Providing feedback to students is one of the most essential responsibilities of a preceptor. It is through the process of giving and receiving meaningful feedback that a rich opportunity for learning is created. (Groves, Mitchell, Henderson, Jeffrey, Kelly & Nulty, 2015; Pollack, 2012).
As part of the preceptorship experience, both verbal and written feedback will be provided to the student. This section pertains to verbal feedback, while written feedback will be addressed in the “assessment” section.
While assessment is an important part of the preceptorship experience, it is important to create an environment that focuses on learning rather than on assessment and evaluation.
The following points can help a preceptor to provide effective feedback and make it meaningful to student learning:
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Established course outcomes and the student’s learning goals create the foundation for feedback.
Example - “Avery, let’s talk about your IV start for Mr. J”, rather than “Avery, let’s talk about IV starts.”
Example – “Avery, the technique that was used for the dressing change could be improved by doing x, y, and z,” rather than, “I notice that you often rush when you change dressings.”
Example - “I found that your technique was solid; you followed the process really well. For the next time, focus on communicating to the client what is happening.”
Example - “I wonder if you were so focused on the task itself that it prevented you from communicating with Mr. J effectively” rather than “You didn’t communicate with Mr. J, probably because you were focused on what you were doing.”
Example - “How do you think you will approach this next time?”
Example – “How do you feel you did?” rather than “I think that went well.”
Planning for time to share feedback is important.
Example – “You improved on x since last time. I suggest you focus on y and z and try this approach the next time.”
Privacy is key when providing feedback. It should not be provided in a public setting not should it be shared with anyone except for the faculty liaison.
It may take some time to become comfortable in giving feedback to the student. Every student is unique in their learning needs and the preceptor/student partnership takes time to build. Ongoing daily feedback will help both the preceptor and student to feel more comfortable with the feedback process. (Gaberson et al., 2015; Kim, Lea, Eudey & Dea, 2014; Pollack, 2012)
Preceptorship is intended to provide a learning opportunity for students that will occur over an extended period of time. A great deal of growth will occur during these twelve weeks. As the experience progresses, students will continue to develop increased independence and deepen their learning. (Kim et al., 2014)
Source: Edgar Dale (1969)
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By the completion of the twelve week preceptorship experience, the student should be able to manage an average assignment in the area of practice. Focus on the following areas to help the student develop competence and independence throughout the experience.
The following information has been developed by Em M. Pijl, BScN, MEd, PhD, RN © 2005 – University of Lethbridge. Adapted and used with permission of author by Debra Amirault, Dr. Lisa Keeping-Burke, Karen Tamlyn and Dr. Monique Mallet-Boucher, University of New Brunswick, 2017.
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Organization
Strong organizational skills will help students cope with the many unexpected situations and competing responsibilities inherent in daily practice. Help the student to develop an organized approach to client care assignments and to formulate a daily routine and plan. Encourage the student to observe other coworkers’ methods of organization as potential alternative strategies, in addition to preferences and practices of the student and preceptor. Consider the student’s preferences and practices objectively, and offer suggestions or recommendations based on optimal effectiveness.
Prioritization
Managing responsibility and care for multiple clients is one of the most challenging things for students. In previous clinical practice, students have been assigned clients or populations by their instructors, and preceptees are not accustomed to the new level of responsibility associated with a full workload. As such, students may tend to address issues in the order in which they arise, rather than prioritizing them. Talking with the student about how you decide what to do first and why, is important in learning how to set priorities. Explain the rationale for your clinical decisions when managing your assignment, including potential implications to alternative courses of action.
Working as a Team
Help the student understand that she/he cannot do everything alone. Working as part of a team and seeking assistance when needed, is something the preceptor should discuss and role model.
Understanding the roles and contributions of other health care team members, working together, and sharing workload is a skill essential to managing the demands of most assignments. In clinical courses completed during the nursing program, students do not often have consistent opportunities to develop this skill. Preceptors can assist students to work together with the entire health care team in order to coordinate and assign care and take a role in ensuring a safe and professional practice environment (NANB, 2015).
Confidence Building
Students will become more confident over time as skills are successfully performed and appropriate clinical decisions are made. The preceptor can support a student’s confidence by sharing positive feedback in addition to recommending areas for improvement. Celebrate the student’s successes and reinforce their progress by demonstrating your confidence in them.
Conversely, confidence can be damaged by unsolicited advice, learning experiences that are too challenging, and feedback that focuses solely on what the student did not do well.
Guided Independence
Knowing when the student is able to provide care and when the preceptor needs to intervene is one of the most challenging aspects of the role. It is important for the student to have the opportunity to provide care when they have the skill and knowledge to be able to do so safely. Preceptors should coach students through decision making processes by stimulating critical thinking and encouraging the development of independent problem solving skills.
A preceptor must intervene if safety concerns arise.
It is inevitable that during a twelve week learning experience, there will be some challenging times. You may find that the student is struggling in more than one area. This section will include suggestions for those expected bumps in the road, as well as guidance if the preceptor has concerns about client safety or the student’s ability to meet course outcomes.
Keep the lines of communication open with the student. Because everyone reacts to and processes stressful situations differently, communication can be challenging at times. Open communication is the single most important thing in mitigating potential problems and resolving issues.
Communicating about student progress and areas for improvement will help the student develop insight into their own practice and will foster learning.
In the case of an incident or “near miss”, it is important to debrief following the situation, so the student can clearly understand the factors that lead to the situation and the potential consequences that were avoided.
The faculty liaison is available to support the preceptor and the student at any point during the preceptorship experience. Their role is to be a resource and to provide guidance. The faculty liaison is familiar with both the student’s learning goals as well as the course outcomes and can help to guide the learning experience.
The faculty liaison will be in contact with the preceptor and student on a regular basis – at minimum once per set of shifts. However, the preceptor is encouraged to contact the faculty liaison at any time with questions or concerns.
The following are examples of situations when a preceptor should contact the faculty liaison directly, and should not wait until the faculty liaison next contacts them.
If the student’s nursing care does not progress and maintains at an unsatisfactory level, do not wait until the formal assessment points to reach out to the faculty liaison and to communicate with the student. Consult with the faculty liaison; she/he can help the preceptor to assess specific challenges and learning needs, as well as assist the preceptor in sharing their concerns and providing constructive feedback to the student.
Assessment of student learning is an active process, involving ongoing dialogue between the student, preceptor and faculty liaison. It reinforces strengths and identifies challenges as students strive to improve and develop their nursing care and move toward independent practice. (Gaberson et al., 2015)
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At UNB, the assessment tool utilized in the clinical setting is a document referred to as the Collaborative Assessment of Student Abilities (CASA). The CASA is not intended to replace ongoing verbal feedback, which is an integral part to learning within the preceptorship experience. It is a formal and summative assessment document which considers nursing care that has been provided, and the student’s ability to meet course outcomes.
The CASA will be completed at three assessment points during the course, approximately at weeks 4 (assessment 1), 8 (assessment 2), and 12 (final assessment). The CASA includes not only the preceptor’s assessment, but the student’s self-assessment of their learning.
As noted in Section 1 (Preceptorship and the UNB Nursing Program), the UNB Faculty of Nursing curriculum is guided by five abilities with specific course outcomes associated with each ability. The following are tips related to assessing student progress and course outcomes:
The CASA should be filled out considering nursing care that has been provided consistently throughout the experience. Using the following rubric, identify the rating which best represents the progress toward each of the learning outcomes associated with the five UNB Nursing Program abilities; knowledge and its application, communication, critical thinking/ skills of analysis, professional identity, and social justice/effective citizenship.
| Progressing Well (PW) |
The student is progressing well towards consistently meeting the outcome by the end of the course. |
| Needs Development (ND) | The student is making progress; however, needs to demonstrate further growth and development in this area of practice in order to consistently meet this outcome by the end of the course. Needs Development rating will also be given if the student has not yet had the opportunity to demonstrate progress towards meeting course outcome. Strategies for continued growth must be identified and documented on the midway CASA. |
| Limited Progress (LP) | Despite opportunity, the student demonstrates little to no progress towards meeting the course outcome (Assessment 1, Assessment 2). Strategies for continued growth must be identified and documented on midway CASA |
The preceptor, student and faculty liaison should collaborate to determine the three assessment points. At each assessment point, this process will be followed:
While PW, ND, and LP are ratings that can be utilized in the CASA for assessment points 1 and 2, the final CASA must only include “Outcome Met- OM” or “Outcome Not Met-ONM” ratings.
The student must receive “Outcome Met- OM” for all outcomes on the final CASA in order to receive credit for the course. As preceptorship is a university course, responsibility for determining whether a student will receive credit or no credit for this course rests with the faculty liaison.
Assessment meetings differ from the ongoing daily feedback discussions. These are formal discussions held at designated assessment points during the experience. Dates and times for these meetings should be scheduled collaboratively with the student and preceptor, after the student has had an opportunity to review the CASA that has been completed by the preceptor. All meetings should occur in a private location. These assessment meetings should provide an opportunity for in-depth discussion of the student’s practice and progress toward achieving the learning outcomes. Additionally, the learning outcomes that require further development should be discussed and strategies for improvement identified.