Preceptorship: a review of the literature

Nurse preceptors' perceptions of the fundamentals of nursing knowledge gained by students in clinical rotations at nursing homes: A qualitative study

BACKGROUND

International evidence suggests that clinical nurses and nursing students perceive fundamental care as not being important, not complicated and even not a nurse's responsibility, thus resulting in negative patient outcomes.

AIM

To explore nurse preceptors' perceptions about the factors that influence nursing students' gaining of knowledge about fundamental care during their clinical practice at nursing home.

METHODS

A qualitative descriptive study using individual interviews was conducted from September 2020 to April 2021. Nine nurse preceptors employed at five nursing homes participated. The data were analysed by employing an inductive qualitative content analysis.

FINDINGS

The analysis generated one main category-'Fostering students' knowledge and understanding of fundamental care'-supported by two categories: (i) 'Nurse preceptors - enablers of nursing students' learning fundamental care' and (ii) 'Nursing home - a learning environment that facilitates students' learning about the delivery of fundamental care', which can be interpreted as the preconditions that may contribute to fostering students' knowledge and understanding of fundamental care.

CONCLUSION

The study reveals that nurse preceptors' attributes, an effective preceptorship and a social learning environment can create opportunities for nursing students learning the provision of fundamental care in nursing homes. Furthermore, Vygotsky's theory of sociocultural learning may be applied when teaching in clinical nursing education.

Effect of Nurses' Preceptorship Experience in Educating New Graduate Nurses and Preceptor Training Courses on Clinical Teaching Behavior

Only few studies have examined the preceptor training courses and their effects on clinical teaching behaviors (CTBs) of preceptors. This study investigated preceptors' experiences in educating new graduate nurses and the effect they had on clinical teaching behavior (CTB) based on whether they participated in a preceptor training program. A descriptive online survey method was used, and the participants included 180 registered nurses who were preceptors. The Clinical Teaching Behavior Inventory (CTBI-22) was used, and perceptions of teaching experiences were measured by six items. Data were analyzed using multiple linear regression. Preceptors working at general hospitals or hospitals were less likely to have participated in a preceptor training program than those working at tertiary hospitals. The overall mean score of CTB was 89.30, and "guiding inter-professional communication" showed the lowest mean score. Positive perceptions of preceptorship experiences were positively related with CTB, and the number of precepting experiences affected CTB only for nurses having undergone preceptor training courses. The use of role-playing as a method in training courses positively affected preceptors' CTB. These findings suggest that preceptors need support from nurse managers and colleagues, and preceptor training programs should be developed.

Preceptoria na Residência de Medicina de Família e Comunidade da Universidade de São Paulo: políticas e experiências

Introdução: A atividade de preceptoria dentro da formação médica tem sido globalmente estabelecida como modelo para o processo docente na área e existem diversas formas e experiências de organização. O Programa de Residência Médica (PRM) em Medicina de Família e Comunidade (MFC) da Faculdade de Medicina da Universidade de São Paulo (FMUSP) apresenta um modelo de preceptoria incomum, composto por preceptores do programa de residência médica e por preceptores dos residentes (tutores), cada um com especificidades próprias e complementares. Objetivo: Nosso objetivo neste relato de experiência foi compartilhar as políticas institucionais e experiências de preceptoria em nosso programa de residência médica, bem como apontar as múltiplas adversidades existentes e possíveis formas de enfrentamento. Resultados: Atingir o nível de excelência no desenvolvimento das competências necessárias para a formação do especialista em MFC, em situações adversas de valorização da especialidade e do corpo docente, é uma tarefa árdua. Neste difícil desafio de conduzir o PRM e garantir o desenvolvimento das competências almejadas com qualidade, o papel do preceptor do programa de residência médica e do preceptor do residente (tutor) são fundamentais. Conclusão: Frente aos desafios apontados, observa-se grande desgaste dos tutores, que voluntariamente desempenham as atividades de ensino mesmo atuando em sobrecarga assistencial. A falta de reconhecimento, escasso apoio institucional e da gestão administrativa são fatores que oferecem obstáculos ao melhor desenvolvimento e ampliação do programa de residência.

There for us': Exploring preceptorship among newly qualified Child Branch staff nurses

A qualitative study (N=6) was undertaken examining the experiences of newly qualified staff nurses following Project 2000 Child Branch education, within which the experience of preceptorship was explored. All staff had an allocated preceptor, but experienced the process with varying degrees of success. In-depth interviews were undertaken at five months post-qualifying: content analysis of the data revealed a number of themes relating to the process of preceptorship, and the staff nurses' views of factors which either promoted or hindered its effectiveness. Factors contributing to successful preceptorship appeared to be: the availability of the preceptor; planning of learning objectives; ongoing feedback regarding progress; the enthusiasm and commitment of the preceptors for their role. In no case did preceptorship appear to have a formal structure and it was unclear what criteria would be used to assess staff performance at the end of the preceptorship period. This paper examines the background to preceptorship and the debate concerning its structure and intended outcomes. The experiences of the study participants are then examined in the light of this discussion. The study identifies some fundamental questions about the nature and process of preceptorship.

Prepared for practice? Exploring the experiences of newly qualified Project 2000 Child Branch staff nurses

The passage from student to staff nurse is identified by the UKCC as being a major transition (UKCC, 1993). This small, qualitative study (n=6) was designed to explore the experience of being a newly qualified staff nurse following Project 2000 Child Branch education. Participants were also asked to reflect on Project 2000 as preparation for nursing practice.

The overall experience of participants was reported as positive. Challenges and stresses had been encountered, however, all staff describing initial feelings of fear, the impact of their new responsibilities, and areas where they felt they lacked adequate experience. Comments were made concerning Project 2000 in relation to clinical preparation and experience, course content and structure, and the emphasis given to the Common Foundation Programme. They felt that they had moved successfully through the transition experience because of the degree of support they had received, because they were prepared to ask questions and because they had the ability to learn quickly. All members felt that the Project 2000 programme prepared them well for practice.

Are preceptors adequately prepared for their role in supporting newly qualified staff?

OBJECTIVE

The purpose of this UK based study is to ascertain the support provided to preceptors and the qualities they require to carry out their role supporting newly qualified professionals.

DESIGN

A qualitative descriptive approach was adopted to elicit the experiences and perceptions of the preceptors in practice.

SAMPLE AND METHODS

A cross-section of 30 preceptors were randomised across 3 hospital sites within one acute Trust. Questionnaires were distributed with a response rate of 37% (n=11). Five preceptors participated in a semi-structured interview (n=5).

FINDINGS AND DISCUSSION

The themes that emerged from the analysis were lack of preparation for their role, expectations of the preceptors and how they perceive the role and the limitations and difficulties associated with being a preceptor.

CONCLUSIONS

Preceptor attributes and programme approaches have been discussed in the existing literature although guidance concerning preparation and training for the role in the UK is less well documented. The findings of this small scale study may be useful in planning and developing preceptorship programmes in the future to provide sustainable support to develop the preceptor as well as the preceptee.

'Newcomer adaptation': a lens through which to understand how nursing students fit in with the real world of practice

Aims and objectives

To present a discussion on newcomer adaptation as a lens through which to understand how nursing students adapt to clinical practice and raise awareness of strategies that can be used to enhance their learning experiences.

Background

Socialisation is an important factor that facilitates students’ learning in the clinical setting. Therefore, it is beneficial to examine organisational socialisation literature, particularly that pertaining to newcomer adaptation.

Design

This is a critical review of organisational socialisation literature.

Methods

Seminal literature and more recent research in the field of organisational socialisation and newcomer adaptation were accessed. In addition, nursing and allied health literature examining students’ socialisation and the clinical learning environment was retrieved.

Conclusions

It is revealed in this article that to create an appropriate clinical learning environment, an understanding of socialisation tactics could be beneficial. Role modelling is deemed crucial to successful newcomer adaptation. Peer support is necessary but must be advocated with caution as it can have a negative impact when students form a ‘parallel community’. Students with some knowledge of the workplace tend to adapt more easily. Likewise, students’ disposition and, in particular, their confidence can also enhance the socialisation process.

Relevance to clinical practice

Both the organisation and the student can impact on how successfully the nursing student ‘fits in’. Understanding this through the lens of newcomer adaptation means that strategies can be put in place to facilitate this process.

A systematic review of the literature to support an evidence-based precepting program

AIM

To provide a systematic review of the literature regarding development of an evidence-based Precepting Program for nurses transitioning to burn specialty practice.

BACKGROUND

Burned patients are admitted to specialty Burn Centers where highly complex nursing care is provided. Successful orientation and integration into such a specialized work environment is a fundamental component of a nurse's ability to provide safe and holistic patient care.

DESIGN

A systematic review of the literature was performed for the period 1995-2011 using electronic databases within PUBMED and Ovid search engines.

DATA SOURCES

Databases included Medline, CINHAL, ProQuest for Dissertations and Thesis, and Cochran Collaboration using key search terms: preceptor, preceptee, preceptorship, precept*, nurs*, critical care, personality types, competency-based education, and learning styles.

REVIEW METHODS

Nurses graded the level and quality of evidence of the included articles using a modified 7-level rating system and the Johns Hopkins Nursing Quality of Evidence Appraisal during journal-club meetings.

RESULTS

A total of 43 articles related to competency (n=8), knowledge acquisition and personality characteristics (n=8), learning style (n=5), preceptor development (n=7), and Precepting Programs (n=14).

CONCLUSIONS

A significant clinical gap existed between the scientific evidence and actual precepting practice of experienced nurses at the Burn Center. Based on this extensive review of the literature, it was determined that a sufficient evidence base existed for development of an evidence-based Precepting Program.

A preceptorship programme for newly qualified nurses: a study of preceptees' perceptions

AIM

This paper presents the evaluation of a preceptorship programme for newly-qualified nurses (NQNs) to determine preceptee engagement with the preceptorship programme, and the impact, value and sustainability of the programme from the preceptees' perspectives.

BACKGROUND

The literature suggests that NQNs find the transition from student to qualified nurse to be stressful and that preceptorship can reduce this stress and promote adaptation to the new role.

SETTING

This study took place in one NHS Healthcare Trust in South West London, UK.

PARTICIPANTS

Ninety NQNs were invited to participate in the study and the response rate was 48.9% (n=44). The study took place in 2011.

METHODS

Evaluative research design was used incorporating a fourfold evaluation framework of preceptee engagement, impact, value and sustainability (Ooms et al., 2011). This was a mixed methods study. Qualitative and quantitative data were collected through questionnaires, reflective journals and through personal audio recordings made by the preceptees. Quantitative data were analysed through descriptive statistics and t-tests, and Cronbach's alpha coefficient was used to assess reliability of impact and value scales. In addition analysis of open-ended questions and qualitative data was undertaken using the Framework Method of analysis.

FINDINGS

Findings show that preceptee engagement in the programme was high and preceptorship was highly valued by the majority of preceptees (85%). Preceptors played a positive role in terms of alleviating stress. Preceptorship impacted positively on preceptees in terms of development of communication skills and clinical skills, and role, personal and professional development. In addition, preceptees felt that the programme was of value despite acknowledging difficulties in making time to meet with preceptors. Preceptees also indicated that they would wish to be preceptors in the future and that they would recommend preceptorship to all nurses who are either newly qualified or new in role. Preceptees judged the preceptorship programme positively for engagement, impact, value and sustainability.

CONCLUSION

The study is unique when mapped against other research studies as it explores a breadth of evaluative issues not found in other preceptorship studies, e.g. engagement, impact, value and sustainability of preceptorship. The study adds insights about sustainability of preceptorship programmes and expectations of competence of NQNs that do not appear in previous literature about preceptorship.

A Literature Review of Preceptorship: A Model for the Medical Radiation Sciences?

Preceptorship is a time-limited, education-focused model for teaching and learning within a clinical environment that uses clinical staff as role models. Its primary goal is to assist new staff and students to adapt to their roles, develop clinical skills and socialize the novice to a department or institution. It has been widely used within the allied health professions; however, very little is known of its practice within the medical radiation sciences. The purpose of this paper was to review the literature available regarding the practice of preceptorship within the medical radiation sciences as well as provide a general overview of the key components to consider in any application of preceptorship. Key findings have been categorized into the following components: evolving definitions of preceptorship, purpose of preceptorship, benefits, roles within preceptorship, qualities of a good preceptor, drawbacks, structured and self-directed preceptorship programs.

Lived experiences of clinical preceptors: a phenomenological study

The aim of this study is to explore the clinical preceptors' experiences and the meanings of their lives in clinical teaching. A phenomenological approach was adopted, and a 'snowballing' sampling method was used to recruit 20 clinical preceptors. Data were collected using audio-taped individual interviews. A content analysis was conducted and the results were clustered into four themes, which are (a) 'teaching is learning', (b) 'being unable to do what one would like to do', (c) 'experiencing bittersweet moments', and (d) 'being a role model and acting as a mother'. These findings demonstrate that the clinical preceptors are experiencing diverse feelings, both positive and negative. Strategies that address the needs of clinical preceptors must be developed in order to foster the positive experiences, and to retain experienced clinical preceptors.

A systematic review of the experiences and perceptions of the newly qualified nurse in the United Kingdom

AIM

A systematic literature review of the experiences and perceptions of newly qualified nurses in the UK during the transition from student to staff nurse.

BACKGROUND

It has been widely recognised that newly qualified nurses experience a period of transition. Over the past decade there has been radical reorganisation of nurse education in the UK which has raised issues of preparation for practice.

DATA SOURCES

Searches were made of the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and MEDLINE.

METHODS

A systematic review was carried out. Papers were critically reviewed, relevant data were extracted and synthesised.

RESULTS

Four themes were identified from the empirical evidence base: transition and change, personal and professional development, pre-registration education, preceptorship and support.

CONCLUSION

Transition remains a stressful experience for newly qualified nurses in the UK. Reasons include an increase in personal and professional development, changes in pre-registration education and lack of support once qualified.

RECOMMENDATIONS

Further research is needed to address the current situation in relation to the transition period including pre-registration education, preparation for practice and support in both primary and secondary care.

Preparation of nurses who precept baccalaureate nursing students: a descriptive study

Clinical preceptorship is employed by baccalaureate nursing education programs as a capstone experience and a means of initiating the professional socialization of senior-level students who will shortly be new graduates. This quantitative, descriptive study explored the perceptions about preceptor preparation among nurses who precept baccalaureate nursing students. Mercer's Role Attainment Theory was the theoretical framework for this study, in which 75 participants from two hospitals in the Midwest completed a survey. Two key findings emerged from the data: All preceptors of senior-level nursing students want to know what their responsibilities are with regard to the student and the preceptorship experience, and nurses in critical care areas identified learning how to teach critical thinking to senior-level students as more essential than did nurses in other areas.

Contextual Factors That Have an Impact on the Transitional Experience of Newly Qualified Occupational Therapists

Many newly qualified occupational therapists (NQOTs) experience difficulties when moving into practice, with limited opportunities to co-work with colleagues. In 2005, a preceptorship programme designed to ease these transitional challenges was piloted.

The programme was evaluated using mixed methods within a realist framework in order to understand the contextual factors that have an impact on the transitional experience of NQOTs and their engagement with the programme. Semi-structured interviews were carried out with four pairs of NQOTs and supervisors at 6 and 12 months into the programme. The findings suggest that the demands placed on new practitioners are increasing, with early expectations of autonomy within an interprofessional context. Strategies that assist transition include co-working, role modelling and informal support. The preceptorship programme facilitates the provision of these.

The study highlights the importance of situated learning theories and communities of practice as frameworks to prepare therapists to analyse the complexities of the workplace and to facilitate negotiated access to the multidisciplinary communities.

Evaluating a preceptorship programme in South West Ireland: perceptions of preceptors and undergraduate students

AIM

The study sought to evaluate stakeholder perspective of preceptor preparation and attributes.

BACKGROUND

In Ireland, undergraduate students are supported by a named preceptor on clinical placement. A preceptor is a registered nurse who has completed a teaching, assessment and preceptorship programme. Preceptor preparation is costly in terms of facilitation and staff release/replacement. To date, in Ireland, research has not explored the effectiveness of preceptor preparation.

METHOD

An utilization-focussed approach was adopted incorporating a two-phase research process; Phase 1 being exploratory while Phase 2 aimed to validate inductions derived from the previous stage. Results The programme is effective in meeting its learning outcomes. The findings are categorized into four theme areas: the importance of preceptor characteristics, the demonstration of these characteristics, knowledge demonstrated by the preceptors and the skills demonstrated by the preceptor.

CONCLUSION(S)

Preceptors, to be effective within the preceptor/student relationship, need to integrate both their professional and personal attributes to effectively socialize students to the profession of nursing.

IMPLICATIONS FOR NURSING MANAGEMENT

The preceptor role is invaluable within nurse education. This study supports the release of registered nurses to attend preceptor preparation programmes. It highlights the importance of nursing management in preceptor selection, release, support and monitoring in order to create an effective clinical learning environment.

An Evaluation of a Preceptorship Programme for Newly Qualified Occupational Therapists

Following the introduction of preceptorship as a requirement for most newly qualified practitioners in the National Health Service in the United Kingdom, a preceptorship programme for occupational therapists was designed. This was the first of its kind within occupational therapy and was endorsed by the College of Occupational Therapists. Participation in preceptorship was intended to ease the transition of newly qualified occupational therapists.

This paper offers a definition of preceptorship for the profession in the United Kingdom and reports on a small qualitative study that evaluated the extent to which the interventions of the preceptorship programme ameliorated the challenges of transition. The evaluation was conducted within a realist framework. Data were collected by semi-structured interviews from four pairs of newly qualified occupational therapists and preceptors during the pilot year. The findings suggest that the preceptorship programme was successful in supporting the development of new practitioners and that implementation was optimised through strong leadership, a learning culture and positive supervision.

This paper contributes to the body of knowledge relating to the transitional experience of occupational therapists and recommends changes to the programme to optimise its effectiveness for practice.

The teaching-coaching role of the APN

The demand for well-educated and skilled healthcare providers has never been greater. As a result, enrollment is expanding in academic settings that prepare advanced practice nurses for primary care and acute care roles. The growth in programs has led to a corresponding increased demand for clinical mentors and preceptors. The preceptors and sites must meet standards established by the academic institution, advanced practice nurse certification organizations, and state legislatures. There are a number of issues that must be considered by both students and preceptors when negotiating a clinical experience-andragological, curricular, credentialing, and legal matters must be satisfied along with meeting the clinical hour requirements. Producing a quality healthcare professional requires cooperation among the academic institution, faculty, administration, community clinicians, healthcare facilities and their staff, the students themselves, and patients who are willing to allow a student to provide care for them under the supervision of a licensed professional/preceptor.

Preceptorship: facilitating student nurse education in the Republic of Ireland

Nursing is a practice-based discipline and clinical practice is considered to be an integral part of nurse education. The pivotal role that preceptors play in the socialization, teaching and assessing of student nurses, is vital in helping students to integrate theory with practice. However, some evidence suggests that there can be minimal contact between the stakeholders involved in the students' education process, namely the university lecturers and preceptors. The focus of this article is on exploring the literature on models of support for student nurses with particular emphasis on the concept of preceptorship.

Evaluation of a forensic psychiatric setting to provide a graduate nurse programme

There has been growth in the number and diversity of models of Australian graduate nurse programmes in psychiatric nursing. Programmes have also been established in specialist areas, and evidence is needed regarding best models of graduate nurse programmes and the ability of specialist areas to prepare nurses for psychiatric nursing. This paper reports on a qualitative project that examined the adequacy of a forensic psychiatric hospital to provide a graduate nurse programme. Individual, semistructured interviews were undertaken with nurses participating in the programme, and nurses who had completed the programme and had remained at the hospital or were nursing in other areas. Participants identified that the environment was safe and supportive of professional practice and development, and that skilled nurses were willing to encourage and teach graduates. Processes such as orientation, preceptorship and academic study were appreciated; however, their colleagues' willingness to be available, to teach, and to support were more valued. Participants reported that they felt confident and prepared as psychiatric nurses. Although limitations of undertaking a graduate nurse programme in a forensic setting were identified, the participants from past programmes who had gone on to work in other services did not report that their nursing careers had been disadvantaged. It can be concluded that as long as the context of the programme has adequate resources to support and assist graduates to develop the skills, knowledge and attitudes of psychiatric nursing, then the specialist nature may not be a limitation.

Transition to mental health nursing through specialist graduate nurse programs in mental health: a review of the literature

Specialist graduate nurse programs (GNPs) in psychiatric/mental health nursing have been widely implemented across public healthcare services throughout Victoria, Australia. Broadly, these programs aim to assist newly graduated nurses during the transition from nursing student to registered nurse. This paper presents a review of the literature relevant to GNPs; specifically focusing on graduate transition. An adequate orientation to clinical areas and ongoing support throughout the transition process were identified as significant determinants of new graduates" satisfaction with the initial post-qualification period. However, the literature suggests that the inadequacy of psychiatric/mental health nursing content in undergraduate nursing courses creates additional difficulties within this specialty area of practice. Moreover, the current literature review emphasises the need for further research to evaluate the effectiveness of GNPs for nursing in general and for psychiatric/mental health nursing in particular.

Using clinical nurses as preceptors to teach leadership and management to senior nursing students: A qualitative descriptive study

The preceptor model of clinical education uses nurses to fulfill the role of 'teacher' in a one-on-one relationship with students. The current nursing shortage, however, places increased demands on nurses and threatens their continuation in this role. The purpose of this qualitative descriptive study was to gain a better understanding of the nurse preceptor's experience. Five themes evolved during data analysis: (1) making it worthwhile for the nurse, (2) making a difference, (3) engaging in the process, (4) "I love being a preceptor, but..., and (5) accepting the role, taking responsibility. Making it worthwhile for the nurse included how nurses saw personal and professional rewards and benefits in precepting. Making a difference described how nurses felt they made a difference in student learning. Engaging in the process described how nurses created learning opportunities for students by being a good role model and protecting students from negative experiences. "I love being a preceptor, but..." identified aspects of the precepting role that were difficult. Accepting the role, taking responsibility identified the different people involved in the complex precepting experience; the preceptor, nursing faculty, students, and the nurse manager that all had to work together if students were to have a good experience. Findings can be used to develop better support for preceptors as well as more structured and consistent orientation to the role.

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.

Clinical teaching and support for learners in the practice environment

The purpose of planned clinical experience for students of nursing is primarily to provide students with the opportunity to develop their clinical skills, integrate theory and practice, and assist with their socialization into nursing. Nursing, in the main, is a practice-based profession. To this extent, it is essential that nurse education continues to have a strong practical element despite its full integration into higher education institutions (Department of Health, 1999). However, providing adequate support and supervision for learners is challenging. Undoubtedly, exacerbated by increasing numbers of learners, staff shortages and mentors training deficits. This article aims to critically analyse several strategies, which can be used to promote clinical learning.

The transition from student to qualified nurse: a militaryperspective

This article explores some of the issues surrounding my transition from student nurse to qualified Royal Air Force staff nurse. It supports much of the research showing that the transition to staff nurse is stressful, with the time for preceptorship and supernumerary status varying. The education and support received during this period is still largely dependent on staff availability and this remains an area of concern. For military nurses the transition period is extra challenging, as there are military as well as nursing demands. This includes working predominantly in a civilian environment, while being aware that we may be deployed overseas with the military. However, the ability to adapt and adjust to changing circumstances is what essentially makes military nurses unique and distinctive. Provided that support is in place and appropriate clinical experience is obtained, we can fulfil our primary military roles.

A case study of a preceptorship programme in an acute NHS Trust - using the European Foundation for Quality Management tool to support clinical practice development

AIMS

To discuss the results of the evaluation, assessment and effectiveness of the trust-wide clinical practice development of a preceptorship programme for newly qualified nurses at Salford Royal Hospitals NHS Trust. To apply the European Foundation for Quality Management (EFQM) model as a tool for monitoring and assessing the performance of the programme.

BACKGROUND

Newly qualified nurses need support and preparation for their working role in their first recruitment. A preceptorship programme, developed around a quality-monitoring framework, was introduced to address this need at Salford Royal, an acute NHS Trust.

METHOD

The generic EFQM model was adapted to the specific case of the preceptorship programme. A questionnaire survey was undertaken to obtain evidence to assess how the EFQM tool was applied in the context of the preceptorship programme. Pre- and post-programme questionnaires were sent to preceptees and post-programme questionnaires to respective ward managers.

FINDINGS

Following introduction of the preceptorship programme, recruitment and retention of newly qualified nurses have increased, with preceptees self-reporting increased levels of confidence. Use of the EFQM tool has provided the information that managers and departments require. Anecdotal evidence to date suggests that barriers are being broken down. Utilization of the framework has also identified areas of practice that need to change.

CONCLUSIONS

This paper demonstrates how use of a generic tool such as EFQM can provide systematic and evaluative information for nursing.

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.

Effective collaboration enhances rural preceptorship training

Preceptorship is a valuable strategy largely underestimated in its ability to influence nursing students' attitudes and beliefs about mental health nursing. As a model, it has the potential to influence nursing practice, enhance clinical learning, promote recruitment and retention, and generate a more collaborative approach for nursing student supervision. The relationship is usually for a fixed and limited timeframe where the preceptor inspires and supports the growth and development of the student nurse, and encourages role socialization into the profession (Morton-Cooper & Palmer 2000). The challenge for mental health services is to achieve success in the provision of effective preceptorship, ensure positive and rewarding clinical experiences for nursing students, and improve recruitment and retention rates for the service. These aims are substantially more difficult to achieve in the absence of quality education, training and support for preceptors. This paper describes the use of preceptorship training to address recruitment issues in a rural service, particularly the need for effective preceptorship at undergraduate level, which has been shown to have an impact on the willingness of new nursing graduates to enter the mental health nursing field. The design and delivery of the training programme is outlined, including details of the program evaluation and its subsequent impact on psychiatric nurses' approach to and practice of preceptorship. Finally, the broader issue of the value of training nurses in larger groups, enlisting a critical mass of preceptors within an individual mental health service, is discussed.

Evaluating the impact of a preceptorship course on mental health nursing practice

The crisis in the recruitment of nursing graduates into the mental health nursing field dictates the need for assertive and innovative strategies to promote the positive aspects of this field of nursing. A positive clinical experience has been identified as one of the most important determinants of nursing students' attitudes towards mental health nursing. The Centre for Psychiatric Nursing Research and Practice implemented the course "Preceptorship in Psychiatric Nursing" as a means to increase the skill level within and interest towards the preceptorship role in clinical practice. This paper presents an evaluation of courses conducted between 2000 and 2002. The findings suggest that participants (n = 150) were highly satisfied with the content and delivery of the course, and that it is likely to affect their attitude towards and fulfillment of the preceptorship role.

Moving to an all graduate profession: preparing preceptors for their role

The world of Irish Nurse education has changed significantly over the last number of years, moving from certificate to diplomat status, from hospital-based training to integration within the higher education sector. The Irish Government has now committed pound 223,470,000 for the implementation of a four year pre-registration nursing degree programme. Consequently, from 2002 onwards all Irish pre-registration nurse education will be at graduate level. In recognition of the importance of student learning during practice placement the recommended that nursing students be supported by a named preceptor. This recommendation has significant resource implications in terms of current staff demands, staff preparation and ongoing support for the preceptor role. This paper will focus on a review of the literature on student support mechanisms during practice placements with particular emphasis on the concept of preceptor and preceptorship.

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.

Clinical education: a challenging component of undergraduate nursing education

Clinical education is an essential part of every undergraduate nursing curriculum. The main benefits are that it allows students to put theory into practice and experience the realities of the practice-based nursing profession. Limitations include the unstable nature of the clinical area as a learning environment and the challenges this produces with students' assessments. This article reviews the literature and concludes there is room for significant improvement in the area of clinical education and numerous strategies can be implemented to do so.

An action research project to evaluate the clinical practice facilitator role for junior nurses in an acute hospital setting

It has been well documented that newly qualified nurses require support in developing confidence and professional competence. Although preceptorship models have gone some way in addressing this need, innovative and flexible models of facilitation and development are also required to respond to local demands. In the project reported here a number of supernumerary clinical practice facilitators (CPFs) were appointed to support both healthcare assistants and newly qualified registered nurses to enhance their competence and clinical skills. It was anticipated that they might also encourage awareness of other professional issues, such as evidence-based practice, as well as having a positive influence on the clinical learning environment and staff morale. This article describes how an action research approach was used to establish the CPF role in a variety of clinical areas across a large inner-city National Health Service Trust. It outlines the evaluation undertaken and the further contribution that such roles could provide.

Supporting students in practice

This article reports a project aiming to assess the effectiveness of clinical nurses employed in support roles for students in clinical practice in one UK higher education institution and its linked NHS Trusts. Focus groups and telephone interviews were used to collect data from the clinical support nurses themselves, senior nurse managers and pre- and post-registration students. Findings show that personal commitment to the role was high and that these support staff made a valuable contribution to up-to-date clinical input into classroom teaching. Managers also valued the university-clinical link role fulfilled by these staff. Students had mixed opinions, pre-registration students having had little exposure to this kind of support and post-registration students often not regarding clinical support as necessary because of their own existing clinical experience and expertise. For clinical support staff themselves, the role was a busy one and they often experienced conflict and role overload in balancing the education and clinical sides of their work. Necessary improvements for functioning of the roles were identified, including having regular meetings between university and NHS managers and support teachers for liaison purposes, joint appraisal, and formal support mechanisms for role occupants. The overall conclusion drawn is that the roles were successful in bridging the theory-practice gap for the University and NHS Trust managers, but less so for students, and that they did this at some personal cost for role holders.

Action research in action: reflections on a project to introduce Clinical Practice Facilitators to an acute hospital setting

AIMS OF THE PAPER

The process and philosophical basis of action research are discussed in this article by reviewing the insights that were gained from a study designed to enhance the support available to junior nursing staff in an acute hospital setting.

RATIONALE

It has been well documented that newly qualified nurses require help to develop professional competencies. With this in mind, the role of Clinical Practice Facilitator was established within a National Health Service (NHS) Trust to enhance clinical skill acquisition and the professional development of newly registered nurses and health care assistants.

DESIGN

In order to facilitate the inception, development and subsequent evaluation of these new roles, an action research approach was adopted. Strategies used to encourage collaboration and flexibility during the project are also discussed.

RESULTS

The primary aims of the project were achieved and the authors suggest that the choice of action research was significant to the successful outcome. However, a number of issues arose which deserve more attention including the importance of the interpersonal skills of the action researcher and the value of action research to facilitate change which is relevant at both an individual and organizational level.

Evaluating preceptorship arrangements in a paediatric setting

Preceptorship can be a valuable support mechanism for newly qualified nurses. Both preceptors and preceptees need support to ensure effective preceptorship arrangements. Maintaining effective preceptorship arrangements can be challenging for preceptees, preceptors and the organisation. Further research is required to explore the full potential of preceptorship.

What do newly-qualified nurses expect from preceptorship? Exploring the perspective of the preceptee

Preceptorship plays an important role in ensuring the smooth transition from student to registered nurse (UKCC 1993). To date, there has been little evidence to demonstrate the extent to which preceptorship has been introduced, and scant research into newly-qualified nurses' expectations and experiences of preceptorship. A longitudinal, questionnaire survey is exploring the expectations of preceptorship, from the perspective of newly qualified nurses, as part of a Department of Health funded study into the careers of people qualifying from nursing diploma courses. The paper demonstrates how pilot work with a cohort of newly qualified nurses, combined with literature on preceptorship, enabled the identification of key aspects of preceptorship. Findings are presented on the expectations of adult branch nurses at the point of qualification. There was an overwhelming demand for preceptorship, and the majority of respondents anticipated that all identified aspects of preceptorship would be important in their first job. Aspects identified as particularly important were 'constructive feedback on my clinical skills' and 'teaching new clinical skills'. Future questionnaires will reveal the extent to which these expectations are met.

A clinical teaching project. Evaluation of the mentor-arranged clinical practice by RN mentors

This paper explores the relationship between nursing students and mentors and its influence on nursing students' development of professional knowledge during their clinical practice. The paper is based on an evaluation of a new initiative supplementing other clinical experiences for students of nursing, Mentor-Arranged Clinical Practice (MACP), by registered nurse mentors. Sixty-five (95.6%) mentors returned their questionnaires in a self-addressed envelope. Results of the study indicated that there were benefits and rewards for both students and mentors. The mentors felt that students gained more practicum time, confidence and independence in their practice, time management skills, rapport between staff and student, and better integration into the hospital environment. Mentors indicated that the most compelling reasons for becoming mentors were the opportunity to assist mentees to integrate into the nursing unit, to teach, share knowledge, promoting and improving the professional image of nurses, and gain job satisfaction from mentoring. The findings in this study suggest that there is a need for development of mentor relationships in the clinical setting of undergraduate nursing courses.

Effective supervision in clinical practice settings: a literature review

CONTEXT

Clinical supervision has a vital role in postgraduate and, to some extent, undergraduate medical education. However it is probably the least investigated, discussed and developed aspect of clinical education. This large-scale, interdisciplinary review of literature addressing supervision is the first from a medical education perspective.

PURPOSE

To review the literature on effective supervision in practice settings in order to identify what is known about effective supervision.

CONTENT

The empirical basis of the literature is discussed and the literature reviewed to identify understandings and definitions of supervision and its purpose; theoretical models of supervision; availability, structure and content of supervision; effective supervision; skills and qualities of effective supervisors; and supervisor training and its effectiveness.

CONCLUSIONS

The evidence only partially answers our original questions and suggests others. The supervision relationship is probably the single most important factor for the effectiveness of supervision, more important than the supervisory methods used. Feedback is essential and must be clear. It is important that the trainee has some control over and input into the supervisory process. Finding sufficient time for supervision can be a problem. Trainee behaviours and attitudes towards supervision require more investigation; some behaviours are detrimental both to patient care and learning. Current supervisory practice in medicine has very little empirical or theoretical basis. This review demonstrates the need for more structured and methodologically sound programmes of research into supervision in practice settings so that detailed models of effective supervision can be developed and thereby inform practice.

Still fumbling along? A comparative study of the newly qualified nurse's perception of the transition from student to qualified nurse

An earlier study conducted in the United Kingdom, examining the newly qualified nurse's perception of the transition from student to qualified nurse, highlighted the limitations of pre-registration nurse education in respect of failing to provide adequate preparation for the qualified nurse's role. In the intervening years, major reforms in pre-registration nurse education and continuing professional education have occurred. Concomitant with these reforms have been major policy changes in health care delivery that have impacted upon the role of the nurse. Questions now arise as to whether the education reforms have served to equip newly qualified nurses more appropriately with the necessary knowledge, skills and confidence to function in contemporary health care settings. This paper presents the findings of a follow-up study that entailed a secondary analysis of exiting data obtained from in-depth interviews with 10 newly qualified nurses in 1985 and collecting additional data from 25 newly qualified nurses in 1998 in order to ascertain their perceptions of the transition from student to qualified nurse. Interview transcripts from both sources of data were coded and thematically analysed and comparisons made between the two sets of data. The paper focuses on one theme emanating from the original study. Entitled 'fumbling along', it described the haphazard manner whereby the nurses learned to perform their role in the light of what they perceived to be inadequate preparation and lack of support. Similarities and differences in the experiences and perceptions of the two cohorts of nurses are examined in respect of stressful aspects of the role, pre-registration preparation and post-registration development. Data from the follow-up study suggest that although newly qualified nurses still feel inadequately prepared for their role, they have developed a more active style of learning and when supported through a preceptorship scheme appear to find the transition less stressful than nurses in 1985. However, further attention needs to be paid to the development of clinical, organizational and management skills in pre-registration courses and the bridging period between the latter part of the course and the first 6 months post-qualification, in order to enable the neophyte nurse to acclimatize gradually to becoming an accountable practitioner.

An evaluative study of clinical preceptorship

Clinical preceptorships, in collaboration between clinical agencies and educational institutions have been documented as an effective and innovative means of facilitating student learning, providing advantages for both the clinical and educational settings. A preceptorship programme of 100 hours duration was developed and delivered by the nurse education institute, in consultation with a health care organization. The objectives of the preceptorship programme were to help registered nurses, in partnership with clinical nurse educators, to effectively integrate, support and assist the development of clinical competence in the undergraduate nursing student. Following the implementation of the preceptorship programme a research study was conducted to evaluate programme effectiveness. The purpose of the study was to examine preceptors, preceptees, and nurse managers' preceptions of the preceptor role and factors which influenced the performance of preceptors. The methods used in this study included those commonly found in evaluation research. That is, participants were drawn from those who were involved, either directly or indirectly, in the preceptorship programme, namely preceptors, preceptees and nurse managers. Using focus groups, they were each asked to identify the outcomes of the programme in practice. Study findings highlighted the importance of formal preceptor preparation, which was shown to enhance teaching and learning opportunities for student preceptees, personal and professional development of the preceptors, and the promotion of positive partnerships between nurse educators and nurse practitioners. The need for formal recognition of the preceptor role in practice, particularly in relation to the provision of adequate time and resources, emerged from the study. The research findings enabled the development of an evaluative model of preceptorship, which highlights the intrinsic and extrinsic factors impacting on the preceptor role.

An exploration of the preceptor role: preceptors' perceptions of benefits, rewards, supports and commitment to the preceptor role

This Australian study, a replication of Canadian research by Dibert & Goldenberg, was undertaken to explore the relationship between preceptors' perceptions of benefits, rewards and support, and their commitment to the preceptor role. A convenience sample of 134 nurse preceptors involved in an undergraduate nursing course were invited to complete a four-part questionnaire consisting of the Preceptor's Perception of Benefits and Rewards Scale, the Preceptor's Perception of Support Scale, the Commitment to the Preceptor Role Scale, and demographic details. The results, in the main, parallel those of the original research, with differences reflecting the distinct nature and the more recent use of preceptorship in Australia. The results indicate a clear commitment to the preceptor role and a perception that both material and non-material benefits are derived from acting in the role. Additionally, support from the institution and coworkers was considered vital for participation in the role. This not only has implications for nursing educators, administrators and potential preceptors, but also for those being preceptored.

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.