Preceptor Capstones: Are they Beneficial in ADN Programs to Help Transition New Graduates? Chapter I

Running head: PRECEPTOR CAPSTONES 1
Preceptor Capstones: Are they Beneficial in ADN Programs to
Help Transition New Graduates?
Mary Margaret Evans
Bradley University
A Directed Scholarly Project Submitted to the
Department of Nursing
In the Graduate School of
Bradley University in
Partial fulfillment of the
Requirements for the
Degree of Doctor of Nursing Practice.
Peoria, IL
2018
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Abstract
The purpose of the present study was to determine the extent to which the community
college’s capstone course was congruent with the general content of the NRPs at two local
hospitals and to further determine the extent to which new nursing graduates perceive the
importance of the capstone program in preparing them for nursing practice. The project design
incorporated both qualitative and quantitative elements. The qualitative design element used
summative content analysis to examine and compare the two local hospital NRPs and the
community college capstone course content. The quantitative design element consisted of a
survey of recent community college nursing graduates who have completed the community
college capstone course and were in enrolled in the NRP of a local hospital to determine their
perception of the importance of the capstone program content in preparing them for nursing
practice. The results of this study indicated four primary findings:
The results of this study indicated four primary findings:
1. The commonalities among the community college capstone course content and
hospital #2 NRP content suggest that these programs are complimentary and
supportive.
2. NRP content from hospital #2, and the community college capstone course were
congruent with content items identified as important for capstone courses in the
literature review.
3. The results of the study indicate four primary important capstone course content
areas: patient care, critical thinking/problem solving, teamwork and the professional
role and readiness to practice in that order.
PRECEPTOR CAPSTONES 3
4. The identified importance of the overwhelming majority of capstone content items
did not vary significantly with previous nursing experience, which supports the use of
a single curricula.
The results from this project provided significant information to the community college with
respect to capstone course curriculum. For the two local hospitals, the results of this project
indicate strengths and weaknesses related to their current nurse residency programs compared to
the NCSBN model, as well as areas of importance related to content identified by students who
are now new graduates in their institutions
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Table of Contents
Chapter I: Introduction 6
a. Background and Significance 6
b. Problem Statement 8
c. Project Aims 8
d. Clinical Question 8
e. Congruence with Organizational Strategic Plan 8
f. Review of Literature 9
g. Conceptual or Theoretical Framework 16
Chapter II: Methodology 17
a. Needs Assessment 17
b. Project Design 18
c. Population 18
d. Tools 18
e. Project Plan 19
f. Data Analysis 19
g. Institutional Review Board and/or Ethical Issues 19
Chapter III: Organizational Assessment and Cost Effectiveness Analysis 20
a. Organizational Assessment 20
b. Cost Factors 20
Chapter IV: Results 21
a. Quantitative Analysis of Implementation Process 21
b. Qualitative Analysis of Implementation Process 21
PRECEPTOR CAPSTONES 5
c. Quantitative Analysis of Project Outcome Data 22
d. Qualitative Analysis of Project Outcome Data 26
Chapter V: Discussion 30
a. Findings 30
b. Limitations or Deviations from Project Plan 31
c. Implications 31
Chapter VI: Conclusion 31
a. Value of the Project 31
b. DNP Essentials 32
c. Plan for Dissemination 33
d. Attainment of Personal and Professional Goals 33
References 35
Appendices 38
PRECEPTOR CAPSTONES 6
Preceptor Capstones: Are they Beneficial in ADN Programs to Help Transition New Graduates?
Chapter I
Working in a rural setting, many local hospitals desperately seek to employ nurses to
meet the demands of the community. In a community college, it is important to produce new
nursing graduates who can fill employer needs and serve the community they live in. Bridging
the gap from graduation to employment is a key aspect in making sure that new nurse graduates
are prepared to enter the workforce, as well as be successful in their first year of nursing.
Revising curriculum to meet the changing needs of healthcare includes meeting the needs of the
students. Producing high quality nursing graduates who are able to be a successful part of the
nursing workforce is part of the mission of the community college, and the reason to explore the
transition from nursing student to successful nursing professional.
The project incorporated both qualitative and quantitative elements. The qualitative
element used summative content analysis to examine and compare curricular content of the twolocal hospital’s Nurse Residency Programs (NRPs) and the community college capstone course.
The quantitative element consisted of a survey of recent community college nursing graduates
who have completed the community college capstone course and are enrolled in the NRP of a
local hospital to determine their perception of the importance of the capstone program in
preparing them for practice. In an ideal world, what is taught in academe is taught in industry
and also perceived favorably by the student. The project contributions were designed to support
seamless transition from academia to the workforce.
Background and Significance
Nursing faces many challenges today with one of the most prevalent issues being a
significant nursing shortage. To characterize an aging workforce, “Approximately 75% of
PRECEPTOR CAPSTONES 7
registered nurses (RNs) in the United States are ages 50-64, with 55% of nurses currently
employed planning to retire by 2020” (Cochran, 2017, p. 53). Burnout and retention are also
significant issues that lead to a decrease in available bedside nurses. In particular, “during the
first year of practice, 30% to 61% of new graduates change their place of employment” (Bratt,
2009, p. 417) and to make matters worse, “many new nurses leave the nursing profession within
2 years of graduating from nursing school” (Bratt, 2009, p. 417). Adding to these issues is the
need for more complex care with sicker patients and shorter hospital stays, all requiring nurses to
have the ability to care for critically complex patients. Unfortunately, healthcare organizations do
not feel that new graduate nurses are prepared to deal with these complex patients; “employers
believed only 41% of baccalaureate graduates were definitely prepared to care for patients”
(Welding, 2011, p. 37). To address these issues, many hospitals and organizations have
developed NRPs. A NRP is a program that traditionally incorporates a 12 month one on one
mentor program with didactic components that address topics such as communication, skills,
leadership, management, stress and critical thinking.
As a way to support the industry NRPs, one community college in northern Illinois most
recently created a new Capstone Transition into Practice course. There are two goals of this
capstone course: 1) to prepare students for the NCLEX exam, and 2) to provide students with a
learning experience that enables the student to apply the knowledge, skills and attitudes
necessary to implement advanced nursing theory and skills and to transition effectively into the
workplace. By incorporating these two goals into the new capstone course, the community
college’s nursing program is designed to address the nursing shortage and provide quality
nursing graduates that are ready to enter the workforce with confidence.
PRECEPTOR CAPSTONES 8
Problem Statement
It was presently unknown the extent to which the curricula of the community college’s
capstone course and the NRPs of two local hospitals content are congruent and support new
graduate nurses’ needs. It was additionally unknown how recent nursing graduates evaluate the
importance of the content in the capstone course in preparing them for nursing practice. Given
the nursing shortage, aging workforce, burnout and retention issues, these programs needed to be
evaluated in terms of their curricular congruence and perceived importance by recent nursing
graduates.
Project Aims
Given the identified nursing shortage and retention problems, the purpose of the present
study was to determine the extent to which the community college’s capstone course was
congruent with the general content of the NRPs at two local hospitals and to further determine
the extent to which new nursing graduates perceive the importance of the capstone program in
preparing them for nursing practice.
Clinical Question
1) How do new nursing graduates who have completed the community college capstone
course and are enrolled in the NRP of a local hospital perceive the importance of the
capstone program in preparing them for nursing practice?
2) To what extent are the curricula of the community college’s capstone course and the
nurse residency programs of two local hospitals congruent?
Congruence with Organizational Strategic Plan
The community college’s mission states, “the nursing program, through quality
education, desires to transform the lives of our students and the communities they serve. It is
PRECEPTOR CAPSTONES 9
vital that our graduates continue to develop the knowledge, skills and attitudes needed to adapt
quickly within the ever-changing health care environment in our community in an ethical and
collaborative manner” (ADN Handbook, 2018-2019, p. 4). To this end, the aim of this researcher
was to eventually partner with two local healthcare organizations to align the NRPs and the
community college’s capstone course content to ensure that congruence of content and
collaboration of important content are present. The overall goal was to expand the knowledge,
skills, attitudes and employment retention of new nursing graduates.
Review of Literature
Utilizing Bradley University’s library and the community college’s library, a search was
conducted using CINAHL and ERIC EBSCO host. Keywords used included “Nursing Residency
Program” and “Transition into Practice” with no-limiting terms used in the search. The search
was limited to include English as the primary language and articles published between 2009 and
2018. One hundred fifty-five articles were initially returned, and further narrowed down to ten
that were considered relevant to the purpose of this study. The articles ranged from qualitative
research, quantitative research, systematic reviews, peer reviews and some informational pieces.
After completing the literature review, common themes that emerged were such that: 1)
nursing retention is a problem, 2) nursing residency programs are successful, 3) common content
utilized in NRP’s were identified. These themes are explored further in the sections as follows:
Nursing Retention is a Problem. Nursing retention and turnover is an ongoing problem
for new nursing graduates. Nurses aren’t adequately prepared for the complex patient care of the
real world in that “Employers perceived new graduate nurses to be inadequately prepared for
practice” (Latourneau & Fater, 2015, p. 96). Some of the challenges that face new graduates
include “being unprepared to perform basic skills and lacking the ability to connect their
PRECEPTOR CAPSTONES 10
classroom experiences to real-life clinical practice” (Welding, 2011, p. 37). Bratt (2009) went
further to state that “Many new graduates feel unprepared for the demands of practice and
struggle with mastery of clinical skills, time management, development of clinical judgement
and the need to manage a heavier patient care load” (p. 417). These issues form the core of nurse
turnover. According to Cochran (2017), acute care nursing experiences “general turnover rates of
13% and new graduate nurse turnover 18- 50%” (p. 53).
When looking at new graduates specifically, “they are also more likely to resign than
experienced new hires” (Welding, 2011, p. 37). Furthermore, many new graduates are subjected
to reality-shock and traumatic experiences during their first year of work. “New graduates are
faced with significant challenges associated with transitioning from the role of student nurse to
that of newly licensed” (Bratt, 2009, p. 416). These challenges lead them to change jobs in that,
“during the first year of practice, 30% to 61% of new graduates change their place of
employment” (Bratt, 2009, p. 417). Of greater concern is exit from the profession all together in
that, “many new nurses leave the nursing profession within 2 years of graduating from nursing
school” (Bratt, 2009, p. 417). This impacts the nurse, the patient, and the healthcare organization
in many ways, but most significantly is the financial impact. As a result, “When they leave
within a year, the hospital loses its’ investment in their orientation” (Welding, 2011, p. 37).
Nursing turnover and retention issues lead to higher costs for healthcare organizations. It
is estimated that “the cost to recruit and train one new nurse at $62,100-$67,000” (Cochran,
2017, p. 53). Additionally, Bratt (2009) estimated that “a nurse with less than 1year experience
who leaves costs the organization almost $50,000” and “turnover costs can be as high as
$145,000” (p. 417). Welding (2011) additionally estimated a “turnover cost per nurse of
PRECEPTOR CAPSTONES 11
$22,420-$77,200.” (p.37). These costs can only be estimated and may be grossly underestimated
when you consider all costs related to hiring a new nurse.
Organizations face financial drains related to the cost of advertising, recruitment, and
temporary replacements. These costs are underestimated because they do not capture the
tremendous consumption of resources required to orient and educate novice nurses or the
potential negative influence of turnover on staff moral and patient satisfaction. (Bratt,
2009, p. 417)
Nursing retention and turnover has a clear financial impact on healthcare organizations and the
industry in general.
Nursing residency programs are successful. NRPs are successful in combating nursing
turnover. “The burgeoning emergence of NRPs has been stimulated in part by the report
published by the Institute of Medicine (2010) that recommended implementation of residency
programs after pre-licensure education” (Bratt, 2013, p. 102). NRPs’ goals are to support the
new graduate nurse through their first year, increase competence, critical thinking and safety, and
decrease turnover costs to healthcare organizations. As such, “The intention of nurse residency
programs is to help new graduates transition to professional nursing practice” (Latourneau &
Fater, 2015, p. 96). The outcomes are clear; “Nurse residents showed 41% improvement upon
completion of the 1-year NRP” (Welding, 2011, p. 37). Welding (2011) also concluded that
“Besides decreased turnover, this report documented increased confidence, competence, and
mastery among nurse residents” (p. 38). Blevins (2016) suggested that NRPs have shown a
“significant improvement among nurses in the use of technology while providing care,
communications with healthcare providers and patients, the ability to work independently and
accountability for actions” (p. 367). In addition, Blevins stated that research supports the notion
PRECEPTOR CAPSTONES 12
that nurses who participate in a NRP are able to cope with typical stressors encountered during
the first year because they had a support system in place. NRPs also help to build a culture of
support in nursing as well as build confidence and competence in the new graduate.
In addition to the NRP’s impact on the lives of nurses, researchers have reported they
also help decrease turnover rates and provide cost savings related to the implementation of
NRPs. Cochran (2017) reported “Turnover of new nurses decreased from 36.8% before NRP
implementation to 6.4% after the residency program began, with contract labor costs dropping
from $19,099 to $5,490 per average inpatient daily census…” (p. 53). There are savings with
NRPs even compared to normal orientation practices in that “Net savings of using the NRP
rather than a traditional orientation was $10-$50 per patient day over 2 years” (Cochran, 2017, p.
54). Consequently, as turnover rates decrease, retention improves. “Retention rates before
implementation were 35%-61%. After implementation, retention rates improved to 94-97%”
(Cochran, 2017, p. 54). By supporting new nurses through their first year of being a nurse, there
is significant evidence that NRPs combat problems regarding retention and turnover. In
summary, “Evidence regarding the outcomes of residency programs is compelling and reveals
that NRPs are associated with higher rates of new nurse retention, decreased nurse vacancy, cost
savings” (Bratt, 2013, p. 102).
Common content utilized in NRP’s. Implementing a nurse residency program allows a
healthcare organization to make positive changes to retention and turnover rates while supporting
the new nurse. Stating that a nurse residency program is simply in place is not enough to
implement change in that it is the content of these programs that makes a real difference.
NRP programs are on average 12 to 18 months in length, with most being 12 months.
Exceptions included one program that was as short as 3 months, while another program had an
PRECEPTOR CAPSTONES 13
additional 12-month program (total 24 months) that was voluntary for nurses to participate in
(Latourneau & Fater, 2015). As a model of program structure, “A residency program is built
with a robust structure, a variety of educational opportunities based on evidence and support
strategies that create multiple learning opportunities” (Levine, 2017, p. 267). Based on the
review of literature, common components identified included a mentor program, preceptors, face
to face educational sessions, evidence-based practice and many overlapping topics. Key content
topics identified in general included leadership, violence, professional practice, conflict,
teamwork and collaboration and communication. Many of these topics were covered in greater
depth to include setting goals, personality and leadership styles. One program grouped their
program on a “building” basis to include: Building Capacity in Self, Building Capacity of Team,
Building Capacity as a Practitioner, Building Capacity Within the Organization, Building
Capacity Within the Profession. This program also included a review of medical-surgical content
that compromised months 3-10 of their program and was under the Building Capacity as a
Practitioner category (Bratt, 2009).
A summary of NRP content gleaned from the literature review can be found in Table 1. A
total of nine content areas for NRPs were identified from the literature to include content items
of professionalism, clinical skills/medical topics, communication, teamwork and collaboration,
leadership, culture, evidence based practice, safety & quality, violence. Specific content areas
varied by state with Florida and Wisconsin identified as being the most heavily represented in
seven and six content areas respectively. Both Wisconsin and Florida programs were additionally
identified as having partnerships between academe and service areas. Professionalism,
communication, and clinical skills could be found in almost all of the reviewed programs.
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Unique to some programs were the content areas of violence, culture, and evidence-based
practice.
Table 1
Comparison of Common Content utilized in NRPs from Literature Review
Regardless of content, many of the programs shared the same belief that “These new
nurses need to walk away from these sessions with knowledge of evidence-based care, best
practice, and ‘pearls of wisdom’ imparted by more experienced nurses” (Bratt, 2009, p. 423).
Common Content Utilized in Local NRPs. Table 2 represents a summary and
comparison of NRP content areas for the two local hospitals, which are employers of graduates
of the community college nursing program. Hospital #1 is currently revising their NRP to a
program more specific to their hospital. Until the revision is completed, hospital #1 is utilizing
the University of Iowa’s online NRP curriculum. Hospital #2 utilizes the National Council of
PRECEPTOR CAPSTONES 15
State Boards of Nursing (NCSBN) Transition to Practice (TPP) modules for their NRP. Both
programs utilize common concept of communication but vary in other regards.
Table 2
Comparison of NRP Content Utilized in Hospital #1 and Hospital #2
Hospital #1 Hospital #2 – NCSBN Transition to Practice
• Transition from Student to Professional Nurse
• Communication
• Responsibilities of the Professional Nurse
• Decision-Making at the Point of Care
(“Curriculum overview,” 2018)
• Patient Centered Care
• Communication and Teamwork
• Evidence Based Practice
• Quality Improvement
• Informatics
(“Transition to practice”)
Content Utilized in the Community College’s Capstone Course. Table 3 represents a
summary of the community college capstone course content as drawn from the course outline
and course syllabus. The content for the present capstone course was initially constructed
internally without the benefit of rigorous external NRP content literature review or nursing
graduate input.
Table 3
Content Utilized in the Community College Capstone Course
Capstone Course Content
• Delegation
• Communication
• Teamwork & Collaboration
• Clinical Judgement
• Medical-Surgical Topics
• Professionalism
• Evidence-Based Practice
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Capstone Course Content
• Prioritization
• Hazard & Violence
• Quality Improvement
• Data Analysis
• Quality Care
(Transition into practice course outline)
At first glance, there appears to be a number of commonalities of content identified in the
literature review of NRPs, the two local hospitals’ NRPs, and the community college’s capstone
course content. Further in-depth analysis of this commonality was performed using summative
content analysis as previously discussed in paper methodology. Summative content analysis of
hospital #1 and community college capstone course content will be anchored to hospital #2
which utilizes the National Council of State Board of Nursing (NCSBN) Transition to Practice
program.
Conceptual or Theoretical Framework
Benner’s “From Novice to Expert” framework proposes that nurses develop skills and
understanding over time through educational experiences. Benner’s theory implies that nurses
acquire nursing knowledge not only through learning the skill but just as importantly by learning
the theory behind the skill as well. Nurses gain experience and grow as nurses by learning from
the experiences they participate in as nurses. NRPs help build the continuing education and
experience for the new nurse graduate and help them in the transition from novice to expert.
Utilizing Benner’s theory in the capstone course and as part of this project, emphasis is placed on
the importance of the development and understanding of the new nurse graduate. (Benner, 1984)
PRECEPTOR CAPSTONES 17
According to Benner, nurses progress through five stages of professional development:
novice, advanced beginner, competent, proficient and expert. The five levels show progression
through critical thinking and skill acquisition. The novice nurse moves to the advanced beginner
by showing independence in skills and thinking abstractly (Benner, 1984). Benner’s theory
guides the community college’s curriculum to advance the principles of partnership, critical
thinking, collaboration, communication and evidence-based practice toward continuous process
improvement of the graduate’s knowledge and for the safe delivery of patient centered care. The
capstone course provides a strong foundation for students to build from to take with them as new
nurse graduates. The ability to think critically is imperative to their success as a nurse. (ADN
Handbook, 2018-2019).
Chapter II
Needs Assessment
“Operating from a common belief that it is the mutual responsibility of academe and
service to collaborate to create programs that will ensure a quality nursing work force for the
future” (Bratt, 2009, p. 418), the need for this project was based on the ongoing need to
coordinate academic and workforce transition in general, and in particular the community
college capstone course content and local healthcare provider NRPs content.
Project Design
The project design incorporated both qualitative and quantitative elements. The
qualitative design element used summative content analysis to examine and compare the two
local hospital NRPs and the community college capstone course content. Summative content
analysis can be defined as “A summative content analysis involves counting and comparisons,
usually of keywords or content, followed by the interpretation of the underlying context” (Hsieh
PRECEPTOR CAPSTONES 18
& Shannon, 2005 p.1). As such, a summative analysis of content emerging common factors was
completed. The quantitative design element consisted of a survey of recent community college
nursing graduates who have completed the community college capstone course and were in
enrolled in the NRP of a local hospital to determine their perception of the importance of the
capstone program in preparing them for nursing practice.
Population
The population for this project was the most recent nursing graduates (academic year of
2017-2018) of a local community college who participated in the capstone course and are
enrolled in two local hospitals’ NRPs (n=44).
Tools
An expanded Casey-Fink Readiness for Practice Survey was utilized to survey
participants (see Appendix A). Permission to expand and use the survey was obtained from the
authors (see Appendix B). The original survey was constructed in 2008 with “survey items and
demographics summarized using descriptive statistics and tests of associations. Alpha was set at
0.05” (Casey & Fink, 2008, p. 649). This survey was expanded to exclude demographic
questions and other questions not relative to the present project or capstone course content. The
question scale utilized for the additional questions was a scaled important/unimportant
assessment drawn from capstone course content. Face validity is provided on the basis that this
survey has been used by a number of other researchers, including Aggar, Bloomfield, Thomas
and Gordon (2017). Convergent content validity is provided by the observation that the
proposed expanded survey includes all content items common to the present capstone course
curriculum. There have been no specific reliability studies performed or identified relative to the
Casey-Fink Readiness for Practice Survey. The survey also included content and items common
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to the literature review, NRP content, and the local hospital NRP content as a matter of divergent
validity. The respondents were asked to indicate on a 4-point Likert scale the extent to which the
capstone program content is considered important or unimportant in preparing them for nursing
practice.
Project Plan
The Casey-Fink Readiness for Practice Survey was administered in an email and on
Survey Monkey on June 25, 2018 with a cut-off date of July 2, 2018. The survey was
administered using Survey Monkey and sent via e-mails provided voluntarily by graduating
students of academic year 2017-2018 of the community college’s nursing program.
As per prior table summary analysis of the NRP content gleaned from the literature
review, a summative content analysis using simple counts and comparisons of content was used
and represented in a color-coded table as a summary of the community college’s capstone
program curricula and the two local hospitals NRP curricula benchmarked on hospital #2 and the
NCSBN program. An additional interpretation of the underlying common content was performed
in terms of subset similarities as a matter of greater in-depth comparison.
Data Analysis
A simple distribution of responses was calculated to include response mean and standard
deviation per item as a measure of response variance. In addition, a t-test analysis of significant
differences in responses between those students with and without prior nursing experience was
performed using an alpha level of .05 for null hypothesis rejection.
Institutional Review Board and/or Ethical Issues
Institutional Review Board approval for this project was obtained from the Bradley
University’s Committee on the Use of Human Subjects in Research (CUHSR) (see Appendix C).
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No respondent identifiable data was collected. Participants were made aware of the project when
they voluntarily provided their e-mail to the community college’s Dean of Health Professions. A
cover letter was included that explained the purpose and extent of the study (see Appendix D).
Completion of the survey indicated informed consent.
Chapter III
Organizational Assessment
For this project, organizational cooperation and collaboration was forthcoming. Current
e-mail addresses for nursing graduates used in the sample were obtained from the community
college with permission from the administration. Organizational cooperation was further
achieved by contact with representatives from the two local hospitals who provided information
about how they currently utilize a NRP and the curriculum used for their NRP. Hospital #1
currently utilizes the University of Iowa’s Nurse Residency Program online curriculum. Hospital
#1 has been dissatisfied with the curriculum, and they are currently exploring developing their
own curriculum to implement when their contract is completed. Hospital #2 utilizes the
Transition to Practice program and was one of the participating hospitals in the NCSBN study on
the Transition to Practice program.
Cost Factors
No budgetary needs existed for the research in that no expenses were incurred with the
project. The potential cost savings to healthcare organizations are significant however, as
indicated in the literature review.
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Chapter IV
Quantitative Analysis of Implementation Process
The expanded Casey-Fink survey was reproduced into a SurveyMonkey questionnaire
and administered online via e-mail on Monday, June 25, 2018. The survey was sent to 44
students who successful passed the community college capstone course. The survey closed on
Monday, July 2, 2018 after 8 days. There were 20 total responses, with 19 of the 20 surveys
completed with no missing data. As such, 19 were identified as being usable for a response rate
of 43%. Modification was made to the inception date the survey was administered, and no
interventions were required during questionnaire administration.
Questionnaires were completed and submitted on reasonable and consistent basis over
time. Which may be reflective of the four reminder e-mails sent, the last being sent on July 1st.
At the close of the survey, the raw data and responses were exported to Excel and basic data
analysis was performed.
Qualitative Analysis of Implementation Process
Hospital #1 and hospital #2 each provided an outline of their nurse residency programs,
with each program being one year in length. Hospital #1 was in transition to change from the
University of Iowa’s Nurse Residency Program online curriculum to their own nurse residency
program, and as such, provided a limited and non-detailed program curriculum in outline form.
Hospital #2 utilizes the NCSBN Transition into Practice modules for their nurse residency
program. This program content was much more comprehensive in nature and used as the
benchmark for content analysis. The unequal program content and detail created a challenge in
terms of a balanced analysis. A more complete comparison was possible between the community
college capstone course content and hospital #2 nurse residency program content.
PRECEPTOR CAPSTONES 22
Quantitative Analysis of Project Outcome Data
Table 4 presents the demographic profile of the survey respondents. As such, 84% of
respondents were female with the average age of all respondents being 33 years. Respondents
and sample characteristics were therefore considered a reasonable representation of community
college nursing students.
Table 4
Demographic Profile

n (%)
Average Age of Respondents
Female 16 (84) 33 years
Male 3(16)
Table 5 presents the rank order distribution of capstone content importance means.
Table 5
Rank Order Distribution of Capstone Content Importance Means
Question M* SD
Prioritizing patient care needs 3.74 0.523
Recognizing changes in patient condition 3.74 0.523
Having opportunities to practice skills and procedures more than
once
3.74 0.523
Providing Quality Care 3.74 0.523
Taking action to solve problems 3.63 0.571
Identifying actual or potential safety risks and hazards to my
patients
3.63 0.571
Problem solving/Clinical 3.58 0.587
Collaborating with interdisciplinary team members 3.58 0.587
Readiness to assume an RN role 3.53 0.681
Asking for help 3.53 0.681
Using current evidence-based practice to make clinical decisions 3.53 0.598
Analyzing patient data 3.53 0.681
Preparing for the professional role 3.53 0.821
Reviewing Medical-Surgical patient care for various diseases 3.47 0.826
Simulation to help me feel prepared for clinical practice 3.42 0.761
PRECEPTOR CAPSTONES 23
Quality Improvement in work processes 3.42 0.827
Ethical issues in my patient care responsibilities 3.37 0.826
Responding to workplace violence 3.37 0.826
Communicating with patients from diverse populations 3.32 0.821
Documenting care in the electronic medical record 3.26 1.040
Communicating with physicians 3.05 0.813
Delegating tasks to the nursing assistant 2.89 0.918
Note. *n=19
The means of the capstone content importance responses ranged from a high of 3.74 to a
low of 2.89, with some natural clustering noted. It is also noted that all but one of the content
item means were measured to be important at least at the 3+ level indicating general perceived
importance for almost all content items. Said another way, no content item means were
identified as unimportant or very unimportant. Using a general rule of thumb data break point of
3.5 on a 4-point scale of importance, four identifiable clusters of high importance were observed.
The first high scoring cluster consisted of four content areas: providing quality patient
care, prioritizing patient care needs, recognizing changes in patient condition and having
opportunities to practice skills and procedures more than once. This cluster had the highest mean
of 3.74 and had the lowest variance of 0.523. These first cluster content items could be
interpreted to center around patient care. The second highest scoring cluster had the largest
between group mean separation of 0.11 of all the content areas. The second cluster consisted of
two content items: taking action to solve problems and identifying actual or potential safety risks
and hazards to my patients. It had the second highest mean of 3.63 with the second lowest
variance of 0.571. The second cluster content items could be interpreted to center around critical
thinking related to problem solving. The third highest scoring cluster consisted of two content
areas: problem solving/clinical and collaborating with interdisciplinary team members. It had the
third highest mean of 3.58 with the third lowest variance of 0.587. The third cluster content items
PRECEPTOR CAPSTONES 24
could be interpreted to center around problem solving and teamwork. The fourth highest scoring
cluster consisted of five content areas: readiness to assume an RN role, asking for help, using
current evidence-based practice to make clinical decisions, analyzing patient data, and preparing
for the professional role. It had a mean of 3.53 with a variance that ranged from 0.598-0.821.
These fourth cluster content items could be interpreted to center around the professional role of a
nurse and readiness to practice. As such, the results of the study indicate four primary important
content areas to include patient care, critical thinking, problem solving, teamwork and the
professional role and readiness to practice in that order. Therefore, it is this researcher’s
conclusion that capstone courses should include and emphasize the four content areas.
Table 6 presents the t-test analysis of content item importance responses between those
students with and without prior nursing experience. As such, an independent samples t-test was
conducted to compare levels and capstone course content importance in previous nursing
employment and no previous employment conditions. The mean of each content item relative to
students with nursing experience was compared to those with no previous nursing experience.
Table 6
Comparison of Means for Participants With and Without Previous Nursing Experience
Question With Previous Nursing
Experience
M
n = 8
Without Previous
Nursing Experience
M
n =11
Sig
Communicating with physicians 3.13 3.00 0.914
Communicating with patients from diverse populations 3.13 3.45 0.231
Delegating tasks to the nursing assistant 3.00 2.91 0.632
Documenting care in the electronic medical record 3.38 3.36 0.736
Prioritizing patient care needs 3.63 3.82 0.231
Readiness to assume an RN role 3.50 3.55 0.605
Problem solving/Clinical 3.50 3.64 0.365
Ethical issues in my patient care responsibilities 3.25 3.45 0.391
Recognizing changes in patient condition 3.50 3.91 0.032*
Having opportunities to practice skills and procedures
more than once 3.63 3.82 0.231
PRECEPTOR CAPSTONES 25
Asking for help 3.50 3.55 0.605
Using current evidence-based practice to make clinical
decisions 3.38 3.64 0.176
Collaborating with interdisciplinary team members 3.50 3.64 0.365
Simulation to help me feel prepared for clinical practice 3.38 3.45 0.563
Taking action to solve problems 3.50 3.73 0.209
Identifying actual or potential safety risks and hazards to
my patients 3.50 3.73 0.209
Providing Quality Care 3.50 3.91 0.032*
Reviewing Medical-Surgical patient care for various
diseases 3.50 3.73 0.832
Analyzing patient data 3.38 3.64 0.237
Quality Improvement in work processes 3.38 3.45 0.595
Responding to workplace violence 3.38 3.36 0.750
Preparing for the professional role 3.50 3.55 0.669
Note. *p < .05.
Independent-samples t-tests were conducted to compare the means for responses given by
participants with and without previous nursing experience. The overwhelming majority of
content importance ratings did not vary significantly by previous nursing experience. This
indicates that regardless of nursing experience, students in the community college capstone
course viewed the content items as similarly important. As such, capstone course content need
not vary because of previous nursing experience. Only two of the 22 content areas were
identified as being significantly different at the 0.05 level. One of these was recognizing
changes in patient conditions. There was a significant difference in the scores for those with
nursing experience (M=3.5, SD =0.523) and those without nursing experience (M=3.91,
SD=0.523) conditions; t(17)=2.292, p=0.032. This result indicates that nursing experience has an
effect on rating the importance of including capstone content regarding recognizing changes in
patient conditions. Specifically, experienced nurses are more comfortable with recognizing
changes in patient conditions and therefore do not rate it as being important capstone course
content. The second significant difference was rating the importance of providing quality care.
There was a significant difference in the scores for those with nursing experience (M=3.5, SD
=0.523) and those without nursing experience (M=3.91, SD=0.523) conditions; t(17)=2.292,
PRECEPTOR CAPSTONES 26
p=0.032. This result indicates that nursing experience has an effect on providing quality care.
Specifically, nurses with experience may feel that it is an expectation that nurses provide quality
care and therefore do not rate it as being important capstone course content.
Qualitative Analysis of Project Outcome Data
Table 7 presents the primary content of the two local hospital nurse residency programs
(NRPs) and the community college capstone course.
Table 7
Summative Content Analysis of Local Hospital NRP’s and Community College Capstone Course
Hospital #1 Hospital #2 (NCSBN Model) Community College Capstone Course
Patient Centered Care
EMR/Documentation/Chart Audit
Time Management
Stress Management/SBAR
Patient Centered Care (NCSBN Model)
• Multi-Dimensional Care
• Advocacy
• Decision Making related to Patient Care
• Prioritizing
• Evaluating Patient Care
• Professional Boundaries
Patient Centered Care
Quality Care
• Clear communication
• Quality Improvement Processes
related to Patient care
Clinical Judgement
• Patient Needs
• Community Needs
• Clinical Judgement
• Detect Patient Variances
Prioritization
• Plan care on acuity of patients
Medical-Surgical Topics
• Invasive Monitoring
• Traction Devices
Communication and Teamwork
Work Place Violence/Horizontal
Violence
Leadership
Professionalism/Social
Media/Organizations
Communication and Teamwork
• Socializing Organization
• Personal Effectiveness with
Communication
• Clearly Communicate and Collaborate
• Delegation
• Scope of Practice (RN/LPN)
• Team Functioning
• Professional Development
Communication and Teamwork
Delegation
• Decision Making related to Patient
Care
• Facilitate Tasks
Teamwork & Collaboration
• Strategies for Improving Team
Function
Communication
• Clear communication
Evidence Based Practice
Journal Article Review/Evidence Based
Practice
Evidence Based Practice
• Evidence Based Practice
• Search Databases
• Critiquing
• Evaluate Practice Changes
• Evidence Based Implementation Models
• Utilizing and Implementing Evidence
Based Strategies/Practices
Evidence Based Practice
Evidence-Based Practice
• Utilize databases to support clinical
decisions
• Evidence based practice to guide care
• Evidence based practice and patient
teaching
Professionalism
• Professional Standards
• Nurse Practice Act
• Roles of Nurses
• Leadership Skills
PRECEPTOR CAPSTONES 27
Hospital #1 Hospital #2 (NCSBN Model) Community College Capstone Course
Quality Improvement Quality Improvement
• Use data to identify gaps in care
• Identify methods of opportunity
• Identify barriers
• Utilize Evidence Based Practice
• Develop Implementation Plan
Quality Improvement
Quality Improvement
• Structure and process of care related
patient outcomes
• Quality Improvement and Patient
outcomes
• Safety Designs
Hazard & Violence
• Potential hazards
Informatics
Casey Fink Survey
Personalities/Color Test
Informatics
• Identify electronic/print resources for point
of care
• Information needed at point of care
• Access information
• Tools/Technologies to improve point of
care
• Challenges with technology
• HIPAA
• Compliance
Informatics
Data Analysis
• Quality Improvement Processes
• Root Cause
• Data Trends
• Workflow
Targeted Changes
Summative content analysis of hospital #1 and community college capstone course
content was benchmarked with hospital #2, which utilizes the National Council of State Board of
Nursing (NCSBN) Transition to Practice program. While not identified in the literature review as
a gold standard, the NCSBN surveys nursing graduates every two years to consistently
understand expectations of the first-year nurse, and as such is the most current. At first glance,
hospital #1 content does not align well with the content from Hospital #2 and the community
college capstone course. However, the community college capstone course content aligns well
with the Hospital #2 content.
Hospital #1 includes content relevant to topics for a new nursing graduate. However,
when compared to hospital #2, hospital #1 is lacking in content and appears to be missing
important content items such as patient centered care and clinical judgement, and decision
making. After comparing hospital #1 and hospital #2 content items, the NRP at hospital #1
leaves much to be desired and is not congruent with current recommended content found in the
literature. The community college capstone course content aligns more directly with content
from the hospital #2 NRP. Natural alignment of similar content items can be seen in Table 7. The
PRECEPTOR CAPSTONES 28
commonalities among the community college capstone course content and the hospital #2 NRP
content suggest that the programs are complimentary and supportive. Capstone course content
areas not included in hospital #2 NRP content include hazards and violence. No content was
identified as missing from the capstone course content when compared to hospital #2 NRP
content.
Performing a summative content analysis of the hospital #2 NRP, the community college
capstone course, and content areas identified in the literature as important for capstone courses
(as summarized in Table 1) produced the following results (see Table 8).
Table 8
Summative Content Analysis of Literature Review, Hospital #2 NRP Program and Community
College Capstone Course
Literature Review Hospital #2 NRP Community College Capstone Course
Patient Centered Care
Clinical Skills/Medical Topics
Culture
Patient Centered Care
• Multi-Dimensional Care
• Advocacy
• Decision Making related to Patient Care
• Prioritizing
• Evaluating Patient Care
• Professional Boundaries
Patient Centered Care
Quality Care
• Clear communication
• Quality Improvement Processes
related to Patient care
Clinical Judgement
• Patient Needs
• Community Needs
• Clinical Judgement
• Detect Patient Variances
Prioritization
• Plan care on acuity of patients
Medical-Surgical Topics
• Invasive Monitoring
• Traction Devices
Communication and Teamwork
Communication
Teamwork & Collaboration
Leadership
Communication and Teamwork
• Socializing Organization
• Personal Effectiveness with
Communication
• Clearly Communicate and Collaborate
• Delegation
• Scope of Practice (RN/LPN)
• Team Functioning
• Professional Development
Communication and Teamwork
Delegation
• Decision Making related to Patient
Care
• Facilitate Tasks
Teamwork & Collaboration
• Strategies for Improving Team
Function
Communication
• Clear communication
PRECEPTOR CAPSTONES 29
Literature Review Hospital #2 NRP Community College Capstone Course
Evidence Based Practice
Professionalism
Evidence Based Practice
Evidence Based Practice
• Evidence Based Practice
• Search Databases
• Critiquing
• Evaluate Practice Changes
• Evidence Based Implementation Models
• Utilizing and Implementing Evidence
Based Strategies/Practices
Evidence Based Practice
Evidence-Based Practice
• Utilize databases to support clinical
decisions
• Evidence based practice to guide care
• Evidence based practice and patient
teaching
Professionalism
• Professional Standards
• Nurse Practice Act
• Roles of Nurses
• Leadership Skills
Quality Improvement
Safety & Quality
Quality Improvement
• Use data to identify gaps in care
• Identify methods of opportunity
• Identify barriers
• Utilize Evidence Based Practice
• Develop Implementation Plan
Quality Improvement
Quality Improvement
• Structure and process of care related
patient outcomes
• Quality Improvement and Patient
outcomes
Informatics Informatics
• Identify electronic/print resources for point
of care
• Information needed at point of care
• Access information
• Tools/Technologies to improve point of
care
• Challenges with technology
• HIPAA
• Compliance
Informatics
Data Analysis
• Quality Improvement Processes
• Root Cause
• Data Trends
• Workflow
Targeted Changes
Misc
Violence
Misc
• Safety Designs
Hazard & Violence
• Potential hazards
The prior identified content analysis congruence between hospital #2 and the community
college capstone course were also compared against the nine literature review areas. Natural
alignment can be seen in Table 8. The last content topic of informatics from hospital #2 wasn’t
congruent with literature review content. Of the nine content items from Table 1, violence was
not identified as congruent with hospital #2 NRP content. The commonalities between the
literature review content and the hospital #2 NRP content and the community college capstone
course content suggest that the three sources are complementary and supportive. Therefore, NRP
content from hospital #2, and the community college capstone course are congruent with content
items identified as important for capstone courses found in the literature review.
PRECEPTOR CAPSTONES 30
Chapter V
Findings
The results of this study indicated four primary findings:
1. The commonalities among the community college capstone course content and
hospital #2 NRP content suggest that these programs are complimentary and
supportive.
2. NRP content from hospital #2, and the community college capstone course were
congruent with content items identified as important for capstone courses in the
literature review.
3. The results of the study indicate four primary important capstone course content
areas: patient care, critical thinking/problem solving, teamwork and the professional
role and readiness to practice in that order.
4. The identified importance of the overwhelming majority of capstone content items
did not vary significantly with previous nursing experience, which supports the use of
a single curricula.
Limitations or Deviations from Project Plan
No deviations from the project plan occurred. A limitation in analysis was that hospital
#1 provided only a basic NRP outline, which limited the ability to conduct an in-depth content
analysis with hospital #2 program and the community college capstone course. Another
limitation is related to the timing of the data collection. The nursing graduates completed the
NCLEX in late May and early June. With the survey being administered at the end of June, many
of the graduates had just begun working, so their perspective of perceived importance of
capstone content may have been limited by this limited nursing experience. This study’s results
PRECEPTOR CAPSTONES 31
pertain to a population from rural northern Illinois, which may or may not be applicable to the
entire state or the nation as a whole.
Implications
The results of this study can be used to revise the community college capstone course
curriculum by incorporating and emphasizing content items identified as most important by the
nursing graduates. The implications for hospital #1 are significant. As presented and reviewed,
the hospital #1 NRP curriculum falls well outside that of hospital #2 as well as content identified
as important in the literature review. Implications for future research include capstone course
content evaluation after new graduates have completed the NRP at their place of employment.
This could provide a more comprehensive evaluation of the capstone course content. A statewide
evaluation of important capstone content items with nursing programs that have a capstone
course in their final semester could provide a large sample size and greater statewide
representation. On the basis of the literature review, it appears in general that the states of
Wisconsin and Florida lead the nation in NRP content areas and were additionally identified as
having partnerships between academe and service providers. This implies that the state of
Wisconsin and Florida may have a future leadership role in program development on a national
basis.
Chapter VI
Value of the Project
The results from this project provided significant information to the community college
with respect to its capstone course curriculum. Reviewing capstone course content through the
feedback of student perception of course content importance helps to validate the content of the
course and identify any curriculum revisions that might need to occur. For the two local
PRECEPTOR CAPSTONES 32
hospitals, the results of this project indicate strengths and weaknesses related to their current
nurse residency programs compared to the NCSBN model, as well as areas of importance related
to content identified by students who are now new graduates in their institutions. It allows them
to understand what those new graduates perceive to be important content items and can help
guide the curriculum of the nurse residence program specific to the new graduates they are
hiring.
DNP Essentials
This project meets several aspects of the DNP Essentials and has provided great
professional and personal growth. In Essential I, the project aligns with “develop and evaluate
new practice approaches based on nursing theories and theories from other disciplines”. This
project recognized different learning and nursing education theories related to nursing
curriculum and new graduate success. In Essential III, the project aligns with “use analytic
methods to critically appraise existing literature and other evidence to determine and implement
the best evidence for practice”. This project evaluated local nurse residency program content
compared to the local community college capstone course content and their natural alignment
with nurse residency program content identified as important in the literature. Another outcome
from Essential III aligned with this project, “use information technology and research methods
appropriately, and disseminate findings from evidence-based practice and research to improve
healthcare outcomes”. Specifically, this project involved utilizing a research database search
engine to conduct a literature review, as well as analyzing the findings of the literature review to
determine the importance and value of the project related to nursing education. From Essential
VI the project aligns with, “employ effective communication and collaborative skills in the
development and implementation of practice models, peer review, practice guidelines, health
PRECEPTOR CAPSTONES 33
policy, standards of care, and/or other scholarly products”. This project involved communication
and collaboration with the two local hospitals to understand what their NRP needs were and, how
they were utilized in the program content. Finally, from Essential VIII, this project aligns with
“guide, mentor, and support other nurses to achieve excellence in nursing practice, along with
use of conceptual and analytical skills in evaluating the links among practice, organizational,
population, fiscal, and policy issues”. Specifically, this project will guide the content of the
community college capstone course curriculum to help educate future nursing students.
Plan for Dissemination
The results from this study will be shared with the community college administration, and
hospital #1 and hospital #2 nursing administrations in August. Further discussion in the form of a
presentation of this study may result after the college and hospital administrations review the
study. After the project is presented to college administration and hospital administrations
submission for publication will be forthcoming in an appropriate journal.
Attainment of Personal and Professional Goals
Through this project, I have been able to determine the importance of a course that I
developed and taught as part of a new nursing curriculum. Being able to have a more in-depth
questionnaire-based evaluation of what students perceive as important to their education can help
guide my professional practice as an educator. Through the literature review, a clear goal for the
community college capstone course became apparent, transition students from academe to the
workforce. It was the goal of the course all along but there wasn’t significant data or information
that provided insight on how or if it was being achieved. This project has provided the research,
data and support to help the capstone course evolve into a true transition from student to new
nurse graduate. This project has allowed me to see a course development from start to finish
PRECEPTOR CAPSTONES 34
with, much like the nursing process assessment, diagnosis, planning, implementing and
evaluation.
PRECEPTOR CAPSTONES 35
References
Aggar, C., Bloomfield, J., Thomas, T. H., & Gordon, C. J. (2017). Australia’s first transition to
professional practice in primary care program for graduate registered nurses: a pilot
study. BMC Nursing, 1-11. http://dx.doi.org/10.1186/s12912-017-0207-5
Benner, P. (1984). From Novice to Expert; Excellence and Power in Clinical Nursing Practice.
Menlo Park, CA: Addison-Wesley.
Blevins, S. (2016). Nurse residency programs: Supporting nurse graduates. MEDSURG Nursing,
25(5), 367-368.
Bratt, M. M. (2009). Retaining the next generation of nurses: The Wisconsin nurse residency
program provides a continuum of support. The Journal of Continuing Education in
Nursing, 40(9), 416-425.
Bratt, M. M. (2013, November 3, 2013). Nurse residency program: Best practices for optimizing
organizational success. Journal for Nurses in Professional Development, 29(), 102-110.
http://dx.doi.org/10.1097/NND.0b013e318292649f
Casey, K., & Fink, R. (2008). Casey-Fink Readiness for Practice Survey [Survey]. Published
instrument. Retrieved from https://www.uchealth.org/professionals/professionaldevelopment/casey-fink-surveys/casey-fink-readiness-practice-survey/
Casey, K., Fink, R., Jaynes, C., Campbell, L., Cook, P., & Wilson, V. (2011). Readiness for
practice: The senior practicum Experience. Retrieved from https://www.uchealth.org/wpcontent/uploads/2016/10/PROF-Casey-Fink-Journal-Nursing-Ed-Readiness-Article.pdf
Cochran, C. (2017). Effectiveness and best practice of nurse residency programs: A literature
review. MEDSURG Nursing, 26(1), 53-57, 63.
PRECEPTOR CAPSTONES 36
Dyess, S., & Sherman, R. (2009). The first year of practice: New graduate nurses’ transition and
learning needs. The Journal of Continuing Education in Nursing, 40(9), 403-410.
http://dx.doi.org/10.3298/00220124-20090824-03
Hsieh, H., & Shannon, S. (2005, November 1, 2005). Three approaches to qualitative content
analysis. Qualitative Health Research.
http://journals.sagepub.com/doi/abs/10.1177/1049732305276687?journalCode=qhra
Latourneau, R., & Fater, K. (2015). Nurse residency programs: An integrative review of the
literature. Nursing Education Perspectives, 36(2), 96-101. http://dx.doi.org/10.5480/13-
229
Levine, J. (2017). Transition to practice – part 1: Implementing the AAACN ambulatory care
nurse residency program: The importance of a structural framework. Nursing Economic$,
35(5), 267-271.
More, L. (2017). Transition into practice – part 2: Implementing an ambulatory care registered
nurse residency program: Competency – it’s not just a task. Nursing Economic$, 35(6),
317-322.
Nurse residency program curriculum overview. (2018). Retrieved April 28, 2018, from
https://uiowa.edu/ionrp/curriculum-overview
Outline of NCSBN’s transition to practice modules. In Outline of NCSBN’s transition to practice
modules. Retrieved from www.ncsbn.org
Sauk valley community college: Associate degree nursing student handbook. (2018-2019).
Dixon, IL: Sauk Valley Community College.
Sauk valley community college: Transition into practice course outline. (2018-2019). Dixon, IL:
Sauk Valley Community College.
PRECEPTOR CAPSTONES 37
Welding, N. M. (2011). Creating a nursing residency: Decrease turnover and increase clinical
competence. MEDSURG Nursing, 20(1), 37-40.
PRECEPTOR CAPSTONES 38
Appendix A
Expanded Casey-Fink Readiness for Practice Survey
Thank you in advance for your willingness to participate in this survey. All responses are
anonymous and held in confidence and used as input into the nursing capstone course and nurse
residency program content.
Please fill in the blank or circle the best response that represents your individual profile.
1. Age ______ years
2. Gender
a. Female
b. Male
3. What previous health care work experience have you had:
a. Nursing Assistant
b. Medical Assistant
c. Volunteer
d. Unit Secretary
e. EMT
f. EMT – Paramedic
g. LPN
h. Other: (Please specify)___________________
4. Was your capstone clinical practicum experience at your current place of employment?
a. Yes
b. No
5. How many NCLEX-RN questions/week did you review while in your capstone course?
#_____________Questions
List THREE skills/procedures you are most uncomfortable performing independently at this
time? Select from the list below.
1.____________________________
2.____________________________
3.____________________________
4. __________ I am independent in all skills listed below
List of Skills
Assessment skills
Bladder catheter insertion/irrigation
Blood draw/venipuncture
Blood glucose monitoring device
Central line care (dressing change, blood
draws, discontinuing)
Charting/documentation
Chest tube care
PRECEPTOR CAPSTONES 39
EKG/Telemetry monitoring and
interpretation
Giving verbal report
Intravenous (IV) medication administration
Intravenous (IV) starts
IV pumps/PCA pump operation
Medication administration
NG tube/Dobhoff care
Pulse oximetry
Responding to an
emergency/CODE/changing patient
condition
Trach care/suction
Wound care/dressing change/wound vac
Please answer each of the following questions by placing a mark inside the box/circle:
What is your current level of confidence in managing a patient care assignment on an adult
Medical/Surgical unit:
Not Confident Confident
1 2 3 4 5
Caring for 2 patients
Caring for 3 patients
Caring for 4 patients
TABLE 1 STRONGLY
DISAGREE
DISAGREE AGREE STRONGLY
AGREE
I feel confident communicating
with physicians.
I am comfortable communicating
with patients from diverse
populations.
I am comfortable delegating tasks
to the nursing assistant.
I have difficulty documenting care
in the electronic medical record.
I have difficulty prioritizing patient
care needs.
My clinical instructor provided
feedback about my readiness to
assume an RN role.
I am confident in my ability to
problem solve.
I feel overwhelmed by ethical
issues in my patient care
responsibilities.
I have difficulty recognizing a
significant change in my patient’s
condition.
I have had opportunities to practice
skills and procedures more than
once.
I am comfortable asking for help.
PRECEPTOR CAPSTONES 40
I use current evidence to make
clinical decisions.
I am comfortable communicating
and coordinating care with
interdisciplinary team members.
Simulations have helped me feel
prepared for clinical practice.
Writing reflective journals/logs
provided insights into my own
clinical decision-making skills.
I feel comfortable knowing what to
do for a dying patient.
I am comfortable taking action to
solve problems.
I feel confident identifying actual
or potential safety risks to my
patients.
I am satisfied with choosing
nursing as a career.
I feel ready for the professional
nursing role.
How important were the following capstone program items in preparing you for nursing
practice?
Very
Unimportant Unimportant Important Very
Important
Communicating with
physicians
Communicating with patients
from diverse populations
Delegating tasks to the nursing
assistant
Documenting care in the
electronic medical record
Prioritizing patient care needs
Readiness to assume an RN
role
Problem solving/Clinical
Ethical issues in my patient
care responsibilities
Recognizing changes in patient
condition
Having opportunities to
practice skills and procedures
more than once
PRECEPTOR CAPSTONES 41
Asking for help
Using current evidence-based
practice to make clinical
decisions
Collaborating with
interdisciplinary team
members
Simulation to help me feel
prepared for clinical practice
Taking action to solve
problems
Identifying actual or potential
safety risks and hazards to my
patients
Providing Quality Care
Reviewing Medical-Surgical
patient care for various
diseases
Analyzing patient data
Quality Improvement in work
processes
Responding to workplace
violence
Preparing for the professional
role
What content could be added to help you feel more prepared to enter the nursing
profession?
______________________________________________________________________________
______________________________________________________________________________
Thank you for completing this survey!
PRECEPTOR CAPSTONES 42
Appendix B
PRECEPTOR CAPSTONES 43
Appendix C
Dear Investigators:
Your proposed study (CUHSR 44e-18) Project proposal: Preceptor capstones: Are they beneficial in ADN
programs to help transition new graduates? has been reviewed and was found to be exempt from full review
under Category 2.
Your vita and ethics certificates are on file.
Be aware that future changes to the protocols must first be approved by the Committee on the Use of Human
Subjects in Research (CUHSR) prior to implementation and that substantial changes may result in the need for
further review.
While no untoward effects are anticipated, should they arise, please report any untoward effects to CUHSR
promptly (within 3 days).
As this study was reviewed as exempt, no further reporting is required unless you change the protocol or
personnel involved.
This email will serve as notice that your study has been reviewed unless a more formal letter is needed. Please
let me know, and I will provide the letter.
Ross L. Fink, Ph.D.
Chairperson, CUHSR
PRECEPTOR CAPSTONES 44
Appendix D
Cover Letter for Survey
April 30, 2018
Dear Nursing Graduate,
I am a graduate student at Bradley University. I am conducting a study to determine the
importance of the community college’s capstone program that you completed related to
preparing you for nursing practice. This is the topic of my scholarly project, which is one of
the components required to complete my Doctorate of Nursing in Leadership.
Given the identified nursing shortage and retention problems that many hospitals face,
the purpose of the study is to determine the extent to which the community college’s
capstone course prepared you for professional nursing practice.
Please take approximately 15 minutes to complete the attached survey. All responses are
confidential and anonymous. Informed consent in this study is implied if the questionnaire is
completed and submitted. Anonymity will be maintained.
You can choose not to participate in this study by not answering or submitting the
questionnaire, but I encourage you to participate in this study to help address the educational
needs of new graduate nurses.
Thank you in advance for your time and participation.
Sincerely,
Mary Margaret Evans, MSN, RN
PRECEPTOR CAPSTONES 45