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By: Lauren Danforth, MSN, RN, NPD-BC
Published: 8/30/2023
At the foundation of any clinical relationship is trust: trust between clinicians and patients, trust among the interprofessional team members, and trust between a new hire and the preceptor. Building a trusting relationship between the new hire and preceptor takes time, but there are some things that a preceptor can do to develop the trusting relationship.1
Expectations within nursing practice are often divided into two buckets: the written competency-based activities and the unwritten rules of practice (Table 1). Quite different from nursing school curriculum, where grades are generated on very specific evaluation criteria, the OR requires new hires to integrate into the culture of daily practice that varies among services and surgeons. The idea that the same procedure can differ due to a surgeon’s preference for instruments is a concept with which new hires struggle.
The unwritten cultural expectations of each OR environment need to be detailed for the new hire. The preceptor needs to be explicit about their expectations around nuances and coach the new hire to create a system that will prompt them to remember preferences. By sharing both the written and unwritten expectations, the new hire has the opportunity to demonstrate responsibility for those expectations, ultimately developing trust between them and their preceptor.
Table 1: Examples of Written vs. Unwritten Rules
Written Rules | Unwritten Rules |
Your shift begins at 0700. | The staff member is expected to be ready to start working at 0700, including changed into OR scrubs and ready for the morning huddle. Most nursing staff members arrive between 0630 and 0640. |
You need to take a break when a staff member comes to relieve you. | If you are intricately involved with a procedure (for example, implants, intubation, or teaching moment with an orientee), you can ask the staff member to come back at a better time for your break. |
You leave at the end of your shift. | If your OR case is running late, you can offer to stay and complete the case. |
One of the most challenging aspects of precepting is entrusting clinical care to the new hire. Preceptors often find themselves in close proximity of the new hire because they cannot relinquish control of patient care, which presents challenges when the new hire is nearing the completion of the orientation period. Additionally, preceptors question whether or not the new hire is competent to practice independently and, therefore, can be entrusted with patient care.
The preceptor should be planning clinical experiences for the new hire that allow them to see the most common procedures to develop competence (Table 2). Too many varied experiences don’t allow the new hire to build on prior knowledge nor demonstrate mastery of skills. The preceptor needs the opportunity to evaluate the new hire on routine procedures and develop trust in the new hire’s ability to practice independently. As the preceptor places the new hire in familiar situations to foster independence, the preceptor is also creating trust by demonstrating to the new hire that they are being put in safe situations where they are well supported.2
Table 2: Action Steps to Develop Clinical Experiences
Action Steps | Examples |
1. Determine what experiences should come first | The orientee scrubs first to build rapport with the surgeons, learn how the instruments are used, and view the procedure to know what steps are involved. |
2. Prepare for the secondary experiences | After the orientee has scrubbed, they can circulate to learn how to anticipate the needs of the scrub personnel. |
3. Build on experiences | The orientee becomes competent in one service line (eg, orthopedics) before moving on to another service line. The preceptor can ensure the orientee is getting the necessary exposure to the various procedures within that service line. |
Note: Developing clinical experiences requires that the preceptor is working closely with the nursing professional development practitioner/orientation coordinator, manager, and charge nurse while knowing the gaps in the orientee’s exposure to the various competencies. | |
New hires require feedback from their preceptors to correct behaviors and grow professionally. The preceptor should establish the frequency and format of feedback delivery, such as by summarizing feedback at the end of each shift, taking time to emphasize what went well and what needs improvement.
Download a Sample Feedback Form
Establishing parameters around feedback delivery helps the new hire trust that the preceptor will be transparent about their progress and provide a safety net for their new practice.
Psychological safety, according to Edmundson and Lei, is the “perceptions of consequences of taking interpersonal risks in a particular context such as a workplace.”3 Psychological safety occurs when the orientee can anticipate how the preceptor gives feedback, responds to questions, and acts as a backup when the team asks specific questions regarding the procedure or care of the patient. Providing a structure for how feedback will be given and inviting the orientee to give feedback about the preceptor’s style of teaching can help create a psychologically safe environment, as can encouraging the orientee to ask questions in a place where others will not overhear the questions and make judgments about the orientee’s knowledge level. Another way for the preceptor to foster psychological safety is to stay close by the orientee, especially early in the orientation period, to help answer questions that team members may ask.
Trust in the preceptor–new hire relationship is a two-way street. The new hire is responsible for gaining the trust of the preceptor. Additionally, the preceptor can role model how to build a trusting relationship by implementing the above strategies, which will enhance the trust of the new hire and lay the groundwork for a relationship built on that trust.
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