PRECEPTORS MAKE ALL the difference. Without the right preceptor, the transition from classroom to patient’s room can be difficult, but a preceptor who demonstrates how to turn classroom theory into skilled clinical practice can put a new nurse on the path to clinical excellence.

What a preceptor needs
What does it take to be a good preceptor? First, it takes a strong relationship with the new nurse. Every new nurse needs one designated preceptor. The preceptor’s schedule should match the nurse’s schedule, and the preceptor and new nurse should share a single patient assignment.

Every preceptor needs certain key qualities: clinical expertise, organizational skills, teaching talent, patience, leadership and, most important, the desire to be a preceptor. Those qualities form the foundation, but preceptors need preparation. Preceptor courses should cover responsibilities, learning styles, documentation, communication, and conflict resolution. Roleplaying prepares preceptors to handle conflict and give feedback.

Preceptors need on-going support. Effective mentors can help preceptors grow and flourish. Mentors—including advanced practice nurses, educators, managers, and experienced preceptors—can demonstrate teaching skills, address preceptor–orientee
relationships, and evaluate orientation effectiveness.

Who you’ll meet
Role-playing will help prepare you for your preceptor—new nurse relationships, but you’ll still encounter challenging situations and interesting personalities. You’ll certainly meet the Expert Orientee, who believes she already knows everything and orientation is just a formality. Statements beginning with, “In my old job, I…” are meant to challenge you as a preceptor. Meet the challenge by acknowledging the nurse’s past experiences as valid, but remind this nurse that performance must be validated to reinforce hospital-specific policies.

The Social Butterfly surrounds the preceptor with a flurry of activities. This nurse is busy with after-work activities, spends time on personal phone calls, and manipulates others by flirting and brown-nosing. The Social Butterfly requires consistent messages from the preceptor as well as the manager and educator. Set limits by stating clear expectations such as, “Make personal phone calls only during your break.” Try positive feedback, too. Involve the Butterfly in activities, such as unit events and professional seminars, because they will foster group participation.

The Disorganized Diva drives an organized preceptor crazy. This nurse is always late and has major life changes—new job, upcoming wedding, new city, new apartment, new friends, new pet, everything in boxes—all at the same time. Prioritizing problems and remembering to perform tasks such as checking lab results, giving medications on time, and following up on abnormal vital signs seem impossible. As a preceptor, teach this new nurse a quick patient assessment that involves the ABCs—airway, breathing, and circulation. Teach her to prioritize patients based on needs. Use checklists, schedules, or color codes to promote organization. Extending orientation may help.

The Mouse is shy, asks few questions, and says “yes” to everything. By conveniently getting busy when approached, this nurse tries to hide a lack of confidence. As a preceptor, you need to articulate your expectations clearly: “I
will be asking you to describe your clinical experiences on a daily basis,” “Prioritize your tasks and discuss the priorities with me,” and “If you’re uncomfortable performing a task, you need to ask questions before performing it.” Also, use one-to-one communication. Provide regular feedback and ask open-ended questions. Be sure to distinguish shyness from a lack of competence.

The Globe Trotter is a foreign nurse experiencing a cultural transition. Speaking and understanding the language may be challenging. If this nurse was an advanced
practitioner in another country, role confusion may be a problem. You must spell out your expectations with a well-defined job description. Be culturally
sensitive. Confirm this nurse’s understanding by asking open-ended questions, and provide a mentor of the same nationality for professional and personal support.

The Needy Nurse will drain your energy. This nurse seeks constant validation, and manipulates everyone—the preceptor, the educator, and other nurses. The Needy Nurse relentlessly seeks help and uses selfdegrading language. Provide honest feedback. Don’t offer praise in response to neediness. Ask thought-provoking questions and give positive reinforcement when appropriate. Above all, avoid “mothering.”

Rewards
Yes, being a preceptor can put you in some interesting relationships, but it can also be very rewarding. A great preceptor can be the first and most important role model in a nurse’s professional life. And a great preceptor can help launch many successful nursing careers.

Selected references
Alspach JG. From Staff Nurse to Preceptor: A Preceptor Development Program. Instructor’s Manual. 2nd ed. Aliso Viejo, Calif: American Association of Critical Care Nurses; 2000.

Dougal J, Gonterman R. A comparison of three teaching methods on learning and retention. J Nurses Staff Dev. 1999;15(5):205-209.

Lavoie-Tremblay M, Viens C, Forcier M, et al. How to facilitate the orientation of new nurses into the workplace. J Nurses Staff Dev. 2002;18(2):80-85.
Morse JS, Oberer J, Dobbins JA, Mitchell D. Understanding learning styles: implications for staff development educators. J Nurses Staff Dev. 1998;14(1):41-46.

Speers AT, Strzyzewski N, Ziolkowski LD. Preceptor preparation: an investment in the future. J Nurses Staff Dev. 2004;20(3):127-133.

Karen Zwerneman, RN, MSN, CCRN, is Director, Neurology, Renal, & Vascular Services at Baylor University Medical Center, Dallas, Texas. Sonya Flanders, RN, BSN, CCRN, is a Cardiovascular Nurse Clinician at Baylor University Medical Center.