Preceptor Development Research Articles

Innovative learning in pharmacy practice: The perceived benefits of and barriers to a layered learning practice model

ObjectiveTo assess pharmacy preceptors’ perceptions of the benefits of and barriers to a layered learning practice model (LLPM) at their practice site. MethodsAn online survey was created using Qualtrics and sent to experiential directors at all colleges [or schools] of pharmacy in Ohio and at Big Ten universities. The experiential directors were asked to send the survey to all preceptors affiliated with their program. The survey assessed the perceived or actual benefits of and barriers to a layered learning model. Benefits and barriers to patient care, student or resident learning, and the practice site were assessed. ResultsIn total, 304 surveys were initiated by precepting pharmacists. Survey respondents reported precepting introductory pharmacy practice experience students (n = 113, 37.1%), advanced pharmacy practice experience students (n = 184, 60.5%), and residents (n = 176, 57.9%) throughout a given year. Survey respondents’ most commonly identified benefits of a LLPM included an increase in patient access to pharmacy team members (n = 97, 42.3%), an increase in the number of precepting opportunities for learners (n = 80, 34.9%), and improvement in patient education (n = 76, 33.2%). The top identified barriers to a LLPM included performing precepting duties that may interfere with preceptor job responsibilities (n = 158, 72.1%), having inadequate workspace for learners (n = 120, 54.8%), and being unable to effectively teach or oversee multiple learners simultaneously (n = 77, 35.1%). ConclusionsThis research provides insight into pharmacy preceptor perception of how a LLPM impacts practice sites, patient care, and training of pharmacy learners. This information may be valuable in the design of preceptor development for colleges of pharmacy and residency programs.

Advancing Pharm. D. Training in Egypt through a Structured Preceptor Development Program.

The Children’s Cancer Hospital of Egypt (CCHE) and the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences (SSPPS) collaborate to offer a Doctor of Pharmacy (Pharm.D.) degree to international pharmacists holding a bachelor’s degree in pharmacy. The experiential training is provided by CCHE’s clinical pharmacist preceptors at CCHE. Clinical pharmacists at CCHE had prior experience precepting baccalaureate pharmacy students, but not Pharm.D. students when this program commenced. Therefore, the SSPPS faculty provided a live preceptor development program for select CCHE clinical pharmacists in 2017. Primary deliverables of the program included the preparation of individual preceptor development plans and experiential syllabi for program participants. Preceptor development plans and experiential syllabi were evaluated by the SSPPS faculty. Program participants were also evaluated on their assessment of learner case scenarios using introductory pharmacy practice experience (IPPE) and advanced pharmacy practice experience (APPE) assessment tools created for the CCHE program. Participant performance on submitted preceptor development plans and experiential syllabi, and performance on the learner cases were all utilized for participant selection as Pharm.D. preceptors in the CCHE Pharm.D. program. This paper describes this preceptor development program, the process utilized to determine selection of Pharm.D. preceptors, and plans for providing continuing preceptor development for preceptors at CCHE.

Pharmacy practice faculty and preceptor development

AbstractFaculty development is a priority for colleges and schools of pharmacy for both corporate and individual success. Recommendations in the 2008 American College of Clinical Pharmacy (ACCP) position statement and white paper on faculty development remain relevant today. However, changes in educational standards, delivery of pharmacy education, and faculty and learners have prompted an update of the 2008 documents. This 2020 white paper focuses on three components: preceptor development, updates in pharmacy practice faculty development, and program formation and implementation. The paper provides evidence and recommendations for preceptor development and summarizes the literature updates related to pharmacy practice faculty development in several areas, including teaching, practice, and research. This update explores additional topics not emphasized in the previous paper, including faculty well‐being, holistic career‐long development, and challenges with implementing and assessing development programs.

Socialization Experiences of Athletic Training Preceptors

Context Preceptors serve to model behaviors for athletic training students (ATSs) and provide meaningful practical experiences. Preceptor development in athletic training has been described as both formal and informal training. Whereas regular and ongoing formal preceptor training is common and an expectation of accreditation, informal training may also be occurring but less is known about its impact. Objective Determine the socialization experiences influencing the role of being a preceptor. Design Qualitative. Setting Focus group. Patient or Participants Inclusion criteria were met if candidates were currently or had been previously a preceptor, whereas exclusion criteria were met if candidates had no previous or current preceptor experience. Participants (age = 32 ± 9 years, clinical-practice experience = 10 ± 8 years, preceptorship experience = 7 ± 4 years) were predominantly women (72.2%, n = 13/18), held a master's degree (77%, n = 14/18), and were educated and eligible for certification through an accredited bachelors program (88%, n = 16/18). Main Outcome Measure(s) A total of 18 individuals participated in 7 focus groups, with 1 focus group excluded for minimal attendance. A 2-member data-analysis team coded focus group transcripts using the phenomenological approach; data were organized into themes and subthemes. Results Preceptors discussed their formal training as programmatic responsibilities (Theme 1) while striving to create an ideal culture and environment (Theme 2) for student learning. The perceived preparedness theme (Theme 3) represented a lack of preparation and how preceptors worked to develop what they did not know. Last, preceptors described how they aimed to continue to improve their ability as preceptors (Theme 4). Conclusions Participants focused on incorporating behaviors modeled for them previously as well as peer feedback to work toward the development of an ideal learning culture for ATSs. Although informal socialization to the role of preceptor is important, it is also irregular; formal pedagogical instruction and development may prove more beneficial.

Registered nurse education in primary care: Barriers and resolutions.

American health care is facing unprecedented challenges due to population aging, chronic disease prevalence, and financial restructuring. The Affordable Care Act (ACA) is transforming the primary care landscape from a reactive, episodic, fee-for-service system to a proactive, preventive, value-based system. A proactive, preventive, and value-based primary care model requires Registered Nurses (RNs) prepared to lead integrated, team-based, coordinated, and proactively managed care. The Health Resources and Service Administration (HRSA) forecasted an inadequate supply of RNs prepared to meet future primary care demands and highlighted the lack of education as a key problem. The primary care RN workforce shortage requires immediate attention by academic, political, and research stakeholders. HRSA has responded with academic funding to increase primary care RN education. This article describes key barriers and resolutions one HRSA-funded academic institution experienced while implementing a primary care RN education program, along with research implications for the future of primary care nursing. This article describes the project's stakeholder, faculty, and student engagement methods. This article also describes the clinic RN preceptor development program, and depicts the Primary Care RN Education Program Student Clinical Experience Preceptorship Model. Nursing education must align with transforming healthcare models while anticipating potential barriers and resolutions to enhancing curriculum with primary care nursing education and clinical experiences. This article provides insight for other academic institutions interested in developing primary care curriculum and academic-clinic partnership models to foster community-based primary care clinical experiences.

The Status and Adequacy of Preceptor Orientation and Development Programs in US Pharmacy Schools

Objective. To identify current preceptor orientation and development programs at US colleges and schools of pharmacy and propose future initiatives for preceptor programs. Methods. An anonymous 28-item survey was administered in January 2017 to 128 experiential education personnel at accredited US schools and colleges of pharmacy. Data from completed survey instruments were tabulated and qualitative responses to open-ended questions were examined using thematic analysis. Results. Eighty-five experiential education administrators participated in the survey (response rate=67%). Most preceptor orientation programs met the majority of requirements as outlined within the Accreditation Council for Pharmacy Education's Standard 20.3, although only 42% of programs mandated preceptor orientation prior to student placement. Two-thirds of respondents offered annual, live preceptor development, and 75% of programs used commercially available online products. Nearly 40% of respondents collaborated with other schools or professional organizations to offer preceptor training. Only 29% of programs had specific requirements for pharmacists to maintain their active preceptor status. Seventy percent of respondents reported spending over $2500 and 39% over $5000 annually on preceptor development. Programs with the highest monetary investment (>$10,000/year) in preceptor development offered multiple venues (live and online) for preceptor training. Programs with significant personnel commitment (≥0.5 FTE devoted to preceptor development) frequently had dedicated site visitors. Conclusion. Preceptor orientation programs at US schools of pharmacy are generally similar, but development programs vary significantly across the Academy. Highly invested programs featured live and online training or site visitors who provided individualized feedback or training. Future studies should explore the cost-effectiveness of program options and their impact on preceptor learning and behaviors.

Program development of a preceptor bootcamp for operational pharmacy preceptors.

To describe the development, design, and implementation of a pilot preceptor development bootcamp and feedback related to its feasibility and impact on operational pharmacy preceptors. The University of Texas MD Anderson Cancer Center designed and implemented a pilot preceptor development bootcamp for operational staff pharmacists serving as residency preceptors for longitudinal weekend staffing experiences. A systematic, multipronged approach was taken to identify preceptor development gaps and design a full-day bootcamp curriculum. The resultant curriculum was comprised of content in major functional areas including using the 4 preceptor roles, documenting performance, giving and receiving feedback, and dealing with difficult situations or learners. The impact of the pilot preceptor development bootcamp was assessed using survey methodology and qualitative feedback from debrief discussions. Implementation of a pilot preceptor bootcamp program addressing major areas of precepting skill was well received, resulted in positive feedback from operational pharmacy preceptors, and was feasible to implement at a large academic medical center.

Identifying and Remediating Quality Issues at Clinical Teaching Sites: A CERA Clerkship Directors Survey

Background and Objectives: Family medicine clerkship directors must secure an adequate number of teaching sites while maintaining or improving the quality of teaching. This survey details how family medicine clerkship directors identify community-based clinical sites with performance challenges, types of challenges, and whether a remediation option exists for struggling clinical sites or preceptors. This study also investigates the relationship between clerkship structure and problems with maintaining high-quality teaching sites. Methods: Data were gathered and analyzed as part of the 2018 Council of Academic Family Medicine’s (CAFM) Educational Research Alliance (CERA) survey of family medicine clerkship directors. Results: There was a significant relationship between ease/difficulty of identifying clinical sites and paying preceptors (P=.032). A lower proportion of sites where a system is in place for remediation reported it being difficult to identify clinical sites (70.0% vs 92.2%, respectively, P=.011). Having a remediation system in place was also associated with less removal of sites (2.5% removed three or more sites vs 25% removed three or more sites, respectively, P=.005). Conclusions: Medical education leaders can explore payment to incentivize community-based preceptors in schools where identifying clinical sites is a challenge. Offering centralized preceptor development activities from medical schools, geared toward the importance of evaluations, balancing learners and opportunities for student engagement, may overcome some of the identified challenges. Medical schools may also consider providing additional time and support for clerkship directors to assist with tracking teaching quality at sites, and to assist struggling preceptors prior to removing them from teaching.

Will We Be Ready? Preparing Psychiatric-Mental Health Nurses for Future Practice.

OBJECTIVE: To review the challenges and issues facing educators as they prepare the psychiatric-mental health (PMH) nursing workforce to meet the needs of future practice. METHODS: Based on the author's 40-plus-year career as an educator, clinician, and researcher, combined with a review of the literature, this article analyzes the current educational milieu for undergraduate, graduate, postgraduate, and continuing education of PMH nurses, including urgent educational priorities. It also offers recommendations to meet the needs of PMH nurses both in education and in clinical practice. RESULTS: PMH nursing education must evolve to provide nursing experiences in nontraditional as well as traditional clinical settings, and incorporate simulation and telehealth/digital/mobile platforms for delivery of content. Development of qualified faculty members and preceptors who represent the diversity of the American population must be addressed to adequately train PMH nurses to meet the demands of their future roles. Methods must also be created to define, teach, and evaluate PMH nurses' clinical competencies pre- and postclinical experiences. CONCLUSIONS: PMH nursing education must evolve and transform to attract, appropriately educate and prepare students for practice, and meet the growing need for qualified practitioners as well as faculty members and preceptors.

Assessment of a Faculty and Preceptor Development Intervention to Foster Self-Awareness and Self-Confidence

Objective. To conduct and evaluate the outcomes of a pharmacy faculty and preceptor development program to foster self-awareness and self-confidence. Methods. A faculty and preceptor development intervention was implemented in a multi-campus college of pharmacy to promote and assess for improvements in self-awareness and self-confidence. Faculty members and preceptors were surveyed regarding their self-perceptions and confidence at baseline and following an intervention in which they completed the Birkman Method self-assessment and participated in a training program with an active-learning component. A longitudinal follow-up survey was conducted to assess the long-term impacts of the intervention. Results. Faculty members and preceptors experienced significant improvements in self-awareness from baseline following the development intervention. They also experienced increases in self-confidence related to coaching. A survey evaluating the longitudinal impact of the intervention indicated a positive association between receiving a sufficient level of Birkman Method training and improved ability of both faculty members and preceptors to manage professional relationships. Similarly, a positive association was identified between the sufficiency of training and preceptors' confidence in their ability to manage personal relationships and stress following the intervention. Conclusion. Faculty members and preceptors teach students to be more self-aware and confident, yet both groups often need to grow in these areas themselves. A faculty and preceptor development intervention using the Birkman Method self-assessment is one approach to facilitating growth in these educators' self-awareness and self-confidence.

Training the trainers: A preceptor development program targeting interprofessional collaboration competencies

IntroductionFaculty and preceptor development have been noted to be areas of need within the expansion of interprofessional education (IPE). The primary objective of this pilot study was to evaluate the impact of a preceptor development program on pharmacy preceptors' self-reported competence toward interprofessional collaboration. MethodsPharmacy preceptors were invited to participate in a two-hour preceptor development program followed by a brief survey. Preceptor development program objectives were to: define IPE and interprofessional collaborative practice (IPCP); describe the benefits of IPCP for patients/clients, healthcare providers, and health systems; discuss the four Interprofessional Education Collaborative (IPEC) Core Competencies; and describe IPE student experiences aimed at increasing collaborative practice. The Interprofessional Collaborative Competencies Attainment Survey (ICCAS) was administered after the preceptor development program. Descriptive statistics were used to characterize the data and paired t-tests were used to analyze pre-/post-program scores. ResultsThirty (35%) preceptors completed the survey. Mean scores for all twenty items in the ICCAS instrument increased from pre- to post-(p < 0.05). The mean total ICCAS score pre- was 5.28 ± 1.12 and post- was 6.17 ± 1.11 (p < 0.01) out of a possible total score of seven. ConclusionsA preceptor development program targeting IPE and IPCP increased pharmacy preceptors' self-reported competence toward interprofessional collaboration.

Effectiveness of a pharmacy teaching certificate program offered to practicing pharmacists

IntroductionRegardless of the practice setting, pharmacists' roles often expand beyond patient-centered services and into health-related educational roles for patients, healthcare providers, and student pharmacists. Teaching roles of a clinical pharmacist can include providing invited presentations (such as continuing education lectures), teaching colleagues about new clinical initiatives, precepting students during advanced pharmacy practice experiences (APPEs) and introductory pharmacy practice experiences (IPPEs), and precepting residents on rotations. This program was designed to evaluate the effect of a university-affiliated pharmacy teaching certificate program on participant knowledge and perceived confidence in specific areas of academic pharmacy and preceptor development. MethodsA 10-month program consisting of four live modules with associated continuing education (CE) credit was offered to pharmacy residents and practicing pharmacists in the surrounding area. The program format utilized didactic and active learning strategies with “at home” assignments to reinforce material presented. Content knowledge was measured with written summative assessments provided at the start and end of each module. Perceived confidence was assessed through online surveys provided at the start and end of the program. All results were evaluated using paired t-tests. ResultsData were obtained from 14 participants in the first cohort and 18 participants in the second cohort. For each of the four modules, there was a significant difference in pre- and post-knowledge assessments. Confidence data was also significantly increased regarding topics in each module. ConclusionKnowledge assessments and perception surveys suggest that this university-affiliated teaching certificate program improved both knowledge and perceived confidence for program participants.

This is how I think: Evaluation of a preceptor development webinar on incorporating the Pharmacists' Patient Care Process into experiential teaching

IntroductionThere is a critical need to establish and teach a uniform pharmacists' patient care process (PPCP) to create consistency in the profession. Little is known about preceptor incorporation of the PPCP into experiential teaching. MethodsUsing a pre-/post-program survey, this study aimed to characterize preceptors' perception of PPCP incorporation in teaching, confidence in PPCP articulation to team members and students, and ability to identify precepting strategies before and after completing a continuing education (CE) webinar. Results103 of the 158 preceptors enrolled in the CE program completed pre-/post-program surveys. Preceptors' perception of PPCP incorporation with introductory pharmacy practice experience (IPPE) students did not change significantly after the program (1.98 vs. 1.88, p = 0.317). However, advanced pharmacy practice experience (APPE) preceptors were less likely to strongly agree to PPCP incorporation after completing the program (1.91 vs. 1.72, p = 0.016). Preceptors felt increased confidence in their ability to articulate the PPCP to both team members (2.07 vs. 1.60, p = 0.000) and students (2.01 vs. 1.63, p = 0.000). Preceptors strongly agreed they had new strategies to use in precepting. ConclusionIn order to prepare student pharmacists, preceptors must be prepared to explicitly incorporate the PPCP into their teaching. A webinar with case examples and a preceptor tool can help equip preceptors to articulate the PPCP to colleagues and students, and to identify strategies to incorporate the PPCP into their precepting.

The Preparation and Development of Preceptors in Professional Graduate Athletic Training Programs

Context As professional athletic training programs transition to the graduate level, administrators will need to prepare preceptors to teach advanced learners. Currently, preceptor development is variable among programs and ideal content has yet to be identified. Exploring the development of preceptors teaching graduate learners can lead to an understanding of effective preceptorships. Objective To explore graduate professional athletic training program administrators' (ie, program directors', clinical education coordinators') experiences preparing and implementing preceptor development. Design Consensual qualitative research. Setting Individual phone interviews. Patients or Other Participants Eighteen program administrators (11 women, 7 men; 5.92 ± 4.19 years of experience; 17 clinical education coordinators, 1 program director). Participants were recruited and interviewed until data saturation was achieved. Main Outcome Measure(s) Interviews were conducted using a semistructured interview guide, and were recorded and transcribed verbatim. Data were analyzed by a 4-person research team and coded into themes and categories based on a consensus process. Credibility was established by using multiple researchers, an external auditor, and member checks. Results Participants reported the delivery of preceptor development occurs formally (eg, in person, online) and informally (eg, phone calls, e-mail). The content typically included programmatic policies, expectations of preceptors, clinical teaching methods, and new clinical skills that had been added to the curriculum. Adaptations to content were made depending on several factors, including experience level of preceptors, years precepting with a specific program, and geographical location of the program. The process of determining content involved obtaining feedback from program stakeholders when planning future preceptor development. Conclusions Complex decision making occurs during planning of preceptor development. Preceptor development is modified based on programmatic needs, stakeholder feedback, and the evolution of professional education. Future research should explore the challenges associated with developing preceptors, and which aspects of preceptor development are effective at facilitating student learning and readiness for clinical practice.

Preceptor Fidelity to the Creation of Precepting-Focused Continuing Professional Development Learning Plans.

To determine preceptor fidelity to the creation of continuing professional development (CPD) learning plans for improvements in clinical teaching. To determine topics of interest for preceptor development programming with a focus on clinical teaching skills. An online CPD program focusing on the reflect and plan stages was launched. The online program introduced preceptors to CPD, encouraged preceptors to review student feedback, and required completion of a CPD precepting plan. Preceptors were provided four guided questions to develop their plans. Preceptor fidelity to the creation of a CPD plan to improve precepting skills was rated as: 1) having a plan for improving a precepting skill, 2) having a plan for improving precepting, but not skill-based, or 3) having a plan lacking a precepting focus. Topics of precepting improvement were identified. Of the 491 preceptors who completed CPD plans, 46.2% of the plans were skill-based. Of those, 59.5% of the CPD plans included specific learning items. Only 3.9% of preceptors submitted nonprecepting focused CPD plans and the remaining 49.9% of CPD plans were non skill-based, but precepting focused. Giving feedback was the most frequently listed topic with 45.8% of preceptors including it in their CPD plans. This online precepting CPD program successfully guided preceptors in developing CPD plans that have the potential to improve student learning experiences. Future precepting CPD programs will need to provide direction on the use of skill-based objectives. Further investigation is needed to determine the effectiveness of the program in changing precepting behavior.

A standardized and layered approach to preceptor development.

A standardized and layered approach to preceptor development.

Identifying self-assessed competencies and areas for improvement within community pharmacist-preceptors support during pre-registration training

BackgroundCompetency frameworks that prompt personal and professional development have become an important component of lifelong learning; they are driven by healthcare professionals’ need for development and professional recognition. This study aimed to evaluate the self-assessed competencies of community pharmacist-preceptors by using Croatian Competency Framework (CCF) and to identify competencies to be improved. The secondary aim was to explore the association between community pharmacists’ characteristics (i.e. age, education etc.) and self-assessed competency performance.MethodsThe study subjects were community pharmacist-preceptors who provide support to and mentor student trainees enrolled in pre-registration training for pharmacy students. At the beginning of their mentorship, the pharmacist-preceptors assessed their competencies on a four-point Likert scale by using the Croatian Competency Framework (CCF), a validated tool for assessment and self-assessment of community and hospital pharmacists. Data were collected via e-mail in the period from October 2015 to April 2016.ResultsOf the 260 community pharmacists approached, final analysis included 223 respondents. The response rate was 85.8%. Community pharmacist-preceptors assessed themselves as the most competent in competencies pertaining to the cluster “Organization and management competencies” (M = 3.64, SD = 0.34), while they considered themselves as the least competent in the competencies pertaining to the cluster “Pharmaceutical public health competencies” (M = 2.75, SD = 0.77). Younger pharmacists with a postgraduate qualification who worked for large pharmacy chains in the capital city area and who had been in their current posts for a shorter period perceived themselves to be more competent.ConclusionThis research represents the first analysis of the CCF in practice and identifies community pharmacist-preceptor competencies that require improvement. Consequently, areas for additional professional education were defined. Implementing modalities to measure and support development of preceptors’ competences is essential for improvement of student training programmes.

Thinking Outside the Box: Are We Ready for Teleprecepting to Expand Training and Practice Venues?

A significant challenge related to nurse practitioner (NP) training is the shortage of clinical sites with qualified faculty to precept NP interns. The problem is compounded in rural communities with provider shortages, restricting their opportunities to train (and potentially recruit) new APRNs. Consequently, these underserved communities have difficulty accessing specialty providers, such as Psychiatric Mental Health Nurse Practitioners (PMHNPs). Combined with geographic distance from urban communities and generally lower pay, many rural and/or remote communities struggle with the disparity in contrast to more populated regions. A needs assessment of an underserved county with poor access to psychiatric services suggests that contracted telepsychiatry was costly and failed to address the long-term dearth of local psychiatric providers. Stakeholders reported that local RNs (and possibly FNPs) were employed by the local hospital and that a subgroup may have aptitude and interest in psychiatry if a university program and preceptors were available. Collaborating with an urban PMHNP program, televideo technology for clinical training and preceptor development offers a solution to the dearth of preceptors. A pilot intervention will use teleprecepting aimed at establishing best practice guidelines for implementation of this novel approach to expanding the clinical training and capacity in rural and under-served communities.

Describing education management and perceptions in health‐system pharmacy: A survey of medical institutions

PurposeTo describe current pharmacy education organizational structures and perceptions in medical institutions in order to inform education management practices and prompt greater discussion about strategies to optimize workforce development and patient care.MethodsTwo surveys were created and distributed to collect information from key personnel involved in educational management at medical institutions across the nation. The education management survey was distributed to residency program directors and requested participants to define their current organizational structure around and resources for education. The education perceptions survey was distributed to health‐system pharmacy personnel and requested participants to describe their perceptions and needs about current education programs and management strategies used in their respective institution.ResultsSixty participants from primarily large academic medical institutions (88%) completed the education management survey (37% response rate). Only 27 (45%) institutions were reported to have an individual responsible for education program oversight and 20 (33%) institutions have an education committee. Participants identified that a significant gap remains in resources available for preceptor development, technician continuing education, and conducting research in health‐system pharmacy. The education perceptions survey was completed by 107 participants from 31 institutions; most participants felt their institutional education structure was “above average” (33%) or “average” (45%).ConclusionThe findings from this study suggest education management in a sample of institutions is variable and in need of greater attention. Institutions are encouraged to commit to refining pharmacy education management models to support lifelong learning practices that are integral for organizational success and advancing the profession.

The art of balance: Preceptors' experiences of caring for deteriorating patients.

To explore nurse preceptors' experiences of caring for deteriorating patients while providing guidance and supervision to a new graduate nurse. Fostering novice nurse development during high-stakes encounters may be challenging for preceptors. Despite myriad preceptor literature, there is limited published research on experience of caring for deteriorating patients while serving as preceptor to a novice nurse. Qualitative interpretive phenomenological analysis. Data were collected through one-on-one, semistructured interviews between August 2016-September 2017 until data saturation occurred. Diekelmann's method was used to analyse the narratives of the purposive sample of 11 nurse preceptors. The findings reveal the experience of preceptors as they balanced their role as nurse with preceptor role to ensure patient safety and novice nurse development. Supporting the novice to care portrays the ways preceptors facilitated novice nurse development in caring for deteriorating patients. Impacting the preceptor role was remembering their own novice experience. Knowing when to step in was influenced by the preceptor's clinical expertise as they came to know (or not) when it was necessary for them to assume care of the patient. Debriefing: an essential preceptor tool emerged as a critical aspect of the experience to review technical aspects of care, vent emotions and provide evaluative feedback and reassurance to the novice. Preceptors' experiences of caring for deteriorating patients while precepting novice nurses require a balancing of roles to ensure patient safety and novice nurse development. Preceptors' clinical expertise was critical in knowing when to step in and assume care of the patient. Caring for deteriorating patients while serving as preceptor to novice nurses requires clinical expertise to ensure patient safety and novice nurse development. Clinical leaders may use the findings from this study to improve preceptor development and support.