Background

North American Dialysis (a pseudonym) or NAD hereafter is a leading healthcare provider focused on delivering high-quality care to people with chronic kidney disease (CKD) and other chronic conditions. The dialysis arm operates in North America with a network of over 2,600 dialysis facilities, outpatient cardiac and vascular labs, and specialty pharmacy and laboratory services.

Nurse Preceptors (NPs) at NAD play a crucial role in supporting and training new nurses, specifically in the field of nephrology (kidney care). Their responsibilities can be broadly categorized into three areas:

Clinical Training and Development:

Orientation and Onboarding: Preceptors guide new nurses through the company's policies, procedures, and culture, familiarizing them with the dialysis unit and equipment post initial training for on-the-job support.
Clinical Skills Development: They provide hands-on training and supervision in administering dialysis treatments, monitoring vital signs, assessing patients, and performing other essential tasks.
Mentorship and Support: Preceptors offer ongoing guidance and answer questions, helping new nurses build confidence and clinical knowledge.
Evaluation and Feedback: They assess new nurses' performance, providing constructive feedback and identifying areas for improvement.

Patient Care and Advocacy:

Collaborative Care: Preceptors work alongside new nurses to deliver safe and effective care to patients undergoing dialysis.
Patient Education: They assist with patient education, ensuring patients understand their treatment and participate actively in their care.
Advocacy: Preceptors advocate for patients' needs and well-being, collaborating with other healthcare professionals to ensure optimal outcomes.

Professional Development:

Continuing Education: Preceptors may facilitate or participate in continuing education opportunities for new nurses, ensuring they stay up-to-date with the latest advancements in nephrology care.
Career Guidance: They may offer advice and support to new nurses as they explore career paths within NAD or the broader healthcare field.

Additionally, depending on their experience and role, nurse preceptors at NAD may also:

Train and mentor Patient Care Technicians (PCTs): This involves guiding PCTs in developing the skills and knowledge necessary to assist with patient care in the dialysis unit.
Contribute to quality improvement initiatives: They may participate in projects aimed at enhancing patient care and unit efficiency.
Serve as role models: By demonstrating professionalism, compassion, and critical thinking, preceptors inspire and motivate new nurses.

Overall, NPs at NAD play a vital role in ensuring the quality of care for patients with kidney disease while supporting the professional development of new nurses. Their dedication and expertise are crucial for fostering a positive and supportive work environment in the dialysis unit.

Because of the critical role of NPs, NAD identified a need for NPs to hone skills beyond just their technical nursing prowess. As a result, the NAD Education Team developed the Nurse Preceptor Training Program to ensure the NPs could proficiently lead others and guide the success of the clinics to ultimately generate better patient outcomes. Topics covered include:

Communication
Correct Process/Workflow
Access to Resources

This evaluation will be a formative evaluation to assist stakeholders with finding areas for improvement.

Stakeholders

There are three types of stakeholders for the Nurse Preceptor Training Program.

Upstream Stakeholders:

The upstream stakeholders for this training program include several members of the NAD Education team. They are as shown in Table 3follows:

Table 3. Upstream stakeholders

Direct Impactees:

The Clinical Education team is responsible for delivering this content to employees. That consists of:

Approximately 150 Clinical Educators
A rotating team of approximately 500 Preceptors

Indirect Impactees:

This program impacts the following job roles/people:

Clinic Managers
Patient Care Technicians
Patients

The most notable impact for the company is the indirect impact that this program has on patient care. The more effective the preceptors are in their role, the better the clinic will operate, ultimately leading to better treatment outcomes for patients.

EVALUATION REQUEST

The subject of this evaluation project is the Registered Nurse Preceptor (NP) training program of North American Dialysis. The purpose of the NP training is to prepare all RNs currently functioning as preceptors (trainers) to be highly functional clinical leaders. The training program is administered via virtual instructor-led sessions that are two hours in length. Sessions are offered once a month across different time zones, and learners self-enroll in the course through the corporate LMS.

The total number of NPs across the organization fluctuates between four and five hundred, depending upon demand. By completing this training the NPs are taught valuable information relative to resources and tools, as well as leadership skills. Because of the large number of NPs within the organization, the impact of their role is far-reaching; patients and other clinical staff impacted by Nurse Preceptors are in the thousands. Having effective leaders in the clinic can lead to better outcomes for patients and can improve working environments, culture, and efficiency. The organization’s mission is to transform healthcare through research, innovation, and compassion. The evaluated training program serves to support the third aspect of the mission, compassion (a measurement of behavior).

The Clinical Career team is the intended user of the information obtained from this evaluation. Applying their seasoned expertise and intimate familiarity with the Registered Nurse Preceptor training program, they will utilize the information to make improvements and changes to the content of the training program as they see fit, making this a formative evaluation.

METHODOLOGY

The basis of the systematic inquiry for the formative evaluation is Chyung’s 10-Step Evaluation Model (Chyung, 2019). The model employs evidence-based practice, where data drives each step and applies professional frameworks and expertise. The application of Kirkpatrick’s Model (Kirkpatrick, 1996) pushed the team to consider the organizational impacts of the training program beyond the immediate changes in behavior or learning acquisition. Additionally, Brinkerhoff’s Training Impact Model (TIM) was employed to further hone the details of the potential impact of the NP training.

Evaluation team members utilized the following tools to ensure adherence to the highest ethical standards in the course of the evaluation:

A critical aspect of the standard that the team followed was the commitment to serving a full range of stakeholders. Upstream and downstream stakeholders were considered by applying Kirkpatrick’s four levels of evaluation. In addition, the team worked diligently to ensure accuracy standards were met by using models such as the Likert model for survey design (Chyung, 2021).

Evidence-based practice was embedded in our evaluation process from beginning to end. Our data collection instruments focused on gathering as much objective data as possible within our given window of evaluation. Additionally, a review of extant data was incorporated into our findings, and the multiple data sets were triangulated, increasing the credibility of the conclusions drawn from our dimensions.

RESULTS & CONCLUSIONS

Stakeholders looked to the results of this evaluation project with anticipation because there had been no opportunity in recent months to delve so deeply into the impact of the Nurse Preceptor training program. Simply conducting the surveys, exams, interviews, and extant data review brought significant value. Though not yet implemented due to the time constraints of the evaluation project, recommendations highlight areas of opportunity within the training as well as celebrate areas of strength. A number of the data collection instruments revealed areas within the Nurse Preceptor role that learners consistently struggled with. This knowledge will prove invaluable to stakeholders in further addressing performance gaps in these areas.

Overall, the NP training program has had a slightly positive impact on the desired outcomes of the training (see Table 1). To achieve a significant improvement, two areas were identified during NP interviews. These are adjusting training materials to incorporate Home Therapies and In-Patient modalities, and increasing focus on knowledge of available resources. More detailed recommendations are presented later in this report under the Recommendations section.

Table 1. Summary of Evaluation Findings

RECOMMENDATIONS

As a result of this evaluation, the team has made the following recommendations to the stakeholders in order of priority:

Add materials regarding Home Therapies and In-Patient modalities

Feedback provided during the interviews identified a heavy bias towards the in-center modality of training. This bias impacts all of the three dimensions, in that the resources, workflows, and patient scenarios covered in the training typically have an in-center focus. Adjusting the content to better reflect all three modalities (home therapies, in-patient, and in-center) would help to improve scores across all dimensions. To fit these adaptations into the program time frame window, we recommended that the team create modality-specific examples and activities that participants can choose (Deci & Ryan, 2012).

Increase focus on Dimension 2: Knowledge of Available Resources

In the feedback gathered by the team, many participants pointed out that knowledge of resources was the most valuable aspect of the training. That said, the stakeholders should focus on improving the scores from good/slightly better to excellent in those areas.
To determine which resources could be improved upon, we recommend analyzing results of the Knowledge Assessments. Investigate those areas that are scoring particularly high and evaluate if there is something different in the approach to introducing those resources. And for those questions that decreased, look into possible reasons why that may have occurred.

REFERENCES

Chyung, S. Y. (2019). 10-step evaluation for training and performance improvement. Thousand Oaks, CA: Sage.

Chyung, S.Y. (2021). Survey Design and Data Analysis [Ebook]. Boise State University College of Engineering.

Deci, E. L., & Ryan, R. M. (2012). Self-Determination Theory. In SAGE Publications Ltd eBooks (pp. 416–437). https://doi.org/10.4135/9781446249215.n21

Kirkpatrick, D. (1996). Evaluating training programs: The four levels. San Francisco: Berrett-Koehler.