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Graduate Clinical Nurse Preceptors: Implications for Improved Intra-Professional Collaboration

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Sr. Rosemary Donley, PhD APRN, FAAN
Sr. Mary Jean Flaherty, PhD, RN, FAAN
Eileen Sarsfield, PhD, P0HCNS-BC
Agnes Burkhard, PhD, RN, APHN-BC
Sandra O'Brien, PhD, FNP, PHCNS-BC
Kelley M. Anderson, PhD, FNP

Abstract

Advanced practice nurses have increased in number and public acceptance. Students preparing for these roles require quality clinical education so they are prepared to assume collaborative roles in healthcare settings. Although graduate clinical preceptors have a vitally important role in the clinical education and professional socialization of advanced practice students, there is a paucity of evidence about factors that influence their role commitment. In this article, the authors review the literature related to graduate-level, clinical-preceptor experiences; describe their study of 91 graduate clinical preceptors that identified factors influencing graduate clinical preceptors’ role commitment; report and discuss their findings; as well as the limitations of this study. They conclude that the graduate clinical preceptor role needs to be more visible and better integrated into schools of nursing and healthcare organizational structures, and identify the need for intra-professional collaboration among nursing faculty, administrators, and clinicians to facilitate the recruitment, cultivation, and retention of graduate clinical preceptors

Citation: Donley, R., Flaherty, M., Sarsfield, E., Burkhard, A., O'Brien, S., Anderson, K., (July 31, 2014) "Graduate Clinical Nurse Preceptors: Implications for Improved Intra-Professional Collaboration" OJIN: The Online Journal of Issues in Nursing Vol. 19 No. 3.

DOI: 10.3912/OJIN.Vol198No03PPT01

Keywords: Graduate clinical preceptors, intra-professional collaboration, advanced practice nurses, benefits of clinical precepting, rewards of clinical precepting, support for clinical precepting, preceptor role commitment, web-based survey, graduate clinical education, lack of graduate preceptors, graduate nursing education, collaboration

Preceptors are essential to achieve manpower projections and the goals envisioned by the authors of The Future of Nursing ... The Patient Protection and the Affordable Care Act (2010) increases the demand for committed clinical preceptors in the education of graduate students of nursing. Preceptors are essential to achieve manpower projections and the goals envisioned by the authors of The Future of Nursing (Institute of Medicine [IOM], 2010). Nursing's ability to fully participate in caring for newly insured patients and managing chronically ill and aged people in community settings is linked to its capacity to collaboratively develop a larger number of advanced practice nurses. Schools of nursing cannot do this alone. Collaboration with the advanced practice nurses within health agencies is essential to meet this need.

Graduate clinical preceptors are playing an increasingly important role in graduate nursing education as enrollments increase and new graduate programs emerge. Clinical preceptors enhance students' access to patients and settings, clinical skill development, role acquisition, socialization, and professional transition into the world of advanced practice (Link, 2009). They hold the key to increasing the number and quality of master of science in nursing (MSN) and doctor of nursing practice (DNP) students preparing for practice in primary, community-based, and acute care settings.

The emerging role of clinical preceptors was highlighted when the American Association of Colleges of Nursing’s (AACN, 2004) member schools endorsed the Position Statement on the Practice Doctorate in Nursing. Looking toward the future, AACN's educational leaders set 2015 as the year when preparation for the advanced practice of nursing would be at the doctoral rather than the master's level (AACN, 2004; 2012a). Faculty of nursing quickly responded as was evidenced by the AACN's (2013) announcement that 217 schools of nursing in 40 states and the District of Columbia offered doctor of nursing practice (DNP) programs; the number of students enrolled in DNP programs also increased from 9,094 to 11,575 from 2011 to 2012.

Graduate clinical preceptors are playing an increasingly important role in graduate nursing education as enrollments increase and new graduate programs emerge. The AACN (2004) directed that master's-level education emphasize the preparation of clinical leaders, rather than the more specific roles of clinical specialists, nurse practitioners, midwives, or nurse anesthetists. Some ten years later, nursing schools' websites indicate that faculty members are preparing clinical nurse leaders, clinical specialists, and nurse practitioners at both the master's and doctor of nursing practice levels. Student enrollment in master's programs increased by 8.2% between 2011 and 2012 (AACN, 2012b). Documents, such as the The Future of Nursing (IOM, 2010) report and the revised Criteria for Nurse Practitioner Programs (National Task Force on Quality Nurse Practitioner Education, 2012), extended AACN's position by not only endorsing higher education of nurses, but urging the creation of clinical environments that challenge nurses to practice collegially to their full capabilities.

The changing face of nursing education and practice, including the need for more clinical preceptors, provided the impetus for this study and reinforced the importance of understanding the motivational variables that influence graduate clinical preceptors’ role commitment. In this article, we will review the literature related to graduate-level clinical preceptors; describe our study of graduate clinical preceptors that identified factors influencing graduate clinical preceptors’ role commitment; report and discuss our findings; and also address the study limitations. We will conclude that the graduate clinical preceptor role needs to be more visible and better integrated into schools of nursing and healthcare organizational structures, and identify the need for intra-professional collaboration among nursing faculty, administrators, and clinicians to facilitate the recruitment, cultivation, and retention of graduate clinical preceptors.

Literature Review

Nursing and medicine... take clinical precepting seriously and wish to legitimize the preceptor role. There is a paucity of research about graduate clinical precepting though much has been written about precepting undergraduate students and new graduates in the United States and around the world (Dibert & Goldenberg, 1995; Happell, 2009; Hyrkas & Shoemaker, 2007; Larsen & Zahner, 2011; Marincic & Francfort, 2002; Usher, Nolan, Reser, Owens, & Tollefson, 1999; Younge, Hagler, Cox, & Drefs, 2008). Billay’s and Myrick’s (2008) integrative review on precepting reflects a sample of 313 articles drawn from 5,311 manuscripts in journals of nursing (20.8%), medicine (12.8 %), pharmacy (4.2 %), and dentistry (2.2%) between January 1994 and January 2005. Nursing and medicine were major contributors to this literature indicating that these professions take clinical precepting seriously and wish to legitimize the preceptor role. Unfortunately, Billay’s and Myrick’s review did not distinguish between precepting graduate and undergraduate nursing students. An examination of the reference list suggests that most of the nursing articles in their review discussed undergraduate clinical education.

The extant literature on graduate preceptorships describes barriers and facilitators in clinical precepting (Brooks & Niederhauser, 2010) and gives examples of teaching strategies and partnerships (Barker & Pittman, 2010; Nickitas, Keida, Nokes, & Neville, 2004; Risco, 2004; Stark, 2004). Typical of this literature, Barker and Pittman (2010) and Nickitas et al. (2004) propose a three-way partnership among preceptors, faculty, and students. Stark adds to this collaboration theme by offering suggestions to help physician-preceptors understand the learning needs of nurse practitioner (NP) students. Campbell and Hawkins (2007), in examining how faculty reward preceptors, describe both traditional rewards, such as tuition benefits, and professional rewards, such as providing professional opportunities, writing letters of recommendation, and honoring preceptors with certificates of appreciation and public recognition. Several other authors (Amella, Brown, Resnick, & McArthur, 2001; Campbell & Hawkins, 2007; Risco, 2004; Wiseman, 2013) discuss challenges (burden and lack of role definition), expectations and issues (competition for clinical sites and office space, inadequate communication, a reduction in the number of patients able to be seen by preceptors, and lack of compensation), along with barriers (time commitment) and rewards (promotion, academic titles, and recognition) associated with precepting graduate nursing students. A few authors describe the clinical precepting of nursing administration students (Cardin & McNeese-Smith, 2005: Hahn, 2010) and nurse anesthetist students (Merwin, Stern, & Jordan, 2008).

In summary, the literature offers observations and advice, but with few exceptions, provides limited data about the motivation of graduate clinical preceptors. Additional research is needed to better inform and promote more collaborative communication among faculty, deans, clinical administrators, and service chiefs about what is important and valued by clinical preceptors. The study reported below addresses this gap in the literature by describing perceptions associated with role commitment and emphasizing the importance of strengthening collaboration among schools of nursing and health services agencies.

The Study of Graduate Clinical Preceptors’ Role Commitment

In this section, we will describe the purpose of this research study along with the research questions asked in the study. We will also share our theoretical framework, the design and methods we used in this study, and our statistical analysis.

Purpose and Research Questions

Our study explored motivational variables among graduate clinical nurse preceptors. Specifically, it described clinical preceptors’ perceptions of benefits, rewards, and supports, and role commitment. It also examined their demographic profiles and preparation for their preceptor roles. The research questions were: What is the relationship between preceptors’ perception of:

  1. benefits and rewards and their commitment to the role;
  2. support for their role and their role commitment; and
  3. personal and professional characteristics, such as preparation for the preceptor role, and their role commitment.

Theoretical Framework

The theoretical framework guiding this study, namely the structural determinants of behavior in organizations (Kanter, 1977), proposes that opportunity and power structures affect human behavior and attitudes in large hierarchical institutions, such as healthcare organizations. Opportunity refers to expectations of rewards, promotion, career mobility, and the acquisition of new skills/knowledge. Power is the capacity to mobilize resources, accomplish objectives, and access support and resources that facilitate autonomy. Kanter (1977) suggests that individuals who perceive high opportunity are more committed to organizational goals; those who see themselves as having power behave in less rigid ways, helping rather than hindering others, and providing opportunities for subordinates to learn and advance in the organization.

Methods and Design

This descriptive, correlational research included: a) modification of the instrument selected to achieve the study’s purpose; b) establishment of validity and reliability of the modified instrument; and c) use of the modified instrument in a web-based survey of a sample of clinical preceptors of graduate nursing students. Web-based survey principles, suggested by Dillman (2007), guided the design, modification, and use of the online survey. Below we will describe our instrument development, protection of human subjects, and sample.

Instrument development. The instrument selected for the research was a three-part questionnaire developed by Dibert and Goldenberg (1995). Designed to study preceptors of undergraduate nursing students in Canada, the survey’s content reflects the theoretical insights of Kanter (1977). The Dibert and Goldenberg instrument is composed of three Likert scales: the Preceptor’s Perception of Benefits and Rewards Scale (PPBR) (14 items); the Preceptor’s Perception of Support Scale (PPS) (14 items); and the Commitment to the Preceptor Role Scale (CPR) (10 items) with response options ranging from 1 (strongly disagree) to 6 (strongly agree). Dibert and Goldenberg substituted the term support for Kanter’s term power in the PPS scale and reported Cronbach alpha’s for each of their scales, namely the PPBR, PPS, and CPR as .91, .86, and .87, respectively. Permission was obtained from Dibert to revise the instrument for use with graduate clinical preceptors in the United States. The modifications to the instrument by the researchers addressed differences in the use, meaning, or interpretation of terms in the United States, and role functions specific to preceptors in graduate clinical education. The investigator-modified instrument, titled the Perceptions of Graduate Clinical Preceptors, included three scales (38 items) and an investigator-designed demographic data form (19 items). This revised instrument was validated by four clinical nurse experts who met the same criteria as the study’s sample. The reliability of the modified instrument (α = .65, p < .001) was established utilizing test-retest methodology with eighteen experienced graduate clinical nurse preceptors.*

Protection of human subjects. This study was approved by a university institutional review board. Informed consent was obtained through an online agreement of participation. The web-based software ensured confidentiality, guarded against repeat users, and used data encryption to protect data. Responses could not be traced to individual respondents and were stored on a password-protected server accessible only to the researchers. Participants were assured that only aggregated data would be reported.

A nonprobability national sample of graduate clinical nurse preceptors was recruited during professional nursing meetings, through professional organizations lists and their websites, and by network sampling. Sample. Informational flyers and descriptive, web-based information were circulated at national professional meetings and through the websites of national nursing organizations. A nonprobability national sample of graduate clinical nurse preceptors was recruited during professional nursing meetings, through professional organizations lists and their websites, and by network sampling. Nurses who met inclusion criteria (possession of an active license as a registered nurse; self-identification as a reader of the English language; experience within the past two years as a clinical preceptor for graduate students; and willingness to provide consent) were given access to the survey. Sample size was determined by a power analysis, based on Cohen’s (1988) formula, to achieve a medium effect size, an alpha < .05, and a power of .80. Sixty-four participants were required to meet this goal. Over sampling was carried out to assure that an adequate number of preceptors completed the online survey. The 91 participants represented a cross section of graduate clinical preceptors who met the inclusion criteria and completed the online survey. Sixty-seven percent (n=61) were advanced practice registered nurses (nurse practitioner, clinical nurse specialist, or nurse midwife).

Statistical Analysis. Data analysis was conducted using the Statistical Package for Social Sciences version 17 (SPSS Inc., Chicago, Illinois). Descriptive and frequency summaries were computed for all study variables, including percentages for categorical variables. Spearman Rho correlations were conducted between the preceptors’ perception of benefits and rewards and their commitment to the role; preceptors’ perception of support for the preceptor role and their commitment to the role; and preceptor’s personal and professional characteristics and commitment to the preceptor role. A p value <.05 was deemed significant. We decided to use Spearman Rho correlations based on the variable’s level of measurement (ordinal). Cronbach’s alpha was used to evaluate the reliability statistics of each domain and the complete instrument, which included all three domains.

Findings

In this section, we will first describe our sample. Next, we will report participants’ perceptions of: a) the benefits and rewards of serving in the preceptor role and their commitment to this role; b) support and role commitment; c) professional and personal characteristics and role commitment; and d) additional findings, along with our reliability statistics.

Sample Characteristics

A total of 91 subjects participated in the survey (Table 1). Females represented 95.6% of the cohort. Participants ranged in age from 21 to over 60 years, with the most prevalent age group between 51-60 years (53.8%); 68.1% of all participants were over the age of 51 years. The majority of participants were white (86.6%), held a master of science in nursing degree (58.8%), and were currently employed (full-time 87.9%, part-time 12.1%); 78% of participants described involvement in professional nursing practice for more than 20 years. The majority of participants were nurse practitioners (58.2%). Seven participants (7.7%) did not report having earned a master's or higher degree. Although the authors recognize that preceptors should possess appropriate graduate degrees, educational level was not part of the inclusion criteria; these self-identified preceptors were included in the data analysis.

Table 1. Demographic Characteristics of Participants

Variable

N     %

Gender

 Female

87  (95.6%)

 Male

4    (4.4%)

Age

  21-30

1   (1.1%)

  31-40

12 (13.2%)

  41-50

16 (17.6%)

  51-60

49 (53.8%)

  >60

13 (14.3%)

Race

 Asian

1  (1.1%)

 Black/African American

5  (5.5%)

 White Hispanic or Latino

6  (6.6%)

 White not Hispanic/Latino

79 (86.6%)

Highest Earned Degree

 ADN/Diploma

2 (2.2%)

 BSN

5 (5.5%)

 MSN

53 (58.8%)

 Master’s other field

9 (9.9%)

 Doctoral in Nursing

16 (17.6%)

 Doctoral other field

4 (4.4%)

Number of Years of Professional Nursing Practice

  0-5

1 (1.1%)

  6-10

3( 3.3%)

  11-15

10 (11%)

  16-20

6 (6.6%)

  >20

71 (78%)

Current Employment Status

  Full time

80 (87.9%)

  Part time

11 (12.1%)

Advanced Practice Nursing Role

  Advanced Public Health Nurse

8 (8.8%)

  Clinical Nurse Specialist

7 (7.7%)

  Nurse Practitioner

53 (58.2%)

  Nurse Educator

4 (4.4%)

  Nurse Administrator

8 (8.8%)

  Certified Nurse Midwife

1 (1.1%)

 Other

7 (7.7%)

N/A

2 (2.2%)

Certified in area of clinical practice

  Yes

75 (82.4%)

  No

11 (12.1%)

  Not applicable

5 (5.5%)

N Values may not equal 91 due to missing data

...84.7 % of the preceptors indicated their willingness to precept two or more students. The participants reported precepting more than five (51.6%) graduate nursing students over the last five years, generally precepting within their area of expertise (89%). Additionally, 84.7 % of the preceptors indicated their willingness to precept two or more students. Preceptors worked in the following settings with students: health departments (41.8%), other (15.4%), hospitals (13.2%), outpatient clinics (13.2%), school health (7.7%), community, non-profit (6.6%), and long-term care/rehabilitation (2.2%).

Preceptors reported divergent experiences in preceptor preparation, with 52.7% reporting some form of preparation, and almost half (47.3%) of the sample describing no formal preparation for their precepting roles (Table 2). Preceptors rated the adequacy of preparation as excellent (22%), good (44%), fair (20.9%), and poor (11%). Preceptors received the support from the students’ educational institutions in the form of preceptor manuals (24.2%), preceptor workshops (11%), and formal preceptor orientations (14.3%). The majority of the sample did not have their role as preceptors included as a responsibility in their job descriptions (69.2%) or as a part of their performance reviews (71.4%). Table 2 summarizes the characteristics of the precepting experiences.

Table 2. Characteristics of Precepting Experience

Precepting students in one’s own practice specialty area

n

   Yes

81 (89%)

    No

2 (2.2%)

    Not always

7 (7.7%

Setting for precepting student

 

    Hospital

12 (13.2%)

    Health Department

38 (41.8%)

    Community Clinic

6 (6.6%)

    LTC/Rehab

2 (2.2%)

    School Health

7 (7.7%)

    Out-patient Clinic

12 (13.2%)

    Other

14 (15.4%)

Number of graduate nursing students precepted over last 5 years

 

   1-3 students

23 (25.3%)

   4-5

21 (23.1%)

   5 or more

47 (51.6%)

Number of students willing to precept per year

 

   1

13 (14.3%)

   2

44  (48.4%

   >2

33 (36.3%)

Preceptor responsibilities incorporated into job description

 

   Yes

17 (18.7%)

   No

61 (69.2%)

   Unsure

 8 (8.8%)

Preceptors responsibilities part of performance review

 

   Yes

20 (22%)

   No

64 (71.4 %)

   Unsure

5 (5.5%)

Did you have preparation for the preceptor role?

 

   Yes

48 (52.7%)

   No

43 (47.3%)

How were you prepared for the preceptor role:

 

 Preceptor manual

 

   Yes

22 (24.2%)

   No

69 (75.8%)

   Preceptor workshop

 

   Yes

10 (11%)

   No

81 (89%)

Formal preceptor orientation

 

  Yes

13 (14.3%)

  No

78 (85.7%)

Rate the adequacy of preparation for the preceptor role

 

  Excellent

20 (22%)

  Good

40 (44%)

  Fair

19 (20.9%)

  Poor

10 (11%)

Not applicable

1 (1.1%)

N Values may not equal  91 or 100% due to missing data

 

Perception of Benefits, Rewards, and Role Commitment

The first research question explored the relationship between preceptors’ perception of benefits and rewards (PBR) and their commitment to the preceptor role (CPR). A statistically significant relationship was found to exist between perceptions of benefits and rewards, and commitment to role (rs(82) = .620, p=.000) (Table 3).

Perceptions of Support and Role Commitment

The second research question explored the relationship between participants’ perceptions of support (PPS) and role commitment (CPR). A statistically significant relationship was found to exist between perception of support and role commitment (rs(81) = .508, p = 0.00) (Table 3).

Table 3. Correlations Between Preceptors Perceptions of Benefits and Rewards, and Support and Commitment to Role

Domains

N

Rho

p

Benefits and rewards scale

82

.620

.000

Support scale

81

.508

.000

N=number of participants; Rho= Spearman Rank Order Correlation Coefficient; p=level of significance

N Values may not equal 91 or 100% due to missing data

Professional and Personal Characteristics and Role Commitment

The third research question explored the relationship between professional and personal characteristics and role commitment (CPR). Two characteristics, a willingness to precept more than two students each year (rs (87) = .348, p = .0001) and participation in preceptor workshops (rs(87) = .327, p = .002), were found to be positively correlated with role commitment. No other significant correlations were identified among study variables. Table 4 summarizes the relationships between the professional and personal characteristics and role commitment.

Table 4. Correlation Between Professional/personal Characteristics and Role Commitment

Preceptor Characteristics

n

Rho

p

Willing to precept more than two students each year

87

.348

.000

Preceptor attended a preceptor workshop as part of their orientation

87

.327

.002

Race/Ethnicity

87

-.020

.855

Gender

87

-.004

.968

Age

87

.026

.809

Education

85

.170

.121

Numbers of years since completion of highest level of education

87

-.184

.088

Employment status

87

-.126

.243

Precepting in one’s area of practice

86

-.209

.053

Certified in area of clinical practice

87

-.045

.679

Setting for precepting students

87

.101

.350

Number of years in nursing practice

87

.117

.279

Number of graduate nursing students precepted over the last 5 years

87

.024

.824

Are your preceptor responsibilities incorporated into your job description

87

.072

.509

Are your preceptor responsibilities a part of your performance review

87

-.072

.509

Received a preceptor manual from the student’s educational institution

87

.003

.977

Participation in a formal preceptor orientation

87

.058

.594

No preparation

87

-.057

.600

Adequacy of role preparation

87

-.201

.062

N Values may not equal 91 or 100% due to missing data

Additional Findings

The most highly ranked benefit... was that precepting contributed to the profession. The rank ordered mean scores for preceptor’s perceptions of benefits and rewards are presented in Table 5. Rank ordered means are reported on a Likert scale where 1 is strongly disagree and 6 is strongly agree. Nine of the 14 items reflecting benefits and rewards had a mean score of 5 or above indicating important benefits or rewards. The most highly ranked benefit, as determined by the preceptors, was that precepting contributed to the profession. Conversely, the lowest ranked benefit, as determined by the preceptors, was that serving as a preceptor would improve their chances for promotion/advancement within the workplace.

The rank ordered mean scores for preceptors’ perception of support is presented in Table 6. Notably, these rankings were lower with mean scores ranging from 4.85 to 3.68. The highest item related to the adequacy of preceptors’ preparation for the preceptor role, and the lowest ranking related to opportunities for sharing information with other preceptors.

Table 5. Rank-ordered Mean Scores for Preceptor’s Perception of Benefits and Rewards

Item

N

M

SD

Contribute to my profession.

89

5.46

.95

Teach graduate nursing students.

91

5.43

.89

Share my knowledge with graduate nursing students.

91

5.42

.84

Keep current and remain stimulated in my profession.

91

5.29

.89

Gain personal satisfaction from the role.

91

5.27

.97

Socialize the graduate nursing students into their new role.

91

5.22

1.0

Learn from graduate nursing students.

91

5.05

.886

Improve my teaching skills.

91

5.04

.97

Increase my own professional knowledge base.

91

5.04

1.0

Be recognized as a role model.

91

4.74

1.11

Influence change in my practice setting.

91

4.74

1.16

Increase my involvement within my workplace.

91

4.36

1.32

Improve my organizational skills.

88

3.91

1.42

Improve my chances for promotion/advancement within my workplace.

91

3.21

1.36

M=mean(mean range = 1-6), SD = standard deviation

N Values may not equal  91 or 100% due to missing data

Table 6. Rank-ordered Mean Scores for Preceptor’s Perception of Support

Item

N

M

SD

I feel I have had adequate preparation for my role as a preceptor.

91

4.85

1.15

My goals as a preceptor are clearly defined.

91

4.74

1.16

I am asked to function as a preceptor an appropriate number of times per year.

91

4.44

1.04

My colleagues within my workplace are encouraging of my preceptor experience.

91

4.38

1.22

The clinical course guidelines clearly outline the responsibilities of the nursing faculty member in relation to my preceptor role.

89

4.38

1.23

My colleagues within my workplace understand the goals of my preceptor experience.

91

4.36

1.16

I feel my supervisors at work are committed to the success of the preceptor experience.

91

4.35

1.36

The nursing faculty member spends time with the student.

88

3.97

1.15

I have sufficient time to provide care or carry out my normal duties while I function as a preceptor.

91

3.96

1.26

Others with expertise within my workplace are available to help me develop in my role as a preceptor.

91

3.93

1.38

My workload is appropriate when I function as a preceptor.

91

3.90

1.23

I feel my supervisors at work are available to help me develop in my role as a preceptor.

90

3.71

1.35

There are adequate opportunities for me to share information with other preceptors.

91

3.68

1.25

M=mean(mean range = 1-6), SD = standard deviation

N Values may not equal 91 or 100% due to missing data

Reliability Statistics

The overall Cronbach’s alpha of 0.951 of the revised instrument, Perceptions of Graduate Clinical Preceptors, indicated a high level of internal consistency. The three scales also reflected high internal consistency with Cronbach’s alphas’ of 0.923 for the PPBR scale, 0.899 for the PPS scale, and 0.961 for the CPR scale.

Discussion

This study explored the factors that motivate graduate clinical preceptors with the goal of enhancing their role commitment. This investigation is unique because it examined the perceptions of a national cross-section of graduate clinical preceptors; and while the sample was largely made up of nurse practitioners, it also included advanced public health nurses, nurse administrators, clinical nurse specialists, and nurse educators. Findings also confirmed Kanter’s (1977) notion that benefits and rewards, and organizational support, affect essential behaviors, such as role commitment.

Perceptions of Benefits and Rewards

A key finding of this study is that role commitment is enhanced when preceptors experience benefits and rewards associated with the preceptor role. A key finding of this study is that role commitment is enhanced when preceptors experience benefits and rewards associated with the preceptor role. This finding supports Kanter’s (1977) insight that experiencing organizational benefits and rewards for behavior increases role commitment. Interestingly, the benefits and rewards most often identified by the preceptors were in relationship to their perception that they were contributing to the profession. This lends support to the findings of Wiseman (2013) who surveyed a smaller local sample of clinical preceptors about the barriers and motivators for precepting advanced practice students. Similar to Wiseman’s work, we found that contributing to the profession was a strong intrinsic motivator for our study participants, who reported that they derived benefits from teaching and sharing knowledge with their students, increasing their teaching skills, and keeping abreast of developments in nursing.

Schools of nursing and health agencies are encouraged to collaborate to establish formal preceptor orientation and recognition programs... Preceptors’ lowest means scores in our study were related to enhancing their organizational skills and improving their opportunities for promotion or advancement within their organization. For Kanter (1977) opportunity refers to expectations of rewards, promotion, career mobility, and the acquisition of new skills/knowledge. Clearly, the preceptors whom we surveyed perceived the experience of precepting graduate students as a benefit. However, they did not report that clinical precepting provided opportunities to advance their careers or offered mobility within their practice or organization. These findings suggest the need to examine how schools of nursing and healthcare organizations can develop more formal and meaningful systems of rewards and benefits that facilitate professional development and career mobility. Schools of nursing and health agencies are encouraged to collaborate to establish formal preceptor orientation and recognition programs, and to provide regular programs during the semester to enrich and enhance the knowledge, skills, and role efficacy of graduate clinical preceptors. Another potential benefit may include tuition assistance by the academic institutions and/or health agencies.

Perceptions of Support and Role Commitment

A key finding was that role commitment was enhanced when preceptors felt supported in their preceptor role. However, the rank order means for preceptors’ perception of support were generally lower than the rank order means for perceptions of benefits and rewards. This suggests the perception of limited organizational support for the preceptor role. In light of Kanter’s theory, the findings indicate there is room for improvement in empowering and providing support to nurses who are engaged in precepting graduate students.

In responding to questions about support, preceptors gave highest mean rankings to adequate role preparation (Table 6). While the majority of preceptors (66%) rated the adequacy of their preparation for the preceptor role as good or excellent (Table 2), the vast majority (85.7%) indicated no formal preceptor orientation. It is difficult to interpret these data because preceptors were asked to respond to only three types of commonly used modalities for role preparation: formal orientation, preceptor manuals, and/or workshops. Because participants were not asked to identify the methods of role preparation that they found helpful, no further observations can be made about the finding that the majority of preceptors rated their preparation for the preceptor role as excellent or good. Clarifying what clinical preceptors consider to be adequate preparation would help faculty and nurse leaders in clinical settings plan cooperatively for professional role development of new and continuing preceptors.

The lowest mean rankings related to limited opportunities for sharing information with other preceptors, workload adjustments to reflect precepting responsibilities, and supervisor availability to facilitate preceptor role development. These findings support the need to examine what forms of collaboration and communication would best support/empower graduate clinical preceptors and enhance their role commitment. The collaboration and communication modalities envisioned by the investigators transcend contracts and job descriptions. We envision the appointment of graduate clinical faculty liaisons to coordinate and facilitate collaboration in all activities associated with the orientation, assignment, development, evaluation, and support of graduate clinical preceptors. Additionally, the development of collaborative communication plans among faculty, clinical preceptors, service chiefs, and graduate students could establish, enhance, and formalize supports.

Personal and Professional Characteristics

Two professional characteristics were found to be associated with commitment to the preceptor role: a willingness to precept more than two students each year and participation in a preceptor workshop. These findings support Kanter’s (1977) proposition that perceptions of opportunity serve as intrinsic motivators for professional advancement, mobility, and growth.

Although they were not correlated with role commitment, there were several interesting findings related to the personal and professional characteristics of the study sample. In the current study, 68.1% of the participants in the survey were 51 years of age or older. It is likely that many will consider retirement within the next 10-15 years. This observation mirrors the projection of the Health Resources and Services Administration [HRSA] (2013) indicating that over the next 10-15 years nearly one million registered nurses older than 50 years of age, about one-third of the current workforce, will reach retirement age. Recruitment, development, and retention of preceptors must be intentional and strategic in light of the aging nursing workforce.

The precepting of graduate students was not perceived as a formally established vehicle for professional recognition by the survey sample. The precepting of graduate students was not perceived as a formally established vehicle for professional recognition by the survey sample. Only 22% of study participants reported they were sure that preceptor responsibilities were part of their performance review. This finding differed from Wiseman’s (2013) report that 60% of preceptors received recognition of preceptor work in their job evaluations. These contrasting findings suggest the need for further exploration of how preceptor responsibilities are recognized in job descriptions and evaluative structures.

Although fiscal support for the training of medical residents has long been included in Medicare reimbursement formulas, graduate education in nursing is supported by student tuition, university scholarships, and state and federal grants. The Centers for Medicare and Medicaid Services (CMS, 2012) recently launched a four year demonstration project in five hospitals designed to support and facilitate the clinical education of additional advanced practice nurses, specifically nurse practitioners. While the current study explored the rewards of serving as a graduate clinical preceptor, financial compensation for organizations and preceptors warrants future study. Investigation is also needed to advance our understanding of the economic challenges and resource needs of schools of nursing and healthcare agencies. This work may assist in the development of innovative systems that provide robust benefits, rewards, and supports for preceptors in today’s complex healthcare environment.

Limitations of the Study

This study used a nonprobability sample of 91 graduate clinical nurse preceptors who responded to an invitation to participate in an electronic survey. Participants were recruited from multiple national organizations. Although the participants who completed the survey represented multiple regions of the country, the ability to draw conclusions about the general population of graduate clinical nurse preceptors is limited. Participants who belong to national professional organizations and attend national meetings may not be representative of the graduate clinical preceptor population. Additionally, the use of survey methodology restricted the depth of the participants’ responses. While the Cronbach's alpha coefficients for the revised instrument were sound, additional psychometric testing with a larger sample size would be informative for future investigations.

Conclusions

Study data suggest the graduate clinical preceptor role needs to be more visible and better integrated into schools of nursing and healthcare organizational structures. Study data suggest the graduate clinical preceptor role needs to be more visible and better integrated into schools of nursing and healthcare organizational structures. It is essential that clinical preceptors are not peripheral to organizational, academic, and clinical structures. The significant work of precepting graduate students must become better recognized by schools of nursing and the health agencies that employ the clinical preceptor. Recent literature stresses the importance of inter-professional collaboration in health education and practice (Inter-professional Education Collaboration Expert Panel, 2011; Jansen, 2008; O’Daniel & Rosenstein, 2008; and Castner, Ceravolo, Foltz-Ramos, & Wu, 2013). However, our study of role commitment of graduate clinical preceptors suggests a complementary need for intra-professional collaboration among nursing faculty, administrators, and clinicians to facilitate the recruitment, cultivation, and retention of graduate clinical nurse preceptors.

Nursing faculty and their graduate students rely on the expertise and clinical acumen of preceptors to guide and direct students as they learn new clinical roles. Correspondingly, healthcare agencies rely on advanced practice education programs to develop the next cadre of nurse practitioners and advanced clinicians. Successful collaboration by these stakeholders around benefits, rewards, and supports has the potential to make graduate clinical precepting more inviting and rewarding to future preceptors and to strengthen their role commitment.

*Author Note: To obtain the revised instrument, contact Eileen Sarsfield at Eileen.sarsfield@marymount.edu

Acknowledgement

The authors acknowledge several sources of support for this study. The Health Resources and Services Administration (HRSA) Division of Nursing funded four grants that made us realize the importance of graduate preceptors. We also had funding from Kappa Chapter of Sigma Theta Tau International and the Dean's Research Fund at Duquesne University School of Nursing.

Authors

Sr. Rosemary Donley, PhD, APRN, FAAN
Email: donleyr@duq.edu

Dr. Donley is a professor of nursing and the Jacques Laval Chair for Justice for Vulnerable Populations at Duquesne University School of Nursing in Pittsburgh, PA.  In her role as director of several clinically oriented MSN programs, she recognized the critical role of graduate clinical preceptors in educating advance practice nurses.  She currently teaches courses in health policy and social justice at Duquesne University and participates in the clinical education of family nurse practitioners.

Sr. Mary Jean Flaherty, PhD, RN, FAAN
Email: Mflaherty105@comcast.net

Dr. Flaherty is a retired professor of nursing. Recognized for her contributions to graduate nursing education, she conceptualized the need to study factors that contribute to the role commitment of graduate clinical preceptors. Along with Drs. Donley and Sarsfield, she formed a team that successfully competed for four Health Resources and Services Administration (HRSA) grants to prepare graduate students for advanced practice with vulnerable populations.

Eileen Sarsfield, PhD, PHCNS-BC
Email: Eileen.sarsfield@marymount.edu

Dr. Sarsfield is an Assistant Professor at Marymount University in Arlington, VA. Her teaching experience has included the teaching and clinical supervision of master’s level nursing students who worked with preceptors in clinical placements. She has also developed various initiatives and programs to recruit and orient graduate level preceptors. Her academic experience includes teaching community-public health nursing and research at the undergraduate and doctoral levels.

Agnes Burkhard, PhD, RN, APHN-BC
Email: agnes.burkhard@marymount.edu

Dr. Burkhard is an Assistant Professor at Marymount University in Arlington, VA. In a previous position, she served as a clinical faculty member for students enrolled in a clinically focused MSN program. This position involved collaboration and site visits with clinical preceptors in a variety of healthcare settings. She is currently teaching nursing research courses at the graduate and undergraduate levels.

Sandra O'Brien, PhD, FNP, PHCNS-BC
Email: obriens@cua.edu

Dr. O'Brien is a Lecturer at The Catholic University of America in Washington, D.C. While a graduate student, she served as a team member on two quantitative research projects. She also served as a graduate assistant for the development, or continuing validation, of several of the Basic Knowledge Assessment Tools (BKAT) instruments to determine the educational needs of nurses. This background provided the foundation for the instrument development for this research project.

Kelley M. Anderson, PhD, FNP
Email: kma25@gorgetown.edu

Dr. Anderson is an Assistant Professor, Campus Family Nurse Practitioner Program (FNP), Georgetown University School of Nursing and Health Studies in Washington, D.C., and a Nurse Practitioner, Division of Cardiology, Medstar Georgetown University Hospital. In her current position at Georgetown University, she oversees the on-campus FNP program, including overall supervision of clinical placements, working together with the administrative staff and clinical preceptors.

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© 2014 OJIN: The Online Journal of Issues in Nursing
Article published July 31, 2014


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