Preceptor RN Skills Checklist

Preceptor RN Skills Checklist

First Name*

Last Name*

Years of Experience*

E-mail*

example@example.com

ANSWER KEY

PROFICIENCY

1=Not Applicable 2=No Experience 3=Some Experience

4=Experienced 5=Very Experienced

FREQUENCY

1=Never Performed 2=Assisted Only 3=Rarely Performed

4=Occasionally Performed 5=Regularly Performed

General*

Rows	Proficiency	Frequency
Re-Evaluate and Revise Orientation Plan as Needed
Utilize Action Verbs When Creating Goals (Achieve, Apply, Demonstrate, Document, Develop, etc.)
Benner's Model of Competency (Novice, Advanced Beginner, Competent, Proficient, Expert)
Set Goals Using SMART Technique (Specific, Measurable, Attainable, Realistic, Timely)
Develop of Orientation Plan
Prioritize Orientation Based on Learning Needs
Utilize Evaluation Process for Goal Achievement
Assess Preceptee's Knowledge, Skills, and Engagement in Development of Orientation Plan
Distinguish Various Types of Priority Learning Needs (Fatal, Fundamental, Frequent, Fixed, and Facility)
Involve and Engage Other Staff Members to Facilitate the Orientation Process

Assess and Validate Level of Competence*

Rows	Proficiency	Frequency
Critical Thinking Competence
Technical Competence
Interpersonal Competence

General*

Rows	Proficiency	Frequency
Recognize and Appropriately Apply Methods for Dealing With Conflict (Avoidance, Accommodation, Competition, Compromise, Collaboration)
Assess Preceptee's Time Management, Critical Thinking, and Problem-Solving Skills
Assess barriers to Goal Achievement and Revise Orientation Plan as Applicable

Recognize and Develop Strategies to Deal With Difficult Situations*

Rows	Proficiency	Frequency
Failure to make Progress
Disengagement From the Learning Process
Time Wasters (Internal, External)
Unsafe Behaviors of Preceptee
Disorganization
Preceptee Overestimation of Their Abilities

Utilize Strategies for Teaching*

Rows	Proficiency	Frequency
Time Management Skills
Prioritization Skills
Problem-Solving Skills
Critical Thinking Skills

Utilize Appropriate Responsibilities and Techniques for Delegation*

Rows	Proficiency	Frequency
Identify Appropriate Tasks for Delegation
Rights of Delegation (Right Task, Circumstance, Person, Directions, Communication, Supervision, and Evaluation)
Scope of Delegation

General*

Rows	Proficiency	Frequency
Apply Nursing Code of Ethics
Ability to Adjust Preceptee's Responsibilities Based on Performance
Function Within Nursing Scope of Practice
Recognize the Responsibilities of Preceptee (Engagement, Self-Evaluation, Accountability, Developing Personalized Goals)
Ability to Use Multiple Types of Equipment Used Throughout the Preceptorship
Conduct Orientation Process in Professional Manner at all Times
Recognize Basic Nursing Skills and Knowledge of a New Graduate Nurse or Newly Licensed Nurse
Recognize 4 Stages of Reality Shock and Develop Strategies to Assist Preceptee With Those Challenges (Honeymoon Phase, Shock Phase, Recovery Phase, Resolution Phase)
Operate Within the Role of Preceptor (Role Model, Socializer, Educator, Coach)
Utilize Policies and Procedures of Unit, Department, and Organization
Utilize Various Coaching Techniques (Sponsoring, Encouraging, Counseling, Confronting)

General*

Rows	Proficiency	Frequency
Recognize Different Teaching / Learning Styles (Visual / Spatial, Auditory, Tactile / Kinesthetic)
Adjust Teaching Style Based Individual Learning Style of Preceptee
Utilize Critical Elements Strategies of Adult Learning (Motivation, Reinforcement, Retention, and Transference)
Promote Self-Directed Learning of the Preceptee
Apply Teaching Strategies for Cognitive Learning (Recall, Mathematical Conversions, Interpreting Lab Results, Performing Assessments, Evaluating Effectiveness of Interventions, etc.)
Apply Teaching Strategies for Affective Learning (Performing Self Assessment, Evaluating Evidence Based Studies, Discussing Feelings / Attitudes in Various Situations)
Apply Teaching Strategies for Psychomotor Learning (Return Demonstration, Participate in Mock Emergencies, Simulation Labs)

Recognize Factors that Affect Learning & Develop Strategies to Adapt Learning Based on Those Factors*

Rows	Proficiency	Frequency
Generational / Age Differences (Baby Boomers, Generation X, Generation Y)
Cultural / Religious Differences
Language Barriers (English as a Second Language)
Environment of Learning
Intellectual Ability

Utilize Various Teaching Methods Throughout the Preceptorship*

Rows	Proficiency	Frequency
Verbal Explanation of Procedures
Return Demonstration
Simulation Lab
Hospital References
Observational Opportunities
Library
Internet

General*

Rows	Proficiency	Frequency
Recognize and Appropriately Utilize Various Types of Feedback (Positive, Negative, Constructive)
Provide Timely Feedback to Preceptee
Utilize Written & Verbal Communication Techniques for Feedback
Utilize Appropriate Confrontation Techniques for Constructive Feedback
Assess and Adapt to Communication Patterns as Needed (Passive, Aggressive, Assertive)
Utilize SBAR Technique to Facilitate Preceptee's Communication Within Healthcare Setting

Age Specific Criteria*

Rows	Proficiency	Frequency
Newborn / Neonatal (up to 30 days)
Infant (30 days to 1 year)
Toddler (1 to 3 years)
Preschooler (3 to 5 years)
School Age (5 to 12 years)
Adolescents (12 to 18 years)
Young Adults (18 to 39 years)
Middle Adults (40 to 64 years)
Older Adults (65 & up)

The information provided is true and to the best of my knowledge. I hereby authorize Summit Medical Staffing to present my Skills Checklist to facilities for the purpose of employment. Please Type Your Name in This Box to Electronically Sign this Form. *

First NameLast Name

Date*

MonthDayYear

Hour MinutesAM/PM Option

Form Reply Email Address

example@example.com

Salesforce Check

Orientation Plan (Assessment, Plan, Implementation, Evaluation)

Critical Thinking & Problem Solving

Roles and Responsibilities

Adult Learning

Communication