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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

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UMI Number: 3174254

Copyright 2005 by
Moran, Carmella

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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: INTRO DUCTION...............................................................1
F oundations W ithin T he D iscipline of E ducational P sycho logy ....................... 4
Social Constructivist Views o f Learning.
.............
.4
M entoring............................................................................................................................5
A pprenticeship................................................................................................................... 7
Distinction Between Expert and Novice Learners........................................................ 8

Brief Description of Study. ........................................

Research Q uestions......................................................................................................... 10

CHAPTER II; REVIEW OF LITERATURE

...................................... ..12

R ole of P receptor ...............................................................................................................12


Selection and P reparation . ...........................................................................................13
Preceptor B enefits , Support , and Rewards
........
16
N ew Graduates in Specialized Settings ....................................................
18
P rofessional Implications ...........................................................................
21

CHAPTER HI: METHOD

....................

.............2 4

P ro ced u re .......................................................................................................................2 4
P articipants and Sampling P l a n ...................
25
Instrum entation ..............................................................................
27
D e s ig n .......................
28
H ypotheses
...............
28
Statistical Analyses
.......
29

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


Sample Characteristics ...................
Demographic information
..........
Nursing L icensure.......................................
Education o f Participants...............
Employment Inform ation....................
Current E nrolm ent in a Nursing Education P ro g ram
v

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30
30
.33

........

...33
36
40

Precepting Newly Hired Nurses


............................................... ............................ 41
Precepting Nursing Students .......................
42
Precepting T raining ........................................................
44
R e s u lts R e la te d t o A d d re ssin g R e s e a rc h Q u e stio n l
................................... 46
R esults Related to Addressing R esearch Question 2
..................
49
R esults Related to Addressing Research Question 3
................51
Results Related to A ddressing R esearch Q uestion 4 ....................................... .53
R esults Related to Addressing R esearch Q uestion 5 ..........................
55
C H A P T E R V : D ISC U SS IO N ....

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...............................5 7

D iscussion rleated to addressing R esearch Q uestion 1


.............
58
D iscussion rleated to addressing R esearch Question 2 .................................... 59
D iscussion rleated to addressing Research Question 3 .................................... 60
.60
D iscussion rleated to addressing R esearch Q uestion 4 .....................
D iscussion rleated to addressing Research Q uestion 1 ..................
60
L imitations Of The St u d y .................................................................................
61
R ecommendations F o r F uture R e se a r c h ................................................................... 62
A PPEN D IC ES
Appendix A:
Appendix B:
Appendix C:
Appendix D:
Appendix E:

L etter T o P otential P a rticipa n ts ......................................................65


Approval F or C onducting R e s e a r c h ................................................ 67
P receptor Q u estio n n a ire ...................................................................... 69
P erm ission To U se T he P r e c e p to r Q u e s tio n n a ir e ....................... 74
H ighest R ank -O rdered M ean Scores F or P receptors
P erception of B enefits and R e w a r d s ................................................ 76
Appendix F: H ighest R ank -ordered M ean Scores F or P receptors
P erception of B enefit s An d R ewards m D ibert and
G gldenberg 1995 St u d y ..................
78

R EFER EN C ES
VITA

........

........S O

.........

............86

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LIST OF FIGURES
F igure 1: E thnicity O f P articipants
...............
32
F ig u re 2: Y e a rs L icensed As A R e g is te re d N u r s e .....................................
..33
F igure 3: B asic N ursing P reparation .
........................... ................................... 34
F igure 4: H ighest N ursing d egree O btained ..................................................................35
.......................
...36
F ig u r e s : H ighest N on N ursing D egree
F igure 6: E mployment I n f o r m a t io n .....................................'......................................... .37
F ig u r e ?: H ours W o r k e d ....................
38
F igure 8: T ype Of N ursing U n it .......................................................
....3 9
Figure 9: T ype O f N ursing P rogram P articipants A re E nrolled In
............. 41
F igure 10: P recepting N ewly H ired N u r s e s ....................................................................42
F igure 11: P recepting N ursing St u d e n t s ....................................................................... 43
Figure 12: N umber Of Years A s P receptor ...................................................................... 44
F igure 13: P receptor Training ............................................................................................. 45
F igure 14: P recepted As A N ew H ere ............................................................................... 46

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LIST OF TABLES
Table 1: A Comparative Summary O f C haracteristics A ssociated W ith
P re c e p to rs , M ento rs , A n d M a st e r s .
.................... ..7
Table 2: D istribution O f P articipants Across N ursing Un its .
.............
..26
Table 3: A ge Of P articipants ..............................................................
31
Table 4: C urrent E nrollment in A N ursing P rogram ..........
40
.......................
47
Table 5: R elationship B etween PPBR Scale and CPR Scale
Table 6: H ighest Rank -O rdered M ean Scores F or P receptors P erception
O f B enefits and Rewards ..............................
....49
50
Table 7: R elationship B etween PPS Scale An d CPR Scale . .............
T able 8: Relationship B etween The P receptors Y ears Of N ursing
E xperience An d T he P receptors P erception O f B enefits An d
R ewards A ssociated W ith The R o l e ......................................................
51
Table 9: R elationship B etween T he P receptors Y ears Of N ursing
E xperience An d T he P receptors P erception O f Support
A ssociated W ith The R o l e .....................................
52
Table 10: R elationship B etween The P receptors Y ears Of N ursing
E xperience A nd T he P receptors Commitment Associated W ith
T he R o le .................................................................................................................. 53
T able 11: D ifferences In R esponses On T he PPBR, PPS An d CPR Scale
Across N ursing Un its ..............................................................
54
T able 12: Relationship Among P receptors H aving B een P recepted In
Orientation , The PPBR, PPS, An d CPR Scales ......................
55
T able 13: D ifferences B etween P receptors H aving B een P recepted In
( M entation And The PPBR, PPS, An d CPR Scales ....................................56
T able 14: H ighest Rank -O rdered M ean Scores F or Preceptors P erception
Of B enefits An d Rew ards In D ibert A nd G oldenberg 1995 Study
79

vlii

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Carmella M. Moran
Loyola University Chicago
PRECEPTORS PERCEPTIONS OF BENEFITS, REWARDS, SUPPORTS, AND
COMMITMENT TO THE PRECEPTOR ROLE

ABSTRACT
Preceptorship programs are widely used for socialization of newly hired nurses.
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. A preceptor is defined as someone who takes the novice
with minimal skills and knowledge to a level of competency. The preceptor works oneon-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. Preceptors are staff who take on the role of 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 if preceptors 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 of 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 the preceptor 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 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 the preceptors
years of nursing experience and the preceptors (a) perception of benefits and rewards
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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 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)
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 of 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 of unit
the preceptor works on 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.
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 of 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 o f 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, increased patient 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 in place
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 the practice-theory gap that exists
1

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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 of 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 o f 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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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 of 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 of 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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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 can be 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 of 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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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 from people 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 of 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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6
and 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 of teachers, such as preceptor, 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 many persons, 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 ancient process of education of artisans, craftsmen, or
tradesmen was 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- o f practices, or processes associated with a craft or
profession qualifies the master (expert). It is important that the master continue with their

individual work, despite their relationship with the apprentice. The distinguishing
characteristics among preceptors, mentors, and masters are summarized in Table!.

T able 1

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


masters.

PRECEPTORS

MENTORS

a role model, resource


a trusted advisor or teacher
person & teacher
a fixed & limited time a lifelong process
period

MASTERS

a teacher

a master continues their 1


work,
despite
their I
relationship
with
the 1
apprentice
an organized method of seeks a close & personal a formalized relationship 1
relationship
training new workers
based on well outlined rules 8
of behavior
|
a demonstrated expertise
a well experienced and a previous training &, 1
seasoned professional
experience with own trade; |
practice or process of 1
artistic creation qualify the 1
master
f

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8
Distinction 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 solution seems to 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 a procedure 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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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 the Study


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

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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 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?

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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)
commitment to the role?

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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, a preceptor 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 possess
12

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13
experience, advanced clinical skills, and a willingness to teach (Wright, 2002). The
formality of 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 of 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 of 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 ai, 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 of 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 of study must be understood by the adult learner

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(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 of the
preceptors: the responsibilities of preceptees; and the benefits and disadvantages
associated with a preceptorship.
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 by peers 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 of 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 of 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 of 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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17
rewards 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 of 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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19
less 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 of 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 of 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 of 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 of the least popular
specialty career choices for nurses. Results of 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 of new
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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22
Retention 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 was a 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 of 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, selfconfidence, 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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23
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 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 of the completed questionnaires implied their consent to participate in the
study.

Participants and Sampling Plan


A community hospital located in the midwestem part of the 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 o f 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 of 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 of the investigator to obtain
data from nurses assigned to these units. Table 2 contains information related to
distribution of participants across the nursing units.

T able 2 : Distribution of Participants Across Nursing Units

Nursing Unit
Intensive Care Unit /Cardiac Care Unit
Cardiovascular Intensive Care Unit
Operating Room
Same Day Surgery
Recovery Room
Emergency Room
Ambulatory Care
Cardiac Catherterization Lab
2E-te!emetry
2W-telemetry
3E-orthopedics
3W-neurololgy
4E-medical
4W-oncology
5E-medica!/surgical
5W-pediatrics
Nursery
Labor & Delivery
Postpartum
6E-surgical
6W-$urgicai
Rehabilitation Unit
Undeclared

Number of
Respondents
16
5
4
9
0
4
1
0
6
6
3
3
6
4
3
1
4
10
2
9
1
5
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 of 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 of hospital
unit preceptor worked in. The dependent measures include: perception of benefits and
rewards; perception of support; and commitment to the preceptor role. These measures
were obtained from the participants responses to the four-part questionnaire (Preceptors
Perception of Benefits and Rewards (PPBR) Scale, Preceptors Perception of 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.
2. There are no significant relationships in the outcome measures (perception of
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 of 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.
5. There are no significant relationships in the outcome measures (perception of
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 o f2004. 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. The participants responses
were clustered into the four age ranges presented in Table 3.

Table 3: Age of Participants

Valid

20-29
30-39
40-49
50 and above
Not provided
Total

Frequency
20
22
32
27
4
105

Percent
19.0
21.0
30.5
25.7
3.8
100.0

Valid Percent
19.0
21.0
30.5
25.7
3.8
100.0

Cumulative
Percent
19.0
40.0
70.5
96.2
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 o f 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 of 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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33
Nursing 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

30-

0=24
n=22
20-

n=14

u.
1-5

6-10

11-15

16-20

21-25

26 or more

Number of Yearn Licensed as a Registered Nurse

Education of Participants. The types of programs from which participants


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

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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 an Associate
program (n = 35; 33.3%), followed by a Diploma program (n = 15; 14.3%). A
comparative display o f the types o f basic nursing educational preparation among the
respondents is presented in Figure 3.

Figure 3: Basic Nursing Preparation

.--ssociate
.03 /

33.3 %

Diploma

15.00 ! 14 .3 %

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


highest nursing degree obtained (n = 56; 53.3%). An Associate degree was the second

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35
most frequently reported degree held (n = 26; 24.8%), followed by a Masters degree (n =

11; 10.5%). Only one respondent reported holding a Doctorate degree (n= 1; 1.0%).
Eleven respondents (10.5%) reported not having a nursing degree. A graphic display of
the highest nursing degree obtained among the respondents is presented in Figure 4.

Figure 4: Highest Nursing Degree Obtained

None
11.00/10.5%
Doctorate

Masters

Bachelors

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36
A large number of participants reported not having a degree other than a nursing

degree (n = 88; 83.8%). A baccalaureate degree was reported by a small number of


individuals (n = 10; 9.5%). A few respondents reported having an Associate degree (n =
4; 3.8%) followed by a Masters degree (n * 3; 2 .9% ). A display of the responses related
to the highest non-nursing degree earned is presented in Figure 5.

Figure 5; Highest Non Nursing Degree

Associate

4.00/3.8%
10.00/9.5%
Masters

3.00/2.9%

/
I
%

....

None

88 ,0 0 / 83 .8 %

Employment Information. Participants were asked to indicate the length of time


they had been employed at the hospital targeted for study. The length of employment
ranged from 1 to more than 26 years. The majority o f the respondents had been

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37
employed at the institution for 1 to 5 years (n = 37; 35,2%) followed by 6 to 10 years (n =
29; 27.6%). The percentage of respondents reporting that they had been at the institution
22 to 20 years was 21.9%. Thirteen percent of the staff had been at the institution over
20 years. Figure 6 contains additional information related to the length of time the
respondents had been employed at the institution targeted for systematic study.

Figure 6: Employment Information

40-

11=37

30-

n=29

20-

s=14

10-

a=9

n=7

0......
1-5

11-15
6-10

21-25
16-20

.
Not Provided
26 or more

Most respondents reported working between 33 and 40 hours per week (n = 73;
69.5%).

Seventeen respondents (16.2%) worked 1 7 - 2 4 hours per week and twelve

respondents (11.4%) worked 25 - 32 hours per week. A display of the responses related
to the number of hours worked is presented in Figure?.

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38

Figure 1 Hours Worked


%

33-40

Hours

Twenty-three nursing units were targeted for data collection in this research study.
Preceptors from thirteen general units were invited to participate in the study including:
ambulatory care; 2E-teiemetry; 2W-telemetry; SE-orthopedics; 3W-neurology; 4Emedical; 4W-oncology; SE-medical/surgical; 5W-pediatrics; nursery; labor and delivery;
postpartum; and rehabilitation. It should be noted that responses from participants
working on general floor units were reconfigured and combined to form one group. The
majority of participants were from the general units (n = 57; 54.3%). Five critical care
units were invited to participate in the study including: the intensive care unit; cardiac
care unit; cardiovascular intensive care unit; cardiac catheterization lab; and the

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39
emergency room. Responses from participants working on critical care units were
combined to form one group. Five surgical units were invited to participate in the study
including: operating room; recovery room; same day surgery; 6E-surgical; and 6Wsurgicai. A comparable number of responses were received from critical care services (n
= 25; 23.8%) and surgical services (n = 23; 21.9%). Figure 8 contains a display of the
type o f unit is which the participants were employed.

Figure St Type of Nursing Unit

Surgical Services
23.00/21.9%

m,

ICare Service
57.00 / 54.3%
Critical Care Serve

25.00/23.8%

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Current Enrollment In a Nursing Education Program. The majority of the


participants were not currently enrolled in a nursing program (n = 88; 83.8%). A small
number reported being enrolled in a nursing program (n = 17; 16.2%). Table 4 contains
information related to current enrollment in a nursing program.

Table 4% Current Enrollment in a Nursing Program

Valid

Frequency

Percent

Valid Percent

Cumulative
Percent

No

88

83.8

83.8

83.8

Yes

17

16.2

16.2

100.0

Total

105

100.0

100.0

The majority of participants enrolled in an advanced nursing program reported


that they were working toward a Masters Degree (n = 13; 12.4%). A small number of
participants reported working toward a Bachelors Degree (n = 3; 2.9%). Only one
respondent reported working toward a Doctorate Degree (n = 1; 1%). Figure 9 displays
the type of nursing program In which participants were enrolled.

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41

Figure 3i Type of Nursing Program Participants Are Enrolled In

Doctoral
1 .0 0 / 1,0 %
Masters

13.00/12.4%
Baccalaureate

3.00/2.9%

None
88.00/83.8%

Precepting Newly Hired Nurses. A large number of nurses participating in the


study served as preceptors for newly hired nurses (it = 101; 96.2%). Criteria for
inclusion into study was that the participant be a registered nurse with at least one year of
clinical experience and that they functioned as a preceptor for a newly hired nurse and/or
nursing student. Four of the respondents (n = 4; 3.8%) had never functioned as a
preceptor for a new hire, but had been &preceptor for a student. A display o f the
responses related to precepting newly hired nurses is presented in Figure 10.

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42

FigurelO: Precepting Newly Hired Norses

No

4 .0 0 / 3 .8 %

Precepting Nursing Students. A smaller number of the staff reported having


functioned as a preceptor for a student. Of the 105 participants in the study, eighty-four
(0%) reported having been a preceptor for a nursing student. Twenty-one (20%) had not
been a preceptor for a nursing student. A graphic display of the responses related to
precepting nursing students is presented in Figure 11.

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43

Figure 11: Precepting Nursing Students

No
21 .0 0 / 20 .0%

The majority o f participants reported having been a preceptor between 1 and 5


years (n = 43; 41%), followed by 6 to 10 years (m = 27; 35.7%), 16 to 20 years (ft = 14;
13.3.%), 11 to 15 years (n = 7; 6.7%), 26 or more years (n = 6; 5.7%), and 21 to 25 years
(n = 4; 3.8%). Two thirds of all respondents indicated that they have functioned as a
preceptor for less than eleven years (n = 70; 66.7%). Four participants did not provide
information regarding the number of years having functioned as a preceptor. Figure 12
contains a display of the number of years participants have preceptored newly hired
nurses and/or nursing students.

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44

Figure 12: Number of Years as Preceptor

50 i
n g |3

40-

30-

O
i

20-

Frequency

1
I
J lLL Tim
n=27

1-5

11-15

6-10

21-25

16-20

Not provided
26 or more

Years As Preceptor

Preceptor Training,, The majority o f the respondents reported not having ever
attended a preceptor training workshop and/or class (n =55; 52.4%). Fifty individuals or
47.6% reported that they had attended a preceptor training workshop and/or class. Figure
13 displays the distribution of training received among the preceptors within the sample
of respondents. Half of the preceptors who reported having had training (n = 25; 50%)
indicated that it had been 1 to 5 years since training was received. Nine preceptors
reported that it had been 6 to 10 years. Twelve responded that they were unsure about
how long it had been since they were trained.

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45

Figure 13: Preceptor Training

SCO'. . 47.6%

The majority of respondents reported having been precepted as a new hire (n =


92; 87.6%). Only thirteen (12.4%) of the respondents indicated not having been
precepted as a new hire. A graphic display of the responses related to being precepted as
a new hire is presented in Figure 14.

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46
Figure 14: Precepted as a New Hire

NO

Yes
92.00 / 87.6%

Results Related t Addressing Research Question 1: W hat is the relationship


between the preceptors perception of benefits and rewards associated with the
preceptor role and the preceptors commitment to the refe?

A multiple regression procedure was used to test for relationships between the
preceptors perceptions of benefits and rewards associated with the preceptor role and
their commitment to the role. Relationships were found between the scores on the

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47
Preceptors Perception of Benefits and Rewards Scale (PPBR) and the Commitment to
the Preceptor Role Scale (CPU). The findings indicated that the more the preceptors
perceived there were benefits and rewards associated with the preceptor role, the more
they were committed to the role (n = 105, R square = .216, Std Error of the Estimate =
.6210, F value = 28.395 and significance- = .000). Over 21.6% of the variance was
accounted for by the scores on the Preceptors Perception of Benefits and Rewards Scale.
These statistically significant findings provide support for the hypothesis that the more
the preceptors perceived that there were benefits and rewards associated with the
preceptor role the more they were committed to the role. Table 5 contains additional
information regarding the relationship between the preceptors perceptions o f benefits
and rewards and commitment to the preceptor role.

Table 5: Relationship between PPBR Scale and CPR Scale


Unstan dardized
Coef Relents

Standardized
[ Coefficients

Std. Error j

Beta

375

.070

.465

Sig.

5.329

.000

1
BENEFIT

In the original study conducted by Dibert and Goldenberg (1995), the relationship
between the preceptors perceptions of benefits and rewards associated with the preceptor
role and their commitment to the role was documented. Significant relationships were
found between the scores on the two scales (PPBR and CPR). The more the preceptors

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48
perceived that there were benefits and rewards associated with the preceptor role, the
more they were committed to the role (n = 52, r = 0.6347, P = 0.000).
Overall, the findings of this study are congruent with those reported by Dibert and
Goldenberg (1995). The findings indicated that preceptors are likely to be committed to
the preceptor role when there are worthwhile benefits and rewards. Scores for the
Preceptors Perception of Benefits and Rewards Scale ranged from 1.21 to 6.00 (M =
4.93, SD = 0.86). 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 nurses and nursing students to
integrate into the nursing unit, 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. The highest rank-ordered mean scores for
benefit and reward items are presented in Table 6.

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49

Table 6 Highest rank-ordered mean scores for Preceptors Perception of


Benefits and Rewards

Item' "

~~~~~~

' ~~_

__

___

Share my knowledge with new nurses and nursing students


Teach new staff nurses and nursing students
Assist new staff nurses and nursing students to integrate into the
nursing unit
Contribute to my profession
Gain personal satisfaction form the role
Improve my teaching skills
Keep current and remain stimulated in my profession
Be recognized as a role model
Learn from new nurses and nursing students
Increase my own professional knowledge base
Influence change on my nursing unit
Improve my organizational skills
Increase my involvement in the organization within this hospital
Improve my chances for promotion/advancement within this
institution

Standard
Mean Deviation
5.5238 .8781
5.4667 .8556
5.4571
5.2000
5.1143
5.0952
5.0784
5.0571
4.9238
4.8762
4.5714
4.5619
4.5238

.8990
.9942
1.0859
1.1225
.9919
1.0992
1.1905
1.2534
1.2998
1.2929
1.2717

3.7048

1.4671

Results Related to Addressing Research Question 2i What is the relationship


between the preceptors perception of support for the preceptor role and the
preceptors commitment to the role?

The relationship between the preceptors perception of support for the preceptor
role and the preceptors commitment to the role was found to be statistically significant
with 16.6% of the variance accounted for by the scores on the Preceptors Perception of

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50

Support on the Preceptor Role Scale. Relationships between the scores on the
Preceptors Perception of Supports Scale (PPS) and Commitment to the Preceptor Role
Scale (CPR) indicated that the more the preceptors perceived that there were supports
associated with the preceptor role, the more they were committed to the role (n = 105, R
square = .166, Std. Error of the Estimate = .6405, F value = 20.515 and significance =
.000). Table 7 contains additional information regarding the relationship between the
preceptors perception o f support for the preceptor role and the preceptors commitment

to the role.

Table 7: Relationship between PPS Scale and CPR Scale


Unstandardized
Coefficients
Model
B

Std. Error

(Constant)

3.025

.349

SUPPORT

.400

.088

Standardized
Coefficients

Sig.

Beta

.408

8.666

.000

4.529

.000

The relationship between the preceptors perception of support for the preceptor
role and their commitment to the role was also determined by using the Pearson productmoment correlation coefficient. There was a statistically significant relationship found
between the preceptors perception of support for the role and their commitment to the
role (n = 30, r = 0.4644, P = 0.010). These findings are congruent with those reported by
Dibert and Goldenberg (1995).

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51

Results Related to Addressing Research Question 3: What is the 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?

Multiple regression coefficients were calculated between the preceptors years of


nursing experience and the scores on the PPBR, PPS and CPR scales. Linear regression
analysis was used to determine whether there was a relationship between the preceptors
years of nursing experience and the preceptors perception of benefits and rewards
associated with the preceptor role. No statistically significant relationship was found (R
square= .024, F= 2.525, and P= .115. Table 8 contains additional information regarding
the relationship between the preceptors years of nursing experience and the preceptors
perception of benefits and rewards associated with the preceptors role.

Table 8: Relationship between the preceptors years of nursing experience and the
preceptors perception of benefits and rewards associated with the role

Regression
Residual
Total

Sum of Squares
1.860
75.904
77.764

df
1
103
104

Mean Square
F
1.860
2.525
.737

a Predictors. (Constant), YEARSRN


b Dependent Variable: BENEFIT

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Sig.
.115

52
There was no statistically significant relationship found between the preceptors
years o f nursing experience and the preceptors perception of support associated with the
preceptor role (R square = .000, F = .011 and P = .917). Table 9 contains additional
information regarding the relationship between the preceptors years of nursing
experience and the preceptors perception of support associated with the preceptor role.

Table 9i Relationship between the preceptors5 years of nursing experience and the
preceptors perception of support associated with the role

Sum of Squares
5.581E-03
Regression
Residual
52.657
Total
52.663

df
1
103
104

Mean
Square
5.581E-03
.511

F
.011

Sig.
.917

a Predictors: (Constant), YEARSKN


b Dependent Variable: SUPPORT

A linear regression analysis was used to determine whether there was a


relationship between the preceptors years of nursing experience and the preceptors
commitment associated with the preceptor role. A statistically significant relationship
was not found (R = .009, F = .923 and P= .339). Table 10 contains additional information
regarding the relationship between the preceptors years of nursing experience and the
preceptors perception of commitment associated with the preceptor role.

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53
Table 10: Relationship between the preceptors years of nursing experience and the
preceptors commitment associated with the role

Sum of Squares
Regression
AS
Residual
50.224
50.674
Total

df
1
103
104

Mean
Square
.450
.488

F
.923

.S ig,
.339

a Predictors: (Constant), YEARSRN


b Dependent Variable: COMMIT

None of the correlations reached statistical significance, implying that years of nursing
experience were not related to preceptors perceptions of benefits, rewards, supports, nor
commitment to the role.
In the original research study conducted by Dibert and Goldenberg, Spearman
rank-order correlation coefficients (rfao) were calculated between the preceptors years of
nursing experience and the scores on the PPBR, PPS, and CPR scales. No statistically
significant relationships were found. Taken together, these findings indicate that it can
be safely concluded that years of nursing experience are not related to the preceptors
perceptions of benefits and rewards, supports or commitment to the preceptor role.

Results Related to Addressing Research Question 4: Are there differences in the


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

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54
role, (b) perception of support for the preceptor role, and (c) commitment to the role
across types of units in which the preceptor works?

A series of F-tests were used to determine if there were statistically significant


differences between the unit in which the preceptor worked and the scores on the
Preceptors Perception of Benefit and Rewards Scale (F value = .272, significance =
.763), Preceptors Perception of Support Scale (F value = 1.934, Significance = .150),
and Commitment to Preceptor Role Scale (F value = . 130, Significance = .878). No
statistically significant differences were found between the type of unit the preceptor
works on and the preceptors preceptors (a) perception of benefits and rewards
associated with the preceptor role (b) perception of support for the preceptor roie, and (c)
commitment to the role. Table 11 contains additional information related to testing for
differences in patterns of responses across working units.

Table 11: Differences in responses on the PPBR, PPS and CPR Scales across
working units

Sum of Squares
SUPPORT Between Groups
1.924
Within Groups
50.739
Total
52.663
BENEFIT Between Groups
.412
Within Groups
77.352
Total
77.764
.129
Between Groups
COMMIT
Within Groups
50.545
Total
50.674

df
2
102
104
2
102
104
2
102
104

Mean Square
.962
.497

F
1.934

Sig.
.150

.206
.758

.272

.763

6.459E-02
.496

.130

.878

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55
Results Related to Addressing Research Question 5: What are the 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
of support for the preceptor role, and (c) commitment to the role?

A Enear regression analysis was used to determine if there were relationships


among the preceptor having been precepted in orientation, 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, when the variables are analyzed
separately.

None of the variables when examined alone accounted for any variability

(see Table 12).

Table 12: Relationships among Preceptors having been precepted in orientation,


the PPBR, PPS, and CPR Scales

Coefficients
Unstandardized
Coefficients
NM
B
Std. Error
1
(Constant)
2,113
.243
BENEFIT
-7.15E-2
.042
SUPPORT
-9.267E-02
.#50
COMMIT
.104
.053
a Dependent Variable: PREASNEW

Standardized
Coefficients
Beta
-.186
-.199
.218

SIg.

8.684
-1.676
-1.855
1.937

.000
,97
.066
.056

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56
F-tests were used to test for differences in the scores on the three scales for the
preceptor having been precepted in orientation condition. A statistically significant
difference was found (8% of the variability in R square was accounted for, standard error
of the estimate = .32, F = 2.767, and P = .046). There was a statistically significant
difference found across the scores on the three scales and the preceptor having been
precepted in orientation condition (see Table 13).

Table 13; Differences between Preceptors having been precepted in orientation and
the PPBR, PPS, and CPR Scales

Mean
df
Square
Sum of Squares
3
.288
1
Regression
.865
101
.104
10.525
Residual
11.390
Total
104
a Predictors: (Constant), COMMIT, SUPPORT, 1IENEFIT
b Dependent Variable: PREASNEW

F
2.767

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

Sig.
,046

CHAPTER V
Discussion

The major aim of this dissertation research study was to obtain empirical
information about the relationships among the preceptors perceptions of benefits,
rewards, supports and commitment to the preceptor role. The study was designed to
address the following research questions: (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 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? (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
between 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) commitment to the role? A four-part questionnaire
[the Preceptors Perception of Benefits and Rewards (PPBR) Scale, the Preceptors
57

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58
Perception of Support (PPS) Scale, the Commitment to the Preceptor Role (CPR) Scale,
and a demographic information component] was used to address these research questions.

Discussion Related to Addressing Research Question 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?
The findings of this study indicated that preceptors are more committed to the role
of the preceptor when they perceive worthwhile benefits and rewards associated with the
role. Dibert and Goldenberg (1995) reported similar findings. They found that the more
the preceptors perceived that there were benefits and rewards associated with the
preceptor role, the more they were committed to the role. Similar findings were reported
by others (Turnbull, 1983; Shamian & Inhaber, 1985; 0 Mara& Welton, 1995; and
Wright, 2002). Appendix E contains a summary table of the highest rank-ordered mean
scores for the Preceptors Perception of Benefits and Rewards. Ability to share their
knowledge with new nurses and nursing students was identified by the participants as the
most highly rated benefit and reward associated with the preceptor role. In the original
study conducted by Dibert and Goldenberg (1995), sharing of knowledge with new staff
nurses and nursing students was ranked fourth by preceptors as perceived benefits and
rewards associated with the preceptor role. Teaching of new staff nurses and nursing
students was reported to be the second highest ranked score by the participants in both
the original study and my study. A literature review (McGregor, 1999) provides support
for the benefits associated with the preceptors ability to teach and influence nursing
practices. The ability to assist new staff nurses and nursing students to integrate into the

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59
nursing unit was found to be the highest rank-ordered benefit and reward in the original
study. It was ranked third in my study. In both studies, the opportunity to improve
chances for promotion and/or advancement within the institution was the lowest ranked
item associated with the preceptors perception of benefits and rewards. Appendix F
contains a list of the highest rank-ordered mean scores for the preceptors perception of
benefits and rewards in the Dibert and Goldenberg (1995) study.

Discussion Related to Addressing Research Question 2: What is the relationship


between the preceptors perception of support for the preceptor role and the
preceptors commitment to the role?
The findings indicated that the preceptors are more committed to the role of the
preceptor when they perceived that there was support for the preceptor role. Dibert and
Goldenberg (1995) reported similar findings. Fehm (1990) identified support for
preceptors as being essential to the success of preceptor programs. The literature
supports (Balcain et a!., 1997, Craven & Broyles, 1996, & Staab et al., 1996) the
provision of structured training programs for preceptors who work with new hires and/or
new graduates. It was recommended that orientation programs be designed to address the
needs and concerns of the preceptors. Important components of preceptor training
include teaching/learning strategies, principles of adult education, communication skills,
values and role clarifications, conflict resolution assessment of individual learning needs,
and systematic evaluation of novice performance (de Blois, 1991, Westra & Graziano,
1992).

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60

Discussion Related to Addressing Research Question 3: What is the relationship


between the preceptors years of nursing experience and the preceptors (a)
perception of benefits and rewards associated with the preceptor role, (to) perception
of support for the preceptor role, and (c) commitment to the role?
The findings of this study clearly indicate that the number of years of nursing
experience was not related to the preceptors perceptions of benefits and rewards,
supports, or commitment associated with the role. The results are congruent with the
findings reported by Dibert and Goldenberg (1995) in the original study.

Discussion Related to Addressing Research Question 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?
An analysis of the results of the study indicated that there is no relationship
between the types of unit the preceptor works on and the preceptors perception of
benefits and rewards, supports, and commitment associated with the role. Overall, it
appears that the type of clinical setting does not alter the orientation challenges faced by
preceptors. Preceptors are one of the key individuals who impact the transition of new
hires and/or new graduates to role of staff.

Discussion Related to Addressing Research Question 5; What is the relationship


among preceptor having been precepted in orientation and the preceptors (a)

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61
perception of benefits and rewards associated with the preceptor role, (b) perception
of support for the preceptor role, and (c) commitment to the role?
The findings of this study indicated that there is no relationship among the
preceptor having been precepted in orientation and the preceptors perception of benefits
and rewards, support, and commitment associated with the role when the variables were
examined individually. However, a statistically significant difference was found across
the scores on the Preceptors Perception of Benefits and Rewards (PPBR) Scale,
Preceptors Perception of Support (PPS) Scale, Commitment to the Preceptor Role (CPR)
Scale when the variables were examined collectively. There was a statistically
significant difference found across the scores on the three scales between those
preceptors who had been precepted and those preceptors who had not been precepted.

Limitations of the Study


Participants for this dissertation research study, were obtained from a sample of
nurses employed in one medical center located in a large metropolitan area in the
Midwestern part of the United States. It is recognized that the self-selecting convenience
sampling approach utilized in this study limited the extent to which generalizations can
be made beyond the group of participants targeted for systematic study.
A relatively low response rate is another possible limitation. The response rate
was 21.5%. Efforts were made to obtain a higher response rate. An additional
consideration to be made when examining the results is related to the peculiar
characteristics of the preceptorship program targeted for study. It is important to keep in

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62
mind that while many nurse preceptor programs have developed over the past few years,
they vary considerably in terms of length, content, structure, and complexity.

Recommendations for Future Research


A review of the literature provides support for the view preceptor step programs
enhance the socialization of new graduates to the role of professional registered nurse. A
precepted program bridges the theory and practice gap to minimize the reality shock that
most new graduates experience with their first job. Emphasis has been given to the
importance of a comprehensive orientation program for new nurses (Balcain, Lendrum,
Bowler, Doucette & Maskell, 1997; Beeman, Jeraigan, & Hensley, 1999). Brasler (1993)
examined the effectiveness of the various components of the orientation program on the
clinical performance of novice nurses. The results indicated that there is a positive
relationship between preceptor expertise and novice nurses clinical performance. This
finding provides support for the importance of an orientation program that is designed to
addresses both the acquisition of knowledge and skills needed to be a preceptor.
Given what is reported above, more research is needed to identify the most
effective preceptor behaviors and the long-term effects preceptorships have on job
retention and satisfaction. Overall, the findings suggest that preceptors perceptions of
benefits, rewards, and support are related to commitment to the role. However, managers
and administrators in the hospitals must be educated to value the importance of
preceptorships. Hospital managers and administrators can establish preceptor programs
that clearly define the roles and responsibilities of the preceptor and the new hire.
Without programs that are crafted to develop preceptor skills and provide support for the

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63
role, preceptorships are likely to be ineffective. Preceptorship goals and objectives will
probably not be met.
It is recommended that this study be replicated using a different setting in order to
increase generalizability. Further research is needed to determine what specific forms of
benefits and rewards, other than those identified in this study, could be more
meaningfully incorporated into preceptorship programs. Studies need to be done to
determine the continuing education needs of preceptors. Moreover, it is recommended
that strategies be designed to promote collaborations between educators and preceptors to
establish preceptor programs that provide for the special needs of the novice nurses.
Support needs to be provided to the preceptors in their role.
The economic climate in health care necessitates that orientation programs
prepare new hires and graduates to function independently, 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 to the successful completion of the orientation process for new 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
characteristics of successful preceptors. 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 relationships with

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64
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 skills 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
training component to maintain high quality patient care.

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APPENDIX A: Letter to Potential Participants

65

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66
Dear Registered Nurse:
Hello. My name is Caraiella Moran. I am a Ph.D. student at Loyola University Chicago.
While pursuing my degree, I developed a special interest in preceptorships.
Preceptorship programs are widely used for socialization of newly hired nurses. The
shortage of qualified nurses, increased patient acuity, and early patient discharges puts
substantial pressure on the new nursing graduate to perform independently and quickly.
The overall purpose of my dissertation research study is to examine the relationships
among preceptors perceptions of benefits, rewards, support, and commitment to the
preceptor role.
This packet contains information related to nursing preceptorships. I would appreciate it
if you would express your voice on this issue by participating in my study regarding
preceptors commitment to working with newly hired nurses and/or student nurses. All
staff nurses who function as a preceptor for newly hired registered nurses and/or student
nurses are Invited to participate in the study. Your Input is very important to me. Your
participation is voluntary. There will be no negative consequences if you choose not to
participate. Your responses to this survey will be kept confidential. The results of the
survey will be reported as group data. There will be no way to identify responses of
specific individuals who complete the survey.
If you agree to participate, please complete the enclosed: Four-part Preceptor
Questionnaire. Completion of the forms should only take approximately 10 minutes, and
may be done at your convenience during off-duty time. Please complete the
questionnaire and return it to Carmella Moran, in the enclosed envelope via inter-office
mail. I hope you enjoy the enclosed mint, as a small token of my appreciation for your
efforts to consider my request.
Should you have any questions related to this research project, about being a participant,
or if you would like to obtain a summary of the findings, please contact me at Elmhurst
College, Deicke Center for Nursing Education (630-617-3328). If you have any
questions regarding your rights as research participants please contact the Loyola
University Compliance Manager (773-508-2689).
Thank you In advance for taking the time to consider my request to participate in my
dissertation research project

Sincerely,
Carmella M. Moran RN, MSN

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APPENDIX B: Approval for Conducting Research

67

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68

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APPENDIX C: Preceptor Questionnaire

69

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70
Preceptor Q uestionnaire**
P a r t I : PKECEPTOtfs P e rc e p tio n o r Bm&m am b ew ahb s S c a le

Please consider eacli statement w ill reference to your experience as a preceptor.


Using t i e scale below, please circle the number that best describes your response to
the statement,
1
2
3
4
5
6
Strongly
Moderately
Disagree
Agree
Moderately
Strongly
Disagree
Disagree
Agree
Agree
la m a preceptor because as a preceptor I have the opportunity to:
1. Teach new staff nurses and nursing students.

1 2 3

4 5 6

2.

Assist new staff nurses and nursing students to integrate into


the nursing unit.

1 2 3

4 5 6

3.

Increase my own professional knowledge base.

1 2 3

4 5 6

4.

Keep current and remain stimulated in my profession.

1 2 3

4 5 6

5.

Influence change on my nursing unit.

1 2 3

4 5 6

6.

Gain personal satisfaction from the role.

1 2 3

4 5 6

7.

Be recognized as a role model.

1 2 3

4 5 6

8.

Improve my teaching skills.

1 2 3

4 5 6

9.

Share my knowledge with new nurses and nursing students.

1 2 3

4 5 6

10. Learn from new nurses and nursing students.

1 2 3

4 5 6

11. Contribute to my profession.

1 2 3

4 5 6

12. Increase my involvement in the organization within this


hospital.

1 2 3

4 5 6

13. Improve my organizational skills.

1 2 3

4 5 6

14. Improve my chances for promotion/advancement within this


organization.

1 2 3

4 5 6

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71
Preceptor .Qcisticw m m ie **
F a r t Us H K B f O i s B m c irn c w o f Support Scaus
Please consider each statement with reference to your experience as a preceptor.
Using the scale M ow , please circle the number that best describes your response t
the statement
1
2
3
4
5
6
Strongly
Moderately
Disagree
Agree
Moderately
Strongly
Disagree
Disagree
Agree
Agree
15. I feel I have had adequate preparation for my role as a
preceptor.
16. My goals as a preceptor are clearly defined.

1 2 3 4 5

17. The nursing staff do not understand the goals o f the


preceptor program.
18. My co-workers on the nursing unit are supportive of the
preceptor program.
19. My workload is appropriate when I function as a preceptor.

1 2 3 4 5 6

20. I do not have sufficient time to provide patient care while I


function as a preceptor.
21. I feel I function as a preceptor too often.

1 2 3 4 5 6

1 2 3 4 5 6
1 2 3 4 5 6
1 2 3 4 5 6
1 2 3 4 5 6

1 2 3 4
22. I feel the Nursing Managers are committed to the success of
the Preceptor Program.
1 2 3 4
23. Nursing Managers are available to help me develop in my
role as a preceptor.
1 2 3 4
24. Clinical Nurse Specialists/Clinical Consultants/Department
Educators are available to help me develop in my role as a
preceptor.
1 2 3 4
25. There are adequate opportunities for me to share
information with other preceptors.
Please answer questions 26 to 28 if you have been a preceptor for a nurse during orientation.
1 2 3 4
26. The Nursing Manager provides support by helping me to
identify an orientees performance problems.
1 2 3 4
27. The Nursing Manager spends too little time with the new
orientee.
1 2 3 4
28. The guidelines clearly outline the responsibilities of the
Nursing Manager in relation to my preceptor role.
Plea* answer questions 29131 if jm have been &psweptor for a aanslHg student
1 2 3 4
29. The nursing faculty member provides support by helping me
to identify a students performance problems.
1 2 3 4
30. The nursing faculty member spends too little time with the
nursing student.
1 2 3 4
31. The guidelines dearly outline the responsibilities of the
nursing faculty member in relation to my preceptor role.

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

5 6
5 6
5 6
5 6

5 6
5 6
5 6

5 6
5 6
5 6

72
P r e c e p t o r Q c e s h c w h a m e *
P a r t H is C m sM m m m t o t h e P recep to r Mo l e S c a m *
Please consider each statement with reference to your experience as a preceptor.
Using the scale below, please circle t ie number that best describes your response to
the statement.
I
2
3
4
5

Strongly
Moderately
Disagree
Agree
Moderately
Strongly
Disagree
Disagree
Agree
Agree

32. I am willing to put in a great deal o f effort beyond what is


normally expected in order to help the preceptee be successful.

12

3 4

5 6

33. I am enthusiastic about the preceptor program when I talk to


my nursing colleagues.

12

3 4

5 6

34. I feel very little loyalty to the preceptor program.

12

3 4

5 6

35. I find that my values and the values o f the preceptor program
are very similar.

12

3 4

5 6

36. I am proud to tell others that I am a preceptor.

12

3 4

5 6

37. It would take very little change in my present circumstances to


cause me to stop being a preceptor.

12

3 4

5 6

38. There is not too much to be gained by continuing to be a


preceptor.

12

3 4

5 6

39. I really care about the fate of the preceptor program in this
hospital.

12

3 4

5 6

40. Deciding to be a preceptor was a definite mistake on my part.

12

3 4

5 6

41. Being a preceptor really inspires me to perform my very best.

12

3 4

5 6

Adapted fra::. - V' :;

i* .

'

welopei by Mowday, Steers, ami

Porter (1979).
Mowiay, MX, Steers, K.M., & Porter, L.W. (1979). T ie measurement f organizational commitment
Journal o f Vocatmml Behavior, 14,224-227.

Adapted from JMIfeert, C. & GeMeafcerg, f t (1995% Preceptor51perceptions of benefits, rewards,


snpports and commitment to the preceptor role. Journal of Advanced Marsing, 21(6), 1144-1151._______

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PiicE Prom Q uestionnaire*


P a r t IV ; D iM O G iA P H ic lN r M A ii iF o iM
Please answer the following q uestions about y ou rself for statistical purposes by
responding to the follow ing:
1.

What is your age?________

2.

Gender: (Circle sue): Female/Male

3.

Ethnicity: (Circle one or indicate other): African Americas / Asian / American Indian / Caucasian /
Hispanic / Other
______

4.

Type of basic nursing preparation: (Circle one): Associate/Diploma/Baccalaureate

5. Highest nursing degree obtained: (Circle one): Associate / Baccalaureate / Masters / Doctorate
6. Highest non-nursing degree obtained: (Circle one): Associate / Baccalaureate / Masters / Doctorate
7.

Number of years licensed as a Registered Nurse:________ _

8. Number of years employed in nursing at Alexian Brothers Medical Center _________


9.

Setting of employment at Alexian Brothers Medical Center (Circle oik or indicate other):
ICU / CCU / CVICU/ OR / PACU / Same Day Surgery / ER / Ambulatory Care / Cathe Lab / 2E /
2W / 3E / 3W / 4E / 4W / 5E / 5W Peds / Nursery / Labor & Delivery / Postpartum / 6E / 6W / Rebah/
Other__________________

10. Average number of hours worked per week, in your current position:_________
11. Are you currently enrolled in a nursing program? (Circle one): Y es/No
If answered yes to item #11, indicate the type of nursing program in which you are enrolled
(Circle one): Baccalaureate / Masters / Doctorate
12. Have you ever been a preceptor for a newly hired nurse? (Circle one): Y es/N o
If you answered yes to item #12, indicate number of years you have functioned as a preceptor._____
13. Have you ever been a preceptor for a nursing student? (Circle one): Y es/N o
If you answered yes to item #13, indicate number of years you have functioned as a preceptor.______
14. Years of experience as a preceptor tor newly hired nurses and/or student nurses:

__

15. Have you ever attended a Preceptor Trammg Class or Workshop? (Circle one): Y es/N o

If you answered yes to item #15, indicate low long ago? _ _ _ _ _ _


16. Where you ever precepted as a newly faired nurse? (Circle one): Y es/N o
THANK TOO t a t TAKING THE T B tt TO COMHJRE THIS qUESXXONNAUE.

Instkocteons: Return the coMmn ookshdpmaese r a w rm attaches envelope through jmts-$ice mail.

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APPENDIX D: Permission to use the Preceptor Questionnaire

74

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75
Preceptor tool
Date:
4/7/2004 7:43:02 AMCentral Daylight Time
From: alawKdtuwo.ca (AnsxlaLaw)
To: carmellamoran(8saolcom
CC: deoldenbtebuwo.ca
File:
instrmBatt8.pdf 0238206bytes) DL Time (115200 bps): < 1 minute
Stibj:

Attached is a file with the instrument with description that you have requested from Dr. Dolly Goldenberg.
Angela Law
School of Nursing
The University of Western Ontario
London, Ontario
N6A 5C1
Phone: (519) 661-4064
Fax: (519) 661-3410
The UWO School of Nursing and lota Omicron Chapter of STT International will host the CASN
National Nursing Research Conference In May 12-15, 2004. Mark you' calendars ami plan to be
here!
<>

----------------------- H ead ers-------------------------------Retum-Path: <alaw1@uwo.ca>


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Subject: Preceptor tool
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APPENDIX E: Highest rank-ordered mean scores for Preceptors Perception of


Benefits and Rewards

76

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77

Table 6: Highest rank-ordered mean scores for Preceptors Perception of


Benefits and Rewards

Item

~ '

'

Share my knowledge with new nurses and nursing students


Teach new staff nurses and nursing students
Assist new staff nurses and nursing students to integrate into the
nursing unit
Contribute to my profession
Gain personal satisfaction form the role
Improve my teaching skills
Keep current and remain stimulated in my profession
Be recognized as a role model
Learn from new nurses and nursing students
Increase my own professional knowledge base
Influence change on my nursing unit
Improve my organizational skills
Increase my involvement in the organization within this hospital
Improve my chances for promotion/advancement within this
institution

Standard
Mean Deviation
5.5238 .8781
5.4667 .8556
5.4571
5.2000
5.1143
5.0952
5.0784
5.0571
4.9238
4.8762
4.5714
4.5619
4.5238

.8990
.9942
1.0859
1.1225
.9919
1.0992
1.1905
1.2534
1.2998
1.2929
1.2717

3.7048

1.4671

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APPENDIX F: DIbert & Goldenberg Study; Highest rank-ordered mean scores for
Preceptors5 Perception of Benefits and Rewards

78

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79
Table 14: Highest rank-ordered mean scores for Preceptors Perception of
Benefits and Rewards in JMberf & Goldenberg 1995 Study

Item

~~~~~~~~

Assist new staff nurses and nursing students to integrate into the
nursing unit
Teach new staff nurses and nursing students
Improve my teaching skills
Share my knowledge with new nurses and nursing students
Gain personal satisfaction form the role
Increase my own professional knowledge base
Keep current and remain stimulated in my profession
Contribute to my profession
Learn from new nurses and nursing students
Be recognized as a role model
Increase my involvement in the organization within this hospital
Improve my organizational skills
Influence change on my nursing unit
Improve my chances for promotion/advancement within this
institution

Standard
Mean Deviation
530
5.12
5.04
5.02
4.93
4.74
4.74
4.63
4.58
4.58
4.16
4.12
3.79
3.12

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0.99
1.05
1.01
0.89
1.21
1.21
1.29
1.04
1.03
1.11
1.02
0.92
1.24
1.29

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VITA

After graduating with a Bachelors of Science in Nursing Degree from Loyola


University Chicago (1980), Carmeila Moran began working as a registered nurse on a
medical-surgical unit and eventually transferred to critical care. While pursuing a
Masters of Science Degree in Nursing, Carmeila accepted a position as staff educator.
After receiving a Masters of Science in Nursing degree from Loyola University Chicago,
Carmeila accepted a position as a staff nurse in the Open Heart and Heart Transplant unit
at Loyola University Medical Center, Maywood, Illinois. She accepted her first position
in nursing education in 1986, when she became a nursing instructor at DePaul University.
During her career as an educator, she has been employed at several institutions
including: Augustana Hospital and Health Care Center, Chicago, Illinois, University of
St. Francis, Joliet, Illinois, and Elmhurst College, Elmhurst, Illinois. As an educator, she
developed and implemented the first online nursing course in the Baccalaureate degreenursing program at Saint Joseph College of Nursing & Allied Health. She played a
substantial role in the development of a Bachelor completion track for registered nurses.
Carmeila served as Senior Level Department Chair for two years at University of St.
Francis, Saint Joseph College of Nursing & Allied Health.
After seven years of teaching, Carmeila accepted a position as Vice President of
Case Management for R.SKCO, (A CNA Company). As a nurse consultant for over 500
86

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87
Nurse Workers Compensation Case Managers, her responsibilities included:
development and implementation of national policies and procedures for Medical Claims
Consultation & Life Care Planning Services; product development; implementation,
trainings sales presentation and marketing for new products; and coordination &
implementation of an on-line orientation and training program for all new hires in case
management throughout the country. Carmeila5s special interest in mentoring led her to
the development and implementation of a Mentor Program for all new hires in case
management.
Carmeila has been actively involved in professional organizations throughout her
professional career. She was inducted into the Sigma Theta Tau Nursing Honor Society
in 1986, and currently functions as the Faculty Counselor for the Zeta Beta Chapter at the
Elmhurst College, Deicke Center for Nursing Education. Carmeila recently received a
research grant from the Zeta Beta Chapter to fond her dissertation research project. She
continues to maintain membership in this organization as well as the Educators of
Illinois, American Educational Research Association, and American Society of Pain
Management Nurses.
Carmeilas professional activities have included several presentations related to
her role as an educator and her work as Vice President of Case Management. She
presented a paper at the Risk Management National Conference in 2001 related to
integrated programs for decreasing workers compensation costs.
She has received numerous awards during her professional career. The Nurse
Educators of Illinois (formerly Illinois League for Nursing) named Carmeila as the
recipient of the Faculty Research Support Award for 2004.

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DISSERTATION APPROVAL SHEET

This Dissertation submitted by Carmeila M. Moran has been read and approved by the
following committee;
Ronald R. Morgan, Ph.D., Director
Professor of Educational Psychology
Loyola University Chicago
Jack Kavanagh, Ph.D.
Professor of Research Methodology
Loyola University Chicago
Virginia Keck Ph.D.
Director, Nursing Education (Retired)
Kellogg Community College
The final copies have been examined by the director of the dissertation and the signature
which appears below verifies the fact that any necessary changes have been incorporated
and that the dissertation is now given final approval by the committee with reference to
the content and form.
The dissertation is therefore accepted in partial fulfillment of the requirements for the
degree of Doctor of Philosophy.

y / z

Date

Directors Signature

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