Connecting educators and practice leaders

For nearly 70 years, the nursing profession has faced challenges in consistently addressing the struggle experienced by new nurses as they transition from student in the classroom to professional with the many new experiences in practice. Practice leaders have long expressed concerns that new graduates lack the necessary readiness to enter the clinical realm. They point to the limited practical and technical preparation of new nurses, criticizing the academic overemphasis on conceptual learning, which they feel may not always translate to the reality of clinical work.

Conversely, nurse educators argue that clinical environments place excessively high expectations on new graduates. They also report new nurses feeling overwhelmed by the increasing clinical and systems complexities of healthcare, making it more challenging to adequately prepare students.

This disconnect between educators and practice leaders exacerbates the challenge of preparing new nurses for practice. For too long, the nursing profession has failed to sustainably resolve these differing perspectives. This issue demands a national conversation and the development of integrated models that effectively bridge the gap between education and practice.

Drawing from recent work in Arizona and supported by a $75 million state preceptor grant (ARS 36-1803 Grant: Nurses for a Healthy Arizona), we developed a preceptor domain framework designed to stimulate ideas and guide the implementation of relevant and effective strategies. We aim to create a substantive and sustainable approach to address the challenges associated with the transition to nursing practice.

Preceptor grant initiative

In 2023, in response to the post-pandemic decline in the nursing workforce, the Arizona legislature passed HB 2691, which allocated more than $130 million over 3 years to address the state’s significant nursing shortage and increase the number of practice-ready nurses. The legislation provided funds to nursing schools and healthcare providers to increase the number of practice-ready nurses across various health settings in the state.
A significant portion of these funds ($75 million) has been dedicated to developing transition-to-practice programs (1803 funds) across Arizona, with a focus on designing and implementing preceptor programs that bridge the gap from classroom to clinical practice under the auspices of the Arizona Board of Nursing. These efforts aim to foster a work culture that encourages nurses to grow and remain in Arizona’s healthcare settings. (See Transition to practice solution.)

The vital preceptor role

Grant 1803 emphasizes the importance of the nurse preceptor role as a key component of the transition from student nurse to RN. When nursing education shifted from hospital-based training to academic-based education, a gap emerged, which has resulted in a significant deficit in clinical skills and opportunities for practice as the graduate nurse moves from the learning environment to myriad healthcare practice settings (teaching/academic medical centers, community hospitals, specialty hospitals, surgical centers, primary care clinics).

As health settings and clinical nursing practice have become more complex, issues regarding transition to practice at this intersection have presented greater challenges. The profound consequences of inconsistency around this transition impact both new nurses and the health systems that employ them. For example, many healthcare systems use proprietary, for-profit models with widely varying degrees of evidence-based legitimacy as the foundation for their preceptor programs. (See Preceptor models.)

A well-constructed, formalized preceptor program could provide an effective solution to the challenges of transitioning nurses into practice. Such programs serve as a critical bridge between education and clinical practice. We can no longer continue with inconsistent, variable, and nonstandardized approaches that may lack cultural specificity, evidence-based practices, and competency-grounded frameworks.

In addition, we’ve failed to consistently and effectively address the significant organizational and cultural issues that drive high nurse turnover. This failure has led to onboarding chasing turnover in an endless cycle, which results in a constant deficit in adequate numbers of sustainable nursing resources. As the effectiveness of evidence-based preceptor programs becomes more evident, a growing need exists to scale and standardize these programs at state and national levels. Organization leaders shouldn’t view the preceptor role as an incidental, a temporary, or a stopgap measure but rather as a fundamental component of successful transition into the nursing professional community of practice.

The already substantial demands of professional nursing practice make it essential to allocate appropriate resources, adjust workloads, and provide the necessary support for effective preceptorship activities. Historically, failure to address the resource needs for central professional activities—such as governance, education, and relationship-building—has negatively impacted nurses. This neglect contributes to a perception among nurses that organizations don’t fully recognize their value, which undermines their sense of ownership and accountability in patient care and community health.

Preceptor program essentials

After ensuring adequate resource support for the transition to practice, an organization’s focus must shift to onboarding and readiness. Practice readiness isn’t a destination but rather a continuous demonstration of competence and the seamless interface of the nurse with the practice environment. This readiness depends on several factors, some of which are standardized, while others are specific to the organization and its culture.

Arising out of the Arizona experience, the essential domains of practice readiness include technical/clinical skills, personal/professional learning and adaptation, relational and interactional capacity, communication effectiveness, membership in the nursing professional community of practice, and cultural/organizational engagement. Each of these domains has specific metrics (such as skill demonstration and membership characteristics), which enumerate the expectations for nursing performance, readiness, and goodness of fit with state licensure and practice standard requirements. These comprehensive components ensure that the full range of roles, performance expectations, and nursing community membership activities are addressed, forming a clear and measurable foundation for nursing practice. (See Effective transition to practice: Funding pipeline.)

Domain 1: Technical/clinical skill sets

The functional elements of nursing practice, fundamental to the profession, include good judgment, critical thinking, skill application, care evaluation, and communication/documentation. These competencies remain central to the nurse’s successful transition and application of nursing skills in the patient care environment. Historically, technical proficiency has comprised the bulk of nurse preparation, reflecting a focus on process and safety—two critical elements in addressing medical concerns and related nursing activities.

Preceptor’s role. However, the increasing recognition of patients’ personal, cultural, and social determinants of health has highlighted the need to integrate these factors into nursing practice, which reflects the differences in nurse preparation related to critical thinking and clinical leadership. The preceptor plays a crucial role in modeling the application of these factors and skill sets, ensuring that onboarding nurses can demonstrate them effectively.

Domain 2: Personal/professional learning

Continuing competence and safe nursing practice require lifelong learning. Early in a nurse’s career, nursing leadership must focus on cultivating a culture of safety and continuous learning to enhance practice knowledge and application. Personal and collective ownership of this learning proves vital for positive role self-perception and professional impact.

Preceptor’s role. Structured processes—such as goal-setting, continuing education planning, and performance evaluation—are necessary for maintaining practice readiness throughout a nurse’s career. The preceptor serves as a role model, transferring these learning commitments to onboarding nurses and reinforcing the importance of ongoing professional development.

Domain 3: Relational/interactional capacity

Nursing is inherently relational, with every aspect of practice grounded in relational competence. Advancing nursing work and improving patient care outcomes depends on the preceptor’s ability to demonstrate and reflect relational skills.

Preceptor’s role. Key components of relational capacity include professional identity, self-awareness, emotional intelligence, personal presentation, mindfulness, professional role competence, and membership in the nursing community of practice. The preceptor’s expression of these characteristics significantly influences the preceptee’s development of similar skills, fostering a culture of professional values and relational capacity.

Domain 4: Professional communication

Every nurse who provides clinical continuity across healthcare settings must possess effective communication skills. They must facilitate, integrate, and coordinate communication among clinicians, patients, families, and the broader healthcare system.

Preceptor’s role. The preceptor’s role in communication includes language proficiency, expressive maturity, media management, message clarity, writing skills, listening, interpretation, and application. With the increasing integration of machine learning and artificial intelligence in healthcare, the preceptor’s role in ensuring the new nurse’s competence in these evolving communication technologies will prove critical.

Domain 5: Membership in the nursing community of practice

Nurses serve as more than individual functionaries; they’re integral members of the nursing professional community of practice. This membership comes with responsibilities regulated by the state and advanced by each nursing practice community, ensuring that nurses meet standards of character, knowledge, and performance.

Preceptor’s role. The preceptor plays a key role in instilling a sense of professional obligation and encouraging active participation in professional activities, governance, and peer dynamics. This involvement demonstrates commitment to the profession and reinforces the individual ownership of practice and the collective accountability necessary for high-quality nursing practice.

Domain 6: Sustaining a culture supporting professional practice

A supportive culture helps nurses feel engaged, valued, and safe in their work environments. The COVID-19 pandemic highlighted the importance of organizational culture in nurse retention, with many nurses citing a lack of engagement, investment, support, and leadership as reasons for leaving their positions.

Preceptor’s role. The preceptor communicates the organization’s culture to onboarding nurses, shaping their early experiences and influencing their long-term perceptions of and participation in the practice environment. Key cultural elements include clear organizational goals, supportive leadership, fairness, equity, opportunity, professional governance, and systems support.

The bridge to practice

These preceptor domains attempt to address the full range of components essential to the transition of nurses from classroom education to clinical practice. For too long, transition to practice has been a fragmented process, focused primarily on technical and clinical activities not always fully addressing broader professional development, engagement, and evidence of sustaining organizational commitment. A carefully considered and well-constructed preceptor program can reintegrate the critical elements of professional nursing practice and renew the sense of community and value that underpins effective nursing and enhances nurse satisfaction and retention.

As healthcare becomes increasingly complex, both clinically and operationally, the role of the nurse in coordinating, integrating, and facilitating these complexities is more critical than ever. Healthcare systems must understand and relate to nurses as professionals. The positive and sustainable future of a stable and effective nursing professional community of practice includes how well we develop, model, and manage the preceptor role to ensure the successful transition of new nurses into the profession.

Tim Porter-O’Grady is a professor at Emory University and a senior partner at TPOG Associates LLC, in Atlanta, Georgia. Kathy Malloch is an 1803 grant consultant at the Arizona State Board of Nursing in Phoenix. Kathy Scott is president and CEO at Kathy Scott Associates in Phoenix, Arizona.

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Key words: preceptor, preceptee, transition to practice, practice-ready nurses

American Nurse Journal. 2025; 20(5). Doi: 10.51256/ANJ052520