The term "reality shock" is sometimes used to describe the reaction of students when they discover that the clinical experience does not always match the values and ideals that they had anticipated. There are four phases of adaptation to this reaction: the honeymoon, the shock, the recovery and the resolution. This same paradigm is described by Patricia Benner and her colleagues in the classic text From Novice to Expert: Excellence and Power in Professional Nursing Practice.
|Stage||Behaviors||How to Help|
|The Honeymoon|| perceives everything as being wonderful
fascinated by the newness of the experience
focused on mastery of skills, routines and integration with the staff
| harness the student’s enthusiasm for skills and routines
be realistic but don’t stifle the enthusiasm
introduce the student to the staff, be inclusive
|The Shock/Crisis|| sets in when needs and goals are not met
rejects school and work values
preoccupied with the past
| be a good listener
have the student record his/her suggestions for improvement
provide opportunities to vent
assist the student to see more of the situation and view it more objectively
|The Recovery|| sense of humor returns
discrimination between effective and ineffective behaviors
| assist student to see positives
talk about ways to improve the work environment
verify and support critical thinking efforts
|The Resolution|| conflicts in values resolve in either constructive or destructive ways (crisis doesn’t last forever)
could see rejection of role/nursing or burnout, or new ways to cope positively
| assist the student with constructive problem solving
help the student with new, more helpful coping mechanisms
acknowledge and manage conflicts that persist
I: Establishing the Relationship
Establishing trust is one of the most crucial steps in the preceptor-student relationship and provides the foundation upon which the learning experience will develop. The student frequently experiences anxiety in this new learning situation and can benefit from structure provided by the preceptor in the form of carefully scheduled meetings and conferences. The preceptor’s availability at the beginning of the student’s placement is crucial in planning the student’s experience.
In the first few weeks of the semester, the focus of the relationship is to clarify roles, discuss mutual experiences, review the student’s background, career goals and learning objectives and to discuss agency policies. Orienting the student to the clinical setting, especially if the student has not been there before, promotes entry into the system and communicates respect and acceptance. The preceptor and student negotiate and determine the frequency of scheduled conferences that best meets the needs of the student and the schedule of the preceptor. Weekly or bi-weekly conferences are recommended.
II: The Working Phase
The implementation of an educational plan is the main focus of the working phase. Reviewing the student’s experience, discussing patients, exploring feeling regarding the experience and identifying the meeting of learning objectives are all appropriate areas that can be discussed. Feedback from the preceptor on a regular basis assists the student in maximizing his/her strengths and systematically addressing problems that may interfere with the achievement of the professional role.
During this phase, the preceptor serves as role model, resource person and consultant to the student. By demonstrating his/her own skills as an expert clinician, the preceptor assists the student in role development, application of theory and science, problem solving and decision making. An effective strategy is to encourage the student to observe and analyze the preceptor’s role as s/he works with patients and families and interacts with colleagues and staff members. Mutually sharing observations and discussing strategies for nursing practice enables the student to enrich his/her own understanding of how the role is operationalized and how problems are solved.
By applying the principles of adult education, the student’s self-direction and autonomy are fostered. Over time, utilization of the preceptor changes: the preceptor becomes less directive and the student becomes more independent and self-reliant. A loss may be felt by the student and preceptor as the relationship changes.
Evaluation is an ongoing process to assess how the learner is achieving his/her goals. At least daily verbal feedback is helpful. Students, through their clinical logs and competency check lists, should track their own progress and accomplishments. Formal, written evaluation procedures should occur at midterm and at the end of the experience, using the program evaluation forms provided. The clinical faculty liaison is responsible for the grade but the input of the preceptor is invaluable. Nevertheless, the final responsibility for the grade belongs to the faculty member. Even if the student does not agree with the evaluation received, all parties involved should sign the evaluation form. The student has the opportunity to write a response.
There are many aspects of being a preceptor to a nursing student. Each student in the ETP program is an adult learner. Recognizing this as well as the steps involved in learning a new role that are specific to an adult learner will assist you in being a successful preceptor. Following are several tips on problem solving, decision making, communication, conflict resolution and advice from other preceptors.
Benner, Patricia (1984). From Novice to Expert: Excellence and Power in Clinical Nursing Practice, Jossey Bass, San Francisco CA.
Ferszt, Ginette (1987) Clinical Preceptor’s Manual, University of Pennsylvania School of Nursing, Philadelphia, PA.
Alspach, Jo Ann Grif. . From Staff Nurse to Preceptor: A Preceptor Development Instructor's Manual [2nd ed.]. Aliso Vieji, CA. American Association of Critical Care Nurses.
Rodrigues, L. (March/April 1992) Nursing Staff Development Insider (2) 2.