Learn the value of being a nurse preceptor
editors-noteEDITOR’S NOTE: Mary Krugman, PhD, RN, FAAN, and Joan Monchak Lorenz, MSN, RN, PMHCNS, BC, past authors of this educational activity, have not had an opportunity to influence the content of this version. Sheila J. Leis, MS, RN-BC, is a full time nursing faculty member at Indiana Wesleyan University. Her professional experience includes more than 15 years as a professional development specialist in a centralized nursing education at an 800+ bed Magnet hospital. Cynthia Saver, MS, RN, is president of CLS Development Inc. in Columbia, Md.
An experienced medical/surgical nurse preceptor realizes that the new graduate nurse has missed several subtle but critical criteria that indicate a patient is experiencing a rapidly deteriorating change in condition. The preceptor steps in quickly, outlining the clinical issues that the new graduate has missed as she calls the physician and the rapid response team.
Later, the preceptor and the new graduate debrief and review the events that just occurred, with the preceptor asking the graduate nurse questions to facilitate learning and reviewing the progression of the situation to identify strategic condition changes that the new graduate did not see as critical. At the close of the day, the new graduate tells the preceptor, “I don’t think I will ever forget this day. Thank you.”
Nurse preceptors are experienced nurses who fulfill their job responsibilities according to established policies and procedures, using established, evidence-based nursing practice standards when providing patient care.1 The preceptor’s role is to help the less experienced nurse identify learning needs and set goals for improvement while providing feedback on the nurse’s progress.1 Preceptors are role models for professionalism and best practices in the clinical setting, socializing nurses into the work group, providing education and orientation.
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Nursing preceptors are in demand for a profession that according to the U.S. Bureau of Labor Statistics is expected to grow from 2.75 million RN positions in 2014 to 3.19 million RN positions in 2024.
Nursing preceptors are in demand for a profession that according to the U.S. Bureau of Labor Statistics is expected to grow from 2.75 million RN positions in 2014 to 3.19 million RN positions in 2024. The bureau also projects a need to replace 525,000 RNs by 2022, bringing the total number of job openings to 965,000 by that year.2 Nursing also has significant numbers of new graduates each year. The National Council of State Boards of Nursing reported that nearly 230,000 took the NCLEX exam in 2015, with a passage rate of nearly 70%.3 All new graduate nurses have common needs during the transition from their graduation into practice in their first nursing job. These needs include assessing knowledge, developing time management skills, and socialization to the work group. An extended precepted orientation helps meet these needs, which in turn requires more preceptors. Besides working with new graduates, preceptors help nurses who change positions, whether they move within an organization when switching specialties or enter a new facility. Preceptors are also needed for nursing students receiving their clinical education in a healthcare facility. Academic hospitals have a particularly high need for preceptors because they often serve large numbers of nursing students from the undergraduate level to the advanced practice level.

The role of preceptor was formalized more than 30 years ago when advances in technology and treatment made nursing care more complex. With the development of specialty units, a different type of orientation became necessary to ensure that newly hired nurses could safely manage patient care in complex environments. Preceptorship programs are now found in many healthcare facilities across the country. Many facilities, organizations, and institutions of higher learning have contributed to a consensus on the competencies that preceptors need. Besides being clinically competent, a successful preceptor needs to be a coach, advocate, cheerleader, and role model. Preceptors need to be respectful when talking with others and display a professional demeanor. They also need to possess certain skills.
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Preceptor competencies4,5
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Use of evidence-based professional nursing practice
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Effective communication and teaching skills
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Ability to evaluate and provide constructive criticism and praise
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Ability to minimize reality shock
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Assessment of learning needs
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Assistance in setting daily goals and plans
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Encouragement and motivation skills
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Knowledge of agency standards, professional issues, and healthcare policy
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Time management and critical thinking skills to ascertain patient priorities
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Reporting and documentation of patient care
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Ability to transition patient care from preceptor to preceptee safely over time
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Facilitation of conflict resolution
The preceptor role is a unique, intense relationship between an expert nurse and a novice nurse. Even though the relationship may last for only a short time, it can have significant benefits for the preceptee. Nurses describe the best preceptors as patient, kind, clinically astute, excellent communicators, and extraordinary role models who possess the qualities one aspires to as a developing professional. Nurse preceptors are called on to nurture and cultivate the development of another over time, a challenge in the fast-paced healthcare environment.6 Given national patient safety expectations, regulatory agencies require preceptors to add to their roles and responsibilities elements such as surveillance and protection of the patient during the preceptor process. One model of these changes emphasizes the critical role of the preceptor to ensure patient safety. Using core competencies from the Quality and Safety Education for Nurses initiative and simulation of safety risks, preceptors are educated on improving safety in healthcare. Pre- and post-training surveys reveal increased confidence toward the preceptor role after this training.7
Many nurses become preceptors for the rewards of sharing expertise and knowledge, the personal growth gained from teaching others, and the satisfaction of seeing nurses develop professionally.
There are two phases of the preceptorship experience. The first establishes the relationship between the preceptor and the preceptee. Establishing trust is critical and provides the foundation for the relationship as it matures. The preceptor helps establish trust by providing structure and consistency. During this phase, the preceptor helps the preceptee by clarifying roles and reviewing with the preceptee his or her experiences and learning needs. It is also the time to discuss agency policies and unit procedures. The working phase follows. Discussing patients, sharing observations, discussing strategies for optimal patient care and eliciting regular feedback from the preceptor helps develop the preceptee into a valuable team member for the unit.Many nurses become preceptors for the rewards of sharing expertise and knowledge, the personal growth gained from teaching others, and the satisfaction of seeing nurses develop professionally.1
Phases of the relationship
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A preceptor checklist
All preceptors touch other nurses’ lives in unique and lasting ways through how they interact with new nurses, teach specialized skills, and model professionalism. Preceptors must ask themselves:
Do I introduce new employees to other hospital staff and physicians so they feel welcomed?
Am I modeling evidence-based practice?
Do I stimulate the new nurse to question practice and search for evidence thereof?
Do I guide the new nurse or student to look up standards, policies, and procedures?
Do I stimulate critical thinking by asking questions about what is happening to the patient rather than telling the preceptee what I observe and think?
Do I ask preceptees to differentiate care priorities and outline what should happen next or do I just tell them what to do?
Do I help new graduate nurses practice how to handle difficult situations, or do I just tell them how to do it?
Do I welcome experienced nurses by validating competencies during orientation in a way that demonstrates respect for their experience and by accepting them onto the team?
Do I provide feedback that is objective and specific in an affirming manner?
Do I provide support and suggestions for remediation plans when needed?
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Select the best
Finding enough clinical nurses who are patient and inspiring teachers and have the required competencies to be preceptors can be a challenge. Ideally, the preceptor should be motivated to support the novice nurse, be an expert clinician, and be a role model for the clinical service, interprofessional collaboration, and the profession. Healthcare facilities usually write out criteria for selecting preceptors, which may include a requirement of a certain number of years of employment in the clinical service and approval of the nurse manager. As many institutions experience nursing shortages, less stringent criteria have become more common. Some hospitals make serving as a preceptor part of nurses’ job descriptions, particularly if teaching is a part of the hospital’s mission.
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Today’s complex clinical staffing situations may make it challenging for facilities to meet the ideal criteria for preceptor selection. In a crunch, nurses who thought they did not want to be preceptors may be called on to serve and then find the role surprisingly rewarding, performing with skill despite earlier reservations. Nurses with limited experience may also be called on to serve as preceptors, requiring additional support from unit educators or more experienced preceptors.
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Clinical vignette
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Start questions
Scenario:
Sam has agreed to precept an experienced nurse, Jane, starting on his pulmonary unit. Jane has completed centralized clinical orientation; the nurse manager has met with Jane to review the unit’s mission, vision, and performance expectations; and the clinical nurse educator has reviewed Jane’s orientation plan, the unit standards of care, thus completing Jane’s orientation. Sam expects it will be a “quick start” with Jane because her résumé reflects pulmonary experience.
On Jane’s first day on the unit, they attend report and start rounds to do initial patient assessments before medication administration. Sam reviews the computerized care plans for each patient. As the day progresses, it becomes clear that there are unanticipated issues. One patient is on remote monitoring of cardiac dysrhythmias. Jane asks how that works. Another patient has chest tubes after lung surgery. Sam asks Jane to check the chest tube suction equipment. Jane looks at him blankly and asks, “What do I check for?”
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As a first step to these issues, Sam should:
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Page the supervisor for immediate help
Page the educator for immediate help
Ask the charge RN to cover his patients; go to a private area to talk with Jane about her questions
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b.
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d.
Tell the charge nurse Jane will never make it
Sam speaks with Jane, who says she just has first-day jitters. She says she knows chest tubes and remote monitoring. The equipment just “looks different.” Sam is uncertain about this explanation. He should:
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a.
Start with the remote monitoring equipment, retrieving the step-by-step competency from the online computer link
b.
Tell Jane to keep her phone on for the calls from the telemetry technician
c.
Move directly to chest tubes and review all of the elements of chest tube management
d.
Bring the educator into the meeting with Jane so all three can discuss this together
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Sam reviews the situation with Jane and the educator present. Sam would be best supported by:
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The educator assuring Sam to power on; Jane just has the jitters and will overcome them
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The educator volunteering to create a detailed competency checklist for the equipment while Sam consults with another preceptor
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The educator removing Sam as preceptor, as he and Jane do not seem compatible
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The educator recommending several short meetings during the day to check on Jane’s jitters
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Sam continues with Jane’s orientation after equipment checkoffs. Jane is tense. At times she seems close to tears. They care for an adult patient with cystic fibrosis who is on a complex intervention for delivering medications by pump. Jane seems unable to follow the steps for the pump setup despite three attempts after watching Sam and having him talk her through it. Since her jitters continue, Sam should:
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Talk with Jane further about the acuity on the unit because the patient assignments on this day were typical of the unit population
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Hold an end-of-the-day meeting with the manager
c.
Power on, hoping Jane will eventually relax
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Fill out the hospital’s preceptor evaluation of employee form to document Jane’s continued issues. Sign the form, have Jane sign it and submit it to the educator.
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Answers
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ANSWERS:
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c.
Sam must ask Jane what the barriers are, as she is an experienced nurse and ordinarily would not question these types of equipment.
d.
Sam cannot determine why an experienced nurse should have jitters. Because he feels confused, and Jane is not clear in her explanation, he should obtain help.
d.
Because of Jane’s uncertainty, it’s important for Sam to check in regularly.
d.
By documenting the issues, Sam is starting a key process: to identify problems using factual data. This documentation can be used to modify the orientation plan and provide a record in case the manager needs to take future action.
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Nurse managers and clinical nurse educators face challenges in covering the needs of their preceptors. To maintain the integrity of the program and prevent preceptor burnout, institutions may use the strategy of matching the level of preceptor experience with that of the novice nurse. New preceptors may be matched with nursing students; experienced preceptors who do best with short preceptor assignments may be given the new experienced nurse in that specialty; and preceptors who enjoy the longer-term, more committed experiences may be assigned to graduate nurses.

Whatever process an institution chooses for selection of preceptors, the impact of preceptors on the outcomes of nursing orientation, nursing turnover, and patient care must be carefully examined. This includes an opportunity for the preceptee to evaluate the preceptor, as the quality of a preceptor has a significant effect on a clinical setting and nurse performance and retention.
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New preceptors may be matched with nursing students; experienced preceptors who do best with short preceptor assignments may be given the new experienced nurse in that specialty...
The quality and safety of orienting nurses to new positions are also maintained through the support of the clinical nurse educator. This professional development specialist, who functions under specific standards, provides the educational and clinical expertise to oversee the precepting process and is a resource for both the preceptor and the preceptee.8 Although the role may vary from setting to setting, professional development specialists support both preceptors and new employees to ensure successful orientations.
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Learning to be a preceptor
Many healthcare institutions have extensive programs to instruct and support preceptors. The programs usually include instruction on adult learning styles, conflict management, instructional techniques, critical thinking, validating clinical competence, and ways to manage and document performance issues. Through these programs, many seasoned nurses are able to change their thinking from “new nurses need to learn the hard way, like I did” to “I need to consider how to support their learning.”
Clinical nurse educators in the facility are usually assigned to design a centralized program that includes preceptor selection criteria, an outline of expectations for the role, a staff development program to provide educational support, guidelines for staffing when precepting, ways to recognize and select preceptors, continuous evaluations, and membership on an oversight committee. Some facilities hold activities, such as “preceptor action days,” to support and retain preceptors by providing them with training on topics, such as teaching methods, which may include role playing and interactive sessions for sharing among preceptors.
Many instructional methods are available for preceptor development, including classroom instruction, vendor-generated CDs, online programs, textbooks, and journal literature. Academic institutions may also provide education for preceptors as partnerships develop between programs of nursing and clinical facilities.1,9 One expert developed the Preceptor Orientation Self-Learning Education module as a teaching/learning tool for preparing preceptors for senior nursing students. In a pilot study, this tool was found to be an effective and convenient teaching/learning option in preparing nurses for their roles as clinical preceptors to nursing students.10 Academic educators have become increasingly involved in the function of the preceptor role as healthcare institutions assume a more active role in supervising nursing student clinical experiences. Nursing schools often post their preceptor handbooks online, making them readily available to others.1,11
Precepting: The Chance to Shape Nursing’s Future
By Sheila J. Leis, MS, RN-BC, and Cynthia Saver, MS, RN
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This course is 1 contact hour
Courses must be completed by Sept. 30, 2018
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Goals and objectives: The goal of this program is to provide nurses with knowledge and insight into the preceptor role. After studying the information presented here, you will be able to:
  1. Discuss why preceptors are critical to the professional future of nursing
  2. Identify the essential elements and strategies to strengthen the preceptor role
  3. Discuss how preceptors improve retention and recruitment
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Read the rest of this course and take the test to earn credit
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Earn 1 credit hour with this continuing education course
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