What makes a great preceptor? Nursing students have their say

Introduction 

The time that student nurses spend in clinical practice is vital in the pathway to becoming registered nurses (RNs). During this time, clinical preceptors play an important role by teaching students valuable lessons and modelling good RN practice. Preceptors have a significant impact on student nurses’ learning, on their view of nursing, their motivation and their love for the career.

As second-year student nurses on our second clinical placement, we encountered a variety of preceptor behaviours that negatively and positively motivated us.

We experienced preceptors who complained and rolled their eyes when assigned a student, or who had to be convinced to do so. We experienced being given “scut” work (ie unrewarding menial tasks), minimal effort from preceptors to build rapport, and expressions of annoyance at our questions.

However, we also experienced preceptors who put effort into building rapport, encouraged our involvement, encouraged and answered questions, and modelled skilled nursing practice. Preceptors who made us feel welcome and comfortable created the best opportunity for us to learn.

‘We experienced preceptors who complained and rolled their eyes when assigned a student, or who had to be convinced to do so.’

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Precepting is an essential role that helps build the next generation of nurses. In this article, we describe student nurses’ experiences working with preceptors and outline what we believe makes a great preceptor.

What is preceptorship 

The New Zealand Nurses Organisation defines preceptorship as an education-focused model for teaching and learning in a clinical environment, using clinical staff as role models.1 Typically, preceptors orientate students to the clinical role, help them develop clinical skills and socialise them to the department or institution.1 The role of a preceptor requires a number of diverse qualities2 — it can be described as teacher, tutor and role model responsible for sharing knowledge, guiding and inspiring.2,3

RNs are required to fulfil a preceptorship role, to mentor, teach and support colleagues and student nurses, as detailed in principle six, standard seven, of the Nursing Council Code of Conduct.4 The requirement is also listed in the Nursing Council’s Competencies for Registered Nurses.5 RNs must maintain professional development through contributions to supporting, directing and teaching others (competency 2.9) and provide care through collaboration, guidance and support with colleagues, including students (competency 4.1).5 The relationship between preceptors and students is essential to developing a student’s skills helping them integrate theory into practice, and fostering their clinical reasoning and judgment.

Therefore, preceptors are responsible for creating an open, supportive relationship with students to foster an effective and constructive learning environment.2

Impact of negative preceptor behaviour

A poor experience of preceptorship can negatively affect a student’s learning while in the clinical setting. In one study, some students reported feeling unwelcome or that their needs were unmet, which led to inhibited learning and feelings of discomfort in clinical settings.6 In another 2019 study, New Zealand student nurses reported experiencing negative preceptor behaviours and poor treatment, such as bullying.7 One individual in this study claimed that her preceptor said,

“I don’t know why we have to put up with you students and have you on the ward. You’re not trained properly, I look stupid when you make a mistake and I don’t get paid any extra money for your being on my shift with me”.7

Students in that study also reported being ignored, being verbally abused, and, in some cases, being sexually and racially harassed. These students, along with others who witnessed the abuse, subsequently described a loss of learning opportunities and decreased motivation. Student nurses tend to be younger than the preceptor they are working with and can be more vulnerable to bullying due to the power dynamic.7

A co-author of this article experienced feeling unwelcome and a burden to the staff on the ward when a preceptor rolled their eyes and negotiated to have the student re-assigned to another colleague. Negative clinical experiences and preceptor behaviours are one reason that students drop out of a nursing programme, thus posing a risk to the retention of nursing students.8

Impact of positive preceptorship 

Positive preceptorship can have a profound impact on student nurses’ future professional practice. Their experience of clinical practice is critical for gathering real-life experiences in the modern health-care environment and forming ideas about the kind of nurse they want to be. The 2019 New Zealand study also described students feeling valued and welcomed in their clinical placements by preceptors who encouraged them to ask questions and elaborate on their ideas — to engage in collaborative learning.7

However, we also experienced preceptors who put effort into building rapport, encouraged our involvement, encouraged and answered questions, and modelled skilled nursing practice.

From a student’s perspective, the critical attributes of a successful preceptor include a willingness to develop a relationship with the student, helping the student define and reach their goals, having sufficient knowledge and expertise, and having confidence in their own practice. Other crucial attributes include honesty, sincerity, active listening, responsiveness, accessibility, reliability and being non-judgmental.9 Students learn better from preceptors who are committed to being actively involved in the student’s clinical education.10

Two main themes of good preceptorship include a caring student-preceptor relationship and a safe, supportive learning environment.11 Compassionate preceptors, who are willing to share experiences and knowledge, leave a better imprint and inspire students to provide skilled patient care.12

Preceptorship can also be beneficial for RNs. Preceptors who enjoy sharing knowledge and expertise with students may find that being a preceptor increases job satisfaction and enhances self-fulfilment.1

Students should receive an informative learning experience from willing preceptors when asking questions about practice. Preceptors should also maintain respect, support and compassion when engaging and teaching students. One group of researchers found that learning was enhanced when there was a positive preceptor-student relationship due to the active participation of both parties.13  When students are observing procedures, they tend to ask questions. Such inquiry should be seen as positive, rather than negative. Students need to feel confident to talk through their thinking with their preceptor before undertaking nursing actions to avoid mistakes. Asking questions and discussing experiences encourages students to learn through reflection — a process that preceptors facilitate.   When students seek knowledge from preceptors who are motivated to share, this creates a mutually beneficial relationship that positively impacts student nurses’ future practice.

Barriers to great preceptorship

Barriers to great preceptorship are often out of preceptors’ control. Preceptors have reported that they have difficulty mentoring students while at the same time providing care for a large patient load.14 A reduced workload would allow preceptors time to invest in improving the education and experience of student nurses.

One hallmark of a successful preceptor is educational preparation for their role, which results in a better understanding of preceptor requirements,15 and gives them the confidence and knowledge to educate students.14 Preceptors do receive initial education on how to be a preceptor,15 but more support is needed for RNs to attend preceptor training.

Preceptors would benefit from a clinical adult teaching course to prepare them for their important role.16 They need to be able to assess students’ capabilities, know their curriculum background – ie where the student is at in their nursing education programme – and delegate safe nursing care. This then would “free up” preceptors and help students to feel part of the nursing team, contributing positively to lessen the preceptors’ clinical load.

Supporting great preceptorship by easing preceptor workloads and supporting their education in the role is essential to improving student experiences in the clinical setting.

Suggestions for preceptors 

Preceptors as individuals can take steps to improve the student nurse experience of preceptorship.  These steps include strategies to build rapport, role modelling, strategies to promote growth and learning and being passionate.3,14,17,18

Building rapport

Supportive environments are essential for clinical learning. Rapport between a student nurse and their preceptor fosters a safe learning environment.16  Preceptors can build rapport simply by using a student’s first name, finding shared interests, or being receptive to questions.17 Rapport creates a more supportive and safe environment where students are comfortable asking questions and making mistakes.17

A caring relationship is a foundation for learning, while respect creates a good atmosphere, which encourages reciprocity and mutuality.19 Preceptors can build a caring relationship by paying attention to students’ verbal and nonverbal cues.  Students may be apprehensive about attending clinical placement, but by paying attention to body language and cues such as fidgeting, preceptors can observe when a student is uncomfortable and ask if they are okay.

Building mutual respect is important to the preceptor role.20  Mutual respect comes from being willing to facilitate learning and bolstering self-confidence to help students develop the skills to stand up for themselves and advocate for patients.

Role modelling

Good preceptorship also involves role-modelling. Student nurses learn by watching preceptors, often imitating the professional and clinical practice that their preceptors demonstrate.18 A preceptor who is a good role model and demonstrates good nursing practice will, therefore, improve the practice of future nurses. The Nursing Council’s domains of nursing competence offer a framework in which nurses can model good practice.5 It is important preceptors make professional responsibility visible by adhering to professional, ethical and relevant legislated requirements. It is also important to apply Te Tiriti O Waitangi principles to enable client safety, independence, quality of life, and health.5

Student nurses learn by watching preceptors, often imitating the professional and clinical practice that their preceptors demonstrate.

Preceptors model quality nursing care through skilled use of the nursing process, demonstrating professional, caring and supportive nurse-patient relationships.5 When students observe preceptors in situations such as interacting with the family of a deceased patient, the preceptor must demonstrate a caring but professional relationship. Some interactions and skills are harder to teach in the classroom than in a real-world setting, and are much better demonstrated by skilled nurses. The skills that preceptors show in these situations are the skills that student nurses will take away and apply as RNs.

Promoting growth and learning

Preceptors who encourage students to ask questions, who don’t judge those questions, and who willingly respond, enhance the growth and learning of students.3 Encouraging student involvement, critical thinking, and problem-solving skills (except where this compromises patient safety) also promotes learning. Preceptors can seek out opportunities for students to learn and practise new skills.3

Being passionate

The ability to motivate and instil passion in student nurses is also a quality of a great preceptor. Preceptors can do this by being passionate about nursing themselves, thus inspiring the next generation of nurses. Preceptors who lacked interest in or commitment to their role could have harmful effects on student development.14 A positive, patient, supportive and passionate preceptor role-models their passion which is more likely to instil that same passion in their students.

Table 1 outlines preceptor behaviours that may help support students in clinical practice.

Table 1: Good preceptor behaviours and rationale

Behaviours	Rationale
Builds rapport and creates a supportive environment by: Addressing student nurses by their first name. Identifying shared interests. Being receptive to questions. Answering questions willingly, providing valuable and informative answers. Spending time building rapport.	Builds a relationship between student and preceptor that means students feel comfortable asking questions, making mistakes, and being open to criticism. Helps student nurses feel safe and supported, creates an environment for growth and learning.
Role model: Demonstrates the four domains of competence. Continues to put patient safety first. Demonstrates professional, caring and supportive nurse-patient relationships.	Demonstrates best nursing practice. This allows student nurses to observe essential nursing skills and implement them themselves once a registered nurse.
Encourages growth and learning: Encourages involvement in all situations (dealing with codes, last days of life, after death cares) unless it will affect patient safety. Helps students seek opportunities for learning, such as experiencing procedures or scenarios that might be interesting and beneficial to the student nurse. Encourages students to ask questions. Is receptive to questions, and does not judge what is asked. Encourages critical thinking and problem solving.	Encourages student nurses to apply the skills they have learned in theory, develop understanding, and improve the nursing care they will provide in the future.
Motivates: Demonstrates their passion. Is willing to inspire. Shows interest and commitment to the nursing profession.	Has positive effects on student development, encourages students to be passionate about the role of nursing.

Conclusion 

This article explores preceptorship from the perspective of second-year nursing students. Being a good preceptor is an essential part of an RN’s role and a professional responsibility, and contributes vital clinical learning to student nurses’ development. Understanding preceptorship and what it entails guides preceptors to enable student nurses to learn in the clinical setting. To improve nursing education, it is vital to understand how preceptors’ behaviour encourages or discourages students. This article offers suggestions for preceptors to enhance the quality of student education during their clinical practicum. Student nurses must be taught well by enthusiastic and kind preceptors to foster these same qualities in the next generation of nurses.

Stephanie Rooke, Grace Thevenard, Saumi Suthendran, Suyeon Skyla Jung, Nathalie Tolentino and Jamie Fraser Annandale are third-year student nurses at the University of Auckland. Kim Ward, RN, PhD, is a senior lecturer at the School of Nursing, University of Auckland.

• This article was reviewed by Louise Rummel, RN, PhD, a senior lecturer, academic/research, in the School of Nursing, Manukau Institute of Technology (MIT), Auckland.

References

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