The Nurse to Nurse Project Preceptor Program

In 2005, the Nurse-to-Nurse Project began expanding the Nurse Mentor Certification Program to include a new, more effective model of nursing preceptorship that includes common standards, proven training elements, and clear expectations—the Preceptor Education Program.  Working in concert with selected Bay Area hospitals, CNF assesses each hospital’s specific preceptor system and programs.  CNF then designs a complementary set of expansions and enhancements within the context of each hospital’s existing preceptor program.  Through this approach, CNF is able to test a wide range of preceptor program adaptations that will apply—in replication phases—to a broad range of hospital systems and settings.

Together, these projects will result in a replicable model intervention that can effectively address the critical shortage and long-term retention of qualified nurses in hospitals throughout California and the nation.

Preceptor Preparation

Initial preceptor preparation requires classroom education, for which 12 CEHs are awarded.  Advanced instruction may be given later as needed.

The training modules include:

1.        The Role of the Preceptor

2.        Working as a Preceptor

A.       Ethics for Direct Care Nurses

B.       Advocacy and Power Relationships

C.       Cultural Diversity in Nursing Care

3.        Learning Theories and Communication

4.        Guidelines for Assessing Preceptees

A.       Constructive Feedback and Conflict Resolution

B.       Goal-Setting and Skill Acquisition

C.       Clinical Assessment Guidelines

5.        Cultural Diversity in the Healthcare Setting

6.        Critical and Reflective Thinking and Assessing Clinical Competence

A.       Critical and Reflective Thinking

B.       Clinical Competency Assessment Tool

7.        Professional Nursing Practice

8.        Leadership

Preceptor Selection and Qualifications

Preceptors are volunteers, are experienced, possess good critical thinking skills and are clinically competent. Preceptors are patient advocates and can guarantee that patient advocacy, as required by the California Nurse Practice Act is nurtured in preceptees. Preceptors are socially and emotionally suited to precepting. Qualities valued in effective preceptors include the following:

·              Patience

·              Understanding

·              Empathy

·              Trust

·              Flexibility

·              Realistic expectations

·              Good communication and interpersonal skills

·              Ability and willingness to teach

These qualities can be cultivated and encouraged in willing preceptors.

Length of Preceptorship

Newly graduated registered nurses are precepted for a minimum of 12 weeks.  This time span can be extended or shortened as needed for RNs transitioning to new specialty areas or returning to the workforce after absences. Successful performance is measured by the setting and attainment of specific goals.  Monitoring of progress is done by skills maintenance checklists, ongoing assessments, and written progress reports.

Preceptor to Preceptee Ratio

Preceptors work with only one preceptee at a time. Preferably, each preceptee has one primary and one or, at most, two backup preceptors during their time on any given unit. Ideally, preceptors and preceptees work the same schedule, with the preceptor having input into the pair’s patient assignment.

Reduced Patient Load

The patient assignment must allow a preceptor the time and focus to work with the preceptee effectively to assure that accurate assessment of clinical skills, constructive teaching, and subsequent evaluation of learning can occur. Patient load and acuity are adjusted according to the needs of the preceptee and gradually increased as his/her skills develop. 

Normal Preceptee Shift

Although didactic classes are most often taught on the day shift, RNs should be precepted as much as possible on the shift for which they were hired in order to maximize their practical experience.

Meetings

Meeting time between preceptors and preceptees off the nursing unit (a minimum of once a week) is essential so that preceptees get constructive feedback on their skills and performance, both positive and negative, without distraction.  They need to be made aware of problem areas and helped to focus on improving in those areas.

Periodic Evaluation

Periodic meetings with the responsible nurse manager and/or educator are held.  A manager evaluation of the ongoing preceptor/preceptee relationship and monitoring of preceptee clinical progress should take place regularly (at least monthly). Any developing problems should be dealt with immediately.

Formal Preceptee Assessment

A detailed formal assessment is performed midway through the preceptorship.  This includes both preceptor and preceptee and is geared to determine the preceptee’s progress toward the program goals.  All involved should know where the preceptee currently stands, his/her areas of strength and weakness, and how development is progressing overall.

If disciplinary action related to poor preceptee performance becomes necessary, the preceptor should not be present. A separate meeting should be held if a specific learning or action plan necessitating preceptor participation is implemented.

Preceptor Assessment

At least once during the preceptorship the preceptee assesses the preceptor.  This should take place early in the process. Any problems (communication styles, generational differences, simple misunderstandings, etc.) should be identified and remedied early.  If necessary, preceptors can be changed.