Staff nurses work as preceptors to train nursing students, new graduate nurses, and experienced nurses in clinical settings. Nurse preceptors work as teachers, mentors, role models, or supervisors, following guidelines from the National Council of State Boards of Nursing (2012), the American Association of Colleges of Nursing (2008), and the Commission on Collegiate Nursing Education (2013). Researchers have found preceptorships to be an integral part of nursing education (Kalischuk et al., 2013; L'Ecuyer, von der Lancken, et al., 2018; Martínez-Linares et al., 2019; McClure & Black, 2013). Preceptors guide the learning and growth of a nurse, provide protection during difficult situations, and assist in development of critical thinking, decision making, and priority setting (Bowen et al., 2019; Chen et al., 2012; McClure & Black, 2013; Quek & Shorey, 2018). The relationship between preceptor and preceptee is significant (Edward et al., 2017; Martínez-Linares et al., 2019; Washington, 2013), as are preceptor training programs, which have been shown to improve organizational outcomes related to retention rates, critical thinking, and reduced stress levels in new graduate nurses (Brook et al., 2019; Pennington & Driscoll, 2019; Piccinini et al., 2018). Conversely, unsatisfactory preceptorships, in which preceptors are inconsistent or inexperienced, are less effective and result in lower confidence and delayed progression of a new graduate nurse (Bengtsson & Carlson, 2015; Irwin et al., 2018).
Competency of nurse preceptors is an essential factor for the success of a preceptorship experience. Mann-Salinas et al. (2014) found that the most critical component of a comprehensive preceptor program was a motivated, trained, and supported group of highly competent preceptors. Other researchers have addressed the components of preceptor performance including knowledge, skills, attitude, role, role preparation and support, and preceptor characteristics (Butler et al., 2011; Carter et al., 2016; Cotter & Dienemann, 2016; Cotter et al., 2018; Forneris & Peden-Mcalpine, 2009; L'Ecuyer, Hyde, et al., 2018). These researchers noted that competency assessment for nurse preceptors is complex, is multifaceted, and lacks a clear component for evaluation by preceptors themselves (Carter et al., 2016; Forneris & Peden-Mcalpine, 2009; Sedgwick et al., 2014). Importantly, no instrument for assessing preceptor competence exists. Therefore, the researchers have undertaken a three-phase approach to develop a Preceptor Self-Assessment Tool (PSAT). The goal of developing a self-assessment tool is to allow nurse preceptors to reflect and evaluate their role competency. This article summarizes phase one and reports on the methodology and results of phase two, the content validity index (CVI) of the PSAT.
Background and Conceptual Framework
Competency has been described as a synergistic combination of knowledge, skills, and attitudes to solve problems in complex situations (Fernandez et al., 2012). This description along with Bloom's taxonomy of the cognitive, affective, and psychomotor learning domains (Bloom et al., 1956) serve as a framework for describing the complex work of staff nurse preceptors. Nurse educators have viewed preceptor competence as the ability to engage in learning, critical thinking, and reflective practice, including critical analysis skills (Sedgwick et al., 2014). O'Malley et al. (2000) suggested that the preceptor's characteristics should include experience and expertise in their specialty, good communication, leadership skills, decision-making ability, professional growth, positive attitude toward coworkers, flexibility, and teaching ability. In addition, the preceptor should be sensitive to preceptee's needs and should possess teaching and evaluation capabilities (O'Malley et al., 2000). Rodrigues and Witt (2013) suggested that preceptor competency consisted of nine domains—education, professional values, basic public health sciences, management, health care, teamwork, communication, community orientation, and professional development (Rodrigues & Witt, 2013).
Nurse preceptor preparation programs have been found to be effective ways of introducing nurses to the role of preceptor. Often, training courses and support for preceptors stop after these initial courses. Follow up in terms of advanced training needs and further development have not been discussed in the literature. Because staff nurses are diverse in background, educational preparation, and work experience, it is likely that their needs for training regarding the preceptor role are unique. These conclusions, and the fact that there is no tool known for preceptors to self-assess their role competency, have led to the desire to develop and test the PSAT.
Phase One: Summary of Item Development
The intent of this project was to develop a tool to be used by preceptors to explore their own needs regarding development and training for the preceptor role. This tool can be used prior to training courses to assess perceptions of development needs, after courses to measure changes in perceptions of competency after training, or later to identify needs for advanced training beyond basic courses. This information will benefit both preceptors and educators, who can work together to find resources that bridge the development needs. The goal of phase one was to develop items for the PSAT. The concept of preceptor competency was explored through a comprehensive literature review and qualitative study with a statewide sample of nurse preceptors (L'Ecuyer, Hyde, et al., 2018) to generate an item pool. Competencies of nurse preceptors were described in 553 responses as a range of attributes distributed across a final list of 25 defined attributes (categories) in which preceptors described their competency in terms of what they know, what they do, and how they behave (L'Ecuyer, Hyde, et al., 2018). The attributes were sorted into domains of knowledge, skills, attitudes, and other. The first three domains aligned with Bloom's taxonomy of the cognitive, affective, and psychomotor learning domain (Bloom et al., 1956). In addition, preceptors described “feeling supported” and “having enough time” as attributes of their competency, which suggests that there are other conditions that must be present for preceptors to do their work. Within each of the four domains, descriptions of preceptor competency were further sorted into categories and defined. The domains, categories, definitions, and sample statements are outlined in a previous publication (L'Ecuyer, Hyde, et al., 2018).
Phase Two: CVI Methods
To further validate the findings, phase two consisted of development and distribution of a content validity survey to a panel of subject matter experts. The goal of phase two was to determine content validity of the PSAT. Literature and data from phase one were again reviewed. Although it was important to collapse the original 69 items to four domains and 25 attributes (categories) in phase one of the study, it was also important to expand them for subject matter expert (SME) review in phase two to ensure the meaning of the original data was conveyed. For example, within the knowledge domain, the expertise and knowledge category was expanded to five items (1 = has clinical experience, 2 = has clinical nursing knowledge, 3 = is knowledgeable about resources, 4 = is knowledgeable about the institution, and 5 = is knowledgeable about policies and procedures). Further, the 69 items represent original data from preceptors, and it was important that SMEs examine the complete list to help determine validity of each item. Again, this important step informs the final items of the PSAT tool, ensures that each category sufficiently describes a concept and validates earlier decisions by the researcher to collapse versus expand the categories (Table 1).
Preceptor Self-Assessment Domains, Definitions, and Preceptor Self-Assessment Tool (PSAT) Items (1–69)
A survey of the items was created in Qualtrics® using a 4-point Likert scale of 1 = not relevant, 2 = somewhat relevant, 3 = quite relevant, and 4 = highly relevant (Polit & Beck, 2017; Polit et al., 2007). Fourteen SMEs were recruited and asked to review the content validity index of the PSAT. The SME inclusion criteria were as follows: nurses who have worked as preceptors for a minimum of 5 years, nurse faculty who have worked with preceptor and student pairs, nurses who work in staff development as preceptor trainers, or nurses who work in staff development with preceptor and new graduate or new employee nurse pairs. The SMEs were recruited from across the state of Missouri and represent a variety of backgrounds and nursing expertise. The purposive sample of SMEs received an email invitation to complete the CVI survey. All SMEs fit the inclusion criteria; therefore, demographic data were not collected.
The CVI was calculated for the relevancy of the 69 items. The Item-Level CVI (I-CVI) was calculated for each survey item, and the Scale-Level CVI (S-CVI) was calculated for the overall survey tool. In addition to rating the items, SMEs were also asked to provide feedback and comments for each item. The following formulas were used to calculate the I-CVI and S-CVI (Polit et al., 2007):
- I-CVIs = N of experts agreeing on items rated a 3 or 4/Total N of experts
- S-CVI = Final average of I-CVI scores
A pool of 69 items generated from the literature and a previous study (L'Ecuyer, Hyde, et al., 2018) were evaluated for content validity by SMEs. Eleven of 14 SMEs who were invited completed the CVI assessment (79% response rate). The sample SMEs were expert nurse preceptors, nurse educators who train preceptors, or nurse faculty who work with students and preceptor pairs, and they worked in a variety of setting across the state of Missouri. The S-CVI for the entire survey instrument was 0.91 (Table 2). The I-CVI scores ranged from 0.45 to 1.0. Polit et al. (2017) suggested using a cut-off score of 0.80 to determine item validity. Most items had a CVI score above 0.80 and were deemed excellent. Item 64 (has a good sense of humor) had the lowest score (0.45) and was removed. Item 69 (flexible schedule) had a CVI score of 0.73 and was removed. Items 54 (is kind), 55 (is friendly), and 57 (is personable) had a score of 0.73. These three items were within the category of kindness, along with item 56 (is respectful, which had a score of 1.00). After review of their CVI scores, the four items in the kindness category were collapsed to one item, and this category was renamed to respect. Item 67 (established team to enable preceptor function) also had a CVI score 0.73. After review, it was kept because the researchers felt that teamwork among preceptors is an important component of feeling supported. Only one qualitative comment was provided, and no revisions to the item were made. After CVI by SMEs and review by the researchers, the PSAT tool includes a total of 64 items.
Content Validity Index for Items of Preceptor Self-Assessment Tool
The nurse PSAT was developed to help preceptors identify their role competencies and identify areas for further education or development. Preceptor competence is an important concept because they are consistently described as key components of clinical education for nurses, and their competence is critical to the success of preceptor programs (Mann-Salinas et al., 2014; McClure & Black, 2013; Schumacher & Risco, 2017). Preceptors have repeatedly reported the need for adequate preparation, clear role expectations, and support for their role (Omansky, 2010; Tracey & McGowan, 2015; Valizadeh et al., 2016; Walker & Norris, 2020). The sustainment of adequately trained and competent preceptors is the responsibility of nurse leaders and those who oversee new nurse on-boarding (Mann-Salinas et al., 2014). Tools to help nurses better understand their own talents and needs for further development are needed. The PSAT will give preceptors an opportunity to reflect on their individual skill set of the preceptor role. It may identify needs previously undiscovered. Findings may encourage preceptors to discuss needs with mentors, nurse educators, or nursing administrators to help nurses find effective ways of developing their preceptor skills. The preceptor skill set is complex, and it is unlikely that it can be fully developed in one introductory training session. Advanced courses need to be developed and offered to support the complex work preceptors do as clinical educators. The PSAT tool can help identify gaps in training and inform the curriculum and development of advanced training.
The items in the PSAT CVI survey were developed based on literature reviews and findings from a previous qualitative study of preceptors' perceptions of preceptor competency. In the content validity process, most items were scored as highly relevant and therefore retained. Of the 69 items in the survey pool, six had CVI scores of less than the suggested cut-off score of 0.78. Five were removed. Because those items were not found in the literature related to preceptor competency, and their relevancy was rated low by SMEs, the researchers were comfortable removing them from the competency tool. One low scoring item (established team to enable preceptor function, 0.73) was retained. This item has also not been found in the literature; however, the researchers decided the concept was important enough to retain it for further testing in the next phase tool development. After CVI testing and further researcher discussion, the number of PSAT items is 64. Because the SMEs rated most of the items as relevant, the original set of domain categories is largely unchanged after the phase two CVI study. Overall, the S-CVI for the survey tool was 0.90, which is the recommended criterion for the S-CVI (Polit & Beck, 2006; Polit & Beck, 2017).
Generalization of these results is limited in that the SMEs used for this study are from only one state. Demographic data were not collected from SMEs, which means we do not know that the pool of SMEs represents the pool of nurse preceptors in terms of demographics. The items generated are from preceptors also from one state. Future research with a diverse, representative national sample of nurse preceptors will be necessary.
It will be an important next step to further reduce items in this 64-item tool. A tool has greater likelihood of being adapted and useful for nurses if its length is reasonable. More input from preceptors is needed to identify which items might overlap and which items can be collapsed. For that reason, the next phase of this research will include pilot testing of the PSAT tool using a large sample study population of nurse preceptors.
This study contributes to the identification of key components of preceptor competency and will allow preceptors to assess their individual strengths and identify areas that would benefit from further development. Findings will also benefit organizations and nurse leaders who are responsible for robust preceptor programs that support the recruitment, education, and retention of new nurse employees. Nursing education relies on skilled preceptors, who are a critical hidden workforce. Efforts should continue to identify the needs of preceptors and support their development. The psychometric properties of the PSAT were described in this study. To fully describe the concept of preceptor competency, further testing is indicated.
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Preceptor Self-Assessment Domains, Definitions, and Preceptor Self-Assessment Tool (PSAT) Items (1–69)
|Domain/Category||Definition||PSAT Items on Content Validity Index|
| Expertise and knowledge||Current on evidence-based practice, nursing essentials, nursing resources||Has clinical experience|
|Has clinical nursing knowledge|
|Is knowledgeable about resources|
|Is knowledgeable about the institution|
|Is knowledgeable about policies and procedures|
| Learning styles||Learning is unique, teaching should be individuals||Understands the influence of learning styles|
|Can adapt to preceptees' various learning styles|
| Personality issues and types||Personality types and implications||Understands the influence of personality types|
|Can adapt to preceptees' various personality types|
| Role preparation||Precepting methodology||Is prepared for the preceptor role|
|Has completed a preceptor training course|
|Understands the role of the preceptor|
| Emotional intelligence||Management or expression of emotions||Understands the influence of emotional intelligence|
| Clinical competence||Current and capable clinical skills||Has strong clinical skills|
|Has current clinical skills|
| Teacher competence||Ability to teach||Is a good teacher|
|Understands teaching role|
| Clinical thinking||Analyze and evaluate objectively to form a judgment||Helps preceptee develop critical thinking skills|
| Communication||Exchange information||Is a good communicator|
|Explains things clearly|
|Is a good listener|
| Interpersonal skills||Network; handle interpersonal issues including conflict||Demonstrates interpersonal skills|
|Works well with others|
| Feedback/evaluation skills||Report on performance to assist, improve, validate||Is able to give feedback|
|Gives constructive feedback|
|Is able to evaluate performance|
|Is able to evaluate competency|
| Protector/safety||Intervene to prevent errors or aggressions of others||Acts to protect preceptee|
|Creates a nonthreatening environment|
| Flexibility||Adjust to change, tailor education to preceptee's needs||Is flexible|
| Organization||Use time effectively, be efficient, be productive||Is organized|
|Can manage time|
|Has prioritization skills|
|Has delegation skills|
|Has problem solving skills|
| Setting goals||Establish objectives to work toward||Can create a plan|
|Works with preceptee to set goals|
|Knows expectations of preceptor and preceptee|
| Role model||Act as an example to be imitated||Is a role model|
|Has leadership qualities|
| Open to improvement||Demonstrate willingness to be a better preceptor||Is open to improving preceptor skills|
| Learning opportunities||Ability to identify learning moments||Can provide learning opportunities for preceptee|
| Patience||Accepting and tolerant, calm and composed||Is patient with preceptee|
| Desire to be preceptor||Willing to assume preceptor role||Has desire to be a preceptor|
|Is willing to be a preceptor|
| Understanding||Empathetic, compassionate, aware||Is understanding|
| Approachable||Open, considerate of new ideas||Is approachable|
|Is open minded|
| Kindnessb||Friendly, generous, and considerate||Is kinda|
| Confidence||Self-assured and conscious of strengths and weaknesses||Is confident|
|Is comfortable in preceptor role|
| Trustworthy||Honest, truthful, reliable||Is trustworthy|
|Positive attitude||Optimistic in thinking, feeling, behaving; sense of humor||Has a positive attitude|
|Has a caring attitude|
|Has a good sense of humora|
| Feeling supported||Having adequate material and human resources||Administrative and managerial support|
|Institutional resources to do the job of preceptor|
|Established team to enable preceptor function|
| Having enough time||Having time to spend on precepting duties||Adequate time|
Content Validity Index for Items of Preceptor Self-Assessment Tool
|Item No.||No. of SMEs in Agreement of Item Rated 3 or 4||I-CVI||Interpretation|