Preceptorships

Bristol, T. J. (2003). Preceptorships. Nursing Matters: Student Edition, 20-23.

Nursing students learn our profession in a variety of formats and venues. Much of the theory and basics of nursing are acquired through class time spent with faculty experts in discussions, lectures, labs, or working on projects. The clinical practice is acquired and enhanced in practice settings such as hospitals, clinics, long-term care facilities and home health agencies. Learning the art of clinical practice can be facilitated in the clinical format or the preceptor format.

As most of us well remember, the clinical format usually involves a nursing faculty member from the student's school. The instructor takes a group of students to a clinical facility. Under the supervision of the instructor the students learn the application of theory obtained in the classroom environment.

The preceptor format involves collaboration between a nurse practicing in the clinical environment and the preceptee from an affiliating school. The preceptor guides the training and directly works with the student/intern. The student/intern practices at the facility when the nurse is working. The student usually follows the nurse's schedule. The preceptorship may or may not be monitored by nursing faculty from an affiliating school.

Let's review two recent studies on the use of preceptorships in nursing academia.

The University of Texas at Tyler College of Nursing

Haas and others (2002) report on a study in which preceptorships were implemented and observed. This study included over 200 students and spanned four semesters. The preceptor-student interactions were monitored by researchers. Benefits of this type of clinical learning included:

1.The students are able to better manage time, take larger patient loads, and manage more skills than students in traditional clinical formats.

2. Students in preceptorships practice more interdisciplinary skills.

3. Students felt camaraderie with the staff nurses.

4. Hospital administrators noted that nurses on off-shifts were able to precept now that students could practice on any shift.

5. Preceptorships offered a better preview of future nurses.

6. Managers noted that the staff nurses displayed higher levels of professionalism on floors where preceptorships were occurring.

7. Faculty and staff noted an overall "renewed sense of pride in nursing" as an ongoing consequence of the preceptorships.

Critical Thinking and the Preceptorship

Myrick (2002) closely analyzed the relationships between preceptors and preceptees in a large hospital setting. She spent 14 weeks observing, interviewing and analyzing written material from 6 preceptors and 6 preceptees. She then describes the impact that this process has on the critical thinking ability of nursing students. Her findings and recommendations include the following.

1. Climate has a major impact on a student's ability to improve critical thinking skills. This played out in noting the importance of the entire team of nurses showing camaraderie towards the student preceptee. Given the immense importance of this climate issue, the nursing units where precepting occurs should be monitored frequently by faculty and staff development coordinators. One should assess for the team building spirit amongst all staff. When this spirit is lacking, a reevaluation may need to be made as to whether or not that particular unit is optimal for preceptees.

2. A One-to-One relationship was noted as an advantage in clinical skill acquisition and improving critical thinking ability. Using one preceptor to one student for the entire experience was reported to be optimal.

3. An interesting observation was that critical thinking was taught more by example than direct questioning and intentional teaching. The questions asked by the preceptors tend to be of a lower level than will normally be used to stimulate critical thinking. This issue points to the importance of the faculty or staff development coordinator facilitating practice in the art of higher level questioning. Another recommendation is to have faculty continually involved in precepting the preceptor.

When considering the use of clinical preceptorships, the format of the diploma schools come to mind. Students were trained by the hospital in the hospital. Many times nurses and faculty alike voice the idea that the diploma schools will return. What if we try to capture the best of both worlds?

Nursing's history reveals a struggle to attain and maintain professional respect in the health care community. It is for this reason that we need the academic rigor found in our colleges and universities. We see a need for academia to assist in acquisition of critical thinking skills. At the same time current research is displaying some exciting benefits for clinical settings and students alike when considering the use of preceptors in training students.

In light of the current nursing and faculty shortages, the profession should continue to pursue collaboration between current clinical practice and academia. This collaboration may not only help us navigate the shortages, but may also improve the profession as a whole. The next time you encounter a student, offer a complement. It may not only give them the encouragement they need to finish the day, but the boost they need to continue their pursuit of this great profession. When your facility is developing preceptorships, contact a local college or university for their input. When the faculty are redesigning curriculum, invite a few nurse preceptors and staff development coordinators from the clinical agency.

One of my colleagues on nights noted "3/4 of the bookwork that I learned in class, I KEPT because of all the time I spent in the hospitals." Lorna A., RN, Diploma Graduate, 1955.

Let's put our heads together and use Lorna's insight to improve the future of nursing.

References

• Haas, B. K., Dardorff, K. U., Klotz, L., Baker, B., Coleman, J., & Dewitt, A. (2002). Creating a collaborative partnership between academia and service. Journal of Nursing Education, 41(12), 518 - 523.
• Myrick, F. (2002). Preceptorship and critical thinking in nursing education. Journal of Nursing Education, 41(4), 154 - 164.