Authors

  1. Modic, Mary Beth MSN, RN
  2. Schloesser, Mary EdD, RN

Article Content

In the first column, we suggested that a key to the development of a new employee is the relationship, skill, and support provided by the preceptor. Selecting the right person to become a preceptor is important to the overall success of the preceptor program. A brief review of the literature (Collins & Thomas, 2005; Connelly & Hoffart, 1998; Craven & Broyles, 1996; Speers, Strzyzewki, & Ziolkowski, 2004) identified preceptor selection criteria as positive attitude, willingness to serve as a preceptor, and experience in the clinical area. In addition, individuals should possess positive interpersonal skills, promote learning and trust, be positive role models for professionalism and patient care, and be thoughtful decision makers.

 

A question we are often asked is how much clinical experience is needed to become a preceptor. In general, the literature reports that an individual should have a minimum of 1 year in the clinical specialty and 6 months in the facility. Considering Benner's (1984) estimation of the time required to make the transition from advanced beginner to competent nurse, and what we have found in our practice (Schoessler & Waldo, in press), a nurse may be just entering competent practice at 12 to 18 months and not be solidly competent until 2 years into the practice. That means that some nurses selected to be preceptors may only be entering the competent stage of practice. These newly competent nurses often express concerns on being preceptors because they lack the in-depth clinical knowledge that they ascribe to the preceptor role. Although their concern is justified, it is important to remember that all nurses, whether newly competent (1 year in practice), competent, proficient, or expert, experience their own developmental challenges and bring their own developmental strengths to the role. As educators and managers, we need to be alert to these challenges and strengths and be watchful and supportive of both the preceptor and the newly hired nurse. Here is a quick review of the most common strengths, challenges, and suggested organizational responses.

 

Advanced beginner to newly competent nurses are still in the process of developing their comfort in the clinical area and lack the knowledge, skills, and ability to manage complex patients without guidance. This individual brings the developmental strengths of acute awareness to the issues and concerns of the new nurse. The newly competent nurse easily remembers what it was like to be new and can sympathize with the stresses and strains of adapting to the work role. Their developmental challenges include lacking the in-depth knowledge of the expert nurse and having a limited understanding of how things are handled. They may not have encountered all of the skills needed in their clinical specialty and may feel at a loss to know how to cope with them, let alone orient a newly hired nurse to them. In acknowledgment of these factors, the educator and manager should first set clear expectations for the newly competent nurse preceptor and share these with the unit charge nurses. The role of the newly competent nurse preceptor can include introducing the newly hired nurse to the facility, the interdisciplinary team members, the unit routines, care of the noncomplex patient, and to resources for problem solving for patient care. In reality, this is a lot of responsibility, but one that the newly competent nurse is capable of carrying out. Many newly competent nurses tell us that they only realized what they had learned in their first year of practice when they had to begin explaining it to someone else. Even so, the manager should try to match the experience level of the preceptor to the experience level of the newly hired nurse and should consider pairing the newly competent preceptor with a more experienced preceptor. The more expert preceptor can introduce the newly hired nurse to the management of more complex patients and provide support and mentoring for the newly competent nurse preceptor.

 

Individuals at the competent level of practice have strengths in knowledge of their particular specialty and unit and can articulate their thinking in ways that new nurses can understand. These individuals experience challenges with time management and may feel stressed and lose some of their innate positive attitude when pressured by time and the assumption of multiple roles. Managers should plan work schedules so that these preceptors do not become overburdened by serving as preceptors at the same time as they are serving as charge nurses. Managers and educators should watch for signs of stress and know when to offer support and provide breaks in precepting to allow the competent nurse to enjoy "just doing patient care."

 

Individuals who are at the proficient and expert levels of practice have strong knowledge bases, know resources and how to access them quickly, have excellent patient management skills, and have a deep knowledge of the organization. These individuals identify and sort through problems based on pattern recognition and are sometimes challenged to remain articulate about their thinking in ways that more linear thinking newer nurses can understand. Answering questions from beginning nurses can sometimes stop the expert in his or her tracks and leave the expert struggling to verbalize thought patterns that are innate and skillfully automatic. Experts also have sometimes forgotten what it was like to be new and expect more of new nurses than is appropriate for their level of practice. Because of this, matching an expert nurse with an advanced beginner nurse may not be the best for either party. Managers need to be alert to this possibility and should balance the care of complex patients (typically assigned to the expert nurse) and the newly hired nurse's need for less complex patients during orientation.

 

Each level of nurse preceptor (newly competent, competent, and proficient/expert) brings strengths and challenges to the preceptor role. Managers and educators need to consider these strengths and challenges when making preceptor assignments and need to be watchful and supportive of both the preceptor and the new hire if we are to maximize the strengths of the preceptor-new-hire relationship and bring people into our organizations well.

 

REFERENCES

 

Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park, CA: Addison-Wesley Publishing. [Context Link]

 

Collins, M., & Thomas, T. (2005). Creation of a stepdown nurse internship program. Journal for Nurses in Staff Development, 21(3), 115-119. [Context Link]

 

Connelly, L., & Hoffart, N. (1998). A research-based model of nursing orientation. Journal for Nurses in Staff Development, 14(1), 31-39. [Context Link]

 

Craven, H., & Broyles, J. (1996). Professional development through preceptorship. Journal of Nursing Staff Development, 12(6), 294-299. [Context Link]

 

Schoessler, M., & Waldo, M. (2006). The first 18 months in practice: A developmental transition model for the newly graduated nurse. Journal for Nurses in Staff Development, 22(2), 47-52. [Context Link]

 

Speers, A., Strzyzewski, N., & Ziolkowski, L. (2004). Preceptor preparation: An investment in the future. Journal for Nurses in Staff Development, 20(3), 127-133. [Context Link]