Selecting clinical preceptors for basic baccalaureate nursing students: a critical issue in clinical teaching

A student nurse experience of an intervention that addresses the perioperative nursing shortage

Registered nurses are the largest group of professionals in the global healthcare system. The number of nurses is estimated to be 19.3 million throughout the world (Flinkman et al 2013). In the United States the need for registered nurses is growing. It has been predicted that 260,000 positions for registered nurses will remain unfilled by the year 2025 (Harris et al 2014) with a shortage of registered nurses projected to spread across the United States between 2009 and 2030 (Juraschek et al 2012). Compounding the projected nursing shortage is the increased attrition rate, which is as high as 61% within the first year (Pine & Tart 2007). There are several reasons for this shortage including supply and demand issues, projected changes to healthcare and the aging population. Additionally, the number of college graduates who have majored in nursing has not met the demand (Dunn 2014).

Nursing students' perceptions of tutorial strategies during clinical learning instruction: A descriptive study

CONTEXT

Teaching strategies and methodology used in clinical training are varied and have different levels of outcome.

METHODS

A descriptive study was carried out in Italy on a convenience sample of third year students at four campuses of the Verona University, using a questionnaire divided into four sections: trainees' perception of the levels of usefulness of various teaching strategies, the levels of effectiveness, the level of supervision and the perceived complexity.

RESULTS

308 students compiled the questionnaire. All the tutorial strategies included were perceived as having medium to high levels of usefulness, ten out of the eleven learning strategies were found to be very useful. A medium-high level of usefulness was perceived for supervision (M 2.9±1). The two skills recorded as needing the most supervision were the management of therapy (M 3.8±1.03; Me 4) and performing nursing techniques (M 3.7±0.95; Me 4). The most complex activities were considered to be confronting an emergency situation (M 3.8±1.03) and the planning of care for a group of patients (M 3.3±0.941), and these two activities had had the least amount of supervision.

CONCLUSIONS

A tutoring model emerged that was centred on learning by experience and with guidance.

Precepting an unsafe student: the role of the faculty

According to a recent study, one of the central findings indicated that preceptors require significantly more support than they are currently receiving from faculty especially when precepting a student who is engaging in unsafe practice. In this grounded theory study, 22 preceptors were interviewed. The findings reveal some interesting implications not only regarding the staffing of preceptorship programs but also the process of preparing faculty as to how to provide preceptors with sufficient and appropriate support throughout the preceptorship experience.

The One-Minute Preceptor

The One-Minute Preceptor (OMP) is a teaching tool that has been used successfully for over 10 years in family practice residency programs. It was designed to enhance the teaching skills of physicians involved in the clinical education of new residents. This article describes the five steps of the OMP and how it was taught to a group of nurse preceptors and reports their evaluations of the impact that this education had on their ability to instruct and offer feedback to the novice nurse.

Teaching Can Never Be Innocent: Fostering an Enlightening Educational Experience

Becoming cognizant of the actual and potential oppressive dimensions of the teaching practices of nurse educators is essential in establishing a more democratic and enlightening experience for both teachers and students. Although there has been an ardent trend toward the promotion of critical thinking and reflective ability among nursing students, rarely has attention focused on the ability of nurse educators to be critically reflective of their own teaching. The authors pose key questions about the reality of nursing education today and how it can sometimes continue to reflect a philosophy that seems to contravene the notion of a more liberated approach to teaching. In that process, they reflect critically on the subtle incongruities and complexities between teachers' intentions and their practice.

Preceptorship and interpersonal conflict: a multidisciplinary study

BACKGROUND

The impetus for the study was the concern of teachers about the potentially deleterious effects of conflict in the preceptee-preceptor relationship. Preceptorship, in which students work alongside designated professionals in clinical settings, can provide opportunities to integrate theoretical and practice knowledge, and can play a part in professional development. However, students may experience communications and interpersonal problems with their preceptors and, if the conflict thereby generated is not challenged and resolved, negative outcomes can occur for students, preceptors and teachers.

AIM

The purpose of the study was to explore the nature of conflict in preceptorship experiences.

METHODS

A modified, simultaneous quantitative/qualitative triangulated method was used, with the quantitative results reported in this paper. A total of 548 questionnaires were mailed to students and preceptors in the final clinical experience of undergraduate programmes in four disciplines. The return rate was 42.7% (234 questionnaires).

FINDINGS

Data revealed the prevalence of conflict, the degree to which this affected preceptorship relationships, factors occurring in the practicum that may contribute to conflict, the degree to which the conflict was resolved, and the outcomes of conflict.

CONCLUSIONS

It is only through an understanding of the dynamics involved in conflict, and its negative effects on students, that teachers, preceptors and students alike can respond proactively to conflicts and become adept at seeking and implementing effective solutions.

Students' perceptions of the effectiveness of mentors in an undergraduate nursing programme in Hong Kong

AIM OF THE PAPER

This paper reports the results of a multiple-phase study on a mentoring scheme for nursing students in one of the universities in Hong Kong. Using a qualitative approach, students' perceptions of the various roles of mentors were collected, and this information was used as the basis to design a tool for subsequent evaluation of the mentoring scheme.

BACKGROUND

The nursing department in one of the universities in Hong Kong initiated and developed the idea of an 'Honorary Clinical Instructors' scheme (HCI scheme) for the supervision of the pre-registration nurses. The scheme was examined in a local context, where the Chinese culture dominated, so that a standardized protocol that takes into account the potential cultural dimensions could be established.

DESIGN

The mentoring roles outlined by the English National Board (ENB) for Nursing, Midwifery, Health Visiting were used as a framework to identify undergraduate nursing students' perception of the effectiveness of mentors. Information gathered from interviews with Year 2 students (n=12) and Year 3 students (n=10) was used as the basis to design a questionnaire for subsequent programme evaluation. An evaluation questionnaire based on the interviewing results was developed for further evaluation of the mentoring scheme.

FINDINGS

After the mentoring scheme was evaluated in semester one, a series of strategies were designed to improve the preparation of mentors and the implementation of the scheme. The strategies were identified as effective by the significant differences in the perceptions students had towards the mentoring scheme in semester one and semester two (t189=-4.80, P < 0.001), with semester two (n=81) having a mean score difference of 8.69 higher than in semester one (n=110).

CONCLUSIONS

It was concluded that the questionnaire developed in the project could be adopted as a useful instrument to evaluate the effectiveness of mentoring programmes for nursing courses, and that the results of this study may also stimulate more research interest in this area to improve the quality of clinical teaching in the pre-registration nursing education programmes in the future.

Nursing work force in practice and education: what can we learn from the current crisis?

A major factor in the growing crisis in health care is the serious shortage of nurses in practice and education. The current work force shortage is different and more critical than previous cyclical deficits. Because it is projected to be of unprecedented severity and to endure long into the future, it demands significant attention and innovation. Nurses in clinical practice and in faculty roles are growing older, and the nursing work force in general is becoming relatively less educated. A strong nursing work force of the future will require new approaches to recruitment, preparation, and retention of nurses, interdisciplinary partnerships, and infusion of support from a variety of sources.

Student nurses' perception of independence of supervision during clinical nursing practice

The purposes of this longitudinal study were to examine Swedish student nurses' perceptions of independence and to explore to what extent the students had had opportunities to practise different tasks during clinical practice. Data were collected on weekly self-assessment forms during the first and final clinical courses of a 3-year nursing programme for 60 and the remaining 48 students, respectively. The majority of the students rated themselves as being independent of supervision to a great extent both at the beginning and throughout the clinical courses. Some students reported no or few opportunities to practise certain tasks during both courses. Factors that may have influenced the students' perception of independence are discussed, such as preparation before the clinical courses and the importance students gave to certain tasks. Clinical practice should be carefully planned and individualized to facilitat students' opportunities to practise different tasks.

Self-efficacy of preceptors in the community: a partnership between service and education

Developing partnerships between service and education is one strategy to enhance student learning. A pre-test-post-test design was used to compare changes in perceptions of self-efficacy expectations in the supervision of a team of four senior nursing students. A convenience sample of eight community practitioners completed the Community Advisor Self-Efficacy (CASE) questionnaire prior to and following a 13 week community health practicum. Following the community practicum, the preceptors were also invited to attend a focus group to discuss their experience. No significant differences were found between the pre- and post-self-efficacy scores. Community practitioners felt reasonably confident in assuming the preceptor role. They felt most efficacious in encouraging students to use agency personnel and in providing student feedback, but somewhat less confident in areas such as selecting learning experience congruent with course objectives, and trusting the students' readiness to work with communities. All strategies to assist the preceptors in assuming their role were considered helpful. Evidence of the preceptors and faculty advisors working in partnerships with the students was not clearly evident. Findings are being used to refine strategies for preparing and supporting agency personnel for their role in working with students.

Preceptorship: the progression from student to staff nurse

Preceptorship assists the development from learner to accountable staff nurse. Time has to be available for preceptorship to be successful. The learning objectives need to be relevant for the individual preceptee. Preceptors require considerable support for their role. Preceptees had difficulty adjusting to being staff nurses and experienced high levels of stress. Most progress was observed after a three month period, when ability and confidence levels had increased and stress levels decreased.

A Pilot Study to Compare the Effectiveness of Preceptored and Nonpreceptored Models of Clinical Education in Promoting Baccalaureate Students' Competence in Public Health Nursing

Preceptor models in nursing have only recently begun to be evaluated, and the published results of their effectiveness are inconsistent and inconclusive. To date, the preceptor evaluation studies found in nursing literature refer to clinical practice in hospitals. This descriptive correlational pilot study (N = 25) compared the effectiveness of preceptored and nonpreceptored models of clinical nursing education in promoting baccalaureate nursing students' competence in public health nursing. The study also compared the learning experiences of students in the two models. Findings from the study revealed that although students in both models reported similar numbers of learning experiences, there were some differences in the types of experiences obtained. Students in both models demonstrated significant gains in perceptions of clinical competence during the 12-week experience. However, there was no significant difference found between the two groups in gain in perceived clinical competence.

A Review of Preceptorship in Undergraduate Nursing Education: Implications for Staff Development

Nurse educators regularly develop clinical learning experiences for undergraduate students using the expertise of experienced RNs as preceptors. Preceptors help students develop a knowledge base and clinical skills. This article reports a literature review and summarizes the benefits of preceptorship, outlines preceptor responsibilities and qualities, and discusses the process of preceptor selection and role preparation. Suggestions for collaborative efforts regarding the preceptor experience among staff nurses, nurse educators, and staff development educators are highlighted.

A preceptorship program in an Israeli bone marrow transplantation unit

Bone marrow transplantation (BMT) departments are unique in character. This is due largely to the following factors: the diseases treated, long-term hospitalization, strong family involvement in the care of patients, and the use of experimental treatment. Because of these factors, clinical experiences in a BMT unit may be a threatening experience for both nursing students and nurses. The BMT unit at Hadassah Hospital has, therefore, developed and implemented a preceptorship program for nursing students and nurses involved in advanced courses. The program includes three aspects: (a) a comprehensive medical knowledge base, (b) instruction in special nursing skills aimed at meeting both the physical and psychologic needs of BMT patients and their families, and (c) supervised involvement in patient and family education and counseling. Our goal is to enable students to care for patients throughout the BMT experience, from admission to post-BMT follow-up. Feedback elicited from students who have undergone the program was positive. They said that the program helped them overcome their fears and encouraged them to apply for nursing jobs in the unit.

A collaborative preceptor model for clinical teaching of beginning nursing students

With decreased clinical and faculty resources, monitoring students in the clinical area for safety and progress can be difficult. The authors discuss a project that used preceptors for selected beginning students to address issues related to high student-to-faculty ratios, individualized teaching, role modeling, and increased faculty time for scholarship. Based on student evaluation of the pilot project, the authors recommend using nurse preceptors for teaching beginning nursing students.

Job satisfaction in preceptorship and its effect on the clinical performance of the preceptee

This study was designed to examine the relationship between preceptor/preceptee job satisfaction and preceptee clinical performance. A correlational descriptive design using quantitative data was employed through a mailed survey. Seventy-nine questionnaires were mailed to preceptors, 100 to preceptees. The response rate for preceptors was 49.4% while the response rate for preceptees was 33%. Herzberg's theory served as the conceptual framework. Three baccalaureate schools of nursing in Atlantic Canada comprised the setting. Analysis of data included frequencies, percentages, t-tests, and Pearson's product-moment correlation coefficient. Findings indicate that preceptors and preceptees differ significantly regarding aspects of their job, and their job in general. They also differ significantly in their rating of how often preceptees perform the planning/evaluation components of their care. A positive significant relationship exists between preceptee job satisfaction and clinical performance. No relationship was found to exist between preceptor job satisfaction and preceptee clinical performance. Additionally, in view of the limitations of the study (small sample, low response) limited conclusions can be drawn from the study.

Assessing and preparing students for distance preceptorship placements

Preparing students for distant preceptorship placements requires knowledge of individual students through formal and informal mechanisms. Since they receive support via telephone, fax or mail, the first onus is on students to manage their preceptorship situations effectively. In order to enhance their abilities in preceptorship situations, students can be assessed for their learning and personality styles. Findings from two style assessment tools, Kolb's Learning Style Inventory and Myers-Briggs Type Indicator, can be used to gain insight into students' interactions with preceptors and to assist instructors in giving the right kind of support and direction after students are placed.

Use of clinical map guides in precepted clinical experiences

A common concern of preceptors and students is the mutual lack of clarity about expectations for precepted clinical experiences. In collaboration with nurse preceptors, a clinical map with clear time lines to guide students through the phases of the preceptorship was developed. Use of the map helped bring clarity and consistency to precepted clinical experiences.

Reflection on clinical leadership behaviours

This paper uses leadership theory and personal observations to reflect on leadership behaviours observed during a third year clinical placement on an Oncology Unit. It examines the consequences of the different leadership styles of two registered nurses, firstly a clinical nurse consultant (CNC) and secondly a level one registered nurse, who acted as the author's preceptor. Conclusions are drawn about the value of preceptoring baccalaureate undergraduates.