An investigation of the preceptors' perceptions of benefits, rewards, supports, and commitment to...

7/25/2019 An investigation of the preceptors' perceptions of benefits, rewards, supports, and commitment to the preceptor r

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LOYOLA UNIVERSITY CHICAGO

AN INVESTIGATION OF THE PRECEPTORS PERCEPTIONS OF BENEFITS,REWARDS, SUPPORTS, AND COMMITMENT TO THE PRECEPTOR ROLE

AMONG A SAMPLE OF NURSES

A DISSERTATION SUBMITTED TO

THE FACULTY OF THE GRADUATE SCHOOL

IN CANDIDACY FOR THE DEGREE OF

DOCTOR OF PHILOSOPHY

PROGRAM IN EDUCATIONAL PSYCHOLOGY

BY

CARMELLA MORAN

CHICAGO, ILLINOIS

MAY 2005

roduced with permission of the copyright owner. Further reproduction prohibited without permission.


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UMI Number: 3174254

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Moran, Carmella

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Copyright by Carmella M. Moran, 2005All rights reserved



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ACKNOWLEDGEMENTS

I wish to express my sincere gratitude to the individuals on my dissertation

committee who provided guidance and support throughout the dissertation process.

Ronald R Morgan, chairman of the dissertation committee, has been a mentor throughout

my doctoral studies. His guidance and support have been indispensable to the completion

of this dissertation research project. Jack Kavanagh provided Ms statistical expertise and

encouragement to my efforts. Special thanks are extended to Virginia Keck, who''s

mentoring has had a significant impact on my professional growth and career. Thank you

all very much.



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DEDICATION

It is with great love that I dedicate tWs dissertation to my husband Tim and my

son Joey. Your love, support, and encouragement has allowed me to complete my

doctoral studies. I would also like to dedicate this dissertation to my parents, Tony and

Toni, whose love, support, and guidance has contributed to the success of this important

milestone in my life. Finally, I would like to thank all my family and friends who have

put up with me through this long process.



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TABLE OF CONTENTS

ACKNOWLEDGEMENTS.................. ...... .... ..... .... .... .... .... ..... .... .... ........Iii

LIST OF FIGURES................ . ...................................................................................... vii

LIST OF TABLES.......................................................................

A B S T R A C T ..........................................................................................ix

CHAPTER I: INTROD UCT ION...................... ... ... ... ... ... ... .... .... .... .... ... .... 1

Foundations WithinTheDisciplineof Educational Psychology....................... 4

Social Constructivist Views of Learning. ............. .4

Mentoring............................................................................................................................ 5

Apprenticeship................................................................................................................... 7Distinction Between Expert and Novice Learners ........................................................ 8

Brief Description of Study. ........................................ 9Research Que stions ......................................................................................................... 10

CHAPTER II; REVIEW OF LITERATURE ...................................... ..12

Roleof Preceptor............................................................................................................... 12

Selection an dPreparation. ........................................................................................... 13

PreceptorBenefits, Support, an dRewards ........ 16

New Graduatesin SpecializedSettings.................................................... 18

ProfessionalImplications...........................................................................

21

CHAPTER HI: METHOD .................... .............24

Procedure ........................................................................................................... ............24

Participantsand SamplingPl a n ................... 25

Inst ru men ta tion .............................................................................. 27

De si g n ....................... 28

Hypotheses ............... 28

StatisticalAna lyses ....... 29

CHAPTERIV: RESULTS .... ..... ...... ..... ...... ..... ..... ...... ..... ...... ..... ...... .....3 0

SampleCharacteristics ................... 30Demographic information .......... 30

Nursing L icensu re ....................................... .33Education of Participants............... ...33

Employment In form ation .................... 36

Current Enrolm ent in a N ursing Education P rog ram ........ 40

v



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Precepting Newly Hired Nurses ............................................... ............................ 41

Precep ting Nursing Students ....................... 42

Precepting T rainin g ........................................................ 44

R es u l ts R e l a t ed t o A d d ress in g Res ea rch Q u est io n l ................................... 46

ResultsRelatedto Addressing ResearchQuestion2 .................. 49

ResultsRelatedto Addressing ResearchQuestion3................

51

ResultsRelatedto AddressingResearchQuestion4 ....................................... .53

ResultsRelatedto AddressingResearchQuestion5 .......................... 55

CHA PTERV : DISCUSSION. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ................. . . . . . . . . . . . . . .57

DiscussionrleatedtoaddressingResearchQuestion1 ............. 58

Discussionrleatedtoaddressing ResearchQuestion2 .................................... 59

Discussionrleatedto addressing Research Question3 .................................... 60

DiscussionrleatedtoaddressingResearchQuestion4 ..................... .60

Discussionrleatedtoaddressing Research Question1 .................. 60

LimitationsOfThe St u d y.................................................................................

61

Recommendations ForFutureResearch ................................................................... 62

APPENDICES

AppendixA: LetterTo PotentialParticipants...................................................... 65

AppendixB: ApprovalForConductingRe se a rch ................................................ 67

AppendixC: PreceptorQuestionnaire...................................................................... 69

Appendix D: Permiss ion To Use The Pre ce p to r Q ue s t ionn ai re ....................... 74

AppendixE: HighestRan k-OrderedMeanScoresForPreceptors

PerceptionofBenefitsand Re w a r d s................................................ 76

AppendixF: HighestRan k-orderedMea nScoresForPreceptorsPerceptionof BenefitsAnd Rewardsm D ibertand

Ggldenberg1995 St u d y .................. 78

REFERENCES ........ ........SO

VITA ......... ............86

vi



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LIST OF FIGURES

Figure1: E thnicity OfParticipants ............... 32

Figu re 2: Y ea rs Licensed As A R e g i ste re d N u r s e ..................................... ..33

Figure3: BasicNursingPreparation . ........................... ................................... 34

Figure4: HighestNursingdegreeObtained.................................................................. 35

Fi g u r e s : HighestNon NursingDegree ....................... ...36

Figure6: E mploymentIn fo rm a tio n ..................................... '......................................... .37

Fi g u re?: HoursWo r k e d .................... 38

Figure8: TypeOfNursingUn it ....................................................... ....39

Figure 9: Type OfNursingProgramParticipantsAre Enrol ledIn ............. 41

Figure10: PreceptingNewlyH ired Nu r s e s....................................................................

42

Figure11: PreceptingNursing St u d e n t s ....................................................................... 43

Figure12: NumberOfYearsAsPreceptor...................................................................... 44

Figure13: PreceptorTraining............................................................................................. 45

Figure14: P receptedAsA New Here ............................................................................... 46

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LIST OF TABLES

Table1: A ComparativeSummary OfCharacteristicsAssociatedWith

Precep tors , M entors, A n d M asters. .................... ..7

Table2: DistributionOfParticipantsAcrossNursingUnit s. ............. ..26

Table3: AgeOf Participants.............................................................. 31

Table4: CurrentEnroll men tin ANursingProgram .......... 40Table5: RelationshipBetweenPPBR Scalean dCPR Scale ....................... 47

Table6: HighestRan k-OrderedM ea nScoresForPreceptors Perception

Of Benefitsand Rewards .............................. ....49

Table7: RelationshipBetweenPPS ScaleAnd CPR Scale. ............. 50

Table8: RelationshipBetweenThe Preceptors YearsOfNursing

ExperienceAnd The Preceptors Perception OfBenefitsAnd

RewardsAssociatedWithThe Ro l e ...................................................... 51

Table9: RelationshipBetweenThePreceptors YearsOf Nursing

ExperienceAnd The Preceptors Perception OfSupport

AssociatedWith The Ro l e ..................................... 52

Table10: RelationshipBetweenThe Preceptors YearsOfNursing

ExperienceAnd The Preceptors Commitment AssociatedWith

TheRole.................................................................................................................. 53

Table 11: D ifferencesIn ResponsesOn ThePPBR, PPS And CPR Scale

AcrossNursing Units.............................................................. 54

Table12: RelationshipAmong Preceptors HavingBee nPreceptedIn

Orientation, The PPBR, PPS, And CPR Scales...................... 55

Table 13: D ifferencesBetweenPreceptors HavingBeenPreceptedIn

(M entationAnd ThePPBR, PPS, And CPR Scales.................................... 56

Table14: HighestRank-OrderedMea n ScoresForPreceptors Perception

OfBenefitsAnd RewardsIn DibertAndGoldenberg1995 Study 79

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Carmella M. Moran

Loyola University Chicago

PRECEPTORS PERCEPTIONS OF BENEFITS, REWARDS, SUPPORTS, ANDCOMMITMENT TO THE PRECEPTOR ROLE

ABSTRACT

Preceptorship programs are widely used for socialization of newly hired nurses.

Apreceptor program is an organized method of training new employees by an

experienced staff nurse who serves as a resource and guide to the new graduate and/or

new hire as they learn their role. Apreceptor is defined as someone who takes the novice

with minimal skills and knowledge to a level of competency. The preceptor works one-

on-one with the new graduate (referred to as the preceptee) in structured activities to help

them master basic skills, knowledge, role expectations, andprocedures, as well as the

socialization process. Preceptors are staff who take on the role o f preceptor along with

their patient care nursing responsibilities. Preceptors agree to partner with the new hire to

share knowledge, facilitate integration of newly hired staff and obtain recognition and job

satisfaction. Preceptorship programs are encouraged to take into consideration the

special needs and concerns of the preceptors. It should be noted that the establishment

and maintenance of a preceptor program requires significant financial and human

resources. Such an investment could be lost ifpreceptors are not supported after they are

in the role.ix



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This study was designed as a systematic replication of the study conducted by

Dibert and Goldenberg (1995). The overall purpose of this dissertation research project

was to examine the relationships among preceptors perceptions of benefits, rewards,

supports, and commitment to the preceptor role at a community-based medical center in

the midwestem part o f the United States. The term preceptor was defined as a registered

nurse with at least one year of clinical experience who teaches, instructs, supervises, and

serves as a role model for a graduate nurse or a student, for a set period of time, in a

formalized preceptorship program. A sample of 674 professional registered nurses were

invited to complete a four-part questionnaire consisting of the Preceptors Perception of

Benefits and Rewards (PPBR) Scale, the Preceptors Perception of Support (PPS) Scale,

the Commitment to the Preceptor Role (CPR) Scale and a demographic scale. As in the

research study conducted by Dibert and Goldenberg (1995), benefits and rewards were

defined as positive outcomes associated with a service. These outcomes were measured

using the Preceptors Perception of Benefits and Rewards (PPBR) Scale. Supports were

defined as the conditions that enabled the performance of a function. The Preceptors

Perception of Support Scale was designed to measure support. Commitment was defined

as attitudes, which reflected dedication to thepreceptor role. The Preceptor Role Scale

was used to measure commitment. Five research questions were addressed. (1) What is

the relationship between the preceptors perception of benefits and rewards associated

with the preceptor role and thepreceptors commitment to the role? (2) What is the

relationship between the preceptors perception of support for the preceptor role and the

preceptors commitment to the role? (3) What is the relationship between the preceptors

years of nursing experience and the preceptors (a) perception o f benefits and rewardsx



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associated with the preceptor role, (b) perception of support for the preceptor role, and (c)

commitment to the role? (4) Are there any differences in the preceptors (a) perception

of benefits and rewards associated with thepreceptor role, (b) perception of support for

the preceptor role, and (c) commitment to the role across types of units in which the

preceptor works? (5) What is the relationship among the preceptor having been

precepted in orientation and thepreceptors (a) perception of benefits and rewards

associated with the preceptor role, (b) perception of support for the preceptor role, and (c)

commitment to the role?

A between subjects design was used to address the research questions and test the

null hypotheses. The independent variables included: the preceptors experience with

being precepted; the preceptors level of preparation; years of experience as a preceptor;

age; type of basic nursing preparation; highest nursing degree held; highest non-nursing

degree held; years licensed as a registered nurse and type of hospital unit in which the

preceptor worked. The dependent measures included; perception o f benefits and rewards;

perception of support; and commitment to the preceptor role.

Surveys were distributed to 674 registered nurses. Staff employed for at least one

year and with preceptor responsibilities were invited to participate in the study. A packet

of materials was assembled for each participant. Potential respondents (n=488) included

a sample of registered nurses who functioned as preceptors in one of 23 nursing units.

Survey results were received from 105 registered nurses. The response rate was 21.5% of

the population targeted for systematic study. An examination of the scores on the

Preceptors Perceptions of Benefits and Rewards Scale indicated that preceptors are

likely to be committed to the preceptor role when there are what they consider to be

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worthwhile benefits and rewards associated with the role. Participants reported that they

worked as a preceptor for the opportunity to share their knowledge with new nurses and

nursing students., to teach new staff nurses and nursing students, to assist new staff and

nursing students to integrate into the nursing unit and to contribute to their profession

and to gain personal satisfaction from the role. The items reported to be least important

were the opportunity to influence change on their nursing unit, improvement in

organizational skills, increased involvement in the organization within the hospital and

improved chances for promotion and/or advancement within the institution.

Relationships were found between the scores on the Preceptors Perception of

Support Scale and Commitment to the Preceptor Role Scale. These findings indicate that

the more the preceptors perceived that there were supports associated with the preceptor

role, the more they were committed to the role. Taken together, the findings of this study

appear to be congruent with those reported by Dibert and Goldenberg (1995).

A linear regression analysis procedure was used to determine if there was a

relationship between the preceptors years of nursing experience and the preceptors (a)

perception of benefits and rewards associated with the preceptor role, (b) perception of

support for the preceptor role, and (c) commitment to the role. In the original study,

Dibert and Goldenberg (1995) also found no relationship between the years of nursing

experience and the preceptors perception of benefits and rewards, and supports or

commitment to the preceptor role. No differences were found between the type o f unit

the preceptor works on and the preceptors (a) perception of benefits and rewards

associated with the preceptor role, (b) perception o f support for the preceptor role, and (c)

commitment to the role.xli



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A linear regression analysis procedure was used to determine if there were

relationships among the preceptor having been precepted in orientation and the

preceptors (a) perception of benefits and rewards associated with the preceptor role, (b)

perception o f support for the preceptor role, and (c) commitment to the role. None of the

variables when examined alone accounted for any variability. However, a statistically

significant difference was found across the participant groups (those who had been

precepted in orientation compared to those who had not) on the Preceptors Perception of

Benefits and Rewards (PPBR) Scale, Preceptors Perception of Support (PPS) Scale, and

Commitment to the Preceptor Role (CPR) Scale when the variables were examined

together.

The economic climate in health care necessitates that orientation programs

prepare new hires and graduates to function effectively and efficiently as soon as

possible. It is important that educators and clinicians responsible for developing

orientation programs and selecting preceptors are informed about issues related to

successful preceptor programs. The preceptor is believed to be the key person who

contributes toward the successful completion o f the orientation process for new nurses.

Preceptors have traditionally been selected for the role because o f their clinical

expertise. While clinical expertise is a very important requirement, it cannot be the only

quality that preceptors possess. Having an interest in teaching, demonstrating good

interpersonal skills, self-confidence, and patience are all reported to be important

qualities in a preceptor. In sum, the effectiveness of the preceptorship is based on the

quality of the preceptors. Understanding the preceptors experiences and perceptions

with regard to the benefits, rewards, and supports for the relationship with graduate

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nurses can be a means to improve and promote effective transition, retention, satisfaction,

and socialization to the role of professional registered nurse. The preceptor relationship

is mutually beneficial for the nurse, the preceptor, and the hospital. Such a relationship

elevates the professionalism and skill of the new hire and/or graduates as well as the

preceptors. In a period of severe shortages of experienced nurses, preceptorship

programs are believed to be particularly important with respect to mitigating the negative

effects of such a shortage by providing an efficient and effective tool to maintain quality

patient care.



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CHAPTER I

Introduction

Preceptorship programs are widely used for socialization of newly hired nurses

(Shaman & Infaaber, 1985). The shortage of qualified nurses, increasedpatient acuity,

and early patient discharges puts substantial pressure on the new nursing graduate to

perform independently and quickly. In their transition to the professional role, graduate

nurses share a variety of experiences with more experienced registered nurses. These

experiences are reported to have an impact on the graduate nurses own professional

development and socialization to the professional role. For example, Thomka (2001)

reported that there is considerable literature related to the concept of mentoring in nursing

and its role in the professional development of nurses, but there is little documentation

related to the graduate nurses experiences and perceptions with regard to the initial

relationship building with experienced staff during orientation to their first practice

setting.

Challenges faced by new graduates in their transition to the role of professional

registered nurse were first identified by Kramer (1974). Approximately 35% to 60% of

new graduates change places of employment during the first year. This change inplace

of employment has been reported (Delaney, 2003) to have negative affects for nurses and

health care institutions. It is well documented (Alexander, 1993, Kotecki, 1992,

Oermann &Moffitt-Wolf, 1997, Reilly &Oermann, 1992) that new graduate orientation

programs that utilize preceptors can effectively narrow thepractice-theory gap that exists1



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within the nursing profession. It should be noted that the establishment and maintenance

of a preceptor program requires significant financial and human resources. Such an

investment could be lost if preceptors are not supported after they are in the role.

The concept of preceptor originated in the 15th century to describe a teacher who

was responsible for the transmission of precepts. Precepts are defined as principles

governing conduct, actions, and/or procedures-to one or more understudies (Bowles,

1995). Shamian and Infaaber (1985) define preceptorship as a period o f time used for

orientation and socialization of new graduates. Romas (2003) defines a preceptor as

someone who takes the novice with minimal skills and knowledge to a level of

competency. The preceptor works one-on-one with the new graduate (referred to as the

preceptee) in structured activities to help them master basic skills, knowledge, role

expectations, and procedures, as well as the socialization process.

According to Finger and Pape (2002), precepting includes both personal and

professional development. Kramer (1974) provided evidence to support the view that

new graduates experience high levels of stress, value conflict and role uncertainty to the

extent that frustration, expressions of hostility, burnout, and resignation were not

uncommon during the transition to becoming professional registered nurses. Kramer

(1974) referred to the discrepancy between the concept of nursing introduced in school

and the realities of clinical practice as reality shock. Preceptors are viewed as facilitating

competence and confidence In practice while decreasing the reality shock that many new

nurses encounter.

Researchers (Bick, 2000; DeSimone, 1999) have defined preceptors roles in

numerous ways. A review of the literature by Burke (1994) contains a description of the



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3

role of a preceptor as having several main functions (e.g., providing orientation and

support and the teaching and sharing of clinical expertise). Preceptors provide the new

graduate nurse with support as they transition into the role of a professional registered

nurse. Morrow (1994) defined the preceptor as a staff nurse, who teaches, counsels and

inspires, serves as a roie model, and supports growth and development of an individual

for a fixed and limited amount o f time with the specific purpose of socializing the new

graduate into the role. Cerinus and Ferguson (1994) provide documentation for the

multiplicity and complexity of the responsibilities of the preceptor. Shamian and Inhaber

(1985) compared preceptor responsibilities to the nursing process. They described the

preceptor as being responsible for the assessment of the preceptee, planning of the

preceptorship period to meet individual needs, the implementation of teaching and role

modeling, and evaluation o f the preceptee throughout the preceptorship period.

According to Squires (2002), regardless of age or educational preparation, new

graduate nurses experience similar emotions when starting a new job. Positive emotions

include excitement at the thought of being paid, a sense of accomplishment at having

successfully graduated from nursing school and passing the NCLEX-RN examination

(Squires, 2002). Negative emotions experienced by most new graduates involve fear of

making mistakes, stress over their ability to manage all aspects of care for patient

assignment, and the clash between educational preparation and the realities of clinical

practice (Hamel, 1990 & Oermann & Moffitt-Wolf, 1997).



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4

Foundations within the Discipline of Educational Psychology

The study was anchored within the discipline of educational psychology. The

knowledge structures and frameworks used to organize the study included: social

constructivist views of learning; mentoring, apprenticeships; and distinctions between

expert and novice learners.

Social Constructivist Views of Learning. Social learning theory emphasizes

that we learn much by observing those around us. We acquire knowledge, skills,

attitudes, and culturally appropriate behavior, more efficiently and with fewer mistakes

when we observe the behaviors and the consequences of those behaviors. In a classic

study, Bandura (1963) illustrated the impact of and the conditions necessary for

observational learning to occur. Bandura demonstrated that exposure to a model can

affect a persons ability to learn new behavior.

The transition between nursing school and work canbe a difficult journey. A

preceptor can assist and support a successful transition from student to professional

registered nurse. The overall trend in learning theory has been toward a shift away from

behavioral to cognitive psychology. Ann Browns theory of learning is an example of a

current cognitive, social and cultural constructivist view. Ann Brown (1994) views

learners as active constructors, rather than passive recipients of knowledge. According to

Brown, the fundamental principle behind the design o f a community of learners is to lure

students into enacting roles typical of a research community. It is the role of the expert

(professional registered nurse) in the community of learners to teach other group

members (new graduate nurses) to become experts. Precepting focuses on facilitating the

learning of the members of the community.



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5

The assumption that a great deal of learning takes place within a cooperative

social environment is representative of the views of Russian psychologist Lev Vygotsky.

According to Vygotsky, individual intellectual development cannot be understood

without reference to the social context in which the individual exists. In Vygotskys

theory, social interactions are expected to promote development through the guidance of

people who have achieved the desired skill (Rogoffi, 1990). Vygotskys model for the

mechanism through which social interactions facilitate cognitive development resembles

an apprenticeship in which a novice learner works closely with an expert in joint problem

solving activities within a zone of proximal development (ZPD). This allows the novice

to participate in skills beyond their independent capabilities (Rogoff, 1990). Vygotskys

notion that individuals begin to learn frompeople around them, or their social world, is

applicable to the nursing profession (Gage & Berliner, 1998). According to Vygotsky,

individual intellectual development cannot be understood without reference to the social

context in which the individual exists. In Vygotskys theory, social interactions are

expected to promote development through the guidance o f people who have achieved the

desired skills. Classrooms are considered to be multiple zones of proximal development.

A zone of proximal development defines the distance between a novices current level of

learning and the level that can be reached with the help of an individual who has achieved

the desired skill (the expert) (Gage & Berliner, 1998). A new graduate nurse will have a

significant level of dependence on their preceptor and co-workers. Over time the new

graduate will assume more independence and responsibility.

Mentoring. In Websters Dictionary (Jagim, 2001), a mentor is defined as a

trusted advisor or teacher. Mentoring is an important way to team a variety of personal



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6and professional skills and is considered to be one of the oldest forms of influence. It Is

believed that the concept of mentoring originated in early Greek civilization. In the

Odyssey o f Homer, the goddess Athena frequently assumes the form of Mentor when she

appears to Odysseus or Telemachus (Ryan & Brewer, 1997). Mentoring has become

synonymous to a wise and trusted teacher. Klein and DIckenson-Hazard (2000) stated

that the mentoring relationship is a lifelong process, requiring commitment of self and

time to be successful. There is considerable discussion in the literature concerning the

concept of mentoring in the nursing profession and its role in the professional

development of nurses (Usher, Nolan, Reser, Owens, & Tollefson 1999).

It should be noted that mentors are not preceptors. According to Kroil (1999),

mentors establish a long-term relationship that supports, guides and/or teaches the new

nurse. The mentor is different from other types o f teachers, such aspreceptor, supervisor,

role model, or tutor. The preceptor is often more clinically focused and serves like a role

model, whereas a mentor seeks a close and more personal relationship. The mentor is

engaged in an interactive, continuing process, whereas exposure to role models

(preceptors) is often brief. Role modeling is not necessarily interactive. Indeed a role

model may not be aware that he or she is being observed. Bhagia & Tinsley (2000)

reported that role models affect manypersons, but mentors usually have relationships

with only a few.

Mentors are usually highly experienced and seasoned professionals. However,

experience alone is no guarantee of being a successful mentor. Simmons (2000)

identified skills such as confidence, political awareness, strong moral fiber, and the

ability to motivate others as vital attributes of an effective mentor.



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7

Apprenticeships. The ancientprocess of education of artisans, craftsmen, or

tradesmen w as accomplished through a master-apprentice relationship. According to

Davenport (2000), a formalized relationship is based on adherence to well outlined rules

of behavior. The role of the master is to teach the apprentice. Both previous training and

experience with a particular trade, set- of practices, or processes associated with a craft or

profession qualifies the master (expert). It is important that the master continue with the ir

individual work, despite their relationship with the apprentice. The distinguishing

characteristics among preceptors, mentors, and masters are summarized in Table!.

Table 1

A comparative summary of characteristics associated with preceptors, mentors, and

masters.

PRECEPTORS MENTORS MASTERS j

a role model, resourceperson & teacher

a trusted advisor or teacher a teacher 1

a fixed & limited timeperiod

a lifelong process a master continues their 1work, despite their Irelationship with the 1

apprentice

an organized method oftraining new workers

seeks a close & personalrelationship

a formalized relationship 1based on well outlined rules 8of behavior |

a demonstrated expertise a well experienced and

seasoned professional

a previous training &,1

experience with own trade; |practice or process of 1artistic creation qualify the 1master f

roduced with permission of the copyright owner. Furthe r reproduction prohibited without permission.


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8Distinction Between Expert and Novice Learners. Experts differ from novices

in taking more time to study a problem. But once they start to work, they solve problems

faster than novices. The experts are also more likely to construct an abstract

representation of the problem in their minds. It appears that in their working memory

they hold mental representations of whatever they need to solve the problem. Experts

typically: 1) classify a problem as a particular type; 2) represent the problem visually in

their minds; and then 3) use well-known routines to solve the problem. The classification

of the problem is considered to be critically important because once a problem is

classified; the solutionseemsto follow easily. Experts have stored in memory many

problem schemata and associated actions that generally produce a solution. They have

acquired these schemata as a result of extensive experience with the phenomena in their

fields. Novices by contrast, do not appear to have developed elaborate schemata. Each

problem they face is truly new and therefore extremely difficult. It usually takes 7-10

years to become an expert (Gage & Berliner, 1998).

Benner (1984) identified the movement from novice to expert within the health

care profession as involving changes in three aspects of performance. Initially the learner

shifts from relying on abstract principles to concrete (care-based) experiences.

According to Daley (1999), a novice has little experience with real (care-based)

situations, and therefore must rely on decontextualized facts and principles. A novice

health care professional is most likely to leam through formal mechanisms such as

reading about aprocedure and/or attending a continuing education program to form

concepts. In contrast, experts tend to use more informal mechanisms such as consulting

with other health care professionals and drawing from previous situations.



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9

Novice nurses move from viewing situations as discrete, and unrelated parts to

seeing situations as part of a whole (Benner, 1984). When moving from a novice to an

expert, Benner stated that the professionals position shifts from a detached observer to

an involved performer. The nurse with expertise has the ability to perceive and recognize

complex patterns in clinical situations. This specialized ability to recognize and interpret

complex patterns allows the expert to be prepared to intervene in an effort to prevent

problems before they occur. Benner (1982) reported that the expert has an intuitive grasp

of the situation and zeros in on the accurate information of the problem without wasteful

consideration of a large range of unrealistic possible solutions to a problem. Expert

nurses have the ability to recognize and interpret complex patterns in clinical situations

that are not visible to the novice. Experts recognize similarities in patient conditions in

spite of the fact that not all aspects of both conditions are the same.

Brief Description of theStudy

This study was designed as a systematic replication of a study conducted by

Dibert and Goldenberg (1995). In this study, the term preceptor was defined as a

registered nurse with at least one year of clinical experience who taught, instructed,

supervised, and served as a role model for a graduate nurse or a student, for a set period

of time, in a formalized preceptorship program. A sample of 674 professional registered

nurses from a community hospital located in the Midwestern part of the United States

was invited to complete a four-part questionnaire consisting of the Preceptors Perception

of Benefits and Rewards Scale, the Preceptors Perception of Support Scale, the

Commitment to the Preceptor Role Scale, and demographic scale. As in the original

roduced with permission of the copyright owner. Furthe r reproduction prohibited without permission.


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10

study conducted by Dibert and Goldenberg (1995), benefits and rewards were defined as

positive outcomes associated with provision of a service. Benefits and rewards were

measured by the Preceptors Perception of Benefits & Rewards (PPBR) Scale. Dibert

and Goldenberg defined Supports as the conditions which enabled the performance of a

function. The Preceptors Perception of Support Scale was used to measure support.

Commitment was defined as attitudes which reflected dedication to the preceptor role.

The Preceptor Role Scale was used to measure commitment.

Research Questions

It should be noted that the first three research questions are the same as the

original research questions targeted for study by Dibert and Goldenberg (1995).

Research questions four and five are new questions. The following research questions

were addressed:

1. What is the relationship between the preceptors perception of benefits and

rewards associated with the preceptor role and the preceptors commitment to the

role?

2. What is the relationship between the preceptors perception of support for the

preceptor role and the preceptors commitment to the role?

3. What is the relationship between thepreceptors years of nursing experience and

the preceptors (a) perception of benefits and rewards associated with the

preceptor role, (b) perception of support for the preceptor role, and (c)




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II

4. Are there differences in the preceptors (a) perception of benefits and rewards

associated with the preceptor role, (b) perception of support for the preceptor role,

and (c) commitment to the role across types of units in which the preceptor

works?

5. What is the relationship among the preceptor having been precepted in orientation

and the preceptors (a) perception of benefits and rewards associated with the

preceptor role, (b) perception of support for the preceptor role, and (c)




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CHAPTER II

Review of the Literature

In this chapter, the following areas of research will be described and critically

evaluated: the role of the preceptor; selection and preparation of preceptors; preceptor

benefits, supports, and rewards; new graduates in specialized settings; and professional

implications.

Role of Preceptor

A review of the literature supports the use of preceptorship programs for

socialization of new graduates to the role of professional registered nurse (Dibert &

Goldenberg, 1995). In nursing, apreceptor is usually a staff nurse with demonstrated

expertise who serves as a role model, resource person, and teacher (Brasler, 1993, p.

158). A preceptor program is an organized method of training new employees by an

experienced staff nurse who serves as a resource and guide to the new graduate and/or

new hire as they learn their role. Programs designed to orient the new graduate must take

into consideration the needs and concerns of the preceptors (Beaman, Jernigan, &

Hensley, 1999).

Preceptors are staff who take on the role of preceptor along with their patient care

nursing responsibilities. Preceptors agree to partner with new hire to share knowledge,

facilitate integration of newly hired staff and obtain recognition and job satisfaction

(Shamian & Inhaber, 1985, & Young et al., 1989). Preceptors are expected to possess12



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13

experience, advanced clinical skills, and a willingness to teach (Wright, 2002). The

formality o f the relationship is limited to the time frame of orientation. It does not

usually include a contractual component and does not necessarily include a personal

element.

The current literature does stress the importance o f a comprehensive orientation

program for new nurses (Balcain, Lendrum, Bowler, Doucette & Maskell, 1997; Beeman,

Jemigan, &Hensley, 1999). Brasler (1993) examined the effectiveness of the various

components o f an orientation program on the clinical performance of novice nurses. The

results indicated that there was a positive relationship between preceptor expertise and

novice nurses clinical performance. This finding provides support for the view that the

provision of an orientation program that addresses both knowledge and skill needs in

preceptors yields positive outcomes. As hospitals hire increasing numbers of nurses with

little or no clinical experience, the staff may be asked repeatedly to orient novice nurses.

This situation can contribute to burnout (Greene & Puetzer, 2002).

Selection and Preparation of Preceptors

Much has been written (Balcain et a i, 1997, Craven & Broyles, 1996 & Staab et

al, 1996) about the importance of training the nurse preceptors who will be working with

new graduates. Beeman, Jemigan, and Hensley (1999) claim that the preceptor should be

provided structured education to facilitate the development o f skills necessary to

effectively interact with the new graduate nurse. According to Staab et al. (1996),

preceptor training should include role modeling, completion of required documentation,

confrontation, coaching, counseling, communication models, characteristics of the adult



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14

learner, learning styles, and managing those learning experiences. Staab, Granneman, and

Page-Reahr (1996) identified the preceptor as having concerns that center on the ability

to successfully meet multiple demands. These include: (a) managing individual

workload; and (b) orienting the new graduate and completing the extensive paperwork

required to document the competency of the new nurse. The preceptor is often selected

because of their clinical skills, teaching ability, and willingness to train new employees.

Johantgen (2001) provided evidence to support the notion that preceptors demonstrate

personality characteristics of maturity, enthusiasm, self-confidence, responsibility, and

respect.

A formal preceptor preparation program is essential to any orientation process and

is designed to prepare qualified staff nurses as preceptors who will ensure the

development of competent and safe practitioners. One of the challenges for educators is

to design preceptor programs with the essential content. Content should be practical and

applicable to orientation of new hires (Baltimore, 2004). Clay et al. (1999) identified

four adult educational principles that preceptor development programs should be based

on (the content is based on the perceived learning needs of the learner, material is

repeated and sequenced in a logical fashion, active learning methods facilitate retention,

and a safe, and supportive learning environment must be provided for the learners).

A key concept of adult education theory is the belief that learning for adults

should be needs-based (Cafferella, 1994; Courtney, 1992; Darkenwald &Mariam, 1982;

Knowles, 1973; & Vella, 1995). Secondly, adults dont tolerate disorganization, the

order of what will be taught, the transition from one topic to another, and the overall

understanding of the program o f study must be understood by the adult learner



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15(Cafferella, 1994). Thirdly, adults expect and desire to be active learners (Cafferella,

1994; Knowles, 1973; and Vella, 1995). Vella (1995) claims that as a group, adult

learners would rather discuss a topic than hear a lecture. Knowles (1973) reported that

adults learn by -watching others (e.g., role modeling). A supportive and safe environment

improves the adults ability to team (Knowles, 1973 & Vella, 1995). OMalley et al.

(2000) proposed that the following components be included in a preceptor training

program: a definition of preceptorship and the roles of those involved; the aims and

objectives of the preceptorship; the desired qualities and responsibilities o f the

preceptors: the responsibilities of preceptees; and the benefits and disadvantages

associated with apreceptorship.

Preceptors responsibilities include role modeling, socializing, and educating

newly hired staff (Baltimore, 2004). As role models, preceptors display a competence

that others strive to emulate. Preceptors behave as socializers when actively integrating

orientees into the social culture of the unit and the facility. Helping new hires to feel

welcomed bypeers and coworkers, and assisting them in establishing relationships and

becoming familiar with the written and unwritten norms of the unit manifest further

examples of the socializing role. Educator responsibilities requires the preceptor to

assess orientation needs, plan learning experiences, and assist in the assignment selection

to facilitate the new hires achievement of learning needs and goals.

Preceptors have traditionally been selected because of their level of clinical

experience. While one would not debate this as a critical requirement, it cannot be the

only characterisitic the preceptor possesses. Having an interest in teaching, serving as a

mentor, coaching, having good communication skills, self-confidence, patience, and the



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16

ability to assess learning are also considered to be key characteristics of a preceptor

(Horn, 2003). According to Fawcett (2002), preceptors who are described as

unforgettable have patience, enthusiasm, knowledge, a sense of humor and the respect of

their peers. Leadership and communication skills, decision-making ability, and a strong

interest in professional growth have also been documented as important criteria for a

preceptor (OMalley et al., 2004). Preceptors are believed to be one o f the key

individuals who influence a new graduate or newly hired nurse during orientation.

De Blois, (1991) and Westra and Graziano (1992) identified teaching/learning

strategies, principles of adult education, communication skills, values and role

clarification, conflict resolution, assessment of individual learning needs, and evaluation

of preceptee performance as being the core components o f preceptor training. Hospitals

have a responsibility to provide preceptors with the knowledge and skills necessary to

supervise and teach newly hired staff nurses. A formal preceptor preparation program is

considered essential for any successful orientation program. Qualified staff nurses are

prepared to function as preceptors. Preceptors ensure the development o f competent

practitioners.

Preceptor Benefits, Supports and Rewards

PreceptorsMps have been used to bridge the gap between nursing education and

the reality of the workplace. A competent, interested preceptor during orientation can

facilitate a successful transition from the role of student to a professional nurse. Turnbull

(1983) reported that reward mechanisms are integral to the success of preceptor

programs. Shamian and Inhaber (1985) have documented a set of intrinsic and extrinsic



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17rewards associated with preceptor programs. Preceptors are more likely to be committed

to the role when they perceive the rewards to be personally and/or professionally

beneficial (OMara & Welton, 1995). According to Wright (2002), one reward for

preceptors is the satisfaction of seeing a new nurse develop into a confident professional.

McGregor (1999) stated that a preceptors realization of Ms or her own growth in the role

of a teacher can be a positive factor with respect to preventing and/or reversing burnout

in an experienced nurse. The most frequently identified preceptor benefits are the

opportunity to teach and influence practice, increase a persons knowledge base,

stimulate a persons thinking, and individualize orientation to meet preceptees learning

needs (Bizek & Oermann, 1990). In a study by conducted by Bizek and Germane (1990),

it was found that there was little or no job satisfaction associated with the preceptor role.

A case was made for the view that these negative findings were due to lack of time, little

workload relief, and low incentives. Young et al (1989) identified several issues

associated with the role of preceptor: lack of flexibility in the orientation program to meet

individual learning needs; lack of support from non-preceptor colleagues; and insufficient

time to spend with new staff and schedule changes. The researchers stressed the

importance of developing clearly identified roles and responsibilities, clinical objectives,

and providing ongoing support and guidance to overcome problematic issues.

In the Dibert and Goldenberg (1995) study, the investigators claimed that

assisting new hires to integrate into the nursing unit, teaching, improving their teaching

skills, sharing knowledge, and gaining personal satisfaction from preceptoring were the

rewarding aspects of preceptoring. In Diberts and Goldenbergs (1995) study of 59

Canadian nurses, they found that preceptors are likely to be committed to the role of



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18

preceptor when there are worthwhile benefits, rewards, and supports. As noted in

Chapter I, the overall purpose of this dissertation research replication study was to

compare the Diberts and Goldenbergs findings with a sample of nurses in the United

States. Researchers, Letizia and Jennrich (1998) and Ohrling and Hailberg (2000) have

documented a number of positive intrinsic influences on preceptors. They include: the

opportunity to improve existing skills by preparation for a new role; sharing knowledge;

and stimulating personal thinking and satisfaction.

Several investigators (HitcMngs, 1989, Begle & Willis, 1984) have identified

extrinsic rewards that may be useful. They include: preceptor luncheons; journal

subscriptions; the opportunity to attend conferences; tuition waivers; and letters of

commendation. Shogan et al. (1985) administered a survey to 76 preceptors. He found

that preceptors have a broadened knowledge base and a set of clinical skills, increased

professional growth, and job satisfaction as a result o f precepting. Fehm, (1990)

identified support for preceptors as being essential to the success of preceptor programs.

Dibert and Goldenberg (1995) identified lack of support from management and other

staff and insufficient time to fulfill the preceptor role along with their other

responsibilities as problematic issues related to the successful implementation of

preceptorship programs.

New Graduates in Specialized Settings

According to Kells and Koemer, (2000) the most stressful time of a nurses career

is the first three months of employment. There are several reasons for high stress at this

point in a nurses career. First, the current educational process allows the student nurse



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19less time working in the hospital environment than in previous training programs.

Second, due to the present shortage of trained nurses, newly hired nurses are often

responsible for their own patients soon after being hired. As new members of the

profession, graduate nurses will have a variety of mentoring experiences with registered

nurses during their transition to the professional role. In nursing, graduate nurses depend

on professional registered nurses for assistance with the practical application of newly

acquired nursing knowledge and the acquisition of technical skills (Thomka, 2001). The

new graduate nurse is prepared as a generalist. Passage of the licensure examination

(NCLEX-RN) only indicates that the graduate is a minimally safe practitioner. It is the

preceptor who will model the behaviors and technical skills and aid in socializing the new

graduate. The one-on-one guidance from the preceptor allows the nurse to become

familiar with an institutions policies and equipment. The preceptor provides a set of

opportunities for the new staff nurse to learn and assume increased responsibility under

the guidance of a competent experienced nurse (Wright, 2002).

As a new nurse graduate begins his or her professional career in a specialty setting

(e.g., critical care, perioperative, perinatal, mental health or community health), he or she

must develop the technical skills and demonstrate the competencies needed to provide

safe care in the desired specialty setting. The critical care setting exemplifies the

disparity between competencies that are possessed by the graduate nurse and those that

are required for the critical care setting. The new graduate is unfamiliar with the

individual agency where they choose to practice. The preceptor models behaviors and

technical skills expected on the unit, and aids in socializing the new graduate into the

work setting (Carey & Campell, 1994). Many researchers have identified that the



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20

implications o f hiring inexperienced graduate nurses directly into a critical care area are

related to a decrease in quality of patient care and productivity, clinical judgment, stress,

accountability, and lack of supervision (Hughes, 1987),

Authors (Graling, Rusynko, &Penprase) have identified the perioperative setting

as being particularly challenging for new graduate nurses. The perioperative setting has

been hard hit by the nursing shortage. Two prominent reasons have been identified as

having an impact on perioperative nursing (lack o f student exposure to the perioperative

setting and a decreasing number of nurses choosing to enter the field). Penprase (2000)

discussed how an orientation program utilizing preceptors can reduce the reality shock

and prepare nurses for perioperative nursing after graduation. According to Graling &

Rusynko (2001), two years after implementation of a nurse fellowship program at a

health care system consisting of five hospitals in Virginia, the operating room nurse

vacancy rates decreased from 27% to 15.5%.

The perinatal setting is not an exception to the challenges faced by the new

graduate nurse. Clinical education hours spent in labor and delivery are often limited.

Many nursing students do not even spend an entire shift on a unit during their clinical

experience. According to Horn (2003), preceptors are one of the key individuals

impacting the new graduates transition.

According to a review o f the literature conducted by Durkin (2002), psychiatric

nursing may be at a recruitment disadvantage compared to other nursing specialties. In a

similar study, Happell (1999) stated that psychiatric nursing was one o f the least popular

specialty career choices for nurses. Results o f a study done at a large urban mental health

facility (Thomka, 2001), indicated that there is considerable consistency regarding the



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21

way in which graduate psychiatric nurses receive assistance in their professional

development and role socialization.

In sum, my review of the literature related to the orientation of new graduates in

psychiatric mental health and community health settings indicated that there is a distinct

lack of information. That is to say that there appears to be very little information related

to the orientation and training of new graduates in these specialized areas.

Professional Implications

The economic climate in health care necessitates that orientation programs

prepare new hires and graduates to function effectively and efficiently as soon as

possible. It is important that educators and clinicians responsible for developing

orientation programs and selecting preceptors are informed about issues related to

successful preceptor programs (Bain, 1996). According to research conducted by

Messner, Abelleria, and Erb (1995), traditional orientation programs can cost from

$8,000 to 50,000. Experts estimate that the cost of turnover can reach as high as 150% of

the new graduates annual compensation (Contino, 2002). Considering the current and

projected nursing shortages and their effect on health care, nurse educators and

administrators need to develop preceptor programs that increase the likelihood ofnew

graduate nurse success. The current shortage of nurses requires a nurse to be

independently responsible for a patient assignment earlier than in the past.

Squires (2002) reported that the rural community hospitals challenge with new

graduate retention clearly acknowledges the importance of orientation programs.



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22Retention rates for new graduates one year after hire had fallen to 30% for a rural

community hospital. Feedback obtained from new graduates indicated that a lack of a

structured orientation process wasa significant factor related to retention failure.

Implementation of an orientation program with a consistent preceptor was reported to

increase the one-year retention rate to 77% (Squires, 2002).

The preceptor is believed to be the key person who contributes toward the

successful completion o f the orientation process for new graduate nurses. Preceptors have

traditionally been selected for the role because of their clinical expertise. While clinical

expertise is a very important requirement, it cannot be the only quality that preceptors

possess. Having an interest in teaching, demonstrating good interpersonal skills, self-

confidence, and patience are all reported to be important qualities in a preceptor. In sum,

the effectiveness of the preceptorship is based on the quality o f the preceptors.

Understanding the preceptors experiences and perceptions with regard to the benefits,

rewards, and supports for the relationship with graduate nurses can be a means to

improve and promote effective transition, retention, satisfaction, and socialization to the

role of professional registered nurse. The preceptor relationship is mutually beneficial

for the nurse, the preceptor, and the hospital. Such a relationship elevates the

professionalism and skill of both the new graduates as well as the preceptors.

Marshall (2001) claims that the current nursing shortage is different and more

critical than what has prevailed in the past. The shortage is projected to be of

unprecedented severity and to proceed long into the future. Two-thirds of the nurse

workforce are now over the age of 40. Between 40 percent and 60 percent of these nurses

are expected to retire within the next 15 years (Cordeniz, 2002). In a period of severe



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23shortages of experienced nurses, preceptorship programs are believed to be particularly

important with respect to mitigating the negative effects of such a shortage by providing

an efficient and effective tool to maintain quality patient care.



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CHAPTER HI

Method

Procedures

The overall purpose of this dissertation research project was to examine the

relationships among preceptors perceptions of benefits, rewards, support and

commitment to the preceptor role. The study took place at a community-based medical

center located in the midwestem part of the United States. A letter describing the

research project was sent to all potential participants (see Appendix A). The investigator

received permission from the Vice President - Chief Nurse Executive at the Medical

Center to utilize staff nurses at the institution targeted for systematic study (see Appendix

B). A preceptor program was established in the hospital as part of the orientation process

for newly hired registered nurses.

A four-part preceptor questionnaire (see Appendix C) was distributed to a sample

of approximately 674 registered nurses. It should be noted that the institution does not

keep records regarding the identity of the staff members who function as preceptors for

newly hired registered nurses and/or students. Permission to utilize the Preceptor

Questionnaire was obtained from Goldenberg (see Appendix D). A packet of

information was provided for each registered nurse employed foil or part-time on the unit

who functions as a preceptor. The packet contained the letter describing the study (see

Appendix A) and the four-part preceptor questionnaire (see Appendix C). The packet of

24



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25

information was placed in each staff nurses employee mailbox. Instructions directed the

respondent to return their completed survey in an interoffice envelope provided by the

investigator. Preceptors were assured that their replies were anonymous and confidential

and that return o f the completed questionnaires implied their consent to participate in the

study.

Participants and Sampling Plan

A community hospital located in the midwestem part ofthe United States was

selected as the institution targeted for systematic study. The hospital employs 674

registered professional nurses. The hospital educator could not provide data regarding

how many of the employed registered nurses function as preceptors. It should be noted

that staff have to be employed for a minimum of one year at the institution before they

are allowed to function as a preceptor. The Human Resources department was contacted

to determine the number of staff who would not be eligible to participate in the study

since they had not been employed at the hospital for at least a year. It was reported that

186 professional registered nurses had been hired during the period of time between

September 2003 to September 2004, which made them ineligible for inclusion in the

study. Surveys were distributed to all registered nurses. Staff with preceptor

responsibilities were invited to participate in the study. Potential respondents (n = 488)

included a sample of registered nurses who functioned as preceptors in one o f the 23

nursing units (intensive care unit, cardiac care unit, cardiovascular intensive care unit,

operating room, same day surgery, recovery room, emergency room, ambulatory care,

cardiac catheterization lab, 2E-telemetry, 2W-telemetry, 3E-orthopedics, 3W-neurology,



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4E-medical, 4W-oncology, 5E-medical/surgical, 5W-pediatrics, nursery, labor &

delivery, postpartum, 6E-surgica! and 6W-surgical and rehabilitation units). In-patient

nursing units were selected for study based upon the ability o f the investigator to obtain

data from nurses assigned to these units. Table 2 contains information related to

distribution of participants across the nursing units.

Table 2: Distribution of Participants Across Nursing Units

Nursing Unit

Number of

RespondentsIntensive Care Unit /Cardiac Care Unit 16

Cardiovascular Intensive Care Unit 5

Operating Room 4

Same Day Surgery 9

Recovery Room 0

Emergency Room 4

Ambulatory Care 1

Cardiac Catherterization Lab 0

2E-te!emetry 6

2W-telemetry 6

3E-orthopedics 3

3W-neurololgy 3

4E-medical 6

4W-oncology 4

5E-medica!/surgical 3

5W-pediatrics 1

Nursery 4

Labor &Delivery 10

Postpartum 2

6E-surgical 9

6W-$urgicai 1Rehabilitation Unit 5

Undeclared 3



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27

Instrumentation

A four-part questionnaire was used to collect data [the Preceptors Perception of

Benefits and Rewards (PPBR) Scale, the Preceptors Perception of Support (PPS) Scale,

the Commitment to the Preceptor Role (CPR) Scale, and a demographic information

component (see Appendix C)]. The PPBR Scale includes 14 items rated on a 6-point

Likert scale (where a 1 indicates strongly disagree and a 6 indicates strongly agree)

developed by Dibert and Goldenberg (1995). The scale was based on the literature

related to a set of rewards and benefits associated with the role of the preceptor The PPS

Scale includes 17 items that are also rated on a 6-point scale to measure preceptors

perceptions of support for the preceptor role. The questions were based on factors

identified by Dibert and Goldenbergs in their review of the literature related to what is

known about the perceived supports for the preceptor role. The 10-item CPR Scale was

adapted by Dibert (1993) [in Dibert & Goldenberg (1995)] from the Organizational

Commitment Questionnaire (OCQ) developed by Mowday et al. (1979). The CPR Scale

consists of 10 items rated on a 6-point scale that was developed to measure commitment

to the preceptor role (Usher et al., 1999). Reliability analyses of the three scales (PPBR,

PPS, & CPR) were reported by Dibert and Goldenberg (1995). The scales were reported

to have alpha coefficients of 0.91,0.86, and 0.87, respectively. Usher, Nolan, Reser,

Owens, and Tollefson (1999) discussed the variability in the literature concerning the

minimum level of alpha that is considered to be desirable for a scale that has been

developed to measure a particular construct.. Bums and Grove (1993) identified 0.80 as

the lowest acceptable alpha value for a well-developed instrument, while less refined



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28

useable scales can have reliability estimates as low as 0.70. Using these criteria to

determine the adequacy o f the scales, the scales appear to be reliable.

Design

A quantitative between subjects design was used to address the research questions

and test the null hypotheses. The independent variables include: the preceptors

experience with being precepted; the preceptors level of preparation; years of experience

as a preceptor; age; type of basic nursing preparation; highest nursing degree held;

highest non-nursing degree held; years licensed as a registered nurse; and type o f hospital

unit preceptor worked in. The dependent measures include: perception of benefits and

rewards; perception o f support; and commitment to the preceptor role. These measures

were obtained from the participants responses to the four-part questionnaire (Preceptors

Perception o f Benefits and Rewards (PPBR) Scale, Preceptors Perception o f Support

(PPS) Scale, Commitment to the Preceptor Role (CPR) Scale, and a demographic

information component (see Appendix C).

The following null hypotheses were tested:

1. There are no significant relationships in the outcome measures (perception of

benefits & rewards associated with the preceptor role) and the preceptors

commitment to the role.


support for the preceptor role) and the preceptors commitment to the role.



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29

3. There axe no significant relationships in the outcome measures (perception of

benefits & rewards, perception of support, and commitment to the role) across

years o f nursing experience.

4. There are no significant differences in the outcome measures (perception of

benefits & rewards, perception of support, and commitment to role) across

hospital unit types.


benefits & rewards, perception of support, and commitment to role) across '

preceptor experience conditions.

Statistical Analyses

The data sets were analyzed using the Statistical Package for Social Sciences

(SPSS). Descriptive statistics were used to analyze the data collected from the

demographic questionnaire. Combinations of ANOVA, FAMOVA, and multiple

regression analysis procedures were used to analyze the quantitative (survey) data sets.

The level of significance selected for interpreting the findings was 0.05 (2-tailed

significance).



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CHAPTER IV

Results

Sample Characteristics

As noted in Chapter HI, surveys were distributed to 674 registered nurses

employed at a medical center hospital located in the midwestem part of the United States.

Data was collected during the fall of2004. Staff members employed for at least one year

and with preceptor responsibilities were invited to participate in the study. Potential

respondents (n=488) included a sample of registered nurses who functioned as preceptors

in one of 23 nursing units. Survey results were received from 105 registered nurses. The

response rate was 21.5% of the population targeted for systematic study.

Demographic information. The surveys were returned from a diverse group of

registered nurses employed at the institution targeted for study. Females represented

98.1% of the participants (n = 103) and 1.9% were males (n = 2). Men still comprise a

small percentage of the total RN population. According to the findings of the National

Sample Survey of Registered Nurses in 2000, there were an estimated 2,694,540

registered nurses in the United States. Males comprise 146,902 or 5.4% of the registered

nurse population in the United States (Spratley, Johnson, Sochalstic, Fritz, and Spencer,

2000). The lower proportion of male participants to female participants may be a result

of the small sample size (n = 105) compared to a national sample (n = 2,694,540).

30



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31

The age of the participants ranged from 22 to 62 years. The mean age was 41.75

years. Most of the respondents were between 40 and 49 years of age (n = 32; 30.5%).

Twenty-seven (25.7%) of the respondents were 50 years and above. The age ranges of

20-29 (n = 20; 19%) and 30-39 (n - 22; 21%) represented in the sample were very similar

in number. Age was indeterminate for 4 of the respondents. Theparticipants responses

were clustered into the four age ranges presented in Table 3.

Table 3: Age of Participants

Frequency Percent Valid PercentCumulative

PercentValid 20-29 20 19.0 19.0 19.0

30-39 22 21.0 21.0 40.0

40-49 32 30.5 30.5 70.5

50 and above 27 25.7 25.7 96.2

Not provided 4 3.8 3.8 100.0

Total 105 100.0 100.0

The National Sample Survey of Registered Nurses documents the continuing

trend of aging in the registered nurse population. The average age of the RN population

was 45.2 in 2000 compared to 44.3 in 1996. The reported age of participants was 3.45

years younger than the overall age of nurses in the National Sample Survey of Registered

Nurses represented in 2000 (Spratley, Johnson, Sochalstic, Fritz, and Spencer, 2000).

Spratley and associates (2000) reported that nurses employed in hospital settings are

younger than the average age of all registered nurses nationwide.

Individuals from three ethnic backgrounds participated in the study. The majority

of the participants were Caucasians (n = 5; 81%), followed by Asians (a - 17; 16.2%),



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32

and Hispanics (n = 3; 2.9%). Figure 1 displays the ethnic diversity represented within the

sample of respondents.

Figure 1: Ethnicity of Participants

lif^panie

3.00/ 2.9%

Asian

17.00/ 16.2%

The percent of Caucasian participants (81%) was slightly lower than the percent

of Caucasian registered nurses (86.6%) reported nationally (Spratley et. al, 2000). The

percent o f Asian participants (16.2) was more than four times higher than the percent of

Asian registered nurses (3.7%) reported nationally (Spratley et. al, 2000). There appears

to be no specific explanation for the differences identified in the ethnicity of participants..



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33Nursing Licensure, The majority of the participants reported having had a

registered nurse license for 6 to 10 years (n = 29; 27.6%), followed by 26 or more years

(n - 24; 22.9%), 1 to 5 years (n = 22; 21.0%), 11 to 15 years (n = 14; 13.3%), 21 to 25

years (n = 11; 10.5%) and 16 to 20 years (n = 5; 4.8%). Figure 2 displays information

related to the length of time respondents reported having a nursing license.

Figure 2: Years Licensed as a Registered Nurse

3 0 -

0=24n=22

2 0 -

n=14

5

u.21-25 26 or more6-10 11-15 16-201-5

Number of Yearn Licensed asa RegisteredNurse

Education of Participants. The types of programs from whichparticipants

received their basic nursing education included Diploma, Associate, and Baccalaureate

degree programs of study. The majority of respondents reported receiving their basic

nursing degree from a Baccalaureate program (n = 55; 52.4%). The number of

participants reporting receiving their basic nursing degree from a Baccalaureate program



49/103

34

was higher than the national average of 30% (Spratley et al., 2000). This finding was

anticipated because the hospital in which the study was conducted offers an onsite

bachelors degree completion program for employees with a diploma or associate degree.

The second most common type of basic nursing preparation program was anAssociate

program (n = 35; 33.3%), followed by a Diploma program (n = 15; 14.3%). A

comparative display of the types o f basic nursing educational preparation among the

respondents is presented in Figure 3.

A Baccalaureate degree was reported by the majority of respondents as the

highest nursing deg

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