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Running Head: CNA PRECEPTOR PROGRAM 1
Implementation of a Certified Nursing Assistant Preceptor Program
Elizabeth Hotaling
State University of New York Institute of Technology
NUR 444 Nursing Leadership
CNA PRECEPTOR PROGRAM 2
Abstract
Following the success of preceptor programs for Registered Nurses and Licensed Practical
Nurses, Certified Nursing Assistant (CNA) preceptor programs are an emerging movement in
health care. Due to the high number of CNAs employed in long-term care facilities it is these
type of facilities that are developing and implementing CNA preceptor programs. Coordinating
with the Staff Development Department of Kingsway Community, a long-term, skilled nursing
facility located in Schenectady, NY, the need for such a program was identified. A CNA
preceptor program was planned for, developed, implemented, with future evaluation methods put
into place at Kingsway Community. All appropriate forms and documentation were developed
for continued use at the facility. The preceptor training material was also developed for
continuous use as education materials for future preceptors. The initial preceptor training course
was instructed by the nursing leadership student, with two Staff Development employees
including the Staff Development Coordinator present to enable them to instruct future training
classes. Evaluation of preceptors and of the program will be conducted after each preceptor –
preceptee relationship. Once the first set of preceptees has completed their preceptorship, the
evaluations will be reviewed by the Staff Development Coordinator. The project and program
was executed and implemented successfully, with methods of future evaluation in place.
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Table of Contents
Abstract…………………………………………………………………………….2
Introduction………………………………………………………………………..5
Background………………………………………………………………………..6
Nursing Theory……………………………………………………………………7
Figure 1 – Differences in Experience Levels……………………………..8
Planning & Development of Preceptor Program………………………………….8
Criteria for Preceptor Selection…………………………………………..9
Obtaining Interest & the Application Process……………………………9
Figure 2 – Informative Poster……………………………………………10
Figure 3 – Application Form…………………………………………….11
Program Guide Development……………………………………………12
Interview Process………………………………………………………………...12
Figure 4 – Program Guide………………………………………………..13
Figure 5 – Interview Tool………………………………………………..14
Training of Preceptors……………………………………………………………15
Development of Educational Materials…………………………………..15
Communication Skills……………………………………………………16
Motivational Skills………………………………………………………..17
Teaching Adult Learners………………………………………………….17
Figure 6 – Assumptions Regarding Adult Learners……………………….18
Evaluations…………………………………………………………………………18
Figure 7 – CNA Preceptor Evaluation Form………………………………19
Figure 8 – Preceptor Self-Evaluation Form ………………………….……20
CNA PRECEPTOR PROGRAM 4
Conclusion………………………………………………………………………………21
References……………………………………………………………………………….22
Appendix A – Package of All Developed Documentation
CNA PRECEPTOR PROGRAM 5
According to the Oxford Dictionary, a preceptor can be defined as a teacher or instructor.
The term is most commonly used when referring to teaching practical clinical skills in nursing or
medicine. Structured preceptor programs have been in place in many nursing facilities to some
extent for registered nurses (RNs) for decades and for licensed practical nurses (LPNs) for
several years. The implementation of Certified Nursing Assistant (CNA) preceptor programs is
an up and coming movement in health care today. Many innovative skilled nursing facilities that
employ large numbers of CNAs are looking towards replacing classical orientation programs
with formal preceptor programs.
Kingsway Community in Schenectady, NY offers multiple nursing services for seniors
including a 160 bed skilled long-term nursing facility. Kingsway Community employs over
sixty CNAs and offers a CNA six week training program for those interested in becoming CNAs.
Working with the Staff Development Coordinator, Phyllis Rosenberger, RN BSN, a CNA
preceptor program was developed and implemented within the facility. The goals of the project
were developed at the beginning of the process and are as follows:
• Upon completion of this project there will be a clearly written program guide for a
CNA Preceptor Program for Kingsway Community Nursing Center.
• Upon completion of this project, all specifically qualified and selected
experienced CNA preceptors will have completed the preceptor training class.
• Upon completion of this project, introduction to the preceptor program will
become a standard component to the new hire orientation for CNAs.
• Upon completion of this project, evaluation of the preceptor class and each
preceptor will be evaluated with self-evaluations and trainee-completed evaluations
CNA PRECEPTOR PROGRAM 6
Background
Prior to the development of the preceptor program, research was conducted into the
history of preceptor programs, the emergence of CNA preceptor programs, and critical
components to preceptor training programs. According to Myrick & Yonge (2005) the concept
of preceptorships in nursing was first used during the time of Florence Nightingale. Myrick and
Yonge go on to discuss that due to hospital diploma programs, preceptorships fell to the way-
side until the 1960s when nurse practioner programs revitalized the method of teaching and
training.
Since the 1970s preceptor programs have been growing and gaining popularity. As
previously discussed the concept was revitalized by nurse practioners, it then spread to use with
RNs. There are multiple benefits to formal preceptor programs. By establishing a specific one
on one preceptee-preceptor relationship, a new employee is granted a specific mentor, teacher,
role model and long term support system for their entire orientation and professional
development. The American Association of Colleges of Nursing (AACN) (2012) has stated that
the use of preceptorships and residencies can help to benefit nursing practice by increasing
socialization, increasing clinical skill, competence, individual confidence, and reduce long term
turnover rates. Due to the physical demands, high stress, extreme responsibility and low
compensation rates of CNA positions, there has been a long standing reputation for high turnover
rates for CNAs. The opportunity to decrease CNA turnover rates while implementing a program
that offers so many other benefits including increasing quality of care is what makes CNA
preceptor programs so attractive to skilled nursing organizations. Not only are specific nursing
organizations such as Kingsway implementing such programs, some states are offering statewide
preceptor training programs. The Iowa Health Care Association along with the National
CNA PRECEPTOR PROGRAM 7
Association of Health Care Assistants (NAHCA) offers an intensive two-day CNA Preceptor
Certification Course. This course allows for any health care organization in Iowa to send CNAs
for certification. This is an alternate method to developing facility specific programs such as the
one developed at Kingsway Community.
Nursing Theory
In 1984 Patricia Benner developed the Novice-to-Expert Model of nursing experience.
Hood & Leddy (2006) discuss the five stages of the theory and what experience levels they
correlate to; Stage I is a novice nurse which can correlate to student nurses, Stage II is an
advanced beginner which can correlate to new graduate nurses, Stage III is the competent stage
which correlates to about 2-3 years clinical experience, Stage IV is the proficient stage which
correlates to 3-5 years of clinical experience, and lastly is Stage V the expert stage, consisting of
several years of experience. This theory was adapted to apply to the levels of experience for
CNAs and to stress these different levels during the preceptor training course. The novice level
was adapted to brand new CNAs that were starting orientation right after completing the six
week CNA training course. The novice level was not applied to individuals still in the training
course due to the fact that individuals in the course only experience five clinical days within the
six week period. It was determined that five clinical days was not enough to qualify as
completing the novice experience level. The advanced beginner level was adapted to correlate
with CNAs who were new to the facility, but had some previous clinical experiences. The
competent level was adapted to CNAs who had completed their orientation, passed all
competencies and were developing their independent clinical experience. The proficient level
was adapted to CNAs who had months of experience and were able to excel in all their skills and
daily tasks. The expert level was adapted to CNAs who had years of experience and
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demonstrated clinical excellence. It was stressed to the preceptors during the training course that
they were at proficient to expert levels and their main focus as a preceptor had to be encouraging
the same clinical excellence in their preceptees. White (2008) discusses the learning differences
between novice nurses and advanced beginner nurses. These differences were applied to
precepting CNAs and reviewed during the preceptor training course, Figure 1 illustrates these
differences.
Figure – 1 – Differences in Experience Levels
New CNAs (Novice)
• Little or no experience, needs complete guidance and instruction
• Needs rules and regulations• Requires constant feedback,
suggestions for improvement as well as praise for tasks done correctly
• Due to inexperience, new CNAs need a non-judgmental, supportive approach with constant conversation. Never stop talking to a new CNA.
Previously experienced CNAs (Advanced
Beginner)
• Functions with directions, needs to learn facility specific policies, procedures, & routines
• Encourage questions• May be focused on remembering rules,
think out loud during all skills and tasks• May need support in setting priorities• Need to base preceptor actions upon
orientee’s level of experience
Planning and Development of Preceptor Program
After the goals of the project had been established, the background information provided,
and the connection to nursing theory obtained, the planning and development stage was initiated.
During the planning stage, the qualities of effective preceptors were researched. According to
Ohio University Heritage College of Osteopathic Medicine the four major principles of effective
Precepting new CNAs vs. Experienced CNAs
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preceptors are; communication, careful analysis, skill in teaching and practice, and ability to
motivate the preceptee. These concepts were integrated into the development of not only the
teaching materials, but also into the criteria developed for preceptor selection. Basic good
standing within the organization was also considered while developing these criteria.
Criteria for Preceptor Selection
After review of the research and determination of good-standing, the official criteria were set for
perspective preceptors. It was determined that to be eligible for a preceptor position a CNA
employee must have been employed at Kingsway Community for at least six months. This may
not appear to be a long enough time, but considering the turnover rates for CNAs it was the
recommended length of time by the Staff Development Coordinator. The rest of the criteria is as
followed: must have exceptional annual competencies, must demonstrate strong interest and
ability in training new employees, must not be under any form of disciplinary action, must
possess excellent communication skills, and lastly must have the recommendation of the nurse
manager.
Obtaining Interest and the Application Process
Once the criteria were set, an informative poster was developed to be displayed on each
of the nursing units within Kingsway. The main objective of the informational posters was to
obtain interest in the program and identify interested CNAs. The posters also provided
information on how interested individuals could apply for the preceptor program. Prior to the
posters being displayed, the same preceptor criteria were used to develop an application that
would be used to review each interested CNA. At the time the posters were displayed on each
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of the four nursing units, applications forms were left at each nursing station. Figure 2 illustrates
the informative poster, displaying the program criteria, benefits, and application process.
Figure 2 – Informative Poster
CNA PRECEPTOR PROGRAM 11
The application was developed using the known qualities of effective preceptors.
Application questions were designed to allow applicants the ability to showcase the qualities that
would assist them in a preceptor role. Questions were developed to allow individuals to discuss
their clinical experience, communication skills, teaching and training experiences, motivational
skills, and problem solving abilities. Figure 3 illustrates the application form that was created
and used for this step of the project.
Figure 3 – CNA Preceptor Application Form
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Program Guide Development
While the initial documents were being created, the sections of the entire program began
to take form. Using the tasks that had been completed and looking forward to the tasks that
would need to be completed, a program guide was developed. The purpose of the program guide
was to allow for standardization of preceptor training, evaluation, and formalize the process.
This would allow for the same steps to be followed during the next preceptor selection, training,
and evaluation. It will also allow for standardized review of the process during New York State
Department of Health Annual Survey. The Staff Development Coordinator stated that the
program would be a standard component for all newly hired CNAs. The program guide was
reviewed at the beginning of the preceptor training class to allow for an understanding of how
the program was developed and how it will be run. Figure 4 illustrates the main components of
the Kingsway Community CNA Preceptor Program Guide.
Interview Process
All applications that were received by Staff Development were reviewed. Interviews
were set according to applicants’ work schedules. The Staff Development Coordinator obtained
verbal recommendations from the nursing managers for each of the applicants. Half the
interviews were conducted by the Staff Development Coordinator and the other half were
conducted by the nursing leadership student. Prior to the interviews an interview tool was
developed to assist with the process. The purpose of the tool was to revisit the qualities of
effective preceptors that had been used when developing the application and also to offer
behavioral questions. As previously discussed, the principles developed by the Ohio University
CNA PRECEPTOR PROGRAM 13
Figure 4 – CNA Preceptor Program Guide
Heritage College of Osteopathic Medicine of communication, analysis, skill in teaching, and
motivation were re-addressed in the first half of the interview tool. The second half of the
interview tool offered behavioral interview questions. McNeil (2012) discusses that behavioral
interview questions that allow the candidate the chance to discuss actions he or she took in a
previous situation are the best predictor for how that individual will act in a future, similar
CNA PRECEPTOR PROGRAM 14
situation. Behavioral questions were developed to elicit information from the applicants about
their previous actions in situations of teaching, training, motivating, communicating, re-
directing, and encouraging others. McNeil (2012) also discusses that when listening to the
candidates responses to behavioral questions, and good interviewer should listen for three
specific components; the situation, the actions taken, and the outcome. McNeil’s suggestions
were used as guidelines prior to the interview process. Figure 5 illustrates the interview tool that
was developed and used for each of the interviews.
Figure 5 – Preceptor Interview Tool
CNA PRECEPTOR PROGRAM 15
Training of Preceptors
Development of Educational Material
Due to scheduling constraints, a one hour power point and discussion focused training
course was developed to be taught to the selected preceptors. The first points that were
discussed during the training session and through the power point were the definition of a
preceptor and the goals of the preceptor program. The first goal of the program is to choose the
most qualified and experienced CNAs from Kingsway to act as mentors, role models, and
teachers to new CNAs. The second goal is to ensure that each new CNA is provided with proper
unit socialization and training to increase their hands-on skills, knowledge, competence, and
confidence as a CNA. The next element that was covered pertained to characteristics of effective
preceptors. According to Kelly-Heidenthal (2004), effective preceptors are clinically
experienced, like to teach, and are committed to being good preceptors. Since the element of
communication is such an important concept in precepting, ability to be an effective
communicator was added to these characteristics. The role of a CNA is a constantly hands-on,
clinical role; because of this, the concept of clinical excellence was stressed. The preceptors
were instructed that it is their clinical excellence that they need to learn how to pass on to their
orientees. The best method for teaching clinical excellence was discussed, the Staff
Development Coordinator, Phyllis Rosenberger wanted the concept of “see one, do one” to be
emphasized. This concept was used to develop and teach the following steps:
Demonstrate a skill or task per the competency checklist
Have the orientee demonstrate the task back
Offer suggestions or tips for improvement (Effective feedback is important)
CNA PRECEPTOR PROGRAM 16
Sign off orientee for that specific skill/task on the competency checklist
Using information from the Ohio University “The Effective Preceptor” monograph, tips for
teaching clinical skills were provided to the preceptors. The tips offered were that preceptors
need to;
Provide effective role modeling
Demonstrate skillful interactions with residents
Present information to the orientee with organization and clarity
Generate interest in residents’ care and daily activities with enthusiasum
Give appropriate responsibilities to the orientee
Communication Skills
Again using information obtained from the Ohio University “The Effective Preceptor”
monograph, suggestions on communication between preceptor and preceptee were given.
During the training course it was pointed out that an effective preceptor should be able to clearly
and concisely describe a task prior to and during task demonstration. It was explained that
preceptors should be personable and approachable towards their orientees at all times. Preceptors
need to be able to listen to their orientees questions, comments and opinions, so that a respectful
learner relationship is developed. The importance of constant communication between
preceptor and preceptee was also a topic of discussion during preceptor training. Constant
communication is vital no matter how much experience the orientee may have, but is most
important when precepting CNAs who have just completed the training course. It was
recommended that preceptors use a narrative when describing how they complete a task to a
preceptee.
CNA PRECEPTOR PROGRAM 17
Motivational Skills
The ability to provide motivation to a preceptee is an important skill of effective
preceptors. The Ohio University “The Effective Preceptor” monograph discusses motivational
techniques that preceptors should use. The following is a list of suggested motivational
techniques that were offered during preceptor training:
Emphasize problem solving and independent thinking
Encourage constant, active involvement of the orientee (needs to always be hands on)
Demonstrate enjoyment and enthusiasm for patient care and teaching
Develop a supportive relationship with the orientee
The importance of maintaining a positive attitude while precepting was also discussed
during the preceptor training. According to White (2008), being able to teach with a respectful
and positive attitude represents the true art of teaching. Preceptors should treat their orientees as
equals and demonstrate care about their success.
Teaching Adult Learners
During the preceptor training class, education regarding the proper way to interact with
adult learners was reviewed. White (2008) lists several assumptions regarding adult learners that
can be applied to CNA preceptorships. Figure 6 displays the assumptions about adult learners.
Figure 6 – Assumptions Regarding Adult Learners
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Tips for effectively teaching adults were given during the preceptor training courses.
These tips according to White (2008) include the following:
Adults should take responsibility in their own learning, preceptors are facilitators of the
learning process
An effective preceptor must consider an adult’s previous experiences (work, family,
education) during the teaching process
Learning needs to “make sense” to adults, provide proper reasoning for tasks
Develop a learning environment by always showing respect to your orientee
Evaluations
Evaluation methods for assessing the competency of the orientees and the effectiveness
of the preceptors had to be considered. During the preceptor training course the preceptors were
asked to give their opinions and suggestions for improvement to the orientee competency forms.
The competency checklists that had been in use at Kingsway for CNA orientation were to be
CNA PRECEPTOR PROGRAM 19
modified using these suggestions by the Staff Development Coordinator. Methods to evaluate
the preceptors were considered extremely valuable. Evaluation forms to be completed by the
orientees after each orientation were developed. Figure 7 displays the preceptor evaluation form.
Figure 7 – CNA Preceptor Evaluation Form
CNA PRECEPTOR PROGRAM 20
Future feedback from preceptor self-evaluations will provide valuable information. Not
only will the feedback allow for individual preceptors to continue improving their skills, but it
will also provide a method of evaluating the entire program. A preceptor self-evaluation form
was developed following a similar format as the CNA preceptor evaluation. Figure 8 displays
the preceptor self-evaluation form.
Figure 8 – Preceptor Self-Evaluation Form
CNA PRECEPTOR PROGRAM 21
Conclusion
Working under the guidance of the Staff Development Coordinator at Kingsway
Community, Phyllis Rosenberger, RN, BSN, a CNA Preceptor Program was developed and
implemented within the facility. All necessary forms and documents were developed and
approved by the Staff Development Coordinator. The official program guild will allow for
future groups of preceptors to receive the same training and for a standardized process to be
followed. Through the application and interview process the best qualified CNAs were chosen
to act as preceptors within the facility. The chosen preceptors then attended an hour long
preceptor training course. Future preceptor training courses will be taught by Staff
Development. The Staff Development Coordinator has also established that this program is now
a standard component of orientation for all newly hired CNAs. The development of evaluation
forms to assess the preceptor will allow for continuing evaluation of individual preceptors as
well as the overall effectiveness of the program. All pre-set goals of this project were met
successfully. The anticipated success of this program has led the Staff Development Department
to plan on applying a similar format in an attempt to renovate the LPN Preceptor Program.
CNA PRECEPTOR PROGRAM 22
References
CNA Certified Preceptor Course. (2012). Iowa Health Care Association. Retrieved from:
http://www.iowahealthcare.org/
Hallmarks of Professional Nursing Practice. (2012). American Association of Colleges of
Nursing. Retrieved from: http://www.aacn.nche.edu/publications/white-papers/hallmarks-
practice-environment
Hood, L. & Leddy, S. K. (2006). Conceptual Bases of Professional Nursing. Philadelphia:
Lippincott, Williams, & Wilkins.
Kelly-Heidenthal, P. (2004). Essentials of Nursing Leadership and Management. Clifton Park,
N.Y: Delmar Learning.
Mcneil, R. (2012). Better Interviewing, better hires. Long-Term Living: For the Continuing Care
Professional, 61(9), 32-33.
Myrick, F., & Yonge, O. (2005). Nursing Preceptorship: Connecting Practice & Education.
Philadelphia: Lippincott, Williams, & Wilkins.
Preceptor. (n.d.). In The Oxford online Dictionary. Retrieved from:
http://oxforddictionaries.com/definition/american_english/preceptor?
region=us&q=preceptor
The Effective Preceptor. (n.d.). Hertiage College of Osteopathic Medicine Ohio University.
CNA PRECEPTOR PROGRAM 23
Retrieved from: http://www.oucom.ohiou.edu/fd/monographs/effective.htm
White, D. (2008, March). Novice to Expert: Benner’s Model of Practice. Presented at Graduate
Nurse Internship for Northeast Health, Troy, NY.
White, D. (2008, March). Preceptors Influencing Values, Outcomes, and Transitions: Teaching
the Adult Learner. Presented at Graduate Nurse Internship for Northeast Health, Troy,
NY.