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Making the preceptorship model work better for students: the initial meeting between a nursing student and preceptor nurse can be critical to the success of a clinical placement.

As a former NZNO National Student Unit (NSU) delegate at the Christchurch Polytechnic Institute of Technology (CPIT), I was privileged to hear first-hand about the concerns facing many nursing students. Two issues that regularly cropped up were socialisation between students and preceptors on first meeting, and failings in the preceptorship model.

Several students discussed with me the difficulties they faced getting to know a new preceptor nurse. I believe the socialisation process is very important for students, and even more critical for those who perhaps find it difficult meeting new people and being in new environments. For some students, this initial meeting on the first day of a clinical placement has been quite traumatic, simply because the preceptor nurse has not taken the time to get to know the student. A number of students claim the nurse has done little more than acknowledge their existence, allowing no opportunity for the student to introduce themselves. This has not been a good start to the placement.

It is often said the nursing profession eats its young; in some cases the lack of warmth and regard have broken the delicate shells of those just starting out in the profession. In an era of nursing shortages, nurses should support, encourage and teach students, "not eat them". (1) In fact, a "positive, welcoming clinical" environment for the student nurse creates warm-hearted memories and has the potential to attract the new graduate nurse back to the environment when qualified. (2)

There is no doubt nursing is a tough profession that requires a lot of hard work to ensure good outcomes for patients. However, those who have taken on a preceptorship role, whether voluntary or otherwise, and have a student in tow, need to take the time to get to know their student on first meeting. Having one preceptor for the clinical period is a rarity. More commonly, the student nurse will be placed with a number of preceptors over the course of the placement, meaning s/he must meet and gain the confidence of the new nurse on each occasion.

Preceptorship has been described as "among the most stressful of student experiences", operating within what can be a tense environment, bringing together "two complete strangers (student and preceptor) in a professional relationship that may potentially lead to conflict, dissatisfaction and disenchantment for both parties'". (3) Preceptors do not always act kindly and supportively towards students. (4) This can have a direct bearing on the quality of the learning experience for the student and lead to lack of confidence when performing a skill in front of the preceptor. Students may begin to doubt their skills and abilities. One commentator has said "preceptorship is about fostering and taking someone under your wing, as well as teaching and assessing". (5)

Each new meeting between student and preceptor needs a time of socialisation which should be considered very important. This enables the preceptor to discover what skills the student nurse has and makes the student feel more at ease. Although preceptors will argue students should have certain clinical skills before entering the clinical environment, student nurses are exposed to different clinical skirls at different times and may have only performed a particular skill once or twice before the placement.

For example, a student completing a mental health placement will receive little, if any, time in the drug room due to the rules governing the dispensing of medications for that facility. This student, whose next placement is in a surgical area, will go in with little experience or skill in this area. Through investigation and conversation, the preceptor will gain at least a rudimentary insight into the student's feelings and skirls before launching into the shift. Time spent talking can reduce the student's anxiety and provide information that will set the tone for the day. One writer has said how lucky nurses are to have such "eager helpers" to grace the ward. Building rapport and encouraging students into the nursing role will mean more hands on deck to help with the patient load. (6)

Nurses should reflect on their early nursing days and remember when they were standing in front of a buddy nurse wondering whether to move to the left or right, or whether they were going to harm the first patient they encountered. Nurses should also recall the preceptor nurse who made a real difference for them during their early days on a ward. Nursing students are the "colleagues of tomorrow", so every new encounter between student and preceptor should start off on the right note. (7)

At the same time, the student also needs to be proactive in the relationship and speak up if things are not going well on the clinical placement. Students can do this with their preceptor, charge nurse, clinical lecturer or NZNO delegate, and the earlier the better before things escalate.

Does the preceptor model work?

Some students believe the preceptorship model is flawed in several areas. The model requires the experienced nurse to act as a resource and role model in a "one-on-one relationship" with an undergraduate to facilitate her/his learning. The concept is widely used in undergraduate programmes, although in several guises. Theoretically, the nursing school matches the current learning and assessment requirements with a matched student and preceptor. However, there is little control of the environment in which the students learn and unclear performance issues for all participants. (8)

A classic problem some students face is the competency assessment form the preceptor nurse is required to complete. All categories have to be marked as a pass or fail, and, though linked to the Nursing Council's competencies, (9) depend a great deal on the preceptor's personal opinion.

Understanding clinical assessment forms

As opinion and standards of practice vary between nurses, so does the potential for a nurse to pass or fail a nursing student. Some nurses may not understand the clinical assessment forms and, as a result, incorrectly mark the criteria, causing much bewilderment and anxiety for the student who needs each section filled in correctly to pass each stage. Some preceptor nurses refuse to flu out the forms until certain criteria have been met. One preceptor, for example, refused to sign a particular form until the student in question had made up for lost sick leave time. Although the student was entitled to sick leave and her clinical tutor had assured her this would not be a problem, the pressure this brought to the student was unnecessary and almost put her off nursing.

There is no doubt preceptor nurses are often under pressure from the stresses of the ward environment. It is worth asking whether the preceptorship model has failed to keep pace with the changing ward environment. The model may have worked well 20 years ago when a preceptor was able to educate and mentor the same student for the entire clinical placement. With high patient loads and winter peaks where hospital beds are continually at a premium, the pressure of professional development programmes nurses are required to undertake to maintain Nursing Council requirements, is it any wonder nurses struggle to undertake the preceptorship rote effectively and fairly? (4) It is just too much to ask of a nurse under stress. Students need an even playing field and should not be subjected to the uncertainty of the current preceptor models on offer; surety there is a better way of doing business. Students need to be assessed by preceptors who understand the requirements. They also need support from clinical tutors who know the clinical area to which the student is assigned.

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I look forward to a preceptorship programme that supports students in their training, bringing together student teaming, clinical tutors, preceptors and teaching hospitals. Preceptor nurses also need to be fully supported by the nursing faculty and by hospital management, so they fully understand assessment requirements and receive the recognition they deserve for the training, stress and time taken up in teaching and supporting students.

Postscript: Late last year, I was part of the pilot dedicated education unit programme. Although not without its teething problems, I found it a positive step forward for students and preceptors, and thank hospital and CPIT staff for recognising the need for change in this area.

DEDICATED EDUCATION UNIT

In August last year, a pilot new model of preceptorship, based on the concept of a dedicated education unit, was launched in five areas of three Canterbury District Health Board (CDHB) hospitals (see Kai Tiaki Nursing New Zealand, September 2007, news and events, p10). This was a joint venture between the CDHB and the school of nursing at CPIT that aimed to improve the learning experience and clinical support for students on placement.

According to project team member and CPIT senior nursing lecturer Isabel Jamieson, feedback from the 60 students who were involved in the pilot has been overwhelmingly positive. "In their evaluations, students said they felt well supported by the clinical and academic staff and members of the multi-disciplinary team, and found their assessments fair and valid. We are now awaiting feedback from the governance group in order to pull together a final report. We are keen to roll the model out further, though at present we are unsure how it will be sustained financially," she said.

References

(1) Zimmermann, P. (2002) 8 tips for dealing with students; Nursing, 32: 6, 97.

(2) Howard,V. & Tasota, F. (2004) How to spell relief for the nursing shortage: S-T-U-D-E-N-T-S. Nursing; 34; 9, 32.

(3) Yonge, 0., Myrick, F. & Haase, M. (2002) Student nurse stress in the preceptorship experience. Nurse Educator; 27: 2, 84-88.

(4) Daigle, J. (2001) Preceptors in nursing education--facilitating student learning. Kansas Nurse; 76: 4, 3.

(5) Cowen, G. (2002) Positive preceptors promote successful practice. Australian Nursing Journal; 10: 5, 40.

(6) Kupferman, K. (2005) 10 ways to help students grow. Nursing; 35; 4, 56-57.

(7) Thomas, N. & Thompson, J. (2003) Tomorrow's nurses need your help today. RN; 66: 6, 51-53.

(8) Seldomridge, L. & Walsh, C. (2006) Evaluating student performance in undergraduate preceptorships. Journal of Nursing Education; 45: 5.

(9) Nursing Council of New Zealand. (2005) Competencies for the registered nurse scope of practice. Wellington: author.

Steve Fox is a third-year nursing student at Christchurch Polytechnic Institute of Technology and was a member of the National Student Unit from 2006 to mid 2007.
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Title Annotation:VIEWPOINT
Author:Fox, Steve
Publication:Kai Tiaki: Nursing New Zealand
Geographic Code:8NEWZ
Date:Feb 1, 2008
Words:1720
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