NSG/531 Week 1: The Nurse Educator Role and a Needs Assessment, sample paper

Eleven of Thirty-Four Gone in a Year: A Needs Assessment for Preceptor Development on the Medical-Surgical Units of a 190-Bed Community Hospital

[Student Name]

University of Phoenix

NSG/531: Program and Course Development

Week 1 Assignment

[Instructor Name]

[Date]

The hospital, its data and its staff are a composite written for a model paper.

Last year, the four medical-surgical units at our 190-bed community hospital hired 34 new graduate nurses. Eleven of them, 32%, left the hospital within twelve months, and four left nursing altogether. Each departure means paying again to recruit and orient someone new, and it leaves the units with months of short staffing and inexperience. As the clinical nurse educator for the medical-surgical service, I was asked by the chief nursing officer to find out why. This paper describes my role and presents the needs assessment that followed.

The Clinical Nurse Educator's Role

In a hospital, the clinical nurse educator plans, delivers and evaluates education that keeps nurses competent for the care in front of them, from orientation through ongoing competency. Unlike academic faculty, the hospital educator's learners are employees with limited time, and success is judged by performance, retention and patient outcomes rather than grades. The role also includes consultation. When managers bring a problem such as turnover, the educator's first task is to decide whether it is an education problem at all, and if it is, which learners need what. A needs assessment protects both the learners and the budget from a program built on a guess.

Why New Graduates Leave

The literature describes the first year of practice as a period of intense stress. Duchscher (2009) described transition shock, the anxiety, insecurity, inadequacy and instability new nurses feel as they move from student to professional, and noted that the new graduate's roles, responsibilities, relationships and knowledge all shape how intense and long it is. Casey et al. (2004) found that graduate nurses did not feel skilled, comfortable and confident for as long as a year after hire and argued for extended orientation and support. Because the preceptor is the person a new graduate works beside every shift in the first months, the preceptor is the most direct influence on that experience.

Source 1: Turnover and Timing

Of the eleven new graduates who left, seven left between months four and nine, after orientation ended but before they felt competent. Nine of the eleven had been precepted on the two units with the highest patient turnover. Units with lower turnover among new graduates had preceptors with more years of experience and fewer changes of preceptor during orientation.

Source 2: Exit Interviews

Exit interviews with the eleven nurses were reviewed. Eight named preceptor-related reasons. Five said they had three or more different preceptors during a twelve-week orientation. Four said their preceptors "did the hard things themselves" rather than letting them practice. Three described being criticized in front of patients. Two said they never learned how to organize a six-patient assignment before orientation ended.

Source 3: New Graduate Survey

All 23 new graduates still employed completed a short survey adapted from the domains of the Casey-Fink Graduate Nurse Experience Survey. On a four-point scale, the lowest-rated items were "my preceptor explained the reasons behind decisions," median 2, and "I received regular feedback on my progress," median 2. Most rated their preceptors' clinical skill highly, with a median of 4.

Source 4: Preceptor Survey

Forty-one nurses had precepted in the past two years; 33 responded. Only 9 had received any preceptor training, most of it a single online module years ago. Twenty-six said they were given a full patient assignment while precepting. Asked what would help, the most common answers were learning how to give feedback without discouraging, knowing how to tell whether an orientee is progressing and having protected time. Seventeen said they would not volunteer to precept again under current conditions.

Source 5: Observation

With permission, I shadowed six preceptor and orientee pairs for two hours each. Preceptors were clinically excellent and kind, but most taught by doing: they performed tasks while the orientee watched and rarely asked the orientee to explain her thinking. Feedback, when given, came at the end of the shift in general terms such as "good job today." None used a written plan for the orientation or a way of tracking progress.

The Gap

The sources agree. The hospital's preceptors are strong nurses who have not been taught how to precept. They teach by demonstration rather than by coaching clinical reasoning, give little specific feedback, have no structure for tracking progress and precept while carrying full assignments, with frequent changes of preceptor. New graduates experience this as a lack of explanation, feedback and consistency, and many leave in the months after orientation ends. Stated as a gap for program planning: most preceptors cannot yet coach a new graduate's clinical reasoning, give specific feedback or track progress against a plan, and the organization does not yet give them the time or structure to do so.

What the Literature Says About Preceptors

The pattern found here is well described. A review of the precepting literature found that preceptors are often chosen for clinical skill or availability rather than teaching ability, receive little preparation, carry full workloads while precepting and are rarely recognized for the role, and it proposed selection criteria, formal preparation, defined responsibilities and organizational support as the basis for effective programs (Ward & McComb, 2017). Each of those gaps appears in our data: preceptors chosen because they were on the schedule, 24 of 33 with no training, 26 with full assignments and 17 unwilling to precept again. The match between our findings and the published pattern increases confidence that the problem is real and that the solutions described in the literature can apply here.

Cost of the Gap

The gap has a financial side that leaders will weigh. Replacing a registered nurse requires recruitment, a twelve-week orientation during which the orientee and preceptor are both paid and months of lower productivity. Using the hospital's own estimate of the cost to replace one medical-surgical nurse, the eleven departures last year cost far more than a preceptor program would. Presenting the gap in both clinical and financial terms makes it easier for leaders to fund the time preceptors need.

What Education Cannot Fix

Two findings are not education problems. Full patient assignments during precepting and frequent preceptor changes are staffing and scheduling decisions made by managers. I will bring these to the nurse managers and the chief nursing officer alongside the education plan, because training preceptors to coach better will have limited effect if they have no time to coach.

Learner Characteristics

The learners are experienced medical-surgical nurses with a median of eleven years of practice, most with associate degrees and some with baccalaureate degrees. They work twelve-hour shifts, value practical learning and are proud of their clinical skill. Many feel they were never asked whether they wanted to precept. Their experience is the program's greatest resource.

Conclusion

The needs assessment traced a 32% first-year turnover among new graduates to a gap in preceptor preparation and support. Preceptors know how to nurse but have not been taught how to teach, and the organization has not given them the time or structure to do it well. The rest of this course will design a preceptor development program to close the education part of that gap.

References

Casey, K., Fink, R., Krugman, M., & Propst, J. (2004). The graduate nurse experience. Journal of Nursing Administration, 34(6), 303-311. https://doi.org/10.1097/00005110-200406000-00010

Duchscher, J. E. B. (2009). Transition shock: The initial stage of role adaptation for newly graduated registered nurses. Journal of Advanced Nursing, 65(5), 1103-1113. https://doi.org/10.1111/j.1365-2648.2008.04898.x

Ward, A., & McComb, S. (2017). Precepting: A literature review. Journal of Professional Nursing, 33(5), 314-325. https://doi.org/10.1016/j.profnurs.2017.07.007