A culture of support enhances success.

The learning that occurs when a student or new nurse works with a preceptor can prove pivotal in their professional journey. Preceptors—who educate students, new graduates, and new employees in the clinical environment—continue to demonstrate a positive effect on recruitment, onboarding, and retention. They have a significant impact on how new graduates experience the beginning of their career.

Important to that experience includes how new nurses are socialized into the clinical setting. They learn the unique professional traditions of nursing through the eyes of their preceptors, who show them the real culture, not the ideal presented in school. As frontline ambassadors to clinical practice, preceptors serve as the purveyors of culture for new nurses entering the profession. As leaders, preceptors’ authentic use of this skill has a positive effect on a nurse’s ability to develop self-efficacy, job satisfaction, and clinical performance.

New nurse experience

Starting a new job is a stressful and vulnerable time for new nurses. A survey by NSI Nursing Solutions noted that 23.8% of all newly hired nurses in 2023 left within a year. During this critical period (transition to practice), nurses may experience transition shock, which can include frustration, fear, stress, self-doubt, anxiety, self-perceived incompetence, and burnout. These negative feelings can prove overwhelming, and many new nurses consider leaving a position or the profession. According to Goh and Lopez, the intention to leave is most common among young, newly graduated nurses. The support of a good preceptor serves as one of the most meaningful tools available to prevent the loss of nurses due to turnover or failure to transition.

New nurses need emotional, physical, sociocultural, developmental, and intellectual experiences. Improving the work environment and offering social and peer support may help increase a sense of belonging for new graduates. A preceptor is well positioned to offer these strategies.

Data from the NSI Nursing Solutions report indicate that from 2020 to 2024, the average hospital turned over 106.6% of its workforce, resulting in losses of $3.9 million and $5.8 million per year. These numbers add to the rising costs of healthcare. An adequately educated and prepared preceptor pool will not only increase satisfaction and improve orientation of new nurses but also help combat these staggering turnover rates.

The preceptor workforce

The 2022 National Nursing Workforce Survey estimated a loss of 200,000 experienced RNs—including experienced preceptors—over a 2-year period; 28% of respondents indicated that they plan to retire in the next 5 years. The National Advisory Council on Nurse Education and Practice recognizes the preceptor shortage as a crisis. In addition, preceptors have described their frustration with a lack of leadership support and limited time to dedicate to preceptees. Few guidelines and rules for the use of preceptors exist. A review by L’Ecuyer and colleagues of all U.S. states and territories found few regulations; some states had none.

Building an adequate preceptor workforce requires new and intentional strategies to prepare, educate, and support preceptors. Nurses are being recruited to the role of preceptor earlier than ever before. These early career nurses may lack the experience and skill set of previous preceptors.
Organizations should offer preceptor preparation courses as early as possible, and educators should work toward meeting the needs of both early career and experienced nurses. Single, beginner preceptor preparation courses no longer meet the needs of nurses who precept in an increasingly complex healthcare setting with sicker patients and fewer resources. Education must be broad enough to cover foundational concepts while also challenging enough to help nurses learn, grow, and accumulate preceptor competencies. Ongoing education and advanced courses designed to meet the needs of both preceptors and preceptees should include adult learning principles, learning theories, teaching and learning strategies, communication styles, conflict navigation, constructive feedback techniques, safety concern identification, and learner socialization.

Preceptor competency

The American Nurses Association defines competency as an anticipated level of performance that integrates knowledge, skills, abilities, and judgment, which the individual performs successfully. Nurses in the preceptor role must demonstrate both nursing and precepting competencies.

In broad terms, these competencies include teacher-learner, supporter, facilitator, socialization agent, evaluator, protector, teacher, clinical expert, communicator, role model, consultant, professional, and leader. Preceptors themselves have described 40 competencies across the domains of knowledge, skills, and attitudes. Efforts to define the preceptor role have focused on its magnitude and importance. Next steps must include improving and standardizing the development of the preceptor workforce.

Preceptor development

Combatting strain on preceptors caused by nurse and preceptor shortages, lack of education, and complexities of the role requires that faculty members, clinical educators, and leaders work collaboratively to create dynamic preparation programs aimed at developing the preceptor workforce. Preparation should include basic standardized education and ongoing supplemental training based on each preceptor’s needs. For example, education could address soft skills such as critical thinking and communication or focus on team building and conflict management strategies. Various delivery modalities (in-person, virtual) can help increase efficiency and effectiveness, while also enhancing preceptor interest and engagement.

To ensure informed and tailored preceptor development, organizations should implement needs assessment surveys. For example, the Preceptor Self-Assessment Tool (PSAT-40) evaluates 40 preceptor competencies across the domains of knowledge, skills, and attitudes. Completing the PSAT-40 offers nurses an opportunity to consider the complexity of the preceptor role, as well as insight into their perceived strengths and abilities. Preceptor self-assessment helps clarify the role and aids identification of gaps, which, if addressed, can improve the experience for the preceptor and the learner.

PSAT-40 scores range from beginner to intermediate, advanced, and proficient. Results may prompt nurses to work on specific areas as they prepare to serve as preceptors. Aggregate scores provide a team snapshot, which identifies what a group of nurses already knows about the role and what competencies need further development. Organizations can use the tool with nurses who express an interest in precepting or integrate it into succession plans to educate new preceptors.

As Sandberg noted, “We cannot change what we are not aware of, and once we are aware, we cannot help but change.” For preceptors, this means reflecting on the role requirements (competencies) to create awareness of proficiency. An awareness of your skillset can lead to identifying growth areas, followed by a willingness to change and a desire to grow.

Educators and managers should promote the importance of preceptor competency as they support early career preceptors acquiring role proficiency and expertise. Workforce development includes preceptor development and requires resources, tools, and access to ongoing educational opportunities.

Preceptor development also should align with improvements in new graduate orientation programs (transition to practice, nurse residencies), which must become standard practice to support new nurses, ease their professional adjustment, reduce transition shock, and improve retention. A review by Weller-Newton and colleagues of transition-to-practice programs found many inconsistencies across clinical settings and organizations in the amount of preceptor/mentor education, the use of formal content and study time, and program duration. One commonality was the use of precepted clinical experiences, including dedicated education units.

Because clinical experiences rely heavily on the preceptor workforce, attention to the needs of preceptors remains vital. Specific strategies exist to aid that effort. For example, organizations can reduce a preceptor’s clinical assignments, schedule new nurses on the same shifts as the preceptor, arrange for new nurses and their preceptor to share patient assignments, and keep the preceptor–preceptee ratio low. These strategies have the potential to improve transition to practice for new nurses and offer needed support to preceptors.

Culture of support

Just as preceptors serve as ambassadors for quality culture, this same culture must provide organizational support for the role. Merely extending the tasks of the staff nurse and considering this effective precepting isn’t sufficient. The role requires specific competencies as well as leadership and organizational support to ensure proper preceptor recognition and development. This culture of support for the preceptor’s importance can help ensure successful onboarding of the next generation of nurses. Patient safety and quality care depend on preceptor and preceptee success.

Kristine L’Ecuyer is an associate professor and interim dean at the Saint Louis University Trudy Busch Valentine School of Nursing in St Louis, Missouri. Shelley Von Der Lancken is an assistant professor at the Saint Louis University Trudy Busch Valentine School of Nursing. Heidi Keeler is an associate professor at the University of Nebraska Medical Center in Omaha.

American Nurse Journal. 2025; 20(7). Doi: 10.51256/ANJ0725130

References

American Nurses Association. Competency model. 2018. nursingworld.org/globalassets/docs/ce/177626-ana-leadership-booklet-new-final.pdf

Bryan V, Vitello-Cicciu J. Perceptions of preceptors’ authentic leadership and final year nursing students’ self-efficacy, job satisfaction, and job performance. J Prof Nurs. 2022;41:81-7. doi:10.1016/j.profnurs.2022.04.003

Catarelli B, Nobles P, Aull M, Yi F. Evaluating burnout and resiliency in new graduate nurses: A Cross-sectional study. J Nurs Adm. 2023;53(5):259-65. doi:10.1097/NNA.0000000000001279

Chandler GE. Succeeding in the first year of practice: Heed the wisdom of novice nurses. J Nurses Staff Dev. 2012;28(3):103-7. doi:10.1097/NND.0b013e31825514ee

Duchscher JEB. Transition shock: The initial stage of role adaptation for newly graduated registered nurses. J Adv Nurs. 2009;65(5):1103-13. doi:10.1111/j.1365-2648.2008.04898.x

Goh YS, Lopez V. Job satisfaction, work environment and intention to leave among migrant nurses working in a publicly funded tertiary hospital. J Nurs Manag. 2016;24(7):893-901. doi:10.1111/jonm.12395

Gueorguieva V, Chang A, Fleming-Carroll B, Breen-Reid KM, Douglas M, Parekh S. Working toward a competency-based preceptor development program. J Contin Educ Nurs. 2016;47(9):427-32. doi:10.3928/00220124-20160817-10

L’Ecuyer KM, Hyde MJ, Shatto BJ. Preceptors’ perception of role competency. J Contin Educ Nurs. 2018;49(5):233-40. doi:10.3928/00220124-20180417-09

L’Ecuyer KM, Subramaniam DS, Reangsing C. Development of the preceptor self-assessment tool and use of the content validity index. J Contin Educ Nurs. 2020;51(10):469-76. doi:10.3928/00220124-20200914-09

L’Ecuyer K, Subramaniam DS, Reangsing C, DuBois JC. Psychometric testing of the Preceptor Self-Assessment Tool (PSAT)-40 for nursing preceptors. J Contin Educ Nurs. 2022;53(11):491-9. doi:10.3928/00220124-20221006-06

L’Ecuyer KM, Von Der Lancken S, Malloy D, Meyer G, Hyde MJ. Review of state boards of nursing rules and regulations for nurse preceptors. J Nurs Educ. 2018;57(3):134-41. doi:10.3928/01484834-20180221-02

Mingpun R, Srisa-ard B, Jumpamool A. Strengthening preceptors’ competency in Thai clinical nursing. Educ Res Rev. 2015;10(20):2653-2660. doi:10.5897/ERR2015.2468

National Advisory Council on Nurse Education and Practice. Preparing Nurse faculty, and Addressing the Shortage of Nurse Faculty and Clinical Preceptors: 17th Report to the Secretary of Health and Human Services and the U.S. Congress. January 2021. hrsa.gov/sites/default/files/hrsa/advisory-committees/nursing/reports/nacnep-17report-2021.pdf

NSI Nursing Solutions Inc. 2024 NSI National Healthcare Retention & RN Staffing Report. March 2025. nsinursingsolutions.com/Documents/Library/NSI_National_Health_Care_Retention_Report.pdf

Porter-O’Grady T, Malloch K, Scott K. Renewing the nursing culture: Sustaining the professional community of practice through the role of the preceptor. Nurs Adm Q. 2024;48(2):87-96. doi:10.1097/NAQ.0000000000000639

Sandberg S. Lean In: Women, Work, and the Will to Lead. New York City, NY: Random House, NY; 2013.

Smiley RA, Allgeyer RL, Shobo Y, et al. The 2022 National Nursing Workforce Survey. J Nurs Regul. 2023;14(1):S1-90. doi:10.1016/S2155-8256(23)00047-9

Smith LC, Watson H, Fair L, et al. Evidence-based practices in developing and maintaining clinical nurse preceptors: An integrative review. Nurse Educ Today. 2022;117:105468. doi:10.1016/j.nedt.2022.105468

Spector N, Blegen MA, Silvestre J, et al. Transition to practice study in hospital settings, J Nurs Regul. 2015;5(4):24-38. doi:10.1016/S2155-8256(15)30013-4

Ulrich BT. Mastering Precepting: A Nurse’s Handbook for Success, 2nd ed. Indianapolis, IN: Sigma Theta Tau; 2018

Vázquez-Calatayud M, Eseverri-Azcoiti MC. Retention of newly graduated registered nurses in the hospital setting: A
systematic review. J Clin Nurs. 2023;32(19-20):6849-62. doi:10.1111/jocn.16778

Weller-Newton JM, Murray M, Phillips C, Laging B, McGillion A. Transition to practice programs in nursing: A rapid review.

J Contin Educ Nurs. 2022;53(10):442-50. doi:10.3928/00220124-20220907-05