LEWISTON, Idaho — When it comes to nurse retention in Idaho and the U.S., Ann Leung is determined to find a solution. This spirit of leadership within nursing is exactly what Lewis-Clark State College, which has produced some of the top nurses in the northwest since 1965, is hoping to foster.
Leung is the first student to graduate from LC State’s Master of Science in Nursing Leadership in Heathcare program — and the first-ever master’s student to graduate from LC State in its 133-year history. The online MSN degree helps registered nurses who already have a bachelor’s degree develop the skills needed to be effective leaders in the healthcare and academic world.
All participants in the MSN program complete a 500-hour practicum project, where they explore a topic of professional interest such as safety management, quality improvement, and policy management. The practicum allows students to do a deep dive into a project they are passionate about, where they can produce real-world solutions.
Leung’s practicum project centered on developing a structured preceptor training program and resource guide that can be implemented at heathcare facilities across the country, with the goal of streamlining and strengthening nurse training and retention.
“A preceptor is usually the one that's assigned to orient the new hire,” Leung said. “When we have a new nurse, we have another senior nurse to teach (the trainee) at bedside, daily work, and just get them to work on the floor.”
This professional interest ties to personal experience for Leung, who grew up and got her bachelor’s degree in Hong Kong before coming to the U.S. Upon moving to the states, Leung discovered that the hospital and healthcare system was quite different from her experience in Hong Kong.
“Most (international) nurses come to the states through an agency,” she said. “The agency will have orientation programs for maybe a month, then send (the nurse) to a hospital they’re assigned to.”
This process can be overwhelming to the nurses, she said.
“You only have one month to learn about a new culture, new environment, new climate.”
While Leung did not come to the states through an agency program, she still experienced the holes in the state’s nurse training system first-hand — upon becoming a nurse in the U.S., she didn’t receive any additional orientation aside from standard training at her facility.
And she thinks that feeling of “transition shock” — defined for her research as “a state of professional disorientation experienced by new graduates” — could be addressed to better support both international and domestic nurses.
That support would prove invaluable to the U.S. healthcare industry, which faces a high level of turnover across the board, and especially in nursing.
“Too many nurses leave the field just one to two years after entering practice, despite years of preparation,” said Michelle Pearson-Smith, Nursing & Health Sciences Division chair. “Strong preceptorship programs are critical to retaining new nurses. Nursing is a high-stakes profession. When you are responsible for someone’s life, having the right mentorship and guidance early in your career can make all the difference.”
Leung’s research found that 22.3% of registered nurses resign within one year of being hired, a reality that costs around $61,000 on average each time a registered nurse leaves and a new one is hired. Organization-wide, this turnover can cost a facility hundreds of thousands of dollars annually. It also increases workload and burnout among staff, potentially resulting in poorer patient outcomes and reduced quality of care.
“And we're just talking about nursing. There are other professions that I haven't looked into yet,” Leung said.
While presenting her research at the 2026 Northwest Rural Health Conference in Spokane, Leung had a chance to meet with other researchers in the field, including a Washington State University group whose research showed how social connection plays a major deciding factor for pharmacists considering whether to practice in a rural area.
“It's about socialization,” she said. “So that's how it connects back. If we have a better preceptor/perceptee relationship, that would be a big factor to help (healthcare professionals) stay within the facility.”
The same can be said for rural organizations, which face unique challenges such as a lack of a dedicated clinical education department, fewer staff members, and a smaller budget, Leung found.
A trained preceptor can help a new nurse become familiar with an organization’s culture and process, and that support will aid in retention, Leung said. To do this, she recommends preceptors participate in a blend of online and in-person workshops. Part of her practicum included creating a booklet organizations can purchase to provide step-by-step instructions for preceptor training, as well as a website outlining her recommendations.
“We're hoping that developing preceptors can help with retention and turnover,” Leung said. “And that will also help with improving the nurse's competence and, ultimately, patient outcome.”
Beyond preceptor/preceptee training, Leung has a special interest in assisting international nurses who relocate to the U.S. If cultural and practical support can be provided before an international nurse leaves their home country, Leung said, those resources can help them succeed in the states.
“We don't have to fix the nursing shortage all by ourselves,” Pearson-Smith said. “We could look internationally, right?”
During her research, Leung discovered Canada has a training program for international nurses, which is a total of 48 hours of instruction. This program was a good representation of the kind of training Leung would like to see in the U.S.
After graduation, Leung hopes to further investigate how to provide support for international nurses coming to the states — support she wished she had when making the move from Hong Kong to Pullman.
“I want to make actual application from the knowledge that people have already found,” she said. “We need a solution. People know there's a (nursing) shortage problem, but how we solve it is another bigger problem, and a lot of people don't have the tools to do it.”
And while there’s more research to be done, LC State’s MSN program in nursing leadership helped Leung make some progress toward a solution, and form connections with industry professionals in the area along the way.
“I think the faculty are all very supportive and present,” she said. “If I have questions, they're really responsive, and I think one of the advantages of taking the course at LC is I also live in the area, and for my practicum project, faculty can help me connect with the people I can work with in the area instead of just me trying to find somebody that we don't know each other and try to work together. … We have somebody in the middle to connect with the mentor.”
Although the degree is fully online, each cohort gathers on campus once to meet face-to-face with their fellow students, nursing faculty, and program administration, said Sheri Cutler, an associate professor and MSN program coordinator at LC State. The program also puts a strong emphasis on maintaining communication between faculty and students through Teams meetings and emails.
“I feel like I had all the attention and help that I needed,” Leung said.
Cutler said they plan to keep the program small, maintaining a low student-to-faculty ratio to ensure each student receives the individualized attention and support they need to succeed in alignment with LC State culture. The degree attracts people from all different industries, too.
“Everybody comes with different backgrounds,” Cutler said. “We have some students that are not working in hospitals, they're working for insurance companies or academics, so they have a lot of different professional experiences and backgrounds. It's fun to learn from each other.”
LC State currently has three pathways to pursue the Nursing Leadership in Healthcare master’s degree: BSN to MSN, RN to MSN, and a new program — Direct Entry MSN, which allows students with a prior non-nursing bachelor’s degree to obtain an MSN as well as meet the requirements for state licensure as an RN. Leung is the first to complete the BSN-MSN degree.
“She's the first one in our master's program and our graduate program, any pathway, to graduate,” Cutler said. “It's exciting. She’ll be the first one to cross the stage.”
Leung joined the program in the spring of 2025. She currently works as a registered nurse at Pullman Regional Hospital, and upon graduation she will consider her next steps. She would like to pursue developing the training program for internationally educated nurses looking to get a job in the states. She is also considering a Ph.D. or a doctor of nursing practice (DNP) degree.
No matter what path she takes, Leung will continue to follow her passion for helping nurses succeed, whether through preceptor training or international nurse support.