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Evaluation of a leadership orientation program in Taiwan: Preceptorship and leader competencies of the new nurse manager
Nurse Education Today 31 (2011) 809–814
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Nurse Education Today j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / n e d t
Evaluation of a leadership orientation program in Taiwan: Preceptorship and leader competencies of the new nurse manager Hsiu-Yueh Hsu a, Lai-Liang Lee b, Chia-Yun Fu b, Chi-Chieh Tang c,⁎ a b c
Director of Department of Nursing, Meiho Institute of Technology, Pingtung, Taiwan, R.O. China Department of Nursing, Yuan's General Hospital, Kaoshiung, Taiwan, R.O. China Department of Early Childhood Education, Director of Department of Health Care of Students' Affaires, National Pintung University of Education, Taiwan, R.O. China
a r t i c l e
i n f o
Article history: Accepted 2 December 2010 Keywords: Leadership orientation program A new nurse manager Preceptorship Leader competencies
s u m m a r y The Leadership Orientation Program is designed to provide new nurse managers with the experience and support that assures them of a smooth transition from their current roles to being managers. The main objective of this study was to gain an understanding of the relationship that exists between a nursing preceptorship and a new nurse manager's competencies; it also attempted to establish a predictive model of leader competencies to improve the program. A descriptive cross-sectional research design and rigorous questionnaires were used in this study. Fifteen new nurse managers, 101 staff nurses, and 20 nurse administrators were recruited from those engaged in ongoing preceptorship. Over the course of the study statistically significant improvements in preceptorship were noted in both new manager educational background and support from staff nurses. Eighty-five percent of new nurse managers had good or excellent performance ratings (Mean = 84.25%). The significant predictive factors of nurse leader competencies were the educational background of new managers and the teaching resources available with regard to preceptorship (R2 = 88.5%, F = 6.86, p b 0.001). © 2010 Elsevier Ltd. All rights reserved.
Introduction Too often, new nurse managers (NNM) are brought into an organization and given assignments with the hope that their prior experience in combination with a brief orientation will adequately prepare them for their new role. The ideal orientation program builds on experiential knowledge and develops leaders who establish structured goals and expectations, use visionary approaches to solve problems, and place a priority on teaching their staff to adapt to their environment and facilitate a high-level practice (Conley et al., 2007). Yuan's General Hospital is a comprehensive teaching hospital in Kaohsiung, Taiwan. Their leadership orientation program was developed as a competency-based evaluation process, and it encompasses five components: nursing administration, instruction, preceptor competencies, project writing/evidence-based research, and computer software application. A competency-based evaluation process of leadership orientation programs includes the development of emotional intelligence by helping NNMs appreciate the organiza-
⁎ Corresponding author. Department of Early Childhood Education, National Pintung University of Education, No. 4-18 Ming Shen Road, Pingtung, Taiwan 900, R.O. China. Tel.: +886 8 7226141 31551; fax: +886 8 7338536. E-mail addresses: [email protected] (H.-Y. Hsu), [email protected] (C.-Y. Fu), [email protected], [email protected] (C.-C. Tang). 0260-6917/$ – see front matter © 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.nedt.2010.12.003
tion's culture and core values, as well as teaching them how to factor these values into their decisions and interactions with others. It also helps them anticipate any behaviors they may encounter and helps develop preceptorships by assisting preceptees with role transition, providing job satisfaction, and enhancing the retention rate (Salt et al., 2008). Literature A new nurse manager (NNM) is a nurse clinician with the role of transforming staff nurses into clinical experts, consultants, motivators, socialization facilitators, providers of clinical knowledge, and role models for their profession as well as supporters for staff (LockwoodRayermann, 2003). In addition, a successful NNM should be willing to teach knowledge, skills, flexibility, and assertiveness to new nurses (Byrd et al., 1997). Preceptorship occurs when a senior person provides information, advice, and emotional support to a junior person (Lev et al., 2010), so preceptorship involves an preceptee's adjustment to a new environment in which the NNM (preceptor) formulates a counseling program and coordinates interaction among new nurses and nurse administrators (Corlett et al., 2003). Development of positive preceptorship depends on a NNM's professional experience, competency, and flexibility within an organization (Kaviani and Stillwell, 2000). Positive preceptorship has the potential to implicitly influence nursing practices, enhance clinical learning,
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improve recruitment and retention, reduce turnover costs, enhance the quality of nursing care (especially by reducing medication errors), encourage critical thinking, and generate a more collaborative relationship with staff (William and Burkhead, 2002; Charleston and Goodwin, 2004; Fox et al., 2006; Lee et al., 2009). A leadership orientation program adopts an adult learning model and emotional intelligence (Orsini, 2005). The objectives of a leadership orientation program include: (1) easing the difficulties of the transition from theory to practice, (2) improving the job satisfaction of staff nurses, (3) reducing the cost-benefit ratio of recruitment and retention (Salt et al., 2008), (4) consolidating the partnership between preceptor and staff (Sowan et al., 2004), and (5) developing professional behaviors and critical thinking (Orsini, 2005). In this sense, pedagogical theory, instruction strategies, adult learning principles, communication skills, value and role clarification, conflict resolution, learning needs, and performance appraisals should all be involved in a leadership orientation program (Kaviani and Stillwell, 2000). Preceptorship program evaluation strategies that have been described in previous literature focus on the evaluators, the educational program, preceptor responses regarding support, and performance (Kaviani and Stillwell, 2000; William and Burkhead, 2002). Cooperation and critical thinking are positively related to a nurse preceptor's competency (Orsini, 2005). Flynn (1997) suggested that evaluations could be year-based. For the purposes of this study the effectiveness of the preceptorship programs was quantified and triangulated through the use of three targeted feedback forms. Data collected from the NNM participants, their supervising mentors, and the staff nurses of the NNMs. The present study was carried out in a regional teaching hospital in Kaoshiung. Nurse manager competencies were evaluated using a summative assessment six months after the program. The aim was to understand the NNM's level of satisfaction with the Leadership Orientation Program, the preceptorship, an NNM's competencies, the relationship between these elements, and their predictive factors. Finally, we applied the research findings as feedback in order to improve the leadership cultivated by the program (Fig. 1).
Input Variables
Age Marital status Education Clinical experience Clinical ladder credit
Research design A three-phased questionnaire survey was employed to evaluate the Leadership Orientation Program: (1) Leadership orientation workshop: The workshop was developed jointly by a focus group of eight scholars and professionals from a teaching hospital and a nursing faculty. The objective of the training course was to provide NNMs with instructional principles, standardized content for guiding staff nurses, and ways to improve their unit management knowledge and skills, application of computer software, and research methods. A seventy-hour leadership training course was offered from January to July 2007. (2) Instruction for unit staff nurses: The duration of the preceptorship was three months, and 101 staff nurses were involved in evaluating the preceptorship. We attempted to understand the relationship between nursing preceptorship and an NNM's competencies, and to understand their predictive factors. Participants and procedure of data collection The data for this study were collected in three phases. The target group for the first phase included all NNMs who had attended the leadership orientation workshop. Convenience sampling was used for recruitment at a 700-bed regional teaching hospital in Kaohsiung City, Taiwan. The subjects included NNMs, ward-based staff nurses, and nurse administrators. Initially, 19 NNMs were selected, but only 15 finished the training. The evaluation forms for the workshop were mailed in July 2007, with a response rate of 100%. The second phase of data collection took place three months after the NNMs' instruction of the staff nurses (October 2007). The targeted staff nurses (101 subjects) and nurse administrators (20 subjects) ward-based paired with the NNMs responded to the “Perception of Preceptorship” questionnaire. At the same time, the NNMs also responded to the “Perception of Preceptorship” questionnaire and the “Supportive Environment Survey” questionnaire. The third phase of data collection took place in December 2007. The targeted nurse administrators used
Moderators
Output Variables
Environment support
Recruitment Criteria of the New Nurses Manager (NNM)
Demographic characteristics of New Nurse Managers (NNM)
Methods
Administrators’ support Peer support
Preceptorship
Leader Competencies of the NNM
Leadership
New Nurses Managers
Orientation Program
(preceptor)
Clinical competence
Staff nurses (preceptee) Nurse administrators
Management/ Instructional skills Advanced training credits
First Phase (Jan.~July, 2007) recruitment of new nurse managers implementation of workshop (70 hours) evaluation the workshop (July, 2007)
Demographic Characteristics of Staff Nurses’ & Nurses Administrators Age, Marital status, Education, Position Clinical experience Clinical ladder credit
2nd Phase (Oct., 2007)
3rd Phase (Dec., 2007)
Survey of preceptorship (triangulated data)
Evaluation of NNMs’ competencies (nurse
Survey of environment support
administrators were the reviewers)
Fig. 1. Evaluation model of the leadership orientation program and procedures for data collection.
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the “Evaluation Sheet of Preceptors’ Nursing Competencies” for the outcome variables. Further, 66.7% of the NNMs possessed more than a bachelor's degree of science in nursing (BSN), with an average seniority of 10.33±3.30 years and a mean age of 32.75±3.15 years old. 66.7% of the total had qualified for N2 credit, and 53.3% were married. Most nurse administrators were also head nurses, married, and with qualifications above that of BSN (70.0%). Their average seniority was 19.56±3.44 years and their average age was 42.11±3.33 years old. Most staff nurses were junior college graduates and unmarried with an average seniority of 4.41±0.44 years, a mean age of 26.93±0.95 years old, and 51.5% and had completed N1 training. The ethnicity of the respondents was homogenous: All the NNMs were Taiwanese females. Instruments A five-part questionnaire was used to collect the data: (1) Evaluation Form of Leadership Orientation Workshop (EFLOW) (input variables); (2) measuring tools for the moderate variables consisting of Perception of Preceptorship (PP) scale for NNMs, staff nurses, and nurse administrators; (3) Supportive Environment Survey (SES) Scale; (4) Evaluation Sheet of Preceptors' Nursing Competencies (ESPNC); and (5) a demographic information sheet. Items were generated from a literature review, the researchers' clinical experience, and case interviews. The content validity was assessed by means of the known-groups technique (2 clinical nursing administrators, 1 hospital chief executive officer, and 2 nursing faculty professors). Few modifications were required; the agreement degree was 95% (Mean score = 3.8, full score= 4.0). Construct validity was examined by exploratory factor analysis (EFA) for three scales. Internal consistency was assessed with Cronbach's alpha reliability coefficient. Alphas ranged between 0.800.97 for different subscales (Table 1). The EFLOW Scale included 15 rated items on a 10-point Likert scale (from 1 = strongly disagree to 10 = strongly agree) and reflected an NNM's experience with the workshop (Charleston and Goodwin, 2004). “Curriculum and instruction” and “teaching resources” were analyzed by exploratory factor analysis. “Curriculum and instruction” included items such as whether the teaching style suited the learning style, whether the notes were relevant and useful, interest level, altering practice in workplace, whether the presenters were knowledgeable and enthusiastic throughout the course, whether the curriculum was structured and logical, whether they felt more confident in dealing with the issues of preceptorship, whether the
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assessment tasks were suitable for the subject, and whether they would recommend the course to colleagues. “Teaching resources” involved items such as whether the NNMs had the opportunity to participate fully in sessions, whether there were more lecture-style presentations or hands on demonstrations of technique, and whether they got more out of open forum discussions. The cumulative percentage of total explained variance was 81.62%. PP scale served as the evaluation instrument for “preceptorship” that was employed within the nursing unit (Byrd et al., 1997). The self-evaluation of the NNM, nurse administrators, and staff nurses were examined using a multi-data source. Three of the evaluation sets contained 6 items: coordination and negotiation, administrative affairs, professional skills and competency improved after training, mentorship, proactive attitude, and problem-solving/crisis management ability. A 5-point Likert scale with ratings from 0 to 4 was also adopted. The SES Scale consisted of 6 items rated on a 5-point scale that measured an NNM's perception of support from the clinical nursing education faculty, empowerment, guidance from the nurse administrator and group discussions, understanding among staff nurses, as well as respect and support (William and Burkhead, 2002). “Support from staff nurses” and “Support from nurse administrators” accounted for 77.18% of total variance. The ESPNC was derived from the Committee of Nursing Personal and Education of the study hospital, and it covered three areas: professional competence (10 items, 30%), management/instructional skills (15 items, 55%), and advanced training credit (3 items, 15%). Data analysis Data were analyzed using the SPSS 14.0 software (SPSS Inc., Chicago, IL, USA). Descriptive statistics were used to analyze the data collected from the demographic sheet and the scales. Inferential statistics were used to analyze the remaining data, including Spearman's Rank Correlation, ANOVA, Student's t-test, MANOVA, and stepwise regression to understand the predictive factors concerning preceptorship and nursing competence. Ethical considerations The institutional review boards of both the college and the hospital approved the study. Respondents were informed of its purpose in a cover letter and were assured that their replies to the questionnaire
Table 1 Experience of evaluation of the Leadership orientation workshop, supportive environment, preceptorship and nurse manager competencies. Number of items
Serial no. of item
Explained variance
Cronbach α coefficiency
Mean ± SD (per dimension)
Mean ± SD (per item)
Part I: Evaluation Form for Leadership Orientation Workshop (EFLOW) (na = 15) Curriculum and instruction Teaching resources
15 items
1–15
81.62%
.928
111.47 ± 3.21
7.43 ± 0.83
12 3
1–5, 9–15 6–8
65.18% 16.45%
.978 .801
87.97 ± 3.25 23.50 ± 0.77
7.33 ± 1.05 7.83 ± 1.00
2 1
Part II: Supportive Environment Survey (SES) (na = 15) Support from nurse administrator Support from staff nurses
6 items 3 3
1–6 1–3 4–6
77.18% 20.27% 56.90%
.822 .698 .906
22.87 ± 0.65 11.13 ± 0.42 11.73 ± 0.34
3.81 ± 0.42 3.91 ± 0.44 3.71 ± 0.55
1 2
Part III: Perception of Preceptorship (PP) Self-evaluation of NNM (na = 15) Evaluation by Nurse Administrators (nc = 20) Evaluation by staff nurses (preceptee) (nb = 101)
21 items 7 7 7
1–21 1–7a 1–7b 1–7c
71.61% 65.67% 71.18%
.847 .929 .945 .928
56.15 ± 6.77 18.07 ± 4.00 27.00 ± 4.65 18.45 ± 4.49
2.67 ± 0.32 2.58 ± 0.56 3.85 ± 0.67 2.63 ± 0.64
3 1 2
Part IV: Evaluation Sheet of Preceptors’ Nursing Competence(ESPNC) (nc = 20) Clinical competence Management/instructional skills Advanced training credit
28 items
1–28
.699
84.25 ± 1.12(100)
10 15 3
1–10 1–15 1–3
.804 .865 .807
25.75 ± 0.52 (30) 46.26 ± 1.04 (55) 11.89 ± 0.40 (15)
85.8% 84.1% 79.3%
1 2 3
86.36% 75.86% 50.75%
Note: (1) New Nurse Managers: NNM; (2) na = Numbers of NNM; nb = Numbers of staff nurses (preceptee); nc = Numbers of nurse administrator.
Rank
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would remain anonymous and confidential. A signed consent form was obtained from each respondent and results were only presented at the group level to ensure anonymity.
Results Evaluation of the leadership orientation workshop, supportive environment, perception of preceptorship, and nurse manager competencies “Teaching resources” in EFLOW showed the highest satisfaction rate at 78.3% (7.83 ± 0.26), and “curriculum and instruction” was rated at 73.3% (73.3 ± 0.27). The score for “Support from nurse administrator” (11.73 ± 0.34) was higher than that for “Support from staff nurses” (11.13 ± 0.42.). In the “Preceptorship Scale,” nurse administrators exhibited the highest opinion toward “preceptorship” (3.86 ± 0.15), falling between excellent and good, followed by staff nurses (2.63 ± 0.06). The score of the NNM's self-evaluation preceptorship was the lowest (2.58 ± 0.15) with scattered data ranging between good and normal. In “nurse manager competencies,” the average score for ESPNC was 84.25 ± 1.12, of which 55% was dispersed between 85 and 89. One participant scored higher than 90 (5%), and 3 scored below 80 (15%). This indicates that most respondents improved on their abilities following the end of the program. The unit characteristics and evaluation criteria that led to participants scoring below 80 require further investigation (Table 1). Positive and statically significant correlations exist between an NNM's education/nursing clinical ladder credit and “satisfaction toward instruction and courses” (γ = 0.61, p = 0.017; γ = 0.55, p = 0.035). The higher the education level and age of a NNM, the better the NNM's perception of preceptorship (γ = 0.59, p = 0.02; γ = 0.52, p = 0.046). The higher the education and age of a nurse administrator, the better a NNM's competencies (γ = 0.56, p = 0.03; γ = 0.88, p = 0.02). A staff nurse's position and “nursing seniority” were negatively related to a NNM's competencies (γ = −0.60, p = 0.02; γ = −0.66, p = 0.01) (Table 2). An NNM's perception of preceptorship was positively correlated to a supportive environment (γ = 0.52, p = 0.04). Preceptorship and an NNM's competencies showed a positive correlation (γ = 0.73, p = 0.002), and there was an especially strong correlation between
an NNM's management skill and preceptorship (γ = 0.76, p = 0.001). None of the correlations between the evaluation of the workshop and the perception of a supportive environment, preceptorship, or nurse manager competencies were statistically significant (Table 3). Predictive factors of “preceptorship” and an NNM's “nurse manager competencies” The nurse manager competencies of NNMs were the dependent variable for the purpose of investigating predictive factors, and a stepwise regression analysis was conducted on the demographic variables regarding NNMs, staff nurses, and nurse administrators, and the evaluation of the leadership workshop, the perception of a supportive environment, and preceptorship. It was found that the perception of a supportive environment from staff nurses was the predictive factor for preceptorship (F = 7.68, p = 0.016). Additionally, an NNM's educational background, preceptorship, and satisfaction with teaching resources constituted the predictive model of an NNM's nursing competence, which accounted for 88.5% of the total explained variance (F = 15.13, p b 0.001) (Table 4). Discussion The self-evaluation of preceptorship by NNMs represented the lowest scores when compared to staff nurses and nursing administrators, a result which revealed the influence of stress on NNMs. The role of the NNM is currently undergoing changes as a result of a range of different factors, including updates to professional education, types of nursing, workplace, and the various learning needs of preceptees, so awareness of the importance of ongoing support is critical to the future success of preceptorship (Hyrkas and Shoemaker, 2007). The selection criteria of a potential NNM should possess a bachelor degree or higher and should also have passed N2 credit. In addition, the education level and nursing clinical ladder credit of the nurse administrator should be equal or superior to that of a NNM. Our findings were in line with a previous report that an RN should have at least 2 years of work experience in order to qualify as a preceptor or NNM (Hallin and Danielson, 2009). Pairing new managers with their supervisors rather than with nurse manager colleagues allows new
Table 2 Demographic variables and evaluation of leadership orientation workshop, supportive environment, preceptorship and nurse manager competencies. Variables
Evaluation (EFLOW)
Support (SES)
Preceptorship (PP)
Competencies (ESPNC)
Hypnoses’ test
M ± S.D
Wilks'Λ/p
M ± S.D
Wilks'Λ/p
M ± S.D
Wilks'Λ/p
M ± S.D
Wilks'Λ/p
85.5 ± 4.4 84.0 ± 5.9
0.192/0.899
22.63 ± 3.42 23.14 ± 1.07
309/.740
58.9 ± 6.4 53.0 ± 6.2
1.265/.334
85.5 ± 4.4 84.0 ± 5.9
192/0.899
r
P value
R
P value
r
P value
r
P value
0.406 0.078 0.078 0.308 0.595 0.172 0.269 0.518 0.045 0.584 −0.591 −0.266 0.142 −0.166 −0.222
0.134 0.782 0.782 0.265 0.019* 0.540 0.333 0.070 0.873 0.022* 0.020* 0.337 0.572 0.554 0.426
−0.154 0.483 −0.134 0.172 0.239 0.221 0.284 0.570 0.373 0.509 −0.179 0.010 −0.372 −0.305 −0.350
0.583 0.068 0.635 0.539 0.391 0.428 0.305 0.026* 0.171 0.053 0.523 0.971 0.172 0.269 0.201
−0.317 0.393 −0.106 0.184 0.522 −0.357 −0.109 −0.145 −0.325 −0.116 −0.317 0.038 −0.245 −0.167 −0.137
0.250 0.147 0.708 0.512 0.046* 0.192 0.700 0.605 0.237 0.680 0.250 0.892 0.378 0.552 0.626
−0.325 −0.194 −0.426 −0.216 0.047 −0.600 0.067 −0.659 −0.327 −0.428 0.237 0.380 −0.076 0.875 0.047
0.236 0.488 .114 .439 .867 .018* .814 .014* .234 .111 .395 .162 .789 .022* .867
New nurse managers
New nurse managers
Staff nurses
Administrators
Marital status Married Single
Position Education Experience Age Ladder credit Position Education Experience Age Ladder credit Position Education Experience Age Ladder credit
Note: (1)M ± S.D = Mean ± Standard Deviation; *p value b 0.05, **p value b 0.01, ***p value b 0.001;MANOVA test method = Wilks' Λ. (2) Evaluation Form of Leadership Orientation Workshop: EFLOW; Supportive Environment Survey: SES; Perception of Preceptorship: PP; Evaluation Sheet of Preceptors’ Nursing Competence: ESPNC.
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Table 3 Relations between experiences of evaluation of preceptors' training workshop, supportive environment, preceptorship and nurse manager competencies. Variables
EFLOW
Pearson Correlation (γ/P)
γ
EFLOW Curriculum and instruction Teaching resources SES Support from nurse management Support from staff nurses PP Self-evaluation of preceptor Evaluation by Nurse managers Evaluation by staff nurses ESPNC Professional competence Management/instructional skills Advanced training credit
SES p
1
γ
PP p
γ
0.563 0.360 .
0.206 − 0.084
ESPNC p
γ
p
− 0.299 0.158
0.279 0.574
0.273 0.346
0.326 0.206
.
0.226 −0.209 0.209 0.189 −0.219 −0.034 0.275 −0.265 −0.292 −0.178 0.059
0.418 0.456 0.455 0.499 0.433 0.904 0.322 0.339 0.292 0.526 0.834
0.162 0.254 1
0.388 0.515 0.117 −0.017 0.204 0.285 0.111 −0.073
0.153 0.049* 0.679 0.951 0.466 0.304 0.693 0.796
0.284 0.609 1
0.733 0.240 0.761 −0.083
0.460 0.767 0.305 −0.016*
0.002** 0.287 0.001** 0.769
1
Note: (1)*p b 0.05, **p b 0.01, ***p b 0.001 (Pearson Correlation; 2-tailed significant test); (2)Evaluation Form of Leadership Orientation Workshop: EFLOW; Supportive Environment Survey: SES; Perception of Preceptorship: PP; Evaluation Sheet of Preceptors' Nursing Competence: ESPNC.
managers to benefit from their supervisor's knowledge of the organization and promotes the development of a mentoring relationship that lasts well beyond the orientation period (Conley et al., 2007). A positive relationship existed between a supportive environment and preceptorship, which is similar to the idea that the rich diversity of an orientation program facilitates a positive preceptorship (Byrd et al., 1997; Bourbonnais and Kerr, 2007). The present study emphasized the importance of an NNM's educational background, supportive environment, level of satisfaction of teaching resources in the preceptorship. Each of which seem to be critical predictive factors of nursing leadership competencies that are compatible with the finding that a supportive environment expedites the development of the professional role of a nurse (Drennan, 2002). Moreover, positive preceptorship improves job satisfaction among nursing staff (William and Burkhead, 2002) and self-efficacy (Lev et al., 2010).
offers many opportunities for further research. Further studies conducted with large sample sizes in both medical centers and regional teaching hospitals would help to generalize regarding scale and external validity. Second, qualitative research based upon interviews (including individuals and focus group), analysis of messages regarding work stress posted by NNMs on the internet, authentic assessment of preceptorship, turnover rate of new nurses in their first year, job satisfaction, and cost analysis of the program would help paint a clearer picture. Third, longitudinal studies conducted with respect to the professional role models of an NNM, and as the supportive learning environment, preceptorship, and nurse manager competencies will help show how they tend to change over time. Further study carried out in relation to the agents of socialization and job performance of the educator will help clarify the strengths and weakness of preceptorship even further. Conclusions and recommendations
Limitation of the study The study was limited to one regional teaching hospital; therefore the results may not reflect the experiences of NNMs in different institutions. In addition, the small sample size was restricted to female nurses, which limits a generalization of the results, and, as subjects were aware of their being observed, there was a risk to external validity with regard to the Hawthorne effect. Implications for further study Understanding of the relationship between NNMs efficiency and the preceptorship programs which get them started in hospital wards
The findings of this study provide healthcare administrators with additional options with respect to the recruitment of NNMs, preceptee or manager preceptor pairing, and evaluation indicators for an orientation program. Overall, we presented the conditions required to positively enhance an NNM's preceptorship and nurse manager competencies. A qualified NNM needs to have a university degree or higher and should have attained a level beyond grade N2. Furthermore, multiple teaching resources, a supportive learning environment, and a positive preceptorship helps improve an NNM's competencies. An NNM's professional competencies will be further enhanced as a socialization facilitator and educator when resources are directed more toward teaching facilities, improving the education
Table 4 Summary table of stepwise regression for NNMs' competencies (N = 15). Model
Input Variables
R2
R2 change
F value
Unstandardized coefficients (B)
Standardized coefficients (Beta)
T value
1 2 3
Preceptorship Educational background of an NNM Teaching resources
0.538 0.813 0.885
0.538 0.275 0.072
15.129 17.705 6.857
0.738 −4.050 0.454
0.991 −0.597 0.270
8.852*** −5.34*** 2.619***
※ Dependent variable:leader competencies (Y) ※ Input variables:[position, age, ladder credit, clinical experience, and education of preceptors (X1–5)] support of nurses’ manager (X6) support of staff nurses (X7), [position, age, ladder credit, clinical experience, and education of nurses’ manager (X8–11)], [position, age, ladder credit, clinical experience, and education of staff nurses (X12–15)], teaching resources (X16), curriculum & instruction (X17), preceptorship (X18) → Predictors in the model: preceptorship (X18), educational background of preceptors (X2), satisfaction of teaching resources (X16) Unstandardized regression model:ㄚ = 44.28 + 0.738X18 − 4.05X2 + 0.45X16 Standardized regression model:ZY = 0.99X18 − 0.597 X2 + 0.27X16 Note: (1)*p b 0.05, **p b 0.01, ***p b 0.001 (2) an NNM = a new nurse manager.
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level of a NNM, providing incentives, effective support from the organization, and strengthening the relationship among staff nurses, nursing administrators, and the NNMs. It is hoped that the results of the present study will improve the selection of NNMs and enhance the professional growth and job satisfaction of nurses, as well as relieve stress on NNMs and reduce the training costs and turnover rate of newly graduated nurses. References Bourbonnais, F.F., Kerr, E., 2007. Preceptoring a student in the final clinical placement: reflections from nurses in a Canadian hospital. Journal of Clinical Nursing 16 (8), 1543–1549. Byrd, C.Y., Hood, L., Youtsey, N., 1997. Student and preceptor perceptions of factors in a successful learning partnership. Journal of Professional Nursing 13 (6), 344–351. Charleston, R., Goodwin, V., 2004. Effective collaboration enhances rural preceptorship training. International Journal of Mental Health Nursing 13 (4), 225–231. Conley, S.B., Branowicki, P., Hanley, D., 2007. Nursing leadership orientation: a competency and preceptor model to facilitate new leader success. The Journal of Nursing Administration 37 (11), 491–498. Corlett, J., Palfreyman, J.W., Staines, H.J., Marr, H., 2003. Factors influencing theoretical knowledge and practical skill acquisition in student nurses: an empirical study. Nurse Education Today 23 (2), 183–190. Drennan, J., 2002. An evaluation of the role of the clinical placement coordinator in student nurse support in the clinical area. Journal of Advanced Nursing 40 (4), 475–483. Flynn, J.P., 1997. The Role of the Preceptor: A Guide for Nurse Educators and Clinicians. Springer Publishing Company, USA.
Fox, R., Henderson, A., Malko-Nyhan, K., 2006. A comparison of preceptor and preceptee's perception of how the preceptor's role is operationalized. Journal of Clinical Nursing 15 (3), 361–364. Hallin, K., Danielson, E., 2009. Being a personal preceptor for nursing students: registered nurses' experiences before and after introduction of a preceptor model. Journal of Advanced Nursing 65 (1), 161–174. Hyrkas, K., Shoemaker, M., 2007. Changing in the preceptor role: re-visiting preceptors' perceptions of benefits, reward, support and commitment to the role. Journal of Advanced Nursing 60 (5), 513–524. Kaviani, N., Stillwell, Y., 2000. An evaluative study of clinical preceptorship. Nurse Education Today 20 (3), 218–226. Lee, T.Y., Tzeng, W.C., Lin, C.H., Yeh, M.L., 2009. Effects of a preceptorship programme on turnover rate, cost, quality and professional development. Journal of Clinical Nursing 18 (8), 1217–1225. Lev, E.L., Kolassa, J., Bakken, L.L., 2010. Faulty mentors' and students' perceptions of students' research self-efficacy. Nurse Education Today 30 (2), 169–174. Lockwood-Rayermann, S., 2003. Preceptor leadership style and the nursing practicum. Journal of Professional Nursing 19 (1), 32–37. Orsini, C.H., 2005. A nurse transition program for orthopaedics: Creating a new culture for nurturing graduate nurses. Orthopaedic Nursing 24 (4), 240–246. Salt, J., Cummings, G.G., Profetto-McGrath, J., 2008. Increasing retention of new graduate nurses: a systematic review of interventions by healthcare organizations. The Journal of Nursing Administration 38 (6), 287–296. Sowan, N.A., Moffatt, S.G., Canales, M.K., 2004. Creating a mentoring partnership model: a university-department of health experience. Family & Community Health 27 (4), 326–337. William, T., Burkhead, C., 2002. The creation, implementation, and evaluation of a nurse residency program through a shared leadership model in the intensive care setting. Dimensions of Critical Care Nursing 21 (4), 154–161.
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Nurse Education Today j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / n e d t
Evaluation of a leadership orientation program in Taiwan: Preceptorship and leader competencies of the new nurse manager Hsiu-Yueh Hsu a, Lai-Liang Lee b, Chia-Yun Fu b, Chi-Chieh Tang c,⁎ a b c
Director of Department of Nursing, Meiho Institute of Technology, Pingtung, Taiwan, R.O. China Department of Nursing, Yuan's General Hospital, Kaoshiung, Taiwan, R.O. China Department of Early Childhood Education, Director of Department of Health Care of Students' Affaires, National Pintung University of Education, Taiwan, R.O. China
a r t i c l e
i n f o
Article history: Accepted 2 December 2010 Keywords: Leadership orientation program A new nurse manager Preceptorship Leader competencies
s u m m a r y The Leadership Orientation Program is designed to provide new nurse managers with the experience and support that assures them of a smooth transition from their current roles to being managers. The main objective of this study was to gain an understanding of the relationship that exists between a nursing preceptorship and a new nurse manager's competencies; it also attempted to establish a predictive model of leader competencies to improve the program. A descriptive cross-sectional research design and rigorous questionnaires were used in this study. Fifteen new nurse managers, 101 staff nurses, and 20 nurse administrators were recruited from those engaged in ongoing preceptorship. Over the course of the study statistically significant improvements in preceptorship were noted in both new manager educational background and support from staff nurses. Eighty-five percent of new nurse managers had good or excellent performance ratings (Mean = 84.25%). The significant predictive factors of nurse leader competencies were the educational background of new managers and the teaching resources available with regard to preceptorship (R2 = 88.5%, F = 6.86, p b 0.001). © 2010 Elsevier Ltd. All rights reserved.
Introduction Too often, new nurse managers (NNM) are brought into an organization and given assignments with the hope that their prior experience in combination with a brief orientation will adequately prepare them for their new role. The ideal orientation program builds on experiential knowledge and develops leaders who establish structured goals and expectations, use visionary approaches to solve problems, and place a priority on teaching their staff to adapt to their environment and facilitate a high-level practice (Conley et al., 2007). Yuan's General Hospital is a comprehensive teaching hospital in Kaohsiung, Taiwan. Their leadership orientation program was developed as a competency-based evaluation process, and it encompasses five components: nursing administration, instruction, preceptor competencies, project writing/evidence-based research, and computer software application. A competency-based evaluation process of leadership orientation programs includes the development of emotional intelligence by helping NNMs appreciate the organiza-
⁎ Corresponding author. Department of Early Childhood Education, National Pintung University of Education, No. 4-18 Ming Shen Road, Pingtung, Taiwan 900, R.O. China. Tel.: +886 8 7226141 31551; fax: +886 8 7338536. E-mail addresses: [email protected] (H.-Y. Hsu), [email protected] (C.-Y. Fu), [email protected], [email protected] (C.-C. Tang). 0260-6917/$ – see front matter © 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.nedt.2010.12.003
tion's culture and core values, as well as teaching them how to factor these values into their decisions and interactions with others. It also helps them anticipate any behaviors they may encounter and helps develop preceptorships by assisting preceptees with role transition, providing job satisfaction, and enhancing the retention rate (Salt et al., 2008). Literature A new nurse manager (NNM) is a nurse clinician with the role of transforming staff nurses into clinical experts, consultants, motivators, socialization facilitators, providers of clinical knowledge, and role models for their profession as well as supporters for staff (LockwoodRayermann, 2003). In addition, a successful NNM should be willing to teach knowledge, skills, flexibility, and assertiveness to new nurses (Byrd et al., 1997). Preceptorship occurs when a senior person provides information, advice, and emotional support to a junior person (Lev et al., 2010), so preceptorship involves an preceptee's adjustment to a new environment in which the NNM (preceptor) formulates a counseling program and coordinates interaction among new nurses and nurse administrators (Corlett et al., 2003). Development of positive preceptorship depends on a NNM's professional experience, competency, and flexibility within an organization (Kaviani and Stillwell, 2000). Positive preceptorship has the potential to implicitly influence nursing practices, enhance clinical learning,
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improve recruitment and retention, reduce turnover costs, enhance the quality of nursing care (especially by reducing medication errors), encourage critical thinking, and generate a more collaborative relationship with staff (William and Burkhead, 2002; Charleston and Goodwin, 2004; Fox et al., 2006; Lee et al., 2009). A leadership orientation program adopts an adult learning model and emotional intelligence (Orsini, 2005). The objectives of a leadership orientation program include: (1) easing the difficulties of the transition from theory to practice, (2) improving the job satisfaction of staff nurses, (3) reducing the cost-benefit ratio of recruitment and retention (Salt et al., 2008), (4) consolidating the partnership between preceptor and staff (Sowan et al., 2004), and (5) developing professional behaviors and critical thinking (Orsini, 2005). In this sense, pedagogical theory, instruction strategies, adult learning principles, communication skills, value and role clarification, conflict resolution, learning needs, and performance appraisals should all be involved in a leadership orientation program (Kaviani and Stillwell, 2000). Preceptorship program evaluation strategies that have been described in previous literature focus on the evaluators, the educational program, preceptor responses regarding support, and performance (Kaviani and Stillwell, 2000; William and Burkhead, 2002). Cooperation and critical thinking are positively related to a nurse preceptor's competency (Orsini, 2005). Flynn (1997) suggested that evaluations could be year-based. For the purposes of this study the effectiveness of the preceptorship programs was quantified and triangulated through the use of three targeted feedback forms. Data collected from the NNM participants, their supervising mentors, and the staff nurses of the NNMs. The present study was carried out in a regional teaching hospital in Kaoshiung. Nurse manager competencies were evaluated using a summative assessment six months after the program. The aim was to understand the NNM's level of satisfaction with the Leadership Orientation Program, the preceptorship, an NNM's competencies, the relationship between these elements, and their predictive factors. Finally, we applied the research findings as feedback in order to improve the leadership cultivated by the program (Fig. 1).
Input Variables
Age Marital status Education Clinical experience Clinical ladder credit
Research design A three-phased questionnaire survey was employed to evaluate the Leadership Orientation Program: (1) Leadership orientation workshop: The workshop was developed jointly by a focus group of eight scholars and professionals from a teaching hospital and a nursing faculty. The objective of the training course was to provide NNMs with instructional principles, standardized content for guiding staff nurses, and ways to improve their unit management knowledge and skills, application of computer software, and research methods. A seventy-hour leadership training course was offered from January to July 2007. (2) Instruction for unit staff nurses: The duration of the preceptorship was three months, and 101 staff nurses were involved in evaluating the preceptorship. We attempted to understand the relationship between nursing preceptorship and an NNM's competencies, and to understand their predictive factors. Participants and procedure of data collection The data for this study were collected in three phases. The target group for the first phase included all NNMs who had attended the leadership orientation workshop. Convenience sampling was used for recruitment at a 700-bed regional teaching hospital in Kaohsiung City, Taiwan. The subjects included NNMs, ward-based staff nurses, and nurse administrators. Initially, 19 NNMs were selected, but only 15 finished the training. The evaluation forms for the workshop were mailed in July 2007, with a response rate of 100%. The second phase of data collection took place three months after the NNMs' instruction of the staff nurses (October 2007). The targeted staff nurses (101 subjects) and nurse administrators (20 subjects) ward-based paired with the NNMs responded to the “Perception of Preceptorship” questionnaire. At the same time, the NNMs also responded to the “Perception of Preceptorship” questionnaire and the “Supportive Environment Survey” questionnaire. The third phase of data collection took place in December 2007. The targeted nurse administrators used
Moderators
Output Variables
Environment support
Recruitment Criteria of the New Nurses Manager (NNM)
Demographic characteristics of New Nurse Managers (NNM)
Methods
Administrators’ support Peer support
Preceptorship
Leader Competencies of the NNM
Leadership
New Nurses Managers
Orientation Program
(preceptor)
Clinical competence
Staff nurses (preceptee) Nurse administrators
Management/ Instructional skills Advanced training credits
First Phase (Jan.~July, 2007) recruitment of new nurse managers implementation of workshop (70 hours) evaluation the workshop (July, 2007)
Demographic Characteristics of Staff Nurses’ & Nurses Administrators Age, Marital status, Education, Position Clinical experience Clinical ladder credit
2nd Phase (Oct., 2007)
3rd Phase (Dec., 2007)
Survey of preceptorship (triangulated data)
Evaluation of NNMs’ competencies (nurse
Survey of environment support
administrators were the reviewers)
Fig. 1. Evaluation model of the leadership orientation program and procedures for data collection.
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the “Evaluation Sheet of Preceptors’ Nursing Competencies” for the outcome variables. Further, 66.7% of the NNMs possessed more than a bachelor's degree of science in nursing (BSN), with an average seniority of 10.33±3.30 years and a mean age of 32.75±3.15 years old. 66.7% of the total had qualified for N2 credit, and 53.3% were married. Most nurse administrators were also head nurses, married, and with qualifications above that of BSN (70.0%). Their average seniority was 19.56±3.44 years and their average age was 42.11±3.33 years old. Most staff nurses were junior college graduates and unmarried with an average seniority of 4.41±0.44 years, a mean age of 26.93±0.95 years old, and 51.5% and had completed N1 training. The ethnicity of the respondents was homogenous: All the NNMs were Taiwanese females. Instruments A five-part questionnaire was used to collect the data: (1) Evaluation Form of Leadership Orientation Workshop (EFLOW) (input variables); (2) measuring tools for the moderate variables consisting of Perception of Preceptorship (PP) scale for NNMs, staff nurses, and nurse administrators; (3) Supportive Environment Survey (SES) Scale; (4) Evaluation Sheet of Preceptors' Nursing Competencies (ESPNC); and (5) a demographic information sheet. Items were generated from a literature review, the researchers' clinical experience, and case interviews. The content validity was assessed by means of the known-groups technique (2 clinical nursing administrators, 1 hospital chief executive officer, and 2 nursing faculty professors). Few modifications were required; the agreement degree was 95% (Mean score = 3.8, full score= 4.0). Construct validity was examined by exploratory factor analysis (EFA) for three scales. Internal consistency was assessed with Cronbach's alpha reliability coefficient. Alphas ranged between 0.800.97 for different subscales (Table 1). The EFLOW Scale included 15 rated items on a 10-point Likert scale (from 1 = strongly disagree to 10 = strongly agree) and reflected an NNM's experience with the workshop (Charleston and Goodwin, 2004). “Curriculum and instruction” and “teaching resources” were analyzed by exploratory factor analysis. “Curriculum and instruction” included items such as whether the teaching style suited the learning style, whether the notes were relevant and useful, interest level, altering practice in workplace, whether the presenters were knowledgeable and enthusiastic throughout the course, whether the curriculum was structured and logical, whether they felt more confident in dealing with the issues of preceptorship, whether the
811
assessment tasks were suitable for the subject, and whether they would recommend the course to colleagues. “Teaching resources” involved items such as whether the NNMs had the opportunity to participate fully in sessions, whether there were more lecture-style presentations or hands on demonstrations of technique, and whether they got more out of open forum discussions. The cumulative percentage of total explained variance was 81.62%. PP scale served as the evaluation instrument for “preceptorship” that was employed within the nursing unit (Byrd et al., 1997). The self-evaluation of the NNM, nurse administrators, and staff nurses were examined using a multi-data source. Three of the evaluation sets contained 6 items: coordination and negotiation, administrative affairs, professional skills and competency improved after training, mentorship, proactive attitude, and problem-solving/crisis management ability. A 5-point Likert scale with ratings from 0 to 4 was also adopted. The SES Scale consisted of 6 items rated on a 5-point scale that measured an NNM's perception of support from the clinical nursing education faculty, empowerment, guidance from the nurse administrator and group discussions, understanding among staff nurses, as well as respect and support (William and Burkhead, 2002). “Support from staff nurses” and “Support from nurse administrators” accounted for 77.18% of total variance. The ESPNC was derived from the Committee of Nursing Personal and Education of the study hospital, and it covered three areas: professional competence (10 items, 30%), management/instructional skills (15 items, 55%), and advanced training credit (3 items, 15%). Data analysis Data were analyzed using the SPSS 14.0 software (SPSS Inc., Chicago, IL, USA). Descriptive statistics were used to analyze the data collected from the demographic sheet and the scales. Inferential statistics were used to analyze the remaining data, including Spearman's Rank Correlation, ANOVA, Student's t-test, MANOVA, and stepwise regression to understand the predictive factors concerning preceptorship and nursing competence. Ethical considerations The institutional review boards of both the college and the hospital approved the study. Respondents were informed of its purpose in a cover letter and were assured that their replies to the questionnaire
Table 1 Experience of evaluation of the Leadership orientation workshop, supportive environment, preceptorship and nurse manager competencies. Number of items
Serial no. of item
Explained variance
Cronbach α coefficiency
Mean ± SD (per dimension)
Mean ± SD (per item)
Part I: Evaluation Form for Leadership Orientation Workshop (EFLOW) (na = 15) Curriculum and instruction Teaching resources
15 items
1–15
81.62%
.928
111.47 ± 3.21
7.43 ± 0.83
12 3
1–5, 9–15 6–8
65.18% 16.45%
.978 .801
87.97 ± 3.25 23.50 ± 0.77
7.33 ± 1.05 7.83 ± 1.00
2 1
Part II: Supportive Environment Survey (SES) (na = 15) Support from nurse administrator Support from staff nurses
6 items 3 3
1–6 1–3 4–6
77.18% 20.27% 56.90%
.822 .698 .906
22.87 ± 0.65 11.13 ± 0.42 11.73 ± 0.34
3.81 ± 0.42 3.91 ± 0.44 3.71 ± 0.55
1 2
Part III: Perception of Preceptorship (PP) Self-evaluation of NNM (na = 15) Evaluation by Nurse Administrators (nc = 20) Evaluation by staff nurses (preceptee) (nb = 101)
21 items 7 7 7
1–21 1–7a 1–7b 1–7c
71.61% 65.67% 71.18%
.847 .929 .945 .928
56.15 ± 6.77 18.07 ± 4.00 27.00 ± 4.65 18.45 ± 4.49
2.67 ± 0.32 2.58 ± 0.56 3.85 ± 0.67 2.63 ± 0.64
3 1 2
Part IV: Evaluation Sheet of Preceptors’ Nursing Competence(ESPNC) (nc = 20) Clinical competence Management/instructional skills Advanced training credit
28 items
1–28
.699
84.25 ± 1.12(100)
10 15 3
1–10 1–15 1–3
.804 .865 .807
25.75 ± 0.52 (30) 46.26 ± 1.04 (55) 11.89 ± 0.40 (15)
85.8% 84.1% 79.3%
1 2 3
86.36% 75.86% 50.75%
Note: (1) New Nurse Managers: NNM; (2) na = Numbers of NNM; nb = Numbers of staff nurses (preceptee); nc = Numbers of nurse administrator.
Rank
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would remain anonymous and confidential. A signed consent form was obtained from each respondent and results were only presented at the group level to ensure anonymity.
Results Evaluation of the leadership orientation workshop, supportive environment, perception of preceptorship, and nurse manager competencies “Teaching resources” in EFLOW showed the highest satisfaction rate at 78.3% (7.83 ± 0.26), and “curriculum and instruction” was rated at 73.3% (73.3 ± 0.27). The score for “Support from nurse administrator” (11.73 ± 0.34) was higher than that for “Support from staff nurses” (11.13 ± 0.42.). In the “Preceptorship Scale,” nurse administrators exhibited the highest opinion toward “preceptorship” (3.86 ± 0.15), falling between excellent and good, followed by staff nurses (2.63 ± 0.06). The score of the NNM's self-evaluation preceptorship was the lowest (2.58 ± 0.15) with scattered data ranging between good and normal. In “nurse manager competencies,” the average score for ESPNC was 84.25 ± 1.12, of which 55% was dispersed between 85 and 89. One participant scored higher than 90 (5%), and 3 scored below 80 (15%). This indicates that most respondents improved on their abilities following the end of the program. The unit characteristics and evaluation criteria that led to participants scoring below 80 require further investigation (Table 1). Positive and statically significant correlations exist between an NNM's education/nursing clinical ladder credit and “satisfaction toward instruction and courses” (γ = 0.61, p = 0.017; γ = 0.55, p = 0.035). The higher the education level and age of a NNM, the better the NNM's perception of preceptorship (γ = 0.59, p = 0.02; γ = 0.52, p = 0.046). The higher the education and age of a nurse administrator, the better a NNM's competencies (γ = 0.56, p = 0.03; γ = 0.88, p = 0.02). A staff nurse's position and “nursing seniority” were negatively related to a NNM's competencies (γ = −0.60, p = 0.02; γ = −0.66, p = 0.01) (Table 2). An NNM's perception of preceptorship was positively correlated to a supportive environment (γ = 0.52, p = 0.04). Preceptorship and an NNM's competencies showed a positive correlation (γ = 0.73, p = 0.002), and there was an especially strong correlation between
an NNM's management skill and preceptorship (γ = 0.76, p = 0.001). None of the correlations between the evaluation of the workshop and the perception of a supportive environment, preceptorship, or nurse manager competencies were statistically significant (Table 3). Predictive factors of “preceptorship” and an NNM's “nurse manager competencies” The nurse manager competencies of NNMs were the dependent variable for the purpose of investigating predictive factors, and a stepwise regression analysis was conducted on the demographic variables regarding NNMs, staff nurses, and nurse administrators, and the evaluation of the leadership workshop, the perception of a supportive environment, and preceptorship. It was found that the perception of a supportive environment from staff nurses was the predictive factor for preceptorship (F = 7.68, p = 0.016). Additionally, an NNM's educational background, preceptorship, and satisfaction with teaching resources constituted the predictive model of an NNM's nursing competence, which accounted for 88.5% of the total explained variance (F = 15.13, p b 0.001) (Table 4). Discussion The self-evaluation of preceptorship by NNMs represented the lowest scores when compared to staff nurses and nursing administrators, a result which revealed the influence of stress on NNMs. The role of the NNM is currently undergoing changes as a result of a range of different factors, including updates to professional education, types of nursing, workplace, and the various learning needs of preceptees, so awareness of the importance of ongoing support is critical to the future success of preceptorship (Hyrkas and Shoemaker, 2007). The selection criteria of a potential NNM should possess a bachelor degree or higher and should also have passed N2 credit. In addition, the education level and nursing clinical ladder credit of the nurse administrator should be equal or superior to that of a NNM. Our findings were in line with a previous report that an RN should have at least 2 years of work experience in order to qualify as a preceptor or NNM (Hallin and Danielson, 2009). Pairing new managers with their supervisors rather than with nurse manager colleagues allows new
Table 2 Demographic variables and evaluation of leadership orientation workshop, supportive environment, preceptorship and nurse manager competencies. Variables
Evaluation (EFLOW)
Support (SES)
Preceptorship (PP)
Competencies (ESPNC)
Hypnoses’ test
M ± S.D
Wilks'Λ/p
M ± S.D
Wilks'Λ/p
M ± S.D
Wilks'Λ/p
M ± S.D
Wilks'Λ/p
85.5 ± 4.4 84.0 ± 5.9
0.192/0.899
22.63 ± 3.42 23.14 ± 1.07
309/.740
58.9 ± 6.4 53.0 ± 6.2
1.265/.334
85.5 ± 4.4 84.0 ± 5.9
192/0.899
r
P value
R
P value
r
P value
r
P value
0.406 0.078 0.078 0.308 0.595 0.172 0.269 0.518 0.045 0.584 −0.591 −0.266 0.142 −0.166 −0.222
0.134 0.782 0.782 0.265 0.019* 0.540 0.333 0.070 0.873 0.022* 0.020* 0.337 0.572 0.554 0.426
−0.154 0.483 −0.134 0.172 0.239 0.221 0.284 0.570 0.373 0.509 −0.179 0.010 −0.372 −0.305 −0.350
0.583 0.068 0.635 0.539 0.391 0.428 0.305 0.026* 0.171 0.053 0.523 0.971 0.172 0.269 0.201
−0.317 0.393 −0.106 0.184 0.522 −0.357 −0.109 −0.145 −0.325 −0.116 −0.317 0.038 −0.245 −0.167 −0.137
0.250 0.147 0.708 0.512 0.046* 0.192 0.700 0.605 0.237 0.680 0.250 0.892 0.378 0.552 0.626
−0.325 −0.194 −0.426 −0.216 0.047 −0.600 0.067 −0.659 −0.327 −0.428 0.237 0.380 −0.076 0.875 0.047
0.236 0.488 .114 .439 .867 .018* .814 .014* .234 .111 .395 .162 .789 .022* .867
New nurse managers
New nurse managers
Staff nurses
Administrators
Marital status Married Single
Position Education Experience Age Ladder credit Position Education Experience Age Ladder credit Position Education Experience Age Ladder credit
Note: (1)M ± S.D = Mean ± Standard Deviation; *p value b 0.05, **p value b 0.01, ***p value b 0.001;MANOVA test method = Wilks' Λ. (2) Evaluation Form of Leadership Orientation Workshop: EFLOW; Supportive Environment Survey: SES; Perception of Preceptorship: PP; Evaluation Sheet of Preceptors’ Nursing Competence: ESPNC.
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813
Table 3 Relations between experiences of evaluation of preceptors' training workshop, supportive environment, preceptorship and nurse manager competencies. Variables
EFLOW
Pearson Correlation (γ/P)
γ
EFLOW Curriculum and instruction Teaching resources SES Support from nurse management Support from staff nurses PP Self-evaluation of preceptor Evaluation by Nurse managers Evaluation by staff nurses ESPNC Professional competence Management/instructional skills Advanced training credit
SES p
1
γ
PP p
γ
0.563 0.360 .
0.206 − 0.084
ESPNC p
γ
p
− 0.299 0.158
0.279 0.574
0.273 0.346
0.326 0.206
.
0.226 −0.209 0.209 0.189 −0.219 −0.034 0.275 −0.265 −0.292 −0.178 0.059
0.418 0.456 0.455 0.499 0.433 0.904 0.322 0.339 0.292 0.526 0.834
0.162 0.254 1
0.388 0.515 0.117 −0.017 0.204 0.285 0.111 −0.073
0.153 0.049* 0.679 0.951 0.466 0.304 0.693 0.796
0.284 0.609 1
0.733 0.240 0.761 −0.083
0.460 0.767 0.305 −0.016*
0.002** 0.287 0.001** 0.769
1
Note: (1)*p b 0.05, **p b 0.01, ***p b 0.001 (Pearson Correlation; 2-tailed significant test); (2)Evaluation Form of Leadership Orientation Workshop: EFLOW; Supportive Environment Survey: SES; Perception of Preceptorship: PP; Evaluation Sheet of Preceptors' Nursing Competence: ESPNC.
managers to benefit from their supervisor's knowledge of the organization and promotes the development of a mentoring relationship that lasts well beyond the orientation period (Conley et al., 2007). A positive relationship existed between a supportive environment and preceptorship, which is similar to the idea that the rich diversity of an orientation program facilitates a positive preceptorship (Byrd et al., 1997; Bourbonnais and Kerr, 2007). The present study emphasized the importance of an NNM's educational background, supportive environment, level of satisfaction of teaching resources in the preceptorship. Each of which seem to be critical predictive factors of nursing leadership competencies that are compatible with the finding that a supportive environment expedites the development of the professional role of a nurse (Drennan, 2002). Moreover, positive preceptorship improves job satisfaction among nursing staff (William and Burkhead, 2002) and self-efficacy (Lev et al., 2010).
offers many opportunities for further research. Further studies conducted with large sample sizes in both medical centers and regional teaching hospitals would help to generalize regarding scale and external validity. Second, qualitative research based upon interviews (including individuals and focus group), analysis of messages regarding work stress posted by NNMs on the internet, authentic assessment of preceptorship, turnover rate of new nurses in their first year, job satisfaction, and cost analysis of the program would help paint a clearer picture. Third, longitudinal studies conducted with respect to the professional role models of an NNM, and as the supportive learning environment, preceptorship, and nurse manager competencies will help show how they tend to change over time. Further study carried out in relation to the agents of socialization and job performance of the educator will help clarify the strengths and weakness of preceptorship even further. Conclusions and recommendations
Limitation of the study The study was limited to one regional teaching hospital; therefore the results may not reflect the experiences of NNMs in different institutions. In addition, the small sample size was restricted to female nurses, which limits a generalization of the results, and, as subjects were aware of their being observed, there was a risk to external validity with regard to the Hawthorne effect. Implications for further study Understanding of the relationship between NNMs efficiency and the preceptorship programs which get them started in hospital wards
The findings of this study provide healthcare administrators with additional options with respect to the recruitment of NNMs, preceptee or manager preceptor pairing, and evaluation indicators for an orientation program. Overall, we presented the conditions required to positively enhance an NNM's preceptorship and nurse manager competencies. A qualified NNM needs to have a university degree or higher and should have attained a level beyond grade N2. Furthermore, multiple teaching resources, a supportive learning environment, and a positive preceptorship helps improve an NNM's competencies. An NNM's professional competencies will be further enhanced as a socialization facilitator and educator when resources are directed more toward teaching facilities, improving the education
Table 4 Summary table of stepwise regression for NNMs' competencies (N = 15). Model
Input Variables
R2
R2 change
F value
Unstandardized coefficients (B)
Standardized coefficients (Beta)
T value
1 2 3
Preceptorship Educational background of an NNM Teaching resources
0.538 0.813 0.885
0.538 0.275 0.072
15.129 17.705 6.857
0.738 −4.050 0.454
0.991 −0.597 0.270
8.852*** −5.34*** 2.619***
※ Dependent variable:leader competencies (Y) ※ Input variables:[position, age, ladder credit, clinical experience, and education of preceptors (X1–5)] support of nurses’ manager (X6) support of staff nurses (X7), [position, age, ladder credit, clinical experience, and education of nurses’ manager (X8–11)], [position, age, ladder credit, clinical experience, and education of staff nurses (X12–15)], teaching resources (X16), curriculum & instruction (X17), preceptorship (X18) → Predictors in the model: preceptorship (X18), educational background of preceptors (X2), satisfaction of teaching resources (X16) Unstandardized regression model:ㄚ = 44.28 + 0.738X18 − 4.05X2 + 0.45X16 Standardized regression model:ZY = 0.99X18 − 0.597 X2 + 0.27X16 Note: (1)*p b 0.05, **p b 0.01, ***p b 0.001 (2) an NNM = a new nurse manager.
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