When Preceptors Avoid Attachment - Emerging Nurse Leader

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

A preceptor shared her thoughts about the role today in a recent workshop, “There was a time when I was excited to precept. I love watching our baby nurses grow over time. I invested my knowledge and emotion. Frankly now, it is just too painful to watch us orient new staff only to have them leave our team. I don’t invest as much of myself anymore or become too attached. It is too hard.” She is not alone, as many managers have observed this behavior with their preceptors. There is a psychological term for this behavior. It is known as an avoidant attachment style.

While attachment disorders are primarily found in children – an avoidant attachment style can occur in adulthood during extreme stress. Your attachment style involves your behaviors, interactions with others, and how you form relationships with them. During the past year, the turnover on teams (nationally 27%), especially in acute care environments, has been highly disruptive to core team relationships. New graduates often announce on the day of their arrival on units that they will be short-timers. Seeing one’s current job as a short tour of duty on a career trajectory has become mainstream thinking.

It is not surprising that preceptors are burned out and emotionally exhausted. Nurse managers struggle to find nurses who are willing to precept new staff. A manager told me she recently met with a preceptor who did not invite the new graduate to lunch with her on their first day working together. I was shocked to see this young nurse standing in the hall alone. She told me that her preceptor had gone to lunch. The preceptor told me she needed a break and was sure this new graduate had no plans to stay in the unit.

A decision to withdraw emotionally when in a preceptor relationship can have devastating effects on the transition of new nurses. Feeling like you are included as part of a team is critical to the development of psychological safety. Without an investment in a relationship, the new nurse will feel disconnected from others on the unit. Press Ganey’s research has shown that new nurses who don’t form attachments to their team, the leader, and the organization are a flight risk.

So how should nurse managers respond to the problem? A frank discussion with preceptors is essential – let them know how avoidant attachment happens. Ask them to come to you if they feel these emotions. A second important strategy is to do regular onboarding check-ins with new nurses.

You should schedule a check-in at the end of the first week. Examples of questions to ask during a Week ONE check-in include the following:

Has our team made you feel welcome?
Did you receive what you needed to begin work? (ex. New employee benefits information, ID badge, keys, email, and electronic medical record access)
Do you have questions that we have not answered?
What challenges do you see in your new role?
Is there anything we should change to help new staff better adjust to the unit?

Schedule 30-, 60- and 90-Day Check-Ins with New Staff – ask questions such as:

What is going well for you on the unit?
Has the job been what you expected – if not, what is different?
What about the position is most challenging for you?
Do you have all the necessary information, tools, and skills to do the role?
What can I do to better support you as your leader?
Are there experiences or learning development opportunities that you would like to have?
Do you feel comfortable with the team and our organization?
Are there things I should know as a manager that I may not that impact the experience of new employees?
Do you have any suggestions for or see any weaknesses in specific systems, processes, and procedures that could be improved?

So many health systems are making significant investments in recruitment right now. Focusing on the human connection costs nothing yet can have tremendous payback in retaining staff. We must find ways to help and coach our preceptors, so they don’t avoid attachment with new staff.

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