The Journal of Continuing Education in Nursing

Teaching Tips 

Precepting

Karren Kowalski, PhD, RN, NEA-BC, ANEF, FAAN

Abstract

Precepting differs from coaching and mentoring in that it is time limited, structured, and based on specific organizational goals, objectives, and competencies related to a specific unit or area, as well as the organization. It also requires a prepared preceptor and support from the organization and the professional development faculty. [J Contin Educ Nurs. 2020;51(2):62–64.]

Abstract

Precepting differs from coaching and mentoring in that it is time limited, structured, and based on specific organizational goals, objectives, and competencies related to a specific unit or area, as well as the organization. It also requires a prepared preceptor and support from the organization and the professional development faculty. [J Contin Educ Nurs. 2020;51(2):62–64.]

Precepting is a critical part of the process of enculturating new employees into a unit or area of health care. A preceptor is a person who guides, tutors, and provides direction to the preceptee who is the health professional undergoing training (Lexico, n.d.; Merriam-Webster, n.d.). This series of Teaching Tips columns has attempted to assist professional development faculty to understand the distinctions between precepting, coaching, and mentoring (Kowalski, 2019; Kowalski, 2020). In Table 1, the descriptions of each of these roles is compared. A preceptor, in an ideal situation, has volunteered to be a preceptor and has received preparation for the role via webinar, classroom work, or both.

Comparison of Precepting, Mentoring, And Coaching

Table 1:

Comparison of Precepting, Mentoring, And Coaching

The precepted experience is usually a prescribed length of time and in the best case, the new hire is “buddied” with the preceptor and they work together. In the beginning of the process, it is helpful for the preceptor and the preceptee to have time together to establish a relationship, discover some commonalities and mutual interests, and begin to form a foundation to build on. This can also provide the opportunity for the preceptor to introduce the new nurse to the current staff. In addition, all team members are introduced and their role in care of the patient is described (e.g., physical therapy, social worker, case manager), as well as how to contact them.

Establishment Phase

Ciocco (2016) believed that precepting occurs in two phases: the establishment phase and the working phase. In the establishment phase, the preceptor has advance notice of the arrival of the new clinical nurse and details about the nurse (such as years of experience, the area that was their first choice, and the new hire competency assessment results). The standard competencies and the specific learning and practice objectives for orientation to the specific area should also be available so that the preceptor can organize their thoughts and an orientation plan for the new nurse. These are sometimes formatted and standardized objectives with the possibility of individualizing these to the skill set of the new hire. They are in writing with the ability to identify those activities that were accomplished and what still needs to be experienced. The preceptor meets with professional development staff and unit leadership to plan the experience. The preceptor reviews the preceptee's skill set as established through simulation so that the preceptor can assess the preceptee's preparedness for patient care and to understand what the preceptee knows and what they need to learn. With the preceptee, the preceptor reviews the assessments, any previous experience, future goals and objectives, and the learning style, as well as how best to teach, give feedback, and effectively reach goals. The orientation plan should be thoroughly reviewed with the preceptee, and open, honest communication is encouraged.

Working Phase

During this phase, the orientation plan is implemented, and the preceptor serves as a role model for the new nurse while acting as a consultant and a resource person. Clinical experience is presented in a way that encourages the use of critical thinking skills and models professional nursing skills, both theory and practice, as well as problem solving and decision making. During the initial stages of the working phase, the preceptor encourages the preceptee to observe the preceptor and other clinical nurses as they provide patient care and function as integral team members with other professionals involved with the care. It is important to debrief these activities at the end of the shift to emphasize observations and the resultant learning. These observations are then aligned with the transition process including objectives and competencies. Regular feedback is provided by the preceptor in a positive, supportive way that augments the preceptees' learning.

Progress is monitored as the preceptee moves from observation to application and to a self-directed role in which the preceptee becomes more independent and the preceptor takes on an observational, supportive, and advisory role. Goals are reestablished as the preceptee progresses and continual reassessment and reevaluation is performed by the preceptor. These activities are monitored with each shift the preceptor and preceptee work, and daily logs, competency checklists, and any additional documentation is addressed. The preceptor also has ongoing conversations with the unit leadership and the professional development faculty responsible for the transition into effective unit practice. As the orientation and the preceptor and preceptee relationship nears culmination, it is not unusual for the preceptee to experience a sense of loss and it is important to discuss these issues. The relationship will change and the preceptor can still be a supportive resource for the newly oriented nurse—the preceptor can be a friend and a professional colleague.

Possible Complications

Goals for the newly hired nurse may not be clear and this can complicate the process. A lack of support from nursing administration may be a difficulty. Staffing pressures may complicate the precepting process and result in doubling of the workload and responsibilities of the preceptor. In some situations, preceptors are not paid nor do they receive other rewards for this work, which can further complicate the process. When staffing is short or when an excess of admissions occurs, patient care can supersede the orientation process and compromises the precepting process, which can affect the progress of the preceptee.

Positives in the Precepting Process

Many positives exist in this precepting model, not just for the new hire but for the staff and for the patients. For example, both the preceptor and the preceptee learn new skills and a good program ensures a positive transition into the unit and a high quality of care to patients. The preceptor can facilitate the new nurse in accomplishing goals, increasing self-confidence, and even realizing their dreams. Effective preceptorships and orientation of newly hired clinical nurses support the nurse's desire to remain in the unit, thus decreasing turnover. A confident new nurse can be successfully incorporated into the unit nursing family.

Effective Precepting

Efficient preceptors provide leaning and practice objectives that are clear, concrete, measurable, and written and therefore consequently more easily evaluated. The effective preceptor orients the preceptee to all unit-based policies, procedures, and resources. The preceptor does not allow the preceptee to work above their scope of practice and or for staff members to pressure the preceptee to do so. The preceptor is objective in all assessments and is supportive in all communication, including asking effective questions that lead the preceptee through a process of discovery and learning. The preceptor problem solves with the preceptee whenever a difficult situation arises. The preceptor facilitates a welcoming environment in the unit and supports integration into the staff community.

Inappropriate Preceptor Behaviors

Lack of clarity about the goals and competencies involved are on the top the list, as neither the preceptor or the preceptee will have any idea about what needs to be accomplished or how to proceed. If the preceptor has an inconsistent communication style, has a negative attitude toward the preceptee, or fails to practice based on evidence, the process flounders and can be unsuccessful. If the preceptor attempts to create the newly hired nurse in their own image rather than support the preceptee to become the best possible nurse, the process fails. When the preceptor fails to establish a meaningful relationship or belittles the preceptee in communication or patient care activities, the process can be unsuccessful. If the preceptor leaves the preceptee alone in new situations or creates significant down time or spending time at the nurse's station rather than creating significant positive learning situations, the orientation is ineffective. If the preceptee is used as staff prior to completion of the preceptorship, it can lead to an unsuccessful outcome. Most importantly, the preceptor desire to perform this work—if it is an assignment because it is the next nurse's turn, with little or no preparation, the process can be unsuccessful.

Summary

Having an effective precepting program with preceptors who are prepared and supported improves the transition of new hires into a busy unit. It can also support quality patient care and contribute to staff retention. The confidence of the new nurse and acceptance by the existing staff can also be positively impacted. Although different than coaching and mentoring, well-run preceptorships and effective preceptors are an attribute to any organization.

References

  • Ciocco, M. (2016). Fast facts for the nurse preceptor. New York, NY: Springer.
  • Kowalski, K. (2019). Mentoring. The Journal of Continuing Education in Nursing, 50, 540–541.
  • Kowalski, K. (2020). Coaching. The Journal of Continuing Education in Nursing, 51, 12–14.
  • Lexico. (n.d.). Preceptee. In Lexico. Retrieved from https://www.lexico.com/en/definition/preceptee
  • Merriam-Webster. (n.d.). Preceptor. In Merriam-Webster.com dictionary. Retrieved from https://www.merriam-webster.com/dictionary/preceptor

Comparison of Precepting, Mentoring, And Coaching

PreceptingMentoringCoaching
Involves assessing and teachingInvolves mentor sharing knowledgeInvolves questioning and assessing
Limited time investment, typically a few weeksLonger time investment—could be yearsLimited investment that is contracted
Evaluates attainment of specific goalsMentor facilitates decisionsFocused on reflective listening
Focused on the learner and required tasksFocused on the menteeFocused on tasks and behaviors
Authors

Dr. Kowalski is President and CEO, Kowalski and Associates, Larkspur, Colorado, and Professor, Texas Tech University, School of Nursing, Health Sciences Center, Lubbock, Texas.

The author has disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Karren Kowalski, PhD, RN, NEA-BC, ANEF, FAAN, President and CEO, Kowalski & Associates; e-mail: karren.kowalski@att.net.

10.3928/00220124-20200115-04

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