceptee throughout their clinical orientation to a specific healthcare environment during preceptorship. A new FNP’s career happiness, professional growth, confidence, and socializing can all benefit from maintaining the support of the FNPS (Bartlett et al., 2020). Preceptorship programs can also help nurses remain in the profession longer. Preceptorship programs are not just for new nurses, but also for nurses who have taken a break, and undergraduate and graduate nursing scholars can all gain from such a collaboration. Preceptorship programs are often employed to guarantee continued professional growth and promote learning in the clinical environment, to develop competent and independent nurses, as healthcare procedures become more complicated, putting greater demands on the nursing career to sustain high-quality healthcare. Such collaborations give professional consent and permit preceptors to gain the information and skills they need to take charge of the nursing career to uphold high-quality healthcare (Dingle & Avant, 2018). Moreover, these collaborations give professional approval and allow precepts to gain the information and skills they need to take charge of their nursing course.
Define Improvement
Although it is voluntary, a preceptorship project/program helps newly registered and FNPs professionals get off to the best possible start in their job. The preceptorship program aims to provide several advantages for both employers and precepts. Nurses, midwives, and nursing assistants will receive the following benefits: Preceptorship supplies the organized consent that students require to successfully incorporate their understanding into day-to-day practice (Bartlett et al., 2020). It permits FNPS to venture on a lifelong expedition of reflection and self-identify their professional development requirements. A satisfactory preceptorship knowledge provides newly registered nurses and nursing associates confidence and a sense of belonging, which makes them feel appreciated.
Identify Changes That Result in Improvement
Nursing preceptors are chosen for different reasons, including a passion for teaching, a devotion to the nursing career, and the subjective gratification they obtain from becoming preceptors. Nurse leaders and instructors can usually locate potential preceptors by conducting a staff survey (Dingle & Avant, 2018). The project has ensured that FNPs attain different qualifications including a baccalaureate or higher degree, reasonable interpersonal skills, cultural sensitivity, clinical competency, zeal for education, delivering recommendations for problem-solving and clinical assessment, constructively presenting favorable and unfavorable feedback, stimulating autonomy, and being devoted about nursing to enhance healthcare provided. Change identification sets the pace for action improvement of purported nursing challenges.
Plan Phase
Doctors and pharmacists, hospital managers, a quality advancement manager, a critical care manager, an emergency department (ER) director, and critical care charge nurses are all part of the preceptor training program. Nurses were given a pre-test and post-survey to measure their knowledge and attitudes about preceptorship. Then, based on the results of the survey, committee members prepared and delivered an education program to nurses in the form of a workshop, which included the most up-to-date facility preceptorship statistics as well as the need for nurse education. When the patient met the criteria, nurses were taught how to start the process. Based on the current research and SCC recommendations, nursing education also included a lecture and simulation drill.
Do Phase
Following the education and training of staff nurses, the nurse-driven procedure was implemented. Nurse education was focused on obtaining various qualifications, such as a baccalaureate or higher degree, exemplary interpersonal skills, cultural sensitivity, clinical competency, confidence in teaching, problem-solving and clinical decision recommendation, constructively presenting favorable and unfavorable feedback, encouraging independence, and being passionate regarding nursing.
Study Phase
Numerous facilities have a standard preceptorship program; smaller organizations promote and support such collaborations, but they cannot have a formal program. Nevertheless, all FNPs require supportive work surroundings in which their job and responsibilities are clearly defined. They also require training, which could involve live educational events or self-study possibilities. For preceptors, a combined learning method is frequently the most suitable. This requires going to an initial session, which could last a few hours, and then completing online modules. Communication, safety culture, clinical judgment, critical thinking, priority, and constructive feedback are all covered in these sessions.
Act Phase
Even though the average knowledge and care compliance rate improved as a result of the program, there is still space for improvement. To ensure that quality and healthcare are provided, and the shortage of qualified nurses is addressed, education, reinforcement, and close monitoring are required. Nurses’ education and monitoring are also significant in ascertaining the need for work motivation and enhancement of work structure. The committee will design a new action plan based on the issues identified for ongoing quality improvement after reviewing the reasons for failure to comply with the program or completion of bundle elements within the timeframe.
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