Preceptors are vital to practice transition of both experienced staff and those entering the workforce from an educational setting. As NPD practitioners, we know that role development of preceptors is crucial to the impact of organizational outcomes, first-year turnover rates, and overall satisfaction.

Prior to 2021, our organization was facing a voluntary turnover rate approaching 30%. We could attribute some of this turnover to the residual impact of COVID-19 on healthcare, but we were also dealing with extreme civil unrest within our community following the aftermath of a nationally televised event. As an organization, we were not only trying to manage staff burnout and moral distress but had the added stressor of rioting in the surrounding area, causing many of our staff members to feel unsafe coming to work.

A key component of our strategic plan moving forward was to focus on the recruitment of new team members. I was informed by senior leadership that we should expect over 1,100 new employees including nurses, nursing support staff, and other licensed personnel expected to start by the end of the year. I immediately went into panic mode. At that time, preceptor training was only available at three locations, was unique to each facility, and we only had a total of 196 trained preceptors throughout the system, all of whom were nurses. My immediate thoughts were, “We don’t have enough preceptors or dedicated education staff focused on preceptor development. How are we going to get these folks onboarded successfully?”

I collaborated with my team of NPD practitioners across our health system to begin developing an evidence-based, innovative program to prepare preceptors who facilitate the transition of newly hired employees into the work environment. We decided to call our program Preceptor University (PreceptorU).

Program Eligibility

Prior to 2021, preceptor training was only offered to nursing staff. To be more inclusive and address rising turnover among many professional and clinical roles, we decided to make PreceptorU available to all employees with at least one year of experience in their current role, who had worked with UofL Health for at least six months, and who had supporting documentation from their direct leader.

PreceptorU Components

As I thought about how to expand PreceptorU across the healthcare system, I had a vision to separate training into three comprehensive parts given that each of our facilities is unique in-patient population, acuity, and specialty. In this case, one size did not fit all!

• Part I — Introduction to Precepting: Is a four-hour course hosted at the system level led by myself as the program coordinator. Part I covers general topics such as the preceptor role, adult learning principles, preferred learning styles, communication techniques, time management, organization, problem solving, preceptor challenges, critical thinking, goal setting, conflict management, feedback, and debriefing.
• Part II — Facility Specific Training: Is a two-hour course hosted at the facility level led by an NPD practitioner. Part II reviews the onboarding process for new orientees, development of an individualized orientation plan, resources available for preceptors, chain of command, and the preceptor role in supporting nurse residency.
• Part III — Care Area Specific Training: Is a two-hour course hosted at the departmental level led by a clinical educator or NPD practitioner. Part III focuses on orientation pathways, documentation standards, the role of the preceptor in evaluation, communication with leadership, and clinical skills competency. For non nursing departments, the program coordinator collaborated with an educator or leader to design and implement part III curriculum to meet program objectives.

To set PreceptorU apart from other programs, I knew I wanted to add additional components to assure role development of the preceptor:

• Competency Management: In addition to training, each preceptor completes annual competencies focused on the preceptor role. As an example, preceptors may be asked to submit one source of evidence or written exemplar for each of the preceptor core competencies: goal setting, feedback, resource utilization, or skills. Another competency could be demonstration of a skill that has been identified as high risk on the unit’s competency assessment.
• Preceptor News: The final component of PreceptorU is a dedicated newsletter sent to all preceptors quarterly with important updates related to the role. Topics may include training and competency updates, changes in orientation processes, new product or policy changes, or continuing education and professional development opportunities.

PreceptorU NPD Structure

I quickly realized that I could not coordinate this program alone, so I started to assemble a team of highly motivated NPD practitioners to serve as facility liaisons and oversee curriculum for parts II and III. PreceptorU consists of 28 talented NPD team members, each with a unique role in supporting the program:

• Program Coordinator
  • Recruits and manages a committee of stakeholders
  • Oversees program management, evaluation, and outcome data
  • Conducts program advertisement at a system level
  • Processes and approves participant applications
  • Maintains the PreceptorU intranet site including program information, eligibility, applications, incentive information, and program outcomes
  • Mentors liaisons at the facility and departmental level
  • Serves as the primary nurse planner for APU contact hours
  • Manages the preceptor incentive program
  • Maintains an “Active Preceptor List” eligible for incentives and awards
  • Coordinates annual “Preceptor of the Year” awards and celebrations
  • Organizes quarterly PreceptorU committee meetings to review program elements
• Facility Liaisons
  • Collaborates with the committee to develop objectives for Parts II and III
  • Designs and implements Part II curriculum at the facility level
  • Coordinates with clinical educators to design and implement Part III curriculum
  • Tracks completion for Parts II & III
• Clinical Educators
  • Designs and implements Part III content at the departmental level
  • Develops a needs assessment of skills competency
  • Reviews and updates orientation and performance evaluation documents
  • Tracks completion for Part III in collaboration with the facility liaison. For non-nursing departments, Part III content is managed by a specialty educator or leader within the department

Preceptor Incentive Options

Support for preceptors in the form of benefits and rewards is an important component of preceptor training. Preceptors were previously recognized through our nursing professional development programs and were eligible for preceptor of the year awards, but when our organization redesigned preceptor training, one of the main components I wanted to incorporate into the program design was a monetary bonus or incentive. I approached our executive senior leadership with a proposal listing a few options for incentives with an associated cost analysis. After selecting the option for an hourly incentive for precepted time, the Chief Nursing Officer presented this proposal to our shared governance for review and approval.

Current incentives available to PreceptorU participants are:

• Preceptor of the Year: This recognizes preceptors who go above and beyond through a peer-nominated process. One recipient from each of our organization’s facilities is selected annually and celebrated during hospital week. Award winners receive a certificate, engraved award, flowers, and are featured in our newsletter.
• Clinical Ladder Recognition: Trained preceptors receive an activity point towards their portfolio within our nursing professional development program for both initial training completion and maintenance of annual preceptor competencies. In our continued commitment as an academic medical organization, we also offer additional points for hours spent precepting clinical students. Other organizations may apply training recognition through their annual review process or role development.
• Incentive Pay: When PreceptorU launched in 2021, it was approved for our nursing staff who completed all components of the program, to receive $2 an hour in addition to their hourly compensation for preceptor time. After the first year of implementation, a return on investment was provided to senior nursing leadership who then approved nursing support staff who were trained preceptors to earn $1 an hour in addition to their hourly wage for precepting. As the popularity of the program spread, and more leaders began to equate preceptor training with improved retention, we were able to collaborate with executive senior leadership of other departments who now offer incentive pay to other roles participating in the program. Respiratory therapists, medical technologists, and pathologists receive a $2 incentive, certified medical assistants receive $1.50, and laboratory assistants and phlebotomists receive $1 per hour.

Here are some other options available to help recognize preceptors for the impactful work they do that we currently have not implemented but you may want to consider:

• Annual Bonus Structure: An alternative option to hourly compensation is to allot an annual bonus for preceptors who have completed training and maintain competency throughout the year.
• Incentivized Bonus Structure: An additional option would be a bonus offered to the primary preceptor based on retention of the orientee. The preceptor would receive a monetary bonus if the orientee remains employed within the organization at predetermined increments.

Program Impact

I am so incredibly proud of our team and the work they have implemented. Since we launched PreceptorU in July 2021, we now offer preceptor training at all 11 locations, and have increased the number of preceptors who have attended training from 196 to 954 with 180 approved applicants scheduled for training.

• Nurses: 716
• Nursing support staff (patient care assistants, mental health techs, surgical techs): 142
• Certified medical assistants: 24
• Laboratory staff (lab assistants, phlebotomists, medical technologists, pathologists): 19
• Respiratory therapists: 12
• Other roles (sterile processing, blood bank, paramedics): 41

As an organization, we have also seen a decrease in voluntary one-year turnover rate for all team members in a patient facing role from 30% to 21% since this training was implemented. Specifically, nursing turnover improved from 25% to 16.6% at the conclusion of fiscal year 2024.