Essential Competencies of Preceptors: A Focus on Working with APRN Students

Module 1: Preceptor Roles and Responsibilities

ADULT LEARNING PRINCIPLES

Adults learn differently than children, and it is important that principles of adult learning be incorporated into precepted experiences. In the United States, Knowles (1984) is generally credited with introducing the concept of andragogy, defined as an integrated approach to adult learning. The following video (Runtime: 02:44) provides an introduction to the key principles of adult learning as described by Knowles.

As presented in the video, the adult values learning experiences that:

• Allow autonomy and self-direction
• Acknowledge previous life experiences
• Focus on goals
• Provide relevance
• Incorporate practical content and competencies
• Respect the individual learner

Adult learning emphasizes the active role of the learner in the teaching-learning process, and focuses on the individual's past experiences and future goals.

According to Knowles (1980, 1984), six assumptions guide adult learning principles, and include the following:

TABLE 1

Adult learning:	Preceptor focus	Student focus	Example
is self-directed/autonomous responsibility for one’s own actions	- facilitate the process of goal-setting -provide freedom for students to assume responsibility for choices - balance the graduate nursing student’s expectations for self-directed learning and the learning needs required to provide safe, effective care to the patients - facilitate a balance by providing new learning experiences for the student, while at the same time holding the student accountable for some “self-directed” inquiry and preparation outside of the clinical site	- actively involved in the learning process - choices are relevant to their learning objectives - direct learning goals with the guidance responsible for their choices - students understand that they will be required as professional registered nurses to maintain their knowledge and competence	- provide APRN student with increased patient load as knowledge and skills develop, allow student to identify new learning goals as original ones are accomplished
utilizes knowledge & life experiences	- encourage learners to connect their past experiences with their current knowledge - help students in drawing out relevant past knowledge and experiences - relate the sum of learners’ experiences to the current learning experiences - acknowledge competencies from previous clinical experience - discuss the new role differences and expectations	- bring to their current and past knowledge, opinions, and experiences - expect acknowledgement of knowledge and competence from previous clinical experience	- have student compare previous experiences with specific medical diagnoses to current patient, discussing similarities and differences in symptoms, comorbidities and plan of care
is goal-oriented clear understanding of why specific knowledge is important to them	- goal-oriented - learning outcomes should be clearly identified - align the learning activities to objectives and a timeline to completion of activities and objectives - facilitate the student’s learning by consistently addressing “why” in clinical settings	- motivation to learn is increased when the relevance to ‘real-life’ situations is clear - openness to acquire relevant and adequate knowledge -incorporate the “why” in clinical settings	- incorporating rationales into discussions of medications and procedures - explaining how decisions are made about patient care
is relevancy-oriented focus on what is important for satisfactory role performance	- ensure assigned tasks are related to learning goals - maximize opportunities for the student experiences with relevant skills, balanced with an emphasis on the “why” of the tasks and rationales	- relating the assigned tasks to their own learning goals - student desires to be perceived as competent	- review established learning goals and assign patients that will allow the student to address these objectives,  discuss the measures needed for various treatment options
highlights practicality - motivation of the learner - adults relate the importance of learning to its value and usefulness to real life situations	- identify appropriate ways and convert theoretical learning to practical activities through clinical placement - facilitate motivation by working with students to provide consistent and repetitive learning experiences that increase confidence	- implementing theoretical knowledge in real life situations - student may be motivated more by learning experiences that promote comfort and confidence in their clinical performance	External motivators - grades   Internal motivators - increased job satisfaction and self-esteem
encourages collaboration	- facilitate/support collaborative relationships	- facilitate/support collaborative relationships	- allow graduate student to attend/participate in grand rounds, multidisciplinary team meetings, and initiate discussions with other licensed personnel  regarding patients’ progression

Incorporation of these six assumptions into the preceptorship acknowledges the nursing student's adult learning preferences, and should promote a positive learning environment.

Benner's Novice to Expert

Patricia Benner (1984) is well known for her work on the novice to expert model that correlates stages of competence to how nurses acquire skills and knowledge. Many preceptor programs incorporate this Novice to Expert model, and content about this model is included to assist the preceptor in understanding these stages (Table 2).

TABLE 2

Stage	Characteristics
Novice	- Little or no experience in the role - Learning needs focused on basic content - Little to no understanding of the context of concepts - Tend to be rule-oriented and concrete
Advanced Beginner	- New APRNs are typically characterized in this stage - Demonstrates understanding of basic knowledge, - Skills and role expectations - Experience gained through learning and performing interventions - Applies content learned to guide practice
Competent	- Typically applies to clinicians with 2 – 3 years of experience - Have developed an identity as an APRN - Demonstrate greater efficiency and organization in practice - Practice from a sound knowledge base - Resourceful in finding needed information to guide practice
Proficient	- Demonstrate ability to quickly analyze situations - Decision-making is more holistic - Anticipates what to expect in clinical situations
Expert	- Performance is fluid, flexible and highly organized - Consistently sees the “big picture” and responds quickly to changes in patient status

APRN students may be at the novice or the advanced beginner stage prior to entry into their respective programs. Once they have worked in clinical roles, they advance through Benner's stages, ultimately to the expert level. Classifying the specific stage is not as important for the preceptor, as is acknowledging that all learners may be at different stages. Similar to adult learning principles, an understanding of these stages assists the preceptor in individualizing the experiences to meet the student's learning needs.