The Journal of Continuing Education in Nursing

CNE Article 

Preceptor and Self-Evaluation Competencies Among New RN Graduates

Susan Prion, EdD, RN, CNE; Audrey Berman, PhD, RN; Judith Karshmer, PhD, RN, PMHCNS-BC; Paulina Van, PhD, RN, CNE; Jonalyn Wallace, MSN, RN; Nikki West, MPH

Abstract

Do you want to Participate in the CNE activity?

How to Obtain Contact Hours by Reading This Issue

Instructions: 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded after you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. In order to obtain contact hours you must: 

1. Read the article, “Preceptor and Self-Evaluation Competencies Among New RN Graduates,” found on pages 303–308, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz.

2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study.

 

3. Go to the Villanova website to register for contact hour credit. You will be asked to provide your name, contact information, and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated.

This activity is valid for continuing education credit until June 30, 2018.

Contact Hours

This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated.

Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Objectives

To describe the reliability and validity of a tool for assessing the Quality and Safety Education for Nurses competencies among new nurse graduates in transition-to-practice programs.

To list opportunities to use the tool in clinical settings.

Disclosure Statement

Neither the planners nor the authors have any conflicts of interest to disclose.

Four transition-to-practice programs for new RN graduates who had not yet found employment in nursing were based on the Quality and Safety Education for Nurses (QSEN) competencies of knowledge, skills, and attitudes (KSAs). To support consistent evaluation of participants by preceptors, a 35-item tool was developed that used a 4-point scale to assess selected behaviors. This article describes the initial reliability and validity testing of the tool, which had good internal consistency, with a Cronbach’s alpha of 0.92 for preceptor evaluation of participants and 0.82 when used as a self-evaluation tool. Six content experts evaluated the tool’s face validity; it successfully discriminated between junior-level baccalaureate nursing students and nursing faculty. Although the tool does not exhaustively reflect the QSEN KSAs, it provides a way to assess competencies among new nurse graduates.

J Contin Nurs Educ. 2015;46(7):303–308.

Dr. Prion is Associate Professor, and Dr. Karshmer is Dean and Professor, School of Nursing and Health Professions, University of San Francisco, San Francisco; Dr. Berman is Dean and Professor, and Dr. Van is Associate Professor, Samuel Merritt University School of Nursing, and Ms. West is Program Director, California Institute for Nursing & Health Care; and Ms. Wallace is Director of Academic Relations, Kaiser Permanente Northern California Patient Care Services, Oakland, California. At the time of the study, Dr. Van was Chair and Professor, Department of Nursing & Health Sciences, California State University—East Bay, Hayward, and Ms. Wallace was Professional Development Consultant, Community Benefits, National Patient Care Services, Kaiser Permanente, Oakland, California.

This work was supported by the Gordon and Betty Moore Foundation, Kaiser Permanente National Patient Care Services, Kaiser Permanente Northern California Regional Patient Care Services, Kaiser Permanente Fund for Health Education at the East Bay Community Foundation, Alameda County Workforce Development Program, and the Department of Labor.

Dr. Prion received a consulting fee from the California Institute for Nursing and Healthcare for this work. The remaining authors have disclosed no potential conflicts of interest, financial or otherwise.

The authors thank Susan Herman, DNP, RN, NEA-BC, CENP, Maria-Jean Caterinicchio, MS, RN, NE-BC, and Lyn Marshall, RN, MS, without whose substantial contributions the competency tool would not have existed. Jessie Jones-Bell, RN, MS, also provided pivotal assistance.

Address correspondence to Susan Prion, EdD, RN, CNE, Associate Professor, School of Nursing and Health Professions, University of San Francisco, 2130 Fulton Street, San Francisco, CA 94117-1080; e-mail: prions@usfca.edu.

Received: October 28, 2014
Accepted: March 09, 2015

Abstract

Do you want to Participate in the CNE activity?

How to Obtain Contact Hours by Reading This Issue

Instructions: 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded after you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. In order to obtain contact hours you must: 

1. Read the article, “Preceptor and Self-Evaluation Competencies Among New RN Graduates,” found on pages 303–308, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz.

2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study.

 

3. Go to the Villanova website to register for contact hour credit. You will be asked to provide your name, contact information, and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated.

This activity is valid for continuing education credit until June 30, 2018.

Contact Hours

This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated.

Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Objectives

To describe the reliability and validity of a tool for assessing the Quality and Safety Education for Nurses competencies among new nurse graduates in transition-to-practice programs.

To list opportunities to use the tool in clinical settings.

Disclosure Statement

Neither the planners nor the authors have any conflicts of interest to disclose.

Four transition-to-practice programs for new RN graduates who had not yet found employment in nursing were based on the Quality and Safety Education for Nurses (QSEN) competencies of knowledge, skills, and attitudes (KSAs). To support consistent evaluation of participants by preceptors, a 35-item tool was developed that used a 4-point scale to assess selected behaviors. This article describes the initial reliability and validity testing of the tool, which had good internal consistency, with a Cronbach’s alpha of 0.92 for preceptor evaluation of participants and 0.82 when used as a self-evaluation tool. Six content experts evaluated the tool’s face validity; it successfully discriminated between junior-level baccalaureate nursing students and nursing faculty. Although the tool does not exhaustively reflect the QSEN KSAs, it provides a way to assess competencies among new nurse graduates.

J Contin Nurs Educ. 2015;46(7):303–308.

Dr. Prion is Associate Professor, and Dr. Karshmer is Dean and Professor, School of Nursing and Health Professions, University of San Francisco, San Francisco; Dr. Berman is Dean and Professor, and Dr. Van is Associate Professor, Samuel Merritt University School of Nursing, and Ms. West is Program Director, California Institute for Nursing & Health Care; and Ms. Wallace is Director of Academic Relations, Kaiser Permanente Northern California Patient Care Services, Oakland, California. At the time of the study, Dr. Van was Chair and Professor, Department of Nursing & Health Sciences, California State University—East Bay, Hayward, and Ms. Wallace was Professional Development Consultant, Community Benefits, National Patient Care Services, Kaiser Permanente, Oakland, California.

This work was supported by the Gordon and Betty Moore Foundation, Kaiser Permanente National Patient Care Services, Kaiser Permanente Northern California Regional Patient Care Services, Kaiser Permanente Fund for Health Education at the East Bay Community Foundation, Alameda County Workforce Development Program, and the Department of Labor.

Dr. Prion received a consulting fee from the California Institute for Nursing and Healthcare for this work. The remaining authors have disclosed no potential conflicts of interest, financial or otherwise.

The authors thank Susan Herman, DNP, RN, NEA-BC, CENP, Maria-Jean Caterinicchio, MS, RN, NE-BC, and Lyn Marshall, RN, MS, without whose substantial contributions the competency tool would not have existed. Jessie Jones-Bell, RN, MS, also provided pivotal assistance.

Address correspondence to Susan Prion, EdD, RN, CNE, Associate Professor, School of Nursing and Health Professions, University of San Francisco, 2130 Fulton Street, San Francisco, CA 94117-1080; e-mail: prions@usfca.edu.

Received: October 28, 2014
Accepted: March 09, 2015

For newly graduated RNs, the transition from student to advanced beginner professional nurse is challenging. A pivotal Institute of Medicine (IOM, 2010) report on the future of nursing identified postgraduate residencies as one of eight recommendations for preparing nurses for effective professional practice, and evidence is accumulating about the effectiveness of nurse residency programs. In a 2012 review of 20 studies evaluating residency programs for new RN graduates, organizational outcomes, such as recruitment, retention, and turnover, were most commonly measured (Anderson, Hair, & Todero, 2012). The most frequently used tool in nurse residency program evaluations was the Casey-Fink Graduate Nurse Experience Survey, which measures self-perceived competence (Casey, Fink, Krugman, & Propst, 2004). Performance-based clinical competence was assessed by only three studies (Beecroft, Kunzman, & Krozek, 2001; Cleary, Matheson, & Happell, 2009; Herdrich & Lindsay, 2006), using instruments that measure professional autonomy (Schutzenhofer, 1987), nursing competencies (Wandelt & Stewart, 1975), and performance of nursing behaviors (Schwirian, 1978).

On the basis of the IOM competencies for nursing (IOM, 2003), the Quality and Safety Education for Nurses (QSEN) initiative defined six safety and quality competencies and proposed that knowledge, skills, and attitudes (KSAs) be developed for each: patient-centered care, teamwork, evidence-based practice, quality improvement, safety, and informatics (Cronenwett et al., 2007). QSEN competencies are being broadly integrated into prelicensure curricula and are assuming increasing importance among inpatient nurse leaders (Barnsteiner et al., 2013; Berman, Johnson, & West, 2014; Falls & Hensel, 2012). However, to the best of the authors’ knowledge, no psychometrically validated measurement tool exists for assessing the performance of new RN graduates, related to the QSEN competencies. The purpose of this article is to describe the development and validation of a tool with which clinical preceptors can assess the performance of new RN graduates with respect to QSEN competencies.

Tool Development

In 2010, four academic–practice partnerships in California offered transition-to-practice programs for new RN graduates who had not yet found employment in nursing (Berman, Beazley, et al., 2014; Jones-Bell et al., 2014; Wallace et al., 2014; West et al., 2014). Each partnership had the flexibility to design a program to best meet the needs of the clinical practice sites, but all developed curricula based on the QSEN competencies (West et al., 2014). A tool that is congruent with the QSEN framework was needed to evaluate the effects of the program on participants’ performance.

Clinical nurse leaders from three facilities collaborated to develop a tool to evaluate the performance of new graduate participants in terms of QSEN competencies. Over a period of several weeks, the workgroup translated the QSEN KSAs into discrete, observable behaviors, adapting and expanding on a published assessment of new RN graduate proficiencies (Berkow, Virkstis, Stewart, & Conway, 2009). The tool was subsequently approved by the transition program’s evaluation advisory committee. Table 1 displays the behaviors related to the QSEN competencies included in the tool, with the 36th item asking preceptors to evaluate the overall clinical competency of the new RN graduate. A 4-point scale indicated the level of competency: 0 = not applicable, 1 = beginning, 2 = developing, and 3 = accomplished (Table 2). The response scale was adapted from Lasater’s Clinical Judgment Rubric (Lasater, 2007). Preceptors were provided with the instrument and definitions of competency levels as part of their initial preceptor training, but no additional training or analysis of preceptor evaluation skills was consistently included.

Behaviors Assessed in the Quality and Safety Education for Nurses Competency Evaluation ToolBehaviors Assessed in the Quality and Safety Education for Nurses Competency Evaluation Tool

Table 1:

Behaviors Assessed in the Quality and Safety Education for Nurses Competency Evaluation Tool

Definitions of Postgraduate Competency Levels Used in the Evaluation Tool Response Scale

Table 2:

Definitions of Postgraduate Competency Levels Used in the Evaluation Tool Response Scale

Although the tool was not developed for self-assessment by participants, preceptor–mentors quickly recognized the usefulness of shared and structured feedback discussions with their mentees, using the tool’s observable QSEN behaviors. Over the course of the transition-to-practice programs, preceptors began to ask participants to self-evaluate their competencies and to compare their ratings with preceptor assessments. For this reason, the psychometric testing included both preceptor rating data and a self-evaluation test of reliability. In addition, the tool was administered to junior-level nursing students and baccalaureate nursing program faculty members to evaluate concurrent validity.

Internal Consistency

Cronbach’s alpha was computed for the 35-item scale, using 193 preceptor assessments of new RN graduate competency, which was completed at the start and at the end of the transition-to-practice program. Cronbach’s alpha was 0.92. A subsequent self-evaluation, completed by 94 junior-level baccalaureate students and 17 baccalaureate nursing program faculty members, returned a Cronbach’s alpha of 0.82.

Face Validity

A request to evaluate the face validity of the instrument and a link to an online evaluation form was sent by one of the authors (S.P.) to six content experts, each of whom had demonstrated expertise in QSEN content as a designated trainer at their university or clinical facility or through peer-reviewed publications about QSEN-related content. In addition, each expert had experience working with prelicensure students in clinical environments similar to those used in the transition program. Two content experts were unable to complete the face validity evaluation as requested due to other responsibilities; thus, four experts analyzed the instrument.

The authors provided the experts with the following definitions for the QSEN competency areas (Cronenwett et al., 2007; QSEN Institute, 2014):

  • Patient-centered care: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
  • Teamwork and collaboration: Function effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care.
  • Evidence-based practice: Integrate best current evidence with clinical expertise and patient and family preferences and values for delivery of optimal health care.
  • Quality improvement: Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems.
  • Safety: Minimize risk of harm to patients and providers through both system effectiveness and individual performance.
  • Informatics: Use information and technology to communicate, manage knowledge, mitigate error, and support decision making.

The experts were asked to answer the following questions for each item:

  1. Does the question clearly relate to one of the six QSEN competencies being evaluated?

  2. In which QSEN competency content area does it fit BEST? (Select only one category.)

  3. Is the intent of the question clear?

  4. Is the language of the question clear and unambiguous?

  5. Is the content of the question clear and unambiguous?

  6. Is the question written at an appropriate level for undergraduate nursing students?

  7. Is the format of the question (e.g., use of terms, specific situation cited, grammar) clear and understandable?

  8. Do you suggest a change in the question format?

The experts unanimously agreed about the category to which each item belonged and offered comments about three items. With respect to the first item (Table 1; “Conducts comprehensive psychosocial and physical health history that includes the patient’s perspective and considers cultural, spiritual, and social factors”), one reviewer noted that the descriptor comprehensive might lack precision, but the reviewer did not offer alternative wording. With respect to the second item (Table 1; “Complete understanding and interpretation of assessment data”), the same reviewer wondered whether “complete understanding” was measurable and was concerned that preceptors’ standards for the completeness of understanding might vary. Similarly, no alternative wording was suggested.

One reviewer was unsure whether item 16 (Table 1; “Locates, critically reviews, and applies scientific evidence and medical literature”) was a reasonable expectation for a new RN graduate. She noted that, as an expert nurse, she was still trying to perfect the skill of locating, reviewing, and applying scientific evidence and medical literature, but she did not recommend a change based on her observation. All experts noted that item 13 (Table 1; “Communicates observations or concerns related to hazards to patients, families, and the health care team and uses the organizational reporting system for errors”) represented activities that even experienced nurses often found difficult to perform. Although the experts did not suggest a change in the item, they noted that it represented an expectation of new RN graduate performance that was perhaps unrealistically high.

Three experts offered summative comments that the items had face validity for evaluation of QSEN competencies and were usable. They also noted that the tool did not exhaustively assess all QSEN prelicensure KSAs (QSEN Institute, 2014), but its relative brevity enhanced its value. A content validity ratio (Lawshe, 1975; Wilson, Pan, & Schumsky, 2012) was not initially calculated for this instrument.

Concurrent Validity

The tool was also administered to 17 nursing faculty members, with and without current clinical experience, and 94 junior-level students in a traditional baccalaureate program, who self-rated their performance on the items. The mean student score was 2.23 (range = 1.74 to 2.72; SD = 0.29), and the mean faculty score was 2.86 (range = 1.86 to 3; SD = 0.27). The lowest score for students and faculty alike was for item 35 (Table 1; “Utilizes clinical technologies [e.g., smart pumps, monitors]”). Among the students, mean scores reflected high levels of self-rated developing competency (⩾2.5) on seven items (items 10, 20, 21, 24, 25, 29, and 30), lower levels of developing competency (2.02 to 2.47) on 22 items, and beginning competency (1.74 to 1.97) on six items. Among the faculty, mean scores reflected accomplished competency (3.0) on 23 items, high levels of developing competency on eight items, lower levels of developing competency on two items, and beginning competency on a single item.

Discussion

The tool, which was developed to assess competency of new RN graduates, had good internal consistency and face validity and discriminated between levels of nursing experience, as measured among students and faculty. Basic psychometric testing with prelicensure students and nursing faculty confirmed that the tool can discriminate between various levels of self-assessed mastery of the included QSEN competencies. Approximately 10 minutes was required for participants (preceptors, students, and faculty) to complete the tool.

Limitations

Limitations of the assessment tool include its intended purpose. It was developed to provide feedback to new RN graduates participating in transition-to-practice programs, not to provide an exhaustive evaluation of all QSEN competencies. The face validity analysis confirms that the included items are valid, but the tool does not comprehensively address all aspects of the six QSEN competencies. Consequently, it can be used when comprehensive evaluation of all aspects of the QSEN competencies is not necessary.

An additional limitation is the 4-point scale, which contrasts with the 5-point Likert scale used by Berkow et al. (2009) to assess the perceptions of nurse leaders around the proficiencies of new RN graduates. Although a 4-point scale enabled rapid tool completion, it may have resulted in the loss of some information. Finally, the study findings require validation in other populations and settings.

Conclusion

The assessment tool presented in this article is an instrument that can be quickly completed and easily used in the clinical setting for purposes that include self-evaluation and peer or coach feedback, with minimal training required. Selected behaviors that fulfill the six QSEN competencies provided a meaningful assessment of developing competencies among new RN graduates participating in a transition-to-practice program.

References

  • Anderson, G., Hair, C. & Todero, C. (2012). Nurse residency programs: An evidence-based review of theory, process, and outcomes. Journal of Professional Nursing, 28, 203–212. doi:10.1016/j.profnurs.2011.11.020 [CrossRef]
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Behaviors Assessed in the Quality and Safety Education for Nurses Competency Evaluation Tool

Competency
Patient-centered care

Conducts comprehensive psychosocial and physical health history that includes the patient’s perspective and considers cultural, spiritual, and social factors

Complete understanding and interpretation of assessment data

Able to anticipate risks related to assessment data

Integrates knowledge of pathophysiology of patient conditions

Decision making is based on sound clinical judgment and clinical reasoning

Advocates for patient as appropriate in multidisciplinary team discussions

Recognizes changes in patient status and conducts appropriate follow up

Prioritizes actions related to patient needs and delegates actions, if appropriate

Establishes rapport with patients and their families

Safety

Demonstrates safe practices related to medication administration, including rights, verification of allergies, two patient identifiers, read-back process, and independent double-checks for high-alert medications

Demonstrates safe use of equipment that is appropriate to the setting, such as intravenous set up, pumps

Educates patient on safety practices when administering medications, drawing blood, starting an intravenous line, using patient-controlled analgesias

Communicates observations or concerns related to hazards to patients, families, and the health care team and uses the organizational reporting system for errors

Applies basic principles and practices of sterile asepsis while administering injections, placing urinary catheters, and performing open-wound care

Evidence-based practice

Uses library, Internet, and colleagues to efficiently manage information

Locates, critically reviews, and applies scientific evidence and medical literature

Understands the principles of evidence-based practice and applies the principles to pain management

Teamwork and collaboration

Establishes rapport with patients and their families

Communicates with interprofessional team

Asks questions of appropriate team member when unsure about any aspect of care

Is receptive to input from others and not becoming defensive

Documents patient assessment data in a complete and timely fashion

Able to interpret physician and interprofessional team’s orders

Able to work as part of a team

Uses appropriate language and tone when resolving conflict

Professionalism

Able to keep track of multiple responsibilities and completes tasks within expected time frames

Recognizes and reports unsafe practice by self and others

Able to work autonomously and be accountable for own actions

Behavior is ethical and honest, as judged by the American Nurses Association ethical principles

Expresses importance and demonstrates habits for life-long learning

Complies with legal and regulatory requirements relevant to nursing practice

Quality

Evaluates and implements systems improvement based on clinical practice data

Understands quality improvement methodologies

Informatics

Navigates the electronic health record

Utilizes clinical technologies (e.g., smart pumps, monitors)

Definitions of Postgraduate Competency Levels Used in the Evaluation Tool Response Scale

Competency LevelDefinition Provided to Preceptors and Participants
BeginningNot yet effective in assessing, observing, recognizing patterns and deviations, or seeking information. Takes unfocused approach to organizing data and requires assistance in diagnosing problems, planning interventions, and performing skills. Shows hesitance in communicating and responding to clinical scenarios.
DevelopingCaptures obvious patterns and attempts to monitor a variety of data but overlooks some important information. Performs basic assessment and clinical skills but still requires some guidance and direction. Shows solid foundation in leadership and communication abilities, although remains disorganized and hesitant in some aspects of clinical situations.
AccomplishedEffectively assesses, seeks information, recognizes patterns and deviations, and plans interventions. Displays confidence and leadership ability, communicates effectively, and requires guidance only in complicated cases. Demonstrates proficiency in most nursing skills, and requires minimal prompting in responding to clinical scenarios.

Key Points

New RN Graduates

Prion, S., Berman, A., Karshmer, J., Van, P., Wallace, J. & West, N. (2015). Preceptor and Self-Evaluation Competencies Among New RN Graduates. The Journal of Continuing Education in Nursing, 46(7), 303–308.

  1. A 35-item tool uses selected Quality and Safety Education for Nurses knowledge, skills, and attitudes to help preceptors assess the competencies of new graduate RNs in transition-to-practice programs.

  2. The tool was also used by new graduate RNs to assess their own performance.

  3. The tool had good internal consistency when used for preceptor evaluation of new graduate RNs and for self-assessment by new graduate RNs.

  4. The tool also successfully discriminated between junior-level baccalaureate nursing students and nursing faculty.

10.3928/00220124-20150619-01

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