Preceptorship for Newly Registered Nurses

Karen Elcock,Kath Sharples

• Publisher: Learning Matters
• Year: 2011
• ISBN:
  9780857253743
• Edition: 1
• Topic: Medicine
• Subtopic: Nursing

Newly qualified nurses can find their first year of practice a daunting experience. This book is specifically written to support new nurses through the demands of their preceptorship year. Each chapter provides friendly and practical support on the main areas of development needed for new nurses to become confident practitioners. The book is also designed for use on formal preceptorship programmes and covers each of the areas for professional development outlined in the Department of Health?s new Preceptorship Framework (2010). Packed with activities, case studies and down-to-earth advice, this book provides essential support for the newly registered nurse.

Chapter 1
Beginning the preceptorship journey

Preceptorship Framework and KSF

This chapter maps to the following elements of the Department of Health Preceptorship Framework and the NHS Knowledge and Skills Framework.

Preceptorship Framework

• Develop confidence and self-awareness
• Increase knowledge and clinical skills
• Integrate prior learning into practice

NHS Knowledge and Skills Framework

• Communication
• Personal and people development

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Chapter aims

The aim of this chapter is to introduce you to the Preceptorship Framework and its relationship to the Knowledge and Skills Framework. By the end of this chapter you will be able to:

• outline the key elements of the Preceptorship Framework;
• explore the benefits of undertaking a preceptorship programme;
• reflect on how the Knowledge and Skills Framework is relevant to you and your career;
• identify the key elements of the preceptor role;
• appreciate your responsibilities as a newly registered nurse.

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Setting the scene

Your first day at work as a registered nurse is probably one of the most exciting and nerve wracking days you will encounter. Even if your first post is somewhere you worked as a student, entering that practice area as a qualified nurse will be very different. The challenges of the transition phase from student to staff nurse are well documented in the literature and it was Kramer (1974) who coined the phrase reality shock to describe the initial work experience of newly qualified nurses and described the discrepancies that arise between their expectations and the real world of nursing.

If you have just completed a return to practice course or overseas nursing programme, it is likely that you will still have a certain degree of nervousness as you move from your protected role as student to registered nurse.

It is to be hoped that you have found a first post with an employer who runs a preceptorship programme which will help you with this transition. However, this book will help support your first few months as a registered nurse with or without a preceptorship programme in place.

Activity 1.1: Reflection

Identifying your fears

Note down the fears, worries or concerns you had before taking up your first post or in your first few weeks in post.

There is a brief outline answer to this activity at the end of the chapter.

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It is not surprising to find that the majority of newly registered nurses want a post where preceptorship is offered (Robinson and Griffiths, 2009) and as a consequence will tend to apply for their first post in the NHS which will provide a structured programme of support for newly qualified practitioners, although increasingly independent sector organisations are recognising the need to offer preceptorship programmes as well.

The need to provide support to newly registered nurses through preceptorship is well recognised (UKCC, 1986, 1993, 1999; Department of Health, 2001a) but it has never been made a mandatory requirement, although Agenda for Change (AfC), the NHS national pay and grading system which was introduced in 2004, identified the need for preceptorship and linked this with the first year for staff in Band 5 posts (The NHS Staff Council, 2010). In 2006 the NMC strongly recommended that all new registrants have a period of preceptorship of at least four months on commencing employment (NMC, 2006) and went further as part of its consultation of pre-registration nursing education in 2008 in proposing that there should be a mandatory period of preceptorship for all new registrants. They stepped back, however, from this requirement when they published their Standards for Pre-registration Nursing Education (NMC, 2010a) and simply stated that newly qualified nurses cannot be expected to have extensive clinical experience, specialist expertise, or highly developed supervision and leadership skills (NMC, 2010a, page 5) and that these skills would be further developed through the preceptorship period and ongoing professional development.

The review of the NHS undertaken by Lord Darzi in 2008 (Department of Health, 2008a) also identified the need for a foundation period of preceptorship for newly qualified nurses, which led to increased funding to support the implementation of preceptorship schemes within the NHS.

All of the above culminated in the publication of the Preceptorship Framework for Newly Registered Nurses, Midwives and Allied Health Professionals (Department of Health, 2010a) that could be used as a resource by both employers and newly qualified healthcare professionals in setting and running preceptorship programmes.

What is preceptorship?

There are a number of different definitions for preceptorship, but the one agreed in the Preceptorship Framework is:

A period of structured transition for the newly registered practitioner during which he or she will be supported by a preceptor, to develop their confidence as an autonomous professional, refine skills, values and behaviours and to continue on their journey of life-long learning.

(Department of Health, 2010a, page 11)

Just to confuse matters, many countries outside the UK use the term preceptorship to describe the support provided to student nurses by qualified practitioners which we call mentorship, so care should be taken in reading books or articles on preceptorship as they may not be appropriate to your needs.

Preceptorship in the UK is recommended for all new registrants and that includes:

• newly qualified practitioners registering with the NMC for the first time;
• qualified practitioners registering on a new part of the NMC register having undertaken a further registerable qualification;
• practitioners who have qualified overseas and are newly registered with the NMC;
• practitioners who have completed a return to practice programme and have re-registered with the NMC.

The benefits of preceptorship

As well as easing the transition for newly registered nurses, preceptorship is also perceived as having a number of other potential benefits to the preceptee as well as benefits for the preceptor, the employer and the healthcare professions as a whole (Department of Health, 2010a; Higgens et al., 2010; Roxburgh et al., 2010) including:

• enhanced recruitment;
• improved retention;
• reduced sickness/absence;
• reduction in near-miss incidents made by newly registered nurses;
• personal and professional development for the preceptor in developing appraisal, mentoring, supervising and supportive skills;
• increased confidence and competence for the newly registered nurse.

Central, however, to a preceptorship programme is the drive to ensure that patients/clients and service users receive safe and effective care and treatment and a better patient experience.

Activity 1.2: Reflection

The benefits of preceptorship

Make a list of what you hope to gain from undertaking a preceptorship programme. What are your expectations?

There is a brief outline answer to this activity at the end of the chapter.

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The Preceptorship Framework

The Preceptorship Framework for Newly Registered Nurses, Midwives and Allied Health Professionals was published in March 2010 and can be found on the Department of Health website (www.doh.gov.uk). It is a best-practice guidance document which you can use as a resource but is also useful for employers both inside and outside the NHS in England. Scotland has its own web-based multiprofessional preceptorship programme called Flying Start NHS (www.flyingstart.scot.nhs.uk/) and the Welsh and Northern Ireland Assemblies both support the use of preceptorship for new registrants during their first year although they have not adopted a specific framework as yet.

The Framework provides:

• a definition of preceptorship;
• the key elements of good preceptorship;
• suggested benefits of preceptorship;
• standards for preceptorship;
• guidance on developing preceptorship programmes;
• a suggested set of outcome measures;
• a set of pledges for the preceptee, preceptor, employer and strategic health authority.

The suggested content for preceptorship programmes described in the Framework by the Department of Health (2010a) forms the basis for this book:

• confidence in applying evidence-based practice;
• develop confidence and self-awareness;
• implement the codes of professional values;
• increase knowledge and clinical skills;
• integrate prior learning into practice;
• understand policies and procedures;
• reflection and receiving feedback;
• develop an outcome based approach to continuing professional development;
• advocacy;
• interpersonal skills;
• manage risk and not being risk averse;
• equality and diversity;
• negotiation and conflict resolution;
• leadership and management development;
• team-working;
• decision-making.

Flying Start NHS

Flying Start NHS was first developed in Scotland in 2006 as a national development programme for nurses, midwives and allied health professionals to help them manage the transition from student to newly qualified practitioner and develop their learning and confidence (Roxburgh et al., 2010). The Department of Health has worked with NHS Scotland to develop a web-based programme for England (www.flyingstartengland.nhs.uk) with ten units of study that allow practitioners to map their progress against the Knowledge an...