Adult Learners

Many nursing students at Amarillo College are adult learners who come to the clinical setting with a variety of previous nursing experiences (LVNs or Nurse Techs), and other students come from non-nursing backgrounds with other unique experiences to enhance their nursing practice. Regardless of the type of their experiences, adult learners are interested in sharing their history and merging their past lives into their new roles. Adult learners are also often experiential learners who prefer to take an active part in the learning process rather than being passive recipients of information and typically learn better when the topic is of immediate value (Burns, Beauchesne, Ryan-Krause, and Sawin, 2006).

Methods

There are many teaching strategies that are effective with adult learners in a precepted clinical experience.

Some of these methods include:

Modeling

Modeling is an effective teaching strategy where the preceptor demonstrates his/her clinical expertise when seeing patients while the beginning learner observes. This approach allows the student to see the reality of classroom education applied to actual patients. It is often during this modeling experience that the preceptor may be challenged to answer the "why" questions of adult learners. However, modeling and observation are relatively passive. Learners need to actually apply skills themselves to achieve mastery.

Direct Questioning

Direct questioning is helpful in fostering critical thinking and clinical reasoning skills. Preceptors are most effective when the questioning is not perceived as "grilling”. Questions like "What do you think?" and "Why do you think that?" stimulate thinking and allow the student to share observations and interpretations with the preceptor.

Think Aloud Method

The "Think Aloud Method" requires the student to provide a rationale for specific questions that were asked and physical examination techniques used to show how conclusions were reached. This approach fosters critical thinking and clinical reasoning skills. It is useful with all levels of learners because it requires the student to verbalize thoughts and support decisions.

Feedback

Feedback from preceptors is essential, especially with adult learners whose learning is enhanced if they believe they are making progress. Effective feedback describes specific situations and skills and is given immediately after the preceptor's observation of these concrete events. This reinforces what was done correctly, reviews what needs to be improved, and corrects mistakes. Feedback is less judgmental than evaluation and is best given informally throughout the student's experience. Feedback can be more meaningful if the student has the opportunity to do a self-assessment prior to hearing the preceptor's comments. For example, a preceptor asking the question, "How well do you think you handled that situation?" will give the student the chance to share his/her rationale for the approach and prompt further discussion about the question, "How could you have done it differently?"

Top 10 Tips

As a preceptor, you will be one of the most influential people within your preceptees nursing career. You directly have the ability to give them a positive, reassuring, confidence-building, and educational start to their career. These 10 tips shared by Michael Heuninckx (2014), an experienced emergency department RN, include excellent information that will help make your preceptor experience more rewarding for both you and the nursing students you precept.

1. Tell them your story and express to them your passion for nursing. This is an effective way for the student nurse to learn more about you, both personally and professionally. Being a preceptor, you have to be authentic. You want to create a positive and open atmosphere for learning and communication. Communication is critical and during your time with them, they need to feel like they can tell or ask you anything.
2. Being a preceptor takes a lot of patience. Having your favorite coffee or candy on hand, exercising and getting adequate rest are some ways you can take care of yourself. Taking care of yourself will help ensure that you are patient. Getting advice from a nursing colleague is often helpful. It is also helpful to confer with the nursing instructor in an ongoing manner.
3. Remember everyone starts somewhere. Take time to reflect back on your experiences when you were a new nurse. You did not know everything when you started. You made mistakes daily. You asked a lot of questions. You felt insecure and inadequate because you asked so many questions. You learned something new every day. You were not the best.
4. Know they are already scared. If they are not, this might be red flag! You need to emphasize to your preceptee that the nursing profession is intense because it requires high level critical thinking and clinical reasoning to provide safe patient care. Make sure you reassure them through your guidance, knowledge, and encouragement that it is your personal mission for them to become a successful nurse.
5. Encourage them to ask questions. You should be worried if they don’t! Remember, you have to create an environment that is based on mutual trust, respect, and collaboration for them to feel confident. Your preceptee will feel confident to ask you questions when they know you care about them and respect them. As a preceptor, watch how you respond to all questions asked. Be conscious of your responses in regards to tone and pitch, as well as all nonverbal facial and body expressions. Have a calm and relaxed demeanor and make sure to smile.
6. Clearly communicate your expectations and any rules/regulations on day one. This is the best time to review the clinical course competencies with your preceptee. Clear communication at the beginning of the clinical learning experience will promote an effective teaching and learning environment and ensure safe patient care. 
7. Ask them what they expect to gain from the clinical learning experience. No two students are the same. Each one has their own strengths, weakness, expectations, and goals/needs. Encourage your student to express their concerns or worries so you can help them find solutions to these problems.
8. Reflect about the day at the end of every shift with your student. This time of reflection is important when you are a preceptor. This gives you the time to discuss any question or concerns you had during the day in a private and personal manner. At times, you might be too busy to fully say everything you want to discuss about a topic. Or your students might have a question they wanted to ask you in private. Again, anything you can do to improve communication and the quality of communication is key.  
9. Increase your knowledge about leadership. Being a preceptor is also a leadership role and your leadership abilities will be passed on to your student, who is observing your action and how you deal with certain situations. You can help your preceptee develop a professional image through your role modeling.
10. Be careful with everything you do and everything you say. Your student is always watching and always listening. They will be observing if you are performing nursing skills according to practice standards. They will hear and take note of what you talk about and how you talk about patients, the job, nursing as a profession, the organization you work for, and your other colleagues. Be respectful at all times when referring to patients, families, colleagues, or anyone else who passes your way.

Conflict/Conflict Resolution

About Conflict and Conflict Resolution

As a preceptor, you may experience conflict with your preceptee. Conflict can create stress among individuals and can be either constructive or destructive.  Constructive conflict stimulates desired change or results in positive growth. Destructive conflict causes stress, interferes with quality of patient care, work satisfaction, and effective communication.

Guidelines for Expressing Conflict include:

• Use “I” statements to clarify your own opinions and experiences from hearsay. “I believe that...”
• State the conflict or disagreement clearly, making your position obvious.
• Collect information about the situation so that the specific problem can be identified.
• Listen to how others perceive the situation. Are assumptions based on fact or opinion?
• Recognize the point of view expressed by others, and acknowledge there could be other solutions.
• Give your reasons if you think they will help identify or solve the problem, and describe your thoughts and perceptions accurately.

If you do experience conflict with your preceptee, please remember to notify the nursing instructor. We want to assure you have a rewarding experience as a preceptor. We will adjust the clinical schedule as necessary to facilitate a meaningful learning experience for everyone.

References:

Boyar, K. When nurses precept students: Views from both sides of the equation. 
http://www.americannursetoday.com/when-nurses-precept-students-views-from-both-sides-of-the-equation/ 
Heuninckx. M. 10 Tips to prepare you for precepting a new nurse graduate. 
http://www.nursetogether.com/precepting-a-new-nursing-graduate-10-tips 
Burns, C.,  Beauchesne, M., Ryan-Krause, P. and Sawin, K.  Pediatr Health Care.
Mastering the preceptor role: Challenges of clinical teaching. Journal of Pediatric Health Care. 2006;20(3):172-183

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