A critique of the undergraduate nursing preceptorship model

The effect of the preceptorship training program on the participation of clinical nurses in training nursing internship students: a quasi-experimental study

INTRODUCTION

Clinical education is a fundamental part of nursing professional education. One method of education is the implementation of the preceptorship program, in which clinical nurses are responsible for educating nursing students. The present study aimed to determine the effectiveness of the preceptorship training program for the participation of clinical nurses in the education of nursing students.

METHODS

This quasi-experimental study was conducted in 2023 at the teaching hospital in Tehran, Iran. The sample consisted of 66 nurses from a teaching hospital selected using the accessible method and randomly were put into two groups. The workshop addressed the educational needs of preceptors and students, their readiness for their role, and strategies to effectively support students. Prior to the study, the nurses' level of participation was assessed utilizing a valid IMSOC questionnaire that gauged their involvement in guiding nursing students. The participation rate was reassessed after one month using the same questionnaire. The data were analyzed using SPSS version 19.

FINDINGS

The two groups were homogeneous in terms of demographic characteristics. The average score for nurses' participation in the education of students before the intervention was 101.84 ± 15.42 in the test group and 107.24 ± 10.53 in the control group; these two groups were not significantly different (P = 0.10). After the intervention, the scores reached 118.90 ± 15.11 in the test group and 106.21 ± 11.96 in the control group, indicating a significant difference (P < 0.001). A comparison of the nurses' participation scores in the test group indicated a significant difference from the pretest to the posttest, with the improvement in all nurses's participation scores (P < 0.001). However, in the control group, this difference was not significant (P = 0.41).

CONCLUSION

The preceptorship training program is effective in light of increasing the participation of clinical nurses in the education of nursing students. This program can improve various aspects, such as motivation, satisfaction, commitment, implementation, and obstacle removal. Considering the importance of clinical training for nursing students and the essential role of preceptors, it is recommended that managers and health trustees in all university hospitals implement a preceptorship training program to increase the participation of clinical nurses in the education of nursing students.

'Working as a Real Nurse': Nursing Students' Experiences of a Clinical Education Ward in Psychiatric Care

Although the concept of clinical education wards has shown encouraging outcomes regarding nursing students' satisfaction with clinical placements in somatic care, the existing research in a psychiatric context is sparse. This study aims to explore nursing students' experience during clinical education at a psychiatric clinical education ward. A qualitive descriptive study with content analysis, using interviews with 16 bachelor's degree nursing students was conducted. The results indicated that an enriched and adapted learning environment focusing on psychiatric nursing with peer learning supported independence and progression into the future nursing role.

Undergraduate nursing student and preceptors' experiences of clinical placement through an innovative clinical school supervision model

This study explores final year undergraduate nursing and midwifery students and their preceptors' experiences of a newly introduced Clinical School Supervision (CSS) model, which was implemented to reduce a perceived disconnect between theory and practice. A descriptive design was used with qualitative data collected through open-ended survey questions. Respondents included 43 undergraduate nursing and midwifery students involved in the final year and 13 clinical preceptors from a large metropolitan tertiary health service in Victoria, Australia. Qualitative data were analysed using thematic analysis. Students described the CSS as a favoured supervision model with students being able to take advantage of support from both the academic supervisor and nursing staff in the clinical setting, a model which also supported student's sense of belonging. Students experiences indicated the CSS model facilitated consolidation of knowledge, reflective practice and transition to graduate nursing. The preceptors described a commitment to and preparedness for the role, although they found they had little break from teaching and their rosters did not always align with their students'. Preceptors also shared experiences of unfulfilled expectations, lack of recognition and incentives for supervising students. Further studies are needed to identify effective ways to support preceptors in their roles.

Clinical teaching practices of nurse educators at a public college of nursing in South Africa: A survey study

Standardisation of clinical teaching practices by nurse educators for undergraduate students is vital, especially within large nursing education institutions distributed over multiple campuses. This quantitative study investigated current clinical teaching practices of nurse educators at a Public College of Nursing in South Africa. A total of n = 68 nurse educators were selected from 5 campuses over a two-month period (April-May 2016), using convenience sampling. Data was collected with a structured questionnaire, the design of which was informed by the Dundee Three Circle Outcomes Model for Clinical Teaching. The results showed that 37% (n = 25) of the nurse educators had above 10 years of clinical teaching experience. Of the 66% (n = 45) who had formal education on clinical teaching practices, 49% (n = 33) received in-service education. Most nurse educators were willing to share amongst colleagues documents they used for clinical teaching, to promote standardisation of teaching practices. Further, they evidenced best clinical practices regarding planning for assessment and clinical placement of students. However, there were significant variations in the majority (seven) of the nine investigated clinical teaching practices among participants. In-service education was positively correlated to best clinical teaching practices (Chi square (d.f. = 2, n = 68) = 7.24; p = .027; V = 0.33 Medium).

Should we use preceptorships in undergraduate nursing education?

BACKGROUND

Clinical learning experiences are the cornerstone of undergraduate nursing education as they allow students to apply theory to practice and help them develop as competent practitioners who are prepared for the realities of diverse, complex, and ever-changing practice environments.

PROBLEM

The traditional clinical teaching model, where small groups of students work with educators who are on-site facilitating learning, has numerous issues and thus there have been calls for reform. This Creative Controversy focuses on one reform option, the alternative clinical teaching model of preceptorships, which has gained popularity in recent years.

APPROACH

Current evidence surrounding preceptorships in undergraduate education was examined and critiqued.

CONCLUSION

Despite their popularity, there is a lack of robust evidence surrounding preceptorships and the motivations for using this model remain questionable. Future study is needed so preceptorships are implemented according to evidence-based teaching practices and not clouded by inappropriate motivations. The author challenges readers to question their practices and work to positively contribute to the science and practice of nursing education.

Nursing students' perception of the clinical learning environment and supervision in relation to two different supervision models - a comparative cross-sectional study

Background

Knowledge concerning nursing students' experiences of the clinical learning environment and how supervision is carried out is largely lacking. This study compares nursing students' perceptions of the clinical learning environment and supervision in two different supervision models: peer learning in student-dedicated units, with students working together in pairs and supervised by a "preceptor of the day" (model A), and traditional supervision, in which each student is assigned to a personal preceptor (model B).

Methods

The study was performed within the nursing programme at a university college in Sweden during students' clinical placements (semesters 3 and 4) in medical and surgical departments at three different hospitals. Data was collected using the Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale, CLES+T, an instrument tested for reliability and validity, and a second instrument developed for this study to obtain deeper information regarding how students experienced the organisation and content of the supervision. Independent t-tests were used for continuous variables, Mann-Whitney U-tests for ordinal variables, and the chi-square or Fischer's exact tests for categorical variables.

Results

Overall, the students had positive experiences of the clinical learning environment and supervision in both supervision models. Students supervised in model A had more positive experiences of the cooperation and relationship between student, preceptor, and nurse teacher, and more often than students in model B felt that the ward had an explicit model for supervising students. Students in model A were more positive to having more than one preceptor and felt that this contributed to the assessment of their learning outcomes.

Conclusions

A good learning environment for students in clinical placements is dependent on an explicit structure for receiving students, a pedagogical atmosphere where staff take an interest in supervision of students and are easy to approach, and engagement among and collaboration between preceptors and nurse teachers. This study also indicates that supervision based on peer learning in student-dedicated rooms with many preceptors can be more satisfying for students than a model where each student is assigned to a single preceptor.

The learning environment on a student ward: an observational study

INTRODUCTION

Worldwide, a growing number of healthcare students require clinical environments for learning. Some wards have become adapted 'student wards' to meet this demand. Benefits have been reported from the students', supervisors' and patients' perspectives. There is no definition of a student ward, and little research on what the term means. A deeper understanding of the characteristics of student wards is needed to support their use. The aim of this study is to describe what characterises the learning environment on one student ward.

METHODS

An ethnographic approach was used for an observational study on a student ward in a hospital in Sweden. Student nurses, supervisors and others on the ward were observed. Field notes were thematically analysed.

RESULTS

Four themes were identified: 'Student-led learning' described students learning by actively performing clinical tasks and taking responsibility for patients and for their own learning. 'Learning together' described peer learning and supervision. 'Staff's approach to learning' described personalised relationships between the students and staff and the build-up of trust, the unified inter-professional approach to teaching, and the supervisors' motivation for teaching and for their own learning. 'Student-dedicated space' described the effect of the student room on the learning environment.

DISCUSSION AND CONCLUSIONS

This study describes the characteristics of a student ward that centred around a community of practice that shared a view of learning as a priority, allowing staff to provide clinical care without compromising students' learning. This qualitative study at a single centre lays the groundwork for future research into other student wards.

Gender Division of Labor, Burnout, and Intention to Leave Work Among Young Female Nurses in Japan: A Cross-Sectional Study

Women in Japan face difficulties balancing work and personal life due to the gender division of labor, and medical professions are no exception. The purpose of this study was to investigate if the gender division of labor affects the intention to leave the workplace among the nursing profession. Among 328 female nurses working for three university-affiliated hospitals in Tokyo, Japan, above 70% were in their 20s and 30s and single, and agreed with the gender division of labor that men should be the breadwinner and women should assume family responsibilities. Adjusting for three types of Copenhagen burnout inventory, stepwise multivariable logistic regression models identified that being younger (all p-values < 0.05), each domain of burnout score (each p < 0.001 for work-, personal-, and client-related burnout) increased a risk of intention to leave, and high support decreased the risk (all p < 0.001). Women who agreed with the gender division of labor were more likely to have intentions to leave (p = 0.003 but this association disappeared when adjusted. The findings of study demonstrate that perceptions toward gender division of labor are not a determinant of intention to leave the workplace but the young nurses and those who scored high on burnout were the most vulnerable population.

'It's complicated': Staff nurse perceptions of their influence on nursing students' learning. A qualitative descriptive study

BACKGROUND

During both teacher-led clinical practica and precepted practica, students interact with, and learn from, staff nurses who work on the clinical units. It is understood that learning in clinical practice is enhanced by positive interactions between staff nurses and nursing students. While much is known about preceptors' experiences of working with nursing students, there is little evidence to date about staff nurses' perspectives of their interactions with students in teacher-led practica.

PURPOSE

To understand teacher-led clinical practica from the perspective of staff nurses.

METHOD

A qualitative descriptive approach answers the question: How do staff nurses perceive their contributions to nursing students' learning during teacher-led practica? Nine staff Registered Nurses (RNs) working within a regional acute care hospital in western Canada were interviewed using semi-structured interviews. Interview transcripts were analyzed using cross case analysis to discover themes and findings were checked by several experienced RNs.

RESULTS

Analysis showed that nurses' interactions with nursing students are complicated. Nurses want to "train up" their future colleagues but feel a heavy burden of responsibility for students on the wards. This sense of burden for the staff nurses is influenced by several factors: the practice environment, the clinical instructor, the students themselves, and the nurses' understanding of their own contributions to student learning.

CONCLUSIONS

Staff nurses remain willing to support student learning despite multiple factors that contribute to a sense of burden during teacher-led practica. Workplace environment, nursing program, and personal supports are needed to support their continuing engagement in student learning. Nurses need to know how important they are as role models, and the impact their casual interactions have on student nurses' socialization into the profession.

In-depth Knowledge of the Role of the Clinical Mentor

OBJECTIVES

This work sought to unveil the meaning expressed by clinical nurses by being mentors for students from the nursing internship level.

METHODS

Phenomenological research. In-depth interviews were conducted with nine clinical nurses from a hospital in Santiago de Chile, who participate as mentors of nursing students in their last stage of university formation.

RESULTS

Four comprehensive categories were obtained with their respective units of meaning by nursing: 1) vocation and gratification, 2) personal and professional challenge, 3) big responsibility, and 4) transmission of experience.

CONCLUSIONS

Clinical mentorship is a relevant experience in the professional lives of nurses, which implies overcoming challenges, self-training, and delivering the best of oneself, for the purpose of training future professionals prepared to practice nursing integrally.

Preceptors' conceptions of a peer learning model: A phenomenographic study

BACKGROUND

During the past few years nurses precepting undergraduate nursing students have been put under greater pressure because of increased number of students admitted to the universities combined with a shortage of clinical placements. One solution is the preceptor model peer learning where two students are tutored by the same preceptor simultaneously.

OBJECTIVES

The aim of this study was to describe the variation of registered nurses' conceptions of preceptorship in a peer learning model for undergraduate nursing students.

DESIGN

The study used a qualitative descriptive design and a phenomenographic approach.

SETTINGS

The interviews took place at somatic and psychiatric units at two different hospitals in southern Sweden.

PARTICIPANTS

Twelve informants participated who had worked as registered nurses between 1-17years and acted as peer learning preceptors between 2month and 6years.

METHODS

Each nurse was interviewed individually using a semi structured interview guide. Follow up questions were used to make the informants develop and deepen their answers.

RESULTS

Four different descriptive categories emerged in the study: 1) Preceptorship in peer learning generates development and new perspectives 2) Preceptorship in peer learning enables student reflection and independence 3) Preceptorship in peer learning engenders insufficiency and stress 4) Preceptorship in peer learning requires education and support.

CONCLUSIONS

The result of this study showed that preceptors conceived that peer learning enabled them to take a step back which gave them a new role and perspectives. The consequence was that the students could be more independent which saved time for some of the preceptors. However, some preceptors perceived insufficiency and stress while working with two students. It is also important to educate both students and preceptors to optimise the use of peer learning.

Experiencing authenticity - the core of student learning in clinical practice

INTRODUCTION

Learning in clinical practice is challenging regarding organizational and pedagogical issues. Clinical education wards are one way to meet these challenges by focusing on both patient care and student learning. However, more knowledge is needed about how students' learning can be enhanced and about patients' and supervisors' roles in these settings.

METHODS

The aim was to explore nursing students' learning on a clinical education ward with an explicit pedagogical framework. Semi-structured interviews of students were analyzed using qualitative content analysis and an ethnographic study including observations and follow-up interviews of students, patients and supervisors was conducted.

RESULTS

The core of student meaningful learning experiences both external and internal authenticity. Students in early stages immediately created mutual relationships, experienced both external and internal authenticity, and patients became active participants in student learning. Without a mutual relationship, patients passively let students practice on their bodies. Students nearing graduation experienced only external authenticity, creating uncertainty as a threshold for learning. Caring for patients with complex needs helped students overcome the threshold and experience internal authenticity. Supervisors' challenges were to balance patient care and student learning by working as a team. They supported students coping with the complex challenges on the ward.

DISCUSSION/CONCLUSION

Students need to experience external and internal authenticity to make learning meaningful. Experiencing authenticity, involving meaning-making processes and knowledge construction, is linked to transformative learning and overcoming thresholds. Therefore, an explicit pedagogical framework, based on patient-centredness, peer learning and the supervisory team, creates the prerequisites for experiencing external and internal authenticity.

To belong or not to belong: nursing students' interactions with clinical learning environments - an observational study

BACKGROUND

Belongingness has been argued to be a prerequisite for students' learning in the clinical setting but making students feel like they belong to the workplace is a challenge. From a sociocultural perspective, workplace participatory practices is a framework that views clinical learning environments to be created in interaction between students and the workplace and hence, are dependent on them both. The aim of this study was to explore the interdependence between affordances and engagement in clinical learning environments. The research question was: How are nursing students influenced in their interactions with clinical learning environments?

METHODS

An observational study with field observations and follow-up interviews was performed. The study setting comprised three academic teaching hospitals. Field observations included shadowing undergraduate nursing students during entire shifts. Fifty-five hours of field observations and ten follow-up interviews with students, supervisors and clinical managers formed the study data. A thematic approach to the analysis was taken and performed iteratively with the data collection.

RESULTS

The results revealed that students strived to fill out the role they were offered in an aspirational way but that they became overwhelmed when given the responsibility of care. When students' basic values did not align with those enacted by the workplace, they were not willing to compromise their own values. Workplaces succeeded in inviting students into the community of nurses and the practice of care. Students demonstrated hesitance regarding their desire to belong to the workplace community.

CONCLUSION

The results imply that the challenge for clinical education is not to increase the experience of belongingness but to maintain students' critical and reflective approach to health care practice. Additionally, results suggest students to be included as an important stakeholder in creating clinical learning environments rather than being viewed as consumer of clinical education.

Supervisors' pedagogical role at a clinical education ward - an ethnographic study

Background

Clinical practice is essential for health care students. The supervisor’s role and how supervision should be organized are challenging issues for educators and clinicians. Clinical education wards have been established to meet these challenges and they are units with a pedagogical framework facilitating students’ training in real clinical settings. Supervisors support students to link together theoretical and practical knowledge and skills. From students’ perspectives, clinical education wards have shown potential to enhance students’ learning. Thus there is a need for deeper understanding of supervisors’ pedagogical role in this context.

We explored supervisors’ approaches to students’ learning at a clinical education ward where students are encouraged to independently take care of patients.

Method

An ethnographic approach was used to study encounters between patients, students and supervisors. The setting was a clinical education ward for nursing students at a university hospital. Ten observations with ten patients, 11 students and five supervisors were included in the study. After each observation, individual follow-up interviews with all participants and a group interview with supervisors were conducted. Data were analysed using an ethnographic approach.

Results

Supervisors’ pedagogical role has to do with balancing patient care and student learning. The students were given independence, which created pedagogical challenges for the supervisors. They handled these challenges by collaborating as a supervisory team and taking different acts of supervision such as allowing students their independence, being there for students and by applying patient-centredness.

Conclusion

The supervisors’ pedagogical role was perceived as to facilitate students’ learning as a team. Supervisors were both patient- and student-centred by making a nursing care plan for the patients and a learning plan for the students. The plans were guided by clinical and pedagogical guidelines, individually adjusted and followed up.

Assessing the impact of academic-practice partnerships on nursing staff

Background

The ‘spillover effect’ of academic-practice partnerships on hospital nursing staff has received limited attention. In 2007, the Department of Veterans Affairs (VA) created the VA Nursing Academy (VANA) to fund fifteen partnerships between schools of nursing and local VA healthcare facilities. In this paper, we examine the experiences of the VA staff nurses who worked on the units used for VANA clinical training.

Methods

We used survey methods to collect information from staff nurses at all active VANA sites on their characteristics, exposure to the program’s clinical training activities, satisfaction with program components, and perspectives of the impact on their work and their own plans for education (N = 314). Our analyses utilized descriptive statistics and bivariate and multivariate regression.

Results

Results show that staff nurses working on VANA units had moderately high levels of exposure to the program’s clinical education activities, and most reported positive experiences with those activities. The vast majority (80 %) did not perceive the presence of students as making their work more difficult. Among those who were enrolled or considering enrolling in a higher education program, over a quarter (28 %) said that their VA’s participation in VANA had an influence on this decision.

The majority of staff nurses were generally satisfied with their experience with the students. Their satisfaction with the program was related to the level or dose of their exposure to it. Those who were more involved were more satisfied. Greater interaction with the students, more information on the program, and a preceptor role were all independently associated with greater program satisfaction.

Conclusions

Our study suggests that academic-practice partnerships may have positive spillover effects on staff nurses who work on clinical education units. Further, partnerships may be able to foster positive experiences for their unit nurses by focusing on informing and engaging them in clinical training activities. In particular, our results suggest that academic-practice partnerships should keep unit nurses well informed about program content and learning objectives, encourage frequent interaction with students, involve them in partnership-related unit-based activities, and urge them to become preceptors for the students.

Electronic supplementary material

The online version of this article (doi:10.1186/s12912-015-0085-7) contains supplementary material, which is available to authorized users.

Helping community-based students on a final consolidation placement make the transition to registered practice

The pressure of role transition on new nurse registrants has affected recruitment and retention, which, along with an ageing workforce, has resulted in a global shortage of nurses that is now reaching crisis point. This article examines and discusses what can be done to attract and prepare the future workforce in the community, focusing on helping students to make the transition to registered practice that begins during their final consolidation of practice placement. There is currently limited evidence on the effectiveness of how community placement teams prepare finalist students for registered practice and this could be seen as an opportunity lost given the urgent need to recruit more registered nurses to work in primary care. Recommendations for enhancing this crucial stage of the student journey are made, and a case for the need to know more from students about how they experience their final practice placement when allocated to a community setting is presented.

Identifying clinical learning needs using structured group feedback: first year evaluation of pre-registration nursing and midwifery degree programmes

BACKGROUND

Facilitating and supporting clinical learning for student nurses and midwives are essential within their practice environments. Clinical placements provide unique opportunities in preparation for future roles. Understanding the experiences of first year student nurses and midwives following clinical exposures and examining the clinical facilitators and barriers can assist in maintaining and developing clinical supports.

METHODS

The study used a structured group feedback approach with a convenience sample of 223 first year nursing and midwifery students in one Irish university in April 2011 to ascertain feedback on the clinical aspects of their degree programme.

RESULTS

Approximately 200 students participated in the process. Two key clinical issues were identified by students: facilitating clinical learning and learning experiences and needs. Positive learning environments, supportive staff and increased opportunities for reflection were important issues for first year students.

CONCLUSIONS

The role of supportive mentoring staff in clinical practice is essential to enhance student learning. Students value reflection in practice and require more opportunities to engage during placements. More collaborative approaches are required to ensure evolving and adapting practice environments can accommodate student learning.

Student nurses' experiences of the clinical learning environment in relation to the organization of supervision: a questionnaire survey

AIM

The aim was to investigate student nurses' experiences of the clinical learning environment in relation to how the supervision was organized.

BACKGROUND

The clinical environment plays an essential part in student nurses' learning. Even though different models for supervision have been previously set forth, it has been stressed that there is a need both of further empirical studies on the role of preceptorship in undergraduate nursing education and of studies comparing different models.

METHOD

A cross-sectional study with comparative design was carried out with a mixed method approach. Data were collected from student nurses in the final term of the nursing programme at three universities in Sweden by means of a questionnaire.

RESULTS

In general the students had positive experiences of the clinical learning environment with respect to pedagogical atmosphere, leadership style of the ward manager, premises of nursing, supervisory relationship, and role of the nurse preceptor and nurse teacher. However, there were significant differences in their ratings of the supervisory relationship (p<0.001) and the pedagogical atmosphere (p 0.025) depending on how the supervision was organized. Students who had the same preceptor all the time were more satisfied with the supervisory relationship than were those who had different preceptors each day. Students' comments on the supervision confirmed the significance of the preceptor and the supervisory relationship.

CONCLUSION

The organization of the supervision was of significance with regard to the pedagogical atmosphere and the students' relation to preceptors. Students with the same preceptor throughout were more positive concerning the supervisory relationship and the pedagogical atmosphere.

The role of the clinical preceptor: an integrative literature review

The clinical learning environment has been identified as being central to nursing education. The clinical learning environment provides undergraduate nursing students with the opportunity to combine cognitive knowledge with the development of psychomotor and affective nursing skills. The preceptor role in undergraduate nursing education is complex and multifaceted. Undergraduate nursing students identify preceptors as key to their learning in the clinical setting; however, staff nurse preceptors often feel unprepared to serve in this role. This integrative literature review explores the role of the staff nurse preceptor through the perspective of undergraduate nursing students, nursing faculty, and staff nurses who are assigned to precept students as a function of their nursing role. Recommendations are made to facilitate the preparation of clinical preceptors to fulfill this essential role in preparing nursing students for clinical practice.