The decline in preceptor engagement is a pervasive challenge being faced by nursing programs. According to a CORE survey of 150 nursing programs, 61% of nursing programs are experiencing decline in finding preceptors. And of that 61%, 32% of those are seeing significant decline.
Nursing professionals across the country are feeling the pinch of precepting. Work loads get increasingly large, various nursing programs are competing for the same preceptors, and the preceptor candidate pool dwindles as nurses’ positions and availability are in constant change. The high turnover in nursing exacerbates the situation, necessitating constant orientation of new nurses on units, thereby reducing opportunities for precepting nursing students.
For clinical education programs, this creates uncertainty in a critical area of a nursing student's development. This shows with the results of new nurses in clinical settings. According to one article, only 10% of nurse executives feel that new nurses are adequately trained for a full time nursing role upon graduation. Combine that with each percentage point in nursing turnover costing hospitals $300,000 and you can see why the decline in preceptor participation and its impact on nurse readiness is a critical obstacle needing addressing.
The factors impacting preceptor participation and the decline in preceptors continues to become more difficult to overcome, as well. Beyond the availability and the competition, several locations are asking for payment to make their preceptors available, a proposition many schools aren’t willing or able to meet.
This makes cultivating those preceptors who do want to work with nursing programs vitally important. One of the ways you can get a preceptor invested in your program for a long period of time is providing an efficient onboarding process.
Swift and effective onboarding programs alleviates much of the uncertainty for the preceptor, especially if they are navigating precepting for the first time. Employing some key strategies at the outset will ensure you have a preceptor that feels well prepared to work with your student, is properly motivated to give them firm and constructive feedback, and feels valued by your program post-precept so you can re-engage them for new cohorts and get them excited about doing it again.
Mutli-threading Relationships
You know the concept of multi-threading: building relationships with several stakeholders in order to not be over reliant on a single relationship to drive the result you are looking for. This practice is employed a lot in sales and building sales relationships, but the guiding principle applies regardless of whether you are seeking a monetary or relational outcome.
For nursing programs, multithreading will be getting as many relationships within the site established as possible. While that will obviously mean the preceptors themself, it’s also ideally the Nursing Unit Manager too. And if you can, getting that relationship established all the way up to the Chief Nurse Officer (or Director of Nursing) will also pay dividends for your program.
It’s one thing to simply want to establish the relationship and another to know how to establish the relationship at each level. As you ladder up the threading of communication, you will need to understand and meet the needs and desired outcomes for each.
As you go higher up in the healthcare administration chain, recognizing and finding balance with each stakeholder is key. The Unit Manager is balancing the schedule of all nurses within the unit. They are constantly short staffed. As Dr. Nancy DeBasio of Wagner College notes in a past CORE webinar, you want to put the Nursing Unit Manager’s needs in your corner, balance those needs, and find common ground.
That common ground could be simply painting the long term picture of their site having better trained or more available nursing professionals post-precept should the student successfully complete their externship and seek employment there in the future. Also, once the student is more up to speed they do become a valuable set of hands that are familiar with the site protocols and help alleviate some work from the preceptor over time.
With the Unit Manager, you also want to clearly define the expectations and differentiate the preceptor role from the staff nurse role. They will be performing a lot more hands-on instruction and helping to teach more than administer care on days they are precepting.
Preceptors sometimes have difficulty separating the role of preceptor to being a staff member. One strategy Dr. DeBasio has seen employed to help the Unit Manager is having the preceptors wear different colored scrubs on days they are precepting. So days when they are assuming more of a staff nurse role, they wear blue scrubs, and days when they are precepting they wear red scrubs.
This gives the Unit Manager a visual aid to know how to balance their workload over the course of their preceptorship.
The Unit Manager being able to support the preceptor is extremely important. As an academic, you have to come to terms with nurse work loads becoming greater over time and a major barrier to their availability — this in part explains why some sites are going as far as asking for payment for preceptor participation.
Can the Unit Manager adjust workload on days when an individual is precepting? Or can they get additional coverage on those days so the preceptors can dedicate more time to the student? Work with them to find a balance, understand their challenges, and be proactive with strategies to help them - ideally with supporting resources or examples from successful use cases at other sites.
Understanding Preceptor Motivations
More than anything you want to know why a nursing professional wants to precept. The motive is key here. Not every preceptor is precepting because they feel a professional call to action. Some are being told to do so as it’s often seen by their Director of Nursing as a growth experience for them. Some take on precepting to earn continuing education credits (CEUs).
Your responsibility as someone looking at it in the interest of your student is to get to know their reasons and experiences:
- Why do they want to precept?
- What experiences do they have with students in a nurse unit?
- Have students been placed at this site before?
- Does this person exhibit a level of patience you’d expect they’d need?
- How would they handle a student error?
When speaking with a potential preceptor, getting a strong sense of their personality is key.
Working with the Unit Manager here is vital, as well. You want to know which nurses the Unit Manager would entrust with students:
- Which nurses do they feel are most patient or supportive with their peers?
- Have any shown a desire to help bring forth the next generation of nurses?
- Do any nurses consistently provide constructive feedback?
- Have any held a clinical leadership role there or at a previous stop?
Pairing a preceptor and a student should ideally be done based on the experience level of the student and the comfort of the faculty - both at the nursing program and at the clinical site.
You want the preceptor to feel valued and that the time and energy they devote to orienting a new nurse will yield a significant return on investment once the student becomes acclimated.
This individual is key to your students feeling prepared and ready to embark on the next step of their career. If you at all can control it, don’t make finding a preceptor for a student be a last minute fire drill.
Giving Preceptors Appropriate Resources
Support for the preceptor has to come from both sides. The clinical side should ideally be giving the preceptor resources to help them feel well equipped and you as the academic side should be helping them feel well-prepared too.
On the clinical side, giving nurses resources around improving their communication skills can be of value. Veteran preceptor, Christine Dunker, BSN, RN, took it upon herself to complete communication training courses outside work to better prepare her to be an effective preceptor when she first began precepting nursing students. Nurse resilience training is also beneficial in helping nurses to experience less stress and burnout.
As a clinical or academic stakeholder, that type of resource can very easily be made available to help new preceptors feel empowered and enabled to onboard and help a new nursing student successfully complete an externship.
On the academic side, support is also critical. Table stakes in this instance, according to Dr. DeBasio, would include ensuring the preceptors have a dedicated point of contact as the nursing school they can directly contact. The faculty member who is overseeing the students’ clinical rotation should be proactively maintaining communication with the preceptor to ensure they aren’t meeting any difficulties.
Too often, preceptors are left with the feeling that their experience is entirely sink or swim. They are assigned a student and then given little by way of resources to refer to when small persistent issues occur. One common challenge is student tardiness. A student will arrive late for a rotation and the preceptor won’t be sure how to address this issue.
One way for the academic side to make the preceptor feel supported is giving them resources to address small, common issues encountered just like the tardiness situation. One school created a series of short video and PDF modules to help guide preceptors through common student challenges like being late or not speaking up when they didn’t know something.
You can also provide guidance for how to help the student think through common challenges they encounter. One thing that Dunker did with her preceptor student is not simply give the answers to the student when they ask a question but instead focus on asking questions in return to get them thinking about what they were doing and the rationale behind it.
These guiding onboarding principles can be crucial in a preceptor feeling like they have the tools available to grow a student from a nervous, unsure nurse into a confident administrator of care.
Recognize Preceptors Proactively
No matter the profession, everyone loves and craves recognition for their work. Preceptors are no different. And you should be looking for ways to engender as many positive feelings of your preceptors working with your students as possible.
Recognition is a few parts of that. And having several ways of recognition can go a long way towards getting preceptors happy, engaged, and wanting to work with future cohorts of students from your program.
Sometimes recognition can be as simple as giving them a certificate or a plaque thanking them for precepting.
Other ways can include food. As Dr. DeBasio notes, few nurses aren’t happy to receive a box of donuts for the unit staff or chocolate as a thank you for their continued work to help mentor nursing students from their programs.
Some programs go ever farther, which is where you can get creative and really make it fun and rewarding. For instance, you could create a special jacket for the preceptor that they can wear on their precepting days to match that dedicated scrub color. Other programs create pins with the college logo for preceptors.
Or, you can invite the preceptor to attend the pinning ceremony for the student. That’s a great way for the preceptor to see the result of all their work with their student over the course of the externship and can be a very satisfying professional experience.
The whole idea is to make the preceptor or the nursing unit feel appreciated for the time they are taking to help nurses develop and become a contributing member of the profession. Any strategies you can employ to make them feel continuously appreciated will go a long way towards them becoming long term preceptor sites for your program.
What the Preceptor Path Forward Looks Like
Academic and clinical stakeholders each hold a major piece of the pie in helping to get preceptor participation levels back on the upswing and getting new nurses feeling ready to enter the workforce. The need for nurses is only going to increase as the population in the U.S. continues to get older and their healthcare needs increase.
Serious engagement in long-term programs where benefits are made clear by both clinical sites and academic institutions can be very influential in keeping preceptor participation high, nursing students feeling prepared for the profession, and the nursing pipeline flowing at sites in need.
CORE Higher Education Group
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