Clinical practice is one of the underpinning elements of the nursing degree. On graduation, registered nurses are expected to be competent in a diverse number of practical skills, as well as being able to demonstrate skills in leadership, assertiveness, critical thinking, and teamwork. For these reasons, the time spent on clinical experience must be of maximum benefit to students to help them prepare for the realities of the workplace.
One method of clinical teaching in undergraduate nursing programs is the use of preceptorship. Preceptorship refers to a particular teaching learning method in which an experienced nurse provides individual guidance to a less experienced nurse, in this case a student (Barrett, 1992). Preceptorship has been used widely in Australia as a means of clinical preparation for students prior to registration. It has been suggested that an undergraduate preceptor program reduces the impact of "reality shock" and role dysfunction following registration (Barrett, 1992; Dobbe, 1988; Howie, 1988; & Perry, 1988).
To help prepare students and preceptors for the preceptorship experience, a teaching/learning package titled "Transition to Professional Practice" was developed at the University of Canberra. The package consists of two self-paced learning modules, one for students and one for preceptors, and an accompanying video. Evaluations have identified that both preceptors and students benefited from the package and felt more prepared for the clinical experience. The self-directed, self-paced format of the package meant that students and preceptors could undertake the learning at their own pace in their own time.
DEVELOPMENT OF THE PRECEPTOBSHIP PACKAGE
Development of the "Transition to Professional Practice" package occurred in response to a number of issues identified by students and preceptors. These were primarily related to preparation for the preceptorship experience. In the past, a number of measures had been taken to overcome these problems including workshops that outline the roles and responsibilities of preceptors and students, a pamphlet to describe the basic activities of a preceptor, and liaison visits to the healthcare faculties from university staff.
Despite these measures, program evaluations continued to indicate that preceptors and students experienced role confusion. Both groups reported that work and study pressures prevented them from attending all the workshops necessary to prepare them for the preceptorship program. As a result, students and preceptors had different expectations about what students were to accomplish. In addition, students experienced difficulty explaining their learning requirements. In response to these reports, the decision was made to develop a self-directed, self-paced learning module that would guide and assist the preparation of preceptors and students for the roles and demands of the preceptorship program.
The development of the preceptorship package required consultation with a number of groups who had a stake in the successful implementation of the program. These groups included nurse academics, staff from care agencies, preceptors, and students. Although each group is aiming towards the provision of sound patient care, each has slightly different needs that need to be taken into account when developing a preceptorship package.
Inclusion of representatives of each of these stakeholders into a reference group helped ensure the ultimate success of the teaching package. The composition of the final reference group consisted of university lecturers, representatives from each of the hospitals in the region, a charge nurse, registered nurse preceptors, and past and present students. To strengthen the educational and graphic aspects of the learning package, specialists in each of these areas also participated. This reference group met regularly and made a considerable contribution to the final package by offering advice on topics for inclusion, proofreading the various stages of the document, and suggesting improvements for more "user friendliness."
THE PRECEPTORSHIP PACKAGE
The Transition to Professional Practice" preceptorship package consists of three parts: (1) a self-paced preceptor module, (2) a self-paced student module, and (3) an accompanying video that complements both modules. The modules are designed in a format that allow students and preceptors to work at their own pace in their own time. The purpose of the package is for students and preceptors to enter the preceptorship program with clear expectations of their roles and responsibilities. To accomplish this purpose, specific learning goals were incorporated into the package. These goals included: the development and use of the learning plan, the ability of both student and preceptor to determine learning goals, and the ability of the preceptor and student to give and seek appropriate feedback. The ultimate aim of the package is to enhance the use of clinical situations as learning events.
Information presented in the preceptor and student modules was planned in response to previous evaluations and on the advice of the reference group. Preceptors in the past had reported feeling unable to provide a meaningful experience because they had limited under* standing of specific teaching techniques such as giving feedback, asking critical questions, and assisting students to set personal goals. The preceptor module helps to remedy this by making suggestions within each of these areas. Students had reported feeling unable to approach their preceptor with their specific learning needs so aspects of assertiveness are addressed in the student module.
Topics within each module include communication skills, asserti venese, teaching and learning, time management, and professionalism. Each topic has been written to meet the needs of either the preceptor or student. For example, in the communication section, the preceptor module discusses "Giving Unpleasant Information"; the student module discusses "Receiving Unpleasant Information."
To assist with specific teaching and learning needs the preceptor module has a section on "Asking Critical Questions" and "Managing Student Progress." The student module has information on "Developing a Learning Plan" and "Ensuring a Successful Evaluation." Other topics such as "Information Sharing" and "Adult Learning Principles" are the same for each module with examples specific to the audience.
Each module has clearly outlined learning objectives and key points. These make it possible for the student or preceptor to skim the module to find areas that meet their particular needs. Each section has learning activities to be completed by the preceptor or the student. Students are expected to complete all learning activities and maintain a journal record of these activities. The journal is submitted to academic staff for marking. Preceptors are encouraged to maintain a record of activities but these are not required as part of the program.
A professionally-developed video supplements the written modules and illustrates two clinical scenarios. In 15 minutes, the viewer is exposed to many of the interpersonal skills required to facilitate a successful preceptor experience. These include some of the main aspects of assertiveness, communication, and giving appropriate feedback. Icons throughout the preceptor and student modules identify concepts that are demonstrated in the video.
The final activity in the student module asks the student to identify their learning objectives and goals, and develop these in a learning plan. The culmination of the preceptorship package is for the student and preceptor to meet and discuss the learning plan. The preparation and discussion of this plan ensures that both student and preceptor have a clear understanding of their roles and responsibilities in the preceptorship program. Preceptors, in return, can identify those goals that are unrealistic or suggest additional goals related to the specific clinical area.
EVALUATION OF THE PKECEPTORSHIP PACKAGE
The overall aim of the preceptorship package is to enhance the use of clinical situations as learning events. This is to be demonstrated by students effectively:
* defining their learning objectives
* developing a learning plan
* identifying and participating in learning experiences
* undertaking continuous self-evaluation
* integrating into the health team
The overall aim of the preceptor package is the same as the student package but this is to be demonstrated by preceptors promoting their roles as:
The preceptorship package has been in use for one year. Evaluations of the package have been undertaken using questionnaires and focus groups for both preceptors and students. The focus group discussions were tape recorded and summary notée were made by an observer.
Student evaluation of the package was undertaken by the use of questionnaires and focus groups at the completion of the preceptorship program. Participating in the program were 41 students, and all students completed the evaluation questionnaire. Results of these evaluations identified that students felt well prepared to commence the program.
Students reported that the preceptor package was well structured and easy to follow. They believed that having separate books for preceptor and student really helped to highlight each groups' individual needs. The package helped them to set goals and objectives, and encouraged them to share these with their preceptors.
Almost all (92%) of the students felt prepared for the preceptorship program. +. Studente also reported that the ability to approach their preceptor with a learning plan and request feedback resulted in a more positive learning experience. Often, this meeting was an important "getting to know you" session for both the student and preceptor. One student commented:
Through the learning plan, my preceptor hae an idea of what I want to do.
A focus group was formed by 14 of the 41 students who had participated in the program. During the focus group discussion, all students (n = 14), agreed that one of the most important parts of the package was on assertiveness. This, combined with the learning plan, helped them to approach their preceptor and to ask for specific feedback on their progress,
Past evaluations have identified that students often had difficulty approaching their preceptor with their specific needs. The learning plan helped to "break the ice" and provide a focus for evaluation and discussion of performance. When diecussing the learning plan, preceptors and students were guided by the learning module to discuss worst-case scenarios and what to do if either of them felt pressured by the teaching/learning situation. The video reinforced the communication content from each module and gave students specific tips on how to deal with difficult situations.
The one message students believed very strongly about passing to future groups was that all students should take the preceptor program very seriously and achieve as much out of this time as possible. They all felt acutely aware that this was their finpl chance to achieve their clinical goals before the responsibilities of being a registered nurse.
Negative aspects of the package were also discussed. Students felt rushed to complete the package when they had many other pieces of assessable work to submit. Although they found the information of considerable value, they did not have the time to appreciate this at the beginning of the semester. Activities in the package were designed to stimulate student thinking and challenge them to consider a variety of learning and practice issues. From the student perspective, the time taken to complete activities outweighed the perceived benefits.
One student commented:
What I liked the least was the amount of activities we had to do. On top of everything else we had to do like patient papers and nursing research it added to the stress and workload.
The students' evaluation of the module and video demonstrated considerable support for the program and made some constructive suggestions for future improvements.
Each preceptor was given a preceptor module for their own use and had access to the video that was available in each ward area. Preceptors were encouraged to maintain a journal of module activities but this was not a requirement of participation.
A total of 19 (out of 52) preceptors completed the preceptor evaluation form, a response rate of 36%. Despite this low return rate, certain conclusions could be drawn from the responses. Evaluation questionnaires from preceptors indicated general acceptance of the program. Past evaluations had indicated that preceptors were unclear about their role and the expectations of students. The preceptorship package has assisted preceptors in this area.
Focus group discussions were held at each of the participating hospitals as part of the evaluation process. Overall, preceptors (n = 13) reported that they generally liked the package. They found that there were considerable advantages in the selfdirected nature of the package as they were able to complete the package in their own time. Because each preceptor had a personal copy of the preceptor module, they were able to refer back for information dealing with specific situations.
Preceptors reported that the preceptor module had been a very good guide to new preceptors and helped reinforce learning principles and communication techniques for experienced preceptors. The focus on student goals had helped to clarify expectations for both the student and preceptor. The learning plan also helped them identify specific learning situations for students. Many preceptors used the module as a reference and returned to this when new situations occurred. One preceptor commented that the module helped her the most by:
. . .guiding my student to undertake new experiences- allowing her time for critical t>""l""g before undertaking a new task. Encouraging her self-assessment to the level of her experience. She was, I thought, too hard on herself.
Although the majority of preceptors did not maintain a formal journal on the activities, they commented that just thinking about some of these helped to clarify their ideas. The preparation of the student learning plan helped the preceptor to identify the learning needs of students and also gave them a chance to discuss together their roles. The video recognized some of the pressures that occurred on the wards and suggested ways of lessening these for both the student and preceptor. The parts of the module that were the most favorably received were those dealing with giving constructive feedback and asking critical questions.
Preceptorship has been identified as an effective and appropriate way to undertake clinical teaching. However, this success depends greatly on inclusion of all stakeholders when planning and developing a preceptorship program and adequate preparation of students and preceptors to maximize this clinical experience. The development and implementation of the self-directed, self-paced learning package "Transition to Professional Practice" has contributed to this preparation and assisted students and preceptors in their respective roles.
Preceptorship programs offer a relatively low cost alternative to closely supervized clinical teaching and also help to prepare students for the reality of the workplace. It has also been reported that students who participated in preceptorship programs were more likely to remain in their first position after graduation and reported a greater degree of work-role satisfaction from direct patient care activities than those who did not participate in a preceptorehip program (Bizek & Oermann, 1990). The cost benefits of preceptorship consequently impact both on the university clinical budget and hospital recruitment costs.
A follow-up study of graduates who had participated in preceptorship programs concluded that the programs increased positive role transition, job satisfaction, and improved retention of new graduates (McGrath & Princeton, 1987). Preceptorship can assist in the assumption of a professional role on graduation and thus facilitate the transition from student nurse to registered nurse (Jairath et al., 1991). Using the preceptorship package encourages students to identify professional goals and self-assess their progress, both important parts of professional development.
The overall aim of the preceptorship package was to enhance the use of clinical situations as learning events. The use of the learning plan assisted both students and preceptors to identify learning goals and direct clinical experiences toward these goals thus enhancing learning. Students reported that using the assertive communication techniques outlined in the module assisted them to ask for feedback on their progress. They felt more comfortable interacting with their preceptor following the meeting to discuss the learning plan.
The main criticisms of the package came from students who believed that completing the journal activities added considerably to their workload. In response to these concerns, changes are planned in the future delivery of the preceptorship package. Students will be introduced to the module and video in the semester preceding their final clinical placement. Some of the activities will be incorporated into existing class time rather than have to be written in their journals.
Preceptors welcomed the self-directed nature of the program. This lessened the problems of attending all the workshops and also provided a valuable reference tool. All preceptors reported that as a result of the preceptorship package they could identify the characteristics of a preceptor and knew what was expected of them during the program. Experienced preceptors reported that they used the assertiveness and feedback sections of the package most frequently. The learning plan gave them the opportunity to meet their student and have clear expectations of what students were trying to achieve during the program.
One of the major factors impacting on the success of a preceptor program is the preparation of both students and preceptors for this valuable clinical experience. The use of "Transition to Professional Practice," a self-paced, self-directed learning package, enhances this experience and clarity's the role expectations of both student and preceptor. Evaluations demonstrate that students have used the skills gained from the package to identify their learning needs and communicate these to their preceptors. These skills are essential to enhance the use of clinical events as learning situations.
This project was funded by a Committee for the Advancement of University Teaching Grant.
- Barnett, T. (1992). Preceptorship. In G. Gray, & R. Pratt (Eds.). Issues in Australian nursing 3 (pp. 246-266). Churchill Livingstone: Melbourne.
- Bizet, K. A German, M. (1990). Study of educational experiences, support and job satisfaction among critical care nurse preceptors. Heart and Lung, 19(4), 439-444.
- Dobbs, K, (1988). The senior preceptorship as a method for anticipatory socialization of baccalaureate nursing students. Journal of Nursing Education, 27(4), 166-171.
- Gray, G., & Pratt, R. (Eds.). (1992). Issues in Australian nursing 3. Churchill Livingstone: Melbourne
- Howie, J. (1988). The effective clinical teacher: A role model. Australian Journal of Advanced Nursing, 5(2), 23-26.
- Jairath, N-, Costello, J., Wallace, P., & Rudy, L. (1991). The effect of preceptorship upon diploma program nursing students' transition to the professional nursing role. Journal of Nursing Education, 30(6), 251-256.
- McGrath, B., & Princeton, J. (1987). Evaluation of a clinical programme for new graduates eight years later. Journal of Continuing Education in Nursing, 18(4), 133-136.
- Perry, M. (1988). Preceptorship in clinical nursing education: A social learning approach. The Australian Journal of Advanced Nursing, 5(1), 19-25.