The Power of Preceptorship
The clinical experience is an essential component to nursing education. The identification of formal preceptors grows increasingly difficult as competition for clinical sites and nursing faculty shortages continue to place a strain on the system.
Nurses serve as preceptors for new staff, novice student graduates, and nursing students at multiple levels of degree seeking from technical to master’s level. New staff and or students demand additional time and preparation from the identified preceptor. Preceptors may have formal training within the organization or from educational institutions affiliated with the facility. However, the variation in formal preparation may be as brief as a few minutes to programs lasting weeks.
As important as the formal preceptor is to nursing education, all nurses must be prepared to be viewed as a preceptor to a new student or nurse.
Nurses possess a keen sense of observation skills and are trained from their first day of nursing school to observe using all their senses. Seeking to continue to investigate issues they do not understand and explore areas that are new or demand clarity. It should not come as a surprise that nurses from all levels of educational preparation are observed by new nursing staff, new graduates, and student nurses.
Significance of Problem
Nursing students are especially sensitive to their position in a patient care setting. They are immediately identifiable to everyone based on uniform, badges, plethora of on-body resources and physical language often giving them away as they try not to display a general “sore thumb” appearance. New nurses and nursing students try to not take up too much “space” in report where there seems to always be a disproportioned chair to nurse ratio. The nursing station looms ominously as if the experience echo’s that of being granted an audience with the Great Wizard of Oz in the Emerald Palace. One wrong move and the voice behind the curtain demands your removal! “Blend, blend, blend” is the matra of the day, do not misplace a chart, quickly try to match the face of the physician in the provider directory with the one that just walked up and asked a question which caused their heart to suddenly lurch into their throat.
While the nursing students' formally identified preceptor is planning the day and how the student or new staff member's role fits in that day, there is plenty of time for the new charge to observe interaction among other nurses, staff, providers and healthcare team. Memories from these experiences will influence their decision to remain in the profession or continue working towards further educational goal attainment.
In 2008, the American Association of Colleges of Nursing (AACN) found that 27% of new graduate nursing students will leave their job within the first year. This was similar to findings by Kovner, Brewer, Fairchild, Poornima, Kim and Djukie (2007), which indicated that 13% of newly licensed RN’s changed jobs after one year and 37% felt ready to change jobs.
The reason for entering nursing seems far away from the reality of the situation a new nurse or nursing student finds themselves during their training. Helping others may give way as seasoned nurses express their cynical views of a troublesome or demanding patient. Rudeness and hostility either overtly displayed or indirectly experienced through indifference or passive hostility aimed at the new nurse or nursing student affect patient care outcomes.
Influences Affecting Issue
Lack of formal preceptor training and ongoing continuing education opportunities may influence willingness and/or ability to serve in preceptorship capacity. The lack of guidelines defining professional responsibility as a preceptor and support for preceptors with additional resources, information, and recognition affects their ability to effectively work in the preceptor role. Behavior of all nurses should be reviewed by managers for professionalism and expectations clearly defined as a health care team member that communicates effectively with other health care team members, patients, visitors, and volunteers. Lack of communication from educational institutions and clinical faculty on learner objectives and expectations must be shared with preceptors and clinical facilities. Uncommunicative faculty with preceptors greatly affects the future willingness to continue as a preceptor (Lyon & Peach, 2001). As more demands are made on professional nurses to act as preceptors and give back to the profession may lead to professional or personal burnout. Consequently affecting the preceptors desire to continue as a preceptor or increases the need for them to take a break from the formal preceptor role.
Therefore, the informal preceptor role can not be underestimated as more new nurses and nursing students observe other seasoned registered nurses for professional ques on behavioral expectations. Treatment of others in the clinical setting and style of communication and decision making under pressure are observed overtly and covertly by others.
Implications for Practice
New nurses and students must take on the responsibility of preparedness for entering the clinical setting. New nurses and students need to understand the mission of the institution, the general climate for delivering patient care, organizational structure, understand client based, organizational climate and formal or informal lines of communication which may require a willingness to spend time outside the work setting to understand. Development and evaluation of clinical objectives or goals shared with preceptors assists everyone in understanding current knowledge and skill levels as well as areas of needed improvement or reinforcement. Communication is key between the preceptor and the new nurse or nursing student. Increased communication is imperative when problems or concerns are identified for early resolution.
Preceptors benefit from the additional assistance in providing patient care. New nurses and nursing students bring fresh perspective to patient care situations including new knowledge or skills that can be extremely advantageous. The patient care setting can become newly infused with enthusiasm that can spread and expand among current staff. The new energy created when respectful collaboration occurs between preceptor and new nurse or student help to provide optimism and positive feelings that are welcomed by any manager.
Staff benefit from others modeling collegiality and exemplar behavior that create an environment of acceptance and support for all members of the health care team.
Time considerations are both stretched and conserved when preceptors are paired up with new nurses and/or students. Teaching, reviewing, guiding, directing, and supporting another individual takes time. Conversely the addition of another individual to share the work load saves time if they are well prepared to accept responsibility for learning.
The relationship between preceptors and new nurses and/or nursing students can not be underestimated. Those that accept the responsibility of preceptorship should be rewarded for their willingness to devote time, share knowledge and skills as well as professional anecdotal insight with a new or future colleague. It is our professional responsibility as licensed professional healthcare team members to help others to rise up to meet their potential. The old “eat their young” attitude cannot be tolerated. Reciprocal respect and support must be embedded in the nursing profession for those learning or new to the professional role.