Hospitals have entered a high-stakes era, where big government quality mandates are driving new business and patient care models. In the world of nurse training and bedside care this has far-reaching effects. No hospital role is more integral to the quality movement than nursing. Consequently, nurse bedside readiness is much more critical than it was even a few years ago. New nurses, whether they are fresh out of college or experienced clinicians, need to be fully competent and engaged in all patient-care processes soon after they are hired to ensure hospitals continue to meet quality and patient experience objectives. Simply said, the new hospital culture calls for high performers who have the skills and confidence to work well in diverse environments, manage complex technologies and medical equipment, as well as deliver high-touch patient care. Bringing new nurses up to speed in this dynamic care environment is a challenge to be sure, but it is imperative as Value-Based Purchasing and pay-for-performance programs start to become the standard across government and commercial payers, respectively.
Preceptorships: The Cure for New Nurses
One of the best ways a hospital can prepare new nurses for the rigors of their job is by offering an advanced onboarding process that is anchored by a nurse preceptorship program. In fact, hospitals that offer well-structured preceptorships that include highly trained preceptors, not only quickly transition nurses towards clinical competency but also help them become sharpened, critical thinkers (Gross-Forneris & Peden-McAlpine, 2009). These “super” preceptorships surpass typical checklists, mentorships, and casual buddy programs. Rather, what makes these programs a success is twofold. First, they are custom designed to quickly and thoroughly assess knowledge, attitudes, and skills; develop and teach targeted competencies; and help the new recruit assimilate into the social fabric of the organization. Secondly, nursing and teaching roles require very different skillsets. Therefore, advanced preceptorships include a formal framework in which the preceptors themselves go through training so that they are fully prepared to translate their extensive bedside experience into an organized, yet easy-to-follow learning experience.
Anecdotally, the quality of hospital preceptorships still varies widely from informal pairings of staff nurses and new recruits to full-blown learning programs with an advanced education curriculum. This needs to change. The American Hospital Association recommends that preceptorships take place over the entire first year of employment. (American Hospital Association, 2012) The cost of not going the distance with new recruits can be a tough financial pill to swallow. Replacing just one nurse can cost as much as $90,000. The bottom line is that skilled preceptors provide the right training and social connections to help nurses move through the well-documented four stages of reality shock—the honeymoon phase, shock, recovery, and resolution—that occur after leaving school and entering the workplace. It’s time to include nurse preceptorship programs in strategic planning.
American Hospital Association. (2012). Developing an effective health care workforce planning model. Accessed September 2013: http://www.aha.org/content/13/13wpmwhitepaperfinal.pdf.
Gross-Forneris, S., & Peden-McAlpine, C. (2009). Creating context for critical thinking in practice: The role of the preceptor. Journal of Advanced Nursing, (65)8, 1715-1724.
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