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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.


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


Conclusion………………………………………………………………………………21

References……………………………………………………………………………….22

Appendix A – Package of All Developed Documentation


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


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


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


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


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


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


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


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


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


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


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)


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.


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


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


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


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


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.


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

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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

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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.

http://www.aacn.nche.edu/publications/white-papers/hallmarks-practice-environment

http://www.aacn.nche.edu/publications/white-papers/hallmarks-practice-environment


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.

http://www.oucom.ohiou.edu/fd/monographs/effective.htm

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