a systematic review on interventions supporting preceptor ...a systematic review on interventions...

A Systematic Review onInterventions Supporting PreceptorDevelopment

Maryann Windey, PhD, MS, MSN, RN-BC ƒ Carol Lawrence, PhD, MS, BSN, RNC-OB, CBC ƒKimberly Guthrie, PhD, MS, MSN, RN ƒ Debra Weeks, DNP, MSN, RN-BC ƒElaine Sullo, MLS, MAEd ƒ Deborah W. Chapa, PhD, ACNP-BC, FNAP, FAANP

Increases in newly licensed nurses and experienced nurses

changing specialties create a challenge for nursing professional

development specialists (NPDS). The NPDS must use the

best available evidence in designing programs. A systematic

review of interventions for developing preceptors is needed

to inform the NPDS in best practice. A search was conducted

for full-text, quantitative, and mixed-methods articles

published after the year 2000. Over 4000 titles were initially

identified, which yielded 12 research studies for evaluation

and syntheses. Results identified a limited body of evidence

reflecting a need for NPDS to increase efforts in measuring

the effectiveness of preceptor development initiatives.

(See CE Video, Supplemental Digital Content 1, http://links.

lww.com/JNPD/A9)

Building a comprehensive nurse preceptor devel-opment program is essential for acute caresystems in today’s healthcare environment. Acute

care organizations are challenged with an overwhelmingnumber of nursing students obtaining clinical practice

hours, newly licensed nurses entering the profession, andexperienced nurses seeking opportunities in new practicespecialties (Auerbach, Buerhaus, & Staiger, 2011). Meetingthe psychosocial and developmental needs of these nursestransitioning into new roles falls to the nursing professionaldevelopment specialist (NPDS). TheNPDS serves a vital rolein the creation of preceptor development programs and re-lies on best practices as identified in the literature (AmericanNurses Association & National Nursing Staffing Develop-ment Organization, 2010). Prepared preceptors can alsolead to nurses’ improved satisfaction and improved reten-tion rates (Lee, Tzeng, Lin, & Yeh, 2009; Sandau, Cheng,Pan, Gaillard, & Hammer, 2011).

BACKGROUND AND SIGNIFICANCENursing Turnover and ReplacementTheNPDSmust keep informed of nursingworkforce trends,such as turnover rates, projected shortages, and changingdemographics, and their implications when planning pre-ceptor development interventions. The turnover rate ofnew nurses has been reported anywhere between 35%and 61%during the first year of practice (Anderson, Linden,Allen, &Gibbs, 2009; Beecroft, Kunsman, & Krozek, 2001).Moreover, the cost of replacing one nurse is at least $44,000,withonestudyestimatingup to$67,100 (Halfer,Graf,&Sullivan,2008; Jones, 2005). Estimates that account for inflation and aremore practical, are probably closer to $82,000 if vacancies arefilled with experienced nurses (Jones, 2008).

Surge of New NursesFederal and state legislators have worked to address con-cerns over the nursing shortage for years. It has beenreported that 850,000 nurses in the United States are be-tween 50 and 64 years old (Buerhaus, Auerbach, Staiger,& Muench, 2013). The 2004 National Sample Survey of Reg-istered Nurses reported that over 55% of nurses intend toretire between 2011 and 2020, and as a result, new nursingprograms have appeared throughout the country, andpostsecondary schools have expanded their programs(Dracup & Morris, 2007). This surge of new nurses is pre-dicted to swell toward the end of this decade, and it willdramatically increase between 2020 and 2030 (Auerbachet al., 2011). These trends point toward an overwhelming

Maryann Windey, PhD, MS, MSN, RN-BC, is Intern DevelopmentSpecialist, Lee Memorial Health System, Fort Myers, Florida.

Carol Lawrence, PhD,MS, BSN, RNC-OB, CBC, is Supervisor of PerinatalPractice, Education, Research, and Lactation, Lee Memorial HealthSystem, Fort Myers, Florida.

Kimberly Guthrie, PhD, MS, MSN, RN, is Clinical Education Specialist,Lee Memorial Health System, Fort Myers, Florida.

Debra Weeks, DNP, MSN, RN-BC, is Professor of Nursing, FloridaSouthWestern State College, Fort Myers, Florida.

Elaine Sullo, MLS, MAEd, is Coordinator, Information & InstructionalServices, The George Washington University, Washington, DC.

Deborah W. Chapa, PhD, ACNP-BC, FNAP, FAANP, is Director, DoctorofNursingPractice, TheGeorgeWashingtonUniversity,Washington,DC,and Nurse Practitioner in Palliative Care, Lee Memorial Health System.

Source of funding: was a research grant from the Association for NursingProfessional Development.

The authors have disclosed that they have no significant relationshipwith,or financial interest in, any commercial companies pertaining to this article.

Supplemental digital content is available for this article. Direct URL cita-tions appear in the printed text and are provided in the HTML and PDFversions of this article on the journal’s Web site (www.jnpdonline.com).

ADDRESS FOR CORRESPONDENCE: Maryann Windey, 636 Del PradoBlvd. Cape Coral, FL 33990 (e<mail: [email protected]).

DOI: 10.1097/NND.0000000000000195

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need for prepared nursing preceptors to assist with thetransitioning of nurses into the workforce.

Identified Gap in the LiteratureThe literature is abundant with interventional researchstudies attesting to the successful outcomes related tothe development of preceptors. Billay and Myrick (2007)completed an integrative review summarizing how alliedhealth disciplines describe preceptorship; however, thestudy did not address preceptor development.Mann-Salinaset al.’s (2014) systematic reviewonevidenced-based precep-tor programs found a paucity of evidence-based strategies tosupportpreceptordevelopment.Theauthors’ reviewexcludedstudies including preceptors of students (Mann-Salinas et al.,2014). This identified gap in the literature is a challenge fortheNPDS,who is taskedwithgathering the evidence availableto provide for the developmental needs of both students andstaff requiring preceptor support during role transition.

Preceptor DevelopmentPreceptor development is one intervention that the NPDSuses to address the development needs of those enteringnew roles within the acute care organization. Luhanga,Dickieson, and Mossey (2010) state that the success ofthe orientation to the environment is dependent on theproper preparation of the preceptor as supported by a for-malized educational program. When Billay and Myrick(2007) conducted their integrative review on allied healthpreceptorship, education of the nursing preceptor was aprominent theme in the literature. The need for the creationof preceptor development programs is profuse in the nursingliterature (Almada, Carafoli, Flattery, French, & McNamara,2004; Luhangaet al., 2010).Moreover, one study reported that49%ofpreceptors didnot feel theywere adequatelypreparedfor the role of preceptor (Yonge, Hagler, Cox, &Drefs, 2008).

PURPOSE OF THE STUDYA formalized systematic review is essential to help the NPDSevaluate best practices for preceptor development programs.Levels of evidence reside on a hierarchy with systematicreviews ranking the highest (Bettany-Saltikov, 2012). Thepurpose of this study was to review, assess, analyze, andsynthesize the best available evidence of interventions thatsupport preceptor development to inform theNPDS practice.

SYSTEMATIC REVIEW METHODOLOGYStudy DesignA systematic review was conducted, guided by processesrecommended by the Evidence Based Practice Centersfunded by the Agency for Healthcare Research and Quality(2014). Processes were developed to identify and select rel-evant articles, review and rate the individual articles, andthen synthesize results and grade the evidence. No meta-

analysis was planned as considerable heterogeneity acrossarticles was anticipated with regard to participant samples,definitions of outcomes, length of follow-up, and settings.

Literature Search and EligibilityA literature search was conducted as recommended by thePreferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement (Moher, Liberati, Tetzlaff,Altman,&PRISMAGroup, 2009). Studyeligibility criteriawereestablished a priori. Inclusion criteria were primary studieswithnursingpreceptors of students, newgraduates, or nurseschanging specialties; full text; published; peer reviewed; andEnglish language originating from any country. Quantitativestudies about nursing preceptor developmentwere includedif thesettingswereacutecarehospitalor inpatient rehabilitation,and reported at least one intervention and onemeasurable out-come. Excluded studies were unpublished dissertations andthosestudies focusedonpreceptorsofadvancedpracticenurses.

Search strategies were adapted from Cochrane and theNational Institute for Health andClinical Excellence protocolsto systematically searchPubmed,CINAHL (EBSCOHost),Dis-sertations & Theses (Proquest), ERIC, Scopus, and CochraneLibraries of Systematic Reviews andClinical Trials (OVID) da-tabases from 2000 through March 2014 (Chandler, Churchill,Higgins, Lasserson, & Tovey, 2013). The searches weredesigned for high sensitivity to locate any study of preceptordevelopment. The search was limited to articles publishedbetween January 2000 and March 2014 to capture a timelybody of research that is consistent with the findings ofBillay and Myrick (2007), who reported that most articlespertaining to education of nursing preceptorswere publishedafter 2000. Search selection strategies were conducted in astepwise fashionwitha teamof five reviewers: Two reviewersindependently examinedall titles for inclusion criteria. Consen-sus was reached, and abstracts were reviewed independentlyby two reviewers. Consensuswas reached, and the full-textarticles were randomly assigned and examined by two re-viewers. Bibliographies of full-text articles were searched tolocate additional articles, and 94were found (see Figure 1).

Data ExtractionData were divided among the research team. Each sectionof data was extracted by two reviewers with both clinicaland methodological expertise. Detailed evidence tableswere completed from the data extraction performed. Datawere rechecked against the original articles for accuracy. Ifdiscrepancies were discovered, these were discussed bythe team, resolved, and corrected.

Quality Assessment Tools

Medical education research study quality instrumentThe Medical Education Research Study Quality Instrument(MERSQI) andBest Evidence inMedical Education (BEME)were used to rate study quality andwere selected because of

Journal for Nurses in Professional Development www.jnpdonline.com 313


their frequent use inquality assessmentofmedical andnursingeducation (Cook, Levinson,&Garside, 2011; Reed et al., 2008;Sullivan, 2011; Yucha, Schneider, Smyer, Kowalski, & Stowers,2011). The MERSQI contains 10 items that rate study qualityin six domains of research quality: study design, sampling,type of data (subjective or objective), validity, data analysis,and outcomes (Reed et al., 2008). The maximum score foreach domain is 3with amaximumMERSQI score of 18. Thepotential range is 5Y18. Domain scores that had a ‘‘not ap-plicable response’’ optionwere adjusted to thepercent of totalachievable points for that domain to allow for total scale scor-ing (Reedet al., 2008).MERSQIhasbeen found tohave strongcontent validity, interrater reliability (r = .72Y.998), and in-ternal consistency reliability (! = .57Y.92) and adequatepredictive validity and criterion validity comparedwith othervariables, suchaspublishedversus rejectedmanuscripts (Cooket al., 2011;Reedet al., 2007, 2008;Yuchaet al., 2011). Internal

consistency of theMERSQI in nursing education is supported(! = .55; Yucha et al., 2011).

Best evidence in medical educationThe BEME global scale assesses two domains, the strengthof the evidence (range = 1Y5, 1 = no clear conclusions canbe drawn to 5 = results are unequivocal) and outcomesbased on the Kirkpatrick’s levels of educational outcomes(seeTable 1;Hammick,Dornan,&Steinert, 2010; Littlewoodet al., 2005). Limited validity and reliability evidence for theBEMEwas located in the literature. However, positive corre-lations have been found between the MERSQI and BEMEinstruments (r = .58Y.62; Cook et al., 2011). Two reviewersindependently rated the quality of each studywith an agree-ment rate of 100%. The research team discussed but did notrank three additional items as recommended by Colthartet al. (2008): (a) the appropriateness of the design of the

FIGURE 1 Flow diagram: review of records for interventions to support preceptor development.



study to answer the research questions posed, (b) howwellthe design was implemented, and (b) the appropriatenessof the analysis with elaboration on any concerns.

RESULTS OF THE STUDYFour thousand five hundred one articles were identifiedthrough database searching and other sources. Twelve articleswere selected for qualitative synthesis (see Figure 1). The12 interventional researcharticles thatwere selected forqualityrevieware summarized inTable 2. Tenof the researcharticleswerequasi-experimental, and twowereofexperimentaldesign.Seven of the articles used a longitudinal design, and five useda cross-sectional design. In addition, 11 of the studies used aprospective design, whereas one used retrospective and pro-spectivedimensions. In6of the12articles, researchers reportedusing a theoretical or conceptual model as a framework fortheir studies (see Table 2). Ten studies used the primary in-tervention of workshops, which may have included variousinstructional methodologies such as group discussion, roleplay, and/or printed materials (see Table 2). The two remain-ing studies used CD-ROM or a printedmanual self-directedlearning.

Content TopicsStudy authors reported the inclusion of a variety of contenttopics as part of the preceptor development intervention(see Table 2). Content most frequently reportedwas givingand receiving feedback (83%), effective communication

(75%), facilitating adult learning (58%), reviewing rolesand responsibilities of the preceptor role (58%), and the de-velopment and evaluation of clinical judgment (50%).Contents such as evidenced-based practice, mentoring,time management, diversity, rewards and benefits, andmotivation were reported infrequently, with inclusion inonly one study each. Thereweremany evaluationmethods(dependent variables) used to determine effectiveness ofthe intervention (see Table 2). Dependent variables asreported by the study authors ranged from low-level par-ticipant satisfaction measures to high-level patient safetyquality indicators, such as decreases in medication errors,patient falls, and incidents.

Quality Assessment ScoresMERSQI and BEME scores were calculated based on therigor of the research design and the level of outcomesreported (see Table 3). The range of MERSQI scores was7Y15, with a mean of 11.38 (SD = 2.21; see Table 1). Therange of BEME strength scores for the 12 articles was2Y4, with a mean of 3.08 (SD = 0.67). The BEME outcomescores were predominately lower level outcomes (25.0%2a-Attitudes or perceptions, 41.7% 2b-Knowledge andskills, 16.7% 3-behavioral change, 8.3% 4a-organization prac-tice, 8.3% 4b-patient benefits). A correlation between bothtools’ strength scores showed a positive but weak correla-tion (r = .13) and was not statistically significant (p 9 .05).

Methodological ConcernsAfter addressing the three additional discussion ques-tions, as recommended by Colthart et al. (2008), theresearch team identified methodological concerns. Twoof the 12 studies were found to use an inappropriate de-sign for the study question. One study used a posttest-only design, and another study used a dependent variable(evaluation) that was inconsistent with the research ques-tions. Seven of the studies (58.3%) had a design that wasnot well implemented. Some examples of concern werehigh attrition rates, small sample sizes, and/or lack of fidel-ity to administer the intervention reliably. Additionalconcerns ranged from unreported validity of the instru-mentation to a risk of a Type 1 error from lack of controlfor t test pretest scores. Six of the studies (50%) reportedan appropriate analysis for their study. The discussion alsoidentified strength in the diversity of interventions, sampleselections, and design analysis.

DISCUSSIONThis systematic review provided a rigorous analysis of thecurrent state of evidence pertaining to preceptor development.Most studies reported success with a variety of instructionalstrategies, many of which were offered during workshops.Multiple creativemodalities were implemented, such as theuse of CD-ROM, learner-directed modules, and resources.

TABLE 1 Descriptive Statistics for QualityVariables (n = 12)

MERSQI score

Mean (SD) 11.38 (2.21)

Median (range) 11 (7Y15)

BEME strength of evidence score

Mean (SD) 3.08 (0.67)

Median (range) 3 (2Y4)

BEME outcome score

1: Participation (0)

2a: Attitudes or perceptions 25.0% (3)

2b: Knowledge and skills 41.7% (5)

3: Behavioral change 16.7% (2)

4a: Organizational practice 8.3% (1)

4b: Patient benefits 8.3% (1)

BEME = Best Evidence inMedical Education;MERSQI =Medical EducationResearch Study Quality Instrument.



TABLE

2Description

oftheArticlesSe

lected

forQua

litativeAna

lysis

Article

ResearchQue

stion

Theo

retical

Fram

ework

Inde

pend

ent

Variable(s)

Dependent

Variable

(orOutcome)

SampleSize

andSetting

Results

Nursing

Specialty

Popu

lation

Al-Hussam

i,Saleh,

Daraw

ad,an

dAlram

ly(2011

)

Nurses

whoco

mplete

apreceptortrainingprogram

willshow

increased

know

ledgeof

theconcepts

andskillsof

preceptorship

comparedwith

thecontrol

group.Gen

der,yearsof

clinical

experience,an

dlevelofed

ucatio

nwill

affect

knowledge

levels

forboth

theexperim

ental

andco

ntrolgroups.

King’stheo

ryof

goal

attainmen

tPrecep

torsattend

edclasswhereseven

moduleswere

presentedby

lecture,

groupdiscu

ssion,

andprintedmaterials.

Increasedpreceptor

knowledge

asmeasuredbythe

Knowledge

Assessm

entIndex

n=68

,preceptors;

fourhospita

lsiden

tifiedas

governmen

tal,

teaching,

and

private

inJordan

Theexperim

entalgroup

had

significantlyhigherknow

ledge

scoresafterim

plemen

tatio

nofthepreceptortraining

program

asco

mpared

with

theco

ntrolgroup(p

G.001).

Theexperim

entalgroup

had

sign

ificanth

igher

scoreson

theposttest(p

G.001)a

sco

mpared

with

thepretest.

Analysisofco

varian

ceresults

showed

nodifferen

cein

perform

ance

relatedto

demog

raphics

such

asage,

yearsofexperienceinnu

rsing,

andas

apreceptor(p9.05).

Notiden

tified

Notspecified

Bradleyetal.(2007)

Whatimpactdo

esthe

blendedlearning

approach

haveon(a)learner

satisfactionwith

the

educatio

nal

experience,

(b)learner

preparationin

theclassroom

setting,

and

(c)instructorsatisfaction

with

teachingin

the

classroom

setting?

Notreported

Five

self-paced

Web

-based

training

andinstructor-led

sessions

Learner

satisfaction,

instructorperceptions

oflearnerpreparation

andpartic

ipation,

instructor

satisfaction

n=12

0preceptors,

n=16instructor

faculty,sixpediatric

hospita

ls

Highim

pactreported

by

preceptors:onlineco

ntent

prepared

them

forclassroom

activities

(91%),classroo

mactivities

reinforced

conc

ept

learne

din

theWeb

-based

training

(96%),im

proved

know

ledgerelatedtotherole

(94%

),un

derstood

strategies

forprovidingandreceiving

feedback

(93%

).Mod

erate

impactrepo

rtedby

instructor

faculty:changed

theway

they

taugh

ttheliv

eco

urse

(56%),stronglyagreed

that

onlin

eco

urseprovided

the

opportunity

touse

activ

elearningstrategies

intheliv

eclasses(53%),increased

satisfactionin

teachingthe

material(53%).

92%

ped

iatric

nurses,8%

RT,

rehab

ilitatio

nspecialistsan

dlabo

ratorytechs

Onlyiden

tifiedas

new

employ

ees

Hagleret

al.(2012)

Does

instructionin

eviden

ce-based

practice

(EBP)methodsincrease

knowledge

and

endorsem

entofEB

Pam

ongpreceptors?

Notreported

Eigh

thalf-day

workshopstaugh

tbyacad

emic

expertsin

EBP

EBPBeliefsscale,

increasedinterest

inEB

P,seeking

further

education/

trainingin

EBP,

increaseduseofEB

P

n=16

0preceptors,

sixdiverseho

spitals

inArizon

a(56Y

450

beds;sixno

nprofit,

oneteaching,

two

federal,two

specialty

hospitals)

Statisticallysign

ifican

tim

provemen

tontheEB

PBeliefsScaleafterintervention

(pG.001

).Intheendofstud

ysurvey,6

2%

reported

anincreasedinterestin

EBP,

43%

reported

seeking

additionaled

ucatio

ninEB

P,an

d52%

reported

anincrease

intheiruse

ofE

BP

Notiden

tified

Studen

tnurses

Con

tinued

TABLE

2Description

oftheArticlesSe

lected

forQua

litativeAna

lysis



.Contin

ued

Article

ResearchQue

stion

Theo

retical

Fram

ework

Inde

pend

ent

Variable(s)

Dependent

Variable

(orOutcome)

SampleSize

andSetting

Results

Nursing

Specialty

Popu

lation

Hallin

andDanielson

(2009)

Towhat

extentd

opreceptorsin

2000

(preim

plemen

tatio

n)an

d20

06(postim

plem

entation)

differconcerning:Preceptor

preparation?Su

pportfrom

teache

rs,colleague

s,ch

ief

nurses,and

enrollednu

rses?

What

relatio

nshipsexist

betweenpreceptors’

experiences

ofpreceptoring

andtheirpersonal

and

clinical

characteristics?

And

ersson

-Tho

rell,

Westlu

nd,an

dAthlin

’sPreceptor

Model

Preceptormodel,

preceptorw

orkshops,

plan

ning

/evaluation

ofmeetin

gs,

personal

supportof

thepreceptor,

guidelines

for

preceptorrefle

ctive

andself-learning

activities,w

orksheets

forfeed

backan

devaluationof

studen

ts,a

nd

precepteegoalsetting

Perceived

experiencesof

preceptor

preparationan

dperceivedexperiences

ofpreceptorsupp

ort

n=11

3precep

tors

(preinterven

tion),

n=109

precep

tors

(postin

terven

tion),

county

hospita

lin

Swed

en

Sign

ifican

tim

provemen

tin

preceptors’experiences

between20

00an

d200

6(p9

.05)insevenofthenine

variables

studied.Sign

ificantly

more

preceptorsin

2006reported

that

they

wereprep

ared

for

therolean

dha

dsupp

ortfrom

instructors,peers,ch

ief

nurses,and

stud

ents(pG.05).

Astrongpo

sitiverelatio

nship

was

found

inprecep

tors’

expe

rien

cesin

therolean

dlevelo

finterestinfuture

preceptoring(r=.21Y

.071

,p=

.03toG.001).Othercorrelations

foundam

ongpersonal

and

clinical

characteristics.

Med

ical

infectioncare,

orthoped

icsurgical,

gynecological

care,emergency

andped

iatric

care

Studen

tnurses

Horton,DeP

aoli,

Hertach

,an

dBower

(2012)

Did

thepreceptors

feel

betterprepared

toprecept

afterattendingtheNurse

PreceptorAcadem

y?

Watson’sTheo

ryofHuman

Caring

NursePreceptor

Academ

yday

(8-hour)workshop

that

included

assessinglearning

needs,

communication

constructive

feed

back,

conflict

resolution,

completionof

MyersYB

riggsType

IndicatorAassessment

toincrease

awaren

essof

individu

aldifferences

andbeh

aviors

Preceptor

preparation,cou

rse

contentb

eing

used

inpractice,preceptor

satisfaction,an

dsupport

n=71

4preceptors,

18Kan

sasCity

Metropolitan

hospita

ls

Preceptorpreparation:4.46

ona5-pointLikertscale(1=

no,2

=probab

lynot,3=

undecided

,4probab

ly,5=

yes).Courseco

ntentusage

3Y9

monthsafterattending

workshop:65%

usedsetting

weeklygo

als;49%

used

MyersYB

riggspersonality

type

A

andself-aw

arenessinformation;

46%

used

weeklyevaluations;

44%

usedpreceptee’s

evaluationofp

receptor

perform

ance;4

1%

used

criticalthinkingquestio

ns;

33%

used

finalmeetings

with

preceptee,manager,and

/or

educator;2

6%celebrated

attheendof

orientation;

25%

used

novice-to

-expertm

odel;

15%

used

conceptm

apping;

9%used

graduationfornew

graduatenu

rses

Perceived

supp

ort:fro

mco-w

orkers=

4.13,from

man

ager

and

educators=4.20(1

=definitely

notto

5=allof

thetim

e).

Preceptorsatisfactionwith

theirrole=4.17an

dlevelof

beinghap

pyas

preceptor=

4.18based

ona5-point

Likertscale(1

=very

low,

5=very

high).

Notiden

tified

New

lylic

ensed

nurses

Con

tinued

TABLE

2Description

oftheArticlesSe

lected

forQua

litativeAna

lysis,Con

tinu

ed



.Contin

ued

Article

ResearchQue

stion

Theo

retical

Fram

ework

Inde

pend

ent

Variable(s)

Dependent

Variable

(orOutcome)

SampleSize

andSetting

Results

Nursing

Specialty

Popu

lation

Komaratat

and

Oumtanee

(2009)

Will

new

grad

uatenurses’

competen

cyincrease

after

theim

plemen

tatio

nofthe

nursemen

torship

model?

Will

aman

ual

of

men

torship

increase

preceptorkn

owledge?

MortonYC

oopers

andPlam

er’sMod

elofMen

torship

Process,a

nd

Taechaveerako

rnan

dOumtanee’s

Nurse

Com

petency

Concepts

Men

torship

model:

(a)p

reparationof

preceptorsvia

workshopan

dindep

enden

tstudy

ofaman

ual

of

men

torship,(b)

workingwith

precepteewith

assign

edduties,(c)

mentoringtermination

New

lylicensed

nurseco

mpeten

cy(N

ursing

Competen

cyScale),preceptor

knowledge

(Men

torship

Knowledge

Scale)

n=19new

lylicensednurses;

onehospital

inBangkok,T

hailand

New

lygrad

uated

nurses’

competencywas

significantly

higher

postexperim

entthan

preexperim

ent(p

G.05).

Preceptorknowledge

scores

increasedfrom

8.35to11

.76

(maxim

umscore

=15).

Notiden

tified

New

lylicensed

nurses

Leeet

al.(2009)

Willapreceptorship

program

affect

(a)new

nurseturnoverrates;(b)

turnoverco

st;(c)quality

ofnursingcare;(d)

satisfactionofp

receptors’

teaching

;and

(e)preceptor

percep

tionsof

rewards,

ben

efits,support,an

dco

mmitm

ent?

Notreported

(a)A

9-hour

preceptortraining

program

with

monthly

seminars,

(b)trainingman

ual

with

instructions

fornew

staff

New

nurse

turnov

errates;turnover

costs;

quality

ofnu

rsing

care

(med

ication

errors,fallrates,and

patientsatisfaction);

satisfactionof

preceptor’s

teaching;

andpreceptor

perceptio

nsof

rewards,ben

efits,

support,an

dco

mmitm

ent

n=24preceptors,

n=34

newnu

rses,

1800

-bed

teaching

med

ical

center

inTaiw

an

Turnoverratesim

proved

from

33.1%

(preintervention,

previousyear)to

15.4%

(postintervention)

Decreased

turnovercostsaved$1

86,102

duringa6-m

onth

study

perio

dMedicationerrorrates

improved

(previou

syear

=0.037per

1000patient

daysto

0.013duringstudy

period);fallratesim

proved

(previousyear

=0.29per

1000patientd

aysto

0.23

duringstudyperiod);

adverseeven

tdecreased

(previousyear

=0.30per

1000patientd

aysto

0.24

duringstudyperiod).

Overallpatientsatisfaction

did

notsign

ificantly

improve

overpreviousyear

(p9.05).Su

bcatego

ries

of

attitudeofnursingstaff,

privacyofpatients,tranq

uility

ontheward,a

ndfeed

back

ofq

uestio

nsto

provider

improved(p

G.05).

Satisfactionwith

preceptors

was

above

satisfactory

andpositive,

butnot

sign

ificant(p

9.05).

Notiden

tified

Studen

tnurses

Con

tinued

TABLE

2Description

oftheArticlesSe

lected

forQua

litativeAna

lysis,Con

tinu

ed



.Contin

ued

Article

ResearchQue

stion

Theo

retical

Fram

ework

Inde

pend

ent

Variable(s)

Dependent

Variable

(orOutcome)

SampleSize

andSetting

Results

Nursing

Specialty

Popu

lation

Preceptorperceptionsof

rewards,ben

efits,

support,

andco

mmitmen

twere

described

2.85Y3

.15ona

4-pointLikertscale(higher

score

indicatinggreater

understan

dingofben

efits,

rewards,support,an

dco

mmitmen

t).

Parker,Lazenby,

andBrown,(2012)

Istherean

increase

inperceived

knowledge

(of

thepreceptor)afterview

ing

aninstructional

CD?

Notreported

Astate-of-the-

science

CD-ROM

instructional

tool

forthepreceptor

Perceived

knowledge,CD

effectiven

essan

dqualitysurvey,

telephonesurvey

toassessifpreceptors

view

edCD

and

associated

factors

fornotview

ing,

preferen

ceov

erWeb

-based

optio

nan

d/orno

tebo

ok

n=11

2senior

stud

ents/preceptor

dyadsrecruite

d;

however,few

completed

follo

w-up(final:

n=14Y18basedon

outcom

emeasure;

multiplesm

allrural

community

hospita

lsan

dmetropolitan

med

ical

centers,

both

teaching

andresearch

Themeankn

owledgescores

wereno

tsignifican

t(p9.05).

CD

effectiven

ess/qu

ality:

positivefeedback

with

quality

(overallqu

ality

rating=good,

M=4.5;1=stronglydisagree,

5=stronglyagree).The

preceptorsresponded

with

thegreatestagreem

ent

regardingtheun

derstand

able

contento

fthe

CD.T

heleast

agreem

entwas

fortim

erequ

ired

forview

ingtheCD.

72.2%

oftheprecep

tors

stated

they

didnot

view

the

enclosed

CD,6

5%repo

rted

lack

oftim

eas

afactorfor

not

view

ingtheCD,and

50%

indicatedthataWeb

-based

form

atcouldbe

abetteroption.

Multip

lebut

not

limed

tolabo

r/delivery,medical

surgical,

emergency,

neo

natal

intensive

care,

bonemarrow

tran

splant

Studen

tnurses

Riley-Dou

cet(20

08)

WillaPreceptorO

rientation

Self-LearningEd

ucatio

nmodule

impactp

receptor

know

ledgeandsatisfaction?

Notreported

Preceptorman

ual

that

included

sectionson

introductionto

the

capstonesenior

nurseco

urse,

teachingstrategies

forthe

adultlearner,

effectivepreceptoring,

coaching

,feedb

ack

andevaluation

Preceptorknow

ledge

ofco

urse

objectives

andsatisfaction

n=119preceptors,

vario

usteaching

hospita

lsin

the

Midwest

Knowledge:posttest

knowledge

scores,

M=90

.13%

(SD=7.019

%).

Notspecified

Studen

tnurses

Con

tinued

Description

oftheArticlesSe

lected

forQua

litativeAna

lysis,Con

tinu

edTA

BLE

2



.Contin

ued

Article

ResearchQue

stion

Theo

retical

Fram

ework

Inde

pend

ent

Variable(s)

Dependent

Variable

(orOutcome)

SampleSize

andSetting

Results

Nursing

Specialty

Popu

lation

Satisfaction:Ona5-point

Likertscale(1=strongly

disagree,

5=strongly

agree),preceptors

reported

satisfactionwith

themodule

(M=4.49,SD

=0.569),

highread

ability

ofthe

self-learning

mod

ule(M

=4.48

,SD=0.58

5),satisfaction

with

thelayoutofthemod

ule

(M=4.32,SD

=0.632),

andhelpfulness(M

=4.41,

SD=0.615).

Sandau

etal.(2011

)What

was

theeffect

ofa

n8-ho

urpreceptoredu

cation

program

on(a)p

receptors’

confidence

andcomfortin

fivespecificpreceptorin

groles,(b)satisfactionan

dco

nfid

ence

among

preceptees

whohad

precep

torswho

completed

theworkshop,

and(c)

precep

teeretention?

BetweenCohort1

preceptorsan

dCohort2

preceptors,was

therea

differen

cein

comfort,

confid

ence,an

dthefiv

especificpreceptorroles?

Ben

ner’sNovice

toExpert

8-hourman

datory

preceptorworksho

pPreceptor’s

self-rep

orted

confiden

cean

dco

mfortin

five

specific

roles,

freq

uen

cyof

coachingcritical

thinkingan

dprovidingform

alfeedback,preceptees’

satisfactionan

dco

nfid

ence,

preceptees’retention

rateswerecompared

for1-yearpre/post

workshop.

Cohort1:past

precep

tors(n=74)

andpastpreceptees

(n=39

),Coh

ort2:

preintervention(n=

300)preceptors

andpreintervention

preceptees(n=53

),alargeMidwest

hospita

l,lic

ensed

for926bed

s

At3Y6

months,

Cohort1

preceptors

reported

improvedsatisfaction(p

9.05)withtheirpreceptor

educationin

allfive

roles

than

they

had

before

the

workshop.Sign

ifican

tim

provemen

tin

thef

requen

cythepreceptor

worked

withpreceptees

intheprevious3Y6

monthsto

actively

coachcritical

thinking(p

G.001),butno

sign

ifican

tincrease

was

notedin

freq

uen

cyof

form

alfeed

back(p

9.05).

Preceptees

inCohorts1

and2showed

nosign

ificant

differen

cein

satisfactionor

confid

ence

(p9.05).

Retentionratesforp

receptees

for1

yearbeforeversus

1year

aftertheed

ucatio

nal

interven

tionwere

sign

ificantly

greater1-year

postinterven

tion(p

G.05).

Notspecified

Experienced

nurses,same

specialty,

and

experienced

nurses

chan

ging

specialty Con

tinued

Description

oftheArticlesSe

lected

forQua

litativeAna

lysis,Con

tinu

edTA

BLE

2



.Contin

ued

Article

ResearchQue

stion

Theo

retical

Fram

ework

Inde

pend

ent

Variable(s)

Dependent

Variable

(orOutcome)

SampleSize

andSetting

Results

Nursing

Specialty

Popu

lation

Cohorts1an

d2preceptors

had

sign

ifican

tlyhigher

satisfactionwithed

ucation

scores

relatedtopreceptorin

g(p

=.001

).Nosignificant

differencewas

foun

dwith

comfortandconfidence

inthefivepreceptorin

groles

(p9.05).H

owever,transfer

nurses

show

edsignificantly

higher

scores

inconfidence

onthecompletionof

first

assignmentand

confidence

intheuseof

criticalthinking

(pG.05).

Smed

ley,

Morey,

andRace(2010)

Willpreceptors,after

completingtheco

urse

report,(a)increase

know

ledg

eofthe

teaching

andlearning

proc

ess;(b)

increase

knowledge,

understan

ding,an

duse

of

generic

preceptorskills;

(c)increase

preceptor

self-effic

acy;

and(d)

positivelych

ange

attitude

towardstuden

tnurses?

Notreported

Anaccreditedcourse

inthemasterof

nursingcu

rriculum

ataco

llege.The

blended

course

was

provided

over

asemesteran

dincluded

bothlecture

andself-directed

learning.

PreceptorProgram

Educational

Outcomes

(PPEO

)scale.Th

esubscales

include

preceptor

knowledge

ofteaching

andlearning

processed

,generic

preceptorskills,

preceptor

self-effic

acy,an

dpreceptorattitudes

towardstudentnurses.

n=117preceptors,

onehealthcare

facilityin

Australia

Nosign

ifican

tdifferen

cewas

foundin

anyofthe

PPEO

subscales

based

on

dem

ograp

hic

variab

les

(pnotreported

).Threeregressionmodels

wereiden

tifiedthat

support

variousoutcomemeasures

andPPEO

subscalean

ddem

ograp

hic

variab

les:

predictorsofstuden

tpreceptorself-efficacy

(mod

elacco

untedfor74.1%

of

varian

ce,p

G.05),predictors

ofch

ange

inpreceptor

attitudetowardstuden

tnurse(m

odel

acco

untedfor

54%

ofv

ariance,p

G.05),

andpredictorsofc

han

gein

genericpreceptor

skills

(mod

elacco

untedfor7

2.6%

ofvarian

ce,p

G.05).

Notspecified

Studen

tnurses

Sorensenan

dYa

nkech

(2008)

Can

aresearch

-based

,theo

ry-drivenpreceptor

educational

program

improve

thecritical

thinkingscoresofnew

grad

uatenurses?

Sorensenan

dYa

nkech

’sco

nceptual

model

Research-based

,theo

ry-driven,

preceptor3-hour

educatio

nal

program

Criticalthinkingof

newgraduatenu

rses

asmeasuredby

Califo

rnia

Critic

alThinkingSkills

Test(CCTST

)

Controlgroup:

n=16new

grad

uatenurses,

experim

ental

group:n

=15new

grad

uatenurses,

15preceptors

attended

the

educatio

nal

program

ina

Midwestern

not-for-profit

hospita

lsystem

Sign

ifican

ce(p

G.05)was

achievedin

theevaluation

subscaleoftheCCTST

intheco

ntroland

expe

rimen

tal

groups.Nostatistical

differen

ce(p

9.05)was

foundin

thean

alysisan

dinference

subscalean

dtotal

scalescores.

Notspecified

New

lylicensednurses

TABLE

2Description

oftheArticlesSe

lected

forQua

litativeAna

lysis,Con

tinu

ed



Most studies reported outcomes that predominatelyaddressed participant satisfaction and self-efficacy, ratherthan higher level outcomes based on Kirkpatrick’s levelsof educational outcomes (Littlewoodet al., 2005).One criticalfindingwas the lackof rigorous interventional studiesdesignedwith valid and reliable assessment tools, control groups, andcontrol for extraneous variables. The findings of this reviewhighlight the challenges of experimental educational researchin the nursing professional development specialty.

Study findings add an increased understanding of thepsychometric properties of the MERSQI and BEME instru-ments. The MERSQImean score of 11.38 (SD = 2.21) in thisstudy is consistent with Reed et al. (2008;mean = 10.7, SD =2.5) for accepted manuscripts for publication in medical

education, supporting it as a valid and reliable instrument.A weak, nonsignificant correlation between the MERSQIand BEME strength scores (r = .13, p 9 .05) is inconsistentwith Cook et al. (2011), who found a significantly positivemoderate correlation (r = .58, p = .001). However, thesefindings are conceptually logical given that greater sensitivitycan be obtained with an instrument with a greater numberof items and suggest that the BEME and MERSQI are mea-suring different dimensions of quality.

LIMITATIONS OF THE STUDYThis review has several limitations. First, studies includedin the review were implemented in a variety of inpatientclinical settings and may not be generalizable to allhealthcare environments. Second, exclusion of qualita-tive studies potentially impacts the depth and richnessof information synthesized. Third, given the high volumeof the synonyms used in the search strategy, it is possibleto have inadvertently omitted a relevant study.

PRACTICE IMPLICATIONS FOR THE NPDSThe major practice implication is the limited body ofknowledge supporting specific interventions and theirefficacy in developing preceptors. The NPDS is taskedto evaluate preceptor development programs’ impacton their organization’s results and patient outcomes, inaddition to evaluating participant satisfaction. Implica-tions for further research include the need for morereliable and valid instruments to measure learning andapplication, more rigorous research design, and mea-surement of organizational and patient benefits.

CONCLUSIONThis systematic review found a limited body of literatureevaluating interventions to support preceptor develop-ment. Of the studies that were located, many had designandmethodological concerns.Most of the studies evaluatedmultimodal interventions; therefore, assessment of the im-pact of any particular component was problematic. Futureresearch should focus on more rigorous study design andevaluation using high-level outcome measures.

ACKNOWLEDGMENTSThe authorswould like to acknowledge and thank the Asso-ciation for Nursing Professional Development for supportingthis research study through a grant.

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TABLE 3 Quality Assessment Summary forthe Final Sample of Articles (n = 12)

ArticleMERSQIScore

BEMEStrengthScore

BEME HighestOutcomeScore

Al-Hussamiet al. (2011)

14.0 4 2b

Bradley et al.(2007)

10 3 2a

Hagler et al.(2012)

11.5 4 3

Hallin andDanielson(2009)

10.5 3 2a

Horton et al.(2012)

7 3 3

Komaratat andOumtanee(2009)

13 3 2b

Lee et al.(2009)

15 3 4b

Parker et al.(2012)

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Riley-Doucet(2008)

10.5 2 2b

Sandau et al.(2011)

11 3 4a

Smedley et al.(2010)

9.5 4 2a

Sorensen andYankech(2008)

13.5 3 2b

BEME = Best Evidence inMedical Education;MERSQI =Medical EducationResearch Study Quality Instrument.



http://www.ahrq.gov/research/findings/evidence-based-reports/stakeholderguide/chapter2.html



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For more than 25 additional continuing education articles related to professional development,go to NursingCenter.com\CE.



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