‘Preceptorship’ – helping newly qualified nurses ‘thrown in at the deep end’

Preceptorship is support for newly qualified nurses (NQNs) as they transition from studenthood to the demands, and responsibilities, of being a qualified nurse. Preceptorship refers to ‘a period of structured transition for the newly registered practitioner during which he or she will be supported by a preceptor, to develop their confidence as an autonomous professional, refine skills, values and behaviours and to continue on their journey of life-long learning’ (DoH 2010: 11). It is underpinned by a range of government policies and good practice guidelines, including A High Quality Workforce: NHS Next Stage Review which states: ‘A foundation period of preceptorship for practitioners at the start of their careers will help them begin the journey from novice to expert’ (DoH 2008: 72). Preceptorship aims to address how knowledge acquired in nurse training is recontextualised in practice (Evans et al 2010) and how newly qualified nurses (NQNs) adapt to the ‘real world of practice’ (Houghton 2014).

In addition to needing support in developing their clinical skills and self-confidence in their own nursing judgements, many NQNs find time-management in busy clinical contexts a challenge (O’Kane 2012) and, in parallel, experience difficulties in relation to delegation skills. Inability to delegate can lead to NQNs feeling overwhelmed, which can result in burnout and high staff turnover of NQNs. However, despite the need for registered nurses to be competent in delegating and supervising unregistered health care assistants, research suggests that their nurse education does not always equip them with the necessary skills (Hasson, McKenna and Keeny 2013). Preceptorship then becomes a vital means of supporting them in acquiring those skills.

Even though research repeatedly affirms the importance of preceptorship, it is not consistently available to NQNs cross the UK, nor, even if offered on paper, is it always reliably delivered in practice (Higgins Spencer and Kane, 2010) particularly at times where there are considerable restraints upon nursing budgets (Avis, Mallik and Fraser 2013). This means that many NQNs feel they find themselves in ‘Sink or Swim’ situations (Hughes and Fraser 2001). While many will swim, some inevitably will sink. This is a terribly waste not only of training, but also of people who want to be, and could be, competent and confident nurses, provided they are given sufficient support during their transition from student to qualified nurse. Investment in preceptorship can have huge benefits in supporting and retaining NQNs (Whitehead et al 2013) and as such should be made consistently and robustly available to nurses during their initial post-qualifying period.

References
Avis, Mark, Mallik, Maggie and Fraser, Diane M. (2013). ‘”Practising under your own Pin”–a description of the transition experiences of newly qualified midwives.’ Journal of Nursing Management 21(8): 1061-1071
Department of Health (2008). A High Quality Workforce: NHS Next Stage Review. London: Department of Health.
Department of Health (2010) Preceptorship Framework for Newly Registered Nurses, Midwives and Allied Health Professionals. London: Department of Health
Evans, Karen, et al. (2010) ‘Putting knowledge to work: A new approach.’ Nurse Education Today 30(3): 245-251.
Hasson, Felicity, Hugh P. McKenna, and Sinead Keeney (2013) ‘Delegating and supervising unregistered professionals: the student nurse experience.’ Nurse Education Today 33(3): 229-235.
Higgins, Georgina Spencer, Racheel Louise and Kane, Ros (2010). “A systematic review of the experiences and perceptions of the newly qualified nurse in the United Kingdom.” Nurse Education Today 30(6): 499-508.
Houghton, Catherine E. (2014) ‘”Newcomer adaptation”: a lens through which to understand how nursing students fit in with the real world of practice.’ Journal of Clinical Nursing: Advance access, http://onlinelibrary.wiley.com/doi/10.1111/jocn.12451/full
Hughes, Anita J., and Fraser, Diane M. (2011). ‘”SINK or SWIM”: The experience of newly qualified midwives in England.’ Midwifery 27(3): 382-386.
O’Kane, Catherine E. (2012). ‘Newly qualified nurses’ experiences in the intensive care unit.’ Nursing in Critical Care, 17(1): 44-51.
Whitehead, Bill, et al. (2013). ‘Supporting newly qualified nurses in the UK: A systematic literature review.’ Nurse Education Today 33: 370–377.