The Nurse Preceptor: Knowledge Transfer in Health Care
Jennifer Rippy and Howard Baker
Creating a learning organization is a
strategic imperative for a growing number of hospitals, health care teaching
and research facilities, and health system boards.
Some leading children’s health care programs have strategic plans
that include becoming a learning organization.
For instance, Children’s Hospital, University of Manitoba plans as
one of its objectives developing the Child Health Program as a learning
organization. “Our vision is that within 5 years the Child Health Program
will be a learning organization” (Child Health, 2002).
One
aspect of a learning organization is knowledge management.
The Hospital for Sick Children (HSC) is one of the largest pediatric
academic health science centers in the world.
Affiliated with the University of Toronto, HSC has “knowledge
management” as one of its “Strategic Imperatives” (Strategic Plan,
1999).
Knowledge management addresses how organizations can manage the
knowledge embedded in its systems, and contained in the heads of its
employees. It also systematically considers how advanced information
technology can be used to leverage existing knowledge and create new knowledge
(Levine & Gilbert, 1999).
Knowledge
transfer is one aspect of knowledge management.
Nurses in face-to-face situations often
share tacit or informal knowledge. Such
sharing is an important part of experiential learning (Levine & Gilbert,
1999). Nurses receive all kinds
of information on a daily basis, such as input from patients, supervisors,
ancillary staff, and the environment itself.
The nurse must decide what knowledge to internalize, based on training
and education, and apply that knowledge to practice.
Ideally, nurses are provided with orientation upon being hired
regarding their role. This
orientation should include the transfer of knowledge from an experienced nurse
to the new nurse. An experienced
nurse may provide training, or “precepting” to a new nurse to help him or
her adjust to the new role. The
“preceptor” is the knowledge transfer expert in the nursing arena.
The term preceptor, or teacher, has been known since 15th century
England. The clinical preceptor is of critical importance in the education and
socialization process of the advanced nursing student. It is within the
context of the student's preceptorship experience and practicum that the
student learns to apply an expanded knowledge base and to function in the
advanced practice nursing roles of clinician, consultant, educator, leader,
and researcher (Ball State University School of Nursing, 2001).
The concept of knowledge transfer is most often associated with
businesses, and the training of workers. A
health care system is a business that cares for people.
Ron Miskie, founder of CorporateEducation.biz (http://www.ktic.com/),
defines knowledge transfer as “a set of critical business
practices that can be applied to improve the capabilities and effectiveness of
an organization…it is built on the solid foundations and experiences of
documentation and training.” Knowledge
might be defined as information and data made useful.
Knowledge
is a personal ability when it is achieved; it is a corporate asset when it is
shared. It is a collection of insights that, when applied, make the
organization more effective and profitable. Unlike data and information, which
tell us what happened and what exists, knowledge tells us what works, what
matters, what we should trust, where things go wrong and how we can fix them (Miskie,
1996).
Miskie
continues by saying that knowledge transfer combines skills, methods,
procedures, and business systems with an instructor, trainer, or documentation
specialist. In the health care environment a “nurse preceptor” often
fills the role of trainer.
Teachers, who are supposed to be knowledge transfer experts, cannot
simply “know the material.” They
must understand the material in order to properly transfer knowledge to
others. A knowledge transfer
expert is not an expert just by having knowledge of the material to be
presented. Roger Squire (1996), a
staff member at CorporateEducation.biz, gives several characteristics that are
important in any knowledge transfer expert.
A
knowledge transfer expert has the ability to organize and convey data and
information, has oral communication skills, and has the ability to learn
things quickly. In the business
world, the knowledge transfer expert understands (1) adult learning theory;
(2) human factors that influence learning; and (3) methods of transferring
knowledge (Squire, 1996).
Therefore,
the person in charge of knowledge transfer understands that barriers exist to
learning. The knowledge transfer
expert helps to present information to others in a way that minimizes
distractions. Using a quiet room
on an upper floor can help to prevent eyes from wandering outside during a
presentation. One-on-one training
by a nurse preceptor in a quiet place away from others can greatly facilitate
learning. The knowledge transfer
expert must know that prior experiences and the level of education of the
learner impacts learning capabilities.
In business, Chief Knowledge Officer (CKO) is another name for a
knowledge transfer expert. Rebecca
Barclay (1997), a knowledge management strategist with Knowledge Transfer
International, depicts the knowledge transfer expert as a visionary. The CKO
is driven by the challenge to change the organization for the better.
A CKO is an evangelist that
preaches and exemplifies the important skills required to leverage the
knowledge embedded in every person and system (Bontis, 2001).
The
CKO’s visionary purpose is to educate each employee in order for each
employee to be able to satisfy client needs.
This is also true in the health care environment.
Every
person who steps through the door of a hospital is a “customer,” whether
that customer is a fellow employee, a patient, a visitor, or a vendor.
Every one of these individuals has needs that must be satisfied.
The nurse preceptor must instill in the student the desire to help
satisfy needs of others. This does not just mean patients. The “customer” can also be a family member or an employee
of the hospital.
Sometimes
the nurse will not be able to meet the need but knows where the need can be
met. In such a case, the student nurse can learn to direct a
customer to someone who can satisfy the need.
One
example of this is when dealing with a patient who speaks only a foreign
language. A nurse preceptor might
introduce the trainee nurse to various language resources available to the
nurse. These include finding a
translator in the hospital, using a bilingual family member, or obtaining
written material in the hospital in the patient’s native tongue.
Barclay
(1997) says that the knowledge transfer expert helps to bridge the gap between
information, knowledge, and the customer base.
The knowledge transfer process impacts the organizational culture of
the business because with knowledge the people become empowered to make
decisions, take effective action to benefit customers, and become effective
workers. Mapped to the health care environment, the new nurse is able
to decide when it is appropriate to seek out help for problems beyond his or
her scope in order to benefit the patient.
By working cooperatively with others, an effective, empowered, and
synergistic work environment can be created.
A
nurse preceptor who is training a new nurse can be viewed as a knowledge
transfer expert. The nurse preceptor uses various methods to transfer knowledge to the new nurse.
In the case of a brand new trainee nurse, the nurse preceptor might
actually pretend to be a patient in a bed and let the trainee take the
preceptor’s blood pressure and pulse to calm and ease the trainee into the
new work environment.
Miskie
(1996) says that communication must occur in the language that the student
understands and in terms that make sense.
This communication is often in the form of modeling behavior
appropriate for patient care. By
demonstrating appropriate behavior for someone, visual learning occurs.
The student can then practice the behavior to internalize the learning.
The student nurse thus receives information that is converted to
knowledge. This is not
instantaneous knowledge creation. The
preceptor transfers knowledge with verbal communication by explaining why
certain procedures are done. At that point auditory learning occurs.
Written communication allows for knowledge transfer while teaching the
documentation of patient care. Sometimes
the nurse preceptor will attach sticky notes to paperwork to remind the
trainee to complete certain parts of a form.
Practicing
behaviors is a good way to transfer information into knowledge.
Experiential learning through enacting a procedure ingrains the
knowledge into the brain. Through
different methods, the new nurse internalizes the concepts and information,
and knowledge is the result.
Miskie
(1996) mentions that by using the appropriate methods for training, the
experience of learning can be shared with others, thus spreading knowledge in
a “ripple effect.” Knowledge
that is shared can then be viewed as a corporate asset.
“Knowledge appears to be an increasing proportion of many
organizations’ total assets” (Levine & Gilbert, 1999).
Wayne Childers, an Innovation Agent for AH HA! Learning program, writes
that in order to really learn something it takes effort, time, and courage. “Time pressures encourage people to stick with the status
quo.” An approach called “go-slow-to-go-fast”
helps to deepen knowledge transfer and accelerate decision-making (Childers,
2000). This approach involves
taking the time to cover all aspects of the information being transferred to
others in order to facilitate understanding.
A new nurse is not expected to perform without cues from others in the
beginning. Any person needs
orientation to a new environment. Such
orientation takes time. A period
of eight weeks might be set for information and knowledge transfer to occur
before the new nurse is allowed to practice without having a preceptor check
his or her work. The preceptor
must work slowly and patiently with the new nurse to facilitate knowledge
transfer.
The skills of management are best learned with the help of coaches and
peers (DeMarco, 2001). We learn
by talking and listening to each other. This
awareness of the importance of being heard and understood says a lot for the
teacher. Knowledge can be most
smoothly transferred from one person to another when there is trust and
respect for the individual delivering the message.
Listening empathically builds trust and is a vital characteristic of a
knowledge transfer expert. A new
trainee nurse appreciates being told by the nurse preceptor that he or she was
also once a trainee.
In
nursing, the new nurse must trust in the preceptor’s ability and knowledge.
This is critical, since human lives are at stake.
The preceptor must be willing to listen to the new nurse’s concerns
and put those concerns to rest with correct information.
A
great deal of the nurse preceptor’s knowledge comes from experience.
That is why experienced nurses are typically chosen to train new
nurses. Every experienced nurse
has made mistakes and also learned from the mistakes of others.
They typically seek to discover the best practices of others.
They have also made a commitment to personally ongoing learning.
Those
who have learned and internalized the knowledge gained from real-life
experiences can pass that knowledge on to create valuable knowledge in others.
Such knowledge transfer will ensure the highest quality of health care.
Successful knowledge transfer will be demonstrated through the honesty
and confidence exhibited by the newly trained nurse.
This behavior in turn will ease patient concerns and have a positive
impact on the services delivered to all customers and clients.
References
Ball State University
School of Nursing (2001). Clinical Preceptor Information. Retrieved
March 5, 2003 from http://www.bsu.edu/web/nursing/forms/18_clinical_preceptor_information.pdf
Barclay, R.
(1997). The CKO—Vision,
strategy, ambassadorial skills, and a certain je
ne sais quoi. Retrieved March 5, 2003 from http://www.ktic.com/topic6/13_CKO.HTM
Bontis,
N. (2001). 2001). CKO
Wanted – Evangelical Skills Necessary: A review of the Chief Knowledge
Officer position, Knowledge and Process Management, 8, 1, 29-38. Retrieved
March 5, 2003 from http://www.business.mcmaster.ca/mktg/nbontis/ic/publications/BontisKPM.pdf
Childers, W.
(2000). Fast 50:
Go slow to go fast—Take time to become wise. Retrieved June 21,
2002 from http://www.fastcompany.com/fast50/profile/?childers328
Child Health (2002). The
Child Health Quality Initiative. Retrieved March 30, 2003 from http://www.umanitoba.ca/faculties/medicine/pediatrics/dept_info/chq/
DeMarco,
T. (2001). Slack:
Getting Past Burnout, Busywork, and the Myth of Total Efficiency.
Random House: New York, NY.
Levine, D. &
Gilbert, A. (1999). Managerial Practices Underlying One Piece of the
Learning Organization. Institute of Industrial Relations, University of
California, Berkeley. Retrieved March 30, 2003 from
http://ist-socrates.berkeley.edu/~iir/cohre/knowledge.html
Miskie, R. (1996).
Documentation and training—The foundation of knowledge.
Retrieved March 5, 2003 from http://www.ktic.com/resource/km2/Documentation
and training &mdash%3b the foundation of knowledge management.htm
Squire, R.
(1996). Articulating the value of the knowledge transfer expert.
Retrieved March 5, 2003, from http://www.ktic.com/resource/km3/Articulating
the value of the knowledge transfer expert.htm
Strategic Plan
(1999). The Hospital for Sick Children in the new millennium- A road map
from 1999 to 2004. Retrieved March 30, 2003 from http://www.sickkids.on.ca/aboutHSC/section.asp?s=Strategic+Plan&sID=228
About the authors:
Jennifer
Rippy
For the past seven years
Jennifer Rippy has been immersed in the health care environment.
She has served as a nurse’s aide, registered nurse, and
interim team leader for her department. Working
as a registered nurse has opened her eyes and mind to the workings of the
health care system. She currently
works as a registered nurse in the Mother-Baby Unit at Trinity Mother Frances
Hospital in Tyler, Texas.
She holds bachelor’s
degrees in Neuroscience from Texas Christian University and Nursing from the
University of Texas at Tyler. She
is currently pursuing a master’s degree in nursing to become a Family Nurse
Practitioner through Texas Tech University Health Science Center.
She serves as a preceptor and knowledge transfer expert for new
employees in her work area and loves her clientele.
Jennifer Rippy can be contacted at jrippy@prodigy.net.
Howard
Baker
Howard Baker is Assistant
Professor of Computer Information Systems at the University of 
Louisiana
at Monroe. He holds a B.S. in Management from Samford University (Birmingham,
AL), a Master of Accounting (MAcc) from the University of Southern California,
and a Ph.D. in Information Systems from the University of Texas at Arlington.
He is also a Certified Internal Auditor (CIA).
Before entering his teaching career he worked for a Fortune 100 company
as a project leader, two large financial institutions as head of information
systems auditing, and as an information systems consultant in Europe and
Australia. Dr. Baker has been a Franklin Covey 7 Habits of Highly Effective
People certified facilitator since 1994, and has served the University of
Texas at Tyler as their facilitator since 1997. He is also an adjunct
professor in the Master of Public Administration program at the University of
Texas at Tyler. His areas of research include knowledge management, data
security, learning organizations, and leadership. He is a regular contributor
to weLEAD magazine (http://www.leadingtoday.org/).
Howard Baker can be contacted at hbaker@leadingtoday.org.