Today's healthcare workplace requires nurses and staff to adapt on a daily basis. New reimbursement models, technology, and evidence-based improvements make change an everyday part of nursing practice. Traditionally, nurse preceptors introduce nursing students, novice nurses, and experienced nurses to new clinical settings, but their skillsets can be applied to a variety of unit change challenges. As you integrate new technology, practice models, service lines, or even work culture transformations on your unit, consider engaging your nurse preceptors as change agents.
This article describes relevant skillsets that equip preceptors to serve as effective change champions and identifies additional change competencies for future development.
The literature is clear that strong professional development for preceptors positively impacts patient outcomes and staff retention.1-6 The process for transitioning into a preceptor role is varied and begins by validating the clinical experience and skillsets of the nurse being considered for the role. The ideal preceptor has the knowledge, skills, and attitudes necessary to facilitate effective teaching and learning for the adult learner. Characteristics important to look for in preceptor candidates include experience, positive attitude, emotional intelligence, patience, caring, ability to evaluate performance, and potential for providing effective feedback.2,7,8
Although interpersonal, clinical, and teaching skills are important, additional development regarding the preceptor role is paramount because optimal knowledge and skill acquisition at any level are dependent in part on the preceptor's ability to assess learning progress, provide effective feedback, and offer support.2 Vital components for early preceptor development include teaching and learning strategies, learning evaluation, reflective and critical reasoning, communication skills, and understanding the preceptor role.9
Approaches to preceptor development
Often delivered in a classroom setting in 1 or 2 days, there are various types of preceptor development programs that train preceptors how to facilitate new nurses' transition to practice in hospital settings. However, information on preparing preceptors specifically for prelicensed nursing students is limited. Consequently, the literature is clear on the need for academic-practice partnerships to design more preceptor development programs with a focus on prelicensed nursing students.2,8,10,11
Shepard and Allen describe a three-tiered approach to preceptor development in which participants attend a face-to-face workshop and learn about concepts essential for nurse preparation and adult learning principles.10 Following the class, participants are linked to a learning management system preloaded with additional online content. Then, they're provided with ongoing clinical support for questions and concerns that come up during precepting.
Online preceptor education programs are also an accessible and effective strategy for preceptor preparation.12,13 Once basic preceptor skills are developed, similar educational models—whether through academic partnerships, face-to-face workshops, or online programs—can be added to assist your preceptors to incorporate additional change skills, such as change management principles, strategic perspectives, conflict resolution, persuasion strategies, and the ability to inspire others.
Building on a strong foundation
Although a primary goal of preceptors is to ensure a safe learning environment for patients and learners, they also guide students and staff in developing problem-solving and decision-making skills as they're adapting to the clinical setting.14-16 A primary role for many nurse preceptors is providing direct instruction to nursing students focused on basic skills and knowledge in the clinical setting. Preceptors assist students with change in different ways, based on the preceptee's novice-to-expert abilities.17 Characteristics most often demonstrated by preceptors working with nursing students include providing opportunities for learning, modeling professional behavior, evaluating, and communicating preceptee progression.18,19
Another vital role of the preceptor is to assist novice nurses to move into real-world nursing. With new graduates, preceptors socialize and coach new nurses by helping them apply the knowledge and skills learned in their nursing education programs. Preceptors may also orient experienced nurses with skillsets ranging from competent to expert.
Precepting requires a wide variety of competencies, and successful preceptors are able to identify individual learning styles and apply teaching strategies to best meet that need. Preceptors evaluate clinical competence and document learning progress, and they teach and role model time management, priority setting, critical thinking, problem solving, and evidence-based practice. Effective preceptors demonstrate strong interpersonal skills, such as communication, conflict management, and collaboration, as they facilitate knowledge of organizational standards and social introduction to the unit and health system culture. Although all of these skills are important, preceptors must also obtain the following core competencies for initiating and facilitating change.1,20
Change champion skills
Successful preceptors demonstrate several change champion skills, including initiating, facilitating, and implementing.20 (See A closer look at change champion skills.) Preceptors who possess these skills can facilitate the development of higher functioning teams, improved problem solving and critical analysis, conflict resolution, and effective feedback and communication networks.
A preceptor's ability to develop others is contingent on several factors, including professional expertise, communication skills, and the ability to create strong working relationships. Determining the best strategy to promote learning is highly dependent on the level of the learner and includes an assessment of the learner's needs. Developing others should always be done in collaboration with the learner, the faculty, and the organization's leadership (when applicable).
It isn't good enough to have expertise in nursing practice to succeed as a preceptor. The most effective preceptors play a significant role in helping an organization move toward a vision and goal. To do so, the preceptor must have knowledge, skills, and attitudes that facilitate change. Getting people motivated to change is often more about relationships than enforcing policy and instilling fear of reprimand. Developing others requires trusting relationships, which enhance the ability to influence.
Preceptors are the lifeline of survival for those new to nursing or transitioning to a new aspect of nursing, positioning them well to serve as organizational change agents. Effective communication is fundamental to getting things done. Communication between a preceptor and nurse should be open, honest, and reciprocal, and it should include both formal and informal discussions. The preceptor must understand that constructive feedback can be difficult to hear, so it's important that the discussion is presented in a tactful, nondemeaning manner.
The preceptor needs to be specific when giving feedback to avoid ambiguity and misunderstandings, along with allowing time for questions, listening to responses, and inviting the nurse to summarize an understanding of what was said to ensure clarity. When the recipient believes that feedback is genuinely intended to help rather than be punitive, it's better received.21 Sharing personal examples of professional triumphs and failures can help nurses feel less threatened. In addition, this type of self-disclosure may help build trusting relationships.
Employee and student satisfaction are largely linked to the quality of working relationships. Demonstrating respect through communication, attitude, behaviors, and strong emotional intelligence is essential to building trusting relationships.22 Preceptors are the primary individuals responsible for socializing the student and/or new nurse to the role, their new colleagues, and the culture.
Nurse preceptors can play a major role in facilitating change in healthcare systems, but doing so requires focus, attention to detail, patience, and the ability to effectively work with people. Change champions need to develop skills for working with teams.20 Preceptors who demonstrate strong people skills may find championing change to be less daunting and because they work closely with most nurses on your unit, they already possess an in-depth understanding of the nurses' individual likes, dislikes, and preferences.
Applying preceptor skills to unit changes
In addition to assessing learning needs and developing and implementing learning plans, preceptors can readily transfer their skills to assist with unit changes. Role modeling is a powerful preceptor skill that can impact organizational change at the unit and system levels. On the unit or in the organization, positive role modeling influences the behaviors and actions of others. It motivates individuals to tap into their fullest potential and strive to positively impact unit and/or organizational culture, thereby influencing outcomes. When nurses have a role model they admire and look up to, a nurse preceptor is often that person.23
Effective nurse preceptors demonstrate an abundance of skills, competencies, and talents and are willing to share them with others. Examples of expertise and abilities critical to unit success include interpersonal communication, decision-making, time management, assessment, and developing process improvement plans to positively impact unit and organizational climate, culture, and governance. Look for opportunities to engage your preceptors as leaders in unit initiatives, such as patient safety and quality improvement.
Preceptors also have a tremendous impact on health outcomes because they establish work culture norms during the orientation process. Baggot and colleagues upheld that inadequate onboarding and orientation processes contribute to negative patient outcomes.5 They reported that 58% of errors occur because of inappropriate orientation and training of nurses. Healthcare organizations would be wise to invest resources for identifying preceptor characteristics early in certain nurses, developing additional preceptor competencies, and further developing change skills. These actions, along with preparing and using qualified and experienced preceptors, can significantly reduce the number of errors and improve unit retention.1-6
To encourage preceptors to apply their skills to unit needs and changes, consider these tips.
- Select the right people. Preceptors must have a vested interest in the role. Choose nurses who genuinely express the desire to be preceptors. Look for individuals who have the capacity to support the transition and development of nurses and assess and identify unit needs and opportunities for improvement. If preceptors are truly invested in the mission and goals of the unit and/or organization, they're more likely to contribute to overall unit goals in meaningful and significant ways.
- Invest in preceptor development. Studies report that preceptors are provided with little to no dedicated time for training and/or for preceptee supervision, so it's vital for resources to be allocated to support training and implementation of the preceptor role.1,11,24,25 In annual evaluations, encourage self-assessment of preceptor skills. Look for opportunities to continue to develop preceptors as change agents. Unit managers can provide timely feedback to nurse preceptors or request that they lead unit changes.6 This allows for professional growth and development.
- Recognize and award preceptor performance and efforts. As important as it is to attract qualified nurse preceptors, we must also retain them. Preceptors are more inclined to engage in unit activities and process improvement efforts when they're recognized and supported. Preceptor recognition and awards also improve unit visibility. One strategy is to designate preceptors as unit coaches or champions. This sends a clear message not only to preceptors, but also other unit staff members that the organization appreciates their contribution and their role is vital to unit success.
Engaging skills for smoother change
Although preceptor skills are used in developing, mentoring, and evaluating new and/or transitioning nurses, these skillsets can be equally applied to other unit operations as staff members experience change or new roles. Continuously assess the skills and talents of each of your nurses. Identify those with the potential to serve as preceptors. Develop them as preceptors, change champions, and nurse leaders. Seek opportunities to engage their skills and talents to benefit unit needs. Nurse preceptors are a valuable resource for adapting staff to change and new roles.
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