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It’s harder for new graduate RNs to achieve clinical competence—here’s why

Transition to practice is traditionally a challenging time for new graduate RNs. But in recent discussions with nursing leaders around the world, I’ve observed a new phenomenon: it is taking longer for new RNs to develop clinical competence despite an increased investment in onboarding and training.

According to Patricia Benner’s article in The American Journal of Nursing, “From Novice to Expert,” nurses develop clinical competence through time and repeated practice providing the same type of care in similar situations before providing care in variable situations. Given this, my team identified several factors that may explain this slower progression from “novice” to “competent.”

  1. First, the complexity of patients means there are a growing number of skills and competencies nurses must learn right out of the gate to deliver safe care today.
  2. Second, it is more difficult to learn these new competencies because the fast-paced care environment means there is less time to absorb new information and practice new skills.
  3. Third, there are a very limited number of less acute, less complicated patients to which managers can assign new nurses.
  4. Finally, as baby boomers continue to retire, there are fewer experienced nurses to coach novice nurses.

In response, many hospital and health systems are investing more time and resources to help new graduate RNs transition to practice—an average of 137 non-productive hours to onboard a single RN.

Preceptor role more critical than ever

Given this trend, the preceptor role has never been more important. Preceptors take on significant responsibility helping new-graduate nurses develop clinical competence, confidence, and critical thinking skills. In addition, preceptors can influence new nurse socialization, communication, and retention. Yet few organizations have updated their preceptor program to address this harder road to clinical competence. In our research, preceptors overwhelming wanted to help here, but reported feeling unsupported, exhausted, and burned out by the revolving door of new graduate RNs.

Last year, we worked with a few progressive organizations who addressed this challenge directly by revamping their preceptor program for today’s environment. The goal: support preceptors so they can be effective teachers and build clinical competence in the new workforce—without burning themselves out.

From that work, we developed a toolkit to help your organization do the same. To get started, I recommend using our preceptor program diagnostic. This tool helps you assess your organization’s preceptor program compared to industry best practice and identify the greatest opportunities for improvement. After completing this diagnostic, use the remaining sections of this toolkit to improve the prioritized areas.

Given that more new graduates will enter the workforce as experienced nurses retire, it is important for nurse leaders to consider how investing in preceptor support will help new graduate RNs as they develop clinical competence—building a stronger workforce for today and tomorrow.

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