Schools of nursing depend on preceptors to assist in the education and training of nursing students. Yet faculty often struggle with placing students in various healthcare settings due to the lack of trained and available preceptors. Developing and educating preceptors is a vital part of the process. There is a need to build a preceptor program at healthcare institutions.
This article attempts to (1) identify the essential components of a preceptor program by reviewing the literature and (2) suggest an evidence-based preceptor program of value. A literature review was conducted on the role of the preceptor, preceptor training, and preceptor programs in order to make evidence-based recommendations to a large health care facility that was lacking any type of formal process for selection, training, education, and development of nurse preceptors. Subsequent research on outcomes and lessons learned once preceptor program is implemented is suggested and planned.
Benefits of preceptors
Nurse preceptors are jewels to both undergraduate faculty and healthcare institutions. They are the ones who train the nursing students and new nurses. The preceptor aids in the “development of professional identity and socialization into the discipline” (Trede, Sutton, & Bernoth, 2016, p.271). Preceptors guide safe practice, accomplish connectedness, create positive learning experiences and relationships, deliver feedback, and “consult with supportive colleagues for advice and guidance” (Trede et al., 2016, p.271). The one-to-one relationship between an experienced nurse and nursing student (or novice nurse) assist the transition into the workforce (Valizadeh, Borimnejad, Rahmani, Gholizadeh, & Shahbazi, 2016). An effective preceptor is not only instrumental in molding the new nurse in the institutions mission and vision but can lead a new nurse to higher levels of job satisfaction, work effectiveness, better quality of care, and patient outcomes (Watkins, Hart, & Moreno, 2016). They can improve the retention rate of new nurses “anywhere from 15% to 37%” (Watkins et al., 2016, p.37).
Preceptor challenges
Preceptors experience many challenges when an effective nurse preceptor program does not exist. Some of those challenges include “workload pressures, insufficient time, restricted communication with other preceptors, lack of structure, lack of clear protocols, lack of appreciation, poor preparation for the role, and insufficient formalized training” (Trede et al., 2015, p. 272). Workplace structure, workplace cultures, managers, peers, and other healthcare professionals influence preceptors. The workplace-learning environment shapes the supervision practices (Valizadeh et al., 2016).
Benefits of preceptor program
A preceptor program creates a supportive workplace, provides role clarity with clear expectations of the preceptor role and responsibilities (Trede et al., 2016). Preceptor education assists in the development of critical thinking of new graduate nurses (Schuelke & Barnason, 2017). Having a preceptor program can create a workplace environment conducive to learning and success. It can provide improved “sufficient work hours, collaboration, reciprocity, policy and organizational support, critical and constructive feedback” (Trede et al., 2016, p.272). Additionally, academic partnerships “can be effective in reducing healthcare costs, improving patient outcomes, and improving quality and safety, in patient care” (Sharpnack et al., 2014, p.255). The benefits of such a program are numerous. The rewards far outweigh the challenges of developing nurse preceptors and sustaining them.
Need for preceptor program
With competition from so many nursing programs seeking clinical sites and numerous nurses entering the healthcare industry, it becomes imperative to have a nurse preceptor program in place. There is much in the published literature and books on preceptor’s roles and responsibilities. Fewer references are available in the literature on how to start a preceptor program and program components.
Following a presentation to all key stakeholders, it is imperative to draft a policy to detail a clear and consistent process of preceptor identification, preceptor selection, role clarification, and role expectations to reduce the stress and confusion amongst preceptors.
Preceptor selection
The literature suggests nurse educators and nurse managers survey and identify potential preceptors based on Commission on Collegiate Nursing Education (CCNE)(2015) standards: BSN degree or higher, good interpersonal skills, culturally sensitive, “clinically competent, enthusiasm for teaching, provides guidance for problem-solving and clinical judgment, gives positive and negative feedback in a constructive manner, empathetic towards learners, promotes autonomy when appropriate, passionate about nursing” (Mohide et al., 2012, p.25). Additional criteria include full-time employment at the time of recruitment, minimum three years of work experience, and intermediate level in clinical competency (Kang, Chiu, Lin, & Chang, 2016). The highest rating RN’s are then selected to be preceptors (a five point rating scale with 1 being the lowest and 5 being the highest). The nurse educator then observes the nurse demonstrating a complete head-to-toe assessment. The preceptor completes a self-assessment like the Nyberg Caring Assessment Scale (1990) (Cotter & Dienemann, 2016). The manager then confirms that the candidate has a positive annual performance appraisal. The preceptor name, results of head-to-toe assessment, and self-assessment score aid the chief nurse administrator in the final selection.
Curriculum format, content and interval
Assessing the needs of the preceptors and identifying the topics that should be included in the curriculum and the preferred form of instruction, is ideal and guarantee success of the preceptors in their role. Foy, Carlson, and White (2013) created a survey tool entitled “RN Preceptor Learning Needs Assessment” which is useful to assess what topics, format, and when in the educational process the preceptor desires to learn the educational content. Following the survey results, the remaining content is delivered at intervals and in formats tailored to the results of the learning needs assessment specific to the institution (Cotter & Dienemann, 2016). For those institutions that prefer a consistent preceptor program, the following are recommended.
Format
The educational format for training preceptors initially starts with a live educational session 4-6 hours in duration. However, having preceptors come-in on a scheduled day off or getting off the unit creates challenges of having preceptors attend live educational training sessions (Sharpnack et al., 2014). Therefore, blended learning sessions with the use of technology would be more convenient and are recommended for follow-up classes (Cotter & Dienemann, 2016; Schuelke & Barnason, 2017). After the initial 4-6 hour introduction session, 5 online modules would be required before being assigned a preceptee. Providing compensation for this time of learning improves outcome (Sharpnack et al., 2014).
Content
Top ranked curriculum topics identified by preceptors include feedback, roles and responsibilities, adult learning styles and principles, prioritizing, time management, evaluation, communication and conflict, teamwork, patient centered care, culture of safety, evidence-based practice (EBP), clinical resource, and critical thinking (Foy et al., 2013; Sharpnack et al., 2014; Windey , Guthrie., Sullo, Lawrence, Weeks, & Chapa, 2015; Wu, Enskar, Heng, Pua, & Wang, 2016). The introductory 4-6 hour live session includes an overview of nursing theories, preceptor roles & responsibilities, prioritization/time-management, and preceptee evaluation. The follow-up 5-online modules include: Module 1) communication, conflict management, and teamwork. Module 2) culture of safety, patient and family centered care, and quality improvement/assessment. Module 3) Evidence based practice (EBP). Module 4) clinical resources, policies, information technology. Module 5) clinical judgment, clinical reasoning, and critical thinking.
Interval
New preceptors should be allowed to enroll in the class when they feel ready and given 12 months to complete all requirements (Cotter & Dienemann, 2016; Foy et al., 2013). Once the coursework is complete, the preceptor is ready to be assigned. Established preceptors, will be “grandfathered-in” and given 12-months to complete requirements while continuing to precept current students and/or nurses. In addition, the establishment and adherence to quarterly discussion sessions with preceptor and faculty to reflect on learning and application are recommended (Cotter & Dienemann, 2016). Furthermore, yearly evaluations of preceptors and identification of new potential preceptors by the nurse managers, educators, faculty and nursing administration benefit the program along with evaluation of program outcomes.
Rewards to preceptors
Rewards to preceptors are vital to the success of the program. Lack of external incentives and recognition can lead to disappointment, dissatisfaction, and attrition among preceptors (Valizadeh et al., 2016). Financial or education incentives for preceptors can exist in the form of tuition reimbursement, continuing education hours, merit-based bonus, or clinical promotion based on annual performance appraisal (Cotter & Dienemann, 2016; Jackson,2001; Sharpnack et al., 2014; Valizadeh et al., 2016). In addition, preceptors would benefit from personal roster preferences in scheduling taken into account, support from nurses working on the floor, not placed as charge, and a reduced workload while training, for example not to have the same patient assignment as non-preceptors (Valizadeh et al., 2016). It is imperative for nurse managers and nurse educators to compensate time or support release time for educational needs, provide access to free education resources, and provide further development opportunities (Valizadeh et al., 2016).