Eileen S. Robinson, MSN, RN, Director, Continuing Education, Elsevier
A preceptor plays a vital role in ensuring a successful orientation outcome and the most recent study of the preceptor’s impact was reported by The National Council of State Boards of Nursing’s Transition to Practice Study.1 The study identified that “ preceptorship, as well as a preceptor who was educated for the role”, was one of the characteristics associated with effectively transitioning a newly-licensed nurse to a competent clinician.1 While preceptors were traditionally only assigned to newly-licensed nurses, having a preceptor for experienced nurses who are newly hired or transition to a new nursing specialty is just as critical.
AN EFFECTIVE PRECEPTOR
We’d all agree that a preceptor must demonstrate clinical expertise and competence to be a role model for safe, quality patient care. However, precepting is a multifaceted role that demands other vital skills. An effective preceptor needs to be capable of:2,3
- Assessing learning needs and setting goals
- Developing and implementing a learning plan
- Teaching time management and prioritization in providing care to a patient population
- Evaluating clinical competence and documenting learning and clinical progress
- Teaching and promoting clinical reasoning, critical thinking, and problem solving
- Providing constructive feedback and coaching
- Role-modeling evidence-based professional nursing practice
- Applying effective communication, interpersonal, and conflict management skills to foster interprofessional collaboration and patient satisfaction
- Facilitating social interaction and fostering acclimatization to the organization’s and unit’s culture
- Collaborating with a manager and educator to promote positive orientation outcomes
Although this list may seem daunting, the evidence shows an effective preceptor contributes to a nurse’s earlier competency development, a decrease in medication errors, job satisfaction, and increased retention rate. All of these positive outcomes impact the financial sustainability of an organization.1,4
PREPARING THE PRECEPTOR
Whether you’re just beginning to develop a preceptor program or you have one in place, these few tips provide some food for thought.
- Begin with the end in mind. In his book, 7 Habits of Highly Effective People, Covey was on point by telling us to consider first the outcome that we want to achieve.5 By thinking about what you and your organization want as the end result, you lay the ground work for what the program needs to include and how to select preceptor candidates. This exercise also lays the foundation for developing the performance metrics you can use to measure the success of the program.
Your organization’s mission statement, nursing practice model, and orientation framework are among some of the resources you can use to help define that outcome. And don’t forget to look at data from previous orientees’ evaluation of the orientation, preceptor, etc. that may contribute to establishing your desired end result.
- Involve stakeholders in planning. To determine that endpoint, you need to involve those who have a strong vested interest in the program’s results—nurse educators, preceptors, and nurse managers—and they need to be engaged when you brainstorm about the desired end-result. The nurse educator brings knowledge of research and best practices that support the content and strategies for delivering the program; the preceptor provides insight into what is working (or not) and what development and support is needed for preceptors in an exisiting program or in a new one; and the nurse manager plays a key role in the preceptor’s success in applying what was learned. Evidence shows that when a manager knows what was learned, and creates an environment where learning can be applied, the desired end result is achieved.6,7
- Choosing content and strategies. Let the vital skills listed above guide your outline of the content to include. Describing who will deliver the program and how it will be delivered take a bit more thought. Traditionally, preceptors spent most of their time in a classroom type setting for varying lengths of time – 2 hours to 10 hours.8 However, today, more organizations are increasingly designing a blended-learning approach for the preceptor program because evidence indicates that this method promotes learning and retention of new concepts and is learner-centered in its approach.9
Examples of blended learning programs include:
- Independent learning, for example self-paced web-based learning modules that present foundational concepts
- Self-assessment, for example web-based tools to assess teaching style and conflict management style
- Self-reflection, for example considering implications of self-assessment results
- Discussion and feedback, for example facilitated discussion with peers about self-reflection application exercises
- Application, for example developing open-ended questions to promote clinical reasoning and critical thinking
Whether you’re considering a blended-learning approach or the more traditional approach, you want to do a comparison and determine which is most cost effective and flexible in the context of time and resource utilization. One colleague shared that in her organization, a bigger upfront investment in resources for the new program resulted in a less costly program over time. And some of those savings were reflected in the financial benefit of increased staff retention, decreased medication errors, and clinical competency of new nurses earlier.
Selecting preceptor candidates. Criteria for the selection of preceptors that were reported in the literature and shared with me by colleagues include the following:
- A commitment and desire to be a preceptor
- Clinical competence
- Continuous professional development
- Caring attributes
- A minimum number of years of experience, for example 2 years
- A minimum level of academic education, for example BSN
- Nursing specialty certification
You may want to set required criteria and preferred criteria.
After you finalize the criteria for preceptor selection, you want to identify available tools and processes that will facilitate an objective assessment of how well the preceptor candidate demonstrates the criteria and the decision-making process. Several web-based tools (some free) are available that you can use as one method of evaluating the preceptor candidate. I’ve listed a few at the end of this article.
The “who” and how” of your selection process needs to be defined. It’s helpful to have an evaluation tool for those who may be asked to provide a recommendation for a preceptor candidate. For example, list the criteria you’ve established. Provide Yes/No answer options and where appropriate, request a numerical rating for criteria such as Clinical Competence. Consider requesting recommendations and reviews from peers, nurse educators, and current and former nurse managers. The preceptor applicant may complete a self-assessment as part of organization’s process.
The final decision-making process varies. Organization’s that have a Nursing Practice Council or a similar group engage them in the review of applicants and final selection.
In closing here are a few random “kernels” that I’d like to share from personal experience and my colleagues.
- When you consider the role and responsibilities of today’s preceptor, it is essential that nurses who are selected to serve as preceptors are competent in building human relationships.2
- Expect preceptor competency to evolve according to how Benner described the evolution through other nursing competency stages—passing through the novice and advanced beginner stages before achieving the competent state.10 A one-day class will not create a competent preceptor. Retention and application of learning is demonstrated more often when learning occurs over time.11
- Engage all stakeholders in the evaluation process including the orientee, preceptor, nurse educator, and nurse manager. And use that feedback to sustain and improve your program.
- For those preceptors who complete the preparation program and successfully function in the preceptor role, support them in their continuing professional development.
- Identify ways to recognize the preceptors for their commitment to welcoming and developing the novice nurse to the profession or specialty in order to ensure quality, safe patient care and optimal outcomes.
- Let the profession know about your successful program by writing and speaking about it. I can assure you your colleagues want to hear about it. So please share your story.
- 16 Personality Types: http://www.16personalities.com/
- Personal Style Inventory: http://pgis-tk.cta.int/m03/docs/M03U01_handout_Personal_Style_%28full%29.pdf
- Personal Style Coaching Inventory: http://www.waschercoaching.com/pcsi.php
- Teaching Style Survey: http://longleaf.net/teachingstyle.html
- Watson, J. Assessing and Measuring Caring in Nursing and Health Science: Second Edition Springer Publishing Company.© 2008
- Spector N. The National Council of State Boards of Nursing’s Transition to Practice Study: Implications for Educators. (2015). Editorial. J Nursing Education. 54(3);119-120.
- Preceptor Preparation Helps Hospitals Improve Nurse Retention Rates. White Paper. Elsevier. 2013.
- Foy D, Carlson M, White A. RN preceptor learning needs assessment. J Nurses Prof Dev. 2013;29(2):64-69.
- Pellico LH, Djukic M, Kovner CT, Brewer CS. Moving on, up or out: changing work needs of new RNs at different stages of their beginning nursing practice. Online J Issues Nurs. 2010;15(1).
- Covey S. 7 Habits of Highly Effective People. Free Press. Imprint Simon and Schuster Publishers. © 1989
- Wick C, Pollock R, Jefferson A. The New Finish Line for Learning. Training + Development. July 2009;64-69.
- Wright D. The Ultimate Guide to Competency Assessment in Healthcare. Minneapolis, MS: Creative Health Care Management, Inc. 2005;33.
- Elsevier/MC Strategies Preceptor Survey. October-November 2009
- National Council of State Boards of Nursing. Transition to Practice: Promoting Public Safety. Fact Sheet. 2009.
- Benner P. From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Menlo Park, CA: Addison-Wesley; 1984.
- Thalheimer W. Spacing Learning Over Time. Presentation at: ASTD Annual Conference. San Diego, CA; June 2007
Eileen is a former professional development specialist who was responsible for the orientation and professional development of critical care, emergency, and trauma nurses. She is the Director, Continuing Education at Elsevier and directed the development of the Mosby’s Preceptor