Nurses as Teachers

Module 2: Competency

Define competency and explain the process

proc to teach and validate
competency.
Demonstrate the use of questioning in the implementation of
competency development.
Demonstrate the use of feedback as a strategy for competency
development and validation.

Introduction
Competency
essentially, the goal of the precepting process. Competency involves a
proficiency in technical skills, interpersonal skills, and critical thinking skills. Developing
competency is a process of assessing, planning, implementing, and evaluating an orientee. Validation
of competency requires validation of a specific learning experience, providing honest and objective
feedback, allowing for further opportunities for improvement, and achieving degrees of success.
Rural facilities have unique challenges in competency development and validation due to high risk/
low frequency events. Additionally, preceptors need to guide orientees through the stages of reality
shock in order to provide an environment conducive to forging competency.

Thesaurus: Competence
Capability, Ability, Skill, Fitness, Aptitude, Proficiency,
Competency, Know-How, Experience

www.nursesasteachers.org

2007 Rural Connection, Inc.

47

[ Module 2 ]

Defining Competency

Only 35% of new RN graduates, regardless of educational preparation and credentials, meet entry level
expectations for clinical judgement. - - Del Bueno, 2005.

Activity: Look at each group of words, choose the word that closely reflects the idea of competency.
A

Why did you choose that word?

Group One
knowledge
forceful
energetic
engaged

Group Two
original
dexterity
applicable
dominant

Group Three
casual
imaginative
expert
skill

Group Four
casual
performance
engaged
routine

Group Five
forceful
ingenious
defined
expectations
habit

Competency is...
The effective application of knowledge and skill in the work setting. (del Bueno, 1990)
The ability to perform a task with desirable outcomes under the varied circumstances of the real world.
(Benner, 1982)
The Joint Commission definitions speak more to the validation of competency...
Assessing staffs ability to meet performance expectations.
...the systematic collection of practitioner-specific data to determine an individuals capability to
perform up to defined expectations

Competency underscores what an orientee can DO and competency

validation must be measured in a clinical or simulated setting. It is
essentially the goal of the precepting process!

Nursing
N
ursing in
in rural
rural aareas
reas iiss uunique
nique aand
nd tthere
here are several common threads in rural nursing, including:
geographic isolation, scarce resources, and multiple practice roles (rural nurses wear many, many hats).
As such, rural nurses must be highly autonomous and independent.
What are your orientees strengths? How might those strengths work well in the rural setting? How
would you incorporate those strengths into building your orientees competency?

(SOURCE: Bushy, Orientation to Nursing in the Rural Community, 2000, p. 193)

48

2007 Rural Connection

Connection, Inc
Inc.

www.nursesasteachers.org
w
ww nursesasteachers org

[ Module 2 ]

Reality Shock

Reality shock is the shock-like reaction that newly graduated nurses, students, and newly hired
employees experience when they find that the careers for which they have been preparing or
transferred into do not operate with the same values and ideas that they learned in nursing
school or experienced in their pervious practice setting.
Phase

Ways to Assist Orientees

1. Honeymoon
~ Orientees are happy to
be in clinical rotations,
finished with school,
starting a new job!
Everything is probably
going great.
2. Shock
~ Orientee begins to
encounter weaknesses,
discrepancies, and
inconsistencies in the
work environment.

Develop the initial bonds between preceptors and orientees, created by a

mutual sense of trust, respect, and honor.
Harness their enthusiasm for learning new skills and routines.
Be realistic but do not stifle their enthusiasm.
Introduce them to new staff and coworkers.

Anticipate that orientees may experience some dissatisfaction with new

positions, peers, or employers.
Listen attentively.
Model the ideals of professional nurses.
Help orientees find appropriate supplies and functional equipment
when needed.
Provide opportunities to vent frustrations in a constructive manner.
Always treat orientees kindly.
3. Recovery
~ Orientee begins to
Help them view situations realistically.
Ask them to keep a journal of improvements they would like to suggest
perceive the realities
and what outcomes they expect or would like to see.
of the professional
Help them recognize positive aspects of their current work settings, as
practice environment
well as areas where improvements might be made.
with a balanced view of
Ease them into their roles and responsibilities. Do not release orientees
both the negative and
positives aspects.
to take full patient assignments until they are ready.
Protect them in times of adversity.
Always speak kindly about nurses and other healthcare providers.
Help orientees regain their sense of humor.
4. Resolution
Identify and manage any conflicts and confusions that persist.
~ Orientees may adopt Assist them in constructive and creative problem-solving.
less than ideal beliefs to Describe mechanisms and processes available to resolve perceived
resolve conflicts of values
problems or confusion.
and find ways to fit in
Give simple, easy-to-follow directions for tasks.
with their coworkers.
Help them combine the best aspects of their prior school or work
expectations with their current work situations.
Caution: Help orientees retain the positive aspects of their nursing
values/belief systems from school and from the practicing nurses.

(adapted from Alspach-Grif, A Preceptor Training Program, 2006)

www.nursesasteachers.org

2007 Rural Connection, Inc.

49

Categories of Competency

[ Module 2 ]

TECHNICAL SKILLS are tasks performed efficiently and safely using the following:
cognitive skills
knowledge
psycho-motor skills and abilities
technical understanding (ability to follow directions and carry out procedures)

Technical competence is the most familiar and objective skill domain. Elements are traditionally found
on checklists and competency is measured by direct observation of psycho-motor tasks. Efficiency
components are often added to assess advanced competency.

INTERPERSONAL SKILLS are tasks performed efficiently and safely using the following:
communication
directing others
customer service
articulation (of expectations and boundaries)
conflict management
appreciating diversity
delegation facilitation
team building
collaboration
listening
respecting
caring

Interpersonal competence is the effective use of interpersonal communication when working with
others. This competency, also, is often found on checklists and measured by direct observation of
interactions and behaviors that consistently convey caring and courteous attitudes. Team building,
conflict resolution, and customer relations are the key elements of interpersonal competence.
CRITICAL THINKING SKILLS are tasks performed efficiently and safely using the
following:
problem-solving
fiscal responsibilities
time management
clinical reasoning
priority-setting
reflective practice
planning
learning / teaching
creativity
dealing with change
ethics
resource allocation
Critical thinking / Decision-making competence is the skill that addresses orientees abilities to apply
principles of critical thinking, creative problem-solving, clinical judgement and decision-making
to evidence-based practice: assess facts, recognize problems, identify alternative actions, anticipate
outcomes, and make choices. To measure competencies in this skill domain, preceptors must be more
creative in their verification methods. Competencies are predicated on orientees abilities to recognize
problems, identify alternative actions, anticipate outcomes, and make choices based on the most
current best practices. Asking questions helps them get beneath the surface of problems, generate more
questions, and increase the number of possible solutions.
50

2007 Rural Connection, Inc.

www.nursesasteachers.org

[ Module 2 ]

Categories of Competency

Precepting in Practice
...an implementation strategy
Consider the process for competency validation/orientation checklists at your facility. How are the
concepts of technical skills, interpersonal skills, and critical thinking skills assessed in this process?

Commitment
Collaboration

Competency
When individuals know what is
expected of them and feel skilled
in taking action, they are more
able to participate in the change
process. Their competency
is developed when they are
provided the education to expand
their knowledge and skills.

Change requires people to work

together to achieve a shared goal.
When individuals understand
the part they have to offer, feel
competent and confident in their
abilities to accomplish the work,
and respect the contributions
of others, collaboration and
teamwork thrive

www.nursesasteachers.org

True commitment to
accomplishing a shared goal
comes from each individualss
contribution, ownership for
their part, and competence and
confidence in accomplishing
the work in collaboration with
others. When these conditions
are in place, progress is steady,
problem-solving is creative and
proactive, and desired results are
achieved.

2007 Rural Connection, Inc.

51

[ Module 2 ]

Competency Development

Competency Development
Assess
- What competency do I want to help my orientee develop?
- What does my orientee already know?

Plan
- How will I teach this?
- What tools do I have or need?

Implement
- Am I using the right tools / methods effectively?

Evaluate
- How will I know if my orientee is competent in this skill?
- How will I validate?

Competency Module Case Study

You are the preceptor of a newly hired RN who recently graduated. As her preceptor, you
need to know if she knows how to start an IV and you will be validating her competency to
perform this skill. You have the tool that your facility provides for this competency.

ASSESS
Questions:

What competency do I want to help my orientee develop?

What does my orientee already know?
Assessment Tools:
Orientation Checklists (varies in each setting)
Competency Measurement Systems (PBDS, Hospital Specific Competency Checklists, Rural
Connection Competency Toolkit)
Using these tools, a preceptor can assess an orientees competency by using a variety of verification
methods. Competency verification methods are approaches to competency assessment that
preceptors can use to complement the unique ways that orientees access and process information.

Activity: Using the competency verification methods on the next page, think about the case
study about starting an IV.

52

2007 Rural Connection, Inc.

www.nursesasteachers.org

[ Module 2 ]

Assess - Competency Validation Methods

Competency Validation Methods

Tests/examsmeasure cognitive skills and knowledge only; they are for competencies that
require an outcome of the retention or understanding of information.
~ written tests, quizzes, surveys, worksheets, calculation tests
Return demonstrationsmeasure technical skills only
~ CPR, ACLS, use of new equipment, skills checklists, direct observation
Evidence of daily workmeasure skills in the technical domain; assess the actions
demonstrated on a daily basis to do the job
~ direct observation
Case studiesmeasure critical thinking skills
~ performance-based interviews
Exemplarsmeasure both critical thinking skills and interpersonal skills that are difficult
or impossible to observe
~ customer service, learning on the fly, professionalism
Peer reviewsmeasure both critical thinking skills and interpersonal skills
~ professionalism, 360-degree assessments, customer service
Self assessmentsmeasure critical thinking skills associated with values, beliefs, myths,
and assumptions
Discussion/reflection groupsmeasure critical thinking skills; when linked with mock
events, may measure technical and interpersonal skills
~ debriefing after a crisis intervention, discussions using case studies, root cause analysis
after a sentinel event
Presentationsmeasure knowledge and understanding
~ debriefings, grand rounds, shift reports, journal clubs, review boards, inservices
Mock events/surveysassess responses in daily work or practice; reflect individual
performance; important to debrief after mock events
~ simulations, mock codes, simulated disaster drills or other emergency situations, mock
surveys for accreditation, mock surveys of proper equipment use and maintenance
Quality improvement monitorscheck compliance with policies and protocols;
benchmark desired outcomes and achievement of those outcomes
~ chart/documentation audits, medical records, compliance with policies and protocols,
appropriate equipment set-up/tear-down/clean-up

www.nursesasteachers.org

2007 Rural Connection, Inc.

53

[ Module 2 ]

Plan
Plan
How will I teach this?
What tools do I have or need?
How will I teach this?

What needs to be learned or experienced?

How is the information/skill going to be used or
implemented?
How is the learning going to be evaluated?
How would the orientee learn this best based on
learning style?

Apathy can be overcome by

enthusiasm, and enthusiasm can
only be aroused by two things:
first, an ideal, which takes the
imagination by storm, and second, a
definite intelligible plan for carrying
that ideal into practice.
- - Arnold Toynbee

What tools do I have or need?

Does my setting have a pre-existing training methodology or tool for this skill?
Am I the best person to teach this skill?
When would be the best time to teach this skill?

Activity: Below are some examples of competency practice tools at your finger tips. Looking at the
tools, in your facility, in what order would you have your orientee practice them?

______
______
______
______
______
______
______
______
______
______
______
______
______
______
______
______
______
______

54

DEMONSTRATE a skill with the orientee at your side

Allow the orientee to SHADOW you or a co-worker with skill proficiency
Ask the orientee to ANTICIPATE what will happen next by creating scenarios
READ hospital policy and procedures
OBSERVE a procedure
VIEW videos or training manuals
Skill SIMULATION
USE the Rural Connection Competency Toolkit
REVIEW the competency checklist with step-by-step instructions
Have the orientee ASSIST you
COMPLETE documentation and order entry for meds, therapy, diagnostic testing, etc.
DO learning modules
DESCRIBE priorities, potential complications & expected interventions when executing a skill
Have the orientee PRACTICE a skill or piece of equipment and offer feedback
REVIEW charting, computer use, forms, flowsheets, I&O
SCAVENGER HUNT for supplies/equipment/information/people
STUDY information specific to procedures and equipment use
TOUR different areas or parts of the building

2007 Rural Connection, Inc.

www.nursesasteachers.org

[ Module 2 ]

Plan

In the case study starting an IV, to answer the questions How will I teach this? and What
tools do I have or need?, you should first find out your orientees preferred learning style.
How will you find that out?
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
From your assessment, you discover that your orientee is a novice who has never done this skill
before. What is the primary characteristic of a novice learner?
_______________________________________________________________________
How will that influence your learning sessions?
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Your orientee is a kinesthetic learner. Which of the Plan strategies might be most effective
and benefitial to your orientee?
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________

www.nursesasteachers.org

2007 Rural Connection, Inc.

55

[ Module 2 ]

Implement
Implement
Am I using the right tools / methods effectively?

Review the competency validations tools available in your practice.... then review the specific
learning experience you need to validate. The following questions will help identify actionsteps or gaps between where your orientee is and the tools you need to get them to where they
need to be.
Questions

Information Gained

What are we trying to achieve?

When are we going to do it?
How will we know when we have
succeeded?
What is happening right now?
What are the consequences?
What do we want to be different?

Clear objectives
Agreed dates
Measurement

What can we change?

What are the options?
How can we change it?
What are the risks?
What are the barriers?
What steps are we going to take to
achieve this?
Who is going to do what?
What is our time frame?
What resources do we need to help us?
What actually happened?
Did we achieve the outcome we wanted?
What went well?
What have we learned?
How can we improve?

Clear picture of current situation &

actions
Effect of current actions
Gap between where we are and where we
want to be
Identify possibilities
Broaden vision
Seek solutions
Evaluate choices
Obstacles to overcome
Clear action steps
Agreed responsibilities
Agreed milestones
Determine support

Clarify outcomes
Evaluate degree of success
Discoveries made
Establish further potential

(Adapted from Motivating People, T. Bently, pg. 99)

56

2007 Rural Connection, Inc.

www.nursesasteachers.org

[ Module 2 ]

Implement

For the starting an IV case study, imagine that your orientee has successfully started an IV in a
simulation. Even though you are confident that your orientee is able to complete the procedure
safely, you want to develop her ability to think critically about the procedure as it applies to a real
patient and examine her own competency in this procedure. A method that will assist the orientee
in both of these areas is questioning.
You have found an opportunity for your orientee to do an IV start on a patient with you at her
side. The orientee approaches the patient, pulls back the covers and begins to look for a vein. The
patient makes eye contact with you and looks frightened and questioning. You want to model how
to make the patient comfortable while you are doing the procedure, so you introduce yourself and
the orientee, as well as explain the procedure to the patient. During your explanation, the orientee
goes to the nurse server and begins to put on gloves. You have discussed with the orientee during
your previous teaching, the risks and complications of this procedure. So, during the procedure,
the orientee begins to talk to you about the risks and possible complications. I sure hope I can
find a vein on the first try....
The orientee performs the IV insertion safely, according to the directions you have provided. As
she finishes, a call light sounds and she says to you, I need to get that. She removes her gloves and
lays them on the counter and leaves the room. She has forgotten to remove the tourniquet. You
make the patient comfortable, remove the tourniquet and dispose of the dirty supplies. Now you
must give the orientee feedback on the procedure and validate the competency.
How will you employ questioning techniques in this situation with the orientee?
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
________________________________________________________ __________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________

www.nursesasteachers.org

2007 Rural Connection, Inc.

57

[ Module 2 ]

Evaluate / Validate
Evaluate / Validate
How will I know if my orientee is competent in this skill?
How will I validate?
evaluate
1 : to determine
or fix the value of
2 : to determine the
significance, worth, or
condition of, usually by
careful appraisal and
study

validate
1 a: to make legally valid
: ratify b: to grant official sanction to by marking
<validated her passport> c: to confirm the validity of
(an election); also : to declare (a person) elected
2 a: to support or corroborate on a sound or
authoritative basis, experiments designed to validate
the hypothesis> b: to recognize, establish, or illustrate
the worthiness or legitimacy of validate his
concerns

Orientation provides a time for both performance development and validation.

The process is intended to

support the developing nurse in his/her transition to the role of the nurse in any new setting. Performance
(competence) assessment/validation:
is a critical component of the performance development process
at some point, competence must be demonstrated
requires specific and measurable criteria
is a pass/fail process with pre-determined measurable criteria that must be met

Validation of a Specific learning experience

Remember... competence is the combination of skill, knowledge base, and critical thinking transformed
into effective and relevant action. In most instances, the preceptor becomes the validator the person who
signs off and verifies the competence for the orientee. This signature indicates that there is evidence that
the orientee has the ability to deliver a certain aspect of care or knowledge with a thorough grasp of:

TECHNICAL SKILLS,

INTERPERSONAL SKILLS,

CRITICAL THINKING SKILLS.

Evaluation method:
Verbal explanation
Demonstration
Observation

58

2007 Rural Connection, Inc.

Level of Competency Achieved

Times completed successfully
Beginner
Practice exercise
Intermediate
Interactive class
Expert

www.nursesasteachers.org

[ Module 2 ]

Evaluate

Level of Competency Archived...........3

COMPETENT

NOVICE

Requires direct supervision in

all functions, fails to perform
nursing care safely, does not
recognize the need to increase
knowledge or skill base and
cannot independently use
knowledge appropriate to nursing
care.

Usually functions with minimal

need for supervision, usually
performs patient care safely,
and applies nursing knowledge
appropriately. Has recognized
the need to learn and improve
skills.

EXPERT
Consistently functions with
minimal need for supervision,
safely performs patient care,
incorporates nursing knowledge
and patient care skills, applies
nursing knowledge appropriately.
Demonstrates a desire to learn
more.

Activity: Facilitating Competency - - Spinning Towards Success

Questioning tool for evaluating competency
Questioning techniques help gain more factual information and better insight into the situation.
Instructions: Read and understand the following questioning techniques. Then, spin the Spinning Towards
Success pinwheel and test your ability to frame the different kinds of questions...
Exploratory: Questions that seek to know what happened and gain a clear picture of the situation
Informational: Questions that seek to clarify the outcomes, discoveries made, and other factors that may
have influenced a situation
Reflective: Questions that hope to identify possibilities, broaden vision, and evaluate choices
Reflective & Solution - Oriented: Questions that seek solutions and to identify persons and ideas for
the future
Agreeing: Questions that hope to find agreed timelines, measurement, and objectives
Planning: Questions to prompt creation of a future plan, prioritization of problem, and to develop
resolutions
Open: Questions that generate awareness and responsibility during the learning process
Closed: Yes or no questions that save people from having to think and close exploration
...continued on next page.

www.nursesasteachers.org

2007 Rural Connection, Inc.

59

[ Module 2 ]

Evaluate

Questioning tool for evaluating competency .... continued

Technique
Exploratory / Open

Question
When did you first form that
opinion?

Informational /

Open
Reflective &

Solution - Oriented /
Open
Planning / Open

Closed

What would work best for

you?
What else was happening at
the time?
What ideas do you have for
resolving this situation?
What steps can we take to
prevent this from happening
again?

Information Gained
Specifically, what was
happening that resulted in the
problem starting and when it
happened.
Persons preferred option
and one they see they can
achieve.
Other factors that may have
influenced the situation.
The persons ideas for
resolving the situation.

How will I know if there are

any problems in the future

that we need to discuss?
Are you sure you know how to
do this?

Responsibility & actions the

person is willing to take in the
future to prevent the problem
recurring.
Responsibility & actions the
person is willing to take in the
future to resolve the situation.
Yes or No opinion or answer.

Questioning
Questioning may compel the orientee to give a descriptive account of what they did (actions) and
reflect on:
what worked well and why
what didnt work well and why
what could be done differently next time to improve performance
In developing effective questioning skills, remember that open questions are much more effective for
generating awareness and responsibility in the learning process. Closed questions save people from
having to think and close the door to deeper exploration on the issue. The most effective questions
for raising awareness and responsibility begin with words that seek to quantify or gather facts.
Words Like:
What........................?
When.......................?
Who.........................?
How would................?
60

2007 Rural Connection, Inc.

www.nursesasteachers.org

[ Module 2 ]

Feedback

Feedback - - Honest and objective feedback about performance

Principles of providing feedback:

Positive: Whenever possible, provide positive feedback.
Constructive: When necessary, provide constructive feedback.
Negative: Unless an emergency situation arises, avoid giving negative feedback.

Honest and Objective Feedback

Specific
Factual
Information sharing
Descriptive
Based on mutual respect

Timed appropriately
Sensitive to the orientee
Constructive
Directed at behavior
Leads to positive outcomes

Know when to give feedback:

Timing is everything. If possible, give feedback immediately, when the situation is still fresh so
that learning can occur immediately. Preceptors need to consider the situation as a whole, not just
from the aspects of their own needs. Make an appointment with the orientee, setting time, place
and the agenda. Remember, no surprises. Encourage the orientee to evaluate own performance
and share own observations.

POSITIVE FEEDBACK

Be clear about what you want to say.

Be specific.
Be descriptive.
Dont use labels or exaggerate.
Speak for yourself, give I-messages.
Phrase the issue as a statement, not a question.
Listen to the other persons response and discuss future
strategies for handling a similar event.

www.nursesasteachers.org

Small opportunities are

often the beginning of great
enterprises.
- - Demosthenes
Opportunity is missed by
most because it is dressed
in overalls and looks like
work.
- - Thomas Edison

2007 Rural Connection, Inc.

61

Feedback

[ Module 2 ]

Activity: Positive Feedback

Remember, part of your role as a preceptor is to act as a role model and demonstrate how to give
effective feedback to the learner about performance.
What is positive feedback? Give an example.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
What are the long-term benefits of positive feedback?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Describe a time when positive feedback made a difference in your learning experience?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Evaluating performance / competency involves both sending and receiving information and both
parties feeling valued and understood, even though they may hold different values or opinions.
Feedback needs to encourage the orientee to engage thinking and get involved.

TYPES OF NEGATIVE FEEDBACK

Personalized criticism:
Negative comments about the persons abilities. This usually results in loss of confidence and selfesteem. It also blocks the learning process and the orientees future performance becomes worse
rather than better.
Judgmental comments:
Negative comment about the work itself. Although directed at the work and not the person,
it lessens confidence and belief in own abilities. It offers no information as to what needs
improvement.
Unspecified Comments:
Talking in very general terms without specifying exactly what was good or what needed changing.
Person still uncertain what and how to improve.
Giving Advice:
Telling the person what to do and how to do it better next time. Telling usually meets with
resistance and excludes the person from the relationship and thinking for oneself.
Body language: and words or tone of voice dont match.
62

2007 Rural Connection, Inc.

www.nursesasteachers.org

[ Module 2 ]

Feedback

What is negative feedback? Give an example.

____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
What are the long-term drawbacks of negative feedback?
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Describe a time when negative feedback made a difference in your learning experience.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Feedback should recognize the degree of success achieved
Evaluations should be affirming and future-oriented. It is important to identify things that are
positive and encouraging. You will also want to identify what has been accomplished and suggest
ways to build on those areas in the future. Evaluations should be educational and enhance selfesteem.
Always recognize the good
Encourage
Define what is expected and whats been achieved
Recognize skills & abilities
Recognize & acknowledge efforts
Allow the orientee an opportunity to learn from trial & error
Recognize team work
Find a quiet, controlled environment without interruptions.
Maintain a relaxed but professional atmosphere.
Put the orientee at ease.
Review specific examples of both positive and negative behaviors.
Discuss future needs and goals.
Express confidence in the orientees ability to do the work.
Be sincere and constructive in both praise and criticism.
Ask the orientee how you, as a preceptor, can improve the learning experience.
Based on the evaluation feedback, what could the orientee do to improve the learning experience?

www.nursesasteachers.org

2007 Rural Connection, Inc.

63

[ Module 2 ]

Feedback
When not to give feedback:
[
[
[
[
[
[
[
[

You dont have sufficient information about the situation.

You dont care about the person.
The time, place or circumstances are inappropriate.
You do not have time to fully discuss the events with the person. Its unfair to give hit and run
feedback.
The person has no power to prevent the situation happening again.
The other person seems low in self-esteem.
You are low in self-esteem.
Your purpose is not really improvement, but to demonstrate how much smarter or responsible
you are.
When you sit down with an orientee for an evaluation, do the following:
In the IV insertion case study, the final steps are feedback and validation. Is there something you
might do differently or something that might be more helpful for your orientee? ___________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
___________________________________________

Precepting in Practice
...an implementation strategy
Would my orientees performance improve if I...
gave more encouragement?
provided more feedback about what is expected?
listened more to staff concerns about the job?
let orientees try new ways to achieve their goals?
recognized their skills & abilities more often?
recognized & acknowledged their efforts more often?
allowed them more opportunity to learn from trial & error?
provided more training & a more supportive learning environment?
asked them more about how I could best support them?
role modeled best practice better?
gave more examples of best practice?
encouraged team work more?
used problem solving processes with them more?
gave better feedback?
set definite objectives & followed through better?
(adapted from the Vermont Nursing Internship Program).

64

2007 R
Rurall C
Connection,
i
IInc.

www.nursesasteachers.org
w
ww nursesasteachers org

[ Module 2 ]

Whats Next...?

Competency Validation Quick Action Plan

Does one skill have you and your orientee at a crossroads in learning a specific competency?
Try having the orientee complete the following form...

Quick Action Plan

Action Plan Discussion Points
Objective:
What skill or ability do you want to change
or improve? (It must be specific, attainable,
and measurable.)

Comments / Actions Needed

Goals Achieved:
How will you know what you have
accomplished? (Be specific)

Problems:
What barriers, resistance, or obstacles
might you anticipate?

Solutions:
How do you plan to avoid or deal with these
problems?

Resources:
What people, time, equipment, and
materials will you need?

Benefits:
Whats in it for you and for the organization?

www.nursesasteachers.org

2007 Rural Connection, Inc.

65

[ Module 2 ]

Swansons Five Caring Processes

Competency..... thats not on your checklist.

Kristen Swanson: Five Caring Processes

Maintaining Belief

Maintain a fundamental belief in persons and their capacity to make it through events
and transitions and face a future with meaning. Practices include having faith and
maintaining a hope-filled attitude, going the extra mile.

Knowing

Strive to understand an event as it has meaning in the life of the other. Understand the
lived realities of those served. Practices include avoiding assumptions, centering on the
other, thoroughly assessing, seeking cues and expertise from other colleagues.

Being with

Be emotionally present to the other. Practices include being there, enduring, listening,
attending, disclosing, not burdening.

Doing for

Do for the other what they would do for themselves if it were possible. Practices
include preserving dignity, protecting, comforting, and performing competently.

Enabling / Informing

Facilitate the others passage through life transitions and unfamiliar events. Practices
include explaining, informing, generating options, supporting, advocating, validating,
anticipating and preparing for future needs.
Source: Swanson, Kristen (1999). Effects of Caring, Measurement, and Time on Miscarriage
Impact and Womens Wellbeing. Nursing Research, 48, 288-298.

66

2007 Rural Connection, Inc.

www.nursesasteachers.org

[ Module 2 ]

Competency Validation - Case Study

Jeremy
emy iiss a people
peopple person.
perrson
n. He
He quickly
quiickkly adjusted
addjusted to
t the organizational climate. He has already made
a few friends on the unit and treats coworkers, patients, families, and visitors with respect. He is
very proficient with the computer documentation systems and completes his notes and reports in a
timely manner. During your review of his patient care records, you note several discrepancies with
care procedures that are not in accordance with established unit policies and procedures.
How would you evaluate Jeremy and provide him with feedback on his performance?

Britney has been a very enthusiastic orientee.

orientee Her
H customer service skills are well developed.
She takes extra time with her patients, readily anticipating their needs and meeting them.
Her competency verifications are complete. She finished her competency skills checklist. She
consistently demonstrates increasing knowledge of unit policies and procedures. Yesterday, she
filled out all the proper forms for a patient transfer to another health care facility. Her only
problem is organization. Despite having given her feedback and recommendations several times
during orientation, she is frequently late in completing assignments and leaving her shift. Youre
starting to be concerned about the amount of overtime Britney has accumulated due to her lack of
organizational skills.
How would you evaluate Britney and provide her with feedback on his performance?

www.nursesasteachers.org

2007 Rural Connection, Inc.

67

[ Module 2 ]

Case Study for Competency

Youu are a preceptor iin

n a 1100 bbed
edd rurall h
hospital
ospiital in which you have very limited support services.
In addition to providing nursing care to a variety of patients, nurses are also expected to provide
most of the RT, OT, PT, social work and pharmacy services (mixing IVs, dispensing emergency
meds, etc.) especially on nights and weekends. Your orientee is an experienced RN from a large
urban medical center who is angry about performing the non-nursing functions and seems
overwhelmed. On several occasions she has asked other nurses on the floor to complete these tasks
for her and its starting to create some tension amongst the staff who is gossiping about why this
outsider came to town. Your orientee is married to your sons baseball coach and you attend the
same church.
Are there symptoms of Reality Shock going on with this new RN?

How will you approach this nurse in social/community situations when you are not in the
workplace?

Consider
onsiider h
how
ow ddeveloping
evellopiing andd mai
maintaining
intaiiniing com
competency might be unique in a rural facility. Nurses
in rural facilities work in many different areas as Expert Generalists and with this comes the
challenge that rural nurses must also be competent in a multiplicity of skill areas. Furthermore,
whereas an urban facility might see certain types of high-risk specialty cases with some regularity,
these might be seen infrequently in a rural facility. These high-risk, low-frequency cases pose
significant challenges to maintaining competency. How might a preceptor in a rural facility work
with an orientee in developing competency in a high-risk, low-frequency skill?

(Source: Bigbee (1993) The Uniqueness of Rural Nursing, p. 139)

68

2007 Rural Connection, Inc.

www.nursesasteachers.org

[ Module 2 ]

Developing a Teaching Strategy

Growing into the Preceptor you want to be...

Incorporating the Nursing Process - - assess, diagnose & plan, and treat - - develop a teaching strategy to use
with orientees that combines an understanding of learning styles and generational differences, and integrates
Benners Model of Nursing Clinical Competence and the concepts of adult learning.
I. Assess

1. What is your learning style? ___________________________

2. What is your orientees learning style? ________________________
3. Where is the orientee on Benners Model of Nursing Clinical Competence? ____________________
Youll need to assess the orientees previous experience and competencies in order to assess learning needs.
4. Does the orientee have any non-learning needs? ____________________________________________________________
___________________________________________________________________________________________________________________

Note: Learning needs are gaps between an orientees present level of competence, performance,
knowledge, or abilities that result from the need for additional instruction or practice. Non-learning
needs are when there are gaps in competence, etc., that result from something other than additional
instruction or practice. They are situations that ought to be addressed during the preceptorship and
include:

personal or family problems

environmental factors (stress or anxiety,
health problems (including lack of sleep)
cluttered work areas, noise or other
attitude problems (lack of motivation or
distractions)
desire to learn)
use of drugs or alcohol
lack of resources
unrealistically heavy patient assignments
conflicting demands on time or attention
5. Determine the priority of the learning needs.
Ask the orientee to prioritize learning & non-learning needs
As the preceptor, develop a prioritized list of the orientees needs - - some
needs should take priority because they represent:
- essential aspects of care (CPR performed correctly)
- safe patient care (proper medication administration)
- elements of care for all patients (proper documentation)
Negotiate the prioritization list with the orientee until consensus is achieved.
Remember, for the adult learner, it is important to allow the orientee to have
some discretion in this as well.
Write the list out for future reference.

www.nursesasteachers.org

2007 Rural Connection, Inc.

69

[ Module 2 ]

Developing a Teaching Strategy

II. Diagnose & Plan

1. Establish a plan for how the preceptorship experience will meet the learning needs of the
orientee. One strategy is to divide the list into groups to be achieved over a period of time.
Identify a period of time each day where the orientee will be in clinical.
Be specific about the learning needs that should be met during each period.
Record the progress of the orientee at each objective.
2. Establish goals and objectives for the preceptorship. Ensure that there is enough time during
the preceptorship to reach these goals and objectives. Be realistic about the time it will take.
3. Determine what activities will help to meet these goals and objectives. Select teaching methods that are
appropriate for the learning needs and are compatible with the orientees learning style.
III. Implement
Precepting clinical staff involves more than helping them with technical and psycho-motor skills. Clinical
competencies require knowledge of theory, principles use, interpersonal and communication skills, and an
appropriate disposition or attitude towards the preceptorship and the patients being cared for during the clinical
experience.
1.
2.
3.
4.

Prioritize the objectives weekly.

Take advantage of low-volume procedures.
Use the entire patient population, not just a specific group.
Let others know of learners needs.

IV. Evaluate

Providing feedback to orientees is essential.

Measure the behavior

Compare the behavior against an established standard
Appraise whether the observed behavior meets the standard
Base your decision and recommendation on that appraisal.

Adapted from Swihart, D. (2007). Nurse Preceptor Program Builder. HCPro, Inc.

70

2007 Rural Connection, Inc.

www.nursesasteachers.org

[ Module 2 ]

Whats next...?

Precepting in Practice
...an implementation strategy
As a preceptor, how do you respond to these Whats next...? situations or statements?
1) Your orientee comes to you and asks, What do you think I should do about Mrs. Jones chest
pain? She says it feels like it did when she had her heart attack.
Whats next...?

2) You have a new graduate who has no clinical work experience beyond his student learning. This
is your first meeting. It is the beginning of your shift.
Whats next...?

3) You are a preceptor for a new graduate who has difficulty discussing patient needs / concerns
with physicians. She has just successfully convinced an MD to talk to a patient who is concerned
about her diagnosis.
Whats next...?

4) Your orientee is in his third week of orientation. He successfully completed his clinical
assignment for medication administration. He comes to you in a panic saying, I just gave Mr.
Smith the wrong medication.
Whats next...?

www.nursesasteachers.org

2007 Rural Connection, Inc.

71

[ Module 2 ]

72

2007 Rural Connection, Inc.

www.nursesasteachers.org