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Running head: NURSE PRACTITIONER PRECEPTOR TRAINING 1

Practice Inquire Project Final Manuscript

Development of a Nurse Practitioner Preceptor Training Program

to Increase Readiness to Become a Preceptor

Miki Miura

University of Hawaii at Hilo School of Nursing

May 20, 2019

Committee Chair:

Katharyn Daub, EdD, CTN-A MNEd, RN

Committee Member:

Patricia Hensley, DNP, APRN, FNP-BC

Michelle Chino-Kelly

NURSE PRACTITIONER PRECEPTOR TRAINING 2

Abstract

An increasing demand for nurse practitioners (NPs) to cope with a shortage of physicians

has highlighted the urgency for expansion of NP programs. However, an insufficient number of

preceptors limits the ability of NP programs to accept more students. Preceptor training not only

increases NPs’ competency in teaching, but it also enhances their self-efficacy. Based on

Bandura’s self-efficacy theory, improvement of NPs’ self-efficacy is likely to lead to positive

changes in behavior, thus, it can enhance their willingness to participate in preceptorship and

ultimately increase the NP’s readiness for a preceptor role. Preceptor training is highly desired

by NPs, yet, there are a limited number of preceptor training for NPs available.

The aims of this a practice inquiry project (PIP) were to develop a NP preceptor training

program based on a literature review and to evaluate the program after implementing a pilot

program. Literature shows that the One Minute Preceptor (OMP) model has been used among

other healthcare disciplines and can promote effective and efficient communication between

preceptors and students. An NP preceptor training program that teaches NPs about the OMP was

created based on the literature review. For the second part of this project, a pilot test of the

program was conducted and evaluated. A total of nine NPs participated in this pilot study. Four

surveys were administered at three different points (pretest, posttest and three-month follow-up)

to examine if the participants’ self-efficacy as a preceptor and willingness to become a preceptor

improves after the piloted program. The results demonstrated that the piloted preceptor training

improved multiple aspects of their self-efficacy and brought positive effects on preceptors’

decision to participate in preceptorship. Future studies should employ more participants to

increase the power of the results.


Table of Contents

Abstract…………………………………………………………………………………………...2

Chapter 1: Statement of the Problem ………………………………………………………….7

Introduction and Background……………………………………………………………………..7

Significance………………………………………………………………………………………10

Problem Statement……………………………………………………………………………….11

System and Population Impact……………………………………………………………….…..12

Goals of the Project……………………………………………………………………………....13

Aims and Objectives……………………………………………………………………….…….13

Specific Aim 1…………………………………………………………………….……..13

Specific Aim 2…………………………………………………………………………..13

Chapter 2: Project Description……………………………………………………………….14

Review of Literature…………………………………………………………………………….14

Demand for NP Preceptors……………………………………………………………...14

Physician Shortage………………………………………………………………14

Expanding Expectations for NPs………………………………………………..15

Increased Demand for NP Programs…………………………………………….15

Role of Preceptors…………………………………………………………….....16

Preceptor Shortage……………………………………………………………....17

Barriers and Incentives to NP Preceptor Role…………………………………………..19

Barriers for NPs’ Participation in Preceptorship……………………………..….19

Incentives for Participation in Preceptorship…………………………………….20

Preceptor Training and Resources……………………………………………………….22


One Minute Preceptor Model…………………………………………………….25

Final Summary of Literature Review……………………………………………………………27

Conceptual and Theoretical Foundations……………………………………………………..…28

Concept Maps and Definitions……………………………………………………….….28

Readiness……………………………………………………………….………..29

Preceptor Qualities…………………………………………………………….…29

Self-Efficacy……………………………………………………………………..30

Willingness………………………………………………………………………30

Theoretical Framework: Bandura’s Self-Efficacy Theory…………………...………….30

Chapter 3: Project Design and Evaluation Plan…………………………………….………..33

Development of a NP Preceptor Training Program……………………………………………...33

Contents of the NP Preceptor Training Program………………………………………………..34

Project Setting……………………………………………………………………………………35

Target Population……………………………………………………………………………..…36

Data Collection and Instrument………………………………………………………….………36

Demographic Questionnaire…………………………………………………………….37

NP Preceptor Self-Efficacy Questionnaire……………………………………………....37

Willingness Questionnaire………………………………………………………………38

Course Evaluation Survey………………………………………………………………..39

Project Implementation…………………………………………………………………………..39

Data Analysis Methods…………………………………………………………………………..41

Project Budget and Justification…………………………………………………………………42

Human Subjects Protection………………………………………………………………………45


Chapter 4: Results………………………………………………………………………………46

Results…………………………………………………………………………..………………..46

Role and Timing of Each Instruments……………………………………….….……….46

Participants and Their Participation…………………………………………….….…….46

Results of Demographic Assessment…………………………..………………...………46

Results of Willingness Assessment……………………………………….……………..47

Willingness Pretest………………………………………………………………47

Willingness Posttest……………………………….……………………………..48

Willingness Follow-up Test……………………….……………………………..49

Results of Self-Efficacy Assessment……………………...……………………………..50

Results of Course Evaluation…………………………………………………………….64

Chapter 5: Recommendation and Conclusions……………………………………………….66

Discussion……………………………………………………………………………………….66

Strengths and Limitations of the Project…………………………………………………………73

Recommendation and Implication for Practice…………………………………………………..74

Conclusion……………………...………………………………………………………………..76

References………………………………………………………………………………………..77

Appendix A………………………………………………………………………………………86

Appendix B…………………………………………………..……………………….………….87

Appendix C………………………………………………………………………………………88

Appendix D………………………………………………………………………………………90

Appendix E………………………………………………………………………………………92

Appendix F………………………………………………………………………………………93


Appendix G……………………………………………………………………….……………..94

Appendix H…………………………………………………………………….………………..95

Appendix I………………………………………………………………….……………………96

Appendix J………………………………………………………………………………………97

Appendix K………………………………………………………………………………………99

Appendix L………………………………………………………………………………..……101

Appendix M…………………………………………………………………………………….112


Development of a Nurse Practitioner Preceptor Training Program to Increase Readiness to

Become a Preceptor

Chapter 1: Statement of the Problem

Introduction and Background

Expectations for the role of nurse practitioners (NPs) have increased in recent years due

to the severe shortage of physicians that the U.S. healthcare system is facing. It is estimated that

in 2020, there will be a deficit of approximately 91,500 physicians, including both primary care

physicians and specialists (Kirch, Henderson, & Dill, 2012). Increasing the number of NPs is

considered an essential solution for this issue (U.S. Department of Health and Human Services

Health Resources and Services Administration [HRSA], 2013). Despite the greater demand for

NPs, the shortage of NP preceptors has been one of the biggest challenges to NP preparation

(Fitzgerald, Kantrowitz-Gordon, Katz, & Hirsch, 2012). This problem has negatively impacted

prospective NP students across the country because of the limited capacity of nursing programs

to accept students (Forsberg, Swartwout, Danko, Delaney, & Murphy, 2015). In nursing, a

preceptor is an expert nurse who establishes a one-on-one relationship with a nursing student

during a specific amount of time with the aim that the student improves their clinical knowledge

and skills (Parsons, 2007). Preceptors play a critical role in facilitating excellent clinical learning

of healthcare providers and they are vital to NP education (Wilson, Bodin, Hoffman, & Vincent,

2009). This shortage of NP preceptors will hinder the growth of NPs who are expected to serve

as major primary care providers in the U.S. healthcare system.

The severe lack of nursing preceptors has been recognized for more than a decade

(Amella, Brown, Resnick, & McArthur, 2001; Olson & Schram, 2006). NPs are particularly

needed in rural areas; however, a severe deficiency of preceptors in those areas exits (Fitzgerald


et al., 2012). For example, the recruiting and retaining of NP preceptors has been a serious

concern at the University of Hawai‘i at Hilo (UHH), which is located in a rural community on

the island of Hawai ‘i. Due to challenging clinical placement, Doctor of Nursing Practice (DNP)

students at UHH often are forced to fly to other islands, mainly O‘ahu, to achieve their clinical

requirements, which can put extra financial burden and time constraints for those NP students.

Moreover, even if DNP students at UHH decide to fly to other islands for clinical rotations,

many students still experience a hardship of finding their preceptors because they need to

compete with other health care students, such as NP students from nursing programs on O‘ahu or

online nursing programs, who are also looking for clinical placements. In order to meet

increasing demand for NPs, particularly in rural communities like Hilo, it is critical to find

solutions to alleviate NP preceptor shortages.

An important question is why do NPs not want to be preceptors to teach future colleagues

of their own kind? There is a large pool of NPs who can be great candidates for NP preceptors in

this country. Various studies identified the barriers and incentives for NPs’ decisions to

participate in preceptorship. A study by Forsberg et al. (2015) revealed that various obstacles for

NPs’ participation in preceptorship, including: concerns about a decline in productivity;

reluctance to participate in preceptorship on a volunteer work basis without monetary

compensation; exhaustion from mentoring students; lack of support from employers; and an

overwhelming number of requests from students for preceptorship. On the other hand,

opportunities to teach and learn, credits that can be used for renewal of the NP license, access to

medical references and resources, adjunct faculty status, and monetary compensation are

recognized as incentive factors for participation in preceptorship (Webb, Palan Lopez, &

Guarino, 2015). In addition, preceptorship training is also an incentive for NPs to participate in


preceptors (Roberts, Wheeler, Tyler, & Padden, 2017). Literature shows that preceptor training is

desired by NPs. A national survey in 2016 showed the majority of NPs were interested in

additional resources to enhance their preceptor role (Roberts et al., 2017). About 37% of those

polled specifically mentioned formal preceptor mentoring training program as a desired

preceptor resource (Roberts et al., 2017). Research in the field supports the effectiveness of

training programs for preceptors (Bazelle & Dains, 2017). Several studies provide evidence that

preceptor development programs enhance preceptors’ competency in mentoring students

(Bazzell & Dains, 2017). One survey also revealed that 95% of preceptors are willing to take a

preceptor training course if it is available (Amella et al., 2001). There are many preceptor

education programs for registered nurses; however, preceptor training programs for NPs are

scant (Bazzell & Dains, 2017). This deficiency of available preceptor NP training further

hinders NPs in electing to become preceptors (Fitzgerald et al., 2012).

The One Minute Preceptor (OMP) model is a widely used tool among various healthcare

professionals--such as physicians, registered nurses, and pharmacists--to enhance their clinical

teaching skills (Furney et al., 2001; Kertis, 2007; Weitzel, Walters, & Taylor, 2012). The OMP

model was initially developed for family physician preceptors (Neber, Gordon, Meyer, &

Stevens, 1992). It targets relatively new educators who can be unsure about how to interact with

their students successfully (Neber et al., 1992). The OMP model consists of five microskills that

can be mastered in one to two hours, be applied to preceptors’ teaching practice right away, and

the skills can be preserved for years (Neber et al., 1992). The model aims to help educators to

understand students’ knowledge level, critical thinking process, facilitate effective teaching and

immediate and precise feedback (Neber et al., 1992). Literature demonstrated that students


evaluated that use of the OMP model led to effective teaching over use of the traditional teaching

style (Teherani, O’Sullivan, Aagaard, Morrison, & Irby, 2007).

Significance

Preceptors play a critical role in the education of NP students. Traditionally, NP training

relies on preceptors to provide excellent clinical training for NP students (Davis & Fathman,

2018). Preceptors provide NP students with practical advice through mentorship in actual clinical

settings (Webb et al., 2015). Expectations for the role of preceptor have increased as many NP

programs provide online courses and the direct interaction between NP faculties and their

students has declined (Roberts et al., 2017). Various factors affect the shortage of NP preceptors.

The growing numbers of students enrolled in NP programs is one of the major factors driving the

shortage of preceptors (Webb et al., 2015). The number of NP programs has increased in order to

meet the demand for NPs in the US (Webb et al., 2015). The number of students enrolled in NP

programs has doubled between 2002 and 2012 (Webb et al., 2015). Consequently, the need for

preceptors has intensified. In 2015, 450 nursing programs provided NP courses such as DNP

programs (American Association of Colleges of Nursing [AACN], 2015). Between 2010 and

2015, there was an 81% increase in enrollment in entry-level NP programs (AACN, 2015).

Moreover, rivalry for clinical rotation with other healthcare professions, such as medical

students, has worsened the shortage (Webb et al., 2015). Pressure on preceptors to be productive

for their provider role can be a barrier for NPs to be a preceptor (Webb et al., 2015). Other health

care providers, including physicians and physician assistants, have played the role of preceptor

for NP students in the past. Although there are some advantages of having mentors from outside

of the NP professions, it has been recommended that the majority of clinical preparation should

occur under the supervision of NPs (Olson & Schram, 2006). Students will understand the


unique role of NP better by learning under the mentorship of the same profession (Olson &

Schram, 2006). According to a report from the AACN (2015), more than 60% of NP programs

expressed serious anxiety about their capability to find clinical sites and 59% of NP programs

also reported difficulty finding competent NP preceptors. Given these challenges, there is a

critical need for NP preceptor training programs that help to increase the readiness of NPs for

preceptorship as well as enhance their mentoring skills to increase their competency.

Hawai‘i healthcare professionals face serious concerns with regard to the preceptor

shortage, and the attention drawn by this issue has been recently heightened even more. A bill for

an act regarding healthcare preceptor tax credits was introduced to the Hawai‘i state legislature

on January 19th, 2018, and it was approved as Act 43 on June 13, 2018 (Hawaii State

Legislature, n.d.). The Act 43 aims to mend shortage of primary care providers by promoting the

participation of advanced practice registered nurses (APRNs), such as NPs, physicians and

pharmacists in volunteer-based preceptorship. It will allow these preceptors to get $1,000 worth

of income tax credit for each volunteer based clinical preceptorship beginning after December

31, 2018 (“SB no. 2298 S.D.2 H.D.3 C.D.1,” n.d.). Like the preceptor tax credit law, strategies

to promote NPs’ participation in preceptorship without adding financial burden to NP students

are critically needed to increase the number of preceptors nationally and locally. Preceptor

training can be another excellent strategy if it is proven that preceptor training can indeed

promote NPs’ participation in preceptorship by increasing their readiness for a preceptor role.

Thus, a study to examine such association is needed.

Problem Statement

An increasing demand for NPs to fill the primary care provider role has highlighted the

urgency for expansion of NP programs. Increasing the number of NP preceptors is critical to


meet the demand from increased enrollment in NP programs. Preceptor training can not only

empower potential preceptors to participate in preceptorship, but also increase the competency of

preceptors’ mentoring skills. Preceptor training is desired by NPs, yet there are a limited number

of resources for preceptor training specifically designed for NPs. In order to increase the number

of NPs participating in preceptorship, it is imperative that NP preceptor training programs be

developed to provide the knowledge and skills necessary for successful preceptorship and

empower potential preceptors to increase their self-efficacy, thus enhancing their readiness for a

preceptor role. This pilot project aimed to determine whether such a program would enhance

self-efficacy among NPs in mentoring skills and positively affect their decision to become a

preceptor by increasing their readiness.

System and Population Impact

Systems and populations that are impacted by this problem of NP preceptor shortages

include NP programs, NP students, qualified nurses who are considering advancing their career

and becoming an NP, healthcare facilities and communities. NP programs are impacted because

they may have to limit the number of enrollments even if they want to expand the program due to

insufficient supply of preceptors. NP students are impacted because some students may have to

travel far distances using their precious money and time because they cannot find preceptors who

can take them in their local communities. Nurses who are considering becoming an NP are also

impacted because entering an NP program may be more competitive due to insufficient number

of preceptors. Healthcare facilities and communities may be also impacted. They may

desperately need health care providers and may benefit from having NPs, but may not be able to

obtain NPs due to shortages of NP preceptors who can train future NPs.


Goals of the Project

The overall goal of this project is to increase self-efficacy among NPs in skills to mentor

NP students so that more NPs will be both prepared and encouraged to participate in

preceptorship. The goal of this pilot project was to test and evaluate an NP preceptor training

program focused on educating NPs about the OMP model so that it can be determined if such

preceptor training would increase NPs’ self-efficacy as a clinical educator and facilitate their

decision to become a preceptor.

Aims and Objectives

There were two main aims of this project. The first aim was to develop an NP preceptor

training program to teach NPs about the OMP model grounded in available evidence. Objectives

for achieving this aim included:

1. Analyze existing literature regarding the OMP model.

2. Develop an NP preceptor training program to teach NPs about how to use

the OMP model in their practice setting based on the analysis of existing literatures about

the OMP model.

The second aim of the project was to perform an evaluation of the proposed OMP model-

based NP preceptor training program. Objectives for achieving this aim included:

1. Conduct a pilot test of the NP preceptor training program.

2. Evaluate the piloted program in terms of feasibility and effectiveness,

particularly for increasing NPs' self-efficacy in teaching NP students and willingness to

become a preceptor.

3. Make suggestions for improving the NP preceptor training program based

on the results of the pilot test and evaluation results.


Chapter 2: Project Description

Review of Literature

Chapter Two describes a review of literature (ROL) investigating and synthesizing the

current state of the NP preceptor demand. This chapter then follows with an overview of the

barriers and incentives for NPs to participate in preceptorship. Additionally, the ROL discusses

current preceptor training resources and the evidence regarding the effectiveness of those

resources. Finally, this chapter concludes with a discussion on how this ROL led to the

development of the proposed NP preceptor training program.

Demand for NP preceptors.

Physician shortage. A report estimates that this country may be confronted by the

shortage of 45,400 primary care physicians and 46,100 medical specialists (Kirch et al., 2012).

The U.S. government’s attempt to increase access to health care by the implementation of the

Affordable Care Act (ACA) in 2010 is expected to improve healthcare outcomes in this country;

however, existing physician shortage is nevertheless a serious problem (Kirch et al., 2012). The

shortage of physicians varies depending on geographic locations. According to a national report

by the U.S. Department of Health and Human Services, Health Resources and Services

Administration, National Center for Health Workforce Analysis (HRSA NCHWA) (2013), there

were approximately 861,000 persons in this country who proclaimed their occupation as

physician between 2008 and 2010. The report also showed that central and southern states in the

U.S. tend to have more severe physician shortages, shown by a fewer number of physicians per

100,000 working-age population. Moreover, physician supply tends to focus on urban areas

(Hing & Hsiao, 2014), and concern for physician shortages in rural communities are more

serious. A national report revealed that the State of Hawai‘i has the highest rate of primary care


physicians per 100,000 population among all states in the U.S. (Hing & Hsiao, 2014); however, a

report from University of Hawai‘i system claims that in 2017 there was still a statewide shortage

of 769 full-time equivalents (Hawaii/Pacific Basin Area Health Education Center [HPBAHEC],

2017). Hawai‘i County, also known as Big Island, has the worst physician shortage among

Hawaiian Islands, lacking 38.7% of physician than their demand (HPBAHEC, 2017).

Expanding expectations for NPs. Expanding the roles of NPs and physician assistants

(PAs) is expected to confront the projected deficiency in providers in the current U.S. healthcare

system (Kirch et al., 2012). Healthcare services that nursing professionals deliver are highly

regarded and appreciated by both patients and the overall healthcare system. Further increases in

NP and PA preparation programs are believed to reduce the negative effect of the anticipated

worsening of the physician shortage (Kirch et al., 2012). The AACN (2015) agreed with this

view and highlighted that there has been a notable rise in recognition of NP contributions to

improve the U.S. healthcare system. Supply of NPs also varies depending of geographic

distribution. Approximately 110,000 persons in the U.S. proclaimed their occupation as NP

between 2011 and 2012, and Hawai‘i is one of states that has the lowest number of NPs per

100,000 working-age population in the U.S. (HRSA NCHWA, 2013). As mentioned earlier,

there is a physician shortage in the State of Hawai‘i; thus, the number of NPs is expected to

increase in the state to address the healthcare provider shortage.

Increased demand for NP programs. In order to meet the increasing demand for NP

roles, there have been some changes in nursing education. According to AACN (2015), there has

been a more than 80% increase of acceptance for introductory NP programs, and 130 new

graduate DNP programs created between 2010 and 2015. The increased number of NP

preparation programs subsequently escalated the demand for nursing faculty and clinical


preceptors. However, insufficient supply of nursing faculty in this country has been noted as a

major causation of the country’s shortage of nursing professionals (Yordy, K. D. 2006).

Although there are many prospective NP students who desire to join the workforce, the short

supply of nursing faculty and preceptors for the programs inhibit the highly desired increase in

producing more NPs.

Role of preceptors. A preceptor is a skilled professional who establishes a one-to-one

bond with a student, and mentors and supervises the student’s performance in a clinical setting to

improve the student’s clinical competency and skills (Parsons, 2007). Preceptors play an

essential role to guide NP students through the critical thinking process of applying knowledge

and skills that students acquired in classrooms to actual clinical settings (Clark, Kent & Riesner,

2018). Skillful and self-confident preceptors are essential to NP education (Hildebrandt, 2001).

A competent preceptor is someone who is a great leader, facilitator, role model, and educator

(Shinners & Franquiero, 2015). Preceptors ought to have enthusiasm to educate, competency in

their specialized clinical area, proficient communication skills, and capability of providing

effective feedback (Clark et al., 2018).

For the past 45 years, NP programs have placed one student with one preceptor at a

clinical site to have one-to-one relationships (AACN, 2017). AACN (2017) stated that this

traditional preceptor model is no longer sustainable in the current healthcare environment due to

insufficient supply of preceptors in contrast to increased demand for preceptors and clinical sites.

Therefore, adjustment of this current preceptor model is necessary for NP programs to ensure

students have adequate clinical education (AACN, 2017). Clark et al. (2018) suggested a new

preceptor model in which two students are paired up with one preceptor. Their NP program

demonstrated successful teaching outcomes with this suggested preceptor model (Clark et al.,


2018). With either model, it is evident that competent and motivated preceptors are vital for the

success of clinical education in NP programs.

Preceptor shortage. Insufficient numbers of clinical sites and preceptors have been

recognized as a major inhibitor of extending the size of nursing schools. According to National

League of Nursing (NLN) (n.d.), 40% and 18% of Master of Science in Nursing (MSN) and

doctorate nursing programs reported that the shortage of clinical sites was a primary barrier to

extend the programs in 2016, respectively. Insufficient clinical sites are particularly problematic

for MSN programs, including NP programs, and it was the most critical barrier to increase the

number of students in the program over any other factors, such as shortage of faculty and limited

classroom space (NLN, n.d.). NLN (n.d.) also stated that 40% and 59% of MSN and doctorate

programs, respectively, rejected qualified applicants to enroll in the programs in 2016, despite

the fact that this nation acutely needs nurses with higher academic degree to serve higher roles.

This shortage of preceptor is affecting schools of nursing in the state of Hawaii as well.

According to a report from Hawaii State Center for Nursing (2018), one third of schools of

nursing in the state experience hardship obtaining preceptors to supervise nursing students during

their clinical training.

There are various factors associated with securing clinical sites for NPs, and finding

willing and competent NP preceptors is one of the most critical factor for NP programs to ensure

the clinical sites of students. The Joint Report of the 2013 Multi-Discipline Clerkship/Clinical

Training Site Survey implemented by the collaboration of the AACN, the American Association

of Colleges of Osteopathic Medicine (AACOM), the Association of American Medical Colleges

(AAMC), and the Physician Assistant Education Association (PAEA) revealed that more than

70% of NP schools cited the number of clinical sites as a determinant of their ability to accept


new students (Erikson et al., 2014). The report also demonstrated that the majority of all

disciplines considered that creating new clinical sites was more challenging in 2013 than it was

in 2011(Erikson et al., 2014). Furthermore, the report showed security and legal prerequisite and

preparation of preceptors were major influential factors that affect the capability of creating new

clinical sites (Erikson et al., 2014).

In addition to increasing demand for NP preceptors, expected roles for those preceptors

are also changing in order to match the nation’s health care needs. The National Advisory

Council on Nurse Education and Practice (2010) issued recommendations regarding the

transformation of nursing education, and strongly emphasized the importance of gaining clinical

mentors to meet the demand for the future nursing workforce. Preceptors play an essential role in

training future nursing professionals, including NP students and novice NPs, while expectations

for the role are growing more than ever. In addition to the need for increasing the number of NP

preceptors, the expected roles and responsibilities of preceptors are expanding. The trend for the

preparation of healthcare professionals has shifted from the traditional content-based education

to competency-based education with the paradigm shift of healthcare to focus on patients’

outcomes, and preceptors perform a vital role to accomplish the expected transformation

(Schumacher & Risco, 2017). In addition to their traditional role in overseeing students’ clinical

performances on daily basis and promote the learning process, NP preceptors are now required to

take part in the evaluation process of students’ competency as well as contribute to developing

and refining the NP preparation programs by providing their insights regarding students’ clinical

experience. (Schumacher & Risco, 2017).

The demand for the number of NP preceptors is intensifying and expectations for the

roles and responsibilities of NP preceptors are growing to meet the demand for competent NPs.


However, there are not enough preceptors to train APRN students (Fitzgerald et al., 2012).

Fitzgerald et al. (2012) stated that shortage of APRN preceptors are especially critical in hospital

settings. They also noted despite the substantial demand for APRNs to provide care in rural

settings, finding preceptors in rural areas is even more difficult (Fitzgerald et al., 2012).

Furthermore, competition to obtain preceptors and clinical sites with other healthcare programs,

such as medical schools, worsens the present condition of shortage of NP preceptors (Fitzgerald

et al., 2012). The authors argued that the lack of validated preceptor training and resources

further hinders APRNs from being preceptors (Fitzgerald et al., 2012).

Barriers and Incentives to NP Preceptor Role. This section examines various factors

that affect practicing NPs’ decisions to participate in preceptorship. Moreover, this section

provides ideas for what is needed to promote NPs’ participation in preceptorship and how the

suggested project intervention would address NPs’ current concerns about precepting.

Barriers for NPs’ participation in preceptorship. Several studies have examined

possible barriers to becoming an NP preceptor. One study stated that time restrictions, limited

exam rooms, problems associated with students’ use of electronic medical records (EMRs), lack

of support from employers, and insufficient supporting staff are the most significant barriers for

NP participation as preceptors (Roberts et al., 2017). The authors also noted that lack of

readiness among NPs themselves can be an inhibiting factor for participation in preceptorship.

Another study agreed that time limitation is a main barrier for NPs in participating in

preceptorship, noting concerns about fulfilling expected productivity as a key barrier (Webb et

al., 2015). Other literature concurred that concerns for decline in productivity inhibits practicing

NPs to participate in preceptorship (Amella et al., 2001; Forsberg et al., 2015). One of the

literatures demonstrated the majority of NP preceptors need to work later to fulfill productivity


expectations, and the number of patient encounters decreases when they are precepting students

(Amella et al., 2001). Multiple studies supported the idea that EMR issues and lack of

understanding from employers are potential barriers for NPs to become preceptors (Forsberg et

al., 2015; Roberts et al., 2017). Additional time and personal expenses for training NP students

on EMR use, and the necessity of creating a new account for student access hinder NPs’

participation in preceptorship (Forsberg et al., 2015). The authors added that students’ scant

clinical background and lack of definite incentives are also considered as inhibiting factors

among NPs (Forsberg et al., 2015). Moreover, insufficient financial support from the government

causes a serious external problem to effective NP education (Fitzgerald et al., 2012).

Incentives for participation in preceptorship. Literature shows that primary incentives

for NPs to participate in preceptorship are monetary compensation, the ability to participate in

evaluation of students, opportunities to acquire new clinical knowledge, and access to continuous

education (Roberts et al., 2017; Webb et al., 2015). A survey by Webb et al. (2015) demonstrated

that 79% of participants responded that monetary compensation would be important incentives to

become a preceptor. The authors added that sense of commitment to the profession, established

partnership with nursing faculty, personal relationship with student, and credit toward

recertification are also key incentives. Additionally, the self-confidence level of NPs also affects

the decision of being a preceptor (Webb et al., 2015). NPs who are confident as a clinical expert

are more likely to participate in preceptorship (Webb et al., 2015). Thus, confidence among NPs

is an incentive to become a preceptor.

A new trend of paying preceptors has been seen among NP schools in recent years.

Although the current percentage of NP programs that pays clinical preceptors is still smaller than

other healthcare disciplines, it is evident that this trend will be worsened as other healthcare


disciplines also suffer from obtaining adequate number of motivated and competent preceptors

(Erikson et al., 2014). The competitions for securing the number of preceptors with other

disciplines likely intensifies the trend of NP programs paying for preceptors, as preceptors may

feel more willing to accept a preceptor role if there is monetary compensation. For instance,

doctor of osteopathic medicine (DO) programs had the highest percentage of giving monetary

compensation to preceptors among the group of medical doctor (MD) schools, DO schools, NP

schools and PA schools; 71% of DO schools reported to give monetary compensations to clinical

site and/or preceptors (Erikson et al., 2014). The DO schools’ strategy to attract clinical sites and

preceptors seems to be successful as the data from the survey revealed that obtaining clinical

sites for primary care rotations is not a significant concerns for DO programs; only 3 % of DO

programs reported hardship of securing clinical sites for family medicine rotations while 34 to

60% of MD, NP and PA programs experience the difficulty (Erikson et al., 2014). The method of

attracting preceptors by monetary compensation, however, will increase financial burden for NP

students. The survey reported that the average compensation for preceptorship to clinical sites

among the four healthcare disciplines was $125 per student per week (Erikson et al., 2014).

Forty-two percent of NP schools responded that the budget to pay preceptors is created by

raising tuition (Erikson et al., 2014).

The increased financial burden to NP students may also discourage qualified nurses from

advancing their career path to become an NP. This effect would further hinder the increase in the

number of NPs to serve as major primary care providers in the U.S. healthcare system. Thus,

there need to be other solutions to address the shortage of NP preceptors. The preceptor tax

credit bill in Hawai‘i, which was previously mentioned, can be a great way to facilitate NPs’

participation in preceptorship without increasing a financial burden on students. In addition,


preceptor training and resources are also feasible and cost-effective methods to promote NPs’

preceptorship participation. For instance, the proposed preceptor training program for this project

would cost $305 per session and can include 20 NP participants at one time. If this preceptor

training can improve NPs’ self-efficacy and motivate them to become a preceptor without having

to give them monetary compensation, NP programs and NP students would save a great amount

of money. Lifting students’ financial burden would encourage prospective NP students to pursue

the career path to become a NP, which would thus contribute to boosting the number of NPs in

the future.

Preceptor training and resources. As expectations and demand for NP preceptors

increases, it is important to provide sufficient support to NPs, easing their hesitation to accept

and continue to serve as a preceptor. A survey done by Donley et al. (2014) revealed that close to

half (47.3%) of graduate clinical nurse preceptor participants, which were mostly NPs, never

received any formal preceptor preparation, with only 11 % of the participants receiving a

preceptor workshop in the past. In addition, 66% of the survey participants considered that their

preparation for the preceptor role was adequate, while 33.9 % of them considered their

preparation to be fair or poor (Donley et al., 2014). Although this data shows that there are many

graduate clinical nurse preceptors who consider themselves well-prepared for a preceptor role

without formal preceptor training, it is arguable whether graduate nurses can be excellent

preceptors without receiving formal training to be a clinical educator. Carlson and Bengtsson

(2015) asserted that being a good educator is a separate issue from being a good clinician. They

insisted that nursing professional with abundant clinical experience may not necessarily be a

competent mentor without formal preceptor training (Carlson & Bengtsson, 2015). Although

some may argue that NPs can learn how to be a good preceptor by trial and error of years of


being a preceptor, it would be more ideal to have NPs obtain formal preceptor training as a part

of preparation for a preceptor role so that students do not have to be a guinea pig while

preceptors are building mentorship skills. Preceptor training is desirable to assure high quality

clinical education for NP students, but NP preceptors also desire to receive preceptor training. A

survey by Amella et al. (2001) revealed that 95% of preceptor survey respondents showed their

willingness to attend preceptor training programs. Another study demonstrated that a preceptor

training program for registered nurses (RNs) successfully increased the participants’ sense of

competency as a mentor, improving mentoring skills, and gaining more respect from colleague

health care professionals (Carlson & Bengtsson, 2015). While there are many preceptor

resources for RNs with proven better student outcomes, preceptor training and resources for NPs

are insufficient (Bazelle & Dains, 2017). Therefore, the need for establishing evidence-based

preceptor training for NP preceptors is critical.

There are various preceptor tools and guidelines that are proven to be effective for other

health care professionals. For instance, E-tips, OMP learning model, and SNAPPS 6-step

technique are validated preceptor models (Bazelle & Dains, 2017). E-tips is a well-accepted

preceptor education model among various healthcare professionals (Bazelle & Dains, 2017). It is

a Web-based preceptor training resource that incorporates various teaching strategies (Kassam et

al., 2012). Among preceptors who examined the effectiveness of E-tip, 60% of them stated that it

enhanced their confidence beyond expectation (Kassam et al., 2012). The OMP model was

originally developed by a medical school (Bazelle & Dains, 2017). The OMP model consists of

five steps of clinical education process that is relevant to various clinical situations (Bazelle &

Dains, 2017). The OMP has been utilized during the orientation for newly graduated RNs and its

effectiveness has been validated (Kertis, 2007). The OMP model is also proven to enhance


physician preceptors’ competency as a mentor (Furney et al., 2001). The SNAPPS mnemonic is

used to improve students’ performance in case presentations, plus aims to promote students’

analyzing and reasoning processes (Wolpaw, Wolpaw, & Papp, 2003). The mnemonic of

SNAPPS stands for summarize the history and physical assessment results, Narrow possible

diagnosis, Analyze differential diagnoses, Probe the mentor by raising questions about things

that are unclear to them, Plan treatment, Select problems associated with the case and follow up

study (Wolpaw et al., 2003). Use of SNAPPS improved medical students’ performance in

efficient case presentation (Wolpaw, Papp, & Bordage, 2009). Moreover, the use of SNAPPS

also improved medical students’ performance in coming with differential diagnoses and

explaining their reasoning (Wolpaw et al., 2009). While they may be used for NP preceptorship,

the relevance of these preceptor models to NP preceptors has not been proven. Therefore,

development of evidence-based preceptor training for NP preceptors is urgently needed (Bazelle

& Dains, 2017).

A few studies reported that there are some, though not many, preceptor trainings and

resources particularly addressed to NP preceptors. An online presentation on the American

Association of Nurse Practitioners (AANP) website provides various practical tips for NP

preceptors and it can be accessed without any fee (Barker & Pittman, n.d.). National

Organization for Nurse Practitioner Faculties (NONPF) (n.d.b) also provides various preceptor

resources, including a series of short videos to demonstrate ideal interaction between a NP

student and a preceptor. They also have a preceptor manual, which can be purchased through the

NONPF website. Schumacher and Risco (2017) provided a preceptor checklist as a guidance for

effective competency-based NP education. These NP preceptor training programs and resources

appear promising to empower practicing NPs to become a preceptor, as well as to promote


effective preceptorship. However, no research examined the efficacy of these NP preceptor

training methods.

One Minute Preceptor model. Out of the various preceptor tools and resources

mentioned above, the researcher opted to educate NPs on the One Minute Preceptor (OMP)

model during a preceptor training. The OMP model was originally created for family practice

physicians who are new to the role of preceptor in order to facilitate successful educational

communication with their residents in their busy practice (Neber et al., 1992). The model can be

taught in one to two hours and can be utilized right away (Neber et al., 1992). Additionally,

preceptors can retain the skills for years (Neber et al., 1992). The OMP model consists of five

“microskills”: 1) get a commitment, 2) probe for supporting evidence, 3) teaching general rules,

4) reinforce what was done right, 5) correct mistakes (Neber et al., 1992, p. 420). These steps

were incorporated in order to pay attention to preceptor-learner communication on the decision-

making approach exercised by the learner (Neber et al., 1992). The model is intended to maintain

the length of the encounter to a maximum of five minutes in order to suit the needs of busy

clinical practice environments (Neber et al., 1992). Because this model is easy to learn and is

applicable to busy NP preceptors’ clinical schedules while improving the quality of

preceptorship, this model was chosen to be taught during the proposed preceptor training.

Various studies have been conducted to examine the effects of the OMP model in clinical

education settings. A randomized controlled trial targeted second- and third- year internal

medicine residents and investigated how use of OMP model affected their mentoring behaviors

(Furney et al., 2001). Residents who were assigned to the intervention group received a one-hour

educational course about the OMP model which included presentation, group debate and role

playing. The results showed that about 90% of the residents in the intervention group responded


that the intervention was helpful or highly helpful. Students of participating residents evaluated

that the teaching behaviors of the residents in the intervention group were enhanced. The study

also showed that the residents who received training about the OMP model were able to increase

the motivation of their students to do additional reading better than ones in the control group

(Furney et al., 2001).

Another study analyzed how brief preceptor training about the OMP model affected the

nature of feedback to students among internal medicine physician preceptors in an outpatient

setting (Salerno, O’malley, & Pangaro, 2002). The results of the study demonstrated that

preceptors felt that their educational encounter with their students improved and that their ability

to empower their students to process reasoning of their thinking on their own were enhanced.

The participating preceptors also expressed that they were able to evaluate their students’

performance more effectively and plan better for post-encounter teaching. This study also

showed that use of the OMP model did not affect the time taken for communication between

preceptors and students or patient satisfaction with the experience (Salerno et al., 2002). Another

study examined the effectiveness of the OMP model from medical students’ perspectives

(Teherani et al., 2007). The researchers asked third- and fourth-year medical students to evaluate

and compare mentoring approach using the OMP model and traditional mentoring approach. The

results showed that students preferred mentoring approach based on the OMP model than the

traditional mentoring approach (Teherani et al., 2007). Although there are multiple studies that

showed effectiveness of the OMP model among physicians and other healthcare professionals,

there is no study that examined whether this model is beneficial for NP preceptors to this date.


Final Summary of Literature Review

Expectation for NPs to serve as primary health care providers has intensified due to

insufficient supply of physicians in the U.S. healthcare system. In order to meet the increasing

demand for NPs, the number of NP preparation programs has increased. However, many

graduate nursing programs reported that they were unable to expand the programs due to the

shortage of clinical sites. Finding willing and competent preceptors is essential to secure enough

clinical sites for NP students. However, there are not enough NP preceptors to provide clinical

education to NP students. In addition to the soaring need for increasing NPs who are willing to

participate in preceptorship, expected roles for NP preceptors has also been escalated. As the

trend of preparation for nursing professionals has shifted toward competency-based education,

the role of preceptors in NP education has increased. Competition to secure preceptors and

clinical sites with other healthcare professionals worsened the shortage of NP preceptors.

Moreover, lack of validated NP preceptor training and resources can discourage practicing NPs

to participate in preceptorship and may worsen the situation.

Various barriers and incentives for preceptor participation have been identified. Time

limitation and concerns for decreased productivities are major barriers for NPs to participate in

preceptorship. Lack of readiness among NPs can also be a barrier; self-confidence among NPs is

likely to promote participation in preceptorship. It may not be possible to remove all the potential

barriers and endorse incentives to attract NPs to participate in preceptorship; however, preceptor

training may be a more feasible and efficient method to address the deficiency of NP preceptors.

There are preceptor training programs and resources available, and many have been proven to

increase preceptors’ confidence as well as improve students’ outcomes. In particular, the OMP

preceptor model has been shown to be effective in enhancing communication between preceptors


and students and promoting student-centered learning. Some preceptor training resources were

specifically designed for NPs; however, there is no study that examined if those resources are

actually effective among NP preceptors. Moreover, there is no study that assessed if

enhancement of preceptors’ self-efficacy in their teaching skills by preceptor training is

associated with changes in willingness of NPs to participate in preceptorship. Such studies are

critically needed and are hoped to promote NPs’ readiness for the role, therefore encouraging

their participation in preceptorship.

Conceptual and Theoretical Foundations

The development of clinical evidence-based practice recommendations requires clear

concepts and an explicit framework. The following section provides an overview of concepts for

understanding development of NP’s readiness for preceptorship. A concept map of readiness was

developed by the author, and it was used to guide the development of the suggested intervention

program. In addition, a description of how theoretical underpinnings contributed to the suggested

intervention and how they would help to analyze the project results will be discussed. Bandura’s

self-efficacy theory will be used to guide the construction and evaluation of the suggested

program.

Concept maps and definitions. The Readiness Concept Map for NP Preceptorship

(Figure 1) was developed by the author to understand what mechanisms make NPs feel ready to

become a preceptor. It was also used to recognize the intervention needs to promote NPs’

readiness to participate in preceptorship. This concept map was created based on literature from

the field of both nursing and linguistics. The Readiness Concept Map is further described below.


Figure 1. Readiness Concept Map for NP Preceptors

Readiness. Readiness is a highly abstract and broad concept that can be interpreted in

multiple ways. Oxford Dictionaries (n.d.) provided three definitions of readiness: the state of

being entirely prepared for certain thing; willingness to carry out action; and trait of being

prompt, instant or instantaneous. The concept of readiness occurs when a person is thinking of

carrying out an action. The term “readiness” can be used to assess the degree of preparedness,

confidence, as well as one’s willingness to perform a certain task. In addition, the concept of

readiness is associated with the concept of changing a behavior to more desired behavior.

Preceptor qualities. Literature suggests that multiple personal qualities promote effective

preceptorship. Honesty, trustworthiness, approachability, and patience are identified as favorable

preceptor personality traits by existing NP preceptors (Murray & Buckley, 2017). Literature also

indicates that leadership skills, clinical expertise, and time management skills are essential


qualities that are necessary to be a competent preceptor (Barker & Pittman, 2010; Edmunds,

1983; Logan, Kovacs, & Barry, 2015). These preceptor qualities are considered to be vital when

fulfilling the expected role of NP preceptor and contribute to NPs’ readiness to precept.

Self-efficacy. Self-efficacy is one’s recognized view in his/her abilities to coordinate and

conduct the sequences of action that are necessary to get to desired achievement (Bandura,

1997). Self-efficacy indicates confidence in one’s capability to exercise control over his/her own

motivating force, performance, and social setting (Carey, n.d.). Preceptor education and

resources, such as training to acquire successful communication skills or educational models to

guide the mentorship, are effective at enhancing preceptors’ self-confidence (Bazell & Dains,

2017; Murray & Buckley, 2017). NPs who are confident in their teaching skills, thus have strong

self-efficacy, would be more willing to participate in preceptorship and maintain commitment to

their preceptor role even if there are barriers to the participation. More detailed definition of self-

efficacy based on Bandura’s self-efficacy theory will be discussed later in the theoretical

framework section.

Willingness. Willingness is one of the essential features of readiness and also can be an

influential factor for readiness for NP preceptorship. The willingness of NPs guides their

ultimate decisions regarding preceptorship participation. Balance between perceived benefits and

disadvantages of becoming a NP preceptor greatly influence NPs’ willingness. If a NP only

perceives the preceptor role as an additional burden on workload, they might not be willing to

accept the offer, as they do not see benefits outweighing the perceived disadvantages.

Theoretical framework: Bandura’s Self-Efficacy Theory. The definition of self-

efficacy, a key concept of this project, is based on a well-known psychologist Albert Bandura’s

(1997) self-efficacy theory. Bandura defined self-efficacy as a self-recognized belief that one can


coordinate and implement a plan of action in order to achieve a goal. Bandura also proclaimed

that the view of one’s efficacy influences the person’s behavior. For instance, if a person

believes that he/she has no abilities to achieve goals, the person will not make an effort to make

them come true (Bandura, 1997). On the other hand, a person who believes that he/she has

abilities to attain the goals are more likely to attempt to make efforts to reach the goals.

Recognition of self-efficacy is not necessarily true reflection of one’s skills or abilities, rather, it

is a conviction that one is able to successfully carry out a task under various situations with

whatever skills one has (Bandura, 1997). For instance, a person may think that he/she can climb

Mount Everest even if the person has never climbed a mountain and never had any training for it.

In this situation, we can say that the person has perceived self-efficacy to climb Mount Everest,

regardless of whether or not the person actually obtains skills to do so. Bandura asserted that

there is a triadic reciprocal causal relationship between behavior, internal personal factors, which

manifests as cognitive, affective and biological phenomena, and environmental events (see

Figure 2).

Figure 2. Triadic Reciprocal Causation in Human Agency. B represents behavior; P is the

internal personal factors; and E represents the external environment. Adapted from “Social

Foundation of Thought and Action: A Social Cognitive Theory,” by A. Bandura, 1986.

Englewood Cliffs, N. J.: Prentice-Hall.


Behavior, internal personal factors and environment are interacting determinants that

affect one another (Bandura, 1997). Based on this theory, it can be said that self-efficacy, a

cognition about one’s own abilities and skills, is an internal personal factor that can influence

one’s behavior. Bandura explained that people who have increased self-efficacy perceive

challenging jobs as trials to be overcome instead of risks that they should avoid. Thus, those who

have strong self-efficacy are determined to accomplish difficult tasks and more likely to retain

their firm commitment to their determination. Recognition of self-efficacy is an important

predictor of the achievement of one’s goal, regardless of how skillful the person really is.

Successful completion of mission necessitates both skills and high self-efficacy to use the skills

effectively (Bandura, 1997).

This project is based on Bandura’s theory that the level of self-efficacy influences

people’s change behavior. It is expected that increased self-efficacy will enhance an NP’s

willingness to become a preceptor, which ultimately promote readiness of the NP’s for the

preceptor role and positively affect NPs’ behavior in regard to participation in preceptorship.

Literature shows that training programs to educate preceptors about the OMP model increased

their self-confidence. Enhancing NPs’ self-efficacy as a clinical educator by teaching them about

the OMP model would lead to their increased willingness to become a preceptor. Therefore, it

would also enhance their readiness for a preceptor role. It would ultimately lead to increased

number of NP preceptors as well as producing more competent preceptors. Although there are

various barriers for NPs to participate in preceptorship as discussed earlier, enhanced self-

efficacy could make NPs believe that they can overcome those challenges and be successful with

teaching NP students. Based on Bandura’s self-efficacy theory, it is expected that increased self-

efficacy will positively affect NPs’ behavior to participate in preceptorship.


Chapter 3: Project Design and Evaluation Plan

This chapter describes the methods used to implement and evaluate the project to achieve

its objectives. The process of the development of the suggested NP preceptor training program

will be described in this section. Lastly, this section discusses human subject protection.

Development of a NP Preceptor Training Program

Existing preceptor training resources for NPs are limited. The OMP model has been

shown to be beneficial for both preceptors and preceptees among other health care professionals

and was introduced as a potentially useful preceptor tool for NPs in the past. A preceptor training

program to educate NPs about the OMP model was created for this project using available

resources after a rigorous analysis of existing literature regarding the OMP model. Literature

research was performed using CINAHL and PubMed to obtain research data regarding use of the

OMP model within and out of the nursing profession. Additional articles cited in those literatures

were also obtained. Obtained literatures were thoroughly reviewed and analyzed for appropriate

incorporation into the NP preceptor training program. Then, an NP preceptor training program

about the OMP model was developed based on analysis of existing literatures about model

within and out of the nursing profession. A video regarding application of the OMP model in

actual clinical teaching settings among NP preceptors, which was created by National

Organization of Nurse Practitioner Faculties (NONPF) (n.d.a), was incorporated into the lecture

part of the preceptor training program after obtaining a permission of adoption of the video by

the chief executive officer of the organization. In addition, literature about existing NP preceptor

training programs and current state of NP preceptorship was obtained and analyzed to assure that

the newly developing NP preceptor training program about the OMP model would be suitable for

use among NPs.


Contents of the NP Preceptor Training Program

The NP preceptor training program, which was implemented for this project, consisted of

three parts. The first part was a lecture by the researcher regarding the five steps of the OMP

model and the benefits of using the model. The five steps of the model were explained along

with examples of conversations between NP preceptors and preceptees in order to deepen the

understanding of the steps by the training participants. The lecture was concluded with a review

of the previously mentioned video by the NONPF so that participants can develop more concrete

idea of how to incorporate the model to communication with their preceptees in actual clinical

teaching practice. This part took approximately 30 minutes. The second part was simulation of

OMP use by role-playing. The participants were asked to pair up to a person next to them to

create groups of two to three persons. Then, one member of each group was asked to play a role

of an NP student and another member of each group was asked to play a role of NP preceptor.

Participants who played a role of an NP student were given a sheet that describe a scenario that

describe the brief history of a patient the student is seeing in the scenario, findings from physical

exam that the student already performed, diagnosis that the student is considering, and treatment

plan. Participants who played a role of a student were asked to use the given information to

respond to their preceptors since the intention of the role-playing is not to test those participants’

ability to present clinical cases, but to have the participants, who played a role of an NP

preceptor, to practice utilization of the OMP model. The participants who played a role of an NP

preceptor were asked to guide communication with the student based on the five steps of the

OMP model. All participants received a pocket reference of the OMP model which can be

attached to their employee badge so that they can refer to it during the role-playing if they forget

the five steps (see Appendix A). Two scenarios were given during this role-playing, and one


described a case about possible pregnancy and the other described a case about strep throat.

These scenarios were chosen because these are cases primary care NPs would commonly

encounter in their practice because all of the participants practice in primary care settings. This

role-playing part took approximately 30 minutes. The last part of the preceptor training program

was dedicated to Q&A regarding the OMP model and free discussion among the participants

regarding application of the OMP model to their teaching practice and their experiences of being

a preceptor. During the free discussion, the researcher functioned as a facilitator and had the

participants to freely express their opinions. This part took approximately 30 minutes. In total,

the entire program took one and a half hour.

Project Setting

A pilot study to assess the feasibility and effectiveness of the proposed NP preceptor

training program derived from the OMP model was implemented at Waianae Coast

Comprehensive Health Center (WCCHC). The WCCHC is a Federally Qualified Health Center

(FQHC) located in West Oahu (WCCHC, n.d.). The health center is the largest FQHC in the

state of Hawai‘i and service more than 37,000 patients a year. The health center employs a total

of 86 health care providers, including 30 NPs as of January 28, 2019 (A. Kawaiaea, personal

communication, January 28, 2019). The WCCHC has a mission of being a learning center and

provides abundant opportunities for health care training to ensure that the community will

continue to receive high-quality health care services in the future (WCCHC, n.d.). Based on the

mission, the health center actively supports their providers to become preceptors for students

from various health care disciplines, including NP students. The health center also offers

residency programs for NPs (WCCHC, n.d.). The WCCHC hosted a preceptor training for the

health care providers employed at the health center once in the past, but the training targeted


both physicians and NPs, and it was not tailored specifically for NPs. This project was the first

preceptor training program specifically designed for NPs implemented at the health center.

Target Population

The target population of this project is NPs at the WCCHC. All NPs who were employed

at the health center were qualified for participation in the project regardless of their specialty or

years of clinical and preceptorship experiences. Potential participants were informed about the

project at a monthly women’s health department meeting. In addition, emails with attached

recruitment flyers (Appendix B) were sent to all NPs at the health center using organization

email system one month prior to the implementation of the pilot project.

Data Collection and Instrument

In order to evaluate the pilot program in terms of feasibility and effectiveness,

particularly for increasing NPs' self-efficacy in teaching NP students and willingness to become

a preceptor, four assessment instruments were used for data collection: 1) Demographic

Questionnaire, 2) NP Preceptor Self-Efficacy Questionnaire, 3) Willingness Questionnaire, and

4) Course Evaluation Survey. These questionnaires were administered before the intervention

(pretest), immediately after the intervention (posttest 1), and 3 months after the intervention

(posttest 2). Table 1 shows timing of administration of four questionnaires. The pretest and

posttest 1 assessments were implemented with paper surveys, and the posttest 2 assessment were

implemented with an electronic survey.

Pretest Posttest(Immediately after

Follow-up(3 months after


training) training)

Demographic Questionnaire X

NP PreceptorSelf-Efficacy Questionnaire X x x

Willingness Questionnaire X x x

Course Evaluation Survey x

Table 1. Timing of Administration of Questionnaires

Demographic Questionnaire. The Demographic Questionnaire (Appendix C) was used

to collect background data about program participants. The questionnaire assessed participants’

age, gender, years of experience as a preceptor, a NP and a registered nurse, and educational

level. The questionnaire also asked participants whether they had received preceptor training

previously or not, and if so, what kind of preceptor training they had received. This questionnaire

was adapted from a study that examined preceptor’s self-efficacy among public health nurses by

Parsons (2007) with the author’s permission. This data was used to examine if any particular

demographic variables affect the effectiveness of the proposed NP preceptor training program.

The demographic questionnaire was administered only once, prior to the training session.

NP Preceptor Self-Efficacy Questionnaire. Measurement of NPs’ self-efficacy to teach

NP students was assessed via the NP Preceptor Self-Efficacy Questionnaire (Appendix D). This

questionnaire was also created based on Parsons’ Preceptorship Self-Efficacy Instrument (2007),

which was shown to be a validated tool for measuring self-efficacy among public health nurse

preceptors. The questionnaire was adapted for use for NP preceptors after obtaining the author’s

permission. The NP Self-Efficacy Questionnaire consisted of 21 questions. Participants were

asked to grade their confidence in carrying out behaviors related to the preceptor duty, learning


pattern/mentoring tactics, acquiring critical thinking skills, difficult circumstances, giving

feedback and review, and general confidence in teaching NP students. The 21 questions were

answered in a likert-type scale, and self-efficacy evaluation were varied from one (completely

lacking in confidence) and six (completely confident). The NP Preceptor Self-Efficacy

Questionnaire was administered before the training session, immediately after the training

session and 3 months after the training session was implemented.

Willingness Questionnaire. Measurement of NPs’ willingness for participating in

preceptorship was assessed via the Willingness Questionnaire. This questionnaire was used to

assess how the proposed NP preceptor training affected participants’ willingness to be a

preceptor. There were three versions of Willingness Questionnaire for different timing of

administration (see Appendix E, F and G). These questionnaires were administered before the

training session, immediately after the training session, and 3 months after the training session is

completed.

All three versions contained two questions, which are: “If you are not currently scheduled

to precept in the next 6 months, how likely are you to agree to become a preceptor in the next 6

months if given the opportunity?” and “What will make you more likely to participate in

preceptorship? Please describe the reason briefly below.” The Willingness Questionnaire for

pretest contained one additional question to these, which was: “Are you currently scheduled to

precept in the next 6 months?” The Willingness Questionnaire for posttest 1 also contained the

three questions but also included one additional question, which was: “Has this program had a

positive effect on your decision to precept in the future?” This question was asked in order to

assess participants’ perspective toward the effectiveness of the program on their willingness to

become a preceptor. On the other hand, the Willingness Questionnaire for posttest 2 contained a


total of six questions, including “Did you precept student(s) during the last 3 months after the

program?”; “If you used the OMP, how useful was it for your precepting practice?” and “Has

this program had an positive effect on your decision to precept in the future?” Except the

question, “What will make you more likely to participate in preceptorship? Please describe the

reason briefly below,” all questions were asked to answer either on dichotomous scales or

ordinal scales (likert-type scales).

Course Evaluation Survey. The effectiveness of the delivery of the suggested preceptor

training and the adoptability of the skills and knowledge of the OMP model into the participants’

teaching practice were evaluated using the Course Evaluation Survey (Appendix H). This survey

was administered once and at the posttest point. The survey consists of questions. The first

question was: “Do you think today’s lecture about the One Minute Preceptor Model was helpful

to you?” The second question was: “Do you think you will use the skills and knowledge you

learned from today’s lecture in your teaching practice?” These two questions were asked to

answer on ordinal scales (likert-type scales). The last question of this survey was: “Please write

any suggestion to improve the content and implementation of this course.” The participants were

asked to write their response freely for this question.

Project Implementation

Following sections describe the implementation process for each aim.

Aim 1. Develop an NP preceptor training program to teach NPs about the OMP model

grounded in available evidence.

The proposal of this project was submitted to the UHH School of Nursing (SON)

Scientific Review Committee (SRC), and they approved the project in May 2018. A

collaborative partnership with WCCHC was initiated by presentation of the suggested preceptor


training program by the author to the director of Women’s Health and NP residency program of

WCCHC. The supervising NP signed a Memorandum of Agreement (MOA) for the project on

August 6, 2018. An application for this project as an exempt study was submitted to the UH IRB,

and it was approved for implementation on September 11, 2018. (see Appendix I for approval

letter)

Aim 2. Perform an evaluation of the proposed OMP model based NP preceptor training

program.

NPs who belong to the women’s health department were informed about the preceptor

training during a monthly department meeting September 5, 2018. They were also contacted for

recruitment for the preceptor training via email with attached recruitment flyer using the

organization email system on September 28, 2018. The author researched for additional potential

participants via an organization directory at the WCCHC. Inclusion criterion was NPs who were

currently employed at the WCCHC. There was no exclusion criterion for the participation of the

program because all of NPs who are employed at the WCCHC are presumably fluent in English.

This program was targeted for any NPs employed at the WCCHC regardless of their experience

as NPs, age or gender. Twenty additional potential participants were identified using the

organization directory. Those potential participants were contacted via an organization email on

September 14, 2018, which invited the potential participants for participation in the preceptor

training using the recruitment flyer. The pilot project was implemented at a conference room of

the WCCHC on October 6th, 2018. Appendix J shows the timelines for each objective and other

task.

Data Analysis Methods


The collected data from the Demographic Questionnaire, Willingness Questionnaire, and

Course Evaluation were inputted into excel spreadsheets. Answers for each question in these

instruments, except those what were open-ended questions, were coded so that it is easier to

analyze the data. As this project was a pilot project and the number of the participants were

limited (n=9), the data from these assessment tools was analyzed manually using code books

which were made by the author with Excel spreadsheets.

The data collected from the NP preceptor self-efficacy questionnaire was analyzed

separately in order to rigorously analyze the changes of the answers over time. The data collected

from this instrument include one categorical, independent variable (time) with three variants

(pre, post, follow-up), and one dependent variable (self-efficacy) measured on a 6 point Likert

scale from completely lacking in confidence (1) to completely confident (6). The null hypothesis

for each of these tests was that there was no significant difference between each measurement

time. The alternative hypothesis was that there would be a difference over time.

One-way, repeated measures analysis of variance (RMANOVA) was selected as a test to

analyze the data collected from the self-efficacy questionnaire. The rationale behind this method

is that the data were assumed to be normally distributed with no significant outliners. Since

ordinal variables with five or more categories can often be used as continuous without any harm

to the analysis (Norman, 2010; Sullivan & Artino, 2013; Zumbo & Zimmerman, 1993), the

dependent variable was considered as ordinally approximation of a continuous variable.

Due to the small sample size (n=9) and missing pre-test data for one participant, the non-

parametric equivalent of the RMANOVA, the Friedman’s Exact test, was also run. This allowed

for a more conservative estimate particularly when statistical significance was borderline at the

5% alpha level. Further, ANOVAs with repeated measures are particularly susceptible to the


violation of the assumption of sphericity, where the variances of the differences between all

combinations of related groups (levels) are equal. Violation of sphericity causes the test to

become too liberal (i.e., an increase in the Type I error rate). Mauchly’s Test was used to decide

if any of the data violated the assumption of sphericity. This was not the case, so no modification

of the degrees of freedom (e.g., Greenhouse Geisser Sphericity Collection) was needed.

Data analysis was conducted under the guidance and supervision of a researcher at UHH,

who has extensive experience conducting public health and social justice research.

Project Budget and Justification

A total project cost estimate was made based on rough calculations of direct and indirect

costs (see Table 2). Personnel cost included wages for lecture NP and one support staff. Wage

for lecture NP was calculated as in-kind donation from the sub-investigator, who is the author of

this paper. Wage for one support staff was calculated as $15 per hour and the support staff was

planned to be hired for 3 hours to prepare for the training session, to help the lecture NP to

conduct survey and implement the training session, and to clean up after the training. A total cost

for wage for one support staff is $45. Statistician was planned to be hired to help analyze

research data. According to the Bureau of Labor Statistics (2018), the mean wage in 2017 was

approximately $40 per hour. It is expected that it will take approximately four hours for the

statistician to review the data collected for this project and analyze the data. Thus, a total of $160

would cost to hire a statistician to help analyze the data for this project. Overall, the estimated

total personnel cost was $205.

Estimated operation costs included fee to rent a classroom, a laptop, a projector, and a

large projector screen, and to print handout materials and printing pretest and posttest surveys.

The fee for renting a classroom, a projector, and a large projector was calculated as in-kind


donation from WCCHC. The fee for renting a laptop was also calculated as in-kind donation

from sub-investigator. The fee for printing handout materials was estimated as one dollar per

participant; the estimated number of participants to the pilot program was 20; thus, the estimated

fee for printing handout materials was $20. The estimated fee for printing pretest and posttest

surveys, and consent form per participant was also one dollar; since the estimated number of

participants was 20, the total estimated fee for printing pretest and posttest surveys, consent form

was $20. Overall, the estimated total operation cost was $40. Therefore, the estimated total direct

cost was the sum of the estimated total personnel cost ($205) and the estimated total operation

cost ($40) and it was $245.

The estimated indirect costs for the project include refreshments (e.g. coffee and pastries)

for participants during the training session ($50) and office supplies (e.g. staplers & pencils)

($50). The estimated total indirect cost was $60. In conclusion, the estimated total project cost

was the sum of the estimated total direct cost ($245) and the estimated total indirect cost ($60),

and it was $305.

The plan for this project was carried out based on the budget noted as above, however,

the actual spending was actually much less than expected. Support staff was not needed since the

number of the participants was not as big as initially expected; therefore, the lecture NP, who is

the primary author of this paper, conducted this program solely. Cost for hiring a statistician was

saved because a professor at UHH who is an extremely experienced researcher volunteered to

help the primary author to analyze the data collected for this pilot study and there was no longer

need to hire a statistician. An unexpected spending was a one-month membership fee for

SurveyMonkey, which was $37. Generally, the web service is free to use; however, the self-

efficacy survey contained more than 10 questions, and the website requires an user to become a


member to conduct an online survey that contains more than 10 questions. This was not

considered when the project budget was calculated. Thus, the overall actual spending for the total

direct cost for this project was $77, which includes fee for printing handout materials ($20), fee

for printing pretest and posttest surveys and consent form ($20), and a one-month membership

fee for SurveyMonkey. The actual spending for the total indirect cost was the same was it was

planned, which was $60. In total, the actual spending for total project cost was $137, which was

$168 less than budgeted prior to the implementation. In addition, it is important to note that

although the actual number of participants were only nine; however, the materials and setting

was done to host 20 participants. The actual total cost was $6.85 per participant. Table 2 shows

the detailed information regarding budget and actual spending for this project.

CATEGORY BUDGETED AMOUNT ACTUAL SPENDING

Personnel

Lecture NP In-kind donation from author In-kind donation from author

Support staff ($15/hr x 3) $45 $0 (Support staff not needed)

Wage for statistician ($40/hr x 4) $160 In-kind donation from a professor

Fringe N/A N/A

Travel N/A N/A

Operations

Classroom In-kind donation from WCCHC In-kind donation from WCCHC

Projector In-kind donation from WCCHC In-kind donation from WCCHC

Large projector screen In-kind donation from WCCHC In-kind donation from WCCHC

Laptop In-kind donation from author In-kind donation from author

Printing handout materials $20 $20

Printing pretest and posttest surveys and consent form $20 $20

SurveyMonkey 1 mo membership $37

TOTAL DIRECT COST $245 $77

Indirect Costs


Refreshments $50 $50

Office supplies $10 $10

TOTAL INDIRECT COST $60 $60

TOTAL PROJECT COST $305 $137

Table 2. Budget and Actual Spending

Human Subjects Protection

In order to assure human subject protection, an approval of the proposed project from the

University of Hawaii (UH) institutional review board (IRB) as an exempt research was obtained

(Appendix J). Participants in this project were NPs only, and no patients or vulnerable

populations were included in this study. Participants were assured that participation in this study

is completely voluntary and participation in the project was separated from other duties for the

NPs’ employment. The participants will be asked to sign a consent form to participate in the

study (see Appendix K) prior to implementation of the NP preceptor training program. To ensure

confidentiality, the researcher did not to obtain information that can directly identify the study

subjects, such as name, address, and phone number. Instead, each participant was asked to create

a participant ID on their own using their birth year and first three letters of their mother’s maiden

name and asked to use the same ID when they answered pretest and posttests in order to track the

changes of their answer over time. Moreover, the researcher also ensured that participation in

this study is voluntary. The study was implemented separately from participants’ employment

obligations at the collaborating health center. The researcher had an agreement with the

administration of the health center via a pre-established Memorandum of Understanding (MOU)

regarding the implementation of the piloted program (Appendix L). Required CITI training

courses were also completed (see Appendix M).

Chapter 4: Results


In this chapter, the results of the project are presented according to the aims and

objectives outline in chapter one.

Results

Role and timing of each instruments. Participant feedback and self-assessment were

measured at three points in time: before the preceptor training program was introduced, after the

program was completed, and at a 3-month follow up. As discussed previously, three instruments

were used to measure the results of the intervention: a willingness questionnaire, a NP preceptor

self-efficacy questionnaire, and a course evaluation. There were 21 questions in the NP Preceptor

Self-Efficacy Questionnaire. The questionnaire containing the same 21 questions was repeated at

all three points of measurement. Willingness questionnaire was administered before the course

was taken, after the course was taken, and at three months follow-up. This short assessment

contained three common questions and added one to two additional questions at each point of

measurement (see Appendix D, E, and F). The course evaluation was administered once after

completion of the course.

Participants and their participation. A total of nine individuals participated in the NP

preceptor training program. Out of them, only eight participants took the pre-assessment, as one

participant came late for the program. All nine participants took post and follow-up assessments.

Results of demographic assessment. Eight out of nine participants completed the

Demographic Questionnaire, as the one participant came late and missed the pretest point. The

result of the questionnaire revealed that the ages of the participants ranged from 34 to 66. The

average age of the participants was 48.9. All of the participants were female. They all also had

experience being a preceptor in the past, but the years of experience as a preceptor varied and

ranged from less than 1 year to more than 10 years. The years of experience as an NP also varied


and ranged from one to three years to more than 20 years. Half of the respondents had an NP

experience of more than 10 years. The years of experience as a registered nurse (RN) varied as

well, ranging from five to 10 years to more than 20 years. Six respondents (75%) answered that

they had received formal preceptor training in the past, and only half of them (37.5% of all

respondents) had received a preceptor training particularly aimed for NPs. Two respondents

(25% of all respondents) said they received preceptor training for RNs, and two respondents

mentioned that they received preceptor training for other professions (25% of all respondents).

Among those who had received any formal preceptor training in the past, the cumulative hours of

training they had ranged from five to 10 hours to 20-30 hours. The participants were asked to

answer topics that were covered in previous preceptor training with categorical variables and

their responses included: evaluation of students, preceptor roles and responsibilities, learning

styles, student objectives/expectations, teaching strategies, communication strategies, and

cultural competency. One of the respondents had a Doctoral degree as her highest level of

nursing education, while the other seven had Master’s degrees.

Results of the willingness assessment.

Willingness pretest. The willingness pre-test asked three questions:

Q1. Are you currently scheduled to precept in the next 6 months?

Q2. If you are not currently scheduled to precept in the next 6 months, how likely are you to

agree to become a preceptor in the next 6 months if given the opportunity?

Q3. What will make you more likely to participate in preceptorship? Please describe the reason

briefly below.

Of the eight participants who completed the willingness pretest, six (75%) were

scheduled to serve as a preceptor in the next six months. The two who were not scheduled were


divided in their likelihood to serve with one indicating not likely and one indicating somewhat

likely. “Time” and “getting paid” were the two most frequently mentioned factors that would

influence a decision to serve as a preceptor with only one respondent noting the value of being

mentor.

Willingness posttest. The willingness post-test asked four questions including a repeat of

the three questions that were included in pre-test:




Q3. Has this program had a positive effect on your decision to precept in the future

Q4. What will make you more likely to participate in preceptorship? Please describe the reason

briefly below.

Only eight participants responded, as one participant did not participate in this

assessment. There was no change in the number of participants scheduled to serve as a preceptor;

a total of six participants (75%) responded that they were scheduled to precept in the preceding

six months, but there was a slight increase in the likelihood of one to consider serving as a

preceptor. Almost all respondents (80%) agreed that the program had a positive effect on their

decision to precept in the future, with one indicating a neutral response and all others noting they

“agreed” or “strongly agreed.” While “time” and “money” were still noted as factors in their

decision-making at post-test, the participants also noted “training” “communication” and the

value of teaching others to strengthen their own skills.

Willingness follow-up test. The willingness follow-up assessment included six questions:

Q1. Did you precept student(s) during the last 3 months after the program?


Q2. Did you use the OMP in your precepting practice since the program?

Q3. If you used the OMP, how helpful was it for your precepting practice?



Q5. Has this program had a positive effect on your decision to precept in the future?

Q6. What will make you more likely to participate in preceptorship?

Of those who responded to the follow-up assessment (n=7), four (57%) indicated they

had served as a preceptor in the preceding three months. All four indicated they had used the

OMP and the model was helpful. Three participants (75%) particularly mentioned that the model

was very helpful. Of those participants who responded to “Q4. If you are not currently scheduled

to precept in the next 6 months, how likely are you to agree to become a preceptor in the next 6

months if given the opportunity?”, all noted that they are either “very likely” or “somewhat

likely” to agree to become a preceptor in the preceding six month with 80% of them answered

the likelihood is “very likely.” Almost all seven respondents (86%) “agreed” or “strongly

agreed” that the program had a positive effect on their decision to precept in the future while one

participant chose a “neutral” answer. None of the respondents disagreed that the program had a

positive effect on their willingness to become a preceptor in the future.

A sixth open-ended question asked about factors that might influence future decisions

about being a preceptor. The comments were decidedly different from the pre- and the post-test.

Most comments noted the value of mentorship. The comments included, “fulfillment in helping

pass on my knowledge to the next generation of nurse practitioners.” The responses also

included the need for quality time to the job well. For instance, “I would like to be able to stop


clinic about 30 minutes earlier to discuss patients with students.” Other also noted “ongoing

training” and “mentorship.”

Results of self-efficacy assessment. The NP preceptor self-efficacy questionnaire was a

21-question assessment of perceived individual self-efficacy for serving as a preceptor for nurse

practitioner students. The exact same 21 questions were asked at pretest, posttest, and three-

month follow-up. Followings describe the analysis of data collected for the NP preceptor self-

efficacy questionnaire by questions.

Question 1 – You have the ability to carry out your role as preceptor. There is a

borderline significant difference between the means of the differences between all three times F

(2, 10) = 4.0, p<.053. Since the significance was slightly higher than the 5% limit, the

Friedman’s test was affirmed that time had a close to significant effect on perceived self-efficacy

χ2 (2) = 5.692, p<.058. Conover’s post hoc test indicated there was no significant difference

from pre-test to post-test (P = .810); however, the difference from post-test to follow-up was

statistically significant (P = .022). Figure 3 shows the change from pretest to follow-up in

participants’ self-perception of their ability to carry out their role as preceptor.

Figure 3. You have the ability to carry out your role as preceptor


Q2 – You have the necessary knowledge to work with a nurse practitioner student.

There is a significant difference between time and self-efficacy F (2, 10) = 5.0, p=.031. (Figure)

Friedman test also indicated a significant result χ2 (2) = 6.500, p=.039. Conover’s post hoc test

indicated there was no significant difference from pre-test to post-test (P = .428); however, the

difference from post-test to follow-up was statistically significant (P = .033). Figure 4 shows the

change from pretest to follow-up in participants’ self-perception of whether they have the

necessary knowledge to work with an NP student.

Figure 4. You have the necessary knowledge to work with a nurse practitioner student.

Q3 – You have the necessary knowledge of the preceptor role to perform effectively as

a preceptor. There is a significant difference between time and self-efficacy F (2, 10) = 5.0,

p=.031. (Figure) Friedman test also indicated a significant result χ2 (2) = 6.125, p=.047.

Conover’s post hoc test indicated there was no significant difference from pre-test to post-test (P

= .654); however, the difference from post-test to follow-up was statistically significant (P

= .030). Figure 5 shows the change from pretest to follow-up in participants’ self-perception of


whether they have the necessary knowledge of the preceptor role to perform effectively as a

preceptor.

Figure 5. You have the necessary knowledge of the preceptor role to perform effectively as a

preceptor

Q4 – You can maintain effective communication with students. There is a significant

difference between time and self-efficacy F (2, 10) = 4.5, p=.040. Friedman test also indicated a

significant result χ2 (2) = 6.615, p=.037. Conover’s post hoc test indicated there was no

significant difference from pre-test to post-test (P = .211) or from post-test to follow-up (p

= .058); however, the difference from pre-test to follow-up was statistically significant (P

= .006). Figure 6 shows the change from pretest to follow-up in participants’ self-perception of

whether they can maintain effective communication with students.


Figure 6. You can maintain effective communication with students

Q5 – You can balance the multiple demands of students and your workload

simultaneously. There is a significant difference between time and self-efficacy F (2, 10) = 5.0,

p=.031. (Figure) Friedman test also indicated a significant result χ2 (2) = 6.706, p=.035.

Conover’s post hoc test indicated there was no significant difference from pre-test to post-test (P

= .060) or from post-test to follow-up (P = .188); however, the difference from pre-test to follow-

up was statistically significant (P = .005). Figure 7 shows the change from pretest to follow-up in

participants’ self-perception of their ability to balance the multiple demands of students and their

workload simultaneously.

Figure 7. You can balance the multiple demands of students and your workload simultaneously


Q6 – You can assume a facilitative rather than a directive role with students. There is

no significant difference between time and self-efficacy F (2, 10) = 1.522, p<.265.

Q7 – You can effectively assess students' learning needs. There is a significant

difference between time and self-efficacy F (2, 10) = 10.88, p<.003 (see Figure 8) Friedman test

also indicated a significant result χ2 (2) = 8.588, p=.014. Conover’s post hoc test indicated there

was significant difference from pre-test to post-test (P = .045); however, the difference from

post-test to follow-up was not statistically significant (P = .201). Figure 8 shows the change from

pretest to follow-up in participants’ self-perception of their ability to effectively assess students’

learning needs.

Figure 8. You can effectively assess students' learning needs.

Q8 – You can adapt your clinical teaching to meet a student's learning style. There is a

significant difference between time and self-efficacy F (2, 10) = 5.0, p=.031. On the other hand,

Friedman test indicated a borderline significant result χ2 (2) = 5.700, p=.058; however, this is a

more conservative test and the result was borderline not statistically significant (p>.05).

Bonferroni post hoc test indicated there was no significant difference from pre-test to post-test


(Pbonf =.424) or from post-test to follow-up (Pbonf =1.000); however, the difference from pre-

test to follow-up was statistically significant (Pbonf = .038). Figure 9 shows the change from

pretest to follow-up in participants’ self-perception of their ability to adapt their clinical teaching

to meet a student’s learning style.

Figure 9. You can adapt your clinical teaching to meet a student's learning style

Q9 – You can select learning experiences that are congruent with course objectives.

There is a significant difference between time and self-efficacy F (2, 10) = 8.4, p=.007. Friedman

test also indicated a significant result χ2 (2) = 8.588, p=.014. Conover’s post hoc test indicated

there was no significant difference from pre-test to post-test (P = .067); however, the difference

from post-test to follow-up was statistically significant (P = .015). Figure 10 shows the change

from pretest to follow-up in participants’ self-perception of their ability to select learning

experiences that are congruent with course objectives.


Figure 10. You can select learning experiences that are congruent with course objectives

Q10 – You can promote the integration of skills learned in the classroom to the

practice setting. There is a significant difference between time and self-efficacy F (2, 10) = 15.0,

p<.001. Friedman test also indicated a significant result χ2 (2) = 10.30, p=.006. Conover’s post

hoc test indicated there was significant difference both from pre-test to post-test (P = .023) and

from post-test to follow-up (P<.001). Figure 11 shows the change from pretest to follow-up in

participants’ self-perception of their ability to promote the integration of skills learned in the

classroom to the practice setting.

Figure 11. You can promote the integration of skills learned in the classroom to the practice

setting


Q11 — You can assist students to develop problem-solving skills. There is a significant


significant result χ2 (2) = 7.625, p=.022. Conover’s post hoc test indicated there was significant

difference from pre-test to post-test (P = .004); however, the difference from post-test to follow-

up was not statistically significant (P = .795). Figure 12 shows the change from pretest to follow-

up in participants’ self-perception of their ability to assist students to develop problem-solving

skills.

Figure 12. You can assist students to develop problem-solving skills

Q12 – You can assist students to develop critical thinking skills. There is a significant





up in participants’ self-perception of their ability to assist students to develop critical thinking

skills.


Figure 13. You can assist students to develop critical thinking skills

Q13 – You can challenge students to use critical thinking skills. There is a significant

difference between time and self-efficacy F (2, 10) = 4.3, p=.045. On the other hand, Friedman

test indicated a borderline significant result χ2 (2) = 5.692, p=.058. Again, this is more

conservative test and the result was only borderline and not significant. Bonferroni post hoc test

indicated that there was no significant difference from pre-test to post-test (Pbrof= .127) or from

post-test (Pbonf= 1.000). Conover’s post hoc test indicated there was significant difference from

pre-test to post-test (P = .022); however, the difference from post-test to follow-up was not


participants’ self-perception of their ability to challenge students to use critical thinking skills.


Figure 14. You can challenge students to use critical thinking skills

Q14 – You can deal effectively with unexpected events or unforeseen problems. There

is a significant difference between time and self-efficacy F (2, 10) = 14.1, p=.001. Friedman test

also indicated a significant result χ2 (2) = 9.500, p=.009. Conover’s post hoc test indicated there

was no significant difference from pre-test to post-test (P = .496); however, the difference from

post-test to follow-up was statistically significant (P <.001). Figure 15 shows the change from

pretest to follow-up in participants’ self-perception of their ability to deal effectively with

unexpected events or unforeseen problems.

Figure 15. You can deal effectively with unexpected events or unforeseen problems


Q15 – You can deal effectively with challenging students. There is a significant





up in participants’ self-perception of their ability to deal effectively with challenging students.

Figure 16. You can deal effectively with challenging students

Q16 – You can deal effectively with conflict in the student/ preceptor relationship.



there was significant difference from pre-test to post-test (P = .049); however, the difference

from post-test to follow-up was not statistically significant (P = .392). Figure 17 shows the

change from pretest to follow-up in participants’ self-perception of their ability to deal

effectively with conflict in the student/ preceptor relationship.


Figure 17. You can deal effectively with conflict in the student/ preceptor relationship

Q17 – You can support student ideas even when they are incongruent with your own.



there was significant difference from pre-test to post-test (P = .011); however, the difference

from post-test to follow-up was statistically significant (P = .664). Figure 18 shows the change

from pretest to follow-up in participants’ self-perception of their ability to support student ideas

even when they are incongruent with your own.

Figure 18. You can support student ideas even when they are incongruent with your own


Q18 – You can provide verbal feedback to students about their performance. There is a

borderline significant difference between time and self-efficacy F (2, 10) = 4.130, p=.049.

However, Friedman test indicated a significant result χ2 (2) = 6.500, p=.039. Conover’s post hoc

test indicated there was no significant difference from pre-test to post-test (P = .428); however,

the difference from post-test to follow-up was statistically significant (P = .033). Figure 19

shows the change from pretest to follow-up in participants’ self-perception of their ability to

provide verbal feedback to students about their performance.

Figure 19. You can provide verbal feedback to students about their performance

Q19 – You can provide a written final evaluation of student performance. There is a

significant difference between time and self-efficacy F (2, 10) = 7.0, p=.013. Friedman test also

indicated a significant result χ2 (2) = 7.538, p=.023. Conover’s post hoc test indicated there was

no significant difference from pre-test to post-test (P = .570); however, the difference from post-

test to follow-up was statistically significant (P = .009). Figure 20 shows the change from pretest

to follow-up in participants’ self-perception of their ability to provide a written final evaluation

of student performance.


Figure 20. You can provide a written final evaluation of student performance

Q20 – You can provide constructive feedback. There is a significant difference between

time and self-efficacy F (2, 10) = 6.0, p=.019. Friedman test also indicated a significant result χ2

(2) = 7.625, p=.022. Conover’s post hoc test indicated there was no significant difference from

pre-test to post-test (P = .795); however, the difference from post-test to follow-up was


participants’ self-perception of their ability to provide constructive feedback.

Figure 21. You can provide constructive feedback


Q21 – Rate your overall level of confidence in precepting a nurse practitioner student.

There is a significant difference between time and self-efficacy F (2, 10) = 10.0, p=.004.

Friedman test also indicated a significant result χ2 (2) = 8.375, p=.015. Conover’s post hoc test

indicated there was no significant difference from pre-test to post-test (P = .173); however, the

difference from post-test to follow-up was statistically significant (P = .009). Figure 22 shows

the change from pretest to follow-up in participants’ self-perception of their overall level of

confidence in precepting an NP student.

Figure 22. Rate your overall level of confidence in precepting a nurse practitioner student

Results of course evaluation. The course evaluation included three questions:

1. Do you think today's lecture about the One Minute Preceptor Model was helpful to

you?

2. Do you think you will use the skills and knowledge you learned from today's lecture in

your teaching practice?

3. Please write any suggestion to improve the content and implementation of this course.


All nine respondents (100%) indicated that they agreed that the OMP lecture was helpful

to some extent with most of them (89%) responding “strongly agree.” Eight respondents

(88.9%) also “strongly agreed” that they would use the skills and knowledge in their

teaching practice. One respondent was less sure and only “moderately agreed.”

Comments on the content and implementation of the course were positive and included

comments such as:

“I liked being able to talk to other preceptors about problems with students”

“I enjoyed the free time at the end to talk story”

“Assessing different learning styles”

“Great lecture”


Chapter 5: Recommendations and Conclusions

This PIP aimed to develop and implement a preceptor training program for NPs that

focused on educating NPs on use of the OMP model and evaluating the effectiveness of the

piloted program. The overall goal of this project was to enhance self-efficacy among NPs in

skills to mentor NP students so that more NPs would be both prepared and motivated to

participate in preceptorship. The goal of the pilot project was to test and evaluate the suggested

NP preceptor training program and determine if such preceptor training indeed increased NPs’

self-efficacy as a clinical educator and facilitated their decision to become a preceptor. This

chapter evaluates the practicality and feasibility of the piloted NP preceptor training program.

Additionally, this chapter discusses analysis of the outcomes of the pilot project in regard to

whether goals of this project were fulfilled.

Discussion

This study demonstrated that the piloted NP preceptor training program improved

participants’ self-efficacy. The data analysis of the NP self-efficacy questionnaire demonstrated

that out of the 21 questions contained in the questionnaire, 20 questions showed significant

differences between time and self-efficacy. Significant difference between time and self-efficacy

was observed particularly in the following aspects of self-efficacy: knowledge to work with an

NP student; knowledge of the preceptor role to perform effectively as a preceptor, the ability to

maintain effective communication with students; the ability to balance the multiple demands of

students and own workload simultaneously; the ability to effectively assess students’ learning

needs; the ability to adapt clinical teaching to meet a student’s learning style; the ability to select

learning experiences that are congruent with course objectives; the ability to promote the

integration of skills learned in the classroom to the practice setting; the ability to assist students


to develop problem-solving skills; the ability to assist students to develop critical thinking skills;

the ability to challenge students to use critical thinking skills; the ability to deal effectively with

unexpected events or unforeseen problems; the ability to deal effectively with challenging

students; the ability to deal effectively with conflict in the student/ preceptor relationship; the

ability to support student ideas even when they are incongruent with own; the ability to provide a

written final evaluation of student performance; the ability to provide constructive feedback; and

overall level of confidence in precepting an NP student. None of scores of the 21 questions in the

self-efficacy questionnaire were lower at post-test and follow-up compared to pre-test; therefore,

there was no negative effect on the participants’ self-efficacy observed in this study. Some of the

results were borderline, but they were going in the expected direction, which shows that self-

efficacy improved over time after the implementation of the preceptor training program.

Alternatively, it can be considered that the suggested preceptor training may not improve all

aspects of NP preceptors’ self-efficacy as the level of self-efficacy was measured from 21

different aspects in this study.

Interestingly, almost half of the aspects of self-efficacy measured improved significantly

from post-test to three-month follow-up although there was no significant improvement from

pre-test to post-test (see Table 3). These results suggest that the participants’ perception of their

self-efficacy did not change much immediately after the preceptor training program, but, after

thinking a while and actually using the OMP model in practice, they grasped the concepts and

effective use of the model further, and they really felt an increase in their confidence and

abilities.


Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10

Q11

Q12

Q13

Q14

Q15

Q16

Q17

Q18

Q19

Q20

Q21

Significant x x x x x x x x x x x x x x x x x x

Borderline significant x x

Significant change from pretest to posttest

x x x x x x x x

Significant change from posttest to follow-up

x x x x x x x x x x

Significant change from pretest to follow-up

x x x

Not significant X

Table 3. Timing of significant change of self-efficacy

The data analysis of the willingness questionnaire also showed the positive effects of the

preceptor training program. Although only a slight increase was noted from pretest to posttest, of

those who responded to the follow-up willingness questionnaire three months after the program,

a great majority of them said that they are very likely to agree to become a preceptor if they are

given the opportunity. In addition, almost all respondents at post-test and at follow-up noted that

the program had a positive effect on their decision to become a preceptor in the future. None of

the respondents opposed that the program had positive effect on their decision to precept a

student. The follow-up willingness questionnaire revealed that four out of seven respondents

served as a preceptor from the time of program implementation, and all of them used the OMP


model. Moreover, all of them thought that the model was helpful for their precepting practice.

The piloted preceptor training program also influenced the participants’ perception on positive

influential factors for their decision on participating in preceptorship. At pretest, “time” and

“money” were noted as major factors by the respondents; however, at posttest, “training”

“communication” and “value of teaching others to strengthen their own skills” were also noted in

addition to “time” and “money.” The follow-up willingness questionnaire further showed

changes of their perspective on influential factors, and more respondents commented on the

value of mentorship.

One unexpected outcome of the piloted preceptor training program was the appreciation

from the participants regarding an opportunity for NP preceptors to discuss their problems with

others. At the end of the program, the participants were given time to ask questions about the

lecture on the OMP model but also time to freely discuss their issues with preceptorship. Topics

they discussed included the difference of competency among NP students based on where they

are from and whether the students had nursing experiences prior to the NP school, and difficulty

of dealing with students who did not build adequate knowledge and skill base from lectures at

their NP programs prior to clinical rotation. Many of them voiced their concerns about lack of

support to them from the NP programs and inadequate preparation of students by NP programs

prior to clinical rotations. The comments of the participants from the course evaluation

demonstrated that multiple participants enjoyed talking to other NP preceptors about what they

struggle during preceptorship. This effect of the program was not particularly intended but is an

important positive effect of the preceptor training. NP preceptors usually practice independently

and may not have opportunities to meet with other preceptors and discuss about their role and

responsibility as a preceptor. Discussing their struggle with their role of a preceptor, obtaining


other preceptors’ insights about potential solutions for issues with students and NP programs,

and learning how to balance their employment obligations and teaching all seemed to be

beneficial for the participants. Preceptor training programs can provide opportunities for NP

preceptors to share their concerns and issues with their preceptor role among their peer

preceptors and obtain emotional support, which may further increase their self-efficacy.

Feasibility is a crucial point to consider for whether the suggested NP preceptor training

will be adopted in the real-world setting. One aspect to consider in terms of feasibility of the

suggested preceptor training program is whether there will be enough participants. Many NPs

have busy lives and have other obligations such as taking care of their families besides their job

duty. In this project, a total of 29 NPs who are registered on the WCCHC organization directory

were contacted and recruited for participation in the piloted preceptor training program, and nine

NPs participated in the pilot program. Although the piloted program was conducted only once,

31% of all NPs at the health center participated. Moreover, four additional NPs were interested

in the program but were unable to attend because they already had arrangement on that day of

the implementation. For the actual program implementation, preceptor training should be

conducted at different times and days to fit NPs’ busy schedule to increase the participation rate.

Literature suggests that 95% of NP preceptors desire to attend a preceptor training program

(Amella et al., 2001); thus, it can be expected that there will be many NPs who attend the

suggested preceptor training program if it is available to them.

The results of the course evaluation suggested that the skills and knowledge about the

OMP model acquired during the piloted preceptor training program are likely to be adopted in

the participants’ actual precepting practice. The vast majority of the participants “strongly

agreed” that the lecture about the OMP model in the preceptor training program was helpful and


that they will use skills and knowledge they learned from the lecture in the preceptor training

program in their teaching practice. The OMP model is a particularly valuable preceptor tool and

suitable for preceptor training for NPs because it can be learned within one to two hours, and the

skills and knowledge of the model can be applied right away (Neber et al., 1992). In fact, in this

study, all participants who served a preceptor role within three months after the preceptor

training responded that they utilized the skills and knowledge of the OMP model to their actual

teaching practice. The model is an excellent resource for NP preceptors as it does not require re-

training for years (Neber et al., 1992); thus, it fits busy lives of NP preceptors.

Another aspect of feasibility to consider is a cost. The cost of the suggested program is

very low. Although, it was estimated to cost $305, the actual cost ended up only $137. The

program was prepared to host maximum of 20 participants; therefore, the cost of the project per

participant was less than seven dollars. Thus, financial barrier to adopting the suggested program

is not high at all. As to who should adopt the suggested program, it is ideal for nursing schools to

host such a program. Amount of time that is required for clinical preceptorship is already a major

barrier for NP preceptors (Roberts et al., 2017). Although this piloted program was implemented

at a health center where the primary author is employed due to its convenience to available

resources, some employers may not have money and time to conduct preceptor training on their

own. Moreover, NPs reported that lack of support from their employers are a prohibiting factor

to become preceptors (Roberts et al., 2017); thus, it may be difficult to expect employers to host

a preceptor training program, particularly because there is no obvious immediate profit for them

to conduct preceptor training program. Therefore, the suggested NP preceptor training ideally

should be adopted by nursing schools that offer NP preparation. Nursing programs can greatly


profit from implementing NP preceptor training by promoting recruiting preceptors as well as

improving the quality of clinical training for their NP students.

Replicability of the program is another important factor to consider for evaluation of the

project. In terms of characteristics of the participants, NPs with different professional and

personal backgrounds participated in this piloted project because there was no exclusion criterion

for participants. Although the sample size of the pilot program was limited (n = 9), the

characteristics of the participants showed that the results of this pilot study is likely to be a

reflection of overall NP population in this country. The age of participants ranged from 34 to 66,

and the average age of the participants was 48.9. According to a national survey for NPs

conducted by the American Association of Nurse Practitioners [AANP] (2019b), the mean age of

NPs is 49 years. Thus, it can be said that the participants of the piloted program reflect the

overall population of NPs whom the suggested preceptor training targets. Moreover, the years of

experience as NPs among the participants ranged from one to three years to more than 20 years.

The half of the participants had more than 10 years of experience as an NP. The mean years of

experience as an NP among all NPs in the U.S. is 10 years (AANP, 2019b). Overall, a variety of

characteristics seen among the NPs participated in the program and they reflected the overall

NPs in the U.S. The piloted program was implemented at a federally qualified health center in a

rural community in the state of Hawaii. According to AANP (2019b), 89.2 % of NPs practice in

non-urban settings, such as rural communities. All of the participants were NPs who serve in

areas of primary care, which is reflective of national trend that the majority (87.1%) of NPs are

certified in a field of primary care (AANP, 2019b). It is important to note that all participants in

this pilot program have been a preceptor, and the length of experience as a preceptor varied from

one to three year to more than 10 years. Out of eight participants who responded to the


demographic questionnaire, six (75%) mentioned that they received a preceptor training for

either an RN, an NP, or other profession prior to this program. Although the power of this study

is limited due to the limited size of the sample, it can be mentioned that this kind of preceptor

training can be beneficial for NP preceptors who are new to a preceptor role to those who have

abundant experience in precepting students and received some kind of preceptor training in the

past.

Based on the evaluation of the results as above, it can be said that the goal of this piloted

NP preceptor training program, which aimed to increase NPs’ self-efficacy as a preceptor and

enhance their willingness to participate in preceptorship, was fulfilled. Although changes of the

level of the participants’ willingness to become a preceptor over time was not assessed

statistically due to the format of the willingness questionnaire and the nature of the variable, the

participants perceived that the piloted program had positive influence on their decisions to

become a preceptor in the future. The results demonstrated that the piloted NP preceptor training

program can enhance NP preceptors’ self-efficacy and willingness to participate in preceptorship

immediately and for a long term.

Strengths and Limitations of the Project

As any study has strengths and limitations, there are strengths and limitations of this

project. Strengths include that this is the first study to this date that examined if preceptor

training increases NPs’ self-efficacy and willingness to become a preceptor. In addition, the

suggested preceptor training program was created specifically for NPs. Furthermore, this is the

first study to this date that showed quantitative results demonstrating the OMP model can be

actually beneficial for NP preceptors. Gatewood and De Gagne (2019) published a study a few

months ago, and their systematic review regarding the OMP model showed that very limited


amount of quantitative studies examined the adoptability of the model in clinical setting. Their

study found that the majority of those quantitative studies were done among medical students,

residents, and doctors, and none of them were done among NP students and preceptors. Past

literature shows the potential benefits from application of the OMP model to NP preceptorship;

however, the feasibility and effectiveness of actual use of the model among NPs was examined.

One limitation of this project is the small sample size (n= 9) as it was a pilot study.

Future studies should employ a larger sample size in order to strengthen the power of the results.

Moreover, the employment of convenience sampling method is another limitation of this project.

This method was used because of its ease of use; however, the use of the method could have

caused some selection bias.

Recommendation and Implication for Practice

An insufficient supply of preceptors for NP students is a great concern for the U.S. health

care system at the present day and the future. Reliance on NPs to provide safe and cost-efficient

care for American citizens is expected to increase further due to impending worsening of the

physician shortage. Thus, it is critical to address the NP preceptor shortage issue.

The number of NPs in the U.S. is growing rapidly. Currently, there are more than

270,000 NPs in this country (AANP, 2019a). There are approximately 400 academic institutions

that offer NP programs in the U.S. (AANP, n.d.). Data from AACN (2018) showed that about

26,000 new NPs graduated in 2016-2017. Based on this data, it can be considered that the

number of practicing NPs are far more than that of the NP students. Although competitions with

other healthcare programs to find preceptors have been one of the causes for insufficient supply

for NP programs, these data show that there are enough number of NPs, who are potential

preceptors exist. Thus, better utilization of available human resources, in other words,


encouragement of practicing NPs to become preceptors would seem to be a critical solution for

this problem. Literatures revealed that there are multiple barriers for NPs to become a preceptor.

Compensation for preceptorship is a new trend to facilitate NPs to become a preceptor, however,

financial burden on NP programs and students is a concern. Potential alternative solutions, such

as preceptor training, to encourage NPs to become a preceptor without putting large financial

burden on NP programs and students are preferred and should be investigated.

Preceptor training is desired among NPs and can be beneficial for all NP preceptors,

students and NP programs. This piloted study showed that an NP preceptor training program can

increase NPs’ self-efficacy as a preceptor and bring positive influence on their willingness to

become a preceptor without excessive time or cost. As this was a piloted study, the sample size

was small; therefore, the power of the study is limited. Recommendations for future studies

include having a larger sample size to lead a stronger result. Moreover, implementing preceptor

training program on several days would fit NPs’ busy schedule better and increase their

participation rate. In addition, this piloted program was implemented at a health center that

employs NPs due to availability of resources for the study investigator, but such programs should

ideally be hosted by nursing schools that offer NP programs. Such nursing schools can directly

profit from conducting preceptor training because preceptor training can positively influence

NPs’ decisions to participate in preceptorship; thus, promote recruitment of preceptors for their

students as well as improve the quality of clinical education for their students. Additionally,

nursing schools usually already have resources for operation of such programs (e.g. a classroom,

a projector, a large projector screen, laptop, and a printing machine); thus, implementation of

preceptor training is more feasible. Furthermore, preceptor training is more cost-effective for

nursing schools compared to providing monetary compensation to each preceptor. It is hoped


that nursing schools across the country would consider providing preceptor training to NPs in

their community who are potential and existing preceptors to their students. Further studies are

necessary to examine the effects of preceptor training with larger samples and appropriate

contents and delivery of preceptor training.

Conclusion

This piloted study examined the effects of a preceptor training program for NPs on their

self-efficacy and willingness to become a preceptor. The results show that the suggested program

can increase NP preceptors’ self-efficacy as a preceptor and bring positive influence on their

decision to participate in preceptorship. Implications for practice include conducting such

preceptor training by nursing schools as a way to promote recruitment of NP preceptors and

improve the quality of clinical education for their students. Future studies should employ larger

samples to bring stronger results.


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Appendix A

One Minute Preceptor Pocket Guide

One Minute Preceptor


Appendix B

Recruitment Flyer


Appendix C

Demographic Questionnaire

Participant ID Number: _____________________

1. Age ____2. Gender __ M __ F__Other3. Have you been a preceptor (either for nursing students or NP students)?__No, never been a preceptor

__Yes, for less than 1 years__Yes, for 1 year to less than 3 years__Yes, for 3 years to less than 5 years__Yes, for 5 years to less than 10 years__Yes, for 10 years or more__Prefer not to answer

4. How long have you been a nurse practitioner?__Less than 1 year__1 year to less than 3 years__3 years to less than 5 years__5 years to less than 10 years__10 years to less than 20 years__20 years or more__Prefer not to answer

5. Years as a registered nurse__Less than 1 year__1 year to less than 3 years__3 years to less than 5 years__5 years to less than 10 years__10 years to less than 20 years__20 years or more__Prefer not to answer

6. Have you ever received formal preceptor training?__No __Yes __Don’t know/ Not sure __Prefer not to answer

a. If yes, please check all the training you received


__Preceptor training for registered nurses__Preceptor training for nurse practitioners__Preceptor training for other professions

b. If yes, approximate cumulative hours of past preceptor training___Less than 2 hours__2 hours to less than 5 hours__5 hours to less than 10 hours__10 hours to less than 20 hours__20 hours to less than 30 hours__30 hours or more

c. If yes, please check all the topics that were covered in previous preceptor training:___Learning styles___Evaluation of students___Teaching strategies___Conflict management___Communication strategies___Cultural competency___Preceptor roles and responsibilities___Student objectives/expectations___Other (please list)___________________________________________

___________________________________________7. Highest level of nursing education completed:___Baccalaureate degree___Masters degree ___Doctoral degree

Adapted with permission from Parsons (2007). Improving preceptor self-efficacy using an online educational program. International Journal of Nursing Education Scholarship, 4(1). doi: 10.2202/1548-923X.1339


Appendix D

NP Preceptor Self-Efficacy Questionnaire

Please circle the most appropriate response for each item below using the following scale:

1 = Completely lacking in confidence2 = Mostly lacking in confidence3 = Slightly lacking in confidence4 = Slightly confident5 = Mostly confident6 = Completely confident

HOW CONFIDENT ARE YOU THAT:

1 You have the ability to carry out your role as preceptor.

1 2 3 4 5 6

2 You have the necessary knowledge to work with a nurse practitioner student.

1 2 3 4 5 6

3 You have the necessary knowledge of the preceptor role to perform effectively as a preceptor.

1 2 3 4 5 6

4 You can maintain effective communication with students.

1 2 3 4 5 6

5 You can balance the multiple demands of students and your workload simultaneously.

1 2 3 4 5 6

6 You can assume a facilitative rather than a directive role with students.

1 2 3 4 5 6

7 You can effectively assess students' learning needs. 1 2 3 4 5 6

8 You can adapt your clinical teaching to meet a student's learning style.

1 2 3 4 5 6

9 You can select learning experiences that are congruent with course objectives.

1 2 3 4 5 6

10 You can promote the integration of skills learned in the classroom to the practice setting.

1 2 3 4 5 6


11 You can assist students to develop problem-solving skills.

1 2 3 4 5 6

12 You can assist students to develop critical thinking skills.

1 2 3 4 5 6

13 You can challenge students to use critical thinking skills.

1 2 3 4 5 6

14 You can deal effectively with unexpected events or unforeseen problems.

1 2 3 4 5 6

15 You can deal effectively with challenging students. 1 2 3 4 5 6

16 You can deal effectively with conflict in the student/ preceptor relationship.

1 2 3 4 5 6

17 You can support student ideas even when they are incongruent with your own.

1 2 3 4 5 6

18 You can provide verbal feedback to students about their performance.

1 2 3 4 5 6

19 You can provide a written final evaluation of student performance.

1 2 3 4 5 6

20 You can provide constructive feedback. 1 2 3 4 5 6

21 Rate your overall level of confidence in precepting a nurse practitioner student.

1 2 3 4 5 6

Adapted with permission from Parsons (2007). Improving preceptor self-efficacy using an online educational program. International Journal of Nursing Education Scholarship, 4(1). doi: 10.2202/1548-923X.1339

Appendix E

Willingness Questionnaire (Pretest)


Please circle the most appropriate response for each item below.


1. No 2. Yes

Q2. If you are not currently scheduled to precept in the next 6 months, how

likely are you to agree to become a preceptor in the next 6 months if given

the opportunity?

1.Not likely 2. Somewhat not likely 3. Neutral 4. Somewhat likely 5.

Very likely

Q3. What will make you more likely to participate in preceptorship? Please

describe the reason briefly below.

Appendix F


Willingness Questionnaire (Posttest)



1. No 2. Yes



1.Not likely 2. Somewhat not likely 3. Neutral 4. Somewhat likely 5. Very likely

Q3. Has this program had an positive effect on your decision to precept in the future?

1. Strongly disagree 2. Disagree 3. Neutral 4. Agree 5. Strongly agree

What will make you more likely to participate in preceptorship? Please describe the reason

briefly below.

Appendix G


Willingness Questionnaire (Follow-up)


Q1. Did you precept student(s) during the last 3 months after the program?

1. No 2. Yes

Q2. Did you use the OMP in your precepting practice since the program?

1. No 2. Yes

Q3. If you used the OMP, how helpful was it for your precepting practice?

1. Not helpful 2. Somewhat not helpful 3. Neutral 4. Somewhat helpful 5. Very helpful



1.Not likely 2. Somewhat not likely 3. Neutral 4. Somewhat likely 5. Very likely

Q5. Has this program had an positive effect on your decision to precept in the future?

1. Strongly disagree 2. Disagree 3. Neutral 4. Agree 5. Strongly agree

What will make you more likely to participate in preceptorship? Please describe the reason

briefly below.

Appendix H


Course Evaluation Survey

Please check the most appropriate response for each item below.

1. Do you think today's lecture about the One Minute Preceptor Model was helpful to you?__Strongly disagree__Moderately disagree__Slightly disagree__Slightly agree__Moderately agree__Strongly agree

2. Do you think you will use the skills and knowledge you learned from today's lecture in your teaching practice?

__Strongly disagree__Moderately disagree__Slightly disagree__Slightly agree__Moderately agree__Strongly agree

3. Please write any suggestion to improve the content and implementation of this course.

Appendix I


University of Hawaii Institutional Review Board Approval Letter

Appendix J

Timeline


Month/Year Project Goal Related Objective Activity Completion Date

3/2018 Develop a NP preceptor training program to teach NPs about One Minute Preceptor model grounded in available evidence.

Analyze existing literature regarding One Minute Preceptor model.

Perform a literature research to obtain research data regarding use of One Minute Preceptor model.

5/13/18

5/2018 Develop a NP preceptor training program to teach NPs about how to use One Minute Preceptor model in their practice setting based on the analysis of existing literatures about One Minute Preceptor model

Develop NP preceptor training program to teach NPs about One Minute Preceptor model based on available literature.

5/27/18

5/2018 Perform an evaluation of the proposed NP preceptor training program about One Minute Preceptor model

Conduct a pilot test of the NP preceptor training program

Submit PIP proposal to SRC. 5/31/18

6/2018 Submit a proposal to administration of WCCHC regarding implementation of the pilot testing at WCCHC and obtain MOU.

6/30/18

7/2018 Conduct oral proposal defense.Submit PIP to IRB.

7/30/18

8/2018 Recruit participants using poster, emails, and word-of-mouth.

8/31/18

8/2018 Hire one support staff to help the implementation of the pilot testing.

N/A(Did not need support staff)

8/2018 Hire a statistician. N/A (Did not need statistician)

9/2018 Conduct a pilot test of NP preceptor training program at WCCHC.

10/6/18

5/2018 Evaluate the piloted program.

Develop surveys for data collection.

5/27/18


9/2018 Administer the demographic survey, the NP preceptor self-efficacy questionnaire, and the willingness questionnaire before the training session (pretest).

10/6/18

9/2018 Administer the NP preceptor self-efficacy questionnaire and the willingness questionnaire immediately after the training session (posttest 1).

10/6/18

12/2018 Administer the NP preceptor self-efficacy questionnaire and the willingness questionnaire 3 months after the training session (posttest 2).

1/31/19

2/2019 Analyze the collected data. 3/26/19

3/2019 Make suggestions for improving the NP preceptor training program based on the results of the pilot test.

Evaluate the piloted program. 3/31/19

Appendix K

Consent Form


University of Hawaii at Hilo

Consent to Participate in Project:

Development of a Nurse Practitioner Preceptor Training Program

My name is Miki Miura. I am a graduate student at the University of Hawaii at Hilo in the School of Nursing. As a part of the requirements for earning my doctorate degree, I am doing a research project. The purpose of my project is to create an evidence-based nurse practitioner preceptor training program and examine if such program can improve self-efficacy of nurse practitioners and encourage them to precept students. The program will teach nurse practitioners about the One Minute Preceptor model, a well-established preceptor method used among other healthcare professionals to improve communication between students and preceptors and to help preceptors to give appropriate and adequate feedback to their students. I am asking you to participate because you are a nurse practitioner who is qualified to be a preceptor or has been a preceptor and practices at Waianae Coast Comprehensive Health Center.

Activities and Time Commitment: If you participate in this project, you will be asked to fill out a survey before the preceptor training class, immediately after the class and 3 months after the completion of the class. Survey questions will include question like, “You can maintain effective communication with students” “You can effectively assess students’ learning needs” Each survey will take 5 minutes or less. You will be also be asked about your demographic data, such as years of experience as a nurse practitioner and years of experience as a preceptor, once prior to the class.

Benefits and Risks: One benefit of participating in this project is that you may gain knowledge and skills regarding the One Minute Preceptor model at no cost. Take home pocket reference will be provided to each participant to remind them about the steps of the One Minute Preceptor model. If you feel stressed or uncomfortable answering any of the survey questions you can skip the question. You can also stop the survey or you can withdraw from the project altogether without any penalty.

Privacy and Confidentiality: I will keep all information in a safe place. Only my University of Hawaii advisors and I will have access to the information. Other agencies that have legal permission have the right to review research records. The University of Hawaii Human Studies Program has the right to review research records for this study. In order to minimize the risk of identification of the study participants, names of you and other participants will not be obtained. Instead, you will be given a participant ID during the survey, and the ID will be used to identify each participant in order to compare differences among pretest and posttests that each participant completes. Additionally, when I report the results of my research project, I will not use any other personal identifying information that can identify you. I will report my findings in a way that protects your privacy and confidentiality to the extent allowed by law. The project findings will be reported in aggregate, and no individual responses that can identify the responders will be shared.


Voluntary Participation: Your participation in this project is completely voluntary. You may stop participating at any time. If you stop being in the study, there will be no penalty or loss to you. Your choice to participate or not participate will not affect your rights to services at the Waianae Coast Comprehensive Health Center or employment condition. If you choose not to participate in this research project, you will also not be in the preceptor training class.

Questions: If you have any questions about this study, please call me at 808.932.7067 or email me at [email protected]. You may also contact my advisor, Dr Katharyn Daub at 808.932.7073 or [email protected]. You may contact the UH Human Studies Program at 808.956.5007 or [email protected] to discuss problems, concerns and questions, obtain information, or offer input with an informed individual who is unaffiliated with the specific research protocol. Please visit http://go.hawaii.edu/jRd for more information on your rights as a research participant.

Filling out the survey will be considered your consent to participate in this study.

Please keep a copy of the consent form for your records.

Mahalo!

Appendix L

Memorandum of Understanding with Waianae Coast Comprehensive Health Center

http://go.hawaii.edu/jRd

mailto:[email protected]




Appendix M

CITI Certificate

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