Preceptors in nursing education: striking a balance between nursing student learning and client care

In the Irish healthcare system ward staffing is not matched with client acuity. With the recession came a moratorium on staffing and this combined with reduced length of stay for clients impacted significantly on nursing staff. Added to this a large number of front-line staff took early retirement leading to burnout of existing staff. Clear guidelines have been laid down by HIQA (2012a, 2012b) on the appropriate governance structure to ensure that client care is delivered safely and is of a high quality. The environment where nursing students undertake their clinical placement can have a positive or negative effect on them depending on the ratio of staff nurses to clients.The undergraduate nursing degree programme has been in place in Ireland since 2002. Nursing students register their qualifications with Bord Altranais agus Cnáimhseachais na hÉireann (Nursing and Midwifery Board, Ireland) upon successful completion of the programme. Nursing students are supported and facilitated on clinical placement by a qualified staff nurse named a preceptor. The term “preceptor” is the term used in Ireland to refer to a registered nurse who supports, guides and assesses nursing students on practice placement; the terms “mentor”, “practice placement supervisor” and “clinical supervisor” are also used in the literature to refer to the same role (Mead, 2012). For the purposes of this study the term “preceptor” will be used throughout this document.The quality of the nursing programme depends on the experience and level of supervision the nursing students receive in the clinical learning environment. This qualitative study explored current standards of the preceptorship model of nursing, to determine how preceptors perceive their role and the values preceptees place on the level of support they receive from preceptors during their clinical placements. I also needed to determine the level of support and training preceptors received from lecturers in higher education and management in the teaching hospital. The theoretical frameworks I used in the study were the Legitimate Peripheral Participation Theory(Lave and Wenger, 1991), which describes how newcomers become experienced members and eventually old-timers of a community of practice, and Social Learning Theory (Bandura, 1977), which proposes that learning takes place as a result of social interaction with other staff, including preceptors, through both verbal and non-verbal language.The literature implied that the role of the preceptor is stressful and the training inadequate (Haggerty et al., 2012; Eley, 2010; McCarthy and Murphy, 2010). This study set out to explore the tripartite relationship between preceptors, nursing students and lecturers. Using a qualitative approach, I conducted 24 semi-structured interviews with nursing students (n=8), preceptors (n=8) and lecturers (n=8). The study findings suggested that the preceptor’s role is difficult owing to time constraints, ward acuity and lack of resources. Part of the remit of a nurse working on a ward necessitates working different shifts and preceptors identified that it can be difficult to match the duty of a staff nurse with that of a nursing student. Preceptors found it challenging to give enough quality time to the students. Client care is always a priority with staff nurses, and must come first; the time they can spend with nursing students therefore tended to be ad hoc in nature. According to the preceptors they need on-going support from management of the hospital and lecturers in higher education. Those interviewed suggested they loved their role but felt they could not give enough quality time to the students. They would like more support from clinical placement coordinators (CPCs), from lecturers in higher education, and from management of the hospital. The preceptors also suggested that the training they receive needs to be more comprehensive, and to include more refreshers on curricula, teaching and assessing nursing students and providing feedback.The nursing students valued the time they spent with their preceptor, but this was sometimes limited owing to resources, ward acuity and working different shifts. They latched on to any available nurse when their preceptor was busy elsewhere or off duty. Overall, they would much prefer to have their named preceptor with them for support and guidance and because the preceptor was their assessor for their final interview on the clinical placement. The lecturers acknowledged the wonderful work the preceptors do in facilitating the nursing students in the clinical area. They believed that the preceptors should be given more support in the form of refreshers and “protected time”to precept the students. The lecturers would like to be more visible in the clinical area, but because of their teaching, research and administrative role their time is limited to quick visits to the ward. Some lecturers acknowledged that to remain current it is important for them to spend more time in the clinical area.Preceptors, employed by health care institutions, undertake the responsibility of supporting nursing students without protected time or remuneration. The nursing students are also supported by clinical placement co-ordinators (CPCs) on a 1 : 30 ratio. CPCs are employed by health care institutions to co-ordinate clinical placements. They assist with teaching and learning of students but do not formally assess them. They were not included in this study as there were insufficient numbers to match the sample size.To conclude, if there is insufficient time to precept nursing this can be a lost learning opportunity for the students. The nursing students miss the direct support and feedback from their preceptor and their learning is limited. They can finish their clinical placement not having reached their potential and maximised their learning. Despite the current climate of austerity there is a need to retain our highly qualified and capable nursing workforce.