Building Trust With Your New Hire

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

Be Explicit About Expectations

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

Create Opportunities for Clinical Experiences

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

Form an Environment of Feedback

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.

Create a Psychologically Safe Environment

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.

Conclusion

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.

References:

1. ten Cate O, Chen HC. The ingredients of a rich entrustment decision. Med Teach. 2020;42(12):1413-1420. https://doi.org/10.1080/0142159X.2020.1817348
2. Ulrich BT. Mastering Precepting: A Nurse’s Handbook for Success. Indianapolis, IN: Sigma Theta Tau International; 2019.
3. Edmundson AC, Lei Z. Psychological safety: The history, renaissance, and future of an interpersonal construct. Annu Rev Organ Psychol Organ Behav. 2014;1:23-43.

AORN Resources

Open access:

• AORN Position Statement on Orientation of the Registered Nurse and Surgical Technologist to the Perioperative Setting
• 2 Ways to Create Connection and Build Trust - AORN Article
• 3 Ways Leaders Can Build Team Trust - AORN Article
• Your Practice: 12 Tips for New Preceptors - AORN Periop Today

AORN members can access:

• Tips for Being an Effective Nurse Preceptor - AORN Journal