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Evaluating the preceptor role for pre-registration nursing and midwifery student clinical education
Nurse Education Today 34 (2014) 19–24
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Evaluating the preceptor role for pre-registration nursing and midwifery student clinical education☆,☆☆ Anthony O'Brien a, 1, Michelle Giles a,⁎, Shane Dempsey b, Slater Lynne c, Michelle E. McGregor d, Ashley Kable c, Glenda Parmenter e, Vicki Parker e a Centre for Practice Opportunity and Development (CPOD), Hunter New England Local Health District/The University of Newcastle, Level 3 Education Block, John Hunter Campus, Locked Bag 1, HRMC, Newcastle, NSW 2310, Australia b School of Health Sciences, Faculty of Health, The University of Newcastle, Callaghan, NSW 2308, Australia c School of Nursing and Midwifery, Faculty of Health, University of Newcastle, Callaghan , NSW 2308, Australia d Greater Newcastle Acute Hospital Network (GNAHN), Hunter New England Local Health District, NSW, Australia e School of Health, University of New England (UNE) NSW, Australia
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Article history: Accepted 22 March 2013 Keywords: Nurses/midwives/nursing Preceptors Clinical supervision Teaching and learning Clinical practice
s u m m a r y Aim: The aim of this research is to evaluate the perceptions of the Registered Nurse (RN), Registered Midwife (RM) and Enrolled Nurse (EN) about their experience of preceptoring an undergraduate student within a large Local Health District in New South Wales (NSW) Australia. Background: In the current Health Workforce Australia (HWA) literature, the term ‘Clinical Supervisor’ has subsumed the role of mentor, preceptor, buddy and facilitator of clinical practice. Preceptor in this paper describes the supervisory, facilitating and teaching role of the registered nurse in the clinical practice undergraduate nursing and midwifery educational pairing. Design: A quantitative cross sectional design was used and data collected using the Clinical Preceptor Experience Evaluation Tool (CPEET), a previously validated and reliable survey tool. Method: Nurses and Midwives across nine acute care facilities that preceptor undergraduate students were invited to complete the survey between March and May 2012. Results: There were 337 survey respondents across nine acute hospitals included in this study (22.5% response rate). Differences were observed between preceptors who had training in precepting in three of the subscales. Differences were observed in all four subscales between those preceptors with access to university facilitators in their location and those without immediate access. Conclusion: The majority of preceptors score highly on all subscales indicating they are generally satisfied with the role of precepting. Significant differences on several items suggest that some aspects of the role are more challenging and less satisfying than others. © 2013 Elsevier Ltd. All rights reserved.
Introduction During clinical placement, students convert theory into practice, master the skills that define their particular profession, refine their scope of practice and gain a sense of the social and professional culture of their chosen profession (Health Workforce Australia, 2010, 2011; Health Education and Training Institute, 2012). The Health Workforce Australia's (HWA) (2010) recent review of clinical
☆ “No conflict of interest has been declared by the author(s).” ☆☆ Funding: This Research was funded by a University of Newcastle, NSW, Australia, Teaching and Learning Project Grant. ⁎ Corresponding author. Tel.: +61 249213592; fax: +61 49223290. E-mail addresses: Tony.O'[email protected] (A. O'Brien), [email protected], [email protected] (M. Giles). 1 Tel.: +61 2 4985 5925; fax: +61 2 4922 3290. 0260-6917/$ – see front matter © 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.nedt.2013.03.015
supervision identifies a number of attributes common to the concept of clinical supervision which include, mentoring, precepting, buddying, and accessibility to facilitators, practice educators, and clinical educators. The HWA (2010) Clinical Supervision Support Project discussion paper brings together a comprehensive review of the literature surrounding the attributes of clinical supervision in the context of the functions of clinical supervisors in their relationship with undergraduate health students. This review process has provided some clarity around the importance of effective clinical supervision of undergraduate health students in Australia, and the educational and clinical expectations required during the pairing of a student and a clinical supervisor. With specific reference to nursing and midwifery education and training, the preceptor–preceptee relationship is an integral part of the overarching clinical supervisor relationship, where the clinical supervisor provides a direct oversight of the undergraduate student
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clinical experience (Health Workforce Australia, 2010). It is the preceptor who directly interacts (1:1) with the student at the bedside, or in the clinical facility. Hunter New England Local Health District (HNELHD) The Hunter New England Local Health District (HNELHD) provides care for approximately 840,000 people and covers a geographical area of over 130,000 km. The local health district is divided into eight geographical clusters and employs over 15,000 staff. The HNELHD provides health services to 11.3% of the New South Wales (NSW) population and to 20% of the state's Aboriginal population (NSW Department of Aboriginal Affairs, 2007; HNELHD, 2012). The HNELHD spans 25 local council areas and 32 local government areas. In 2009 (last figures available) nurses across regions in Australia ranged from 997 full-time equivalent nurses per 100,000 head of population in major cities to 1240 in very remote areas. Nurses are also an ageing population with the average age of registered nurses being 50–54 years, as well as being made up of over 80% females (Australian Institute of Health and Welfare, 2012). The number of registered nurses in NSW is currently 64,420 with nearly 14,000 enrolled nurses registered in June 2012. Midwives, in turn, are also ageing (mostly 51–55 years of age) with 12,646 midwives who are also registered as nurses and 370 as midwives only (Nurses and Midwives Board, NMBA, 2012). In relation to research that involves Nurse (includes Enrolled Nurse) and Midwife opinion in HNELHD there has been no previous representative data collected around the preceptor/student clinical placement pairing. HNELHD provides clinical placement opportunities for undergraduate nurses and midwives from 8 tertiary institutions. The Bachelor of Midwifery programme was introduced locally in 2011 and over the past several years there have been large increases in undergraduate nursing intakes at a local university. In 2012 there were over 2500 nursing and midwifery student placements requested in the Tertiary Referral Hospital within the Local Health District (LHD). Numbers across the entire LHD were not available.
an important role in retaining students in nursing (Ainsley and Chapman, 2009; Smedley, 2008) and in assisting learning, closing the theory practice gap and in the development of competencies (Levett-Jones and Lathlean, 2008; Freiburger, 2002). There has been a large volume of research conducted around the preceptor model (Myrick et al., 2010; Roberts, 2009; Queensland Health, 2001) with the major themes involved in preceptorship correlating with the new HWA (2010) definition for clinical supervision. Key features are: • Preceptor-ship serves to bridge the theory — clinical gap, learning occurs in the everyday work environment and it is tailored to the professional context and specific needs of the learner (Williams, 2010; Cope et al., 2000); • Socialization into nursing and health professions and in particular the work culture and community of practice is facilitated by preceptors stewarding the developing professional into their role in clinical practice (Myrick et al., 2010; Roberts, 2009; Queensland Health, 2001; Cope et al., 2000); • Preceptors foster the growth of practical wisdom — that is, the interactive often quasi-educational relationship encourages the ongoing interpretive process of applying principals, evaluating actions, and synthesizing this into workplace activity (Myrick et al., 2010; Cope et al., 2000); and • Preceptorship involves a supportive teaching and learning relationship to promote the transition from a student into an authorised registered health professional (Queensland Health, 2001). Aim The aim of this research was to evaluate HNELHD preceptor perceptions of their preceptor clinical teaching, and learning support role, with undergraduate nursing and midwifery students. Method Data Collection and Recruitment
Literature Review The educational context in clinical settings for undergraduate nursing and midwifery students is multifactorial, varied and complex. A wide range of factors, including variable staffing levels; ageing workforce issues; patient acuity, scope of practice, educational qualifications of the existing and developing workforce; staffing tiers on the wards, patient workload ratios; and case mix, can all affect the preceptor student interpersonal dynamic (Myrick et al., 2010; Roberts, 2009; Queensland Health, 2001; Ainsley and Chapman, 2009; Cope et al., 2000; Levett-Jones and Lathlean, 2008; Smedley, 2008). Hallin and Danielson (2008) explored preceptor experiences before and after the introduction of a preceptorship model and found that even after the introduction of the model, preceptors experienced difficulty in balancing patient care with preceptoring of a student (Yonge et al., 2002). Flanagan and Clarke (2009) and Walker et al. (2008) highlight that the preceptor experiences increased stress and workload, along with a reduction in the time spent with their patients, with little reward when precepting an undergraduate student. In Australia, throughout the process of interaction between the preceptor and the student, the preceptor is often providing feedback to both the student and academic staff from the institution where the student is enrolled. Paton (2009) explains this relationship as a triad between student, preceptor and academic institution. A university facilitator usually provides debriefing with the students around clinical goals and monitors assessment requirements (Burns et al., 2006), however there are a range of models across health professions depending on distances from clinical facility to the enrolling university. The preceptor plays
A descriptive cross-sectional, multisite survey was used to evaluate preceptor opinions in relation to their roles, challenges, experience and satisfaction in supporting undergraduate pre-registration nursing and midwifery students during clinical placement. Participants included Registered Nurses (RNs), Registered Midwives and Enrolled Nurses (ENs). The study was conducted in nine public acute care hospitals in the HNELHD in rural, regional and metropolitan NSW. The sample was recruited between March and May 2012. Ethics approval was obtained from the Hunter New England Human Research Ethics Committee (HNEHREC) as a Low Negligible Risk study in February 2012. The Clinical Preceptor Experience Evaluation Tool (CPEET) was administered to participants to gain insight into their opinions as to the preceptor experience in the workplace The CPEET has been utilised in a number of evaluative studies and has established cross cultural validity and reliability (O'Brien and Bremmer, 2008; Lee Xin Yu, 2011). The four subscales of CPEET measure opinion in relation to the preceptor: Role — relationship between the student and the preceptor, role modelling, participating together in patient care, facilitation of critical reflection and being available to teach the student about case studies and care plans and items about the function and impact of the preceptor role. Satisfaction — finding the time to teach and support the student in clinical practice, being motivated to do so and managing ones time to take on the challenge.
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Experience and Education — enacting the role through others in their work environment and linking the student to clinical practice opportunities. Being with a student encourages the preceptor to stay up to date with the current evidence and to reflect on their own practice. Challenges — being focused on the challenges faced when implementing the role into everyday practice, the rewards related to professional development, changing practice and the preceptor role having meaning and being rewarding, including an incentive to teach and engage the student.
Table 1 Demographic characteristics of the preceptors (N = 337). Characteristic Gender Age
Primary specialty
A seven point Likert scale asked respondents to rate their level of agreement with 39 items related to the four subscales. The Likert scale ranged from 1 — strongly disagree to 7 — strongly agree. Hardcopies of the surveys were hand delivered by one of the research team to the Nursing Unit Manager (NUM) in each ward within HNELHD. The surveys, along with information sheets and a research flyer, and a collection envelope, were left in a visible place within each ward area (i.e. handover area, or tea room). The NUM communicated the purpose of the survey at ward meetings and shift handovers.
Highest education
Data Analysis Data analysis was performed using IBM SPSS Statistics 20. Descriptive statistics (Mean SD) were calculated for each of the four subscales. Analysis of variance was used to determine if differences between preceptor scores on the four subscales were due to age, specialty, highest education credential achieved, years of post-registration experience and preceptor preparation. The internal consistency reliability (Cronbach alpha) values for the four subscales in the CPEET were: ‘Roles’ (α = .96), ‘Challenges’ (α = .82), ‘Experience and Education’ (α = .79), and ‘Satisfaction’ (α = .93) (Table 3). When appropriate, post-hoc analyses were conducted using Tukey's HSD (Honestly Significant Difference) test. Consistent with the advice on performing and reporting inferential statistics in nursing (Gaskin and Happell, 2012) effect sizes are reported and interpreted and the experiment wise Type I error rate was controlled. Using Cohen's (1988) broad conventions for the social sciences, small, medium, and large effects for η2 are .01, .06, and .14, respectively. To control the experiment wise error rate, the sharper Bonferroni procedure for multiple tests of significance, as described in Hochberg (1988), was used. Applying this procedure, α was set at .0021 for this study. Statistically significant findings (i.e., those for which p b .0021) are denoted with an asterisk (*) following reporting of the p values. Results Demographic Characteristics A total of 1500 surveys were distributed to all eligible inpatient wards across 9 acute care hospitals in both rural and metropolitan areas of the HNELHD. Of the total surveys distributed there were 337 respondents, a response rate of 22.5%. Ninety one percent (91%) of the respondents were female, 8% male, almost half of the participants were aged between 41 and 60 years (41 to 50, 26%; 51 to 60, 23%) (Table 1). The primary specialty work areas for most preceptors were medical (22%), surgical (22%), critical care (15%), paediatrics (12%), and peri-operative (10%). The highest qualification for almost half (48%) of the preceptors was a Bachelor's degree, with 27.4% having completed postgraduate education. Half of the preceptors (54%) had over 10 years of post-registration experience, with a further 20% having 5 to 10 years of experience. Most preceptors had permanent positions and worked either full time (54%) or part time (40%). The majority of preceptors were classified as RN's (63%), Clinical Nurse
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Post-registration experience
Employment conditions
Classification
Percentage Female Male 20–25 26–30 31–40 41–50 51–60 >60 Mixed med/surg Medical Surgical Critical care Emergency Perioperative Rehab/disability Paediatrics Midwifery Hospital certificate TAFE certificate Diploma Bachelor Grad cert Grad dip Masters 0–1 years 1–2 years 2–5 years 5–10 years >10 years Permanent full time Permanent part time Temporary full time Temporary part time Casual RN RM RN/RM EN EEN CNS CNC NE/CNC CMS NUM/MUM
91.1% 8.3% 11.9% 16.3% 19.6% 26.4% 23.4% 1.5% 8.3% 22.0% 21.7% 15.4% 2.7% 9.8% 0.6% 11.6% 7.1% 14.2% 1.8% 7.7% 47.5% 11.3% 13.1% 3.0% 4.7% 4.7% 15.7% 19.6% 54.0% 54.3% 39.8% 3.6% 0.3% 1.8% 62.9% 2.4% 4.2% 0.6% 8.3% 11.9% 0.9% 2.4% 3.0% 3.0%
Note. Percentages for some demographics do not sum to 100% due to a small amount of missing data.
Specialists (CNS) (12%), and EN's (8%). With respect to becoming a preceptor only 36% of respondents indicated that they had undertaken educational preparation for precepting, supervising, or teaching undergraduate nursing and midwifery students. The majority of educational preparation was either LHD or university conducted 1 to 2 days mentoring/preceptoring programmes, 4 respondents had completed Certificate 1V in education (Vocational qualification) and 3 had postgraduate education qualifications. The average number of hours spent in student education roles (either formally or informally) on any one shift varied widely between preceptors, with the most common responses being 1 to 2 h (30%), 2 to 5 h (23%) or 5 to 10 h (29%) with students. A large proportion of the participants (75%) reported being responsible for one student in the clinical area at any one time. Almost two-thirds (61%) of the preceptors indicated that there were designated university facilitators in support of the students available to their wards. The means and standard deviations for the four subscales were: Roles (M = 5.75, SD = 1.10), Challenges (M = 4.80, SD = 1.20), Experience and Education (M = 5.31, SD = 1.18), and Satisfaction (M = 5.46, SD = 1.29). On each subscale, the scores ranged from 7 (the highest possible average) to 0 (the lowest possible average) (Table 2).
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Table 2 Descriptive statistics for the Clinical Preceptor Experience Evaluation Tool items. Item
M
SD
Roles domain 1. Clinical preceptors are a professional confidante to students. 2. Clinical preceptors are a support person for students during their clinical placement. 3. Clinical preceptors are a professional friend to students. 4. Clinical preceptors are a positive role model. 5. Clinical preceptors facilitate active learning experiences for the student. 6. Clinical preceptors promote students' active participation in patient care. 7. Clinical preceptors provide clinical practice supervision for the students. 8. Clinical preceptors provide constructive feedback to the student. 9. Clinical preceptors encourage students to apply theory to the clinical situation. 10. Clinical preceptors facilitate students to make the links between theory and clinical practice. 11. Clinical preceptors facilitate students to analyse clinical problems. 12. Clinical preceptors facilitate students to critically reflect upon clinical problems. 13. Clinical preceptors model multidisciplinary teamwork for the students. 14. Clinical preceptors support students by being available to answer questions. 15. Clinical preceptors facilitate students' learning by using case studies and care plans. 16. Clinical preceptors treat students with respect. 17. Clinical preceptors treat students fairly.
5.60 6.16 4.87 6.10 6.10 6.15 6.14 5.91 5.76 5.72 5.72 5.64 5.88 6.06 5.22 6.14 6.16
1.30 1.07 1.51 1.03 1.02 .98 1.06 1.13 1.26 1.26 1.21 1.27 1.18 1.03 1.45 1.05 1.05
Challenges domain 18. It is acceptable for students to clarify with the preceptor when there is a difference in practice. 19. Personality clashes will not negatively affect my attitude towards a student. 20. Though I am very busy, I am willing to be a preceptor. 21. I am motivated to precept students. 22. Being a preceptor will not take my time away from providing direct patient care. 23. Being a preceptor is not time consuming. 24. I am willing to make time to support unmotivated students.
6.16 5.42 5.69 5.69 4.42 3.00 3.78
1.02 1.55 1.38 1.33 1.88 1.77 1.82
Experience and education domain 25. Clinical preceptors clarify the role of preceptor with colleagues on a regular basis to ensure the needs of the students are met. 26. Being a preceptor, I need to know what the expected level of skill competence should be for a student's scope of practice. 27. I read updated texts and journals regularly. 28. Being a preceptor facilitates professional reflection on my own role as a nurse. 29. Being a preceptor challenges my work attitudes. 30. Being a preceptor helps to expand my nursing knowledge.
4.57 6.24 4.89 5.74 5.35 5.66
1.61 1.06 1.60 1.33 1.51 1.32
Satisfaction 31. Being a preceptor is meaningful. 32. Being a preceptor is satisfying. 33. The role of preceptor is professionally rewarding. 34. The preceptor role is an incentive to teach. 35. I enjoy the student/preceptor interaction. 36. Being a clinical preceptor is an incentive for my own professional development. 37. I enjoy facilitating novice nurses to develop as professionals. 38. The clinical preceptor experience breaks the monotony of daily nursing practice. 39. It is stimulating to work with enthusiastic nursing students.
5.87 5.58 5.60 5.40 5.64 5.63 5.79 4.45 6.08
1.16 1.35 1.34 1.50 1.33 1.39 1.27 1.81 1.17
Age There were no differences between the scores for preceptors in the different age groups for all four subscales: role subscale (η2 = .01, p = .607), challenges subscale (η2 = .02, p = .431), experience and education subscale (η2 = .01, p = .602), and satisfaction subscale (η2 = .01, p = .539).
and a moderate effect size, for differences between preceptors on the challenges subscale (η2 = .07, p = .004). Post-hoc testing, however, did not show any significant differences between the specialties. On the 7-point scale, the mean subscale scores for the specialties were in a fairly narrow band, ranging from 4.52 (perioperative) to 6.00 (“other” specialties). Highest Education
Specialty There were no differences between the scores for preceptors with different primary specialties for the role subscale (η2 = .03, p = .488), experience and education subscale (η2 = .04, p = .094), and satisfaction subscale (η2 = .05, p = .035). There was a significant difference,
Table 3 Means, standard deviations, and Cronbach's alpha values for the CPEET subscales. Subscale
M
SD
α
Roles domain (1–17) Challenges domain (18–24) Experience and education domain (25–30) Satisfaction (31–39)
5.75 4.80 5.30 5.46
1.10 1.20 1.18 1.29
.96 .82 .79 .93
For the purposes of this analysis, the highest education category was recoded into three categories: hospital and TAFE certificates, undergraduate degrees (bachelors, diplomas), and postgraduate degrees (graduate certificates, graduate diplomas, masters). There were no differences between the scores for preceptors with different levels of education for the role subscale (η2 = .02, p = .086), challenges subscale (η2 = .01, p = .262), experience and education subscale (η2 = .003, p = .569), and satisfaction subscale (η2 = .01, p = .298). Years of Post-registration Experience There were no differences between the scores for preceptors with different lengths of post-registration experience for the role subscale (η2 = .01, p = .409), challenges subscale (η2 = .02, p = .161),
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experience and education subscale (η2 = .01, p = .547), and satisfaction subscale (η2 = .02, p = .177). Preceptor Preparation There were no differences between the scores for preceptors who had, and those who had not had, preparation for the role with respect to the role subscale (η2 = .02, p = .365). On the challenges subscale, however, there was a small difference between preceptors who had (M = 5.06, SD = 1.22), and those who had not had (M = 4.66, SD = 1.18), preparation for the role (η2 = .03, p = .003). Similarly, on the experience and education domain, there was a small difference between preceptors who had (M = 5.58, SD = 1.04), and those who had not had (M = 5.16, SD = 1.23), preparation for the role (η2 = .03, p = .002*). Likewise, on the satisfaction subscale, there was an equally small difference between preceptors who had (M = 5.76, SD = 1.13), and those who had not had (M = 5.29, SD = 1.35), preparation for the role (η2 = .03, p = .001*). Facilitators on the Wards The preceptors with access to university facilitators scored more highly on the roles domain (M = 5.88, SD = 0.93 versus M = 5.53, SD = 1.25, η = .024, p = .005), challenges domain (M = 5.00, SD = 1.14 versus M = 4.44, SD = 1.24, η = .049, p = .00006*), experience domain (M = 5.49, SD = 1.09 versus M = 4.97, SD = 1.31, η = .044, p = .0001*), and satisfaction subscale (M = 5.67, SD = 1.78 versus M = 5.04, SD = 1.42, η = .054, p = .00002*). Preceptor Classification For the purposes of this analysis, the data from preceptors classifying themselves as RNs was compared with the data of other classifications (e.g., CNS). There were no differences between the scores for preceptors in the different age groups for the role subscale (η 2 = .00, p = .794), challenges subscale (η 2 = .00, p = .764), experience and education subscale (η 2 = .00, p = .875), and satisfaction subscale (η 2 = .003, p = .294).
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Results from the survey indicate that preceptors are less satisfied when challenged with difficult students and those who are unmotivated, and where precepting becomes time consuming. Providing students with understanding of the preceptor role before and as part of an orientation process prior to a clinical placement experience may facilitate the development of a closer more rewarding educational relationship, and perhaps pre-empt some of the less satisfying aspects of taking on a student (O'Brien et al., 2008). Almost two-thirds (61%) of the preceptors indicated that there were designated university facilitators in support of the students available to their wards, and in all the subscales, preceptors with a university facilitator available were significantly more satisfied with their role. Fox (2010), in a study of the preceptor as a mentor, found that although preceptors are required to teach at a rapid pace, they find their teaching role inherently satisfying. Scores on subscales in this study concur with these views. Burns et al. (2006) also conclude that investing time and resources into developing individuals as preceptors benefits the student, preceptor and the faculty with more efficient, less stressful teaching in clinical settings. Facilitator support and educational preparation of the preceptor seem to go hand in hand. Preceptors in this study who had undergone some training or education for the role had higher scores on the challenges domain, experience and education domain, and the satisfaction subscale. This could be influenced by the fact that preceptors with educational preparation may have sought this education themselves to improve their experience of precepting and are thus more willing preceptors. Lower scores on means indicate that some preceptors are not satisfied in relation to the time they have to support a student whilst they fulfil their role; that time taken with unmotivated students is not satisfying; and that being a preceptor takes time away from the patient and disrupts the daily routine. This study has highlighted the need for more preceptor training programmes to be offered to clinicians with only one third of respondents reporting any formal education in preceptoring. When comparisons were made against other hospitals in relation to scores on subscales there was a significant difference in all comparisons on all the subscales for one of the site hospitals. Further research could determine what it is in this particular hospital environment that makes the preceptor enjoy the role more than the other hospitals surveyed.
Rural or Metropolitan Facility Subscale mean scores from metropolitan facilities were compared to those from the rural facilities. Although the mean score of all subscales was higher in the rural setting, the difference was only minimal and not statistically significant. Roles domain (M = 6.05, SD = 0.80 versus M = 5.80, SD = 0. 92, p = .049), challenges domain (M = 5.08, SD = 1.05 versus M = 4.82, SD = 1.08, p = .074), experience domain (M = 5.60, SD = 0.93 versus M = 5.34, SD = 1.00, p = .038), and satisfaction subscale (M = 5.88, SD = 1.01 versus M = 5.46, SD = 1.12, p = .005). Discussion Knowing the opinion of registered nurses, midwives and enrolled nurses', towards the clinical supervision role, is an important factor in providing students with effective information prior to placement. This is so they can maximise their learning and development opportunities. It has been identified that preceptorship can be one of the most important professional relationships during educational preparation and the experience can have long term effects on how well a student integrates into the practice environment (Yonge et al., 2002). Being better prepared for the relationship with a clinical supervisor/preceptor is an important step in maximising the quality of the clinical placement educational experience and reducing stress levels (Bremmer, and O'Brien, 2007).
Conclusion The study has found that there are discernible differences in preceptor opinion when nominated preceptors have had some training, and when there is a university trained and paid facilitator present on the ward where students are placed. The issue of training and educational preparation for clinical supervision is currently being championed by Health Workforce Australia (HWA) towards a standardised preparation for the clinical supervision of health students. Whilst this study was focused on nursing and midwifery, there appears to be considerable common ground across clinical supervision for the other health professions to warrant the use of evaluation tools when students are being precepted. Indeed, a comparison of the health professions with a modified CPEET tool is worthy of further study. There is also a need for further research to compile qualitative information about being supervised and supervising across health disciplines. Acknowledgements Gratitude is extended to the Hunter New England Local Health District (HNELHD) Nursing Unit Managers and Nurse Educators assisting with the distribution and collation of the surveys and to all nursing and midwifery staff who completed the survey. Gemma Howard provided data entry and endnote support. Dr. Cadeyrn Gaskin was
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contracted to provide the statistical reporting on the dataset. Nurse Manager Catherine Turner is acknowledged for her editorial comment. References Ainsley, J., Chapman, Y., 2009. Preceptors and patients — the power of two: nursing student experiences on their first acute clinical placement. Contemporary Nurse 34 (1), 34–47. Australia, Nurses and Midwives Board, 2012. Nurse and Midwife Data: June 2012. NMBA, Melbourne. Australian Institute of Health and Welfare, 2012. National health workforce series no. 2. Cat. no HWL 48 Nursing and Midwifery Workforce 2011.Australian Institute of Health and Welfare, Canberra. Bremmer, J., O'Brien, A.P., 2007. From shadow to mirror image — baccalaureate nursing clinical education at NUS. Singapore Nursing Journal 34 (3), 24–32. Burns, C., Beauchesne, M., Ryan-Krause, P., Sawin, K., 2006. Mastering the preceptor role: challenges of clinical teaching. Journal of Paediatric Health Care 20 (3), 172–183. http://dx.doi.org/10.1016/j.pedhc.2005.10.012. Cohen, J. (1988). Statistical power analysis for the behavioural sciences. Hillsdale, NJ:, Erlbaum. Cope, P., Cuthbertson, P., Stoddart, B., 2000. Situated learning in the practice placement. Journal of Advanced Nursing 31 (4), 850–856. http://dx.doi.org/ 10.1046/j.1365-2648.2000.01343.x. Flanagan, J.B.S., Clarke, D., 2009. Creating context for critical thinking in practice: the role of the preceptor. Journal of Advanced Nursing 65 (8), 1715–1724. Fox, K.C., 2010. "Mentor Program Boosts New Nurses' Satisfaction and Lowers Turnover Rate". The Journal of Continuing Education inNursing 41 (7), 311. Freiburger, K.C., 2002. Clinical issues — preceptor programs increasing student selfconfidence and competency. Nurse Educator 27 (2), 58–60. Queensland Health, 2001. Queensland Health Preceptor Program for Nursing Transition Support (Brisbane). Gaskin, C.J., Happell, B., 2012. Power of mental health nursing research: A statistical analysis of studies in the International Journal of Mental Health Nursing. International Journal of Mental Health Nursing. http://dx.doi.org/10.1111/j.1447-0349.2012.00845.x. Hallin, K., Danielson, E., 2008. Registered nurses'’ perceptions of their work and professional development. Journal of Advanced Nursing 61 (1), 62–70. http://dx.doi.org/10.1111/ j.1365-2648.2007.04466.x.
Health Education and Training Institute (HETI), 2012. NSW Clinical Supervision Support Project — Part A: Mapping Study. New South Wales Government, Sydney. Health Workforce Australia (HWA), 2010. Clinical supervisor support program. Discussion Paper. The Australian Government, Sydney. Health Workforce Australia (HWA), 2011. National clinical supervision competency framework project plan. National Clinical Supervision Competency Framework (HWA-RFT/2011/001). TheAustralian Government, Sydney. Hochberg, Y., 1988. A sharper Bonferroni procedure for multiple tests of significance. Biometrika 75, 800–802. Hunter New England Local Health District, 2012. Facts and figures. retrieved August 13, 2012 from http://www.hnehealth.nsw.gov.au/about_us/facts_and_figures. Lee, Xin Yu Jasmine, 2011. Evaluating the preceptor role in pre-registration nursing student clinical education. Honours National University of Singapore, Singapore. Levett-Jones, T., Lathlean, J., 2008. ‘Don't rock the boat’: nursing students' experiences of conformity and compliance. Nurse Education Today 29, 342–349. Myrick, F., Yonge, O., Billay, D., 2010. Preceptorship and practical wisdom: a process of engaging in authentic nursing practice. Nurse Education in Practice 10 (2), 82–87. http://dx.doi.org/10.1016/j.nepr.2009.03.018. NSW Department of Aboriginal Affairs, 2007. Two Ways Together Report on Indicators 2007 (retrieved on 13 August 2012 from). O'Brien, L., Buxton, M., Gillies, D., 2008. Improving the undergraduate clinical placement experience in mental health nursing. Issues in Mental Health Nursing 29, 505–522. O'Brien, A.P., Bremmer, J., 2008. The preceptor evaluation tool, unpublished report. Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore. Paton, B.R., 2009. Preceptors matter: an evolving framework". The Journal of Nursing Education 48 (4), 213–216. Roberts, D., 2009. Friendship fosters learning: the importance of friendship in clinical practie. Nurse Education in Practice 9, 2009, 367–371. Smedley, A.M., 2008. Becoming and being a preceptor: a phenomenological study. Journal of Continuing Education in Nursing 39 (4), 185–191. Walker, R., Cooke, M., McAllister, M., 2008. The meaningful experiences of being a Registered Nurse (RN) buddy. Nurse Education Today 28, 760–767. Williams, C., 2010. Understanding the essential elements of work-based learning and its relevance to everyday clinical practice. Journal of Nursing Management 18 (6), 624–632. http://dx.doi.org/10.1111/j.1365-2834.2010.01141.x. Yonge, O., Krahn, H., Trojan, L., Reid, D., Haase, M., 2002. Being a preceptor is stressful! Journal for Nurses in Staff Development 18 (1), 22–27.
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Evaluating the preceptor role for pre-registration nursing and midwifery student clinical education☆,☆☆ Anthony O'Brien a, 1, Michelle Giles a,⁎, Shane Dempsey b, Slater Lynne c, Michelle E. McGregor d, Ashley Kable c, Glenda Parmenter e, Vicki Parker e a Centre for Practice Opportunity and Development (CPOD), Hunter New England Local Health District/The University of Newcastle, Level 3 Education Block, John Hunter Campus, Locked Bag 1, HRMC, Newcastle, NSW 2310, Australia b School of Health Sciences, Faculty of Health, The University of Newcastle, Callaghan, NSW 2308, Australia c School of Nursing and Midwifery, Faculty of Health, University of Newcastle, Callaghan , NSW 2308, Australia d Greater Newcastle Acute Hospital Network (GNAHN), Hunter New England Local Health District, NSW, Australia e School of Health, University of New England (UNE) NSW, Australia
a r t i c l e
i n f o
Article history: Accepted 22 March 2013 Keywords: Nurses/midwives/nursing Preceptors Clinical supervision Teaching and learning Clinical practice
s u m m a r y Aim: The aim of this research is to evaluate the perceptions of the Registered Nurse (RN), Registered Midwife (RM) and Enrolled Nurse (EN) about their experience of preceptoring an undergraduate student within a large Local Health District in New South Wales (NSW) Australia. Background: In the current Health Workforce Australia (HWA) literature, the term ‘Clinical Supervisor’ has subsumed the role of mentor, preceptor, buddy and facilitator of clinical practice. Preceptor in this paper describes the supervisory, facilitating and teaching role of the registered nurse in the clinical practice undergraduate nursing and midwifery educational pairing. Design: A quantitative cross sectional design was used and data collected using the Clinical Preceptor Experience Evaluation Tool (CPEET), a previously validated and reliable survey tool. Method: Nurses and Midwives across nine acute care facilities that preceptor undergraduate students were invited to complete the survey between March and May 2012. Results: There were 337 survey respondents across nine acute hospitals included in this study (22.5% response rate). Differences were observed between preceptors who had training in precepting in three of the subscales. Differences were observed in all four subscales between those preceptors with access to university facilitators in their location and those without immediate access. Conclusion: The majority of preceptors score highly on all subscales indicating they are generally satisfied with the role of precepting. Significant differences on several items suggest that some aspects of the role are more challenging and less satisfying than others. © 2013 Elsevier Ltd. All rights reserved.
Introduction During clinical placement, students convert theory into practice, master the skills that define their particular profession, refine their scope of practice and gain a sense of the social and professional culture of their chosen profession (Health Workforce Australia, 2010, 2011; Health Education and Training Institute, 2012). The Health Workforce Australia's (HWA) (2010) recent review of clinical
☆ “No conflict of interest has been declared by the author(s).” ☆☆ Funding: This Research was funded by a University of Newcastle, NSW, Australia, Teaching and Learning Project Grant. ⁎ Corresponding author. Tel.: +61 249213592; fax: +61 49223290. E-mail addresses: Tony.O'[email protected] (A. O'Brien), [email protected], [email protected] (M. Giles). 1 Tel.: +61 2 4985 5925; fax: +61 2 4922 3290. 0260-6917/$ – see front matter © 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.nedt.2013.03.015
supervision identifies a number of attributes common to the concept of clinical supervision which include, mentoring, precepting, buddying, and accessibility to facilitators, practice educators, and clinical educators. The HWA (2010) Clinical Supervision Support Project discussion paper brings together a comprehensive review of the literature surrounding the attributes of clinical supervision in the context of the functions of clinical supervisors in their relationship with undergraduate health students. This review process has provided some clarity around the importance of effective clinical supervision of undergraduate health students in Australia, and the educational and clinical expectations required during the pairing of a student and a clinical supervisor. With specific reference to nursing and midwifery education and training, the preceptor–preceptee relationship is an integral part of the overarching clinical supervisor relationship, where the clinical supervisor provides a direct oversight of the undergraduate student
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clinical experience (Health Workforce Australia, 2010). It is the preceptor who directly interacts (1:1) with the student at the bedside, or in the clinical facility. Hunter New England Local Health District (HNELHD) The Hunter New England Local Health District (HNELHD) provides care for approximately 840,000 people and covers a geographical area of over 130,000 km. The local health district is divided into eight geographical clusters and employs over 15,000 staff. The HNELHD provides health services to 11.3% of the New South Wales (NSW) population and to 20% of the state's Aboriginal population (NSW Department of Aboriginal Affairs, 2007; HNELHD, 2012). The HNELHD spans 25 local council areas and 32 local government areas. In 2009 (last figures available) nurses across regions in Australia ranged from 997 full-time equivalent nurses per 100,000 head of population in major cities to 1240 in very remote areas. Nurses are also an ageing population with the average age of registered nurses being 50–54 years, as well as being made up of over 80% females (Australian Institute of Health and Welfare, 2012). The number of registered nurses in NSW is currently 64,420 with nearly 14,000 enrolled nurses registered in June 2012. Midwives, in turn, are also ageing (mostly 51–55 years of age) with 12,646 midwives who are also registered as nurses and 370 as midwives only (Nurses and Midwives Board, NMBA, 2012). In relation to research that involves Nurse (includes Enrolled Nurse) and Midwife opinion in HNELHD there has been no previous representative data collected around the preceptor/student clinical placement pairing. HNELHD provides clinical placement opportunities for undergraduate nurses and midwives from 8 tertiary institutions. The Bachelor of Midwifery programme was introduced locally in 2011 and over the past several years there have been large increases in undergraduate nursing intakes at a local university. In 2012 there were over 2500 nursing and midwifery student placements requested in the Tertiary Referral Hospital within the Local Health District (LHD). Numbers across the entire LHD were not available.
an important role in retaining students in nursing (Ainsley and Chapman, 2009; Smedley, 2008) and in assisting learning, closing the theory practice gap and in the development of competencies (Levett-Jones and Lathlean, 2008; Freiburger, 2002). There has been a large volume of research conducted around the preceptor model (Myrick et al., 2010; Roberts, 2009; Queensland Health, 2001) with the major themes involved in preceptorship correlating with the new HWA (2010) definition for clinical supervision. Key features are: • Preceptor-ship serves to bridge the theory — clinical gap, learning occurs in the everyday work environment and it is tailored to the professional context and specific needs of the learner (Williams, 2010; Cope et al., 2000); • Socialization into nursing and health professions and in particular the work culture and community of practice is facilitated by preceptors stewarding the developing professional into their role in clinical practice (Myrick et al., 2010; Roberts, 2009; Queensland Health, 2001; Cope et al., 2000); • Preceptors foster the growth of practical wisdom — that is, the interactive often quasi-educational relationship encourages the ongoing interpretive process of applying principals, evaluating actions, and synthesizing this into workplace activity (Myrick et al., 2010; Cope et al., 2000); and • Preceptorship involves a supportive teaching and learning relationship to promote the transition from a student into an authorised registered health professional (Queensland Health, 2001). Aim The aim of this research was to evaluate HNELHD preceptor perceptions of their preceptor clinical teaching, and learning support role, with undergraduate nursing and midwifery students. Method Data Collection and Recruitment
Literature Review The educational context in clinical settings for undergraduate nursing and midwifery students is multifactorial, varied and complex. A wide range of factors, including variable staffing levels; ageing workforce issues; patient acuity, scope of practice, educational qualifications of the existing and developing workforce; staffing tiers on the wards, patient workload ratios; and case mix, can all affect the preceptor student interpersonal dynamic (Myrick et al., 2010; Roberts, 2009; Queensland Health, 2001; Ainsley and Chapman, 2009; Cope et al., 2000; Levett-Jones and Lathlean, 2008; Smedley, 2008). Hallin and Danielson (2008) explored preceptor experiences before and after the introduction of a preceptorship model and found that even after the introduction of the model, preceptors experienced difficulty in balancing patient care with preceptoring of a student (Yonge et al., 2002). Flanagan and Clarke (2009) and Walker et al. (2008) highlight that the preceptor experiences increased stress and workload, along with a reduction in the time spent with their patients, with little reward when precepting an undergraduate student. In Australia, throughout the process of interaction between the preceptor and the student, the preceptor is often providing feedback to both the student and academic staff from the institution where the student is enrolled. Paton (2009) explains this relationship as a triad between student, preceptor and academic institution. A university facilitator usually provides debriefing with the students around clinical goals and monitors assessment requirements (Burns et al., 2006), however there are a range of models across health professions depending on distances from clinical facility to the enrolling university. The preceptor plays
A descriptive cross-sectional, multisite survey was used to evaluate preceptor opinions in relation to their roles, challenges, experience and satisfaction in supporting undergraduate pre-registration nursing and midwifery students during clinical placement. Participants included Registered Nurses (RNs), Registered Midwives and Enrolled Nurses (ENs). The study was conducted in nine public acute care hospitals in the HNELHD in rural, regional and metropolitan NSW. The sample was recruited between March and May 2012. Ethics approval was obtained from the Hunter New England Human Research Ethics Committee (HNEHREC) as a Low Negligible Risk study in February 2012. The Clinical Preceptor Experience Evaluation Tool (CPEET) was administered to participants to gain insight into their opinions as to the preceptor experience in the workplace The CPEET has been utilised in a number of evaluative studies and has established cross cultural validity and reliability (O'Brien and Bremmer, 2008; Lee Xin Yu, 2011). The four subscales of CPEET measure opinion in relation to the preceptor: Role — relationship between the student and the preceptor, role modelling, participating together in patient care, facilitation of critical reflection and being available to teach the student about case studies and care plans and items about the function and impact of the preceptor role. Satisfaction — finding the time to teach and support the student in clinical practice, being motivated to do so and managing ones time to take on the challenge.
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Experience and Education — enacting the role through others in their work environment and linking the student to clinical practice opportunities. Being with a student encourages the preceptor to stay up to date with the current evidence and to reflect on their own practice. Challenges — being focused on the challenges faced when implementing the role into everyday practice, the rewards related to professional development, changing practice and the preceptor role having meaning and being rewarding, including an incentive to teach and engage the student.
Table 1 Demographic characteristics of the preceptors (N = 337). Characteristic Gender Age
Primary specialty
A seven point Likert scale asked respondents to rate their level of agreement with 39 items related to the four subscales. The Likert scale ranged from 1 — strongly disagree to 7 — strongly agree. Hardcopies of the surveys were hand delivered by one of the research team to the Nursing Unit Manager (NUM) in each ward within HNELHD. The surveys, along with information sheets and a research flyer, and a collection envelope, were left in a visible place within each ward area (i.e. handover area, or tea room). The NUM communicated the purpose of the survey at ward meetings and shift handovers.
Highest education
Data Analysis Data analysis was performed using IBM SPSS Statistics 20. Descriptive statistics (Mean SD) were calculated for each of the four subscales. Analysis of variance was used to determine if differences between preceptor scores on the four subscales were due to age, specialty, highest education credential achieved, years of post-registration experience and preceptor preparation. The internal consistency reliability (Cronbach alpha) values for the four subscales in the CPEET were: ‘Roles’ (α = .96), ‘Challenges’ (α = .82), ‘Experience and Education’ (α = .79), and ‘Satisfaction’ (α = .93) (Table 3). When appropriate, post-hoc analyses were conducted using Tukey's HSD (Honestly Significant Difference) test. Consistent with the advice on performing and reporting inferential statistics in nursing (Gaskin and Happell, 2012) effect sizes are reported and interpreted and the experiment wise Type I error rate was controlled. Using Cohen's (1988) broad conventions for the social sciences, small, medium, and large effects for η2 are .01, .06, and .14, respectively. To control the experiment wise error rate, the sharper Bonferroni procedure for multiple tests of significance, as described in Hochberg (1988), was used. Applying this procedure, α was set at .0021 for this study. Statistically significant findings (i.e., those for which p b .0021) are denoted with an asterisk (*) following reporting of the p values. Results Demographic Characteristics A total of 1500 surveys were distributed to all eligible inpatient wards across 9 acute care hospitals in both rural and metropolitan areas of the HNELHD. Of the total surveys distributed there were 337 respondents, a response rate of 22.5%. Ninety one percent (91%) of the respondents were female, 8% male, almost half of the participants were aged between 41 and 60 years (41 to 50, 26%; 51 to 60, 23%) (Table 1). The primary specialty work areas for most preceptors were medical (22%), surgical (22%), critical care (15%), paediatrics (12%), and peri-operative (10%). The highest qualification for almost half (48%) of the preceptors was a Bachelor's degree, with 27.4% having completed postgraduate education. Half of the preceptors (54%) had over 10 years of post-registration experience, with a further 20% having 5 to 10 years of experience. Most preceptors had permanent positions and worked either full time (54%) or part time (40%). The majority of preceptors were classified as RN's (63%), Clinical Nurse
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Post-registration experience
Employment conditions
Classification
Percentage Female Male 20–25 26–30 31–40 41–50 51–60 >60 Mixed med/surg Medical Surgical Critical care Emergency Perioperative Rehab/disability Paediatrics Midwifery Hospital certificate TAFE certificate Diploma Bachelor Grad cert Grad dip Masters 0–1 years 1–2 years 2–5 years 5–10 years >10 years Permanent full time Permanent part time Temporary full time Temporary part time Casual RN RM RN/RM EN EEN CNS CNC NE/CNC CMS NUM/MUM
91.1% 8.3% 11.9% 16.3% 19.6% 26.4% 23.4% 1.5% 8.3% 22.0% 21.7% 15.4% 2.7% 9.8% 0.6% 11.6% 7.1% 14.2% 1.8% 7.7% 47.5% 11.3% 13.1% 3.0% 4.7% 4.7% 15.7% 19.6% 54.0% 54.3% 39.8% 3.6% 0.3% 1.8% 62.9% 2.4% 4.2% 0.6% 8.3% 11.9% 0.9% 2.4% 3.0% 3.0%
Note. Percentages for some demographics do not sum to 100% due to a small amount of missing data.
Specialists (CNS) (12%), and EN's (8%). With respect to becoming a preceptor only 36% of respondents indicated that they had undertaken educational preparation for precepting, supervising, or teaching undergraduate nursing and midwifery students. The majority of educational preparation was either LHD or university conducted 1 to 2 days mentoring/preceptoring programmes, 4 respondents had completed Certificate 1V in education (Vocational qualification) and 3 had postgraduate education qualifications. The average number of hours spent in student education roles (either formally or informally) on any one shift varied widely between preceptors, with the most common responses being 1 to 2 h (30%), 2 to 5 h (23%) or 5 to 10 h (29%) with students. A large proportion of the participants (75%) reported being responsible for one student in the clinical area at any one time. Almost two-thirds (61%) of the preceptors indicated that there were designated university facilitators in support of the students available to their wards. The means and standard deviations for the four subscales were: Roles (M = 5.75, SD = 1.10), Challenges (M = 4.80, SD = 1.20), Experience and Education (M = 5.31, SD = 1.18), and Satisfaction (M = 5.46, SD = 1.29). On each subscale, the scores ranged from 7 (the highest possible average) to 0 (the lowest possible average) (Table 2).
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Table 2 Descriptive statistics for the Clinical Preceptor Experience Evaluation Tool items. Item
M
SD
Roles domain 1. Clinical preceptors are a professional confidante to students. 2. Clinical preceptors are a support person for students during their clinical placement. 3. Clinical preceptors are a professional friend to students. 4. Clinical preceptors are a positive role model. 5. Clinical preceptors facilitate active learning experiences for the student. 6. Clinical preceptors promote students' active participation in patient care. 7. Clinical preceptors provide clinical practice supervision for the students. 8. Clinical preceptors provide constructive feedback to the student. 9. Clinical preceptors encourage students to apply theory to the clinical situation. 10. Clinical preceptors facilitate students to make the links between theory and clinical practice. 11. Clinical preceptors facilitate students to analyse clinical problems. 12. Clinical preceptors facilitate students to critically reflect upon clinical problems. 13. Clinical preceptors model multidisciplinary teamwork for the students. 14. Clinical preceptors support students by being available to answer questions. 15. Clinical preceptors facilitate students' learning by using case studies and care plans. 16. Clinical preceptors treat students with respect. 17. Clinical preceptors treat students fairly.
5.60 6.16 4.87 6.10 6.10 6.15 6.14 5.91 5.76 5.72 5.72 5.64 5.88 6.06 5.22 6.14 6.16
1.30 1.07 1.51 1.03 1.02 .98 1.06 1.13 1.26 1.26 1.21 1.27 1.18 1.03 1.45 1.05 1.05
Challenges domain 18. It is acceptable for students to clarify with the preceptor when there is a difference in practice. 19. Personality clashes will not negatively affect my attitude towards a student. 20. Though I am very busy, I am willing to be a preceptor. 21. I am motivated to precept students. 22. Being a preceptor will not take my time away from providing direct patient care. 23. Being a preceptor is not time consuming. 24. I am willing to make time to support unmotivated students.
6.16 5.42 5.69 5.69 4.42 3.00 3.78
1.02 1.55 1.38 1.33 1.88 1.77 1.82
Experience and education domain 25. Clinical preceptors clarify the role of preceptor with colleagues on a regular basis to ensure the needs of the students are met. 26. Being a preceptor, I need to know what the expected level of skill competence should be for a student's scope of practice. 27. I read updated texts and journals regularly. 28. Being a preceptor facilitates professional reflection on my own role as a nurse. 29. Being a preceptor challenges my work attitudes. 30. Being a preceptor helps to expand my nursing knowledge.
4.57 6.24 4.89 5.74 5.35 5.66
1.61 1.06 1.60 1.33 1.51 1.32
Satisfaction 31. Being a preceptor is meaningful. 32. Being a preceptor is satisfying. 33. The role of preceptor is professionally rewarding. 34. The preceptor role is an incentive to teach. 35. I enjoy the student/preceptor interaction. 36. Being a clinical preceptor is an incentive for my own professional development. 37. I enjoy facilitating novice nurses to develop as professionals. 38. The clinical preceptor experience breaks the monotony of daily nursing practice. 39. It is stimulating to work with enthusiastic nursing students.
5.87 5.58 5.60 5.40 5.64 5.63 5.79 4.45 6.08
1.16 1.35 1.34 1.50 1.33 1.39 1.27 1.81 1.17
Age There were no differences between the scores for preceptors in the different age groups for all four subscales: role subscale (η2 = .01, p = .607), challenges subscale (η2 = .02, p = .431), experience and education subscale (η2 = .01, p = .602), and satisfaction subscale (η2 = .01, p = .539).
and a moderate effect size, for differences between preceptors on the challenges subscale (η2 = .07, p = .004). Post-hoc testing, however, did not show any significant differences between the specialties. On the 7-point scale, the mean subscale scores for the specialties were in a fairly narrow band, ranging from 4.52 (perioperative) to 6.00 (“other” specialties). Highest Education
Specialty There were no differences between the scores for preceptors with different primary specialties for the role subscale (η2 = .03, p = .488), experience and education subscale (η2 = .04, p = .094), and satisfaction subscale (η2 = .05, p = .035). There was a significant difference,
Table 3 Means, standard deviations, and Cronbach's alpha values for the CPEET subscales. Subscale
M
SD
α
Roles domain (1–17) Challenges domain (18–24) Experience and education domain (25–30) Satisfaction (31–39)
5.75 4.80 5.30 5.46
1.10 1.20 1.18 1.29
.96 .82 .79 .93
For the purposes of this analysis, the highest education category was recoded into three categories: hospital and TAFE certificates, undergraduate degrees (bachelors, diplomas), and postgraduate degrees (graduate certificates, graduate diplomas, masters). There were no differences between the scores for preceptors with different levels of education for the role subscale (η2 = .02, p = .086), challenges subscale (η2 = .01, p = .262), experience and education subscale (η2 = .003, p = .569), and satisfaction subscale (η2 = .01, p = .298). Years of Post-registration Experience There were no differences between the scores for preceptors with different lengths of post-registration experience for the role subscale (η2 = .01, p = .409), challenges subscale (η2 = .02, p = .161),
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experience and education subscale (η2 = .01, p = .547), and satisfaction subscale (η2 = .02, p = .177). Preceptor Preparation There were no differences between the scores for preceptors who had, and those who had not had, preparation for the role with respect to the role subscale (η2 = .02, p = .365). On the challenges subscale, however, there was a small difference between preceptors who had (M = 5.06, SD = 1.22), and those who had not had (M = 4.66, SD = 1.18), preparation for the role (η2 = .03, p = .003). Similarly, on the experience and education domain, there was a small difference between preceptors who had (M = 5.58, SD = 1.04), and those who had not had (M = 5.16, SD = 1.23), preparation for the role (η2 = .03, p = .002*). Likewise, on the satisfaction subscale, there was an equally small difference between preceptors who had (M = 5.76, SD = 1.13), and those who had not had (M = 5.29, SD = 1.35), preparation for the role (η2 = .03, p = .001*). Facilitators on the Wards The preceptors with access to university facilitators scored more highly on the roles domain (M = 5.88, SD = 0.93 versus M = 5.53, SD = 1.25, η = .024, p = .005), challenges domain (M = 5.00, SD = 1.14 versus M = 4.44, SD = 1.24, η = .049, p = .00006*), experience domain (M = 5.49, SD = 1.09 versus M = 4.97, SD = 1.31, η = .044, p = .0001*), and satisfaction subscale (M = 5.67, SD = 1.78 versus M = 5.04, SD = 1.42, η = .054, p = .00002*). Preceptor Classification For the purposes of this analysis, the data from preceptors classifying themselves as RNs was compared with the data of other classifications (e.g., CNS). There were no differences between the scores for preceptors in the different age groups for the role subscale (η 2 = .00, p = .794), challenges subscale (η 2 = .00, p = .764), experience and education subscale (η 2 = .00, p = .875), and satisfaction subscale (η 2 = .003, p = .294).
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Results from the survey indicate that preceptors are less satisfied when challenged with difficult students and those who are unmotivated, and where precepting becomes time consuming. Providing students with understanding of the preceptor role before and as part of an orientation process prior to a clinical placement experience may facilitate the development of a closer more rewarding educational relationship, and perhaps pre-empt some of the less satisfying aspects of taking on a student (O'Brien et al., 2008). Almost two-thirds (61%) of the preceptors indicated that there were designated university facilitators in support of the students available to their wards, and in all the subscales, preceptors with a university facilitator available were significantly more satisfied with their role. Fox (2010), in a study of the preceptor as a mentor, found that although preceptors are required to teach at a rapid pace, they find their teaching role inherently satisfying. Scores on subscales in this study concur with these views. Burns et al. (2006) also conclude that investing time and resources into developing individuals as preceptors benefits the student, preceptor and the faculty with more efficient, less stressful teaching in clinical settings. Facilitator support and educational preparation of the preceptor seem to go hand in hand. Preceptors in this study who had undergone some training or education for the role had higher scores on the challenges domain, experience and education domain, and the satisfaction subscale. This could be influenced by the fact that preceptors with educational preparation may have sought this education themselves to improve their experience of precepting and are thus more willing preceptors. Lower scores on means indicate that some preceptors are not satisfied in relation to the time they have to support a student whilst they fulfil their role; that time taken with unmotivated students is not satisfying; and that being a preceptor takes time away from the patient and disrupts the daily routine. This study has highlighted the need for more preceptor training programmes to be offered to clinicians with only one third of respondents reporting any formal education in preceptoring. When comparisons were made against other hospitals in relation to scores on subscales there was a significant difference in all comparisons on all the subscales for one of the site hospitals. Further research could determine what it is in this particular hospital environment that makes the preceptor enjoy the role more than the other hospitals surveyed.
Rural or Metropolitan Facility Subscale mean scores from metropolitan facilities were compared to those from the rural facilities. Although the mean score of all subscales was higher in the rural setting, the difference was only minimal and not statistically significant. Roles domain (M = 6.05, SD = 0.80 versus M = 5.80, SD = 0. 92, p = .049), challenges domain (M = 5.08, SD = 1.05 versus M = 4.82, SD = 1.08, p = .074), experience domain (M = 5.60, SD = 0.93 versus M = 5.34, SD = 1.00, p = .038), and satisfaction subscale (M = 5.88, SD = 1.01 versus M = 5.46, SD = 1.12, p = .005). Discussion Knowing the opinion of registered nurses, midwives and enrolled nurses', towards the clinical supervision role, is an important factor in providing students with effective information prior to placement. This is so they can maximise their learning and development opportunities. It has been identified that preceptorship can be one of the most important professional relationships during educational preparation and the experience can have long term effects on how well a student integrates into the practice environment (Yonge et al., 2002). Being better prepared for the relationship with a clinical supervisor/preceptor is an important step in maximising the quality of the clinical placement educational experience and reducing stress levels (Bremmer, and O'Brien, 2007).
Conclusion The study has found that there are discernible differences in preceptor opinion when nominated preceptors have had some training, and when there is a university trained and paid facilitator present on the ward where students are placed. The issue of training and educational preparation for clinical supervision is currently being championed by Health Workforce Australia (HWA) towards a standardised preparation for the clinical supervision of health students. Whilst this study was focused on nursing and midwifery, there appears to be considerable common ground across clinical supervision for the other health professions to warrant the use of evaluation tools when students are being precepted. Indeed, a comparison of the health professions with a modified CPEET tool is worthy of further study. There is also a need for further research to compile qualitative information about being supervised and supervising across health disciplines. Acknowledgements Gratitude is extended to the Hunter New England Local Health District (HNELHD) Nursing Unit Managers and Nurse Educators assisting with the distribution and collation of the surveys and to all nursing and midwifery staff who completed the survey. Gemma Howard provided data entry and endnote support. Dr. Cadeyrn Gaskin was
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