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Do preceptorship Program support the clinical competency of Critical care nurses? A triangulation measurement

This quasi-experimental study demonstrates that a six-week designed preceptorship program significantly enhances the clinical competency of novice intensive care unit nurses, as evidenced by statistically significant improvements in evaluations from head nurses and peers, though not from the nurses' self-assessments.

Original authors: Sajede Esmaeili Sorboni, Zohre Pouresmail, Maryam Bagheri, Fatemeh Heshmati Nabavi

Published 2026-07-07

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CC BY 4.0

Original authors: Sajede Esmaeili Sorboni, Zohre Pouresmail, Maryam Bagheri, Fatemeh Heshmati Nabavi

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine you just graduated from driving school. You know the rules of the road, you can read a map, and you've practiced in a parking lot. But now, you're being handed the keys to a massive, high-speed ambulance racing through a chaotic city during a storm. That is what it feels like for a new nurse entering an Intensive Care Unit (ICU). The gap between "knowing the theory" and "saving a life" can feel like a canyon.

This study asks a simple question: Does having a "driving coach" (a preceptor) help new nurses cross that canyon faster and more safely?

Here is the breakdown of the research using everyday analogies:

The Setup: The "Training Wheels" Program

The researchers set up a special program called the Designed Preceptorship Program (DPP). Think of this as a six-week "boot camp" where experienced nurses (the coaches) are paired with new nurses (the rookies).

The Coaches: 12 expert nurses were first given their own 17-hour "coach training" to make sure they knew how to teach effectively.
The Rookies: These new nurses were split into two groups.
- The Intervention Group: Got the special "coach" treatment. They spent time shadowing their expert, doing 4 hours of hands-on training (like learning how to manage breathing machines or read heart rhythms), and attending 4 one-hour "clinical rounds" (like a guided tour of the hospital's most critical areas).
- The Control Group: Got the standard hospital training, which is like just being told, "Good luck, figure it out as you go."

The Measurement: Three Different Judges

To see if the training actually worked, the researchers didn't just ask the nurses how they felt. They used three different judges to score the nurses' skills, similar to how a gymnastics competition might have a panel of judges, a coach, and the athlete themselves.

The Head Nurse (The General Manager): The boss who oversees the whole department.
The Shift Supervisor (The Floor Captain): The person right there on the floor, watching the nurses work shift-by-shift.
The Novice Nurse (The Athlete): The new nurse rating their own skills.

The Results: Who Saw the Improvement?

1. The Bosses and Captains Said: "Yes, they got much better!"
When the Head Nurses and Shift Supervisors looked at the data, the results were clear.

The nurses who had the "coach" (the DPP group) showed a significant jump in their clinical skills compared to the group that didn't.
Interestingly, the Shift Supervisors gave the highest scores. The researchers suggest this is because the supervisors are like the "floor captains" who are right there in the trenches with the nurses every day. They saw the small, daily improvements that the Head Nurse (who might be in an office) might miss.

2. The New Nurses Said: "I'm still not sure."
Here is the twist: When the new nurses looked at themselves, they did not feel like they had improved significantly.

In fact, their self-scores actually went down slightly.
Why? The researchers explain this with a great analogy: Before the training, the new nurses didn't know what they didn't know (they were "ignorant of their ignorance"). After the training, they learned how much there is to know in the ICU. They realized how complex the job is, so they became more humble and critical of their own skills. They didn't necessarily get worse; they just realized how hard the game really is.

The Big Takeaway

The study concludes that yes, the preceptorship program works. It successfully boosts the clinical competence of new ICU nurses.

However, the paper highlights a crucial lesson on how we measure success:

If you only ask the new nurses, you might miss the progress because they are too busy realizing how much they have to learn.
If you only ask the boss, you get a good picture, but you might miss the daily details.
The Best Approach: Use Triangulation (a fancy word for "looking at the same thing from three different angles"). By combining the views of the boss, the floor captain, and the nurse, you get the most accurate, reliable, and complete picture of whether a nurse is truly ready to save lives.

In short: Giving new ICU nurses a dedicated mentor for six weeks makes them better at their jobs, but you have to ask the right people (the people watching them work closely) to see the full extent of that improvement.

Technical Summary: Impact of a Designed Preceptorship Program on ICU Novice Nurses' Clinical Competency

Problem Statement
Clinical competency (CC) is a fundamental necessity in the nursing profession, particularly within the high-stakes environment of Intensive Care Units (ICUs). As the medical landscape evolves with rapid technological advancements, the need for Continuing Professional Development (CPD) to maintain and enhance nursing skills has become critical. While preceptorship systems have been utilized since the 1980s to bridge the gap between academic learning and real-world practice, there remains a need to empirically determine the specific impact of structured preceptorship programs on the clinical competency of novice nurses in ICUs. Furthermore, existing literature highlights concerns regarding the reliability of self-assessment versus managerial assessment, suggesting a need for triangulation in evaluation methods to obtain a more complete and accurate picture of a nurse's capabilities.

Methodology
This study employed a quasi-experimental design with a pre-test/post-test structure involving control and intervention groups. Conducted in 2021 at two tertiary teaching hospitals in eastern Iran, the research sample consisted of 101 novice nurses working in ICU departments.

Intervention: The intervention group underwent a six-week "Designed Preceptorship Program" (DPP). This program was facilitated by 12 expert nurses (preceptors) who first completed a 17-hour training course to standardize their instructional capabilities. The DPP consisted of four hours of integrated theoretical-practical on-the-job training and four one-hour clinical rounds. The curriculum covered respiratory patterns, mechanical ventilation, arterial blood gas interpretation, cardiac dysrhythmia management, pharmacology, and routine ventilator care.
Control: The control group received standard institutional educational protocols without the structured DPP.
Data Collection: Data were gathered at baseline (pre-intervention) and two weeks post-intervention. Three standardized instruments were used to assess clinical competency from multiple perspectives:
1. Demographic Information Form: Completed by nurses.
2. Creighton Clinical Competence Questionnaire: A 23-item tool assessing assessment, communication, clinical judgment, and patient safety.
3. ICU Nurses' Clinical Competence Questionnaire: A 44-item tool covering care management, individual management, practical competence, knowledge inquiry, and patient-centeredness.
Evaluation Sources: Competency was evaluated by three distinct sources to ensure triangulation: Head Nurses, Shift Supervisors, and the Novice Nurses themselves (self-assessment).
Statistical Analysis: Data were analyzed using SPSS software. Descriptive statistics, Mann-Whitney U tests, Wilcoxon signed-rank tests, and multi-key/quantile regression models were utilized to adjust for covariates such as pre-test scores and gender.

Key Results
The study found that the two groups were homogeneous regarding most demographic variables, though differences existed in gender distribution and formal ICU training history.

Head Nurse Perspective: The intervention group showed a statistically significant increase in clinical competency scores compared to the control group. Specifically, after adjusting for pre-test scores and gender, the mean competency score in the intervention group increased by 8.5 points relative to the comparison group ( $P < 0.0001$ ). In contrast, the control group's scores decreased slightly.
Shift Supervisor Perspective: Similarly, the intervention group demonstrated a significant improvement. The mean competency score increased by 5.2 units compared to the control group after adjustments, a difference that was statistically significant ( $P < 0.0001$ ). Notably, shift supervisors generally assigned higher scores than head nurses, potentially due to their closer, daily interaction with the nurses.
Self-Assessment (Novice Nurses): Unlike the external evaluations, the self-assessment scores did not show a statistically significant difference between the intervention and control groups. In fact, the intervention group's self-assessment scores slightly decreased post-intervention, though this was not statistically significant ( $P = 0.22$ ). The study notes that novice nurses may underestimate their competencies due to an increased awareness of knowledge gaps and the specialized demands of ICU work.
Triangulation: The Kruskal-Wallis test indicated significant differences in competency score changes across the three evaluation groups, reinforcing the value of using multiple data sources.

Significance and Claims
The authors conclude that the Designed Preceptorship Program (DPP) effectively increases the clinical competency of novice nurses working in ICUs, as evidenced by evaluations from Head Nurses and Shift Supervisors.

The paper emphasizes the significance of triangulation in competency assessment. By incorporating evaluations from Head Nurses, Shift Supervisors, and the nurses themselves, the study provides a more accurate and reliable measurement of clinical performance than single-source assessments. The authors argue that Shift Supervisors, due to their intimate and continuous working relationship with nurses, offer a unique and valuable perspective that complements the oversight of Head Nurses.

The study modestly claims that while the DPP successfully improved objective measures of competency, the lack of significant change in self-assessment scores highlights the complexity of self-evaluation in nursing. The authors suggest that the discrepancy between self-perception and external evaluation may stem from the nurses' growing recognition of the specialized skills required in critical care, leading to a more cautious self-rating. Ultimately, the research supports the implementation of structured preceptorship programs and advocates for multi-faceted evaluation approaches to ensure the quality of care in critical care settings.

The Setup: The "Training Wheels" Program

The Measurement: Three Different Judges

The Results: Who Saw the Improvement?

The Big Takeaway

Technical Summary: Impact of a Designed Preceptorship Program on ICU Novice Nurses' Clinical Competency

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