Where have all the preceptors gone? Nurse leaders offer strategies to build a pipeline

Nurse leaders in hospitals and academia agree more nurse preceptors are needed to guide new graduates through their first year at the bedside.

"Without preceptors, we cannot onboard newly hired nurses to the clinical environment. They are also critical to socializing new nurses, which is important for retention," Kelly Kester, DNP, RN, clinical operations director of heart services at Duke University Hospital in Durham, N.C., told Becker's.

However, similar to challenges being faced when it comes to filling open nursing positions vacated through burnout or retirement, experienced preceptors are difficult to find. 

Sarah Cartwright, DNP, RN, associate professor, assistant program director of nursing operations and interim program director of the University of St. Augustine (Fla.) for Health Sciences' School of Nursing, said hospitals may be able to retain experienced nurses by tapping those who are considering shifting out of their current roles. Instead of leaving the profession entirely, they could be incentivized to become preceptors, she said. 

But there is a cost associated with this, Dr. Cartwright said, noting that in a preceptor relationship, the healthcare system is often paying twice — for the bedside nurse and the preceptor — to care for the same patients.

Still, she said she believes the investment in preceptor programs is worth it in the long run. "Preceptors provide a huge savings when it comes to retaining new nurses and building quality and safety nets at hospitals," she said.

Becker's spoke with some nursing school deans and clinical nursing leaders to get some insight into strategies that might help encourage nurses to take on educational leadership roles.

Devin Bowers, DNP, RN, practice excellence director at the American Association of Critical-Care Nurses, suggested new preceptors take formal training through the AACN's Preceptor Challenge.

Editor's note: Responses have been edited for length and clarity.

Question: Why are hospitals having so much trouble recruiting preceptors? 

Dr. Devin Bowers: With limited numbers of preceptors in units, many of the same preceptors are asked to step into this role again and again. When a preceptor works with an orientee, that nurse is ultimately responsible for the duo's assigned patients as well as educating and overseeing the orientee's care delivery. 

Wearing both of these hats for an extended period of time is taxing. A solution to preceptor burnout is to give unit preceptors time away from precepting to practice independently. However, this solution is only available when there are enough preceptors to meet the unit's needs for supporting orientees. One can start to see how the cycle is perpetuated. 

Karen Cox, PhD, RN. President of Chamberlain University (Chicago): The reasons that direct care nurses are often unwilling or uninterested in precepting newly graduated nurses result from a couple of factors. One is the high turnover of these graduates at the rate of 30 percent. This means preceptors may put a great deal of energy into these new nurses' onboarding experience only to have them leave within months of starting. 

Also, new nurses are not always practice-ready. One of the programs we have initiated at Chamberlain University is called "Practice Ready. Specialty Focused." This program allows students the opportunity to have a more concentrated and intentional experience in a specific clinical area after they complete a 16-hour course related to the specialty. This means, as both a student and a new nurse, there is good alignment in terms of what the practice area is really like, and they are much more practice-ready.

Q: What can be done to incentivize experienced nurses to take on preceptor roles? 

DB: Preceptor shortages may be addressed by a strategic effort to amplify the importance of the role — by clearly articulating the link between the role and the overall health of the work environment and ultimately patient care.

Some tactics to consider are holding focus groups with unit councils to understand current challenges preceptors face and invite brainstorming for possible solutions; developing a meaningful recognition approach for preceptors; and creating friendly competitions among the preceptor/orientee pairs. Everyone likes to have fun, but the key to this approach is to not let the game aspect overshadow the importance of the preceptor role or the orientee's learning. 

KC: One way to increase practice readiness is a program we have developed that ensures nursing students have every opportunity to work in the healthcare setting while in school (most Chamberlain students work full-time) as opposed to retail, etc. This ensures they have experiences and observations in addition to the standard clinicals students experience. In addition, the students are eligible to be paid for work experience for a portion of their clinicals which, again, gives them a different experience.

Dr. Kelly Kester: Investing in preceptor education and development allows nurse leaders to engage nurses in precepting earlier in practice. This allows newer nurses to become engaged as preceptors, expanding the preceptor pool. Pairing first-time preceptors with experienced preceptors in a mentoring relationship may help new preceptors feel supported and provide them with someone to talk through challenges and practice giving constructive feedback, which is often one of the hardest tasks of a preceptor.

Focusing on retention through relationship-building will address the preceptor shortage with time. Relationships between bedside nurses and unit leaders, and among the team, will help restabilize the local workforce.

Kelly McCullough, DNP, APRN. Dean of Quality and Effectiveness at Rasmussen University (Bloomington, Minn.): Nursing schools can invite experienced clinicians in as guest speakers (or to participate in post-conference sessions) where they can share their knowledge and insights with both student nurses and faculty. This allows clinicians to contribute to the educational process and enhances their skills as potential preceptors. This exposure can inspire and motivate clinicians to take on the role of preceptors and provide valuable insights to new graduates.

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