Journal of Nursing Education

The Effect of Preceptorship Upon Diploma Program Nursing Students' Transition to the Professional Nursing Role

Nalini Jairath, PhD, RN; Judy Costello, MScN, RN; Paulette Wallace, BScN, RN; Laura Rudy, BScN, RN

Abstract

ABSTRACT

This quasi-experimental study determined the effect of a 17-week pregraduate preceptorship program upon diploma nursing students' (N = 22) performance of the professional nursing role. Nine students participated in the preceptorship program; 13 received the standard pregraduate clinical experience. Nursing performance was measured using Schwirian's Six Dimension Scale of Nursing Performance prior to, during, and upon completion of the pregraduate clinical experience. Based on the faculty adviser's appraisals, the preceptorship program was associated with significantly greater improvements in nursing performance within the teaching/collaboration and planning/evaluation dimensions.

Abstract

ABSTRACT

This quasi-experimental study determined the effect of a 17-week pregraduate preceptorship program upon diploma nursing students' (N = 22) performance of the professional nursing role. Nine students participated in the preceptorship program; 13 received the standard pregraduate clinical experience. Nursing performance was measured using Schwirian's Six Dimension Scale of Nursing Performance prior to, during, and upon completion of the pregraduate clinical experience. Based on the faculty adviser's appraisals, the preceptorship program was associated with significantly greater improvements in nursing performance within the teaching/collaboration and planning/evaluation dimensions.

Introduction

Prior to graduation from a nursing program, senior nursing students begin the role transition from student to professional nurse. They must acquire requisite knowledge and occupational skills, and exhibit the behaviors expected of professional nurses (Clayton, Broome, & Ellis, 1989; Watson, 1983). During this transition, students may experience increased role conflicts between the value systems and behaviors internalized during nursing education and those associated with the realities of the practice setting (Kramer, 1974). In students who are unable to synthesize the two value systems, these conflicts may lead to dissatisfaction and poor nursing performance.

Hospital-based preceptorship programs prior to graduation have been introduced to minimize role conflict and facilitate assumption of the professional nursing role. In preceptorship programs, the preceptee practices in conjunction with a clinically expert, professional nurse preceptor. The preceptor serves as a role model and provides direct teaching, support, and guidance to the preceptee (Caty & Scott, 1988; Chickarella & Lutz, 1981; Friesen & Conahan, 1980; Goldenberg, 1987; McGrath & Kaewing, 1978; Morrow, 1984; Shamian & Inhaber, 1986). Evaluations of preceptorship programs document increased exposure of undergraduate nursing students to the realities of nursing practice (Caty & Scott, 1988), smoother role transition from student to graduate nurse (McGrath & Princeton, 1987), and short-term improvements in job satisfaction of new staff nurses (Giles & Moran, 1989; Shogan, Prior, & Kolski, 1985).

When the effects of preceptorship programs upon senior baccalaureate nursing students' performance of the professional nursing role were measured, however, outcomes varied. No significant differences in nursing performance were identified in seven preceptorial and five nonpreceptorial students in a study by Myrick and Awrey (1988). The preceptorship program was of 3 weeks' duration, and nursing performance was based on professional nurse and student self-appraisals.

In contrast, significantly greater improvements (p<0.05) in nursing performance were identified in 33 preceptorial compared to 33 nonpreceptorial nurses in a study by Clayton, Broome, and Ellis (1989). The 10-week preceptorship program was provided during the senior pregraduate practicum. Nursing performance was based on selfappraisals, determined prior to and following the practicum and 6 months after graduation.

Although these two research studies used the same instrument (Schwirian's Six Dimension Scale of Nursing Performance [6-D Scale]), the preceptorship programs and measurement approaches differed. Furthermore, since Clayton et al. (1989) only used student self-appraisals of performance, the reported improvements in nursing performance are based on highly subjective data. Therefore, additional research is required before definitive conclusions can be drawn regarding the effect of preceptorship programs on student nursing performance.

This preliminary study examined the effect of a 17-week preceptorship program on faculty and self-appraisals of performance of the professional nursing role by pregraduate nursing students.

Methods

Sample

The sample consisted of 22 consenting nursing students enrolled in the final semester of a 3-year diploma RN program at a local community college. Age ranged from 22 to 49 years with a median of 27 years and a semiquartile range (SQR) of 6 years. Eighteen subjects (81.8%) had prior experience as health care aides, nurse's aides, and registered nursing assistants. Previous years of employment in health care ranged from 0.3 to 18 years with a median of 1.3 years and a SQR of 2.7 years. Neither age nor previous years of health care experience were normally distributed.

Procedures

A repeated measures, control group, quasi-experimental approach was selected. Nine students volunteered to participate in the preceptorship program and were assigned to the experimental group; 13 student volunteers received the standard clinical experience and were assigned to the control group. Informed consent was obtained for all subjects. The limited number of preceptors available in the preferred clinical placement areas precluded random and equal assignment of students to the study groups; staffing shortages precluded intake of a large number of students to increase sample size.

Appraisal of student nursing performance was obtained from two sources: faculty adviser and student selfappraisal. Student self-appraisals were determined at O (i.e., prior to), 4, and 17 weeks, and faculty adviser appraisals at 4 and 17 weeks. (During the first 4 weeks, the faculty adviser familiarized herself with students' performance in the clinical areas.)

Instrumentation

Performance of the professional nursing role was measured using the 6-D Scale (Schwirian, 1979). Its six composite subscales measured nursing performance within the dimensions of leadership (L), critical care (CC), teaching/collaboration (TC), planning/evaluation (PE), interpersonal relations/communication (IPR), and professional development (PD) (Schwirian, 1978). The 6-D Scale and subscale values were expressed on a scale from O to 4 with higher ranks denoting better performance.

The 6-D Scale was selected for the current study because of its comprehensive, systematic, and behaviorally based approach to measurement of nursing performance. The 6-D Scale evaluated aspects of nursing performance addressed in the preceptorship program. Test-retest reliability and content validity of the total scale and subscales were previously established (McCloskey & McCain; Schwirian, 1978; Schwirian, 1979). Cronbach's alpha coefficients for dimension subscales ranged from 0.84 to 0.98 (Schwirian, 1978) for professional nurses and from 0.73 to 0.96 for senior nursing students (Clayton et al., 1989).

Interrater reliability has not been established between student and professional nurse appraisals using the 6-D Scale. For the study sample, no significant correlations (Pearson's r; p>0.05) between student and faculty adviser total 6-D and subscale scores were identified.

The preceptorship program

A 17-week, in-hospital, unit-based preceptorship program was designed to meet the learning needs of preceptees. Program format was based on extensive literature review, educational program requirements, and investigation of local preceptorship programs. Program length corresponded to the duration of the pregraduate clinical experience (i.e., one semester). Unit-based preceptors implemented, individualized, and supervised program offerings. For the assigned preceptees, the preceptor guided their orientation and socialization to the clinical area, and assisted them to identify learning needs and to establish objectives for the pregraduate clinical experience. The preceptor also ensured that they acquired the necessary technical and behavior skill by direct teaching, establishment of learning opportunities, ongoing monitoring, and performance evaluations.

Preceptors were selected from volunteer staff nurses from four participating clinical areas. Selection criteria included leadership abilities, teaching abilities, caring attitudes and behaviors, clinical skills and experience, and recommendation by the nurse manager. All preceptors attended a 1-day workshop addressing communication, learning (i.e., principles of adult education, developing learning objectives, evaluation criteria), and reality shock.

Results

Six-D Scale and subscale scores were analyzed using Student's t test to determine the equivalency of the experimental and control groups at measured time intervals. Research hypotheses that the experimental group would show significantly greater improvements in 6-D Scale and subscale scores over time were tested using either the i test or repeated measures analysis of variance (ANOVA). The alpha level selected was 0.05.

Eaculty appraisals of nursing performance

Six-D Scale and subscale scores based on the faculty adviser's appraisals of students at 4 and 17 weeks are reported in Table 1. Six-D total scores and subscale scores for the groups were equivalent at 4 weeks. At 17 weeks, however, the experimental group had significantly higher scores on the teaching/collaboration subscale than the control group (2.92 + 0.14 vs. 2.68±0.30; i = 2.5077; p = 0.0220).

Table

TABLE 1Faculty Appraisals of Nursing Performance of Students

TABLE 1

Faculty Appraisals of Nursing Performance of Students

The changes in 6-D Scale and subscale scores from 4 to 17 weeks are reported in Table 2. The experimental group had significantly greater increases from 4 to 17 weeks in teaching/collaboration and planning/evaluation subscale scores than the control group. For both groups, 6-D Scale and the subscales acores for critical care, teaching/ collaboration, planning/evaluation, interpersonal relations/ communication, and professional development increased significantly; ulereases in leadership subscale scores were not significant.

Student self -appraisals of nursing performance

Student self-appraisals of nursing performance at O, 4, and 17 weeks are reported in Table 3. At O and 4 weeks, the experimental and control groups were equivalent with respect to nursing performance. At 17 weeks, however, the professional development subscale scores of the experimental group were significantly higher than those for the control group (3.83 ± 0.21 vs. 3.46 ± 0.45; i = 2.60, p = 0.02).

Repeated measures ANOVA failed to identify significant interactions between time (i.e., O, 4, 17 weeks) and group (experimental/control). Significant time-related effects for all 6-D subscale scores and for total scores for the 6-D Scale were identified.

Discussion

The significant increases in total 6-D Scale and some subscale scores for both preceptorial and nonpreceptorial students indicate that pregraduate clinical experience was associated with increased evidence of behavior consistent with the professional nursing role. Therefore, role transition from student to professional nurse appears to have been facilitated.

From the faculty adviser's perspective, participation in the pregraduate clinical experience was associated with significantly greater improvements in some 6-D subscale scores than the standard pregraduate clinical experience. Therefore, the preceptorship program was associated with greater benefit than the standard pregraduate clinical experience. These benefits were consistent with the objectives of our preceptorship program to consolidate and facilitate role transition and the transfer of students' knowledge and skills from the educational to the practice setting. Benefits were also consistent with outcomes of preceptorship programs described in the narrative literature (Caty & Scott, 1988; Chickarella & Lutz, 1981; Friesen & Conahan, 1980; Goldenberg, 1987; Morrow, 1984; Shamian & Inhaber, 1986), but not with earlier research.

Table

TABLE 2Change in Faculty Appraisals of Nursing Performance from 4 to 17 Weeks

TABLE 2

Change in Faculty Appraisals of Nursing Performance from 4 to 17 Weeks

Table

TABLE 3Student Self-Appraisals of Nursing Performance*

TABLE 3

Student Self-Appraisals of Nursing Performance*

Myrick & Awrey (1988) failed to identify significant differences between the preprogram to postprogram total 6-D Scale and subscale scores of preceptorial and nonpreceptorial students. The lack of congruence with this study's positive findings may reflect differences between the preceptorship programs and ratings by professional nurses, baccalaureate, and diploma nursing students.

From the students' perspective, the preceptorship program was not associated with greater increases in Six-D Scale and subscale scores over time. The majority of our sample had previous health care employment, which may have already facilitated transition to the professional nursing role and minimized the perceived impact of the preceptorship experience. In addition, unit-specific orientation programs and other variations in the pregraduate clinical experience received by nonpreceptorial students may also have enhanced transition to the professional nursing role.

Although the findings of nonsignificant changes in student self-appraisals of nursing performance were consistent with Myrick and Awreyk (1988) pilot study, they were not consistent with the larger study by Clayton et al. (1989) that identified significant differences between postprogram scores of preceptorial and nonpreceptorial nurses. Reasons for these differences in the outcomes of preceptorship programs are unknown, but may reflect differences in the types of programs studied, attributes of the student samples, and time frames used to evaluate nursing performance.

Implications for Research and Practice

The findings provide some evidence that a preceptorship program promotes assumption of behaviors consistent with the professional nursing role and thus facilitates role transition from student to professional nurse. However, in conjunction with related research, no consistent pattern regarding the effects of preceptorship programs on nursing performance has emerged. Therefore, nurse educators and researchers should carefully consider the use of costly, labor-intensive preceptorship programs as a strategy to facilitate assumption of the professional nursing role by pregraduate students.

Replication of the study using a larger sample is warranted. Appraisers of nursing performance, such as faculty or staff nurses, should be blinded to the group (preceptorship program or standard clinical experience) to which students are assigned. The effect of perceptual factors on scoring of the 6-D Scale should also be systematically investigated because in this study, no significant correlations existed between faculty and student self-appraisals of nursing performance. In addition, our diploma students' subjects rated their performance higher than baccalaureate students in Myrick's & Awrey*s (1988) study, despite comparable professional nurse ratings for the two groups.

The relationship between program structure and performance-related outcomes should also be investigated given differences in the attributes (i.e., purposes, structure, duration) of the preceptorship programs previously studied. Furthermore, the nursing behaviors in the clinical setting corresponding to the small but statistically significant differences in 6-D Scale and subscale scores should be investigated and the nature of performancerelated changes more closely characterized.

References

  • Caty S., & Scott, B. Í1988). Preceptors for pregraduates. Canadian Nurse, 84(10), 20-23.
  • Chickerella, E.G., & Lutz, W.J. (1981). Professional nurturance: Preceptorships for undergraduate nursing students. American Journal of Nursing, 81, 107-109.
  • Clayton, G., Broome, M. & ElMs, L. (1989). Relationship between a preceptorship experience and role socialization of graduate nurses. Journal of Nursing Education, 28, 72-75.
  • Friesen, L., & Conahan, B. (1980). A clinical preceptor program: Strategy for new graduate orientation. Journal of Nursing Administration, 10(4), 18-23.
  • Itano, J., Warren, J., & Ishida, D. (1987). A comparison of role conceptions and role deprivation of baccalaureate students in nursing participating in a preceptorship or a traditional clinical program. Journal of Nursing Education, 26, 69-73.
  • Kramer, M. (1974). Reality shock: Why nurses leave nursing. St. Louis, MO: C.V. Mosby.
  • McCloskey, J., & McCain, B. (1988). Nurse performance: Strengths and weaknesses. Nursing Research, 37, 308-313.
  • McGrath, B.J., & Kaewing J.R. (1978). A clinical preceptorship for new graduate nurses. Journal of Nursing Administration, 8, 12-18.
  • Morrow, K. (1984). Preceptorships in nursing staff development. Rockville, MD: Aspen.
  • Myrick, F., & Awrey, J. (1988). The effect of preceptorship on the clinical competency of baccalaureate nurses: A pilot study. The Canadian Journal of Nursing Research, 20(3), 29-43.
  • Schwirian, P. (1978). Evaluating the performance of nurses: A multidimensional approach. Nursing Research, 27, 347-351.
  • Shamian, J., & Inhaber, R. (1985). The concept and practice of preceptorship in contemporary nursing: A review of the literature. International Journal of Nursing Studies, 22(2) 70-88.
  • Watson, A.B. ( 1983). Professional socialization of the registered nurse. In W. Hölzerner (Ed.), Review of research in nursing education (pp. 34-59). Thorofare, NJ: Slack Inc.

TABLE 1

Faculty Appraisals of Nursing Performance of Students

TABLE 2

Change in Faculty Appraisals of Nursing Performance from 4 to 17 Weeks

TABLE 3

Student Self-Appraisals of Nursing Performance*

10.3928/0148-4834-19910601-05

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