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

Experiences of preceptorship in Singapore: A qualitative exploratory study of preceptors' experience in precepting nursing students during pre-registration of clinical placement in an acute hospital

BACKGROUND

Preceptors play an important role in teaching and guiding nursing students to transit to the role of registered nurses. Nursing students are trained to acquire the skills and knowledge in providing good quality care to patients. However, the preceptors in the clinical area may face challenges in providing care to their patients in addition to their preceptor role. It is vital to explore and gain insights on the preceptorship experience to better understand their challenges and facilitate their preceptorships and the learning experience of the nursing students.

AIMS

This study explored the preceptors' experience to understand their challenges and support received in the facilitation of the preceptorship and learning experience of the nursing students in an acute care hospital in Singapore.

METHODS

Semi-structured interviews were conducted from June to October 2021 with ten registered nurses working in an acute hospital. Thematic analysis was conducted.

RESULTS

Three main themes emerged from the thematic analysis: (1) preceptor-student relationship; (2) barriers and challenges to successful preceptorship; and (3) outcomes of successful preceptorship.

CONCLUSIONS

This study provided valuable insights in the experience of the preceptors in Singapore. Recommendation for nursing management and leaders to establish support system in promoting recognition of preceptors, establish dialog sessions between stakeholders. Nursing education to provide support and to review the efficacy of the current preceptorship program to identify correlation with successful precepting experience for both preceptors and nursing students. Despite challenges faced by the preceptors, their experience had been positive and they are committed in precepting the nursing students.

Appraisal and Evaluation of the Learning Environment Instruments of the Student Nurse: A Systematic Review Using COSMIN Methodology

BACKGROUND

Nursing education consists of theory and practice, and student nurses' perception of the learning environment, both educational and clinical, is one of the elements that determines the success or failure of their university study path. This study aimed to identify the currently available tools for measuring the clinical and educational learning environments of student nurses and to evaluate their measurement properties in order to provide solid evidence for researchers, educators, and clinical tutors to use in the selection of tools.

METHODS

We conducted a systematic review to evaluate the psychometric properties of self-reported learning environment tools in accordance with the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) Guidelines of 2018. The research was conducted on the following databases: PubMed, CINAHL, APA PsycInfo, and ERIC.

RESULTS

In the literature, 14 instruments were found that evaluate both the traditional and simulated clinical learning environments and the educational learning environments of student nurses. These tools can be ideally divided into first-generation tools developed from different learning theories and second-generation tools developed by mixing, reviewing, and integrating different already-validated tools.

CONCLUSION

Not all the relevant psychometric properties of the instruments were evaluated, and the methodological approaches used were often doubtful or inadequate, thus threatening the instruments' external validity. Further research is needed to complete the validation processes undertaken for both new and already developed instruments, using higher-quality methods and evaluating all psychometric properties.

Clinical educators can supervise students without increased stress: a study of interacting factors using insights from complexity theory

Supervising students in healthcare settings is complex and can be stressful for clinical educators. However, it is unclear how to design student placements without clinical educator stress. Using complexity theory as a lens, fuzzy set Qualitative Comparative Analysis (fsQCA) was used to explore factors associated with no increased stress for clinical educators during speech pathology (SP) placements. Factor selection was informed by the Demand- Control- Support model and existing literature. No single factor was necessary for clinical educators to experience no increased stress. Varied combinations of all factors were found in 10 paths to no increased stress. These combinations often had passing student(s); however, multiple paths included other factors that could be adjusted by clinical educators prior to placement. For example, having more than one workday per week without students was a factor in four paths to no increased stress despite other potential challenges such as a higher caseload throughput. More experienced educators, who had other supporting factors (e.g. lower caseload throughput or workplace engagement such as support from colleagues and managers), also perceived no increased stress in four paths. Student placements without increased stress for clinical educators require consideration of multiple interacting factors. Principles of complexity theory provide insight into how clinical educators uniquely respond to their individual circumstances, resulting in different experiences of student placement impact even within similar workplaces. FsQCA has highlighted practical ways clinical educators supervise students without increased stress. However, any changes for an individual clinical educator need to be considered in combination with other factors given the complexity of clinical education and healthcare settings.

Evaluating the preceptor-preceptee relationship among Pharm D students at the King Saud University School of Pharmacy

OBJECTIVE

To evaluate preceptee satisfaction concerning preceptorship and the preceptor-preceptee relationship among pharmacy students.

METHODS

A cross-sectional study was conducted from May 2017 to August 2017 on senior Pharm D students at King Saud University (KSU) College of Pharmacy. A survey instrument was used to get feedback from students regarding their clinical rotations and internships and to evaluate their satisfaction toward preceptorship to meet the goals of the curriculum. Data were entered into SPSS, version 24.

RESULTS

Of the 52 students surveyed, 36 (69.2%) were female. More than half of respondents were somewhat satisfied with their preceptors and 11.5% were satisfied. Additionally, only 17% of students rated their preceptors as having excellent clinical teaching skills; about 19% of students rated them as "needs improvement." About 40% of students rated their preceptors as very good, concerned, competent, and safe in their care for persons living with serious co-morbidities and diseases. About half of students (48.1%) rated their non-faculty KSU preceptors' teaching behavior as not satisfactory compared with only four respondents with respect to KSU faculty preceptors' teaching behavior.

CONCLUSION

Pharm D students were somewhat satisfied with their preceptors' teaching behaviors in communication skills, practice, and teaching skills as well as feedback and evaluation to students. To enhance the quality of experiential education, preceptors should be trained to develop programs that direct and energize advancement.

Precepting a Student? Here are the Job Descriptions

Often a community health nurse is asked to precept a nursing student. Having a student accompany a nurse into patients' homes and clinics provides valuable learning experiences for the student. In this one-to-one, apprentice-type relationship with a community-skilled nurse, the student synthesizes clinical knowledge by learning skills, roles, responsibilities, and standards of care outside the acute care setting and enhances assessment, decision-making, and communication skills. In addition, preceptor experiences are opportunities to ignite professional enthusiasm, as well as serve as recruitment and retention modalities. To assist in implementing and/or continuing preceptor practicums with nursing schools, this article lists the job descriptions for all those involved in preceptorships.

Guidelines for Public Health Practitioners Serving as Student Preceptors

Student fieldwork and service learning are valuable strategies for developing the skills of future public health professionals. Practitioners who serve as preceptors to students often receive little preparation for guiding and evaluating students. Findings from a review of fieldwork and service learning literature and a program evaluation of an undergraduate public health program at a large southern public university were used to construct guidelines for the practitioners supervising students in the field. These guidelines should aid practitioners in their role as preceptors of public health students. The guidelines address assessing student competencies, developing student competencies, writing learning objectives, evaluating students, maximizing the student precept or relationship, and managing problems.

Dichotomy between theory and practice in chest radiography and its impact on students

Introduction

It is important that theory is synchronous with clinical practices that students engage in. Lack of congruence between theory and practice presents serious problems to students. This study was therefore conducted to determine if there was a theory–practice gap in chest radiography during clinical rotations, and any associated causes and effects on radiography students.

Method

A descriptive survey design was used to conduct this study from 2 February to 27 July 2014. A semi‐structured questionnaire consisting of open‐ and close‐ended questions was used to purposively collect data from 26 radiography students in Ghana who had completed theory lessons in chest radiography and had either completed or were undertaking clinical rotations in chest radiography.

Results

Twenty‐five (96%) respondents indicated the presence of theory–practice gap in chest radiography during clinical rotations, where differences between theory and clinical practice were observed. Lack of working materials 16 (62%), heavy workload 14 (54%), equipment breakdowns 14 (54%) and supervisory factors 11 (43%) were identified as the causes. Many students (81%) experienced diverse adverse effects such as confusion 10 (38%), poor performance during clinical examinations 6 (23%) and entire loss of interest in the professional training 1 (4%) of this dichotomy.

Conclusion

Dichotomy between theory and practice found in chest radiography has diverse adverse effects on students. Regular feedback on the quality of clinical practice received by students should be encouraged to determine the existence of any gaps between theory and practice in order to promote effective clinical rotation programmes in radiography.

Factors associated with students' perception of preceptor excellence

OBJECTIVES

To identify factors associated with preceptor excellence as rated by student pharmacists and to assess the correlation of excellent ratings with years as pharmacist, specialty certification, and faculty appointment status.

METHODS

A retrospective analysis of student pharmacist evaluations of preceptors from May 2009 to May 2012 was completed to determine factors associated with preceptor excellence.

RESULTS

Preceptors who showed an interest in teaching, related to the student as an individual, encouraged discussion, were accessible, provided feedback, served as a role model, were organized, and/or spent increased time with students were more likely to be rated excellent.

CONCLUSION

Serving as role models and showing an interest in teaching demonstrated the strongest association with being an excellent preceptor. Identifying factors students associate with preceptor excellence may result in enhanced preceptor recruitment, development, and training.

Putting the (R) ural in preceptorship

Rural nursing is recognized as a unique health care domain. Within that context, the preceptorship experience is purported to be an important approach to preparing safe and competent rural practitioners. Preceptorship is the one-to-one pairing of a nursing student with a professional nurse who assumes the mandate of teacher and role model in a designated clinical/contextual setting, in this case the rural setting. A research gap exists in the literature in which rural preceptorship is specifically explored. The purpose of this paper is to review preceptorship in relation to preparing nursing students specifically for the rural setting. Understanding how preceptorship as an educational model can prepare nursing students to transition to rural practice is an important endeavor. An authentic rural preceptorship may serve to influence the recruitment and retention needs for registered nurses in rural areas. A greater understanding of rural preceptorship serves to illustrate the appropriate support, socialization and contextual competence required to prepare nursing students for rural nursing practice. This paper's review may serve to highlight the research that currently exists related to rural preceptorship and where additional research can contribute to further understanding and development for authentic rural nursing preparation.

Improving teaching strategies in an undergraduate community health nursing (CHN) program: implementation of a service-learning preceptor program

A service-learning component was added to the existing preceptor practicum program at the University of North Carolina Charlotte's School of Nursing (UNCC SON) in the fall of 2007 for nursing students in the community health nursing (CHN) practicum course.

OBJECTIVE

The preceptorship model is commonly used in undergraduate nursing education. The aim of this study was to improve teaching strategies in the existing school health nursing (SHN) preceptor program by the addition of a service-learning community partnership. Adding the service-learning component was based on the Polvika model.

PARTICIPANTS

A total of 27 nursing students and 33 preceptors participated in the study.

DATA ANALYSIS

Percentages, means, standard deviations, and rankings were used to analyze the data. The participants completed a multiple-choice survey and ranked a list of tasks.

RESULTS

The students were able to fulfill their task responsibilities, and the service-learning preceptor program was cost effective for the SHN preceptors through hours saved by the nursing students.

CONCLUSION

The preceptor role is associated with many factors, including perceived burden, which affects their willingness to work with students. The findings demonstrated that service learning is an effective teaching strategy in the CHN nursing students' learning by fostering the preceptors' benefits, rewards, support, and commitment to the role.

Undergraduate nursing students' preparedness to "go rural"

This article reports on a theme emerging from a focused ethnography examining the professional socialization of undergraduate fourth year nursing students during a rural hospital preceptored clinical experience. Nursing students and preceptors geographically dispersed over a 640,000 square kilometer rural area participated in this study. Students report student preparedness for the rural hospital setting means to "know what you are getting into". Assisting nursing students to prepare for the rural hospital preceptorship facilitates a positive experience thus increasing the effectiveness of the preceptorship model of clinical teaching. Having a positive rural-based experience also has the potential for recruiting new staff. These preliminary findings suggest that student preparation for the rural hospital preceptorship includes cognitive and psychological preparation, as well as the acquisition of common advanced clinical skills.

Factors influencing student nurses' career choices after preceptorship in a five-year junior nursing college in Taiwan

This study was conducted to explore the influence factors of a preceptorship in career choices following student nurses' graduations. A total number of 326 student nurses in their fifth year of junior nursing college were selected as participants. A validated and reliable questionnaire was used in this study. Data were analyzed by the Statistical Package for the Social Science (SPSS) for windows for percentage, mean, standard deviation, and Pearson's correlation. The results showed that: (1) the first five factors influencing student nurses' career choices were good unit environment, nurse's professional role, self-professional knowledge deficiency, nurse's professional knowledge, and patient's and family's good feedback; (2) the correlation between the chosen field of practice and willingness to work after graduation showed a strong relationship in all areas. Notably, the preceptorship had an impact on student nurses selecting a nursing career. These results can give nurse educators guidance in preparing student nurses as they enter the work force.

Partnerships for Learning Population-Based Public Health Nursing: Web-Delivered Continuing Education for Public Health Nurse Preceptors

Public health and other community health nurses frequently serve as preceptors to undergraduate student nurses learning population-based nursing in community/public health practicum courses. The extent of preparation and support for the preceptor role provided by schools of nursing is often limited. One strategy to address this problem is to provide targeted, Web-delivered continuing education (CE) to preceptors. A Web-delivered CE course entitled, "Partnerships for Learning Community Health Nursing," was created and pilot tested. Course content includes preceptor roles; assisting students in learning population-based public health nursing, critical thinking, and cultural competence; learning styles and teaching strategies; what to do in challenging situations; evaluation and feedback; and specific information about school policies, procedures, and course assignments. Precourse knowledge was assessed using a mailed survey. Postcourse knowledge and satisfaction were assessed using questions embedded in the course. Postsemester knowledge and satisfaction were evaluated through a postsemester survey. Knowledge gain was tested using repeated measures ANOVA and paired t tests. Thirteen preceptors participated in the pilot test. Repeated measures ANOVA indicated that knowledge gain occurred (multivariate F=55.603, df=2, error df=11, p<.0001). Participants increased knowledge from pretest to posttest (t=-10.25, p<.00001) and from pretest to end of the semester (t=-4.95, p<.0003). Knowledge decline from end of course to end of semester was not significant (t=1.94, p=.08). Participants reported satisfaction with the course. Web-delivered CE for community/public health nurse preceptors can support preceptor learning and is an acceptable method for receiving this type of education. Further research is needed on the impact of preceptor education on student learning.

Students' perception of the psycho-social clinical learning environment: an evaluation of placement models

Nursing is a practice based discipline. A supportive environment has been identified as important for the transfer of learning in the clinical context. The aim of the paper was to assess undergraduate nurses' perceptions of the psychosocial characteristics of clinical learning environments within three different clinical placement models. Three hundred and eight-nine undergraduate nursing students rated their perceptions of the psycho-social learning environment using a Clinical Learning Environment Inventory. There were 16 respondents in the Preceptor model category, 269 respondents in the Facilitation model category and 114 respondents in the clinical education unit model across 25 different clinical areas in one tertiary facility. The most positive social climate was associated with the preceptor model. On all subscales the median score was rated higher than the two other models. When clinical education units were compared with the standard facilitation model the median score was rated higher in all of the subscales in the Clinical Learning Environment Inventory. These results suggest that while preceptoring is an effective clinical placement strategy that provides psycho-social support for students, clinical education units that are more sustainable through their placement of greater numbers of students, can provide greater psycho-social support for students than traditional models.

The CCARE model of clinical supervision: bridging the theory-practice gap

Clinical supervision of nursing students is a key component of nursing education. The clinical setting provides students with an opportunity to develop a professional identity, knowledge base, and the ability to transfer classroom knowledge to the clinical setting. This paper suggests a model of clinical supervision that will address how to bridge the pre-existing theory-practice gap in nursing education through an attitude of caring and the utilization of caring behaviours based on Leininger's theory of culture care. Key concepts included in this model are: communication, collaboration, application, reflection and evaluation, these concepts comprise the CCARE model of clinical supervision.

Evaluating Student Performance in Undergraduate Preceptorships

This article explores the challenges in evaluating student performance in preceptorships based on data collected during academic years 1999-2002, which revealed an unusually large number of high grades and relatively few average grades. Multiple perspectives are explored, including preceptor issues of selection, orientation, recognition, role conflict, and experience with giving grades; faculty issues of role confusion and unclear expectations for student performance; and environmental issues of lack of control of the learning environment and differences in the values of education and workplace. Solutions are proposed, including an orientation for preceptors and faculty, ongoing faculty mentoring of preceptors, official preceptor recognition, clear articulation of expectations for student performance and faculty site visits, and creation of grading rubrics for various aspects of the course to be used by preceptors, faculty, and students.

Nursing Education and Service Collaboration: Making a Difference in the Clinical Learning Environment

This article focuses on innovative collaborative steps that were identified in recent research conducted by these authors on the relationship between academia and service. These steps are currently being implemented in the hope of improving the important role that the clinical environment plays in student nurses' education. Few factors in nursing education are as important as the clinical environment in which students do their training. This article elaborates on these steps and offers practical suggestions for improving the relationship between academia and service.

Promoting Effective Preceptorship Experiences

Preceptors and students alike want and need a positive preceptorship experience. There are some factors, however, that must be considered when arranging such experiences, including sufficient time, workload management, use of space, monetary payment for preceptorship, preparation for the role, the one-to-one relationship, and the learning environment. This article concludes with specific strategies that address these factors. The first uses a theoretical model, one advocated by the authors, the Preceptor Enabling Model. This model delineates the roles and responsibilities of students, preceptors, staff, and faculty. Preceptors, too, need preparatory workshops, paid time for orientation to the role, evaluation of preceptors, and finally, support.

Coping with uncertainty within the preceptorship experience: the perceptions of nursing students

A substantial amount of time and resources are channelled into supporting clinical practicum in nursing education programmes. Attention is targeted at the most effective models to achieve this aim. The provision of sound support models regardless of specific clinical setting is recognized as integral to student development and transition periods throughout nurses' careers. Within the mental health setting, this situation is compounded by the negative attitudes nursing students tend to hold towards people experiencing a mental illness. Preceptorship has been widely used both nationally and internationally for clinical practicum. Although this model seems to have been endorsed by virtue of its increasing use, additional examination is necessary to assess efficacy and effectiveness across clinical practicum, including those in mental health settings. In utilizing a grounded theory approach, this study addresses the question: what is the experience of preceptorship for undergraduate nursing students in the mental health setting? The major themes identified include: 'fear of the unknown', 'reconciling difference between general acute health and mental health settings' and 'supporting practice'.

Attempting to accomplish connectedness within the preceptorship experience: the perceptions of mental health nurses

The provision of sound support models for clinical practicum is recognized as integral to the development of nursing students and their transition to registered nurses. In mental health settings, there is the additional issue of positively influencing recruitment rates. Preceptorship has been widely adopted nationally and internationally, however, there is a paucity of research, particularly in mental health settings, to assess its effectiveness. The current study utilized a grounded theory approach to explore the experience of preceptorship for mental health nurses. The findings suggest that mental health nurses seek to accomplish connectedness in the preceptorship relationship. A number of factors inhibit the degree of success in achieving this connectedness, including fear of mental health settings, misconceptions about mental illness and organizational constraints.

Contributing to the theory development of preceptorship

The purpose of the study was to clarify and analyze the concept of preceptorship as experienced by the preceptor. Preceptorship is a teaching method commonly used in many professions. The current study assists in the clarification and analysis of the concept of preceptorship as experienced by the preceptor. Regarding methodology, the literature was reviewed to compare the experience of clinical teaching with preceptorship. Literature was reviewed from the following fields/domains: nursing, medicine, education, social work, rehabilitation, dentistry, law, and pharmacy. Through application of the framework outlined by Walker, L.O., Avant, K.C., 1995. Strategies for Theory Construction in Nursing, third ed. Appleton & Lange, Norwalk, attributes, antecedents, consequences, and empirical referents were identified that help define preceptorship. There were three main findings: The nature of the relationship between the preceptor and preceptee is pivotal, evaluation is a challenge, and preceptorship is distinct from mentorship. The consequences of a preceptorship experience are better prepared and more confident preceptors, evolution into a mentorship relationship, and professional development of both the preceptor and the preceptee. This article concludes with numerous topics that could be addressed in future research: (a) screening tools for the preceptor; (b) evaluation of the preceptee; (c) the relationship between preceptee, preceptor, and faculty; (d) preparation of the preceptor, and (e) rewarding the preceptor.

Preceptor leadership style and the nursing practicum

Preceptors are clinically based nurses that agree to participate with nursing students in an effort to provide them with opportunities to reinforce their knowledge with clinical experience. Preceptors serve as nursing role models to students and can facilitate their understanding and socialization into the reality of nursing. Studies on preceptorships have focused traditionally on the experience of precepting from the perspectives of student, employer, and preceptor. Literature related to methods for matching preceptors and students is very limited. Selection of preceptors to serve as role models for students should not be limited to clinical skill alone. Student learning and clinical experience can be influenced directly by the leadership characteristics that a preceptor possesses. To make the experience of precepting positive and beneficial for preceptor, student, and faculty, an examination and discussion of the potential preceptor's leadership style should be conducted. Situational leadership and the four different styles of leadership identified by Hersey and Blanchard provide a useful model for identifying leadership traits in preceptors that nursing faculty will find useful as they seek to match preceptors in a way that will facilitate knowledge acquisition and application for nursing students in the clinical setting.

Hallmarks of the professional nursing practice environment

THE AMERICAN Association of Colleges of Nursing (AACN) is the national voice for university and 4-year college education programs in nursing. Representing more than 560 member schools of nursing at public and private institutions nationwide, AACN's educational, research, governmental advocacy, data collection, publications, and other programs work to establish quality standards for bachelor's-degree and graduate-degree nursing education, assist deans and directors to implement those standards, influence the nursing profession to improve health care, and promote public support of baccalaureate and graduate nursing education, research, and practice. Task forces are appointed by the AACN Board of Directors as issues arise that require study and action. This white paper was prepared by the AACN Task Force on Hallmarks of the Professional Practice Setting.

Preceptor behaviors integral to the promotion of student critical thinking

In the practice setting, preceptors not only contribute to the relational aspect of the preceptorship experience but, through their behaviors, they also effectively promote the critical thinking ability of students. Through the use of a grounded theory method in a recent study, four specific preceptor-generated behaviors were identified as integral to the promotion of the critical thinking ability of basic baccalaureate nursing students in the practice setting: role modeling, facilitation, guidance, and prioritization. In this article, the description and meaning of these four behaviors are explored and their significance to preceptors and nurse educators who wish to ensure that the critical thinking ability of nursing students is fostered in the practice setting is discussed.

Precepting in 2002

Preceptorships have been used to bridge the gap between nursing education and the reality of the workplace. The role of preceptors to prepare new or transitioning nurses to function more efficiently and earlier has become increasingly important in recent years. To foster positive attitudes in the experienced nurses toward accepting and functioning in the roles of preceptors, nursing administration and nursing education must collaborate. Preceptors have the ability to shape, nurture, influence, and support novice nurses. Experienced nurses hold the responsibility to encourage this commitment.

Fieldwork education: The future of occupational therapy depends on it

Fieldwork continues to be the cornerstone of preparation for entry-level occupational therapy clinicians. During the past five years the Canadian healthcare system has experienced decreases in federal funding, organizational changes such as the movement to programme management, and increased focus on community-based needs. Two fieldwork projects were tested at a large health sciences facility, to meet the challenge of providing effective fieldwork experiences that build on current educational methodologies while still responding to changing realities in healthcare practice. The academic programme with which the health sciences facility is affiliated has developed a strong focus on self-directed learning, using problem-based and small group learning formats. The development, implementation and evaluation of the two fieldwork projects is described. Discussion focuses on the processes needed to facilitate innovative, flexible fieldwork models.

Being a preceptor is stressful!

Results of a mail survey of 295 preceptors indicated preceptoring nursing students can be a stressful experience, with overwork identified as the main source of stress. Overwork resulted from unsuitability of students for the clinical area, lack of time, and insufficient feedback and guidance. The findings suggest that both students and preceptors require proper readiness assessment and preceptorship preparation. Preceptorship stress needs to be acknowledged; it can be addressed through workload adjustments and by providing feedback and support from nurse educators, peers, and managers.

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.