Filling the Gaps

As COVID lingers, Oregon’s clinical preceptors seek to balance their role as critical mentors with the threat of burnout.

In a monastery, a “preceptor” is the abbey’s primary music-maker; in Freemasonry, a preceptor is the leader of a lodge. For new nurses at certain Oregon health care facilities, a preceptor can be a crucial guide who helps them settle into their first real job.

Preceptors are experienced practitioners with a passion for sharing their knowledge with the next generation. In some places, they orient and train aspiring nurses (and established ones, too), awakening their skills and imparting to them the organization’s best practices. New nurses in hospitals with a preceptor program typically interact with them twice: once during their clinical training as nursing students and again as freshly minted RNs. Clinical preceptors fill a number of gaps—some of which are widening precariously.

“Students’ experiences with their preceptor aren’t always great,” suggests Cindy Bianchini, who directs Legacy Health’s RN residency and academic relations program in Portland. “They can arrive at their new job traumatized and intimidated, until a good preceptor makes space for them to ask questions and make mistakes.”

“Preceptors carry the culture of the organization,” adds Sandra Maddux, director of clinical and professional development at Bay Area Hospital in Coos Bay. Yet a preceptor who disagrees with a certain policy might skip over or put their own spin on one they’re required to teach: “‘I know we’re supposed to do it this way, but let me show you how to really do it,’” she says, channeling one. “A preceptor can have a positive or negative influence.”

Competency lies at the core of proven clinical preceptor programs. At Legacy, preceptors are evaluated by professional development, assessment, planning, implementation, evaluation, role modeling, and advocacy. (That four of these are already known as sequential steps in the nursing process shows nurses know what works and are eager to apply it to other aspects of their job.)

Michelle Arthur, a clinical preceptor and ED staff nurse at Portland Adventist Health, is also an instructor. “When I started teaching, I saw the gap between tasks and the mechanics of things,” she says. “But how do you train someone to critically think? How do you train them to process what they’re seeing? You don’t get a lot of practice for what to do when someone is yelling at you and throwing poop.”

For Arthur, the preceptor’s role is to teach nurses everything they need to know to care for their patients safely and to successfully integrate into the culture of the unit.

“I love training brand-new nurses,” she grins. “You can mold them. Say an ambulance is arriving: I teach them that if we’re just sitting there charting, we’re going to go check on the ambulance too, even if it’s someone else’s. It’s modeling, ‘Nope, we’re a team and we’re going to do this together.’”

Like most nurses, preceptors were feeling burned out before the pandemic, and COVID has only made things worse. Now, organizations are undertaking a wide range of rewards, from coffee cards to continuing-ed programs, to incentivize them to stay. At Portland Adventist, Arthur created a weekly SBAR newsletter and an information packet with daily checklists for training and supporting her precepting colleagues. At Legacy, nurses who complete their orientation nominate an outstanding preceptor; every nominee is recognized. At Bay Area and other hospitals, they receive a higher wage.

Still, money is beside the point. “Preceptors are intrinsically motivated,” Legacy’s Bianchini says. “They love to see people succeed and grow. They’ve had a good experience and want to give back to the organization.”

Yet across the state—and across the country—the number of preceptors is dwindling. Late last year, the National Advisory Council on Nurse Education and Practice released its 17th Report to Congress and the HHS secretary, addressing the dangerous shortage of nurse faculty and clinical preceptors. It recommends increased funding for programs that raise the number of nursing faculty and clinical preceptors and support for academic coursework that prepares nurses for both.

“Preceptors are the crux of onboarding,” says Bianchini. “It’s already humbling and anxiety-producing to be new, but how a person gets onboarded is predictive of their commitment to the organization. If it’s not done right, people leave.”

A good preceptor is many things: compassionate coach and adept communicator; patient, understanding role model; supportive, eagle-eyed evaluator; skilled at listening and relationship-building; focused on safety above all. As the pandemic lingers and nursing schools struggle to retain their own faculty, health care facilities across the state are scrambling to prevent a looming shortage of these mentors from becoming a gap of its own.

OCN is a nonprofit organization created by nursing leaders in 2002. OCN facilitates research and collaboration for Oregon’s nursing workforce to support informed, well-prepared, diverse and exceptional nursing professionals. Recognized by the Oregon state legislature as a state advisor for nursing workforce issues, OCN fulfills its mission through nurse workforce researchbuilding partnerships, and promoting nursing and healthcare.