JAN
JOURNAL OF ADVANCED NURSING
ORIGINAL RESEARCH
Being a personal preceptor for nursing students: Registered Nurses’ experiences before and after introduction of a preceptor model Karin Hallin & Ella Danielson Accepted for publication 27 August 2008
Correspondence to K. Hallin: e-mail:
[email protected] Karin Hallin MSc RNT Lecturer Department of Health Sciences, Mid Sweden ¨ stersund, Sweden University, O Ella Danielson PhD RN Professor Institute of Health and Care Sciences, The Sahlgrenska Academy at Gothenburg University, Sweden
H A L L I N K . & D A N I E L S O N E . ( 2 0 0 9 ) Being a personal preceptor for nursing students: Registered Nurses’ experiences before and after introduction of a preceptor model. Journal of Advanced Nursing 65(1), 161–174 doi: 10.1111/j.1365-2648.2008.04855.x
Abstract Title. Being a personal preceptor for nursing students: Registered Nurses’ experiences before and after introduction of a preceptor model. Aim. This paper is a report of a study to compare Registered Nurses’ experiences of acting as personal preceptors for nursing students in the year 2000 with the year 2006 and explores relationships between preceptors’ experiences and personal/ clinical characteristics. Background. Preceptoring is experienced as stressful and challenging. How successful preceptors are in this role depends largely on the support they receive. Knowledge about preceptors’ experiences over time and in relation to a preceptor model is limited. Method. Data were collected by questionnaire in 2000 (n = 113) and 2006 (n = 109) with preceptor groups in a hospital in Sweden before and after introduction of a preceptor model. Data were analysed with descriptive and correlational statistics using parametric and non-parametric methods. Findings. Statistically significant improvements were noted in preceptors’ experiences between 2000 and 2006. Statistically significantly more preceptors in 2006 reported that they felt prepared for their role and felt support from teachers, colleagues, chief nurses and enrolled nurses. Least improvement was seen in relation to the questionnaire items workload, constructive feedback and support in linking research results to practice. A strong positive relationship existed between preceptors’ experiences of the preceptor role and the level of interest in preceptoring. Conclusion. The preceptor model offers a way to support and facilitate preceptors and to develop co-operation between university and hospital. Future research should focus on students’ experiences, experiences of first-time preceptors, head preceptors and teachers from a longitudinal perspective. Keywords: experience, nursing students, preceptor, preceptor model, questionnaire, Registered Nurses, support
2008 The Authors. Journal compilation 2008 Blackwell Publishing Ltd
161
K. Hallin and E. Danielson
Introduction Registered Nurses (RNs) acting as preceptors have to balance the needs of nursing students with those of seriously ill patients in workplaces with high staff turnover, high care technology, and demands for cost effectiveness. Studies suggest that RNs can better meet their preceptor obligations if they receive support (Yonge et al. 2002a, 2002b) and a collaborative relationship is developed with the university ¨ hrling & Hallberg 2001). Although studies on RNs’ (O preceptorship experiences have provided valuable knowledge, no studies found have investigated changes in these experiences over time. Our study is based on comparisons of results from data collections carried out in 2000 and 2006 in Sweden, before and after the introduction of a clinical preceptor model. The terms clinical supervisor, mentor and preceptor are often used synonymously in the literature. We have elected to use the term preceptor, as defined below.
Background Being a preceptor is experienced stimulating and challenging (Stone & Rowels 2002, Shannon et al. 2006) but stressful (Yonge et al. 2002b, Hautala et al. 2007). Highest ranked rewards are preceptors’ opportunities to share students’ knowledge and enthusiasm for learning, to foster their learning-behaviours, and to follow their development of skills, attitudes and confidence (Stevenson et al. 1995, Stone & Rowels 2002, Shannon et al. 2006). Important rewards include salary increases, paid time off and participation in workshops (Stevenson et al. 1995). In two Canadian studies and one Australian study (Dibert & Goldenberg 1995, Usher et al. 1999, Hyrkas & Shoemaker 2007) the benefits and rewards of acting as a preceptor have revealed a statistically significant correlation between commitment to the role of preceptor and availability of benefits and rewards. Various researchers describe preceptorship as demanding and time-consuming (Yonge et al. 2002b, Hautala et al. 2007). Preceptors report that time spent supervising students conflicts with their care delivery (Watson 2000), and that in such situations patients’ needs have priority while students’ needs must be set aside (Coates & Gormley 1997). Preceptors often experience a gap between theory and practice (Landmark et al. 2003), and they have little ¨ hrling & Hallberg time to reflect on students’ experiences (O 2001). Preceptors’ workloads are often large, especially when staff teams have more students than they have the capacity to support (Hutchings et al. 2005). Consequently, it is not always possible to provide appropriately-qualified nurses for all students, and preceptors may therefore be 162
appointed on a ‘now it is your turn’ basis (Landmark et al. 2003). Some nurses feel prepared for the preceptor role (Hautala et al. 2007), while others, mainly novice nurses, feel unprepared (Landmark et al. 2003). Nurses are often unsure about students’ responsibilities for their own progress (Landmark et al. 2003) and many feel inadequately prepared as evaluator (Coates & Gormley 1997). Lofmark and Thorell-Ekstrand (2000, 2004) report that evaluating students has become more complicated and more demanding since nursing schools became incorporated into universities. Support from colleagues is considered vital for preceptors, but is problematic when colleagues do not understand the goals of the preceptor programme (Usher et al. 1999). A major problem, particularly when students have poor skills, is insufficient support from managers and educators (Hautala et al. 2007, Luhanga et al. 2008). Lack of recognition and didactic plans represent barriers to achieving the goals of preceptoring (Landmark et al. 2003). Feeling supported is related to preceptors’ opportunities to talk directly to teachers (Watson 2000). Thus, teachers need to spend time with preceptors to discuss curricula and ¨ hrling & Hallberg 2001). Guidepedagogical strategies (O lines about the demands and expectations of the preceptor role and what students can and cannot do in clinical practice must be formulated (Hautala et al. 2007). A strategy recommended by Hutchings et al. (2005) is to give preceptors the opportunity to share knowledge and experiences with colleagues. This also means that an inexperienced preceptor should work together with an experienced preceptor. This strategy has the further advantage of optimizing preceptor– student contacts when preceptors have irregular working hours (Hutchings et al. 2005). Attributes of the preceptor have been found to influence the quality of the preceptorship. For example, interest in supervision has been shown to enhance the development of a good relationship between preceptors and students (Brammer 2006). Self-confidence and self-awareness have a bearing on the preceptor’s inclination to critically appraise their role as preceptor (Landmark et al. 2003). Age and years of nursing experience have been shown to correlate statistically significantly with perceptions of receiving support (Hyrkas & Shoemaker 2007), while years of preceptor experience and educational background were of less importance in some studies (Dibert & Goldenberg 1995, Usher et al. 1999, Hyrkas & Shoemaker 2007). Nevertheless, Watson (2000) found that preparatory courses for preceptors help to make nurses feel more secure in their role (P = 0Æ002). A variety of preceptor/mentor/supervisor and collaboration models have been proposed in the literature. Although such
2008 The Authors. Journal compilation 2008 Blackwell Publishing Ltd
JAN: ORIGINAL RESEARCH
Being a personal preceptor for nursing students
models describe the importance of learning environments and preceptors’ preparation from a theoretical perspective, in practice they are developed on the basis of local needs and conditions (Fulton et al. 2007). Important components of these models include support, cooperation and organization for professional development and highlight nursing skills, pedagogical competence, research and the ability to translate classroom knowledge to clinical settings (Baxter 2007, Haggman-Laitila et al. 2007). Most recent models have focused on clinical supervision which bridges the theory– practice gap (Severinsson 1998, Baxter 2007), problem-based learning (Ehrenberg & Haggblom 2007), the role of a practice educator (Jowett & McMullan 2007), and the role of a placement facilitator (Clarke et al. 2003). Other models have focused on a clinical placement coordinator (Drennan 2002), two preceptors for one learner (Hutchings et al. 2005) and roles to facilitate expansion of placement capacity (Magnusson et al. 2007). In our study, the preceptor model (Andersson-Thorell et al. 1998) was based on collaboration between preceptors and teachers, who offered support to both preceptors and students (Figure 1, Table 1). The model was influenced by John Dewey’s (1964) philosophical and theoretical thoughts about education as integrated unities of theory, practice, reflection and acting. Accordingly, students must take an active role in their education, rather than simply being passive recipients, and educators must aim to develop students’ problem-solving and critical thinking abilities. Learning is best fostered by giving students opportunities to act, at first in delimited learning situations and then in more complex situations, and to reflect on their experiences. According to Scho¨n (1987), practitioners who are experienced and skilled are better able to reflect, experiment and improvize during actions. In summary, the literature shows that preceptorship is stimulating, but is also stressful. Preceptor nurses often face conflicts in allocating their time between patient care and
students’ needs for preceptoring. A common message stemming from studies of preceptors’ experiences and preceptor models is that support from teachers, co-workers and chief nurses (nurse leaders of units) is crucial. Skills in nursing and pedagogy are also important for the quality of preceptorship. Factors influencing commitment to the preceptor role include self-confidence, self-awareness and interest in preceptoring, as well as age, years as an RN and having taken a preceptor preparation course.
The study Aim The aim of the study was to compare RNs’ experiences as personal preceptors for nursing students in hospital units in the year 2000 with the year 2006 and to explore relationships between preceptors’ experiences and their personal/clinical characteristics. The research questions were: • To what extent do RNs in 2000 and 2006 differ concerning: preceptor preparation? support from teachers, colleagues, chief nurses and enrolled nurses? • What relationships exist between RNs’ experiences of preceptoring and their personal and clinical characteristics?
Definitions The terms ‘personal preceptor’ and ‘preceptoring’ are defined as an RN’s individualized day-to-day support to nursing students, including teaching, reflecting, feedback and evaluation to bridge the theory–practice gap (Yonge et al. 2007). The term ‘nursing student’ refers to those students enrolled in a 3-year bachelor programme.
Nursing student 35 hours a week
Link teacher Planning/Evaluation supporter 3 hours per student, per 8-week period
Figure 1 A preceptor model designed to support both nursing students and preceptors.
Personal preceptor Main supporter
Head preceptor Group/Individual supporter 8 hours a week
Clinical teacher Pedagogical supporter Responsible for the development of the preceptor model 50% of fulltime work
2008 The Authors. Journal compilation 2008 Blackwell Publishing Ltd
163
K. Hallin and E. Danielson Table 1 Components of the preceptor model: parts, required competence, tasks and employers Parts
Required competence
Tasks
Nursing student*
Satisfactorily prepared for clinical education
Personal preceptor
Registered Nurse Interested in preceptoring Preceptor preparation course, 7Æ5 ECTS credits ‡2 years of clinical experience as a Registered Nurse Registered Nurse Interested in preceptoring ‡60 ECTS credits in nursing science Preceptor preparation course, 7Æ5 ECTS credits ‡5 years of clinical experience as a Registered Nurse Registered Nurse Several years of nursing experience Teaching qualifications Registered Nurse Specialist education ‡120 ECTS credits in nursing science Several years of nursing experience Qualified teacher Several years of teaching experience
Have individual goals related to curriculum requirements Follow one or two personal preceptors’ assigned shifts. Be responsible for own learning Evaluate own clinical education Preceptor for one to two nursing students; Two RNs can collaborate. Recognize student’s realistic learning needs Plan/arrange/reflect/follow up student’s learning Assess and evaluate student’s capacity
Head preceptor
Link teacher Clinical teacher
Employers
Hospital
Link between one hospital unit and the university Plan students’ schedule and appointment of personal preceptors Arrange weekly meetings with a group of students to link theory and research with practice Be the closest support to personal preceptors
Hospital
Meet students and personal preceptors to clarify outcomes and objectives for learning Take part in mid and final evaluation Overall responsibility for the development of the preceptor model in one hospital Support head preceptors and personal preceptors Collaborate with link teachers Collaborate with chief nurses Provide guidelines concerning didactics and evaluation Arrange meetings and workshops for head/personal preceptors Distribute students’ evaluation to preceptors and chief nurses
University
University
*Two to four nursing students in the fourth/final semester of a 3-year nurse education programme practice at a unit for 6–8 weeks. Medical/surgical units educate nursing students for 14–16 weeks each semester (total six to seven nursing students in each unit). Emergency/ pediatric units educate nursing students for 6–8 weeks each semester (total two to four nursing students in each unit). ECTS = European Credit Transfer System; 7Æ5 ECTS credits represent 5 weeks of study; 60 ECTS credits represent 1 year of study.
Design A descriptive cross-sectional design was adopted. Data were collected by means of self-administrated questionnaires from two independent preceptor groups, one in 2000 and one in 2006.
Setting The preceptor model was introduced at a county hospital in central Sweden in 2000, and by 2006 it had been implemented in nearly all units (n = 16) with clinical education for nursing students. These units provided 6–8 weeks acute care education for nursing students in their fourth and/or final semester of a 3-year bachelor of nursing programme. All students were enrolled at the same university. The preceptor model was designed to support both nursing students and preceptors in their endeavours to bridge the gap between 164
theory and practice. The model consists of nursing students, personal preceptors (RNs; main and daily supporters of students), head preceptors (expert RNs; supporters of groups of students and personal preceptors), link teachers (university educators; participating in tripartite planning/evaluation meetings held with students and personal preceptors) and one clinical teacher (university educator; responsible for development of clinical education and support of personal and head preceptors). Figure 1 and Table 1 present the meanings of these terms, along with support, time requirements, required levels of competence, tasks and employers. Specific elements of the preceptor preparation programme concerned the university’s demands on preceptors, students’ outcomes, didactic plans, guidelines for reflective and self-learning opportunities and identification of ‘unsafe students’. Worksheets for feedback and evaluation of students, as well as workshops and collaboration opportunities, with the university were offered. Central to the
2008 The Authors. Journal compilation 2008 Blackwell Publishing Ltd
JAN: ORIGINAL RESEARCH
preparation programme was problem-solving, critical thinking and to give preceptors possibilities to act and reflect on experiences. A contract between the university and the healthcare organization was established in 2002, and this regulated preceptor preparation and practice sites. According to the contract, the university paid the hospital about 135 Euros for having a student for a week (1 Euro = £ 0Æ79 = US$ 1Æ49). As the preceptoring duties are included in a Swedish RN’s responsibilities, no financial compensation is paid to preceptors.
Participants The total number of RNs employed at the units was about 400, with between 12 and 40 RNs in each unit. Participants were enrolled consecutively. Inclusion criteria were identical in the two data collections. The RNs in the two samples (160 in 2000 and 154 in 2006) worked 75–100% of full-time and had acted as a personal preceptor for at least two nursing students during the previous 2 years. Fifteen RNs in the 2006 group were excluded because they had at some point served as head preceptor.
Being a personal preceptor for nursing students
personal and clinical characteristics; experiences of preceptor preparation; experiences of support from teachers; and experiences of support from colleagues, chief nurses and enrolled nurses. A fifth area concerning the use of offered support (three items) was added to the questionnaire in 2006. Items were rated on a four or five-point response scale. The response alternative ‘no opinion’ was available for items concerning experiences of support (Table 2).
Validity and reliability The whole questionnaire was examined for face and content validity. Items were generated from a literature review and content validity was assessed by means of the known-groups technique (Polit & Beck 2004). The questionnaire was pilottested in 1999 with four teachers and four senior nurses who were not involved in the study. Few modifications were required. Internal consistency was assessed with Cronbach’s alpha reliability coefficient (Polit & Beck 2004). Alphas ranged between 0Æ83 and 0Æ95 for the different subscales (mean 0Æ87). No power analysis was undertaken as all RNs in all units were invited to participate.
Ethical considerations Data collection Data were collected during January and February in 2000 and during March and April in 2006, before and after the introduction of the preceptor model. Data collection procedures were the same in both 2000 and 2006. Chief nurses or selected nurses identified the RNs who met the inclusion criteria and gave the names to the researchers. Self-administered questionnaires were stamped with code numbers and sent to the RNs by internal post along with a letter explaining the aim of the study and voluntary nature of participation and guaranteeing confidentiality. Completed questionnaires were returned to the researchers in sealed envelopes. Two reminders were sent. The response rates were almost the same in 2000 and 2006 at 70Æ6% (113/160) and 70Æ8% (109/154) respectively. Twelve questionnaires in total were returned unanswered with the comments ‘not interested’ or ‘on sick leave’, but the majority of those who did not respond gave no reason. Because of the fact that only 24 RNs participated in both studies, the two samples were considered to be independent.
Questionnaire A questionnaire comprising 83 items was developed in 1999. For this study 36 items covering four areas were used:
The study was approved by the appropriate ethics and management committees. To ensure anonymity, results are presented only at group level.
Data analysis Data from the two collections were analysed using SPSS version 12 (SPSS Inc., Chicago, IL, USA). The level of statistical significance was defined as <0Æ05 (two-tailed). Descriptive statistics was used to characterize the study samples. Comparisons between groups were made using the t-test for quantitative variables, and the Pearson chisquared test and the Mann–Whitney U-tests were used for ordinal data. Spearman’s rho and the chi-squared test were used for categorical variables. In chi-squared analyses, some variables were recoded to attain cell-frequencies with expected counts of at least five. Response scales were recoded combining the alternatives very good and good, poor and very poor, agree totally and agree in part and disagree in part and disagree totally. Because of the skewness of the data, dependent variables could not be dichotomized for the purpose of performing logistic regression analyses of relationships between the RNs’ experiences of preceptor preparation and their personal/ clinical characteristics.
2008 The Authors. Journal compilation 2008 Blackwell Publishing Ltd
165
K. Hallin and E. Danielson Table 2 The questionnaire with question areas, items and response scales Question areas
Items in the questionnaire
Response scales
Personal and clinical characteristics (nine items)
Gender Age Specialist-education Preceptor preparation course, 7Æ5 ECTS credits, Academic credits in nursing sciences Years as a Registered Nurse Number of semesters as a personal preceptor Workplace at time of the data collection
Male/Female Years Yes/No Yes/No 30, 60, 90, 120 ECTS credits Years Number of semesters Medical/infection care; surgical/orthopaedic/gynaecological care; emergency/paediatric care Very high degree, high degree, neither high nor low degree, low degree, very low degree Agree totally, agree in part, disagree in part, disagree totally
Interested in preceptoring nursing students
Experiences of preceptor preparation (nine items) Cronbach’s alpha = 0Æ86
Experiences of support from teachers (six items) Cronbach’s alpha = 0Æ94
Experiences of support from colleagues, chief nurses, enrolled nurses in hospital (four items each) Cronbach’s alpha = 0Æ83, 0Æ87, 0Æ84
Additional questions in the 2006 questionnaire concerning use of offered support (three items)
Knowing the demands on a preceptor Being a role model for nursing students Being confident in one’s ability to offer guidance Feeling secure in the preceptor-role Having a stimulating assignment Developing one’s pedagogical skills Receiving required support Receiving sufficient appreciation Receiving constructive feedback Evaluating nursing students Discussing levels of clinical education Discussing principals of preceptoring Linking theoretical knowledge to nursing situations Developing nursing students’ personal characteristics Linking research results to practical nursing Receiving assistance in problem-solving Being met with understanding that it is time-consuming to precept Redistributing tasks to cover nursing students’ needs Reducing workload Participating in workshops Making use of written guidelines Reading students’ evaluations
Very good, good, fairly good, poor, very poor, no opinion
Very good, good, fairly good, poor, very poor, no opinion
Yes/No Very high degree, high degree, neither high nor low degree, low degree, very low degree
ECTS = European Credit Transfer System; 7Æ5 ECTS credits represent 5 weeks of study; 60 ECTS credits represent 1 year of study.
younger (P = 0Æ02) and had fewer years in the nursing profession (P = 0Æ001). This group also had a higher level of academic education (P < 0Æ001), and fewer were specialist nurses (P = 0Æ01) (Table 3).
Results Personal and clinical characteristics No statistically significant differences were noted between the 2000 and 2006 groups concerning gender, number of semesters as a personal preceptor, number of RNs working in different hospital units, number of RNs who had taken the preceptor preparation course, and RNs’ interest in preceptoring. However, participants in the 2006 group were 166
Experiences of preceptor preparation Comparisons between the two groups showed statistically significant differences in seven of nine investigated variables (P < 0Æ001–0Æ036) (Table 4).
2008 The Authors. Journal compilation 2008 Blackwell Publishing Ltd
JAN: ORIGINAL RESEARCH Table 3 Comparisons of personal and clinical characteristics between the two independent preceptor groups
Being a personal preceptor for nursing students
Personal and clinical characteristics
Group in year 2000 (n = 113)
Group in year 2006 (n = 109)
Gender (%) Male 6Æ2 11Æ0 Female 93Æ8 89Æ0 Age Mean/Median 41Æ7/42 38Æ6/35 SD /Range 8Æ7/23–64 9Æ6/26–64 Specialist-education (%) Yes 49Æ6 33Æ0 No 50Æ4 67Æ0 Preceptor preparation course, 7Æ5 ECTS credits (%) Yes 49Æ6 47Æ7 No 50Æ4 52Æ3 Academic credits in Nursing (%) 30 ECTS 77Æ0 20Æ2 60 13Æ3 29Æ3 90 9Æ7 50Æ5 120 0Æ0 0Æ0 Years as a Registered Nurse Mean/Median 15Æ2/14 11Æ2/8 SD /Range 8Æ9/2–37 9Æ3/1–39 Number of semesters as a personal preceptor Mean/Median 10Æ3/9 8Æ7/6 SD /Range 6Æ9/1–35 7Æ8/1–36 Workplace at the time of data collection (%) Medical/Infection 33Æ6 40Æ4 Surgical/Orthopaedic/ 32Æ8 37Æ6 Gynaecological Emergency/Paediatric 33Æ6 22Æ0 Interested in preceptoring nursing students (%) Very high degree 15Æ2 16Æ7 High degree 50Æ9 39Æ8 Neither high nor 27Æ7 38Æ9 low degree Low degree/Very 6Æ3 4Æ7 low degree
(n) no reply
Comparison between groups
0/0
v2 (1) = 1Æ64, P = 0Æ20
6/3
t = 2Æ45, d.f. = 211, P = 0Æ02
0/0
v2 (1) = 6Æ25, P = 0Æ01
0/0
v2 = 0Æ17, d.f. = 1, P = 0Æ68
0/0
v2 = 74Æ20, d.f. = 2, P < 0Æ001
0/0
t = 3Æ23, d.f. = 219, P = 0Æ001
7/5
t = 1Æ62, d.f. = 209, P = 0Æ11
0/0
v2 = 0Æ16, d.f. = 2, P = 0Æ16
1/1
v2 = 3Æ91, d.f. = 3, P = 0Æ27
ECTS = European Credit Transfer System; 7Æ5 ECTS credits represent 5 weeks of study; 60 ECTS credits represent 1 year of study.
In the 2006 group, nearly all participants reported that they were aware of the demands on a preceptor (92Æ7%) and that they were a role model for the students (95Æ4%). A high proportion reported that they were confident in their ability to offer guidance (84Æ4%) and felt secure in the preceptor role (78Æ0%). Similarly, most considered that working as a preceptor was stimulating (74Æ3%), that they had developed their pedagogical skills (75Æ2%), received required support (56Æ0%) and were given sufficient appreciation (54Æ1%). The greatest improvements between 2000 and 2006 were seen in relation to the latter two items.
Least agreement was seen in relation to the item ‘receiving constructive feedback’ (29Æ4%); however, a statistically significantly greater percentage agreed with this item in 2006 than in 2000.
Experiences of preceptor support Statistically significant differences were observed between the two groups concerning support from teachers (P < 0Æ001), colleagues (P < 0Æ006–0Æ033), chief nurses (P = 0Æ007– 0Æ032), and enrolled nurses (P < 0Æ001–0Æ004) (Table 5).
2008 The Authors. Journal compilation 2008 Blackwell Publishing Ltd
167
K. Hallin and E. Danielson Table 4 Registered Nurses’ experiences of their preceptor preparation
Questionnaire item* Knowing the demands on a preceptor Being a role model for nursing students Being confident in one’s ability to offer guidance Feeling secure in the preceptor role Having a stimulating assignment Developing one’s pedagogical skills Receiving required support Receiving sufficient appreciation Receiving constructive feedback
Group in year 2000 (n = 113)
Group in year 2006 (n = 109)
No reply
(%) Agree totally/ Agree in part
(%) Agree totally/ Agree in part
n
Z
72Æ6 68Æ1 74Æ4
92Æ7 95Æ4 84Æ4
0/2 5/1 1/1
3Æ26 2Æ66 2Æ10
0Æ001 0Æ008 0Æ036
75Æ2 68Æ1 62Æ8 23Æ0 21Æ3 8Æ8
78Æ0 74Æ3 75Æ2 56Æ0 54Æ1 29Æ4
2/2 1/2 0/1 5/1 4/1 4/2
0Æ93 1Æ43 3Æ30 5Æ59 5Æ36 4Æ63
0Æ35 0Æ15 0Æ001 <0Æ001 <0Æ001 <0Æ001
P value Asymp. Sig. (two-tailed)
*Items with Likert-scales: Agree totally, agree in part, disagree in part, disagree totally. Z-transformation of the U score (Mann–Whitney U-test).
Ratings of support from the teachers increased statistically significantly for all six investigated items, and more than half of the 2006 group experienced very good/good support in evaluating nursing students. Less than half of the participants rated other aspects of support as very good/ good and 1–12% experienced the support from teachers poor or very poor. Only 14Æ7% considered that support in linking research results to practical situations was very good/good. Most preceptors rated support from colleagues as very good/good and a statistically significant increase was found in three of the four items comprising this scale. High ratings in the 2006 group regarded support in problem-solving (73Æ4%), appreciation of the time required by preceptor duties (61Æ5%), support in redistributing tasks (55Æ1%) and reducing workload (36Æ7%). A smaller percentage of participants considered that support from chief nurses and enrolled nurses were very good/good. A relatively high proportion of the preceptors had no opinion on any of the items except support from colleagues. Ratings on the three items added to the questionnaire in 2006 (n = 109) indicated that 69Æ7% had participated in at least one workshop, while 30Æ3% had never participated. More than a third (38Æ5%) read guidelines to a very high/ high degree, 35Æ8% read them moderately, 23Æ0% read them to a low/very low degree and 2Æ8% did not answer. A quarter (26Æ6%) read students’ evaluations to a very high/ high degree, 22Æ0% read them moderately, 37Æ6% read them to a low/very low degree, 11Æ0% had no opinion and 2Æ8% did not answer. 168
Relations between RNs’ experiences of preceptoring and their characteristics In both the 2000 and 2006 groups, strong positive correlations existed between the preceptors’ level of interest in preceptoring and all nine of the preceptor preparation/ support variables (rs = 0Æ21–0Æ71, P = 0Æ030–<0Æ001). A number of statistically significant correlations were found between other participant characteristics and preceptor preparation/support variables (Table 6). Preceptors who had taken the preceptor course differed statistically significantly from those who had not regarding two items. The majority in both groups who had taken the course were aware of the demands on a preceptor (v2 = 7Æ77, d.f. = 2, P = 0Æ021, v2 = 9Æ64, d.f. = 2, P = 0Æ008) and more preceptors in the 2006 group felt secure in the preceptor role (v2 = 10Æ025, d.f. = 2, P = 0Æ007). In the 2006 group, years as an RN and number of semesters as a personal preceptor were positively related to awareness of the demands on a preceptor (rs = 0Æ22, P = 0Æ03), being a role model for nursing students (rs = 0Æ20, P = 0Æ04, rs = 0Æ31, P = 0Æ002), being confident in one’s ability to offer guidance (rs = 0Æ22, P = 0Æ05, rs = 0Æ24, P = 0Æ01), and feeling secure in the preceptor role (rs = 0Æ30, P = 0Æ002, rs = 0Æ30, P = 0Æ002). In the 2006 group, more of those with at least eight semesters as a personal preceptor (v2 = 6Æ95, d.f. = 2, P = 0Æ03) and those with at least 5 years experience an RN (v2 = 15Æ18, d.f. = 4, P = 0Æ004) reported feeling secure. Specialist education and academic credits in nursing seemed to be of less importance
2008 The Authors. Journal compilation 2008 Blackwell Publishing Ltd
JAN: ORIGINAL RESEARCH
Being a personal preceptor for nursing students
Table 5 Preceptors’ experiences of support from teachers, hospital colleagues, chief nurses and enrolled nurses in hospital Group in year 2000 (n = 113)
Questionnaire item* Support from teachers concerning Evaluating nursing students Discussing levels of clinical education Discussing principals of preceptoring Linking theoretical knowledge to nursing situations Developing nursing students’ personal characteristics Linking research results to practical nursing Support from colleagues concerning Receiving assistance in problem-solving Being met with understanding that it is time-consuming to precept Redistributing tasks to cover nursing students’ needs Reducing workload Support from chief nurse concerning Receiving assistance in problem-solving Being met with understanding that it is time consuming to precept Redistributing tasks to cover nursing students’ needs Reducing workload Support from enrolled nurses concerning Receiving assistance in problem-solving Being met with understanding that it is time consuming to precept Redistributing tasks to cover nursing students’ needs Reducing workload
Group in year 2006 (n = 109)
(%) Very good/ good
(n) No opinion/ no reply
(%) Very good/ good
(n) No opinion/ no reply
Z
P value Asymp. Sig. (two-tailed)
17Æ7 17Æ7 20Æ4 8Æ0 12Æ4 2Æ7
11/3 12/1 13/1 13/2 16/2 26/1
51Æ3 43Æ2 39Æ5 37Æ6 36Æ7 14Æ7
10/3 13/3 13/3 16/3 16/3 22/5
6Æ79 5Æ67 5Æ73 6Æ72 6Æ03 4Æ97
<0Æ001 <0Æ001 <0Æ001 <0Æ001 <0Æ001 <0Æ001
60Æ0 53Æ1
6/0 2/0
73Æ4 61Æ5
3/1 0/0
2Æ74 1Æ07
0Æ006 0Æ29
41Æ6
4/0
55Æ1
1/1
2Æ13
0Æ033
28Æ3
5/0
36Æ7
2/1
2Æ61
0Æ009
24Æ8 24Æ8
35/2 15/0
41Æ3 37Æ7
23/3 4/2
2Æ68 1Æ55
0Æ007 0Æ12
11Æ5
21/1
22Æ0
11/2
2Æ14
0Æ032
7Æ1
15/0
13Æ8
6/2
2Æ51
0Æ012
22Æ1 24Æ8
21/3 6/2
38Æ6 33Æ9
17/1 3/0
2Æ94 2Æ87
0Æ003 0Æ004
18Æ5
13/2
38Æ5
4/1
2Æ89
0Æ004
15Æ9
12/2
31Æ2
5/1
3Æ53
<0Æ001
*Items with Likert-scales: very good, good, fairly good, poor, very poor, no opinion. Z-transformation of the U score (Mann–Whitney U-test).
for preceptors’ experiences of being prepared and feeling supported. Overall, few relationships were found between RNs’ characteristics and their ratings of items on working as a preceptor being stimulating, receiving required support, sufficient appreciation and constructive feedback.
Discussion Study limitations Our initial intention was to follow the experiences of each RN, but high staff turnover at the hospital units made this unfeasible. However, the 6-year period between the two data collections was necessary to recruit sufficiently-skilled head preceptors and to deploy internal and external network
support. The questionnaire in 2006 lacked items on support from head preceptors. As a result, respondents were only able to rate support as either support from colleagues (Table 5) or as non-existent. Relatively high percentages of preceptors chose the response choice ‘no opinion’ for items experiences of support (Table 5). Conceivably, preceptors either thought that they did not need support or were unaware that support was available. About 30% in the two groups did not participate, and it may be that the most enthusiastic preceptors returned the questionnaire. RNs with fewer than two preceptorships were excluded, but this category of preceptors constitutes an interesting target for further studies. Participants were recruited from a single hospital, were not randomly selected and no control group was used; hence, our findings should be interpreted with caution. Moreover, the
2008 The Authors. Journal compilation 2008 Blackwell Publishing Ltd
169
K. Hallin and E. Danielson Table 6 Comparisons between the 2000 and 2006 preceptor groups: differences and correlations between Registered Nurses’ experiences of preceptor preparation/support and their characteristics Independent variables
Group in year and number of replies Age 2000 Dependent variables Likert-scales: 1 = Disagree 2006 totally, 4 = Agree totally Knowing the demands on a preceptor Being a role model for nursing students Being confident in one’s ability to offer guidance Feeling secure in the preceptor role Having a stimulating assignment Developing one’s pedagogical skills Receiving required support Receiving sufficient appreciation Receiving constructive feedback
2000 2006 2000 2006 2000 2006 2000 2006 2000 2006 2000 2006 2000 2006 2000 2006 2000 2006
Number of Years as a semesters as Registered personal Specialist Nurse preceptor -education
n = 107 n = 112 n = 106 n = 109 rs rs (n (n (n (n (n (n (n (n (n (n (n (n (n (n (n (n (n (n
= = = = = = = = = = = = = = = = = =
113) 107) 108) 108) 112) 108) 111) 107) 112) 107) 113) 108) 108) 108) 109) 108) 109) 107)
0Æ05 0Æ07 0Æ14 0Æ06 0Æ17 0Æ06 0Æ08 0Æ19 0Æ06 0Æ00 0Æ24* 0Æ22* 0Æ04 0Æ06 0Æ03 0Æ09 0Æ00 0Æ10
0Æ03 0Æ12 0Æ08 0Æ20* 0Æ05 0Æ22* 0Æ08 0Æ30** 0Æ16 0Æ05 0Æ17 0Æ17 0Æ09 0Æ11 0Æ07 0Æ11 0Æ03 0Æ03
n = 107 n = 109 rs 0Æ08 0Æ22* 0Æ09 0Æ31** 0Æ07 0Æ24* 0Æ21* 0Æ30*** 0Æ14 0Æ12 0Æ10 0Æ11 0Æ03 0Æ00 0Æ02 0Æ13 0Æ07 0Æ04
Preceptor preparation course
Academic credits in Interested in Nursing preceptoring
n = 113 n = 113 n = 113 n = 109 n = 109 n = 109 P value for v2 P value for v2 rs
n = 112 n = 109 rs
0Æ14 0Æ61 0Æ50 0Æ49 0Æ69 0Æ16 0Æ78 0Æ51 0Æ52 0Æ27 0Æ09 0Æ007** 0Æ49 0Æ21 0Æ92 0Æ99 0Æ36 0Æ05
0Æ24* 0Æ53*** 0Æ21* 0Æ42*** 0Æ26** 0Æ39*** 0Æ46*** 0Æ49*** 0Æ53*** 0Æ71*** 0Æ35*** 0Æ47*** 0Æ24* 0Æ25** 0Æ22* 0Æ34*** 0Æ23* 0Æ44***
0Æ021* 0Æ008** 0Æ84 0Æ39 0Æ69 0Æ91 0Æ07 0Æ007** 0Æ64 0Æ09 0Æ16 0Æ77 0Æ83 0Æ78 0Æ44 0Æ43 0Æ36 0Æ25
0Æ12 0Æ10 0Æ12 0Æ05 0Æ08 0Æ14 0Æ25** 0Æ13 0Æ21* 0Æ10 0Æ25** 0Æ17 0Æ01 0Æ05 0Æ04 0Æ10 0Æ03 0Æ21*
Significant relations detected with the Spearman’s rho and the chi-squared test: *P < 0Æ05; **P < 0Æ01; ***P < 0Æ001 (two-tailed). Independent groups in the years 2000 (n = 113) and 2006 (n = 109).
fact that the first author was a clinical teacher in the hospital may have biased our results in the second data collection. However, the relationship to personal preceptors was less prominent after 2003, when the roles of head preceptors and link teachers were developed.
Discussion of results There were some statistically significant differences between the 2000 and 2006 groups regarding personal and clinical characteristics. For example, the educational level was statistically significantly higher in the 2006 group. This was probably because of the fact that a bachelor of nursing degree was not instituted until 1993 in Sweden. The RNs were also younger and had less nursing experience in the 2006 group (Table 3). Reasons for this could be high staff turnover and lack of demand for specialist education in Swedish basic care units. According to our preceptor model, RNs must have at least 2 years’ work experience to qualify as a personal preceptor. This requirement was difficult to meet in medical and surgical units. To recruit and keep experienced staff in all 170
hospital units, only specialist nurses should be offered permanent tenure. Experiences of preceptor preparation Our results show that the RNs felt statistically significantly more prepared to act as preceptors after the preceptor model had been introduced. Improvements were also noted in relation to most of the other areas investigated (Table 4). For example, we found that most RNs in the 2006 group were aware of the demands on a preceptor, were confident in their ability to precept students and felt secure in the preceptor role. These results suggest that the preceptor preparation programme has been successful. It is also encouraging that, although the fact that the preceptor role is often considered stressful and time-consuming (Yonge et al. 2002b, Hautala et al. 2007), 75% of the RNs stated that it was stimulating. Despite important improvements compared with 2000, only 29% of the RNs in the 2006 group were satisfied with the amount of constructive feedback they received. In spite of the fact that the model encourages reflective learning, preceptors’ need for feedback was apparently neglected. It is of utmost
2008 The Authors. Journal compilation 2008 Blackwell Publishing Ltd
JAN: ORIGINAL RESEARCH
importance that teachers, head preceptors, chief nurses, and co-workers become more attentive to preceptors’ need for feedback, and that preceptors themselves are sensitive to the feedback they do receive. As students are an important source of feedback, it is remarkable that only a quarter of the preceptors in our study often read students’ evaluations. Preceptors in Sweden do not receive financial compensation, but instead are offered the opportunity to attend professional courses. Although preceptors regard continuing education and opportunities to share students’ knowledge as highly valued rewards (Stone & Rowels 2002, Shannon et al. 2006), to be able to redeem these rewards they must be given time off from their normal work. However, it is uncertain how much time preceptors are in fact able to take from their daily work and how well they can make use of the allotted time (4 hours per week of the model). Nevertheless, preceptors’ needs for continuing education and feedback should be highlighted. The more preceptors perceive that the role has benefits and rewards, the more committed they feel to their role (Dibert & Goldenberg 1995, Usher et al. 1999, Hyrkas & Shoemaker 2007). Experiences of preceptor support There were great differences between the two groups regarding perceived support from teachers, colleagues, chief nurses and enrolled nurses. Overall, our results showed statistically significant improvements compared with the year 2000 (Table 5). Greatest support from the teachers was seen in relation to evaluating students. However, the improvements in satisfaction with such support (17–51%) should be considered in the light of the fact that evaluating students has become more demanding (Lofmark & Thorell-Ekstrand 2004) and that preceptors often feel inadequately prepared as evaluator (Coates & Gormley 1997). It may be that much of the improvement in support in our study regarding evaluating students may be ascribed to the three-way (tripartite) meetings held between link teachers, students and preceptors. Link teachers were allocated 3 hours per student, per 8 week period for three-way meetings. According to Watson (2000), preceptors’ feelings of being supported are related to their opportunities to talk to teachers directly. Our preceptors rated links between research and practical nursing situations as poor. This result is not encouraging, but nor is it surprising given that nurses are generally uncomfortable with research-based practice (Kajermo et al. 2001, Kuuppelomaki & Tuomi 2005, Danielson & Berntsson 2007). Supporting personal preceptors in making use of research is still one of the most important tasks for clinical teachers and head preceptors. However, we found that 30% of the preceptors had never participated in a workshop, and that
Being a personal preceptor for nursing students
23% used written guidelines to a low/very low degree. Our results are consistent with those of Pulsford et al. (2002), who found that fewer than half of their respondents had attended an update session in the past year, and that 20% had never attended an annual update. Failure to take part in such education programmes may be due to lack of interest or high workload. This disappointing result needs to be further studied to understand its causes better and to suggest relevant solutions. In line with the study by Usher et al. (1999), we found that preceptors reported that they received much support from colleagues, but considerably less from chief nurses and enrolled nurses. Despite co-workers’ understanding that preceptorship is time-consuming, it seemed to be difficult for preceptors to obtain reductions in workloads. In trying to strike a balance between demands for patient care and student preceptoring, most preceptors had to deal with workloads on their own. Time for reflection and research discussions with students is necessary but difficult to arrange ¨ hrling & Hallberg 2001). Resources described in a (O preceptor model do not help preceptors in setting aside time; rather, this is the responsibility of the chief nurse. Relationships between RNs’ experiences of preceptoring and preceptor characteristics We found a positive relationship between preceptors’ experiences of the preceptor role and level of interest in preceptoring (Table 6). This suggests that interest in preceptoring is a basic characteristic of preceptors. As there is scarcity of preceptors and Swedish RNs’ are required to act as preceptors, this shortage may be difficult to overcome. One solution is to have two RNs precepting the same student. As observed in other studies (Landmark et al. 2003, Brammer 2006), an interested and an uninterested preceptor may create different learning opportunities. In the 2006 group, preceptors who had attended the preceptor preparation course differed statistically significantly from those who had not in two important ways. Attendees were more aware of the demands on a preceptor and felt more secure in the preceptor role. Similarly, Grant et al. (1996) and Watson (2000) reported that preceptor preparation courses help nurses to feel more prepared for the role. Although the university in our study required preceptors to take the preceptor preparation course, only half had in reality taken it. This should be taken into consideration by chief nurses and educators. Our 2006 results indicated, in line with Grant et al. (1996), that number of semesters as a personal preceptor was statistically significantly and positively related to preceptors’ feeling prepared for the preceptor role. Few other similarities
2008 The Authors. Journal compilation 2008 Blackwell Publishing Ltd
171
K. Hallin and E. Danielson
What is already known about this topic •
•
Registered Nurses who serve as preceptors have to balance the needs of nursing students with those of seriously ill patients. The preceptor’s role is stimulating and challenging, but also stressful and time-consuming.
What this paper adds •
•
•
A preceptor model, implemented in a well-developed programme, enhances Registered Nurses’ perceptions of self-preparedness and support for the preceptor role. Despite the existence of a support system, preceptors receive little feedback and limited support in reducing workloads and in linking research to practical nursing. There is a strong positive correlation between preceptors’ experiences of the preceptor role and their level of interest in preceptoring.
Implications for practice and/or policy •
•
A preceptor model is needed that promotes with partnership for facilitating learning environments and is flexible enough to accommodate all kinds of nursing students, nurse preceptors, and teachers. For implementation of the model to be successful, managerial support is needed to ensure that sufficient time is available for preceptoring, both for nursing students and preceptors.
were found in comparisons of our correlation results to results from smaller sample sizes (Dibert & Goldenberg 1995, Usher et al. 1999, Hyrkas & Shoemaker 2007) and with lower response rates (Hyrkas & Shoemaker 2007). The preceptor model The model, with its supporting system and philosophy of education, was successfully developed in different hospital environments over the course of 6 years. Several strengths of the model have been shown. Collaboration between preceptors and teachers enables support to be quickly given to both students and preceptors, and carefully delineated role descriptions have probably prevented conflicts. Head preceptors, in close cooperation with clinical teachers and personal preceptors, play important roles in carrying out pedagogical improvements in each unit; however, high workloads, reorganizations and high staff turnover have hindered progress. Workplaces need to build up high quality learning environments (Bjo¨rkstro¨m et al. 2006, Danielson & 172
Berntsson 2007, Hallin & Danielson 2008) by having staff with talents for problem-solving, critical thinking, and an ability to reflect, experiment and improvize (cf. Dewey 1964, Scho¨n 1987). Despite a number of shortcomings in the support system in our study, the preceptor model implemented has given RNs opportunities to advance into professional preceptors. The collaboration between the university and the hospital has meant that the two can make demands on each other and work jointly to further refine the preceptor model.
Conclusion We recommend a preceptor model with a unique partnership for facilitating learning environments. The model should be flexible enough to accommodate all kinds of nursing students, nurse preceptors and teachers. Attention should be paid to the time available and to the needs of both nursing students and preceptors. However, a preceptor programme, even a well-developed one, takes time to implement and must undergo continuous refinement. Important elements for success will be supporters with a strong interest in collaboration and preceptoring, in addition to the endurance to start afresh again if things do not go as planned. Longitudinal studies, both quantitative and qualitative, are needed to act as signposts for progress and improvements.
Acknowledgement We wish to thank all the Registered Nurses who participated in the two data collections.
Funding This study was financially supported by Mid Sweden University.
Author contributions KH and ED were responsible for the study conception and design. KH performed the data collection and data analysis, supported by ED. KH and ED were responsible for the drafting of the manuscript. ED made critical revisions to the paper for important intellectual content.
References Andersson-Thorell K., Westlund A. & Athlin E. (1998) Modell med kombinationstja¨nster fo¨r handledning i den kliniska delen av sjuksko¨terskeutbildningen [A Model with Joint Appointments for
2008 The Authors. Journal compilation 2008 Blackwell Publishing Ltd
JAN: ORIGINAL RESEARCH the Clinical Practice Element of Nurse Education]. Ja¨mtlands la¨ns ¨ stersund (In landsting [The County Council of Ja¨mtland], O Swedish). Baxter P. (2007) The CCARE model of clinical supervision: bridging the theory-practice gap. Nurse Education in Practice 7(2), 103– 111. Bjo¨rkstro¨m M.E., Johansson I.S. & Athlin E.E. (2006) Is the humanistic view of the nurse role still alive – in spite of an academic education? Journal of Advanced Nursing 54(4), 502– 510. Brammer J. (2006) A phenomenographic study of registered nurses’ understanding of their role in student learning – an Australian perspective. International Journal of Nursing Studies 43(8), 963– 973. Epub 19 Dec 2005. Clarke C.L., Gibb C.E. & Ramprogus V. (2003) Clinical learning environments: an evaluation of an inovative role to support preregistration nursing placements. Learning in Health and Social Care 2(2), 105–115. Coates V.E. & Gormley E. (1997) Learning the practice of nursing: views about preceptorship. Nurse Education Today 17(2), 91–98. Danielson E. & Berntsson L. (2007) Registered nurses’ perceptions of educational preparation for professional work and development in their profession. Nurse Education Today 27(8), 900–908. Epub 2 Mar 2007. Dewey J. (1964) John Dewey on Education: Selected Writings. Edited and introduced by Archambault R.D. Random House, Inc., New York, NY. Dibert C. & Goldenberg D. (1995) Preceptors’ perceptions of benefits, rewards, supports and commitment to the preceptor role. Journal of Advanced Nursing 21(6), 1144–1151. Drennan J. (2002) An evaluation of the role of the clinical placement coordinator in nursing student support in the clinical area. Journal of Advanced Nursing 40(4), 475–483. Ehrenberg A.C. & Haggblom M. (2007) Problem-based learning in clinical nursing education: integrating theory and practice. Nurse Education in Practice 7(2), 67–74. Epub 6 Jan 2006. Fulton J., Bohler A., Hansen G.S., Kauffeldt A., Welander E., Santos M.R., Thorarinsdottir K. & Ziarko E. (2007) Mentorship: an international perspective. Nurse Education in Practice 7(6), 399– 406. Epub 20 Feb 2007. Grant E., Ives G., Raybould J. & O’Shea M. (1996) Clinical nurses as teachers of nursing students. Australian Journal of Advanced Nursing 14(2), 24–30. Haggman-Laitila A., Eriksson E., Meretoja R., Sillanpaa K. & Rekola L. (2007) Nursing students in clinical practice – developing a model for clinical supervision. Nurse Education in Practice 7(6), 381–391. Epub 17 Jan 2007. Hallin K. & Danielson E. (2008) Registered Nurses’ perceptions of their work and professional development. Journal of Advanced Nursing 61(1), 62–70. Epub 22 Nov 2007. Hautala K.T., Saylor C.R. & O’Leary-Kelley C. (2007) Nurses’ perceptions of stress and support in the preceptor role. Journal for Nurses in Staff Development 23(2), 64–70. Hutchings A., Williamson G.R. & Humphreys A. (2005) Supporting learners in clinical practice: capacity issues. Journal of Clinical Nursing 14(8), 945–955. Hyrkas K. & Shoemaker M. (2007) Changes in the preceptor role: re-visiting preceptors’ perceptions of benefits, rewards, support
Being a personal preceptor for nursing students and commitment to the role. Journal of Advanced Nursing 60(5), 513–524. Jowett R. & McMullan M. (2007) Learning in practice – practice educator role. Nurse Education in Practice 7(4), 266–271. Epub 24 Oct 2006. Kajermo K.N., Nordstrom G., Krusebrant A. & Lutzen K. (2001) Nurses’ experiences of research utilization within the framework of an educational programme. Journal of Clinical Nursing 10(5), 671–681. Kuuppelomaki M. & Tuomi J. (2005) Finnish nurses’ attitudes towards nursing research and related factors. International Journal of Nursing Studies 42(2), 187–196. Landmark B.T., Hansen G.S., Bjones I. & Bohler A. (2003) Clinical supervision – factors defined by nurses as influential upon the development of competence and skills in supervision. Journal of Clinical Nursing 12(6), 834–841. Lofmark A. & Thorell-Ekstrand I. (2000) Evaluation by nurses and students of a new assessment form for clinical nursing education. Scandinavian Journal of Caring Sciences 14(2), 89–96. Lofmark A. & Thorell-Ekstrand I. (2004) An assessment form for clinical nursing education: a Delphi study. Journal of Advanced Nursing 48(3), 291–298. Luhanga F., Yonge O. & Myrick F. (2008) Precepting an unsafe student: the role of the faculty. Nurse Education Today 28(2), 227–231. Epub 5 Jun 2007. Magnusson C., O’Driscoll M. & Smith P. (2007) New roles to support practice learning – can they facilitate expansion of placement capacity? Nurse Education Today 27(6), 643–650. Epub 28 Nov 2006. ¨ hrling K. & Hallberg I.R. (2001) The meaning of preceptorship: O nurses’ lived experience of being a preceptor. Journal of Advanced Nursing 33(4), 530–540. Polit D.F. & Beck C.T. (2004) Nursing Research: Principles and Methods, 7th edn. Lippincott Williams & Wilkins, Philadelphia, PA. Pulsford D., Boit K. & Owen S. (2002) Are mentors ready to make a difference? a survey of mentors’ attitudes towards nurse education. Nurse Education Today 22(6), 439–446. Scho¨n D. (1987) Educating the Reflective Practitioner. Jossey-Bass, San Francisco, CA. Severinsson E.I. (1998) Bridging the gap between theory and practice: a supervision programme for nursing students. Journal of Advanced Nursing 27(6), 1269–1277. Shannon S.J., Walker-Jeffreys M., Newbury J.W., Cayetano T., Brown K. & Petkov J. (2006) Rural clinician opinion on being a preceptor. Rural Remote Health 6(1), 490 (electronic). Epub 23 Feb 2006. Stevenson B., Doorley J., Moddeman G. & Benson-Landau M. (1995) The preceptor experience: a qualitative study of perceptions of nurse preceptors regarding the preceptor role. Journal for Nurses in Staff Development 11(3), 160–165. Stone C.L. & Rowels C.J. (2002) What rewards do clinical preceptors in nursing think are important? Journal for Nurses in Staff Development 18(3), 162–166. Usher K., Nolan C., Reser P., Owens J. & Tollefson J. (1999) An exploration of the preceptor role: preceptors’ perceptions of benefits, rewards, supports and commitment to the preceptor role. Journal of Advanced Nursing 29(2), 506–514.
2008 The Authors. Journal compilation 2008 Blackwell Publishing Ltd
173
K. Hallin and E. Danielson Watson S. (2000) The support that mentors receive in the clinical setting. Nurse Education Today 20(7), 585–592. Yonge O., Krahn H., Trojan L., Reid D. & Haase M. (2002a) Supporting preceptors. Journal for Nurses in Staff Development 18(2), 73–77. Yonge O., Krahn H., Trojan L., Reid D. & Haase M. (2002b) Being a preceptor is stressful! Journal for Nurses in Staff Development 18(1), 22–27.
Yonge O., Billay D., Myrick F. & Luhanga F. (2007) Preceptorship and mentorship: not merely a matter of semantics. International Journal of Nursing Education Scholarship 4(1), article 19. Retrieved from http://www.bepress.com/ijnes/vol4/iss1/art19 on 10 November 2008.
The Journal of Advanced Nursing (JAN) is an international, peer-reviewed, scientific journal. JAN contributes to the advancement of evidence-based nursing, midwifery and health care by disseminating high quality research and scholarship of contemporary relevance and with potential to advance knowledge for practice, education, management or policy. JAN publishes research reviews, original research reports and methodological and theoretical papers. For further information, please visit the journal web-site: http://www.journalofadvancednursing.com
174
2008 The Authors. Journal compilation 2008 Blackwell Publishing Ltd
