This paper presents an orientation and development guide for nursing preceptors in clinical training settings. It outlines the preceptor's role as a bridge between academic theory and real-world practice, detailing responsibilities for one-on-one student supervision using a competency-based approach. The guide also addresses the ethical and legal obligations of preceptors when supervising student nurses, reporting requirements, and performance appraisal processes. Two practical scenarios are examined: one addressing a preceptor who consistently arrives late and allows unsupervised student practice, and another exploring how faculty can support a preceptor seeking to complete a BSN degree. The guide draws on evidence-based frameworks to promote safe, professional, and effective clinical education.
The role of a preceptor in any student program is paramount to clinical training. The preceptor demonstrates the practical side of the academic program, performing procedures and protocols in accordance with current evidence-based practice within the confines of the nursing profession's practice protocols and the policies and procedures of the facility in which he or she works. The preceptor also allows the student nurse the opportunity to observe a balanced continuum of care.
Within this relationship, the preceptor models the realities of practice for the student and helps guide the student in organizing behaviors and strategies for effective and efficient patient care. In addition, a preceptorship provides the student with the opportunity to experience the pressures of day-to-day relationships with patients, other professionals, the referral system, local, state, and federal rules and regulations, and the realities of productivity-based practice. Preceptors are the vital link between the concepts and evidence-based approaches to care and the realities of actual practice (Barker & Pittman, 2010, p. 145).
When the clinical student is ready to stop observing and begin practicing independently, the preceptor acts as a guiding and observing coach, allowing the student nurse the opportunity for professional and practical development of skills. In this role, the preceptor is expected to demonstrate the utmost professionalism and skill, and to aid in the development of the student nurse so that he or she may eventually practice independently with the same professionalism and attention to detail.
Nursing instructors are spread very thin in a clinical setting. Although the expectation is that they will stand back and observe the work of the preceptor, they cannot be present for every procedure or training experience of every student nurse. Nursing instructors rely heavily on preceptors to demonstrate procedures and practices that coincide with the materials being taught in theory and coursework. They also rely on preceptors to serve as the eyes and ears of the clinical setting — noting the readiness or developmental needs of the nursing student so that these needs or proficiencies can be supported through praise or further clinical training, away from patients.
The most important role of a preceptor, as with any nurse, is that of patient advocate — one who will realistically support nursing students in their attempt to become safe providers of care to patients in vulnerable positions of health and wellness. The instructor and student have an obligation to communicate to the preceptor the clinical readiness of the student nurse, and the preceptor has the obligation to note this level of skill and use it as a starting point for observation and determination of independent skill development opportunities (Barker & Pittman, 2010).
Competency is based not only on skill of performance but also on taking into account the safety and comfort of a patient. Student nurses are considered competent to practice only once they have demonstrated appropriate skill to the preceptor and/or the nursing instructor. To a large degree, the bulk of clinical skills development is in the hands of preceptors, who seek to support competency, intervene when the patient may be at risk due to incompetency, and report back to the nursing instructor. The nursing instructor will then communicate with the nursing student to address competency issues or achievements in the appropriate manner.
To accomplish this, each student has a comprehensive list of procedures and practices that must first be observed and then applied, in order to determine the competency and skill they are developing. At no time should the patient, nursing student, preceptor, or any other non-preceptor care provider feel unsafe or at risk of harm. The preceptor often has the role of assuring the patient that the nursing student is competent and able to perform the needed procedure safely and effectively, with the patient's health and wellbeing in mind — sometimes even before this is fully known to the preceptor. If for any reason the nursing student's actions compromise the patient beyond what is competent, the preceptor must be present to take over and advocate for patient wellbeing above all else.
Preceptors supervising students are expected to be present for demonstrations as well as to observe when a nursing student is believed to have achieved the skill needed to perform procedures. They are ethically and legally obligated to intervene if the safety or wellbeing of any involved party is compromised, in their professional judgment. Once a skill set has been demonstrated by the nursing student, some tasks can be delegated to him or her without direct observation — provided the nursing instructor is aware of and has approved independent care. However, the preceptor must remain available and reachable in a rapid manner, and a nursing instructor must be present in the facility at all times for any student nurse to perform procedures.
The legal allowances of the student nurse program demand these standards, as do the legal and ethical policies and procedures of the facility contracted with the nursing school to provide a safe and productive clinical setting. A preceptor cannot delegate any responsibilities to another individual who has not met the conditions of being a preceptor or who is not fully qualified to observe and supervise a student nurse (Barker & Pittman, 2011, p. 146).
"Reporting duties and preceptor evaluation processes"
"Response plan for a chronically late, non-supervising preceptor"
"Supporting a preceptor in pursuing BSN degree completion"
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