ALTHOUGH NURSE PRECEPTORS ARE WIDELY USED IN UNDERGRADUATE NURSING EDUCATION, LITTLE IS KNOWN ABOUT HOW THE EXPERIENCED NURSES WHO HELP STUDENTS LEARN CLINICAL NURSING VIEW THE PRECEPTOR ROLE Nurse preceptors facilitate learning and build confidence in nursing students. Over the past several decades, the use of preceptors has gained popularity in academic settings (Rose, 2008). The preceptor has a significant impact on the preparation of nursing students for real-world practice (Raines, 2009).

Several authors have established that preceptorships are vital to the academic preparation of nursing students (Alspach, 2000; Carney, 2005; Haitana & Bland, 2011; Vickous & Franklin, 2005). Through guidance, supervision, and role modeling, nurse preceptors help develop knowledge, clinical skills, and professional attitudes in nursing students (Smedley, 2008). Brammer (2006) looked at Australian nurses' understanding of their role as preceptors. They found inconsistencies in understanding the role that affected student learning and professional development. Zilembo and Monterosso (2007) showed that students, as preceptees, rated competence as a highly desirable attribute in preceptors. Spouse (2001) found that exposure to effective clinical practices directly enhanced student confidence and clinical skill development. In a small qualitative study (n = 8), Bourbonnais and Kerr (2007) found that the safety of the student and the patient was accomplished through a clear view of the preceptor role; however, that vision was not described.

The role of faculty was explored in studies focused on the preceptor's role with graduate students. Gibson and Hauri (2000) found that preceptors desired faculty support and feedback and involvement in shaping the curriculum. Lyon and Peach (2001) showed that good communications with school of nursing faculty was a key factor in nurses' willingness to serve as preceptors. In a qualitative study, Bourbonnais and Keer (2007) highlighted the importance of support from nursing faculty, as well as recognition by fellow nurses of the workload involved in being a preceptor.

Relationship support from faculty for both preceptors and students was the common element in these studies. However, studies from the perspective of nurse preceptors regarding the experience of working with undergraduate nursing students are lacking. Rice (2003) wrote about the differences between nursing education and nursing service, highlighting the difference between the ideal and real world of clinical nursing practice. Nurse preceptors can serve as a bridge between theoretical education and the actual experiences for students who are preparing to enter the clinical work environment.

Palmer, Cox, Callister, Johnsen, and Matsumura (2005), who found that unit-based nurses make a tremendous difference in the quality of the clinical learning environment, identified a need for more positive relationships between staffnurses and faculty Consequently, understanding the perceptions of nurse preceptors who work with undergraduate nursing students is important to the education of pre-licensure nurses and to the continuing professional development of practicing nurses. It is hoped that the stories resulting from this research on the perceptions of nurse preceptors will provide nurse faculty with insight into their needs and desired level of support.

Method This qualitative study explored the views and experiences of nurse preceptors participating in a countywide Preceptor of Excellence program. The research approach was a person-centered one as discussed by Mearns and McLeod (1987). The primary interest was in the participants' subjective experience of the phenomena under investigation, and the research approach was consistent with a phenomenological method of investigation. The focus of this study was, what factors facilitated and/or inhibited nurse preceptors' willingness to precept pre-licensure nursing students in the clinical setting.

The study proposal was approved by the university institutional review board and the sponsor of the Preceptor of Excellence program. Following completion of the informed consent procedures, a semistructured interview was used to gather the experiences and perspectives of nurse preceptors. The interview consisted of openended questions to allow participants to fully share their perceptions, feelings, and the needs they have when working with nursing students in the practice environment.

The Preceptor of Excellence program was a multicomponent educational offering supported by the Palm Healthcare Foundation and available to nurses working at health care facilities in Palm Beach County in Florida. The program consisted of two one-day workshops offered at six-month intervals and an onunit precepting assessment completed at the nurses' home institution. The chief nursing officer at the health care organization designated nurses for participation in the program. The goal of the program was to recognize excellence in precepting among nurses working in the county.

Data collection and preliminary analysis were done concurrently, allowing identification of coding, validation of the emerging codes with participants, and gathering of additional information for verification, relevance, and saturation. Data were considered saturated by dense categories that made sense, with no new data emerging. These criteria were achieved after 26 participants shared their experiences. No new data emerged in the last five interviews; therefore, data gathering was terminated.

Transcripts were analyzed for common themes as appropriate for phenomenological inquiry (van Manen, 1990). Words, statements, and paragraphs were extracted to identify the meaning of precepting a nursing student to these nurse preceptors. Themes were exemplified by quotes that provide a rich description of the meanings. Trustworthiness of the data was established through member-checks, to verify that the themes identified reflected experiences and captured their meanings (Sandelowski, 1993). An audit trail was established through field notes maintained by the researcher during the interviews and by electronic tracking in the analysis of the data. These notes included bracketing to control for research bias and the researcher's impressions associated with exposure to the participants or the data during each encounter.

Results Thirty-seven nurse preceptors indicated their agreement to participate in this study. Nurse preceptors representing different types of health care settings (acute care hospitals, extended care/hospice facilities, and community settings) were contacted and completed the data collection process. Consistent with a qualitative approach, data saturation was achieved after 26 nurse preceptors shared their stories and data collection was terminated.

All nurses participating in this study had experience working with nursing students in the clinical area. These nurse preceptors had between three and 24 years of nursing experience and at least one year's experience as a nurse preceptor working with undergraduate nursing students at their current place of employment. The Table shows the demographic characteristics of the participants.

Three consistent themes emerged from the stories collected. These themes were common across the different types of settings in which the nurse preceptors worked. Typical quotations are offered for each theme.

THEME 1 BEING ENGAGED IN THE EDUCATIONAL PROCESS Participants consistently stated that they wanted to know the expectations of the course and the faculty. Nurse preceptors wanted to know what the student was supposed to get from a day in the clinical area.

"Don't just drop the student offand tell me how long they are going to be there, let me know what they are supposed to accomplish during the time they are with me."

"[For community health] the faculty isn't always present. Sometimes we only have what the student tells us they are supposed to be doing to act on. The experience could be much better planned with more input from the faculty...something more similar to how we plan an orientation for our new staff."

The nurse preceptors also wanted to share their evaluations regarding whether or not students had fulfilled expectations.

"I would like to be asked for my evaluation of the student. It bothers me when I observe a student really struggling and then hear they are receiving As in the course....but then again, the instructor didn't see what I saw."

"Maybe my standards are too high, but sometimes I wonder how some of these students are evaluated. No one ever asks if the student was at the setting for the required number of hours or, more importantly, what they did while they were here."

Consistently, but especially in the community health setting, nurse preceptors wanted to know faculty and have the opportunity to talk with faculty about the students' activities in the clinical setting. Clearly these nurse preceptors wanted more than just time with students. While it was acknowledged that patient care needs are a priority, the participants in this study stated that they make accommodations to meet the learning needs of students. The desire to share their evaluations of the students' nursing skills and knowledge is an important finding.

THEME 2 ACKNOWLEDGE My EFFORTS Nurse preceptors wanted their supervisors and faculty to recognize the extra effort involved in precepting nursing students.

"Some faculty are appreciative of what we do...they share information about the student, the experience, take the time to introduce themselves and the student and then thank you at the end of the day...other faculty just drop offthe students and then disappear."

"Getting to participate in programs like this or getting to go to a conference because I am a preceptor makes it worth it. Our CNO and one school had a lunch each semester for the nursing students and their preceptors...it was just nice to be acknowledged."

Nurse preceptors consistently indicated that they wanted faculty to be available, to elicit and acknowledge their feedback, and to assist in making learning experiences available.

"I spend 6 or 8 hours with the student, while the faculty checks in for about 15 minutes. Then the student says it was a good day, but no one asks me how the student did...sometimes I feel the faculty thinks I am invisible."

"Caring for patients takes longer with a student. Not just explaining everything, but the reality is, they perform procedures slower than I do. I would like the faculty to be available to assist, either with the student or maybe doing something else so I have time with the student."

A number of the facilities in this study pay preceptors a premium for new stafforientation; that same premium is not paid for precepting a nursing student. However, the participants acknowledged that while premium pay is "nice," personal motivation and giving back to the profession were the reason they precept students.

"I had great preceptors as a student and I think it is important to pass on what I learned from them."

"If they don't get a good experience as a student, they are a mess when they get out of school and get a job. I would like to think I help them to learn it right the first time."

THEME 3 IT DEPENDS ON THE STUDENT Qualities of the individual student greatly influenced the preceptor's experience. Nurse preceptors used words such as prepared, interested, and willing to jump in as characteristics of students they enjoy precepting. In contrast, students who continually had to be told what to do, were unprepared, and lacked initiative were consistently mentioned as more challenging to precept.

"When the student is good, it is no big deal, actually I enjoy having students on those days. But when the student is weak, disinterested, or unprepared, I can't wait for the day to end. It might be just a feeling, but it seems the instructor doesn't come around as much when the student is weak."

"At the beginning of the day, when I see the students sitting around the nurses' station, and chatting among themselves, I know it is going to be a long day."

"When the student comes unprepared, I give them a textbook and a list of things to look up. I don't have time to teach them everything, also they need to learn to come to clinical prepared and how to look up what they don't know. That is the reality of working in our setting."

These preceptors are clearly assessing the readiness of the student for the clinical experience and that assessment influences the remainder of the experience.

Discussion Findings from this study provide evidence that nurse preceptors yearn to be actively involved in the clinical education of undergraduate nursing students. Recognition of the continued reliance on preceptors for clinical teaching with students in prelicensure programs is important. The nurse preceptor is an essential bridge between the world of the academic textbook and classroom and the real world of human patients and clinical settings. Schools of nursing and faculty need to respond to the call from nurse preceptors to be an integral part of the student's educational process.

While the preceptor role is generally viewed as a short-term relationship, the nurse preceptors in this research are asking for a more involved role. Nurse faculty can provide more information about clinical and course objectives in advance of the student's arrival at the clinical setting and listen to the feedback of preceptors. Meetings with groups of preceptors prior to the beginning of a clinic experience and ongoing, open communications are strategies to meet the desire of nurse preceptors working with undergraduate nursing students for greater involvement with the school of nursing. The nurse preceptors participating in this study demonstrated a commitment to nursing students. Faculty need to reciprocate this commitment to the nurse preceptor.

The finding by Hautala, Saylor, and O'Leary-Kelly (2007) that preceptors considered nonmaterial benefits, specifically recognition by others, to be important is supported by this study. Being asked for feedback, communicating with faculty, and being acknowledged for their efforts were considered significant motivators, more important than additional pay. Similarly, opportunities to participate in professional development programs, such as the Preceptor of Excellence Program, would be a potential way for the nursing school and faculty to recognize the contributions of nurse preceptors.

Nurse preceptors play an important role in the preparation of the next generation of nurses. Therefore, hearing and responding to their stories is important to the quality of the nursing education program. Welcoming the nurse preceptor as a member of the clini cal education team has potential benefits to all involved: strengthening of the educational program and the achievement of outcomes, nurturing the professional growth of the nurse preceptor, creating a better learning experience for the student, and enhancing collaboration between the academic and practice setting.

References

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Author affiliation:

About the Author Deborah A. Raines, PhD, EdS, RN, ANEF, is a methodologist for the Richard W. Riley College of Education and Leadership at Walden University and an evaluator at the College of Nursing and Health Professions at Western Governors University. The Preceptor of Excellence Program was implemented and supported by the Palm Healthcare Foundation, West Palm Beach, Florida. For more information, contact Dr. Raines at Deborah.raines.phd@gmail.com.