Accelerated preceptorship model for internationally educated nurses

Key benefits and outcomes

• IENs have been better supported to interact with their peers, build their confidence, and integrate in their clinical area as key members of the team. 
• IEN retention remains high after one to two years, with an attrition rate of 2-3 per cent reported. 
• The trust has received the CapitalNurse Preceptorship Quality Mark as a result of the new programme. 

What the organisation faced

Royal Brompton and Harefield hospitals, which specialise in heart and lung care, received their first cohort of 32 IENs in 2017. Initially assigned to a general preceptorship programme for all newly qualified nurses (NQN) (preceptees), the IENs underwent training aligned to the CapitalNurse framework and tailored to fit the needs of the organisation’s specialised care. 

In 2019, however, international recruitment increased significantly with the NHS’s 50,000-nurse national target, which in turn increased the number of nurses recruited at Royal Brompton and Harefield hospitals. Following the increase, it was recognised that the previous preceptorship model was no longer meeting the needs of the international recruits, as many of the nurses already had over 10 years of nursing experience. These experienced IENs in particular did not feel they benefited from the standard preceptorship model. 

What the organisation did

Royal Brompton and Harefield NHS Foundation Trust and Guy’s and St Thomas’ NHS Foundation Trust merged in 2021. This meant that while Royal Brompton Hospital and Harefield Hospital were running two separate preceptorship programmes for IENs and NQNs, the rest of the trust continued to run one core preceptorship programme. At Royal Brompton Hospital and Harefield Hospital, the NQN programme ran for 12 months with five study days, whereas the IEN programme ran for three months with two study days. 

Trust leadership therefore agreed to a new, accelerated model and highlighted the need for certain topics to be taught in a tailored way for IENs including introduction to UK healthcare, good communication, speaking up, escalation processes and psychological safety. 

The new programme was launched in March 2024. All IENs are offered the accelerated preceptorship programme. Some may still need to join the 12-month preceptorship programme, depending on their individual needs and clinical experience (this is reviewed on a case-by-case basis). The new accelerated programme runs for six months, with two study days at the beginning and end of the programme to allow the preceptees to connect with colleagues. It ensures that study days are tailored, acknowledging that the trust has a wide variety of specialty areas. 

The goal for all the preceptorship programmes is for the preceptee to develop their confidence and autonomy and be able to translate and embed their knowledge into everyday practice. Preceptees also have access to a psychological team focusing on wellbeing support. 

Results and benefits

Since rolling out the accelerated preceptorship programme, both Royal Brompton and Harefield hospitals have seen an increase in retention rates, with only 2 per cent of leavers being IENs in 2022-23 compared with 3 per cent the year before.

The new model has been very well received and represents a new area of collaborative working across the newly merged trust. 

More recently, the programmes have been made available to support other non-nursing roles such as operating department practitioners.

The programme has been awarded the CapitalNurse Preceptorship Quality Mark, after consistently achieving the CapitalNurse framework standards. 

Overcoming obstacles

Royal Brompton Hospital and Harefield Hospital struggled with allocating a preceptor to a preceptee during the programme, and were not given protected time to meet for their professional developmental meetings. Furthermore, rostering preceptees to work with their preceptors for at least four shifts in a month was challenging, given the skill mix and workload. They have been able to improve this by having touch points during clinical visits throughout the programme by collaboratively working with the educational and management team. 

Next steps

The programme was rolled out trust-wide in March 2024, focusing in particular on safeguarding, equality, diversity and inclusion (EDI), exploring cultural differences, and communication. The organisation is also now recognising the previous experience of IENs so that it is reflective in their pay and banding. This will open up more pathway opportunities and career development for IENs to reach band 6 more quickly. 

Top tips

• Get to know your IENs’ needs, acknowledge their previous experience, and incorporate this into any programmes, using their knowledge and experience as a resource. 
• Make sure programmes are flexible and tailored to whoever is on the course on the day (ie based on specialties and work areas). 
• Inform and signpost recruits about career developments and opportunities that are available to them, aiding retention. 
• Facilitate relationships between different teams across the trust (corporate, educators, management, and IENs) and introduce them to international recruitment leads in the trust. 
• Develop a strong preceptorship policy that outlines needs, roles and responsibilities, for both the facilitators and preceptees. 

Contact details

For more information about this case study, please contact the accelerated preceptorship programme team at Guy’s and St Thomas’ NHS Foundation Trust: AcceleratedPreceptor@gstt.nhs.uk.