Arizona spent $75 million formalizing the preceptor role. Three years, more than 60 hospitals, one question: what happens when you treat preceptorship as a discipline instead of an assignment handed to whoever is free that shift?

Preceptor retention went from negative 11% to 35%. Of the 12 organizations tracking ROI with an outside economist, 91% were positive in the first year, almost entirely from lower turnover. In several cases, new nurses reached full competency in about half the time it previously took.

Home health proved it too

A large Wisconsin home health agency redesigned its 12-week orientation and added a full year of mentorship beyond the 3-month preceptorship. Mentors, who were educators and clinical nurse specialists rather than field preceptors, met with each new nurse quarterly, joined them on admission visits, and ran chart audits to track the path to independent practice.

First-year nurse retention went from 54% to 93%. Agency-wide turnover for all home health nurses dropped from 15.4% to 10.1%. Leadership was impressed enough to replicate the mentorship program across hospice, physical therapy, occupational therapy, and speech therapy.

Both hit the same wall

Sustaining it. The Wisconsin agency watched retention dip every time leadership changed, going through three agency presidents during the four-year project. The mentorship program is what stabilized the gains. In Arizona, the 15 minutes of protected time per shift for preceptor and nurse to talk through the day was the clearest driver of results and the hardest thing to get organizations to sustain, even while the grant money was flowing. The plan for after the funding runs out is a book and a handbook.

This is the pattern across healthcare. The model gets proven. The system to keep it alive never gets built.

The system that keeps it alive

The preceptor decides whether a new nurse stays or quits. In home health, that nurse is often alone in a living room within weeks, with no hallway to ask for help in. A mentorship program that depends on grant cycles and leadership willpower will not survive contact with reality.

HOP builds the sustainability into the workflow itself. When a new clinician flags low confidence in a skill or competency, their preceptor is notified and builds a plan of correction: a course, a field visit, a one-on-one session, a shadow shift, in-house training. Whatever closes the gap. Every step is trackable.

Agencies configure their own shadow visits in the app. The standard cadence is 30, 60, and 90 days, but they can build any type of visit, including preceptor visits, on whatever schedule fits their orientation. Each visit checks whether the trainee meets expectations for the skills and tasks at that stage. When they don't, the preceptor builds a growth huddle: customized education aimed at the specific gap, aligned with the agency's policies and grounded in evidence. Then a follow-up visit confirms the gap is closed before the clinician is released to the field.

No grant required. No heroics from leadership. The model works, and now it has a system that keeps it working.

Sources: Becker's Hospital Review on the Arizona preceptor grant; Pennington & Driscoll (2019), "Improving Retention of Home Health Nurses," Home Healthcare Now.