Background

Preceptor program facilitates and supports nurses’ transition from theory to the technical world in the changing healthcare organization. It is the stage from theory to nursing practice that integrates new graduate nurses and also experienced nurses in the healthcare organization and practical clinical settings. The preceptor acts as facilitator and educators in helping the newly joined students and nurses to expand their clinical skills and knowledge that would allow the preceptees to apply their learning into the practice. The newly hired nurses lack the practical knowledge and there is a gap between the theory and practical knowledge. This wide gap can put the patients’ life at risk during the emergency and that leads to medical errors. This challenges the decision making of the nurses and as a result they lose confidence. The preceptors aid in assimilating the specific roles among the team members so that they are able to manage in complex settings and work in rapidly changing environment in healthcare settings. To provide best quality of healthcare and effective services, the preceptor program is implemented to provide the newly graduate nurses and students develop practical skills and make themselves adapt to the rapidly changing demands of the healthcare organization. The following essay deals with the effective leadership role of the ward manager in the preceptor plan and in providing effective training that would help the newly graduate nurses in getting adapted to the new clinical settings.

As a nurse in the respiratory ward of the Princess Margaret Hospital, it is necessary to take care of patients with Non Invasive Ventilation (NIV) and Invasive Mechanical Ventilation (IMV). The nurses also have the responsibility to take care of the patients with chest drain or the management of a ventilator. Therefore, there is a need to provide the safe and best quality of healthcare to every patient under their provision of care and also ensure patient safety. Every year, there are newly graduate nurses in the ward who lack the practical knowledge in handling the chest drains, managing ventilator alarms and in detecting the ventilator on getting disconnected. Therefore, there is an urgency to incorporate a preceptor program for the newly graduate nurses to help them cope with the new working environment by the ward manager. This program would also help them to develop their practical knowledge and skills that would successfully contribute to the organization in providing safe and best quality of healthcare to the patients.  

The ward manager plays the role of the leader who is able to implement the preceptor program in the respiratory ward through leadership qualities. They are successful leaders who motivate the preceptors to take active part in the preceptor program in a clinical setting. There are specific roles that the ward manager should possess in order to lead a team of preceptors. Effective leadership skills are required to lead and motivate the members of the team to achieve the goals of the team (Mårtensson et al., 2016). Moreover, to lead the team the ward manager should have effective communication skills and capability to make professional interaction. They should also be able to design motivation strategies for the preceptors and in making of assignments related to patient care. They also assess the assignments of the registered nurses and also give feedbacks according to their performances. They also promote team spirit and professional behavior that is exhibited by working in a framework in which the preceptors are able to take up the program in a professional setting (Spector, Ulrich & Barnsteiner, 2017).

Role of Leader in a Preceptor Program

The ward manager is a skilled clinician who is experienced and possesses strong leadership skills and critical thinking skills. From a leadership perspective, the skills, knowledge, values and attitudes along with commitment, motivation and overall capacity of the leaders include the preceptorship. The work-related characteristics, intelligence traits and personality traits are the essential characteristics that are essential for a leader in a preceptor program. The ability to inspire and motivate the registered nurses, teaching and training, demonstration of the program and providing guidance are the work related traits that are required in a leader who also acts as a leader. The intelligence traits like ability to clarify concepts to the preceptors and knowledge of basic teaching skills are of paramount importance for the nurse preceptors to take active part in the preceptor program in their ward (Brown, 2014). The ward manager’s ability to motivate the preceptors, boosts their self-confidence, provides feedback and in acknowledging their work are the personality traits that are needed in the ward manager to implement the program in the ward.

To achieve the above leadership characteristics, the ward manager should develop essential qualities like having a clear vision, knowing one’s strength and weaknesses, passion, living in accordance with one’s values and morals and maintaining a positive attitude. The ability to motivate every person within their sphere, improving communication skills and continuing education and learning would help the leaders to achieve the effective leadership qualities. These are the essential leadership qualities that are required in the ward manger to act as a leader in implementing the preceptor program (Lin, Viscardi & McHugh, 2014).

Effective leadership skills in the ward manager assist in achieving change management outcomes.  It provides effective management in a healthcare setting with better experiences and health outcomes for the patients under the provision of care (Li & Su, 2014). It ensures to give high quality of healthcare and efficient and safe care to the patients. The process of change in management demands highly efficient and competent leadership qualities and therefore, leaders play a central role in the cultivation and evolution in an organization. This would also help to achieve the hospital’s vision of Healthy People, Happy staff, trusted by the community” and value “we care we share” and mission is to deliver effective and best quality healthcares services to the patients by the professional and caring team. Good leadership qualities in the ward manager will also bring about management change via professional training and provide pleasant working environment to the staffs and community. This partnership leads to innovation and excellence (Lalonde & McGillis Hall, 2016).

Among all the leadership theories, the charismatic and transitional leadership approaches are employed in a preceptor program. These approaches coexist with the organizational changes for the efficient functioning of the healthcare organization. They are based on an individual’s vision, willingness to learn, courage, openness to values and morals for the better and efficient organizational change.

The charismatic leadership was developed by Max Weber that is based on the radical changes in an organization (Pollard & Wild, 2014). It is based on the charismatic personality of the leader who is intended to influence and power others to fulfill the organizational objectives of efficient healthcare system. The charismatic leaders exhibit high level of confidence, competence, ambition, charm, conviction, tendency to dominate, openness and work for better changes (Schuelke & Barnason, 2017). They have ideal goals with strong commitment that are aimed at achievement of the successful organizational changes. They have a sense of vision and consistent in their efforts to capitalize the organizational success. They have the articulation, sensitivity to the team member needs and personal risk taking. They are committed to the goals and devote themselves to the preceptor program. This helps the preceptors to get motivated to take part in the preceptor program and feel confident and encouraged. As a charismatic leader is optimistic and have a clear vision about one’s responsibilities and that motivates the preceptors, their goals and handle issues with confidence. They have excellent communication and listening skills with self-improvement that provides empathy towards the preceptors and inspire them to initiate and maintain a significant organizational change by implementing the preceptor program (Murray & Buckley, 2017).

Charismatic and Transitional Leadership Approaches in Preceptor Program

Transformational leadership style was developed by James Mc Gregor and was later formulated by Bass. In this style, the leaders are highly ambitious with a clear vision and passion. They have enthusiasm and energy that helps them to achieve the organizational goals (Phillips, Esterman & Kenny, 2015). They work to sustain motivation and commitment and believe that success comes with the consistency of these attributes. In a preceptor program, a transformational leader develops trust and mutual respect that would help the preceptors to take up challenges and build confidence in the preceptees. The transformational leaders are enthusiastic and make the preceptors believe that organizational transformation leads to achievement of the organizational goals and bring about successful change. This leadership encourages providing collaborative care by sharing goals and brings about innovation via organizational change. They are also intended to provide an encouraging environment to the preceptors with continuous support and providing feedback on performance. In this way, the preceptors are consistent with their performance and motivated towards one shared goal of providing the best quality of care to the patients and improve patient safety (Phillips, Kenny, Esterman & Smith, 2014). Therefore, the charismatic and transformational leadership styles could help to improve the preceptor program.

In the view to implement preceptor program, Kotter’s eight-stage change process, Pettiigrew’s model and PEST analysis that would help to bring about successful change. There are eight stages in the Kotter’s change process to bring about successful change (Mann-Salinas et al., 2014).

The first step involves building urgency that would allow the ward staffs understand the need for change. This could be done by providing evidences and real cases from the ward. For example, the newly graduate nurses lack respiratory knowledge, insertion of urinary catheter and stomach tube and other related assistance. They cannot provide patient safety in instances like chest drain slip out, ventilator disconnect and in working of ventilator alarm. This step should be undertaken with honest discussion about the issue.

The second step involves the creation of a guide coalition that involves the people at different levels and departments to establish goals. For the implementation of the preceptor program, the pulmonary department, ward manager and human resource team are one of the coalitions that would help to inspect the respiratory ward frequently and make necessary assessments.

Third step involves the formulation of a strategy that will engage the participants to take initiative to achieve the goal. In this step, the hospital authority and the clinical department work for the implementation of the preceptor program.

The fourth step involves the communication between the participants as the vision is clear by the hospital authority. The ward manger communicates with the subordinates so that the preceptor program is successfully implemented in the respiratory ward. In order to achieve this step, the ward manager who act as leaders adopt the charismatic and transformational leadership style by encouraging the registered or experienced nurses to actively participate in the preceptor program. The leader also provides support and acceptance among the preceptors by understanding their low morale in taking up the preceptor program.  

The fifth step is to empower the registered nurses to take up the preceptor program. Before the implementation of this step, the concerns of the preceptors should be removed and encourage them to take active part in the program and implement them in their clinical practice.

The sixth step involves the achievement of the short term goals. This could be done by organizing a workshop where the preceptors would strive for winning. According to Kotter, success provides the participants a clear idea of what is going on and what needs to be done in the future. They would feel motivated and encouraged to take up the challenges they face in the clinical setting through rewarding and appreciating the best preceptors.

The seventh step involves the consolidation of gains and scope for further improvement. As a leader, looking for the success and ways to improve are of paramount importance in this stage. For example, the preceptors would spend more time in the program and be consistent with the preceptorship program.

The last step is to anchor to the preceptor program so that they are able to continue with their clinical practice. As a leader, the ward manager should involve in continuous evaluations and feedback on performance that would help to consolidate the program leading to success. Moreover, the leader should keep supporting the preceptors by providing them motivational support for a long time.

In the Andrew Pettigrew model, there are three dimensions involved in the strategic change. The first step is the content, second step implementation and the third step is the context that is the internal and the external environment (Leong & Crossman, 2015). The first step involves the defining of the purpose, objectives and goals for the organization change that comprises of a strategy that would help the newly graduate nurses and students to work in the clinical settings and provide them a smooth transition from nursing theory to knowledge in practice. The second step process involves the implementation of the preceptor program that would help the newly graduate nurses and students to work in complex clinical environment where they can apply their theory into practical clinical settings. The third step is the analysis of the internal and the external environment. The internal environment comprises of the hospital’s mission, organizational culture, leadership style and the organization’s activities like the preceptor program, preceptors and the preceptees behavior and the decisions made before and during the implementation of the preceptor program. The external environment comprises of the whole healthcare system that is aimed at providing the best quality of care to the patients under their provision and promote patient safety and the organizational change as a result of external possibilities. The economy, competition, technology and workforce also act as the external forces.

PEST analysis comprises of the political, economical, social and technological analysis in an organization. The political factors include the government intervention in the program with policy, regulations and laws related to the implementation of the preceptor program that might affect the performance of the healthcare organization. The economic analysis includes the financial resources, organizational services that are available within the economy. The social analysis comprises of the demographic changes and the way the preceptors and the preceptees would behave under the preceptor program. Lastly, the technological innovations which consists of the new approaches, mitigation of old problems and technical support that would provide new ways of thinking and innovation is the technological analysis.

The organizational culture greatly affects the preceptorship program and also preceptors and the preceptees. The organizational goals of providing the best quality of care to the patients and in improving the patient safety greatly affect the preceptor program. The newly graduate nurses are exposed to the organizational values and beliefs and their engagement with the existing members of the team would also shape the attitude of the new nurses (Tourangeau et al., 2014). The inter-departmental interaction, reduction of medical errors and effective decision making will affect the behavior of the newly graduate nurses and students (Schaffer, Sandau & Diedrick, 2013). The organizational objectives and goals can also affect the experiences of the newly graduate nurses. The economic goals and profit might diminish the organizational culture and so during a preceptor program, priority should be given to the quality of the learning environment rather than the productivity. The organizational culture helps to work to provide collaborative healthcare and encourage the creation of effective relationship between the members. In a preceptor program, when the newly graduate nurses work in collaboration with each other, they are able to enhance their relationships and provide effective collaborative healthcare services.

The main restrictions in the implementation of the preceptor program include the discrepancies in the application of theory to clinical practice. There is also lack of trust; time and knowledge also contribute to ineffective communication between the leader and the preceptors. There are limitations regarding the proper orientation, creation of complex situations, feedback, acknowledgement, proper support, encouragement, motivation and spending quality time together between the leader and the preceptors are some of the limitations that restrict the implementation of the preceptor program. There are also other challenges like personal judgments about the preceptor and lack of encouragement and commitment from both sides also restrict the program (Lalonde & McGillis Hall, 2017). The lack of leadership skill in the leader and poor interrelationships between the ward manager and the preceptors because the preceptor program is an overwhelming load for the registered nurses that limits the program.

The facilitator and management strategies in which the ward manager acts a professional role model who helps to guide and mentor the preceptors in the preceptor program. The ward manager acts as the clinical facilitator who encourages and motivates the preceptors to take an active part in the preceptor program. They inspire the registered nurses to motivate and show enthusiastic behavior towards the preceptor program. The ward manager helps the preceptors in understanding their objectives and in assisting them to plan for the achievement of the goals. The facilitators act neutral by not taking position in any of the discussion.

For a successful preceptor program, the first and foremost thing is the employment of an effective preceptor by the ward manager. One should be efficient enough to demonstrate leadership qualities and have necessary skills and competencies. One should act as a role model exhibiting efficient leadership qualities in inspiring and motivating the preceptors (Seibert & Bonham, 2016). There should be continuous assessment of the working environment and fulfillment of the desired goals. The time management and evaluation of the clinical competence will document the progress of the program. The continuous assessment of the performance with constructive feedback also provide successful running of the preceptor program. The effective communication with development of interpersonal skills and fostering of social interaction also helps in the successful implementation of the preceptor program (Volberding & Richardson, 2015). The assessment of the quality management with performance is also some of the benchmarking practices that would help to implement the preceptor program (Ackman & Romanick, 2011).

Using benchmarking as a tool, a leader can discover the various ways of achieving better performance. One gets to know about the recent situation of the competitors in the industry. This information helps to identify the gaps in the organizational activities and thus competitive advantage can be gained (Seibert & Bonham, 2016). With an analytic approach towards the benchmarking, an organization might lower is cost of labor and can also focus on quality improvement of the product or the service. This in turn will automatically increase the sales and profit of the organization because the savings and acceptability of the product will automatically prove to be profitable.

The preceptor should be motivated so that they are able to provide the best learning environment to the newly graduate nurses and successful implementation of preceptor program. Since the nurses take an assignment for the patients, the preceptor program can be a burden for the nurses and so they need to be encouraged. For their encouragement, they needs to be motivated by the leader so that they provide an effective learning environment to the newly graduate nurses and precept them. They should be actively motivated by the leader through praising that applies greater efforts and prevent avoidant behavior by the preceptors. Through praising, a preceptor boosts self-confidence and extrinsically motivated. The preceptors should be continuously encouraged by the leader so that they are continuously encouraged to take up the program in an efficient way. The leader motivates the preceptors to meet the expected outcomes of the preceptor program through rewards and appreciation. The best preceptor is awarded in the ward by the colleagues would help to motivate them and keep engaged in the preceptor program. Leader should keep moving the preceptors through preceptor program by applying transformational leadership style to keep them motivated and engaged (Kang et al., 2016).

Conclusion

The preceptor program is an effective strategy to help the newly graduate nurses to cope up with the new working environment in a clinical setting. It is a transition stage from nursing theory to practical knowledge. The leader acts as a role model who plays an important role in the implementation and assessment of the preceptor program. For this, they should possess effective leadership skills that would help in the successful implementation of the preceptor program. The charismatic and transitional leadership are the two leadership styles that are implemented in the preceptor program to encourage and provide support to the preceptors. For the effective implementation, PEST analysis, Kotte’s analysis and Pettigrew model are used. There are some restrictions to the successful implementation of the changes like lack of motivation, support, knowledge, skills and competencies that affects the preceptor program. The quality and performance assessment are the two benchmarking practices that would help in the successful implementation of the preceptor program. Therefore, the preceptors need to be encouraged by the leaders in order to provide the best learning environment to the preceptees.

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