WCU Journal of Health and Wellness
WCU Journal of Health and Wellness
Venkova, S. V., Murray, A., & Kincaid, P. (2026). Exploring Structured Preceptorship Models in Advanced Practice Nursing: Strengthening Clinical Education and Enhancing Productivity. West Coast University Journal of Health and Wellness, 3(1), 40–51.

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Introduction

Nurse practitioners have emerged as one of the most desirable and fastest-growing professions in the United States (U.S.) healthcare workforce. Ranked the number one job in the U.S. from 2024-2026 by the 2024 U.S. News & World Report, NPs represent a critical pathway for addressing healthcare shortages, particularly in underserved and rural communities (AANP, 2026). The Association of American Medical Colleges (2024) projects a national shortage of up to 86,000 physicians by 2036, including between 20,200 and 40,400 primary care physicians. Despite this continued growing demand, the infrastructure supporting NP education has struggled to keep pace. NP programs across the country face increasing pressure to produce competent, practice-ready graduates while simultaneously struggling with worsening shortages of qualified clinical preceptors.

The preceptor shortage produces measurable downstream consequences for student progression and program completion. In a survey of 334 NPs practicing in Texas, identifying a preceptor was the most frequently cited barrier to clinical placement (33%), with 46% of NPs stating they were required to find placements independently. In addition, approximately 60% of practicing NPs stated that they are not currently precepting students (Gigli & Gonzalez, 2022). Doherty et al. (2020) conducted a national survey of NP program directors across the United States to examine the clinical placement processes from an institutional standpoint. The study’s findings were similar: providing quality clinical sites and preceptors was one of the greatest challenges for NP programs, and the burden of securing placements often fell on students themselves with 40% of students having to find their own preceptors.

The shortage of preceptors does not operate in isolation; it directly shapes the quality of the clinical education students receive. When programs struggle to secure enough preceptors, students may be placed with clinicians who lack formal preparation for the teaching role or who cannot devote adequate time to instruction amid competing clinical demands. The literature documents a clear chain connecting the erosion in the consistency and quality of preceptorship to negative student outcomes, alongside a broader, well-established gap between NP education and practice readiness.

Clinical Preceptors

Clinical Preceptors play a unique and vital role in NP education. Preceptors serve as hands-on mentors and role models within the clinical environments, where the complexity of patient care cannot be simulated. The American Association of Colleges of Nursing (2026) recognizes preceptors as essential to translating didactic, academic preparation into clinical competence, where knowledge is met with the acquisition of critical thinking and skills. However, the demands placed on preceptors, many of whom receive little to no formal preparation for their teaching roles, have become increasingly burdensome. Lofgren et al. (2021) found that preceptors reported significant challenges balancing clinical productivity with student supervision, stating time constraints and lack of institutional support as primary impediments. McCann et al. (2024) expanded on these findings, reporting that preceptor motivations have grown increasingly intrinsic- driven by personal enjoyment, professional obligation, and a desire to mentor future colleagues - even as external barriers have intensified, including reduced clinic throughput when supervising students and inadequate recognition from academic programs.

The Current Literature Review

The purpose of this literature review was to critically examine the current evidence on structured preceptorship models in NP education and to evaluate their relationship to NP student clinical competence and preceptor productivity. Through thematic synthesis of the included literature, the review sought to derive a set of evidence-based best practices for structured preceptorship, organized according to three themes identified during analysis: preceptor support and productivity, structured communication models and assessment frameworks, and student outcomes. In doing so, this review aimed to establish a foundation for an integrative preceptorship model - one that not only improves student clinical competence but also strengthens, sustains, and retains the preceptor relationships essential to the continued viability of NP clinical education.

Methods

A systematic search of CINAHL (via Wiley Online Library) and PubMed was conducted for literature published between 2019 and 2026. Search terms included nurse practitioner, clinical education, clinical preceptorship, structured preceptorship, preceptor productivity, NP student competence, student competency, preceptor development, role transition, advanced practice nursing, and were combined using Boolean operators (AND, OR, NOT) to refine results. Four primary database searches yielded 644 records, with an additional 15 studies identified through other methods, including supplementary PubMed searches, citation searching, and hand-searching of reference lists.

Inclusion and Exclusion Criteria

Studies were eligible for inclusion if they addressed structured preceptorship, preceptor productivity, clinical competency assessment, NP role transition, or graduate outcomes within NP or advanced practice registered nurse (APRN) education. Sources were limited to English-language publications relevant to graduate-level clinical training. Articles were excluded if they focused on undergraduate education, clinical nurse specialists rather than NP/APRN education, new graduate RN (rather than APRN) populations, or onboarding and residency experiences. Additional exclusions encompassed publications falling outside the review’s central thesis, such as social determinants of health, artificial intelligence in APRN education, APRN role implementation, and competency mapping.

Screening and Selection (PRISMA)

Screening followed PRISMA 2020 guidelines. Records were assessed by title and abstract, followed by full-text eligibility review. Two reports were excluded - one with a new graduate RN rather than APRN/NP focus, and one excluded for translation-related reasons that rendered it unusable for the review. This process yielded 13 included studies from database searches and 15 from other methods, for a total of 28 included studies (Page et al., 2021).

Quality Appraisal

All 28 included sources were critically appraised using the Melnyk and Fineout-Overholt (2023) hierarchy of evidence, which ranks evidence from Level I (systematic reviews and meta-analyses) through Level VII (expert opinion). The included literature clustered predominantly at Levels IV through VI, reflecting a body of scholarship that is largely descriptive, developmental, and exploratory rather than experimental. See the Appendix.

Synthesis Approach

Synthesis was conducted by the authors using a constant comparative approach in which findings were grouped by shared conceptual content and examined for patterns and divergences. Claude (Anthropic, 2025) was used to assist with organizing and formatting the synthesis outputs, including the table of evidence and thematic synthesis table; it was not used to generate findings, appraise evidence, or make inclusion decisions.

Results

Three themes emerged and structured the synthesis: preceptor support and productivity (14 articles), structured communication models and assessment frameworks (8 articles), and NP student outcomes (6 articles). The themes are summarized below.

Theme 1: Preceptor Support and Productivity

This theme was the most heavily represented in the literature, addressed by fourteen of the included sources. See Table 1. A consistent finding was that NP preceptors frequently assume the teaching role without formal preparation, with clinical teaching identified as a distinct competency requiring targeted development (McNeil & Jakubisin Konicki, 2021). Studies evaluating structured preparation reported favorable outcomes, where formal preceptor training programs produced measurable gains in preceptor competency and confidence (Maldonado et al., 2024), an interprofessional work-group approach enhanced teaching effectiveness and engagement (Li Sharpe et al., 2024), and a theory-based survey grounded in the Integrated Behavioral Model provided a validated means of assessing preceptor readiness (DeClerk & Parks, 2025).

Productivity emerged as a central and recurring barrier. Reduced clinical throughput, lost patient flow and income, time burden, and administrative load were repeatedly identified as the primary deterrents to precepting (Lund et al., 2024; McCann et al., 2024; Wiggins et al., 2025), with the COVID-19 pandemic intensifying these pressures and adding emotional exhaustion to the role (McCann et al., 2024). The preceptor shortage itself was shown to create a bottleneck in NP education: in one survey, 61% of students rated the difficulty of finding a preceptor at the highest end of a ten-point scale, a barrier directly associated with delayed graduation and increased student cost (McInnis et al., 2021). Proposed solutions included recognition programs, financial remuneration, scheduling flexibility, and accommodation of preceptors’ clinical responsibilities (Henry-Okafor et al., 2023). Institutional support and clear faculty communication were consistently identified as facilitators of preceptor satisfaction (Lofgren et al., 2021; Todd et al., 2019), while academic-practice partnerships strengthened the consistency of clinical placements (Halverson et al., 2026).

Theme 2: Structured Communication Models and Assessment Frameworks

This theme was addressed by 8 of the 28 sources and represented the most rapidly developing area of the literature, characterized by the emergence and validation of formal frameworks adapted from graduate medical education. See Table 1. The EPAs are units of professional practice that a trainee can be entrusted to perform independently once they have demonstrated the requisite competence, translating broad competencies into observable, assessable clinical tasks. EPAs were shown to standardize performance expectations and create a shared language between students and preceptors across diverse educational contexts (Han et al., 2026; Moore et al., 2024).

The PRIME-NP model represented a second major contribution. A competency-based framework that defines the domains of NP performance and pairs them with criterion-referenced evaluation, PRIME-NP was validated and demonstrated interrater reliability for an associated Objective Structured Clinical Examination (OSCE) rubric (D’Aoust et al., 2024), with subsequent work demonstrating its application to curriculum development (Slyer et al., 2025).

Structured clinical communication tools also appeared in the evidence. The SNAPPS model is a learner-centered, six-step case-presentation framework that guides students to actively reason through a case using summarization, narrowing, analysis, probing, planning, and selection to report findings to the preceptor. The SNAPPS model was found to reduce student anxiety during preceptor presentations while strengthening clinical reasoning and promoting self-directed learning (Castillo & Chaplin, 2026).

The Cognitive Preceptorship model applies the principles of cognitive apprenticeship using modeling, coaching, scaffolding, and fading to facilitate the NP role-transition process. It offers a framework for scaffolding cognitive load as students move toward independent practice (Pleshkan & Boykins, 2022). Diagnostic reasoning, identified as a core competency, was found to be essential but inconsistently taught and assessed, with validated assessment tools remaining underdeveloped (Burt et al., 2025; Smith et al., 2025).

Theme 3: NP Student Outcomes

This theme was addressed by 6 of the 28 included sources and was the most outcome-oriented, linking the structure and quality of clinical training to graduates’ readiness for practice. See Table 1. The quality of supervision during the clinical experience was found to matter more than the volume of hours, with supervised time alongside expert preceptors perceived as more educationally valuable than unsupervised hours (Leonardsen, 2023). This finding gained added significance amid the unresolved debates over clinical-hour adequacy (Buonocore & Horahan, 2026). Role transition emerged as a period of vulnerability, where structured, psychologically safe preceptorship experiences demonstrated strong association with successful transition to practice (Pleshkan, 2024), and pandemic-era training disruptions were shown to have lasting effects on new graduate confidence and readiness (Best-Rhodes, 2026).

Table 1.Thematic Synthesis of Included Sources.
Theme Sub-focus Key sources Central finding
1. Preceptor Support & Productivity Preparation gaps McNeil & Jakubisin Konicki (2021); Morr (2019) Preceptors assume the teaching role without formal preparation; clinical teaching is a distinct competency requiring development
Structured training programs Maldonado et al. (2024); Li Sharpe et al. (2024); DeClerk & Parks (2025) Formal preparation (PTP, interprofessional work-group, IBM-based survey) yields measurable gains in preceptor competency and confidence
Barriers, productivity & facilitators Wiggins et al. (2025); Lofgren et al. (2021); Todd et al. (2019); McCann et al. (2024); Lund et al., (2024) Institutional support facilitates precepting; time burden, administrative load, reduced clinical throughput, lost patient flow and income, and post-COVID exhaustion are key deterrents
Preceptor gap & workforce sustainability Henry-Okafor et al. (2023); McInnis et al. (2021); Doherty et al. (2020) The preceptor shortage creates a bottleneck in NP education; 61% of students rated finding a preceptor as highly difficult and 40% do most of the work securing their own placements, delaying graduation and raising costs. Recognition, remuneration, and scheduling flexibility are needed to sustain the workforce
Retention & partnerships L'Ecuyer et al. (2025); Halverson et al. (2026) Positive preceptorship drives retention; academic-practice partnerships strengthen transition to practice
2. Structured Communication Models & Assessment Frameworks Entrustable Professional Activities Han et al. (2026); Moore et al. (2024) EPA frameworks standardize performance expectations and create a shared language between student and preceptor
PRIME-NP model D'Aoust et al. (2024); Slyer et al. (2025) Validated competency model with reliable OSCE rubric; applicable to curriculum development
Structured communication tools Castillo & Chaplin (2026); Pleshkan & Boykins (2022) SNAPPS reduces student anxiety while strengthening clinical reasoning; the Cognitive Preceptorship model scaffolds cognitive load during role transition
Diagnostic reasoning Smith et al. (2025); Burt et al. (2025) Diagnostic reasoning is essential but inconsistently taught and assessed; assessment tools remain underdeveloped
3. Student Outcomes Certification & clinical hours APEA (2024); Buonocore & Horahan (2026); Leonardsen (2023) Multi-year pass-rate decline; no consensus on clinical-hour adequacy; quality of supervised hours matters more than volume
Role transition Pleshkan (2024); Best-Rhodes (2026) Structured, psychologically safe preceptorship supports transition; pandemic disruptions had lasting effects on readiness
EBP & emerging competencies Ligita et al. (2024); Quattrini et al. (2026) Preceptors who model EBP build stronger research-utilization skills; AI-readiness is an emerging preparation need

Three themes derived from constant comparative Three themes derived from constant comparative analysis of the 28 included sources (2019–2026).
Note. PTP = Preceptor Training Program; IBM = Integrated Behavioral Model; EPA = Entrustable Professional Activity; OSCE = Objective Structured Clinical Examination; EBP = evidence-based practice; AI = artificial intelligence. Table created with the assistance of Claude (Anthropic, 2025).

Summary of Findings

Across all three themes, structure emerged as the single most important operative variable. Many of the frameworks in the review relied on structure to produce positive results, moving the focus away from ad hoc arrangements. The distribution of evidence, weighted most heavily toward preceptor support and productivity (approximately fourteen sources), followed by communication and assessment frameworks (approximately eight) and student outcomes (approximately six), reflects a field that has invested substantially in understanding the preceptor role and the tools of assessment, while leaving the explicit relationship between structured preceptorship and preceptor productivity comparatively underexamined. No widely adopted model simultaneously addresses student clinical readiness and preceptor productivity within a single, cohesive framework. This gap carries real consequences: preceptors who feel overburdened and underrecognized withdraw from the talent pool, and students who receive inconsistent or misaligned supervision enter independent practice underprepared (Lofgren et al., 2021; McCann et al., 2024; Pleshkan, 2024). This gap represents both a limitation of the current evidence and the primary opportunity for the creation of an integrative, productivity-conscious model that can be tailored to our institution and program-specific needs.

Discussion

The evidence presented in this integrative review converges on a message that structured preceptorship is no longer a pedagogical preference but a systemic imperative for the future of advanced practice nursing education. As NP programs contend with rising enrollment and persistent shortages of qualified clinical preceptors, the concerns about ad hoc, unstructured preceptorship arrangements have become untenable (APEA, 2024; Morr, 2019). The literature reviewed here consistently demonstrates that when preceptors are equipped with targeted preparation, embedded within competency-based frameworks, and supported through academic-practice partnerships, both student clinical outcomes and preceptor professional satisfaction improve meaningfully (Maldonado et al., 2024; Todd et al., 2019; Wiggins et al., 2025).

Best Practices

The evidence points to a set of actionable best practices, organized by theme.

  1. Preceptor Support and Productivity

  2. Structured Communication Models and Assessment Frameworks

    • Embed competency-based frameworks. Incorporate competency-based frameworks similar to EPAs and the validated PRIME-NP model to standardize performance expectations and assessment (D’Aoust et al., 2024; Han et al., 2026).

    • Use structured communication tools. Models such as SNAPPS and Cognitive Preceptorship strengthen clinical reasoning and scaffold the student-preceptor exchange (Castillo & Chaplin, 2026; Pleshkan & Boykins, 2022).

    • Teach diagnostic reasoning explicitly. Make reasoning a deliberate, assessed competency rather than an implicit one (Smith et al., 2025).

  3. Student Outcomes

    • Prioritize quality of clinical hours. Supervised time with expert preceptors matters more than raw hour counts (Leonardsen, 2023).

    • Structure role transition to be psychologically safe. Intentional, supportive transition experiences improve readiness (Best-Rhodes, 2026; Pleshkan, 2024).

    • Model EBP and prepare for emerging competencies. Recognize that the preceptor shortage and readiness gaps directly threaten graduate competence and timely completion (Ligita et al., 2024; McInnis et al., 2021).

Implications

Drawing on competency-based education, scaffolded learning theory, cognitive apprenticeship, workforce productivity science, CCNE quality standards, and NONPF core competency domains, we propose an integrative framework, summarized below as a set of best-practice recommendations, that addresses these gaps and offers a practical model for academic-practice partnerships. We propose that the pilot is first implemented at our institution and, if successful, scaled into the standard NP preceptorship model across the system.

The proposed framework draws from the strongest and most consistent evidence identified in the review and consists of four distinct layers: vetting, preparation, scaffolded implementation, and evaluation. See Figure 1.

  1. Vetting

    Formal accreditation and regulatory bodies establish minimum qualification thresholds for clinical preceptors. Thus, the initial step in the model is to implement rigorous, systematic preceptor vetting processes that assess the preceptor’s clinical credentials, scope of practice and the broader organizational capacity of the clinical site itself. Sites lacking the patient population diversity, clinical volume, or preceptor engagement needed to fulfill program learning objectives represent a structural mismatch that, left unaddressed, compromises the integrity of the clinical training experience (Halverson et al., 2026; Li Sharpe et al., 2024; McNeil & Jakubisin Konicki, 2021).

  2. Preparation

    This second layer of the framework consists of intentional preceptor and student training on structured communication and assessment tools. The focal points and considerations at this level are as follows:

    • Require standardized, compensated orientation covering CCNE expectations, NONPF competency domains, and progression benchmarks before any student placement; formal training is associated with greater preceptor confidence and reduced role ambiguity (McNeil & Jakubisin Konicki, 2021).

    • Deliver training asynchronously to accommodate time constraints, the most frequently cited barrier to preceptor development (Morr, 2019).

    • Embed productivity-focused teaching strategies such as workflow integration, delegation, and treating patients while teaching in tandem to directly offset perceived reduction in productivity (Slatyer et al., 2023).

    • Require student pre-placement training focused on EMR navigation, concise documentation, and structured case presentation. Strengthening documentation and presentation skills addresses two of the leading opportunities for improving preceptor-perceived workflow efficiency (McNeil & Jakubisin Konicki, 2021; Morr, 2019).

    • Orient students to productivity-conscious behaviors and the progressive autonomy model before clinical entry, consistent with evidence that pre-experience preparation improves use of clinical time (Benner, 2001).

    • Front-load readiness training to shift onboarding burden away from the preceptor and accelerate meaningful workflow integration (Pleshkan & Boykins, 2022).

  3. Scaffolded Implementation

    • Implement a stepwise approach grounded in Vygotsky’s Zone of Proximal Development and Benner’s Novice-to-Expert theory to include a four-stage progression- observation, assisted participation, supervised management, and bridge to independent practice (Benner, 1984, 2001).

    • Define explicit expectations at each stage for students and preceptors to standardize progression criteria, consistent with the AACN Essentials (American Association of Colleges of Nursing [AACN], 2021).

    • Reframe the student as a progressively productive contributor rather than a passive learner (Lofgren et al., 2021; McCann et al., 2024).

    • Standardize feedback delivery through real-time coaching, rapid debriefing, and competency checkpoints aligned with NONPF domains to reduce variability in feedback quality (Lofgren et al., 2021).

    • Formalize faculty-preceptor touchpoints to keep clinical experiences aligned with curricular objectives (Markaki et al., 2021; Baptiste et al., 2022).

  4. Evaluation

    • Include competency-based milestones anchored in NONPF and CCNE standards (Chicca & Shellenbarger, 2023).

    • Use shared evaluation tools across preceptors and faculty to reduce inter-rater variability, mirroring the PRIME-NP model’s use of OSCE (D’Aoust et al., 2024; Slyer et al., 2025).

    • Extend measurement beyond student competency to include evaluation of preceptor satisfaction, perceived productivity, and intent to continue precepting, following the clinical experience.

The model positions scaffolded clinical progression as the central mechanism linking structured preceptor and student preparation to student, preceptor, and practice-level outcomes, with feedback continuously informing refinement of the model. Figure 1 created with the assistance of Claude (Anthropic, 2025).

Conclusion

This review represents the initial phase of a broader effort to translate existing evidence into an original, integrative model for implementation at our institution. Rather than simply consolidating frameworks already shown to be effective, the proposed model advances them by explicitly positioning preceptor productivity as a central design element, alongside student competency, communication, and assessment, in support of stronger academic-practice partnerships. The intended outcomes include improved diagnostic reasoning, more consistent competency assessment, greater preceptor retention, and ultimately stronger patient safety and quality of care.

Submitted: June 12, 2026 PDT

Accepted: July 06, 2026 PDT

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Appendix

Integrative Review: Table of Evidence
Author(s) & Year Purpose / Research Question Design / Method Sample / Setting Key Findings Level of Evidence Relevance to Review
AACN (2026) Provide guidance on roles and responsibilities in APRN clinical education Professional guidelines / resource document APRN programs, preceptors, faculty, students nationally Delineates distinct roles: faculty hold primary accountability for outcomes; preceptors create safe learning environments; students communicate needs. Emphasizes faculty-preceptor communication as pivotal. Level VII (Expert opinion / organizational guidance) Establishes foundational framework for shared accountability in NP clinical education
APEA (2024) Analyze five-year trend in FNP certification pass rates and identify contributing factors Descriptive analysis with expert commentary National FNP certification candidates (AANPCB & ANCC, 2018–2023) FNP pass rates declined 13% over 5 years (AANPCB). Key contributors: online-only programs, student self-sourcing preceptors, inadequate remediation, weak critical thinking skills, and burnout. Level VII (Expert opinion / industry report) Documents the scope of NP graduate preparation deficits and identifies preceptorship as a root cause
Best-Rhodes (2026) Examine support needs of new graduate nurses post-COVID-19 Descriptive / qualitative inquiry New graduate nurses in continuing education settings New graduates report increased anxiety, reduced confidence, and need for structured mentorship post-pandemic. Preceptor support and structured orientation are critical to retention and competency. Level VI (Descriptive/
qualitative study)		 Contextualizes post-pandemic preceptorship challenges relevant to NP transition
Buonocore & Horahan (2026) Survey NP certifiers on clinical hours and DNP transition in academic programs Cross-sectional survey NP certifying organizations and academic program leaders Variability in clinical hour requirements across programs; concern about adequacy of clinical hours during DNP transition; certifiers identify gaps between academic preparation and entry-level competency. Level IV (Cross-sectional survey) Highlights structural challenges in DNP transition affecting clinical training adequacy
Burt et al. (2025) Review tools for assessing diagnostic reasoning competency in advanced practice Integrative review Published literature on diagnostic reasoning assessment tools Identified lack of standardized, validated tools for assessing diagnostic reasoning in APRN education. OSCEs and simulation-based assessments are most promising but inconsistently applied. Level I (Integrative review) Supports need for validated competency assessment methods in NP education
Carroll et al. (2022) Guide clinicians in designing and conducting scholarly quality improvement projects Practical/
methodological guide		 Clinical improvers across settings Provides a framework for rigorous QI design including clear aim statements, measurement plans, and PDSA cycles. Emphasizes scholarly rigor in improvement science. Level VII (Expert
opinion / methodological guide)		 Informs methodological rigor for QI-based preceptor development initiatives
Castillo & Chaplin (2026) Evaluate the SNAPPS model for reducing student stress in clinical presentations Descriptive / program evaluation DNP students in clinical practicum SNAPPS model reduced student anxiety during preceptor presentations and improved clinical reasoning articulation. Preceptors reported more focused, productive teaching interactions. Level VI (Program evaluation / descriptive) Offers a practical structured tool to improve student-preceptor clinical reasoning exchanges
D'Aoust et al. (2024) Validate the PRIME-NP competency model and assess OSCE rubric inter-rater reliability Psychometric validation / criterion-based OSCE study NP students and faculty evaluators across programs PRIME-NP model demonstrated strong construct validity. OSCE rubric demonstrated acceptable inter-rater reliability, supporting its use as a standardized clinical competency assessment tool. Level III (Correlational/
validation study)		 Provides validated framework for standardized NP competency assessment
DeClerk & Parks (2025) Develop and psychometrically evaluate a theory-based preceptorship survey for NPs Instrument development / psychometric evaluation NP preceptors across clinical settings Developed a reliable, valid survey instrument for assessing NP preceptorship quality grounded in the Integrated Behavioral Model. Identifies key domains: role clarity, feedback, teaching strategies, and professional support. Level III (Instrument development study) Provides a validated tool to measure and improve NP preceptorship quality
Doherty et al. (2020) Examine clinical placement processes through a national survey of NP programs Cross-sectional national survey NP program directors across the United States Securing placements demands substantial institutional/personnel effort; 40% of students do all or most of the work finding their own preceptors; clinical-hour requirements vary; preceptor remuneration rarely involves direct payment; few programs use electronic matching. Level IV
(Cross-sectional national survey)		 National-level evidence of the placement burden and structural inconsistency in NP education
Halverson et al. (2026) Examine optimization of academic-practice partnerships to promote transition to practice Descriptive / partnership analysis Academic and clinical nursing partnership stakeholders Structured academic-practice partnerships improve the consistency and quality of clinical placements and strengthen transition to practice, benefiting both students and preceptors. Level VI (Descriptive study) Supports academic-practice partnerships as a mechanism for sustainable, high-quality preceptorship
Han et al. (2026) Develop an EPA-based evaluation framework for advanced practice nurses Framework development / validation Advanced practice nurses in China Developed and applied an EPA-based evaluation framework that standardizes clinical performance expectations, demonstrating cross-cultural applicability for competency assessment. Level V (Framework development study) Reinforces the utility and transferability of EPA frameworks in APN competency assessment
Henry-Okafor et al. (2023) Address the preceptor gap in NP education Descriptive / issue analysis NP programs, preceptors, and clinical sites The preceptor shortage threatens NP training. Recommends recognition programs, financial remuneration, scheduling flexibility, and accommodation of clinical responsibilities to recruit and sustain preceptors. Level VII (Expert opinion / issue analysis) Directly links preceptor productivity and support to workforce sustainability
L'Ecuyer et al. (2025) Examine the role of preceptors in nurse retention Descriptive / literature synthesis Nurses and preceptors in clinical settings High-quality preceptorship directly linked to improved nurse retention and job satisfaction. Trained preceptors are more effective and report greater satisfaction in the role. Level VI (Descriptive/
literature synthesis)		 Reinforces the downstream impact of preceptor quality on workforce stability
Leonardsen (2023) Examine the impact of clinical experience on advanced practice nursing education Cross-sectional survey study Norwegian advanced practice nurses Clinical experience is essential to APN competency development. Supervised, structured clinical hours correlated with higher self-reported competence and readiness for practice. Level IV
(Cross-sectional
study)		 International evidence supporting the centrality of structured clinical experience in APN education
Li Sharpe et al. (2024) Develop an interprofessional collaborative approach to preceptor development Evidence-based practice / program development NP and interprofessional preceptors Structured interprofessional preceptor development improved preceptor confidence, teaching skills, and student satisfaction. Cross-disciplinary collaboration enhanced the clinical learning environment. Level V (Evidence-based
program report)		 Supports structured, collaborative approaches to preceptor training
Ligita et al. (2024) Explore preceptors' experiences guiding students in research use and evidence-based practice Qualitative study Preceptors guiding nursing students Preceptors who modeled evidence-based practice and facilitated critical appraisal produced students with stronger research-utilization skills, shaping students' professional approach to clinical decision-making. Level VI (Qualitative study) Positions the preceptor as a formative influence on EBP and research utilization
Lofgren et al. (2021) Explore preceptor perspectives and experiences with APRN students Mixed methods survey APRN preceptors (n = 524) Preceptors motivated by desire to shape the profession but report time burden, lack of preparation, and insufficient faculty communication. Desire for more structured support and recognition. Level IV
(Mixed methods survey)		 Identifies key barriers and motivators for APRN preceptors; informs support interventions
Maldonado et al. (2024) Enhance clinical preceptor competency through structured training Performance improvement initiative / QI Nurse anesthesia preceptors Structured Preceptor Training Program significantly improved teaching competency scores. Participants reported increased confidence and use of evidence-based teaching strategies post-training. Level V
(QI / performance improvement)		 Demonstrates effectiveness of structured preceptor training programs
McCann et al. (2024) Examine changes in preceptor motivation, barriers, and student impact post-COVID-19 Mixed methods study NP preceptors nationally Post-COVID preceptors report increased administrative burden, time constraints, and burnout. Motivation persists (intrinsic: enjoyment, professional obligation) but is threatened by lack of support, compensation, and recognition. Level IV
(Mixed methods
study)		 Documents post-pandemic shifts in preceptor burden; underscores urgency of support structures
McInnis et al. (2021) Examine the significance of the NP preceptorship shortage Descriptive / survey + issue analysis 232 graduate nursing students; NP program context 61% of students rated difficulty finding a preceptor at the highest end of a 10-point scale. The shortage creates a bottleneck, delaying completion of the required 500+ clinical hours and increasing student cost. Level VI (Descriptive survey /
issue
analysis)		 Quantifies the placement-difficulty burden and its link to delayed graduation
McNeil & Jakubisin Konicki (2021) Identify clinical teaching needs of NP preceptors Descriptive survey NP preceptors (n = 133) Preceptors identify unmet needs in teaching strategies, student evaluation, and faculty communication. Most had no formal preceptor training. Strong desire for structured development resources. Level VI (Descriptive survey) Establishes baseline of preceptor training deficits and informs program development
Moore, Chan, et al. (2024) Develop and validate a set of core entrustable professional activities (EPAs) reflecting the activities performed by all NPs Instrument development / Delphi validation study NP practice experts across the United States representing most NP populations Eight EPAs were developed and validated through a two-round Delphi process. The EPAs map advanced-level NP competencies to workplace expectations, providing a shared framework for competency-based workplace assessment among NP preceptors. Level IV
(Delphi validation study)		 Provides a validated EPA framework standardizing NP competency expectations across preceptors
Lund et al., (2024) Identify barriers to precepting health professions learners during COVID-19 Cross-sectional / descriptive study Preceptors across health professions, including NPs Identified productivity-related deterrents—low patient flow, reduced income, increased hours, workload expectations, and self-perceived lack of qualification—all exacerbated by the pandemic. Level IV
(Cross-sectional study)		 Frames preceptor productivity loss as a measurable, multidimensional deterrent to precepting
Morr (2019) Examine demand and resource gaps in NP preceptor development Expert commentary / news analysis NP educators and program leaders Growing demand for NP preceptors outpaces development resources. Most preceptors receive no formal training; programs lack infrastructure to support development systematically. Level VII
(Expert opinion / commentary)		 Establishes historical context for persistent preceptor resource deficits
Pleshkan (2024) Systematically review clinical education and preceptorship during NP role transition Systematic review Published studies on NP preceptorship and role transition Preceptorship quality significantly affects NP role transition outcomes. Structured preceptor-student relationships, clear competency goals, and faculty oversight are key success factors. Level I (Systematic review) Strongest evidence linking preceptorship quality to NP competency and role transition
Pleshkan & Boykins (2022) Propose a cognitive preceptorship model for NP role transition Model development / conceptual paper NP students in role transition; literature synthesis Cognitive Preceptorship model integrates cognitive apprenticeship theory with NP role transition. Emphasizes modeling, coaching, scaffolding, and fading as core preceptor strategies. Level VI (Theoretical/
conceptual model)		 Provides theoretical grounding for structured NP preceptorship interventions
Quattrini et al. (2026) Describe a competency-based approach to AI-ready DNP education Conceptual / curriculum framework DNP programs and faculty Argues NP programs must prepare graduates for AI-assisted clinical decision-making, extending the preceptor's role to modeling thoughtful technology integration in practice. Level VII
(Expert
opinion / conceptual framework)		 Identifies AI-readiness as an emerging competency and preceptor responsibility
Slyer et al. (2025) Apply the PRIME-NP model to NP curriculum development Curriculum development / educational application NP faculty and program curricula PRIME-NP model successfully operationalized into curriculum frameworks. Competency-based approach improved alignment between clinical training and certification outcomes. Level V
(Program development report)		 Demonstrates practical application of validated competency model in NP education
Smith et al. (2025) Extend a scoping review of diagnostic reasoning in NP education Scoping review extension Published literature on clinical/diagnostic reasoning in NP education Diagnostic reasoning is inconsistently taught and assessed in NP programs. A gap exists between clinical reasoning curricula and certification exam requirements. Simulation and OSCEs most effective. Level I (Scoping review) Identifies a critical gap in diagnostic reasoning preparation relevant to declining pass rates
Todd et al. (2019) Analyze the preceptor experience in the Graduate Nurse Education Demonstration Cross-sectional analysis NP preceptors in GNE Demonstration sites (n = 1,007) Preceptors report moderate satisfaction but highlight time burden and lack of compensation as barriers. Academic-practice partnerships in the GNE model improved preceptor support and student outcomes. Level IV (Cross-sectional study) Large-sample evidence on preceptor experience; supports structured academic-practice partnerships
U.S. News & World Report (2024) Announce best jobs rankings for 2024 National workforce ranking (BLS data analysis) National occupational data (Bureau of Labor Statistics) Nurse Practitioner ranked #1 job overall in 2024, based on growth potential, salary, job security, and work-life balance. Strong 10-year outlook driven by healthcare workforce demand. Level VII (Workforce/industry data report) Establishes workforce context and urgency for producing competent NP graduates
Wiggins et al. (2025) Examine NP preceptors' perceived facilitators and barriers to precepting Descriptive survey NP preceptors (AANP members) Top facilitators: intrinsic motivation, desire to give back, collegial relationships. Top barriers: time constraints, lack of compensation, administrative burden, insufficient faculty communication. Level VI (Descriptive survey) Current evidence on preceptor barriers; supports structured support and compensation models

Note. Level of Evidence based on Melnyk & Fineout-Overholt hierarchy: Level I = Systematic review/meta-analysis; Level II = RCT; Level III = Controlled trial/quasi-experimental; Level IV = Case-control/cohort/cross-sectional; Level V = Systematic review of qualitative/descriptive studies; Level VI = Single qualitative/descriptive study; Level VII = Expert opinion/organizational guidance. Newly added sources are highlighted.
Note. Table created with the assistance of Claude (Anthropic, 2025).