graduate for the unit of hire, or language and cultural issues. In the case of incompatibility, another preceptor may be assigned. If a new nurse or an experienced nurse enters a care setting with skill defi cits, the clinical nurse educator may develop an education plan for knowledge and skill gaps to be remediated by extending orientation. Others may need help to transfer to a more suitable position. Cultural diversity issues may require interventions that include support from experts in the human resources department. T e preceptor experience works best when the preceptor, the clinical nurse educator, and the nurse manager become partners, working with the preceptee as a team to resolve problems so that regardless of the outcome, patient safety is maintained. T e types of programs that facilities develop for new graduate
RNs as well as experienced RNs moving into new positions include enhanced orientations, preceptorships, internships, and support groups. Some advocate for RN residency programs.16
Recent
literature on these programs focuses on the need to enhance critical thinking in graduate nurses. One study shows that doing so may increase the graduate’s interest in conducting research.17 Another study showed that having preceptors attend an education- al program had positive outcomes on preceptees’ critical thinking skills.18
T ese studies show how focused educational strategies
can make a diff erence for both the preceptor and preceptee in the transition into practice. Nursing is complex, and nurses typically do not adjust to a new
facility in a short time. A preceptor’s patience, support, and guid- ance are essential for the preceptee’s development. Providing only a short period of orientation to a new facility or unit, or placing the novice nurse in demanding clinical situations prematurely may compromise patient safety and undermine the nurse’s con- fi dence and competence. After a preceptorship, the preceptor often becomes a formal
or informal coach until the preceptee no longer feels the need for continued support to manage a full assignment. T is experience can also provide a sense of belonging gained through relation- ships developed in the clinical service. Preceptors who continue relationships with their preceptees can build on this sense of belonging and integration into the team.
Celebrating good work Supporting preceptors is critical to sustaining the participation of these valued employees. Recognition and support can be created in many ways, from establishing networking opportunities to provid- ing monetary incentives. A preceptor newsletter or hospitalwide group meetings can encourage networking. Some institutions include a “preceptor fair” in these meetings, with speakers, helpful information updates, and/or skill stations. Recognition can also include events to honor preceptors, such as awards at Nurses Week celebrations, pins, certifi cates, or names
on unit plaques. Some hospitals provide monetary incentives, such as paying for continuing education courses or providing for tuition reimbursement. Others provide additional pay diff eren- tials for hours worked as a preceptor. Academic institutions may contribute to clinical agency preceptor rewards, such as tuition reimbursement toward a master’s degree. T e importance of recognition for preceptors cannot be over-
estimated. T e greater the benefi ts and rewards that preceptors receive, the more committed they are to serve as preceptors. Rewards can be tangible or intangible, but the key is to recognize the preceptors’ eff orts to shape the workforce.
Why are preceptors so important? Most preceptors perform conscientiously, focusing on the imme- diate shift functions without realizing the larger impact of their work. But the stakes are high for the preceptor, the healthcare institution, and the nursing profession. Preceptors must be made aware of the infl uence their performance may have on their or- ganization regarding nurse turnover. Nurse turnover represents a signifi cant cost for healthcare institutions. Turnover costs include direct expenses (advertising, recruiting, temporary labor and time for the hiring process) and indirect costs (low morale, constant orientation and training, instability caused by the use of contract labor, and the time needed to precept new employees). T e estimated cost of replacing a registered nurse ranges from about $10,000 to $88,000 per nurse.19
T e cost of preceptor de-
velopment is minimal compared with the cost of unit instability, poor morale related to turnover and staffi ng shortages, problems with patient safety related to higher nurse-patient ratios, and the actual costs of replacing the lost nurse. In addition, how precep- tors interact and support nursing students during their clinical rotations can make a signifi cant impact on recruitment of these students after graduation. Precepting is giving a gift of one’s self to another, a commitment
to share one’s own knowledge and expertise, and an experience that is part of the timeless tradition of nursing. Preceptors have an opportunity to prepare new graduate nurses or nurses new to the clinical setting, going beyond just teaching them how to complete their daily assignments to helping them discover their identity as professional nurses and developing their confi dence in delivering outstanding patient care. Preceptors, by their power and leadership, can create a caring environment in which nurses can grow and thrive, contributing to that next generation of professional excellence. •
EDITOR’S NOTE: Mary Krugman, PhD, RN, FAAN, and Joan Monchak Lorenz, MSN, RN, PMHCNS, BC, past authors of this educational activity, KDYH QRW KDG DQ RSSRUWXQLW\ WR LQư XHQFH WKH FRQWHQW RI WKLV YHUVLRQ
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 edu- cation at an 800+ bed Magnet hospital. Cynthia Saver, MS, RN, is president of CLS Development Inc. in Columbia, Md.
To see the references and take the test, go to
CE.Nurse.com/Course/CE393
2017 • Visit us at
NURSE.com 35
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