CHAPTER

1 W HAT IS A PRECEPTORSHIP ?

LEARNING OBJECTIVES

After reading this chapter, the participant will be able to

• explain the need for establishing effective nurse preceptorships in today’s complex healthcare
environments
• differentiate between coaching, precepting, and mentoring
• describe the role of preceptorships in orientations

The capacity to watch over and guard the well-being of others is an important gift, and one that is learned
with great difficulty. For it is one thing to see the situation others are in, but it is quite another to care
enough about them to want to help, and yet another to know what to do. —Judie Bopp

Introduction

Why is it so important for nurses to precept others? Why do preceptees need to experience the guid-
ance and facilitation shown by working nurses in clinical settings? We can find many reasons and
benefits in recorded literature (see the Bibliography for more information). However, perhaps the
most basic and all-encompassing reason is that it works.

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So often, two peers can solve difficulties they encounter in their work together much better than with
an educator or manager—no matter how expert or experienced the manager may be. In many ways,
the working nurse preceptor can help a new nurse or student preceptee more than the educator or a
peer. The problem or issue the preceptee wants the preceptor to explain is one that the preceptor has
recently handled. On the other hand, more experienced staff on the unit may have encountered the
situation or question so long ago that they have forgotten much that is important to the preceptee.
The staff see a multitude of other problems, limitations, needs, and issues that “ought” to concern the
preceptee, but do not. The staff also see the problem or situation in such a completely different light
that they cannot fully understand what is really troubling the new preceptee (Benner 1984).

Effective, consistent, thorough preceptorships are a major factor in the recruitment and retention of
nurses. Magnet Recognition Program® hospitals support professional nursing practice within the con-
text of teaching and learning environments. They provide consistently high-quality nursing care while
accommodating excellent preceptorships. Reconciling these two factors requires creativity, flexibility,
and a commitment to quality nursing care through facilitated orientations, competency assessments,
and competency verifications by preceptees.

The need for effective preceptors continues to rise as companies groom and grow talent from within
their ranks. Establishing definitive nurse preceptorships to guide nursing students and prepare new
nurses for today’s demanding professional practice environments is efficient and cost-effective when
done well. Although nurse managers are the key to nurse recruitment, staff nurses are the key to
retention. Professional nurse preceptors demonstrate skill in communication and the ability to work
collaboratively with others, embrace servant leadership in their sense of service to others, enjoy well-
established credibility, and determine the best possible patient care outcomes in all practice settings.
An effective staff nurse preceptorship program with such preceptors is critical to the success of student
nurses, new graduate nurses, and experienced nurses moving among the multiple disciplines and spe-
cialty areas of our complex healthcare systems.

Key definitions

Many experts have defined and described the concepts of coach, preceptor, and mentor. Yet nurses
remain confused as to how to apply these concepts in practice. The definitions presented here draw
from multiple resources, so the terms can be standardized in training and implementation.

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 W HAT IS A PRECEPTORSHIP ?

Coaches
Coaches advise and instruct the nurse primarily on job-related activities and tasks—in other words,
how to perform and prioritize technical tasks, documentation, nurse and patient safety issues, organi-
zational relationships and etiquette, professional work habits, and how to organize and delegate work
assignments and duties. Coaches introduce new nurses or students to the healthcare team and describe
the roles of each member. They make suggestions on effective patient care activities; time and stress
management; and how to organize, prioritize, and delegate work assignments. Coaching is generally
time-limited and reliant on proximity. Coaches often orient new nurses and students and help new
nurses verify their initial unit-specific competencies when they first arrive on the unit or work area.

Mentors
Mentors encourage nurses to move beyond the status quo and help them find groundbreaking profes-
sional opportunities, such as exploring new leadership roles, accepting speaking or writing engagements,
or acquiring advanced learning experiences. They challenge mentees and step into the background, urg-
ing the new or experienced nurse forward. Mentors allow nurses to learn through many of their own
failures as mentees grow and develop through debate, active listening, and open communication with
one another. By acting as a source of intellectual stimulation and encouragement, mentors help nurses
develop trust in their own abilities and skills. They push them to search out professional paths that
the nurse might not have known about or taken much longer to discover otherwise.

Mentorships can continue for an indeterminate length of time and are not reliant on proximity. They
evolve into mutual or shared mentoring behaviors. Some nurses have continued to mentor one anoth-
er across years and continents, well beyond the initial phase of the mentorship.

Orientation
Orientation is a period of introduction to the philosophy, mission, vision, goals, policies, procedures, role
or position expectations, physical facilities and resources, patient populations, and services of a particular
practice setting upon entry into a new position or setting or when roles/responsibilities change.

Preceptors
Preceptors are experienced and competent staff nurses who may have received formal training to func-
tion in this capacity and who serve as role models and resource people to newly employed staff nurses,
student nurses, or new graduate nurses (preceptees). They merge the knowledge, skills, abilities, and

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roles of both coaches and mentors to help preceptees develop and mature into strong practicing pro-
fessionals within new or different professional practice environments.

Preceptors introduce preceptees to their new roles and responsibilities, coach them on “the basics”
(where to park; when to report; where to find supplies and resources; how to find and use unit/area-
specific equipment, unit/area rules or guidelines, and the organization’s strategic plan, etc.), support
and shape critical-thinking skills, evaluate performance and give feedback for improvement, and
introduce the nurse to a wider network of nurses, frequently recommending preceptees for projects,
committees, advancements, and honors within the professional practice environment and community.
Precepting is generally time-limited and reliant on proximity. Preceptors orient new nurses and stu-
dents, help them verify their initial service-specific and unit-specific competencies when they first
arrive on the unit or work area, and provide ongoing support and encouragement as preceptees transi-
tion into their new roles. Eventually, the preceptorship may evolve into a mentorship as the preceptee
matures into his or her new role and responsibilities.

Relationship-based care
Relationship-based care (RBC) is a nursing model for transforming practice (Koloroutis 2004), focus-
ing on the value of relationships—the healthcare provider’s relationships with patients, families, and
community; with self; and with colleagues and interdisciplinary team members. RBC and servant
leadership ground the professional practice environment of care into one in which care providers are
central and able to focus all their knowledge, skills, and abilities on patients and families. This is the
essence of staff-centered, patient-focused, relationship-based care. Preceptorships provide a unique
context for RBC wherein preceptees and preceptors “experience the essence of care in the moment
when one human being connects to another. When compassion and care are conveyed through touch,
a kind act, through competent clinical interventions, or through listening and seeking to understand
the other’s experience” (Koloroutis 2004), an effective precepting relationship (a preceptorship)
unfolds. This, too, is the essence of nursing.

For nurses to be successful preceptors, they must first begin with self. Emotions and personal health
affect our reactions to others and may diminish our ability to care for others, to engage in teamwork,
or to anticipate or respond to the needs of new nurses or students. Once personal well-being is man-
aged, focus can shift to helping team members and preceptees. Healthy interpersonal relationships are
critical for delivering interdependent care to patients and their families. Then, and only then, can

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nurses focus on providing care. If one struggles with anxiety, anger, or physical discomfort (self ) and
cannot work well with his or her colleagues (healthcare team and preceptees), he or she cannot engage
effectively in even the most basic aspects or tasks of patient care (patients or their families).

What is a preceptorship?

A preceptorship is a formal agreement between or among individuals to engage in a time-limited

apprenticeship. It is a relationship constructed to link seasoned, experienced nurses (preceptors) with
students, new graduate nurses, or new orientees (preceptees) to facilitate their orientation and integra-
tion into their new roles and responsibilities in the professional practice environment of care.

Preceptorships are intentional, individualized, inspired, and transformational. They occur in multiple
formats that may be used for new-employee orientation, monitoring student nurses, or integrating
new graduate nurses into the culture of the organization and nursing service. They differ from coach-
ing partnerships, shadowing experiences, or buddy systems where new nurses or students are also
assigned to experienced or seasoned nurses. In these, the relationship is loosely organized, coaches or
buddies may change frequently, and they do not usually have the training or experience to manage a
formal preceptorship.

Although preceptorships may extend beyond the orientation or integration phase, they generally do
not facilitate preceptees’ career development beyond their present positions on their assigned units or
work settings. If a preceptorship evolves into formal or long-term career advancement, it has become a
mentorship.

Preceptorships are useful primarily during orientations to the organization; the clinical area or specialty;
and professional practice settings, roles, and responsibilities. According to The Joint Commission, ori-
entations provide new employees with initial information and development that includes an assess-
ment of new nurses’ competency to safely and effectively perform the responsibilities of the jobs for
which they were hired. The scope of the preceptorship must be clearly delineated so that preceptors
know what part of orientation rests with them and what part remains with the organization. Initial
competency verification of knowledge, skills, and abilities needed to achieve the expectations identi-
fied in the new nurse’s position description is a critical part of every preceptorship and generally
occurs during the clinical orientation.

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Competency assessment and verification are shared during preceptorships in which the initial compe-
tencies (knowledge, skills, and abilities) needed to function in specific roles and practice settings are
verified. Preceptors help preceptees develop their unit-specific competencies. They evaluate their
progress and provide feedback to help preceptees improve their knowledge and skills and develop
professionalism while entering their new roles and responsibilities.

Exceptional preceptorships mirror the Relationship-Based Care model

The RBC model (Koloroutis 2004) focuses on positive outcomes in clinical safety and quality, staff
and patient satisfaction, recruitment and retention methods, and strong financial bottom lines to
measure success and promote organizational health in both a philosophical foundation and an opera-
tional framework. The preceptorship design mirrors the RBC framework in transforming the next
generation of excellence in caregiving and changing the condition of what currently exists for the new
employee or student nurse in the professional practice environment.

Preceptors improve patient care

People want to do a good job. Successful preceptorships clearly define measures and outcomes based
on the purpose and vision of the organization, which are articulated and evaluated in the orientation
process for the new nurse or student. Coaching, precepting, and mentoring are all essential concepts
and roles filled with possibilities for increased self-awareness, commitment, and mutual respect among
new nurses and nursing students. Preceptors are nurses talking about difficulties they have met, shar-
ing insights they have gained, and passing on lessons they have learned by caring for patients in the
many arenas of need they encounter each day. They facilitate the orientation, growth, and develop-
ment of nurses who will one day work side by side with them, and who may become their peers,
colleagues, and leaders tomorrow. They can connect with preceptees in ways that no one else can,
building trust and responsibility as they gently draw preceptees into the “real world” of healthcare.

In summary

Who really benefits from all of this effort? Patients—and us! Effective nurse preceptorships provide
the flexibility for the close, trusting relationships needed to develop the new employee, student nurse,
or new graduate nurse to his or her fullest potential. The next step in building formal and informal
professional nurse preceptorships in your organization is to understand the essential roles, responsibili-
ties, and accountabilities of the preceptor and preceptee within the context of those relationships.

6 ©2007 HCPro, Inc. Nurse Preceptor Program Builder, Second Edition