We Don't Miter the Sheets on the Bed: Understanding the Preceptor Role in Nursing Enculturation

Background:  Many studies examine the role of preceptors with students in pre-licensure clinical immersion experiences and how that impacts student socialization to the role of the nurse and the transition from academe to the practice world (Carlson, Pilhammar, & Wann-Hansson, 2010; Dinmohammadi, Peyrovi, & Mehrdad, 2013).  However, students still struggle with this transition to practice and the unique nursing culture (Clipper & Cherry, 2015; Dinmohammadi, Peyrovi, & Mehrdad, 2013).   Research literature supports that nursing has a distinct professional culture yet research on the beliefs of preceptors foundational to their interactions with students is lacking (Hegenbarth, Rawe, Murray, Arnaert, & Chambers-Evans 2015) The majority of research studies on the culture of nursing have been conducted outside of the United States, thus limiting its application in the United States unique health care and educational systems.  Viewing socialization as enculturation to the professional culture and exploring perceptions of nursing culture in the United States is one way of examining this struggle and possible solutions. 

Aim:  The purpose of this study is to gain knowledge and make more explicit the tacit dimensions of preceptors’ perceptions of the culture of nursing and their role in bringing students into that professional culture.  Making preceptors’ perceptions of the professional culture of nursing more explicit facilitates discussion on a more deliberate enculturation process by both preceptors and nursing faculty.  This knowledge will benefit nursing faculty and preceptors to better assist students as they prepare to transition from academia to practice.  A smoother transition from academia to practice can help decrease the practice-education gap.  It will also help decrease the culture shock experienced by new nursing graduates which contributes to high turnover and attrition rates that negatively impact both the new graduates and health care organizations (Clipper & Cherry, 2015).

 Methods: The research design for this study is focused ethnography.   Seventeen BSN prepared registered nurses from five hospitals who have served as a preceptor for a pre-licensure nursing student participated in a semi-structured interview examining the preceptors’ perceptions about the culture of nursing and their role in bringing students into that culture.  The interviews were audio-taped and transcribed verbatim. These transcripts served as the data for this study, and were analyzed using Leininger’s four phases of data analysis.

 Results:  Four themes emerged during data analysis. These themes are 1. Nursing students are part of the unique, dynamic and professional culture of nursing.  2.  There are multifaceted influences to the culture of nursing. 3.  Preceptors help nursing students learn the manifest culture as opposed to the ideal aspects of the culture taught in school.  4.  Nursing students and preceptors mutually benefit from preceptor mentorship and role modeling

 Conclusions:  This study confirms the valuable role of the preceptor in guiding pre-licensure nursing students in the transition to practice and the culture of nursing.  Preceptors agree that there is a unique nursing culture.  However the culture is difficult to define and is influenced by many different facets.  Preceptors follow a process to help students learn the culture of nursing but the processes vary.  They help the students learn the “real world” of nursing, which is often in opposition to what the students learn in school from nursing faculty.  Preceptors serve as both role models and mentors to student nurses, and benefit from working with students.  To help decrease the practice-academia gap, nursing faculty and preceptors need to work together to decrease the stress and anxiety experienced by students as they transition between the two subcultures of academe and practice.  This includes developing a shared definition of the culture of nursing, and helping students learn how to navigate and understand the differences between subcultures within the common culture of nursing.  Strategies such as nurse residency programs and the National Council of State Boards of Nursing  Transition to Practice Model can also assist with the enculturation process (Robert Wood Johnson, 2014).   This study adds another layer of understanding in how students learn the culture of nursing.  Future grounded theory work on this topic will provide a foundation for the processes involved in both practice and academia as students learn the culture of nursing.