Honoring Preceptors

Preceptors hold the key to unit culture. How you welcome and train new nurses in your unit is critical to creating the environment you want to work in as a nurse.

The first year of nursing is often a steep learning curve. A new graduate RN takes on the identity of a nurse and learns to navigate the complicated and diverse culture of the hospital environment, and nurse preceptors acts as their guides. They work together through the first months of transition until the new nurse is ready to handle patient needs and priorities independently within the team healthcare setting.

Preceptors are under-recognized; we know this. Precepting is not something covered in nursing school curriculums. Some people innately have preceptor/mentor skills, and others do not. A challenge facing nursing leadership, along with training and retaining new graduates, is how to identify, train and encourage preceptors.

As any preceptor knows, there are challenges to taking on a new nurse. On top of the burden of being responsible for someone else’s work, there will be crucial conversations to be had. There may be different approaches to care, a conflict of values, intergenerational differences, or a need to protect the new grad from workplace bullying by doctors, co-workers, or patients. Preceptors are asked to encourage engagement, help new nurses through failures, and push them to be more confident in their abilities. The biggest payoff for the preceptor is having a competent well-equipped coworker to work alongside for many years to come.
Two years into the COVID-19 pandemic, preceptor burnout is real and palpable, as is staff turnover. It is at this moment we hold the opportunity to change the way we think about preceptors: to recognize preceptors and support them in their vital work during the nursing shortage.

Grande Ronde Hospital, in rural Eastern Oregon, has spent time looking at ways to increase engagement and satisfaction in their nurse preceptor staff. In May 2022, in preparation for the next round of new graduate nurses to enter its Residency Program, Grande Ronde held a Preceptor Summit Dinner for the preceptors assigned to work with new resident nurses. The goal was to honor the preceptors, thank them in advance for their work, address concerns,
encourage, and re-energize their efforts going into the new grad season.

The preceptor/residency leadership team went through Brene Brown’s book Dare to Lead and found many tools and principles relevant to the leadership work preceptors do in their units. During the dinner, preceptors were presented with their own copies of Dare to Lead, as well as an information sheet on the new grad they were assigned to precept. The attendees particularly appreciated having a manager present to convey gratitude and authentically listen to
specific concerns. Everyone was invited to reflect on the culture they wanted to create for the new grads.

Two tools described in Dare to Lead were used at the dinner: permission slips and container building. First, preceptors attending the dinner were asked to share what they needed to give themselves permission to do, feel, or not do to show up authentically as a preceptor. Following that discussion, preceptors were asked what was needed to show up and do the work, what gets in the way of showing up and doing the work, and what does support look like.

Grande Ronde’s residency coordinators received great feedback from nurse preceptors who participated in the Preceptor Summit Dinner. The preceptors appreciated the opportunity to be heard and share their questions, frustrations, and feedback on improving the precepting experience in their units. Grande Ronde plans to continue using the Summit Dinner as a way to connect and celebrate their nurse preceptors. What was learned from this dinner is that preceptors need supportive spaces. They have lots of good and valid questions and frustrations. They want to be heard and appreciated. They want to create good experiences for the new grads, and they have plenty of their own poor experiences with past preceptors to talk about.

Honoring, training, and supporting preceptors is imperative to tackling nursing shortages, keeping new grads in the field, and improving the overall culture of nursing. Our graduates will achieve the high standards set before them. Supporting both the preceptor and the preceptee is the first step towards this achievement.

Shelby Humphry has been at Grande Ronde Hospital for 8 years and is currently in the Emergency Department with previous experience working as a house float. During her time as a house float and a new grad herself within the organization, she saw a need for a more collaborative plan for orientation in all units. She successfully worked with leadership and administration to implement a vision of culture change aimed at new nurse orientation to promote nurse retention, satisfaction, and education. Her preceptor program has been fully adopted in all inpatient units and continues to grow and change with the shifting needs of a critical access facility.