NUR 6340 Module 5 Preceptor Support Paper: Workload, Recognition and Preparation Example

Why Good Nurses Stop Precepting: Workload, Recognition and Preparation at a Hackensack Hospital

Student Name

M.S. in Nursing, Nurse Educator, Thomas Edison State University

NUR-6340: Healthcare Professional Precepting: Ensuring Career Success

Mentor Name

Month Day, Year

Why Good Nurses Stop Precepting: Workload, Recognition and Preparation at a Hackensack Hospital

The Shortage of Preceptors

The hospital and its staff are invented. A 450-bed hospital in Hackensack hires about 90 new nurses each year, including new graduates and experienced nurses from other hospitals. Each needs a preceptor. This year, nurse managers report that experienced nurses are refusing to precept, and those who agree are precepting back to back. Last month, a medical unit assigned a nurse with eight months of experience as a preceptor because no one else would. An educator, an MSN student, was asked to find out why and propose solutions.

What Preceptors Experience

The educator held three focus groups with current and former preceptors. Their comments were consistent. Precepting adds work without reducing the assignment: preceptors carry a full patient load while teaching. They receive a short orientation to the role but little preparation in teaching. They feel caught between the unit's need for speed and the orientee's need to learn. Recognition is a thank-you at a staff meeting. And when an orientee struggles, preceptors feel blamed.

Omansky (2010) reviewed studies of staff nurses' experiences as preceptors and mentors. Preceptors described satisfaction from helping new nurses and from their own learning, but also role stress: conflicting expectations from managers and educators, the added workload of teaching on top of patient care, inadequate preparation and too little recognition. Many felt that the organization valued their role in words more than in support. Omansky concluded that organizations need to clarify expectations, reduce workload and recognize preceptors if they want them to continue.

Commitment and Support

Hyrkäs and Shoemaker (2007) surveyed preceptors at one organization about their perceptions of benefits and rewards, support and commitment to the role, repeating an earlier survey to see how perceptions had changed. Preceptors' commitment was related to how much benefit and reward they perceived and to how much support they felt from managers and colleagues. Where preceptors perceived few rewards and little support, commitment was lower. The authors suggested that organizations can strengthen commitment by recognizing preceptors and providing practical support.

What the Literature Recommends

Ward and McComb (2017) reviewed the precepting literature in nursing. They found consistent evidence that preceptors need formal preparation for the role, ongoing support, reasonable workloads and recognition, and that the quality of the preceptor relationship influences new nurses' satisfaction, competence and retention. They also noted inconsistent definitions of the preceptor role across organizations and called for clearer role descriptions.

What Orientees Said

The educator also asked recent orientees about their preceptors. Those who had strong experiences described preceptors who had time to explain, who asked what they already knew and who gave honest feedback. Those with poor experiences described preceptors who were rushed, who seemed resentful of the extra work or who changed from day to day because no consistent preceptor was available. Several said they had considered leaving during orientation because of these experiences. The orientees' accounts confirmed that preceptor strain reaches new nurses directly and that support for preceptors is also support for retention.

The Plan

Workload. On precepting days, the preceptor and orientee share an assignment that starts at the orientee's level and grows, rather than the preceptor carrying a full assignment plus an orientee. Preceptors precept no more than two orientees in a row before a three-month break.

Preparation. All new preceptors complete a one-day course covering adult learning, the one-minute preceptor, giving feedback, recognizing transition shock and documenting progress. Experienced preceptors attend a yearly half-day update.

Recognition. Precepting counts toward the clinical ladder, and preceptors receive a differential for each precepting shift. Each year, orientees nominate preceptors for an award presented by the chief nursing officer.

Role clarity. A written role description states what preceptors are responsible for, what educators and managers are responsible for and whom to contact when an orientee struggles, so that preceptors are not left alone with difficult decisions.

Voice. A preceptor council meets every two months, advises on orientation policies and reviews problems.

Responding to Preceptors' Fear of Blame

Preceptors said they feared being blamed when an orientee did not progress. The plan states that decisions about an orientee's readiness are made jointly by the preceptor, educator and manager and that preceptors document observations, not final judgments. The educator meets with any preceptor whose orientee is struggling within a week.

Selecting Preceptors

The plan sets criteria for preceptors: at least two years of experience, competence in the unit's practice, interest in teaching and completion of the course. Managers no longer assign nurses with under a year of experience to precept, a practice that the educator found harmful to both new nurses.

Rolling Out the Changes

The educator proposed starting with two units with the greatest shortage of preceptors, where the shared assignment model and the differential would be tested for six months. Preceptors on these units completed the preparation course first. The council met for the first time in the second month and revised the role description after preceptors pointed out that it did not say who should tell an orientee they were not progressing. After six months, the number of nurses willing to precept on the two units had risen, and the hospital extended the changes to all inpatient units.

Costs and Measures

The differential, reduced assignments and course time have costs. The educator compared them with the cost of new nurse turnover and orientation extensions. The hospital will track the number of available preceptors, preceptor satisfaction, orientees' ratings of their preceptors and first-year retention.

Limits

Focus groups capture the views of those who attend. The survey study was at a single organization. A differential may attract preceptors for pay rather than interest, which selection criteria try to address.

Conclusion

Good nurses were refusing to precept because the role added work, lacked preparation and recognition and carried the risk of blame. Omansky's review, Hyrkäs and Shoemaker's survey and Ward and McComb's review all point to the same remedies. The plan reduces workload, prepares and recognizes preceptors, clarifies the role and gives preceptors a voice, so that the hospital's best nurses will choose to teach again.

References

Hyrkäs, K., & Shoemaker, M. (2007). Changes in the preceptor role: Re-visiting preceptors' perceptions of benefits, rewards, support and commitment to the role. Journal of Advanced Nursing, 60(5), 513-524. https://doi.org/10.1111/j.1365-2648.2007.04441.x

Omansky, G. L. (2010). Staff nurses' experiences as preceptors and mentors: An integrative review. Journal of Nursing Management, 18(6), 697-703. https://doi.org/10.1111/j.1365-2834.2010.01145.x

Ward, A. E., & McComb, S. A. (2017). Precepting: A literature review. Journal of Professional Nursing, 33(5), 314-325. https://doi.org/10.1016/j.profnurs.2017.07.007