Preceptorship: a ‘three-way’ relationship

1 November 2013

Is preceptorship working well for nurses, students and tutors? DAVID MITCHELL’s* reports on his research team’s work looking at preceptorshop of nursing students from the view of all three parties involved.

Preceptors feel at risk, students feel vulnerable, and educators feel like visitors according to our research project into clinical preceptorship.

This project provided the opportunity for our research team to identify the experiences and insights of the three groups directly involved in supporting nursing students in clinical practice – preceptors, educators, and students. As educators ourselves, we were particularly interested in this topic as the literature commonly explores the ‘two-way’ relationship between the preceptor and student, not what is essentially a ‘three-way’ relationship.

We wanted to develop a sense of how these groups worked together (or not), what was going well, and what areas of difficulty might exist. Additionally, we thought that presenting the research results to the three groups at the end of the project would provide a basis for discussion and possible movement towards a greater sense of partnership in the educational, preceptor and student relationship.

Essentially, the findings would encourage those involved to think about and discuss their respective roles. We believed this to be an exciting prospect.

We used focus groups as the primary method of data collection with each group having up to ten students, preceptors, or educators. The main limitation of this qualitative approach is that generalising the findings to a wider population should only be attempted with extreme caution, if attempted at all. A strength of this approach is in the credibility and authenticity of the findings as it is the participants’ experience in their respective roles that is being reported.

While the results in the main tended to reflect what was already known about the subject, themes emerged from each of the groups that were of particular interest.

Student ‘vulnerability’

While feeling well supported in the main the students described in considerable detail their sense of ‘vulnerability’. They described their sense of being under scrutiny at a time when they were lacking in confidence in an environment that was new to them. Of particular concern was their description of several examples of what could best be described as rudeness or dismissive behavior towards them by those in the clinical environment.

While this area has been clearly identified and extensively discussed, what the participants here added was that they believed themselves powerless to do anything about these situations. The students also identified this area as the most important factor affecting their practice yet it was the area they believed they had the least control over.

 

 

“It’s about getting on with people, and if you are there to care about people and care about your patients, why aren’t you caring about each other. Care about your student, care about your preceptor, why compartmentalise caring and treat your student like s*** and then be ‘oh so sweet’ to the clients.”

 

Student participant

Preceptors face tension

While describing a range of positive experiences the preceptors also described the inherent risk to their practice in mentoring a student. The preceptors were very aware of the tension between the potential risk to their clients and providing a sound learning opportunity for the student. This was especially evident in the decisions involved in gradually allowing the students more independence.

The preceptors described the extra challenge to an often demanding workload with supporting a student to take more responsibility in caring for their clients. How do you work with this tension especially with little recognition or resourcing of the extra responsibility and time involved in preceptoring? The clinicians felt this tension acutely.

“[Preceptoring] makes a difference to your patient workload and the amount of staff they’ve got on. If you’ve got a student and you’re short-staffed and you’ve got all that, then it can be stressful at times.”

 

Preceptor participant

Educators feel like ‘outsiders’

While the educators talked of the professionally rewarding aspects of their role they also described feeling like a visitor in clinical areas. They felt that the opportunity to effectively carry out their role, as the person responsible for overall assessment of student progress, was often compromised to some degree especially in busy clinical environments. Examples of these situations included finding suitable times to meet with both preceptors and students, having access to appropriate areas for discussion, and managing to sustain effective communication with differing preceptors.

“You do want [to meet in] the unit where they’re working otherwise you start to see students separately from the practice area. I don’t find that very good either. I quite like to be able to be part of [the clinical area] and then take them aside or vice versa or whatever order suits.”

 

Educator participant

These three themes reflected the major points of difference between each of the groups. In contrast one theme common to all groups was that of the value of preceptor education.

Preceptors, educators and students all identified that completing a preceptor course lead to a noticeable difference in the level of support these preceptors were able to offer to students. While there were exceptions, these preceptors were consistently more positive, focused and engaged with the students than others.

While many, perhaps most, of the findings of this project were predictable or known, the project itself was an excellent example of how a small, relatively inexpensive process provided useful and credible information on which to base discussion on the future focusing of support for nursing students in the local clinical environment.

*David Mitchell is a senior academic at NMIT’s school of nursing.