The pressures on new graduate nurses to transition from education to practice are often too much to take, causing registered nurses (RNs) meant to fuel nursing’s workforce pipeline in the coming decades to question their career choice.
One thing that can ease the transition and help retain new nurses is nurse precepting, said Solimar Figueroa, PhD, RN, MHA, P-PCA, a clinical collaborator for the American Academy for Preceptor Advancement (AAPA).
But precepting bedside nurses isn’t what many think, and nurses who want to become preceptors should learn how to properly do it.
“Preceptorship and mentorship are two different things,” Figueroa said.
Although mentorship is a relationship that can last for much of a mentee’s career and occurs when an experienced nurse guides the professional journey of another nurse, preceptorship is an official relationship, designed in a limited time to evaluate new nurses and offer feedback that helps them gain traction in their practices, according to Figueroa.
Figueroa is a speaker for the Nurse.com Preceptor Specialty Practice, a continuing education course that teaches nurses how to get the most out of their precepting experiences. The course fulfills one of the requirements for the AAPA’s Preceptor Specialist Certification.
Less Confident; Less Competent
In nursing’s early years, charge nurses were preceptors. Diploma-prepared nurses would learn at the bedside, with more experienced nurses teaching them, according to Figueroa.
Now, nurses go to universities and colleges to learn the profession, getting arguably far less bedside experience before assuming their first jobs at hospitals and other settings.
“There’s a huge discussion about the gap between education and practice. When new nurses graduate, they’re less confident and less competent,” she said. “What’s really happening with these new nurses coming in is they’re not prepared to handle a full patient load. So, they have what we call a reality shock, thinking things like ‘I wasn’t prepared this way. This isn’t what I’ve learned.’ Then they start questioning whether they have decided on the right profession.”
To ease the predicted nurse shortage in coming years, the National Academy of Medicine recommends healthcare employers offer new nurses structured nurse residency programs. Preceptorship is part of nursing onboarding residency programs, and trained preceptors are vital for giving new nurses needed confidence and increasing nurse competence, according to Figueroa.
“But that’s not going to happen if you don’t have preceptors, or experienced nurses, teaching these new nurses,” she said. “If your preceptors are not adequately prepared and supported, then your residency program will suffer.”
Experienced nurses have a responsibility to consider precepting as part of what the American Nurses Association (ANA) says is nurses’ social responsibility to protect and uphold the well-being of the populations they serve, Figueroa said.
“As a preceptor, you ensure every new nurse to become confident and competent to deliver quality care. That means you’re ensuring the safety of the patients — the population you serve. So, it’s actually answering to the call of our social responsibility as a nurse,” she said.
Being a Good Teacher Is One Thing — Precepting Is Another
Preceptor certification is a nurse’s way to show he or she is an expert, Figueroa said.
“It’s really important that we’ve certified preceptors that follow the scope and standards of precepting,” she said.
Employers often compensate preceptors or consider the role a way for nurses to climb clinical ladders. But there are no universal guidelines for compensating nurse preceptors, and nurses should inquire about potential benefits or advocate for adequate compensation if there isn’t any, according to Figueroa.
The Nurse.com course covers topics needed for successful precepting, such as boundaries between preceptor and preceptee, critical thinking, communication skills, delegation, time management, evaluation of competency, goal writing, constructive feedback, patient and family engagement, and more.
Tammy Franqueiro, MSN, RN-BC, CENP, Vice President of Versant, a healthcare competency solutions company, and a speaker for the Nurse.com precepting course, said there are many skills useful for nurse preceptors. Among them — giving feedback.
“Feedback helps the preceptee to develop knowledge, skills, and attitudes and establishes the expected performance,” she said. “Feedback should be objective, specific, timely, informal, and done privately,” Franqueiro said. “Be able to flex your teaching style. Be creative, innovative to match your preceptee’s learning needs and experience level.”
Preceptors, according to Franqueiro, should employ multiple approaches to encourage preceptees to think critically and integrate the knowledge into their practice. One of those is to assist preceptees in establishing SMART goals — specific, measurable, attainable, relevant, timely.
“Establish timelines for goals, objectives and outcomes throughout the preceptorship with clear performance expectations specific to the individual,” Franqueiro said.
Experienced nurses who want to hone precepting skills should think back to their first orientations, according to Franqueiro.
“Whether you had a positive support system, were left to figure things out on your own, or worse yet, had a toxic coworker as a preceptor — whichever the situation, use that memory and learn from it to become the preceptor every preceptee wants to work with and learn from,” Franqueiro said.
“Be realistic. Be positive. Be an advocate. Be patient. Be available,” she said.
Precepting can be a satisfying experience, according to Figueroa, who recalls her own experience helping a fellow nurse on his journey.
“There was a new nurse in our residency program who was fascinated about preceptorship. He had a very good experience with his preceptors,” Figueroa said. “He asked me if I could mentor him in his professional growth as a preceptor. We established a trusting relationship. I listened to him. He trusted me. He became an outstanding preceptor, loved precepting and paid it forward. Now he’s a manager in a span of four or five years. He keeps sending me cards that say, ‘I am who I am now because of you.’”
Explore more about precepting through these courses:
Precepting: The Chance to Shape Nursing’s Future
(1 contact hour)
The preceptor’s role is to help less experienced nurses identify learning needs, set goals for improvement, and provide feedback on their progress. Preceptors are role models for professionalism and best practices in the clinical setting, socializing nurses into the work group, while educating and orienting them. Besides working with new graduates, preceptors are assigned to nurses who change positions, whether they move within an organization when switching specialties or they enter a new facility.
Ambulatory Preceptor: The Preceptor Role
(0.50 contact hour)
Preceptors are role models for professionalism and best practices in the clinical setting, socializing nurses into the workgroup while educating and orienting. Besides working with new graduates, preceptors are assigned to healthcare providers who change positions, whether they move within an organization when switching specialties or they enter a new facility. A preceptor is more than a volunteer who trains someone. It is a specialty practice that requires preparation, skill, and talent to yield the best outcomes.
Ambulatory Preceptor: Delegation, Supervision, Teamwork
(1.25 contact hours)
Delegation is a very important means for accurately, efficiently, and safely providing patient care. It is a skill, an art, and a responsibility. When delegation is performed well, it makes a positive impact on patient care and team building. When performed poorly, problems can arise. Concepts of teamwork are a fundamental component of delegation. It is essential to achieve excellence in teamwork through shared leadership, delegation, and participatory supervision.
Wow, can’t agree the more with what this article is about. I hope all nirse managers will find this piece and read and help aspiring new nurses survive this brutal terrain. It is very tough and sometimes depressing to go about your job knowing very well you’re absolutely ill prepared professionally.
Thanks so much for bringing this huge problem to light.
Excellent information that helps us as nurses. Thank you very much.
This was an informative article, and I agree with the statements made by Ms.Figueroa, there is a gap between education and practice. In nursing school, learn vital signs, laboratory tests but managing a full load of patients is not taught. Preceptorship can help fill that gap to help new graduates transition into their role. Structured nurse residency programs are needed, but more importantly, preceptors should have training and support to assume the role of preceptor.
You left out the LPNs who are doing the exact same as the RNs. We may not have the title but we do the same thing at least I know I do and have before. As I know many other LPNs with as many years as I have been a nurse or less.(30+). Just the same for new LPNs graduating as RNs. I’ve seen both LPNs as well as RNs come out of school without any knowledge of how it really is. I have trained and managed them both. There also should be a easier way for LPNs to bridge to a BSN or ADN program. Some move straight up in management and don’t have a clue about what it’s like to be on the floor of a hospital or any other medical setting. It all comes from experience no matter what the title.
We need more information about purchasing this package as a LTI for our Instructor’s onboarding process.
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