THE EFFECTIVENESS OF PRECEPTOR PROGRAMS IN ENHANCING THE RETENTION RATE OF EARLY CAREER NURSES: A NARRATIVE REVIEW
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The Effectiveness Of Preceptor Programs In Enhancing The Retention Rate Of Early Career Nurses: A Narrative Review
Narrative Review
Nursing Competence
Healthcare provision is a vital service, and medical practitioners, upon taking the Hippocratic Oath, vow to amass the life-saving skills needed to promote health and wellness within the society. According to Pasila et al. 2017, preceptorship offers nurses critical orientation skills necessary for their practice by making them active participants in the diagnosis and treatment of patients (p. 25). Wardrop et al., 2019, note that preceptors act as both teachers and role models for their trainees by mentoring them on the appropriate approach for medical interventions for patients with different illnesses (p. 97). Furthermore, the study by Wardrop et al. asserts that expectations of preceptors about their role in aiding the transition of nurses into independent practitioners offer important clues about the overall competence of the preceptee upon completion of the program. Consequently, they aver that nurse managers have either a positive or negative impact on the suitability of a graduate nurse to handle medical emergencies, treat patients with chronic illnesses, and deal with individuals in dire need of special care.
Similarly, Maureen Rebholz and Lisa Baumgartner’s 2015 study in Attributes and qualifications of successful rural nurse preceptors note that student-centered instructions are vital in equipping rural nurses with efficacy, a sense of honor, and medical expertise, which is critical in their performance ( p. 5). For example, respondents recalled their initial experiences as nurse trainees and their attitude towards their duties as huge influencers of the conduct of preceptees once they exit the program. However, the study identifies the challenges such as lower salaries, higher workload, and burnout as some of the shared problems that rural nurses experience akin to their urban counterparts. Nevertheless, according to Allan et al,2017, preceptorships act as domains of learning in which the ward culture is ingrained in the nurses hence fostering greater healthcare competence (p. 130). Additionally, the findings suggest that preceptees can learn “in action” by making supervised ward visits where they interact with the patients hence acquiring helpful insight into their future practice. The authors note that such structured mechanisms allow trainee nurses to apply theoretical models in their practical surroundings.
Consequently, the support given to the trainees by ward managers is integral in their acquisition of medical skills because the former have the requisite knowledge on different treatment methodologies and better understand the health facility’s operations. Allan et al. also cite the possibility of preceptees gaining informal learning through the “rounds” across the wards as a significant indicator of the importance of such programs during their transition period (p. 129). Therefore, the latter study correlates to Maureen and Lisa’s because it also highlights the value placed in ensuring that graduate nurses receive positive preceptorship experiences. Linda Ferguson asserts that mentorship programs should encourage critical thought among novice nurses to enhance intellectual development (2011, p. 122). The author adds that graduate nurses always have a premeditated vision about the nursing practice and endeavor to connect with a mentor who helps them to realize such plans. Therefore, the orientation programs need to be more attentive to the opinions of the novice nurses to give them a sense of belonging.
Turnover Intention
Turnover intention is the willingness of an employee to change jobs or switch from one company to another. Nurses engaged in preceptorship are likely to exhibit such tendencies owing to the stress associated with the profession. According to Sandra Jonsson, Helena Stavreski, and Tuija Muhonen, the integration of recruitment criteria in the preceptorship program is crucial in the retention of nurses (2021, p.1846). The study illustrates that preceptorship adds value to an organization because it identifies the right personnel to hire later. Nevertheless, Jonsson et al., 2021, elucidate that negative preceptorship experiences play a huge role in the frequency of turnover intention amongst nurses. For instance, they note that the lack of reduction of clinical work undertaken by preceptors and unpreparedness amongst them contributes to a hostile demeanor towards the training program hence negatively affecting the ability of early career nurses to maintain enthusiasm for the job (1845). Tracey Coventry and Anne-Maree Hays highlight the above issue by stating that workplace bullying hinders nurses’ retention in various healthcare facilities, especially when senior nurses mete out such behavior against their trainees (2021, p. 35). Therefore, such toxic environments minimize the ability of teamwork. According to Tracey and Anne-Marie, positive preceptorships “…foster positive workplace relationships, increase skill and knowledge development, and enhance patient safety” (p. 35).
A study conducted by Elizabeth Herron in 2017 asserts that New Graduate Nurses (NGN) benefit from positive experiential learning and mutual collaboration with nurse educators hence discarding the notions of quitting the healthcare industry or moving to another medical agency (p. 399). The study further reiterates that preceptorship is vital in eliminating doubt about the suitability of nursing as a career because it exposes graduate nurses to the joys of helping other people live safer and healthier lives for longer. Herron further adds that statistics on the performance of healthcare providers on the “failure to rescue” variable indicate the employees’ position on the turnover intention matter. Therefore, “nurse educators, nurse managers and new graduate preceptors owe it to their new graduate nurse to determine their knowledge base, experience and level of confidence to produce the safest practitioner…” ( p. 399). The quality of care offered in any given medical facility is dependent on the availability of workers hence nursing shortages are preventable through preceptorship programs that encourage trainees to remain in the industry.
Likewise, Jennifer and Margaret add that friendliness and compassion are vital ingredients during preceptorship because they motivate graduate nurses to perform their duties diligently and passionately (p. 173). Moreover, the authors note that “…nursing is one of the most stressful health professions, due to the fast pace of care, increasing levels of acuity, expectations of competence in a wide range of skills and support of the client, relatives and team members” (p. 175). Consequently, peer support, especially from nurse educators, is vital in attracting and retaining healthcare workers because they have the academic qualifications, institutional memory and are aware of the medical histories of most of their clients. The authors elaborate further by equating the likelihood of graduate nurses remaining at their current stations directly to their preceptorship experiences in such organizations. Accordingly, they argue for a friendlier approach in issuing medical briefs and urge for a more tolerant workplace culture among the registered nurses who should accord their trainees a better listening environment.
Consequently, Catherine Schmitt and Rachel Schiffman opine that institutional support is a major factor in reversing turnover intention among novice nurses (2019, p. 5). The unavailability of resources or delays in their disbursement hampers the learning process. It affects the level of service delivery within healthcare agencies because it deprives mentors and mentees of vital tools for attending to their patients. Moreover, the authors note that a shortage of resources for preceptorship programs incapacitates the entire organization because such trainees are relied upon to treat the same patients being attended to by the registered nurses (p. 5).
Job Satisfaction
Jennifer and Margaret’s work also reveals that “…new graduates were given heavier workloads, more night duty and terrible rosters with few weekends off” to highlight the importance of preceptorship to uplift the standards of job satisfaction in the medical field(p. 175). Additionally, according to Eleanor Hollywood in The lived Experiences of newly-qualified Children’s Nurses, hospitals are stressful environments which can easily disrupt the physiological balance of workers because emergencies often force medical practitioners to instantly abandon their routines and respond to the needs of such patients regardless of the personal or professional challenges they might be undergoing at the time (p. 661). Therefore, both studies show that graduate nurses use their job satisfaction levels to gauge their long-term commitment to the organization. The authors further cite the stressors mentioned above as “career-enders” because they lead to a demoralized workforce. The mentorship programs envisioned by the researchers are the ones that lead to contentment among graduate nurses rather than cause disillusionment.
Eleanor adds that preceptors should be prepared to handle the reactions of their various trainees once they are hit with the “reality shock” of the practice (p. 668). Fear and anxiety are the main emotional responses that most nurses experience during their transition, and Eleanor admits as much. According to her, graduate nurses are fearful of making mistakes and view the low staffing levels in their wards to be a huge challenge to their personal and professional acumen. The need for preceptors to alleviate such concerns is paramount, especially for nurse educators with a wide age difference from their preceptees. Indeed Ashley Kennedy concurs with this concept by noting that preceptorship programs should include the”… role of the preceptor, adult learning principles, communication skills, feedback and evaluation, and learning styles” (2019, p. 107). The author justifies the inclusion of these principles in the preceptorship curriculum by citing the need for such mentors to have people-skills before, during and after the transition phase of their graduate nurses.
Job satisfaction is a vital tool for retaining employees within an agency and the nursing practice must also meet this objective to retain novice nurses after the transition period. According to Ashley Kennedy, shared governance between the mentor and the graduate nurse is integral during the decision-making process because it empowers novice nurses, thus making them feel part of the team (2019, p. 113). Moreover, such actions enhance the nurses’ loyalty to the organization and increase their level of commitment. Therefore, Kennedy suggests that preceptors collaborate with their trainees to formulate problem statements, assess gap analyses and hold regular brainstorming sessions to seek solutions. The integration of these strategies would also boost the confidence of the graduate nurses and improve the quality of care given to patients because caregivers would have multiple solutions to various problems. Furthermore, a 2015 study by Lewis and McGowan established that graduate nurses lack a proper understanding of all the nursing concepts, and the preceptorship program should acknowledge this reality early enough (p. 43). Mentors are responsible for incorporating their trainees into the clinical practice at a pace that makes such learners autonomous within a short period. However, the authors note that giving unrealistic expectations only repels the newly qualified nurses from completing the course or dissuades them from offering quality healthcare to patients. Nevertheless, mentors who give novice nurses the benefit of the doubt unreservedly motivate them to perform better each time they attend to a patient. Therefore, Lewis and McGowan advocate for consultations in the decision-making process across various preceptorship programs.
Professional Socialization
Regan et al. 2017, opine that formal and informal interactions are integral in establishing productive relationships within the healthcare industry for a safer medical environment and a higher quality of care (p. 247). The authors add that Nurse Leaders (NL) “… have the capacity and responsibility to foster positive unit cultures where NGNs feel supported, welcomed and safe” through socialization with colleagues and other relevant stakeholders who are vital in creating a support system for career progression, personal growth and emotional work-life balance. Similarly, Catherine Schmitt and Rachel Schiffman add that graduate nurses deserve and value the human connection arising from socializing within the workplace because it helps them to cope with the stress they endure on a daily basis (p. 7).
Linda Ferguson also cites the need for building trust as the ultimate goal for all mentors within the profession hence preceptors ought to interact freely with their trainees (p. 122). Indeed, Ferguson asserts that preceptorships should foster a welcoming social environment when a graduate nurse arrives at the institution. Such a mentee’s reception determines the scale of productivity that the individual can muster. Notably, she states that new nurses need a supportive mentorship network to develop sound clinical judgments that enhance the quality of care for all patients. Another study conducted by Carlos Aparicio in and Jennifer Nicholson in 2020 outlines a reduction in preceptor workload and the provision of “protected time” to guide their trainees on vital work-related skills to be essential techniques for maintaining objective staff engagements during the transition phase (p. 1197). The two researchers also emphasize that opening an informal support group is crucial because it would allow participants to discuss relevant curriculum issues overlooked during the formal sessions.
However, Gazaway et al., 2019, offer a different perspective by suggesting that graduate nurses aspire to have multiple mentors to enhance their bedside clinical skills (p. 1187). According to them, such relationships increase their chances of having secure medical foundations, which are integral in the delivery of patient care. Lewis and McGowan augment this notion by stating that the socialization of medical practitioners is a vital source of consistency in the medical field because such forums keep individuals accountable to their peers (p. 43). Lindfors et al., 2017, also cite preceptor orientation as a pertinent phase for developing trust among clinicians. It introduces graduate nurses to their mentors hence the need for such trainees to establish a working relationship beyond their wards, albeit while maintaining their professionalism (p. 258). Moreover, Andy Tracy opines that successful mentorship programs are built on holding regular formal and informal interprofessional meetings in which employees articulate issues of concern to them for action by the management (p. 443). Furthermore, Tracy posits that such meetings offer valuable interdisciplinary learning opportunities for NGNs thus enhancing service delivery within the organization.
According to Charlotte Austin and Yvonne Halpin, newly qualified nurses are better served by a preceptorship program that installs a personal professional mentor (PPM) role within the agency who acts as a confidant (p. 675). The holder of such a position would guide the nurse through the transition period. Similarly, the authors opine that such mentors should be allowed to enter into the learning space at various intervals because they understand the workings of the organization and are able to connect easily with other registered nurses for a faster educational process. Moreover, PPMs have the ability to tap and channel other resources into the preceptorship program hence facilitating the learning process.
Discussion
Newly qualified nurses join medical organizations with varying expectations. Once they settle into their roles, they often face a “reality shock” that can only be overcome by structured and compassionate mentorship programs run by highly qualified yet affable preceptors. Preceptorship is a vital transitional phase for nurses in which they undergo practical clinical skills under the supervision of a specialist. The studies mentioned above are similar in their findings because they accurately identify the roles of the mentor and the trainee and affirm that preceptors are a vital link in the delivery of healthcare because they transfer medical knowledge to graduate nurses within practical settings (Tracy, 2017, p. 440). Consequently, the transfer of skills requires building trust between the parties. Such a relationship is nurtured from the initial contact that senior registered nurses have with the newly qualified nurses.
Likewise, the rapport created during the preceptorship guides the formal and informal interactions between the preceptor and preceptee hence medical facilities need to assign PPMs for easier absorption of nurses into the practice. Thousands of nurses who enroll in preceptorship programs quickly realize the perils of staffing shortages because they are assigned more responsibilities, especially in odd hours. Therefore, effective mentorship initiatives must integrate flexible schedules for the nurse educators and their trainees alike to encourage the latter to maintain the high levels of enthusiasm that they had during their admission into the program. Additionally, preceptors have the knowledge and clinical skills about the best approach to use when dealing with patients of high acuity hence mentorship programs equip nurses with valuable life-saving skills that reduce the rate of “failure to rescue” within healthcare facilities.
The studies also reaffirm the conventional belief that toxic workplace cultures lower employees’ self-esteem. Respondents were unanimous that turnover intention is a huge impediment to proper service delivery in hospitals. However, preceptorships that boost the confidence of nurses are advisable (Austin and Halpin, 2021, p. 674). For instance, embracing a friendlier approach in the issuance of instructions by supervisors and increasing the frequency of informal social meetings provides newly qualified nurses with a positive perception about the profession, encourages them to be more empathetic to patients, and increases the ties among colleagues for a healthier and safer working environment. Similarly, preceptorship enhances job satisfaction by increasing peer support among workers. The preceptorship curriculum outlines the roles of nurse educators and graduate nurses, which minimizes the chances of friction. Notably, senior registered nurses should always accompany their trainees by integrating a ward culture that encourages interdisciplinary collaboration within the agency.
Furthermore, graduate nurses benefit immensely from the training during the transition phase owing to the large pool of highly skilled trainers at their disposal. Additionally, preceptorship programs are designed so that newly qualified nurses spend most of their time conducting practicals in the wards rather than learning theories. Therefore, the learning modules improve the competencies of nurses by testing their people skills, knowledge in healthcare matters, and the bureaucracy within the organization. Consequently, graduate nurses who complete these programs can independently handle all types of emergencies and the healthcare needs of different patients (Hollywood, 2011, p. 668). Additionally, achieving a work-life balance is crucial in the medical field because nurses work in stressful environments and deserve the love and support of their peers, relatives, and patients. The ideal mentorship curriculum factors in the element of socialization. The mentee’s welfare is well-maintained through higher salaries, reasonable “off” weekends throughout the year, and opportunities for career growth within the organization.
Likewise, graduate nurses gradually gain confidence in handling patients through preceptorships. For instance, the presence of preceptors reassures novice nurses during their practical lessons since most newly qualified nurses suffer from anxiety which makes them afraid of making mistakes (Pasila et al., 2017, p. 24). However, it is incumbent upon ward managers to ensure that such nurses undergo intensive preparatory training sessions to help them cope with the high expectations. Consequently, preceptorship mentors must also undergo similar exercises because the pressure to perform their duties while still supervising various students may be overwhelming and lead to burnout. Notably, the curriculum for such individuals should include regular appraisal meetings in which an assessment is done to see whether the course’s objectives are met within the allotted period.
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