Nurse Education Today (2004) 24, 566–574
Nurse
Education
Today
intl.elsevierhealth.com/journals/nedt
Contributing to the theory development
of preceptorship
Diane B. Billay, Olive Yonge*
Mewburn Veterans Centre, Edmonton, Alberta, Canada
Faculty of Nursing, 3rd Floor Clinical Science Building, University of Alberta, Edmonton,
Alberta, Canada T6G 2G3
Accepted 27 July 2004
KEYWORDS
Summary The purpose of the study was to clarify and analyze the concept of preceptorship as experienced by the preceptor. Preceptorship is a teaching method
commonly used in many professions. The current study assists in the clarification
and analysis of the concept of preceptorship as experienced by the preceptor.
Regarding methodology, the literature was reviewed to compare the experience
of clinical teaching with preceptorship. Literature was reviewed from the following
fields/domains: nursing, medicine, education, social work, rehabilitation, dentistry,
law, and pharmacy. Through application of the framework outlined by Walker, L.O.,
Avant, K.C., 1995. Strategies for Theory Construction in Nursing, third ed. Appleton
& Lange, Norwalk, attributes, antecedents, consequences, and empirical referents
were identified that help define preceptorship. There were three main findings: The
nature of the relationship between the preceptor and preceptee is pivotal, evaluation is a challenge, and preceptorship is distinct from mentorship. The consequences of a preceptorship experience are better prepared and more confident
preceptors, evolution into a mentorship relationship, and professional development
of both the preceptor and the preceptee.
This article concludes with numerous topics that could be addressed in future
research: (a) screening tools for the preceptor; (b) evaluation of the preceptee;
(c) the relationship between preceptee, preceptor, and faculty; (d) preparation
of the preceptor, and (e) rewarding the preceptor.
c 2004 Elsevier Ltd. All rights reserved.
Preceptorship;
Concept analysis;
Nursing education;
Theory development
*
Corresponding author. Tel.: +780 492 2402; fax: +780 492
2551.
E-mail addresses: billayb@shaw.ca (D.B. Billay), olive.yonge
@ualberta.ca (O. Yonge).
Introduction
Preceptorship is a popular and effective method of
teaching nursing students the intricacies of clinical
0260-6917/$ - see front matter c 2004 Elsevier Ltd. All rights reserved.
doi:10.1016/j.nedt.2004.07.010
Contributing to the theory development of preceptorship
practice (Myrick and Yonge, 2001). Kramer first
used the term in 1974 when describing how nursing
students were being taught. Preceptorship is not
unique to nursing; a similar concept is used in
teaching, law, engineering, and other health professions (Kernan et al., 2000; Raschick and Maypole, 1998; Vrahnos and Maddux, 1998).
Walker and Avant (1995) described three basic
elements of theory building (concepts, statements,
and theories) and three basic approaches for building these elements (analysis, synthesis, and derivation). Concepts are the basic building blocks of
theory. They are mental images of phenomena,
ideas, or constructs in the mind about things (Walker and Avant, 1995). Concepts help us to identify
how our experiences are similar or equal by categorizing all the things about them that are alike.
Analysis is useful in areas with an existing body of
theoretical literature, and involves dissecting the
whole into its component parts so that they can
be better understood (Bloom, 1956). Analysis
examines the relationship of each of the parts to
each of the other parts and then to the whole.
Concept analysis contributes to theory development by providing a way of identifying and expressing key ideas about the essence of practice and
helps nurses to gain a more complete and insightful
understanding of practice. Concepts must be
understood in relation to theory development, as
noted by Bixler and Bixler (1945): ‘‘A profession
utilizes in its practice a well-defined and well-organized body of specialized knowledge which is
on the intellectual level of ‘‘higher learning’’ (p.
730). Theory development has metamorphosed
into an activity that takes many forms, occurs at
a variety of levels of abstraction, and infiltrates
each aspect of nursing (Walker and Avant, 1995).
Chinn and Kramer (1995) defined theory as ‘‘a creative and rigorous structuring of ideas that project
a tentative, purposeful, and systematic view of
phenomena’’ (p. 77). Because nursing is practice
based, there are practitioners who must educate
students, administer educational and service
establishments, and develop and test knowledge
(Walker and Avant, 1995). A commitment to practice based education based on sound knowledge is
fundamental to the idea of a profession and practice discipline.
Purpose
Preceptorship is widely used in nursing; therefore
it is important to analyze the concept in order to
facilitate the appropriate application of it. Con-
567
cept analysis renders explicit and theoretical
operational definitions for use in nursing theory
and research (Walker and Avant, 1995). It also
helps to clarify nursing terms that have become
overused and thus have lost their meanings, and
it may be useful for tool development and nursing diagnosis. A concept analysis of preceptorship
would deepen nurses’ understanding of nursing
education and hopefully enhance its application
in the clinical area as well. Implications for educational practice for the preceptor include updated clinical knowledge; opportunity to
socialize students into future professional role;
and enhanced teaching ability through organization, evaluation, constructive criticism, role
modeling, and self-assessment.
To give context to this concept analysis, a brief
discussion of definitions and a review of the pertinent literature identify how the concept is used
in current practice in nursing educational
programs.
Definitions
The following six definitions were deemed relevant
to the current study:
Concept analysis: a ‘‘careful examination and
description of a word and its uses in the language
coupled with an explanation of how it is ‘like’
and ‘not like’ other related words’’ (Walker and
Avant, 1995, p. 38).
Educator: a professor or educator at a university, college, or practice-focused agency who
develops, monitors, maintains, and evaluates the
quality of the preceptorship experience. This person is accountable for educating, supporting, and
evaluating preceptors and preceptees throughout
the experience (Schoener and Garrett, 1996).
Preceptee: a (neophyte nurse or) student engaged in learning the role of the nurse from an
experienced staff nurse or preceptor (Kaviani and
Stillwell, 2000).
Preceptor: an experienced nursing professional
who teaches, supervises, and serves as a role model for a student or graduate nurse, for a prearranged period of time, in a formalized program
(Usher et al., 1999).
Preceptorship: ‘‘involves contact with an experienced and competent role model and a means of
building a supportive one-to-one teaching and learning relationship. This relationship tends to be shortterm [and is aimed at] assisting the newly qualified
practitioner or nursing student to adjust to the nursing role’’ (Kaviani and Stillwell, 2000, p. 219).
568
Reviewing the literature from other disciplines is
a common method used in professional education.
From January 2000 to April 2004 the literature from
various disciplines was reviewed: nursing, medicine, pharmacy, law, social work, rehabilitation,
dentistry, and education. The search terms utilized
were preceptor, preceptorship, clerkship, paradigm, model, framework, supervisor, field educator, articling, internship, clinical educator,
teaching, education, teaching methods, law education, medical education, teacher education,
clinical supervisor, mentor, apprentice, and cooperating teacher. Search methods included using
two etymology dictionaries and searching Networking Edmonton’s online systems (NEOS) library system, the cumulative index to nursing and allied
health literature (CINAHL), the nursing knowledge
network (NKN), MEDLINE, Psychlit, the Web of Science Records, the law database, and ERIC. The total numbers of articles searched was 225, and 45
were included: all national and international articles published in English pertaining to preceptorship in nursing. For the other disciplines, articles
were limited to the role of teacher and learner in
the field setting.
Nursing has developed a highly structured definition for preceptorship, utilizing the concept in the
education of neophyte nursing students and new
employees. Kaviani and Stillwell (2000) and LeGris
and Cote (1997) suggested that preceptors need
formal academic preparation for this role. Schoener and Garrett (1996) similarly stated that preceptors need to be adequately orientated. LeGris
and Cote (1997) contended that the majority of
Canadian baccalaureate students are preceptored
by diploma-prepared nurses who may lack the
teaching background necessary to function effectively as preceptors. Coates and Gormley (1997)
added that just because nurses are knowledgeable
and expert in their field does not mean that they
can automatically function as preceptors.
Functions and behaviors commonly mentioned
specific to the preceptor role are as follows: (a)
role model (Cohen and Musgrave, 1998; Kaviani
and Stillwell, 2000; LeGris and Cote, 1997; McCarty
and Higgins, 2003); (b) facilitator (Kaviani and Stillwell, 2000); (c) socializes students into a new role
(Bradshaw et al., 2002; Cohen and Musgrave, 1998;
Griffin et al., 2002; Kaviani and Stillwell, 2000;
McCarty and Higgins, 2003); (d) supports (Bryant
and Williams, 2002; Cohen and Musgrave, 1998;
Griffin et al., 2002; Kaviani and Stillwell, 2000;
McCarty and Higgins, 2003); (e) needs to be recognized (Kaviani and Stillwell, 2000; LeGris and Cote,
1997); (f) clinically competent and knowledgeable
(Brunt, 2002; Coates and Gormley, 1997; Freil-
D.B. Billay, O. Yonge
burger, 2002); (g) good communication skills (Cohen and Musgrave, 1998; McCarty and Higgins,
2003); (h) good teaching skills (Cohen and Musgrave, 1998; Kaviani and Stillwell, 2000); (i) gives
effective feedback (Cohen and Musgrave, 1998;
McCarty and Higgins, 2003); (j) provides evaluation
(Schoener and Garrett, 1996); and (k) bridges the
theory–practice gap (Corlett et al., 2003; Kaviani
and Stillwell, 2000).
The medical literature also discussed the concept of preceptorship; however, the terms trainee,
supervisor, and clinical clerkship were also used.
According to Fernald et al. (2001), the discipline
of medicine has undergone significant changes that
are affecting the content and process of medical
education. In response to these changes, community-based learning experiences, such as preceptorships in primary care settings, have become more
popular within medical schools. The functions
and/or behaviors of the medical doctor–preceptor
deemed necessary for preceptorship to be successful are as follows: (a) teacher (Kernan et al., 2000);
(b) providing feedback (Kernan et al., 2000; Kilminster and Jolly, 2000); (c) being clinically competent
and knowledgeable (Kilminster and Jolly, 2000); (d)
role model (Barrington and Murrie, 1999; Kilminster
and Jolly, 2000); (e) having good communication
skills (Barrington and Murrie, 1999; Kilminster and
Jolly, 2000); (f) understanding teaching principles
(Kilminster and Jolly, 2000); (g) providing favorable, real-life experiences (Barrington and Murrie,
1999; Kernan et al., 2000); and (h) linking theory
with practice (Kilminster and Jolly, 2000).
Whereas the literature pertaining to nursing and
medicine has been clear about the definitions and/
or uses of preceptorship, the pharmacy literature is
less so. Terms such as clinical clerkship, preceptors, preceptorship, clerkship, and pharmacy fellowship are used. Pharmacy uses clerkships
(Carter et al., 1998) to introduce the student to
the realities of the profession. Faculty supervisors
are used as preceptors to introduce the student
to patient-care activities (Vrahnos and Maddux,
1998). Specific educator behaviors or characteristics have not been explicitly discussed or
documented.
The discipline of law uses the concept of articling when describing education of the law student.
However, actual behaviors or characteristics of the
lawyer(s) under whom the student articles were
not discussed. The term apprenticeship is also utilized in terms of student education, but again,
behaviors and characteristics of the educators
were not discussed.
In terms of the education of social work students, the concepts of field education, field
Contributing to the theory development of preceptorship
instruction, and field educator are predominantly
used, but there is little description of attributes
or admired behaviors of the educators. Cooper
and Crisp (1998) stated that field education is regarded as a pivotal feature of social work education because it provides individualized learning
experiences for students. Field educators provide
reality-based education, frequently without reward or adequate recognition.
The discipline of rehabilitation, like nursing and
medicine, describes educator behaviors more fully
than do law and social work. Rather than preceptorship, concepts used include clinical educator,
clinical supervisor, and clinical teacher. Behaviors
of an educator that are deemed important are: (a)
acting as a facilitator (Cross, 1994); (b) being formally educated as a supervisor (Walker and Openshaw, 1994); (c) evaluating students (Walker and
Openshaw, 1994); (d) being clinically competent
and knowledgeable (Onuoha, 1994); (e) being
approachable (Onuoha, 1994); (f) being respectful
(Cross, 1994); (g) being a mentor (Cross, 1994);
and (h) having good time-management and problem-solving skills (Onuoha, 1994).
In the area of dentistry, Loevy and Kowitz (1998)
used the term preceptor, but they did not describe
how dental students are taught or what educator
behaviors the students deem favorable. No articles
were found that discussed the education process of
the dental student. Similarly, in the area of psychology, the literature did not appear to adequately or systematically address the teaching of
students. Milne and Oliver (2000) utilized the concept of clinical supervisor in terms of the education
of clinical psychologists and noted that few supervisors have received formal education in supervisory methods.
In terms of preparing and educating student
teachers, the education literature has been explicit in the use of the term cooperating teacher (Croker, 1999; Hamilton and Riley, 1999). Other
concepts discussed in relation to educating teachers include internship (Hamilton and Riley, 1999),
mentoring relationship (Smith and Souviney,
1997), and mentor (Clifford, 1999; Cochran-Smith,
2000; Wilder, 1999). Other concepts noted in the
education literature are master teacher (Langdon
et al., 1997), practicum advisor (Clarke, 2000),
teacher educator (Cochran-Smith, 2000; Willis
et al., 1999), and teaching apprenticeship (Willis
et al., 1999).
Teacher attributes or characteristics deemed
important by the education student are nurturer, expert colleague, role model, facilitator, encourager
of reflection, curriculum developer, researcher,
and stimulator of professional development. Other
569
equally important attributes of student educators
are that they are team members and collaborators.
They give personal support and feedback, liaise
with teacher–education colleagues, help bridge
the theory–practice gap, provide practical
field experience, and have good communication
skills.
The review of the literature assists in identifying
the use of preceptorship or similar terms in nursing
and other professional groups. Regardless of how
preceptorship is used, there are a number of
expectations and associated behaviors. Preceptors
should be role models, facilitators for knowledge
acquisition, and conduits through which the neophyte student will learn ‘what it is like to be a
professional.’
Aims
The aim of this study was to describe and define
the concept of preceptorship. By describing and
defining this concept, the nursing profession will
have a clear and explicit understanding of the preceptorship paradigm.
Design
The central question guiding this study was, What is
the concept of preceptorship? Walker and Avant
(1995) stated that ‘‘concept analysis is a strategy
that allows us to examine the attributes or characteristics of a concept’’ (p. 37), but it should never
be viewed as a ‘‘finished product’’ (p. 37). The
analysis itself must be rigorous, but the finished
product is always tentative at best, because no
two people ascribe the same attributes to the same
concept. There is always some difference, so what
is ‘‘true’’ today may be ‘‘not true’’ tomorrow
(p. 37).
Concept analysis is part of theory building and
encourages communication and understanding
among colleagues about the phenomena being analyzed. Ultimately, concept analysis is a careful
inspection and description of a word and its uses
in language combined with an explanation of how
it is ‘‘like’’ and ‘‘not like’’ other related words
(Walker and Avant, 1995, p. 37). Concept analysis
results in the clarity of overused, yet often misunderstood concepts. The ultimate goal of concept
analysis is to acquire knowledge, while simultaneously defining a concept that is not already
understood.
570
According to Walker and Avant (1995), concept
analysis involves the following eight steps:
1. select a concept;
2. determine the aims or purposes of analysis;
3. identify all uses of the concept that you can
discover;
4. determine the defining attributes;
5. construct a model case;
6. construct borderline, related, contrary,
invented, and illegitimate cases;
7. identify antecedents and consequences;
8. define empirical referents.
Selecting a concept and determining its aims
Selection of a concept to be analyzed is always the
first step in concept analysis. The second step is
determining the aims or purposes of analysis, which
requires an answer to the question, Why am I conducting this analysis? There is also an aim to add
knowledge about preceptorship to the existing
knowledge base of the nursing profession.
Identifying uses
Identification of as many uses of the concept as
possible (Walker and Avant, 1995) was achieved
by utilizing many information/reference sources.
To lend validity and credibility to the analysis,
the root meanings of the terms most commonly
used in developing new professionals were determined using two etymological dictionaries (Klein,
1971; Skeat, 1958).
Preceptor. According to Klein (1971, p. 583), preceptor is a noun meaning teacher derived from the
Latin noun praeceptor, which means ‘‘teacher,
instructor’’. This noun relates to the Latin verb praecipere, which means ‘‘to give rules, advise,
teach’’. Precept, another noun, is derived from
the Latin noun praeceptum, which means ‘‘rule,
maxim’’. The Latin prefix root prae- (or pre-) means
‘‘before’’ (both in time and place). The Latin suffix
root -capere means ‘‘to take’’. Skeat’s (1958)dictionary stated that the word precept comes from
the Latin language and means ‘‘a rule of action,
commandment, maxim’’ (p. 470). The Latin word
praecipere is defined as ‘‘to take beforehand; to
give rules’’. The prefix root prae- is a Latin word
meaning ‘‘before’’, and the suffix root -capere, also
from the Latin language, means ‘‘to take’’.
Mentor. Klein’s (1971) etymological dictionary
defines mentor as ‘‘a wise adviser’’ (p. 457). This
D.B. Billay, O. Yonge
word is derived from the Old Indian word mantar,
which means ‘‘one who thinks’’. The Latin derivative monitor, that means ‘‘one who admonishes’’,
comes from the Latin word monitus (past participle
of monere), that means ‘‘to advise, warn, admonish’’. The root prefix men- is of Indo-European lineage and means ‘‘to think’’. The root suffix -tor is
derived from the same lineage and is ‘‘a masculine
agential suffix’’. Skeat (1958, p. 371) stated that
mentor comes from the Greek language and means
‘‘an adviser, monitor’’. This word is adopted from
a story by Homer, in which the goddess Athene
takes the form of mentor to give advice to Telemachus. Skeat noted that the Greek mentor is equivalent to the Latin monitor.
Thus the concepts of preceptor and mentor
overlap to some extent. Both involve the passing
of knowledge or advice. However, the term mentor
implies a collegial, nurturing relationship rather
than a focus on teaching and learning; thus preceptor remains a better choice when referring to a direct teaching and learning relationship and a
program of instruction. Similarly, the concept of
apprentice has a more limited application than
the concept of preceptor. It implies an opportunity
to learn more than it does a direct teaching and
learning relationship and therefore does not relate
as closely to the teaching and learning process involved with student nurses or new employees.
Determining defining attributes
The fourth step in the concept analysis of preceptorship is to determine the defining attributes of
the concept. Students consistently noted that educator characteristics should include role models
and facilitators, being academically prepared for
the preceptor role, evaluators, needing support
and reward, and being clinically skilled and knowledgeable. Other behaviors and/or characteristics
perceived by students as favorable include having
knowledge about the principles of adult education,
the ability to give feedback, and good communication skills (Hutchinson, 1994; Kernan et al., 2000;
Raschick and Maypole, 1998; Vrahnos and Maddux,
1998). Walker and Avant (1995) stated that defining
attributes are not constant, but may change as
understanding of the concept changes or improves.
Constructing a model case
The fifth step in concept analysis of preceptorship
is construction of a model case, which is an example of the use of the concept including all of its
critical attributes (Walker and Avant, 1995). In
Contributing to the theory development of preceptorship
other words, this is a ‘‘real-life’’ example of the
concept, a paradigm. The following is an example:
Case scenario: Preceptorship in an isolated community through the eyes of the preceptor
During the summer of, 2000, while working as an
acting nurse-in-charge in a northern community,
there was an opportunity for an experienced Bachelor of Nursing-prepared outpost nurse (De) to become a preceptor to a third-year university nursing
student (Steve) from a major Canadian university.
Steve was required to conduct his two month
nursing course in a remote setting. De, an experienced nurse, had been a preceptor on two other
occasions and was accustomed to the rigors and
challenges of the preceptorship experience. De
welcomed the opportunity to nurture Steve in his
learning experience and to learn from Steve. Once
in the community, De ascertained how Steve
learned best and adapted her teaching style to
what Steve described. According to Steve, he
learned best by seeing something done initially,
then doing it as a return demonstration. De knew
that young adults had their own personal knowledge that was of worth and needed to be acknowledged. She expected and hoped not only that Steve
would learn, but also that she would learn from
Steve.
The summer was unusually warm; the villagers
were happy that the rain was not as heavy that
year. Everyone enjoyed the chance to visit their
kin without the need to use umbrellas or rain coats.
Approximately one week after Steve arrived in the
community, De noticed that he was having difficulty understanding the determinants of health.
Specifically, Steve was having trouble applying theory to practice. He could not fathom the devastating effects of poverty.
To help fill this gap in Steve’s professional experience and to better link nursing theory to realitybased practice, De arranged through the Chief for
Steve and her and an interpreter to complete home
visits. During each visit she had Steve ask the family open-ended questions about how education,
nutrition, poverty, transportation, and accessibility to health care affected their health and that
of the community. At the end of the three visits,
Steve was asked to describe his feelings about
how theory linked with practice is fundamental to
the practice of community health nursing, what
communication skills were utilized, and what benefit he saw in the home visits.
At the end of the practicum, Steve marveled at
the professionalism that De had demonstrated; he
was in awe he had the opportunity to preceptor
with a nurturing, positive role model such as De,
and hoped his next preceptor would be as inspiring
571
and inspired as De. De had always given constructive comments to improve his practice, and he
appreciated that she had included him in clinical
and cultural experiences from which she felt that
he would benefit.
Constructing other cases
The sixth phase of concept analysis involves constructing borderline, related, contrary, invented,
and illegitimate cases. A scrutiny of cases that
are similar to (but not exactly the same as, or even
contrary in some ways to) the concept of interest
helps to ascertain which defining characteristics
have the best fit for preceptorship (Walker and
Avant, 1995). The main purpose for the use of
these cases is to help decide what does and does
not count as defining attributes for preceptorship
(Walker and Avant, 1995).
Borderline cases have some, but not all, of the
defining attributes. For example, De might precept
Steve but not teach about the health determinants.
A related case would not contain the defining attributes of the preceptor. In this case, De might informally discuss with Steve – who might be the
grandson of the village Chief – the determinants
of health. A contrary case would give a clear example of what the concept is not. De might be assigned to Steve, but when Steve arrives in the
village he is evacuated due to flooding and has to
finish his educational program with a group of seven other students taught by a clinical professor
on a surgical floor in an urban setting. Last, invented cases are clearly outside the experience
or application of the concept. De remains the outpost nurse in the community, but Steve might arrive in the village and not identify himself as a
student nurse or seek out De and then live with a
family as an anthropology student.
Identifying antecedents and consequences
The seventh step in concept analysis is identification of antecedents and consequences, a step often
ignored in concept analysis (Walker and Avant,
1995). However, identification of antecedents and
consequences may illuminate the social contexts
in which the concept is generally utilized. Antecedents are events or incidents that must transpire
prior to the occurrence of preceptorship, including:
1.
2.
alignment with a nursing program through a
contract with the school or agency,
teaching with the preceptorship method,
572
3.
4.
5.
6.
7.
8.
D.B. Billay, O. Yonge
willingness of an organization to accept a
preceptee,
theoretical and clinical preparation to be the
preceptor,
use of learning objectives and goals for the
preceptee,
use of a student syllabus or course
preparation,
shared patient assignment,
ensuring that the preceptee meets agency
requirements such as current cardiopulmonary
resuscitation (CPR) and immunization certification.
Consequences include the following: The preceptor will enhance knowledge about teaching; acquire teaching skills, professional satisfaction, and
personal development; and bridge the theory–
practice gap.
Identifying empirical referents
The final step in concept analysis is identification
of empirical referents. Walker and Avant (1995)
stated that often the critical attributes and the
empirical referents will be the same. Empirical referents are ‘‘classes or categories of actual phenomena that by their existence or presence
demonstrate the occurrence of the concept itself’’
(Walker and Avant, 1995, p. 46). They are useful in
practice because they provide clear, perceptible
phenomena by which to ‘‘diagnose’’ the existence
of the concept in particular clients (Walker and
Avant, 1995). The empirical referents for preceptorship include the following:
1. a defined relationship with the student (DeClute and Ladyshewsky, 1993),
2. a period for orientation,
3. formal linkage with faculty/school,
4. a program/course,
5. an evaluation system,
6. a care recipient (for example: patient,
community).
Discussion
The purpose of this study was to describe a concept
analysis of preceptorship as experienced by the
preceptor. The findings provide clarity when applying the concept of preceptor versus mentor or
apprentice, illustrate the need for organization of
the experience from the interpersonal to the
administrative levels (Letizia and Jennrich, 1998),
and dictate the need for certain personnel to be
present for preceptorship to occur (LeGris and
Cote, 1997). The antecedents identify the need
for the preceptor to willingly teach the student
(Kaviani and Stillwell, 2000; LeGris and Cote,
1997) and orientation (Schoener and Garrett,
1996). Preceptors are not merely being assigned
to preceptees. Rather, the preceptees are being
prepared for an experience in which they have
two teachers: an educator and a preceptor (Kaviani
and Stillwell, 2000). This relationship is bound by a
contract that must be fulfilled. Preceptees must
meet the basic requirements of their agencies prior
to beginning preceptorship regarding immunization, selected skills, and so forth.
The empirical referents identify several areas:
a relationship between preceptors and preceptees
(LeGris and Cote, 1997), a period of orientation, a
defined program, and an evaluation of the preceptee by the preceptor (Schoener and Garrett,
1996). A preceptorship involves a professional
relationship; both preceptors and preceptees
must maintain professional boundaries. Moreover,
preceptors must be knowledgeable about the
application of the principles of teaching and
learning (Kaviani and Stillwell, 2000), apply rolemodeling theory (Cohen and Musgrave, 1998;
Kaviani and Stillwell, 2000; LeGris and Cote,
1997), be able to give constructive feedback
(Cohen and Musgrave, 1998), and evaluate as necessary. Numerous theories and strategies apply to
evaluation; therefore educators need to work
directly with preceptors and preceptees to ensure
that they comprehend their responsibilities in this
area.
Last, it is important that the concept of preceptorship be viewed as distinct from the concept of
mentorship (Coates and Gormley, 1997; McCarty
and Higgins, 2003; Watson, 1999). Distinguishing
between these two concepts results in each concept’s being more clearly defined, thereby providing clearer communication for the nursing
profession about preceptorship and mentorship. It
is through rigorous analysis and the framework provided by Walker and Avant (1995) that all vested
parties will correctly and confidently apply the
concept of preceptorship in practice.
Study limitations
Concept analysis is not always straightforward.
Researchers using this method are likely to encounter problems that will impede the analysis. For
Contributing to the theory development of preceptorship
example, this study included only articles published in English that pertained to preceptorship
in nursing. Other limitations of this study include
limited access to the relevant literature due to
publication in other languages or other disciplines,
time constraints on researchers, and a lack of common terminology and understanding amongst the
different disciplines. This concept analysis has also
been limited to the application of the term as it
pertains to nursing education and not to new
employees in a clinical area.
Conclusions
It is anticipated that the study results may assist
nurses to understand the root meaning of the concept, the function of preceptorship and the preceptor, and the need for one definition of the
concept to provide clarity for the nursing
profession.
The theoretical analysis of the literature involved a critical review of the research and theoretical and expert-opinion literature directly relating
to the concept of preceptorship. Common defining
attributes of the preceptor found throughout the
literature included being a role model, being a
facilitator, having good communication skills, being
knowledgeable about the field of expertise, and
needing to understand the principles of adult education. The three disciplines of nursing, medicine,
and pharmacy have scholarly literature pertaining
to preceptorship. The disciplines of social work,
rehabilitation, and clinical psychology use similar
concepts, such as field education and clinical teacher. The disciplines of education and law use different concepts such as co-operating teacher,
internship, teaching apprenticeships, and articling.
Not one discipline uses just one concept to address
the teaching and learning of students.
Future research questions
Preceptorship is a very complex, challenging, and
demanding activity; and this concept analysis provides beginning work in its scholarly study. Future
research questions arising from this analysis are,
How do preceptors utilize knowledge? How are preceptees and preceptors prepared for the preceptorship experience? Should there be credentialing or
mandatory continuing education courses for preceptors? How should preceptors be selected for preceptorship experience? Does a preceptor screening
573
tool need to be developed? What preparation do
preceptors have in the area of evaluation? How competent are preceptors when evaluating preceptees?
What is the best way to support students and preceptors during the preceptorship experience?
References
Barrington, D.L., Murrie, D.A., 1999. A preceptor model for
introducing undergraduate medical students to palliative
medicine. Journal of Palliative Care 15 (1), 39–43.
Bixler, G., Bixler, R.N., 1945. The professional status of nursing.
American Journal of Nursing 45, 730–735.
Bloom, B.S., 1956. Taxonomy of Educational Objectives. Handbook 1: Cognitive Domain. McKay, New York.
Bradshaw, M.J., Rule, R., Hooper, V., 2002. Spotlight on. . .A
joint junior-senior clinical experience. Nurse Educator 27 (2),
56–57.
Brunt, B.A., 2002. Identifying performance criteria for staff
development competencies. Journal For Nurses in Staff
Development 18 (6), 314–321.
Bryant, S.C., Williams, D., 2002. The senior practicum. Nurse
Educator 27 (4), 174–177.
Carter, J.T., Draugalis, J.R., Slack, M.K., Cox, R., 1998.
Algorithms for estimating learning opportunity and productivity impact at clerkship sites. American Journal of Pharmaceutical Education 62 (2), 156–161.
Chinn, P.L., Kramer, M.K., 1995. Theory and Nursing: A
Systematic Approach, fourth ed. Mosby, Toronto.
Clarke, A., 2000. An advisory practicum for practicum advisors:
a follow-up study. Teaching Education 11 (2), 131–146.
Clifford, E., 1999. A descriptive study of mentor-protégé
relationships: mentors’ emotional empathetic teaching and
protégés’ teacher self-efficacy belief. Early Childhood Development and Care 156, 143–154.
Coates, V.E., Gormley, E., 1997. Learning the practice of
nursing: views about preceptorship. Nurse Education Today
17 (2), 91–98.
Cochran-Smith, M., 2000. The future of teacher education:
framing the questions that matter. Teaching Education 11
(1), 13–23.
Cohen, C., Musgrave, C.F., 1998. A preceptorship program in an
Israeli bone marrow transplantation unit. Cancer Nursing 21
(4), 259–262.
Cooper, L., Crisp, B.R., 1998. Field educator turnover: a
challenge to the quality of field education. Asia Pacific
Journal of Social Work 8 (1), 89–105.
Corlett, J., Palfreyman, J.W., Staines, H.J., Marr, H., 2003.
Factors influencing theoretical knowledge and practical skill
acquisition in student nurses. An empirical experiment.
Nurse Education Today 23 (3), 183–190.
Croker, D.L., 1999. Seduction and resistance in the classroom.
English Journal 88 (3), 17–21.
Cross, V., 1994. From clinical supervisor to clinical educator: too
much to ask. Physiotherapy 80 (9), 609–611.
DeClute, J., Ladyshewsky, R., 1993. Enhancing clinical competence using a collaborative clinical education model. Physical Therapy 73 (10), 683–697.
Fernald, D.H., Staudenmaier, A.C., Tressler, C.J., Main, D.S.,
O’Brien-Gonzales, A., Barley, G.E., 2001. Student perspectives on primary care preceptorships: enhancing the medical
student preceptorship learning environment. Teaching and
Learning in Medicine 13 (1), 13–20.
574
Freilburger, O.A., 2002. Clinical issues: preceptor programs.
Increasing student self-confidence and competency. Nurse
Educator 27 (2), 58–60.
Griffin, M., Hanley, D., Saniuk, C., 2002. Lightening the burden
for preceptors. Consider adding a ‘‘faculty model’’ week to
orientation. Journal for Nurses in Staff Development 18 (6),
322–326.
Hamilton, A.C., Riley, J.F., 1999. Shared perceptions: how
interns and their co-operating teachers view concerns facing
interns. Action in Teacher Education 21 (1), 97–107.
Hutchinson, A.C., 1994. Articling. National 3 (6), 32–39.
Kaviani, N., Stillwell, Y., 2000. An evaluative study of clinical
preceptorship. Nurse Education Today 20 (3), 218–226.
Kernan, W.N., Lee, M.Y., Stone, A.L., Freudigman, K.A.,
O’Conner, P.G., 2000. Effective teaching for preceptors of
ambulatory care: a survey of medical students. The American
Journal of Medicine 108 (6), 499–502.
Kilminster, A.M., Jolly, B.C., 2000. Effective supervision in
clinical practice settings: a literature review. Medical Education 34 (10), 827–840.
Klein, E., 1971. Klein’s Comprehensive Etymological Dictionary
of the English Language. Elsevier, London.
Kramer, M., 1974. Reality Shock. Mosby, St. Louis.
Langdon, P., Weltzl-Fairchild, A., Haggar, J., 1997. Co-operating teachers: concerns and issues. Canadian Review of Art
Education 24 (1), 46–52.
LeGris, J., Cote, F.H., 1997. Collaborative partners in nursing
education: a preceptorship model for BScN students. Nursing
Connections 10 (1), 55–70.
Letizia, M., Jennrich, J., 1998. A review of preceptorship in
undergraduate nursing education: implications for staff
development. The Journal of Continuing Education in Nursing
29 (5), 211–216.
Loevy, H.T., Kowitz, A.A., 1998. How the Middle West was won:
women enter dentistry. International Dental Journal 48 (2),
89–95.
McCarty, M., Higgins, A., 2003. Moving to an all graduate
profession. Preparing preceptors for their role 23, 89–95.
Milne, D., Oliver, V., 2000. Flexible formats of clinical supervision: description, evaluation, and implementation. Journal
of Mental Health 9 (3), 291–304.
D.B. Billay, O. Yonge
Myrick, F., Yonge, O., 2001. Creating a climate for critical
thinking in the preceptorship experience. Nurse Education
Today 21, 461–467.
Onuoha, A.R.A., 1994. Effective clinical teaching behaviors from
the perspective of students, supervisors, and teachers.
Physiotherapy 80 (4), 208–214.
Raschick, M., Maypole, D.E., 1998. Improving field education
through Kolb learning theory. Journal of Social Work Education 34 (1), 31–42.
Schoener, L., Garrett, M.P., 1996. Faculty: the driving force in
preceptorship. Nursing Connections 9 (3), 37–42.
Skeat, W.W., 1958. An Etymological Dictionary of the English
Language. Clarendon Press, Oxford.
Smith, J., Souviney, R., 1997. The internship in teacher
education. Teacher Education Quarterly 24 (2), 5–19.
Usher, K., Nolan, C., Reser, P., Owens, J., Tollefson, J.,
1999. An exploration of the preceptor role: preceptors’
perceptions of benefits, rewards, supports, and commitment to the preceptor role. Journal of Advanced Nursing
29 (2), 506–514.
Vrahnos, D., Maddux, M.S., 1998. Introductory clinical clerkship
during the first and second professional years: emphasis in
clinical practice and writing. American Journal of Pharmaceutical Education 62 (1), 53–61.
Walker, E.M., Openshaw, S., 1994. Educational needs as
perceived by clinical supervisors. Physiotherapy 80 (7),
424–431.
Walker, L.O., Avant, K.C., 1995. Strategies for Theory Construction in Nursing, third ed. Appleton & Lange, Norwalk.
Watson, N.A., 1999. Mentoring today: the students’ views. An
investigative case study of pre-registration nursing students’
experiences and perceptions of mentoring in one theory/
practice module of the Common Foundation Programme on a
Project 2000 course. Journal of Advanced Nursing 29 (1),
254–262.
Wilder, A., 1999. Good teaching looks deceptively easy. English
Journal 88 (3), 17–21.
Willis, J., Thompson, A., Sadera, W., 1999. Research on
technology and teacher education: current status and future
directions. Educational Technology Research and Development 47 (4), 29–45.