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Running head: CLINICAL PRACTICUM PROPOSAL 1

Clinical Practicum Proposal for Nursing 711

Shannon L. Sharrar

Ferris State University

CLINICAL PRACTICUM PROPOSAL 2

Abstract

A proposal for nursing preceptor training is created for a quality improvement project to be

implemented in Nursing 791 at Ferris State University. The quality improvement of nurse

preceptor training is designed based on the plan-do-study-act model starting with clear goals and

components of the project. Evidence supports the need for the quality initiative because job

dissatisfaction, absence of knowledge of education fundamentals, and adverse institutional

consequences are found when preceptor training is lacking. The project site is identified as the

rural hospital of McLaren Central Michigan and two key players are identified as Leslie Peterson

and Bobbie Gross. Quality and Safety Education for Nurses competencies with associated

knowledge, skills, or attitudes and American Nurses Association scope and standards of practice

are dissected to help guide practicum goals. A root cause analysis and failure modes and effects

analysis are created to evaluate and revamp the current preceptor practice at MCM. Two

theories are applied to the project which includes Roger’s change theory focusing on the

diffusion of innovation and the transformational leadership theory. A discussion on evaluating

the success of the preceptor training is given and a tool is created to assess preceptors both

before and after training. The application of informatics is also deliberated. Predicted results of

improved preceptor and preceptee relationship which will transpire to other positive effects are

stated. Lastly, a planning grid is complete with goals, sub-goals, suggested activities to reach

sub-goals, and a timeline.


Clinical Practicum Proposal for Nursing 711

New hospital orientation for any nurse is a stressful time not only for the newly employed

but also for the experienced nurse given the title of a preceptor. In a rural hospital with limited

education resources, important details such as preceptor training are often left out due to larger

issues to tackle. Inadequate preceptor training can lead to a variety of poor outcomes. The

purpose of this paper is to propose a quality improvement (QI) initiative focused on improving

preceptor education in a specific institution where it is lacking.

Quality Improvement Project

At the rural hospital of McLaren Central Michigan (MCM), preceptor nurses are not

given the opportunity for preceptor training. This absence is training negatively affects the

preceptor, the preceptee, and the institution. The current new hire process is one-on-one nurse

clinical training for a fluctuating length of time and with a nurse who can vary from day-to-day.

The inconsistency of the nurse preceptor and the lack of preparation involved is unstable. A

preceptor course will be created to assure nurses at MCM can give and are given adequate

training.

The following are the proposed goals to Nursing 791 clinical practicum:

1. Development and implementation of a preceptor course specific for MCM nursing staff

structured by evidence-based practice.

2. Assess weakness in the process both before development and after implementation of a

preceptor course to promote continuous quality improvement.

The following are the proposed components to Nursing 791 clinical practicum:

1. Creation and completion of a questionnaire for any nurse hired in the last 12 months to

determine major weaknesses in the current orientation process.


2. Attendance of McLaren corporate preceptor course which is not currently offered for

MCM nursing staff.

3. Development of a preceptor course specific for MCM nursing staff structured by

evidence-based practice (EBP) that includes detailed purpose, clear responsibilities,

feedback insight, and frequent goal appraisals.

4. Deliverance of a preceptor course to designated nurse preceptors at MCM.

5. Self-reflections of preceptors’ abilities to precept both before and after completion of

course.

Evidence-Based Needs Assessment

A preceptor model refers to a nurse expert working one-on-one with a developing nurse

in their clinical setting (Gaberson, Oermann, & Shellenbarger, 2015). There are negative

consequences in many aspects of the nursing profession if the clinical nurse expert is not

adequately trained in their preceptor role. The three negative trends which emerged from the

research included job dissatisfaction from both the preceptor and preceptee, absence of

knowledge of education fundamentals by the preceptor, and negative consequences on the

institution as a whole. Adequate preceptor training is currently an innovative quality

improvement initiative and a patient safety strategy due to these trends found (Senyk &

Staffileno, 2017; The Joint Commission, 2019). Nurse educators play a vital role in the

development of nurses and ensuring nurses are given the best possible training is essential in the

complex health care system (National League for Nursing [NLN], 2012).

Job Dissatisfaction

Lack of preceptor training can result in an increase in an undesirable milieu (Kennedy,

2019). A positive attitude is difficult to portray in an environment where chaotic work hours,


high patient demands, minimal or no compensation for training, and contrasting personalities are

all frequently found (Dodge, Mazerolle, & Bowman, 2014). Often preceptors do not feel they

are given adequate time to properly educate (Tracey & McGowan, 2015). A study done by

Dodge, Mazerolle, and Bowman (2014) identified the concept of role strain found when

preceptors try to multitask in the two roles of educator and healthcare provider simultaneously.

Chan et al. (2018) discussed strained relationships with the top areas of concerns including lack

of conflict management and teamwork skills when perceptions of both the preceptor and

preceptee were studied.

Improving nursing resilience and job satisfaction by empowering designated preceptors

through training is a hopeful recommendation to clinical education (TJC, 2019). Standardized

preceptor training could improve job satisfaction by creating pools of skilled preceptors with

uniformity helping to eliminate unnecessary stressors (Senyk & Staffileno, 2017). Preceptor

programs also support employee engagement and recognition which is proven to positively

enhance the milieu (Kennedy, 2019). Lastly, preceptor training can improve job satisfaction by

helping a nurse become emotionally intelligent by growing in areas of self-awareness and

leadership appreciation (Francis, 2018).

Absence of Education Fundamentals

The role of a preceptor is admirable. Often times a preceptor is appointed by peers, but

simply being appointed is not enough. A nurse must be self-aware if they possess the spirit of

inquiry needed to fulfill the role (Quek & Shorey, 2018). Much of the dissatisfaction discussed

thus far is directly related to the limited formal training given to preceptors on education

fundamentals (Bengtsson & Carlson, 2015). Specifically, preceptors have stated the need for

education on teaching strategies, critical thinking, prioritizing, communication techniques, clear


expectations of their role, and objective ways to evaluate clinical judgment (Bengtsson &

Carlson, 2015; Chan et al., 2018; Nielsen, Lasater, & Stock, 2016). Poor role emersion for

preceptors negatively affects basic teaching principles of theoretical application, assessment, and

evaluations (Poe & White, 2010; Senyk & Staffileno, 2017). Limited competence results in a

lack of confidence placing immense tension on the preceptor and preceptee relationship (Senyk

& Staffileno, 2017).

The Vermont Nurses in Partnership (VNIP, 2019) is one of the leaders of formal

preceptor training development. VNIP (2019) was established in 1999 with the purpose of

supporting evidence-based, safe teaching, and learning for direct care providers. VNIP’s (2019)

clinical transition framework can be utilized by all levels of new nursing staff including new

graduates, new hires, and specialty unit transitions. With the varying levels of experience,

Patricia Benner’s Novice to Expert nursing proficiency theory is important to understand when

developing and delivering preceptor training (Benner, 1982; VNIP, 2016). VNIP (2016) feel

most preceptors without proper training do not meet the educational expectations, support needs,

and adequate time to be an effective preceptor. VNIP beliefs are evidence-based and will be

regularly revisited throughout the practicum.

Consequences on the Institution

The most significant negative effect of no formal preceptor training is poor new hire

retention (Kennedy, 2019). Poor retention harmfully affects the wellbeing of nursing staff and

adds to rising institutional costs (Magtibay, Chesak, Coughlin, & Sood, 2017). Additionally,

high nursing turnover rates due to lack of preceptor training have a direct correlation with

increased patient safety concerns (Magtibay et al., 2017; TJC, 2019). Lastly, human capital


declines when the knowledge, skills, and attitudes of staff are not of focus (Covell & Sidani,

2013).

Preceptor training has been studied to have a substantial return on investment (Silvestre,

Ulrich, Johnson, Spector, & Blegen, 2017). Silvestre et al. (2017) study showed once the

implementation of a preceptor program began, the hospital’s turnover rate decreased by 11.3%

over the course of one year. Beyond significant cost saving, using an organized and systematic

approach to the preceptor improves the quality and safety level of the nursing care given (Senyk

& Staffileno, 2017). Focusing on a culture of safety through effective precepting can be done by

asking the what-ifs, huddling for safety, and inspiring lifelong learning (Lim, Weiss, & Herrera-

Capoziello, 2016).

Project Site

The majority of the clinical practicum will take place at MCM hospital. Additional

educational opportunities will presumably be held at McLaren corporate in Flint, MI. MCM is

located in Mt. Pleasant, MI and is considered a small hospital with 118 inpatient beds and

employing roughly 120 nurses (McLaren, 2019). Although considered rural, MCM competes

well having received higher safety scores than nearby hospitals according to the LeapFrog

Hospital Safety Grade (2019). MCM was also given the title of one of the nation’s 100 top

hospitals by Thomson Reuters which focuses on high clinical care, patient satisfaction, patient

safety, institutional organization, and economic strength (McLaren, 2019).

The specific unit utilized for the practicum will be in MCM’s education department

which is run by one sole nurse in charge of all nursing departments. The list of departments

consists of the emergency department, operating room (including same day, recovery, and heart

and vascular center), obstetrics, oncology, outpatient therapy, wound center, progressive care,


intensive care, and medical and surgical units. Recently, MCM has given provisional level four

trauma designation and in order to complete accreditation, many process improvements need to

occur including improved nursing education and orientation.

Key Players

The preceptor for the practicum is Leslie Peterson. Leslie is a graduate of the Masters of

Science in Nursing (MSN) program at Ferris State University in the fall of 2018 with an

education focus. Leslie recently accepted the nurse educator position at MCM. Most of Leslie’s

nursing career has been completed at the bedside in multiple emergency departments. She has

also done an excellent job building her nursing education experience as she has clinically

instructed for multiple nursing student levels and has helped manage an emergency department

(L. Peterson, personal communication, September 10th, 2019). Leslie is incredibly accepting of

help to develop the preceptor program. She was selected as an appropriate preceptor because she

is energetic, motivated, and eager to improve MCM’s educational nursing processes.

Leslie is currently supervised by MCM’s Chief Nursing Officer (CNO) Bobbie Gross,

RN, BSN. Bobbie will be the agency representative for the practicum and a signed agreement

was complete with both Bobbie and Leslie (See Appendix A). As CNO, Bobbie oversees all

nursing responsibilities at MCM and is aware of the need for preceptor development. Bobbie has

been with MCM for over 15 years and initially began as manager of all surgical departments.

Bobbie has been working towards her MSN in administration since she took on the role of CNO

in 2018 (B. Gross, personal communication, September 10th, 2019).

QSEN Graduate Level Competencies

The Quality and Safety Education for Nurses (QSEN, 2012) has created competencies

that encourage graduate level nurses to support improving healthcare quality and safety starting


with nursing education. The competencies include patient-centered care, EBP, teamwork and

collaboration, safety, QI, and informatics and each can be broken down into the knowledge,

skills, and attitudes of the nurse (QSEN, 2012). Four competencies of graduate level nurses as

established by QSEN will be of focus during the practicum and will help guide the project goals.

Teamwork and Collaboration

A skill of teamwork and collaboration is to “lead or participate in the designing and

implementation of systems that support effective teamwork” (QSEN, 2012) and will be

completed through the proposed practicum goal of 1) Development and implementation of a

preceptor course specific for MCM nursing staff structured by evidence-based practice.

Collaboration is a professional standard for nursing (American Nurses Association [ANA],

2010). A nurse leader and preceptor must stimulate a respectful, trusting, and teamwork

environment to help produce the best patient outcomes (ANA, 2010). The ANA (2010) has an

entire tenet focused on professional work environments. To have true collaboration, a nurse

must be able to communicate well with all individuals of the healthcare team (ANA, 2010). The

preceptor course will discuss teamwork and communication skills to improve the experience.

Evidence-Based Practice

An attitude of EBP is “value all components of evidence-based practice” (QSEN, 2012)

and will be completed through the proposed practicum goal of 1) Development and

implementation of a preceptor course specific for MCM nursing staff structured by evidence-

based practice. The concept of EBP is a triad of research, clinical proficiency, and patient

desires (Melnyk & Fineout-Overholt, 2018). Preceptors need to embrace and uphold admirable

clinical qualities of EBP to lead by example (Poe & White, 2010). A preceptor must

acknowledge their own limitations and understand that deviation from EBP requires strong


rationalization (QSEN, 2012). A preceptor’s duty is to show the preceptee skills on how to

search for EBP at their particular institution. Promoting a spirit of inquiry is a crucial step in

EBP and is something that should be implemented in a preceptor program (Melnyk & Fineout-

Overholt, 2018).

Quality Improvement

An attitude of QI is “appreciate that continuous QI is an essential part of the daily work

of the health professionals” (QSEN, 2012) and will be completed through the proposed

practicum goal of 2) Assess weakness in the process both before development and after

implementation of a preceptor course to promote continuous quality improvement. Over the last

two decades, QI has shifted from a quality assurance focus to QI process improvements (Agency

for Healthcare Research and Quality, 2013). This paradigm moves from individual focus of

error and punishment to determining how the system failed the worker (AHRQ, 2013). The

Institute of Medicine (IOM, 2001) stated their quality improvement visions by establishing the

six domains of safe, effective, patient-centered, timely, efficient, and equitable healthcare. The

effects of preceptor training are focused on all six of these domains and continuous quality

improvement is a requirement for best patient outcomes (Billings & Halstead, 2012; IOM, 2001).

Safety

A knowledge of safety is: “describe processes used to analyze causes of error and

allocation of responsibility and accountability” (QSEN, 2012) and will be completed through the

proposed practicum goal of 2) Assess weakness in the process both before development and after

implementation of a preceptor course to promote continuous quality improvement. Safety tools

such as a root cause analysis (RCA) and a failure mode and effects analysis (FMEA) have been

proven to successfully achieve the best possible outcomes (Sherwood & Barnsteiner, 2017). An


RCA can be done to breakdown what is known to be wrong in the current nursing preceptor

process. An FMEA can be completed to identify and remove failures from the current preceptor

process to prevent future adverse events.

ANA Scope and Standards of Practice

Standards of practice describe the responsibilities for which a nurse in a particular role is

accountable for (ANA, 2010). Nursing education is a specialty in which professional standards

of practice, or competencies, have been established (NLN, 2012). Reviewing the standards of

practice allows an advanced practice nurse to understand their expectations and determine career

goals specific to their role. Four core competencies of nurse educators as established by NLN

will be of focus during the practicum and will help guide the project components.

Facilitate Learning

“Facilitate learning” (NLN, 2012, p 14) will be completed through the proposed

practicum components of 1) Creation and completion of a questionnaire for any nurse hired in

the last 12 months to determine major weaknesses in the current orientation process, 4)

Deliverance of a preceptor course to designated nurse preceptors at MCM, and 5) Self-reflections

of preceptors’ abilities to precept both before and after completion of course. Practicum

outcomes will reflect a nurse educator’s responsibility for creating a positive and enthusiastic

learner-centered educational environment (McDonald, 2014). Sub-objectives for this NLN

competencies will focus on using a variety of teaching techniques, self-reflecting, enhancing

technologies skills, and improving communication skills.

Participate in Curriculum Design and Evaluation Outcomes

“Participate in curriculum design and evaluation outcomes” (NLN, 2012, p. 18) will be

completed through the proposed practicum component of 3) Development of preceptor course


specific for MCM nursing staff structured by evidence-based practice (EBP) that includes

detailed purpose, clear responsibilities, feedback insight, and frequent goal appraisals. Practicum

outcomes will reflect a nurse educator’s responsibility for designing a curriculum based on

current EBP literature and prepares preceptors to operate successfully in their new role. Sub-

objectives for this NLN competency will focus on assuring institutional missions are followed

and appropriate objectives, learning activities, and evaluation strategies are used. Utilizing the

insight of peers during the curriculum development and revisions will also be sub-objectives

(Billings & Halstead, 2012).

Functions as Change Agent and Leader

“Functions as change agent and leader” (NLN, 2012, p. 19) will be completed through

the proposed practicum components of 1) Creation and completion of a questionnaire for any

nurse hired in the last 12 months to determine major weaknesses in the current orientation

process and 4) Deliverance of a preceptor course to designated nurse preceptors at MCM.

Practicum outcomes will reflect a nurse educator’s responsibility to function as a change agent

and leader in nursing education and in practice. Sub-objectives for this NLN competency will

focus on assessing the institution's current process to understand areas needing improvement and

developing leadership skills that can be used to effectively contribute to nursing education.

Pursue Continuous Quality Improvement in the Nurse Educator Role

“Pursue continuous quality improvement in the nurse educator role” (NLN, 2012, p. 20)

will be completed through the proposed practicum components of 2) Attendance of McLaren

corporate preceptor course which is not currently offered for MCM nursing staff and 5) Self-

reflections of preceptors’ abilities to precept both before and after completion of course.

Practicum outcomes will reflect a nurse educator’s responsibility for continuing education and


staying knowledgeable in their role. Sub-objective for this NLN competency will focus on

showing enthusiasm for professional development opportunities and effectively utilizing

feedback.

Root Cause Analysis

Fundamental reasoning for a specific problem can be determined in a methodical way

through an RCA (Sherwood & Barnsteiner, 2017). An RCA can help identify the impact a

process problem has on patients and how system-wide the problem may be (Gorbunoff &

Kummeth, 2015). Furthermore, an RCA begins the process of understanding what innovate

improvements can be made to resolve the issue (Gorbunoff & Kummeth, 2015). Typically an

RCA is created through a multidisciplinary approach with all key stakeholders' inputs. When

completing an RCA, a fishbone diagram is constructed to be used as a visual to break down the

“whys” of a problem (Sherwood & Barnsteiner, 2017). Six main categories are often found in a

fishbone diagram including people, equipment, processes, environment, materials, and

management (Sherwood & Barnsteiner, 2017).

An RCA was completed specifically for job dissatisfaction related to poor preceptor

experience and is depicted in a fishbone diagram (See Appendix B). Key stakeholders for this

RCA includes preceptors, preceptees, administration, and patients. The RCA developed for the

practicum included four causes under the categories of environment, material or resources,

process, and people. Many contributing factors were identified including chaotic works hours,

high patient acuity demands, patient safety feeling compromised, minimal or no compensation,

inadequate time to educate, role strain, absences of education fundamentals, lack of confidence,

no goals, unclear expectations, limited communication techniques, contrasting personalities, lack

of conflict management, and poor teamwork.


Failure Modes and Effects Analysis

An FMEA is designed to recognize and resolve possible failures within a system before

they occur (Sherwood & Barnsteiner, 2017). An FMEA identifies not only cause and effect but

also determines how toxic a problem really could become (Gorbunoff & Kummeth, 2015). In an

FMEA, the risk of failure is evaluated by analyzing three factors of probability, detectability, and

severity for each possible mode of failure (Gorbunoff & Kummeth, 2015). To quantify this

calculation and establish a risk priority number (RPN) each factor is given a number on an

established scale and multiplied with each other (Gorbunoff & Kummeth, 2015). The higher the

number the greatest the risk and the more urgent the need for resolution. An FMEA restructures

a process, and if the issue is not 100% preventable, at least it should greatly decrease the risk

(Sherwood & Barnsteiner, 2017).

An FMEA was created to evaluate the current preceptor practice at MCM (See Appendix

C). Five main steps were identified as assign preceptor, determine the schedule, create patient

assignments, establish goals, and complete evaluations. Each step was then broken down into

two failure modes followed by their causes and effects. Although preceptor training cannot

specifically be linked to severe or critical consequences, the frequency of seemingly minor

concerns was found to be extremely high. For the FMEA created, an RPN level of 10 or higher

was decided to require an action plan. See Appendix D for the RPN tool used for the FMEA.

Change Theory and Leadership Theory

Every quality initiative needs a strong theoretical base, both for the purpose of change

and also for the ability to effectively lead change. The change theory utilized in the practicum

will be Roger’s change theory focusing on the diffusion of innovation and the leadership theory


will be transformational leadership. Original theory work was researched to understand the basic

principles of each theory.

Rogers’ Change Theory

Everette Rogers developed a five-stage theory of change known as the Diffusion of

Innovation Model which includes; knowledge, persuasion, decision, implementation, and

confirmation (Roger, 1983). This theory can be best applied to long-term change projects

because diffusion is a process that happens over time (Mohammadi, Poursaberi, & Salahshoor,

2018). Knowledge is the awareness there is a potential for an innovative modification to an

existing process and then researching what the modification would entail (Roger, 1983).

Persuasion is the individual’s assessment of the innovation and its supposed features (Roger,

1983). Persuasion is affected by five different attributes which include; relative advantage,

compatibility, complexity, trialability, and observability (Roger, 1983). The decision stage is as

simple as either accepting or rejecting the change (Roger, 1983). The final two stages of the

model will be what takes place during the practicum experience. Implementation will occur

because it has already been determined that change is the best decision (Roger, 1983). The final

phase of confirmation will be looking for support from peers in the process change (Roger,

1983).

Transformational Leadership Theory

Transformational leadership, or transforming leadership, was originally theorized by

James MacGregor Burns in 1978. Burns (1978) believed in order for a leader to excel they must

be considerate of their followers’ primary needs. This deep feeling of mutual respect will intern

encourage both parties to achieve their highest potential (Burns, 1978). In the classroom,

leadership that exemplifies the true characteristics of transformational leadership is optimal.


Burns (1978) believed it was important to “treat students neither coercively or instrumentally but

as joint seekers of the truth and actualization” (p. 449). For a developing nurse educator, these

words are on point. One of the most important aspects of teaching is establishing a relationship

with students which is mutually respectful and motivating with the same progressive end goals in

mind. The basis of Burn’s theory is inspiring, believing a transforming leader is only truly

successful when each follower becomes a leader in and of themselves. Additionally, a truly

transformational leader has a shared vision with its followers (Marshall, 2011). The

transformational leadership style will be utilized during the practicum and will act as a

fundamental approach to the future nurse educator role and to inspire preceptors in their roles as

clinical educators.

Plan for Evaluating Project Success

Research supports that a registered nurse encounters roughly one work system failure an

hour resulting in decreased productivity and job frustration (Dixon-Woods & Martin, 2016). A

systemized approach to nurse precepting should help decrease some taxing variabilities found

hospital-wide. Evaluating effectiveness is critical to preceptor training success. Important

factors to evaluating which need to be determined are; what is trying to be accomplished, what

changes need to be made, and will the changes result in improvement (Billings & Halstead,

2012; Institute for Healthcare Improvement [IHI], 2019). In a clinical environment, a tool can be

developed with an appropriate rating scale to help make the difficult task of articulating

expectations less subjective (Gurková et al., 2018; Melnyk & Fineout-Overholt, 2018).

Reflecting on the experience before, during, and after implementation is a form of continuous

quality improvement that is essential for the best outcomes (Billings & Halstead, 2012).


A tool was created to complete both a pre and post evaluation for all preceptors who

attend the course (See Appendix E). The purpose of the tool is to determine to what level of

importance the preceptor believes each aspect of their role is both before the course and upon

completion. The role expectations included are professional behavior, communication skills,

clinical reasoning, a spirit of inquiry, teaching strategies, evaluation approaches, and scheduling.

Each role expectation is followed by defining characteristics as examples. The success of the

course should be clearly noted in the difference of importance levels from pre to post

evaluations. Change must be evaluated and tested because not every change equals improvement

so it must be tested to evaluate improvement, cost, social impact, and consequences (IHI, 2019).

Use of Informatics Technology

The main purpose of nursing informatics is to improve communication and clinical

decision making in healthcare (McGonigle & Mastrian, 2014). Nursing informatics, directly and

indirectly, positively influences by promoting safe, high quality, and patient-centered care

(Darvish, Bahramnezhad, Keyhanian, & Navidhamidi, 2014). To facilitate learning effectively,

a range of nursing informatics strategies will be used in a variety of settings during the

practicum. First, an electronic emailed questionnaire will be created to help determine major

weaknesses in the current orientation. Second, a preceptor course will then be developed

through reliable online resources. A nurse educator should be fluent in online literature searches

in professional online databases for evidence-based practice (McGonigle & Mastrian, 2014).

Third, preceptor training will be administered in a classroom setting utilizing visual informatics

technologies to keep students engaged and to review standardized care plans which are common

tools for best patient outcomes. Lastly, informatics will be utilized when networking with peers

on the success of the training such as through emails and an electronic portfolio. Utilizing any


opportunity, understanding a nurse educator should be a continuous learner, and displaying a

positive attitude towards nursing informatics will benefit the practicum as a whole.

Predicted Results

Best practice research is a QI approach identifying the best way to do something by

studying exemplars in the process one is wishing to improve (AHRQ, 2011; Polit & Beck, 2017).

Upon development and implementation of a preceptor course, the predicted result would be

current and future preceptors gain a better understanding of their role. This clarity in preceptor

expectations should result in improved preceptors and preceptees relationships. More

specifically, improvements to the individuals as well as the entire institution should be seen.

Individuals should have increased satisfaction with their job. Preceptors should become more

knowledgeable in their role and how to improve the experience for the preceptee. This

improvement on an individual level should transpire to positively affect the health care

institution by retaining employees which improve productivity as a whole. Lastly, the quality

improvement plan through preceptor training is a patient safety strategy so ideally, the course

could progress to improve patient care.

Planning Grid

The cycle of plan-do-study-act (PSDA) is a concept used to implement a project (IHI,

2019). So far in this proposal, only the plan portion has been dissected. During the actual

practicum will be when do, study, and act are each completed. The “do” phase of the project

will be carried out by implementing the preceptor training course. While doing, it is important to

observe and document issues noted (IHI, 2019). The “study” aspect will be completed through

analyzing if project predictions were correct and when reflecting on what has been learned (IHI,

2019). Lastly, the “act” stage will be completed when revisions to the preceptor course are made


from what was learned through testing (IHI, 2019). A detailed planning grid has been completed

with two main clear goals and broken down further into sub-goals with suggested activities to

complete sub-goals. A timeline broken down into weeks has also been proposed for each sub-

goal. See Appendix F for a detailed planning grid.

Conclusion

True QI initiatives are guided by clinical expertise and professional values and result in

practical and improved healthcare outcomes. Work collectively to create standards of operation

to improve preceptor education is imperative and assures preceptors and preceptees are set up for

success. For the clinical practicum in Nursing 791, a systemic QI approach to improving all

preceptors’ knowledgebase will be completed. Creating a nurse preceptor training course should

result in improved outcomes to preceptees, preceptors, the institution, and most importantly the

patients who are cared for.


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Appendix A


Appendix B

Root Cause Analysis Diagram

Job dissatisfaction related to poor

preceptor experience

Process

Environment Material (Resources)

Patient safety feels compromised

High patient acuity demands

Contrasting personalities

Chaotic work hoursMinimal or no compensation

Inadequate time to educate

Role strain

Lack of conflict management

Poor teamwork

Absence of education fundamentals

No goals

Limited communication techniques

Lack of confidence

Unclear expectations

People


Appendix C

FMEA for current nursing preceptor process at MCM

Step Failure mode Cause Effect Probability Detection Severity RPN Action plan

Assign preceptor

Encouraged to precept without having a desire

Nominated by management or

peers

Decreased motivation to

effectively precept3 3 1 9

No action plan needed but agreement, desire, and enthusiasm to precept is strongly encouraged beyond

management and peer nomination

Personality mismatch

The difference in personalities not

identified

Poor teamwork and collaboration 3 3 1 9

No action plan needed but consideration of personality types when choosing preceptor and educating on communication techniques in preceptor course

Determine schedule

Inconsistent Census variesMissed days or

extended orientation period

4 3 1 12 Discuss new hospital policy of no on-call or hospital release days when presenting in preceptor course

Switching daysPersonal

schedules do not align

Preceptor varies day-to-day 4 3 1 12 Discuss the importance of coordination between

preceptor and preceptee schedules in preceptor course

Create patient

assignments

Limited time to educate

High patient volume or acuity High stress 3 4 1 16

Discuss patient loads to slowly increase in preceptor course and encourage new hospital staffing guidelines

with management and educate on prioritizing skills

High patient volume or acuity Short staffing Potential patient

safety concerns 3 3 5 45Do not allow preceptee to take on duties of an additional nurse while on orientation through

cushioned staffing and educate on prioritizing skills

Establish goals

UnclearPoor quality due

to lack of emphasis

No specific objectives to help

motivate4 3 1 12 Educate on purpose of establishing goals and create a

form with suggested objectives during preceptor course

Not met

The preceptor is missing education

fundamentalsGoals not created 3 4 1 12

Educate preceptors on education fundamentals on clear expectations of their role and teaching strategies to

improve goal establishment

Not a main focus or reviewed often

enough

Unsure of daily or weekly

expectations4 3 1 12 Educate on the timeframe needed to review established

goals during preceptor course

Complete evaluations

No timeline Not a priorityNo formal tracking or identification of ways to improve

3 3 1 12 Educate on newly created evaluation form and establish guidelines of every 2 weeks during preceptor course

No follow-up after completion

of orientation

Never have had established post-

follow-up

No way to identify needed

improvements 5 4 1 20

Create questionnaire assessing preceptor experiences in the last year and 6 months after completion for future

preceptors


Appendix D

Probability Rating ScaleRating Description Definition5 Very High Failure extremely likely to occur4 High Failure likely to occur3 Moderate Average unlikelihood of occurring 2 Low Failure unlikely to occur1 Remote Remote likelihood of occurring

Detection Rating Scale Rating Description Definition5 Very remote Failure cannot be detected without thorough inspection

and this is not feasible or cannot be done easily4 Remote Error can be detected with manual inspection but no process is in place

so that detection left to chance3 Moderate There is a process for double checking but it is not automated2 High Inspection of the process is automated sometimes1 Very high Inspection of the process is automated 100% of the time

Severity Rating Scale Rating Description Definition5 Severe Terminal injury or death4 Major Permeant harm to patient 3 Moderate Temporary harm to patient; initial or prolonged hospitalization2 Moderate Temporary harm to patient; monitoring or minor intervention required1 No harm No harm to patient

Probability X Detection X Severity = Risk Priority Number (RPN)

RPN greater than or equal to 10 = Action plan


Appendix E

Pre and Post Evaluation of Preceptor Course

Please circle 1, 2, 3, 4 or 5 to signify what level of importance you interpret each role expectation to be. Defining characteristics are listed as examples.

1=Very Important 2=Important 3=Neutral 4=Low Importance 5=Not Important

Professional behavior: 1 2 3 4 5The preceptor role models exemplary professional behavior.

• Demonstrates culturally sensitives, ethical, and legal actions. • Advocates for patients, visitors, and peers • Displays patience, friendliness, and is respected by colleagues

Communication skills: 1 2 3 4 5The preceptor role models professional communication skills that facilitate learning.

• Communicates information clearly and in a timely manner with all interdisciplinary teams • Encourages questions • Exhibits best effort in conflict resolution

Clinical reasoning: 1 2 3 4 5The preceptor role models strong clinical reasoning.

• Follows institutional policy & procedures for all patient care • Demonstrates evidence-based practice inquiry into professional practice • Displays effective problem-solving skills

Spirit of inquiry: 1 2 3 4 5The preceptor role models a clear desire to educate.

• Demonstrates support of professional growth and continuing education • Accepts changes with a positive behavior • Knowledgeable of organizational and departmental quality improvements

Teaching strategies: 1 2 3 4 5The preceptor role models the learner-centered teaching strategy.

• Enthusiastic about working with and learning from peers • Values the nurse-educator relationship • Knowledgeable on fundamental teaching principles.

Evaluation approaches: 1 2 3 4 5The preceptor role models constructive evaluation skills.

• Encourages goals and revisits them often • Provide constructive feedback in a private and open-minded manner • Establishes frequency and timeline for evaluations

Scheduling: 1 2 3 4 5The preceptor role models appropriate schedule and time availability.

• Communicates schedule with preceptee • Makes best effort to maintain designated schedule • Allots appropriate time for educating and learning


Appendix F

QUALITY IMPROVEMENT PROJECT FOR PRECEPTOR TRAINING PLANNING GRID

Goals Sub-goals Activities to meet sub-goals Timeline

1: Development and implementation of a preceptor course specific for MCM nursing staff structured by

evidence-based practice.

Meets NLN (2012) Scope of Practice for Academic Nurse Educators:

I: Facilitate Learning

IV: Participate in Curriculum Design and Evaluation of Program Outcomes

Meets QSEN (2012) Competency-KSA:

Teamwork and Collaboration – Skill: Lead or participate in the designing and implementation of systems that

support effective team work

Evidence-Based Practice – Attitude: Value all components of evidence-

based practice

1a: Attendance of McLaren corporate

preceptor course which is not currently offered for

MCM nursing staff.

1b: Create a structured process for preceptor

training.

1c: Establish the detailed purpose of training and

clear responsibilities.

1d: Educate MCM staff on newly established preceptor course.

1e: Deliverance of a preceptor course to

designated nurse preceptors at MCM.

1a: Contact McLaren Corporate to see class availability and options.

1b: Discuss at corporate level training what current process

their process is.

1c: Create outcomes and objectives which will be told at the

beginning of course.

1d: Round on all units and send emails to educate staff.

1e: Establish dates and times for first preceptor courses.

1a: Week 1

1b: Weeks 1-4

1c: Weeks 1-4

1d: Week 5-7

1e: Week 8-10


Goals Sub-goals Activities to meet sub-goals Timeline

2: Assess weakness in the process both before development and after

implementation of a preceptor course to promote continuous quality

improvement.

Meets NLN (2012) Scope of Practice for Academic Nurse Educators:

V: Function as Change Agent and Leader

VI: Pursue Continuous Quality Improvement in the Nurse Educator

Role

Meets QSEN (2012) Competency/KSA:

Quality Improvement – Attitude: Appreciate that continuous QI is an essential part of the daily work of

health professionals

Safety – Knowledge: Described processes used to analyze

causes of error and allocation of responsibility and accountability

2a: Create a questionnaire to determine major

weaknesses in the current orientation process

2b: Distribute questionnaire for any

nurse hired in the last 12 months.

2c: Obtain post intervention data through

evaluation tools.

2d: Self-reflection of preceptors’ abilities to

precept both before and after completion of

course.

2e: Share the impact of training will key

stakeholders.

2a: Discuss with current stakeholders possible issues with

the current process.

2b: Contact newly hired nurses and reach out to them in regards to completing the questionnaire

2c: Collect and analyze evaluation tools

2d: Utilize feedback and complete frequent goal appraisals.

2e: Convey findings at faculty meetings, staff meetings, and

send out email updates.

2a: Prior to or Week 1

2b: Weeks 1-4

2c: Weeks 10-12

2d: Weeks 12-14

2e: Weeks 14-16

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