Effect of Preceptorship Characteristics on Safe Medication Administration Knowledge and Self-Confidence of Senior BSN Students

Preceptorships have become a common model of clinical instruction in undergraduate nursing education; however, best practices or uniform guidelines for use of this model have not been established and should be examined (Lewallen, DeBrew, and Stump, 2014). Preceptorships occur in increasingly complex health care environments with nurses caring for patients with higher acuity in changing staffing models (Zawaduk, Healey-Ogden, Farrell, Lyall, and Taylor, 2014). Nurse educators have the responsibility to prepare students to begin their nursing career in this complex environment with the ability to practice safe nursing care, including the essential component of accurate medication administration. Nursing faculty, in collaboration with nurse preceptors, should facilitate senior nursing students’ knowledge of safe medication management and error avoidance.

An IRB approved pretest-posttest quasi-experimental study of 28 senior BSN students investigated student knowledge and self-confidence of safe medication administration in the context of preceptorships and use of a researcher-developed brief clinical medication workbook given to all study participants. This presentation would explore the results and implications of one of the research questions from this study: whether a 72 hour preceptorship or a 150 hour preceptorship increased student safe medication administration self-confidence and knowledge. Students in the 72 hour preceptorship scored higher on the Safe Medication Administration (SAM) Scale (Ryan, 2007) and a modified NLN Student Satisfaction and Self-Confidence in Learning Questionnaire, SSSCL-SAM.

Mixed design ANOVA data analysis revealed a significant time x semester interaction when total SAM scores were compared between students in the 72 and 150 hour preceptorships. Posttest scores were higher for students in the 72 hour clinical more so than students in the 150 hour clinical An analysis of the SAM Scale divided by the five medication right subscales showed no significant difference in means for Right Person, Right Drug, Right Dose, or Right Route. A significant time x semester interaction and main effect for time (pretest to posttest) was discovered for the subscale Right Time. Student scores in the 72 hour preceptorship increased over time while Right Time knowledge scores in the 150 hour preceptorship students decreased over time.

When the 72 hour and 150 hour preceptorship student SSSCL-SAM (total) scores were compared, a significant main effect for semester with a small effect size was found; 72 hour preceptorship scores were higher than 150 hour preceptorship scores. When comparing SSSCL-SAM subscales, a significant main effect for semester on learning satisfaction was noted with a medium effect size: 72 hour preceptorship scores were higher than 150 hour preceptorship scores. SSSCL-SAM self-confidence subscale analysis revealed a significant time x semester interaction with a small effect; 72 hour preceptorship scores were higher and increased over time while 150 hour preceptorship scores decreased over time.

These findings prompted an inquiry into possible reasons for the outcome. In contrast to the 150 hour capstone preceptorship, use of consistent preceptors was identified as an attribute of the 72 hour critical care preceptorship. A further literature search on consistency and related preceptorship characteristics was carried out.

The effect of the length of preceptorships has been reported in the literature. A study revealed no significant difference in the “clinical knowledge, technical skills, critical thinking, communication, professionalism, management responsibilities, and overall performance” (Kumm, Godfrey, Richards, Hulen, and Ray, 2016, p. 149) of senior nursing students in an 8 week or 16 week senior immersion experience. Another study (Moran, Hansen, and Schweiss, 2018), revealed no difference in “self-efficacy, clinical knowledge, or clinical confidence” between students in senior practicums lasting less than or greater than 150 hours in length (range 80 to 156 hours). Regardless of clinical model used, important factors for clinical experiences include the “centrality of professional relationships, need for consistency and continuity in clinical education delivery, the opportunity for varied clinical education/supervision models and ensuring the viability of the model to function as designed.” (Forber, et al, 2016, p. 90).

Nursing faculty should work to provide the positive clinical environment students desire in preceptorships and ensure that student learning is constructivist in nature and promotes competent nursing practice (Phillips, Mathew, Aktan, & Catano, 2017). Preceptors provide students with guidance and feedback related to safe nursing practice and facilitate positive relationship connections and learning opportunities (Trede, Sutton, and Bernoth, 2016). Availability of trained preceptors is a challenge for faculty when placing students in preceptorships (Nash & Flowers, 2017). Taking into consideration the effect of continuity in preceptorships is part of an educator’s fostering of the triad student-faculty-preceptor relationships (Zawaduk, Healey-Ogden, Farrell, Lyall, and Taylor, 2014). Assigning a student with a team of two preceptors may be beneficial (Smith and Clark, 2016). “Although it may not always be possible to have the student work with only one or two staff members, consistency is important… more than two preceptors can potentially result in a negative experience for both the student and staff.” (Smith and Clarke, 2016, p. 12).

In relation to safe medication knowledge and management, there are additional factors that may affect students in preceptorships. Inconsistencies in preceptor medication administration practices and interpretation of related policies, protocols, and procedures have been observed by novice nurses (Harris, 2014). In addition, preceptor training does not usually address strategies to reduce medication errors (Harris, 2014). It is known that medication errors continue to occur at unacceptable rates with potential serious clinical and financial harm (Institute of Medicine, 2006). Educators should design clinical experiences that provide opportunities for optimal learning of essential nursing knowledge. Further investigation into factors that affect safe medication self-confidence and knowledge of senior nursing students in preceptorships is needed.