The Role of the Preceptor

Episode 3: In this episode, we will discuss improving or establishing a preceptor program within your organization. By the end of this episode, you will have a better understanding of the role of a preceptor, best practices for establishing a preceptor program, and interventions for mitigating preceptor burnout. These are important skills to have if you want to create a successful preceptor program, and we hope you find this episode helpful in achieving that goal.

Guest: Allison Wild, MSN, RN, NPD-BC, PCCN, EBP-C, is a Nursing Professional Development Specialist focusing on staff development and education. She has helped develop staff nurses, preceptors, charge nurses, and other educators through her passion for supporting nursing education for both formal and informal leaders. Her background includes working as a staff nurse, preceptor, charge nurse, and educator in multiple hospital-based settings. 

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Transcript

Transcript

Nicole Weathers

You're listening to the Beyond Nurse Residency Podcast, an educational series where we interview experts on all topics related to the transition of new graduate nurses into practice and beyond. I'm your host, Nicole Weathers, director of the Iowa Online Nurse Residency Program. Thanks for joining us. Let's jump in. 

So first impressions aren't just important, they are everything. And when I reflect on my first job as a nurse and my orientation, the thing that stands out to me the most almost 17 years later is my preceptor. I wish I could share that it was a delightful. Experience that I love going to work every day. Unfortunately for me and maybe many of you, that just wasn't the case. I was bounced around between several different preceptors, some of them kind and compassionate, and clearly remembering what it was like to be new, learning things for the first time, and some of them had been on the unit longer than I had even been alive and had zero patience or desire to teach me the things that I needed to know. It's crazy to think one single person in your organization has the potential to make or break a new hire, but it's common in many organizations to give little thought to how we identify who will serve as a preceptor, what they need to know to fill this important job, and what we can do to support the relationship. And make sure our new hires have the best experience possible. In this episode, we're talking all about the factors around supporting nurses and the role that preceptors specifically play in getting new hires off to a great start. My goal for this episode is that our listeners will walk away with concrete and actionable steps they can take to improve or establish A preceptor program. In their organization. So today I have with me our special guest Allison. So Allison, if you wouldn't mind giving us a brief introduction.

Allison Wild

Yeah. Thank you, Nicole. My name is Allison. I am a nursing professional development specialist. I currently work with new graduate nurses in the state of Iowa. It's funny, you were talking about your first experience and having many different preceptors. My experience was actually the opposite of that, where I had one preceptor, but that person was the charge nurse. So if you can imagine, she was often busy with other duties as the charge. And I felt often alone, sometimes trying to figure out what I was going to do. But the thing that I learned during that experience was. What were my resources and that I should always?

Nicole Weathers

Ask for help, which is such an important thing for a new nurse to learn right, like so at the end of the day, like even if you feel like you're alone, hopefully you're not or somebody there that can help you figure things out and you know, knowing what those resources are are. I mean, that's a huge piece, right? Just knowing what is available in your organization.

Allison Wild

Yeah. I mean, I think if that's the one thing that you can master during orientation, whether you're a brand new nurse or an experienced nurse learning a new role or a new specialty, knowing your resources, knowing who you can talk to, who can ask those questions to is really the best thing you can learn. It's almost that like learning. To learn and embracing that culture of learning.

Allison Wild

A little bit about my background, I'm a cardiac nurse at heart and lifelong learner. I've been a nurse educator for over 8 years now. I've been a preceptor since before I can remember. I probably was that new graduate nurse teaching new graduate nurses out on orientation. I have taught a couple of different preceptor classes throughout my career and currently I work with Nurse Rest. Students, I also work with our educators and very closely with our preceptor program. Some super fun facts about me. My family tries to visit one National Park a year, one Red Sox game a year, and I love reading and I'm currently training for my fifth half marathon.

Nicole Weathers

Oh my goodness, you're busy. Yes, awesome. Well, thank you so much for being here with us today and joining us in this conversation. About, you know, preceptors and and all the things that go along with supporting new nurses. So you know, I work really closely with nurse educators and leaders across the country to support their new grads. That's one of the things that we have in common. And I think one of the things that we sort of connected on initially. So while my focus has always been. On nurse residency programs, we know that transition to practice is influenced by many things, and one thing that's been identified as a major enabler of a positive experience for new grads is that relationship and experience with the preceptor. So let's Start off by making sure all of our listeners are on the same page. So talk to us a little bit about what exactly a preceptor is in their role. So just to caveat though, before we get into that, I know some of you might be seeming like, Oh my gosh. This is really basic. And and it is. But I have worked with different healthcare organizations across the country and I can tell you that there are many terms. That are used interchangeably, so I just want to make sure we're defining from the very beginning what exactly it is that we're talking about.

Allison Wild

Nicole, I would totally agree with that. I've worked at many different hospitals across the country and even just the terms staff nurse versus clinical nurse versus nurse, it could be very varying what the terms are. So Precepting is a style of orientation and new hire for the purposes of our conversation, I'm going to call this person. Orientee. I've heard this call precept as well. But as we start to discuss when we discuss Preceptor and precepts, that can get confusing. So I'm going to use the terminology preceptor and orientee. So this new hire your orientee is higher to an area and paired with one person during their shift and that person has designated their preceptor, some preceptor oriented relationships and nursing follow what we call a single preceptor model. This is where the nurse is paired. The Orientee is paired. With one preceptor for the entirety of their orientation. Now we used to see this more frequently. That's what I had when I was a brand new nurse. You, however, Nicole had a team preceptor approach. This approach is where you have multiple preceptors to 1 orientee.

Nicole Weathers

I think it was like the hot potato approach. It was kind of available to take her today. I don't know if it was meant to be a team approach, but yes, I guess that's what you would.

Allison Wild

Call it. Yeah, I think we see that a lot right now your preceptor is sick. So who's going to take this person today? Who's going to train them? Now, ideally we'd like to be a little bit more strategic, right with our planning and who they're going to be with so that we're selecting the right people to teach them. But these are kind of the two things that we see. So in this model where you have a preceptor and an orientee, your new hire, Sally is paired with an experienced nurse, let's call her Jane. The two worked together during the shift to care for one patient load. This is the important part because sometimes you see and I've worked places where they start to give you a higher patient load because you're two people and sometimes we see that towards the end of Orient. But for an ideal orientation model, what you're going to see is new hire. Sally is paired with Preceptor Jane. The two work together to share that one patient load, and Jane is going to coach and teach Sally into her new role. And they are one dyad working together.

Nicole Weathers

Yes. And I think that is such a good point to bring up because. You are very right and that many times they will see that. Ohh. We have two nurses and so they can take double the traditional maybe patient load or the standard patient load for that. Unit and just really advise people against doing that if at all possible, because the whole purpose is to give that preceptor time to coach and teach. As you said, that orientee on their role, right, and what they're supposed to be doing. And when we start adding extra patience. On to their patient load that just takes time away from teaching, and I think that's a surefire way to burn a preceptor out really quickly and not have a positive experience for that new grad.

Allison Wild

Yeah. And I think the important thing to remember too is that most of the time in these scenarios, the orientee isn't counted into the staffing matrix. So there's no real pole to build them up with more and more patients other than spreading the patient load obviously. But we need to somewhat protect their patient. Road so that they can have that time to learn and grow. I have seen some organizations will even protect the preceptor and oriented in the beginning and give them lighter loads and lighter acuity. But I think in the current state we're not seeing that as much. We're seeing more of this stretch and pole for our preceptors and orientees.

Nicole Weathers

Absolutely. And yes, I think that ideally. That's how you would do it is have a smaller patient loan in the beginning and sort of work your way out. But we do know that preceptors are hard to come by staffing just in general is kind of in a crisis point. All right, Allison, thank you so much for sharing that. Now that we're on the same page and it's clear we are talking about the preceptor, training a new hire, which we're calling an orientee on the job. What are the best ways to determine who becomes a preceptor? Are there best practices for that selection process?

Allison Wild

I mean, we can speak ideally. So I think a lot of times what we see is, oh, Nicole, you're available, you're going to be precepting today. But ideally we want to pick the right people to precept. When I'm looking out at my unit. And I'm looking at my nurses and. I'm trying to decide who am I going to pick as a preceptor, one I'm going to look for those people who are really good staff nurses. They are awesome with patient care. They are safe. They are the people who are often informal leaders on your unit. They're very, very capable and their staff nurse. If I can find that one person who care narrates everything they do. So when I say care rate narrate, I mean that they are talking to the patient about everything they're doing. That's the person I want to pick as a preceptor because they're going to be doing the same thing for that orientee and explaining all of the same processes, and that orientee can just soak. All of that knowledge.

Nicole Weathers

Up. So I'm here to say like good role model, right? They are a good role model. They are somebody you want your new nurses to emulate.

Allison Wild

Yeah, right. Like I want somebody who shows up on time. Someone who has a positive attitude. Someone who embraces my organizations, culture and values, those people. The role models? Yeah.

Nicole Weathers

Yeah, so might not be the most experienced one on the unit, but has all of those other qualities because I think. You can teach some of these other things right? Like you can teach them how to, you know, be a good preceptor, how to teach certain skills. Some of those things, though, that you talked about, like the showing up on time and, you know. Your care and variation and making sure that you know they're talking to the patient in a certain way, like some of those are harder to come by.

Allison Wild

Right. Like I want to build my team and the way to build my team when I think about this is I want my preceptors teaching my orientees the role model version of how to do things, and I want them to learn these orientees. I want them to learn how to be a team player. What's expected of them and how to show up, and the more people that I can train with those preceptors. The better the team is, right? And when you think about the whole goal of Precepting an orientation is I want to build a team that's engaged and happy and wants to stay here. That starts at orientation. That starts on day one that starts with that preceptor, saying, hey, I'm Allison. Welcome to the unit. Don't use that toilet. You need to go use that one when you have to go to the bathroom. That you're like integrated into the team culture.

Nicole Weathers

I love it. I love it. So roll good role model, number one, what else should we consider?

Allison Wild

#2 competent at Precepting and like you said, you can teach them how to be competent and precepting. There are people out there who are inherently good at this. These are your learners, the people who love to learn. They're the ones asking all of the questions, but you can teach them to be competent at precepting.

Nicole Weathers

OK, awesome. Anything else?

Allison Wild

Oh yes, I forgot the most important part. Nicole. They have to want to precept.

Nicole Weathers

Ooh, that's a good one because I so often I see, like you said. Ohh, here's who I'm going to pick. So a lot of times we we see this in healthcare all the time, right? You're being told that here's your new hire that you are going to freeze up today. And they don't always want to do it. So thank you for pointing that out. Tell us more.

Allison Wild

Yeah. So I want to make sure that they want to precept that they are going to be engaged if I pick someone who doesn't want a precept, yet they're not going to really spend the time and effort welcoming this person into my organization or my unit, and they're it's just not going to be the same outcome that we're looking for. Now, what happens if you have a whole unit of people who don't want to pre? Stopped. So that's something that you as a leader or an educator need to start thinking about early on. So when I say that I being identify that person on your unit that you want to precept and start building them up. So recognize those attributes. Tell them that you think that they're going to make a great preceptor, that you understand that they're not ready right now. But maybe we could talk about going to a class or what other things can we do to build this person up? So that they're proactively ready to precept when I need them to instead of being a leader or educator who has to very reactively pick people who don't want to precept what great advice on that like. That's not something that I've ever thought about. But you're almost like planting the seeds in them from the very beginning, right? 

Nicole Weathers

That this is maybe something that you see, maybe you pick out that wow. They would be a really good role model. Maybe they're not competent and precepting maybe they're not ready because they could be super new themselves, but maybe down the road if we start planting seeds, they will eventually get to the point where they are ready and they do want to fulfill this role.

Allison Wild

Definitely. The more seeds you can plan out there, the better. I think that that is just so huge and really you can even dig into, you know, you know, the people in your area who want to excel and build their resume. You can also come at it from that angle as well, like, hey, I know that you're super interested. And becoming a leader or an educator, or going to another specialty, I really think that you would be a great preceptor. Let's do these things to kind of help build your resume. It's the same thing we do with like, committee work as well. Right. Like so. So I know you want to go here. Let's build your resume. Let's get you engaged.

Nicole Weathers

So good, so good. So, OK, those three things. Anything else? As far as identifying who might be a good fit.

Allison Wild

I mean, I think there's the obvious like. They have the time and the schedule.

Nicole Weathers
Yeah. Well, no, that's a good point. Like are we are we identifying like a PRN staff who's here, you know not ever or maybe it's somebody that you know has a lot going on at home and maybe they have missed some shifts or they're going to be going off on a vacation. Or whatever. You know, the case may be. The you know, making sure that they are going to be here readily available and able to focus on sort of this role. So that's great.

Allison Wild

Yeah, I mean, I have seen it too, where preceptors are in a very hard time in their personal lives and that, I mean, no matter how hard you try, that can really spill over into your orientation and teaching of the orientee. So taking that into account and taking into schedules, I mean, I have sat with a schedule. A shift schedule and I'm trying to pair preceptors with orientees and you're sitting there like. This person has to have this day off and I wanted to pair them with this preceptor and it's it's. It's a puzzle, right? But that's a piece of it sometimes, too. Is does this schedule actually work with this new hire schedule? Because they also have classes and other things as well, and sometimes it you know you can do all the hard work and you can think of all these things, but it comes down to. This person's available at the time that I need them to train this person.

Nicole Weathers

Such a good point. Another great point. OK, so we've determined who. Now let's talk about what they need to know to get started. So you said, you know, role model. You said, you know, that they're available, that they want to do it. But you also mentioned being competent. So are there specific things that they should know or? You know, do they know everything simply because they once were an orientee?

Allison Wild

So there are some things that are preceptors need to know that it's out there in the literature. It's out there in the research, the preceptor role essentially encompasses being a facilitator, being that role model that we talked about, being able to evaluate the orientee, the socializer educator. And a protector. So this includes facilitating learning opportunities, role modeling, the hospital and organizational values, unit culture, evaluating their skill attainment and their workload management, which can be very challenging for the precept. After introducing them to the team and important people, I think that one's forgotten quite a bit. So spending some time teaching them how to welcome people into the organization, assessing the orientee to see how they like to learn and how they prefer to learn and be taught, and then protecting them from safety issues and team members. That's one of the biggest things that they can do as well. Whenever I think about orientation, I think of two things. So when I'm talking to a new hire or my new grads, I'm thinking. We're all here for your successful orientation. I want you to complete orientation. I want you to be a successful, functioning team member who can handle the workload. But I'm also here for patient safety and that's why we have a preceptor. And that's kind of what makes nursing. And this preceptor, orientee. Dyad, different than you may see in other.

Nicole Weathers

Fields. OK, I gotta we got to talk about a couple of these things that you said because I think first of all, you know, oftentimes we think learning the role and we think of the role as like taking care of the patients, patients. So we think of assessments and passing meds and you know what they are doing throughout their day. But you pointed out a couple of things. First, being sort of that socialization, right, like welcoming them to the organization, being that friendly face, getting to sort of know them and then making sure as the preceptor, we are introducing them to other members of the healthcare team and getting them, you know, to really begin to develop that sense of. Like belonging, you know on the unit at the organization.

Allison Wild

Yeah. I mean, the goal is to have them stay, right. But if I'm not saying, hey, Nicole, this is Katie over here. Have you met Katie yet? She's a great nurse and managing them up. You're not really getting them engaged and involved. And I probably feel extra passionate about this because I am a closet introvert. I'm an introvert. I'm an extrovert at work, but an introvert in my personal life, and I'm horrible with names and faces. And so anytime I'm the new hire, I am terrified out of my mind because I if you don't introduce me, I'm not going to know their name. And it's going to take me a long time to know their name and that's. Embarrassing as well. And there's just so many things to know, and I've gosh, I have been the new nurse that was not introduced to anybody. And I can tell you that I did not stay there a long time. I did not stay there long term.

Nicole Weathers

At all? Well, because why would you like? You don't know anybody. You don't feel like they value. You know you don't feel like you know them. They probably don't know. You if you are a little bit more introverted and you know you don't, you don't feel like you have those connections. And I think having those connections at work, knowing the people that you're working with are huge.

Allison Wild

Yeah, it's it's a huge deal and you know when we talk about nursing we, you know, historically talk about nurses, eat their young or you know, the buzzwords of incivility. And we're not going to talk a whole lot about that today. But as a preceptor, it's so important that you are socializing them and protecting them from those situations. So that they they feel that sense of belonging, that they feel that connection, because again, that even plays into, you know, resiliency and well-being when we talk about engagement in your work and it really, I mean, gosh, it's amazing how.

Nicole Weathers

How much it starts at that beginning part of orientation, I would almost say like it's the thing that's probably most underestimated, like the power of that.

Allison Wild
100%.

Nicole Weathers

OK. So we talked about socialization. I love that you brought up safety. So again, not necessarily about, you know, learning the day-to-day skills, but making sure that we are keeping our patients safe. So tell us a little bit more about what they need to know there.

Allison Wild

So I think that's a really challenging one for the preceptor. You need to know how to observe and assess the new hire to see if they are being safe with patients. That means you can't sit at the nurses station. You can't be outside the room because you have to be there watching them to make sure that they're safe with patients. I think that one of the easiest examples that you can think of is probably medication safety. So is that new hire? Scanning all of their meds, are they following all of the medication administration rights? Are they actually watching the patient take all of their meds, or did that little old lady just drop every single pill into the bed that you're never going to find any of those pills ever again, right? And then also the other side of that is knowing how to delicately intervene when there's an issue. So what that means is instead of saying Nicole, stop, you're going to injure the patient. Don't give that heparinia the IV it's sub-Q. I'm trying to like yell, but not. Yell on your microphone. You're going to say something like. Hey, Nicole, let me take over for just a second. And then you're going to do and take over and then walk out of the room and debrief outside of the room. The best thing you can do is maybe create a phrase or something beforehand between you and the orientee so that they know that you're going to step in because there's a safety issue. So we're not talking about, like a safe word like bananas, like you're not gonna say, Nicole bananas and then Nicole is supposed to stop what she's doing right. And like you take over, you're gonna say something like, hey, Nicole. I'm going to put on my gloves here for a second, but I've already talked to Nicole about that. I've already talked to you, and you know that if I say I'm going to put on my gloves, that you're going to just pause whatever you're doing. That I'm going to take over safely. And that we're going to have a talk and a discussion. About it afterwards. So it's like two sides of it, right? Like I want to keep the patient safe, but I also need to keep the orientees safe and provide that learning experience and stop them before they make the mistake. Now, if they do, they make a mistake, then I also want to treat it like a learning opportunity so that they are learning and growing in that moment as well.

Nicole Weathers

I love that that is so good. So we are we are teaching preceptors how to socialize new grads, to practice. We are teaching preceptors how to be that protector. So they need to have some of these strategies in their back pocket related to creating. So having that conversation. At a time about, you know, if we're ever in a situation, this is what I'm going to say. What else do we need to teach preceptors about for this role?

Allison Wild

Well, there's that very fun and exciting topic of evaluation. So when I say evaluation, I'm saying the paperwork. There is always some kind of paperwork that the preceptor needs to do and this can be a very important tool. It's often in the form of either. The competency based orientation checklist or competency statements or some kind of plan that the preceptor is following or form that they're filling out to show the orientee is meeting expectations and meeting growth. The really well designed forms will also help that preceptor give the orientee. Feedback as well.

Nicole Weathers

And so, knowing how to give feedback is an important yeah. Thing that they need to know as well. Yeah. So filling out your paperwork evaluation. You know, one hot topic right now that I've had a lot of conversations about is preceptors having the ability to, like you said, observe, assess, evaluate, not just do they know how to insert a Foley or insert an IV. But do they have clinical decision making and critical thinking skills so. Maybe you can talk to us a little bit about that.

Allison Wild

Yeah. So that concept's a little bit harder, right? So and we run, I run into this all the time when preceptors. When preceptors come up to me and they say, you know, I can't tell if they're critically thinking, I can't tell if they're using clinical judgment or what are, what are they thinking, right, like, what are they thinking? And the question is like. Did you ask them? Did you ask any questions to see if they knew why they did that specific thing and teaching preceptors how to ask those questions in a. Gentle way, because again, when we think about, like asking probing questions, there's a difference between me saying like, hey, Sally. Why do you do that? Versus hey, Sally, can you tell me a little bit about? Why you did that that way or tell me more about your thought process. The best thing you can do sometimes too as a preceptor, if you want to see if they're critically thinking, is ask them to do that care narration or tell them, hey, today I want you to pretend like you're precepting me and teaching me. And then in that way, they have to explain all of the things that they're doing as well and kind of the why, but. In general too, like when you're thinking about patient assignments and which patient you're going to go see first as the preceptor, you're going to ask those questions like, all right, who do you want to see first and why? To kind of start digging into some of that clinical decision making.

Nicole Weathers

Awesome. So definitely giving teaching preceptors some strategies for how do you begin to. Sort of probe and ask questions and do so in a way that makes the new grad feel like, you know, comfortable, right? Not that I'm being tested. Not that you don't think I know what I'm doing, but, you know, do it in a more fluid way as part of just sort of that orientation process. So. Such such good points here as far as what they need to know. So we've we know who and what. So let's talk a little bit more about how now you kind of got into a little bit of this at the beginning, but are there best practices? So you talked about like the the. Sort of 1 to 1 diad you talked about sort of that team approach to preceptor, but are there best practices out there? Because I get this question all the time like how how should a preceptor program really be structured? And is there a best way to do it? Do I do one? Do I do 2? And you know what? What's the answer and is there anything out there in the research about this?

Allison Wild

Well, I think the answer is great. I think it can be really hard. It depends on the orientee. It depends on the approach. I you know as a cardiac and a step down nurse, I feel very comfortable in this Gray area. I think it could be very hard for people because they want that black and white answer. But for example you have the one orientee who's bouncing around from preceptor to preceptor, and they're actually learning different ways to time manage, or they're learning different ways to prioritize, and there's certain orientees who kind of thrive in that environment versus your type B. You know, introverted Orientee might not do well with that because it takes them three shifts to open up to their preceptor. So you're going to, for sure, want to make sure. That they're one to one as much as possible, or, you know, only have two preceptors because that can actually. Put them behind so you kind of have to evaluate how it's going as it's going as well. So the worst thing we can do is have them either one be 1 to one with a preceptor, and that preceptor not be a good match. And so they are, you know, four weeks, 5 weeks into orientation. And we're not. We're now finding out that they're they're not being successful. They're not advancing. And the issue is the preceptor. So then we have to switch the preceptor. And then. And start over. Almost right. They're starting from the beginning because the way that the preceptor before was teaching them wasn't working. Now is that the Preceptor's fault? No, not always. Sometimes we have that complete mismatch of personality, or there are so many times that a preceptor is trying to teach the orientee. And the way that they learned, or the way that they like to learn and not in the way that the Orientee learns and by you know that four or six week Mark that orientee no longer has trust with that preceptor. So they can no.

Nicole Weathers

Longer be a working pair and you have to switch that up well, so that's a good point. Something we didn't talk about when we were talking about the what, but they need to know a little bit about adult learning, right and that we don't just teach the way that we learn best and that we should know a little bit about the orientees learning. Styles and be able to kind of change our approach based on where they are, so we provide a preceptor course where we are teaching these things and I would say that. Is number one. Well, not quite number one, but a very popular sort of take away is that they come with the realization that, like, I can't just teach them how I like to be taught, right? I have to really assess that in my learner and change my styles based on that. So that is something that we didn't mention when we were talking about the what.

Allison Wild

That's a very important thing for preceptors to know. I think that was the first hard lesson as a new preceptor that I learned as well. I remember I was training a new graduate nurse and at the time I was more black and white and very type, and she was very. More fluid, flexible and type B and I was trying to teach her my like type a structure and it just it wasn't working and that was a very hard lesson for me to learn as a preceptor. And then I had to kind of grow and learn from that experience. And now in those scenarios I could be a little bit more. Adaptable but sometimes it just takes that time and recognition of like oh. Yeah, that's that's not going to work this time or this isn't going to work for you. And then personally being able to say it's OK that someone does this differently than I do the outcomes the same. Yeah, that's a hard thing for nurses. I think. I think it's a really hard thing for nurses.

Nicole Weathers

Or maybe just for people to say, like, you know what, my way maybe isn't the best way. And there are different ways that you can do this, you know, depending on what The thing is like. Obviously, we don't want people coming up with their own best ways for like, you know, sterile fields and things like that. But, you know, as far as like, how we manage our time or how we approach. Different situations.

Allison Wild

Yeah, I mean, I can think of having that flexibility that whole which patient are you going to see first? Well, I would do it this way, but maybe my orientee would do it another way, but both ways could be correct and sometimes it's just hard to see that flexibility. Bouncing back, I think the other thing that we see with multiple preceptors is if you don't have a really strong orientee who can vocalize where they are on orientation, they're just going to be restarting from the beginning every time. So your new orientee is with. One preceptor, and they're doing really well and they're assessing all the patients and they're advancing in their checklist or paperwork and taking care of the workload, and then they go to a new preceptor who's never seen them before in practice. And then all of a sudden. That preceptor has them, starting from the beginning again, and we see that sometimes too, where they're just going from preceptor to preceptor, to preceptor. And now they're just starting over, starting over, starting over.

Nicole Weathers

OK, so you totally read my mind and I'm wondering with that like again, what do you recommend? Are there best practices for what that communication should look like and then even going a step beyond that with sort of that education or management team and keeping them in the?

Allison Wild

Loop. Yeah. So I've seen. A couple of different things. When we talk about Preceptor to preceptor communication, sometimes there's. Tools that organizations use if the preceptors actually filling out that evaluative skills checklist or competency based orientation paperwork, then sometimes that can be a good tool. I have seen preceptors to preceptors emailing an update like when they're flipping. You have one you know preceptor on days. And one preceptor on nights. And the orientee is flipping back and forth. They will e-mail each other. Some of them verbally talk to the next preceptor, so the most important piece of this preceptor to preceptor communication is that they include the orientee. What can happen when you do not include the orientee in these communications is it turns into this triangulation and incivility. So what we? Don't want to see is. Preceptor Sally, talking to Preceptor Joe at the nurses station. About how our new hire, Katie, is having some issues with time management. And nurse Barb walks by the nurses station. And you're like, oh, you mean that person slow. And then all of a sudden the whole unit thinks that this new hire is slow. Right. And now they have their they're pegged with this huge sinuses slow and I mean that's a a silly example, but I've actually seen this happen more than once.


Nicole Weathers

Ohh it happens. All the time, all the time.

Allison Wild

Then once. Yeah. And so you have to. Be very open and very transparent, and the more that you can create opportunities, whether that's through. Any kind of? Evaluative paperwork or processes where you help the preceptor, an orientee or maybe you teach them to have this open dialogue of feedback and. More importantly too, if you are going to have preceptors talking to other preceptors that the orientee knows that it's happening. And if possible. That they are a part of that conversation.

Nicole Weathers

So do you guys, uh, you know where you work right now? Do you have like set, you know, check in points throughout orientation where you have like you sit down with the preceptor and the orientee or you sit down with the preceptor and the orientee and the manager to have some of these conversations? I mean, is that something that you guys have built into your process?

Allison Wild

We have built-in rounding, so our leaders and educators round with our new graduate nurses and I believe our experienced new hires as well. They have a set number of questions that they ask them and see how they're going and how everything is doing. Sometimes they include the preceptor in those conversations. Sometimes it's just the orientee so that the orientee can feel a little bit more free to vocalize any issues with the precept. Sometimes the educator or leader will also meet with the preceptor before that round to see where they're at. So. We want to see the new hire be self aware, so if they're struggling with something and the preceptor identifies that in this round we want the new hire to also identify it. Otherwise there's something else going on as well.

Nicole Weathers

Great. Good point. All right, Allison, a question that I get frequently about establishing A preceptor program and designing A robust orientation is about time. So how long should a new nurse be on orientation? Number one. Like, what do we suggest? And then how do you decide, you know, how much time they need, etcetera. So maybe you can talk to us a little bit here now about. Best practices related to this topic.

Allison Wild

So orientation length is going to be really dependent on many variables. I'm thinking what specialty training they're receiving, patient populations, what skills they need, what did their school training look like? We're still in that area where some of our new nurses are struggling because they had. Less education and training because of COVID. So what did that look like? What was their previous experience as well? Someone who has been a certified nursing assistant? Patient or patient care technician, something like that on the unit may actually you know they know where things are and they may progress a little bit faster because they're not spending 30 minutes looking for a piece of supply because they have always known where that is because of their previous experience and it will can also depend on the preceptor, right? We've talked about that, the preceptor. And either hinder their orientation and have them kind of. Revert back or they can help them move forward as far as best practice I would say. We're looking at a competency based orientation, so that's based on Donna Wright's competency model. When the new hire shows confidence and they're identified competencies, whatever those may be for the specialty or the unit, then they come off of orientation and. That can be different based on different specialties. Sometimes we're looking at the specific scope and standards of practice, either Ana or specialty specific like Ena is emergency. A1 for OB, things like that.

Nicole Weathers

So I think you know we get the we want the magic wand to like know when this person is going to be done and how much they need. But you know, the short answer is it's, it all depends, right? It depends on various factors and as much as we would love to say yes. Six weeks, 8 weeks, 10 weeks, 12 weeks, whatever. It just, that's just not the case. Like we can't wave that magic wand and give people who are building preceptor programs that specific of an answer.

Allison Wild

Yeah. I mean, if we're thinking ideal state and alignment with evidence based practice and what we're seeing out there in the research, we can't give a specific number of weeks because it's so dependent and it's dependent on the person. And so many factors. However, sometimes our leadership provides us the number of. That they will be on orientation and in those situations, I think that as a leader and an educator. We have to accept that it can be very challenging, but the focus in those scenarios and really any orientation scenario as well is focusing on not necessarily having them. See all of the. Skills and seeing all of the patient population, but we're looking at. Can they manage the workload? I need them to manage the full workload by this number of weeks as designated by my lead. There and how can I instill on them that learning on the fly? So that's Donna Wright's wording. But, you know, I want them to be able to say I have never seen this piece of equipment before. I know that I can check the manufacturers recommendations. I know that I have this policy. And resource. I know that I can go to this educator or charge nurse or my old preceptor who's working, you know, next to me. And I know how to find that information. So it's almost like. Like you have to teach them to learn and how to learn and what those resources are so that when they come off orientation and they can manage the full workload, even though they may not have seen any respiratory patients because it's not respiratory season, they know what their resources are to learn how to care for that patient.

Nicole Weathers

I think. Acknowledging or helping them understand that, like you never know it all like you never know it all. You are never gonna know everything that you need to know to perfectly do this. And acknowledging the fact that we are lifelong learners and we're not gonna be able to see everything on orientation. That doesn't mean that I'm not ready to go. It just means that. I, like you said, have to be aware of where maybe I didn't get as much exposure and be prepared to ask for help and ask questions and know what my resources are.

Allison Wild

Yeah, exactly. I always share with our new grads that I I've been a nurse for a long time. I have never placed an NG tube. I my background is in cardiac care and the. Opportunity never presented itself, so if I was out helping on the unit and somebody asked me to place an Ng tube, I would have to use all the resources and I'd probably try and find somebody so I could see somebody do it once and teach me how to do it. Before I did it. But. I just in my all my years of practice, it just never that opportunity never came up for me and it's so interesting how your patient assignments can be completely different than somebody else who starts at the same time as you. So you have two. New nurses hired on the same unit. They can be in completely different places after a year of practice just based on. What patient assignments they got? What days have they worked? What shifts? They worked, you know, maybe you could go a whole year and maybe never do an admission or a discharge based on where you work. I don't know. Probably not, but. You know, so. You could you could totally not see all of the skills, or even never do something that somebody does all the time. That's where we get some of these nurses on your unit where you're like, oh, I know. I'm going to go to Nicole. The place that IV because she places them all the time. That opportunity, you know, did. I haven't done it in forever because my patients always have lines 

Nicole Weathers

I Don't know. Yeah, no, I get what you're saying. I mean it. Just it really just depends on the cards that you have been dealt in the time that you are on orientation. So I think yes, though recognize being able to recognize that and again know know who it is that you need. Go to. So we've talked a lot about Precepting new nurses. Those, of course, aren't the only ones that need these types of experience. As everyone knows, we have students. We have interns, externs experience nurses, new to the organization, experienced nurses new to the specialty and likely others I have failed to mention all of these people, however. Need preceptor experience or need you know that time with the preceptor to learn their role so that is a lot of people who need these services. Which brings us to our next topic about Preceptor burnout. So. What can organizations maybe do? Or is there any, you know, strategies that you've used or any strategies being shared in the literature about, you know, really trying to mitigate preceptor burnout?

Allison Wild

Yeah, I think a lot of our organizations have spent a lot of time integrating Wellness and resiliency training into nurse residency programs. The important part, too, is going to be identifying those organizational resources and training and making sure that our preceptors have that. Training as well. They are the ones out there coaching and mentoring these new hires. We as educators and leaders need to be coaching and mentoring the preceptors. We want to make sure that they have the support that they need, that we are truly giving them the resources that they need to be successful in that preceptor oriented relationship. That can be shown through, you know, ongoing education, continuing education credits, ongoing training, open forums where they can come and ask questions and get some coaching and mentoring because there's something also to be said as a preceptor to say. In an open forum and say you know I'm having this trouble and for someone else to say, you know, I'm seeing that too. And then for someone else to say, you know, I had that problem and my educator coached me to do XY and Z and it worked. You could try that next time. And then there's some that peer support as as well for those preceptors. I think the other really important thing is again making sure that. The preceptor wants to precept that they have the time to precept and that if something happens, some situation happens with the patient. That they need to spend some time maybe debriefing with the orientee that the team, the charge nurse, the leader, whoever it is, is providing them that opportunity because I think the other piece of the puzzle for our preceptors and burnout is that they don't have the time to truly debrief with the orientee. When something catastrophic happens or something provides some kind of distress, because if it's providing distress to you as a preceptor, it's likely to, you know, providing distress to the orientee as well, so giving them some time for that. Listening to them as well, if the orientee needs more time with a skill and providing that opportunity for the preceptor or an educator to come in and give them that training so they're really struggling with your electronic health system and the the preceptor says they're still struggling. They went to the class, but they just cannot get the electronic health system down. Can we, you know, find some time for them to practice on our playground? And can we do we have a case scenario that they can work through on that electronic health record so that it's not the preceptor trying to play catch up with this one thing that they're struggling with while there's fifty other things? Happening and then the other piece of that as well is. As a leader. Providing reward and recognition for that preceptor in the way that they like to be recognized. So whether that's a huge recognition program that you have for all of your preceptors or it's through whatever recognition program you have at your organization. Where you send each other notes or I mean I've worked places where that you get a note and. Like rewards, it's whatever your organization reward and recognition program is or is it something that you know as a leader or an educator? You write them a thank you note. There's so many different things that you can do to make them feel appreciated. And then also just that culture of saying thank you and acknowledging the hard work that they're doing. And making sure that it's sincere when you provide that and not just something that you know you say because you're saying it.

Nicole Weathers

So it's so funny, like as you're talking about these ways to sort of mitigate preceptor. For now. All I can think about is like these are all the things we're trying to do, even for the new grad, right? That we want to help support their growth and development. We want to give them a group of peers who are experiencing the same things that they are. They give them that forum to be able to talk about some other challenges, reward and recognize them for the amount amount of. Work that they're putting into developing others. I mean, these are all things we say that we want to do through our residency programs with our new grads. But it's not. It's those sorts of things aren't just good for new grads, right? They're good for everyone, whether you're a preceptor or not. Those are the things that make us want to continue to put in this extra effort to be engaged in precepting to be engaged in our organization. I don't. You know, sometimes it's like we think we have to have some new magic bullet. And it's like, no, it's it. It's all the things that we already know how to do. It's just maybe applying them in a little bit different way.

Allison Wild

Yeah. And I think the hard part of that too is this is all stuff that we just need to do as nurses on our units, in our organizations, right. So you ask me for help and I say of course, like I would love to help you. And then when I'm done helping you, you say thank you, like that's a place I want to work, right and really just. Cultivating that culture of recognition. Thanks. Gratitude. Peer support supporting each other, those you know are the places that people are going to stay, or if they leave, it's going to be not because they want to leave that place, but because something else you know they've graduated or their significant others moving or or whatnot.

Nicole Weathers

I mean, it's really not rocket science. These are these are just normal things, like being a good human.

Allison Wild

Yeah, but sometimes you have those difficult cultures and it's a real uphill battle. And sometimes, you know, I've, I've worked in areas where it's an uphill battle. And I was the educator and I resigned to just be the light. And I I wouldn't necessarily at the time at that time in my life, I would not say that. I was always. Swinging to the positive, I think actually on my Clifton strength positivity is one of my lower strengths, but it it shows up in other ways now. But I think you just have to commit to it. I just committed to positivity because everybody else was so burned out and so unhappy and I was like they just need a light and that's. If that's all I can do for this, you know, group of nurses, if that's all I can do for this team, I'm going to be the light. I'm going to say thank you. I'm going to provide, you know, educational opportunities and hope that they show up and. You know, do things that I know that. Mean a lot to them and getting to know them too, like you know, as I said, I'm an introvert, so I'm not necessarily always. On board with chitchat, but I'm going to work really hard to recognize that my preceptor got a haircut or I'm going to work really hard to notice that they're having a hard day and acknowledge that it's it. It even goes back to that clinical judgment thing as an educator and a leader, you have to. Start noticing your staff, right? You need to. Notice them? You need to, you know, say, what does this mean? What is this data telling me? How can I respond to that and then reflect on how you can keep doing better to to uphold them. And you know, it's not easy. It's it's a really hard thing to do. But yeah, I think. We all just kind of need to be kind to each other and when we start to focus on that, it kind of. Falls into place a little bit sometimes.

Nicole Weathers

Ohh my gosh Allison, I feel like we could talk for hours, so we're kind of coming to the end here, so. I mean. Have talked about so many great things when it comes to preceptor programs, you know, different models, who should be a preceptor, what they need to know, how this all should look. We talked about preceptor burnout. So before we go, I have one last question to ask you. So when it comes to preceptors, what is one thing you often see organizations doing wrong or maybe wasting resources on that really isn't making a difference for the new grad at the end of the day? And what would you maybe tell them to do instead?

Allison Wild

I think it's that. We are picking people because they're available. We're not looking at who necessarily has the desire or the passion to precept and and that might just be where we're at right now with nursing and some of the shortages that we're seeing. But I see a lot of organizations putting a lot of focus on hiring our new graduates. And a lot of focus on their programming. And while that is so important. It is also really important for us to focus on our current employees and our preceptors, so I'm talking about, you know, acknowledging my teams attributes. I'm talking about recognizing and rewarding my preceptors all those wonderful things that we just talked about for mitigating burnout, for preceptors, and which are actually all the things we talked about. And mitigating burnout with our new grads, we need to be doing that for all of our staff. And if we focus and turn that focus to our preceptors and their training and their Wellness and picking the right people, I really believe that we would start to cultivate. That right environment and the right team. And people would just be engaged and want to stay, right? That's that's the goal. I want an engaged team that works together and is generally happy when they come to work. Or at least when they experience something that's not happy, they're able to cope together and. And very well ways with good.

Nicole Weathers

Strategies. Ohh, my gosh, Allison. Such an another just great thought there to sort of leave our listeners with, you know, like I said, I feel like we could talk forever about this topic. So many great things. I so appreciate you taking the time out of your busy schedule to share with our listeners about this topic.

Allison Wild

Yes, thank you for having me.

Nicole Weathers
Wait before you go, I want to make sure you know about all the resources you can use to support your new graduate nurses. This includes our Academy, a coaching program designed for organizations as they prepare to implement and sustain A residency program, work one-on-one with a residency program. Expert to make sure your organization is residency. Ready. Then we have our online nurse residency program. This is an evidence based, comprehensive curriculum designed to support your new graduate nurses as they transition from school into practice, wherever that might be. We focus on professional skills, personal well-being competencies. And new graduates even get the opportunity to create real change in their own organization. How cool is that? And we can't forget about our supporting nurses course, an asynchronous continuing education course for preceptors mentors and coaches who learn the skills they need to support any new hire. You can learn more about all of these resources and everything we have to offer using the link in the show notes below.