JNPD Journal for Nurses in Professional Development & Volume 00, Number 0, XYX & Copyright B 2015 Wolters
B 2015 Wolters Kluwer Health, Inc. All rights reserved.
Evaluating Preceptors
A Methodological Study
Heather Bradley, MSN, RN ƒ Donita Cantrell, MSN, RN, BC ƒ
Katherine Dollahan, BSN, RN ƒ Brittany Hall, AASB ƒ
Preston Lewis, DNP, MSN, RN, CCRN ƒ Sharon Merritt, BSN, RN ƒ
Linda Mills, BSN, RN, CDE ƒ Krista Moe, PhD, LP ƒ Dolores White, MSN, RN
The purpose of this study was to develop and test the Baptist
Health Lexington Performance and Proficiency Assessment
for validity and reliability. Twelve expert nurse educators
evaluated the instrument for content validity. The sample for
testYretest included nurse administrators (5), preceptors
(9), and new graduates (10). To evaluate internal consistency,
administrators (12), preceptors (66), and new graduates
(43) responded. Strong validity and reliability were found for
all subscales on the preceptor and new graduate versions.
T
he importance of preceptor programs in assisting
new graduate nurses to transition from the student
role to a professional role is widely recognized
(Horton, DePaoli, Hertach, & Bower, 2012; Thomas,
Bertram, & Allen, 2012). In addition, preceptor teaching
methodologies and competencies are available in the liter-
ature (Hickey, 2009; Horton et al., 2012; Modic & Harris,
2007; Thomas et al., 2012; Zinsmeister & Schafer, 2009);
however, an instrument to evaluate preceptor performance
Heather Bradley, MSN, RN, is Clinical Nurse Specialist, Baptist Health
Lexington, Lexington, Kentucky.
Donita Cantrell, MSN, RN, BC, is Clinical Nurse Specialist, Baptist
Health Lexington, Lexington, Kentucky.
Katherine Dollahan, BSN, RN, is Nursing Educator, Baptist Health
Madisonville, Madisonville, Kentucky.
Brittany Hall, AASB, is Student, College of Nursing, University of Kentucky,
Lexington, Kentucky.
Preston Lewis, DNP, MSN, RN, CCRN, is Evidence-Based Practice
Consultant, Baptist Health Lexington, Lexington, Kentucky.
Sharon Merritt, BSN, RN, is Magnet/Nursing Special Projects Coordi-
nator, Baptist Health Lexington, Lexington, Kentucky.
Linda Mills, BSN, RN, CDE, is Nursing Educator, Baptist Health
Corbin, Corbin, Kentucky.
Krista Moe, PhD, LP, is Psychologist/Evidence-Based Practice Consul-
tant, Baptist Health Lexington, Lexington, Kentucky.
Dolores White, MSN, RN, is Manager of Surgical Telemetry Unit,
Hardin Memorial Hospital, Elizabethtown, Kentucky.
The authors have disclosed that they have no significant relationship with,
or financial interest in, any commercial companies pertaining to this article.
ADDRESS FOR CORRESPONDENCE: Heather Bradley, MSN, RN, 1740
Nicholasville Rd, Lexington, KY 40503 (e<mail: heather.norris2@bhsi.com).
DOI: 10.1097/NND.0000000000000166
Journal for Nurses in Professional Development
Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
and proficiency does not exist. Evaluating preceptors en-
ables revisions to be made to preceptor program curricula,
thereby potentially improving desired outcomes. Adminis-
trators, preceptors, and new graduates alike need to be
included in a comprehensive evaluation of the preceptor’s
performance and proficiency. Development and testing of
the Baptist Health Lexington Preceptor Performance and
Proficiency Assessment (Baptist Health Lexington PPA) in-
strument were initiated in order to address this need. Three
versions of the Baptist Health Lexington PPA were devel-
oped based on constructs identified from the literature, but
modified to reflect the differing perspectives of the three
groups (administrators, preceptors, and new graduates).
Given the present complexity of the practice environ-
ment in acute care settings, the transition from student to
professional nurse is particularly challenging. As a result,
there is a heightened focus from stakeholders on this tran-
sition period for new graduates. Traditionally during this
transition, new nurses are introduced to role expectations
by a seasoned nurse preceptor in order to ensure competency
in their area of practice. Typically, this orientation process
includes a preceptor who guides the new nurse’s activities
and evaluates performance and outcomes. Well-developed,
thoughtful orientation experiences that include preceptors
are correlated to new graduate satisfaction and retention
(Casey, Fink, Krugman, & Propst, 2004; Delaney, 2003;
Roche, Lamoureux, & Teeham, 2004; Winter-Collins &
McDaniel, 2000). In addition to nurse satisfaction and reten-
tion, successful orientation experiences can lead to optimal
patient care (Thomas et al., 2012). The literature shows that
an effective precepted experience can be a vital part of the
new graduate’s transition (Horton et al., 2012; Thomas et al.,
2012). Training of preceptors to provide appropriate guid-
ance for new graduates is an important component of the
precepted experience. Preceptors can guide new nurses as
to how they can provide optimal care, assess gaps in their
knowledge, and provide resources for them to gain needed
information related to practice. An evaluation of the pre-
ceptor’s performance and proficiency as a resource and
guide is necessary in order to identify areas for improve-
ment and to ensure that preceptors provide optimal
leadership and support.
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METHODS TABLE 1 Content Validity Index for the Baptist
This methodological study was designed to develop a valid,
reliable, and clinically useful assessment of the performance Health Lexington Preceptor
and proficiency of preceptors selected to guide new gradu- Performance and Proficiency
ates through the transition from school to professional Assessment : 28-Item Scale Evaluated
practice. This multisite study was funded by the Association as ‘‘Useful’’ or ‘‘Very Useful’’ by
for Nursing Professional Development, approved by the
Baptist Health Lexington Institutional Review Board and Twelve Experts
coordinated from Baptist Health Lexington (the initiating Item Experts in Agreement (n =12) I-CVI
institution). The instrument was tested at the following four 1 12 1.00
hospitals: Baptist Health Lexington (383 beds/urban), Bap-
2 12 1.00
tist Health Madisonville (410 beds/rural), Hardin Memorial
Hospital (285 beds/rural), and Baptist Health Corbin (241 3 12 1.00
beds/rural). 4 11 .92
The initiating institution (Baptist Health Lexington) is a
Magnet redesignated community hospital. A nurse educa- 5 12 1.00
tor at each site was responsible for collecting and reporting 6 12 1.00
data to the nursing research office located at Baptist Health
Lexington. Content validity of the Baptist Health Lexington 7 12 1.00
PPA instrument was established by 12 nurse experts (re- 8 12 1.00
sponse rate, 100%) in the field of education who were
9 12 1.00
asked to rate each of the 28 items regarding their ‘‘use-
fulness’’ in evaluating preceptor performance (Table 1). 10 11 .92
All educators at the four sites were asked to participate 11 12 1.00
and agreed to do so. In order to test consistency over time
(testYretest), five nurse administrators (response rate, 63%), 12 12 1.00
nine preceptors (response rate, 75%), and 10 new gradu- 13 12 1.00
ates (response rate, 71%) responded to the instrument on
two occasions approximately 2 weeks apart. All participants 14 12 1.00
were recruited for this study by the principal investigator 15 12 1.00
through group or individual meetings. Participants re-
16 12 1.00
sponded by completing a questionnaire and placing it in
a locked box in a designated area. Pearson’s r (Polit, 2010) 17 12 1.00
was calculated for each subscale (performance/proficiency; 18 12 1.00
see Table 2). To establish internal consistency, a different
group of participants responded to the instrument at one 19 12 1.00
point in time. Administrators, preceptors, and new gradu- 20 12 1.00
ates from the four institutions were invited to participate.
Twelve administrators (response rate, 71%), 66 preceptors 21 12 1.00
(response rate, 57%), and 43 new graduates (response rate, 22 12 1.00
53%) agreed. Cronbach’s alpha (Polit, 2010) was calculated
23 12 1.00
for each subscale (see Table 3). Data were analyzed using
SPSS version 21 (IBM Corp., 2012). 24 11 .92
25 12 1.00

Instrumentation 26 12 1.00
The Baptist Health Lexington PPA is an investigator- 27 12 1.00
designed instrument developed to assess preceptor perfor-
mance and proficiency (two subscales). Performance relates 28 12 1.00
to the most effective teaching methodologies for preceptors Average I-CVI = .99
as identified in the literature (Horton et al., 2012; Thomas et al.,
Scale-level content validity index, averaging method was used (S-CVI/Ave = .99).
2012; Zinsmeister & Schafer, 2009). Proficiency refers to Values were computed based on Polit et al. (2007). I-CVI, item-level content
the extent to which preceptors address the competencies re- validity index.
quired for new graduates in order for them to make a successful

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TABLE 2 TestYRetest Reliability (Pearson’s r)
of the Baptist Health Lexington
Preceptor Performance and
Proficiency Assessment
Preceptors Preceptees
Measure (n = 9) (n = 10)
Preceptor performance .79** .96*
(Subscale 1)
Preceptor proficiency .99* .97*
(Subscale 2)
Note. *p G .001. **p G .01.
transition from student to professional nurse (Hickey, 2009;
Thomas et al., 2012).
Three versions of this instrument address recommen-
dations provided in the literature regarding competencies
expected of new graduates and corresponding require-
ments for preceptors (Hickey, 2009; Horton et al., 2012).
The instrument is individualized to reflect the roles of re-
spondents (administrator, preceptor, and new graduate
versions). For example, administrators would describe
how they perceive their preceptors’ performance, precep-
tors would describe themselves, and new graduates would
give their perspective on their preceptors’ effectiveness.
Each version of the Baptist Health Lexington PPA has
28 items: 12 items related to preceptor performance
(Subscale 1) and 16 items related to preceptor proficiency
(Subscale 2). Respondents rate each item on a 4-point
Likert scale (4 = strongly agree and 1 = strongly disagree).
A total score can be obtained for each subscale (perfor-
mance, proficiency). Literature-based constructs (Hickey,
2009; Modic & Harris, 2007; Thomas et al., 2012) addressed
in the instrument are presented in Figure 1. The new grad-
uate version of the Baptist Health Lexington PPA in its en-
tirety is presented in Figure 2. The Baptist Health Lexington
PPA takes approximately 5 minutes to complete.
Procedure/Data Analysis
Data analyses were conducted on responses from the four
participating institutions. Content validity was established
using the content validity index (CVI; Polit, Beck, & Owen,
2007) and frequencies of item responses (Polit, 2010).
Using Pearson’s r, the three versions of the Baptist Health
Lexington PPA were tested for consistency over time.
Cronbach’s alpha was calculated in order to determine in-
ternal consistency. An instrument/subscale can be consid-
ered internally consistent when responses to each item are
rated in a similar manner (Polit, 2010).
Content validity
Nurse experts (n = 12) from the four participating hospitals
assisted in establishing content validity of the Baptist
Journal for Nurses in Professional Development
Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Health Lexington PPA. Educational preparation for these
experts included two BSNs, three enrolled in MS/MSN pro-
grams, six MSNs, and one PhD. Experience in hospital-
based education for these individuals ranged from 6 to
20 years. Experts rated each of the 28 items on a 4-point
Likert scale in relation to their usefulness in measuring per-
formance and proficiency of preceptors (4 = very useful
and 1 = not useful). Descriptive statistics were used to de-
scribe levels of usefulness. Item-level CVIs (I-CVIs) and an
average CVI for the instrument were computed (Polit et al.,
2007).
Consistency over time
At the initiating hospital (Baptist Health Lexington), admin-
istrators met as a group with the investigator and received
copies of the instrument. The investigator requested that each
individual complete the instrument and place it in a desig-
nated locked box. Between 10 and 14 days after the first ad-
ministration of the instrument, administrators were asked to
complete it a second time. The investigator or a research as-
sistant approached preceptors and new graduates individ-
ually and asked them to respond to the instrument on two
occasions (10Y14 days apart). Completed forms were then
placed in a designated locked box.
Internal consistency
A different group of participants at each of the four partic-
ipating hospitals completed the instrument on one occasion.
A nurse educator at each facility approached administrators,
preceptors, and new graduates individually, asking them to
respond to the instrument and place completed copies in a
locked box at a specified location. Cronbach’s alpha coeffi-
cients reflecting internal consistency were calculated for
each subscale in each group.
RESULTS
In relation to content validity, experts identified that 25 of
the 28 items on the survey were either ‘‘very useful’’ or
‘‘somewhat useful’’ when evaluating the preceptor’s role
TABLE 3 Internal Consistency Reliability
(Cronbach’s alpha) of the Baptist
Health Lexington Preceptor
Performance and Proficiency
Assessment
Preceptors Preceptees
Measure (n = 66) (n = 43)
Preceptor performance .92 .90
(Subscale 1)
Preceptor proficiency .97 .95
(Subscale 2)
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FIGURE 1 Constructs addressed in the Baptist Health Lexington Preceptor Performance and Proficiency Assessment.

and proficiency. One expert rated three items of little use: internal consistency correlations (.90Y.97) were found for
‘‘collaborated to design learning goals,’’ ‘‘modeled debrief- all subscales for preceptors and new graduates (see Tables 2
ing at the end of each shift,’’ and ‘‘effectively dealing with and 3).
stress inherent in the nurse’s role.’’ Given that debriefing is
a relatively new teachingYlearning method within the nurs-
ing profession, this expert may not have been familiar with
LIMITATIONS
Regarding calculation of consistency over time (testYretest),
this strategy. Although comments were requested on the
the low number of responses of the administrator group (n =
instrument, reasons were not given for ranking the other
5) is a limitation of the study. Similarly, the calculation of in-
two items as ‘‘not useful.’’ In addition, a CVI was used to as-
ternal consistency (Cronbach’s alpha), given the small group
sess the consistency of ratings across experts regarding their
of administrators available (n = 15; 12 responded), was not
agreement of the usefulness of each item. I-CVIs were
feasible. In addition, the study was conducted in one hospital
calculated. I-CVIs ranged from .92 to 1.0 (average I-CVI =
system in one state. Although the instrument was designed to
.99). On the basis of these values, both I-CVI and scale-level
be used in any acute care setting, further testing in other geo-
CVI were deemed to be strong (Polit et al., 2007; see Table 1).
graphical regions is warranted.
Given that .7 or above is an acceptable level for both
testYretest and internal consistency for a new instrument
(Nunnally, 1978), the Baptist Health Lexington PPA appears DISCUSSION
to be a reliable approach for assessing performance and The Baptist Health Lexington PPA appears to have strong
proficiency of preceptors. Strong testYretest (.79Y.99) and contentvalidity,consistencyovertime,andinternalconsistency.

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FIGURE 2 Baptist Health Lexington Preceptor Performance and Proficiency Assessment: New graduate nurses.

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The use of this instrument enables individuals involved in
the preceptorship experience to evaluate and improve pre-
ceptor programs. Effective preceptor programs lead to a
positive transition for students entering professional prac-
tice. For example, at the initiating institution, the use of the
Baptist Health Lexington PPA led to the identification of
three areas of concern among new graduate nurses related
to their precepted experience. In the new nurse graduates’
opinion, their preceptors did not consistently address (a)
locating hospital policies, (b) early identification and man-
agement of the deteriorating patient, and (c) modeling
debriefing at the end of each shift. The three groups (ad-
ministrators, preceptors, and new graduates) agreed that
these areas needed further development. As a result, a clin-
ical nurse educator developed and conducted an educa-
tional workshop for experienced preceptors focusing on
developing expertise in these areas. The content from this
workshop was also incorporated into the new preceptor
class.
The Baptist Health Lexington PPA was tested at four in-
stitutions in both urban and rural settings with different
patient populations and services. Similar results were ob-
tained, suggesting that this instrument may be useful for
various facilities at a national level.
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