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Background: Availability of high-level pediatric training for nurses in Malawi is limited. To address this gap, a novel pediatric critical care nurse preceptor program was developed and implemented by pediatric nurse specialists., Aim: Evaluate the effectiveness of a pediatric critical care nurse preceptor program, via change in nurses' knowledge, skills, confidence, and precepting competence., Design: A 12-month pediatric critical care nurse preceptor program with assessments at baseline, end of intensive (3 months), and end of program (6 months)., Setting: Blantyre, Malawi., Participants: Nurses with two or more years of pediatric nursing experience (N = 20) nominated by unit managers., Methods: Quantitative data were collected throughout program implementation. Assessments included: (1) multiple choice knowledge test, (2) Objective Structured Clinical Examinations in two areas (vital signs and airway, breathing, circulation, disability, exposure assessments; and blood gas and electrolyte analysis), (3) group simulations (cardiopulmonary resuscitation or respiratory distress), (4) Likert-scale clinical confidence survey, and (5) Likert-scale precepting competence survey. Data were analyzed using repeated measures ANOVA with pairwise comparisons. For Likert-scale surveys, median confidence scores were compared using a Friedman test with post hoc pairwise comparisons using Wilcoxon signed-rank tests., Results: Participants demonstrated significant improvement in clinical knowledge (p < .001), vital signs and airway, breathing, circulation, disability, exposure assessment (p = .001), blood gas and electrolyte analysis (p = .001), CPR (p < .001) and respiratory distress (p < .001) simulations, clinical confidence (p = .002), and precepting competence (p = .041)., Conclusion: This pediatric critical care nurse preceptor program was effective in improving participants' confidence and competence (knowledge and skills) in pediatric critical care nursing and precepting. Results suggest the program's potential to address the shortage of highly trained pediatric critical care nurses in Malawi. This lays groundwork for refining and expanding preceptorship, ultimately improving pediatric critical care nursing education in resource-limited settings., Competing Interests: Declaration of competing interest Seed Global Health employs AN, JM, and BvdW. KR was an employee during the study period., (Copyright © 2024 Elsevier Ltd. All rights reserved.)