So many of the nurse leaders I speak with daily ask the same question.
They have often struggled with this problem for quite a while, even though they already have all the resources necessary to solve it.
Their question: How can I improve my nurse retention?
My response: The solution starts on Day 1 with the way you orient and transition nurses to your clincial environment and workplace culture. A smooth and rapid transition is important because most new nurse hires leave within the first year. Who better to help with this transition than preceptors recruited from your current nurse staff?
With the nurse shortage expected to worsen as Baby Boomers age, I consider a preceptor program the first line of defense.
It may be time to shore up your defense if you can't answer "yes, absolutely" to all three questions below:
Is your nurse retention meeting your expectations?
Are new nurses acclimating to your clinical and cultural environment as quickly as you'd like?
Would you describe your nurse staff as a cohesive and collaborative team that pulls together under pressure to solve any challenge?
At the recent ANA conference in Tampa, I saw at least two poster presentations that highlighted successful preceptor programs. The benefits were clear: improved performance, increased job satisfaction and stronger retention. Healthcare facilities throughout the country are adopting preceptor programs that use evidenced-based practices to train nurses who are joining new units. The trainees range from recent graduates to senior nurses with decades of experience. But all are new to their unit or specialty.
Creating a preceptor program isn't difficult with a guide to best practices.
How to begin your preceptor program
1. Select nurses who have been a core team member in the unit for at least one year. These candidates must be able to work with and relate to highly experienced nurses as well as new graduates.
2. Create a formal training program that is online and self-paced, classroom-based or a combination of the two.
3. Adjust your preceptors' workloads to ensure sufficient time to work with their preceptees.
How to succeed as a preceptor
Many preceptors find their new role rewarding and fun. They are often the first to build relationships with new hires, and preceptors quickly see the results of their contributions to the preceptee and later to their unit as a cohesive and high performing team evolves from their efforts. An effective preceptor communicates daily with his/her preceptee and follows a structured learning format.
Set and monitor goals
The first time you meet with your trainee, collaborate to establish goals. Base them on your preceptee's experience and expectations, as well as your unit's needs. Focus on the gap between the two. Begin by getting to know your preceptee: What experience does he/she have? Has he/she performed tasks like those required in your unit? What are your preceptee's strengths and weaknesses?
Midway through the program, goals should be re-evaluated and adjusted if needed.
To reach goals, your preceptee will need daily interaction with you and ample feedback. This will keep your preceptee focused and your preceptor program on target.
Set clearly defined tasks
Outline the skills and behaviors that need to be mastered to achieve the goals you've outlined together. Include both clinical skills and administrative tasks, such as documenting in electronic health records. Don't forget unit and organizational culture as a learning objective. Workplace culture can be a stumbling block to success that is often not apparent until you hit it head on. Corporate cultures vary widely from organization to organization and unit to unit, so help your preceptee understand the beliefs and behaviors that determine how fellow employees and management interact and handle patient interactions.
Define daily expectations
Meet each shift to clarify daily tasks. Checklists work well to communicate tasks and record progress. A monthly checklist can be broken down into daily responsibilities. Touch base midway through the shift to monitor progress, and then provide feedback at the end of the day. These sessions should be brief – about 10 – 15 minutes each meeting. Encourage the nurse to seek out opportunities to learn tasks and review progress together. But be patient. Remember learning may seem painstakingly slow at times but only because you mastered these tasks long ago. Technology may be particularly challenging for some highly experienced nurses.
Provide honest, timely feedback
We learn from both our successes and mistakes, so eagerly offer feedback on both. When a task is performed well, compliment ("That's very good.") and specify what was done well ("You were very timely in administering Ms. Jones' medicine and recording it in the electronic record.")
When offering negative feedback, be equally as specific and add a healthy dose of respect. Negative feedback may be more difficult to give. But healthcare is an exacting profession, so there is no room for ambiguity. Preceptees must perfect proper procedure without deviation.
Feedback is most effective when given immediately after a task is performed. Don't wait until the end of a shift and deliver a laundry list of observations. The shift should end with review only.
Help build clinical judgement
New hires may be hesitant to make decisions, so challenge them to develop their clinical-judgement skills. This will help build confidence and competence.
Make it personal
It's not all business. Your preceptor/preceptee relationship should be enjoyable for both of you. Share your own experiences and be open to learning from your preceptee, as well. People grow from relationships in which there is mutual respect.
Encourage two-way communication by sharing this guidebook with your trainee.
A preceptee's playbook to learning
• Be open to suggestions.
• Don't be afraid to ask questions (open-ended are best). Ask how and why; not do or can.
• Seek clarification if you don't understand.
• Observe colleagues to see how they organize work and perform procedures.
• Look for opportunities to learn but keep your mentors to a small group. Otherwise, it can create confusion.
• Ask how you are doing.
• Read to broaden your knowledge of nursing and healthcare trends.
• Appreciate those that are helping you improve.
• Give feedback to preceptors.
• Share your own self-evaluation of your progress.
• Clearly define past experiences to help the preceptor help you.
• Share your learning style. Do you learn best by reading, observing or doing?
Shari Dingle Costantini is an experienced healthcare-staffing executive with 29 years of experience in strategic leadership, nursing, and international nurse recruitment and placement. She has recruited and hired internationally trained nurses in more than 60 countries, and specializes in nurse retention and diversity strategies to build strong, cohesive workforces. She can be reached at scostantini@avanthealthcare.com
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.