Leading Transformational Change: An Innovative Preceptor Education Program

New RN retention was a strategic goal of the Education and Professional Development Governance Council. Anecdotal reports indicated that new graduate RNs were dissatisfied with orientation, preceptors, and the processes. Staff Development Specialists reported low attendance in the preceptor courses. Newly employed RNs were often not assigned to the same preceptor with preceptors reporting inadequate time with their orientee due to patient load. What was apparent was that the retention rate for RNs who as students completed their medical surgical clinical on the Dedicated Education Unit (DEU) was far higher than employed RNs who had not had the same opportunity (100% vs 85% respectively). The council chose to transform the preceptor program modeling the strategies for developing competent clinical teachers in the DEU.

Three strategies were implemented to achieve the strategic goal: (1) evaluate/revise the current preceptor program; (2) develop and fortify critical thinking in orientees; and (3) support the preceptor/orientee relationship. The Preceptor Survey revealed only 46% of preceptors had taken a preceptor education program. Barriers to being an effective preceptor were lack of self-confidence, not having enough time to spend with orientee, and nervousness. The preceptor voiced being pulled away to do other things and having too many patients to support the orientee.  To develop critical thinking the curriculum for preceptor program was reformulated using eight evidence based concepts. A one-day experiential workshop used three high fidelity simulation labs and was piloted for two Medical Surgical units  and four Critical Care units. Clinical Supervisors for each unit were engaged in this program to foster preceptor/orientee relationships by arranging appropriate patient load and schedules.

The one year orientee retention rate for this pilot program rose from 73%% to 92%. The first cohort of 70 preceptors successfully completed the pilot program where preceptors reported an increase of preceptor knowledge and skills with a score of 3.4 on a 4 point Likert scale. Perceived self-efficacy was also noted. Orientees reported preceptors were competent and available. Coupled with the success was the intentional focus on matching preceptor/orientee schedules and creating a reasonable patient load to meet the need of the newly hired RN. Based on the success of this pilot preceptor program, the Council advocated for and received support to offer the program for all house-wide preceptors. This initial success of this nursing initiative shows considerable impact on the organization goal to retain competent nurses and to support leadership at the bedside.