The concept of the nurse as an educator, otherwise referred to as preceptorship, in nursing practice is nothing new. Infact, it has been an important part of training since the time of Florence Nightingale, the pioneer of modern nursing education. In Ireland, student nurses had to undergo an apprenticeship to become professionals. During this time, experienced nurses were expected to facilitate students in their learning and guide them in the care of patients in a practical setting (Myrick & Yonge, 2005). However, as nursing was gradually adapted into a hospital diploma programme, the concept of preceptorship soon faded into the background as training became integrated with post-secondary institutions and remained dormant for decades. By 2002, nurse training in the Republic of Ireland had become a four-year Bachelor of Science honours degree course in colleges and universities. The notion of preceptorship re-emerged at this time, with nurses assuming the task of assessing student nurses (Morgan & Keogh, 2005).
In this report, the author will endeavor to critically discuss the role of the nurse as an educator in practice. The author will also examine the advantages and disadvantages of being in the position of a preceptor to student nurses.
A preceptor is a registered nurse who teaches a student nurse, from a baccalaureate nursing programme, clinical nursing skills for various lengths of time during the degree (Myrick & Yonge, 2001). The Government of Ireland (2000) describes the preceptor as a registered nurse that builds a relationship with the student, acts as a role model and works closely with the student throughout placement periods. They also recommend that each student should be allocated a preceptor and an associate preceptor. The associate preceptor is also to be a registered nurse and is responsible for the student whenever the preceptor is absent (TCD, 2001).
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The preceptor’s job is to prepare graduates for the ever-changing, complex healthcare environment (Halstead, 2007). They are to ‘bridge the gap between the realism of the workplace and the idealism of an academic environment without compromising professional ideals’ (O’Mara, 1997). As part of current clinical staff, the preceptor will have more up to date information about clinical practices to share with students (Spouse, 1996) and it also helps the students to see their role models in action. In addition to teaching and monitoring the student, the preceptor also has the responsibility of assessing students’ performance in the clinical setting.
As a result of the influence they wield on the development of present and future practitioners and prospective leaders of the nursing profession, it is imperative that the preceptor has enough experience and that he/she is well suited and properly trained for this role. In Ireland, only nurses who have completed an approved preceptorship programme can act as a preceptor (Brown et al., 2009).
The preceptor needs a range of clinical, personal and academic qualities to be successful. These include considerable full time experience in a clinical setting, good communication skills, leadership skills, ability to encourage decision-making and critical thinking in students, enthusiasm and positivity towards teaching and learning (McCarthy & Murphy, 2009). Perhaps the most important quality of a good preceptor is the willingness and desire to teach and share their knowledge and nursing skills with the student (Luhanga et al., 2010). According to Elcigil & Sari (2008), students agree that the best preceptor is one that is emphatic, understanding, supportive, motivating and is also able to provide gentle, constructive criticism.
For the preceptorship experience to be successful, the preceptor needs to form a strong bond with the student. The bond ensures cooperation between the parties involved in the relationship and increases the chances of success. Good communication is essential to forge this connection. Regular meetings are needed and these should involve exchange of ideas with clarity of expectations and recognizing areas of strengths and weaknesses that require improvement (Myrick & Yonge, 2005). The connection helps to provide the ideal teaching-learning climate, a relaxed, positive atmosphere where students feel secure enough to express themselves (Myrick & Yonge, 2001). With avenues of communication open, the perceptee will feel that his/her opinions matter and this will boost self-esteem, respect and willingness to learn. The trust in the relationship will encourages more discussions and critical thinking because the student will feel at ease to express themselves and question the preceptor (Myrick & Yonge, 2005).
The preceptor also needs to communicate to the perceptee that he/she is committed to helping them achieve their desired objectives/goals (Myrick & Yonge, 2005).
Research shows that one of the positive features of being a preceptor is the personal satisfaction derived from watching a student develop into a professional. Many preceptors enjoy working with the students and love their enthusiasm, interest and willingness to learn (McCarthy & Murphy, 2009).
However, there are many challenges in the role of being a preceptor. One of the issues is the increased workload that comes with this role. The preceptor has to take on the responsibility of supporting and evaluating a student while at the same time assuming the complex role of a staff nurse (Myrick & Crawford, 1994). It is especially hard in recent years, with the shortage of nurses compared to the rising numbers of patients in hospitals. Preceptors feel that professional bodies should recognize the extra work involved with preceptoring and make proper adjustments to their normal workload to avoid overworking and job dissatisfaction (McCarthy & Murphy, 2009).
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It is very hard to balance the time spent with students and patients that require the nurse’s time. Preceptors have complained about the limited quality time they get to spend with students. They feel that the continuity needed to teach and assess students will interfere with care of the patients and as a result preceptoring becomes secondary (Flynn & Stalk, 2006). However, this has caused feelings guilt and frustration that they don’t have enough time to spend with their preceptees due to reasons like busy wards, staff shortages, etc. (McCarthy & Murphy, 2009).
Another challenge of being a preceptor is that nurses usually receive little to no remuneration for this additional role they have to adopt. In the US, there are monetary rewards, institutional and workplace recognition in place for preceptors (Leners et al., 2006). This shows that professional bodies recognize the effort these nurses put in to develop professional nurses. However, in countries like Ireland, preceptors are given no recognition or remuneration for working with students. This is because when allocation of the funding for the BSc. Degree in Nursing that was implemented in 2002 was being carried out, the focus was mostly on providing the necessary infrastructure, there was little to no attention given to the costs of preceptoring (McCarthy & Murphy, 2009). Therefore, nurses balk at taking on all that extra work for no compensation.
And finally, preceptors find it difficult to fail a student. It is a huge burden to be responsible for a student’s success or failure (Barker & Pittman, 2010). They fear that failing a student is a reflection on their own skills. They may also be reluctant to confront a student that is not performing well for fear of getting into a conflict. Furthermore, sometimes preceptors may not get support from management or university staff when they fail a student. Therefore, they might be tempted to pass students even when they are not competent enough.
In conclusion, the notion of preceptorship has been around since the beginning of modern nursing education. It faded into obscurity for a few decades but re-emerged in 2002, with the introduction of the B.Sc. Degree in Nursing. Preceptors were allocated to each nursing student to teach, support and assess student nurses. For successful preceptorship to take place, the preceptor needs certain skills and qualities like good communication and leadership skills, interest in teaching and imparting knowledge, the ability to motivate and encourage, and experience in a clinical setting. The preceptor must build a relationship based on trust with the student, to encourage the perfect learning environment.
The role of being a preceptor can be rewarding, with the feeling of fulfillment that comes with watching a student develop from novice into a professional nurse. However, there are difficulties associated with this position. These include the increased workload on the preceptor, the ability to achieve the right balance between patient care and tutoring the student, the little or no remuneration that comes with the position and finally, the burden of being responsible for the decision of the success or failure of the student.
The author, therefore, concludes that a preceptorship is a perfect approach to combining practice and education to prepare students for the reality of life as a professional nurse. However, there are more disadvantages than benefits to the preceptor. There needs to be measures in place to encourage nurses in their roles as educators.
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