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NURSING PRECEPTORS SPEAK OUT: AN EMPIRICAL STUDY

RUTH GRANT KALISCHUK, RN, PHD,⁎ HELEN VANDENBERG, RN, MSC, PHD(C),† AND OLU AWOSOGA, PHD‡

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Increasingly, preceptors across the globe are teaching nursing students in a variety of acute, community, and continuing care practice areas. This article is a report of a study of preceptors' views regarding benefits, rewards, supports, challenges, and commitment related to the nursing preceptorship role in one Canadian undergraduate baccalaureate nursing program. A quanti- tative, descriptive, correlational research design was employed. A six-part questionnaire was developed, piloted, and administered to a purposive sample of 331 preceptors who had worked with baccalaureate nursing students. Employing parametric and nonparametric methods, we analyzed data using descriptive and correlational statistics. Open-ended questions were analyzed using content analysis. Preceptors valued nonmaterial over material rewards. Preceptors expressed a need for lighter workloads, further educational preparation, more time for assessing and assisting students, increased support from stakeholders, and dedicated time for face-to-face contact with nursing faculty. Preceptors' voices need to be heard and acted upon. Preceptors indicated that they need a great deal more support for their efforts than they are currently receiving. Enhancing preceptor support not only encourages preceptor retention, but it will also have a great influence on the experiences of future generations of nurses. (Index words: Preceptorship; Preceptor's voice; Empirical study; Nursing education) J Prof Nurs 29:30–38, 2013. © 2013 Elsevier Inc. All rights reserved.

INCREASINGLY, PRECEPTORS ACROSS the globeare contributing to student learning in nursing education programs within national and international arenas. These important members of the educational team provide many and varied opportunities for nursing students to link classroom learning to real workplace environments. In Canada, preceptorship is defined by the Canadian Nurses Association (CNA, 2004, p. 13) as a “formal, one-to-one relationship of pre-determined length, between an experienced nurse (preceptor) and a novice (preceptee) designed to assist the novice in successfully adjusting to and performing a new role.” Although researchers have begun to describe the

Nursing, Faculty of Health Sciences, University of thbridge, Canada. sistant, PhD Student, University of British Columbia, , Canada. ssistant, Faculty of Health Sciences, University of thbridge, Canada. atefully acknowledge the Faculty of Health Sciences at the ethbridge, Lethbridge, Alberta, for providing funding for tudy. rrespondence to Dr. Kalischuk: Professor of Nursing, alth Sciences, University of Lethbridge, Lethbridge, AB ail: [email protected]

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preceptor role, there is still much to learn about how preceptors understand their multifaceted role within nursing education.

Background Each year, thousands of preceptors all over the world teach students in a variety of acute, community, and continuing care clinical areas. Dibert and Goldenberg (1995) maintain that nurses take on the preceptor role to help students learn how to function in the workplace, improve their own personal teaching abilities, share knowledge, gain personal satisfaction, and expand their own knowledge base. Students who have worked with preceptors report greater confidence, more meaningful feedback about their performance, decreased stress, and an increased ability to identify weaknesses, seek assis- tance, and reflect upon their nursing practice (Kim, 2007). Three factors relevant to the preceptorship ex- perience have been reported in the literature: commit- ment, challenges, and supports/rewards.

Dibert and Goldenberg (1995) contend that those who view the benefits and rewards associated with pre- ceptorship positively demonstrate the most commit- ment. Moreover, they maintain that preceptors with more teaching experience are more committed to the

Professional Nursing, Vol 29, No. 1 (January/February), 2013: pp 30–38 © 2013 Elsevier Inc. All rights reserved.

31NURSING PRECEPTORS SPEAK OUT: AN EMPIRICAL STUDY

preceptorship role. Conversely, variables such as nursing experience, gender, and educational preparation have limited impact on preceptors' perceptions of the rewards and/or commitment to the role (Dibert & Goldenberg, 1995; Hykräs & Shoemaker, 2007; Usher, Nolan, Reser, Owens, & Tollefson, 1999).

Student–preceptor conflict is documented as a major challenge. According to Mamchur and Myrick (2003), conflict between students and preceptors can have a troubling impact on both parties. On the one hand, student–preceptor conflict may create student dissatis- faction with nursing that, in turn, may negatively in- fluence learning or cause the student to leave the profession. On the other hand, such conflict may even- tually lead the preceptor to decline future opportunities to participate in the preceptorship experience (Mamchur & Myrick, 2003).

Another challenge experienced by nurse preceptors is increased workload (Allen, 2002; Hautala, Saylor, & O'Leary-Kelley, 2007; Ohrling & Hallberg, 2000). Pre- ceptors maintain that it is difficult to manage client and coworker demands while simultaneously teaching stu- dents (McCarty & Higgins, 2003). They also indicate that lack of support from administrators, nursing faculty, and coworkers makes it difficult to meet the goals of the preceptorship experience. In addition, program leaders often express concern about the risk of burnout if preceptors' efforts are not appropriately rewarded (Dibert & Goldenberg, 1995).

Working with nursing students with poor nursing skills who require more time for training is cited as one of the most challenging problems facing preceptors (Yonge, Krahn, Trojan, & Reid, 1997). Moreover, these authors contend that nurse educators need time to assess students, placements sites, and individual pre- ceptors. Importantly, when selecting preceptors, ability rather than availability needs to be considered (Bain, 1996). Paying attention to these factors before clinical placements are agreed upon could help build stronger relationships among nursing educators, preceptors, and students.

Supports and rewards are associated with preceptor development. Preceptor development programs are recommended for addressing a variety of problems within the preceptor–student relationship (Clay, Lilley, Borre, & Harris, 1999). Using the principles of adult education, topics such as evaluating students, providing positive and negative feedback, dealing with conflict, and dealing with student failure are commonly addressed in these pro- grams (Clay et al., 1999; Hrobsky & Kersbergen, 2002; Mamchur & Myrick, 2003). McCarty and Higgins (2003) purport that such education needs to be ongoing and readily accessible with input from preceptors. For instance, Stone and Rowles (2002) found that preceptors desired the following Top 5 rewards: a continuing education/appreciation day with a meal, an opportunity to audit a graduate-level nursing course, a free meal, letters/certificates of commendation, and finally, an ap- pointment as an adjunct faculty member. Toward this

end, the CNA (2004) offers insight related to the imple- mentation of preceptorship development programs within a variety of clinical settings.

Researchers are just beginning to study the preceptor- ship experience from a broad-based perspective that includes all stakeholders. Reported here are responses to a questionnaire that was developed, piloted, and admin- istered to nurse preceptors in one Canadian baccalaureate nursing program.

Definitions Congruent with Dibert and Goldenberg's (1995) study, benefits and rewards were defined as positive outcomes associated with the preceporship experience that were measured by the Preceptor's Perception of Benefits and Rewards (PPBR) scale. Supports were defined as factors that enhanced and facilitated the preceptor role. They were measured by the Preceptor's Perception of Support (PPS) scale. Finally, commitment was defined as dedica- tion to a particular course of action. This was measured by the Commitment to the Preceptor Role (CPR) scale.

Study Aim The aim of this study was to examine preceptors' views regarding benefits, rewards, supports, challenges, and com- mitment in relation to the preceptor role in one Canadian liberal arts-based baccalaureate nursing program.

Method The method utilized a quantitative approach that em- ployed a descriptive, correlational design. With permis- sion, based on the work of Dibert and Goldenberg (1995), a six-part questionnaire was developed as follows: PPBR scale, PPS scale, CPR scale, a preceptor reward section, a preceptor support section, and a demographic informa- tion section. The PPBR (14 items), PPS (14 items), CPR (10 items) scales used a 6-point, Likert-type rating scale that ranged from strongly disagree (1) to strongly agree (6; Dibert & Goldenberg, 1995). A minor alteration in terminology was made to the first three scales from the original source. The term new graduate nurse was changed to nursing student. In the preceptor reward sec- tion, preceptors were asked to provide their preferences for rewards and recognition, and a demographic infor- mation section was also provided. Four open-ended questions were utilized to allow preceptors the opportu- nity to verify survey data or offer new ideas about re- wards, challenges, supports, and possible changes.

Prior to administration, a pilot study with a similar population was conducted to evaluate the effectiveness of the questionnaire. Participants of the pilot study sug- gested only minor changes in vocabulary that were sub- sequently adopted.

Sample The questionnaire was administered to a purposive sample of 331 preceptors who had previously worked with students in the Nursing Education in Southwestern Alberta (NESA) Program at least once in the last 3 to 5

32 KALISCHUK ET AL

years. A reminder letter was sent to all potential parti- cipants 1 month following initial distribution. One hundred twenty-nine questionnaires were returned, representing a response rate of 39%. Although not tested, participant demographics for this study represented what would be expected from the general nursing population. The research team hypothesized that the low response rate may have further validated the heavy workloads that nurses repeatedly reported in this study.

The majority of the participants in this study were women (n = 101, 87.8%) in the 40–49 age range (n = 49, 42.6%), with an average of 21.0 years (SD = 9.0 years) of nursing experience (see Table 1). Of those participating, 45.2% (n = 52) were diploma prepared, 48.7% (n = 56) were baccalaureate prepared, and 6.1% (n = 7) were graduate prepared. Approximately two thirds (66.1%, n = 76) of preceptors were employed full-time, and one third

Table 1. Demographic Characteristics of Sample

Variable

Frequency

n % Range M SD

Education Nursing diploma 52 45.2 Bachelor's degree 56 48.7 Other 7 6.1 No. of years of nursing experience 2–40 21.0 9.0 No. of times as a preceptor 1–2 33 28.7 3–5 29 25.2 5–10 28 24.3 10+ 25 21.7 Age 20–29 7 6.1 30–39 22 19.1 40–49 49 42.6 50–59 33 28.7 60+ 4 3.5 Gender Male 14 12.2 Female 101 87.8 No. of preceptor workshops attended in the last 3 years 0 61 53.0 1 44 38.3 2 7 6.1 3 3 2.6 Employment status Casual/relief 0 0.0 Part-time 39 33.9 Full-time 76 66.1 Nonemployed 0 0.0 Area of nursing in which you have acted in the role of preceptor in the last 3 years Acute medical/surgery 16 13.9 Other acute 10 8.7 Acute mental health 4 3.5 Community mental health 4 3.5 Long-term care 4 3.5 Public health 22 19.1 Home care 30 26.1 Other 25 21.7

(33.9%, n = 39) were employed part-time. Several areas of nursing were represented in the sample, including acute medical/surgical (13.9%, n = 16), public health (19.1%, n = 22), home care (26.1%, n = 30), acute mental health (3.5%, n = 4), community mental health (3.5%, n = 4), and continuing care (3.5%, n = 4). All participants had worked previously or were currently working with students at the time of the study.

Data Collection The study took place in southern Alberta, Canada. The NESA Program offers a baccalaureate in nursing degree via both postdiploma and 4-year degree options. The NESA program is a collaborative venture involving Lethbridge College (Years 1 and 2) and the University of Lethbridge (Years 3 and 4). Utilizing a problem-based curriculum, students are encouraged to take responsibil- ity for their own learning. NESA students work with preceptors in a variety of acute, long-term care, and community clinical settings, most often in their senior year. This program is currently in the process of revisit- ing its curriculum.

Ethical Considerations The study received approval from the Ethical Review Committee for Human Subjects at the study. All study data were treated in a confidential and respectful manner throughout the entire research process. Informed consent was implied by completion of the questionnaire.

Data Analysis Prior to statistical analysis, it was found that 1.9% of participant responses were missing values. No single question was missing more than 9% of the data, and missing data were determined to be missing at random. Because the missing values were less than 5% of the total number of cases, the typical method of listwise deletion was considered to be relatively “safe.” Fourteen cases missing 5% or more data were deleted, and the remaining missing values were replaced using the series mean method (Tabachnick & Fidell, 2007). Subsequently, a sample of 115 respondents remained, representing a 35% response rate.

Univariate outliers were detected by converting all scores into z scores and subsequently testing the sta- tistical significance of these scores. Scores in excess of ±3.29 were identified as potential outliers. Twenty scores were slightly greater than ±3.29; however, this was expected for a sample of this size (Tabachnick & Fidell, 2007). Most outliers occurred when participants selected strongly disagree or moderately disagree. These outliers were not removed from the analysis because they were seen as vital in addressing the research aims.

The Kendall Tau b correlation coefficient involving an inferential statistical test was utilized because it is one of the most accurate nonparametric tests available for assessing the strength of relationship between two variables when assumptions of normality are violated and data are ordinal (Morgan, Leech, Gloeckner, &

33NURSING PRECEPTORS SPEAK OUT: AN EMPIRICAL STUDY

Barrett, 2007; Tabachnick & Fidell, 2007). As expected, skewness and kurtosis were not normal for many of the variables. However, data were not transformed because the adopted statistic (Kendall Tau b) did not assume normality and transformation would have com- promised the meaningfulness of the results (Tabachnick & Fidell, 2007).

Cronbach's alpha, a measure of inter-item reliability, was calculated to determine the reliability of the PPBR, PPS, and CPR scales. Standard procedure dictates that reverse-worded questions are removed from the analy- sis, which in this case was four each, from PPS and CPR, respectively (Field, 2009). The Cronbach's alpha value obtained for PPBR, PPS, and CPR scales were as follows: 0.916, 0.821, and 0.863, respectively (Table 2), indicating high inter-item reliability (Burns & Grove, 2005). The sample size needed for determining statistical significance was calculated to be 85 with an alpha of .05 and a medium effect size (Cohen, 1992). Cronbach's alpha was not reported in previous studies; therefore, comparisons to previous inter-item reliability tests were not possible.

Correlations in this study were performed much differently from those identified by Dibert and Goldenberg (1995), Usher et al. (1999), and Hykräs and Shoemaker (2007). Unlike these authors, where 140 correlations from the two scales are averaged, we show our correlations in their entirety. Our research team felt that this course of action was needed because current statistical practices indicate that it is improper to average such correlations, particularly when some are positive, some are negative, and others are nonsignifi- cant. The drawback of this course of action is that we display a large number of correlations, yet we can still compare our results to previously identified important past studies.

Data for the survey were analyzed using the Statistical Package for Social Sciences software (Version 17.0). Descriptive statistics were used to analyze demographic variables such as gender, age, and years of nursing ex- perience. Inferential statistics were used to detect the strength of various relationships, including PPBR and CPR scales; PPS and CPR scales; and the years of nursing experience and the PPBR, PPS, and CPR scales. Finally, content analysis was used to analyze the open-ended questions where written responses were copied verbatim and organized by the number of times different parti- cipants stated the same concept. This section allowed participants the opportunity to verify or build upon survey results.

Table 2. Cronbach's Alpha for PPBR, PPS and CPR Scales

Scale Cronbach's α No. of cases No. of items

PPBR .916 14 115 PPS .821 10 ⁎ 115 CPR † .863 6 † 115

⁎ Questions 17, 20, 21, and 27 removed from the PPS scale. † Questions 31, 34, 35, and 37 removed from the CPR scale.

Results Preceptor's Perception of Benefits, Rewards,

and Recognition In the benefits and rewards section of the questionnaire, respondents were given the statement, “I am a preceptor because as a preceptor I have the opportunity to….” Overall, preceptors responded positively in this section as is evident in Table 3. Of the 14 questions, 10 were answered, with at least 89% (n = 102) agreeing with the statements. One finding that stood out was that only 20.9% (n = 24) of preceptors fulfilled their role because they felt it would improve their chances for promotion within the organization.

In the open-ended section, participants described their most rewarding experience as the ability to observe students develop as practitioners and future profes- sionals. For example, responses included the following: “watching the student blossom,” “watching the light turn on,” and “having them [students] apply what has been discussed and learned.” Preceptors also felt rewarded by watching students develop an interest in, or obtain a position at, their workplace and when students developed enthusiasm and a passion for nursing. One preceptor described her most rewarding experience as engaging with “highly motivated students who loved being with me and loved what I do and, in the process of learning, became colleagues in the great adventure.”

Other rewards described in the open-ended section included the following: student appreciation of pre- ceptors, having the privilege of teaching students, seeing students understand/appreciate key aspects of a particu- lar type of nursing, and having the opportunity to mentor students. Preceptors were rewarded, not only because they felt appreciated but also because they learned a great deal during their interactions with students.

PPS and Challenges In this section of the questionnaire, respondents were asked about various supports for the preceptor role. Preceptors responded positively (82.5%, n = 95) when asked about feeling prepared for the preceptor role. Similarly, 84.3% (n = 97) indicated that their goals as a preceptor were clearly defined. However, 25.2% (n = 29) of preceptors agreed that nursing staff do not understand the goals of the preceptor program. Only 56.5% (n = 65) agreed that nursing unit managers were available to help them develop in their new role, and 40.0% (n = 46) agreed that on-site nursing educators were available to assist them. Less than half of preceptors (46.0%, n = 53) agreed that they are given adequate time to share information with other preceptors. Almost two thirds (61.7%, n = 71) of preceptors felt that their workload while precepting was appropriate, whereas 27.0% (n = 31) felt that they had insufficient time to provide patient care while working as a preceptor. Worthy of note, 37.4% (n = 43) of preceptors indicated that faculty spend too little time with nursing students (see Table 4).

Table 3. PPBR Scale

Statement Range M SD % agree ⁎ % disagree †

1. Teach nursing students 2–6 5.27 0.94 98.2 1.8 2. Assist nursing students to integrate in the nursing unit/workplace 4–6 5.36 0.82 100.0 0.0 3. Increase my own professional knowledge base 3–6 4.87 0.96 93.9 6.0 4. Keep current and remain stimulated in my profession 2–6 4.97 1.03 92.2 7.8 5. Influence change on my nursing unit/workplace 2–6 4.25 1.14 72.2 27.8 6. Gain personal satisfaction from the role 3–6 4.90 0.90 97.4 2.6 7. Be recognized as a role model 1–6 4.49 1.04 89.6 10.4 8. Improve my teaching skills 3–6 4.83 0.95 93.9 6.1 9. Share my knowledge with nursing students 4–6 5.28 0.82 100.0 0.0 10. Learn from nursing students 3–6 5.02 0.92 98.3 1.7 11. Contribute to my profession 3–6 5.11 0.92 97.4 2.6 12. Increase my involvement in the organization within this hospital/community 1–6 4.36 1.10 80.8 19.2 13. Improve my organizational skills 1–6 4.20 1.25 73.1 26.9 14. Improve my chances for promotion/advancement within this organization 1–6 2.98 1.17 20.9 79.1

⁎ With strongly agree, moderately agree, and agree merged. † With strongly disagree, moderately disagree, and disagree merged.

34 KALISCHUK ET AL

In the open-ended section, preceptors described two main challenges. Most commonly reported was the challenge of having unmotivated and uninterested students or those who did not meet preceptor expecta- tions for the necessary skill level. Preceptors found it difficult when “a student was completely not interested in the area assigned” or when “a student portrayed complete disinterest in patients, patient problems, and processes of care and treatment.” Preceptors maintained that it is very challenging to work with students who lacked motiva- tion, interest, and competency.

Workload demand was the second most commonly reported challenge. For instance, one preceptor found it challenging to “schedule adequate preceptor/student preparation time and assessment time afterwards,” whereas another preceptor remarked that “getting all

Table 4. PPS Scale

Statement

15. I feel I have had adequate preparation for my role as a precepto 16 My goals as a preceptor are clearly defined. 17. The nursing staff do not understand the goals of the preceptor 18. My coworkers on the nursing unit are supportive of the precep 19. My workload is appropriate when I function as a preceptor. 20. I do not have sufficient time to provide patient care while I func 21. I feel I function as a preceptor too often. 22. I feel that the nursing unit managers and program managers success of the preceptor program.

23. Nursing unit managers are available to help me develop in my r 24. On-site hospital nursing educators are available to help me d preceptor.

25. There are adequate opportunities for me to share information w 26. The nursing faculty member provides support by helping me performance problems.

27. The nursing faculty member spends too little time with the nur 28. The guidelines clearly outline the responsibilities of the nursi relation to my preceptor role

⁎ With strongly agree, moderately agree, and agree merged. † With strongly disagree, moderately disagree, and disagree merged.

my regular work done and the extra work of explaining all that I'm doing and why” was a daunting task. In a few cases, preceptors indicated that workloads were even being increased because students are sometimes viewed as “an extra pair of hands.”

Unclear expectations about teaching-related respon- sibilities were also challenging. One preceptor said, “I found the goals and objectives of the class to be vague and it was difficult to decide what to address.” Preceptors commented that they need clear direction from nurse educators to fulfil the requirements for student learning.

Other challenges included providing appropriate feedback and support to students who are experiencing difficulties, inspiring students to take responsibility for their own learning, and dealing with a lack of coworkers

Range M SD %

agree ⁎ %

disagree †

r. 1–6 4.30 1.01 82.5 17.5 3–6 4.37 0.90 84.3 15.7

program. 1–5 3.00 0.98 25.2 74.8 tor program. 3–6 4.50 0.87 91.3 8.7

1–6 3.75 1.26 61.7 38.3 tion as a preceptor. 1–6 3.05 1.00 27.0 73.0

1–6 2.83 1.07 13.9 86.0 are committed to the 1–6 4.27 0.99 85.3 14.7

ole as a preceptor. 1–6 3.75 1.20 56.5 43.5 evelop in my role as a 1–6 3.36 1.15 40.0 60.0

ith other preceptors. 1–6 3.47 1.03 46.0 53.9 to identify a student's 1–6 3.93 0.98 76.5 23.5

sing student. 1–6 3.33 1.03 37.4 62.6 ng faculty member in 1–6 4.05 0.93 81.8 18.2

35NURSING PRECEPTORS SPEAK OUT: AN EMPIRICAL STUDY

and/or faculty support. Scheduling preceptorship experi- ences was also identified as problematic.

Commitment and Requests Overall, as indicated in Table 5, preceptors felt positive about the preceptor role as they put a great deal of effort into creating meaningful and positive learning experiences for students. Of concern, 25.2% (n = 29) agreed that it would take very little for them to stop being a preceptor in their present circumstances.

When preceptors were asked about the types of rewards or supports they would like to have in recognition of their contributions to nursing education, 85.2% of preceptors said they favored nonmaterial rewards over material rewards. In order of preference, preceptors identified their Top 3 choices as professional development provided during work hours (54.8%, n = 63), a reduced patient workload when supervising students (37.4%, n = 43), and a certificate of recognition (31.3%, n = 36).

In the open-ended section, nonmaterial supports such as time for “collegial sharing” were more highly valued than material rewards including postsecondary courses, workshops, or financial compensation. Mentioned less often were material items such as gift certificates, certificates of recognition, and thank you cards.

Although many suggestions for material rewards were offered, preceptors emphasized the need for more time to better fulfill the preceptor role. One preceptor commen- ted: “Having a decreased workload enables one to take the time to properly assist/direct/listen to the student.” Others requested more support from nursing faculty, coworkers, and managers. Clearly, preceptors wanted their managers to support them in attending preceptor education workshops. They also wanted more informa- tion about program changes, especially those of a curricular nature. Importantly, a few preceptors felt that the opportunity to participate in preceptorship was a privilege. For example, one preceptor stated, “Precepting itself is a reward. I love the energy and fresh outlook of my students.”

Table 5. CPR Scale

Statement

29. I am willing to put in a great deal of effort beyond what is normall help the student be successful.

30. I am enthusiastic about the preceptor program when I talk to m 31. I feel very little loyalty to the preceptor program. 32. I find that my values and the values of the preceptor program a 33. I am proud to tell others that I am a preceptor. 34. It would take very little change in my present circumstances to ca preceptor.

35. There is not too much to be gained by continuing to be a prece 36. I really care about the fate of the preceptor program in this hos 37. Deciding to be a preceptor was a definite mistake on my part. 38. Being a preceptor really inspires me to perform my very best.

⁎ With strongly agree, moderately agree, and agree merged. † With strongly disagree, moderately disagree, and disagree merged.

The need for a workload reduction during the precep- torship experience was the most common request for change. Suggestions for making this point a reality included “having someone to take part of my caseload while I'm with the student” or “having the organizations work together to allow more resources that can free front line staff of the extra workload.” Preceptors believed that such a change would enable them to better assist with student learning.

Second, preceptors wanted to meet with students prior to the first work day. One preceptor requested “better introductory sessions and orientation to the workplace. I'd like a better way of knowing what to expect in terms of skills from the students and when to push them out of the nest.” A comprehensive and effective orientation was considered as essential. One preceptor suggested requir- ing “background on a student's experiences,” rather than “a word of mouth summary of the student. A more professional approach is needed.” Specifically, preceptors wanted more time to assess student abilities and needs prior to the first work day.

Preceptors also requested more preceptorship training opportunities. Some preceptors desired “more opportu- nities to attend a preceptor workshop,” whereas others suggested “doing more reading/courses related to pre- ceptor roles, communication, and duties.” Preceptors also wanted their managers to allocate additional time for preparation for this important nursing education role.

Other suggested changes are similar to those previ- ously discussed. Preceptors wanted to spend more time with nursing faculty and students who are enthusiastic and interested. They also requested more frequent program updates. A few preceptors suggested scheduling changes to accommodate their work schedules. Others wanted time alone to spend with students during the preceptorship experience, increased preceptorship op- portunities, and a better student evaluation tool.

Correlational Statistics A Kendall Tau b was utilized to examine the strength of the relationships between the ranked items in the PPBR

Range M SD %

agree ⁎ %

disagree †

y expected in order to 1–6 4.33 1.01 80.0 20.0

y nursing colleagues. 2–6 4.38 0.96 83.4 16.6 1–6 2.68 1.14 17.4 82.6

re very similar. 1–6 4.21 0.84 86.9 13.1 3–6 4.56 0.93 91.3 8.7

use me to stop being a 1–6 2.93 1.11 25.2 74.8

ptor. 1–6 2.53 1.04 13.9 86.1 pital/community. 1–6 4.51 1.13 88.8 11.2

1–6 2.07 1.13 4.3 95.7 1–6 4.81 1.07 91.2 8.8

36 KALISCHUK ET AL

scale and the CPR scale. In Table 6, the large number of weak positive correlations obtained indicates that as preceptors perceive greater benefits, they also tend to be more committed to the preceptor role. Yet, as with all correlations, they must be interpreted with caution because they do not point to causality. These findings are similar to results obtained by Dibert and Goldenberg (1995), Hykräs and Shoemaker (2007), and Usher et al. (1999).

A Kendall Tau b was completed to examine the strength of the relationship between the ranked items in the PPS scale and the CPR scale. In Table 7, the large number of weak positive correlations obtained indicates that as preceptors perceive greater support, they also tend to be more committed to the preceptor role. These find- ings are congruent with previously reported findings (Dibert & Goldenberg, 1995; Hykräs & Shoemaker, 2007; Usher et al., 1999).

A Kendall Tau b was also conducted to examine the strength of the relationship between years of nursing experience and the PPBR, PPS, and CPR scales. Find- ings showed no significant correlations among these variables, indicating that the number of years of nursing experience has no impact on preceptors' perceptions of benefits, rewards, support, and commitment to the pre- ceptor role. Other researchers have produced similar results (Dibert & Goldenberg, 1995; Hykräs & Shoe- maker, 2007; Usher et al., 1999).

Study Limitations Although this study offers new and interesting informa- tion about preceptorship, a number of limitations were identified. First, the predominantly quantitative focus of this study limits a deeper understanding of the precep- torship experience. For instance, although this study determined that some preceptors are questioning their involvement with the preceptorship experience, the nature of their apprehension remains unclear. This topic is worthy of further inquiry. Second, this study focused on the preceptorship experience in both urban

Table 6. Correlations Between Preceptor's Perception of Benefits

Kendal tau b 1 CPR 2 CPR 3 CPR 4 CPR 5 C

1 PPBR .218 ⁎⁎ .176 ⁎ −.222 ⁎⁎ .220 ⁎⁎ .25 2 PPBR .292 ⁎⁎ .306 ⁎⁎ −.290 ⁎⁎ .244 ⁎ .29 3 PPBR .317 ⁎⁎ .316 ⁎⁎ −.210 ⁎⁎ .208 ⁎ .36 4 PPBR .268 ⁎⁎ .280 ⁎⁎ −.234 ⁎⁎ .176 ⁎ .37 5 PPBR .313 ⁎⁎ .198 ⁎ −.054 .142 .24 6 PPBR .311 ⁎⁎ .402 ⁎⁎ −.322 ⁎⁎ .308 ⁎⁎ .43 7 PPBR .192 ⁎ .222 ⁎⁎ −.098 .193 ⁎ .29 8 PPBR .330 ⁎⁎ .326 ⁎⁎ −.244 ⁎⁎ .226 ⁎⁎ .42 9 PPBR .311 ⁎⁎ .350 ⁎⁎ −.218 ⁎⁎ .251 ⁎⁎ .38 10 PPBR .323 ⁎⁎ .416 ⁎⁎ −.283 ⁎⁎ .311 ⁎⁎ .42 11 PPBR .285 ⁎⁎ .403 ⁎⁎ −.321 ⁎⁎ .258 ⁎⁎ .33 12 PPBR .336 ⁎⁎ .309 ⁎⁎ −.128 .193 ⁎ .22 13 PPBR .292 ⁎⁎ .218 ⁎⁎ −.067 .155 .23 14 PPBR .129 .124 −.026 .015 .02 ⁎ P b .05. ⁎⁎ P b .01.

and rural settings and, therefore, did not address geo- graphical differences, another identified area for further exploration. Third, this study focused solely on pre- ceptors' experiences. A comprehensive understanding of the preceptorship experience requires exploring the views of many individuals involved in nursing education including students, faculty, nursing managers, and administrators, a viewpoint supported by Allen (2002).

Discussion Overall, most preceptors were committed to, and enthu- siastic about, preceptorship. Preceptors' perceptions about the benefits and rewards were positive, congruent with results obtained in studies conducted by Dibert and Goldenberg (1995), Hykräs and Shoemaker (2007), and Usher et al. (1999). However, preceptors in this study felt less positive about certain aspects of the preceptorship experience, including increased work- place responsibilities and decreased opportunities for influencing workplace change. Noteworthy, some pre- ceptors felt unsupported by nursing faculty, a point made by Fothergill Bourbonnais and Kerr (2007). Preceptors also felt little support from nursing unit managers and on-site nursing educators, congruent with research conducted by Dibert and Goldenberg and McCarty and Higgins (2003). This view differs from recent findings by Hautala et al. (2007), who suggest that preceptors feel adequately supported by coworkers and managers. This variation may demonstrate that support varies greatly among workplaces.

In this study, preceptors valued nonmaterial rewards over material rewards. Essentially, preceptors felt that financial rewards would not help reduce workload or increase the amount of time spent with students, a point echoed by Usher et al. (1999). However, preceptors favored certain material rewards, such as gift certificates, certificates of recognition, and thank you cards. These findings suggest that although preceptors favor non- material rewards, particularly those which support

/Rewards and Commitment to Preceptor Role

PR 6 CPR 7 CPR 8 CPR 9 CPR 10 CPR

1 ⁎⁎ −.099 −.319 ⁎⁎ .268 ⁎⁎ −.170 ⁎ .226 ⁎⁎ 0 ⁎⁎ −.166 ⁎ −.327 ⁎⁎ .284 ⁎⁎ −.275 ⁎⁎ .226 ⁎⁎ 5 ⁎⁎ −.157 ⁎ −.371 ⁎⁎ .294 ⁎⁎ −.269 ⁎⁎ .341 ⁎⁎ 0 ⁎⁎ −.157 ⁎ −.392 ⁎⁎ .268 ⁎⁎ −.280 ⁎⁎ .356 ⁎⁎ 0 ⁎⁎ −.003 −.186 ⁎ .213 ⁎⁎ −.064 .194 ⁎ 5 ⁎⁎ −.219 ⁎⁎ −.351 ⁎⁎ .413 ⁎⁎ −.259 ⁎⁎ .389 ⁎⁎ 9 ⁎⁎ −.075 −.219 ⁎⁎ .213 ⁎⁎ −.125 .193 ⁎ 3 ⁎⁎ −.132 −.400 ⁎⁎ .364 ⁎⁎ −.283 ⁎⁎ .323 ⁎⁎ 7 ⁎⁎ −.175 ⁎ −.350 ⁎⁎ .302 ⁎⁎ −.193 ⁎ .272 ⁎⁎ 1 ⁎⁎ −.183 ⁎ −.359 ⁎⁎ .359 ⁎⁎ −.292 ⁎⁎ .388 ⁎⁎ 7 ⁎⁎ −.190 ⁎ −.345 ⁎⁎ .363 ⁎⁎ −.215 ⁎⁎ .372 ⁎⁎ 4 ⁎⁎ −.065 −.236 ⁎⁎ .321 ⁎⁎ −.096 .191 ⁎ 1 ⁎⁎ .003 −.177 ⁎ .200 ⁎ −.082 .174 ⁎ 8 .070 .065 −.073 .140 −.041

Table 7. Correlations Between PPS and Commitment to Preceptor Role

Kendal tau b 1 CPR 2 CPR 3 CPR 4 CPR 5 CPR 6 CPR 7 CPR 8 CPR 9 CPR 10 CPR

1 PPS .270 ⁎⁎ .457 ⁎⁎ −.278 ⁎⁎ .475 ⁎⁎ .369 ⁎⁎ −.203 ⁎⁎ −.276 ⁎⁎ .367 ⁎⁎ −.264 ⁎⁎ .262 ⁎⁎ 2 PPS .338 ⁎⁎ .439 ⁎⁎ −.367 ⁎⁎ .435 ⁎⁎ .456 ⁎⁎ −.247 ⁎⁎ −.418 ⁎⁎ .403 ⁎⁎ −.309 ⁎⁎ .413 ⁎⁎ 3 PPS −.024 −.183 ⁎ .203 ⁎ −.199 ⁎⁎ −.114 .203 ⁎ .121 −.125 .184 ⁎ −.183 ⁎ 4 PPS .275 ⁎⁎ .425 ⁎⁎ −.325 ⁎⁎ .354 ⁎⁎ .417 ⁎⁎ −.241 ⁎⁎ −.336 ⁎⁎ .379 ⁎⁎ −.296 ⁎⁎ .378 ⁎⁎ 5 PPS .160 ⁎ .404 ⁎⁎ −.256 ⁎⁎ .343 ⁎⁎ .267 ⁎⁎ −.260 ⁎⁎ −.357 ⁎⁎ .313 ⁎⁎ −.283 ⁎⁎ .308 ⁎⁎ 6 PPS −.066 −.178 ⁎ .154 −.119 −.203 ⁎ .221 ⁎⁎ .202 ⁎ −.101 .146 −.090 7 PPS −.251 ⁎⁎ −.357 ⁎⁎ .335 ⁎⁎ −.294 ⁎⁎ −.332 ⁎⁎ .313 ⁎⁎ .320 ⁎⁎ −.266 ⁎⁎ .310 ⁎⁎ −.201 ⁎ 8 PPS .256 ⁎⁎ .453 ⁎⁎ −.384 ⁎⁎ .567 ⁎⁎ .390 ⁎⁎ −.240 ⁎⁎ −.392 ⁎⁎ .467 ⁎⁎ −.332 ⁎⁎ .395 ⁎⁎ 9 PPS .167 ⁎ .346 ⁎⁎ −.238 ⁎ .295 ⁎⁎ .261 ⁎⁎ −.192 ⁎ −.152 .256 ⁎⁎ −.122 .063 10 PPS .132 .316 ⁎⁎ −.266 ⁎⁎ .189 ⁎ .240 ⁎⁎ −.153 ⁎ −.127 .248 ⁎⁎ −.136 .198 ⁎ 11 PPS .014 .149 −.057 .159 ⁎ .098 −.060 −.056 .113 −.045 .103 12 PPS .104 .076 −.038 .278 ⁎⁎ .172 ⁎ −.056 −.217 ⁎⁎ .138 −.192 ⁎ .230 ⁎⁎ 13 PPS −.046 −.104 .112 −.061 −.156 .046 .163 ⁎ −.114 .096 −.151 14 PPS .111 .243 ⁎⁎ −.233 ⁎⁎ .286 ⁎⁎ .278 ⁎⁎ −.125 −.263 ⁎⁎ .283 ⁎⁎ −.194 ⁎ .326 ⁎⁎

⁎ P b .05. ⁎⁎ P b .01.

37NURSING PRECEPTORS SPEAK OUT: AN EMPIRICAL STUDY

increased time with students, they also appreciate other types of recognition.

The most common challenge faced by preceptors was working with uninterested, unmotivated students or students perceived as having less than adequate skills, which is congruent with Yonge et al.'s (1997) research. Preceptors also reported that they felt overwhelmed by the amount of work they were required to complete during preceptorship, a finding highlighted by numer- ous researchers (Hautala et al., 2007; McCarty & Higgins, 2003).

Another interesting finding our study offers is that preceptors want to spend more time with students prior to the first work day. When preceptors are expected to complete all of their regular workload while teaching, they do not have the time they need to properly assess and assist students. As a way of solving this dilemma, preceptors felt they needed either time to spend with students outside of the workplace or a lighter workload to enable them to properly assess and orientate students.

In spite of the challenges, many preceptors valued and felt rewarded through their interactions with students. Whether it was influencing student growth and devel- opment, observing a student's passion for nursing, or promoting student retention within the workplace, most preceptors experienced a great deal of satisfaction.

Recommendations Specific recommendations are directed toward nursing faculty, nursing administration, and educational institu- tions. Nursing faculty members are well positioned to take on a leadership position in terms of providing pre- ceptor support and development. An important finding of this study is that preceptors want increased face-to- face contact with nursing faculty. Hence, it is recom- mended that faculty take the lead in terms of developing relationships and working collaboratively with pre- ceptors to assess and orientate students. For example, faculty members could arrange an introductory meet- ing between the preceptor and student prior to the

preceptorship experience. In addition, faculty could take the lead in developing and administering a student learning assessment tool that subsequently would be shared with preceptors.

Nursing faculty need to ensure that preceptors under- stand their teaching roles and responsibilities. This implies finding out what preceptors know, discerning what they want and need to know, and making sure that they have ready access to current and relevant edu- cational materials. Faculty may also wish to explore the use of a theoretical model for guiding preceptor edu- cation (Yonge, Myrick, Ferguson, & Lughana, 2005). As a way of augmenting face-to-face meetings, faculty might consider the creation of a cyberspace “living resource center” that provides a dedicated space for sharing information and resources related to a variety of commonly encountered preceptorship challenges. Sup- ports and resources for the center might include, but are not limited to, the following: an electronic preceptor manual (less than five pages) outlining preceptor roles and responsibilities that can be easily updated, evidence- based databases, case study materials, videos, contact information for local preceptors, newsletters, a list of mentoring tips, self-evaluation tools, and conference- related information. An on-line continuing education course is another promising possibility (Zahner, Tipple, Rather, & Schendzielos, 2009).

Nursing administrators have a profound influence on all team members. An important finding of this study is that preceptors felt they could be more effective in the teaching role with a lightened workload. Nursing admi- nistrators play a key role here. Nursing leaders in health care agencies and institutions need to work collabora- tively with educational institutions to find innovative ways for reducing preceptor workload. A lightened workload would enable preceptors to excel in their teaching role and support them in attending teaching- related, continuing education events. Another sugges- tion for consideration is the creation of joint appoint- ments as a way of further supporting and assisting

38 KALISCHUK ET AL

practicing nurses in assuming an educational role. Such endeavors would serve to increase preceptor satisfac- tion, enhance student learning, and foster the recruit- ment of new nurses in various workplaces.

Educational institutions play a key role in creating the vision for student success. It is important that strategic plans are sufficiently comprehensive to endorse the value of clinical teaching and, by association, the value of preceptorship. Preceptorship is valued by ensuring the provision of needed resources and supports, as well as taking into consideration the views of all stakeholders. Overwhelmingly, preceptors in this study indicated that they wanted increased opportunities to interact with students, faculty, and administrators. Ensuring that the needs and concerns of these groups are heard and ad- dressed is critical in ensuring that the goals of pre- ceptorship are met (Allen, 2002). If these groups can work together effectively, not only would preceptors teach more effectively, but educational institutions would attract more students, nursing administration would employ exceptional nurses, and student nurses would be better prepared to enter today's workplace.

Conclusion The findings of this study indicate that preceptors need a great deal more support and recognition for their efforts than they are currently receiving. The precep- torship experience can be enhanced through increased and designated time to fulfill the preceptor role, more opportunities for preceptor education, increased com- munication with nursing faculty, and more support from administration. Enhancing preceptor support and recognition will not only encourage preceptor retention, but it will also have a great influence on the recruitment and retention of future generations of nurses.

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