New nurses enter the nursing profession with much excitement but are too quickly overwhelmed by complex patient care and poor staffing.1,2 They are expected to acclimate quickly to high patient-to-nurse ratios and understaffing issues, making them feel unsupported and ultimately leave the profession.1 Furthermore, new nurses report decreased job satisfaction and self-efficacy.3 New RNs, specifically, have the highest turnover rate of all the nurses leaving the bedside.1 However, there may be 203,200 openings for RNs annually through 2031.4
Research shows that a robust mentoring program consistently decreases new nurse turnover.5 Experienced nurses need to support and encourage new nurses entering the profession because those who feel valued are more likely to remain in nursing practice.3 Entry-level nurses lack firsthand experiences and struggle in their new role, but experienced RNs may not know how to support them. This article provides practical guidelines for experienced nurses when precepting, coaching, or mentoring new nurses.
Program types
Hospitals may have specific training programs to prepare the new nurse for practice. There are a variety of approaches when onboarding a new nurse, including a preceptorship that transitions into a mentorship or preceptorships and coaching alone. Experienced nurses working in all healthcare areas may be required to support a new nurse on their unit. The experienced nurse helps the new nurse acclimate to the RN role, where they are expected to implement evidence-based practice into the nursing process. Precepting is conducted in a specific environment and time frame. A preceptor assists the new nurse in learning a particular skill set and evaluates their competency. Precepting may be accounted for in a formal preparation program for a new nurse, including evaluating competency on specific performance goals.6
Mentoring is a chosen relationship that usually endures over time. A mentor is selected by the new nurse based on the skills, knowledge, and attitude to support and guide a new nurse. There may be overlap between the mentor and preceptor relationships. The experienced nurse helps the new nurse develop specific knowledge and skills to facilitate the new nurse's professional and personal growth. The mentor ensures a holistic focus on the new nurse's total professional development while also pushing the new nurse out of their comfort zone.6 A mentor provides a safe environment for the new nurse to ask questions, follow up without fear of judgment, and give honest feedback.6 Nurse leaders need to collaborate with new nurses when they request a mentor or a preceptor who better aligns with their unique personality and learning style. New nurses with well-matched mentors or preceptors are more likely to grow professionally and stay on the unit.7
Coaching, another method to support a new nurse, can be a formal or informal relationship between an experienced and a new nurse. Coaching may be provided in stages and be specific to enhancing individual skills or organizing nursing care during a single shift.7,8 Coaching involves collaboration on targeting the new nurse's potential.6 Coaching may be helpful to nurses throughout their career stages to help them achieve specific professional goals.
The following guidelines will help experienced nurses support new nurses in a respectful and mutually beneficial process when precepting or mentoring. Experienced nurses must assist new nurses' transition to practice through promoting a supportive and caring environment. Mentoring and precepting founded upon evidence-based practice is a step toward upholding and sustaining the nursing profession.9
Beginning the relationship
A good preceptor or mentor must know the requirements for the unit and be willing to share them while providing information appropriate for the new nurse's individual learning needs. For example, the experienced nurse needs to discuss the policies and procedures and show the new nurse how to access and implement them, ensure the new nurse understands, and then let the new nurse repeat the process of finding the required policy and procedures for nursing skills.10
A new nurse selects their mentor based on the experienced nurses' personal style, the new nurse's learning needs, and the support they receive from the experienced nurse on the unit.6 Communication is crucial for effective mentoring or precepting and fosters mutual respect.7,8,11 The communication between the two will set the tone for the entire relationship.
The experienced nurse has a wealth of knowledge regarding the flow and patient care of the work environment; the new nurse brings fresh ideas and current education.12 The experienced nurse should validate what the new nurse brings to the unit, including their unique attributes, energy, recent theoretical knowledge. An important component of a competent nurse is applying nursing science in an empathetic and patient-centered framework. Showing interest and empathy while providing ongoing support and constructive feedback helps the new nurse grow into a competent nurse.13
The relationship should begin by establishing a goal with the new nurse. For example, the new nurse can develop a goal that is specific, measurable, achievable, realistic, and time-bound (SMART). The new nurse should have short-term goals for the current shift and long-term goals for what they want to achieve over time.10,14
One of the new nurse's long-term goals should be to independently care for a full patient assignment through the timely performance of patient assessments, administration of medications, and provision of treatments by the end of the onboarding orientation. At the beginning of the orientation, the new nurse should focus on the short-term goal of caring for one patient. The new nurse and experienced nurse should integrate the evaluation of realistic goals into their daily communication.10,14 A short-term goal may be developed for the next shift if a specific learning need is identified for the new nurse. For example, the new nurse was not able to administer medications on time and include the reason the patient is taking the medications, adverse reactions the patient needs to report, and the relevant labs influenced by the medication.
The relationship between the experienced and new nurse requires psychological support, knowledge exchange, and role modeling.9,15
Daily organization
New nurses are educated to be generalists and know entry-level information for all nursing-care areas. However, they need to know how to organize themselves to care for multiple patients in a fast-paced healthcare setting.
The Agency for Healthcare Research and Quality's (AHRQ) coaching model suggests using the "teach me/show me, watch me, and give feedback" approach to learning.10 The "teach me/show me" aspect of the AHRQ model involves the experienced nurse showing the new nurse how they organize their day at the start of the shift, including a timeline of medications, lab tests, imaging studies, procedures, review of new orders, and pertinent patient information. The experienced nurse will then observe the new nurse organize their care for one patient. The number of patients cared for by the new nurse will increase over time with ongoing communication and feedback. The experienced nurse should explain the tools available in the unit's documentation or organization systems to the new nurse. New nurses should be encouraged to observe their nurse colleagues daily for different organizational approaches.
Daily follow-up
The best way to ensure the new nurse knows critical information and has appropriate critical thinking skills is through active listening, observation, and communication. The experienced nurse should ask questions about the patient's disease process, how it links to the prescribed medications, and how those link to the treatment plan. They should model critical thinking by prioritizing nursing care while explaining the process to the new nurse. For example, the experienced nurse can model how they determine which patient must be assessed first based on factors including the disease process, assessment data such as vital signs from the previous shift, and the medications most urgent to administer.
The experienced nurse can show the new nurse how to obtain lab results and review a medication's indications, dose, adverse reactions, and potential medication interactions before administration. The mentor should verbalize routine nursing interventions, keeping in mind that the new nurse has not had the opportunity to develop a methodical plan when caring for patients. The experienced nurse can also explain how to conduct a focused physical assessment based on the patient's diagnosis. The experienced nurse should explain the importance of an environmental assessment related to patient safety and the assessment of current I.V. infusions noting the tubing dates. They can also review the emergency equipment available in the patient room.
The experienced nurse can assess the new nurse's understanding with questions and discussion.14 The experienced nurse may not know the answer to every question, but they should be able to show the new nurse where and how to find the answer.
SMART goals should be evaluated at the start and end of the day. Having specific goals helps when providing feedback and instruction to the new nurse. The experienced nurse may need to complete evaluation forms for the new nurse on many areas of nursing care, such as skills proficiency, patient communication, organization of care for multiple patients, and safe patient care. Real-time feedback during the shift and overall feedback at the end grounds the learning experience.
Constructive feedback
Constructive feedback is essential for the new nurse's growth. Unfortunately, feedback is not always provided in a constructive format. Constructive feedback provides a meaningful evaluation of the individual's performance to promote a positive change in actions and behaviors.16 Constructive feedback should be simple, honest, focused, respectful, and kind.10,17 Feedback given in a demeaning or condescending tone is destructive and may ultimately make a new nurse feel incompetent.
Feedback is as important for actions and behaviors the new nurse does competently as for those they need to improve. During a private conversation, the experienced nurse should be direct and explain their observations, be specific and clear, and remain objective.18,19
When discussing an area needing improvement, the experienced nurse should begin the feedback with, "I saw...," "I observed...," or "I noticed...."10 For example, "I noticed the patient was not ready for physical therapy at the scheduled time." The experienced nurse should be clear about why the observed behavior or lack of behavior is essential to the patient's healthcare. For example, "It is important to have patients ready to go to their physical therapy appointments by being in the wheelchair and pre-medicated with analgesia so they can fully participate in their treatment plan."
Stay available
The experienced nurse will work side-by-side with the new nurse while modeling the appropriate patient care, sharing clinical expertise, facilitating the application of knowledge, and providing ongoing feedback. Over time, the new nurse will gain independence to organize their day, set priorities, implement care, document, and evaluate the care they provide.
At a certain point, the experienced nurse will only provide stand-by assistance to the new nurse. The experienced nurse should allow the new nurse to take the entire patient assignment but be available to step in immediately if they need support.
Each new nurse will transition to this new level of independence at their own pace. However, some successful transition-to-practice programs last between 27 and 52 weeks with subsequent mentoring.8
Though the new nurse earns a new level of independence, the experienced nurse remains responsible for knowing what is required for each patient's care and supporting the new nurse in balancing the workload. The mentor should not wait until the end of the shift to check in on the new nurse.
During this time of increased independence, the experienced nurse must evaluate the new nurse's documentation for completeness and identification of crucial assessment areas required for the individual unit or patient population. For example, they must consider whether the new nurse assessed chest pain in the cardiac unit and noted relevant vital signs, medications, treatment, and labs. The experienced nurse should ask the patient if they feel the new nurse listens to them and empathetically provides the required care. This should only be asked in the absence of the new nurse.
Long-term relationship
As the new nurse becomes an experienced nurse and the formal mentoring relationship reaches its mutually agreed endpoint, the relationship will change but need not end.19 A mentor and mentee may remain in contact only while working on the same unit or throughout their lifetimes.20
Administration support
According to a 2022 survey, replacing an RN takes about 3 months.1 It costs $52,350 to train a new RN, with the average hospital losing between $6.6m-$10.5M in 2022.1 Developing an effective preceptoring or mentoring program takes time, effort, and the nursing budget to fund it. Still, the cost-benefit analysis favors a robust mentoring program compared with the cost of losing a nurse.4,19-23 New nurses report increased self-confidence and a willingness to stay on the unit and provide quality patient care when they feel supported.4,24
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