The overall experience-level of the nursing workforce is declining, as retirement-age nurses exit the workforce and the number of new nurses continues to grow. At the same time, the patient population is becoming older and more complex, with more chronic comorbidities. As a result, more novice nurses must deliver more complex care. This phenomena is referred to as the experience-complexity gap, and if left unaddressed, may put clinical quality and safety at risk.

In 2019, the experience-complexity gap became a reality at UW Health. The organization faced a shortage of experienced nurses and primary relied on new graduates to fill those vacancies. However, UW Health had not scaled their onboarding to meet the influx of novice nurses. Specifically, they didn’t have enough preceptors to support a growing cohort of new graduate RNs.

Nursing leaders from UW Health attended a Nursing Executive Center national meeting featuring research on the experience-complexity gap, including best practices to help update their preceptor program. This struck a chord given their shortage of preceptors. So UW Health leaders decided to revamp their preceptor program with the help of the Advisory Board’s Nurse Preceptor Toolkit. This toolkit has nine tools designed to help organizations update their preceptor support to more effectively teach the growing novice workforce in today’s complex care environment.

UW Health’s approach to revamping their preceptor program

UW Health’s preceptor work was led by two nursing education specialists. They used the Nurse Preceptor Toolkit do to 3 things with the goal of updating their preceptor program:

1. Identified areas for improvement. The nursing education team used the preceptor program diagnostic to assess their preceptor program and identify their greatest opportunities for improvement.
2. Made the case for additional preceptor investment. After identifying their opportunities, the nursing education team created a case for why they needed time and resources to improve preceptor training and presented it to the Director of Nursing Education and the CNO. As part of their case, they shared the diagnostic results and proposed steps to address their biggest opportunities for improvement, ultimately receiving support to pursue this work.
3. Revamped their preceptor training. With executive buy-in, the nursing education team used Advisory Board’s Nurse Preceptor Toolkit to revamp their basic preceptor class to increase the number of preceptors, and reevaluate their advanced preceptor class to provide more ongoing support.

First, they used the preceptor training topic checklist to prioritize the most important skills and topics to cover when training preceptors. This tool prompts users to rank topics from most to least important to include in preceptor training. The topic checklist includes items such as how to develop clinical reasoning and how evaluate nurse competency.

Second, they used the guide to preceptor role-play to incorporate role-playing exercises into preceptor trainings. The role play scenarios and discussion questions help preceptors practice key skills, such as delivering actionable feedback, developing clinical reasoning in new graduate nurses, and communicating preceptee performance to nurse leaders.

Results

Many of UW Health’s preceptor improvement interventions are still underway or in the planning stages. However, to-date their biggest success was using their diagnostic results and the experience-complexity gap research to secure executive buy-in to redesign their preceptor support. The diagnostic allowed the nursing education team to show leaders where their deficits were. With this insight, executive leaders were quickly on board and gave the nursing education team the go ahead to invest their time into improving preceptor support.

In addition, the new preceptor class has a waiting list, with participants overwhelming rating the training as positive and report using the skills they learned while precepting.