In April this year, I had the opportunity to meet with a group of critical care nurses at the American Association of Critical-Care Nurses(AACN) Region I: Horizons 2008 Convention held this year in Hartford, Connecticut. At a concurrent session related to preceptor development and support, I used an open forum format to elicit participants’ experiences, opinions, and recommendations regarding the preparation and support afforded to preceptors and where enhancements were needed. Although the time available to us was brief and the input was anecdotal, some noteworthy points emerged from the discussion related to the 3 themes: expectations of nurse preceptors, initial educational preparation of nurses to serve as preceptors, and ongoing development and educational support of nurse preceptors.
Expectations of Nurse Preceptors
An increasing number of healthcare organizations have made precepting a required element for nurses by adding it to either the nurse’s job description or to the criteria necessary for clinical advancement and/or pay increases.
Nurses serve as preceptors for a wide variety of orientees—eg, new nursing staff who are traditional new graduates, new graduates for whom nursing is a second or third career, experienced nurses new to a specialty area such as critical care, experienced nurses already familiar with their specialty area, those reentering nursing after a few or many years away from practice, nurses educated outside the United States and new to its language and culture.
In addition to serving as preceptors for new staff, many nurses serve as preceptors for students enrolled in one or more levels of nursing education programs (ie, associate, baccalaureate, and master’s/advanced practice degrees).
In much the same manner that some health care facilities treat nurses as generic commodities (aka, “A nurse is a nurse is a nurse”) for work assignments, a comparable perception of preceptors seems to operate in their assignments to new staff or students.
It is not uncommon for nurses to receive no notice or time to prepare before they are informed of their assignment as a preceptor.
Initial Educational Preparation of Nurses to Serve as Preceptors
Some health care facilities offer no educational program that prepares nurses to function as preceptors for new nursing staff.
Some health care facilities offer an educational program to prepare nurses to function as preceptors, but the duration of that program may only be a few (2–4) hours.
Some health care facilities offer an educational program to prepare nurses to function as preceptors, but have no requirement that nurses complete that program before they are assigned to work as a preceptor.
Although a majority of participants were familiar with AACN’s preceptor training program for nurses1 as well as the version for other health care staff2 (eg, pharmacologists; social workers; imaging, occupational, physical, or respiratory therapists; housekeeping), some relatively new to their role as clinical nurse specialist or as a staff development or academic educator or manager were not aware that those resources exist.
Many nursing education programs offer no instruction to prepare nurses to function as preceptors for their students.
Both preceptors and educators who provide preceptor training programs relate that serving as a preceptor for nurse orientees and serving as a preceptor for students in either a basic (associate, baccalaureate) or an advanced practice (eg, clinical nurse specialist, nurse practitioner) nursing education program are not equivalent situations. The role and responsibilities of preceptors for different types of preceptees/learners are sufficiently different that they warrant preparation programs that address the unique aspects of each.
Ongoing Development and Educational Support of Nurse Preceptors
Many health care facilities offer no ongoing educational development or support for nurse preceptors.
Even at health care facilities that provide initial preparation for the preceptor role, relatively few offer ongoing educational programs for preceptors and some of those offerings occur only once per year.
Schools of nursing with contractual arrangements for student placement at health care facilities typically may offer no ongoing development or educational support for nurses who precept their students.
In their day-to-day work as preceptors, most have no resources immediately available to provide any of the following:
▪ Information they need to understand and effectively manage a variety of teaching and learning situations
▪ Educational strategies for situations they will commonly encounter as preceptors
▪ Diagnosing and troubleshooting learner performance problems.
▪ Suggestions on how to modify strategies for different types of learners
▪ Alternative approaches to try (when the usual ones are not working).
▪ Guidelines for managing problematic instructional scenarios.
▪ Solutions for resolving issues not directly related to teaching or learning.
▪ Working more effectively with learners from different cultures.
▪ Answers to questions they have.
Preliminary Conclusions
With the limited time available for that session, we were barely able to begin identifying where the need for instructional support for preceptors is greatest, what situations preceptors most need help managing, or what their most pressing needs are for instructional assistance. Despite the limited time, we were able to reach a few general conclusions:
The depth and scope of professional responsibility placed on nurse preceptors for orientation of new members of the nursing staff and for assisting in the development of nursing students from a variety of nursing education programs are considerable.
It is unfortunate that some health care institutions and nursing education programs seem to assume that nurses should be able to function effectively as preceptors with minimal or no preparation for that role and with minimal or no ongoing educational support.
We are not doing an effective job in preparing nurses to work as preceptors for the diverse variety of nurse orientees encountered today, ranging not only across age, gender, language, culture, and ethnic differences, but also between students who have never practiced a day as a registered nurse to nurses with considerably more experience, education and expertise in nursing than their preceptors.
We are doing even less in providing ongoing educational support for preceptors after they start working in that capacity.
Many preceptors have few or no resources immediately available to them when they have questions, problems, frustrations, dilemmas, or needs for information or guidance in their daily work.
Open Dialogue
Our session was soon over with so much more that yet needed to be addressed. As a result, I’d like to reopen this dialogue with all Critical Care Nurse readers by soliciting your experience, opinions, and recommendations on these issues:
Case examples/scenarios that preceptors find most difficult to manage
Burning questions preceptors need answered
Guidance preceptors seek
Problems preceptors need help troubleshooting
Information or tools that preceptors would like at their finger-tips
Teaching format that preceptors prefer for their basic and advanced development programs
Topics that preceptors would like covered in their basic and ongoing preceptor development programs CCN
If you would like to contribute your suggestions and help identify ways we can begin to provide preceptors with the instructional resources they need, please go to the Critical Care Nurse Web site at ccn.aacnjournals.org and complete the survey titled “Educational Support for Preceptors.” This survey will be available November 1, 2008, until January 1, 2009.
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