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.

Back to E-Journal