Power to the Preceptors

Project Topic:

Improving and standardizing precepting in the Emergency Department (ED)

Hospital, City and State:

Seattle Veterans Affairs Medical Center, VA Puget Sound Healthcare System, Seattle, Washington

Unit:

Emergency Department

CSI Participants:

• Priya Fernandes, BSN, RN, CEN
• Cara White, BSN, RN
• Rebecca Woo, BSN, RN

Project Goals/Objectives:

1. Increase new staff retention in the first year 60% to 75%
2. Increase preceptor confidence 57% to 75%
3. Increase Healthy Work Environment Assessment Tool (HWEAT)⁷ Skilled Communication score 2.89 to 3.51 and True Collaboration score 2.58 to 3.5

Project Outcomes:

1. Decreased nurse turnover 3 RNs (note: hiring pause for 6 months; data is for 3 months)
2. Increased preceptor confidence 10% on post-survey
3. Decreased HWEAT Skilled Communication and True Collaboration scores
4. Increased HWEAT Effective Decision-Making score (only standard that increased)
5. Potential annualized fiscal impact $157,050

Project Overview:

The Emergency Department is a fast-paced and complex care environment which may be challenging. Nurse turnover in our unit was 40%, which is significantly higher than the national average. Increased staff turnover can be expensive for the hospital, demoralizing for staff, and cause increased staff stress and preceptor burnout.

Utilizing the HWEAT results and talking with staff, the CSI team realized we could potentially decrease turnover rates by providing support to the new hires right from the start. The team created an Emergency Department Preceptor Committee (EDPC) to support the new hires and the preceptors and adapt to the needs of this dynamic environment.

The EDPC utilized a 5-pillar onboarding and orientation framework (CITE)

This involves:

1. Early engagement -Create a welcoming environment by reaching out to the new hires before they start with a welcome email, a small gift, and a request for a picture and quick bio to use to introduce them to staff
2. Strategic preceptor selection - Add representatives from EDPC to the hiring committee to help with preceptor selection, considering preceptor teaching types, and interpersonal skills that align best with the new hires' personalities and learning styles
3. Educator rendezvous
4. Ongoing progress check-ins – created a weekly check-in tool that can identify strengths and weaknesses.
5. Preceptor empowerment - Created preceptor courses, ongoing preceptor workshops, tools and tips intranet preceptor/preceptee SharePoint page, as well as a monthly newsletter featuring our new hires and preceptor fast facts.

After our pre-survey and new course/framework, we had a hiring pause for 6 months. We were unable to precept or implement much preceptor education until November 2024. Only 6 of the original 18 preceptors on staff participated in the post-intervention preceptor survey, showing an increase in preceptor confidence (12/20 responses). The plan will be to sustain the project, collect turnover data, and preceptor confidence/satisfaction, and refine our project with the preceptor committee.