Recently, a reader asked for an opinion regarding entrusting novice nurses in the role of preceptor. This topic could not be timelier given the additional strain COVID-19 is placing upon the nation's medical system. In crises such as the one we are currently experiencing, difficult precepting decisions need to be made. These situations may be a time when choosing the best preceptor with the most experience is not feasible, and the only option may be a nurse with minimal experience. Thus, hospital leadership will look to its nursing professional development (NPD) practitioners to provide sage input into the selection and development of novice nurses as preceptors so that new hires can continue to be trained during times of suboptimal staffing.
Ideally, a preceptor should have clinical experience, be competent and confident in their practice, have a desire to teach, and be nurturing (Lippincott Solutions, 2017). However, health care, even before the COVID-19 crisis, does not often afford the ideal situation. Realistically, no matter the crisis, new hire nurses still require training, and often, the NPD practitioner is limited in their options. During these times, a novice nurse may be the only option. The question then becomes how long a new graduate nurse should be working in a clinical setting before they can precept.
The amount of time a nurse should work clinically before becoming a preceptor is a much debated topic. Some would argue that a nurse should at least be in the competent stage of Benner's novice-to-expert model. It is estimated to take 2-3 years of clinical practice to achieve the competent stage, which is marked by being able to work efficiently and make conscious decisions regarding actions (Davis & Maisano, 2016). Others believe that there should be a minimum number of years of experience (Lippincott Solutions, 2017) but are hesitant to state an exact number. NPD practitioners often struggle with defining a minimal amount of clinical time that is appropriate before allowing a nurse to become a preceptor rather than looking at the attributes that make a good preceptor.
Using a novice nurse as a preceptor may make some NPD practitioners uncomfortable due to the novice nurse's lack of clinical experience, trying to learn how to effectively manage their time and their lack of confidence. However, there are several benefits to using a novice nurse as a preceptor. If the novice nurse is paired with a new hire who is more experienced, they can form a symbiotic relationship. The novice nurse can give insight to the organization's policies and the unit's culture, whereas the experienced new hire can provide clinical experience. Alternatively, it can be valuable for the novice nurse to be paired with a new graduate nurse as their orientation will be fresh in their minds. The novice nurse can provide the information they wish they had when they first started in the organization, and teaching the information helps them to embed it in their minds (Sousa, 2017). Regardless, either situation provides the novice nurse the opportunity to simultaneously learn and further develop as a nurse and gives them a sense of pride and accomplishment (Smith & Sweet, 2019).
Fortunately, being a preceptor encompasses skills beyond clinical expertise to include accountability, organizational skills, teamwork, good communication, and the ability to develop others (Ulrich, 2019). The skills mentioned above are gained through life experience, not clinical experience. Therefore, it is possible for a novice nurse to embody these attributes already.
Thus, using the novice nurse as a preceptor is not the end of the world as long as they have demonstrated strong aptitude in the previous skills. Smith and Sweet (2019) found that novice nurses often undertake the challenge of precepting without the benefit of appropriate education or support while they fulfill the preceptor role. Therefore, the NPD practitioner needs to be aware that the novice nurse preceptor will require a very different type and level of support than the support given to a more clinically experienced nurse who has been precepting for years. Notably, a novice nurse chosen for the preceptor role is still early in their clinical development; keeping this in mind, the NPD practitioner will need to provide more personal guidance and encourage more guidance from the novice nurses' colleagues (Smith & Sweet, 2019).
To this end, the NPD practitioner can be proactive by already having a plan in place for when the need to use a novice nurse arises. A vital component of the plan should include talent scouting-keeping an eye out for new nurses that are motivated, self-reflective, use their resources regularly to perform their job duties, and who are not afraid to say "I do not know" and actively seek out answers to their questions. Once the NPD practitioner identifies the prospective novice nurse, they should not be hesitant to enroll that person in the organization's preceptor development program. Even if the plan is not to use them unless absolutely necessary, you will be giving them the foundational knowledge they will need if they are called upon to precept (Smith & Sweet, 2019). However, there may be times when the NPD practitioner is in a situation where they need a preceptor immediately, and a novice nurse who has not yet been through the preceptor development program is the only person available. In this case, "just in time" training is necessary, and although the staffing need is immediate, the NPD practitioner's response can and should be preplanned. Prepared items such as a preceptor checklist; a list of available organizational and online resources; "grab and go" totes containing training equipment, case scenarios, and critical thinking exercises will assist the novice nurse's transition to a preceptor role (Nelson et al., 2019). In addition, the NPD practitioner can also have online modules available that cover essential preceptor skills such as adult learning principles; communication; the development of learning plans using goals, objectives, and outcomes; coaching; critical thinking; and clinical reasoning (Ulrich, 2019).
Maintaining standards of care in a crisis can be a challenge, but a novice nurse preceptor must be expected to uphold the same standards as a more experienced preceptor. It is incumbent upon the NPD practitioner to recognize that the novice nurse will need to collaborate more with them, their management, and their peers, and the NPD practitioner should create opportunities for this collaboration to occur. Undoubtedly, this will require the NPD practitioner to check-in more frequently with the new preceptor, making themselves available to answer questions and provide feedback to the new preceptor.
Another way to support the novice nurse preceptor is to match them with an experienced colleague who has more clinical and precepting experience. This colleague can be a resource, in addition to the NPD practitioner, who can help mentor the novice nurse into the preceptor role. This mentorship will give the novice nurse preceptor someone on the unit who can be readily available to guide them and provide anecdotal experiences from their practice.
As NPD practitioners, if we do not put measures in place to use novice nurses as preceptors, we will be unprepared when situations such as staff shortages due to a crisis arise. It is the NPD practitioner's responsibility to be forward-thinking and to prepare for such a situation. By preparing novice nurses early to become preceptors, the NPD practitioner improves orientation outcomes by ensuring the novice nurse is prepared to facilitate a successful transition to practice for the new hire. I would love to hear other NPD practitioner's thoughts on using novice nurses as preceptors and how to prepare them for the preceptor role. If there are any questions regarding this article, please e-mail Jennifer Bodine at mailto:[email protected].
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