Kramer's Reality Shock (Kramer, 1974) brought into focus a problem which continues to escalate as a result of the technology explosion, increasingly sophisticated job roles, and nursing's ongoing evaluation of itself. New graduate nurses educated in the academe leave colleges and universities "well-versed in theory but not practiced in skills valued by nursing service for coping with the day-today realities of the work world" (Limon, Spencer & Waters, 1981, p. 269). This discrepancy results in role stress, which according to Hardy (1978), includes role ambiguity, role conflict, incongruity and role overload.
A preceptorship experience allows nurse faculty and staff nurses to collaborate in enhancing the transition from student to staff nurse (Chickerella & Lutz, 1981). The experience provides students with opportunities for role socialization and acquisition of competence and confidence in performing clinical skills (Ellis & Clayton, 1987). The collaboration may enhance the professional socialization process and thus decrease role stress. The purpose of this study was to examine changes in socialization behaviors of senior nursing students after the preceptorship experience.
"Professional socialization is the complex process by which a person acquires the knowledge, skills and sense of occupational identity that are characteristics of a member of that profession" (Watson, 1983, p. 39). Conway (1983) argues that what students know of the role they are about to assume is that portrayed by teachers. Indeed Gunden (1980) concluded that senior students' views of the ideal nurse were congruent with faculty views. Students' views of the profession have been found to shift toward those of faculty during the nursing program (Crocker & Brodie, 1974).
During the educational process, students receive relatively little exposure to nurses in practice. However, it is the "culture of the practicing nurse" whose role expectations these students will encounter after graduation. The students' congruence with faculty opinions may produce a conflict when these students begin practice (Kramer & Schmalenberg, 1977). In a preceptorship experience a student forms an intense relationship with the precepting nurse, who is a practicing staff nurse, and is exposed to her occupational identity through dialogue, observation and role modeling. This experience, occurring at the end of the educational process, should help the student resolve the incongruency and be able to better assume professional role behaviors.
The concept of preceptorship has appeared in the nursing literature for only a short period of time, first appearing in the 1985 International Nursing Index. Since 1980, a recent review of nursing literature produced 46 articles concerning the use of preceptors in academic or clinical settings. The first review article analyzing 21 papers on preceptorship appeared in 1985 (Shamian & Inhaber, 1985), however scant empirical data are yet available on the process.
The use of preceptors in nursing education is based on the androgogical premise that a one-to-one relationship facilitates effective learning. Tough (1979), notes that a practitioner already successful in a particular occupation, is an effective role model because she can adjust teaching to the learner's needs, give immediate answers to questions, and correct errors as soon as they occur. Additionally, the practitioner provides entre as an insider into the clinical organization indicating the norms, mores and role expectations.
The bulk of the preceptor literature is descriptive and has discussed how preceptors are selected, their responsibilities, training and power, how evaluation occurs, how faculty communicate with preceptor and benefits to preceptor. Only two research articles were found and only one of these studied preceptors in an academic setting. Itano (1987) and her colleagues found no differences in role conception and role deprivation among students having a preceptorship experience and students in a traditional clinical experience. They did conclude that faculty had a higher professional conception and lower bureaucratic conception than preceptors. Hence, more study of the relationship between preceptor experience during an academie program and role socialization was warranted.
Students who participated in a preceptorship experience during a senior practicum would report significantly different professional socialization behaviors than students who did not participate.
Design. A pretest-posttest quasi-experimental design was used to test the hypotheses generated in this study. Because students could not be randomly assigned, a nonequivalent control group design was used. The students completed Schwerian's Role Scale three times: 1) prior to the senior practicum experience; 2) immediately after the practicum experience; and 3) six months after graduation. This repeated measure design allowed the investigators to examine the groups for changes over time as well as differences between the groups.
Subjects. The subjects for this study were 66 senior nursing students. The age range of subjects was 19 to 49 with a mean of 27. The majority of students were female and single. Fifteen percent were black and 85% Caucasian.
Procedure. The preceptorship experience occurred in the final quarter of the senior year. Students chose two consecutive, five-week clinical experiences. Clinical options were numerous and varied. Students did not know at the time of selection whether they would be assigned to a faculty member who guided a group of students, or a preceptorship experience.
Students in the experimental group were paired one-toone with staff nurses. To serve as a preceptor, a staff nurse had to be recommended by her head nurse as an exemplary role model for students, to have been practicing on the assigned unit for at least one year, and have a baccalaureate degree in nursing or extensive experience.
Instrument. Schwerian s Six-Dimension Scale of Nursing Performance (Schwerian, 1979) was used to measure role socialization. The questionnaire consists of 52 items and six subscales: 1) leadership; 2) critical care; 3) teaching/collaboration; 4) planning/evaluation; 5) interpersonal relations and communication; and 6) professional development. Respondents use a 4-point rating scale to indicate how well or how frequently they engage in the described behaviors.
An estimate of internal consistency was previously reported for each of the subscales using Cronbach's alpha and ranged from a low of .84 for the leadership scale to .98 for the professional development scale. In this study with an n of 66 alpha, values were computed as follows: leadership (.73); critical care (.79); teaching/collaboration (.83); planning/evaluation (.84); interpersonal relations and communications (.84); and professional development (.96).
The hypotheses in this study were tested using t-tests and an unequal n's 2 x 3 analysis of variance. There was no significant difference in the pretest socialization scores of students prior to the preceptorship experience.
The hypothesis predicting a greater increase in professional socialization scores in the preceptorship group six months after graduation was partially supported. On five of the six subscales interaction effects between groups over time were found. Figure 1 depicts the changes between the two groups at the three different times.
There was a significant difference between groups at 6 months follow-up on the subscales of a) leadership; b) teaching/collaboration; c) interpersonal relations and communications; and d) planning and evaluation, with the preceptor groups scoring higher on all four subscales. There was no significant difference between the groups at the 6-month follow-up on the professional development and critical care subscales.
This study examined the relationship between a preceptorship experience and professional socialization. The group having a preceptorship experience scored higher on five of the six subscales when tested immediately after the experience. Six months after graduation, the preceptorship group scored higher on four of the six subscales indicating that the increase in professional socialization continued over time.
PRECEPTOR AND NON-PRECEPTOR GROUP SCORES OVER TIME ON SCHWERIAN'S SUBSCALES
The findings support that working with a practicing nurse in the clinical environment, as opposed to with a faculty member, will enhance the transition to staff nurse. Precepted students scored higher on: leadership, teaching/ collaboration, interpersonal relations and communications, and planning and evaluation over time. While the remaining two subscales - professional development and critical care - are important they may not be in the same category of importance 6 months after graduation as the other four. Critical care skills are specific to clinical areas and all the students in this study were educated in a tertiary care medical center. Certainly, the importance of professional development cannot be discounted; however, 6 months post graduation is early to measure this variable.
The findings also support the androgogical premise that adults learn more effectively in a one-to-one situation than in a group situation. One-to-one instruction by faculty is prohibitive due to the expense but including qualified staff nurses as preceptors in the learning situation allows use of this strategy.
Preceptorship experiences also seem to enhance collaboration between faculty and practitioners. The preceptors in this study became very interested in the course and academic program. Faculty benefited from their suggestions about clinical experience. The public relations value of the experience cannot be overemphasized. Staff nurses appreciated being recognized as experts in their role. No complaints were ever received about the increased work load to the preceptor or the increased stress from being constantly observed. A tangential benefit is th'at some preceptors returned to the university for graduate school following the experience.
An unexpected development was the students' enjoyment of the experience. The preceptor group, senior students within three months of graduation, had renewed enthusiasm for the program. Many students requested to work with their preceptors on more than the assigned number of days. As a result of conversations with peers in the preceptor group, students in the traditional groups requested preceptor experience.
COMPARISON OF PRECEPTORSHIP AND NON-PRECEPTORSHIP GROUPS SIX MONTHS AFTER GRADUATION ON SUBSCALES
The tremendous body of literature on preceptorship experiences is testimony to the increasing use of the strategy. The paucity of research literature dictates the need for future study. This study needs to be replicated in various settings and with larger groups of students. Further study following graduates for a longer period of time could provide new information regarding the professional development subscale. Other instruments or an instrument developed specifically to measure socialization could be helpful to faculty considering this strategy.
- Chickerella, B.G. & Lutz, W.J. (1981). Professional nurturance: Preceptors for undergraduate nursing students. Am J Nurs, 107-109.
- Conway, M.E. (1983). Socialization and roles in nursing. In Werley, H. & Fitzpatrick, J. (Eds.) Annual review of nursing research (pp 183-208). New York: Spring Publishing.
- Crocker, L.M. & Brodie, B.J. (1974). Development of a scale to assess student nurses' views of one professional nursing role. J Appi Psychol 59, 233-235.
- Elkin, F. & Handel, G. (1972). The child and society: the process of socialization (2nd ed.). New York: Random House.
- Ellis, L. & Clayton, G. (1988). Preceptorship in Nursing, in Fuszard, B. (Ed.), Innovative and teaching techniques in nursing. Maryland: Aspen.
- Gunden, E. A. (1980). A comparative study of perception of sophomore nursing students, senior nursing students, nursing faculty, and clients as to the importance of empathy as an attribute of the "ideal nurse." Indianapolis: Indiana University School of Nursing (ERIC Document Reproduction Service No. ED 189 999).
- Hardy, M. (1978). Role stress and role strain. In Hardy, M. & Conway, M. (Eds.), Role theory: Perspectives for professionals. New York: Appleton-Century-Qrofts.
- Itano, J.K., Warren, JJ. & Ishida, D:N. (1987). A comparison of role conceptions and role deprivation of baccalaureate students in nursing participating in a preceptorship or a traditional clinical program. J Nurs Educ, 26, 69-73.
- Kramer, M. (1974). Reality Shock! Why nurses leave nursing. St. Louis: CV. Mosby Company.
- Kramer, M. & Schmalenberg, C. (1977). Path to biculturalism. Wakefield, MA: Contemporary Publishing, Inc.
- Limon, S., Spencer, JB. & Waters, V. (1981). A clinical preceptorship to prepare reality-based ADN graduates. Nursing and Health Care, 2, 267-279.
- Schwerian, P. (1978). Evaluating the performance of nurses: A multidimensional approach. Nurs Res, 27, 347-351.
- Shamian, J & Inhaber, R. (1985). The concept and practice of preceptorship in contemporary nursing: A review of pertinent literature. Int J Nurs Stud, 22, 79-88.
- Tough, A.M. (1979). The adults learning projects; a fresh approach to theory and practice in adult learning. Toronto: Ontario Institute for Studies in Education. Research in Education Series, No. 1.
- Watson, A.B. (1983). Professional socialization of the registered nurse. In Hölzerner, W (Ed.) Review of research in nursing education ( pp 34-59 ). Thorofare, New Jersey: Slack Inc.
COMPARISON OF PRECEPTORSHIP AND NON-PRECEPTORSHIP GROUPS SIX MONTHS AFTER GRADUATION ON SUBSCALES