Debra M. Wolf, PhD, RN,
Kathleen C. Spadaro PhD, RN, PMHCNS,
and Elizabeth A. Gazza PhD, RN, LCCE, FACCE
Slade, J., Wolf, D., Spadaro, K. & Gazza, E. (June 2013). Using Social Media to Meet the Needs of DNP Preceptors within an Online Program. Online Journal of Nursing Informatics (OJNI), vol. 17 (2), Available at http://ojni.org/issues/?p=2678
Preceptors are nurses willing to share their expertise with students. They are often viewed as an extension of nursing faculty. They must be experientially and academically qualified to serve in the preceptor role while having a clear understanding of the role and their performance expectations. An innovative project was designed to facilitate and improve preceptor development and support while enhancing program quality at a university offering a web-based Doctor of Nursing Practice (DNP) program and creating a pool of potential future nursing faculty. Using Web 2.0 and social media tools, a virtual preceptor resource center (PRC) was created to support preceptors in their role while delivering appropriate resources. The PRC is a virtual environment that preceptors can access twenty-four hours a day, on any given day, from any location. The virtual environment offers educational resources, communication centers supporting preceptor-to-preceptor or preceptor-to-faculty discussions, and easy access to key documents that support their role as a preceptor.
preceptors, social media, DNP, nursing, Web 2.0
The flexibility of web-based education allows nurses, many of whom work shifts and weekends, to earn advanced degrees and certifications. Chatham University, located in Pittsburgh, Pennsylvania, offers a 27-credit, web-based DNP program designed for nursing professionals interested in earning an advanced degree. Under the guidance of nursing faculty, students complete coursework online while engaging in clinical experiences in an institution of their choice, preferably their place of employment, with the supervision of a qualified clinical preceptor. A preceptor is defined as “an experienced nurse who develops a one-to-one time-limited relationship with a nursing student, providing guidance and supervision to promote his/her clinical competence and skill development” (Parsons, 2007, p. 1).
Students enrolled in the program complete clinical practicums across the United States, including Alaska. At Chatham University, preceptors are viewed as an extension of the nursing faculty. Therefore, preceptors must be experientially and academically qualified to serve in their role while having clear role and performance expectations (Commission on Collegiate Nursing Education, 2009). The following is a description of a project designed to facilitate and improve preceptor development and support, while enhancing the program’s quality and creating a pool of potential future nursing faculty.
In order to ensure that preceptors are prepared to serve in their role, it is necessary for nursing education programs to provide development opportunities that are accessible and meaningful. This preparation can be particularly challenging for web-based nursing education programs that utilize remote preceptors who reside, practice, and facilitate student learning in global settings that extend well beyond the physical campus. Financial resources and commitments to employers and family often limit the remote preceptor’s ability to travel to campus in order to participate in development activities. There is also a possibility for these preceptors to feel isolated from the educational community within the nursing education program and uncertain about their contributions to the learning process. Collectively, these barriers can have a negative impact on the number of nurses interested in serving as preceptors and the quality of their experience in this teaching role. Yet the expertise that quality preceptors bring to nursing education is extremely valuable. Therefore, it is necessary to identify a comprehensive approach to ensuring that preceptors are brought together as members of the nursing faculty and have access to and engage in learning experiences to ensure they are prepared to serve in their role while clearly understanding performance expectations.
Parsons (2007) examined the effectiveness of an online preceptor education program for public/community health nurses interested in learning more about becoming a preceptor. A sample of 48 nurses from five U.S. states participated in a computer-assisted public/community health preceptor education program that included eight interactive modules. Topics addressed through the modules included the preceptor role, learning styles, teaching strategies, critical thinking, managing challenging situations, providing feedback, and evaluation. Preceptor knowledge and self-efficacy scores increased significantly after completing the online education program. This outcome seems to indicate that a web-based approach to preceptor development can be effective at overcoming barriers associated with remote preceptors and facilitating their development.
In a study to determine the influence of an ongoing, structured online support program on the teaching practices of nursing preceptors, Myrick, Caplan, Smitten, and Rusk (2011) concluded that online preceptor support is feasible, facilitative, and an accessible medium. Data collected from semi-structured interviews with nine current preceptors revealed that participants felt they were exposed to new knowledge in a flexible and supportive environment through the online program. Also, engagement in the program allowed them to explore approaches to preceptorship and share their experiences through e-technology.
Lastly, Dalton et al. (2007) reported on the benefits of using an online educational curriculum to develop pharmacist preceptors in three Australian states. Five modules on topics such as the student, the preceptor, challenges with precepting, and putting theory into practice were included in the program. Ease of access, self-directed nature of learning, and interactivity were identified as strengths of the program. Participants stressed the benefit of sharing ideas and feedback with peers. Again, this outcome seems to indicate that effective preceptor development, including that of remote preceptors, is most effective when the online approach includes a social component.
A web-based approach to ensure preceptors are prepared to serve in their role and have clear role and performance expectations is a viable option for nursing education programs that utilize the expertise of remote preceptors, such as those offered at Chatham University. The post-Masters DNP program at Chatham University requires students to complete a minimum of 500 supervised clinical hours, in addition to the 500 hours completed during their master’s program, in order to earn a DNP Degree as prescribed by the American Association of Colleges of Nursing (American Association of Colleges of Nursing [AACN], 2006). The students plan, implement, and evaluate an evidence-based practice (EBP) change project, which is the focus of the three courses in the program in which they complete a minimum of 500 clinical hours. Students are encouraged to complete clinical experiences, including the EBP change project, at their place of employment where they are cognizant of the needs of the patients and clients; have access to information, policies, and personnel needed to complete their experience; and will ultimately be able to witness the long-term results of the project.
During the clinical experiences, from planning to evaluation of the EBP change project, students are guided by course faculty and the clinical coordinator who are based at Chatham. At the clinical site, preceptors provide on-site learning support as they supervise the students engaged in clinical practice. Students are required to have at least one program-approved preceptor. Preceptor qualifications include current licensure as a registered professional nurse in the state in which the clinical is occurring, a doctoral degree in nursing, and employment at the clinical site where the student will engage in the clinical experience. Preceptors must agree to be available as a resource to the student during clinical hours and at all stages of the EBP change project. Preceptors share their expertise as clinicians or researchers, assist in accessing agency resources, collaborate with the DNP faculty and the clinical coordinator, and validate clinical hours completed by the student.
The effectiveness of utilizing preceptors as an extension of the faculty was evaluated by the Nursing Program Evaluation Committee (PEC) as part of the program evaluation plan at Chatham. Results of the evaluation revealed that enhancements were needed to facilitate initial and ongoing preceptor development. Preceptors did not seem to consistently have a clear understanding of what was expected of them in their preceptor role. Therefore, the PEC and the clinical coordinator devised an action plan for improvement. The goal was to improve preparation of preceptors for their role and to support them throughout their experience. Preceptors at Chatham have the potential to serve as a pool of future faculty for the program, which is essential at a time when the discipline is experiencing a shortage of qualified nursing faculty. Therefore, adequate preparation and ongoing development and support are essential.
Current preceptors were invited to participate in a survey aimed at: a) identifying the effectiveness of current information provided to them by the program, b) assessing utilization of the preceptor by the student, c) exploring orientation needs, and d) identifying how the nursing program could better support preceptors. An online survey was created using Qualtrics (Version 35.740, Qualtrics Labs Inc., Provo, UT, 2012) software. The survey was distributed electronically via email using a URL link supporting anonymous responses. A total of 100 preceptors who had guided student clinical experiences between Spring 2011 and Spring 2012 were eligible to participate in the survey. The survey consisted of two questions using Likert scale responses, one multiple choice question, and one open-ended question (see Tables 1-3).
Of the 100 preceptors invited to participate, four preceptor email invitations were returned due to inactive email addresses. Forty-three preceptors (45%) responded to the survey. The total number of responses for each question varied because not all respondents answered all of the questions. The following section includes the survey findings for each posed question.
Q1: Effectiveness of current materials. Using a five-point Likert scale, participants were asked to rate the effectiveness of ten items/documents that were currently being provided to the preceptors. Respondents indicated a majority of the information provided was beneficial (see Table 1). Written documents that were sent by the clinical coordinator and information provided by the student were most effective.
Q2: Utilization of preceptor. The second question focused on the utilization of the preceptor by the DNP student during the three clinical courses. Based on a four-point Likert scale, the responses were positive for each of the three clinical courses, based on preceptor feedback about how the student used their support (see Table 2). Another positive finding was that almost no preceptor experienced students coming unprepared to meetings. There was a small, but still concerning, percentage of students who made little contact with their preceptor.
Q3: Orientation needs. The third question was specific to the preceptors’ perceived needs for an orientation to the DNP program and their new role. The respondent could choose as many of the responses as appropriate and write in additional items. Respondents indicated that access to the DNP program mission, goals, and outcomes; program policies and procedures; DNP Program Orientation video; and articles on the preceptor role would be helpful (see Table 3).
Q4: Open comments. The final, open-ended question asked respondents to provide feedback on how faculty could best support them in their role as clinical preceptors, specifically what was being done right and what could be improved. Eleven responses were received and four of the respondents acknowledged they were Chatham DNP alumni and knew the preceptor role from their own experience as a student. Other feedback included needing more information regarding the role of the preceptor, strengthening the connection between the preceptor and faculty, and suggesting access to a clinical preceptor web page.
All responses were automatically stored electronically within Qualtrics (Version 35.740, Qualtrics Labs Inc., Provo, UT, 2012). Survey results supported the need to develop electronic resources for preceptor orientation and development, information sharing, and support. The survey results were presented to the PEC members and to the full nursing faculty. The decision was made to use these results to guide the development of a web-based preceptor resource area.
Meeting the needs of a selected group of professionals across the United States can be a challenging task. Today, with Web 2.0, innovative electronic devices such as smart phones, tablet computers, and iPads, as well as the latest social media tools, communication can occur globally twenty-four hours a day, on any given day. Several published studies found that virtual online educational/informational environments offer a convenient format for knowledge development among healthcare professionals (American Association of Colleges of Nursing, 2007; Pullen, 2006; Zahner, Tipple, Rather, & Schendzielos, 2009). Based on these findings, the decision was made to create a web-based virtual platform, titled Preceptor Resource Center (PRC), where preceptors could have access to resources and support services in an asynchronized manner. In order to create this virtual platform, three strategic planning steps were utilized. The steps included (1) defining criteria to select a platform, (2) identifying functionality the platform should support, and (3) choosing a platform that was user friendly.
The PEC identified three basic criteria to guide selection of a virtual platform. First, the platform had to be easy to access for both the preceptor and the faculty members, meaning individuals could access and use the platform from any electronic device that had internet or WiFi connections. By clicking on a hyperlink one could easily retrieve and utilize the PRC materials. Second, the PRC had to be easy to navigate. The committee wanted individuals to be able to view and move freely through the platform, visualizing all content areas without detailed instruction. The last criteria included finding a virtual platform that was easy to develop and maintain by faculty for routine maintenance and updating of resources. The objective was to create a tool that faculty could use freely to share resources when leading forums that included preceptors and clinical requirements.
The goal was to offer a variety of resources to preceptors in multiple formats. In order to accomplish this, a variety of functionality was needed. The committee determined the PRC should:
Four virtual platform options were identified and explored including a blog, a wiki, an independent web page, and a web-based, electronic educational management platform.
Using a blog or wiki was concerning because the knowledge and skill level needed to maneuver the sites could be challenging for some faculty and preceptors. The PEC asked if individuals would know where to go within a wiki or blog to access hyperlinks, post questions, or to view documents. The PEC also questioned whether unsolicited marketing would be a distraction if open source software was used. Although the university offers access to a blog and wiki, the ability of faculty to access and maintain the site was a concern because only a few faculty were familiar or comfortable with using or maneuvering these platforms.
The DNP program has a university designed and maintained web page that clearly outlines information for potential or current students. Adding a link to this web page that specifically focuses on preceptor resources is a feasible option, but the page would be open to the public unless special coding/accessing was added. Also, in order for web page information to be added or edited, a work order or request form would be required, which could be restricting and limit the flexibility of faculty to maintain updates to the website.
The final platform explored was an educational management system. Moodle is the current learning management system (LMS) used by Chatham University. Moodle is a web-based platform designed in a modular format displaying information in an organized format that provides faculty with the ability to lead traditional, hybrid, or online courses, using various types of software and functionality. This open access LMS has been in existence since 2002 and is operational in 225 countries with 73,267 registered users (Moodle Organization, 2012). In 2009, Chatham University changed learning management platform systems from Blackboard to Moodle following a year-long evaluation process that concluded with a recommendation report from the College of Continuing and Professional Studies and Instructional Technologies department at Chatham. The Moodle pilot experience, along with the positive faculty and student survey responses, the ability to customize the LMS, and the significant reduction in cost for Moodle supported the change of LMS in Fall 2009.
Chatham nursing faculty members have the computer skills and knowledge to independently alter the design of Moodle modules, as well as edit information and resources as needed. This independency, accessibility, and level of functionality were found to be a favorable and compatible platform that meets the functionality identified by the PEC. In addition, the Instructional Support Specialist (ISS) who specializes in Moodle functionality at the university confirmed that individuals not employed at the university could have an account created, allowing access to Moodle using a specified hyperlink, thus maintaining privacy and security of information. Therefore, a decision was made to utilize Moodle as the platform for the PRC.
Once Moodle was selected as the web-based platform, informational content, roles, and responsibilities had to be defined. The PEC discussed the need for access to three key components:
Examples of institutional documents included: clinical site contracts, preceptors role and responsibility documents, matrixes delineating the relationship between learning activities, course and program outcomes, and syllabi of clinical courses. Scholarly resources were also included using hyperlinks to websites that supported the preceptor role and articles from scholarly journals. An audio/video preceptor orientation was created, as well as discussion forums to support networking opportunities amongst preceptors, and preceptors and faculty. The PRC offers individuals the opportunity to post a question or seek input from other preceptors who have visited the PRC. Individuals are also able to post a question directly to the clinical coordinator through a discussion forum.
Coordination and oversight of the PRC was designated to the nursing clinical coordinator who is accountable for:
Through a collaborative effort of the PEC and the ISS, a Moodle site was created that allowed preceptors access from outside the university’s intranet (http://moodle.chatham.edu). Modular blocks were created within the site and titled to reflect content found within each block (see Figures 1-4). To make the PRC attractive, pictures of the university were inserted along with various graphics to offer a welcoming non-threatening virtual environment.
Critical to the success of the PRC was the usage and rate of adoption by the preceptors. Rogers defined rate of adoption as “the relative speed with which an innovation is adopted by members of a social system” (1995, p. 206). Rogers believes a significant portion of any technology adoption is described by five attributes. These attributes include; a) the relative advantage – the benefits are seen as positive or more favorable than the current system/practice; b) compatibility – meets existing lifestyle and needs; c) complexity – perceived as non-complex or easily accessible; d) trialability – user has the ability to trial, visit, test, or explore innovation with no commitments or requirements to return; and e) observability – functionality has been observed or utilized by others. By integrating Rogers’ theory into the implementation strategy, the nursing department was able to strategize and hopefully influence adoption rate.
The PEC realized the relative advantage of creating a PRC was beneficial to all. Creating a virtual platform established multiple benefits to preceptors and faculty, ultimately supporting the academic success for students. By creating a platform accessible via the internet, preceptors were offered educational documents, resources to support their current role, and networking opportunities. Today, with 79% of the U.S. population using the internet (Fox, 2011), 88% having cell phones, and 57% owning computers (Zickuhr, & Smith, 2008), accessibility to the World Wide Web using multiple forms of electronic devices is becoming common practice. By developing a virtual platform the compatibility to meet existing lifestyles was considered favorable. Knowing complexity is negatively related to adoption, the PEC focused on creating a process to access, view, and utilize the platform as simple as possible. The goal was to create a virtual presence that was perceived as a welcoming environment, easy to use, and simple to navigate. Offering easy access supported the non-committal use or trialability of the PRC. The PEC believed having the ability to try, visit, and explore the virtual platform with no commitments or requirements would be seen as favorable because no registration was required and preceptors were given simple directions along with a URL link, username, and password for easy access and viewing. Once preceptors accessed the site, they would be able to observe and utilize resources, view audio/video communication, and review asynchronized discussions. This observability allows individuals the opportunity to explore the site’s offerings and interactions prior to deciding if they would take part in collegial networking activities.
As the PRC was developed and implemented, future plans were already being made. These plans align with the overall goals of the initiative and include growth of the PRC, the individual preceptor, and the pool of potential future nursing faculty.
A continuous improvement process serves as the basis for identifying enhancements that would best serve the needs of the preceptors within the DNP program. Data to be used in the process includes the number of times preceptors access the site, the various items they access, and the overall amount of time they are engaged within the site. Electronic surveys aimed at measuring preceptor satisfaction with the available resources will be created in order to assess needs that are and are not being met. These surveys will be used as data resources for standard measures for the DNP program’s quality specific to use of preceptors as an extension of faculty as identified by CCNE (Commission on Collegiate Nursing Education, 2009).
Facilitating the development of individual preceptors as clinical educators requires connecting preceptors with resources beyond the PRC. While preceptors using the PRC have the opportunity to connect and engage in dialogue with other Chatham preceptors and faculty, the faculty recognizes the need to extend preceptor connections beyond the Chatham community. Future plans include incorporating social media such as Facebook, Twitter, and LinkedIn as tools for engaging in experiences with others in the discipline who can provide additional support and development opportunities.
Preceptors are nurses willing to share their expertise with students. For most, serving in the role of preceptor is their first experience with teaching, and many come to this new role with little or no formal education about nursing education and teaching. Chatham nursing faculty recognize the importance of ensuring that a preceptor’s initial exposure to teaching and nursing education is positive and supportive, because preceptors serve as a pool of future nursing faculty. Future plans for the PRC include creating a section that provides information about the educational preparation needed for employment as nursing faculty and details about the experience of being nursing faculty (Gazza, 2009; Gazza & Shellenbarger, 2010). Through this supplemental section of the PRC, current faculty and preceptors will have the opportunity to dialogue through discussion forums to learn what it is like to be a nursing faculty member. Mentoring relationships that support future nursing faculty could result from this type of interaction.
Preceptors are seen as an extension of the faculty at Chatham. They are a key component of the educational community. Preceptors engage in the work of precepting students at locations beyond the confines of the university campus and, in some cases, with limited experience, information, and support. Using data provided by current preceptors as evidence, the PRC was created and implemented. The overall goal of the initiative was to facilitate ongoing preceptor development and support, enhance program quality, including the student learning experience, and create a potential pool of future nursing faculty for the program. Web 2.0 allowed for the creation of a PRC that delivers the resources needed to reach this goal; is accessible twenty-four hours a day, on any given day, from any location; and is easy to maintain. Future plans encompass ongoing growth of the site, individual preceptors, and pool of future nursing faculty. All of these possibilities will be a result of using a virtual platform to support preceptors within the DNP program at Chatham University.
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Dr. Julie D. Slade is the Clinical Coordinator for the nursing department at Chatham University. In this role that Dr. Slade has helped to evolve over the last two years, she coordinates clinicals for students in the RN-BSN, MSN, and DNP Program. Dr. Slade also works extensively with the preceptors of the students in each of the programs. Dr. Slade’s clinical area of interest is hospice and academic area of interest is the clinical and preceptor experience.
Dr. Debra M. Wolf is an Associate Professor of Nursing and an independent Healthcare Informatics Consultant. Dr. Wolf has over 30 years of experience within the healthcare arena. Her academic area of interest falls within the Doctorate of Nursing Practice and Master of Science in Nursing programs leading course content in evidence based practice, developing practice scholarship, healthcare informatics, innovative technology in education and oversight within the capstone experience. Her area of expertise focuses on integrating technology into a healthcare setting focusing on change management, process redesign and more recently the use of social media in supporting clinicians health 2.0 needs. Dr. Wolf has worked closely with various IT vendors and health systems in exploring and integrating new technologies. Dr. Wolf was invited to testify in front of the IOM on the future needs of nursing where she emphasized the need for innovative technology to be integrated into all nursing programs. Dr. Wolf is a member of multiple organizations including HIMSS, NLN, ANA, and Sigma Theta Tau. In addition she had served on the board of Western PA HIMSS Chapter and on the NLN: Education Technology Information Management Advisory Committee.
Dr. Kathleen C. Spadaro is the co-coordinator for the MSN Program and assistant professor of nursing at Chatham University. She has thirty-six years of nursing experience in clinical, administrative, and academic settings. As a nursing professor, she has taught undergraduate, masters, and doctoral nursing students at both private and state universities. Dr. Spadaro’s research focus is on mindfulness in healthcare, mindfulness-based stress reduction with nursing students, and nursing education. She has published and presented nationally and internationally. Through her part-time private psychotherapy practice, she has also provided mentoring and preceptor experiences to nursing and medical students.
Dr. Elizabeth A. Gazza is director for the RN-BSN, MSN, and DNP Programs and associate professor of nursing at Chatham University. She has over 20 years of experience in education including adult and community education and nursing education. She has taught in public and private institutions and in all levels of nursing education including licensed practical nursing, BSN, MSN, and DNP programs. She has over 8 years of experience in academic administration and previously served as the dean for nursing and allied health at a community college. Dr. Gazza’s research focuses on the nursing faculty experience including faculty development. She has published and presented about the nursing faculty experience, faculty development, and faculty mentoring.