Journal of Advanced Nursing, 1999, 29(2), 506±514

Issues and innovations in nursing education

An exploration of the preceptor role: preceptors' perceptions of bene®ts, rewards, supports and commitment to the preceptor role Kim Usher RN RPN DipHSc BA MNS PhD FANZCMHN FRCNA Head of School, School of Nursing Sciences, James Cook University

Carol Nolan

RN RM DipAppSc(Nurs Ed) BHSc(Nurs) MRCNA

Clinical Coordinator, School of Nursing Sciences, James Cook University

Paul Reser

BSc MSc(TropMed)

Lecturer, Department of Psychology and Sociology, James Cook University

Jan Owens RN RM BEd MEd FRCNA FCNSW Director Clinical School, Department of Health Studies, University of New England, Armidale

and Joanne Tollefson RN BGS MSc(Trop Med) Coordinator of Undergraduate Studies, School of Nursing Sciences, James Cook University, Townsville, Australia

Accepted for publication 25 March 1998

USHER K., NOLAN C., RESER P., OWENS J.

& TOLLEFSON J. (1999) Journal of

Advanced Nursing 29(2), 29(2), 506±514 An exploration of the preceptor role: preceptors' perceptions of bene®ts, 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 bene®ts, 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 Bene®ts 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 re¯ecting 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 nonmaterial bene®ts 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. Keywords: preceptor, nursing students, rewards and bene®ts Correspondence: Kim Usher, School of Nursing Sciences, James Cook University, Townsville, Q 4811, Australia.

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Ó 1999 Blackwell Science Ltd

Issues and innovations in nursing education

INTRODUCTION Preceptor programmes are widely used in undergraduate and postgraduate nursing education programmes in Australia, Canada and the United States, as well as in new graduate programmes in both hospitals and agencies in Australia (Morton-Cooper & Palmer 1993, Madison et al. 1994). However, few research studies have investigated this practice within Australia. The preceptor model is used in an attempt to bridge the gap between education and practice, by helping practitioners achieve con®dence in their practice and facilitating their transition into their new role (Bain 1996). The preceptor, a senior clinical nurse, holds a dual role which includes carrying out ward duties whilst providing orientation, supervision and guidance of a new graduate or student on a one-to-one basis (Kitchin 1993, Madison et al. 1994). Preceptors take on this role for many reasons; for example, to share knowledge, to facilitate integration of newly hired staff, to obtain recognition and job satisfaction, and to learn from the students (Shamian & Inhaber 1985, Young et al. 1989, Atkins & Williams 1995). The preceptors are usually selected for the role as they are perceived by their supervisors, or authority ®gures, as knowledgeable and skilled in the role to be assumed by the newcomer (Madison et al. 1994). There is often lack of de®nition or clarity regarding the concept of preceptorship (Madison et al. 1994, Bain 1996), so for the purpose of this research the term preceptor was de®ned as an experienced practitioner who teaches, instructs, supervises and serves as a role model for a student or graduate nurse, for a set period of time, in a formalised programme. The creation and maintenance of a preceptor programme requires expenditure and commitment by both educational institutions and clinical facilities. Dibert & Goldenberg (1995) claim that such an investment may be lost if administrators fail to support preceptors after they are in the role. Further, there is risk of `burnout' if these highly quali®ed and valued staff are repeatedly asked to assume additional obligations without appropriate rewards and support (Turnbull 1983, Morton-Cooper & Palmer 1993). Thus, the perceived needs and expectations of the preceptors needs to be understood so that preceptors, preceptees and clinical agencies may bene®t from such programmes.

LITERATURE REVIEW The use of a reward or reinforcer for preceptors was put forward by Turnbull (1983) as the key to organizational effectiveness. Both intrinsic and extrinsic rewards for preceptors have been identi®ed as: having the opportunity to teach and in¯uence practice; increasing one's own knowledge base; stimulating one's own thinking; and individualizing orientation to meet preceptees' learning

Exploration of the preceptor role needs (Bizek & Oermann 1990). However, the study by Bizek & Oermann (1990) found that there was little or no job satisfaction from the preceptor role as there was lack of time, little workload relief and low incentives. Luncheons, journal subscriptions, the opportunity to attend conferences and letters of commendation were listed by Dibert & Goldenberg (1995) as incentives for preceptors, but their effectiveness is unknown. A sense of being needed, of being recognized professionally, and the recovery of lost self-esteem are also further reasons for preceptoring (Carruthers 1993). Kitchin (1993) claims that being selected as a preceptor increases the registered nurse's selfesteem as he or she is being recognized for clinical expertise, teaching ability and professionalism. An evaluation of a graduate nurse programme by Kitchin (1993) found that 80 per cent of both preceptors and preceptees stated that they bene®ted from the experience of preceptorship. Preceptors in that study claimed they increased their clinical, communication and teaching skills as a result of the preceptoring experience. It allowed them to re¯ect and evaluate their own practice, while furthering their clinical and communication skills and their ability to demonstrate practical aspects of nursing practice (Kitchin 1993 p. 111). Assisting preceptees to integrate into the nursing unit, teaching, improving their teaching skills, sharing knowledge, and gaining personal satisfaction from preceptoring were rewarding aspects of preceptoring for preceptors in the Dibert & Goldenberg (1995) study. Reciprocity of learning proved to be important to preceptors in a North Queensland study as they felt that this assists them in meeting the challenge of inquiring minds (Owens & Tollefson 1995). According to Dibert & Goldenberg (1995) these values should be recognized and nurtured, so that preceptors will remain motivated and continue to undertake the role. Preparation for the role of preceptoring has been identi®ed as the most important factor related to success of the programmes (Fehm 1990). Salient components of preceptor preparation programmes include: teaching/learning strategies; principles of adult learning; communication skills; values and role clari®cation; con¯ict resolution; assessment of individual learning needs; and evaluation of novice performance (Giles & Moran 1989, de Blois 1991, Westra & Graziano 1992). Nursing staff, nurse administrators and nursing faculty also need a form of preparation as the preceptors in the study by Dibert & Goldenberg (1995) felt that the nursing staff did not understand the goals of the programme, and that nurse administrators and faculty were not highly committed to the programme. This is an area that warrants further investigation. Evaluating preceptees is an important aspect of the preceptor's role; however, Dibert & Goldenberg (1995) found that most preceptors had little or no experience with this role. Owens & Tollefson (1995) ascertained that preceptors

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K. Usher et al. assessed students on a purely subjective basis, with minimal reference to national standard, since most of the preceptors interviewed lacked knowledge of the use of the ANCI competencies or even the de®nition of `novice practitioner'. Overall, the study by Dibert and Goldenberg among 59 Canadian nurses (1995) found that preceptors are likely to be committed to the role of preceptor when there are worthwhile bene®ts, rewards and supports. These ®ndings are important and worthy of further attention, because the integrity of future student clinical placements and new graduate programmes, depends very much on the commitment preceptors have to their role. If this commitment is related to the preceptors' perceptions of bene®ts, rewards and support, then it is essential that these be better understood. Although a relationship between the variables appears to exist, Dibert & Goldenberg (1995) propose the relationship undergo further investigation and replication using larger and different samples. The purpose of this replication study was to compare the ®ndings in an Australian context.

THE STUDY Research questions As this study was designed as a replication of the study undertaken by Dibert & Goldenberg (1995), the same research questions were proposed.  What is the relationship between the preceptors' perception of bene®ts and rewards associated with the preceptor role and the preceptors' commitment to the role?  What is the relationship between the preceptors' perception of support for the preceptor role and the preceptors' commitment to the role?  What is the relationship between the preceptor's years of nursing experience and the preceptor's: (a) perception of bene®ts and rewards associated with the preceptor role; (b) perception of support for the preceptor role; and (c) commitment to the role?  What is the relationship between the number of times the preceptor has acted as a preceptor and the preceptor's: (a) perception of bene®ts and rewards associated with the preceptor role; (b) perception of support for the preceptor role; and (c) commitment to the role? (Dibert & Goldenberg 1995 p. 1146).

Method After receiving ethical and institutional approval to undertake the study, the questionnaire was mailed to all preceptors involved in a third year clinical elective in an undergraduate nursing course in North Queensland.

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Sample

The convenience sample consisted of 134 preceptors, predominantly female, involved in an undergraduate nursing programme in North Queensland. This compares to 59 predominantly female preceptors in the original Canadian study. Generally these preceptors were recommended for the position by their administrators; in many cases, clinicians had not voluntarily taken on this role. The preceptors were informed that their replies to the questionnaire were anonymous and con®dential and that return of the completed questionnaire would be regarded as implied consent. A return rate of 78% was achieved. Of those who responded, 46% had attended a preceptor workshop. Demographic characteristics of the sample are displayed in Table 1. It is interesting to note that 11% of the sample had 2 or less years of nursing experience, and that 21á6% had 5 years or less. Of the 105 individuals in the study, 77 responded to the questions describing their preceptorship experience. They had a mean of 7á2 experiences as preceptors, ranging from 1 to 20, with a standard deviation of 9á5. The distribution was skewed towards lower values, meaning most had fewer experiences, re¯ected in a median value of 3á0. While the vast majority of these preceptors had experience with nursing students, the depth of this experience was likewise rather limited, as indicated by the fact that less than a third (31á7%) had engaged in preceptorship with nursing students on more than one occasion. Experience was greater as far as the number of repeated experiences of preceptorship with the newly hired and new graduates, but remained at only moderate levels of experience with 60% and 54á3%, respectively, reporting more than one occasion. Another measure of depth of preceptorship is obtained by looking at the range of experience across the types of situations. Thirty-eight per cent of preceptors had experience solely with either the newly hired or new graduates or nursing students, 28á6% had experience with two of the groups, while 35á2% reported preceptoring in all three situations. Thus this group consisted of a relatively large number of novice preceptors.

Instruments

A four-part questionnaire was used to collect the data: Preceptor's Perception of Bene®ts and Rewards (PPBR) Scale, Preceptor's Perception of Support (PPS) Scale, Commitment to the Preceptor Role (CPR) Scale, and a demographic information section. This questionnaire, developed by Dibert & Goldenberg (1995), was used with the authors' permission. The PPBR Scale comprises 14 items rated on a 6-point Likert scale (1 `strongly disagree' to 6 `strongly agree') developed by Dibert & Goldenberg (1995) based on literature concerning rewards and bene®ts of the preceptor role. Response to the scale was almost complete, with only

Ó 1999 Blackwell Science Ltd, Journal of Advanced Nursing, 29(2), 506±514

Issues and innovations in nursing education

Exploration of the preceptor role

Table 1 Demographic characteristics of sample Frequency Variable Education Hospital certi®cate Diploma Bachelor's degree Master's degree Age 20±29 30±39 40+ Gender Female Male Years of nursing experience Years as preceptor Types of preceptor experiences with: Newly hired nurses New graduates Nursing students Number of preceptor experiences with: Newly hired nurses New graduates Nursing students

n

%

67 5 32 1

63á8 4á8 30á5 1á0

45 37 21

43á3 35á6 21á1

87 17

83á7 16á3

60 46 101

Range

M*

SD

0±30 0±15

11á8 2á7

7á4 2á7

1±20 1±10 0±20

5á1 4á0 2á6

5á6 3á4 3á1

57á1 43á8 96á2

M = mean; SD = standard deviation. *While parametric summary statistics are of limited value in data which are not normally distributed, they are included here to allow comparison to values in the original Dibert and Goldenberg (1995) study.

four respondents failing to complete all items. Three of these only missed one item, and these missing values were replaced with the median item value to allow for compilation. One case was eliminated as an outlier due to its low score on this scale from responses all strongly disagreeing with perceived bene®ts. The PPS Scale comprises 17 items that are also rated on a 6-point scale to measure preceptors' perceptions of support for the preceptor role. It is based on the factors contributing to support identi®ed in the literature by Dibert & Goldenberg (1995). The ®nal six questions of the scale were only answered if preceptors had experiences with either a nurse during orientation (three questions) or had preceptored a nursing student (three questions). Making a straight additive index would have weighted responses in favour of those who had both experiences. The responses to these questions were therefore weighted for nurses answering based on only one of these experiences. As exclusion of both experiences made the instrument unreliable, those who did not answer any of the ®nal six questions (seven respondents in all) were not included in the analysis of this scale. For the remaining participants, missing data involving seven single items were replaced with the median value to allow for compilation.

The 10-item CPR Scale was adapted by Dibert (1993, in Dibert & Goldenberg 1995) from the Organizational Commitment Questionnaire (OCQ) developed by Mowday et al. (1979 in Dibert & Goldenberg 1995). The CPR Scale consists of 10 items rated on a 6-point scale to measure commitment to the preceptor role. Reliability analyses of the three scales (PPBR, PPS & CPR) were reported by Dibert & Goldenberg (1995) as having alpha coef®cients of 0á91, 0á86 and 0á87, respectively. Reliability is measured using Cronbach's alpha, a cross-sectional approach which estimates internal consistency among items included in an additive scale. Inclusion of any speci®c item is through an assessment of the item intercorrelation and the effect elimination has on the resulting alpha coef®cient. There is some variability in the literature concerning what minimum level of alpha is desirable for a scale intended to measure a particular construct. Burns & Grove (1993) for example state that 0á80 is the lowest acceptable value for a well-developed instrument while less re®ned scales can be as low as 0á70. In a review of this coef®cient (Peterson 1994) a mean value of 0á80 was reported for those constructs concerning involvement and commitment, while satisfaction relating to employment had a mean alpha of 0á82.

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K. Usher et al.

Results Data were analysed using the approaches advocated by Dibert & Goldenberg (1995), which were mainly correlational in orientation. Primarily this was to allow for comparability in results between the two settings. Where differences in the analysis occur, they are due to variations in the nature of the data collected and interpretations of the assumptions that underlie the analysis of the data. Pearson's r was utilized as a measure of correlation except for cases where the assumption of normality was not met. Where the data were skewed or ordinal, Spearman's rho was used as a measure of non-parametric correlation. Assessment of factors relating educational experience and experience as a preceptor to scores on the three scales utilized t-tests and analysis of variance. For the analysis the statistical package SPSS was used, with a signi®cance level of 0á05 (two tail) applied where appropriate for hypothesis testing. Cronbach's alpha was used to analyse the reliability of the instruments used to assess the bene®ts, commitment and support in the preceptor's role. For the 14 items of the PPBR scale, an alpha of 0á9288 was calculated (n ˆ 101), indicating little item speci®c variance, and comparing favourably with previous use of the scale. For PPS, used to measure the perception of support for the role, an alpha of 0á7419 (n ˆ 44) was initially calculated. It was found through inspection of the item intercorrelation that two questions had much lower correlations with the sum of the scores on the remaining questions. Speci®cally, they were `I do not have suf®cient time to provide patient care while I function as a preceptor' and `The nursing faculty member provides support by helping me to identify a student's performance problems.' Elimination of these two items from the scale resulted in increasing Cronbach's alpha to 0á8060. As increasing reliability increases the validity (in reference to the construct) it was decided to eliminate these items from the scale, reducing the number of items to 15. While the CPR scale used to measure commitment was based on an established scale (the Organizational Commitment Questionnaire), the assessment of reliability for the current study using Cronbach's alpha was 0á7701 (n ˆ 93). Item analysis showed that the statement `It would take very little change in my present circumstances to cause me to stop being a preceptor' was least correlated with the other items. Removal of this item resulted in a 9-item scale that had an alpha of 0á7944. Further analysis was conducted using this reduced scale.

Research question 1

The relationship between the preceptors' perceptions of bene®ts and rewards associated with the preceptor role and their commitment to the role was determined using Pearson product-moment correlation coef®cient, r. That is,

510

correlations between the two scales PPBR and CPR were calculated. Dibert & Goldenberg (1995) found that the more the preceptors perceived that there were bene®ts and rewards associated with the preceptor role, the more committed they were to the role. In this study a correlation coef®cient of r ˆ 0á537, P < 0á000, n ˆ 98, was calculated, replicating Dilbert and Goldenberg's ®nding of a statistically signi®cant association between bene®ts and commitment to the preceptor role. It was worth noting that their ®nding of 0á6347 was on a sample of 52 respondents.

Research question 2

The relationship between the preceptors' perception of support (PPS) for the preceptor role and their commitment to the role (CPR) were also determined using Pearson product-moment correlation coef®cient, r. Pearsonian correlation results between the PPS scale and the CPR scale paralleled those found in Dibert & Goldenberg (1995) as reported in Table 2. While in the original study there were two categories of preceptorship (those with newly hired nurses and those with nursing students), the Australian experience with preceptorship was investigated across a more speci®ed range of training situations. Information was gathered on preceptors' work with newly hired nurses having previous employment experience, with nursing students on placement during the course of their university training and newly graduated nurses from tertiary institutions. All correlations as reported in Table 2 were calculated to be signi®cant. The ®ndings indicate that a positive association exists between the preceptors' perceptions of support and their commitment to the role.

Research question 3

Spearman rank-order correlation coef®cients (rho) were used to calculate between the preceptor's years of nursing experience and the scores on the PPBR, PPS and CPR scales. This was necessary due to the lack of normality in the distribution of years of nursing experience, which was positively skewed towards lower number of years. A cross-tabulation of years by the three scales showed few

Table 2 Correlations between preceptors' perceptions of support and commitment to the preceptor role Type of preceptorship

n

r

P

Newly hired nurses, new graduates, nursing students Newly hired nurses New graduates Nursing students

89

0á34

0á001

52 40 85

0á33 0á34 0á34

0á018 0á031 0á001

n = number of subjects; r = Pearson's coef®cient; P = level of signi®cance.

Ó 1999 Blackwell Science Ltd, Journal of Advanced Nursing, 29(2), 506±514

Issues and innovations in nursing education ties in the matrix, thus allowing for the application of Spearman's rho as a measure of association. None of the correlations reached statistical signi®cance, implying that years of nursing experience was not related to the preceptors' perceptions of the bene®ts and rewards, supports, or commitment to the role, paralleling the ®ndings of Dibert & Goldenberg (1995).

Exploration of the preceptor role Table 3 Number of types of preceptor experience and mean scores for scales No. of types of preceptor experience

n

M

SD

PPBR

One Two Three Total

38 29 36 103

59á1 66á5 64á1 62á9

7á32 8á67 7á70 8á37

PPS

One Two Three Total

34 27 32 93

44á9 50á8 48á9 50á0

7á24 7á11 5á29 6á99

CPR

One Two Three Total

36 28 35 99

40á7 43á2 42á1 41á9

5á02 5á95 5á95 5á67

Scale

Research question 4

Spearman rank order correlations between the number of times as a preceptor and scores on the PPBR, PPS and CPR scales were also calculated. No relationship was found to exist between the number of times as a preceptor and scores for the PPBR, PPS and CPR scales. To replicate categories used in the previous study, the number of preceptor experiences with newly hired nurses and newly graduated nurses were combined and analysed in relation to commitment to the role (CPR) but resulted in no signi®cant correlation. This implies that perception of bene®ts and rewards, support and commitment to the preceptor role is not in¯uenced by the number of experiences as a preceptor. An additional dimension to be explored was in the number and types of experiences in preceptorship. Preceptorship in the Queensland research could be with nursing students, with new staff, or with new graduates. Some preceptors had experience with only one type of these experiences while others had some diversity in the roles played as preceptor. Assessment of the numbers for each type of experience for the seven possible combinations of experience showed no signi®cant association through the use of Spearman's rho. As can be observed in Table 3, however, there are differences in responses to the scales depending on the number of experience categories. For scales referring to perceptions of bene®ts and rewards (PPBR) and to perceptions of support (PPS) those with only one type of preceptorship experience reported lower scores relative to two or three types as indicated by the means. For commitment to the role there was relatively little difference in means between the groups. Using analysis of variance to test these differences resulted in an F (2,100) ˆ 7á831, P ˆ 0á001 for the PPBR scale and an F (2,90) ˆ 6á643, P ˆ 0á002 for the PPS scale. Post-hoc analysis of the means using Scheffe's test for differences con®rms that it is for one type of preceptorship where the differences in the value lie. The ANOVA for range of experience and CPR was as expected non-signi®cant (F (2,96) ˆ 1á664, P ˆ 0á195). This difference in scale scores based on the range of experience led to further investigation of the effect this might have on the correlations between commitment to the role as preceptor and both perceived bene®ts and support. Earlier, it was reported that a signi®cant association existed between the measure of commitment (CPR), and the scales that measure perceived bene®ts and

n = number of subjects; M = mean; SD = standard deviation.

rewards (PPBR), and perceived support (PPS). Table 4 re®nes this analysis for the relationship between PPBR and CPR by partitioning the correlation between extent of experience by type. The strength of the association increases as the individuals involved experience more types of preceptorships. This value also more closely approaches that found in the original research. This same association was not found taking this experience into account in assessing differences between perception of support and its value in increasing commitment to the preceptor role. As regards the connection between educational preparation and scores on the scales, the original article used t-tests to compare the groups. Due to the number of groups in the current study, the use of ANOVA was indicated. There was only one Master's prepared preceptor, so this person was not included in the analysis. The remaining three groups (hospital certi®cate, diploma, bachelor degree) did not show any signi®cant differences, paralleling the results of the original study. Reconstituting the groups into university trained and non-university trained, also failed to give any statistically signi®cant result when an

Table 4 Correlations between preceptor's perceptions of bene®ts and commitment to the preceptor role by experience level No. of types of preceptor experience

n

r

P

Single experience type Two experience types Three experience types

36 27 35

0á42 0á54 0á58

0á011 0á004 0á000

n = number of subjects; r = Pearson's coef®cient; P = level of signi®cance.

Ó 1999 Blackwell Science Ltd, Journal of Advanced Nursing, 29(2), 506±514

511

K. Usher et al. independent t-test was applied. Educational preparation therefore did not appear to in¯uence the preceptors' perceptions of bene®ts and rewards, support for the role, or their commitment to the role. Spearman's rho coef®cients were used to determine if there was any signi®cant correlation between the age of the subjects and their scores on the PPBR, PPS and CPR scales. No signi®cant relationship was found to exist between the preceptors' age and the scores on the PPBR scale, the PPS scale and the CPR scale. A t-test was utilized to investigate whether gender had an effect on the perceptions of bene®ts and rewards, support for the role, or commitment to the role of preceptor. Though on average the scores for males were lower than females across all three scales, these differences were not great enough to be statistically signi®cant.

Additional ®ndings

The rank-ordered mean scores for the preceptors' perceptions of bene®ts and rewards are presented in Table 5. The items show consistency in their order in comparison with the original study by Dibert & Goldenberg (1995), with most items showing exactly the same rank order, four items varying by one rank, one by two ranks and two by three ranks. The mean rank for each item in the current study is higher than those reported in the original study, also indicated by calculating a grand mean rank of 4á85 compared to 4á55 for the PPBR scale items in the Dibert & Goldenberg (1995) study. This indicates a greater perception of bene®t from participating in the preceptorship role by Queensland nurses. Rank-ordered mean scores for support items are presented in Table 6 for the items that apply to all respondents (as the full scale is only responded to based on particular experiences). The items also show consistency in their order in comparison with the original study with 3 items showing the same rank order, 3 items varying by one rank, 2 by two ranks. Items relating to serving as a preceptor too often are ranked much lower in the current study while the availability of nursing coordinators is ranked much higher. The ninth ranked item from Dibert & Goldenberg (1995) (referring to having suf®cient time to function as a preceptor) was removed from the scale as indicated earlier due to its low reliability. Overall it appears that the perception of support for this sample is lower, with a grand mean for ranked items of 3á63, as compared to the grand mean of Dibert & Goldenberg (1995) of 4á07 for common items.

DISCUSSION The results for this sample of 134 preceptors, in the main, parallel those found by Dibert & Goldenberg (1995) in their study of 59 Canadian preceptors, with differences arising mainly from structural and historical differences in pre-

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ceptorship as it is practised in North Queensland, Australia. The comparatively lower correlation coef®cients calculated in this study should not necessarily be taken as an indication of a lesser strength of association between the variables being explored. Spurious associations are more common in small samples, with the larger sample size in the current study generally resulting in lower probability values for the test statistic in question. The lack of response by participants in a number of items, particularly in statements about role, may be due to a relatively lower level of experience in preceptoring. There was a clear commitment to the preceptor role when participants perceived there to be both material and non-material bene®ts for acting as a preceptor, with the latter considered to be of greater relative importance. Continued and increased facilitation of access to these bene®ts by the institution is vital for sustaining active involvement in the role of preceptor. Formal recognition of the importance of this preceptoring system as a means of integrating new staff and students into the practice of the hospital, and the opportunity it provides for professional development, seem the most salient means of continuing the positive attitudes towards participation in the role. While material rewards were not considered of the greatest importance for participation by participants, additional access to resources for professional developTable 5 Rank-ordered mean scores for the preceptor's perceptions of bene®ts and rewards Item

M

SD

Assist new staff nurses and nursing students to integrate into the nursing unit Share my knowledge with new nurses and nursing students Improve my teaching skills Gain personal satisfaction from the role Teach new staff nurses and nursing students Keep current and remain stimulated in my profession Contribute to my profession Learn from new nurses and nursing students Increase my professional knowledge base Be recognized as a role model Increase my involvement in the organization within this hospital Improve my organizational skills In¯uence change in my nursing unit Improve my chances for promotion/advancement within this organization

5á39

0á82

5á26

0á86

5á19 5á08 5á06

0á80 0á90 0á98

5á00

1á00

5á04 5á02

0á92 0á89

4á97

0á95

4á93 4á71

0á90 0á95

4á57 4á32 3á79

1á03 1á15 1á15

M = mean (mean range = 1±6); SD = standard deviation.

Ó 1999 Blackwell Science Ltd, Journal of Advanced Nursing, 29(2), 506±514

Issues and innovations in nursing education

Exploration of the preceptor role

Table 6 Rank-ordered mean scores for core items from preceptors' perception of support Item

M

SD

My co-workers on the nursing unit are supportive of the preceptor role My goals as a preceptor are clearly de®ned I feel I have had adequate preparation for my role as a preceptor I feel the nursing co-ordinators and nursing managers are committed to the success of the preceptor programme My workload is appropriate when I function as a preceptor Nursing educators are available to help me develop in my role as a preceptor Nursing co-ordinators are available to help me develop in my role as preceptor There are adequate opportunities for me to share information with other preceptors The nursing staff do not understand the goals of the preceptor programme I feel I function as a preceptor too often

4á42

0á91

4á08 4á03

0á98 1á11

3á79

0á98

3á75

1á19

3á63

1á16

3á40

0á97

3á34

1á19

3á19

1á15

2á73

1á05

M = mean (mean range 1±6); SD = standard deviation.

ment for preceptors would certainly be a means of recognition by the institution of the signi®cance of the role. The support received from the institution and coworkers was also positively associated with valuing participation in the preceptorship role. This was a consistent relationship across the various types of preceptorship, whether with new staff, new graduates or students. Clearly this support was considered vital for participation in preceptorship roles by the individuals participating in this study. Unlike the Canadian nurses in the original study, participants felt that other staff, in general, do understand the programme. There are clear indications though that more support from hospital-based educators is required for preceptors to feel supported in their role. Additional contact with nursing co-ordinators is also seen as desirable in developing as a preceptor. Also vital, are greater opportunities for sharing preceptorship skills with other preceptors, as this study has revealed that a large number have relatively little experience in the preceptor role, while others have had a wealth of experience. For a preceptor programme to be effective, the institution needs to structure further opportunities for these interactions as a central tenet of preceptorship. As this study has revealed, there is less experience with preceptorship as compared to other countries, making contact between

experienced staff and those less experienced in the role of preceptor vital for its effective development. Experience as a preceptor had no apparent association with commitment to the role. This result was not surprising as participants had had relatively little experience with preceptorship. In contrast, the conclusions from the Ontario study indicated that there was a positive association between the number of times as preceptor and commitment to the role. Apparently experience provides a greater opportunity to realize bene®ts. While this relationship was not seen directly in the current investigation (due most likely to a more limited experience with preceptorship by participants), when experience across types of preceptorship was taken into account, there were indications of a positive association among the more experienced. This conclusion is supported in this study where those who have experience across a range of preceptoring experiences are those who are most cognisant of the bene®ts. Commitment remained similar across levels of experience. It is also apparent from the sample that exposure to the range of preceptorship types is bene®cial for motivation; however, this should be viewed with caution, as it could be more of a re¯ection of the type of person attracted to the diverse roles. Further contrasts between the original Dibert & Goldenberg (1995) research and the current project can be seen in the order and relative mean ranks of items in the PPBR and PPSS scales. For the ®rst, the same relative order indicates a similar pattern in recognition of bene®ts with emphasis on altruistic and professional development goals. The overall mean rank is lower, an indication that, due to the lesser institutionalization of the preceptor role, there is a lesser perception of support. This mean difference in ranks, carried through to the PPS scale, with particular items relating to the amount of preceptoring (e.g. `I feel I function as a preceptor too often') showing the greatest difference in their lower placement in item order. While item order indicates some greater appreciation of institutional support, there is an evaluation by preceptors of less support by their colleagues and institution for the role of preceptor in North Queensland than in Canada.

CONCLUSION It is clear that continued positive attitudes towards preceptorship, attention to the development of preceptor skills, support in the role as preceptor, and rewards for participation, need to be ongoing priorities, for without such, preceptorship may become an ineffective programme, unable to ful®l its objectives. A preceptorship policy which clearly de®nes the roles and responsibilities of the preceptor and novice, is one strategy that may enhance preceptorship programmes (Bain 1996). The ultimate success of a preceptorship programme is, however, the responsibility of both educators and clinicians.

Ó 1999 Blackwell Science Ltd, Journal of Advanced Nursing, 29(2), 506±514

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K. Usher et al. Adequate consideration, time and ®nancial resources for its development are essential. Whilst these needs are important, they cannot be considered without those needs of the preceptee. Further research should consider the preceptors' commitment to the programme as students do not always ®nd such programmes to be a success (Earnshaw 1995). Cahill (1996) claims that there is little evidence to suggest that preceptorship is even effective, as investigators have rarely focused on the needs and views of students. Earnshaw's (1995) research highlights the point that not all clinicians, regardless of their background, make good preceptors. Indeed, this should not be overlooked, as a well-designed and thoughtful programme can be useless if preceptors are unsuitable.

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Ó 1999 Blackwell Science Ltd, Journal of Advanced Nursing, 29(2), 506±514