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Supporting preceptors of distance nurse practitioner students
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Teaching and Learning in Nursing 000 (2020) 1 7
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Teaching and Learning in Nursing journal homepage: www.journals.elsevier.com/ teaching-and-learning-in-nursing
Supporting preceptors of distance nurse practitioner students Janet Luimes, MScN, RN, NP* University of Saskatchewan College of Nursing, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada
A R T I C L E
I N F O
Article History: Accepted 4 October 2020 Available online xxx Keywords: Nurse practitioner Preceptor Distance education Quality improvement
A B S T R A C T
Preceptors play an important role in facilitating clinical competency development of nursing students. Support of preceptors is essential to ensure optimal student learning as well as preceptor satisfaction, recruitment and retention. Distance education programs face a unique barrier in supporting preceptors due to lack of physical proximity to preceptors and students. This quality improvement initiative explored current supports available to preceptors of students in distance nurse practitioner programs and the importance preceptors place on these supports. Findings revealed individual, institutional and external factors must be jointly considered to optimally support preceptorship. The study provides a Canadian perspective to a growing body of global research on nurse practitioner student preceptorship, contributing to development of best practices for supporting preceptors and students in distance health education programs. Crown Copyright © 2020 Published by Elsevier Inc. on behalf of Organization for Associate Degree Nursing. All rights reserved.
Preceptors play a key role in facilitating development and evaluation of nurse practitioner (NP) student clinical competence. Given the responsibilities and expectations placed on preceptors, it is imperative they are provided with necessary supports to facilitate student learning and assessment. There is a growing body of international literature exploring barriers and facilitators to NP student preceptorship, with distance education programs identified as a particular challenge (Roberts, Wheeler, Tyler, & Padden, 2017; Webb, Lopez, & Guarino, 2015). Recognizing the importance of preceptorship support in facilitating student learning as well as preceptor satisfaction, retention and recruitment, the College of Nursing, University of Saskatchewan, undertook a quality improvement project to examine supports for preceptors of distance NP students.
Background In Canada, NP education programs require students to possess licensure and experience as a registered nurse (RN). As a result, many NP students have established careers and families when they begin their education. The option for these students to take classes by distance and on a part-time basis is often appealing, as it removes the barrier of relocating and decreases the financial burden of returning to school. Consequently, there has been enhanced interest and demand for distance NP programs. Funding source: This work was supported by the University of Saskatchewan Faculty Recruitment and Retention Funds. Ethical approval: This study was reviewed and exempt by the University Research Ethics Board due to the quality improvement nature of the study (Beh 17-388). *Corresponding author. Tel.: (306) 966-8426. E-mail address: [email protected]
The University of Saskatchewan College of Nursing is situated in Western Canada in a geographic area with high rural and remote health care needs. The NP program focuses on education of NPs to address the primary care needs of rural, remote, and vulnerable populations and as such has adopted a distributed “learn where you live” approach allowing students to remain in their home community while pursuing advanced nursing education. Students in the NP program are dispersed across, University of Saskatchewan and other Canadian provinces. The program utilizes both synchronous (real-time web-based classes) and asynchronous (online) classes to facilitate development of essential advanced practice nursing competencies. During clinical practicum placements, students are supervised by an experienced NP preceptor with supportive guidance provided by NP program faculty via telephone, email, and web-platforms (i.e., Zoom and WebEx).
Significance Clinical experiences are recognized as an essential component of the education of health professionals, providing opportunity for students to apply, develop, and refine clinical knowledge and skills they have learned in the classroom to “real life” practice. As such, standards and guidelines for health professional programs outline a minimum number of clinical hours that must be achieved by each student. For NP programs in Canada, this minimum number of clinical hours is 700 hours (CASN, 2012). The nature of NP practice, which typically involves one-on-one clinical care of patients, does not lend itself ideally to group clinical rotations. Therefore, one-on-one clinical preceptorships are utilized to attain the clinical hour requirements for students. With local and global challenges in the recruitment and
https://doi.org/10.1016/j.teln.2020.10.005 1557-3087/Crown Copyright © 2020 Published by Elsevier Inc. on behalf of Organization for Associate Degree Nursing. All rights reserved.
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retention of preceptors, securing these one-on-one preceptorship experiences is resource consuming and challenging for many NP education programs (Drayton-Brooks, Gray, Turner, & Newland, 2017; Forsberg, Swartwout, Murphy, Danko, & Delaney, 2015). To address the challenges of preceptor recruitment, several authors have explored barriers and facilitators to NP student preceptorship (Hawkins, 2019; Logan, Kovacs, & Barry, 2015; Logan, Kovacs, & Barry, 2018; Roberts et al., 2017; Webb et al., 2015). A review of this literature reveals that barriers and supports for preceptorship may be categorized into three primary areas:
1) Organizational (NP Employer) factors. For example, receiving support from employers for the extra time, physical space, and effort required to teach a student. 2) Educational program factors. For example, receiving support from faculty and educational programs to orientate students to clinical requirements, facilitate learning experiences and assist with evaluation of student clinical competencies. 3) Personal NP attributes. For example, the personal value and commitment an individual places on contributing to the education of future health care professionals.
Distance education of NP students poses a unique barrier to preceptorship due to lack of physical proximity of educational institutions and faculty to students and preceptors. Little is known regarding the optimal supports for preceptors at a distance and the impact of supports on preceptor satisfaction, recruitment, retention and student outcomes (Roberts et al., 2017; Staples and SangsterGormley, 2018). Purpose The purpose of this quality improvement project was to assess the types of supports currently available to preceptors of distance NP students as well as establish the importance preceptors place on different supports as a baseline for enhancing preceptor supports within the University of Saskatchewan, distributive NP program. The overall goal was to improve recruitment and retention of preceptors and the overall student learning experience. The following research questions were asked: 1. What supports are currently available to support preceptors in their preceptorship of students in distance NP programs? 2. What importance do preceptors place on different supports in assisting with their preceptorship of students in distance NP programs? Methods Ethics This study was reviewed and exempt by the University of Saskatchewan, Research Ethics Board as a quality improvement project. Survey development A review of literature was conducted to identify the current state of knowledge regarding supports for NP Preceptors. Based on the literature review and experience of NP faculty, an online survey was developed to explore preceptor perceptions of supports for supervising distance NP students. Barriers and facilitators to preceptorship were divided into two categories: (1) Supports provided by
Educational Institutions and (2) Supports provided by NP Employers/ Organizations. While individual NP characteristics have also been recognized as barriers and facilitators, it was decided not to focus on these items explicitly in the survey but recognize the overarching impact of personal values on preceptorship. Once developed, the survey was pilot tested with five experienced NP preceptors for face validity and clarity. Minor revisions were made to the survey after pilot testing to enhance organization and promote identification of perceived barriers and supports to preceptorship . The final version of the survey contained a combination of 17 open and closed ended questions, taking approximately 10-15 minutes to complete. Questions related to current preceptorship supports, perceived importance of different preceptorship supports, and participant demographics. A copy of the survey tool can be found in the Appendix. Survey deployment The online survey was inputted and deployed by the College of Nursing Strategic Analyst, removing the Principle Investigator from direct interaction with respondents. This was important in protecting result bias due to the Principle Investigator’s former educational relationship with many preceptors. Fluid Survey was used as the online survey platform. Participants Primary care NP and physician preceptors who had supervised a College of Nursing NP student in the past five years, between 2013 and 2017, and for whom an active email address was present in the College’s clinical database (N = 172) were sent an email invitation to participate in the survey. The email invitation included informed consent information, inviting these preceptors to voluntarily and anonymously participate in the survey. The survey was open three weeks from January 8 to January 29, 2018. Reminder emails were sent after one week and two weeks. While the participant list was specific to preceptors of the College, it was intended to also capture individuals who had precepted students in other distance NP programs as it is common practice for preceptors to take students from different education programs. All participants were offered opportunity to enter a draw for one of six $50 gift cards as incentive for completing the survey. Survey analysis Data were analyzed using relative frequency statistics (descriptive statistics) and thematic analysis of open-ended responses. Results The response rate for the survey was 34% (N = 59), with participants representing a range of practice settings, preceptorship experience, and age distribution. 81% of participants identified as NPs and 19% as physicians. The majority were from Saskatchewan (76%) and female (74%), which is consistent with characteristics of preceptors within the University of Saskatchewan, NP program. Many preceptors identified as having five or more years of experience in their role (84%) and experience precepting 6 or more NP students (46%). It is interesting to note that only 22% of participant preceptors had had formal preceptor training. Table 1 contains a detailed overview of participant demographics. The most commonly identified supports provided to preceptors by NP distance-learning programs were preceptorship packages/ manual (91%), faculty/clinical coordinator-initiated contact prior to starting practicum (67%), nonmonetary recognition (i.e., thank you
Please cite this article as: J. Luimes, Supporting preceptors of distance nurse practitioner students, Teaching and Learning in Nursing (2020), https://doi.org/10.1016/j.teln.2020.10.005
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J. Luimes / Teaching and Learning in Nursing 00 (2020) 1 7 Table 1. Participant demographics Professional designation Gender Age
Practice setting
Geographical location
Experience
# of NP students preceptored
Formal preceptor training
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Table 2-2. Supports provided to preceptors by employers Nurse practitioner: 81% (48) Physician: 19% (11) Female: 74% (43) Male: 26% (15) 30-39 years: 29% (17) 40-49 years: 22% (13) 50-59 years: 35% (20) 60+ years: 14% (8) Rural: 64% (38) Urban: 31% (18) Remote: 7% (4) Community-based: 31% (18) Hospital-based: 17% (10) Salaried: 25% (15) Fee-for-Service: 5% (3) Saskatchewan: 76% (44) Alberta: 12% (7) British Columbia: 10% (6) Other: 2% (1) 0-2 years: 5% (3) years: 11% (6) 5-10 years: 35% (20) More than 10 years: 49% (28) 1-2 students: 20% (12) 3-5 students: 34% (20) 6-10 students: 19% (11) More than 10 students: 27% (16) Yes: 22% (13) No: 78% (46)
card and certificate) (59%) and faculty-initiated contact throughout the practicum (55%). Less common supports provided by NP distance learning programs included: A common website for faculty and preceptors to share information about clinical and network (1.7%), video-conference orientation (3%), online resources with clinical teaching and preceptorship strategies (9%), and monetary incentives (9%). Table 2-1 contains a complete listing of preceptorship supports provided by NP distance learning programs as identified by survey participants. The most commonly identified supports provided to preceptors by employers were: physical space to accommodate (59%) and time for consultation with NP faculty regarding student progress/evaluation (45%). In general, preceptors identified low frequency in supports provided by employers (see Table 2-2: Supports provided to preceptors by employers). Looking at the importance preceptors placed on supports provided by NP Education Programs, the most important supports Table 2-1 Supports provided to preceptors by NP distance-learning programs Preceptorship package or manual Faculty and/or clinical coordinator initiated contact prior to start of practicum Nonmonetary recognition Faculty initiated contact throughout the practicum Feedback on preceptorship skills/student experience Coordination of student clinical site requirements (i.e., EMR training and orientation) Preceptorship workshops Information on student strengths and weaknesses Clinical site visits Access to University resources (i.e., library, workshops, and course materials) Monetary incentives Online resources with clinical teaching and preceptorship strategies Video-conferenced orientation Common website for faculty and preceptors to share information about clinical and network
91.4% (53) 67.2% (39) 58.6% (34) 55.2% (32) 25.9% (15) 22.4% (13) 19.0% (11) 15.5% (9) 12.1% (7) 12.1% (7) 8.6% (5) 8.6% (5) 3.4% (2) 1.7% (1)
Physical space to accommodate student Time for consultation and discussion with NP faculty regarding student progress and evaluation Monetary incentives (i.e., preceptor stipend) Increased time for appointments/reduced patient load Recognition of preceptorship as part of role Employer organized clinical site orientation and training (i.e., EMR and policies) Dedicated (paid) time to complete student evaluations Nonmonetary recognition (i.e., verbal support and awards) Recognition of preceptorship as part of performance evaluation Preceptorship training
58.5% (31) 45.3% (24) 37.7% (20) 35.8% (19) 35.8% (19) 26.4% (14) 24.5% (13) 24.5% (13) 20.8% (11) 7.5% (4)
identified by preceptors from NP Education Programs were studentinitiated contact prior to starting practicum, feedback on preceptorship skills and the student experience, preceptorship package/manual, clinical coordinator-initiated contact prior to starting practicum, and coordination of clinical practicum site requirements. Less importance was placed on video-conferenced orientation, clinical site visits, and access to online resources. See Table 3-1 for a detailed overview of preceptor ratings of importance of supports from NP Education Programs in assisting preceptorship of students in distance NP programs. Organizational considerations including physical space to accommodate students, increased appointment times, dedicated time to complete student evaluations and time for consultation with NP faculty were ranked by preceptors as important employer supports for preceptorship of distance NP students. Preceptorship training and monetary incentives were ranked as less important employer supports. See Table 3-2 for a detailed overview of preceptor ranting of importance of employer/organization supports in assisting with preceptorship of NP students in distance learning programs. Additional barriers to preceptorship were identified in free-text comments of participants. These barriers related to increased workload considerations with preceptorship of students: “It is very time consuming to take on students, it is rewarding but is an additional big responsibility” “I am self-employed and fee for service, so all [employer] supports are afforded by myself for educational purposes.” “Preceptoring of students has become a requirement within the job description of many nurse practitioner positions. Several times as a preceptor I had to coordinate the necessary training (i.e., EMR training) to supports students in their clinical placement. Additionally, employers are often not supportive of the extra time required to mentor students and hold NPs accountable for time management, limitation of overtime and yet carry the same patient load as would be required when not preceptoring students.” The importance of program and employer support in addressing these barriers was also highlighted: “Preceptorship is important and time consuming but it isn’t valued by employers such that it is just one more thing on the already large workload and it is not compensated.” “Any interest and support from employer would be appreciated. They show no interest once I accept a student”
Discussion The overall goal of this quality improvement project was to improve preceptor recruitment and retention as well as student learning experiences through identification and implementation of
Please cite this article as: J. Luimes, Supporting preceptors of distance nurse practitioner students, Teaching and Learning in Nursing (2020), https://doi.org/10.1016/j.teln.2020.10.005
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J. Luimes / Teaching and Learning in Nursing 00 (2020) 1 7 Table 3-1 Preceptor ratings of importance of supports from NP Education Programs in assisting preceptorship of students in distance learning programs
Student initiated contact prior to starting practicum Feedback on preceptorship skills/student experience Preceptorship package/manual Clinical coordinator initiated contact prior to starting practicum Coordination of student clinical site requirements (i.e., EMR training) Information regarding student strengths and weaknesses Faculty initiated contact prior to starting practicum Faculty initiated contact throughout the practicum Nonmonetary recognition Monetary incentives Access to university resources Preceptorship workshops Common website for faculty and preceptors to share clinical information and network Online resources with clinical teaching and preceptorship strategies Clinical site visits Video-conferenced orientation
strategies to enhance preceptor supports. Analyzing the survey findings, a number of strategies were identified to optimize supports for preceptors of the University of Saskatchewan, distance NP program. Core and individualized preceptor supports Findings from the survey illustrated commonalities and differences in what preceptors identified as supports for precepting distance NP students. Supports ranked as important to very important by the high-majority of participants may be thought of as core supports for preceptorship, and are likely to benefit most preceptors. Examining how the NP program can optimize core supports is important due to the potential of positively influencing a high number of preceptors. Identified core supports include Student and NP program-initiated contact prior to the start of practicum; Feedback on preceptorship skills and the student experience; Receiving information about the clinical experience (i.e., preceptor manual); Coordination of clinical site orientation and training by employers or educational institutions; Employer supports of physical infrastructure and time to accommodate a student; and Information on student strengths and weaknesses. These core supports are consistent with barriers and incentives to preceptoring identified by other authors. Receiving necessary program information, clear lines of faculty communication, and having the physical infrastructure to support students have been identified as key facilitators to preceptorship (Morgan, Brewer, Buchhalter, Collette, & Parrott, 2018; Roberts et al., 2017, Webb et al., 2015). Time constraints and issues related to electronic medical records have been identified as two common barriers to precepting (Forsberg et al., 2015; Roberts et al., 2017). Individual variation in preceptor perceptions of the importance of different supports was also evident in survey results. For example,
Not Important
Somewhat to moderately important
Important to very important
0 0 5% (3) 7% (4) 3% (2) 0 5% (3) 2% (1) 12% (7) 25% (14) 7% (4) 11% (6) 11% (6) 9% (5) 24% (13) 14% (8)
11% (6) 23% (13) 25% (15) 25% (14) 30% (17) 37.5% (21) 34% (20) 44% (25) 42% (24) 34% (19) 55.5% (31) 54% (30) 56% (32) 58% (33) 58% (32) 81% (46)
89% (50) 77% (43) 70% (41) 68% (39) 67% (39) 62.5% (36) 61% (35) 54% (31) 46% (26) 41% (23) 37.5% (21) 35% (20) 33% (19) 33% (19) 18% (10) 5% (3)
when looking at monetary incentives, there was high variability in importance rankings across preceptors with 20% ranking as not important, 33% as somewhat to moderately important and 47% as important to very important. One participant’s comment summarized the need for individualized supports stating: “My needs as an experienced preceptor may be very different then someone just starting to precept. Different needs and different values on these needs.” Individualized supports which showed higher variability in preceptor ranking of importance included: Clinical site visits, incentives (monetary and nonmonetary), preceptorship workshops, online resources, access to university resources and video-conferenced orientation. Such supports may not be universally helpful to preceptors and as such should be used based on individual identified needs. Opportunities for enhanced preceptor support Survey results identified provision of feedback to preceptors on preceptorship skills and the student experience as an opportunity for improvement. Only 30% of participants reported this feedback was currently occurring whereas 77% ranked receiving such feedback as important to very important and none ranked as not important. Intrinsic motivations (i.e., “giving back,” professional obligation, love for teaching) have been identified by other authors as an important incentives to precepting (Morgan et al., 2018; Roberts et al., 2017; Webb et al., 2015). Receiving feedback from students helps validate intrinsic motivation, as well as providing opportunity for preceptors to continue developing and refining skills and the overall preceptorship experience.
Table 3-2 Preceptor rating of importance of employer/organization supports in assisting with preceptorship of NP students in distance-learning programs
Physical space to accommodate student Increased appointment time/reduced patient load Dedicated (paid) time to complete student evaluations Time for consultation and discussion with NP faculty regarding student Employer organized clinical site orientation and training Recognition of preceptorship as part of performance evaluation Recognition of preceptorship as part of job description/role Nonmonetary recognition Monetary incentives (i.e., stipend) Preceptorship training
Not important
Somewhat to moderately important
Important to very important
2% (1) 5% (3) 8% (5) 3% (2) 5% (3) 8% (5) 7% (4) 3% (2) 20% (12) 12% (7)
21% (12) 22% (13) 19% (11) 26% (15) 29% (17) 26% (15) 27% (16) 42% (24) 33% (19) 43% (25)
77% (45) 73% (42) 73% (42) 71% (41) 66% (38) 66% (38) 66% (38) 55% (32) 47% (28) 45% (26)
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Coordination of clinical site requirements, such as orientation and EMR training, was another identified opportunity for preceptor support. Approximately one-quarter of participants reported coordination of these factors by the program and/or employer was currently occurring and over 65% ranked it as important to very important. Having these requirements organized by the program or employer decreases work for preceptors, allowing them to focus more directly on teaching and mentoring students rather than cumbersome administrative processes and EMR training, which takes away from direct productivity (Forsberg et al., 2015). Study findings suggest further examination of the role of clinical site visits may be warranted. While some programs and regulatory bodies require clinical site visits as part of program requirements, 24% of participants in this survey ranked clinical site visits as not important and 58% as only somewhat to moderately important. These low rankings suggest many preceptors do not find site visits useful. Only 18% ranked as important to very important. A study by Staples and Sangster-Gormley (2018) found that a 48% of Canadian NP programs require NP faculty to visit students in their clinical placements. Given the high percentage of programs requiring visits, and low importance placed on these visits by preceptors, the role and function of these costly visit would benefit from further study to determine how clinical site visits by faculty members support student development and faculty evaluation of competencies.
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support Preceptors of NP students. These findings were reiterated in the findings of this study, as well as the importance of individualized needs assessment and evaluation to ensure the unique needs and outcomes of involved parties are addressed. To optimally support preceptorship of NP students, individual, program and external factors must be jointly considered. This study provides a Canadian perspective to a growing body of global research on NP student preceptorship, contributing to development of best practices for supporting NP preceptors and students in distance education programs. Acknowledgments To Dr. Mary Ellen Labreque, RN(NP), PhD, Director of the Nurse Practitioner Program and Assistant Professor at the University of Saskatchewan College of Nursing; Ms. Wilda Watts, RN, MN, Professional Academic Advisor and Clinical Education Coordinator at the University of Saskatchewan College of Nursing and Ms. Diane Bomans, for Strategic Analyst at the University of Saskatchewan College of Nursing for their support on this quality improvement initiative. Appendix. Survey: Preceptorship Supports in Nurse Practitioner Distance Learning Programs Current Supports for Preceptorship
Future research The most commonly identified employer barriers to precepting NP students found in this study are consistent with findings in literature and include: Lack of space to accommodate students, extra work, and managing workload (Roberts et al., 2017; Staples and Sangster-Gormley, 2018; Webb et al., 2015). Further exploration of how NP Programs can partner with employers to facilitate positive work environments for preceptorship is an untapped avenue with potential to enhance student placement opportunities. Logan et al. (2015) report on how development of a formal institutional process for NP student clinical placements, enhanced the efficiency and effectiveness of clinical experiences for one institution. Broader extrapolation of such processes as a collaboration between NP programs and institutions has potential to have similar positive impact. Remuneration has been identified by several authors as playing a key role in preceptor recruitment and retention (Forsberg et al., 2015; Morgan et al., 2018; Roberts et al., 2017; Staples and SangsterGormley, 2018; Webb et al., 2015). However, survey respondents in this study reported variable rankings of the importance placed on remuneration. In Western Canada there is no institutional or government funding available for NP preceptor remuneration. It is possible this long-standing lack of remuneration has become a cultural norm to some respondents and impacted results. Further study of the role of remuneration in preceptorship would be beneficial. Study limitations Study limitations include the use of a convenience sample and small sample size. As such, survey responses may not be representative of all preceptors. This survey also did not consider student perspectives. It would be interesting to identify if NP students had similar perceptions to preceptors of the importance of different supports.
1. Which of the following have been provided by nurse practitioner distance learning programs to support your preceptorship of nurse practitioner students? (Check all that apply) Preceptorship package/manual Faculty initiated contact prior to the student starting practicum Clinical coordinator-initiated contact prior to the student starting practicum Student initiated contact prior to starting practicum with information about their clinical learning goals and past experiences (i.e., resume) Information from faculty regarding identified student’ strengths and weaknesses Faculty initiated contact throughout the practicum to discuss student development and evaluation Clinical site visits from faculty Preceptorship workshops (in- person or online) Access to University resources (i.e., library, facilities, workshops, learning events) Monetary incentives Nonmonetary recognition (i.e., letter of appreciation, preceptorship certificate, banquet/lunch/dinner, gift) Feedback on preceptorship skills and student experience Access to NP student’s course materials (i.e., clinical course website) A common website (i.e., chat-room, Blackboard discussion board) for faculty and preceptors to share information about clinical and network Video-conferenced (online) orientation Online resources with clinical teaching and preceptorship strategies Arrangement/coordination of student clinical site requirements (i.e., clinical site orientation, EMR access and training)
Conclusion Preceptorship support is essential to facilitate student learning as well as preceptor satisfaction, retention and recruitment. A variety of activities and interventions have been proposed in the literature to
2. Please list any other preceptorship supports you have been provided by nurse practitioner Programs or Faculty. 3. Additional comments on current supports provided by educational institutions:
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4. Which of the following organizational supports have been provided by your employer/ organization to support you in your preceptorship of nurse practitioner students? (Check all that apply)
Community-based
Other (please specify): 3. In what province do you practice?
Increased time for appointments or reduced patient load
Dedicated (paid) time to complete student evaluations
Time for consultation and discussion with NP faculty regarding student progress and evaluation
Employer organized clinical site orientation and training (i.e., EMR)
Physical space to accommodate student
Monetary incentive (i.e., preceptor stipend)
Nonmonetary recognition (i.e., verbal support, awards, encouragement)
Preceptorship training (workshops, online resources, conferences)
Recognition of preceptorship as part of job description/role
Recognition of preceptorship as part of performance evaluation 5. Other: Please list any other preceptorship supports you have been provided by your employer/organization. 6. Additional comments on current organizational supports:
Perceived Importance of Specific Nurse Practitioner Program and Employer Supports
1. Please rate the importance you place on the following Program and Faculty supports in assisting with your preceptorship of nurse practitioner students in distance learning programs.
Saskatchewan Alberta British Columbia Manitoba Ontario Newfoundland Nova Scotia Other (please specify): _______________________
4. How many years have you been practicing in this role?
0-2 years 2-4 years 5-10 years 10years
5. In total, how many nurse practitioner students have you preceptored in your career?
1-2 2-5 6-10 10
6. Have you ever taken formal training in preceptoring of students
Yes
No
1. Please rate the importance you place on the following employer/ organizational supports in assisting with your preceptorship of nurse practitioner students in distance learning programs.
7. A) Have you ever acted as a preceptor for other health professional students (i.e., RN, LPN, physician, dietician)
Yes
No
1. Please comment on any other supports you would find helpful to assist you with the preceptorship of nurse practitioner students in distance learning programs. B) If yes, what type of student: _________________________________ Demographic information 1. Please indicate your age range: 1. What your professional background?
Nurse practitioner
Family physician
Other (please specify):
20-29 30-39 40-49 50-59 60+
2. In what type of setting do you practice (check all that apply)? 2. What gender to you identify with?
Rural Urban Remote/Northern Fee-for-service Salaried Hospital-based
Male
Female
Other
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Not at all important (1)
Somewhat important (2)
7
Moderately important (3)
Important (4)
Very important (5)
Preceptorship package/manual Faculty initiated contact prior to student starting practicum Clinical coordinator-initiated contact prior to student starting practicum Student initiated contact prior to starting practicum with information about clinical learning goals and past experiences (i.e., resume) Information regarding student strengths and weaknesses Faculty initiated contact throughout the practicum Clinical site visits from faculty Preceptorship workshops (in-person or online) Access to University resources (i.e., library, course materials) Monetary Incentives Nonmonetary recognition (i.e., letter of appreciation, preceptorship certificate, banquet/lunch/dinner, gift) Feedback on preceptorship skills and/or student experience Access to NP student’s course materials A common website for faculty and preceptors to share clinical information and network Video-conferenced (online) orientation Online resources with clinical teaching and preceptorship strategies Arrangement/coordination of student clinical site requirements (i.e., clinical site orientation, training, EMR access and training)
Not at all important (1)
Somewhat important (2)
Moderately important (3)
Important (4)
Very important (5)
Increased time for appointments or reduced patient load Dedicated (paid) time to complete student evaluations Time for consultation and discussion with NP faculty regarding student progress and evaluation Employer organized clinical site orientation and training (i.e., EMR) Physical space to accommodate student Monetary incentives (i.e., preceptor stipend) Nonmonetary recognition (i.e., verbal support, awards, encouragement) Preceptorship training (workshops, online resources, conferences) Recognition of preceptorship as part of job description/role Recognition of preceptorship as part performance evaluations
References Canadian Association of Schools of Nursing (CASN). (2012). Nurse practitioner education in Canada National Framework of Guiding Principles & Essential Components. Ottawa, ON: author. https://casn.ca/wp-content/uploads/2014/12/FINALNPFrameworkEN20130131. pdf. Drayton-Brooks, S. M., Gray, P. A., Turner, N. O, & Newland, J. A. (2017). Building clinical education training capacity in nurse practitioner programs. Journal of Professional Nursing, 33(6), 422–428. https://doi.org/10.1016/j.profnurs.2017.02.002. Forsberg, I., Swartwout, K., Murphy, M., Danko, K., & Delaney, K. (2015). Nurse practitioner education: Greater demand, reduced training opportunities. Journal of the American Association of Nurse Practitioners, 27(2), 66–71. https://doi.org/10.1002/ 2327-6924.12175. Hawkins, M. (2019). Barriers to preceptor placement for nurse practitioner students. Journal of Christian Nursing, 36(1), 48–53. doi:10.1097/CNJ. 0000000000000519.
Logan, L. B., Kovacs, K. A., & Barry, T. L. (2015). Precepting nurse practitioner students: One medical center’s efforts to improve the precepting process. Journal of the American Association of Nurse Practitioners, 27(12), 676–682. https://doi.org/ 10.1002/2327-6924.12265. Morgan, M., Brewer, M., Buchhalter, F., Collette, C., & Parrott, D. (2018). Sustaining regional preceptor partnerships: Preceptor incentive survey. The Journal for Nurse Practitioners, 14(1), e1–e4. https://doi.org/10.1016/j.nurpra.2017.08.013. Roberts, M. E., Wheeler, K., Tyler, D., & Padden, D. (2017). Preceptoring nurse practitioner students: A new view Results of two national surveys of nurse practitioner preceptors. Journal of American Association of Nurse Practitioners, 29(8), 484– 491. https://doi.org/10.1002/2327-6924.12482. Staples, E., & Sangster-Gormley, E. (2018). Supporting nurse practitioner education: Preceptorship recruitment and retention. International Journal of Nursing Sciences, 5(2), 115–120. https://doi.org/10.1016/j.ijnss.2018.03.005. Webb, J., Lopez, R., & Guarino, J. (2015). Incentives and barriers to precepting nurse practitioner students. Journal for Nurse Practitioners, 11(8), 782–789. https://doi. org/10.1016/j.nurpra.2015.06.003.
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Contents lists available at ScienceDirect
Teaching and Learning in Nursing journal homepage: www.journals.elsevier.com/ teaching-and-learning-in-nursing
Supporting preceptors of distance nurse practitioner students Janet Luimes, MScN, RN, NP* University of Saskatchewan College of Nursing, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada
A R T I C L E
I N F O
Article History: Accepted 4 October 2020 Available online xxx Keywords: Nurse practitioner Preceptor Distance education Quality improvement
A B S T R A C T
Preceptors play an important role in facilitating clinical competency development of nursing students. Support of preceptors is essential to ensure optimal student learning as well as preceptor satisfaction, recruitment and retention. Distance education programs face a unique barrier in supporting preceptors due to lack of physical proximity to preceptors and students. This quality improvement initiative explored current supports available to preceptors of students in distance nurse practitioner programs and the importance preceptors place on these supports. Findings revealed individual, institutional and external factors must be jointly considered to optimally support preceptorship. The study provides a Canadian perspective to a growing body of global research on nurse practitioner student preceptorship, contributing to development of best practices for supporting preceptors and students in distance health education programs. Crown Copyright © 2020 Published by Elsevier Inc. on behalf of Organization for Associate Degree Nursing. All rights reserved.
Preceptors play a key role in facilitating development and evaluation of nurse practitioner (NP) student clinical competence. Given the responsibilities and expectations placed on preceptors, it is imperative they are provided with necessary supports to facilitate student learning and assessment. There is a growing body of international literature exploring barriers and facilitators to NP student preceptorship, with distance education programs identified as a particular challenge (Roberts, Wheeler, Tyler, & Padden, 2017; Webb, Lopez, & Guarino, 2015). Recognizing the importance of preceptorship support in facilitating student learning as well as preceptor satisfaction, retention and recruitment, the College of Nursing, University of Saskatchewan, undertook a quality improvement project to examine supports for preceptors of distance NP students.
Background In Canada, NP education programs require students to possess licensure and experience as a registered nurse (RN). As a result, many NP students have established careers and families when they begin their education. The option for these students to take classes by distance and on a part-time basis is often appealing, as it removes the barrier of relocating and decreases the financial burden of returning to school. Consequently, there has been enhanced interest and demand for distance NP programs. Funding source: This work was supported by the University of Saskatchewan Faculty Recruitment and Retention Funds. Ethical approval: This study was reviewed and exempt by the University Research Ethics Board due to the quality improvement nature of the study (Beh 17-388). *Corresponding author. Tel.: (306) 966-8426. E-mail address: [email protected]
The University of Saskatchewan College of Nursing is situated in Western Canada in a geographic area with high rural and remote health care needs. The NP program focuses on education of NPs to address the primary care needs of rural, remote, and vulnerable populations and as such has adopted a distributed “learn where you live” approach allowing students to remain in their home community while pursuing advanced nursing education. Students in the NP program are dispersed across, University of Saskatchewan and other Canadian provinces. The program utilizes both synchronous (real-time web-based classes) and asynchronous (online) classes to facilitate development of essential advanced practice nursing competencies. During clinical practicum placements, students are supervised by an experienced NP preceptor with supportive guidance provided by NP program faculty via telephone, email, and web-platforms (i.e., Zoom and WebEx).
Significance Clinical experiences are recognized as an essential component of the education of health professionals, providing opportunity for students to apply, develop, and refine clinical knowledge and skills they have learned in the classroom to “real life” practice. As such, standards and guidelines for health professional programs outline a minimum number of clinical hours that must be achieved by each student. For NP programs in Canada, this minimum number of clinical hours is 700 hours (CASN, 2012). The nature of NP practice, which typically involves one-on-one clinical care of patients, does not lend itself ideally to group clinical rotations. Therefore, one-on-one clinical preceptorships are utilized to attain the clinical hour requirements for students. With local and global challenges in the recruitment and
https://doi.org/10.1016/j.teln.2020.10.005 1557-3087/Crown Copyright © 2020 Published by Elsevier Inc. on behalf of Organization for Associate Degree Nursing. All rights reserved.
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retention of preceptors, securing these one-on-one preceptorship experiences is resource consuming and challenging for many NP education programs (Drayton-Brooks, Gray, Turner, & Newland, 2017; Forsberg, Swartwout, Murphy, Danko, & Delaney, 2015). To address the challenges of preceptor recruitment, several authors have explored barriers and facilitators to NP student preceptorship (Hawkins, 2019; Logan, Kovacs, & Barry, 2015; Logan, Kovacs, & Barry, 2018; Roberts et al., 2017; Webb et al., 2015). A review of this literature reveals that barriers and supports for preceptorship may be categorized into three primary areas:
1) Organizational (NP Employer) factors. For example, receiving support from employers for the extra time, physical space, and effort required to teach a student. 2) Educational program factors. For example, receiving support from faculty and educational programs to orientate students to clinical requirements, facilitate learning experiences and assist with evaluation of student clinical competencies. 3) Personal NP attributes. For example, the personal value and commitment an individual places on contributing to the education of future health care professionals.
Distance education of NP students poses a unique barrier to preceptorship due to lack of physical proximity of educational institutions and faculty to students and preceptors. Little is known regarding the optimal supports for preceptors at a distance and the impact of supports on preceptor satisfaction, recruitment, retention and student outcomes (Roberts et al., 2017; Staples and SangsterGormley, 2018). Purpose The purpose of this quality improvement project was to assess the types of supports currently available to preceptors of distance NP students as well as establish the importance preceptors place on different supports as a baseline for enhancing preceptor supports within the University of Saskatchewan, distributive NP program. The overall goal was to improve recruitment and retention of preceptors and the overall student learning experience. The following research questions were asked: 1. What supports are currently available to support preceptors in their preceptorship of students in distance NP programs? 2. What importance do preceptors place on different supports in assisting with their preceptorship of students in distance NP programs? Methods Ethics This study was reviewed and exempt by the University of Saskatchewan, Research Ethics Board as a quality improvement project. Survey development A review of literature was conducted to identify the current state of knowledge regarding supports for NP Preceptors. Based on the literature review and experience of NP faculty, an online survey was developed to explore preceptor perceptions of supports for supervising distance NP students. Barriers and facilitators to preceptorship were divided into two categories: (1) Supports provided by
Educational Institutions and (2) Supports provided by NP Employers/ Organizations. While individual NP characteristics have also been recognized as barriers and facilitators, it was decided not to focus on these items explicitly in the survey but recognize the overarching impact of personal values on preceptorship. Once developed, the survey was pilot tested with five experienced NP preceptors for face validity and clarity. Minor revisions were made to the survey after pilot testing to enhance organization and promote identification of perceived barriers and supports to preceptorship . The final version of the survey contained a combination of 17 open and closed ended questions, taking approximately 10-15 minutes to complete. Questions related to current preceptorship supports, perceived importance of different preceptorship supports, and participant demographics. A copy of the survey tool can be found in the Appendix. Survey deployment The online survey was inputted and deployed by the College of Nursing Strategic Analyst, removing the Principle Investigator from direct interaction with respondents. This was important in protecting result bias due to the Principle Investigator’s former educational relationship with many preceptors. Fluid Survey was used as the online survey platform. Participants Primary care NP and physician preceptors who had supervised a College of Nursing NP student in the past five years, between 2013 and 2017, and for whom an active email address was present in the College’s clinical database (N = 172) were sent an email invitation to participate in the survey. The email invitation included informed consent information, inviting these preceptors to voluntarily and anonymously participate in the survey. The survey was open three weeks from January 8 to January 29, 2018. Reminder emails were sent after one week and two weeks. While the participant list was specific to preceptors of the College, it was intended to also capture individuals who had precepted students in other distance NP programs as it is common practice for preceptors to take students from different education programs. All participants were offered opportunity to enter a draw for one of six $50 gift cards as incentive for completing the survey. Survey analysis Data were analyzed using relative frequency statistics (descriptive statistics) and thematic analysis of open-ended responses. Results The response rate for the survey was 34% (N = 59), with participants representing a range of practice settings, preceptorship experience, and age distribution. 81% of participants identified as NPs and 19% as physicians. The majority were from Saskatchewan (76%) and female (74%), which is consistent with characteristics of preceptors within the University of Saskatchewan, NP program. Many preceptors identified as having five or more years of experience in their role (84%) and experience precepting 6 or more NP students (46%). It is interesting to note that only 22% of participant preceptors had had formal preceptor training. Table 1 contains a detailed overview of participant demographics. The most commonly identified supports provided to preceptors by NP distance-learning programs were preceptorship packages/ manual (91%), faculty/clinical coordinator-initiated contact prior to starting practicum (67%), nonmonetary recognition (i.e., thank you
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J. Luimes / Teaching and Learning in Nursing 00 (2020) 1 7 Table 1. Participant demographics Professional designation Gender Age
Practice setting
Geographical location
Experience
# of NP students preceptored
Formal preceptor training
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Table 2-2. Supports provided to preceptors by employers Nurse practitioner: 81% (48) Physician: 19% (11) Female: 74% (43) Male: 26% (15) 30-39 years: 29% (17) 40-49 years: 22% (13) 50-59 years: 35% (20) 60+ years: 14% (8) Rural: 64% (38) Urban: 31% (18) Remote: 7% (4) Community-based: 31% (18) Hospital-based: 17% (10) Salaried: 25% (15) Fee-for-Service: 5% (3) Saskatchewan: 76% (44) Alberta: 12% (7) British Columbia: 10% (6) Other: 2% (1) 0-2 years: 5% (3) years: 11% (6) 5-10 years: 35% (20) More than 10 years: 49% (28) 1-2 students: 20% (12) 3-5 students: 34% (20) 6-10 students: 19% (11) More than 10 students: 27% (16) Yes: 22% (13) No: 78% (46)
card and certificate) (59%) and faculty-initiated contact throughout the practicum (55%). Less common supports provided by NP distance learning programs included: A common website for faculty and preceptors to share information about clinical and network (1.7%), video-conference orientation (3%), online resources with clinical teaching and preceptorship strategies (9%), and monetary incentives (9%). Table 2-1 contains a complete listing of preceptorship supports provided by NP distance learning programs as identified by survey participants. The most commonly identified supports provided to preceptors by employers were: physical space to accommodate (59%) and time for consultation with NP faculty regarding student progress/evaluation (45%). In general, preceptors identified low frequency in supports provided by employers (see Table 2-2: Supports provided to preceptors by employers). Looking at the importance preceptors placed on supports provided by NP Education Programs, the most important supports Table 2-1 Supports provided to preceptors by NP distance-learning programs Preceptorship package or manual Faculty and/or clinical coordinator initiated contact prior to start of practicum Nonmonetary recognition Faculty initiated contact throughout the practicum Feedback on preceptorship skills/student experience Coordination of student clinical site requirements (i.e., EMR training and orientation) Preceptorship workshops Information on student strengths and weaknesses Clinical site visits Access to University resources (i.e., library, workshops, and course materials) Monetary incentives Online resources with clinical teaching and preceptorship strategies Video-conferenced orientation Common website for faculty and preceptors to share information about clinical and network
91.4% (53) 67.2% (39) 58.6% (34) 55.2% (32) 25.9% (15) 22.4% (13) 19.0% (11) 15.5% (9) 12.1% (7) 12.1% (7) 8.6% (5) 8.6% (5) 3.4% (2) 1.7% (1)
Physical space to accommodate student Time for consultation and discussion with NP faculty regarding student progress and evaluation Monetary incentives (i.e., preceptor stipend) Increased time for appointments/reduced patient load Recognition of preceptorship as part of role Employer organized clinical site orientation and training (i.e., EMR and policies) Dedicated (paid) time to complete student evaluations Nonmonetary recognition (i.e., verbal support and awards) Recognition of preceptorship as part of performance evaluation Preceptorship training
58.5% (31) 45.3% (24) 37.7% (20) 35.8% (19) 35.8% (19) 26.4% (14) 24.5% (13) 24.5% (13) 20.8% (11) 7.5% (4)
identified by preceptors from NP Education Programs were studentinitiated contact prior to starting practicum, feedback on preceptorship skills and the student experience, preceptorship package/manual, clinical coordinator-initiated contact prior to starting practicum, and coordination of clinical practicum site requirements. Less importance was placed on video-conferenced orientation, clinical site visits, and access to online resources. See Table 3-1 for a detailed overview of preceptor ratings of importance of supports from NP Education Programs in assisting preceptorship of students in distance NP programs. Organizational considerations including physical space to accommodate students, increased appointment times, dedicated time to complete student evaluations and time for consultation with NP faculty were ranked by preceptors as important employer supports for preceptorship of distance NP students. Preceptorship training and monetary incentives were ranked as less important employer supports. See Table 3-2 for a detailed overview of preceptor ranting of importance of employer/organization supports in assisting with preceptorship of NP students in distance learning programs. Additional barriers to preceptorship were identified in free-text comments of participants. These barriers related to increased workload considerations with preceptorship of students: “It is very time consuming to take on students, it is rewarding but is an additional big responsibility” “I am self-employed and fee for service, so all [employer] supports are afforded by myself for educational purposes.” “Preceptoring of students has become a requirement within the job description of many nurse practitioner positions. Several times as a preceptor I had to coordinate the necessary training (i.e., EMR training) to supports students in their clinical placement. Additionally, employers are often not supportive of the extra time required to mentor students and hold NPs accountable for time management, limitation of overtime and yet carry the same patient load as would be required when not preceptoring students.” The importance of program and employer support in addressing these barriers was also highlighted: “Preceptorship is important and time consuming but it isn’t valued by employers such that it is just one more thing on the already large workload and it is not compensated.” “Any interest and support from employer would be appreciated. They show no interest once I accept a student”
Discussion The overall goal of this quality improvement project was to improve preceptor recruitment and retention as well as student learning experiences through identification and implementation of
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J. Luimes / Teaching and Learning in Nursing 00 (2020) 1 7 Table 3-1 Preceptor ratings of importance of supports from NP Education Programs in assisting preceptorship of students in distance learning programs
Student initiated contact prior to starting practicum Feedback on preceptorship skills/student experience Preceptorship package/manual Clinical coordinator initiated contact prior to starting practicum Coordination of student clinical site requirements (i.e., EMR training) Information regarding student strengths and weaknesses Faculty initiated contact prior to starting practicum Faculty initiated contact throughout the practicum Nonmonetary recognition Monetary incentives Access to university resources Preceptorship workshops Common website for faculty and preceptors to share clinical information and network Online resources with clinical teaching and preceptorship strategies Clinical site visits Video-conferenced orientation
strategies to enhance preceptor supports. Analyzing the survey findings, a number of strategies were identified to optimize supports for preceptors of the University of Saskatchewan, distance NP program. Core and individualized preceptor supports Findings from the survey illustrated commonalities and differences in what preceptors identified as supports for precepting distance NP students. Supports ranked as important to very important by the high-majority of participants may be thought of as core supports for preceptorship, and are likely to benefit most preceptors. Examining how the NP program can optimize core supports is important due to the potential of positively influencing a high number of preceptors. Identified core supports include Student and NP program-initiated contact prior to the start of practicum; Feedback on preceptorship skills and the student experience; Receiving information about the clinical experience (i.e., preceptor manual); Coordination of clinical site orientation and training by employers or educational institutions; Employer supports of physical infrastructure and time to accommodate a student; and Information on student strengths and weaknesses. These core supports are consistent with barriers and incentives to preceptoring identified by other authors. Receiving necessary program information, clear lines of faculty communication, and having the physical infrastructure to support students have been identified as key facilitators to preceptorship (Morgan, Brewer, Buchhalter, Collette, & Parrott, 2018; Roberts et al., 2017, Webb et al., 2015). Time constraints and issues related to electronic medical records have been identified as two common barriers to precepting (Forsberg et al., 2015; Roberts et al., 2017). Individual variation in preceptor perceptions of the importance of different supports was also evident in survey results. For example,
Not Important
Somewhat to moderately important
Important to very important
0 0 5% (3) 7% (4) 3% (2) 0 5% (3) 2% (1) 12% (7) 25% (14) 7% (4) 11% (6) 11% (6) 9% (5) 24% (13) 14% (8)
11% (6) 23% (13) 25% (15) 25% (14) 30% (17) 37.5% (21) 34% (20) 44% (25) 42% (24) 34% (19) 55.5% (31) 54% (30) 56% (32) 58% (33) 58% (32) 81% (46)
89% (50) 77% (43) 70% (41) 68% (39) 67% (39) 62.5% (36) 61% (35) 54% (31) 46% (26) 41% (23) 37.5% (21) 35% (20) 33% (19) 33% (19) 18% (10) 5% (3)
when looking at monetary incentives, there was high variability in importance rankings across preceptors with 20% ranking as not important, 33% as somewhat to moderately important and 47% as important to very important. One participant’s comment summarized the need for individualized supports stating: “My needs as an experienced preceptor may be very different then someone just starting to precept. Different needs and different values on these needs.” Individualized supports which showed higher variability in preceptor ranking of importance included: Clinical site visits, incentives (monetary and nonmonetary), preceptorship workshops, online resources, access to university resources and video-conferenced orientation. Such supports may not be universally helpful to preceptors and as such should be used based on individual identified needs. Opportunities for enhanced preceptor support Survey results identified provision of feedback to preceptors on preceptorship skills and the student experience as an opportunity for improvement. Only 30% of participants reported this feedback was currently occurring whereas 77% ranked receiving such feedback as important to very important and none ranked as not important. Intrinsic motivations (i.e., “giving back,” professional obligation, love for teaching) have been identified by other authors as an important incentives to precepting (Morgan et al., 2018; Roberts et al., 2017; Webb et al., 2015). Receiving feedback from students helps validate intrinsic motivation, as well as providing opportunity for preceptors to continue developing and refining skills and the overall preceptorship experience.
Table 3-2 Preceptor rating of importance of employer/organization supports in assisting with preceptorship of NP students in distance-learning programs
Physical space to accommodate student Increased appointment time/reduced patient load Dedicated (paid) time to complete student evaluations Time for consultation and discussion with NP faculty regarding student Employer organized clinical site orientation and training Recognition of preceptorship as part of performance evaluation Recognition of preceptorship as part of job description/role Nonmonetary recognition Monetary incentives (i.e., stipend) Preceptorship training
Not important
Somewhat to moderately important
Important to very important
2% (1) 5% (3) 8% (5) 3% (2) 5% (3) 8% (5) 7% (4) 3% (2) 20% (12) 12% (7)
21% (12) 22% (13) 19% (11) 26% (15) 29% (17) 26% (15) 27% (16) 42% (24) 33% (19) 43% (25)
77% (45) 73% (42) 73% (42) 71% (41) 66% (38) 66% (38) 66% (38) 55% (32) 47% (28) 45% (26)
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Coordination of clinical site requirements, such as orientation and EMR training, was another identified opportunity for preceptor support. Approximately one-quarter of participants reported coordination of these factors by the program and/or employer was currently occurring and over 65% ranked it as important to very important. Having these requirements organized by the program or employer decreases work for preceptors, allowing them to focus more directly on teaching and mentoring students rather than cumbersome administrative processes and EMR training, which takes away from direct productivity (Forsberg et al., 2015). Study findings suggest further examination of the role of clinical site visits may be warranted. While some programs and regulatory bodies require clinical site visits as part of program requirements, 24% of participants in this survey ranked clinical site visits as not important and 58% as only somewhat to moderately important. These low rankings suggest many preceptors do not find site visits useful. Only 18% ranked as important to very important. A study by Staples and Sangster-Gormley (2018) found that a 48% of Canadian NP programs require NP faculty to visit students in their clinical placements. Given the high percentage of programs requiring visits, and low importance placed on these visits by preceptors, the role and function of these costly visit would benefit from further study to determine how clinical site visits by faculty members support student development and faculty evaluation of competencies.
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support Preceptors of NP students. These findings were reiterated in the findings of this study, as well as the importance of individualized needs assessment and evaluation to ensure the unique needs and outcomes of involved parties are addressed. To optimally support preceptorship of NP students, individual, program and external factors must be jointly considered. This study provides a Canadian perspective to a growing body of global research on NP student preceptorship, contributing to development of best practices for supporting NP preceptors and students in distance education programs. Acknowledgments To Dr. Mary Ellen Labreque, RN(NP), PhD, Director of the Nurse Practitioner Program and Assistant Professor at the University of Saskatchewan College of Nursing; Ms. Wilda Watts, RN, MN, Professional Academic Advisor and Clinical Education Coordinator at the University of Saskatchewan College of Nursing and Ms. Diane Bomans, for Strategic Analyst at the University of Saskatchewan College of Nursing for their support on this quality improvement initiative. Appendix. Survey: Preceptorship Supports in Nurse Practitioner Distance Learning Programs Current Supports for Preceptorship
Future research The most commonly identified employer barriers to precepting NP students found in this study are consistent with findings in literature and include: Lack of space to accommodate students, extra work, and managing workload (Roberts et al., 2017; Staples and Sangster-Gormley, 2018; Webb et al., 2015). Further exploration of how NP Programs can partner with employers to facilitate positive work environments for preceptorship is an untapped avenue with potential to enhance student placement opportunities. Logan et al. (2015) report on how development of a formal institutional process for NP student clinical placements, enhanced the efficiency and effectiveness of clinical experiences for one institution. Broader extrapolation of such processes as a collaboration between NP programs and institutions has potential to have similar positive impact. Remuneration has been identified by several authors as playing a key role in preceptor recruitment and retention (Forsberg et al., 2015; Morgan et al., 2018; Roberts et al., 2017; Staples and SangsterGormley, 2018; Webb et al., 2015). However, survey respondents in this study reported variable rankings of the importance placed on remuneration. In Western Canada there is no institutional or government funding available for NP preceptor remuneration. It is possible this long-standing lack of remuneration has become a cultural norm to some respondents and impacted results. Further study of the role of remuneration in preceptorship would be beneficial. Study limitations Study limitations include the use of a convenience sample and small sample size. As such, survey responses may not be representative of all preceptors. This survey also did not consider student perspectives. It would be interesting to identify if NP students had similar perceptions to preceptors of the importance of different supports.
1. Which of the following have been provided by nurse practitioner distance learning programs to support your preceptorship of nurse practitioner students? (Check all that apply) Preceptorship package/manual Faculty initiated contact prior to the student starting practicum Clinical coordinator-initiated contact prior to the student starting practicum Student initiated contact prior to starting practicum with information about their clinical learning goals and past experiences (i.e., resume) Information from faculty regarding identified student’ strengths and weaknesses Faculty initiated contact throughout the practicum to discuss student development and evaluation Clinical site visits from faculty Preceptorship workshops (in- person or online) Access to University resources (i.e., library, facilities, workshops, learning events) Monetary incentives Nonmonetary recognition (i.e., letter of appreciation, preceptorship certificate, banquet/lunch/dinner, gift) Feedback on preceptorship skills and student experience Access to NP student’s course materials (i.e., clinical course website) A common website (i.e., chat-room, Blackboard discussion board) for faculty and preceptors to share information about clinical and network Video-conferenced (online) orientation Online resources with clinical teaching and preceptorship strategies Arrangement/coordination of student clinical site requirements (i.e., clinical site orientation, EMR access and training)
Conclusion Preceptorship support is essential to facilitate student learning as well as preceptor satisfaction, retention and recruitment. A variety of activities and interventions have been proposed in the literature to
2. Please list any other preceptorship supports you have been provided by nurse practitioner Programs or Faculty. 3. Additional comments on current supports provided by educational institutions:
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4. Which of the following organizational supports have been provided by your employer/ organization to support you in your preceptorship of nurse practitioner students? (Check all that apply)
Community-based
Other (please specify): 3. In what province do you practice?
Increased time for appointments or reduced patient load
Dedicated (paid) time to complete student evaluations
Time for consultation and discussion with NP faculty regarding student progress and evaluation
Employer organized clinical site orientation and training (i.e., EMR)
Physical space to accommodate student
Monetary incentive (i.e., preceptor stipend)
Nonmonetary recognition (i.e., verbal support, awards, encouragement)
Preceptorship training (workshops, online resources, conferences)
Recognition of preceptorship as part of job description/role
Recognition of preceptorship as part of performance evaluation 5. Other: Please list any other preceptorship supports you have been provided by your employer/organization. 6. Additional comments on current organizational supports:
Perceived Importance of Specific Nurse Practitioner Program and Employer Supports
1. Please rate the importance you place on the following Program and Faculty supports in assisting with your preceptorship of nurse practitioner students in distance learning programs.
Saskatchewan Alberta British Columbia Manitoba Ontario Newfoundland Nova Scotia Other (please specify): _______________________
4. How many years have you been practicing in this role?
0-2 years 2-4 years 5-10 years 10years
5. In total, how many nurse practitioner students have you preceptored in your career?
1-2 2-5 6-10 10
6. Have you ever taken formal training in preceptoring of students
Yes
No
1. Please rate the importance you place on the following employer/ organizational supports in assisting with your preceptorship of nurse practitioner students in distance learning programs.
7. A) Have you ever acted as a preceptor for other health professional students (i.e., RN, LPN, physician, dietician)
Yes
No
1. Please comment on any other supports you would find helpful to assist you with the preceptorship of nurse practitioner students in distance learning programs. B) If yes, what type of student: _________________________________ Demographic information 1. Please indicate your age range: 1. What your professional background?
Nurse practitioner
Family physician
Other (please specify):
20-29 30-39 40-49 50-59 60+
2. In what type of setting do you practice (check all that apply)? 2. What gender to you identify with?
Rural Urban Remote/Northern Fee-for-service Salaried Hospital-based
Male
Female
Other
Please cite this article as: J. Luimes, Supporting preceptors of distance nurse practitioner students, Teaching and Learning in Nursing (2020), https://doi.org/10.1016/j.teln.2020.10.005
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Preceptorship package/manual Faculty initiated contact prior to student starting practicum Clinical coordinator-initiated contact prior to student starting practicum Student initiated contact prior to starting practicum with information about clinical learning goals and past experiences (i.e., resume) Information regarding student strengths and weaknesses Faculty initiated contact throughout the practicum Clinical site visits from faculty Preceptorship workshops (in-person or online) Access to University resources (i.e., library, course materials) Monetary Incentives Nonmonetary recognition (i.e., letter of appreciation, preceptorship certificate, banquet/lunch/dinner, gift) Feedback on preceptorship skills and/or student experience Access to NP student’s course materials A common website for faculty and preceptors to share clinical information and network Video-conferenced (online) orientation Online resources with clinical teaching and preceptorship strategies Arrangement/coordination of student clinical site requirements (i.e., clinical site orientation, training, EMR access and training)
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Increased time for appointments or reduced patient load Dedicated (paid) time to complete student evaluations Time for consultation and discussion with NP faculty regarding student progress and evaluation Employer organized clinical site orientation and training (i.e., EMR) Physical space to accommodate student Monetary incentives (i.e., preceptor stipend) Nonmonetary recognition (i.e., verbal support, awards, encouragement) Preceptorship training (workshops, online resources, conferences) Recognition of preceptorship as part of job description/role Recognition of preceptorship as part performance evaluations
References Canadian Association of Schools of Nursing (CASN). (2012). Nurse practitioner education in Canada National Framework of Guiding Principles & Essential Components. Ottawa, ON: author. https://casn.ca/wp-content/uploads/2014/12/FINALNPFrameworkEN20130131. pdf. Drayton-Brooks, S. M., Gray, P. A., Turner, N. O, & Newland, J. A. (2017). Building clinical education training capacity in nurse practitioner programs. Journal of Professional Nursing, 33(6), 422–428. https://doi.org/10.1016/j.profnurs.2017.02.002. Forsberg, I., Swartwout, K., Murphy, M., Danko, K., & Delaney, K. (2015). Nurse practitioner education: Greater demand, reduced training opportunities. Journal of the American Association of Nurse Practitioners, 27(2), 66–71. https://doi.org/10.1002/ 2327-6924.12175. Hawkins, M. (2019). Barriers to preceptor placement for nurse practitioner students. Journal of Christian Nursing, 36(1), 48–53. doi:10.1097/CNJ. 0000000000000519.
Logan, L. B., Kovacs, K. A., & Barry, T. L. (2015). Precepting nurse practitioner students: One medical center’s efforts to improve the precepting process. Journal of the American Association of Nurse Practitioners, 27(12), 676–682. https://doi.org/ 10.1002/2327-6924.12265. Morgan, M., Brewer, M., Buchhalter, F., Collette, C., & Parrott, D. (2018). Sustaining regional preceptor partnerships: Preceptor incentive survey. The Journal for Nurse Practitioners, 14(1), e1–e4. https://doi.org/10.1016/j.nurpra.2017.08.013. Roberts, M. E., Wheeler, K., Tyler, D., & Padden, D. (2017). Preceptoring nurse practitioner students: A new view Results of two national surveys of nurse practitioner preceptors. Journal of American Association of Nurse Practitioners, 29(8), 484– 491. https://doi.org/10.1002/2327-6924.12482. Staples, E., & Sangster-Gormley, E. (2018). Supporting nurse practitioner education: Preceptorship recruitment and retention. International Journal of Nursing Sciences, 5(2), 115–120. https://doi.org/10.1016/j.ijnss.2018.03.005. Webb, J., Lopez, R., & Guarino, J. (2015). Incentives and barriers to precepting nurse practitioner students. Journal for Nurse Practitioners, 11(8), 782–789. https://doi. org/10.1016/j.nurpra.2015.06.003.
Please cite this article as: J. Luimes, Supporting preceptors of distance nurse practitioner students, Teaching and Learning in Nursing (2020), https://doi.org/10.1016/j.teln.2020.10.005