J O U R N A L F O R N U R S E S I N S T A F F D E V E L O P M E N T  Volume 25, Number 6, 278284  Copyright A 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Using a model for the utilization of research

..
can aid and direct staff development
..
educators in the appropriate application of
.. Applying the Stetler
..
existing research-based knowledge and help
..
prevent the pitfalls of using research
.. Model of Research
inaccurately. The Stetler Model of Research
..
Utilization was applied to obtain support for
.. Utilization in Staff
and revitalize a preceptor program at one
..
..
large metropolitan tertiary medical center.
.. Development
Applying the Stetler Model resulted in the
..
improvement of nurses satisfaction with their
..
preceptors and a reduction in turnover rate.
.. Revitalizing a Preceptor Program
..
.. Celeste R. Romp, MSN, ARNP, CCNS, RN-BC
.. Ermalynn Kiehl, PhD, ARNP, CNS
..
..
..
..
..
..
..
.................................................

vidence-based practice (EBP) has been or is being

integrated into clinical practice in many healthcare
facilities and is clearly here to stay. Many national
organizations have used research to develop recommendations for practice. The Joint Commissions
(2008) core measures, the American Heart Associations (2005) Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, the
Institute for Healthcare Improvements (2006) 5
Million Lives Campaign, and the American Association
of Critical Care Nurses (2008) Practice Alerts are just a
few examples. Staff development educators have been
involved in disseminating and incorporating into
clinical practice these already-analyzed EBP guidelines.
What are staff development educators to do, though,
when a question arises where no EBP guidelines exist?
Research utilization is more than just performing a
literature search. Using a specific model of research
utilization can direct staff development educators in
the appropriate application of existing research-based

..........................................
Celeste R. Romp, MSN, ARNP, CCNS, RN-BC, is Critical Care Educator,
Jewish Hospital and St. Marys Healthcare, Louisville, Kentucky.
Ermalynn Kiehl, PhD, ARNP, CNS, is Associate Dean, School of Nursing,
University of Louisville, Louisville, Kentucky.
The authors have disclosed that they have no significant relationships
with, or financial interest in, any commercial companies pertaining to
this educational activity.

278

knowledge and help prevent the pitfalls of using

research inaccurately.
The Stetler Model of Research Utilization (see
Table 1) is designed to be useful for the individual
practitioner (Stetler, 1994), and it can provide a
framework for integrating research findings into EBP.
The phases of the Stetler Model include preparation,
validation, comparative evaluation/decision making,
translation/application, and evaluation (Stetler, 2001).
The purpose of this project was to demonstrate how
the Stetler Model of Research Utilization was applied to
obtain support for and revitalize a preceptor program
at one large metropolitan tertiary medical center.

BACKGROUND
The nurse educator at a 442-bed metropolitan community medical center, which employs approximately
760 registered nurses and hires approximately 150 new
registered nurses a year, determined that there was a
need to evaluate the preceptor program for newly
hired nurses. An orientation evaluation survey of
nurses was instituted that included five Likert-style
questions and five open-ended questions about their
experience with their preceptors. Some of the questions orientees were asked included the following: (a)
rate their overall satisfaction with their preceptors in
general, (b) provide specific examples of something a
preceptor said or did that stood out to them as helpful
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TABLE 1

Steps of the Stetler Model

..............................................................................................
Steps of the Stetler model
Phase I: preparation

Phase II: validation

Phase III: comparative evaluation/decision making

Phase IV: translation/application
Phase V: evaluation

Application
Defining the purpose of the review to aid the reviewer in
identifying measurable outcomes; searching for applicable
articles; and identifying barriers, both internal and external,
that could influence the decision-making process
Critiquing the chosen literature with utilization in mind; each article
is validated regarding its relative level of support for the topic
searched and whether there is sufficient evidence in the
literature to continue
Synthesizing and evaluating the findings to determine desirability
and feasibility of applying the findings to practice
Translating findings into a plan then implementing the plan
into practice
Evaluating the change in practice

or exceptional, (c) provide specific examples of

something a preceptor said or did that was not helpful
or frustrated them, and (d) if they would like to
recognize a preceptor for their skills, and if so, why. It
was apparent from the results that the preceptor
practice needed to change. Orientees were describing
interactions with their preceptors that were very
concerning. They reported that their preceptors said
such things as, I hate precepting. . .I dont know why
they gave you to me, and Im not quite sure what to
do with you. Orientees also reported that some
preceptors were difficult to find or bothered by
questions or that the orientees were told to pick up
the pace and get more organized but were not
provided suggestions as to how to do that. Certainly,
how people are treated is important in and of itself, but
considering the shortage of nurses and the cost
associated with the recruitment of nurses in todays
competitive healthcare market, it is even more critical.
Registered nurse turnover cost has been estimated to
be as high as $67,100 (Jones, 2005). One major
characteristic necessary for retaining good nurses is
job satisfaction. Research has shown that a nurses job
dissatisfaction is associated with an increase in
turnover rates (Mills & Blaesing, 2000; Shader,
Broome, Broome, West, & Nash, 2001). Thus, attention
to the satisfaction of newly hired nurses is crucial.
Staffing shortages, large numbers of new orientees
at one time, and the inexperience of staff members
make the preceptor role challenging for staff and
stressful for new orientees (Modic & Schloesser, 2006;
Stevenson, Doorley, Moddeman, & Benson-Landau,
1995; Yonge, Krahn, Trojan, Reid, & Haase, 2002).
Although an initial 8-hour preceptor course existed,
many of those nurses who were precepting had never
attended the class. Preceptors indicated several reasons for not attending. Some were unaware the

preceptor course existed, and others stated that they

did not know it was a requirement. Others mentioned
that they had difficulty recalling the information from
the class, when they had actually attended several years
earlier. Although an annual preceptor update module
existed, many preceptors verbalized that they had not
participated. In some circumstances, busy managers
failed to distribute and remind preceptors about this
requirement.
Before initiating a quick fix for the problem, the
literature needed to be analyzed and a proactive plan
developed. Questions ensued, including the following:
What was in the literature regarding preceptor education? Would providing educational support to preceptors
fix this complex problem? Would preceptor education
increase these newly hired nurses satisfaction?

APPLYING THE STETLER MODEL OF

RESEARCH UTILIZATION
The Stetler Model of Research Utilization (Stetler,
2001) is a five-phase process used for organizing a
research utilization project. Each phase guides the
practitioner in organizing research literature to answer
a question. Therefore, before beginning to organize
the literature, there must be a question.
Phase I: Preparation
The PICO format was used to identify a specific question
for literature review (Melnyk & Fineout-Overholt, 2005).
Using the PICO format clarifies and organizes the patient
population, intervention of interest, comparison of
interest, and outcome of interest as follows:
PWhat is the patient population? New nurses
orienting to an acute care unit,

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279

IWhat is the intervention of interest? Education

for preceptors,
CWhat is the comparison of interest? Current
practice of minimal preceptor education,
OWhat is the outcome of interest? Increased
job satisfaction of the new nurse.
Specifically, are new nurses more likely to be
satisfied with their job if their preceptors have been
provided with preceptor education in the form of
initial and continuing classes versus having a preceptor
with minimal or no preceptor education?
Initial literature searches with the refined PICO
question yielded little relevant literature. However, the
local universitys research help desk provided very
useful information regarding how to ensure that
literature searches generate the results intended. If
staff development educators are not confident that
their searches are obtaining the desired results,
universities typically have a help desk or research
librarian in the library for assistance.

Phase II: Validation

The second phase of the Stetler model involves
critiquing the chosen literature with utilization in
mind. Few staff development educators are also
research experts, so partnering with a research
specialist at the facility or the local university can be
instrumental in helping to wade through the vast
amounts of research terminology needed to determine
the level of support to the designated topic.
The literature search ultimately yielded five research
articles supporting the topic of preceptor education
(see Table 2). Using the Guidelines for Research
Critique adapted from Melnyk and Fineout-Overholt
(2005) and Titler (2001), the articles identified were
analyzed and critiqued. Using the Rating System for
Hierarchy of Evidence provided by Melnyk and
Fineout-Overholt (2005), one article was a Level III,
three were Level VI, and one was Level VII. Although
there are many additional articles that found the same
things to be true, they were not included because of
the lack of documentation of validity.
Phase III: Comparative
Evaluation/Decision Making
To evaluate if the findings were desirable and feasible
to apply to practice, it is essential that the risks
involved, the resources necessary, and the readiness of
staff be considered. Although implementation of an
education program presents very little risk to most
stakeholders, such as nurses, preceptors, educators,
managers, administrators, the facility, and patients
280

(indirectly), there are financial risks for the manager.

The costs of providing individuals additional education
have to be weighed with the benefits of increased
satisfaction of the new nurse, increased nurse retention, and decreased overall orientation training costs.
The increased savings in nurse retention would not
initially be seen. In this case, the cost of providing
preceptor training had to be incurred from the
individual unit budget prior to realizing a savings from
hiring less staff. Additional resources required time
away from other responsibilities for the educator to
promote, prepare, and market the education opportunities to all of the stakeholders. Cost for space
allocation and audiovisual equipment also needed to
be considered (Avillion, 2001). Lastly, readiness for an
education program would need to be assessed and
stimulated. When asked directly, most preceptors
indicated that they were interested in attending the
class. However, managers and administration might
require additional evidence to justify the cost necessary
to support sending preceptors to the education
program.
Taking into account the risks, resources, and
readiness of staff, did the evidence support the
provision of education to preceptors? Because this
type of study does not yield itself to randomized
controlled trials, descriptive and qualitative research
describes outcomes desired in preceptor education.
Thus, there is sufficient evidence to support a
preceptor education program based on its effectiveness in increasing job satisfaction in new nurses. The
decision was that the staff members who precept
would attend an initial preceptor education program.
Preceptors who had already attended initial training
would attend an update.
Phase IV: Translation/Application
Phase IV involves translating the results into a plan and
then implementing it. Program implementation in
hospital settings is challenging due to many factors,
especially financial considerations. Implementing a
more comprehensive education preceptor program
for nurses required obtaining support from administrators and managers, obtaining information from
current preceptors regarding their education and
suggestions for future education of preceptors, and
conducting a program that is current and relevant
and promotes a positive relationship between preceptors and preceptees.
Dissemination of recommendations based on the
review of the literature was accomplished in multiple
ways and to all of the key stakeholders: administrators,
managers, and preceptors. This was done via committee meetings, individual meetings, or direct mailings,
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281

Summary of EvidencePreceptor Education and Nurse Satisfaction

Identifying the experience

of the graduate nurse

Determining graduate
nurses experiences
during orientation in
their own words

Assessed retention and

orientees perceptions of
support, relationships,
environments for learning,
and satisfaction with
orientation
Determining the relationship
between sense of
belonging and job
satisfaction

Casey, Fink, Krugman,

and Propst (2004)

Delaney (2003)

Roche, Lamoureux,
and Teehan (2004)

Level of evidencea

Level VI

Preceptor role had significant effect

on graduate nurses job satisfaction
and developing competency in the
professional role. Preceptors need
formal education regarding the value
and impact of their role and to better
understand reality shock.
Preceptors were found to have a significant
effect on both the transition experience
and the outcome for the new nurses.
When preceptors did not display
professional qualities, graduates
perceptions were less positive. Preceptors
would benefit from ongoing education
to help them address the needs of
graduates during role transition.
Relationship with the preceptor is the
single most important element in
the new nurses satisfaction. Classes
were designed to enhance the
relationships between the preceptors
and the new graduates.
Strong sense of belonging is associated
with a new graduate nurses satisfaction
and is influenced by coworkers and
preceptors. The researchers highlight
a need for extra mentoring and nurturing
and for employers to invest in staff
development and orientation programs
to achieve this.

This is a descriptive quantitative

study using mailed surveys
with Likert-type scales to measure
job satisfaction and sense of
belonging. Sample included 107
new graduate nurses who had
already taken the National Council
Licensure Examination.

Level VI

Level VII

Level VI
(qualitative
sections)

Educated preceptors increased the

satisfaction of the new nurses (p = .01),
when compared with orientees who
had been assigned to a buddy
who had not received any education.

This is a quasi-experimental and

descriptive quantitative study using
convenience sampling and
Likert-type scales that yielded a
Cronbachs alpha of .78 or greater.
Experts reviewed the measures.
Results were validated.
This is a descriptive comparative
cohort study, with qualitative sections.
It used the newly developed but
validated CaseyFink Graduate
Nurse Experience Survey, with a
convenience sample of 270
new graduate nurses from
six different facilities.
This is a phenomenological
qualitative study. It used
purposeful sampling and
audiotaped interviews of 10
graduate nurses using van
Manens Phenomenologic
Evaluative Criteria.

This used a questionnaire with

Likert-type scales and
open-ended questions.

Level III

General findings/Conclusions

Design/Method

Based on the rating system for the hierarchy of evidence of Melnyk and Fineout-Overholt (2005).

Winter-Collins and
McDaniel (2000)

Addressed the question of

preceptors and their effect
on new nurses satisfaction

Purpose

Giles and Moran (1989)

Reference

...............................................................................................................................

TABLE 2

depending on which stakeholder was being addressed.

The direct method of getting the information to the
stakeholders has shown to be more effective than
indirect methods such as posting information on a
bulletin board (Aucoin, 2005). First and foremost,
management needed to agree that the value of
providing additional education could outweigh the
cost if the outcome of the education is longevity of a
good employee. It is realistic and critical in todays
healthcare settings that costs and benefits be weighed
in any project. Before meeting with committees,
individual meetings with key administrative leaders
were held to discuss the plan, troubleshoot potential
issues, and obtain preliminary support. Because
managers have the most direct effect on both the
acceptance of the project and the functioning of the
units, the managers committee meeting was also used
as a dissemination opportunity for information regarding this project. Nursing administration and unit
managers were provided with the research-based
evidence, in a PowerPoint handout, regarding the
advantages gained by providing education to preceptors. This provided the rationale to defend budget
allocations for preceptor-related suggestions, such as
paid time for attending the class. In this way, manager
support was obtained for providing preceptor education for the new preceptors and additional training to
the existing preceptors.
Evaluation of Current Preceptor Program by
Existing Preceptors
After obtaining support of administration and management, a survey was developed to solicit feedback from
existing preceptors. During the process of locating all
preceptors to survey, it was discovered that some
managers were unclear about who the preceptors were
or if they had been to the initial preceptor education.
That realization alone prompted the managers to
reassess and accurately identify preceptors. The
preceptor survey included questions pertaining to (a)
topics for additional preceptor education, (b) preferred length of a class, and (c) level of satisfaction with
and suggestions for improvement of the preceptor
program. In addition, to improve participation in the
survey, funds were allocated from the nursing administration to provide drawings for multiple $10 gift
certificates. With that, out of 230 preceptors who were
sent the survey, 82 were returned for a 36% return rate.
Development of the Preceptor Education Program
When developing and implementing an education program for nurses, several strategies to improve success
must be implemented including establishing a need,
282

promoting enthusiasm to participate, and providing

an incentive to spend time attending the program.
One adult learning concept that needed to be
addressed was the preceptors need-to-know philosophy (Avillion, 2001). Existing preceptors needed to
see the benefit of attending an education program.
Direct flyers and personal invitation letters were sent
using EBP and research terminology in an attempt to
establish the importance of the classes. In addition,
preceptors were assured that they would be paid for
attendance, would be provided food during the course,
and would receive continuing education credit for
attending.
To increase awareness and enthusiasm, preceptor
survey results were also explained at several nursing
education council meetings, and council members
helped disseminate this information on the units to
encourage attendance at the classes. The drawing for
the winners of the gift cards was also done at the
nursing education council meeting to provide additional excitement and enthusiasm for the program.
Lastly, educators completed walking rounds of all of
the units, personally disseminating the information,
promoting attendance, and discussing rationale for
attending.
Phase V: Evaluation
Three methods of evaluation were used in this case,
summative evaluations of each class, changes in job
satisfaction, and registered nurse turnover rates.
Formal summative evaluations confirmed that the
class met the needs of the individual preceptors in
providing them with the identified content. Nurses said
things such as, wonderful update, very informative, excellent, and a very helpful refresher.
Prior to implementation of the program, one group
of 49 nurses completed an orientation evaluation
survey, which, in part, determined their level of
satisfaction with their orientation and their preceptors.
After implementation of the program, a different group
of 34 nurses completed the same survey. These
orientation evaluation surveys were administered after
approximately 68 weeks of orientation. Overall, the
new nurses satisfaction with orientation in general was
not statistically significant but improved from 4.36 to
4.50. However, satisfaction with the preceptors was
statistically significant and increased from 4.40 to 4.69
(p = .016).
Because research indicates that increased job
satisfaction of new nurses increases their likelihood
of being retained (Mills & Blaesing, 2000; Shader et al.,
2001), another evaluation method that has been
analyzed is nurse turnover rate. The 12-month registered nurse turnover rate before implementation of
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the program was 13.9%. After implementation, this

number had dropped to 10.1%. Given the improved
new nurses satisfaction, research would indicate that
the revitalized preceptor program may have been a
contributing factor in this decreased turnover rate.
Consequently, given a 3.8% decrease in turnover rate
for the medical center which averages 760 nurses and
an estimated training cost of $67,100 per new nurse
(Jones, 2005), estimated savings during this time frame
from new nurse training alone is estimated to be $1.8
million. Even after accounting for the preceptor
salaries for attending classes, the educator salary for
providing the education; room costs; and the costs of
food, handouts, and flyers (Avillion, 2001), the monetary benefit of program implementation is evident.

DISCUSSION
All five phases of the Stetler model were used which
resulted in a well-planned execution of the project.
Additional interesting points for discussion include the
issue of rewards and recognition, continuing professional development of the preceptors, and addressing
the education needs of preceptors who were unable to
attend the formal classes.
During the review of the literature, another theme
emerged. Research also indicated that providing
rewards and recognition to preceptors increases
their commitment to the preceptor role (Dilbert &
Goldenberg, 1995; Henderson, Fox, & Malko-Nyhan,
2006; Marincic & Francfort, 2002; Usher, Nolan, Reser,
Owens, & Tollefson, 1999). When the preceptors in
this project were surveyed, a question related to
recognition was included. Food was ranked Number
1, and a written thank-you note was also in the Top 5.
Some ways that rewards and recognition were addressed in this program were by providing refreshments at preceptor classes and by providing thank-you
notes from the nurse manager that included a free
meal ticket. In addition, when orientees praised
individual preceptors on the orientation evaluations,
individual letters were sent to the preceptors homes
thanking them and letting them know why an orientee
had recognized them. When funds were not immediately available to purchase other requested reward
items, such as coffee mugs and canvas bags, promotional item donations from vendors were accepted.
During the preceptor update classes, an additional
survey related to professional development was
distributed to all in attendance. It asked where they
were currently in their own professional development
and what opportunities they would like for additional
professional development. Information provided in
response to those questions included mentor and
clinical ladder programs, professional nursing member-

ships, and area schools at which they could advance

their current degree.
When it was apparent that not all preceptors would
be able to come to the initial six preceptor update
classes that were scheduled, and demand for the
classes continued, additional classes were scheduled.
In addition, brief individual and small group classes
were conducted on the units.

CONCLUSION
The literature supports the educational development of
preceptors to increase new nurses job satisfaction and
ultimately nurse retention. The Stetler Model of
Research Utilization provided an excellent framework
for program development and was used to effectively
apply EBP. The outcome was improvement of new
orientees satisfaction with their preceptors. At this
same time, a 3.9% drop in turnover rate was experienced. Research indicates that the changes made to
the preceptor program were a contributing factor;
however, additional research would be needed to
determine the degree to which preceptor education
programs contribute to decreasing nurse turnover rates.
With the emphasis on EBP, staff development
educators must be able to effectively apply research
to practice. Using the Stetler Model of Research
Utilization as a guide, staff development questions
can be answered by using the steps of preparation,
validation, comparative evaluation/decision making,
translation/application, and evaluation. By ensuring
that all steps are addressed, major pitfalls can be
avoided and research can accurately be translated into
a staff development educators practice.

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Celeste R. Romp, MSN,
ARNP, CCNS, RN-BC, Professional Development, Jewish
Hospital and St. Marys Healthcare, 200 Abraham Flexner Way,
Louisville, KY 40202 (e-mail: kentuckyromps@insightbb.com).

ADDRESS FOR CORRESPONDENCE:

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