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Changes in the preceptor role: re-visiting preceptors’ perceptions of benefits, rewards, support and commitment to the role Kristiina Hyrka¨s & Martha Shoemaker Accepted for publication 25 July 2007
Correspondence to K. Hyrka¨s: e-mail:
[email protected] Kristiina Hyrka¨s LicNSc MNSc PhD RN Director Center for Nursing Research and Quality Outcomes, Maine Medical Center, Portland, Maine, USA; and Adjunct Professor College of Nursing and Health Professions, University of Southern Maine, Portland, Maine, USA Martha Shoemaker BGS BSN (candidate) Research Assistant University of Northern British Columbia, Prince George, British Columbia, Canada
¨ S K. & SHOEMAKER M. (2007) HYRKA
Changes in the preceptor role: re-visiting preceptors’ perceptions of benefits, rewards, support and commitment to the role. Journal of Advanced Nursing 60(5), 513–524 doi: 10.1111/j.1365-2648.2007.04441.x
Abstract Title. Changes in the preceptor role: re-visiting preceptors’ perceptions of benefits, rewards, support and commitment to the role Aim. This is a report of a study to explore the relationships between preceptors’ perceptions of benefits, rewards, support and commitment to the preceptor role. Background. The preceptorship model is widely used in undergraduate and postgraduate nursing education. Preceptor relationships provide students with reality based and skills-oriented learning experiences and are useful for familiarizing newly hired nurses with clinical settings, hospital policies, procedures and routines. Method. Two sub-groups of 82 preceptors were recruited: (A) those in an ongoing preceptorship with undergraduate students and (B) those working with newly hired nurses. Four questionnaires were used: the Preceptor’s Perceptions of Benefits and Rewards Scale, the Preceptor’s Perceptions of Support Scale, the Commitment to the Preceptor Role Scale and a demographic information sheet. The data were collected in November 2004 and April–May 2005. Findings. The findings parallel those reported in the earlier studies, but also reveal interesting differences between the two sub-groups. A positive correlation was found between preceptors working with nursing students and perceptions of support. In this sub-group, perceptions of support increased with years of nursing experience, time since graduation, and age. The preceptors had higher perceptions of the benefits and rewards than reported in earlier studies, but perceptions about support were lower in comparison with findings from an earlier Canadian study. Commitment to the role remained high. Conclusion. The preceptor role is undergoing changes associated with many factors, including workplace, type of nursing, and preceptees’ varying learning needs. Awareness of the importance of this role and ongoing support are critical to its future success. Keywords: empirical research report, nurse education, preceptor, preceptorship, questionnaires, survey
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Introduction
Background
The preceptorship model is widely used in undergraduate and postgraduate nursing education programmes in Canada (Dibert & Goldenberg 1995, Letizia & Jennrich 1998), Australia (Letizia & Jennrich 1998, Usher et al. 1999), the United States of America (USA) (Morton-Cooper & Palmer 1993, Madison et al. 1994), the United Kingdom (Letizia & Jennrich 1998) and Scandinavian countries (Hyrka¨s ¨ hrling & Hallberg 2000, 2001). The popularity of 1993, O the model increased during the 1980s and today it is used both by nurses in clinical settings and in educational institutions. The literature shows that preceptors are an important source of embedded knowledge (Ryan-Nicholls 2004). Preceptorships are an essential component of education, providing students with reality based and skills-oriented learning experiences (Yonge et al. 2002a). Preceptorships are also seen as an effective and efficient means of orienting and providing learning experiences related to preceptees’ diverse backgrounds and varying learning needs: preceptorships allow a ‘tailor-made’ approach to learning (Piemme et al. 1986). Furthermore, preceptor programmes are seen as useful for socializing and familiarizing newly hired nurses with clinical settings, hospital policies, procedures and routines (Dibert & Goldenberg 1995, Stevenson et al. 1995). Regardless of the history of preceptorship and the vivid research activities conducted during the last two decades (Yonge & Myrick 2005), the need for further studies has been highlighted. The preceptor role is multi-faceted, complex, evolving and the implications of preceptorships ¨ hrling & Hallberg 2000, 2001). are still not well-known (O The effects of formal recognition, rewards and benefits (Dibert & Goldenberg 1995, Usher et al. 1999) and preceptors’ differing needs for support also need further clarification (Dibert & Goldenberg 1995, Stevenson et al. 1995, Usher et al. 1999). The majority of earlier studies have focused on preceptors’ experiences of working within established academic support frameworks with nursing student preceptees. However, often the same preceptors are also supporting newly hired staff, and these experiences are mainly unexplored. The study reported here was designed as a replication of those undertaken by Dibert and Goldenberg (1995) and Usher et al. (1999). The purpose was to increase understanding and current knowledge about preceptorships today and preceptors’ perceptions of the benefits, rewards, support and commitment to the role.
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What is known about preceptors’ rewards and benefits today? Turnbull (1983) was one of the first authors in nursing research to point out the importance of rewarding preceptors. In primary studies exploring preceptorship, it has been found that a rewarding component was the renewed desire to learn as a result of interaction with preceptees (McLean 1987, Giles & Moran 1989, Yonge et al. 1989). Radiziwich’s (1987) and Goldenberg’s (1987/88) studies showed that nurses who functioned as preceptors experienced enhanced self-esteem (see also Carruthers 1993, Kitchen 1993). Assignment to the preceptor role was considered an acknowledgement by peers, and especially by supervisors or managers, of clinical expertise, teaching abilities and professionalism. These distinctions were perceived as rewarding (Mooney et al. 1988, Usher et al. 1999). Dibert and Goldenberg (1995) were among the first to study the intrinsic and extrinsic rewards/benefits of preceptorship in nursing (Dibert & Goldenberg 1995, O’Mara & Welton 1995). In the literature, examples of the most frequently cited intrinsic benefits include opportunities to teach and influence practice; share and broaden one’s own knowledge base and stimulate thinking; reflect and evaluate one’s own practice; and see and participate in the growth and development of the novice nurse into a more confident professional (Shogan et al. 1985, Alspach 1989, Bizek & Oermann 1990, Kitchen 1993, Stevenson et al. 1995, Wright 2002, Hales et al. 2004). Examples of extrinsic benefits include pay differential and educational advantages (Alspach 1989); luncheons (Hitchings 1989); journal subscriptions; tuition fee waivers; letters of recommendation; and opportunities to attend conferences (Begel & Willis 1984). Empirical studies have confirmed that the rewards need to be individualized to be worthwhile (Benner 1995), and that preceptors are more likely to continue and commit to the role when they perceive that the rewards are personally meaningful or professionally beneficial (Benner 1995, O’Mara & Welton 1995). According to Stone and Rowles (2002), the highest ranked rewards among the preceptors were ‘continuing education day/appreciation day’, followed by ‘being able to audit selected classroom experiences at the graduate level’. Rewards such as letters of recommendation, certificates and appointment as honorary (unpaid) faculty members were ranked lowest. (see also Stevenson et al. 1995). Contradictory findings have been reported concerning the relationship between the rewards of preceptorship and job
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satisfaction. Early workers (McLean 1987, Yonge et al. 1989) reported increased job satisfaction even though increased workload was recognized as a disadvantage (Shogan et al. 1985, Yonge et al. 1989). Some reports have described the preceptor role as stressful (Shogan et al. 1985, Bizek & Oermann 1990, Stevenson et al. 1995, Yonge et al. 2002b). Others have indicated that preceptorship may actually help to prevent or reverse burnout (McGregor 1999, see also Yonge et al. 2002a). Preceptors are, in general, strongly committed to the role and a few studies have demonstrated that commitment is related to the benefits and rewards (Dibert & Goldenberg 1995, O’Mara & Welton 1995, Usher et al. 1999). However, contradictory findings have been reported concerning the number of preceptor experiences (Dibert & Goldenberg 1995, Usher et al. 1999), with experience in the role leading both to more and less commitment. Ferguson’s (1996) study confirmed preceptors’ strong commitment to student education linked with the achievement of students’ goals and improvement in their clinical skills.
What is known about support and commitment? Today, there is recognition of the time, energy and patience required by preceptors and the need for support to fulfil the role efficiently in an increasingly busy and complex-work environment (Yonge et al. 2002a). The findings concerning ‘support’ seem to be contradictory in the literature. For example, Grealish and Carroll (1998) reported that only half of the preceptors in clinical settings (n = 34) believed that they received any kind of recognition or support. On the other hand, Yonge et al. (2002b) found that the majority (73%, n = 295) of the preceptors received enough support. Studies exploring preceptors’ perceptions of support have shown that the need for support varies. Speers et al. (2004) recognized that support is needed for developing teaching skills and for handling the day-to-day demands of being a preceptor. The need for continuous support rises from the requirements simultaneously to balance demands from patients and preceptees, time constraints, increased workload and stress, lack of financial support and loss of time with patients. Support is also needed in challenging situations such as how to handle ‘unsafe’ or ‘I-don’t-know’ learners (Speers et al. 2004, see also Yonge et al. 2002b). Several concrete means of support have been described in the literature, including: providing education/extra training for the role; allowing schedule and assignment adjustments; allowing preceptors to decline the position at intervals to prevent stress/burnout; providing support handling borderline students; establishing clear guidelines for the role and
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organizing opportunities to meet with preceptors’ managers to share experiences and concerns (Alcock et al. 1988, Lewis 1990, Ferguson 1995, 1996). Education programmes for preceptors are considered strong, systematic and consistent forms of support (Dyer & Pardue 1999). The most supportive education programmes are long in duration, extend over several months and have an evaluation at the end (Dyer & Pardue 1999). Administrative support has been described as special arrangements that ensure consistent schedules, without the requirement to serve as substitute or work rotation staff, and released time and lighter work assignments (Ferguson 1995, 1996). Alspach (1989) found that administrative support was provided most commonly by head nurses and less so by nursing and hospital administrators. Approximately 6Æ6% of preceptors reported no support from the administrative staff or peers. More than half of respondents found their peers supportive. Usher et al. (1999) have confirmed, in a more recent study, that support from the institution and fellow workers is vital for participation as a preceptor. However, Yonge et al. (2002b) found that only 15% of preceptors considered support from the institution to be important. Support from education staff for preceptors has been seen as crucial and, according to Ferguson, the responsibility to provide support ultimately lies with education staff (1995 and 1996). Ferguson (1995, 1996) has found the most important forms of support from educators to be information and reassurance about education and curriculum (e.g. programme expectations, student progress); clarification of details during the preceptorship process (e.g. setting realistic goals, standards for comparison of student performance); and specific information about remedial actions to improve performance deficits. Registered nurse preceptors prepared at the diploma level or lacking past experience were especially likely to seek assistance and support from education staff. For all preceptors, support and feedback were also heavily sought for preparation of evaluations and clarification of performance criteria. Preceptors needed continuous support, reassurance, and encouragement about their teaching role from educators, as well as information and involvement. Without support, preceptors tended to lose commitment (Ferguson 1995, 1996). Preceptors need support from educators, managers and administrators, and the forms and means of support needed from each are different (Speers et al. 2004). Support from educators is, however, most essential to staff nurses who engage in the preceptor role, as they support preceptors with student issues and ultimately reinforce the values of the profession (Hales et al. 2004).
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The study Aim The aim of this study was to explore the relationships between preceptors’ perceptions of benefits, rewards, support, and commitment to the preceptor role with a group of graduating nursing students (Bachelor of Nursing Science) and newly hired nursing staff. The research questions were: 1. What is the relationship between preceptors’ perceptions of benefits and rewards associated with (a) the preceptor role and (b) commitment to the role? 2. What is the relationship between preceptors’ perceptions of support for the (a) preceptor role and (b) the preceptor’s commitment to the role? 3. What is the relationship between the preceptor’s years of nursing experience and the preceptor’s (a) perceptions of benefits and rewards associated with the preceptor role and (b) perceptions of support for the preceptor role and (c) commitment to the role? 4. What is the relationship between the number of times the preceptor has acted as preceptor and the preceptor’s (a) perceptions of benefits and rewards associated with the preceptor role, (b) perceptions of support for the preceptor role and (c) commitment to the role?
Design A descriptive, correlational design was employed. The design resembled the questionnaire surveys undertaken by Dibert and Goldenberg (1995) and Usher et al. (1999).
Definitions The definitions of the key concepts by Dibert and Goldenberg (1995) were adopted in this study. Benefits and rewards were defined as positive outcomes associated with services and measured by the Preceptor’s Perceptions of Benefits and Rewards (PPBR) Scale. Support referred to the conditions that enable the performance of a function and was measured by the Preceptor’s Perceptions of Support (PPS) Scale. Commitment implied a combination of attitudes that reflect dedication to the role of preceptor and was measured by the Commitment to the Preceptor Role (CPR) Scale. In this study, the following definition of a preceptor was summarized from the literature as: an experienced nurse, a resource person and role model for preceptee(s) in one-to-one, one-to-two or oneto-three/multiple relationship(s) who facilitates and evaluates learning, fosters independence, development of skills, competencies and confidence and socializes students or newly 516
hired nurses to the nursing role through direct involvement in the teaching–learning process in clinical settings over a predetermined amount of time defined by educational institution or employer. (Stevenson et al. 1995, Bain 1996, Letizia & Jennrich 1998, Ryan-Nicholls 2004).
Participants and data collection The data for this study were collected in two phases. The target group for the first phase included all preceptors (preceptor sub-group A) in the region who had attended preceptor workshops and who were thus assumed to work as preceptors to newly hired nurses. The Regional Human Resources Office provided 170 preceptors’ names and mailing addresses. The database used to find the respondents and their contact information was updated continuously. The questionnaires were mailed in November 2004 with a reminder letter in December 2004. The second phase of data collection targeted preceptors (preceptor sub-group B) involved in fourth-year clinical practice courses in an undergraduate nursing programme at a local university. The clinical placement coordinator provided 56 preceptor names. The questionnaires were delivered to the preceptors by the educators who worked together and were returned by mail to the primary investigator. These data were collected in April–May 2005. The two mailing lists were checked for overlap and the three respondents found on both lists were excluded from the study.
Instruments A four-part questionnaire was used to collect the data: PPBR Scale, PPS Scale, CPR and a demographic information sheet. The questionnaire, developed by Dibert and Goldenberg (1995) was used with the authors’ permission. The PPBR Scale includes 14 items rated on a 6-point Likert scale (from 1 = strongly disagree to 6 = strongly agree) and measures preceptors’ perceptions of opportunities associated with the preceptor role. The PPS Scale comprised of 17 items that are also rated on a 6-point scale to measure preceptors’ perceptions of support for the preceptor role. The CPR Scale was adapted by Dibert (1993, in Dibert & Goldenberg 1995) from the Organizational Commitment Questionnaire developed by Mowday et al. (1979, in Dibert & Goldenberg 1995). The CPR Scale is comprised of 10 items rated on a 6point scale to measure commitment to the preceptor role. The demographic information sheet included education, age, gender, years of nursing and preceptor experience, and types and number of preceptor experiences. Additional questions focused on professional designation, type of
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employment, year and place of graduation, type of workplace and its location, and type of nursing care provided by a preceptor.
Validity and reliability Dibert and Goldenberg (1995) have reported the reliability analysis and Cronbach’s Alpha coefficients for the three scales (PPBR, PPS and CPR) as 0Æ91, 0Æ86 and 0Æ87 respectively. Usher et al. (1999) have reported almost similar, but slightly lower, Cronbach’s Alpha values (PPBR 0Æ93, PPS 0Æ74 and CPR 0Æ77). Since over 10 years had passed since the development and previous use of the instruments in Canada, we first pilot tested the scales with 17 staff nurses. The sample size was small given the number of items in the questionnaires, but was adequate for the purpose of pilot testing the current relevance of the items (Polit et al. 2001). The reliability analysis of the pilot data indicated that the Cronbach’s alpha was 0Æ88 for the PPBR, 0Æ85 for the PPS and 0Æ64 for the CPR Scale the coefficient. Inspection of the item correlations revealed that two questions in the CPR Scale had much lower correlations with the sum of the scores of the remaining questions. Pilot study participants also commented on the terminology in these two items. For example, in the item ‘Nursing Coordinators are available to help me develop in my role as a preceptor’, the term ‘Nursing Coordinator’ received feedback that the title was unknown within the organization. In our main study, the two items were not changed; however, the terms were explained using footnotes. Cronbach’s alpha coefficients in the data collected with the clarifying footnotes were as follows: PPBR 0Æ90, PPS 0Æ75 and CPR 0Æ86.
Changes in the preceptor role
Coefficients were calculated when variables were measured on ordinal scales (e.g. years of nursing experience). The total sample and two sub-samples were analysed using the same methods. The non-parametric chi-square, Kruskal–Wallis and Mann–Whitney tests were used to determine any differences between the two preceptor sub-groups and differences in scores on the scales. The level of significance selected for data analysis was 0Æ05 (2-tailed significance).
Results Participants The sample for this study consisted of 82 preceptors. The response rate for the first data-collection phase (preceptor sub-group A, n = 55) was 32Æ4%. In the second datacollection phase (preceptor sub-group B, n = 27) the response rate was 48Æ2%. Respondents’ age varied between 23– 61 years (mean 46Æ11, SD 10Æ30) and work experience between 2–38 years (mean 16Æ80, SD 10Æ43). Respondents were predominantly female and were preceptors for undergraduate nursing students and/or newly hired nursing staff, and they worked in different types of healthcare organization. Length of preceptorship experience ranged from 1 to 36 years (mean 7Æ50, SD 8Æ18, mode 1), but did not differ statistically significantly between the two groups. The average number of preceptor experiences was 1Æ2 students and newly hired nurses (mode = 1). Demographic characteristics are displayed in Table 1. Attendance at preceptorship workshops was significantly higher in preceptor sub-group A compared with sub-group B (v2 = 19Æ816, d.f. = 3, P < 0Æ001). However, 80Æ5% of all respondents had attended the preceptorship workshops (Table 2).
Ethical considerations The institutional review boards of the university and hospital approved the study. Respondents were informed of its purpose in a cover letter and were assured that their replies to the questionnaire were anonymous and confidential. Signed consent was obtained from each respondent.
Data analysis Data were analysed using the SPSS 14.0 software (SPSS Inc., Chicago, IL, USA). Descriptive statistics were used to analyse the data collected from the demographic questionnaire, and inferential statistics were used to analyse the remaining data. Pearson’s Product Moment Correlation Coefficients were calculated between the variables measured using interval scales (PPBR, CRP and PPS) and Spearman Rank Correlation
Perceptions of benefits, rewards and commitment Correlation between the two sub-scales (PPBR and CPR) showed that the more that preceptors perceived there were benefits and rewards, the more they were committed to the role (r = 0Æ52, P < 0Æ001, n = 70). Positive correlations were also found in both sub-groups A (r = 0Æ50, P < 0Æ001) and B (r = 0Æ60, P < 0Æ01). Dibert and Goldenberg (1995) have reported similar findings (r = 0Æ63, P < 0Æ001, n = 52), as has Usher et al. (1999) (r = 0Æ54, P < 0Æ001, n = 98).
Perceptions of support and commitment In this study, a positive and statistically significant (r = 0Æ42, P = 0Æ01) correlation was found between perceptions of support and commitment to the role, suggesting that
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K. Hyrka¨s and M. Shoemaker Table 1 Demographic characteristics of respondents (n = 82)
Table 2 Respondents’ preceptorship experiences
Preceptor Preceptor sub-group sub-group A (n = 55) B (n = 27) Total % Education College diploma Bachelor’s degree Other Age £29 30–39 40–49 50–59 ‡60 Gender Male Female Professional designation Registered nurse Other (RPN/LPN)* Place of graduation British Columbia, Canada Elsewhere in Canada International Year of graduation £1980 1981–1990 1991–2000 ‡2001 Years of work experience £10 11–20 21–30 ‡31 Workplace Community health agency Home care agency/nursing home Hospital Other Type of nursing Acute/emergency/intensive care Community health General medical/surgical Elder/long-term care Maternal Other Employment Regular, full-time Regular, part-time Location City/town Rural area *RPN = 3, LPN = 7.
518
29 18 8
14 11 2
43 29 10
52Æ4 35Æ4 12Æ2
4 9 15 26 1
4 5 6 10 1
8 14 21 36 2
9Æ9 17Æ3 25Æ9 44Æ4 2Æ5
1 54
– 27
1 81
1Æ2 98Æ8
45 10
27 –
72 10
87Æ8 12Æ2
33
15
48
58Æ5
17 5
8 4
25 9
30Æ5 11Æ0
27 11 12 5
11 5 5 6
38 16 17 11
46Æ3 19Æ5 20Æ7 13Æ4
13 14 18 10
10 6 8 3
23 20 26 13
28Æ0 24Æ4 31Æ7 15Æ9
12 4
6 1
18 5
22Æ0 6Æ1
35 4
20 –
55 4
67Æ1 4Æ9
10
4
14
17Æ3
10 8 4 8 14
6 6 1 5 5
16 14 5 13 19
19Æ8 17Æ3 6Æ2 16Æ0 23Æ5
43 12
25 2
68 14
82Æ9 17Æ1
45 9
22 5
67 14
82Æ7 17Æ3
Preceptor sub-group A (n)
Preceptor sub-group B (n)
Years of experience as preceptor £10 34 19 11–20 8 4 21–30 3 2 ‡31 1 – Type and number of preceptor experiences Newly hired nurses 34 5 Nursing students 43 19 Attendance at preceptorship workshops During 2003 14 1 During 2004 33 12 Some other occasion – 6 No attendance 8 8
Total
%
53 12 5 1
74Æ6 16Æ9 7Æ0 1Æ4
39 62
38Æ6 61Æ4
15 45 6 16
18Æ3 54Æ9 7Æ3 19Æ5
preceptors’ perceptions of their role were positively related to their commitment to it. Dibert and Goldenberg (1995) and Usher et al. (1999) have reported similar positive statistically significant correlations (respectively, r = 0Æ46, P = 0Æ010, n = 30 and r = 0Æ034, P = 0Æ001, n = 89). Interestingly, we found no association between the number of preceptors’ experiences with students (i.e. type and number of preceptor experiences), perceptions of support (r = 0Æ17, P = 0Æ34) or commitment to the role (r = 0Æ07, P = 0Æ62).
Years of nursing experience, perceptions of benefits, rewards, support and commitment to the role None of the correlations between preceptors’ years of nursing experience and scores on the PPBR, PPS and CPR scales reached statistical significance. This finding parallels those of earlier studies (Dibert & Goldenberg 1995, Usher et al. 1999). Statistically significant correlations were found in members of preceptor sub-group B, who were in an active, currently running preceptorship with undergraduate students. In this sub-group the preceptor’s nursing experience correlated statistically significant (r = 0Æ62, P = 0Æ02) with perceptions of support. Statistically significant associations were found between perceptions of support (PPS) and, preceptor’s age (r = 0Æ68, P < 0Æ01) and graduation year (r = 0Æ60, P = 0Æ02) (Table 3).
Numbers of preceptorship experiences and perceptions of benefits, rewards, support and commitment No statistically significant relationships were found between number of experiences as a preceptor, number of each type of
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Changes in the preceptor role
Table 3 Correlations between preceptors’ perceptions of benefits, support and commitment in the two sub-groups
Benefits
Support
Commitment
Preceptor Preceptor Preceptor sub-group sub-group sub-group Preceptor sub-group A (r) B (r) B (r) A (r) Age Work experience in nursing Graduation year
Preceptor Preceptor sub-group sub-group B (r) A (r)
0Æ10 0Æ15
0Æ06 0Æ06
0Æ09 0Æ07
0Æ68** (P < 0Æ01) 0Æ62* (P = 0Æ02)
0Æ06 0Æ02
0Æ20 0Æ25
0Æ03
0Æ08
0Æ03
0Æ60* (P = 0Æ02)
0Æ10
0Æ12
Levels of statistical significance *P < 0Æ05, **P < 0Æ01.
preceptorship and scores on the PPBR, PPS and CPR scales. These findings are similar to the results of earlier studies (Dibert & Goldenberg 1995, Usher et al. 1999). Nonparametric tests were used to determine the differences between scale scores in the two sub-groups and respondents’ educational preparation, graduation year, attendance at preceptorship workshops, age, workplace and type of nursing. Statistically significant differences were not found between educational background and scores on the PPBR (P = 0Æ06), PPS (P = 0Æ80) and CPR (P = 0Æ66) scales or between age and PPBR scores (P = 0Æ29), PPS (P = 0Æ30) and CPR (P = 0Æ06) (Table 4). These findings were similar to those of earlier studies (Dibert & Goldenberg 1995, Usher et al. 1999). However, in the PPBR Scale, statistically significant differences were found among the preceptors according to graduation year, workplace and type of nursing work. Preceptors who had graduated in 1981–1990 (mean 74Æ60, SD 6Æ97) assessed the benefits and rewards as statistically significantly higher compared with their colleagues who had graduated in 1991–2000 (mean 69Æ25, SD 6Æ85) or late 2001 (mean 66Æ64, SD 7Æ38). The benefits and rewards were also assessed as statistically significantly better/higher by preceptors whose workplaces were homecare or nursing home settings (mean 77Æ80, SD 3Æ42) and when the type of nursing was long-term or elder care (mean 77Æ75, SD 3Æ95) compared with, for example, respondents in community health agencies (mean 64Æ67, SD 9Æ22) or where the type of nursing was community health (mean 63Æ43, SD 8Æ17) (Table 4).
the item rank-orders were different, suggesting changes in preceptors’ perceptions. On the PPBR Scale, only four items (Items 3, 7, 13 and 14) and on the PPS Scale, only two items (Items 17 and 18) had the same rank-order in comparison with the earlier study completed in Canada (Dibert & Goldenberg 1995). The mean rank in the PPBR was higher (grand mean rank 4Æ92) in this study than in the two earlier studies. This indicates that respondents today had higher perceptions of the benefits and rewards from participating in a preceptorship than those (grand mean rank 4Æ55) approximately 11 years ago in Canada (Dibert & Goldenberg 1995) or 6 years ago (grand mean rank 4Æ85) in Australia (Usher et al. 1999). It also appeared that perceptions of support today (grand mean rank 3Æ78) were lower in comparison with the earlier findings (grand mean rank 4Æ07) from Canada (Dibert & Goldenberg 1995), but slightly higher (grand mean rank 3Æ63) than those from Australia (Usher et al. 1999) (Table 5) .Our respondents rated their commitment to their role as preceptor very highly, as demonstrated by a grand mean of 4Æ81 (Table 6). An interesting finding in this study was that preceptors (sub-group B) of undergraduate nursing students assessed the support higher (mean 68Æ64, SD 14Æ51, P = 0Æ04) than the other (sub-group A) preceptors (mean 59Æ32, SD 10Æ27) (Table 7). Closer examination of the two sub-groups and the items in the PPS Scale revealed differences between the mean scores for four items (17, 19, 20 and 23) focusing on: support from the nursing coordinator, other staff not understanding of preceptor programme goals, related workload, and time for patient assignments (Table 8).
Additional findings The rank-ordered means scores for the PPBR, PPS and CPR are presented in Tables 5–7. Comparison of the orders of items in the two earlier studies (Dibert & Goldenberg 1995, Usher et al. 1999) showed high consistency, and most items were in almost the same rank-order. However, in our study
Discussion Study limitations A limitation of this study is that the response rates remained low. In the first phase 32Æ4% (n = 55) of the questionnaires
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K. Hyrka¨s and M. Shoemaker Table 4 Respondent background and perceptions of benefits, support and commitment to preceptor role Benefits Mean Education College diploma Bachelor’s degree Other Age £29 30–39 40–49 50–59 ‡60 Year of graduation £1980 1981–1990 1991–2000 ‡2001 Workplace Community health agency Home care /nursing home Hospital Other Type of nursing Acute/intensive care Community health General medical/surgical Elder/long-term cage Maternal Other
Support SD
P value
Mean (n)
Commitment SD
P value
Mean (n)
SD
P value
69Æ78 65Æ93 73Æ33
9Æ61 9Æ06 6Æ67
0Æ06
63Æ87 60Æ27 62Æ40
14Æ25 9Æ68 11Æ72
0Æ80
48Æ86 48Æ07 50Æ30
6Æ27 7Æ35 7Æ90
0Æ66
70Æ25 64Æ85 70Æ26 69Æ26 72Æ50
4Æ77 7Æ88 10Æ27 10Æ12 9Æ19
0Æ29
61Æ50 55Æ14 65Æ08 63Æ53 78Æ00
5Æ92 9Æ84 11Æ37 15Æ17 N/A
0Æ30
52Æ57 44Æ38 50Æ61 48Æ88 50Æ00
7Æ55 6Æ24 6Æ00 6Æ47 12Æ73
0Æ06
66Æ89 74Æ60 69Æ25 66Æ64
10Æ86 6Æ97 6Æ85 7Æ38
0Æ04*
61Æ00 67Æ00 65Æ29 55Æ83
14Æ09 12Æ91 8Æ98 10Æ42
0Æ26
47Æ91 51Æ44 47Æ38 49Æ44
6Æ63 6Æ24 6Æ43 9Æ06
0Æ27
64Æ67 77Æ80 68Æ83 75Æ00
9Æ22 3Æ42 9Æ23 7Æ00
0Æ02*
64Æ25 73Æ50 61Æ06 N/A
5Æ68 4Æ65 13Æ32 N/A
0Æ07
46Æ12 52Æ80 48Æ68 55Æ57
5Æ54 8Æ14 6Æ93 3Æ40
0Æ32
67Æ00 63Æ43 70Æ86 77Æ75 68Æ38 70Æ67
11Æ92 8Æ17 7Æ67 3Æ95 9Æ67 8Æ20
0Æ04*
63Æ83 66Æ33 62Æ14 69Æ25 63Æ87 56Æ40
4Æ07 4Æ72 14Æ93 8Æ77 12Æ87 16Æ38
0Æ33
50Æ50 45Æ53 50Æ21 54Æ80 47Æ91 48Æ35
6Æ75 5Æ40 7Æ73 6Æ87 6Æ61 6Æ85
0Æ08
Levels of statistical significance: *P < 0Æ05.
were returned and 48Æ2% (n = 27) during the second phase of data collection. The overall response rate remained 36Æ3% (n = 82, n = 226). The interesting differences regarding perceptions of support were mainly found between the workshop-prepared preceptors and those with an active, ongoing preceptorship relationship with undergraduate nursing students. The findings may be biased because of the selection of the respondents. It is likely that the most active and enthusiastic preceptors participated in the preceptorship workshops and completed the questionnaires. The findings may also be positively biased among respondents/preceptors who had an active, ongoing preceptorship relationship with undergraduate nursing students and who were supported by the faculty members. On the other hand, the workshopprepared preceptors may have addressed more critical perceptions, because of the lack of support.
Discussion of results The sample for this study consisted of 82 preceptors, which compares reasonably well to earlier studies using the same 520
scales. The findings parallel those of Dibert and Goldenberg (1995) in their study of 59 Canadian preceptors in Ontario and Usher et al.’s (1999) study of 134 Australian preceptors in North Queensland. Our respondents’ demographic characteristics (i.e. age, work experience, specialty and preceptorship experience) were also comparable with the earlier studies (Dibert & Goldenberg 1995, Ferguson 1995, 1996, Usher et al. 1999, Yonge et al. 2002a, 2002b). However, in our study the average number of preceptor experiences was 1Æ2 students and newly hired nurses, which is lower than in the earlier studies but reflects the fact that the undergraduate nursing programme at the local university had only recently started. Dibert and Goldenberg (1995) reported 4Æ8 students and Usher et al. (1999) reported 3Æ0 students as average preceptor experiences. This study confirmed that the preceptors are committed to their role, especially when benefits are available. The findings also suggest that the benefits and rewards offered to the preceptors have increased or improved as current perceptions were higher than reported earlier (Dibert & Goldenberg 1995, Usher et al. 1999). This trend looks interesting and
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Changes in the preceptor role
Table 5 Highest rank-ordered mean scores for perceptions of benefits and rewards (Preceptor’s Perceptions of Benefits and Rewards)
Share my knowledge with new nurses and nursing students (9) Assist new staff nurses and nursing students to integrate into the nursing unit (2) Learn from new nurses and nursing students (10) Keep current and remain stimulated in my profession (4) Teach new staff nurses and nursing students (1) Increase my own professional knowledge base (3) Contribute to my profession (11) Improve my teaching skills (8) Gain personal satisfaction from the role (6) Be recognized as a role model (7) Influence change on my own nursing unit (5) Improve my organizational skills (13) Increase my involvement in the organization within this hospital (12) Improve my chances for promotion/advancement within this organization (14)
Table 6 Highest rank-ordered mean scores for commitment to the preceptor role
n
Mean
SD
82
5Æ45
0Æ72
81
5Æ44
0Æ73
82
5Æ40
0Æ77
82
5Æ35
0Æ85
82
5Æ29
0Æ82
81
5Æ22
0Æ92
82
5Æ22
0Æ82
81
5Æ20
0Æ86
82
5Æ18
0Æ96
82
4Æ67
1Æ02
81
4Æ63
1Æ16
82
4Æ57
1Æ41
80
4Æ47
1Æ21
Being a preceptor really inspires me to perform my very best (41) I find that my values and the values of the preceptor programmeare very similar (35) I really care about the fate of the preceptor programmein this hospital (39) Deciding to be a preceptor was a definite mistake on my part (40) It would take very little change in my present circumstances to cause me to stop being a preceptor (37) I feel very little loyalty to the preceptor programme (34) There is not too much to be gained by continuing to be a preceptor (38) I am proud to tell others that I am a preceptor (36) I am willing to put in a great deal of effort beyond what is normally expected in order to help the preceptee be successful (32) I am enthusiastic about the preceptor programmewhen I talk to my nursing colleagues (33)
1Æ39
The number in the parenthesis is the item number in the original scale.
81
2Æ89
The number in the parenthesis is the item number in the original scale.
suggests that preceptor commitment and appreciation of nonmaterial benefits are growing stronger. These findings are supported by recent studies by Stone and Rowles (2002) and Hales et al. (2004). Continuous and active facilitation of benefits such as preceptor workshops seem to be vital for sustainable, long-term development of the preceptor role. The findings of our study represent mainly workshopprepared preceptors’ perceptions, as 73Æ2% of the respondents had attended at least one of the two workshops. Earlier studies have shown that education programmes are strong, systematic and consistent forms of support (Dyer & Pardue 1999). Our findings demonstrate that education is also perceived as a benefit.
n
Mean
SD
79
5Æ19
0Æ85
78
5Æ04
0Æ91
77
4Æ99
1Æ03
79
4Æ86
1Æ05
78
4Æ85
0Æ91
80
4Æ78
1Æ12
80
4Æ72
1Æ03
78
4Æ70
1Æ03
81
4Æ63
1Æ16
79
4Æ32
1Æ30
Contrary to concerns in the literature about ‘burnout’ associated with the frequency of preceptorships, Dibert and Goldenberg (1995) reported that preceptors were committed to their role regardless of the increasing numbers of preceptorships. This finding was supported in our study by those preceptors involved in ongoing preceptorships who reported positive perceptions of support regardless of the number of students they preceptored. An explanation for this may be that this sub-group had learned to recognize and use the support provided during the course of their own careers. However, this sub-group also had continuous support from education staff, as they were preceptoring undergraduate nursing students. Conversely, our findings showed that workshop-prepared preceptor’s perceptions of commitment and support decreased with higher numbers of preceptees. An explanation for this may be that this sub-group was not given support outside the workshops. Earlier studies have shown
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521
K. Hyrka¨s and M. Shoemaker Table 7 Comparison of the preceptor’s perceptions of benefits and rewards (PPBR), preceptor’s perceptions of support (PPS) and commitment of the preceptor role (CPR) mean values between the two sub-groups Benefits (PPBR)
Preceptor sub-group A Preceptor sub-group B Total
Support (PPS)
n
Mean
SD
51 26 77
70Æ22 66Æ15 68Æ84
8Æ15 10Æ99 9Æ34
Commitment (CPR)
P
n
Mean
SD
0Æ15
25 14 39
59Æ32 68Æ64 62Æ67
10Æ27 14Æ51 12Æ62
P
n
Mean
SD
P
0Æ04*
50 23 73
48Æ66 48Æ95 48Æ75
6Æ83 7Æ10 6Æ87
0Æ89
Levels of statistical significance: *P < 0Æ05.
Table 8 Highest rank-ordered mean scores’ for preceptors’ perception of support (PPS): means and standard deviations of the sample and the two sub-groups
My co-workers on the nursing unit are supportive goals of the preceptor programme (18) I feel the nursing coordinators and nursing managers are committed to the success of the preceptor programme (22) My goals as a preceptor are clearly defined (16) I feel I have had adequate preparation for my role as preceptor (15) Nursing educators are available to help me develop in my role as a preceptor (24) Nursing coordinators are available to help me develop in my role as a preceptor (23) My workload is appropriate when I function as a preceptor (19) The nursing staff do not understand the goals of the preceptor programme (17) There are adequate opportunities for me to share information with other preceptors (25) I do not have sufficient time to provide patient care while I function as a preceptor (20) I feel I function as a preceptor too often (21)
Preceptor sub- group A
Preceptor sub-group B
n
Mean
SD
n
Mean
SD
51
4Æ25
0Æ89
25
4Æ68
0Æ90
55
4Æ13
1Æ19
26
4Æ65
55
4Æ35
1Æ27
27
55
4Æ09
1Æ25
47
3Æ85
51
Total n
Mean
SD
0Æ07
76
4Æ39
0Æ91
1Æ23
0Æ07
81
4Æ30
1Æ22
4Æ19
1Æ11
0Æ55
82
4Æ29
1Æ21
27
4Æ33
1Æ30
0Æ32
82
4Æ17
1Æ27
1Æ23
21
4Æ43
1Æ25
0Æ11
68
4Æ03
1Æ26
3Æ55
1Æ14
26
4Æ27
1Æ43
<0Æ05*
77
3Æ79
1Æ28
54
3Æ22
1Æ19
27
4Æ15
1Æ13
<0Æ01**
81
3Æ53
1Æ25
55
3Æ58
1Æ01
25
3Æ04
1Æ21
<0Æ05*
80
3Æ41
1Æ10
55
3Æ35
1Æ21
27
3Æ52
1Æ31
0Æ73
82
3Æ40
1Æ24
51
3Æ57
1Æ04
27
3Æ04
1Æ13
<0Æ05*
78
3Æ39
1Æ10
53
2Æ77
0Æ95
27
3Æ00
0Æ92
0Æ40
80
2Æ85
0Æ94
P value
The number in the parenthesis is the item number in the original scale. Levels of statistical significance: *P < 0Æ05, **P < 0Æ01.
that attendance at workshops increases preceptors’ critical awareness of the role (Speers et al. 2004) and also helps preceptors to realize the universal nature of problems and solutions (Yonge et al. 2002b). However, our findings of this 522
study demonstrate the essential need for ongoing support. The implications are that workshops may be regarded as a benefit and as important especially for commitment to the role, but they are not a replacement for ongoing support.
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What is already known about the topic • The rewards and benefits of preceptorships are important for preceptors, and preceptors are committed to their role. • Preceptors need support in their preceptorships and this is provided by administrators, managers and especially faculty. • The preceptor role is multi-faceted, complex and evolving.
What this paper adds • Preceptors need continuous support in their ongoing preceptorship relationships with preceptees. • Preceptors get support from nurse educators for preceptorships with student preceptees, but not from the hospital organization for preceptorships with newly hired preceptees. • Preceptors’ perceptions of the benefits, rewards and support are changing and some new preceptors have international backgrounds, as organizations are increasingly hiring new staff from outside of their own national boundaries.
Support of nurses and preceptorships, especially with newly hired nursing staff, clearly needs more attention, consideration and collaboration with education staff. In our study, statistically significant differences in perceptions of the benefits and rewards were found among preceptors depending on their graduation year, workplace and type of nursing work. The implications of this present a challenge. How can preceptorships be made interesting and motivating for all nurses? The findings seem to suggest that different means are required, and earlier studies may give an answer to the question. Kitchen (1993) has reported that 80% of preceptors benefit from the preceptorship experience and that clinical, communication and teaching skills improve as a result. However, awareness of intrinsic and extrinsic benefits in the context of preceptorship workshops has remained limited, even though it was described in the early 1990s (Dibert & Goldenberg 1995). More research is clearly required to explore perceptions of the benefits of preceptorship today and how these might be related to preceptors’ background. In our study, an interesting and new finding was that 11% of the preceptors had received their education in another country. However, this sub-group was not big enough for further analysis. Empirical studies have not yet described
Changes in the preceptor role
these nurses’ perceptions of preceptorship. Earlier studies (e.g. Yonge et al. 2002b) have only touched on the topic from a different perspective by reporting increased needs for support when acting as a preceptor for students whose English is poor. Our findings imply that, if nursing staff whose first language is not English continue to be hired, further study of the preceptorships will be important and preceptorship programme need to be revised.
Conclusion We recommend that preceptors for newly hired staff be supported in the same way as those for students and that this is planned in collaboration with education staff. Preceptor workshops seem to increase preceptors’ confidence and critical awareness of the role, but this clearly functions as a starting point for a wider preceptor programme. More attention is required to develop efficient support systems such as networks for preceptors of student and newly hired nurses in clinical settings.
Author contributions KH was responsible for the study conception and design and the drafting of the manuscript. MS performed the data collection and KH performed the data analysis. KH obtained funding and MS provided administrative support. KH made critical revisions to the paper. KH provided statistical expertise. KH supervised the study.
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