Mentoring and Preceptorship of Newly Qualified Nurses

Much has been studied in forming a consensus definition of effective mentorship; in specifically looking at the support of newly qualified nurses though, the current term we need to adopt is that of preceptorship. Kramer (1974) made first reference to the notion of ‘reality shock’ as a phase of transition to practice. She describes it thus: “the reactions of new workers when they find themselves in a work situation for which they have spent several years preparing and for which they thought they were going to be prepared, and then suddenly find they are not.”

The recognition of this phenomenon has been the catalyst for others to develop a problem solving strategy for this phase. The concept of changing role perception was primarily studied by Corwin and Taves (1962), Green (1988), Chaska (1978), and Kelman (1961) and defined the process of ‘professional socialisation’ as “the process by which a person acquires the knowledge, skills and sense of occupational identity characteristics of a professional”

Current literature continues to examine this process but broadens the discussion to acknowledge further, the subtle interpersonal dynamics involved in change and learning. Bell (2000) offers a word of caution that students must feel ‘safe enough’ to take risks in front of the preceptor. (Patel & David 1996) assert that an undue emphasis on ability does not encourage students to strive for success, instead they adopt strategies to avoid failure, public humiliation and confirmation that they are less able than their peers.

For a preceptorship relationship to be effective, there needs to be awareness of and ability to, foster differing learning styles. Philips and Baldwin (1997) suggest that as Nursing is a dynamic profession, using a single teaching format fails to motivate learners. Letiza and Kenrick (1998) furthermore identify the right interpersonal dynamics necessary for effective learning to occur. Preceptors need to possess a high level of competence and experience themselves, but matched with a willingness to share. Castledine (2001) notes how in the older ‘apprentice style’ nurse training, student nurses were integrated into the team, learning occurred experientially. Nowadays, preceptors must be prepared to acknowledge and understand ‘how’ preceptees integrate into a new setting. To this end, they must be prepared and able to offer continuity, availability and support.

They must also understand different learning strategies, and assess learning styles of preceptees. Beattie (1998) highlights that, due to the increasing diversity of student demands, a more student centred approach to nurse education must be adopted. Whilst role modelling will be effective for some, others respond better to alternate teaching methods such as coaching or participant observation and role-play.

Thus, attention needs to be directed at the selection and preparation of preceptors. The aim of the preceptor is to enhance the social, professional and skills competence of newly graduated nurses. Schon (1983) articulates how preceptees can learn to reflect ‘in’ action as well as continue to reflect ‘on’ action so they develop confidence to work effectively ‘on their feet’ or ‘autonomously’ rather than in a predominantly retrospective manner. Benner et al (1996) identify how reflection develops knowledge embedded within practice.

There are notable limits to the mentorship of new nurses and a danger that the preceptor role becomes extended to the deeper role of ‘supervisor’ where the socialisation becomes more career orientated than clinical and the emotional relationship becomes more intimate. Such a limit also should extend to duration of role, the function of preceptor being purely for the transition and socialisation period.

Kaviani & Stillwell (2000) suggest that motivation, mutual commitment and inclusion are key factors in effective preceptorship programmes. These fundamental supporting roles have a direct and significant impact on the preceptorship of newly qualified nurses.

References

Bell, C. (2000) The mentor as Partner, Training and Development, 54(2) 52 – 56

Beattie, H. (1998) Clinical teaching models: A review of the role of preceptor in the undergraduate nursing programme. Australian Journal of Advanced Nursing, 15(4) 14 – 19.

Benner, P, Tanner, C & Chesla, CA. (1996) Expertise in Nursing practice: caring, clinical judgement and ethics. New York, Springer.

Castledine, G. (2001) Clinical teaching is the key to improved practice. British Journal of Nursing, 10 (9), 1307.

Corwin, R. and Taves, M. (l962). Some concomitants of bureaucratic

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Chaska, N (1978) The nursing profession view through the mist, New York. Mc Graw

Green, G. (1988) Relationships between role models and role perceptions of new graduate nurses, Nursing Research, 37, (4). 223-227.

Kaviani , N & Stillwell, Y (2000) An evaluative study of clinical preceptorship. Nurse Education Today, 20, 218 – 226

Kelman, H.C. (1961). Processes of opinion change. Public Opinion Quarterly, 25, 57-78.

Kramer, M (1974). Reality shock: Why nurses leave nursing, St Louis, Mosby

Letiza, M & Kenrick, J. (1998) A review of preceptorship in undergraduate nursing education: Implications for staff development The Journal of Continuing education in Nursing, 29 (5)

Morton-Cooper, A & Palmer, A (2000) Mentoring, Preceptorship and clinical supervision. A guide to professional roles in clinical practice.

Patel, L & David, TJ. (1996) Everybody has won and all must have prizes The Lancet, Nov 30th 1996

Phillips R.M., Baldwin B.A. 1997. Teaching psychosocial care to long-term care nursing

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Schon, D. (1983) The Reflective Practitioner. How professionals think in action. London, Temple