The Journal of Continuing Education in Nursing

Original Article 

Exploring Discrepancies in Perceived Nursing Competence Between Postgraduate-Year Nurses and Their Preceptors

Shu-Hwa Chen, MBA, RN; Li-Yu Chien, PhD, RN; Mei-Ling Kuo, MS, RN; Yi-Hui Li, MN, RN; Ming-Chu Chiang, MS, RN; Ya-Ching Liu, MBA, RN

Abstract

Background:

Postgraduate clinical training programs improve the core competence of nurses. How postgraduate-year (PGY) nurses perceive their clinical competence and their preceptors' perceptions may affect program effectiveness. This study compared the perspectives of clinical competencies of PGY nurses engaged in a residency program in Taiwan with their preceptors' perspectives.

Method:

A cross-sectional study was conducted at a medical center in Taiwan. The Nursing Competence Questionnaire was used to obtain data from 99 pairs of PGY nurses and preceptors.

Results:

PGY nurses' scores were higher than their preceptors' for communication, patient education, and management competencies (p <.05). Preceptors with more years of clinical experience exhibited greater assessment discrepancies for clinical care, communication, patient education, research awareness, and overall competence (p <.05).

Conclusion:

Preceptor development courses should be grounded in a strong pedagogical framework. An assessment tool with explicit behavioral indicators would be needed for objective evaluation from both perspectives.

J Contin Educ Nurs. 2017;48(4):190–196.

Abstract

Background:

Postgraduate clinical training programs improve the core competence of nurses. How postgraduate-year (PGY) nurses perceive their clinical competence and their preceptors' perceptions may affect program effectiveness. This study compared the perspectives of clinical competencies of PGY nurses engaged in a residency program in Taiwan with their preceptors' perspectives.

Method:

A cross-sectional study was conducted at a medical center in Taiwan. The Nursing Competence Questionnaire was used to obtain data from 99 pairs of PGY nurses and preceptors.

Results:

PGY nurses' scores were higher than their preceptors' for communication, patient education, and management competencies (p <.05). Preceptors with more years of clinical experience exhibited greater assessment discrepancies for clinical care, communication, patient education, research awareness, and overall competence (p <.05).

Conclusion:

Preceptor development courses should be grounded in a strong pedagogical framework. An assessment tool with explicit behavioral indicators would be needed for objective evaluation from both perspectives.

J Contin Educ Nurs. 2017;48(4):190–196.

Transitioning from graduate training to clinical practice is a challenge for RNs and the health care industry, and preceptorship programs are used to facilitating these transitions (Gueorguieva et al., 2016). Nurse residency programs prepare nurses to work confidently and competently to provide safe patient care. In conjunction with preceptorships, these programs help in the transition, retention, and recruitment of competent, newly employed nurses (Kamboj, 2013; Medas et al., 2015).

In 2007, the Taiwan Joint Commission on Hospital Accreditation launched a postgraduate year (PGY) training program for nurses to bridge the gap between academic education and the postgraduate clinical environment (Joint Commission of Taiwan, 2015). The 2-year, three-stage program involves the following: fundamental training (3 months, Stage 1), core competence training (9 months, Stage 2), and professional training (12 months, Stage 3). Stage 1 and 2 nurses are classified as N on the nursing clinical ladder; Stage 3 nurses are classified as N1.

PGY nurses are assigned qualified clinical preceptors, experienced nurses who play a crucial role in developing nurse competency (Valizadeh, Borimnejad, Rahmani, Gholizadeh, & Shahbazi, 2016). Favorable interactions in clinical teaching require a consensus between preceptors and PGY nurses regarding training objectives. A cohesive relationship between a preceptor and PGY nurse effects the overall success of PGY training programs (Gueorguieva et al., 2016). Discrepancies in the perceived importance of clinical duties and nursing competencies between preceptor and PGY nurse can limit the effectiveness of preceptorships.

Understanding differences in perceptions could improve clinical training. However, studies on clinical competencies of PGY nurses have only involved evaluations by preceptors or self-assessments by PGY nurses. One study compared nursing students' perspectives of their competence with that of their clinical instructors (Lin, Tu, & Hsieh, 2009), and another examined newly graduated nurses' competence through the viewpoints of students and qualified nurses (Lofmark, Smide, & Wikblad, 2006).

Exploring competence from the perspective of PGY nurses and their preceptors could strengthen the effectiveness of nurse clinical training programs. Therefore, the aim of this study was to explore and compare newly employed nurse's self-assessments of clinical competence with their preceptor's assessment, evaluate the discrepancies, and determine factors associated with the discrepancies in perceptions for PGY nurses and their clinical preceptor.

Method

Design, Participants, and Sample Size

A cross-sectional study was conducted from March 2015 to June 2015. Pairs of PGY nurses and their preceptors were purposively sampled from an academic medical center in Taiwan. PGY nurses were newly employed nurses in a 2-year PGY program. Preceptors that were assigned as clinical teaching authorities for PGY nurses were experienced RNs (i.e., N2 to N4 on the clinical ladder) who had completed preceptor training programs. New nurse employees who were not newly graduated were excluded. The mean standardized scores of competence (Lin et al., 2009) determined the sample size (307 PGY nurses and 31 preceptors [10.80 ± 2.58; 8.99 ± 2.49], respectively), which resulted in a Cohen's d effect size of .704. Type I error rate (alpha) of .05 and a statistical power of 0.95 yielded a minimum sample size of 54 PGY nurse–preceptor pairs.

Measures

A researcher-constructed demographic questionnaire collected participant data for factors shown to be associated with clinical nursing competence (Lin et al., 2009; Lofmark et al., 2006):

  • Age.
  • Nursing education level, such as an associate's degree, 2-year bachelor's degree (obtained following junior college), or 4-year bachelor's degree.
  • Hospital unit.
  • Clinical ladder position (N).
  • Clinical experiences.

Preceptor data also included clinical and teaching experience and number of preceptees previously supported.

The Nursing Competence Questionnaire developed by Lin et al. (2009) measured the perceived overall competence and subscales of clinical care, communication, research awareness, patient education, management, and professional growth. This questionnaire contained 58 questions and was scored with a 5-point Likert scale for importance (1 = extremely unimportant to 5 = extremely important) and adequacy (1 = extremely inadequate to 5 = extremely adequate). Score was equal to (adequacy score − 3) × (importance score), which adds weight to the importance of nursing competency in clinical applications, plus 10 points (to avoid a negative score), resulting in a range of 0 to 20. A higher score indicates greater nursing competency. The Cronbach's alpha value was .91 for the current study.

Data Collection

An invitation packet was mailed to 105 PGY nurse–preceptor pairs containing information regarding the study purpose, the study questionnaires, and information pertaining to informed consent. Participants were instructed to answer all questions on their own and to return the questionnaires and signed informed consent by mail to a trained research assistant. A total of 99 pairs of valid questionnaires were returned, for a return rate of 94.2%. The research assistant computer coded the paired data by each new nurses and preceptor, deidentified participants by numbers, and checked data for accuracy. A second researcher, responsible for data analysis, received the coded files, and checked for the integrity of the data prior to analysis.

Data Analysis

Data were analyzed with descriptive statistics using the mean and standard deviation (SD) for demographics and perceived nursing competencies. A paired-samples t test compared the competence scores of PGY nurses and preceptors. Discrepancy in perceived PGY nurses' competence was the difference between the PGY nurses' score and their preceptors'. The participants' demographics and discrepancies in perceived PGY nurses competence were analyzed with independent samples t test, one-way analysis of variance, and Pearson's correlation. Multivariable linear regression analyses identified factors associated with the discrepancies in perceived PGY nurses' competence. Data analysis was conducted using SPSS® version 22 software.

Ethical Considerations

Prior to collecting the data, the study was approved by the hospital institutional review board. Participants were informed of the study purpose, procedures, and their ability to cease participation at any time, for any reason, without any compromise in their work status, and strict confidentiality would be maintained. A signed written consent form was required to analyze the data. Content information was separated from personal information, thereby safeguarding the privacy and rights of the participants.

Results

Participant Demographics

Participant demographics (N = 99 pairs) are shown in Table 1. Most PGY nurses had a 2-year bachelor's degree (84.8%), were PGY 2 (61.6%), and worked in medical—surgical units (58.3%). Preceptors held N2 to N4 positions on the clinical ladder, and the mean clinical experience was 147.4 months (SD = 65.4), 55.6% had previously instructed ⩽ 1 PGY nurses, and only 11% had instructed three or more PGY nurses.


Demographics of PGY Nurses and Preceptors (N = 99 Pairs)

Table 1:

Demographics of PGY Nurses and Preceptors (N = 99 Pairs)

Discrepancies in Perceived Nursing Competencies

The PGY nurses' self-assessment for overall competence (12.8 ± 2.1) was slightly higher than the assessment by preceptors (12.3 ± 2.5), but not significantly different (p = .075). In addition, no significant difference existed between PGY nurses and preceptors in subscale scores for clinical care (13.4 ± 2.3 versus 13.1 ± 3.1, p = .276), research awareness (10.7 ± 2.7 versus 10.1 ± 2.6, p = .084), or professional growth (12.4 ± 2.7 versus 12.7 ± 2.7, p = .351). However, scores were significantly higher (p < .05) for PGY nurses than for preceptors for competencies in communication (14.0 ± 2.6 versus 13.3 ± 2.7, respectively), patient education (12.6 ± 2.5 versus 11.9 ± 3.0, respectively), and management (12.7 ± 2.5 versus 11.9 ± 3.2, respectively).

Association Between the Demographics and Discrepancies in Perceived Nursing Competencies

Score discrepancies between PGY nurses and preceptors were not associated with any demographics of the PGY nurses (data not shown). Table 2 shows discrepancies associated with preceptors' demographics. The only significant demographic was preceptors' position on the clinical ladder and score discrepancies in research awareness (p = .002). Scheffé's post hoc test revealed scores were significantly lower (p < .01) for N4 preceptors than N3 (2.39 versus −0.51), indicating that N4 preceptors exhibited greater assessment discrepancies.


Demographics of Preceptors and Preceptors' Discrepancies in Perceived Nursing Competence Scores for Postgraduate Year Nurses (N = 99 Pairs)

Table 2:

Demographics of Preceptors and Preceptors' Discrepancies in Perceived Nursing Competence Scores for Postgraduate Year Nurses (N = 99 Pairs)

Age, clinical experience, clinical ladder position, and teaching experience of preceptors were significantly correlated to each other (r > .70); therefore, clinical experience was selected to represent the variable for the preceptors. Similarly, clinical ladder position, instead of clinical experience, was selected as the independent variable for PGY nurses. Multivariable linear regression analysis is shown in Table 3. Clinical ladder position of PGY nurses was associated with assessment discrepancies in clinical care (β = −.26, p < .05). Preceptors with 2- and 4-year bachelor degrees assessed higher scores in research awareness and competence than those who had an associate's degree (β = .35, p < .05; β = .38, p < .01, respectively), indicating that preceptors with higher education exhibited greater assessment discrepancies. Preceptors with more months of clinical experience exhibited greater assessment discrepancies with PGY nurses on competencies in clinical care (β = .28, p < .05), communication (β = .28, p < .05), patient education (β = .35, p < .01), research awareness (β = .39, p < .01), and overall competence (β = .35, p < .01).


Regression Analysis of Demographics of Postgraduate Year Nurses and Preceptors and Discrepancies in Perceived Nursing Competence (N = 99 Pairs)

Table 3:

Regression Analysis of Demographics of Postgraduate Year Nurses and Preceptors and Discrepancies in Perceived Nursing Competence (N = 99 Pairs)

Discussion

This study revealed that the self-assessment of nursing clinical competence by newly employed nurses in a PGY training program did not differ significantly from their preceptors' assessments for overall nursing competence. However, the subscales of communication, patient education, and management were considerably higher than assessments of their preceptors. When variables for preceptors were examined, preceptors with more nursing experience had greater assessment discrepancies for PGY nurses' overall competence, clinical care, communication, patient education, and research awareness. Similar studies are lacking in the literature, and therefore comparisons cannot be made with other research.

Nursing clinical competence is developed over time, which requires experience and practice (Benner, 2001). Preceptors provide nurses with hands-on information; they guide nurses in developing clinical skills too complicated to obtain with written instruction (Benner, 2001). The preceptors in this study had considerable clinical experience. Highly experienced preceptors might have evaluated the N and N1 PGY nurses from the perspective of an N2 to N4 nurse, resulting in lower appraisals for the subscales of communication, education, and management practices. Similarly, the PGY nurses' might have underestimated the complexity of these areas due to their limited clinical experience, resulting in their higher appraisals. However, the overall competence was similar for both PGY nurses and preceptors.

Preceptors' lack of time spent with preceptees can be a major barrier to effective preceptorships (Muir et al., 2013; Panzavecchia & Pearce, 2014), which could limit a thorough understanding of all aspects of PGY nurses clinical competence. Unfortunately, the time preceptors spent instructing, training, and supporting the PGY nurses was not quantified. More time with PGY nurses may be required for preceptors to accurately evaluate the subscales of competence in communication, patient education, and management. Further studies are suggested to determine whether this factor may be associated with the discrepancies.

Foley, Myrick, and Yonge (2013) suggested a potential exists for generational misunderstandings and conflict, and these findings suggest that this continues to be a reality in nursing. Preceptors with extensive clinical experience may be unfamiliar with recent reforms in nursing education. The discrepancies between PGY nurses and their preceptors suggest that preceptor courses should be developed, which are grounded in a strong pedagogical framework (Trede, Sutton, & Bernoth, 2016) and include explicit behavioral indicators of clinical competencies in each PGY training stage that are available to both PGY nurses and their preceptors. In doing so, clinical competencies can be evaluated objectively and discrepancies can be minimized for effective preceptorships and PGY training outcomes. Continuing education and professional development educators can thus focus on developing objective competency assessments.

Limitations

Participants were from one academic medical center in Taiwan, which prevents generalizing these findings to a larger population. As mentioned, the amount of time preceptors spent with PGY nurses was not determined. Therefore, the authors suggest further study include time as a potential factor that might influence preceptors' evaluation of PGY nurses' clinical competence.

Conclusion

This study provides nurse administrators with a reference for designing PGY programs and preceptorships. Additional studies should be conducted to determine whether other factors are associated with these discrepancies in perceived competence. The authors suggest preceptorships adopt an educational framework, which accommodates the gap in perceived competence between preceptors and beginning nurses to improve the effectiveness of both PGY programs and preceptorships.

References

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Demographics of PGY Nurses and Preceptors (N = 99 Pairs)

VariablePGY Nurses (n = 99)Preceptors (n = 99)

Mean ± SDn (%)Mean ± SDn (%)
Age (years)23.5 ± 0.935.3 ± 4.9
Nursing education
  Associate degree3 (3)21 (21.2)
  2-year bachelor's degree84 (84.8)39 (39.4)
  4-year bachelor's degree12 (12.2)39 (39.4)
Hospital unit
  Internal medicine28 (28.3)
  Surgery30 (30.3)
  Gynecology and pediatrics11 (11.1)
  Emergency department20 (20.2)
  Operating department10 (10.1)
PGY nurses' clinical ladder position (N)
  Year 1 (N)38 (38.4)
    Stage 126 (26.3)
    Stage 212 (12.1)
  Year 2, (N1), Stage 361 (61.6)
Preceptor clinical ladder position
  N226 (26.3)
  N343 (43.4)
  N430 (30.3)
Experience (months)
  Clinical13.4 ± 5.7147.4 ± 65.4
  Clinical teaching57.1 ± 43.1
Preceptees previously supported (n)
  ⩽155 (55.6)
  233 (33.3)
  ⩾311 (11.1)

Demographics of Preceptors and Preceptors' Discrepancies in Perceived Nursing Competence Scores for Postgraduate Year Nurses (N = 99 Pairs)

VariableClinical CareCommunicationPatient EducationManagementResearch AwarenessProfessional GrowthOverall Competence
Education level
  (1) Associate degree1.28 ± 3.450.38 ± 3.440.38 ± 3.140.26 ± 4.08−0.56 ± 3.63−0.74 ± 3.020.30 ± 3.01
  (2) 2-year bachelor's degree0.45 ± 3.160.81 ± 3.361.05 ± 3.651.41 ± 4.040.91 ± 3.65−0.28 ± 3.540.74 ± 2.88
  (3) 4-year bachelor's degree−0.22 ± 3.280.83 ± 3.600.57 ± 2.780.54 ± 3.510.98 ± 3.41−0.11 ± 3.170.38 ± 2.62
   F value1.480.140.370.791.490.250.23
   p value.234.872.693.458.232.776.799
Clinical ladder position
  (1) N20.48 ± 3.150.38 ± 3.970.62 ± 2.490.84 ± 3.630.47 ± 3.210.02 ± 3.510.48 ± 2.73
  (2) N3−0.23 ± 3.060.17 ± 2.890.12 ± 3.220.65 ± 3.61−0.51 ± 2.99−0.91 ± 2.90−0.08 ± 2.42
  (3) N41.11 ± 3.631.82 ± 3.541.66 ± 3.571.06 ± 4.402.39 ± 4.020.27 ± 3.511.36 ± 3.17
   F value1.522.252.100.106.51**1.322.46
   p value.225.111.128.908.002.271.091
  Scheffé's post hoc test(3) > (2)
Preceptees previously supported (n)
  (1) ⩽10.11 ± 3.030.57 ± 3.551.00 ± 3.060.72 ± 3.330.29 ± 3.09−0.51 ± 3.210.40 ± 2.62
  (2) 20.28 ± 3.560.76 ± 2.74−0.21 ± 3.010.72 ± 3.700.74 ± 3.98−0.23 ± 3.140.31 ± 2.52
  (3) ⩾31.85 ± 3.591.44 ± 4.842.12 ± 3.931.66 ± 6.321.97 ± 4.490.45 ± 4.091.64 ± 4.14
   F value1.310.302.770.291.040.411.03
   p value.274.744.068.752.356.668.359

Regression Analysis of Demographics of Postgraduate Year Nurses and Preceptors and Discrepancies in Perceived Nursing Competence (N = 99 Pairs)

Independent VariableClinical CareCommunicationPatient EducationManagementResearch AwarenessProfessional GrowthOverall Competence

βpβpβpβpβpβ pβp
PGY nurses
  Age.11.357.05.706.03.796.05.676−.03.812.07.581.07.602
  Clinical ladder position (N1/N)−.26*.029−.23.061−.15.228−.09.500.01.928.03.819−.16.186
  Hospital unita
    Surgery−.21.109−.11.420−.18.171−.13.330−.30*.020−.31*.022−.24.067
    Gynecology and pediatrics.00.972−.06.636−.10.401.01.940−.05.674.00.995−.04.730
    Emergency department.05.645.07.568−.02.846.05.714−.06.586.00.992.02.853
    Operating department−.16.173−.10.398−.05.662−.09.469−.14.201−.06.628−.12.293
Preceptors
  Nursing education levelb
    2-year bachelor's degree−.06.680.09.505.14.296.20.177.35*.010.17.228.16.246
    4-year bachelor's degree−.11.424.16.267.08.552.12.430.38**.006.22.128.14.318
  Clinical experience (months).28*.019.28*.027.35**.005.19.137.39**.001.22.071.35**.005
  Preceptees previously supportedc
    2.02.835.07.524−.19.086.03.792.07.486.07.554.00.976
    ⩾3.18.100.11.363.10.397.12.319.14.190.14.222.16.156
Variance explained, R219.5%11.3%16.5%7.1%22.5%13%15.5%
Authors

Ms. Chen is Supervisor, Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, and Assistant Professor, School of Nursing, Fooyin University; Ms. Liu is Supervisor, Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, and Lecturer, School of Nursing, MeiHo University, Pingtung; Ms. Kuo is Associate Director, Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, and Lecturer, School of Nursing, Cheng Shiu University; Ms. Li is Head Nurse, Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, and Lecturer, School of Nursing, National Tainan Junior College of Nursing; Dr. Chien is Assistant Professor, Department of Nursing, Chang Gung University of Science and Technology, Taoyuan; and Ms. Chiang is Director, Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, and Lecturer, Yuh-Ing Junior College of Health Care & Management, Kaohsiung, Taiwan, Republic of China.

The Kaohsiung Chung Gung Memorial Hospital provided research funding and sponsorship for this study (CDRPG8E0021).

The authors have disclosed no potential conflicts of interest, financial or otherwise.

The authors thank all participants who have helped in conducting the research at Kaohsiung Chung Gung Memorial Hospital, Taiwan.

Address correspondence to Li-Yu Chien, PhD, RN, Assistant Professor, Department of Nursing, Chang Gung University of Science and Technology, No. 261, Wenhua 1st Road, Guishan District, Taoyuan City, 33303, Taiwan; e-mail: lychien@mail.cgust.edu.tw.

Received: June 08, 2016
Accepted: November 10, 2016

10.3928/00220124-20170321-10

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