Fourth Year Nursing Students Lived Experiences

FOURTH YEAR NURSING STUDENTS‘ LIVED EXPERIENCES IN THE
STUDENT-PRECEPTOR RELATIONSHIP
ILLUMINATED THROUGH INTERPRETIVE PHENOMENOLOGY
PATRICIA A. DICKIESON
SUBMITTED IN PARTIAL FULFILLMENT

OF THE REQUIREMENTS FOR THE
DEGREE OF MASTER OF EDUCATION
NIPISSING UNIVERSITY
SCHULICH SCHOOL OF EDUCATION
NORTH BAY, ONTARIO
© Patricia Dickieson August 2010

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Abstract
Recognizing the importance of a successful preceptorship experience, the
purpose of this study was to illuminate student nurses‘ lived experiences inside the
student-preceptor relationship. Through better understanding of the student perspective of
this relational process, it is suggested here that the preceptorship model can be used more
effectively as a learning strategy that increases student confidence and competence and
supports the student-to-graduate nurse transition.
A qualitative research approach using hermeneutical phenomenological
methodology was utilized to explore and gain understanding of this relationship from a
students‘ perspective. The lens for exploring this relationship was a humanistic approach
to nursing education (Bevis and Watson, 1989). Semi-structured interviews conducted
with a purposive sample of six participants led to the discovery of lived experience
themes and situational themes.
The study‘s findings are subsumed under the idea of the student‘s fragile
confidence. These respective findings are presented through lived experience themes and
situational themes. The situational themes affected the student‘s lived experience. The
five lived experience themes that emerged were: feeling cared for or feeling uncared for;
feeling comfort or feeling angst; feeling confident or feeling self-doubt leading to
insecurity; feeling motivated or feeling less motivated; and finally feeling grateful or
feeling disappointed.
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Acknowledgments
The list of colleagues and friends who have supported me in my pursuit of this
degree is long. Acknowledging that I cannot thank each of you individually, I do wish to
express my sincerest appreciation to a select few.
Very special thanks go to Dr. Jennifer Barnett, my thesis supervisor. At every
point, I felt both challenged and supported. Dr. Barnett‘s vast experience as an educator
and researcher inspired confidence and commitment. I also wish to recognize and thank
the other members of my committee: Dr. Aroha Page from the Faculty of Nursing,
Nipissing University and Dr. David Gregory from the Faculty of Nursing, University of
Lethbridge. The time these busy professionals have taken to support me is a strong
statement of who they are as people and as educators.
Finally, there are not enough words to thank my immediate family: my husband
Doug and our three children Jamie, Jennifer and Scott. Their belief in me as I have
pursued this personal goal has been unwavering. Thank you for your patience during this
process!
Dedication
This project is dedicated to my father, Charles Patrick Cassidy and
to my sister, Mary Beth (Cassidy) Benedict.
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Table of Contents
Content Page
Abstract ............................................................................................................................. i
Acknowledgments ............................................................................................................ ii
Table of Contents ............................................................................................................. iii
List of Tables ................................................................................................................... v
List of Appendices .......................................................................................................... vi
Chapter One: Introduction ............................................................................................... 1

Preceptorship ............................................................................................................. 2
Rationale for this Study ............................................................................................. 2
Significance of the Study .......................................................................................... 3
Purpose of the Research ............................................................................................ 5
Organization of the Thesis ......................................................................................... 6
Chapter Two: Review of the Literature ............................................................................ 7

Educative Humanistic Paradigm ............................................................................... 7
Relational Process: Interpersonal Dynamics ........................................................... 11
Knowing .................................................................................................................. 12
Trust ......................................................................................................................... 13
Respect ..................................................................................................................... 13
Mutuality .................................................................................................................. 14
Caring ...................................................................................................................... 15
Student-teacher connection ..................................................................................... 16
Emancipation and empowerment ............................................................................. 17
Andragogy ............................................................................................................... 17
Preceptorship ........................................................................................................... 19
Characteristics of the Preceptor ................................................................................ 21
Chapter Three: Methodology and Research Design ....................................................... 26

Methodology ........................................................................................................... 27
Phenomenology as a Philosophy ............................................................................. 27
Research Design ...................................................................................................... 29
Ethics and Human Relations .................................................................................... 29
Sampling................................................................................................................... 31
Method .................................................................................................................... 31
Turning to the nature of lived experience ............................................................... 32
The existential investigation..................................................................................... 32
Phenomenological reflection (The analysis) ........................................................... 34
Naïve reading .......................................................................................................... 34
Wholistic reading .................................................................................................... 35
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Content Page
Structural analysis .................................................................................................... 35

Selective reading ...................................................................................................... 35
Detailed reading ....................................................................................................... 35
Interpretation of the whole ...................................................................................... 36
Phenomenological Writing ...................................................................................... 36
Chapter Four: Findings and Data Analysis ..................................................................... 37

The Accounts and Initial Analysis ........................................................................... 39
Alana‘s verbal account and initial analysis ............................................................. 39
Revised analysis based on member checking ......................................................... 40
Beth‘s verbal account and initial analysis ............................................................... 43
Cathy‘s verbal account and initial analysis ............................................................. 48
Revised analysis based on member checking .......................................................... 50
Debbie‘s verbal account and initial analysis ........................................................... 53
Eva‘s verbal account and initial analysis ................................................................ 58
Flo‘s verbal account and initial analysis ................................................................. 63
Final Analysis .......................................................................................................... 67
Situational context themes ...................................................................................... 68
Lived experience themes ......................................................................................... 70
Interface of Situational Context Themes and Lived Experience Themes ............... 71
Feeling cared for ...................................................................................................... 72
Confidence .............................................................................................................. 73
Level of motivation ................................................................................................. 73
First Person Narratives Based on Synthesis of Themes .......................................... 74
Chapter Five: Discussion and Implications ................................................................... 76

Fragile Confidence .................................................................................................. 77
Growing trust ........................................................................................................... 78
Growing respect ...................................................................................................... 80
Preceptor perceived accountabilities ....................................................................... 81
Providing space for learning ................................................................................... 82
Allowing gradual independence to practice while providing opportunities for
learning and support ................................................................................................ 83
Being a positive role model ..................................................................................... 86
Conclusion ............................................................................................................... 89
Implications for Nursing Education ......................................................................... 90
Implications for Further Research ........................................................................... 92
References ...................................................................................................................... 94
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List of Tables
Table Page
1-1: Situational Content Themes related to Alana‘s Account ....................................... 41
1-2: The Lived Experience: Themes from Alana‘s Account ......................................... 42
2-1: Situational Content Themes related to Beth‘s Account .......................................... 45
2-2: The Lived Experience: Themes from Beth‘s Account ........................................... 46
3-1: Situational Content Themes related to Cathy‘s Account ....................................... 51
3-2: The Lived Experience: Themes from Cathy‘s Account ......................................... 52
4-1: Situational Content Themes related to Debbie‘s Account ..................................... 55
4-2: The Lived Experience: Themes from Debbie‘s Account ....................................... 57
5-1: Situational Content Themes related to Eva‘s Account ........................................... 60
5-2: The Lived Experience: Themes from Eva‘s Account ............................................. 61
6-1: Situational Content Themes related to Flo‘s Account ............................................ 65
6-2: The Lived Experience: Themes from Flo‘s Account ............................................. 66
7: Common Situational Context Themes and Thematic Variations across Accounts ... 69
8: Common Lived Experience Themes and Thematic Variations ................................. 71
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List of Appendices
Appendix Page
A. Information Letter .................................................................................................... 101
B. Consent Form .......................................................................................................... 103
C. Conversational Interview Tool ................................................................................ 104
D. Nipissing University Ethics Approval Letter .......................................................... 105
E. Laurentian University Ethics Approval Letter ........................................................ 106
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Chapter One: Introduction
Situated in the university, nursing is a professional practice discipline based on
four years of theoretical study and clinical practice in supervised contexts. After many
theory courses, nursing students in the final year of a baccalaureate nursing program are
placed in clinical practice settings where practical learning opportunities facilitate the
transfer of knowledge from classroom to real-life patient/client praxis. These experiences
in clinical settings provide opportunities for students to demonstrate patient care, clinical
judgment, critical thinking, and decision-making skills (Gaberson & Oermann, 2007).
In these settings, preceptorship is the approach to teaching-learning. In this model
an expert registered nurse (RN) is paired with a student nurse. A ―salient definition of
preceptorship in the literature is that of a one-to-one relationship between a staff RN and
a nursing student during an intense, time-limited clinical experience, with the support of
nursing faculty to facilitate student learning and provide evaluation of course objectives‖
(Udlis, 2008, p. 20 ). Additionally, it is considered ―as an approach to the teaching and
learning process within the context of the practice setting, affords students the
opportunity to develop self-confidence while increasing their competence as they become
socialized into the profession of nursing‖ (Billay & Myrick, 2007, p. 2). Preceptorships
also comprise a safety net for students as they make the transition into professional
practice and learn to integrate classroom and clinical experiences (Myrick & Yonge,
2005). Prior to the preceptorship experience in year four of the program, students engage
in practice in the clinical context as part of a small group of peers and receive direct
supervision by a clinical educator employed by the educational institution. This clinical
group experience is less intensive than the one-to-one preceptorship experience.
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Preceptorship
The preceptorship model involves contributions by three players: the preceptor,
the student, and the faculty member at the student‘s educational institution. This
combination of persons is referred to as a triad (Myrick & Yonge, 2005) and is central to
the preceptorship experience. Each team member plays a critical role in facilitating the
success of the preceptorship experience and ultimately the learning. The collaborative
partnership among these members further strengthens the experience (Lillibridge, 2007).
Successful preceptorship experiences ensure that competent and confident new nurses
move forward into the workplace with the skills they require to cope within a rapidly
changing health-care environment. To ensure the competency of tomorrow‘s nurses,
today‘s student nurses must be supported as they prepare, practice and otherwise learn
this role. The preceptorship experience as it occurs in the final year of a baccalaureate
nursing program facilitates these goals. Although there is recognition of the important
role each person in the triad plays, this study focused specifically on the student-
preceptor relationship within the preceptorship experience. I believe the quality of the
student-preceptor relationship is central to a successful preceptorship experience.
Rationale for this Study
As a practicing registered nurse my first experience with the concept of
preceptorship was in the early 1990s. As a nurse manager in a community health care
agency, I was responsible for the orientation of newly hired registered nurses (RN‘s) to
community practice. I would pair each new hire with a seasoned registered nurse (RN)
with the goal of facilitating their socialization into the culture of the organization. Some
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pairs were very successful, with the new hire adjusting well to the workplace, while other
pairs were not so successful requiring additional time by the new hire to feel comfortable
in the workplace.
In 2000, as a Laurentian University faculty advisor, I began working with
baccalaureate student nurses (BSN) and their agency preceptors to facilitate student
learning in clinical practice. In this nursing education role, I noted a continuum among
the relationships between students and preceptors with varying achievement of learning.
At the time, I did not critically identify or analyze the root cause of this variation. Now as
a nursing professor I sometimes ask students to share their favorite stories about nursing;
their stories usually involve clinical practice and often involve their preceptors. From the
student perspective, when they share their stories, it seems that if the relationship with the
preceptor was positive, their preceptorship experience was likewise positive; conversely,
if the relationship with their preceptor was negative, their preceptorship experience was
negative. Because the preceptorship experience provides opportunity for students to
integrate their theoretical knowledge into the practice setting, to begin socialization into
the profession, and to model expected professional attributes, the quality of the student-
preceptor relationship needs to be strong and positive to smooth the progress for this to
occur.
Significance of the Study
Preceptorship is widely used by a number of professional faculties, including
nursing, as a teaching and learning model. Nursing uses this model in clinical practice in
support of a cost-effective quality practice experience. While there are many references
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to nursing preceptorship in the nursing education literature, the majority focus is on
preceptor preparation and support, consolidation of skills, encouragement of critical
thinking, the transition into practice, and recruitment and retention (Billay & Myrick,
2008; Myrick & Yonge, 2004; Myrick & Yonge, 2002; Sorenson & Yankech, 2008; and
Udlis, 2008). In the literature, limited attention has been given to the processes or ‗the
happenings‘ inside the one-to-one relationship that develops between a nursing student
and preceptor as well as the impact this relationship has on learning during the
preceptorship experience. It would seem reasonable to hypothesize that effective
preceptor characteristics serve to facilitate a connected preceptor-student relationship,
and, over time spent with the preceptor, fosters student independent functioning. Still, a
number of outstanding questions require attention, as specified here: What is the nature of
the connected relationship between the preceptor and the student? How do the preceptor
and the student work together? What is the process by which a preceptor-student
connection occurs? How do effective preceptor characteristics support a connected
preceptor-student relationship? How can educators support the preceptor-student
relationship so that a connection or space for learning is fostered? What is the effect of
the preceptor-student connection on the nursing students‘ learning experience in clinical
practice? What is the nursing student‘s experience of the student-preceptor connection in
clinical practice? Additional information needs to be gathered about this relationship
from the perspective of students. Insufficient research has been done as to how such a
successful student-preceptor relationship exists as well as the resultant learning that takes
place.
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Purpose of the Research
Recognizing the importance of a successful preceptorship experience, the purpose
of this study was to illuminate student nurses‘ lived experiences in the student-preceptor
relationship. This illumination will assist others in gaining an understanding of the
interpersonal dynamics of the student-preceptor relationship that contributes to positive
experiences within the preceptorship triad. Through better understanding of the student
perspective of this relational process, it is suggested here that the preceptorship model
can be used more effectively as a learning strategy that increases student confidence and
competence and supports the student-to-graduate nurse transition. Thus I asked the
questions:
1. What are the student‘s lived experiences that occur within the student-
preceptor relationship during preceptorship?
2. From the student voice, what are the effects of these lived experiences on
student learning?
3. What are the student‘s lived experiences that occur within the student-
preceptor relationship that create a positive learning environment or a space for
learning?
In short, what is the lived experience of a fourth year nursing student in a preceptorship?
A qualitative research approach using hermeneutical phenomenological methodology was
used to explore and gain understanding of this relationship from a students‘ perspective.
The lens for exploring this relationship was a humanistic approach to nursing education
(Bevis and Watson, 1989). Within a humanistic paradigm, reflective, caring, and
interactive relationships are essential to the enhancement of student-teacher and student-

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preceptor experiences (Bevis and Watson, 1989) as well as fostering the progression of
nurses from novice to expert level (Benner, 1984).
Organization of the Thesis
This thesis is presented in five chapters. Chapter One provides an introduction
presenting the context and background for the study, the problem statement and the
research questions guiding the study. Chapter Two provides a review of the literature
related to the educative humanistic paradigm, relational process: interpersonal dynamics,
andragogy and preceptorship. Chapter Three outlines the methodology used to carry out
the study. Chapter Four provides the findings and discussion of the main themes and
variations to these themes from the phenomenological-hermeneutic research process. In
Chapter Five the findings and implications for nursing education and further research are
discussed.
Chapter Two: Literature Review
For the purposes of this study, a literature search was conducted using the
electronic databases of CINAHL, ERIC, ProQuest Nursing and Allied Health Source,
PubMed and PsychINFO. The descriptors ‗student teacher relationship,‘ ‗nursing
socialization,‘ and ‗teaching learning‘ in combination with ‗preceptorship‘ were used to
identify resources. The connector AND was used, for example, ‗student teacher
relationship‘ AND ‗preceptorship.‘ ‗Humanistic paradigm‘, ‗andragogy‘, ‗trust
development‘ and ‗power dynamics in evaluative relationships‘ were also used as
descriptors. In addition, reference lists from a number of peer reviewed articles were
examined to locate additional information. The search was limited to literature published
in the year 2000 or later and in the English language. Other literature has been used when
determined to be relevant to this topic. For example, textbooks were utilized to augment
the topics of humanistic paradigm, clinical practice, and relational process.
A synthesis of the literature resulted in four main categories: educative humanistic
paradigm, relational process, andragogy, and preceptorship. The educative humanistic
paradigm provides the philosophical underpinnings for exploring the student-preceptor
relationship within preceptorship. The educative humanistic paradigm will be discussed
next.
Educative Humanistic Paradigm
In Miller‘s (2006) view ―holistic education is an effort to cultivate the
development of the whole human being‖ (p.1). This holistic approach to education
reflects the importance of moral, spiritual, psychological, emotional, interpersonal,
physical as well as intellectual development. The need for individual intrinsic
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development is also recognized. Holistic education is characterized by an experiential
learning focus; an equal valuing on personal relationships and academic subject matter;
and a recognition for the unique feelings, ideas, and questions that each student brings to
the learning process. Likewise, Ornstein and Hunkins (2004) view humanistic education
as a type of holistic education.
Nursing education has moved toward educational processes grounded in
humanism. This movement away from a behaviorist paradigm began in the 1980s.
The seminal work of Bevis and Watson (1989) influenced the philosophy of nursing
education to shift from a behavioral approach toward a humanistic orientation. Given this
orientation, it should not be surprising that ―[c]urriculum in the educative-humanistic
paradigm is defined as the transactions and interactions that occur between student and
teacher and among students with the intent that learning take place‖ (Bevis & Watson, p.
190). The learning processes within this humanistic paradigm support an egalitarian and
liberating student-teacher relationship based on the constructs of caring, participation,
reflection, and partnership (Bevis & Watson). The egalitarian relationship proposed by
Bevis & Watson is one in which students are equal partners with teachers; it is a
relationship that enables both students and teachers to grow in a transformative learning
process, resulting in a transformational relationship. The egalitarian nature of this
relationship is critical to the learning process as it increases the chances that the intended
learning take place (Bevis & Watson). Ironside (2005) points out that creating excellence
in nursing education requires that students and teachers work and learn together through
partnerships between and among students and teachers; this, according to Ironside‘s
contention, leads to excellence in nursing education. As well, student-teacher interactions

9
generate a space where caring and compassion as moral imperatives in nursing are
valued. Stated another way, these interactions create a caring environment that supports
the cohesiveness of the relationship (Beck, 2001) and facilitates a safe environment in
which positive student-centered learning can unfold (Ironside, 2005). The outcome is ―a
high quality learning environment…with mutual respect, partnership, support and trust,
where staff are valued, highly motivated and provide supportive relationships‖
(Khomeiran, Yekta, Kiger & Ahmadi, 2006, p. 70). This description aptly describes the
connected student-preceptor relationship. When preceptors feel they are unable to
provide effective support in the relationship or if the student feels they are in an
unsupported environment, then a feeling of frustration can be felt by both partners
resulting in a suboptimal learning environment (Fox, Henderson and Malko-Nyhan,
2006).
Humanistic education focuses on the whole person and emphasizes an
equalitarian student-teacher relationship, participation, partnership, and, ultimately,
support of a person‘s integration of thinking, feeling, and acting as part of the learning
process. Additionally, humanistic educative curriculum designs emphasize growth of
interpersonal skills and positive self-concept. Some educators supportive of the educative
humanism contend that socialization and spirituality should be included as domains in
addition to the cognitive, affective, and psychomotor domains, and that these dimensions
should be interconnected in ways that best support the individual‘s personal journey in
education (Bevis and Watson, 1989; Miller, 2006; Ironside, 2005; Ornstein and Hunkins,
2004). In literature reviewed by Ornstein and Hunkins (2004), it is suggested that
humanistic curricula focus on enabling students to engage in the process of becoming,

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thus enabling their movement toward self-actualization. It is also important in this
learner-centered paradigm to ensure that students are actually learning attitudes, concepts
and skills that are considered essential in the learner‘s chosen profession, in this case,
nursing.
Congruent with humanism are positive interactions between student and preceptor
with the intent of skill acquisition. Benner (1984) used an interpretive phenomenological
approach to study the applicability of the Dreyfus Model of Skill Acquisition to nursing.
The Dreyfus model suggests a student moves through five levels of proficiency in the
development and acquisition of a skill. The five levels of proficiency are: novice,
advanced beginner, competent, proficient, and expert. The five levels of proficiency as
applied to nursing related to skilled nursing practices, that is, skilled nursing interventions
and clinical judgment skills in actual clinical situations. Level 1: Novice is a beginner
with no experience of the situation. This could be a student nurse or a nurse entering a
clinical setting where he/she has no experience. The novice is guided by rules and takes
in little of the situation. Level 2: Advanced Beginner is a new graduate nurse, or a nurse
entering a new clinical area. The advanced beginner demonstrates marginally acceptable
performance with high learning needs and takes in little of the situation. Level 3:
Competent represents a nurse with two to three years experience in the same clinical
setting with little understanding of the whole, while Level 4: Proficient represents a nurse
who has a better understanding and perceives situations as wholes. Finally, Level 5:
Expert is a nurse with an enormous background of experience and an intuitive grasp of
situations. They can solve problems and make decisions with ease since they have a
concept of the whole. The proficiency level of the student is novice with desired
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movement to advanced beginner as they become a new graduate. It is suggested that
recognition and support of behaviors associated with proficiency levels may positively
impact the quality of student learning and the student-preceptor relationship. The next
section of the literature review relates to the phenomena of relational process.
Relational Process: Interpersonal Dynamics
Building relationships within the complex interactions of the practice setting can
be challenging. Zilembo and Monterosso (2008b) suggest a model that focuses on the
interactions that occur within and around the preceptor-student relationship to create a
positive learning environment that ultimately leads to positive patient outcomes. The term
relational process as used in this thesis study builds on work by Myrick and Yonge
(2004) who define relational process as ―a complex, ongoing interpersonal dynamic‖
(p. 374) between the preceptor and student. In this ongoing preceptor-student
relationship, it is important to create space for learning (Ohrling & Hallberg, 2000b). This
space for learning is a space where a student feels secure with their preceptor and is able
to learn, mature and develop professional competence.
In a recent study Crawford, Dresen, and Tschikota (2000) describe the
preceptor-student relationship from a student perspective and identify certain themes as
important in developing a productive relationship. These themes include knowing each
other, mutual valuing, and congruence of values and expectations. Myrick and Yonge
(2001) view the preceptor‘s ability to value as well as to work with and to support the
student as a critical part of the relational process and thus the student‘s learning. Gillespie
(2005) contends that the qualities of knowing, trust, respect, and mutuality are required
12
for creating connection in the student-teacher relationship. It is in this connection that the
potential of transformation and growth exists. ―Student-teacher connection provides a
‗meeting‘ within which students are affirmed, expand their vision of what is possible for
them, and grow toward fulfilling those possibilities. The fruitfulness of the meeting is the
possibility that inhabits student-teacher connection‖ (p. 217). While Gillespie‘s (2005)
research was not specific to the preceptor model of clinical teaching, it does provide an
understanding of students‘ experiences with the student-teacher relationship in the
clinical area. The relationship qualities of knowing, trust, respect, and mutuality
identified by Gillespie are discussed with additional supporting literature relevant to each
quality. The role of knowing to an effective relationship will be discussed first.
Knowing. Several authors have linked knowing the student to an effective
preceptor-student relationship (Beck, 2001; Crawford, Dresen, & Tschikota, 2000;
Gillespie, 2005; Myrick & Yonge, 2001). They suggest that the preceptor knows the
student as a whole person and that the preceptor maintains an accepting and non-
judgmental presence, as well as an ability to help the student know them self and their
abilities as a person, student, and nurse. Given that the student-preceptor relationship
ideally is an egalitarian relationship, it is also valuable for the student to know the
preceptor more holistically; this can facilitate student trust of the preceptor and ease with
the preceptor. Gillespie contends that mutual knowing is a primary quality in the student-
teacher connection and thus an effective relationship. The quality of trust will be
discussed next.
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Trust. Trust has also been identified as a quality integral to an effective
preceptor-student relationship or connection (Crawford, Dresen, & Tschikota, 2000;
Gillespie, 2005; Hohler, 2003; Myrick & Yonge, 2001; Myrick & Yonge, 2004; Ohrling
& Hallberg, 2000c). Yakovleva, Reilly, & Werko (2010) cite ability, benevolence, and
integrity as factors which lead to the formation of trust; and concluded that
trustworthiness is exhibited through ability, benevolence and integrity. Ability reflects
ones work ethic and task oriented nature, whereas, integrity is a subjective measure often
correlated to a person‘s culture and power. Benevolence can be described as the kindness
and affective trust which underlies the relationship. Yakovleva et al. also contend the
level of trust which emerges will be dependent on both people‘s tenancy to trust, and
their perceptions of the other person‘s ability, benevolence, and integrity. The preceptor‘s
trust in the student‘s capacities fosters a student‘s self-trust and contributes to her or his
confidence and to an environment supportive to student learning. In general, trust may
develop over time as student and preceptor get to know each other.
Respect. Respect has been linked to effective preceptor-student relationships
(Beck, 2001; Crawford, Dresen, & Tschikota, 2000; Fernald, Staudenmaier, Tressler,
Main, O‘Brian-Gonzales, & Barley 2001; Gillespie, 2002; Myrick & Yonge, 2001;
Myrick & Yonge, 2004). In particular, Mee (2004) contends that respect between the
preceptor and the preceptee is vital to success for the preceptorship. Respect in the
preceptorship relationship affirms recognition of the student‘s existing and potential
capacities. Myrick and Yonge (2004) have suggested that, if a student feels respected by
the preceptor and if the preceptor is open in the relationship and flexible in her or his
14
thinking, this facilitates critical and reflective thinking, ultimately impacting the learning
relationship.
Mutuality. An effective and connected preceptor-student relationship is likewise
characterized by mutuality (Crawford, Dresen, & Tschikota, 2000; Gillespie, 2002;
Myrick & Yonge, 2001): mutual knowing, mutual trust, and mutual respect. The
mutuality of the relationship aligns with co-participation and egalitarianism despite the
inherent power imbalance. The inherent power imbalance that exists within the student-
preceptor relationship is correlated to different levels of experience, expertise, and
training. The different levels of proficiency were discussed previously. The use of
positive power by the preceptor will result in a mentoring role, rather than one of a
teacher or consultant. When the preceptor acts as a mentor, they minimize the power
difference that exists by utilizing their expert power to empower the student to assume
power. By minimizing this inherent power structure, collaboration is fostered (Murphy &
Wright, 2005). Murphy and Wright (2005) further explain that in order for power to be
utilized properly within this interpersonal relationship it must be openly discussed by
using the term ‗power‘ in conversation; the topic of power must be discussed in the first
student-preceptor encounter, and revisited throughout the relationship. Despite the power
imbalance, preceptors can empower the student by affirming that their understanding is
accurate, allowing them to make autonomous decisions, and giving them choices
(Murphy & Wright, 2005). The same authors go on to conclude that the students expected
this use of power, and appreciated it as it helped them to become better practitioners.
Preceptors should use their power in a positive way to foster trusting relationships.
15
Fostering trust within the student-preceptor relationship facilitates developing
interpersonal skills.
The growth of interpersonal skills and behaviors assist persons in establishing
productive relationships with others. These interpersonal abilities include caring about
people through understanding, empathizing, and motivating others; being able to see
another‘s perspective; and being able to communicate with others (Fenwick & Parsons,
2009). These interpersonal skills and behaviors highlight roles of the preceptor and
student during the preceptorship experience.
Caring. Caring is a core value in nursing. In a meta-synthesis of literature on
caring within nursing education, Beck (2001) identified five themes of caring in nursing
education. The caring themes are presencing, sharing, supporting, competence, and
uplifting effects. The theme of presencing relates to presencing oneself to listen and
understand another person‘s perspective as part of the process of caring. Sharing of self
facilitates the connecting process of caring. Supporting is a key component of caring in
nursing education especially among nursing students. Competence is expressed as a
professional responsibility related to being prepared, explaining, educating, and following
up to ensure that the person has the knowledge and skills to respond appropriately to a
clinical situation. Uplifting effects of caring include being respected and valued as a
unique person. It also includes growth, transformation, and learning to care. These
themes relate to caring experiences among faculty caring for faculty; faculty caring for
students; students caring for each other; and students caring for their clients. The
properties of these themes are important components to strengthen the student-preceptor

16
relationship. ―Caring is a human process…concerned with the human center of self and
other‖ (Watson cited in Bevis & Watson, 1989, p. 53). Preceptors who model caring and
dialogue about caring with their student also support strengthening of the student-
preceptor relationship.
Student-teacher connection. A student-teacher connection is foundational for
effective learning (Beck, 2001; Gillespie, 2005; Gillespie, 2002; Vaughn & Baker, 2004).
Gillespie asserts that students in connected relationships described feeling at ease with
their teacher. ―Their feelings of ease, feeling valued and respected, and experiencing
positive self-regard, reflect the connected student-teacher relationship as a safe
environment that affirmed them as people, learners and nurses, and supported their
learning experience‖(Gillespie, 2002, p. 569). By comparison, in a study conducted by
Kim (2007), findings revealed that students perceived greater competence in their nursing
skills when they experienced a greater degree of interaction in their preceptor
relationship. This also supported their learning experience. Many references in the
literature identify the positive outcomes of relationally-based or humanistic educational
practices as supportive to student learning (Gillespie, 2005; Kim, 2007; Myrick & Yonge,
2004; Myrick & Yonge, 2001; Ohrling, 2000b; Yonge, Myrick & Haase, 2002; Milembo
& Monterosso, 2008a).
In a similar vein, Cranton (2006) contends that establishment of an authentic
student-teacher relationship will lead to a transformative relationship which is central to
transformative learning. Transformative learning refers to a process that occurs when
individuals question assumptions, beliefs, feelings and perspectives in a purposeful way

17
in order to attain personal growth. Cranton suggests that critical reflection as outlined in
Mezirow‘s (2000) conceptualization of transformative learning is one component of
transformative learning. Cranton (2006) further proposes that ―the central process of
transformative learning may be rational, affective, extrarational, or experiential
depending on the person engaged in the learning and the context in which it takes
place‖(p.6). In Cranton‘s view, the development of an authentic teacher-student
relationship is transformative learning.
Emancipation and empowerment. Boychuk Duchsher (2000) has described
emancipation and empowerment in nursing education as a ‗transformed student-teacher
relationship‘ in which both are co-participants in the learning with each learning from the
other. The teacher does not exercise power over the student. At the same time, the
partnership or relationship between student and teacher is one that enables
meaningfulness and motivation to achieve expectations. In other words, it is empowering
and transformative. In this relationship it is important to recognize both student and
preceptor are adult learners. Thus, andragogy or adult learning theory is relevant to
discuss. Andragogy emphasizes the importance of knowledge being transferred in a
manner that is most appropriate for the adult learner, as this increases the likelihood of
the information being understood. Andrgogy will be discussed next.
Andragogy
When precepting adult learners, it is important to understand adult learning theory
in order to most effectively enhance their learning. Use of andragogy is understood to

18
decrease the learner‘s dependency, assist learners utilize their learning resources, enable
students to define their own learning needs, and assist learners in defining, planning, and
evaluating the learning process (Holton, Wilson, & Bates, 2009). In adult learning, the
teacher acts as a facilitator of learning as opposed to the primary provider of information.
The student actively participates in the learning process utilizing their past experiences
concurrently thus allowing more self-directedness in learning (Chesbro & Davis, 2002;
Holton, Wilson, & Bates, 2009).
As noted in the seminal work of Knowles (cited in Chesbro & Davis, 2002
and Holton, Wilson & Bates, 2009) there are six principles about the adult learner which
should serve as a foundation for andragogy. These principles include: 1. as a person
matures their self-concept moves from that of a dependent personality towards one of a
self directed person; 2. adults accumulate a growing reservoir of experiences and these
serve as resources for learning; 3. the readiness of an adult to learn is correlated to the
developmental tasks of their social role; 4. as a person matures there is a change in time
perspective from future application of knowledge to immediate application of knowledge,
therefore, adults are more problem-centered learners in contrast to subject-centered;
5. internal factors rather than external factors are the adults motivation to learn; and
6. adults must understand why they need to learn something before they attempt to learn
it. Knowles (1990) advocates for skill in human relations and utilization of the six
andragogical principles as the basis of adult education.
Also influential to the adult learning theory is andragogy‘s eight design elements
which occur before, during, and after the learning process (Knowles, 1984 cited in
Holton, Wilson, & Bates, 2009). These design elements are: ―preparing the learners,
19
climate setting, mutual planning, diagnosis of learning needs, formulation of learning
objectives, learning plan design, learning plan execution, and evaluation‖ (Holton et al.,
p. 171). Integrating these design elements into the learning process enhances the adult
education experience.
The six andragogical principles and eight design elements form a platform to
help adult students learn and to meet student learning needs within the preceptorship
experience. Utilizing these principles and elements in the student-preceptor relationship
is conducive to the partnership and to participatory, student-centered learning. Student-
centered learning is focused on the student's needs and abilities with the teacher as a
facilitator of learning. Application of adult learning theory in preceptorship supports the
student and preceptor as they enhance their nursing proficiencies during the preceptorship
experience. The topic of preceptorship will now be discussed.
Preceptorship
Use of the preceptorship model is prevalent in nursing education (Udlis, 2008)
and the education of allied health professions (Billay & Myrick, 2008). In particular, it is
regarded to be an effective teaching strategy that facilitates learning and socialization into
the professional role. Udlis discussed the state of knowledge about preceptorship in
undergraduate nursing education through an integrative review of the literature between
the years of 1986 and 2006. Key findings from this review suggest that not only is
preceptorship financially beneficial, it also appears to prepare students for the
professional role of nursing and facilitates their adaptive learning competencies. Billay
and Myrick (2008) discussed the state of knowledge about preceptorship in allied health
20
professions through an integrative review of the literature between the years of 1994 and
2005. Their findings demonstrate that the practice professions of nursing, medicine,
dentistry, and pharmacy utilize preceptorship as a means of professional preparation,
acknowledge that preceptor attributes, experience and knowledge are assets in facilitating
student learning.
In a study conducted by Fernald, Staudenmaier, Tressler, Main, O‘Brian-
Gonzales, and Barley (2001) medical students identified key features that enable a
positive preceptorship experience. These features include having a common
understanding of preceptorship objectives; being engaged in active teaching and active
learning; and being involved in a respectful, trusting relationship. Ohrling and Hallberg,
(2000a) contend that the nursing student‘s learning in preceptorship can be understood in
terms of modes of learning: directing learning; learning in practical action; and feeling in
learning. For example, learning is directed toward increasing competence through
practical actions (by doing, practicing, and performing) with sensitivity to the emotions
one is feeling. Findings dealing with student nurses‘ pre-graduation preceptorship
experiences as described by Wieland, Altmiller, Dorr, and Robinson Wolf (2007)
demonstrated that this experience facilitates an increase in student‘s knowledge and skill
which contributes to increased student confidence, competence, and independence.
In the Oxford English Dictionary (1989), the term preceptor is defined as a
teacher, tutor, or instructor; by comparison, the term preceptee is defined as an individual
who is being trained by the preceptor. Within the preceptorship model, the student is the
learner moving towards the level of a novice practitioner; the nurse preceptor acts as a
role model, advisor, and teacher who guides and facilitates the student‘s learning. This
21
link between preceptor and preceptee has been longstanding. In the recent literature, the
student-preceptor relationship is identified as foundational to the success of the
preceptorship experience. A positive preceptor-student relationship is an integral
component of successful student learning (Crawford, Dresen, Tschikota, 2000; Licqurish
& Seibold, 2007; Vaughn & Baker, 2005); by comparison, if this relationship is strained,
there will be a negative impact on the preceptorship experience, ultimately resulting in
failure to meet the learning expectations (Dube & Jooste, 2006; Manchur & Myrick,
2003).
The power of relationship in the student-preceptor experience should not be
minimized. The phrase ―relationships often trump structure‖ (Granovetter as cited in
Bolman & Deal, p. 168) speaks to the potential power both positive and negative within
relationships. According to Yonge, Myrick and Haase (2002), ―[p]receptorship is among
the most stressful of student experiences‖ in that two complete strangers must work
together to facilitate student‘s goal to assimilate theory and practice in final preparation
for transition to the realities of the real world of nursing (p. 84). The student-preceptor
relationship can ‗make or break‘ the preceptorship experience, thus providing rationale
for establishing meaningful and connected relationships (Yonge et al; Zilembo &
Monterosso, 2008a). In order to understand the student-preceptor relationship,
consideration of the characteristics of the preceptor is required.
Characteristics of the Preceptor. In the Oxford English Dictionary (1989), the
term characteristic is defined as a quality or feature. In the preceptorship experience,
characteristics refer to the qualities or features that the preceptor needs to possess to
22
positively influence the preceptorship relational process, noting that all relationships are
complex. There is much in the literature with respect to preceptor behaviors and their
significance to students. Positive role models and experiences over time facilitate these
ways of behaving (Elzubier & Rizk, 2001; Gray & Smith, 2000; Hirst & Lane, 2005;
Myrick & Yonge, 2002; Zilembo & Monterosso, 2008a).
Contributing to the quality of this relationship are the characteristics or attributes
the preceptor brings to a successful relationship with the student and in facilitating
student learning. A positive preceptorship experience was noted when students worked
with preceptors who were caring, had clinical expertise, provided support and modeled
critical judgment (Delaney, 2003). Giving students the ability to reflect on their own
practice and to articulate this to their preceptor was also cited in positive preceptorship
experiences (Haggerty, 2002). Preceptor qualities of knowledge and skill in assessment
and feedback, good communication skills, leadership and reflective practice skills are
considered essential to ensure the success of this relationship (O‘Malley, Cunliffe,
Hunter, & Breeze, 2006).
Zilembo and Monterosso (2008a) suggest that a student will have a positive
preceptorship experience when the preceptor demonstrates the skills of caring,
compassion, competence, and role modeling. The findings of this study suggest that
students who feel secure with their preceptors will ask more questions and seek out
additional learning opportunities which, in turn, will enhance their experience,
confidence, and competence. Preceptors contribute to the preceptor-student relationship
through role modeling, facilitation, guidance, and prioritization behaviors (Myrick &
Yonge, 2002).
23
According to Dube and Jooste (2006) certain preceptor characteristics enable
preceptors to be sensitive to student learning needs and thus reduce the stress associated
with being in unfamiliar environments. Some of these characteristics included social
skills, ability to teach and guide students, being knowledgeable, flexible and innovative,
and being a positive role model and team player. Dube and Jooste describe social skills as
a preceptor characteristic referring to the preceptors‘ ability to respect students in the
workplace and to acknowledge their frustrations. Being knowledgeable, flexible and
innovative enhanced the preceptors‘ ability to teach and guide students. Teaching and
guiding students was seen as part of the preceptors‘ role expectation and when preceptors
were committed to this it signaled knowing and caring for one‘s student. ―The role model
function of the preceptor is described as the pillar in preceptorship relationships‖ (p. 32)
with the preceptor expected to demonstrate positive behaviours and technical skills.
Finally, being a team player afforded the student independence, opportunities to work
with other nurses, and to feel a sense of belonging to the unit team. These characteristics
were also viewed as ideal to sustain the student-preceptor relationship.
Hirst and Lane (2005) found that effective preceptors tend to be self confident,
knowledgeable, and competent with communication processes. Such preceptors also
assume partial responsibility for the student‘s learning, are capable of maintaining
objectivity, are capable of making difficult decisions, and act as professional role models
with students, co-workers, and patients/clients. In addition, it is valuable for preceptors to
have positive attitudes toward students and others in the setting as well as patience and
desire to motivate students to learn (Smedley, 2008).

24
Gray and Smith (2000) conducted a longitudinal qualitative study to capture
changes in the students‘ perspective of what makes a good preceptor over time. At the
end of the study from a student perspective, an effective preceptor is a good role model,
enthusiastic, approachable, understanding, and knowledgeable. She or he is a good
communicator, has realistic expectations, provides feedback on the student‘s
performance, and demonstrates confidence and trust in the student‘s abilities by gradually
withdrawing supervision.
Other characteristics of the effective preceptor pertain to emotional intelligence.
Goleman (1998) contends that emotional intelligence is what distinguishes the best
leaders and the best relationships from the others. Emotional intelligence is composed of
a set of five traits: self-awareness, self-regulation, motivation, empathy, and social skill.
Social skill as a trait integrates self-awareness, self-regulation, motivation, and empathy
as a way of generating effective interaction that moves an individual in a desired
direction. According to Goleman, these abilities can be strengthened through practice and
feedback. Such skills support the student-preceptor connection. As Dube and Jooste
(2006) conclude: the ―characteristics of the preceptor have a direct bearing on the
outcome of the preceptorship relationship and attainment of the preceptees‘ clinical
objectives‖ (p. 36).
As suggested, preceptor characteristics can be either a motivator or a barrier to an
effective preceptor-student relationship and thus to the broader preceptorship experience.
While a number of studies present a profile of an effective preceptor (Dube & Jooste,
2006; Gray & Smith, 2000; Hirst & Lane, 2005; Myrick & Yonge, 2002; Smedley, 2008;
Zilembo & Monterosso, 2008a), they have not fully captured preceptor-in-relationship-
25
with-student or the interpersonal dynamic that forms a successful student-preceptor
relationship. This study intends to do so.

Chapter Three: Methodology and Research Design
Based on an interpretivist epistemology, the main purpose of qualitative research
is to understand the meanings that certain social phenomenon have for a person; that is,
qualitative research is about gaining a full understanding of a phenomenon based on in-
depth, rich descriptions of the meanings, capturing both emic and etic perspectives (Gall,
Gall, & Borg, 2005). Capturing both emic and etic perspectives facilitates an
―understanding of a complex phenomenon as experienced by participants‖ (Gall et al.,
2005, p. 309).
Qualitative research is an appropriate approach for investigating this issue as the
researcher‘s focus is to understand students‘ experiences. The goal is to explore the
depth, richness, and complexity of the student-preceptor relationship during
preceptorship. In other words, qualitative research provides a platform to gain
understanding of the social reality of a fourth year nursing student who participates in a
relationship with an assigned clinical preceptor. Further, qualitative researchers hold the
view that human feelings and thoughts are worthy of study (Gall et al., 2005). The
qualitative researcher is the instrument for data collection and analysis by becoming part
of the process in order to transform the information (Streubert Speziale & Rinaldi
Carpenter, 2007). That is in order to discover, describe, understand and/or interpret
participants‘ thoughts, feelings, and experiences; this research lens may bring to light
knowledge from a fresh perspective.
The qualitative research approach and an existential orientation in
phenomenological with some hermeneutics were selected in this study as this is best
suited to focus on the lived experience (Todres & Wheeler, 2001; van Manen, 2002;
26
27
van Manen, 1997). As the purpose of this study is to understand the lived experiences of
nursing students‘ relationships with their assigned clinical preceptor, this methodology is
ideal and appropriate.
Methodology
According to van Manen, ―methodology refers to the philosophical framework
that must be assimilated so that the researcher is clear about the assumptions of the
particular approach, whereas method refers to the research technique and the procedure
for carrying out the research‖ (1990, cited in Caelli, 2001, p. 275). Within a qualitative
paradigm, a hermeneutical phenomenological methodology is best suited for interpreting
and understanding the meaning of a nursing student‘s experience inside the student-
preceptor relationship. Phenomenology provides the researcher with a framework to
discover what it is like to live a certain experience (Streubert Speziale & Rinaldi
Carpenter, 2007; van Manen, 1997). Heidegger, a phenomenological philosopher, held
that phenomenology is interpretive (van Manen, 2002; van Manen, 1997). Heidegger
further contended that understanding and interpretation (hermeneutics) are necessary
components of human existence (Loiselle & Profetto-McGrath, 2007). van Manen
(1997) states, ―[h]ermeneutic phenomenology is a human science which studies persons‖
(p. 6) and ―edifies the personal insight‖ (p. 7). These statements further support the
appropriateness of this methodology.
Phenomenology as a Philosophy. In the literature, hermeneutic
phenomenological inquiry is discussed both as a philosophy and a method of

28
investigation (Caelli, 2001; Mackey, 2005). Crist and Tanner (2003) indicate that the
―philosophy of hermeneutics underpins interpretive methodology, the science of
interpreting human meaning and experience‖ (p. 202). ). That is, the true meaning of
phenomena can only be explored through the experience of them as described by the
person. The philosophical tenets embedded in hermeneutic phenomenology serve as the
scaffolding for this study. These philosophical tenets include the following:
a grounding in the life-world as a starting point (Todres & Wheeler, 2001; van Manen,
1997); an interpretive sense of the experience in the life-world (Todres & Wheeler, 2001;
van Manen, 1997); and a languaging reflective of the lived world or of being-in-the-
world (Todres & Wheeler; van Manen).
Grounding in the life-world as a starting point was espoused by Edmund Husserl
and centers around experiential occurrences or lived experiences with attention given to
the notion that ―the lived is greater than the known‖ (Todres & Wheeler, 2001, p. 3).
Husserl, a philosopher, took an epistemological position. Heidegger moved from an
epistemological perspective to an ontological perspective, focusing on the intrinsic nature
of interpreting human existence. The process of the hermeneutic circle, which Heidegger
coined, enriches the interpretive sense or understanding of the experience in the life-
world. The hermeneutic circle guides the inquiry process as analysis moves from parts of
the text in relation to the whole text and vice versa. Finally, being-in-the-world refers to
the co-constituted relationship between human existence and the world. Heidegger
identified structures or languaging to reflect essential qualities of human presence as
described by the person. An example of one such structure includes ―the way that the
quality of interpersonal relationships occur; the interpersonal description of the

29
experience, of presence or absence, active or passive‖ (Todres & Wheeler, 2001, p. 5).
Heidegger‘s existential and ontological way of being-in-the-world are central to this
study.
The philosophical and methodological framework for this study is in keeping with
Heidegger‘s views. Building on Heidegger‘s views is the Dutch phenomenologist and
educator Max van Manen. For van Manen, ―[h]ermeneutic phenomenology is a
philosophy of the persona, the individual, which we pursue against the background of an
understanding of the evasive character of the logos of other, the whole, the communal, or
the social‖ (1997, p. 7). As such this philosophy is congruent with van Manen‘s
interpretive methods.
Research Design
The research process included: ethics and human relations, sampling, and method.
Ethics and Human Relations. Ethical approval was secured from both Nipissing
University and Laurentian University ethics review boards. There were no threats to
participants. The researcher was sensitive to participant fatigue and/or psychological
stress.
The researcher was in a co-teaching position for the 4th year WebCT based
clinical practice course. For this course there were two face-to-face class meetings: one
at the start of the term and one at the end of the term. The researcher and co-teaching
partner met jointly face-to-face with this student group at the start of the term on January
8, 2010. The researcher did not participate in the final face-to-face class meeting
30
scheduled on the afternoon of March 25 and the morning of March 26. This study
commenced after course completion. The researcher‘s co-teaching partner assumed
responsibility for the end of term face-to-face class meeting and all evaluative
components commencing March 15, 2010 to the completion of the course. Thus the
researcher‘s relationship with the project participants was limited to one face-to-face
class on January 8, 2010 and shared evaluation of bulletin board postings prior to March
15, 2010. This change in the researcher‘s course responsibilities was shared with the
students through a WebCT bulletin board posting. The Information Letter (Appendix A)
explicitly stated that student participation in this study was strictly voluntary and would
not affect their status in the nursing program. A student‘s decision to participate or not
participate in the study did not influence their grades or any other decisions that were
inherent in the 4th year clinical practice course. The co-teaching professor was not
influenced to evaluate students in any different manner. Further, the co-teaching
professor did not know whether students participated or not in the study. Individual
students were free to participate if interested, free to not answer any question they found
uncomfortable, and free to withdraw from the study at any time.
Immediately following completion of this 4th year clinical practice course on
March 26 a third party, who was not teaching in the BScN program, introduced the study
and distributed the Information Letter (Appendix A) on the researchers‘ behalf. The
Consent Form (Appendix B) explicitly conveys the same message: a student‘s future
would not be affected in any way by participating or not participating in this study. The
Information Letter (Appendix A) included a description of the research (purpose and
objectives); the role of the participants; the length of time and frequency involved;
31
strategies for disseminating research results; potential risks; potential benefits; and
measures to secure participant‘s privacy, confidentiality and anonymity.
Sampling. Nursing students at Laurentian University who were in the final fourth
year clinical practice course were eligible to participate in this study. This group of
students had completed a 360 hour clinical practice preceptorship prior to this study; as
such, they are the persons who have been living this experience and are information rich
on this topic.
The sampling unit is the individual student as each student‘s experience was
considered to be unique and personal, in-line with phenomenological philosophy. For
each participant, the data collection and analysis focused on their lived experience inside
the relationship with the preceptor. The sample size was small with six students. Data
collection was completed when the data became repetitive in nature (Gall et al., 2005).
Method
van Manen‘s method of phenomenology (1984) was used. His framework
includes four categories: 1. turning to the nature of lived experience; 2. the existential
investigation; 3. phenomenological reflection; and 4. phenomenological writing.
In van Manen‘s view, there is no correct sequential order, and one may work on each
category at the same time.
1. Turning to the nature of lived experience. Turning to the nature of lived
experience refers to committing oneself or being-given-over to the fullness of thinking in

32
an attempt to understand the true meaning of a certain aspect of human existence.
According to Heidegger, ―to think is to confine yourself to a single thought till it stands
still like a star in the world‘s sky‖ (as cited in van Manen, 1984, p. 40). The researcher
used personal journaling to explicate assumptions and pre-understandings as well as
facilitate orientation to the phenomenon. That is, what is it like? or what is the essence of
the lived experience in the student-preceptor relationship?
2. The existential investigation. The existential investigation of experience as we
live it allows for the generation of data as the researcher actively explores the lived
experience, finding ways to more deeply understand it. A semi-structured interview
method which maintained a conversational element was used for data collection. The
researcher‘s role during the interview process was to collect the participant‘s stories.
I began the interviews by asking each student if they had any questions related to
the Information Letter (Appendix A) or the Consent Form (Appendix B). I collected the
consent forms. I reiterated the objectives of the study as stated on the Information Letter.
I then said ―The focus today is about student-in-relationship with preceptor. There are
two groups of questions – one around your learning in the program; the other around your
learning in preceptorship. I am going to start by asking questions about your experiences
in the program and then get into more specific questions about your experiences in
preceptorship.‖ The rationale for beginning with questions related to a student‘s learning
in the program was to allow students to think about their learning in a broader way while
becoming comfortable with the discussion. Once these general questions had been
33
completed, more specific questions related to an experience they had just completed were
asked.
Following the introduction I commenced with the interview questions. I asked
participants to focus on a specific incident or situation then I explored the experience to
its fullest with consideration to feelings, mood and emotions through the use of probing
questions and silence. For example, I asked ―Tell me about a specific practice
experience‖. Later in the interview I said ―Think about some of your experiences with
your preceptor (positive and negative) – what comes to mind?‖ Once the student had an
experience in mind I would ask, ―How did you feel in this experience?‖ In both contacts
with participants I would regularly ask the questions: ―how did that make you feel?‖ or
―what was it like for you?‖ This allowed me to better understand the students‘ lived
experience. ―[I]t is imperative to stay close to [the] experience as lived‖ (van Manen,
1997, p. 67) avoiding generalization about the experience. Gall et al. (2005) recommend
the use of open-ended questions as this allows participants to respond more openly using
their own terms to describe experiences. Semi-structured interviews with reflective
dialogue and inquiring questions facilitated elicitation of the emic perspective.
Participants were interviewed for 45 - 60 minutes on 2 separate occasions. In the
first interview participants were asked questions as outlined on the Conversational
Interview Guide (Appendix C). In the second interview participants were asked to verify
and/or edit information provided in first interview. Each interview was conducted at the
participant's convenience. With permission, the interviews were audio-taped and
transcribed.
34
3. Phenomenological reflection (The analysis). To grasp the essential meaning
or essence of a phenomenon it is important to reflectively ask and to consider ―what is it
that makes this lived experience what it is?‖ (van Manen, 1984, p. 41). The means of
analysis in hermeneutic phenomenology is the hermeneutic circle. The hermeneutic circle
includes three steps in its process: naïve reading, structural analysis, and interpretation of
the whole (Gall et al., 2005). Use of the hermeneutic circle allows the researcher to
discover, describe, understand, and / or interpret the experience that the participant is
sharing. According to van Manen, (1984):
[t]he point of phenomenological research is to ‗borrow‘ other people‘s

experiences and their reflections on their experiences in order to better be able to
come to an understanding of the deeper meaning or significance of an aspect of
human experience, in the context of the whole of human experience. (p. 55)
Additionally van Manen suggests three approaches to uncovering or isolating themes:
―the wholistic or sententious approach; the selective or highlighting approach; and the
detailed or line-by-line approach‖ (1997, p. 93). Each of these approaches has a specific
focus and were used collectively to determine themes in this study. There is overlap
between using the hermeneutic circle and van Manen‘s approaches to uncovering themes.
As such, wholistic reading as described by van Manen has been blended with naïve
reading, the first step of the hermeneutic circle. Selective reading and detailed reading as
described by van Manen have been blended with structural analysis, the second step of
the hermeneutic circle.
Naïve reading. During naïve reading, the researcher read all interviews
individually to gain sense of the whole text; this was followed by documentation and
discussion of impressions.
35
Wholistic reading. In the wholistic reading approach attention was given to
formulating phrases that represented the overall meaning of the text. Different readers
may identify different overall meanings as this is a judgment call. As I read over each
text I tried to formulate a phrase that might capture the main significance of the text. This
is reflected through the initial analysis of each account.
Structural analysis. Structural analysis or interpretive reading involved
identification of patterns, common themes, essences, and / or meaningful connections.
This was done on each interview transcript in order to write the accounts. It was done
again on each account and finally across the six accounts.
Selective reading. In the selective reading approach attention was given to
highlighting phrases in the text that seem to be revealing about students‘ experiences
inside the student-preceptor relationship as described by them. In reviewing highlighted
phrases that stood out in the text, initial themes of this experience emerged. These initial
themes are contained in the first table following each account.
Detailed reading. Finally, in the detailed reading approach attention was given to
asking what each sentence or sentence clusters revealed about the students‘ experience
being described. I read each sentence or sentence cluster and wrote beside them what the
sentence(s) seem to reveal about the lived experiences of each student. The second table
following each account contains these lived experiences. This table contains the themes
as well as moments supporting each theme.

36
Interpretation of the whole. Interpretation of the whole involved reflecting on
initial reading and interpretative reading to ensure a comprehensive understanding was
captured. ―Within the circular process, narratives are examined simultaneously with the
emerging interpretation, never losing sight of each informant‘s particular story and
context‖ (Crist et al., p. 203). Themes from each account were compared and analyzed
several times. This going back and forth between the parts and the whole resulted in the
separation of the lived experience from the situational context. The overall themes
related to the situational context are contained in Table 7. The overall themes related to
the lived experience are contained in Table 8.
4. Phenomenological Writing. Phenomenological writing is describing the
aspect of human existence through varying the examples, writing and rewriting to
uncover deeper and deeper meaning of the phenomenon. van Manen (1997) views the
discovered themes as the structures around which the phenomenological descriptions will
be written. Creation of text writing is reflective in nature and will start with composing
linguistic transformation of the uncovered themes. In order to ―do justice to the fullness
and ambiguity of the experience of the lifeworld, writing may turn into a complex
process of rewriting (re-thinking, re-flecting, re-cognizing)‖ (van Manen, p. 131). This
process of rewriting is relevant as it aims to create depth or explicate the multiple layers
of meaning intrinsic to the experience. Utilizing the uncovered themes now reflected in
Table 7 and Table 8, I wrote two fictional accounts using the first person narrative of
what the lived experience is like. These experience narratives recollect lived experiences
and allow the reader to recognize similar feelings.

Chapter Four: Findings and Data Analysis
van Manen (1997) suggests that ―the purpose of phenomenological reflection is to
try to grasp the essential meaning of something‖ (p.77). In this study the purpose was to
grasp the essential meaning of the student-preceptor relationship from the perspective of
the student and its‘ influence on student learning through student verbal accounts. This
essential meaning is multi-dimensional and multi-layered and critical reflection on the
participants‘ lived experiences is required. This essential meaning, as comprised of
themes, forms the structure of lived experience.
To better understand the meaning of the lived experiences the processes of
explicating my personal beliefs and member checking were followed. Explicating my
beliefs made me aware of potential judgments, presuppositions, personal biases, and
belief systems that may affect analysis. Journaling during the research time-frame helped
me keep an open mind and assess for researcher reflexivity (Cohen et al., 2000; van
Manen, 1997). The following personal assumptions arose from the journaling. One
assumption was that students would clearly articulate course clinical expectations as well
as their personal learning objectives to their preceptor. The depth of sharing clinical
expectations and personal learning objectives seemed to vary, with some students clearly
sharing this information with their preceptors and other students not. The focus of another
assumption was that student and preceptor would work together discussing and resolving
issues as they occurred. If issues were not resolved the assumption was the student
would contact their faculty member at the student‘s educational institution. Some student-
preceptor pairs resolved issues while other student-preceptor pairs did not. None of the
students contacted their faculty member to appraise them aware of issues or to seek their
37
38
guidance with issue resolution. The final assumption was that student and preceptor
would share a balanced relationship recognizing the student as learner partnering with a
preceptor to support this learning process. This did not happen for all students. Some
students felt not listened to and unsupported in their learning expectations.
To better understand the meaning of the lived experiences and to verify accuracy
of the verbal accounts I met with each participant a second time. By returning to the
participants to see that they recognized the findings as true to their experiences,
credibility of the findings was supported. This process is referred to as member checking
(Cohen et al., 2000). Demonstrating trustworthiness of the findings, in addition to
demonstrating credibility, involves dependability, and confirmability of the findings
(Streubert Speziale & Rinaldi Carpenter, 2007).
In this chapter I present findings from six undergraduate fourth year nursing
students who shared their lived experiences inside the student-preceptor relationship. The
names used in the accounts are pseudonyms. Based on the two interviews with each
student an initial analysis including introduction of the situational themes is provided.
This is followed by an analysis of the lived experience for the particular student. In the
final analysis section common themes across all accounts are identified for both the
situational context and the lived experience. This is followed by two first person
narratives, utilizing the uncovered situational and lived experience themes common to all
participants as the basis for the lived experience of a fourth year student inside the
student-preceptor relationship.
39
The Accounts and Initial Analysis
Six pre-graduate student nurses were interviewed. These are their verbal accounts
with initial analysis followed by a revised analysis based on member checking. The first
participant is represented by Alana.
Alana’s verbal account and initial analysis. I feel a lot more confident this year.
I feel like I am working, not in school. The relationship I have with my preceptor is
definitely more casual than with other clinical educators. She is very friendly and open
toward me. She really cares about how I'm doing, what I'm learning, and if I'm
comfortable. She's also great to find things that are going on and to send me to do or
observe procedures. I went to the dialysis floor one day. It was a great learning
experience for me and she covered my patients while I was gone. Doing skills in clinical,
especially like medications, solidifies everything you‘ve learned. It doesn‘t seem real
until you do it in clinical. I feel comfortable making suggestions or asking questions
about why she does, what she does. We had a patient who was allergic to latex. My
preceptor started an IV on the patient and used latex tape. So I could say ―you know she's
allergic to latex, maybe use this type of tape‖ and that was OK. She treats me more like a
colleague than like a student. She refers to me as the other nurse letting patients know
they can ask the other nurse (me) questions.
Learning within the student-preceptor relationship is very rewarding because
you‘re learning so much, you‘re doing things on your own and you're getting feedback
from what you‘re doing. I had a previous preceptor who did not provide much feedback
and sometimes I felt a little lost. I didn‘t feel confident in that situation. It is great to have
someone to bounce ideas off of. I get a real feeling of satisfaction when I do things on my
own. My preceptor trusts me enough to administer medications on my own, to put in NG
tubes on my own, to ask questions when I need to and that makes me feel very confident.
It makes me feel that I'm competent when I can go off all on my own and that she trusts
me to go off on my own. She is a good role model which makes me feel safe to learn
from her.
Over the term my preceptor and I have gotten more comfortable with each other,
we've gotten to know each other better, she's comfortable with my skills, with my
knowledge, she knows my weaknesses, and she knows I will go to her if I have any
questions. By the end of the term I pretty much worked on my own. By the end of the
term with my preceptor it felt like real life - this is what it's going to be like when you're
working in the real world.
This was a confidence building and rewarding experience for Alana. Alana felt
motivated to learn. Inside the student-preceptor relationship Alana felt cared for by her
preceptor. She felt cared for as a person and as a learner. Alana‘s preceptor was friendly
40
and open establishing a colleague-type relationship with Alana. She secured additional
learning opportunities for Alana. The preceptor spent time getting to know Alana through
providing feedback and acknowledging Alana‘s strengths and limitations. Alana felt
comfortable in this relationship; comfortable to make suggestions and to ask questions
about patient care or her preceptor‘s actions. Alana‘s preceptor was available ‗to bounce
ideas off of‘ and this allowed Alana to feel confident in the situation. More specifically
Alana felt comfortable with the way her preceptor treated her: ‗she trusts me to go off on
my own‘ and ‗she refers to me as the other nurse‘. This trust and respect allowed Alana
to feel confident and competent. Alana‘s preceptor allowed Alana to gradually work
more independently knowing that Alana would resource her for discussion or when
necessary. By the end of the term Alana was working on her own with her preceptor
accessible to her. For Alana, she felt working on her own solidified her practice, gave her
a feeling of satisfaction, helped with confidence and allowed her to feel like she was
working in the ―real world‖. As such, this experience increased Alana‘s sense of
autonomy and perhaps readied her for the transition into the work force.
Revised analysis based on member checking. Alana verified accuracy of the
account and the initial analysis. The situational themes are reflected in Table 1-1 and
Alana‘s lived experience is reflected in Table 1-2.
Alana reinforced her perception that there was a direct link between how her
preceptor treated her and how comfortable she felt in their relationship and in the clinical
setting. Alana‘s preceptor treated her with friendliness and openness, with caring
(looking out for her), and with respect as a colleague resulting in a comfortable, trusting
41
relationship where Alana could make suggestions, ask any question and didn‘t feel
anxious about going into clinical. Alana also reiterated the importance of having gradual
independence from her preceptor as this allowed her to solidify her learning and build her
confidence. Alana felt this independence occurred because of their trusting relationship.
Table 1-1
Situational Themes related to Alana‘s Account
Theme and Variations Moment

Preceptor treatment of me
 Caring for me She really cares about how I‘m doing, what I‘m
…creating learning learning, and if I‘m comfortable.
opportunities for Doing skills in clinical …solidifies everything
me you‘ve learned.
She's looking out for me. She really cares about how
I'm doing, what I'm learning, and if I'm comfortable.
Find things that are going on and sends me to do or
observe procedures.
She covered my patients while I was gone (on
different learning experiences)
 Knowing each The relationship I have with my preceptor is

other definitely more casual. She treats me more like a
colleague than like a student.
She is very friendly and open to work with me.
Learning within the student-preceptor relationship is
very rewarding … getting feedback from what you're
doing. … I felt a little lost without it. … didn't feel
competent
She is a good role model.
 Trust / Respect Feel comfortable making suggestions or asking

questions.
She's comfortable with my skills … she knows my
weaknesses, and she knows I will go to her if I have
questions.
Great to have someone to bounce ideas off of.
Gradual independence Real feeling of satisfaction when I do things on my

…gradual giving of own. My preceptor trusts me enough to administer
responsibility medications on my own, …that makes me feel very
confident. It makes me feel that I'm competent when
I can go off all on my own and that she trusts me to
42
go off on my own.
She refers to me as the other nurse.
By the end of the term I pretty much worked on my
own. It felt like real life … like when you're working
in the real world.
These situational themes in Table 1-1 represent triggers for what Alana felt in her lived
experience reflected in Table 1-2.
Table 1-2
The Lived Experience: Themes from Alana‘s Account
Theme and Variation Moment

Cared for She really cares about how I‘m doing, what I‘m
learning, and if I‘m comfortable.
She sends me to do or observe procedures
…covered my patients while I was gone.
Motivated Learning with the student-preceptor relationship

is very rewarding because you‘re learning so
much, you‘re doing things on your own
…getting feedback from what you‘re doing.
She treats me like a colleague …refers to me as
the other nurse.
She trusts me to go off on my own.
She is a good role model …makes me feel safe
to learn from her.
Comfortable She is very friendly and open toward me.

Feel comfortable making suggestions or asking
questions.
She‘s comfortable with my skills …she knows
my weaknesses, and she knows I will go to her
if I have questions.
Great to have someone to bounce ideas off of.
Confident I feel a lot more confident this year. I feel like I

am working, not in school.
Previous preceptor who did not provide much
feedback …felt a little lost. I didn‘t feel
confident in that situation.
She treats me like a colleague …refers to me as
the other nurse.
She trusts me to go off on my own.
43
She is a good role model …makes me feel safe

to learn from her.
In this lived experience Alana felt cared for, motivated, comfortable and confident
as a result of the way her preceptor treated her with caring, respect and trust, and how her
preceptor guided her to independence through getting to know her, being supportive,
providing constructive feedback, and providing learning opportunities. As indicated
previously, Alana felt working independently afforded her the opportunity to solidify her
skills and feel what it was like to work in the real world with the security of a preceptor
to question or bounce ideas off of. We now turn to the second participant: Beth.
Beth’s verbal account and initial analysis. When I started my preceptorship on

the unit I was assigned to different nurses until I was taken on full-time by one nurse.
When I was assigned to a nurse for one or two days it was almost like I was their helper, I
wasn't their nursing student, I wasn't their co-worker. When I started working with my
preceptor I was her student, I was her responsibility. My relationship with her was a very
open and comfortable one. She knows what to look for in a student. Because we worked a
lot of night shifts we were able to discuss our patients in depth, to read their histories and
to relate these to past nursing experiences. One night we had a really bad night shift, first
thing in the morning she e-mails me to make sure I'm okay. My preceptor was kind of
worried about me and I e-mailed her back saying that I was a little stressed. She said ―I
totally understand because I found it to be a stressful night too.‖ She said to me, ―What
would I have done if you weren't there?‖ She would have done fine, but it makes me feel
a little better when she says that.
My preceptor is so experienced and knowledgeable. She always backs up her
answers and explains the why behind what is being done or what is happening. We have
a lot of dialysis patients and when they go down to dialysis their blood pressure is going
to drop and it's important to know why it drops. I'm glad now that I know why things are
done and why things might happen. Sometimes nurses just do it to get the job done. We
have to make sure the patient is safe so we need to know why we're doing it and what to
anticipate. The fact that I know why really puts my mind at ease. I feel safe in the clinical
environment working with someone who is so knowledgeable and skilled. My preceptor
has a passion for nursing and loves teaching. She knows what students need to learn and
sets clear expectations. When I was first with her, she was beside me and would check all
my medications. But now she‘s like … any questions about medications you come back
to me. She has seen me give IM's and insulin before. She'll check my insulin then she will
check that I am comfortable to give it and I'll give it on my own. It's a little more
44
independence every day. I can ask her any question - she doesn't look at me like I should
know that, she just answers or shows me. One night I had to set up a nebulizer and I just
couldn't remember how to set it up. I went up the hall to ask her if she could help me with
the nebulizer. She was in another patient's room and came down the hallway to show me
rather than just telling me to put it on 5 L. I'll never forget that now. Another night we
had a patient dying. His family was there and they had many questions. I didn't know
how to respond to their questions but my preceptor did. As I watched her, I wondered if I
would ever be able to respond to difficult questions in that way. She assured me with
practice I would.
My preceptor has a lot of confidence in me. I enjoyed having the stability
knowing when I went into work I would be with my preceptor. Our relationship came
from both sides; she wanted to teach and I wanted to learn. It can‘t just be all from the
preceptor or all from the student. My preceptor talked to me about patients and their care
just as she would talk to other nurses. She speaks to me as if I am a nurse which really
gives me a sense of what it's going to be like as the nurse.
In this exemplar Beth acknowledged the important roles and accountabilities her
preceptor played in their relationship and how this made her feel. Through preceptor
know-how and positive role modeling Beth felt supported, cared for and safe in the
clinical learning environment. In their relationship there was a valuing of her
communication as evidenced by the time they spent discussing patient care inclusive of
rationale for why events may occur and sharing past nursing experiences. There was also
a validating of her feelings particularly related to Barb‘s comfort in certain stressful
situations. This validation allowed Beth to feel supported and cared for in these situations
building her confidence and facilitating her learning. Beth felt comfortable asking her
preceptor any question and indicated that her preceptor would provide an answer or
would show her without judging her. Beth enjoyed the stability of working with her
preceptor. Beth trusted her preceptor. Additionally, Beth's preceptor trusted Beth as she
had confidence in Beth's abilities including her judgment to appropriately seek assistance.
Beth was treated as a nurse. At the beginning of their relationship Beth's preceptor
45
worked alongside Beth gradually allowing her greater independence and responsibility
congruent with her demonstrated abilities.
Revised analysis based on member checking. The student represented in Beth's
account verified the accuracy of the verbal account and initial analysis. She verified that
at the heart of her positive student-preceptor relationship experience was the way her
preceptor treated her with trust, with support, with confidence, and with open
communication. This made Beth feel good and increased her confidence. Beth‘s
preceptor cared for her. Beth‘s preceptor‘s expertise, positive role modeling and ability to
allow gradual student independence made Beth feel good, made her feel more
comfortable, and gave her the confidence to be more independent day by day. Toward the
end of the placement Beth felt her preceptor was bored as Beth carried the full case load.
Beth felt good knowing her preceptor had such confidence in her abilities. Beth felt that it
was because of the quality of their relationship that they continue to keep in touch and
maintain their relationship even though the placement has been completed. Beth felt so
lucky to have had this preceptor and such a good relationship to prepare her for transition
into the work force. The situational themes are reflected in Table 2-1 and Beth‘s feelings
of her lived experience are reflected in Table 2-2.
Table 2-1
Situational Themes related to Beth‘s Account

Accountability to her role
as preceptor
 Positive role She …came …to show me rather than just telling me
modeling to put it on 5L.
As I watched her I wondered if I would ever be able
to respond to difficult questions in that way.
46
 Supportive of me I totally understand because I found it to be a

stressful night too.
She assured me with practice I would.
 Applying expertise She knows what to look for in a student.

Preceptor is so experienced and knowledgeable.
Preceptor has a passion for nursing and loves
teaching.
She knows what students need to learn and sets clear
expectations.
 Caring for me Bad night shift, first thing in the morning she e-
mailed me to make sure I‘m okay. My preceptor was
kind of worried about me. …She said to me, ―what
would I have done if you weren‘t there?‖
 Trusting I feel safe in the clinical environment working with

someone who is so knowledgeable and skilled.
…any questions you come back to me (preceptor).
I enjoyed having the stability knowing when I went
into work I would be with my preceptor.
I‘d let you take care of me any day (preceptor)
Gradual independence, When I was first with her she was beside me and
Increasing autonomy would check all my medications. But now she‘s like
…any questions you come back to me.
Day by day I got to be more independent. She‘d
show me one day then expect me to do it the next
day.
My preceptor has a lot of confidence in me.
She speaks to me as if I am a nurse.
Increased competence felt good!
By the end my preceptor was bored …I carried the
full load.
What occurred during Beth‘s preceptorship experience affected her lived
experience. The themes from Beth‘s lived experience follow in Table 2-2.
Table 2-2
The Lived Experience: Themes from Beth‘s Account

Cared for She e-mails me to make sure I‘m okay.
When I was first with her, she was beside me
47
…it‘s a little more independence each day.

She speaks to me as if I am a nurse
Motivated When I started working with my preceptor I

…sense of security was her student, I was her responsibility.
She would have done fine [without my help],
but it makes me feel a little better when she
says that.
Comfortable My relationship with her is was a very open and

comfortable one.
Discuss our patients in depth,…and relate these
to past nursing experiences.
Explains the why behind what is being done or
what is happening.
I can ask her any question – she doesn‘t look at
me like I should know that, she just answers or
shows me.
It has to come from both sides.
Confident She knows what to look for in a student.

…doubt [She] has a lot of confidence in me. She speaks
to me as if I am a nurse.
I wondered if I would ever be able to respond to
difficult questions in that way. She assured me I
would.
Grateful I am glad now that I know why things are done

and why things might happen. …puts my mind
at ease. …I feel safe.
She doesn‘t look at me like I should know that,
she just answers or shows me.
I enjoyed having the stability knowing when I
Went into work I would be with my preceptor.
Alana and Beth both felt cared for, motivated, comfortable, and confident in their
lived experiences. Beth felt confident but at times doubted her abilities and appreciated
her preceptors‘ demonstrated support to build her confidence. In addition, Beth also felt
gratitude for having the stability she did with her preceptor.
48
In Alana‘s and Beth‘s accounts the situational themes of caring for me, trust and
gradual independence surfaced as significant. From Alana‘s perspective caring for me
centered more on her learning and creating learning opportunities for her; whereas from
Beth‘s perspective it centered on looking out for her to support Beth‘s learning and
Beth‘s feelings. For both, trusting was foundational to their relationship and integral to
caring. In fact, trust was reciprocal so this theme would be more aptly named trusting
each other. Beth and Alana appreciated the gradual independence they were allowed
recognizing the satisfaction, increased competence and increased confidence they felt as a
result. In Alana‘s account the theme of knowing each other was evident as Alana got to
know her preceptor and recognized she was a good role model. In Beth‘s account the
theme of positive role modeling more strongly influenced Beth‘s experience, ―I feel safe
in the clinical environment working with someone who is so knowledgeable and skilled.‖
Leaving Alana and Beth, we now turn to a third participant – Cathy.
Cathy’s verbal account and initial analysis. This is my final preceptorship and
this is the unit I wish to work on as a new grad. My preceptor left me alone a lot right
from the beginning which was pretty scary. When I saw how ‗missing in action‘ she was
those first couple weeks that made me even more anxious. I was taking it personally –
‗she's not checking in on me because she doesn't like me‘. I liked that I was able to go in
and do my care without someone constantly looming over me but then there was that
feeling, ‗I don't know where I'm at right now! I'd don't know what I should be doing more
of or what I should be doing better at‘. I always asked questions of my preceptor if I
wasn't comfortable but I never took the initiative as I did not want to overstep my
boundaries. Around midterm she started to joke with me and made the comment ―you
really take me too seriously‖. This really caught me off guard. I'm not a serious person at
all. I have a good sense of humor. I just couldn't believe that was her perception of me.
That is when I became more comfortable with her, we started sharing with each other on
a personal level and she started making more positive comments to me like ―good
thinking‖. My preceptor's first language is French. She speaks with patients in French in
my presence even though I do not speak French. So I didn't know what the conversation
was between my preceptor and our patients therefore I would have to ask her or question
the patient again. This was one more experience that made me feel ‗she doesn't like me‘.
49
There were several times that we were late coming off the floor for lunch or break so we
would be by ourselves and that was definitely bonding time. I used that time to debrief
and ask questions because she really wasn't giving me much feedback. So I would say
things like ―Oh my gosh, what a busy day. What else should I be doing? Am I organized
enough?‖ She did always say ―if you need something come get me‖ - I just couldn't find
her! So I would go to the other nurses for guidance.
I was getting ready to do my first dressing change on this unit. I took the
initiative, I got all my supplies and I got my preceptor. She said okay and walked away.
She had never seen me do a dressing change before. I wasn't sure how to take this - does
she think I can do a dressing change well on my own or is she testing me to see if I will
wait for her. I approached her and told her I wasn't comfortable doing the dressing
change by myself so she did watch me set up the tray and then she left. I did the dressing
change. I thought to myself she really doesn't care about me and honestly she isn't the
best nurse either if she leaves her patients with a student she doesn't really know. I don't
know how she could trust me like that.
It was my first day having four patients. My preceptor wanted to see how I would
handle this and didn't provide me with direction. One of the patient's was to leave the unit
for a test; however, I didn't incorporate this into my planning. When I came into his room
my preceptor and the porter were getting him onto the stretcher. I should have done his
care first. I was so embarrassed. You don't want to do wrong in your preceptors‘ eyes,
you want to be the best student. This was not a good learning experience. If she had
asked me questions like ―How are you going to prioritize care this morning?‖, that would
have told me that she was thinking about me and she was trying to give me a better
learning experience.
I was kind of shocked in my final evaluation because my preceptor filled out the
evaluation form quickly, without a lot of thought, and just kept me at the same level as
midterm. That was really disappointing for me. Does she actually think I didn't improve
since midterm?
Learning within the student-preceptor relationship is really subjective to the
particular preceptor. My previous preceptor loved being a preceptor and he liked to teach
students. We have great discussions and he was always around. This preceptor, she was
not there for me and I found this nerve-racking; like walking on egg shells.
This experience was challenging for Cathy. Through her perseverance and sense
of humor Cathy dealt with her feelings of uncertainty and stress in the clinical
environment. From the start of their relationship Cathy's preceptor left her alone a lot or
was inaccessible. Even when Cathy arranged for her preceptor to observe her first
dressing change on the unit or reminded her to complete the evaluation form, Cathy's
preceptor invested little time into these activities. These behaviors made Cathy feel
uncared for, abandoned, that her preceptor didn't like her, and that her preceptor was not a
50
good role model. This was very scary for Cathy contributing to her discomfort and
insecurity. As a result of the limited time Cathy and her preceptor spent together they had
difficulty getting to know each other as well as difficulty feeling comfortable with each
other, Cathy did not know her boundaries, and she felt like she was ‗walking on egg
shells‘. The communication within the relationship was strained. Cathy wanted to work
independently but knew she needed the support of a preceptor to provide guidance and
constructive feedback. Cathy‘s preceptor immediately allowed Cathy to work
independently without the support and communication she needed to feel confident and
competent in her practice. This is exemplified by the situation cited when Cathy was
assigned four patients for the first time. Cathy relied on the other nurses for guidance.
Revised analysis based on member checking. Cathy indicated that the account
and initial analysis provided a very good description of what her experience was like
inside the student-preceptor relationship. In fact she stated that I had ‗nailed it right on‘.
Cathy did request the inclusion of her experience with her preceptor conversing in French
with patients when Cathy didn't understand French. This, again, made Cathy feel ‗she
doesn‘t like me‘ and frustrated. This has been included in the account. Cathy recognized
her need for feedback in order to grow her competence and confidence and sought
guidance from other RNs on the floor. From Cathy's perspective her preceptor ‗was not
there for [her]‘; she did not fulfill the accountabilities of the preceptor role in the student-
preceptor relationship. This was disappointing and nerve-racking for Cathy. The
situational themes related to Cathy‘s account are highlighted in Table 3-1.

51
Table 3-1
Situational Themes related to Cathy‘s Account

Preceptor was not there for
me (preceptor
accountabilities)
 Too much I liked to do my care without someone constantly
independence too looming over me but then there was that feeling, I
quickly don't know where I'm at right now!
First time with four patients. If she had asked me
questions ―How are you going to prioritize care this
morning?‖
 Limited trust Left me alone a lot right from the beginning which
was pretty scary. She's not checking in on me
because she doesn't like me.
First dressing change on unit; first time having four
patients.
Filled out the evaluation form quickly, without a lot
of thought. That was disappointing for me.
 Strained I was shocked in my final evaluation.

communication I just couldn't find her! So I would go to the other
nurses.
There were several times we were late coming off
the floor for lunch or break so we would be by
ourselves and that was bonding time.
Around midterm we started sharing with each other
on a personal level.
I did not want to overstep my boundaries.
Preceptor conversing in French with patients when I
don‘t understand French
 Limited getting to ―You really take me too seriously‖. …I just couldn't

know each other believe that was her perception of me.
We started sharing with each other on a personal
level and she started making more positive
comments to me.
I use that ‗bonding time‘ to debrief and ask questions
because she really wasn't giving me much feedback.
 Negative role
model She isn't the best nurse either if she leaves her patient
with the student she doesn't know. I don't know how
she could trust me like that.
52
Through Cathy‘s account negative situational themes have been identified. Unlike
Alana and Beth, Cathy was given too much independence too quickly with limited time
spent with her preceptor getting to know each other, developing trust or establishing
meaningful communication. Additionally, Cathy‘s preceptor was not a positive role
model, limiting Cathy‘s motivation to learn. Each of these themes is on the opposite end
of the theme continuum when compared to Alana and Beth. As an example, for Alana
and Beth trust was foundational to their positive student-preceptor relationship, whereas,
for Cathy there was limited trust resulting in a negative relationship with her preceptor.
Similarly the feelings that made up Cathy‘s lived experience were negative, again falling
on the opposite end of the theme continuum when compared to Alana and Beth. The
themes related to Cathy‘s lived experience are outlined in Table 3-2.
Table 3-2
The Lived Experience: Themes from Cathy‘s Account

Uncared for Left me alone a lot right from the beginning
…abandoned which was pretty scary.
…frustrated She speaks with patient in French in my
presence even though I do not speak French.
She left me alone to do the dressing change.
Disliked I was taking it personally – ‗she's not checking

in on me because she doesn't like me.‘
Discomfort When I saw how ‗missing in action‘ she was

…presence of angst …made me even more anxious.
I did not want to overstep my boundaries.
Like walking on egg shells.
Insecure Left me alone a lot right from the beginning

…not confident, doubt which was pretty scary.
‗I don‘t know where I‘m at right now!‘
I was so embarrassed. You don‘t want to do
wrong in your preceptor‘ eyes.
I just couldn‘t find her! So I would go to the
other nurses for guidance [and feedback].
53
Disappointed Filled out the evaluation form quickly, without

a lot of thought. That was disappointing for me.
When I saw how ‗missing in action‘ she was
…made me anxious. …what should I be doing
better at. …I would go to the other nurses for
guidance. She was not there for me and I found
this nerve-racking; like walking on egg shells.
The way Cathy felt, her lived experience, affected her preceptorship experience –
an experience she described overall as disappointing. Cathy often felt uncared for,
disliked and uncomfortable in her relationship with her preceptor. The discomfort flowed
into the clinical environment where she was reluctant to take the initiative with her
learning. Her motivation to learn was not optimized. We now move to the fourth
participant: Debbie.
Debbie’s verbal account and initial analysis. Preceptorship in fourth year is

different than the other years in the program because now it is all focused on you and the
learning is very focused. It is just me, my preceptor and getting ready for the transition
from student to nurse. My preceptor was happy to be working with me and that makes a
big difference in knowing that I'm not being a nuisance. I am a very eager, hard working
student and I take control of my learning - my preceptor appreciated these values. She
also recognized that I had ‗it‘. She said having ‗it‘ means you genuinely care about your
patients and it shows in everything you do. She said, ―You have all those qualities that
make you a good nurse‖. My preceptor also has those qualities, she is an amazing nurse,
a very good role model and that motivated me to learn. I felt so thankful and lucky to
have had a good preceptor. I wanted a good preceptor; one I could get along with, trust
and learn from. When speaking with my fellow students the first question we asked was
―how is your preceptor?‖
She provided me with immediate feedback after doing things which always felt
really good. When we would come out of the room she would say ―that was very good‖
or ―the next time you should do this‖. I benefited from either getting the reassurance right
after or something to improve on for the next time. She also asked really good questions
that allowed me to learn. ―Why do you think we did this?‖ or ―What was the purpose of
that?‖ At first I felt a little bit nervous that I would get the wrong answer but as time went
by, when we started to get to know each other, I wasn't nervous about getting the wrong
answer. I liked the questions, even if I was wrong she would explain things to me. I felt
that was a good advantage.
54
We got to know each other on a personal and a professional level. That helped her
trust me and vice versa. When I would do things she knew I was good communicator.
She told me, ―There is no doubt in my mind that if you don't know something or if you're
unsure of something you will ask me. I know I can trust you because I know you will tell
me.‖ And that was exactly right. Because we were able to trust each other I was able to
have more independence which was a real confidence boost.
I was given more independence and my preceptor spent more time sitting at the
desk and would say, ―If you need me let me know‖. It was toward the end of my
placement and a new order came in for a drip that needed to be hung so I prepared
everything. My preceptor said, ―Oh, you doing that?‖ and kind of interfered and started to
take over. And I said, “I've done that, I've done that already.‖ She was kind of thrown
back and said ―I'm sorry for questioning you.‖ I didn't mind the questioning because if I
had made a mistake I wanted to learn from her right away. With the relationship we had,
with the way we knew each other, we just moved on and that was okay. I felt good
because I knew I did everything right. It demonstrated to her that I did it to. The way my
preceptor treated me changed over the placement. At the beginning I was treated more
like a student, she was being safe by checking over everything closely, and gradually I
was treated more like a coworker.
Debbie felt cared for in this relationship as her preceptor was happy to be
working with her, spent time with her, and gradually treated her like a coworker. Debbie
and her preceptor got to know each other gradually over time with preceptor giving
Debbie constructive feedback as events occurred and probing questions to delineate
rationale. As they got to know each other, they also recognized they both had ‗it‘: that
genuine caring which is reflected in one's actions and in one‘s approach. Debbie felt
motivated to learn in this student-preceptor relationship. She attributed this motivation to
her own self-directedness and to her preceptor who she believed was a good role model
and who treated her with trust and respect. Debbie felt comfortable and valued in the
relationship thus, she no longer felt nervous about getting a wrong answer. Debbie and
her preceptor communicated honestly with each other; they trusted each other so if
Debbie didn't know something she would ask her preceptor and her preceptor expected
this of Debbie. This mutual trust facilitated Debbie‘s ability to work independently with
confidence as evidenced by her management of the new drip order. In completing this
55
task independently Debbie demonstrated her competence to herself and to her preceptor.
Debbie felt very good about her ability to manage the new drip order by herself.
Revised analysis based on member checking. Debbie indicated the account was
accurate to her experience. Additionally, Debbie did share she felt so thankful and lucky
to have had a good preceptor. She indicated every student wants a good preceptor. When
speaking with fellow classmates the first question asked is ―how is your preceptor?‖
Debbie indicated she wanted a preceptor she could get along with, trust and learn from.
This idea of the desire for a good preceptor has been added to the account. Debbie
reinforced the value of getting to know each other through a lot of sharing and open
communication on both a personal and professional level. Debbie's preceptor recognized
what Debbie valued and respected her for that. Knowing each other also solidified the
trust between each other. This made learning so much easier as Debbie was not stressed
out at work. From Debbie's perspective the purpose of this last placement was to get
ready to make the transition, and to become more autonomous. Debbie felt really good
about her achievement related to this purpose and felt her preceptor recognized her
achievement as well. Table 4-1 highlights the situational themes related to Debbie‘s
account.
Table 4-1
Situational Themes related to Debbie‘s Account

 Respect She is an amazing nurse, a very good role model and
that motivated me to learn.
I was treated like a coworker.
Communicated honestly with each other.
[They] trusted each other.
56
 Caring for me My preceptor was happy to be working with me

Gradually I was treated more like coworker
Recognized that I had ‗it‘(genuine caring and it
shows in everything you do)
 Knowing each You have all those qualities that make you a good
other nurse. My preceptor also has those qualities.
She asked really good questions and allowed me to
learn. At first I felt a little bit nervous that I would
get the wrong answer … when we started to get to
know each other, I wasn't nervous about getting the
wrong answer.
We got to know each other on a personal and
professional level.
A lot of sharing and open communication
 Trusting each other She provided me with immediate feedback after

doing things.
(Preceptor ) There is no doubt in my mind that if you
don't know something … you'll ask me. (Student )
And that was exactly right.
Trusting each other made learning so much easier; I
wasn‘t stress out at work.
Open honest two way communication.
Gradual independence At the beginning I was treated more like a student,

and giving of she was being safe by checking over everything
responsibility closely, and gradually I was treated more like a
coworker.
Example: preparing drip that needed to be hung.
It felt good because I knew I did everything right.
Toward the end of my placement my preceptor
recognized the autonomy I had achieved and that felt
really good.
The focal point of the situation themes related to Debbie‘s account is on how her
preceptor treated her with respect. As part of that respect Debbie‘s preceptor
demonstrated caring actions toward Debbie, they spent time together getting to know
each other and developing a trust with each other. Because of these actions Debbie felt
competent and confident to gradually work independently. For Debbie the immediate
57
constructive feedback and the probing questions motivated her learning and boosted her
confidence. The themes related to Debbie‘s lived experience inside the student-preceptor
relationship are outlined below in Table 4-2.
Table 4-2
The Lived Experience: Themes from Debbie‘s Account

Cared for Preceptor was happy to be working with me,
…spent time with me …got to know each other
on a personal and a professional level. That
helped her trust me and vice versa.
[preceptor] sorry for questioning you.
Motivated My preceptor has those [genuine caring]

qualities, she is an amazing nurse, a very good
role model and that motivated me to learn.
Because we were able to trust each other I was
able to have more independence which was a
real confidence boost.
Comfortable As time went by, when we started to get to

know each other, I wasn‘t nervous to get the
wrong answer.
She knew I was a good communicator.
Was not stressed out at work.
Confident I liked the questions, even if I was wrong she

would explain things to me. I felt that was a
good advantage.
I felt good because I knew I did everything
right. It demonstrate to [preceptor]that I did it
to.
Accepted My preceptor was happy to be working with

…Grateful me.
So thankful and lucky to have had a good
preceptor.
Alana, Beth, and Debbie were guided by their preceptor to gradual independence
where Cathy was given full independence directly without much preceptor guidance or
58
support. As a result the former students felt cared for, comfortable, confident and
accepted by their preceptor while Cathy felt like she was ‗walking on egg shells‘. While
Cathy was not motivated to take the initiative with her learning, Alana, Beth and Debbie
were motivated to learn and appreciated their preceptors‘ ability to be a positive role
model. The fifth participant, Eva, is next.
Eva’s verbal account and initial analysis. My expectations of the student-

preceptor relationship centered on that one-on-one time with a preceptor to solidify my
learning - if you're having trouble in an area or if you want to get better in a particular
area your preceptor will have time for you. I learn through doing, so having my preceptor
let me do things yet being available as a sounding board in case I got stuck or had
questions.
I felt very comfortable with my first term preceptor. My opinions were valued, I
was included in department activities, and I was allowed independence. It felt very good
not always have someone looking over my shoulder. She would give me responsibilities,
if I had any questions I would go to her, as well she would check on me to see how I was
doing - I was never left hanging. I was treated like I was staff there. As we worked
together we developed a professional relationship and a personal relationship. On a
personal level it was great to get to know each other a little deeper, a little more under the
surface to be able to feel more trust.
It was quite different with my second term preceptor. This was her first
experience as a preceptor. There was not comfort in allowing me the independence with
patient care that a fourth-year student in their final preceptorship should have. The usual
patient load was five or six patients and for about 90% of my placement I was only given
two or three patients. When my preceptor was on days off, I would be placed with other
registered nurses (RN) who would give me their full patient load without looking over
my shoulder throughout the whole shift. At the start of the shift the RN, knowing I was
half way through my placement, would tell me how it was going to be, like ―you're going
to have a full patient load, if you have any questions let me know, I'll check on you
periodically, is that okay?‖ Their expectations were in-line with mine so I said ―yes
okay‖. I did really well with the full patient load and the RN told my preceptor that as
well. For the last three weeks of the placement my preceptor gave me a full patient load
but she was always looking over my shoulder. It felt like she did not want to let go. She
would say ―it‘s my OCD‖ (obsessive compulsive disorder). She wanted to control
everything; this made me feel like a first or second year student. I talked to her about it
and she said ―because it's her first time being a preceptor she feels very leery about
giving me full reign.‖ However, as a fourth-year student in my final placement I thought
that she would trust my abilities and give me a little more independence. I felt very
frustrated a lot of the time.
59
I didn't feel a strong connection with my second preceptor. I felt she didn't want
me in her space, kind of like I was intruding. There were a couple of times when the floor
got really busy, kind of stressful with competing patient priorities, and she wanted to take
over everything and just have me sit back. She didn't like to let people do stuff that she
was supposed to do. She did stuff one way and you had to do it that way. If you didn't do
it that way even though the outcome was the same she didn't like it. I felt in our
relationship there was not openness to my ideas - we could have learned more from each
other.
This was Eva‘s final placement and she came into the relationship with definite
expectations about her learning. Eva learned through doing and expected her preceptor to
allow her independence with patient care while having her available as a sounding board.
Eva‘s preceptor was not comfortable giving Eva a full patient load without constantly
‗hovering‘, even after positive feedback was provided from other unit RNs on how
effectively Eva had managed their caseloads. As a result Eva felt frustrated and angry in
this relationship. Eva felt her preceptor did not want to let go. This caused tension and a
lack of trust inside the relationship. At times Eva felt like she was an intruder in her
preceptor‘s space and felt that there was a lack of openness to her ideas, to new learning.
She felt frustrated due to the lack of independence and lack of space for learning. Eva felt
disappointed with the experience but recognized that this was the first time her preceptor
had filled the role of preceptor. Eva felt without trust, without independence, and without
willingness to let go, this was a negative experience with missed expected growth
opportunities. Subsequently, Eva felt not well supported and not well cared for in the
relationship.
Revised analysis based on member checking. This account resonated with
accuracy for Eva capturing well her feelings inside the student-preceptor relationship.
Eva felt her preceptor wanted to control everything and wasn't receptive to new ideas.
60
Upon further discussion Eva identified a phrase her preceptor would commonly use to
justify her actions toward Eva, specifically her actions associated with limiting her
independence, and providing limited listening to Eva‘s ideas. Eva‘s preceptor would say
―it's my OCD‖ (obsessive compulsive disorder). This phrase has been added into Eva‘s
account as a result of member checking. From Eva‘s perspective her preceptor did not
trust her to work independently. The trust between Eva and her preceptor was limited.
This made Eva doubt her abilities even though coming into this placement she felt very
confident with her level of competence. As a result, Eva felt resentful for missed
expected growth opportunities. Table 5-1 contains the situational theme highlights related
to Eva‘s account.
Table 5-1
Situational Themes related to Eva‘s Account

Lack of trust and respect Other RN would give me their full patient load
(current experience) without looking over my shoulder
Like I was intruding [in her space]
There was not openness to my ideas; made me want
to shut her out.
She has this mindset and there was no changing her
mind no matter how I would approach her. She
would say ―Ya OK‖ but then never acknowledge it
again.
Trust (past experience) I was allowed independence.
Respect (past experience) I was treated like I was staff there.
Lack of independence Usual patient load was five or six patients …I was
(current experience) given two or three patients
The other RN …their expectations were in-line with
mine.
Final placement I thought she would trust my
abilities and give me a little more independence
without hovering.
Preceptor did not want to let go; …wanted to control
everything …this caused tension inside the
relationship.
61
Gradual independence She would give me responsibilities, if I had any

(past experience) questions I would go to her, as well she would check
on me …I was never left hanging.
From Eva‘s account negative contextual themes have been identified that are
directly linked to Eva‘s negative feelings inside her lived experience. The lack of trust
and respect, plus not being allowed greater independence by her preceptor even at the end
of the placement, caused Eva to feel uncared for, frustrated, angry, and disappointed with
her student-preceptor relationship. Even though Eva felt confident with her level of
competence starting this placement and received positive feedback from other unit RNs
on how effectively she managed their caseloads the situational themes identified served
as triggers to make her doubt her abilities, and to feel like a first or second year student.
However, despite the uncomfortable relationship, Eva liked her placement as this is her
area of nursing passion. The themes related to Eva‘s lived experience are further outlined
in Table 5-2.
Table 5-2
The Lived Experience: Themes from Eva‘s Account

Uncared for She wanted to control everything; this made me
feel like a first or second year student.
Excused herself by saying ―it‘s my OCD‖
There was not openness to my ideas.
I felt like she did not want me in her space;
…like I was intruding.
Determined [exercised independence and received feedback

primarily from other RNs] as she didn‘t want
me in her space.
I liked my placement despite the uncomfortable
relationship.
This area of nursing is my passion.
Rejected / Hurt as she didn‘t want me in her space.

62
Disappointed Unmet student expectations of the student-

preceptor relationship. ‗I learn through doing,
so having my preceptor let me do things yet
being available as a sounding board.‘
Presence of Angst She didn‘t want to let go; this caused

 Frustrated and tension…inside the relationship;
angry Felt not well listened to.
Always looking over my shoulder; constantly
hovering. Preceptor did not want to let go.
I felt like she did not want me in her space;
…like I was intruding.
She did stuff one way and you had to do it that
way.
Expected one-on-one time with a preceptor to
solidify my learning, …missed expected growth
opportunities
Confident with some doubt [not being trusted to work independently and
not being listened to by preceptor made Eva
doubt her abilities even though coming into this
placement she felt very confident with her level
of competence]
Felt not well supported.
Both Cathy and Eva experienced limited trust, limited respect, and strained
communication. For Eva, although she had demonstrated competency, she was not
allowed full independence by the end of the preceptorship resulting in her feeling
frustrated and angry. Conversely, Cathy was given full independence at the start of the
preceptorship with limited support and guidance resulting in her feeling abandoned,
insecure and frustrated. In both accounts the impact of the situational piece – preceptor
presence – on the lived experiences caused both Cathy and Eva to feel uncared for, angst,
varying amounts of self-doubt or insecurity, and disappointed. Additionally Cathy felt
disliked by her preceptor and Eva felt like an intruder in her preceptors‘ space. Preceptor
presence was the root of many of Eva‘s and Cathy‘s feelings. From Eva‘s perspective her
63
preceptor hovered, she was always there looking over her shoulder whereas from Cathy‘s
perspective she could often not locate her preceptor, she was ―missing in action – MIA‖.
With her preceptor hovering Eva felt some self-doubt but her determination, anger and
self-confidence served her well to keep her motivated to learn. Without preceptor
presence Cathy experienced discomfort and self-doubt. Cathy was reluctant to take the
initiative with her learning as she did not want to overstep her boundaries with her
preceptor. We now turn to the sixth and final participant: Flo.
Flo’s verbal account and initial analysis. I learned best when I was working
together with my preceptor. When I am trusted by my preceptor it gives me that room to
grow. As I worked with my preceptor and with the other nurses on the unit it was like I
was staff there. I told my preceptor right off the bat that I didn't know how to explain to
families, in a way that they would understand, what was happening to their dying loved
one. Together with my preceptor we found some really good resources that talked about
how the different systems shut down gradually and how it can give you an estimate of
how much time they might have left. She helped me explain this to families so that
eventually I was comfortable explaining this to families on my own. My preceptor is very
passionate about hospice nursing and that has definitely rubbed off on me. I loved going
to my placement. My preceptor shared her knowledge, her ways of teaching, and her
ways of communicating with me.
Our relationship was open; we were able to talk about anything even if it was not
nursing related. We had a friendship while maintaining a professional relationship; a co-
worker relationship. I would go to my preceptor with questions or with ideas about what
we could do with our patients. I felt very comfortable approaching her. We totally trusted
each other. She checked my medications for the first couple of weeks then said ―I know
you're doing alright with your medications and I know if you have any questions you will
come see me‖. Having that trust made me feel so confident. My preceptor was always
there for me. I had a few hard to deal with experiences when patients died; however, I
was able to talk it through with my preceptor. We had a night shift where we were short
staffed. I said ―I think I can do the full assignment by myself‖. My preceptor said ―OK,
don‘t worry if it is too much work for you I will help you‖. She would check in with me
regularly and say, ―let me know if this is too much for you‖.
In another preceptor relationship I did not feel trusted. This made me feel I wasn't
ready to be independent. Even on my last day of the placement this preceptor was double
checking all my medications. She must think I'm stupid. It made me feel like I wasn't
doing everything right and how can I do this by myself when I'm a new grad? This did
affect my sense of confidence and competence in my practice. How should preceptors be
64
selected? Should it be those RNs who really want a student and who have the patience to
work with a student?
Flo loved going to her placement. She had an open and comfortable relationship
with her preceptor; a relationship that allowed her the ease to ask questions, make
suggestions, and carry on both professional and more personal conversations. Flo‘s
preceptor shared her knowledge, her ways of teaching, and her ways of communicating.
She had insight into Flo‘s feelings as evident when patients died and she was available
for Flo to debrief. She listened to Flo‘s expressed areas for learning and together they
achieved them. These actions by Flo‘s preceptor made Flo feel cared for, supported and
furthered her learning. The way Flo‘s preceptor treated her, with trust and as a co-worker,
allowed Flo to feel valued and afforded her that ―room to grow‖. Flo‘s preceptor allowed
Flo gradual independence while offering support should she need it. This made Flo feel
confident and competent in her practice. This experience differed from a past preceptor
relationship where Flo did not feel trusted by her preceptor. This lack of trust negatively
impacted Flo‘s sense of confidence and competence in her practice in the past.
Revised analysis based on member checking. Flo expressed this account was an
excellent representation of her experience hitting on every aspect from her perspective.
Flo felt trust was at the heart of the student-preceptor relationship particularly since she
had previously experienced a student-preceptor relationship where she did not feel trusted
and could compare it to this experience where she felt totally trusted. Flo felt very
appreciative of the trust and positive role modeling shared with her by her preceptor.
This made her feel confident and allowed her levels of confidence and competence to
65
further grow. Table 6-1 reflects the situational themes related to Flo‘s account and Table
6-2 reflects the feelings of her lived experience.
Table 6-1
Situational Themes related to Flo‘s Account

Trust
 Trusting each other Gives me room to grow
(current experience) I know if you have any questions you will come see
me.
Having that trust made me feel so confident.
My preceptor was always there for me. …I was able
to talk it through with my preceptor.
 Lack of trust She must think I am stupid.
(past experience) It made me feel like I wasn‘t doing everything right
and how can I do this by myself when I‘m a new
grad?
 Respecting each Positive role model for me.

other [preceptor] listened to Flo‘s expressed area for
learning and together they achieved them.
 Open …relationship was open, we were able to talk about

communication anything …friendship while maintaining a
…Knowing each professional relationship, co-worker relationship.
other I felt very comfortable approaching her.
 Preceptor providing My preceptor shared her knowledge, her ways of

space and teaching, and her ways of communicating with me.
opportunities for [she] is very passionate.
learning She was a positive role model.
How should preceptors be selected?
Gradual independence …eventually I was comfortable explaining this to

families on my own.
She checked my meds for the first couple of
weeks…
I took the full patient assignment. She trusted me.
66
The situational themes reflected in Flo‘s account resonated across the other five
accounts with varying degrees of emphasis and differing means of enactment. Trust,
respect, caring and getting to know each other through open communication consistently
appears as a beneficial way of treating one‘s student. While these themes were enacted in
a positive way for Alana, Beth, Debbie and Flo, they were enacted in a negative way for
Cathy and Eva. Similarly, the preceptor perceived accountabilities to their student of:
providing space for learning (spending quality time together), providing opportunities for
learning (through constructive feedback, probing questions, doing arranged procedures),
being supportive of the student, being a positive role model and allowing gradual
independence to practice were enacted in a positive way for Alana, Beth, Debbie and Flo
and in a negative way for Cathy and Eva. These situational themes uniquely influenced
the lived experience of each student. The themes from Flo‘s lived experience follow (See
Table 6-2).
Table 6-2
The Lived Experience: Themes from Flo‘s Account
Theme Moment
Cared for I learned best working together with my
preceptor.
My preceptor shared her knowledge, her ways
of teaching and her ways of communicating
with me.
We totally trusted each other.
She would check in with me regularly and say,
―let me know if this is too much for you‖.
Motivated I loved going to my placement.

[preceptor] very passionate about hospice
nursing …rubbed off on me.
Together with my preceptor we [learned].
Comfortable Our relationship was open; we were able to talk

about anything even if it was not nursing
related. We had a friendship while maintaining
67
a professional relationship.
I felt very comfortable approaching her. …go to
my preceptor with questions or suggestions.
…hard to deal with experiences when patients
died, …able to talk it through with my
preceptor.
Confident Having that trust made me feel so confident.

My preceptor was always there for me.
It was like I was staff there.
In another preceptor relationship I did not feel
trusted …this affect[ed] my sense of confidence
and competence in my practice. …made me feel
I wasn‘t ready to be independent; …[preceptor]
must think I‘m stupid.
Grateful My preceptor was always there for me.

For the trust and positive role modeling shared
by her preceptor.
Flo‘s lived experience inside the student-preceptor relationship is unique, as are
the feelings of each participant inside their respective student-preceptor relationship. Yet,
across the accounts of the lived experiences common themes have emerge.
Final Analysis
In van Manen's (1997) view phenomenological themes are like ―knots in the web
of our experiences‖ (p. 90) providing the experiential structures that make up or reflect
the whole of the experience. Collectively themes are offered in an attempt to explicate the
lived experience in a meaningful way. This study explicated the lived experience for the
fourth year nursing student inside the student-preceptor relationship and identified the
situation in which this occurred. This study is an attempt to grasp the essential lived
experience of student-in-relationship-with preceptor. The experience is multi-dimensional

68
represented by themes and multi-layered as represented by variations on each theme. The
themes and thematic variations facilitate understanding of the lived experience. Each
theme alludes to an aspect of the experience in view of the original phenomenological
questions. In this section of chapter four common themes across all accounts have been
identified. First, common situational themes and thematic variation across accounts are
summarized in Table 7 and then, common lived experience themes with corresponding
thematic variations are summarized in Table 8. Following Tables 7 and 8 the interface
between situational themes and lived experience themes as evident through these
accounts have been analyzed. Finally, I have created two first person narratives of the
lived experience based on a synthesis of common themes.
Situational themes. The two main situational themes are preceptor treatment of
me and preceptor perceived accountabilities. The situational theme of preceptor treatment
of me included treatment with trust (Alana, Beth, Debbie, Flo) or limited trust (Cathy,
Eva), treatment with respect (Alana, Beth, Debbie, Flo) or limited respect (Cathy, Eva),
treatment with caring (Alana, Beth, Debbie, Flo) or limited caring (Cathy, Eva), and
getting to know each other through open communication (Alana, Beth, Debbie, Flo) or
limited getting to know each other through closed communication (Cathy, Eva). The
situational theme of preceptor perceived accountabilities included providing space for
learning (Alana, Beth, Debbie, Flo) or provision of limited space for learning (Cathy,
Eva), providing opportunities for learning (Alana, Beth, Debbie, Flo) or provision of
limited opportunities for learning (Cathy, Eva), being a positive role model (Alana, Beth,
Debbie, Flo) or a negative role model (Cathy, Eva), and allowing gradual independence
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to practice with support (Alana, Beth, Debbie, Flo) or full independence without support
(Cathy) or limited independence (Eva). These situational themes will be further discussed
in the interface of themes section.
Table 7
Common Situational Context Themes and Thematic Variation across Accounts
Theme Variation
 With trust  With limited trust
…my preceptor was always there …she‘s not checking in
for me. on me because she
…when I am trusted by my doesn‘t like me (Cathy)
preceptor it gives me that room to …other RN would give
grow. me their full patient load
(Alana, Beth, Debbie, Flo) without looking over my
shoulder (Eva)
 With respect  With limited respect

…speaks to me as if I am a nurse …no openness to my
(Alana, Beth, Debbie, Flo) ideas
(Cathy, Eva)
 With caring  With limited caring

…she really cares about how I‘m (Cathy, Eva)
doing, what I‘m learning, and if
I‘m comfortable.
(Alana, Beth, Debbie, Flo)
 Getting to know each other  Limited getting to know

…on a professional and personal each other
level (Cathy, Eva)
…open, 2 way communication
Preceptor perceived accountabilities

 Providing space for learning  Provision of limited
(spending quality time together) space for learning
… I wasn‘t nervous about getting …missing in action
the wrong answer. (Cathy)
(Alana, Beth, Debbie, Flo) …hovering (Eva)
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 Providing opportunities for  Provision of limited

learning (constructive feedback, opportunities for
probing questions, doing arranged learning
procedures) (Cathy, Eva)
…she asked really good questions
that allowed me to learn.
 Being a positive role model  Being a negative role

…I feel safe in the clinical model
environment working with (Cathy, Eva)
someone who is so knowledgeable
and skilled.
 Allowing gradual independence to  Full independence

practice with support without support
…at first she was beside me, now (Cathy)
she‘s like …any questions you  Limited independence
come back to me. (Eva)
The context each participant experienced affected their lived experience.
Lived experience themes. There are five themes with variations as evidenced in
the theme tables for each participant‘s lived experience. The first theme was feeling cared
for (Alana, Beth, Debbie, Flo) or feeling uncared for (Cathy, Eva).The second theme was
feeling comfort (Alana, Beth, Debbie, Flo) or feeling discomfort with presence of angst
(Cathy, Eva). The third theme was feeling confident (Alana, Beth, Debbie, Flo) or self-
doubt (Cathy, Eva) leading to insecurity (Cathy). The fourth theme was feeling motivated
or feeling less motivated. The fifth theme was feeling grateful (Alana, Beth, Debbie, Flo)
or disappointed (Cathy, Eva). These lived experience themes will be further discussed in
the interface of themes section.

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Table 8
Common Lived Experience Themes and Thematic Variations
Theme Variation
Feeling cared for Feeling uncared for
…as a person and as a learner …feeling abandoned and disliked
(Alana, Beth, Debbie, Flo) (Cathy)
…not open to my ideas (Eva)
Feeling comfort / secure Feeling discomfort and angst

…to ask any question (Cathy, Eva)
Feeling confident Feeling self-doubt (Cathy, Eva)

…and competent leading to insecurity (Cathy)
Feeling motivated Feeling less motivated

…very good role model, …did not take initiative and did not
constructive feedback, want to overstep boundaries (Cathy)
feeling of satisfaction … some self-doubt but her
(Alana, Beth, Debbie, Flo) determination, anger and self-
confidence allowed her to feel
motivation (Eva)
Feeling grateful Feeling disappointed

… Thankful and lucky …she was not there for me (Cathy)
(Beth, Debbie, Flo) …constantly hovering (Eva)
…for missed expected growth
opportunities
Interface of Situational Context Themes and Lived Experience Themes.
Consistently each student expressed feeling ―nervous‖ prior to commencing the student-
preceptor relationship as they felt unsure about how they would meet their preceptors‘
expectations of them. Some described this feeling as being ―scared‖, ―worried‖ or
―terrified‖. Students felt angst or insecure about starting their preceptorship experience.
Each student wanted to have a good relationship with their preceptor as they saw this as
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foundational to having a good preceptorship experience. Prior to and during their
preceptorship, students demonstrated fragile confidence. Comments made by the
preceptor, even those which appeared to be insignificant to the preceptor, caused students
to feel insecure and question their abilities. Once a student felt comfortable in their
preceptor relationship they could gradually release this concern and focus more on their
clients and their learning.
Feeling cared for. The experience of feeling cared for as a person resulted from
preceptor treatment of their student with trust, with respect, with caring and with getting
to know the student and allowing the student to know him/her in turn through open
communication. Feeling cared for as a learner resulted from preceptor‘s perceived
accountabilities of providing space for learning (spending quality time together),
providing opportunities for learning (constructive feedback, probing questions, finding
new skills), being a positive role model, and allowing gradual independence with support.
Foundational to each of these was open, two way communication inside the student-
preceptor relationship. Feeling comfort was also triggered by these actions. The more a
student and preceptor got to know each other, the stronger their trust was for each other
and the greater the comfort the student felt in the relationship. Students who felt uncared
for did not have trusting relationships with their preceptors, did not get to know each
other with significant depth, and as a result the student did not feel comfortable in the
relationship but rather felt angst.

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Confidence. Feeling self-confidence versus feeling self-doubt and insecure was
influenced by preceptor presence in guiding their student to gradual independence. The
preceptor needed to spend time with their student in order to get to know them, to trust
their judgment, to provide guidance and to allow gradual independence with support as
necessary. Some students shared they felt satisfied when they worked on their own after
experiencing gradual independence; this boosted their confidence and competence. Lack
of independence or hovering fostered feeling self-doubt, frustration and anger (angst).
Too much independence too quickly without preceptor support also fostered feeling self-
doubt, frustration and insecurity (angst).
Some students indicated that preceptors who demonstrated trust and respect
toward them triggered feelings of self-confidence and competence. Students felt grateful
when they had preceptors who trusted and respected them, were positive role models,
allowed gradual independence with guidance and support and generally looked out for
them including assisting them to meet defined learning needs. These students were able
to internalize their new abilities in a positive way allowing them to feel growth in
competence and confidence. Other students who did not experience such a trusting and
respecting relationship felt self-doubt, frustration and disappointment when their
expectations for the preceptorship were not realized. These students internalized their
abilities in a negative way.
Level of motivation. Feeling motivated was enhanced when space for learning
(spending quality time together), opportunities for learning (constructive feedback,
probing questions, doing arranged procedures) and strategies for learning (positive role
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model, gradual independence) were effectively utilized. Preceptor treatment of their
student also impacted feeling motivated. Collectively, when these concepts were not
effectively utilized by the preceptor, student motivation was limited.
First Person Narratives Based on Synthesis of Themes
―[A] good phenomenological description is collected by lived experience and
recollects lived experience – is validated by lived experience and it validates inquiry‖
(van Manen, 1997, p. 27). The phenomenological nod acknowledges this lived
experience as one we have experienced or could have experienced. It required the reader
to recognize similar feelings or similar experiences. The first experience narrative reflects
a negative student lived experience inside the student-preceptor relationship.
At the start of clinical I anxiously await to meet my preceptor. Every student

wants a good preceptor. I want a preceptor I can get along with, trust and learn from. I
am so disappointed! My preceptor is not there for me! This is a very scary experience for
me. Right from the beginning my preceptor gives me an assignment to manage on my
own. I like that I am able to go in and do my care without someone hovering over me but
then there is that feeling, ‘I don't know where I'm at right now! I'd don't know what I
should be doing more of or what I should be doing better at’. I need her feedback to
increase my competence and my confidence. Not getting her feedback makes me feel
abandoned and uncared for. I ask questions of my preceptor if I’m not sure or
comfortable with what I am to be doing but I won’t take the initiative as I don’t want to
overstep my boundaries. This is so nerve-racking! I have no opportunity to really get to
know her or to debrief, ask questions or seek feedback because I can never find her! So I
go to the other nurses for guidance and support. My preceptor is a negative role model –
I don’t know how she could just leave me with her patients! I’m so glad I survived this
experience!
The second experience narrative reflects a positive student lived experience inside
the student-preceptor relationship.
At the start of clinical I anxiously await to meet my preceptor. Every student

wants a good preceptor. I want a preceptor I could get along with, trust and learn from. I
am so thankful I got a good preceptor!! My preceptor treats me with respect for the
person I am. She’s very open and friendly. We spend valuable time together getting to
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know each other with lots of sharing and open communication on both a personal and
professional level. My preceptor knows my strengths and limitations and is always
looking out for me – finding extra learning opportunities for me, checking in on me, and
debriefing with me. I feel so cared for. She is an awesome nurse and an excellent role
model – I am motivated to learn as I appreciate her. She assures me that with practice I
will be able to provide competent care just like her. She always asks me if I feel
comfortable with what I have to do. I always respond honestly. I feel comfortable in our
relationship. I can ask her any question or make suggestions for our patients. She listens
to my ideas and treats me with respect and trust. I feel so confident, motivated and
appreciated. I never feel anxious about going into clinical. At the beginning of our
relationship my preceptor works alongside me checking my medications - watching my
assessments, providing me with constructive feedback, asking me probing questions to
make sure I really understand; then gradually she allows me greater independence and
responsibility congruent with my abilities and my comfort. This makes me feel trusted,
competent and confident – and I am learning so much! She is always there for me. She
refers to me as the other nurse which means I’m almost ready for working in the real
world! Overall this is a rewarding experience for me! I have such confidence!
Chapter Five: Discussion
In this phenomenological study, I have examined student nurses‘ lived
experiences in the student-preceptor relationship during preceptorship and the impact this
has had on their perceived learning. The findings are presented through lived experience
themes and situational themes with the situational themes representing triggers to the
students‘ lived experience. This study serves both to validate existing knowledge and to
extend current understanding of this phenomena.
Findings of this study contribute to current knowledge through gaining a better
understanding of the lived experience of a fourth year nursing student inside the student-
preceptor relationship during preceptorship. From a student perspective, knowledge that
how a student felt inside the student-preceptor relationship impacted their self-confidence
and motivation to learn. Positive student feelings of: feeling cared for, trusted, respected,
and grateful inside this lived experience allowed a student to feel motivated to learn
resulting in a positive internalization of ability thus boosting self-confidence. Negative
student feelings of: feeling uncared for, not trusted, not respected, and disappointed at
missed expected growth opportunities inside this lived experience caused even the most
determined and strong student to feel cautious and somewhat unmotivated to learn
resulting in a negative internalization of ability creating feelings of self-doubt and
insecurity. Fragile confidence is a term I have coined to reflect a students‘ feeling of
vulnerability inside the student-preceptor relationship.
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Fragile Confidence
Fragile confidence is a feeling students felt inside the student-preceptor
relationship. Students‘ confidence level fluctuated in the relationship. Where a student
may feel confident and secure with their friends, this confidence may be lessened as a
result of happenings inside the student-preceptor relationship. Students want to be liked,
valued and accepted by their preceptor, feeling grateful when this occurred. Why are
students feeling so grateful when they achieve this kind of positive relationship? Are
students not deserving of a positive relationship and learning opportunity?
With positive experiences inside the student-preceptor relationship a student felt
more comfortable, more a part of the unit team, more deserving and grateful for the
relationship with their preceptor and the resulting positive learning. As previously
indicated, students felt angst about starting their preceptorship experience, and as a result
of some comments made by their preceptor - comments viewed by their preceptor as
insignificant. Being sensitive to a students‘ self-vulnerability or fragile confidence
becomes imperative to facilitating a students‘ motivation to learn and learning. Students
all require a certain level of confidence in order to practice. As students practice with
guidance and support of their preceptor, and thus achieve competencies their level of self-
confidence increases. As self-confidence increases so also does student motivation to
learn and a cyclical process occurs.
Growing trust and respect were foundational to a student feeling cared for in an
authentic way. Once students felt cared for and secure in their preceptor relationship they
could gradually release this worry and focus more on their learning; that being, building
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competence and confidence in clinical practice to facilitate transition from student to
graduate nurse. Growing trust and respect supported a students‘ fragile confidence.
Growing trust. Consistent with the existing literature (Gillespie, 2005; Ohrling
& Hallberg, 2000c) growing trust occurred over time as student and preceptor got to
know each other on both a professional and personal level. Students needed to know
their preceptor in order to trust them and to feel trusted by them. Knowing each other
involved spending time together interacting and communicating. Examples of such
interactions from this study included: discussing patient care issues and patient safety;
receiving constructive feedback; collaborating thus recognizing values, expectations and
abilities held by each; from a student perspective recognizing their preceptor was
available to them and looking out for them; preceptor actions that indicated they
recognized their student would question if unsure; and open communication. Open
communication underlies and interlinks each component. With open communication,
dialogue on any topic can occur between student and preceptor. In growing trust the
student trusts her preceptor to optimize her learning growth, the preceptor trusts her
student to behave professionally and safely as demonstrated by her actions and both
student and preceptor recognize that trust exists. These findings are supported by the
work of Crawford, Dresen, & Tschikota, 2000; Gillespie, 2005; Hohler, 2003; Myrick &
Yonge, 2001; Myrick & Yonge, 2004; Ohrling & Hallberg, 2000c; Yakovleva, Reilly, &
Werko, 2010. The following are excerpts from participants.
The essence of student-preceptor relationship is trust. Trust that I behave

professionally with all the other staff and also that I am a safe student. I think
that if I were a preceptor it would be hard to feel connected to a student if you
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don‘t think they‘re safe. I wouldn‘t blame them for not allowing us to be more
independent if they didn‘t actually trust us because nursing mistakes can have
really bad consequences. If there is no trust, there isn‘t a feeling of safety,
I don‘t think the relationship would really work.
[My preceptor] let‘s me do things on my own, when she trusts me enough to

pour meds on my own, trust me to ask questions when I need to,…she trusts
me to do them on my own and it makes me feel very confident.
[My preceptor] sets up those opportunities for me to do extra things.
Having trust allowed a feeling of security, safety and comfortableness within the
relationship, fostering inquiry and more focused learning. Each student indicated trust
was necessary in order to establish a connected relationship supportive of their learning.
Additionally, when preceptors demonstrated trust in their student, students‘ felt an
increased self-confidence toward learning.
When we started to get to know each other I wasn‘t nervous about getting the
wrong answer.
Trusting each other made everything so much easier – I was not stressed out at
work.
I have stability…knowing I‘m going to be working with [my preceptor].
Conversely, in relationships with limited trust students did not feel that connection or
sense of ease with their preceptor and focused more on pleasing their preceptor than on
their learning. This caused the student to feel uncertain and frustrated. This also caused
the student to question their competence and affected their fragile confidence.
She had left me alone a lot right from the beginning…made me anxious. She‘s not
checking in on me because she doesn‘t like me…I never took the initiative.
I wasn‘t sure if I was competent because she was always double or triple checking
everything.
[My preceptor] was always hovering, it felt like she did not want to let go. I felt
frustrated most of the time.
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Growing respect. Findings in this study validated existing knowledge from the
academic literature (Beck, 2001; Crawford, Dresen, & Tschikota, 2000; Fernald,
Staudenmaier, Tressler, Main, O‘Brian-Gonzales, & Barley 2001; Gillespie, 2002;
Myrick & Yonge, 2001; Myrick & Yonge, 2004). Participants‘ stories revealed that
growing respect evolved over time spent together interacting allowing student and
preceptor to recognize each others‘ values and capacities. Mutual respect strengthened
the connection in the student-preceptor relationship and facilitated sharing. Preceptor
respect for their student was signaled through preceptor actions that demonstrated
acknowledgement of a students‘ worth as a nurse and their potential capabilities. A
preceptor would offer guidance being careful not to take over the students‘ caseload
while supporting the student to realize their learning needs. Additional actions included:
gradual release of responsibility to one‘s student, responsiveness to student learning
needs including seeking relevant learning opportunities, open mindedness to student
ideas, open communication, trust, honesty, and ultimately treating one‘s student like a co-
worker. Students recognized these actions.
[Preceptor] refers to me as the other nurse.
We spent a lot of time talking. We had open communication, the communication

was huge, I was able to ask any question…she always explained the why of
things.
[Preceptor] was happy to be working with me.
Like you genuinely care and it shows in everything you do.
Students articulated respect for preceptors as nurses and as individuals as reflected in
following participant comments.

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[Preceptor] cares, she takes the time to do that extra little bit.
[Preceptor] knows what to look for in students so I find that it creates a good
relationship for us.
I feel safe in the clinical environment working with someone who is so

knowledgeable and skilled.
We got to know each other on a personal and professional level.
She is an amazing nurse, a very good role model.
Students shared that being treated with respect and trust anchored their
relationship. They felt comfortable making suggestions, asking any question, getting the
wrong answer and didn‘t feel anxious in clinical or going into clinical. They felt safe
learning with their preceptor. This affirmation supported students to focus on learning
and built their self-confidence. Students-in-relationship with preceptors without this trust
and respect described their feelings as ―frustrating‖, ―like walking on egg shells‖, and
protected their vulnerabilities and fragile confidence through their own personal
resilience strategies. These findings contribute to the literature on student learning inside
the student-preceptor relationship during preceptorship
Preceptor perceived accountabilities. Preceptor perceived accountabilities
included providing space for learning, being a positive role model and allowing gradual
independence while providing opportunities for learning and support. Each of these
preceptor perceived accountabilities have been discussed in the literature through various
studies (Crawford, Dresen & Tschikota, 2000; Dube & Jooste, 2006; Myrick & Yonge
2002; Ohrling & Hallberg, 2000b; Zilembo & Monterosso, 2008a). This study labeled
these preceptor behaviors as preceptor perceived accountabilities, recognized them as

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triggers impacting the students‘ lived experience inside the relationship and identified
that when enacted in a positive way this supported a students‘ fragile confidence.
Providing space for learning. Providing space for learning involved spending
quality time together. Across all participant stories the value of spending time with their
preceptor was highlighted. Spending quality time together included: getting to know each
other on a professional and personal level, sharing each others‘ expectations and
experiences, recognizing each others‘ capabilities, bonding and debriefing time, and
building of trust and respect. Clear communication was inherent to these. Participants
also indicated it was important to them to feel that their preceptors were happy to be
working with them; that they were wanted, cared for and not considered a nuisance.
Providing space for learning, spending quality time together as described, supported a
students‘ fragile confidence. Spending time together required preceptor presence.
[Preceptor] would always kind of debrief with me and ask really good questions
that allowed me to learn.
It kind of got more into a friendship; we would talk about different experiences in
our life and there was just so much support.
We really got to know each other on personal levels [as well].
My preceptor was always there for me. I was able to talk it through with
my preceptor.
When not much time was spent with their preceptor, one student described feeling scared
and not liked by her preceptor; another student described feeling like an intruder in her
preceptor’s space. Existing knowledge from the academic literature supports that
students feel at ease when they experience quality time with their preceptor (Gillespie,
2002; Kim, 2007).

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A students‘ fragile confidence was impacted by the space for learning or quality
time spent with their preceptor. Spending quality time with their preceptor varied across
student experiences, from a lot of quality time spent to a limited amount of quality time
spent. Spending quality time together positively impacted the student‘s level of self-
confidence and the learning experience. Spending quality time together allowed trust to
build and gradual independence while providing opportunities for learning and support.
This finding is supported by the work of Beck, 2001; Crawford, Dresen, & Tschikota,
2000; Gillespie, 2005; and Myrick & Yonge, 2001.
Allowing gradual independence to practice while providing opportunities for
learning and support. Allowing gradual independence to practice through: use of support
and encouragement, probing questioning, debriefing, constructive feedback and looking
out for their student, facilitated student growth, enabling students to strengthen their
competence and confidence.
When we would come out of the room [preceptor] would say ―that was very
good‖ or ―next time you should do this‖ – that was good for me. I liked that I got
reassurance right after or something to work on for the next time.
Without feedback I felt lost. [Preceptor] was not there for me.
She always asked really good questions that helped me learn.
[Preceptor] made more positive comments towards me; like assurances and
stuff like she would say ―good thinking‖; I gravitated toward those comments.
[Preceptor] helped me to be able to explain that [dying process] to families.
Let me know if this is too much for you...we can share it.
[In difficult situations] my preceptor was always there.
[Preceptor] loved being a preceptor. He loves helping students learn.

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He was always there when I needed to talk to him.
In positive situations the gradual release of nursing responsibilities to the student
and the resulting greater student independence were congruent with students‘
demonstrated capabilities. This required a balance of independence and guidance within
the relationship. Such a relationship is empowering and transformative enabling the
achievement of expectations (Boychuk Duchsher, 2000; Cranton, 2006; Murphy &
Wright, 2005). As cited in four of the six accounts, at the start of the student-preceptor
relationship each preceptor worked alongside their student verifying student skills,
knowledge and safety. With time spent together, preceptor guidance allowed for the
student to demonstrate competence, eventually leading to increased independence. By the
end of the term, students worked on their own, they were responsible for the full caseload
with preceptor guidance still accessible to them. The preceptor provided a supportive
presence initially by being physically present with the student and by the end of the term
through preceptor availability. This progression is reflected in the following comments.
When I was first with her, she was beside me and would check all my
medications. But now she‘s like…any questions about medications you come
back to me. She has seen me give IM‘s and insulin before. She‘ll check my
insulin then she will check that I am comfortable to give it and I‘ll give it on my
own. It‘s a little more independence every day…My preceptor has a lot of
confidence in me.
My preceptor treated me more as a student at the beginning of the term and as a

co-worker as the term progressed.
Gradual release of responsibilities grows trust and supports a students‘ fragile confidence
fostering confidence in students. Development of self-confidence and independence
reciprocate each other. Students felt secure working independently knowing their
preceptor was accessible. This independence was described by one participant as ―[it] felt
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really good‖ and by another as a ―real feeling of satisfaction‖. This positive experience
with independence facilitated a positive learning experience for students.
For students who did not experience a gradual release of responsibilities they did
not have the student-preceptor relationship or the learning opportunities they expected.
One student (Eva) shared she felt her preceptor ―did not want to let go‖ giving her two to
three patients for the majority of the placement and treating her like a second or third year
nursing student. Toward the end of the term the preceptor did allow the student to carry
the full assignment, however, she ―hovered‖. The student stated ―You can‘t feel like
someone is always looking over your shoulder. That creates negativity and frustration
and that‘s not conducive to feeling connection with anybody‖. As a result this student felt
angry she missed expected growth opportunities. Another student shared that her
preceptor left her alone, not providing her with much guidance in terms of support,
probing questioning, debriefing, constructive feedback or by looking out for her. This is
from Cathy‘s account.
[My preceptor's] not checking in on me because she doesn't like me. I liked that I
was able to go in and do my care without someone constantly looming over
me but then there was that feeling, ‗I don't know where I'm at right now!
I'd don't know what I should be doing more of or what I should be doing
better at‘. I always asked questions of my preceptor if I wasn‘t comfortable
but I never took the initiative as I did not want to overstep my boundaries.
She doesn‘t really know how I work. I could‘ve broken my sterile field and
continued going because I didn‘t have anyone there watching me. I don't
know how she could trust me like that.
This student felt stressed in the relationship with her preceptor and limited in the practice
environment as a result of the lack of time spent together and the limited guidance
provided. This triggered fear, self-doubt and damaged the students‘ fragile confidence.
In each of these situations where gradual independence did not occur students felt
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frustration, resentment and disappointment. These were negative learning experiences
from the students‘ perspective.
Being a positive role model. Findings from this study validated existing
knowledge from the academic literature (Dube & Jooste, 2006; Gray & Smith, 2000;
Hirst & Lane, 2005; Myrick & Yonge, 2002; Zilembo & Monterosso, 2008a). Being an
example for one's student provides a way of learning that demonstrates preceptor ways of
treating a student and preceptor perceived accountabilities in the student-preceptor
relationship but also in the nurse-patient relationship and the nurse-coworker relationship.
Each student shared experiences about their preceptor as a role model. Participants
consistently conveyed that they learned best in the practice setting through ―doing‖ with
their preceptor. Students needed to use their preceptor as a role model, as a concrete
illustration, related to the complexity of the tasks and actions they were expected to enact.
This illustration to a student could be demonstrating a new skill, providing verbal
examples or providing feedback regarding performance. Positive role modeling has been
identified as a huge motivator for learning by participants in this study, acknowledging
preceptor presence and a congruence between words and actions as necessary for positive
modeling to occur. Role modeling included being a role model with clients, being a role
model with co-workers and being a role model with students. The values and behaviors in
the exemplar of role modeling with student are applicable and transferrable when
interacting with clients and co-workers.

87
Being a role model with clients allowed students to identify caring nursing
behaviors, advocating for clients and observe how to carry out skills with clients. This
opportunity allowed students another insight to knowing their preceptor.
It‘s so nice to see that after nursing for so long she cares to take the time to do that
extra little bit.
To have a knowledgeable, caring nurse as a preceptor made students feel secure and safe
to learn.
We had a patient dying one night and his family was there and they had a lot of
questions. They were asking the same question but in different ways. And I didn‘t
know the answer to a lot of it. But [my preceptor] knew, she had answers for all
of it. As I watched her, there was much I‘d never thought of.
She was very passionate about that kind of nursing…so experienced with these
patients. She knew so much about how to explain things to families.
Being a role model with co-workers allowed students to recognize when they
were being treated more like a co-worker. Participants reported that as their confidence
and competence developed they were treated as co-workers by not only their preceptors
but also by other workers on the unit. A connected student-preceptor relationship
supported a students‘ position as part of the unit team. It also allowed students to learn
how to work with co-workers and communicate with other members of the health care
team.
As a role model with their student, preceptors demonstrated how to create, or not
create, a connected student-preceptor relationship; a connected relationship being one
with caring, trust, respect, communication, an ability to spend quality time together, an
ability to guide the student to achieve independence gradually, and to role model caring,
professional behaviors with clients and co-workers. As a role model with a student, the
student was afforded the opportunity to see what it was like to work in the real world and
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be treated as a co-worker with the safety net of being able to access their preceptor for
support. This positive role modeling also allowed students to feel safe with their
preceptor, to feel cared for in the practice setting. Some participant comments follow:
To be working with someone who is so knowledgeable and skilled I feel

safe in the clinical environment.
[Preceptor] always makes sure I understand what‘s going on.
I really trust her. I trust her judgment. I would go to her before I would go to
other nurses in the area.
[Preceptor] speaks to me as if I‘m a nurse. She doesn‘t speak to me as the

student…it really gave me a sense of what it‘s going to be like as a nurse.
[Preceptor] really does care about how I‘m progressing, what I‘m learning, if I‘m
comfortable.
[Preceptor took the time to show me how to set up the nebulizer]
Some participants reported that their preceptors also role modeled their valuing of
continued learning by being receptive to student ideas.
Together with my preceptor we found some really good resources that

talked about how the different systems shut down. She helped me to be
able to explain that to families; I eventually got used to being able to
explain that which was really good.
[Preceptor is] an active learner.
Participants reported a feeling of satisfaction when they demonstrated what their
preceptor had been role modeling or received recognition from their preceptor for doing a
task well. As preceptors nursed with students, students were prompted by their example
and experienced confirmation of their existing competencies. This boosted the level of
confidence felt by participants.

89
Conclusion. Fragile confidence as reflecting a students‘ lived experience of
feeling vulnerability inside the student-preceptor relationship can be supported through
preceptor treatment of their student and preceptor perceived accountabilities. Findings
from this study support the current literature (Delaney, 2003; Dube & Jooste, 2006;
Elzubier & Rizk, 2001; Gray & Smith, 2000; Hirst & Lane, 2005; Myrich & Yonge,
2002; O‘Malley, Cunliffe, Hunter, & Breeze, 2006; Zilembo & Monterosso, 2008a)
highlighting preceptor behaviors and their significance to student learning during
preceptorship. Additionally, findings from this study support that it is important for
preceptors to be cognizant of and sensitive to students‘ self-vulnerability or fragile
confidence in order to build student confidence, facilitate student motivation to learn and
learning. As students felt trusted, respected and cared for by their preceptors they
indicated they also felt more motivated and confident in their learning. Through
understanding the situational and lived experience themes exemplified by this study the
preceptorship model can be used more effectively as a learning strategy that increases
student confidence and competence and supports the student-to-graduate nurse transition.
Characteristics of the preceptor and the quality of the interpersonal relationship
strongly affected satisfaction with, and effectiveness of, the preceptorship experience.
This relationship is perceived by the student as pivotal to development as a nurse and to
movement along the novice-expert continuum. Student-preceptor interaction involved a
dynamic and respectful place for learning, with two-way communication that provided a
platform to challenge ideas, beliefs, and approaches; furthermore, it is a place where
support and guidance are provided so that competent practice is enhanced. Additionally,
the student-in-relationship with preceptor provided space for transformation and

90
realization of personal capacity. It is through understanding of the dynamics of the
student-preceptor relationship that those involved in the preceptorship experience—the
preceptor, the student, and faculty—can become more adept at identifying and facilitating
the relational process. Such understanding will foster insight into situations of conflict
and working with the difficult student within preceptorship and how these situations
affect the relational process.
Implications for Nursing Education
This study contributes to the nursing literature on the happenings in the student-
preceptor relationship during preceptorship and the affect this has on student learning.
Recognizing the importance a positive lived experience inside the student-preceptor
relationship has on student learning places an incentive on educators to take action. This
study suggests three areas of recommendations for action in the education of fourth year
nursing students. The first area of recommendation is directed toward the nursing student,
the second toward the practice agency, and the third toward the preceptor.
Recommendations related to nursing student. It would be beneficial for
nursing educators to partner with students in preparation for the preceptorship experience,
including the first meeting with their preceptor. This would facilitate student
understanding of course expectations as well as provide opportunity for students to
discuss their own personal learning objectives and areas of query. Such preparation may
assist in: supporting students to feel more comfortable when commencing clinical,
helping students to feel more comfort communicating with nursing educators (in this
91
case, a faculty member) when clinical issues exist and finally, facilitating students‘ ability
to direct their learning during preceptorship with greater confidence.
In addition to the upfront preparation, ongoing availability of and support from
nursing educators is recommended. This provides opportunity to debrief with students
individually and / or collectively as a group during or following the experience. Such
debriefing allows student sharing of experiences with each other, letting go of negative
experiences and perhaps gaining additional growth as students‘ further recognize
personal and professional learning‘s.
Recommendations related to practice agencies. It would be beneficial for
nursing educators to work closely with practice agencies in the: selection of preceptors,
preparation of preceptors, and ongoing support of preceptors. Participants in this study
indicated their desire to be with preceptors who wanted a student; students did not want
to feel like a nuisance to their preceptor. Selecting preceptors who want to be a preceptor
was viewed as important by students. Participants also conveyed the importance of
preceptor expertise in the preceptor role, particularly preceptor ability to develop a
positive relationship with students and to anticipate student learning needs. Preparation of
preceptors and ongoing support would facilitate this preceptor expertise. Collaboration
between nursing educators and practice agencies in the selection, preparation, and
ongoing support of preceptors may serve to strengthen the preceptorship experience for
both the student and preceptor facilitating student learning and confidence.
92
Recommendations related to preceptors. Finally, it would be beneficial for
nursing educators to prepare preceptors for this role prior to the preceptorship and then to
be available to provide ongoing support during the preceptorship. Potentially such
visibility and availability will signal to preceptors the importance of learning in
preceptorship to student professional growth and development.
It is incumbent upon nursing educators to support the student-preceptor
relationship so that space for learning, opportunities for learning, positive role modeling
and gradual independence to practice is afforded to students. Such support facilitates
transition of student to graduate nurse with the student or graduate nurse able to support
their fragile confidence.
Implications for Further Research
Students‘ lived experiences in the student-preceptor relationship have been
shared. Further insights on the happenings inside the student-preceptor relationship
would be revealed by repeating this study from a preceptor perspective. From the
preceptors‘ perspective in these times of healthcare constraint, how does the preceptor
and the student work together? What is the process by which a preceptor-student
connection occurs? It would be interesting to hear the lived experiences of preceptors and
then compare for similarities and differences to that of students. Such information would
be helpful in structuring preceptorships that best support both student and preceptor.
Research focusing on an effective means of selecting preceptors would serve
great utility in selecting preceptors who are prepared and willing to fill the role of
preceptor to a final year student. Students in this study indicated the desire to feel wanted
93
by their preceptor and not viewed as a nuisance. It may also be beneficial to do research
on preceptor self-efficacy for the preceptor role highlighting their perceived learning
areas, again in an attempt to support the student-preceptor relationship, student learning,
and ultimately client care outcomes.
To repeat this research with students across professional practice disciplines such
as student teachers, social work students, and medical students would potentially allow
recognition of similarities and differences among different disciplines as well as the
opportunity to learn from each other.
Participants in this study were all female. To explore the student-preceptor
relationship when the student is male may potentially provide variation to the lived
experience themes outlined in this study. Additionally, research exploring the student-
preceptor relationship when the preceptor is paired with a difficult or unsafe student
would potentially extend the findings of this study.
A final area of research is to explore the question, ―As nurses, when do we lose
fragile confidence?‖ – after the first year as a nurse? – after the 30th year as a nurse?
– is it situational? – or do some nurses never lose it? The existence of fragile confidence
is an area requiring further research in order for nursing educators to recognize best
practice to support a student‘s growing competence and confidence. Fragile confidence is
a deterrent to positive learning.

94
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Appendix A: Information Letter
Information for Fourth Year Nursing Students
My name is Patti Dickieson. I am a graduate education student at Nipissing University and a

professor in the School of Nursing at Laurentian University. I am working on a project that aims
to better understand the fourth year student-preceptor relationship. You are being invited to take
part in this project. Before you decide, please take time to read the following information
carefully, to understand why the project is being done and what it will involve.
Purpose of the Study

Recognizing the importance of a successful preceptorship experience, the purpose of this study is
to explore and gain an understanding of the lived experiences of fourth year nursing students in
the student-preceptor relationship during preceptorship. This insight to meaning will assist in
gaining an understanding of the interpersonal dynamics of the student-preceptor relationship that
contributes to positive student learning and to positive preceptorship experiences.
Objectives
1. To gain an understanding of the interactions (lived experiences) that occur within the student-
preceptor relationship during preceptorship.
2. From the student voice, to understand the effects these interactions (lived experiences) have on
student learning.
3. To gain an understanding of the interactions (lived experiences) that occur within the
student-preceptor relationship that create a positive learning environment (a space for
learning)
Participation Procedures
As a participant in this study, you would be invited to participate in an individualized
conversational interview for 45 - 60 minutes on 2 separate occasions. During the first
conversational interview you will be asked questions about your experiences with your
preceptor and the effect this has had on your learning. During the second conversational
interview you will be asked to verify and/or edit information provided in first
conversational interview. Each interview will be conducted at the your convenience.
With your permission the interview will be tape-recorded and transcribed. Research
results will be shared with you upon request to the researcher at
pdickieson@laurentian.ca . Grouped research results will be disseminated through thesis
document, peer reviewed journal publications and conference presentations. Anonymity
will be maintain.
Consent
If you decide to take part you will be asked to sign a consent form. Your participation in this
study is strictly voluntary and will not affect your status in the nursing program. Your decision to
participate or not participate in the study will not influence your grades or any other decisions that
are inherent in the practice course you have just completed. The co-teaching professor won‘t be
influenced to evaluate you in any different manner. The co-teaching professor will not know
whether or not you are participating. My course responsibilities were completed March 15, 2010
with the co-teaching professor assuming responsibility for all remaining evaluative components.
You are free to participate if interested; free to not answer any question that makes you feel
uncomfortable; and free to withdraw from the study at any time.
102
Benefits
While there are no direct benefits to you for participating in this study, your feedback is valuable
to the identification of strengths, areas for change and/or enhancement within the School of
Nursing you are enrolled in. Better knowledge and understanding of the student-preceptor
relationship will facilitate the development of strong student-preceptor relationships, which in
turn will potentially facilitate student learning and thus enhance patient care. The final results
may be shared with Schools of Nursing across Ontario to benefit programming. On a personal
level, you may gain a better understanding of yourself and of the concept of student in-
relationship-with preceptor.
Risks or Discomfort
The risk associated with this study is minimal. Participation is voluntary. The researcher is
committed to ensuring your anonymity and confidentiality. There is a possibility that you may
experience some psychological discomfort with increased self-awareness related to your role as
student in-relationship-with preceptor. If this occurs, you will be given the option to either take a
break and resume later or withdraw from the study. Debriefing will also be offered as required.
Privacy and confidentiality

The information you share during the conversational interviews will not be shared with
any other participant or persons outside the research team. To ensure confidentiality a
randomly assigned code number will be used in place of your name on transcribed
interviews. You will be asked to sign a consent form prior to participating in the study.
All data obtained and files generated from the data will be stored in a locked cabinet for
three years after study completion and then destroyed by the researcher. During this
period, access to the files will be limited to the researcher. No names or identifying
information will appear in presentations, reports, or publications. All participant
responses will be presented as aggregate data. Any individual responses that appear in
reports, presentations, or papers will be anonymous.
If you would like more information about the study or about being a participant, please
contact me at (705) 675-1151, ext. 3808 or Jennifer Barnett, Nipissing University Thesis
Supervisor, at (705) 474-3461, ext. 4205.
If you should have any questions regarding the ethics of this research project, please
contact Dr. Jean Dragon, Laurentian University Research Officer at (705) 675-1151, ext.
3213 or Nipissing University Office of the Vice President, Academic & Research, at
(705) 474-3450, ext. 4055.
Thank you for reading this information sheet and for your consideration.
Sincerely,
Patti Dickieson, RN, BScN, M.Ed. (c)

103
Appendix B: Consent Form
CONSENT FORM
Study Title: Fourth Year Nursing Students‘ Lived Experiences in the Student-
Preceptor Relationship Illuminated through Interpretive
Phenomenology
Institution: School of Nursing, Laurentian University
Investigator: Patti Dickieson, R.N.
I have read the information about the research study and understand that:
 Patti, a graduate education student at Nipissing University and a faculty member
in the School of Nursing at Laurentian University, is conducting this study.
 the purpose of this study is to explore and gain an understanding of the lived
experiences of fourth year nursing students in the student-preceptor relationship
during preceptorship.
 this insight will assist in gaining an understanding of the interpersonal dynamics
of the student-preceptor relationship that contributes to positive student learning
and to positive preceptorship experiences.
 my involvement will be to participate in two 45 – 60 minute conversational
interviews.
 the conversational interviews will be tape-recorded with my permission and
transcribed.
 the risk associated with this study is minimal. Should I experience any
psychological discomfort I will be given the option to either take a break and
resume later or withdraw from the study. Debriefing will also be offered as
required.
 my future will not be affected in any way by participating or not participating in
this study.
 my participation in this study is strictly voluntary. I have the right to refuse to
answer any question that makes me feel uncomfortable. I can withdraw at any
time without disadvantage to me or it affecting my status in the nursing program.
 my identity will not be revealed at any time. All information will be confidential.
 I can ask any questions at any time during this project.
if I have any questions or concerns about the study or about being a participant, I
can contact Patti at (705) 675-1151, ext. 3808 or Dr. Jennifer Barnett, Nipissing
Thesis Supervisor at (705) 474-3461, ext. 4205.
 if I have concerns regarding the ethics of this research project, I can contact Dr.
Jean Dragon, Laurentian University Research Officer at (705) 675-1151, ext.
3213 or Nipissing University Office of the Vice President, Academic &
Research, at (705) 474-3450, ext. 4055.
I agree to participation in this study and use of the grouped findings in reports, presentations, and
papers.
Yes No
Participant Signature Date

104
Appendix C: Conversational Interview Guide as Method of Inquiry
Learning in program
 Why did you decide to enter nursing?

 Since you entered nursing, how would you describe your learning experiences
…in nursing school? …in clinical practice?
Tell me about a specific practice experience.
 Have you ever felt connected (positive learning environment; space for learning):
to a teacher, clinical educator, or faculty advisor?
Describe this experience.
Tell me more about what it was about this person that influenced your feelings.
Learning in preceptorship (there is an either/or to some of these questions)
 What is it like for you to be in a student-preceptor relationship?

 What is your relationship like with your preceptor? How do you feel?
 Think about some of your experiences with your preceptor (positive and negative)
– what comes to mind? How did you feel in this experience?
 What is it that makes it possible for you to learn?
 What is it like learning within the student-preceptor relationship? How do you
feel?
 Please tell me about the connection(s) in your relationship with your preceptor.
 a) What is it about your experiences that influenced a connection between you
and your preceptor?
b) What, if any, effect did these experiences of connection have on your learning
experience?
 a) What is it about your experiences that influenced a lack of connection between
you and your preceptor?
b) What, if any, effect did these experiences of lack of connection have on your
learning experience?
 How has your feeling of connection with your preceptor changed, if at all, over
this placement?
 What comes to mind for possibly bettering the connection in a student-preceptor
relationship? What is the essence of this relationship? (relationship
meaning/significance)
 What are the essential aspects of this experience? (meaningful structures)
 Is there anything else you would like to share?
105
Appendix D: Nipissing University Ethics Approval Letter

106
Appendix E: Laurentian University Ethics Approval Letter

Fourth Year Nursing Students Lived Experiences

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FOURTH YEAR NURSING STUDENTS‘ LIVED EXPERIENCES IN THE

SUBMITTED IN PARTIAL FULFILLMENT

© Patricia Dickieson August 2010

Published Heritage Direction du

395 Wellington Street 395, rue Wellington

Your file Votre référence

In compliance with the Canadian Conformément à la loi canadienne sur la

Recognizing the importance of a successful preceptorship experience, the

student-preceptor relationship. Through better understanding of the student perspective of

supports the student-to-graduate nurse transition.

A qualitative research approach using hermeneutical phenomenological

to nursing education (Bevis and Watson, 1989). Semi-structured interviews conducted

themes and situational themes.

feeling comfort or feeling angst; feeling confident or feeling self-doubt leading to

express my sincerest appreciation to a select few.

Very special thanks go to Dr. Jennifer Barnett, my thesis supervisor. At every

statement of who they are as people and as educators.

This project is dedicated to my father, Charles Patrick Cassidy and

to my sister, Mary Beth (Cassidy) Benedict.

Chapter One: Introduction ............................................................................................... 1

Chapter Two: Review of the Literature ............................................................................ 7

Chapter Three: Methodology and Research Design ....................................................... 26

Structural analysis .................................................................................................... 35

Chapter Four: Findings and Data Analysis ..................................................................... 37

Chapter Five: Discussion and Implications ................................................................... 76

1-1: Situational Content Themes related to Alana‘s Account ....................................... 41

1-2: The Lived Experience: Themes from Alana‘s Account ......................................... 42

2-1: Situational Content Themes related to Beth‘s Account .......................................... 45

2-2: The Lived Experience: Themes from Beth‘s Account ........................................... 46

3-1: Situational Content Themes related to Cathy‘s Account ....................................... 51

3-2: The Lived Experience: Themes from Cathy‘s Account ......................................... 52

4-1: Situational Content Themes related to Debbie‘s Account ..................................... 55

4-2: The Lived Experience: Themes from Debbie‘s Account ....................................... 57

5-1: Situational Content Themes related to Eva‘s Account ........................................... 60

5-2: The Lived Experience: Themes from Eva‘s Account ............................................. 61

6-1: Situational Content Themes related to Flo‘s Account ............................................ 65

6-2: The Lived Experience: Themes from Flo‘s Account ............................................. 66

8: Common Lived Experience Themes and Thematic Variations ................................. 71

A. Information Letter .................................................................................................... 101

B. Consent Form .......................................................................................................... 103

C. Conversational Interview Tool ................................................................................ 104

D. Nipissing University Ethics Approval Letter .......................................................... 105

E. Laurentian University Ethics Approval Letter ........................................................ 106

Situated in the university, nursing is a professional practice discipline based on

transfer of knowledge from classroom to real-life patient/client praxis. These experiences

In these settings, preceptorship is the approach to teaching-learning. In this model

preceptorship in the literature is that of a one-to-one relationship between a staff RN and

(Udlis, 2008, p. 20 ). Additionally, it is considered ―as an approach to the teaching and

opportunity to develop self-confidence while increasing their competence as they become

supervision by a clinical educator employed by the educational institution. This clinical

group experience is less intensive than the one-to-one preceptorship experience.

The preceptorship model involves contributions by three players: the preceptor,

changing health-care environment. To ensure the competency of tomorrow‘s nurses,

student-preceptor relationship is central to a successful preceptorship experience.

Rationale for this Study

As a practicing registered nurse my first experience with the concept of

In 2000, as a Laurentian University faculty advisor, I began working with

negative. Because the preceptorship experience provides opportunity for students to

Significance of the Study

Preceptorship is widely used by a number of professional faculties, including

to nursing preceptorship in the nursing education literature, the majority focus is on

preceptor preparation and support, consolidation of skills, encouragement of critical

preceptorship experience. It would seem reasonable to hypothesize that effective