NURSING EXCELLENCE

Development of A Preceptor Program

Sharon Regional Health System

Linda Lucas, RN BSN

Director of Education Services

Prepared ByBrenda Palmer RN

Nurse Educator

April 30, 2008

April 12, 2008

Linda Lucas RN BSN, DirectorSharon Regional Health SystemEducation Services

Dear Linda,

In keeping with our January 12th agreement, I am submitting, per your request, a proposal entitled The Significance of Implementing a Formal Preceptor Program: The Key to Retention and Recruitment of Nurses.

The purpose of this report is to present data to you and the Administrative staff supporting the advantages and benefits of a formal preceptor program for nurses and propose to implement the program at our institution. This report will provide guidelines for developing a program, as well as information for achieving a successful program. In his report, I will also show how a formal preceptor program can improve retention, recruitment, job performance and satisfaction, and help perfect leadership skills of nurses.

Several different methods were utilized in the data collection process for this report. The methods included secondary research collected from the internet, research articles, and books; and the primary research was collected from interviews. The report concludes with a review and discussion of the data, again all in support of the feasibility of a formal preceptor program.

I hope this report will prove to be satisfactory for the implementation of a formal preceptor program.

Sincerely,

Brenda Palmer RN, Nurse EducatorSharon Regional Health SystemEducation Services

Encl.: Formal report on the significance of a formal preceptor program

Table of Contents

Page Numbers

1. Introduction 1-3

2. Findings 4-8

A. Components of a Formal Preceptor Program 41. Formal Preceptorship Diagram 5

B. Preceptor Competencies 6C. Steps for Developing a Successful Program 7

3. Analysis 8A. Conclusion 9B. Recommendation 10

4. References 11

5. Appendix 12-15

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ABSTRACT

The goal of this report is to assess the current preceptor program at Sharon Regional,

identify the problems associated with it, and propose to implement a new preceptor

program with more structure. The proposed new program would be a formal

preceptor program as opposed to the current informal preceptor program. This

report will also:

discuss the benefits and limitations to implementing a formal preceptor program

provide data supporting the benefits prove that a formal program will improve recruitment and retention of new

nurses prove that the overall quality of care administered.

The purpose of this report is to present the information to the Director of Education,

the Directors of Patient Care, and the Vice President of Patient Care and propose that

a new formal program be implemented here at Sharon Regional. This report will

review the components of a formal preceptor program, competencies for preceptor,

and steps for developing a successful program. This report will also show the number

of nurses that have been hired in the last three years and show the percentage of

nurses that have stayed and left within a three year period. The numbers are

indicating that we need to look at why nurses are leaving and my recommendation is

to start with a change in our preceptor program. The research done for this report

strongly suggests that by implementing a program with specific guidelines the

recruitment and retention of nurses will increase and ultimately lead to job satisfaction

and better patient care.

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Report on

The Significance of a Formal preceptor Program and Retention and Recruitment of Nurses

I. INTRODUCTION

The current nationwide shortage of Registered Nurses is a growing problem and it is beginning to

impact upon the recruitment of new nurses and the retention of nurses currently employed here at

Sharon Regional. Two of the biggest causes of the shortage are partially due to the high rate of

retirement among older nurses and a decline in the number of new nurses entering the profession.

Other causes for the mass exodus include “feelings of stress, inadequacy, anxiety, and

disempowerment” (Bally, 2007). Finally, nursing as a profession is no longer an appealing career choice

because women have more professional career options in the work environment.

In the practice of nursing there is a phenomenon known as “nurses eating their young” (Bally, 2007).

This phrase has become more familiar to the new graduate nurse and is also the reason why new nurses

leave their first job within the first six months to a year. The meaning of this phrase “nurses eating their

young” is related to the dysfunctional behavior and attitude of the experienced nurse toward the new

graduate nurse (Bally, 2007). Behaviors such as, “gossiping, criticism, intimidation, passive aggression,

and withholding information” all contribute to the demise of the new graduate nurse who is entering

the nursing profession (Bally, 2007).

One potential resolution to the current crisis in our institution is to develop “long-term solutions such

as strategies aimed at fostering collegial relationships, enhancing nurses’ sense of self, promoting

professional development, and encouraging feelings of professional worth” (Bally,

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2007). A healthy organizational culture can be created by implementing these strategies in our

institution, thus producing a higher caliber leader and a more secure prepared nurse.

Potential benefits and limitations need to be considered, before a new program can be implemented.

The following bullets list some of the benefits and limitations.

Benefits include:

Enhanced job satisfaction , decreased stress, and increased confidence (preceptee)

Decreased cost of care, increased recruitment of new nurses, and increased retention of those already in the workforce (institution)

Increased number of nurses with leadership and teaching skills and improved support for new graduates

According to the CAN (2004) “preceptorship programs have been found to benefit the preceptee,

preceptor, health care institutions and the profession of nursing” (p. 14).

Limitations include:

Lack of experienced nurses capable of mentoring nurses new to the profession

Phenomenon in the practice of nursing known as “nurses eating their young” causing a staggering number of registered nurses to leave the profession

Time factor involved in developing the current preceptors into strong leaders.

Overall cost of implementing a formal program.

The data collected to support the proposal for this report was intense and well researched. Both

primary and secondary research methods were employed to support the feasibility of this report.

Resources were pulled from the internet, journal articles, books, and interviews.

Terms associated with a formal preceptor program and definitions are as follows: preceptor as “an

experienced RN who serves as a teacher assessing the orientee’s learning needs, planning their

experiences, implementing the learning plan, and evaluating the orientee’s learning

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performance. The preceptor serves as a role model demonstrating how a staff nurse performs his/her

job competently and actively integrates the orientee into the social culture of the

organization”(Uniontown Hospital Policy, 2004 p. 2). The Mirriam-Webster online dictionary defines a

Preceptee as “a person who works for and studies under a preceptor: Formal preceptorship “a formal,

one-to-one relationship of pre-determined length, between an experience nurse (preceptor) and a

novice nurse (preceptee) designed to assist the novice in successfully adjusting to and performing a new

role” (CNA, 2004 p. 13). A healthier work environment can be established to assist the growth of new or

developing nurses by providing definitions of preceptor and preceptorship to experienced nurses chosen

to be preceptors, role models and leaders. Another definition important to mention in this report is

informal preceptorship. This type of program is characterized by a shared agreement between the

preceptor and the preceptee to establish a relationship in an unstructured manner, and is based on the

realization of career goals for the preceptee (Bally, 2007).

Our institution has trained nurses informally for many years and in the last couple of years it has not

only been difficult to retain nurses but also to recruit new graduate nurses from our own School of

Nursing. Reasons for difficulty in the areas of retention and recruitment can be contributed to the lack

of a structured mentor program, a void left by retiring nurses, and the willingness of nurses leaving the

profession all together. With that said, now is the time to change from an informal program to a formal

program.

This report has three sections. The first section will cover the components of a formal preceptor

program, second section will cover competencies for preceptors, and the third section will cover steps

for developing a successful program.

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II. Components of a Formal Preceptor Program

In order to seek approval for implementation of a formal program, it is necessary to describe the

components of a preceptor program. First, it is important to understand that nurses who are chosen to

be role models or preceptors have a professional obligation and responsibility to support the

development and socialization of colleagues new to the profession and organizational culture (CNA,

2004). Once this concept is established then guidelines for the program can be developed.

Essential component in the development of a formal program include:

Establishing guidelines for the selection of preceptors

Developing steps for a successful program

Developing and maintaining preceptor competency

Designing specific pathways

Establishing guidelines assist preceptors in achieving professional growth, career development and

assist preceptors with fulfilling their professional obligations and responsibilities to nurses who are new

to the profession. Developing specific steps are a part of an overall strategy to creating an effective

learning environment and ensuring a successful program (C NA, 2004). Maintaining ones competence is

necessary because it assists the preceptor with providing learning experiences that are not only

beneficial for the novice nurse but also for the patient receiving care (CNA, 2004). Finally, designing

pathways allow preceptors to assist new nurses in meeting predetermined goals necessary for assisting

them with completing those goals and orientation. Guidelines for selection of preceptors and steps for

developing a successful program can be reviewed in Appendices A and B.

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This graph is a visual description of the important components of a preceptorship. All of these components are essential for a successful program.

D

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Formal Preceptorship Diagram

Preceptor

Preceptee

Establishing

Guidelines

Develop and

Maintain Competencies DesigningSpecific Pathways

Successful Program

III. Competencies for preceptors

Competencies are important in a preceptorship program because they are tools that are used to

measure knowledge, clinical skills and critical thinking skills of the preceptor. A competency is defined

by Patricia Benner as “an interpretively defined area of skilled performance identified and described by

its intent, function, and meanings” (Benner, 1984 p. 292). Competencies are also the skills, judgment,

and personal attributes required for a person to practice safely and ethically in a designated role and

setting (CNA, 2004). The purpose for developing competencies is to promote professional development,

enhance leadership, provide a continuing competency among nurses, and enhance the quality of work

environments for nurses (C NA, 2004). In The Guide to Preceptorship manual developed by the Canadian

Nurses Association, a list of preceptor competencies was developed by nurses in various parts of the

United States. This list of competencies is divided into five major categories and includes: collaboration,

personal attributes, facilitation of learning, professional practice, and knowledge of the setting. Further

details regarding the five categories can be reviewed in Appendix C

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IV. Steps for Developing a Successful Program

There are many contributing factors which lead to the success of a formal preceptor program. The

CNA (2004) has developed six steps for developing and executing a successful program. They are

assessing needs, identifying a philosophy, creating a plan, organizing a program, implementing a

program, and evaluating a program, see Appendix B. These steps assist with the organization of the

program but a major key element in the success is to gain approval from administration. It is important

to have their support throughout the entire planning and implementing process. Support from the

selected group of preceptors is also vital because they are the foundation for a successful outcome and

are a key piece in the success of the preceptee. These steps and factors are just some examples of how

a program can be successful. It also takes a lot of time and effort to get a program such as this up and

running before it reaches the level of success.

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SUCCESSFUL

PROGRAM

Creating a plan

Organizing a program

Implementing a program

Evaluating a program Identifying a Philosophy

Assessing Needs

V. Methods of Data Collection

Preparation for this report was initiated by searching the literature for information relevant to

preceptorship programs. The process of data collection started with an informal questionnaire sited on

the VHA (see Appendix A). The VHA, which is an internet information sharing network, was used to

collect data from local hospitals. Several questions were formatted and sent to the participating

hospitals inquiring specifically about preceptor programs which may or may not exist in their

institutions. Three hospitals responded and all had preceptor programs. One out of the three hospitals

forwarded their policy which they established in 2004 and titled Professional Partnership Program (see

Appendix A). The other two did not provide information useful for this report. Books, research articles,

and guidelines written by the Canadian Nurses Association were other secondary methods utilized for

this report. Another source that was utilized to support the benefits of a preceptor program was The

Guide to Preceptorship and Mentoring. This guide provided information on how to develop

competencies for preceptors and ways to improve performance and job satisfaction through role

modeling. Research articles were also used to support the proposal and provide data from studies

conducted on graduate nurses.

Primary methods of collection consisted of informal interviews on current preceptors from the acute

and critical care units. Preceptors were selected by their department managers and invited to attend

either a luncheon or dinner to openly discussion goals, responsibilities, formal recognition, and rewards

for participating preceptors. The purpose of the meeting was to obtain ideas and feedback from

preceptors and incorporate their ideas into the proposed new program. The intent was to allow them to

take ownership of the new program which is the first step to the success of the program.

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IV. Analysis

“Preceptor programs are exciting avenues for stimulating professional growth, career development,

staff morale and quality of care within nursing workplaces. As health care organizations compete to

attract and retain a high caliber nursing workforce they will need to focus on providing quality practice

environments” (CNA, 2004 p. 53). The data supporting the benefits of implementing a formal preceptor

program is endless; and it also indicates that many hospitals are beginning to incorporate formal

programs in their institutions.

In this report, I have provided basic information for starting a formal preceptor program. However

the key element to implementing the program is to recognize that there is a great need for change in

our current program. In the last three years as the nurse educator, I have seen how the nursing

shortage is beginning to hit home here at Sharon Regional Health System. From 2005-2007, our

institution has hired 129 nurses out of those 79 have stayed (see Appendix D). The numbers are bit

deceiving. What is not revealed in the data is the number of nurses that began full time and have since

changed their status too per diem. The research conducted for this study has proven to be true in my

opinion. I have been a nurse at SRHS for nineteen years and I am the minority and when I stepped into

the profession as a new graduate nurse my preceptors all had twenty plus years of experience.

Somewhere in the realm of all of the changes in health care, the system has lost its’ sensitivity for

valuing the experienced nurse. Knowledge is important in any profession but experience and knowledge

are more valuable than anything. It is my intent to continue to change, convince, and propose to the

administrative staff how important it is to retain and develop the nurses here at SRHS.

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This report only scratches the surface of implementing a preceptor program. More research needs

to be conducted within the organization in order to gain a better understanding of exactly how many

nurses leave the system and why they leave. In reality the data collection process has just begun for this

program and it is my mission to continue to focus on developing a program that retains and recruits

nurses here at SRHS. I would like to be granted the opportunity to make this program a success and

with support from staff at the patient care and administrative level the program would not only benefit

the hospital but also patient care.

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Works CitedAssociation, C. N. (2004, October). Achieving Excellence in Professional Practice a Guide to Preceptorship and Mentoring. Ottawa, Ontario, Canada.

Bally, J. (2007). The Role of Nursing Leadership In Creating a Mentoring Culture In Acute Care Environments. Nursing Economics , 143-148.

Benner, P. (1984). From Novice to Expert. Meleno Park: Addison-Wesley Pub. co.

Campbell, C. (2007). Mentoring in Nursing. AAACN Viewpoint , 8-10.

Clinical Nursing Orientation Program. (2006, April). Uniontown , Pennsylvainia , USA.

Rogers, B. (2003). The Effective Nurse Preceptor Handbook. Marblehead: Kathryn Levesque, Group Publisher.

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APPENDIX A

Response to question from the VHA

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APPENDIX B

Steps for Developing a Successful Program

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APPENDIX C

Competencies for Preceptors

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APPENDIX D

RN RETENTION PERCENTAGE

YEAR 2007 2006 2005 3 YEAR TOTAL

TOTAL

RNs

47 37 45 129

STAYED

RNs

34 72% 24 64% 21 46% 79 61%

LEFT

RNs

13 28% 13 36% 24 54% 50 39%

This table represents the number of RNs that have been hired over the last 3 years at SRHS, between 2005-2007 61% of the nurses stayed and 39% left.

2005 2006 2007 3 year total0

20

40

60

80

100

120

140

RN who stayedRNs who leftNumber of RNs oriented

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