Exploring Perceptions of Staff Registered Nurse Preceptors for Undergraduate, Pre-Licensure Nursing Students

Purpose:

The purpose of this study was to explore staff nurse experiences as preceptors to undergraduate, pre-licensure nursing students.  Three areas of emphasis were explored: RN perceptions of preparation for the preceptor role, support in the preceptor role, and understanding the preceptor role. 

Methods:

A naturalistic inquiry within an interpretive paradigm guided this qualitative exploratory study. Nine licensed registered staff nurses with experience as preceptors in tertiary care settings in Northeast Tennessee, USA attended one of two focus group sessions lasting between 60-90 minutes each.  A semi-structured interview guide assisted the researcher in data collection.  Transcripts were analyzed using conventional content analysis. Constant comparison, intercoder agreement, member checking, and data triangulation supported reliability and validity.  

Results:

Categories and sub-categories were derived from each area of emphasis. 

Preparation for the role.  Preceptors viewed preparation for the role as a formal process consisting of an educational class with a focus on teaching and learning styles, but did not perceive this class as essential for role preparation.  Only one category was identified: “Teaching and learning styles: ‘It keeps me grounded’”. Preceptors indicated that understanding teaching and learning styles aided their ability to reflect on their practices and practices of co-workers who were precepting students, and intervene to improve student learning when necessary. 

Support in the role.  Preceptors described support in the role as a three-prong system, sought and received in variable amounts from RN co-workers, faculty, and nurse managers.  Nurse manager support was both the least perceived and least sought or expected.  Preceptors reported recruitment of graduating nurses as one of their role functions originating from perceived expectations of their nurse managers.  Manager support was categorized as “They picked me” with the sub-categories “Being selected to serve” and “Preparing for student arrival”.  Faculty support was perceived as mostly positive and was categorized as “It’s there if we need it” with the subcategories “Invisible presence”, “Lack of time”, and “Feeling validated or invalidated”.  Co-worker support was the most perceived and most sought.  Co-worker support was categorized as “We are a team” and included the sub-categories “Sharing responsibility for the preceptee” and “Problem-solving”.  

Understanding the role.  The primary category related to the preceptors’ understanding of the role was “Motivation to serve: ‘It’s how I want to be treated’”.  Preceptors’ motivation to precept emanated from a strong empathetic drive.  

Additionally, one primary role function and two secondary role functions were identified as categories.  Protector was the primary role function characterized by a strong empathetic drive to protect students, patients, their professional identities, and the nature of nursing.  There are two sub-categories included in the Protector function: “Protecting the student: ‘Take ‘em under my wing’” and “Protecting the profession: ‘Nobody knows everything’”.  As protectors, preceptors assumed responsibility for and nurtured the student’s professional and personal growth.  They also engaged in behaviors in and out of preceptorship experiences to ensure high standards of nursing care were met and maintained, including assessment of student motivation and attitude.   Preceptors perceived students with overconfident or resistant attitudes as incongruent with their own professional qualities and as unsafe; they would intervene in an attempt to protect their professional identities and the core values of nursing. 

Socializer and Teacher were identified as secondary role functions and are embedded within the Protector role function.  Sub-categories in the Socializer function include “Helping the student: ‘Let me’” and “Integrating the student: ‘We didn’t mesh’”.  These behaviors aimed to support the student’s professional role development.  Sub-categories in the Teacher function include: “Searching for time: ‘We’re tryin’ to do the best we can’”, “Making assessments: ‘You have to evaluate each person’” and “Making adjustments: ‘I’m pushing and pulling’”.  Preceptors reported frustration with the lack of time for teaching and described assessment as an iterative process influencing the way they interacted with and adjusted their precepting of students.  Adjusting was described as an active process requiring significant energy on the part of the preceptor, with the expectation that the student should also actively engage.  Preceptors described the process of teaching as invigorating or overwhelming depending on the response of the student and used the terms “pushing” and “pulling” to describe activities associated with making adjustments to their teaching.     

Conclusion:

Results indicate the role of preceptor, including functions and expectations, is still not fully understood across the boundaries of practice and education.  Findings suggest that nurse preceptors may require less preparation in the shape of formal didactic presentation and more support through collaborative efforts. 

A new finding is the perceived support from nurse managers in preparing staff for the arrival of students as potential employees. The perceived expectation of recruiting graduating students is also new.  This suggests that nurse managers may have a more in-depth connection to preceptorships than previously thought.  Role expectations should be clear as role overload, role conflict, and role ambiguity are international preceptor concerns (Omansky, 2010).  Integrating findings of role functions into role expectations for preceptors may help further the development of their professional identities.  Findings also suggest that there are other benefits to precepting than what has previously been identified in the nursing literature, such as professional development, recognition, or monetary incentives (Carlson, Pilhammar, & Wann-Hansson, 2010a).  A new finding is the idea of preceptor as protector of self and professional ethos.  This is relatively unexplored in the preceptorship literature. 

Implications for further research include the generation of new knowledge around the importance of manager support for preceptors of pre-licensure students, and deeper understanding of the complexity of the preceptor role.  Implications for nursing education include focusing on issues regarding students’ professional attitudes.  Methods to assess attitudes and development of professional qualities must be clear.  Nursing faculty should ensure that affective outcomes are receiving adequate attention.  It is imperative that faculty review clinical evaluation tools with preceptors so that all areas of the tool are understood and areas of confusion are clarified prior to the preceptorship experience.