Nature of preceptorship and its impact on clinical nursing care from the perspectives of relevant nursing staff

THE UNIVERSITY OF MANCHESTERABSTRACT OF THESIS submitted by Elham Ali Bukhari for the degree of Doctor of Philosophy and entitled Nature of preceptorship and its impact on clinical nursing care from the perspectives of relevant nursing staff. December 2011____________________________________________________________________Background: previous studies have revealed that newly hired nurses experience stress and anxiety when entering a new clinical setting. Failure to support and prepare these nurses may affect their ability to deliver the required level of nursing care. Preceptorship is a time limited, organised clinical instructional programme, which promotes staff development, improves nursing education, reduces nursing shortages, promotes staff retention and decreases staff turnover. Little evidence expounds about how newly hired nurses perceive preceptorship. The impact of preceptorship on the clinical nursing care of newly hired experienced nurses has not been investigated or verified globally neither has it been investigated from a Saudi context.Aims and Objectives: the study aimed to explore the nature of preceptorship and its impact on clinical nursing care as perceived by the nurses who had taken part in a preceptorship programme in Saudi Arabia. The study elicited the participants? understanding and expectations of the preceptorship programme in an attempt to identify those factors that may be directly related to the success or failure of the programme. Furthermore, it aimed to examine the role of preceptorship in developing the clinical practice of newly hired experienced nurses.Methodology: a qualitative design based on the principles of naturalistic inquiry underpinned this study. Thirty national and international nurses of five different grades across wards in one Saudi hospital were first purposively and subsequently convenience sampled to take part in the study. Most participants were of international origin, possessing various levels of experience and education. Preceptees were younger and less experienced than other programme stakeholders. Data were generated using tape-recorded semi-structured individual and focus groups interviews. This action was also supported by a review of the hospital? s preceptorship policy documents. All the interviews were transcribed verbatim and analysed concurrently using thematic analysis based on a constant comparative method.Findings and discussion: Six themes were derived from the interview data to generate an account of participants' experiences. Social learning theory was used as an explanatory framework for understanding the study? s findings. Thus, preceptorship was seen as an important supportive, learning process, although inconsistencies were highlighted related to the participants? understanding and expectations of the programme. The duration of preceptorship was also contested with some needing longer than allocated. Hence, confusion arose regarding when preceptorship should begin and end due to ambiguities within the preceptorship policy documentation. Furthermore, participants perceived preceptorship had a mixed impact on clinical nursing care depending on preceptee/preceptor preparation and workload. Surprisingly recruitment was found to have the biggest impact on the success or failure of the preceptorship programme an unexpected and new finding highlighted by this study.Conclusion: preceptorship is important for the integration of newly hired experienced nurses into their new roles. The meaning of preceptorship as applied to each hospital needs to be defined and articulated clearly and concisely. In order to meet the objectives of preceptorship, policy documentation needs to be clearer, and recruitment processes need to be reviewed in order to match both preceptee experience and qualifications with organisational requirements.