Beyond Nurse Residency

Mastering the Art of Precepting: Insights from Dr. Beth Ulrich

• Nicole Weathers, MSN, RN, NPD-BC • Season 2 • Episode 7

Share episode

What happens when a new nurse is suddenly asked to teach others? For Dr. Beth Ulrich, it launched a lifelong mission to redefine precepting. Drawing from her Mastering Precepting series, she shares why great preceptors do more than teach—they lead, coach, protect, and inspire.

Dr. Ulrich challenges the idea that any skilled nurse can precept, sharing a student’s simple but powerful question: “Why can’t you put us with nurses who like students?” Her insights highlight the importance of intentional selection, preparation, and ongoing support for preceptors.

From building professional identity to supporting nurses through career transitions, this episode offers practical, evidence-based strategies for developing strong, sustainable preceptor programs.

GUEST: Beth Ulrich, EdD, RN, FACHE, FANNA, FAONL, FAAN
Professor, Department of Graduate Studies, University of Texas Medical Branch, School of Nursing; Editor-in-Chief, Nephrology Nursing Journal

Beth Ulrich is a nationally recognized thought leader who is known for her research studying nursing work environments and the experiences of new graduate nurses as they transition from nursing school into the workforce, and for her leadership in developing the roles of nephrology nurses and improving the care of nephrology patients. Dr. Ulrich has extensive experience as a healthcare executive, educator, and researcher. She is currently a professor of nursing at the University of Texas Medical Branch (UTMB) School of Nursing at Galveston, teaching in the DNP Program, and Editor-in-Chief of the Nephrology Nursing Journal.

Dr. Ulrich has been the primary investigator on a series of national nursing workforce and work environment studies, including five studies of nurse work environments conducted for the American Association of Critical-Care Nurses. She has numerous publications and presentations to her credit on topics including nurses' work environments, how new graduate nurses transition into professional nurses, nephrology nursing, and mastering precepting. Dr. Ulrich’s books Mastering Precepting (2012, 2019) and Mastering Simulation (2014, 2020) received AJN Book of the Year Awards. The 3rd edition of Mastering Precepting was published in 2024.

LinkedIn     Facebook

Ulrich, B. (2024). Mastering precepting (3rd ed.). Sigma Theta Tau International.

Ulrich, B., Harper ,M.G,, Maloney, P., Warren, J.I., Whiteside, D., & MacDonald, R. (2025). National Preceptor Competency Consensus Study. Journal of Nursing Administration, 55(1), 14-21. DOI: 10.1097/NNA.0000000000001523

Ulrich, B., Barden, C., Cassidy, L., Varn-Davis, N., & Delgado, S. (2022). Critical care nurse work environments 2021: Findings and implications. Critical Care Nurse, 42(5), 58-70. https://doi.org/10.4037/ccn2022798

Harper, M., Ulrich, B., Whiteside, D., Warren, J.I., & MacDonald, R. (2021). Preceptor practice: Initial results of a National Association for Nursing Professional Development study. Journal for Nurses in Professional Development, 37(2), 154-162 DOI: 10.1097/NND.0000000000000748

Supporting nurses is our priority. Visit https://nursing.uiowa.edu/ionrp to explore our resources for new graduate nurses and beyond.

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.

Nicole Weathers:

When I reflect on my first experience precepting a developing nurse, it might surprise some to learn that it actually occurred. In my fourth month of my first year of nursing as a new nurse on a new unit, I was tasked with precepting three students who needed practicum hours. Despite barely knowing what I was doing myself, I found that I absolutely loved teaching these students. I think it really was that experience that sparked a passion in me for professional development of nurses. In hindsight, though, I sometimes wonder how effective I really was, given my limited experience, understanding of what it even meant to be a preceptor in the first place, and my lack of competence in the critical competencies of the preceptor role.

Nicole Weathers:

In this episode, we will explore the art of mastering precepting in nursing. We'll discuss key roles, new learnings, critical elements of preceptor development and the key differences between precepting students, new nurses and more experienced nurses, along with so much more. My goal for this episode is for our listeners to gain a clear understanding and actionable strategies to improve their work. Today, I have the pleasure of welcoming Dr. Beth Ulrich to the Beyond Nurse Residency Podcast. Hi Beth, how are you?

Dr. Beth Ulrich:

Doing great, Nicole Thanks.

Nicole Weathers:

You know, I first encountered Dr. Ulrich's work back in 2012, while I was working as an MPD practitioner responsible for onboarding and orientation of our new nurse hires, and that is when I bought the first edition of her book, Mastering Precepting. Fast forward over a decade, and I had the incredible opportunity to actually meet Dr Ulrich in person and learn about not only her second but her third edition of the book. And, for those of you who haven't had the privilege of meeting Dr Ulrich, she's an absolute delight and I was so honored that she could join us today. So, while we have had previous podcast discussions on the important topic of precepting, I thought it would be amazing to have the author of Mastering Precepting herself join us to share her insights. So, Dr. Ulrich, why don't we start off by having you share a little bit about yourself with the audience, and then we'll jump into the questions I have for you today?

Dr. Beth Ulrich:

Oh goodness. Well, you know, when you've had a career that spans 50 years or 50-plus years, it gets long. It's like when you become a nurse you strive for your CV to be a little bit longer, and as you get more experienced you're like that makes me look old. When my CV is that long, you try to condense it. I actually, you know, I started off like everybody else starts off or most everybody else starts off in a staff nurse role. But I got into nephrology nursing kind of accidentally. People will say, well, why did you choose nephrology nursing? And I think they want some being called by the kidney right. I wanted to not work weekends. So, like a lot of people, you know, choices are made on very different things. But I got into nephrology very early in nephrology specialty and still to this day, do nephrology. I've been editing their journal for 22 years now and I'm a past president of that association, so my clinical home is nephrology, has been and always will be.

Dr. Beth Ulrich:

At this point Along the way, though, as I got my master's and I got my doctorate, I was really interested in improving care and I thought I could do that best from a leadership, a formal leadership role, and so I became a chief nursing officer of a hospital and then I was a chief operating officer of a hospital, and then I was a chief operating officer of a hospital and then I moved out to actually working with some of the commercial vendors. Like, I worked for a company that did residencies, helped hospitals set up residencies for new graduates. And then I worked for a simulation company on using simulators for training for nurses and other people, and along the way I had a mentor who was a dean, who kept saying to me you need to come teach for me. And I said, when I stopped traveling, you know when I when I can actually be in one place for a period of time? And and so about two days after I got in one place for a period of time, she called and and I started teaching in a DNP program about 10 years ago in the executive leadership portion.

Dr. Beth Ulrich:

The two things that I've put most of my work into is work environment, because I got to do some work on national studies of work environment and I got engaged in that, and then I've led five studies for the American Association of Critical Care Nurses on healthy work environments or the work environment of nurses, and then, when I worked for the company I mentioned that did residencies, I started to see that we needed to do some more about preceptors, because not everybody can be a preceptor, right or not everybody should be a preceptor. So those are kind of the two things, in addition to nephrology, that have been my passion for the last decade plus now.

Nicole Weathers:

I love that, so many interesting things and I always love to hear how people's career sort of you know transition from one thing to the next. I'm with you like what I do now wasn't necessarily something I thought I would do, but you know, it's based on the decision you make and then all of a sudden you're down this path and you don't know where the time went for sure. So let's jump in now to some of the questions that we've got prepared today, and I want to begin with a quote that a very wise woman once shared there's no greater contribution to nursing and to patient care than to ensure the competence of the next generation of nursing. Any idea who said that?

Dr. Beth Ulrich:

Yeah, I'm pretty sure that was me.

Nicole Weathers:

It definitely was. So this is the quote, or this quote, I should say, was on the closing slide of your presentation last fall where we met, and it really resonated with me because, like many as you, sort of disconnect maybe from patient care and, as your career sort of takes you in these different directions, it can sometimes feel as though maybe we're not having the impact that we could be having if we were at the bedside. So this was just a really great reminder for all of us that, even though we might not be directly involved in patient care, through this vital work of teaching and shaping that next generation of nurses, we really are making a significant contribution. So you've shared a little bit already about your background as far as your career and sort of where it's taken you, but maybe you could share, tell us a little bit more about how you got into this work around mastering precepting, because this has been a really significant chunk, I think, of what you've done. So what brought you there?

Dr. Beth Ulrich:

So, if I can take one second to respond to what you just said about being away from the bedside, I think sometimes we don't give ourselves credit for stepping away and recognizing where we're best used in the profession. Right, if you think about the people you've precepted and how many lives they've touched and will touch over their career, and as a preceptor you form that foundation. You know. As an educator, you know, when I talk to folks who are in clinical settings, who want to be an educator, I say you have to get comfortable with you're not directly touching the patient, but you're touching so many people who will, and what you teach them exponentially multiplies as they teach others.

Dr. Beth Ulrich:

And so I really think we have to, absolutely we need clinical nurses, but we've got to have educators and we've got to have managers and you know we have to have all those other people in order for the clinical nurses to work. There was a book one time that said it was about customer service and it said if you're not serving the customer, you best be serving someone who is right. And when you are, you are, by connection, serving, in this case, the patients or the nurses who are on the unit. So I just think it's very important that we get comfortable with that and we understand we all can't practice at the bedside. We probably all shouldn't practice at the bedside, but there are so many other things to do in nursing that ultimately connect to improving patient care and improving nurses' lives.

Nicole Weathers:

Well, in order for care delivery to happen right, you've got to have leaders, you've got to have educators, you've got to have people making the system work. Otherwise you know that clinical nurse isn't going to be able to do their job well either without those pieces.

Dr. Beth Ulrich:

And I think that's part of what happens. You know, one of the things when we talk about staffing, a lot of people talk about the number of bodies on the unit, right, and part of the staffing is who's there to support the nurse. You know, if the nurse is doing the nursing skills, the clinical skills, then who's there to support the nurse? And that makes a huge difference in the nurse's productivity and in the patient outcomes. So I just I think we ought to be more proud of all the things nurses can do and to say it's okay, you know, if you don't want to be in direct care, there's so many more options. So you asked me about mastering precepting.

Dr. Beth Ulrich:

So back when I was working for this company that did basically the architecture for new graduate residencies for hospitals and and especially hospitals that were sort of mid-sized. You know, the big university hospitals, you know, have resources, they have NPD practitioners and and folks who can support something like a residency. But the middle-sized hospitals often have some issues with that and they just don't have the resources. And so I was, I was working for this company, I was doing their, their analytics and their research and you know it's. You're always amazed when you look back and say how did I get into this?

Dr. Beth Ulrich:

And I was looking at a preceptor evaluation that was being used and I didn't particularly like it and I didn't think it was giving us the information we needed. And so I went to the literature, as we're wont to do, because I thought surely somebody's got this right. And back in 2010, 2011,. Mostly the only thing I could find was precepting students, and precepting students just isn't the same as precepting new graduates. There's some similarities, but there's some very big differences there. So I was kind of like and as I'm looking at that, I'm realizing well, there's not other stuff out here about precepting either. And I had also run into because I got to go to a number of different organizations I had run into preceptors who were born to be preceptors. I had also run into preceptors who should never be a preceptor.

Nicole Weathers:

I think we've all had at least one of those in our career.

Dr. Beth Ulrich:

Like I was. I was moderating this panel one time at our school. It was one of those research days where you bring in all the people who've helped you from the hospital and stuff and you provide some education and some and at the end of the day we had this panel just to talk about working between the school and the hospital. And and the panel had some faculty from different you know, the graduate faculty, the undergraduate faculty. It had and it had a student at each one of our programs.

Dr. Beth Ulrich:

And towards the end of the and we're in one of those big meeting rooms towards the end of the conversation I realized that this baccalaureate student who's sitting way far to the side hasn't said hardly anything.

Dr. Beth Ulrich:

And so you know, I ask her, you know, would you like to, would you like to say anything before we close?

Dr. Beth Ulrich:

And she, she just very calmly and nicely said you know the other students and I just don't understand why you can't put us with nurses who like students when we're in clinicals and the whole room shut up, right, the whole room was just gasping embarrassed, right, because here's faculty and preceptors and nursing leaders. I will say I was really happy that they started talking about how can we fix that. But it was one of those moments, you know, why can't you give us somebody who likes having students? So everybody can't be a preceptor, everybody shouldn't be a preceptor, just like everybody shouldn't be an educator and everybody shouldn't be a preceptor. Everybody shouldn't be a preceptor, just like everybody shouldn't be an educator and everybody shouldn't be a manager, you know, and some people shouldn't be at the bedside, you know so. So that's how the whole thing started was one forum that I was looking for, looking for an easy replacement, and I realized, if I couldn't find that information on precepting at that point being in, that was my job that probably other people couldn't.

Nicole Weathers:

I think, so many of the guests how the book was born.., and I think so many of the guests that we've talked to, when you ask them how they got into this, that's really where it all starts right. They went looking for something that they needed and it wasn't there, and that's usually the impetus of whatever sort of direction there may be. Career goes along with, you know other things that they might do. So I want to just circle back to that comment by the nursing student of you. Know, can you just put us with people who want students? And I think that is something that's such a problem sometime in practice is like we tend to just put students new nurses, new grads with who's ever available, regardless of if they're good at taking students and precepting students or if they even know what they are maybe doing, and so I think we're going to talk a lot about that today. Right, and why. That's something that you shouldn't necessarily do, but I think there's this belief that if you know how to do something, you know how to teach somebody to do something.

Dr. Beth Ulrich:

thought everybody who was a good clinical nurse could be a good manager. Well, we proved that to be wrong. Right, literally. This was the ironic part about doing this focus issue. The first article I ever had published was in 1980, back in the dark ages, and I was working on my master's, and it was called teaching the teachers to teach and it was on that very topic of we don't teach people how to teach. So maybe that was a harbinger of me getting into precepting. I don't know.

Nicole Weathers:

One of the key insights from your first book is about the many roles of the preceptor. While we often think of that preceptor's role just what we were talking about right, teaching somebody how to do their job it really extends beyond all of that. So maybe you could discuss some of the key roles of the preceptor that you identified in that first book.

Dr. Beth Ulrich:

Well, and you're exactly right. And that's why we got to those roles, because everybody was like, oh, it's just an add-on, right? If you know how to nurse, you know you can figure out how to precept. And so I was working with a group of experts because there wasn't a lot published at that point other than precepting students and we talked about what things does a preceptor have to do as part of their role, right? And it started to fall into seven categories, and the first was role modeling. And especially with new graduate students who what they see is what they think is right you know and you do something and I do something slightly different and they think one of us is wrong, because they don't have the depth of knowledge or the confidence to understand that there are two different paths, and sometimes there's three and four and five different paths, right? So we wanted to make sure that the preceptors were very aware. I think I should go back to my mom Don't do what I don't, do what I do. Do what I say, right? I don't know if your mom ever said that to you, but mine would do that when I try to argue with her. Well, you do this and she's like we'll talk about influence. That happens all the time. It's not a question of whether you do it, it's how you do it. And people who are novices watch experts, and some of the experts are better than the other experts. So we wanted to make sure that the preceptors were well aware that, from the get-go, they were role modeling right.

Dr. Beth Ulrich:

The next one is teacher-coach, and that's the one I think most of us know best. Right, that's what we think of when we think of preceptor, but the coach part is really important. I was listening to one of your um, one of your podcasts, and I know you had rose sherman on. You know rose and I go way back and you know her coaching book is excellent. And when you combine teaching with coaching, now you're not just didactically preaching to this new, new grad or whoever you're precepting, you've got to coach along with it. Right, you've got to build confidence, because competence without confidence doesn't get you very far, right. So so how do we teach? Not just to teach, but how to coach while you're teaching becomes becomes really important.

Dr. Beth Ulrich:

And then, from practical experience, we had all learned that the preceptor has got to be a facilitator. You know opportunities for your preceptees don't just magically appear and you know, if you have a preceptee and a new graduate nurse, for example, and she needs a certain kind of procedure and those don't happen every day in every shift right, you have to be with intent in order to make sure those experiences occur, and that involves sometimes getting outside of your unit, going to the cath lab, going to the ER, going to x-ray places where your patient goes and where the student needs to understand and the student needs to make connections with the people in those departments, and a lot of staff nurses aren't used to doing that. They're used to calling the pharmacy and telling them they need a drug or something like that, but not used to really setting up collaborative efforts in order to get this preceptee what the preceptee needs in order to become expert or, you know, not novice, and so facilitation was something that we found not everybody was comfortable with, but certainly they needed to do, and it didn't always have to be the NPD or the NPD equivalence job to go make the connections that you know the preceptor ought to be able to make the connections. We also felt very strongly about the protector role, and that applies to protecting the patient. Protecting the patient job one right, but protecting the preceptee.

Dr. Beth Ulrich:

Because, whether it's a verbal abuse issue, whether it's a safety issue with meds or whatever, we got to make sure that we create safe learning environments and to further distinguish it, we've got to create an environment where the preceptee feels okay asking you any question and doesn't preface every question by this might be a dumb question, but just understands that they can ask any question because it's a safe learning environment. And obviously we want to keep the patient safe. And we've got in the case a new graduate, somebody who's who's absolutely a novice, and they make mistakes. It's part of learning, right? You don't learn unless you make mistakes. None of us have not made mistakes. You know any nurse I swear, any nurse who tells you they've never made a medication error, just doesn't understand what they've done their whole career. Because what are the odds? You're never going to make one right. So we all, we all make mistakes. So we have to. We have to give the preceptor the skills to protect the patient without embarrassing the preceptee, but making sure that patient's safe.

Nicole Weathers:

Do you think that when we talk about bullying, instability, things like that that might happen within you know a unit or team, that that is part of that protector role as well? I don't know if it's protecting them from bullying behaviors on the unit, but is that part of that or does that fall into a different category?

Dr. Beth Ulrich:

No, I think it's absolutely part of it. But I think the difference in that one is we want to protect, we want to mitigate, but we also, at the same time, want to be teaching the preceptee how to do it themselves right. We don't want to protect to the part that we don't teach them what they need to know to exist on their own, because somewhere along the line they're going to exist on their own right. So I think we have sometimes we have to step in, especially early on if they get caught in the middle of somebody yelling, somebody you know being incivil or any of those, or you know physical issues, but we have to teach the preceptor how to deal with it, so that one's a protect teach.

Nicole Weathers:

Yeah, Well, and that was one of the things I think Rose kind of talked about on her episode was the importance of just managing conflict communication, some of those interpersonal skills that, because of technology and sort of our society and the way you know social media influences our behaviors, that we've sort of lost some of those skills along the way to be able to handle those types of situations. And then that's kind of a big learning curve, especially for new grads as they come into the workplace.

Dr. Beth Ulrich:

Well, and I think we have to get past, whether we realize it or not, thinking the precept is teaching skills. The precept is teaching them how to be a nurse. They're not just teaching clinical skills, right, and that's one of the things you know. We added a chapter in this last issue of the book on professional identity, right, with Nelda Godfrey and Laurie Shank two of the experts on professional identity coming in, because we have to teach them what it means to be a nurse, right, and that means how a nurse acts, what a nurse knows, what a nurse does. It's all of those things.

Dr. Beth Ulrich:

So precepting is not I'm going to teach you a skill. Precepting is for a new graduate. I'm going to teach you how to be a nurse and all that that implies. So I think that's a very important concept to emphasize to people Socialization agent gosh. This goes back to Marlene Kramer in 1974 with reality shock, right, we have to teach them how to work in the environment and culture that they're now in, and they don't always understand how to pick up all those cues and things. And so you have to teach them the things they can do and you have to teach them the things they can't do. That are written, and then you have to teach them the unwritten rules of the game, as one of my colleagues calls it right.

Nicole Weathers:

Oh, because every unit has unwritten rules.

Dr. Beth Ulrich:

And every shift has unwritten rules. Right, it's both right. And so you have to help them socialize in. That doesn't mean you have to throw them a party every day or anything like that, but you also have to go to the people they're working with and make those connections, you know, when they're first there, so that they feel a part of the whole, so that they understand the culture, because without that they're just going to be living on the periphery the whole time and that's not what we want from them, right? So real important to do the socialization stuff.

Dr. Beth Ulrich:

And kudos to Dr Kramer. She's one of my heroes, right, she, she. One of the best things that she ever taught me was if you want to know what's going on, you go to the people where it's happening. You know, and so the large majority probably all of my research and my surveys and work environment and all those things that I've ever done we go straight to the direct care person. We want to know what's happening in direct care. Don't ask me, I haven't been next to the bedside in a while. Don't ask the manager, because that's not their primary job, you know. You have to ask the person who's closest to what happens.

Dr. Beth Ulrich:

Great advice, yeah, and so she. Just she banged that into my head a couple of times when we were working together, right, and I and I'm grateful for it, and I actually got to co-author an article with her before she passed away, which was probably one of the highlights of my career, and it's interesting because one of the things she talked about was how no other profession expects their person to do multiple things at once in the way we do. And she equated. She said you don't ask a lawyer to try a case in five courtrooms at one time, but you ask a nurse to take care of five patients in different rooms at one time. And we have to teach especially new graduates that skill right to be able to do that. Because, like you were talking about a minute ago, it's not and we were talking about it's not just about skills, it's about time management, it's about prioritization, it's about all those things, and that's why precepting is so complex, it's not just hey, could you watch the student today?

Nicole Weathers:

Well, and while you can give didactic and test questions about those those competencies in nursing school, it's not until you're actually out there taking care of patients, working with a preceptor, that you really get the opportunity to try these strategies out and use these things in real life, right, and so that idea of the preceptor also being a coach alongside you, elbow to elbow, helping you sort of work through these first-time situations, I mean what a big responsibility when you really think about it no-transcript bad or indifferent.

Dr. Beth Ulrich:

You're always influencing, right. You're always influencing on how to treat people, how to take care of patients, all those things. So the leader-influencer part we felt was really important for preceptors to recognize that that was a role they were in and they're not only leading and influencing the preceptee, they're leading and influencing the other people who are working with the preceptee right. So it's both directions, you know.

Nicole Weathers:

Yeah, and I love that you include that one, because I think influence is something that there's not always awareness of. Like, I might not always be aware that I'm influencing all these different people in my role, but when you really take a step back and reflect on that and gain some awareness, it's like wow, with great influence comes great responsibility to make sure that we're performing at our highest standard. Right Because of that, that level of influence that's there.

Dr. Beth Ulrich:

So the last role that we identified was evaluator, and this is the one that sometimes gives the preceptors the most trouble, the most angst, because a lot of times, staff nurses have never, ever, had another person's job in their hand, right. But if you're precepting a new grad and you say, no, they're not ready, no, they're not competent, no, they're doing these. You know I can fix, we can fix this and this, but I don't know that we can fix this part and maybe this is not the person for this unit, right? That's that weighs on new preceptors, especially because they they don't have a badge that says I'm the CNO or I'm the director or I'm the manager or whatever, but they now have that person's career job in their hands, and so it becomes really, really important to teach preceptors how to evaluate, how to give feedback, how to debrief and how to be okay with. I might need to say this person doesn't belong on this unit. And it's just hard.

Dr. Beth Ulrich:

It was hard for me as a new manager, Gosh, I put off terminating somebody for two weeks and then she did something else bad, and then I felt guilty, right, when I knew I should have terminated her. I found every excuse in the world. You know, it's Monday, it's Friday, it's a holiday, it's the afternoon, it's the morning, it's whatever you know. And but when she did the next thing that could have hurt a patient, right, and I knew I, and I terminated her that day, but I knew I should have done it weeks earlier, right, but I didn't have enough experience at that point to understand that as clearly and how important it could be to make sure that the person I'm teaching, the person I'm leading, the person I'm responsible for, is competent to do their job.

Nicole Weathers:

I think that kind of goes back to protecting the patient and protecting the nurse, because you don't want to put that nurse in an unsafe situation in which they're going to potentially harm somebody and then that could be career ending for some right. And so, even though it is hard to evaluate and say this isn't maybe the right fit or the right place, it's really in the best interest of that nurse to get them where they can function the strongest and have the most impact for patients.

Dr. Beth Ulrich:

Well, in the best interest of the patient and the best interest of the organization as a whole, because you don't and the other nurses there, because you know, when we have a nurse on the unit who's underperforming compared to their peers or colleagues, whether it's a new graduate or not, when that person leaves, if you're the manager, and all of a sudden you hear, oh my God, I'm so glad he's gone, she's gone, and they start to tell you the stories. Right, you've got to listen to your gut with management and evaluations and stuff, just like you do when you're taking care of a patient. You know, we all know that we're taking care of a patient. Sometimes we walk in a room and you just know something's wrong, and it's either you recognize a pattern or you recognize the absence of a pattern, something you expected to happen isn't or something you know. It's pattern recognition. Right, it's in our brains. It's not necessarily in the forefront of our brains at that point, but it's someplace back there. The little neuron starts to fire.

Dr. Beth Ulrich:

You know, spidey sense, right, something's wrong, right, you've got to take that into all the aspects of nursing. It's not just when you walk in the patient's room. It's this nurse isn't fitting. There's something about how she does things, that she doesn't understand the need to do things faster or how to do this, or that you got to take that spidey sense into education as well as into or this is a nurse who just I think she doesn't understand. Maybe if I explain it a different way she'll get it and you try that. You know it's that old. Some people learn by touching, some people learn by hearing, some people learn by reading and all those kinds of things. Maybe you just haven't given her the information in a way that she can absorb it the best, or he, but maybe they just can't do it too.

Nicole Weathers:

Both great points. So when you break it down into these seven roles, I mean, precepting is a huge responsibility.

Dr. Beth Ulrich:

Yeah, and it's a complex job too.

Nicole Weathers:

Very complex. So when? So okay, so these were all identified, if I remember correctly, in your first book, because I was somewhat familiar with that. So when we fast forward to book number three, you mentioned professional identity was one of sort of the new learnings or insights that you've added. What are some other like key things that have sort of came up over that 13 year span?

Dr. Beth Ulrich:

Well, we also in the second edition, we added a whole chapter on how to use the book to develop preceptors and how to develop preceptor workshops and preceptor programs and stuff, because we were hearing and when I say we, I mean me and all the people who helped contribute to the book we just started to understand that we could say you need to develop preceptors, but there were a lot of people that needed more information or needed a pathway or needed a map or whatever, and so we added a chapter on here's what you can do this and here's some ideas for you know the activities you can do in your development. And look, this happens to be a curriculum for developing a preceptor, right, and it put all the complexity in there and obviously we use the book as what you could use for that. So that was one thing that we recognized along the way. In this third edition, we also added a chapter on nursing professional development practitioners right, because even though we've been talking about precepting and training them, we realized that we we also added a chapter on nursing professional development practitioners, right, because even though we've been talking about precepting and training them, we realized that we didn't have and we had a called out chapter for managers, like how to hire preceptors and all those things. But we didn't have a called out chapter for NPD practitioners and so Mary Harper and Patsy Maloney worked on that and they're very active leaders in NPD. So we added that chapter.

Dr. Beth Ulrich:

The other thing we added and I have to go back to Mary and Patsy on this about five years ago Mary Harper calls me and she said hey, we're doing this job analysis research thing on preceptors nationally for ANPD and and we're gonna know if you want to play my interpretation, you know. And and then she said we know you're really busy, we know you're doing the work environment stuff, and she's told this story from the stage too. And she says so if you don't have time, we understand, but we want to use your model. And you know, at that point I was like, well, if my model is going to be there which, by the way, I always had a hard time calling it a model, cause I don't see myself as a model girl or a theory girl right, I'm in my hand, I want to use it right now. I want to give people stuff they can use right now. So then I always have a little sort of a tweak.

Nicole Weathers:

You know it makes me pause when it happens, but Because did you call it a model in the first book?

Dr. Beth Ulrich:

I think I did, but only because the publisher said they said first of all, they said we need a visual. I didn't, I hadn't, so I'll make a visual. It's not a very complex model in terms of the visual right and I think I didn't call it the ulrich model. I think I called it a model, precepting so, because I just didn't sound like me to make you call it the ulrich model. But anyway, when mary calls and she said we want to use your model, I think my quote that she says is I said well, where my model go, which is a good philosophy, because the idea of somebody else doing a big, huge national study based on what you've done and you not being part of it, no, I want to be there right. So we spent. It was supposed to be a year project and we got this. Thank God, we got the national survey out right before COVID and everything closed down. But it's the project that keeps on growing, because first we wanted to know about preceptor experiences and things like that and we also wanted to know what kind of what skills and what competencies active preceptors and people who taught preceptors thought were important for preceptors. No-transcript laughing, you know, when the data came back because I was like, what do I do now? I just say, oh, I guess it didn't, plus, I guess maybe more. We have a list of competencies. And we used an eDelphi study after what they told us and we narrowed it down. We got people who teach preceptors I don't know, you might have been in that group, you know, we, we kind of. And so we came up with a list of a consensus list of these are the competencies you need to be a preceptor. And it scared the bejesus out of some people because it took so long. Right, and we said our response was well, the Delphi group it's the only time in my life I've ever done Delphi study and when you send it out on a Delphi study you say I've got X number of things and we need to reduce them. And the Delphi group comes back and says nope, we're going to give you more, you missed a couple, we're going to give you more. So that didn't work out quite the way it was planned, but eventually it did.

Dr. Beth Ulrich:

But we came up with a list bit until we were sure we had them locked in. And so for every role now we've got a solid list of competencies on what a pre-shifter should be able to do. And in doing that we found that there were some core competencies that just kept threading their way through all the roles and so we called them out as core competencies no-transcript getting repeated in each role and then we thought we were done. We were like, oh, this is sad. We've been working together for all these years, now we're done. And then somebody called and said, hey, can I make an assessment out of your competencies? And we were like, hmm, maybe we'll do that, you know, since we've got the research. So now we've actually got an assessment created that can be used by preceptors or preceptor evaluators or preceptees who are evaluating the preceptors, which is an important point because, like ANCC wants to be very clear that there's input from the people being precepted when they're doing their program. To add to that, we've actually got a national database that if people contribute to it, we can do comparative data, and we're hoping that some DNP and PhD students will want to get their hands into there and look even deeper into the data than what we have.

Dr. Beth Ulrich:

So we added the competencies look even deeper into the data than what we have.

Dr. Beth Ulrich:

So. So we added all. We added the competencies, we um, we ran the role definitions by um, the Delphi panel and by the people the 4,000 people and we tweak those a bit. So if you compare the 2012 ones to the 2024 ones, you'll see some slight differences on the on the definitions, but we ended up with a consensus definition on all the roles, um, which is why Mary and I tend to get both, you know, cited when we do them, because we want to make sure they see that it came from both of us.

Dr. Beth Ulrich:

And so that's where we are, you know. And what happens is, every time we do an edition you heard me do it at the meeting we were at is I ask people of use, whatever the current edition is, to let me know what changes they'd make. And that's how we decide what changes we make, what we add or what's missing. And that's how we came up with professional identity and that's how we came up with the NPD chapter, and so you know, it's the Marlene Kramer. Go back to the source, right? If I want to know what needs to be fixed. Go back to the people who are reading the book and using it, right.

Nicole Weathers:

Well, what a great kind of growth mindset to have, though, because I could see where, you know, sometimes we put something out there and we, what we put out there, we think is kind of like how it is. But to have that ability to say, you know, as the world evolves, things evolve and we need to evolve too, so I think that's really, really great and people are willing to help.

Dr. Beth Ulrich:

You know it's. I found that in a lot of cases, you know, a lot of times people don't ask because they don't, they go, nobody will answer this. No, I send it out and people write me and go oh, I'd add this or I'd take away this, or I'd do this. You know, and I think people are in general willing to if it's something they care about and believe is important, absolutely. It's like when we were doing it was because work environment was very important to nurses, and so they will. They will fill out long forms if it's important to them. If it's not important to them, nothing's happening right. And I'm the same way. If somebody sends me a survey, if I think it's an important topic, I'll spend time on it.

Nicole Weathers:

But if I don't you know.

Dr. Beth Ulrich:

So I think you always have to remember that. You know it's not. Sometimes you can ask more questions and people will do it as long as you've got a topic they think is important.

Nicole Weathers:

Well, let's take a dive into one of the things so you mentioned. The newest edition of the book does have, well, the second and third edition. I guess you talked about kind of developing that preceptor workshop educational platform to teach people how to be a preceptor, and that's one of the common topics that we tend to discuss with people. As we have new organizations join us, start using our nurse residency program, we talk a lot about the current state of their preceptor situation, emphasizing that you can have the best nurse residency program in place, but you're going to still struggle with your new grads if your preceptor situation is lacking. So what would you say are some of the critical sort of components of a robust preceptor program?

Dr. Beth Ulrich:

It has to have a structure. It's team ball. You don't teach preceptors, you don't support preceptors. You don't support preceptors without the team being engaged. It's about developing and supporting preceptors, not a one and done workshop. And we heard that really clearly on the national study that we did for ANPD was that you can't just give somebody a two-hour workshop and never talk to them again about how to be a preceptor. We started calling it a booster because we were in the middle of COVID right Boosters. You started calling it a booster because we were in the middle of COVID right Boosters. You know they need.

Dr. Beth Ulrich:

It's just like you bring new graduates back after a while. It's like what's going on, you know, and what do you need to work with, and it doesn't have to be anything formal. You know it could be. Maybe there's some new technology you know we're all using AI now and for stuff and things like that and maybe there are some new things that we can teach our preceptors. But maybe it's just.

Dr. Beth Ulrich:

What kind of problems have you run into in the last six months? You know how'd y'all handle them. Let them talk to you. They can teach each other. It's not like you know you don't have to and you shouldn't just stand in front of a room and preach, right, it's like learn from experiences and let shared experiences do some of the development, because you know, the first time a new graduate, it affects the preceptor too. You know, when they start questioning, did they do everything they should do, and things like that. That's the time to bring everybody together and say let's talk, let's see how you handle this and let's see what we could all do better. And you know, it's kind of like the Army used to call it after action reports. Right, it's a and done and we see so much of that. Right, there's got to be some follow up.

Nicole Weathers:

And that's something as a team we've been talking a lot about, especially after the conference the MCIRN conference that I met you at was this idea of okay, how can we make this not a one and done? What does that look like moving forward? And I love that you kind of point out that it doesn't have to be, you know, a super formal thing, that there are other ways for that learning to kind of take place, and I love the idea of getting them together and letting them learn from one another, because you only have the experience that you have and you can definitely learn from what other people have experienced as well.

Dr. Beth Ulrich:

And the other thing, I think, is that you probably have to make it mandatory, right, because otherwise the people who really need to be there are the people who won't be there. You know, it's like when I do classes or online classes at school. If I just open them up, like, okay, we're going to do Q&A on this assignment, I can almost guarantee you that some of the people that really need that the most will not be in the room if it's not mandatory, right. And so you may do mandatory stuff, but you can also do, you know, some micro learning kind of stuff. It doesn't have to be an hour conversation, it can be a half hour. You know, it can be a get on, you know, and you can have a topic, or you cannot, or you can ask them ahead of time what things have happened that they'd like to talk about no-transcript, and so the manager sees it different, the director sees it different, the preceptee sees it different, but the preceptors have the answers to what they need. It's the Kramer rule Go to the source, right. I think you also need you've got to teach people how to give feedback. When we were first talking today, we were talking about how we don't teach people how to be educators. You have to teach people how to give feedback.

Dr. Beth Ulrich:

The simulation folks have been very clear from the get-go about debriefing and how important that is as part of a simulation. If you just do a simulation, we're going to come in the lab, you're going to do something, you're going to leave. You don't learn from it, right? You come in the lab, you do the thing. Now we're going to sit down and debrief and talk about why we did A or why we didn't do B or whatever, and that's when the learning occurs. So we have to teach the preceptees and it might be role playing, you know, it might, it might. There are certain things you can teach in a class or they can read, but some of the things they got to do you know. But I think they really have to understand how to provide feedback, how to, how to lead the preceptee into reflection.

Nicole Weathers:

Well, right, Because just saying oh yeah, you did fine.

Dr. Beth Ulrich:

Does this to everybody right.

Dr. Beth Ulrich:

And how to come up with a plan that says how are we going to make this better? You know how are you going to improve this, the skill that you just did, and even if you did it right, you know what. What can we, what can you do different the next time or where were you uncomfortable? And they've got to not ask those. Yes and no questions, right, even questioning, right. That's part of feedback. Is I need to ask you something that will force you into giving me a whole sentence or more than one word, or yes or no?

Nicole Weathers:

Well, it's kind of like the idea of teach back for patient education.

Dr. Beth Ulrich:

Exactly, exactly.

Nicole Weathers:

Well, I think those are all great things to kind of think about as people are developing their preceptor workshops or preceptor programs. Maybe now we can talk a little bit about because we hit on this briefly in the beginning but talking about the differences between precepting a student, a new graduate, maybe a more experienced nurse. What words of wisdom can you impart on us around that?

Dr. Beth Ulrich:

Well, let's go back to basics with Pat Benner. Right? Pat Benner did novice to expert, does we're all using it? Right? But one of the things that Pat will remind you of is that you can be a novice in one place and an expert in another place at the same time. You don't just, you're not all novice, you're not all expert. And so I think when we're teaching somebody how to be a nurse practitioner, if you will, or precepting in a nurse practitioner role, or if we're precepting them into a manager role, we're precepting in an educator role. They might be clinical experts in whatever they do.

Dr. Beth Ulrich:

New graduates, when they come in, know they don't know some stuff they need to know. But when you've got somebody who's an expert in something and it's used to being the person other people come to, it's hard for them to put themselves in the student or in the preceptee role, and it's sometimes hard for the people who knew them, who know them in their other role, to do what needs to be done for them as a preceptee. Right? This may be somebody you work for, and now they come into a different role. And now you've got to be the teacher. This may be somebody you work for, and now they come into a different role and now you've got to be the teacher. So I think that's one of the I think that's one of the big differences is that the student, the student nurse, expects to not know stuff when they go into the clinical area.

Dr. Beth Ulrich:

The new graduate nurse it's funny, we used to. We used to sort of plot confidence and competence and things like that, and, and some of the other new graduate programs did too. And one of the things and you guys may, but one of the things we found was when the new graduates started the residency, if you said, how competent are you? They thought they could save anybody, right, you know? I mean they came out of school going I can cure cancer, you know what I mean it's like. And they're all enthusiastic and you don't want to lose that enthusiasm, but you know they're not safe at that point, right, and so you don't know what you don't know, you don't know what you don't know, right, and.

Dr. Beth Ulrich:

And so they'd say, oh, I'm confident up here. And the preceptor would say, oh, you're down here, right. And then there comes that that time when the preceptors they've been there long enough that the preceptor starts to back away, and maybe the preceptor says, okay, you take care of the patient and come get me if you need me. Then they get scared because now they're put in situations where they know they can hurt somebody, they know they don't have somebody like one inch away from them to help them, right. And they know they have to say I don't know what I'm doing in order to go get that person.

Nicole Weathers:

And they have to feel safe to be able to say that.

Dr. Beth Ulrich:

Right, yeah, exactly, and so that's a different teaching than if you're teaching a nurse practitioner how to be a nurse practitioner. You're not teaching a nurse practitioner a lot of times how to do clinical skills. You're teaching them how to be a nurse practitioner, how to identify as a nurse practitioner, what that professional identity means. So I think it's just you have to be aware, you know it gets back to you're back in the teach back right. Assess the patient first, see what the patient knows. You know. In this case the patient is the precept D. See what they know.

Dr. Beth Ulrich:

Working with a lot of, a lot of new graduates and you guys probably see this you know if new graduates come out of a certain school, they know some things and they don't know other things. And if they come out of another school, they know some different things and they don't know other things. Right, and you learn to compensate for that, you know. And if you're in really good relationships, you get the feedback to the school and say you know, the last 10 new graduates that came out of your school that we got seem to be a little weak on X, y, z or they're really strong on this but this. But not everybody does that you know they just sort of take it and they don't analyze the data. And that's important data to have, both on who you hire and on what you need to teach them when they get there. And you know it's like teaching an ADN new graduate and teaching a baccalaureate new graduate. They both have strengths and weaknesses. You just have to know what they are.

Dr. Beth Ulrich:

And not everybody was at the top of their class when they graduated and walked the stage. And not everybody was at the bottom of their class. So you shouldn't make assumptions right. So I think you just have to look more at what the people knew and you need to look more at the role transition. Sometimes like with a nurse practitioner, with somebody going in to be a manager, with somebody being an educator and worrying about they don't touch the patient anymore. You know how do you help them understand that? You do just indirectly. So I think it's more of a role transition than skill transitions. And even though student to professional is a role transition, the clinical part is so overwhelming that that's not what gets you first.

Nicole Weathers:

I hear you. I mean I hear you saying we need to treat each one as a unique situation. Almost it's kind of like parenting your kids. Right, you can't parent them both the same way. They need unique things based off of whatever their background is. I mean, there's a lot of factors that kind of come into what that precepting situation might look like.

Dr. Beth Ulrich:

Well, yeah, I mean, the kids is a good example. I mean, you see families with five kids and there's five totally different individuals, right, they are nothing alike in their personalities. They might look a little alike or whatever, but they're not alike. They live in a different world. The first one and the last one live in very, very different worlds, right? So so I think that's we always have to remember that we we don't make assumptions about the person came from this school, they do this.

Dr. Beth Ulrich:

The person graduated here, they do this. The person's already been a critical care nurse or she can honestly be a nurse practitioner. That's a role transition, you know, and that's that you know. You know, that's the thing I preach that if anybody's going through a role transition, a transition from graduate to practicing, to any of those things, they ought to have a preceptor. We might it might not be a structured residency, but new managers need somebody they can talk to. That's not their boss, you know. It's the same thing. New educators have questions. When they become educators, when they become MPD practitioners, they have questions. Who do they go to? You know, somebody needs to provide that guidance and that support and that, to me, is a preceptor role. We just don't always call it a preceptor. I'm really excited by the way that there are more and more new manager programs and there are programs that are using preceptors and new manager programs. I think we've needed that for a really, really long time.

Nicole Weathers:

Any specific strategies or techniques, when it comes specifically to new graduates and supporting new graduates, that you find particularly effective?

Dr. Beth Ulrich:

Well, I think it's what we were just talking about. You know they're all different. We can't assume new graduates are the same. You know they have different backgrounds and they're not all going to react the same way to everything.

Nicole Weathers:

So, as we look towards the future, how do you see precepting nurses evolving? Do you see any emerging trends or challenges that we should anticipate?

Dr. Beth Ulrich:

Well, you know, the elephant in the room is the workforce shortage, right, and we faced that during COVID and we faced it since COVID, and I think there's a lot of creativity going on. I think people are learning what they can teach online and what they need to teach in person. There's no one right way, there's a bunch of wrong ways, but there's no one magic solution on how you do it. I do think we have to look generationally, but then I say that and then we have nurses starting nursing older, so we can't totally look at that. But people learn different and I think you guys do online on your residency. Some people try that and don't understand how to teach online. So now we're back to we got to prep people and we got to teach people, because if somebody is going to do something online, they need to understand how totally different that is than having somebody in front of you.

Nicole Weathers:

Well, and you can't just take a class for in person and put it online.

Dr. Beth Ulrich:

Right, yeah, yeah, I just don't take that and go here, you know, because that didn't work worth a darn, you know. And you have to have some varying strategies for people who learn differently, right, and you have to have some varying assignments and things like that. And so I do like the preceptor programs that have the preceptor do something during the program. You know that some sort of quality improvement or some sort of way to make things better, right? You know that some sort of quality improvement or some sort of way to make things better, right, and I think more and more preceptor programs are celebrating when people finish, but it's not across the board yet, and I think we really need to recognize this is a big deal. This is something they learned that they didn't know.

Dr. Beth Ulrich:

I ran into one hospital. The OB unit actually did a gold cord and they cut it, sort of like cutting the baby's cord. You know, here's the preceptor at one end and here's the preceptor at the other, and okay, now you're on your own. I also think we have to, we have to realize that you're not going to learn everything in a residency, right, and how we do that transition from you're not in the residency anymore, but we know you don't know everything you need to know. So how am I going to responsibly, as the preceptor, transition you over to your manager or to however you're doing it in your organization, so that you don't stop learning or stop having the opportunity to learn the day you walk out of the residency? Right, because I don't. I don't know about your program, but there's a big percentage of people in the residency who still have things to do and learn.

Nicole Weathers:

Yes, absolutely. Well, I mean, I think as nurses we're lifelong. We're never done right. So just like we weren't done when we graduated nursing school, we're not done now that we're done with residency, or once we learn to become a preceptor or whatever. That next thing is right. It's going to be a continuous process.

Dr. Beth Ulrich:

And I think that gets us to the point of it really does take a village right. The preceptor can't do it all by themselves. Of it really does take a village right. The preceptor can't do it all by themselves and they shouldn't. It takes a big support group, it takes people engaged in having this preceptor succeed. And so how we create environments that expect everybody to play in that game right and that teach everybody how to play in that game. You know, and it's not just other nurses, it's physicians and it's other department managers, and it's you know, it's it's everybody saying this is a new person who's graduated and who's going to be part of us. And how, how do each of us contribute to that person's success?

Nicole Weathers:

I love that idea of really thinking from like an interdisciplinary standpoint.

Dr. Beth Ulrich:

Well, you know it's interesting. I've I've had people who run preceptor programs tell me that you know that they've gotten the physicians involved on certain units. And the physicians some of them, not all of them, some just like us, some of them like to teach. And if you say this is our new nurse, who's? And here's what she is, and she graduated from here, and blah, blah, blah, she could, boy, if you could show her how you do something. You know, if you ask people to help I like the book and how you make it better People will often help. But we hesitate to go across that discipline line and say respiratory therapist, could you help us show our preceptors that precept, these, how to do this? You know, physician, could you help us show our preceptors how to do this? And then they engage because they're part of it.

Nicole Weathers:

It takes a village.

Dr. Beth Ulrich:

Yeah, so I think we got to get the village going, you know, because we can't, can't, three of us can't do everything.

Nicole Weathers:

I love that. Well, beth, we have talked about so much. We've talked about your book, we've talked about changes to your book, We've talked about the difference between you know, training and precepting different levels of nurses coming in to our organizations. It's been a great conversation, but before we let you go, I have one last question. I always ask this, actually, of all of our guests, because I really want to know, when it comes to the topic of precepting, what is one thing that you see organizations doing that you think makes a significant difference and you wish more organizations would just do this thing.

Dr. Beth Ulrich:

I have two. You know I wouldn't stop with one. One and done is not enough. You can't just develop on one and then expect them to go out and run on that for the rest of their preceptor lives and you have to have preceptors who like being preceptors. Back to that student who said why can't we just be put with nurses who like us? You can't just dub everybody a preceptor. You have to not only train them, but you have to know that this is something they enjoy. The third quick little thing is, as we were talking about earlier, there's going to be a fourth edition of the book someday. So if anybody who's listening to this has read the book, has used the book, anything connected with the book, my email address is out there all over the place. It's bethtolrich at gmailcom. Just email me and just give me some hints. You know, give me some tips. I really like this. I think you could make it better by this. I collect those all the time, from the day an edition gets published to the day we do the next one.

Nicole Weathers:

I love that. Well, I know I am actually going to. I mean, I know I said this, but I'm going to go get the new edition of the book because I just have the first one and it sounds like you've added so much good stuff that I definitely need to get that copy myself. So, Beth, it's been so fun visiting with you today. I can't wait for our listeners to hear this episode. I think there's so much good stuff that they're going to take away from it, but I really appreciate all the work that you've done for nursing and for precepting and for spending your valuable time here with me today.

Dr. Beth Ulrich:

Oh, it's been fun, nicole. I really appreciate you having me. You guys do great work up there and you're leading the way on precepting, so it's good to talk to you.

Nicole Weathers:

Wait. Before you go, I want to make sure you know all about our suite of resources you can use to support your new graduate nurses. This includes our academy, a coaching program designed for organizations as they prepare for the implementation and ongoing sustainability of a nurse residency program. Work one-on-one with residency program experts to make sure your organization is residency ready. Our clinician well-being course is an asynchronous online course that aims to enhance the well-being and resiliency of healthcare professionals, equipping them with the necessary psychological capital to navigate challenges inside and outside of work.

Nicole Weathers:

Supporting Nurses is another asynchronous online course for preceptors, mentors and coaches to learn the skills they need to support any new hire. Both of these offerings can be used as a standalone professional development opportunity or to augment any nurse residency program. And we can't forget about the program that started it all the online nurse residency program. This includes a comprehensive curriculum designed to support new graduate nurses, applying all the knowledge they learned in school to their practice. We focus on professional skills, personal well-being, competencies, and new graduate nurses even get the opportunity to create real change in their own organization. Offered completely online and in a blended format, this program is highly adaptable to all clinical practice settings. You can learn more about all of these programs and more of what we offer using the links in the show notes below.