Preceptor-Preceptee Relationships in Healthcare

Abstract

Preceptorship within nursing care is a form of support, which fresh graduates from the nursing school receive, and it assists them to know the organization of the clinical area and roles of the nurse (Clynes & Raftery, 2008). According to Epstein & Carlin (2012), nurses can use a preceptorship model to recruit new staffs and retain them. Although many researchers have conducted studies about preceptorship, little information about interpersonal relationship between preceptor and preceptee exist. The study examined interpersonal relationship between preceptor and preceptee. The objective was to analyze interpersonal relationship between preceptor and preceptee. The study was a descriptive qualitative study and it involved two participants who gave their experience during preceptorship and my personal reflection. The study instruments were a personal reflection checklist and a questionnaire. The contents of the questionnaire and the personal reflection form were orientation, qualities of a preceptor, interaction, and learning. The study found out that good interpersonal relationship is essential for effective preceptorship. The study recommended that health care institutions should select preceptors with knowledge and experience.

Introduction

Background

Preceptorship within nursing care is a form of support, which fresh graduates from the nursing school receive, and it assists them to know the organization of the clinical area and roles of the nurse (Clynes & Raftery, 2008). According to Epstein & Carlin (2012), nurses can use a preceptorship model to recruit new staffs and retain them. Although many researchers have conducted studies about preceptorship, little information about interpersonal relationship between preceptor and preceptee exist.

After the completion of the nursing training, the graduate enters the hospital institution with core abilities because he has been taught how to think logically and solve clinical problems. According to Brathwaite & Lemonde (2011), nurses are taught about reflective practice so that they can identify their strength and weakness and adjust them for the benefit of the patient. Although graduate nurses have knowledge and skills, they do not have enough clinical experience, thus, it is challenging to attend to patients without the guidance of a qualified nurse (Guhde, 2005). Therefore, preceptors play the main role of directing and assisting preceptees to provide quality care to the patients.

Myrick & Yonge (2004) stated that good interpersonal relationship between preceptor and preceptee is essential for the provision of quality care. Nurses should develop a preceptorship model that they can use to direct the graduate nurses. Although different institutions use different preceptorship models, the objective is similar and it is to assist the graduate nurse adapt to the working condition (Rogers, 2012). This means that the qualities that a preceptor has are vital in the learning process of a preceptee. Therefore, good interpersonal relationship is a prerequisite to successful acquisition of skills that are necessary for effective and efficient provision of care.

The significance

This report examines interpersonal relationship between preceptor and preceptee. Little is known about the aforementioned issue and through reflection and interview of other preceptees, I was able to explore factors affecting the interpersonal relationship and their effects on learning. It is difficult to determine how preceptor and preceptee establish an interpersonal relationship while working collaboratively in different shifts, yet they have never met until that specific day when they will have a shift together (Nicol & Young, 2007). In some institutions, the in-charge can request a nurse in advance to be the preceptor while in others; the qualified nurse should be a preceptor the moment he encounter a preceptee.

The questions

How do the preceptor and preceptee develop and sustain interpersonal relationship?

What does interpersonal relationship mean to the preceptor and the preceptee?

Objective

To analyze the relationship between preceptor and preceptee and the effects it has on learning.

Justification

The results of this report will be of benefit to health care institutions. It will demonstrate how nurses can develop and maintain an interpersonal relationship between preceptor and preceptee. People who develop preceptorship model will also benefit from the report because they will start training programs or explore the issue into details via carrying out researches. Despite the fact that the report is nursing oriented, it is a true picture of the interpersonal relationship between new and old employees in any working environment. According to the policy in my professional practice, every nurse should know the preceptorship role.

This report explores the interpersonal relationship between preceptor and preceptee. Once nurses understand preceptorship, they can define their roles and be of help to the preceptee. Finally, the findings of this report will create room for further research about interpersonal relationship between preceptor and preceptee.

Literature Review

Challenges of being a preceptee

One of the challenges of being a preceptee is to assume the responsibility of caring for many patients. Taie (2010) reported that, graduate nurses usually go into shock when they realize that the workload of taking care of many clients is too hard to bear. Taie (2010) called it a “reality shock” and described it as a situation where the newly qualified nurse discovers that learning and practice are two different entities that conflict each other. The nurse can be stressed and experience an approach-approach conflict and start questioning himself whether he is in the right profession. In case the preceptee does not receive the right support, he may go into depression.

According to a research done, Goldenberg et al., (2004) explained that, student nurses usually go through a disturbing journey as they move towards being qualified practitioners. This is because they start realizing that they will be responsible and accountable for their actions. Bowen et al., (2012) concluded that preceptees should learn how to deal with personal as well as professional issues and culture of the workplace or else they will go into “reality shock”. They require maximum support from the hospital institution staffs so that they can adjust and fit in the system of the clinical environment.

The trend of preceptorship

Ehrenberg & Häggblom (2007) stated that the preceptorship framework was introduced around 1980 to reduce the disturbing emotions that preceptees usually go through as they learn the new nursing roles. Preceptorship framework is a program that preceptors use to enhance the assimilation of preceptees into the nursing practice. Since 1980, preceptorship has grown to incorporate clinical placement so that student nurses are exposed to the working environment prior to completion of the training (Nabolsi et al., 2012). After the training, the first year in the work place is for polishing their skills as they relate what they already know with practice (Warren & Denham, 2010). This transition period give them time to learn how to relate with each other as they get used to the working environment.

According to a recent research, preceptorship revolves around interpersonal relationship as the preceptor socializes with the preceptee while orienting him to the work culture (Turner, 2007). The difficulty that arises is that most of the time a preceptor is expected to work collaboratively with a preceptee yet they do not know and understand each other. Therefore, Kuo et al., (2008) stated that preceptor and preceptee needed to understand their roles in order to have effective interpersonal relationship. Besides, they should know the strength and weakness of each other.

Interpersonal relationship and preceptorship

Interpersonal relationship is the core characteristic of preceptorship framework. According to Brunt & Kopp (2007), preceptorship is an association where a preceptor and a preceptee work together so that learning can take place. Preceptorship is imperative because it help in the induction of the preceptee to the clinical environment as well as assisting him differentiate between class and clinical works. Winfield et al., (2009) stated that the goal of preceptorship is to help the preceptee develop clinical confidence through effective interpersonal relationship. Thus, a preceptee require maximum support from the preceptor.

Race & Skees, (2010) stated that roles of the preceptor is to help the preceptees identify the learning needs, manage time and guide them in the clinical works as he address any challenges that they may encounter. Additionally, a preceptor should assume the educator role by building a learner tutor relationship (Bowen et al., 2012). Through the aforementioned relationship, the preceptee can learn about his expectations in the clinical area as well as the roles. The preceptee can discuss with the preceptor any problem that he experience during the learning process. In a research done by Mills et al., (2005), ninety percent of the graduate students who had a good tutor learner relationship reported a smooth transition from being a student to being a qualified nurse.

Methodology

The design

The study was qualitative descriptive. This was because I wanted to analyze the interpersonal aspect of preceptorship. McKinley (2004) stated that, qualitative descriptive research is good when a researcher want to gain insight of an existing phenomenon. The study instrument was a personal reflection checklist and open-ended questionnaire. I used the checklist to reflect about my experience as a preceptee. I administered the questionnaire to two other preceptees I was working with in the same institution so that I could get their opinions about the same issue.

Study population

The study was carried out on two consenting preceptees that I was working with. I was also part of the study as it included my critical reflection.

Inclusion criteria

Any preceptee who was working in the hospital institution

Exclusion criteria

A preceptee who did not want to be included in the study yet he was working in the hospital institution.

Sampling method

I used convenient sampling method because i selected the preceptees who I was working with in the same hospital. Beitz & Wieland (2005) stated that convenient sampling is the easiest method when the researcher does not have enough time to carry out the study.

Sample size determination

The sample size consisted of three preceptees. This is because I managed to find two preceptees who I interviewed and I included my personal reflection in the study.

Data collection procedure

I collected data through interview of the preceptees and my reflective practice. Data collection instrument was open-ended questionnaire and personal reflection checklist. According to Brunt & Kopp (2007), open-ended questions are imperative when the researcher want to gain insight of a particular issue.

The analysis of data

After the collection of data, I went through the participants report so that I could understand their views regarding interpersonal relationship between the preceptor and preceptee. I then presented the findings in form of a write up.

Ethical considerations

I obtained a written permission to carry out the study from the institution that I was working after explaining its importance to the manager. I obtained information from the participants after they had signed consent forms. I told them the purpose of the study and my expectations during the study.

The Findings

Personal reflection

The orientation

During the clinical practice, I had a very nice preceptor who introduced me to the culture of the institution and to all the health care providers. This made me relaxed and redy to learn and work in the new environment. She oriented me to the clinical shifts and allowed me to work at my own pace because everything seemed new to me. My preceptor was compassionate because she tried to accommodate and direct me despite having other duties. This gave me strength and the psyche to work hard.

Regarding communication issues, my preceptor had a good interpersonal relationship. She could identify my needs and address them accordingly. At one time, we had a reflection about the induction process and I informed her of the challenges that I had experienced. She was ready to address them and she could work overtime to ensure that I grasp all the concepts of the clinical works. I felt supported.

The qualities of a preceptor

Some of the characteristics that my preceptor had were role modeling, understanding and supportive. She did her work so well that I admired to be like her. She was always ready to share knowledge and skills. As a result, I learned a lot and was able to link theory with practice. My preceptor gave me a chance of asking questions whenever I did not know anything or when I needed clarification of any issue. I felt at ease and wished to be a preceptor like her.

The interaction

My preceptor believed that interpersonal relationship develops from respect. I respected her and this increased her willingness to teach me. She accepted me on the very first day and this made me have an open mind to the learning process. Additionally, she always encouraged me to intervene accordingly with a rationale. She could identify when I was overwhelmed with work and assisted me.

Learning

The challenges that I encountered during the learning process was that my preceptor was always busy attending to the patients and performing managerial duties. It was hard for her to be fully there for me. As a result, I learnt to direct myself in the entire task that I was given and consult only when necessary. It was a learning experience.

The first participant

The orientation

He entered into practice with no one to guide him. He always felt sad until the day he was given a preceptor who was to take care of him. At that point, he had already developed a negative attitude toward the clinical area and the staffs. His preceptor had to work hard to convince him that he would catch up and he needed not to worry. The preceptor introduced him to the ward environment and taught him the nursing skills bit by bit.

The qualities of a preceptor

His preceptor was always there for him and ready to help him learn. This made him change the negative attitude that he had towards learning. He was open-minded and this quality assisted the participant to communicate freely with him. Additionally, the preceptor gave him the opportunity to ask questions regarding nursing.

The interaction

The interpersonal relationship was built on professionalism, free interaction, keeping on the track, sharing and the ability of the preceptor to assist the participant to learn. Professionalism ensured that the preceptor and the preceptee followed the ethical principles during the learning process. Through free interaction, the preceptor was able to identify the learning needs of the participant via non-verbal communication and assisted where necessary. Although they set goals that they wanted to achieve, preceptor always helped the participant when need arose.

Learning

The participant had a good interpersonal relationship with the preceptor. As a result, he was able to learn the necessary skills that a nurse should know. The open relationship gave the participant psyche to want to know more. As a result, he extended his learning up to home where he could review literatures of what he had seen in the hospital institution.

The second participant

The orientation

The participant knew the preceptor before they worked together. This made their relationship easier and the participant learnt so many things. The preceptor arranged shifts in such a way that he shared the same shift with the participant. This gave the participant an opportunity of asking questions whenever in doubt.

The qualities of a preceptor

The preceptor was always ready to help, flexible and gave feedback. The readiness to help gave the participant a challenge to learn because he had someone by his side. Flexibility allowed the preceptor to spare some time and teach the participant. Feedback helped the participant to identify his mistakes and rectify. As a result, he acquired the necessary skills.

The interaction

Support and humor played an imperative role in the preceptorship. The preceptor was friendly and this gave the participant a chance of asking questions without any fear. The preceptor was supportive because he could work overtime to ensure that the participant acquire the required skills and knowledge.

Learning

Learning was easier because of the good interpersonal relationship. The participant acquired skills and knowledge.

Discussion

The orientation

Although the three participants mate their preceptors in different circumstances, they reported that the preceptors were supportive. Mamchur & Myrick (2003) stated that support at the entry period is imperative to a preceptee because it is a transition from being a student to a qualified nurse. The induction period determines the outcome. For instance, poor orientation can cause emotional disturbance of the preceptee thus, interfering with provision of care. According to Leigh et al., (2005), warm welcome reduce the anxiety that the preceptee may have and make him open up and be ready to learn.

The three participants had no predetermined ideas about their preceptors but were optimistic that they would have one who will introduce them to the working environment and guide them. Chen et al., (2011) stated that introducing the preceptee to the clinical area is important than teaching him the required skills. In this reflection, the preceptors played their role by orienting the preceptees to the work and other staffs.

The qualities of a preceptor

Luhanga et al., (2010) stated that the core qualities of the preceptors are role modeling, guiding the preceptee and educating him. According to the findings, the three preceptors had the aforementioned qualities and for that reason, the precceptees learned a lot. Open mindedness of the preceptors stimulated a positive interpersonal relationship between them and the preceptees. This relationship enabled the preceptees to fit into the clinical environment and work without difficulties. Hunter et al., (2008) reported that when a preceptor socializes a preceptee to the ward environment, the preceptee level of anxiety reduces and he feels motivated to learn and work.

The participants reported that the preceptor must be ready to share their knowledge and experience. This will ensure that learning take place because the preceptees can always ask questions. Reddish & Kaplan (2007) affirmed that most of the preceptees enjoy working with preceptors who are open and ready to share knowledge and experience. That is why the participants were happy working with the preceptors.

Effective communication skill is an important attribute of a preceptor (Anibas et al., 2009). Through effective communication, the preceptor can identify the time when the preceptee is overwhelmed with work and assist him. According to the above study, the preceptors had good communication skills because through non-verbal communication they could identify when the participants were exhausted and gave them the necessary help.

The interaction

The participants believed that they had successful interpersonal relationships because of honesty. Respect between two people is essential for a successful preceptorship (Callaghan et al., 2009). The participants felt that the preceptors were willing to help them and this gave them an opportunity to learn as much as they could. Attentive listening played a key role in the interaction process. The preceptors sacrificed their time and listened to the challenges that the participants were facing. This gave the participants zeal to work hard even when the going was tough.

Smith (2008) stated that, collaborative efforts in preceptorship keep the preceptee calm and willing to learn because he has no fear. The preceptors were friendly and they worked with the preceptees in collaboration. As a result, the preceptors could identify the areas of needs and address them accordingly.

Learning

All the participants reported that the preceptorship was a learning experience. They appreciated the fact that the preceptors were ready to help them learn the nursing skills and adapt to the working environment. Chen et al., (2011) stated that preceptor should be willing to assist the preceptee learn by being a role model and providing support. Additionally, preceptors can share their experiences with preeptees. This will help them appreciate the importance of preceptorship.

Conclusion

A preceptee usually experience emotional disturbance during the transition from being a student to a qualified practitioner. He requires maximum support from the preceptor. Therefore, the preceptor should identify the learning needs and set objectives. Effective interpersonal relationship is essential for preceptorship.

The preceptor should be open minded and introduce the preceptee to the work environment and other staffs. This will ensure that the preceptee is relaxed and ready to learn. According to the reviewed literature, preceptor enhances learning by being the role model. This means that a preceptor should be someone with knowledge and experience so that he can lead by example.

Reccomendations

Based on the findings of the reflection, I recommend that:

  • Preceptors and preceptees should set the learning objectives together and agree on the ways of achieving and evaluating them.
  • Preceptee should always be given a chance to ask questions whenever he is in doubt of any nursing intervention or in case of a challenge.
  • Hospital institutions should select a preceptor with knowledge and experience about the nursing practice.

References

Anibas, M., Brenner, G. H., & Zorn, C. C. R. (2009). Experiences described by novice teaching academic staff in baccalaureate nursing education: A focus on mentoring. Journal of Professional Nursing, 25(4), 211–217.

Beitz, J. M., & Wieland, D. (2005). Analyzing the teaching effectiveness of clinical nursing faculty of full-and part-time generic BSN, LPN–BSN, and RN–BSN nursing students. Journal of Professional Nursing, 21(1), 32–45.

Bowen, A., Fox, R., & Burridge, C. (2012). Preceptorship—Making a Difference. Journal for Nurses in Staff Development, 28(2), E12.

Brathwaite, A. C., & Lemonde, M. (2011). Team preceptorship model: A solution for students’ clinical experience. ISRN nursing, 2011. Web.

Brunt, B. A., & Kopp, D. J. (2007). Impact of preceptor and orientee learning styles on satisfaction: A pilot study. Journal for Nurses in Staff Development, 23(1), 36–44.

Callaghan, D., Watts, W. E., McCullough, D. L., Moreau, J. T., Little, M. A., Gamroth, L. M., & Durnford, K. L. (2009). The experience of two practice education models: Collaborative learning unit and preceptorship. Nurse Education in Practice, 9(4), 244–252.

Chen, Y. H., Duh, Y. J., Feng, Y. F., & Huang, Y. P. (2011). Preceptors’ Experiences Training New Graduate Nurses: A Hermeneutic Phenomenological Approach. Journal of Nursing Research, 19(2), 132.

Clynes, M. P., & Raftery, S. E. C. (2008). Feedback: an essential element of student learning in clinical practice. Nurse education in practice, 8(6), 405–411.

Ehrenberg, A. C., & Häggblom, M. (2007). Problem-based learning in clinical nursing education: Integrating theory and practice. Nurse Education in Practice, 7(2), 67–74.

Epstein, I., & Carlin, K. (2012). Ethical concerns in the student/preceptor relationship: A need for change. Nurse Education Today. Web.

Goldenberg, D., Iwasiw, C., & MacMaster, E. (2004). Self-efficacy of senior baccalaureate nursing students and preceptors. Nurse Education Today, 17(4), 303–310.

Guhde, J. (2005). When Orientation Ends [horizontal ellipsis] Supporting the New Nurse Who is Struggling to Succeed. Journal for nurses in staff development, 21(4), 145.

Hunter, C. L., Spence, K., McKenna, K., & Iedema, R. (2008). Learning how we learn: an ethnographic study in a neonatal intensive care unit. Journal of Advanced Nursing, 62(6), 657–664.

Kuo, H. T., Yin, T. J. C., & Li, I. (2008). Relationship between organizational empowerment and job satisfaction perceived by nursing assistants at long-term care facilities. Journal of clinical nursing, 17(22), 3059–3066.

Leigh, J. A., Douglas, C. H., Lee, K., & Douglas, M. R. (2005). A case study of a preceptorship programme in an acute NHS Trust–using the European Foundation for Quality Management tool to support clinical practice development. Journal of Nursing Management, 13(6), 508–518.

Luhanga, F. L., Billay, D., Grundy, Q., Myrick, F., & Yonge, O. (2010). The one-to-one relationship: is it really key to an effective preceptorship experience? A review of the literature. International Journal of Nursing Education Scholarship, 7(1). Web.

Mamchur, C., & Myrick, F. (2003). Preceptorship and interpersonal conflict: a multidisciplinary study. Journal of Advanced Nursing, 43(2), 188–196.

McKinley, M. G. (2004). Mentoring matters: creating, connecting, empowering. AACN Advanced Critical Care, 15(2), 205–214.

Mills, J. E., Francis, K. L., & Bonner, A. (2005). Mentoring, clinical supervision and preceptoring: clarifying the conceptual definitions for Australian rural nurses. A review of the literature. Rural and Remote Health, 5(3), 1–10.

Myrick, F., & Yonge, O. (2004). Enhancing critical thinking in the preceptorship experience in nursing education. Journal of Advanced Nursing, 45(4), 371–380.

Nabolsi, M., Zumot, A., Wardam, L., & Abu-Moghli, F. A. (2012). The experience of Jordanian nursing students in their clinical practice. Procedia-Social and Behavioral Sciences, 46, 5849–5857.

Nicol, P., & Young, M. (2007). Sail training: An innovative approach to graduate nurse preceptor development. Journal for Nurses in Staff Development, 23(6), 298–302.

Race, T. K., & Skees, J. (2010). Changing tides: improving outcomes through mentorship on all levels of nursing. Critical care nursing quarterly, 33(2), 163.

Reddish, M. V., & Kaplan, L. J. (2007). When are new graduate nurses competent in the intensive care unit? Critical Care Nursing Quarterly, 30(3), 199–205.

Rogers, J. (2012). Evaluating the Effects of Preceptorship Programs On Nurse Job Satisfaction. Web.

Smith, P. (2008). The effectiveness of a preceptorship model in postgraduate education for rural nurses. Australian Journal of Rural Health, 5(3), 147–152.

Taie, E. S. (2010). Developing and Validating a Job Description for Internship Preceptors. Journal for Nurses in Staff Development, 26(3), E8.

Turner, R. S. (2007). Preceptorship in Nursing: Preceptors’ and Preceptees’ Experiences of Working in Partnership. Web.

Warren, A. L., & Denham, S. A. (2010). Relationships between formalized preceptor orientation and student outcomes. Teaching and Learning in Nursing, 5(1), 4–11.

Winfield, C., Melo, K., & Myrick, F. (2009). Meeting the challenge of new graduate role transition: Clinical nurse educators leading the change. Journal for Nurses in Staff Development, 25(2), E7–E13.

Appendices

Appendix A: Participants Concent Form

I hereby certify that i have been informed of the nature of this study and i give my consent to offer any information which is required of me.

Signature of participant: _______________________

Date__________________________

Signature of Researcher: _______________________

Date: _________________________

Appendix B: Personal Reflection Checklist

  1. How was I oriented into the nursing practice?________________________________________________________________________________________________________________________________________________________________________________________________________________
  1. What are the qualities of the preceptor that motivated me to learn?________________________________________________________________________________________________________________________________________________________________________________________________________________
  1. How was my interaction with the preceptor?________________________________________________________________________________________________________________________________________________________________________________________________________________
  1. Was the preceptorship a learning experience?________________________________________________________________________________________________________________________________________________________________________________________________________________

Appendix C: Participants Questionaire

Please answer the following questions.

  1. How was your orientation into the nursing practice?________________________________________________________________________________________________________________________________________________________________________________________________________________
  1. What are the qualities of the preceptor that motivated you to learn?________________________________________________________________________________________________________________________________________________________________________________________________________________
  1. How was your interaction with the preceptor?________________________________________________________________________________________________________________________________________________________________________________________________________________
  1. Was the preceptorship a learning experience?________________________________________________________________________________________________________________________________________________________________________________________________________________