Introduction

By publishing guiding principles for preceptorship, the Nursing and Midwifery Council (NMC)helped to raise its profile and importance for health professionals in the UK. Preceptorship is vital to help professionals grow in confidence and develop lifelong skills to support their professional development (NMC, nd). In Scotland, in response to the NMC’s guidance, NHS Education for Scotland (NES) facilitated a working group that produced a Scottish framework for preceptorship. The framework – namely (NES, 2022) – aimed to provide a consistent approach to supporting and developing preceptorship for newly qualified nurses, midwives and specialist community public health nurses.

This article discusses the development, delivery and evaluation of a preceptorship programme for health visitors (HVs) and school nurses (SNs) that took place in Highland, Scotland, from 2015 until 2022.

The benefits of preceptorship

The transition from student to registrant and integration into a new practice setting can be challenging: newly qualified nurses feel stressed and unsupported during this time (West et al, 2020). NES (2022) suggested that effective preceptorship programmes can:

• Support health professionals during the transition period;
• Help them develop lifelong skills to support their future professional development.

Preceptorship provides positive outcomes and experiences for health professionals, patients and employers (NMC, nd).

For the employer, investment in preceptorship programmes helps retain nurses; this reduces staff turnover rates and associated costs and builds a stable and satisfied workforce.

The benefits of preceptorship for newly qualified registrants are:

• Feeling valued;
• Development of professional confidence;
• A sense of place in the organisation and team (NMC, nd).

Although there is limited evidence related to both HVs and SNs, Phillips et al (2013) suggested that HVs benefit from and welcome preceptorship.

“Health professionals’ wellbeing is essential to enable them to provide compassionate, professional and effective care”

Highland preceptorship programme

While developing our preceptorship programme, we defined preceptorship as the provision of a supportive, nurturing, professional relationship to enable the safe transition of newly qualified preceptees. The programme aimed to provide a clear structure of support – with defined roles and responsibilities – to facilitate the development of skills and autonomy to ensure safe, effective care delivery.

In line with the NMC’s (nd) and McInnes et al’s (2014) recommendations, we developed a programme for newly qualified HVs and SNs in Highland. The programme was ideally situated to support the additional numbers of HVs and SNs recruited as a result of the Scottish Government’s Transforming Roles programme in 2015-21 (Chief Nursing Officer Directorate, 2017).

Our aim was to improve workforce stability and staff retention in Highland. The programme followed the NMC’s and McInnes et al’s (2014) recommendations on preceptorship development. Our aim was to improve workforce stability and staff retention in Highland.

The Highland preceptorship model is a 12-month programme comprising three core components:

• Support;
• Supervision;
• Action learning (Fig 1).

We introduced the programme using a quality-improvement approach in two phases over two years. In the initial phases, video conferencing (VC) was used to enable the preceptees to connect, because they were based in two different operational units. As the programme became embedded, a blend of VC and face-to-face sessions was utilised; this also enabled the programme to be delivered during the Covid-19 pandemic.

During the first Covid-19 lockdown in 2020, the action learning sets were briefly paused while we adapted to new ways of working. Preceptees struggled with changes to service delivery and adaptations to clinical practice brought about by the pandemic, such as the use of VC technology, vacant caseloads and staff shortages.

Health professionals’ wellbeing is essential to enable them to provide compassionate, professional and effective care (West et al, 2020), and it soon became apparent that HVs and SNs were more isolated by working mainly from home. To address this, we reinstated the action learning sets via VC and increased their frequency. Their themes were also adapted to include working from home, work–life balance and the pressures of a reduced workforce.

To date, 47 preceptees have undertaken the preceptorship programme, through six cohorts. Evaluations of each cohort have informed the development of the programme, and it now links more closely to organisational polices. As the programme is now well established and facilitators lead on its structure, line managers are less involved in the programme than they were initially. We have also condensed the documentation, and parts can be used for revalidation purposes with the NMC.

Action learning

As action learning is one of the model’s core components, action learning sets were designed to give preceptees a dedicated space, away from the workplace, where they could:

• Network;
• Obtain peer support;
• Reflect on their clinical practice (International Foundation for Action Learning, nd).

We aimed to support preceptees to bridge the theory–practice gap in a safe, facilitated environment. The sets enable preceptees to explore and adopt coping mechanisms to facilitate their continued development in an ever-changing and pressured working environment; the focus is on the preceptees, their personal and professional values and the impact their role has on them.

The sets’ themes are agreed in advance by the preceptees. The themes relate to key aspects of the HV and SN roles, as well as recognising the pressure on individuals during the transition from student to registrant. Set themes have included:

• Looking after oneself;
• Making sense of assessment information;
• Decision making;
• Enabling courageous conversations;
• Integrated working and responsibilities in relation to paediatric patients with additional needs;
• Leadership, management and delegation.

These themes led to preceptees discussing subjects, including: team dynamics, raising issues with team members, managing workload pressures, self-care, and transition into new roles.

Reflections on the programme

Using VC was initially daunting for the preceptees and facilitators; however, preceptees’ evaluations highlighted that the programme provided an effective learning experience and developed their competency in VC technology. Evaluation also showed that they valued the following:

• Professional networking;
• Relationship building;
• Reduced isolation in remote and rural areas;
• Peer support and reassurance from people experiencing similar challenges;
• Support through a period of change.

In particular, they reported that the action learning sets taught them about the importance of their wellbeing, having autonomy and managing work pressures:

“Looking after myself is key – I am only one person.”

“I take on things I shouldn’t; I need to be more assertive.”

“[A] support network is important when you become overwhelmed.”

The Highland preceptorship model’s strength is that it employs existing organisational infrastructure and resources – as an example, practice teachers initially took on the role of preceptors and facilitated the action learning component of the programme. As the programme has evolved and become embedded, the preceptor and facilitator roles have been taken over by experienced SNs and HVs.

Embedding the programme in the organisation has taken time but we have attained manager buy-in by:

• Keeping it on the organisation’s agenda;
• Promoting its benefits;

Sharing preceptee evaluations. Attending the programme was optional at the start of the programme but is now obligatory for all newly qualified HVs and SNs in the organisation.

We are sharing our learning from the initiative to enable other disciplines in the area to roll out similar preceptorship programmes. Table 1 highlights our key learnings and recommendations to develop and run a preceptorship programme.

Conclusion

The Highland preceptorship programme helped newly qualified HVs and SNs to grow in confidence as they transitioned into their new roles, promoting their wellbeing and mental health. It has fostered continuing professional development and links to revalidation. Using VC also enabled preceptees to stay connected and gain support in a period of uncertainty during the Covid-19 pandemic.

By investing in a preceptorship programme, the organisation aims to support registrants to be confident, capable and qualified, leading to a more stable and satisfied workforce.