Entering the field of nursing, and especially the specialty of oncology nursing, can be daunting. New nurses have been well-trained in the classroom, but the game changes when real patients are involved. We all remember our first job as an oncology nurse and the preceptor who got us through it. Each May, a new class of graduates wonders how they will get through it, too, and that’s where preceptors like ONS members Katie McGrath-Studniarz, RN, OCN®, and Nancy Walrafen, MSN, RN, AOCNS®, can help.
Nancy Walrafen, MSN, RN, AOCNS®
Experiencing the Joy of Precepting
“I know the thrill of having someone explain something to me and it connects, and I like to see that in new nurses eager to learn,” Walrafen says.
McGrath-Studniarz says she decided to precept because of her experience as a new nurse. “I became a preceptor only a couple of years after I had become a nurse myself. My unit’s nurse educator asked if I would attend the next preceptor workshop, and I jumped at the chance to share my passion for educating other nurses. As a fairly new nurse myself, I felt that I could relate to the new nurses and explain things in a way that they would easily understand.”
Residency Program Eases Transition for New Nurses and Increases Retention Rates
The University HealthSystem Consortium/American Association of Colleges of Nursing Nurse Residency Program was created to develop a better educated and empowered nursing workforce. The program focuses on transition into practice during the first year of employment following completion of a baccalaureate nursing degree.
Healthcare organizations across the United States can choose to offer and implement the program. The program boasts increased retention rates of nurses during their first year in participating organizations, compared to the national average.
Learn more about the residency program.
Walrafen turned to precepting out of a desire to pass her experiences on. “Others took the time to help me learn; when I return that, it’s just completing the circle.”
She has been precepting for more than 20 years, and at her institution there’s a formal process for becoming a preceptor. “If you’re precepting a new nurse, you have to be enrolled in the Preceptor Academy or attend our in-house preceptor training. The nurse has to express an interest in doing this, and the nurse manager must also recommend the nurse to precept.”
Addressing New Nurses’ Needs
After precepting new grads and interns for four years, McGrath-Studniarz has good insight into their biggest need. “By no fault of theirs, many new grads and interns don’t have much knowledge of oncology. Unfortunately, most nursing programs only briefly cover it in the classroom. I feel there needs to be increased exposure to oncology in all nursing programs.”
When it comes to the typical needs of a new grad and how to meet them, Walrafen says, “I’m always mindful to acknowledge a ‘good call’—regardless of the magnitude of the call. Gaining confidence is crucial, and it is difficult for a new nurse to recognize progress. That confidence is fundamental in establishing and developing critical thinking skills.”
McGrath-Studniarz agrees that building confidence is imperative to nurses at this stage. “Many of the new grads or interns are low on their self-confidence, needing constant reinforcement and feedback. They want to succeed, so they see not understanding a concept or mastering a skill right away as a failure. I provide constructive feedback and try to never phrase it so that it is coming across as negative or a put down. I’ll often ask them how they think they are doing and go from there. I also always try to point out at least one thing that they have done well.”
Both nurses think the needs of new nurses have changed over time. “Technology has changed the landscape in many ways,” Walrafen says, “but really that basic need for repetition of a task and doing, not watching, will never change. Hands-on learning trumps any skills or simulation lab—not to diminish those methods of learning.”
McGrath-Studniarz, in contrast, focuses on the long-term needs of new nurses and their careers. “Over the past few years, there has been a lot of debate over whether the entry level for nurses should begin with a BSN. To advance your career in nursing, you are expected to have a higher degree or certification. Many new grads or interns feel pressure to seek a higher degree or certification. Going back to school shortly after becoming a new nurse was not the focus of new nurses in years past. It’s great that so many new nurses want to advance their career, but it shouldn’t be because they feel pressured to do so.”
NURSING PROGRAM GRADUATES, 2011
| Nursing Program | Number of Graduates |
| Baccalaureate | 80,767 |
| Graduate | 24,311 |
| Doctoral | |
| Research-focused | 601 |
| Practice-focused | 1,595 |
American Association of Colleges of Nursing. (2012, March 22). New AACN data show an enrollment surge in baccalaureate and graduate programs amid calls for more highly educated nurses [press release].
Retaining New Nurses in Oncology
With the nursing shortage in mind, Walrafen and McGrath-Studniarz say that successful precepting can help a new nurse stay in the field of oncology. “I always share that the sky is the limit on experiences that an oncology nurse can be exposed to,” Walrafen says. “You can touch so many aspects of nursing—hematology, endocrine, orthopedics, metabolic—and caring for patients with cancer can provide you with a really broad picture of many systems. I also focus on the deep, personal experiences that oncology nurses live through caring for those with cancer. You will never feel more appreciated and if you watch your patients carefully, you learn how they maneuver through the trials of illness or end of life. You can develop an insight into life that I feel is unique to oncology nursing.”
McGrath-Studniarz says that she also focuses on the emotional pull of oncology nursing. “We must protect new nurses who enter oncology by fostering and encouraging their passion for the specialty. Nurse preceptors must help new grads deal with the reality shock of becoming an RN. Students are somewhat sheltered from the negative aspects and realities of health care in nursing school, and the preceptor must help to ease the transition into practice. Also, death and dying is a part of being an oncology nurse, but it’s not discussed in depth in nursing school, so nurse preceptors must assess new nurses’s coping mechanisms and discuss them to avoid caregiver burnout.”
What Makes a Successful Oncology Nurse Preceptor?
Walrafen says that a preceptor should be
- A good clinician who demonstrates both the art and science of nursing
- A nurse who offers the rationale for the action and is on top of best practice and evidence-based interventions
- A nurse who recognizes when to literally stop everything else and sit down when a patient needs another’s caring and presence
- A nurse who shows that it’s okay to not know the answer as long as you know where or who can help you get the answer
Similarly, McGrath-Studniarz says that preceptors must be “resourceful, encouraging, supportive, a great communicator, an active listener, and an advocate. They also need to have a good sense of humor. They must be respectful of new grads, because they are now colleagues. This is hard sometimes, but a successful preceptor must also know when to let go and let the new nurse become autonomous, but still be there if needed.”
Walrafen finds precepting highly motivating: “There’s nothing more rewarding than precepting a student and then having them return to your unit for a job because they saw the beauty of oncology nursing.”
McGrath-Studniarz agrees. “The most rewarding experience is seeing new nurses who started out as shy and unsure and become self-confident and competent, knowing that I’ve helped them to see and to reach their full potential. It is always a great feeling to see a nurse you’ve precepted go on to become a preceptor, too.”
You Tell Us! How did you get through your first year as an oncology nurse? Tell us your story in the comments.