The Preceptor Shortage: Bridging the Gap

The shortage of preceptors has become a multifaceted challenge in the nursing profession. As nursing schools increase enrollment to address the national nurse shortage, many local colleges struggle to find health care organizations that can support the clinical hour requirements of current nursing school curricula. At the same time, these organizations face retention issues and a lack of experienced nurses to train new nurses. As a result, some organizations are forced to use contract or novice nurses as preceptors simply due to lack of options. This issue is compounded by challenges in the advanced practice registered nurse (APRN) pipeline, which have reduced hospitals’ ability to retain experienced bedside nurses. So how can we align nursing higher education needs with the limited capacity of health care organizations to support clinical training?To expand access to health care and primary care providers, the number of APRN programs across the country has grown significantly.1 Some institutions now accept nurses with just 1 year of experience. Although this change increases access to advanced education, it has had unintended consequences—exacerbating the experience gap at the bedside. According to the Advisory Board,2 the nursing workforce is “becoming increasingly novice as experienced nurses retire,” yet little emphasis has been placed on how APRN program trends have contributed to this situation.Excluding the first 2 years of the COVID-19 pandemic, most turnover in my unit has been due to nurses pursuing higher education. Although this is a positive reason to leave, strategies must be implemented to recruit and retain both novice and experienced nurses to address the preceptor shortage.Over a decade ago, my organization launched a nurse residency program as a long-term pipeline solution. A consistent requirement of the program is a 3-year commitment: 1 year of nurse residency followed by 2 years of employment. Granted, a 3-year commitment can deter some applicants, but strong retention strategies can make the time commitment less of a concern. For example, nurses at my organization may be promoted from RN-I to RN-II after 1 year if they meet residency requirements and hold a bachelor of science in nursing degree. After completing the second year, they may transfer to other departments. Residency training also includes online and in-person preceptor courses, completed within the first year, expanding our pool of eligible preceptors for new hires and nursing students.To recruit and retain experienced nurses, my organization offers promotions from RN II to RN-III positions for those with a BSN, specialty certification (eg, CCRN for critical care nurses), and at least 3 years of related nursing experience. These promotions come with a $2 to $4 hourly raise, helping to retain nurses with valuable experience and close the experience-complexity gap.During the COVID-19 pandemic, we introduced a preceptor pay differential—$1/hour for precepting nursing students in their final semester, and $2/hour for new hires. Although modest, this incentive has boosted participation. Another recent strategy has been the creation of the Guiding Light Award, which recognizes outstanding preceptors, emphasizing appreciation beyond monetary compensation.One of the most impactful strategies in my unit has been fostering a culture of transparency, resilience, and support among leadership and bedside staff. Our nurses feel a strong duty to patients and one another. Knowing that a resignation letter with a 2-week notice period does little to ensure the unit remains optimally operational, we have built a culture where leadership supports the individual goals of nurses. In turn, bedside nurses are proactive with notifying leadership of their intent to leave far in advance. Even without a formal resignation letter or knowing the exact departure date, the hospital’s leadership has remained committed to allowing nurse leaders to preemptively backfill nurses who will be transitioning to APRN roles. Because it takes roughly 2 to 4 months to hire and onboard a new nurse to the organization, we strategically hire and orient new nurses to the organization 2 to 4 months before a nurse’s anticipated departure. This strategy has effectively minimized gaps in staffing, while maximizing the use of preceptors to train new nurses before they leave the organization.There is no one-size-fits-all solution to the preceptor shortage, which is intertwined with broader nursing workforce and education challenges. Hospitals must remain adaptable, innovative, and focused on organizational culture to bridge the gaps that are affecting the quality of patient care. In addition to these strategies, nurses must feel safe, supported, and valued. We cannot expect nurses to focus on meeting the Maslow hierarchy of needs for our patients,3 if the same hierarchy of needs is not being met for nurses. Supporting nurses is not optional— it is essential for the survival and strength of our workforce.