Nurse Education Today 36 (2016)

268–274

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dt

Review

Conceptualisations and perceptions of the nurse preceptor's role:

A scoping review☆
Franziska Trede a,⁎,1, Katelin Sutton a,1,2, Maree Bernoth b,3,4
a
Education for Practice Institute, Department of Student Learning, Charles Sturt University, Australia
b
School of Nursing, Midwifery, & Indigenous Health, Faculty of Science, Charles Sturt University, Australia

a r t i c l e i n f o s u m m a r y
Article history: Objectives: The practice of nursing is a substantially different undertaking to supervising nursing students. A
Accepted 29 July 2015 clear conceptualisation of the preceptor role reveals its scope, expectations and responsibilities. The aim of
this scoping review is to investigate what is known in the pertinent literature about preceptors'
Keywords:
experiences of their supervision practices and their perceptions of what makes a good workplace
Leadership
environment that enables good preceptorship and is conducive to student learning.
Preceptorship
Nursing theory Design and Data Sources: The literature scoping review design by Arksey and O'Malley was adopted for this
Workplace literature review study because it enables researchers to chart, gather and summarise known literature on a
learning Workforce given topic. Databases searched included Scopus, Ebsco, Informit and VOCEDplus.
issues Scoping Review Method: To answer our research question what is known about how undergraduate nursing student
review preceptors' supervision practices are conceptualised and perceived we posed four analysis questions to our
literature set: (1) How do the articles conceptualise preceptorship? (2) What pedagogical frameworks are
used to under- stand preceptorship? (3) What are the messages for preceptorship practices? (4) What are the
recommendations for future research?
Results: A total of 25 articles were identified as eligible for this study. The results are ordered into four
sections: theoretical conceptualisations of the preceptorship role, pedagogical framework, messages about
preceptoring and recommendations for further research.
Conclusion: The discourse of preceptorship is not underpinned by a strong theoretical and pedagogical base.
The role of preceptors has not been expanded to include theoretical perspectives from socio-cultural practice
and social
learning
paradigms.
Crown Copyright © 2015 Published by Elsevier Ltd. All rights reserved.

Introduction preceptor such as mentor, supervisor or educator (Billay and Yonge,

2004; McCarthy and Murphy, 2010). For the purpose of our review,
In this article, we present our findings from a scoping review of we defined preceptors as nurses employed within a health care
the literature on conceptualisations and perceptions of nurse agency who mentor, monitor, teach, provide feedback and assess
preceptors' supervision practices. Understanding how the undergradu- ate nursing students in their workplace.
preceptor role is conceptualised and perceived reveals Preceptors are primarily practitioners and only secondarily
assumptions of its scope and explains how nurse preceptors are educators (Yonge, 2012). Their educational role is typically seen as an
supported to supervise students and what type of workplace add-on to their primary responsibilities for client service provision
cultures and learning environments are perceived to be conducive (Yorke, 2011). The practice of nursing is quite a different undertaking
to aid or challenge this process. Many different definitions, roles and to supervising nursing students. The tension between being a
understandings are used for the term practitioner and a precep- tor can be conflated by an unsupportive
workplace learning environ- ment (Edwards, 2011; Trede et al., 2014;
☆ This research received no specific grant from any funding agency in the public, Yorke, 2011). Insufficient role clarity and recognition in organisations
commercial, or not-for-profit sectors. can lead to misunderstandings about what is and what can be
⁎ Corresponding author. Tel.: + 61 2 9752 9003; fax: + 61 2 9746 3647. expected from preceptors. Poor recogni- tion of the preceptor role and
E-mail addresses: ftrede@csu.edu.au (F. Trede), kasutton@csu.edu.au (K.
its potential benefit to organisations is compounded by a perception
Sutton), mabernoth@csu.edu.au (M. Bernoth).
1
Suite 1.01, Quad 3, 102 Bennelong Parkway, Sydney Olympic Park, NSW 2127,
that students are a risk to patient safety and error prevention, which
Australia. can lead to unwillingness to supervise students (Luhanga, Yonge, and
2
Tel.: + 61 2 9750 9005; fax: + 61 2 9746 3647. Myrick, 2008; Sanderson and Lea, 2012).
3
Room 002/215, Boorooma Street, Wagga Wagga, NSW 2650, Australia. While we recognise that preceptoring is a personally-owned
4
Tel.: + 61 2 6933 2492; fax: + 61 2 9746 3647. practice, we also recognise that preceptors do not conduct this role

http://dx.doi.org/10.1016/j.nedt.2015.07.032
0260-6917/Crown Copyright © 2015 Published by Elsevier Ltd. All rights reserved.
F. Trede et al. / Nurse Education Today 36 (2016) 268– 269
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274
single-handedly. We agree with Eta et al. (2011) and Siggins Miller
Consultants (2012) who assert that preceptors' supervision practices
are also influenced by organisational workplace structures and
unique workplace cultures, as well as managers, peers and other
health care professionals. More specifically, the complex
interrelationship between workplace learning environments, student
supervision practices and student learning has been overlooked
despite a wide acceptance that workplace learning environments
shape supervision practices (Billett,
2001). There is a need to reconceptualise approaches of
preceptorship in terms of moving away from a focus on individual
preceptor account- ability to a focus on a collective responsibility for
creating conducive workplace environments for student learning.
This call means moving away from a narrow definition of
preceptorship as an isolated and individualised, technical,
competence-focused practice, towards a defi- nition of preceptorship
as a socio-cultural practice that occurs between people and in
specific workplaces (Kemmis and Trede, 2010). Adopting this
conceptualisation means that good preceptorship is a reciprocal,
agentic and shared responsibility which is also shaped by collective
and organisational influences. Understanding how the preceptor role
is conceptualised and perceived reveals the theoretical
underpinnings, scope and recognition assigned to this role. The
following review is limited to the nursing literature and our search
design within it.
The Review
Aim
The aim of this scoping review was to investigate what is known
in the pertinent literature about preceptors' experiences of their
supervi- sion practices and their perceptions of what makes a good
workplace environment that enables good preceptorship and is
conducive to student learning.
Review Question
Arksey and O'Malley (2005, p. 23) suggest that a generalist
question and key terms are imperative to “generate breadth of
coverage”. As the aim of this review was to portray an extensive
scope of literature pertaining to the perceptions of preceptors of
nursing students, the fol- lowing research question guided this
review: What is known about how undergraduate nursing student
preceptors' supervision practices are conceptualised and perceived
from the perspective of the preceptor and the scholar who research
preceptorship? We came to ask this key
review question based on our expansive combined scholarly practice
in workplace learning where we found limited focus on preceptors'
own perceptions of their supervision practices.
Design
Scoping reviews enable researchers to chart, gather and
summarise known literature on a given topic. While systematic
reviews tend to focus on assessing the quality of research
(O'Malley and Croucher,
2005), scoping reviews, in comparison, aim to identify existing
litera- ture on a topic (Arksey and O'Malley, 2005). This includes
different
Table 1
Inclusion and exclusion criteria.
Criterion Inclusion
Time period January 2004 and August 2014
Type of article Original research article published in a peer reviewed journal
Study focus Preceptorship of nursing students involved in undergraduate
professional education for a registered nursing qualification
Preceptors' experiences and perceptions of their supervision
270
270
types of study designs. We adopted Arksey and O'Malley's
methodolog- ical framework and utilised their five stage approach
for this study: (1) isolating the research question; (2) designing
identification of applicable studies; (3) developing a search method
to select studies; (4) mapping the data; and (5) gathering,
summarising and reporting results. Stages one to three are discussed
in this section and stages four and five in the results section.
Search Methods
When conducting a scoping review it is important for researchers
to balance thoroughness with time and cost feasibilities. If clear
criteria are established, these act as controlling and limiting factors
and allow for this balance to be achieved (Kenny et al., 2013). In this
study, key search terms were identified and the following Boolean
search strings devel- oped: supervisor* AND student* (nurs*);
educator* AND student* (nurs*); preceptor* AND student* (nurs*).
The use of truncated words and wild cards (in this instance *)
allowed an expansion of the search to include all terms with the
same root word.
An initial search of Google Scholar was conducted to establish the
probable size and applicability of key terms. However, due to this
search strategy not being replicable the results were not included
in our findings (Giustini and Boulos, 2013). A search of the Cochrane
Library indicated no registered Cochrane reviews. Databases searched
included Scopus, Ebsco, Informit and VOCEDplus.
All potentially relevant studies were scrutinised against pre-
specified inclusion and exclusion criteria to confirm eligibility in and
contribution to our study, see Table 1 Inclusion and Exclusion Criteria.
Search Outcomes
Initially a total of 71 articles were identified using the above men-
tioned search design and criteria. The title, abstract and keywords of
these articles were scrutinised against the inclusion and exclusion
criteria, with all three researchers agreeing and confirming the
elimina- tion of irrelevant studies. This process left a total 65 articles,
which were divided amongst the researchers. Each researcher read
their assigned articles and, for each article, completed a scoping table
with information relevant to the overarching research questions.
Following this, the researchers had three meetings to discuss all of
the articles and their relevance to the research questions and to
meeting the inclusion criteria. As a result of critical discussions
amongst the three researchers
40 further articles were excluded from the review. Close reading re-
vealed that the study focus and/or type of preceptor did not meet our
in- clusion criteria. For example, Lindquist et al. (2012) were
excluded as the clinical educators in the study were employed by the
university, while Zahner (2006) was excluded as the study focused
on a pro- gramme evaluation and included no information about the
supervisors' perception of their own practices. Overall, 25 studies
met all inclusion criteria and included research pertaining to nursing
preceptorship in countries as varied as Australia, Botswana,
Cameroon, Canada, Finland, Honduras, Ireland, New Zealand, Sweden
and the United States, see Table 2 Overview of Included Research
Articles. A number of articles were written by the same authors,
reducing research of nursing
Exclusion
Before January 2004 and after August 2014
Any publication that was not original research, peer-reviewed, journal article and/or
unpublished. For example, PhD theses, books, book chapters and reports
practices
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No reference was made to nursing, professional entry level or the research article described a needs assessment or a programme evaluation 271
Type of preceptor Employed within the healthcare system Employed by universities
 270
Table 2
Overview of included research articles.

No Author/title Year Location/journal Research focus

1 Bourbonnais and Kerr/Preceptoring a student in the final clinical placement: 2006
Reflections from nurses in a Canadian hospital
2 Brammer/A phenomenographic study of registered nurses' understanding of their 2006
role in student learning—An Australian perspective
3 Carlson and Bengtsson/The uniqueness of elderly care: Registered nurses' experience 2014
as preceptors during clinical practice in nursing homes and home-based care
4 Carlson, Pilhammar, and Wann-Hansson/“This is nursing”: Nursing roles as mediated 2010
by precepting nurses during clinical practice
5 Carlson, Pilhammar, and Wann-Hansson/Time to precept: Supportive and limiting 2010
conditions for precepting nurses
6 Charleston and Happell/Attempting to accomplish connectedness within the 2005
preceptorship experience: The perceptions of mental health nurses
7 Charleston and Happell/Psychiatric nurses and undergraduate nursing students' 2005
perceptions of preceptorship in the mental health setting
8 Charleston and Happell/Recognising and reconciling differences: Mental health 2006
Canada/Journal of Clinical Nursing
Australia/International Journal of Nursing Studies
Sweden/Nurse Education Today
Sweden/Nurse Education Today
Sweden/Journal of Advanced Nursing
Australia/International Journal of Mental Health Nursing
Australia/International Journal of Mental Health Nursing
Australia/The Australian Journal of Advanced Nursing
To capture personal reflections on being a preceptor and to identify the supports and
challenges to enacting the role.
To gain an insight of the variation of understanding registered nurses have of their role with
students and explore the qualitatively different ways registered nurses perceive their role
with students on clinical experience and the implications of this understanding for student
learning.
To describe registered nurses' experience of precepting undergraduate student nurses
during clinical practice in nursing homes and home-based care.
To describe how preceptors mediated nursing as a profession to undergraduate nursing
students during clinical practice.
To describe conditions for precepting in a Swedish clinical context from the perspective of
precepting nurses.
To explore and describe the experience of preceptorship from the perspective of mental
health nurses who were in a preceptor role
To explore the experience of preceptorship for mental health nurses and undergraduate
nursing students in a mental health setting.
To recognise the specific issues within the mental health setting, as well as the paucity of

nurses and nursing students' perceptions of the preceptorship relationship
9 Eta, Ataga, Atashili and D'Cruz/Nurses and challenges faced as clinical educators: A
survey of a group of nurses in Cameroon
10 Haitana and Bland/Building relationships: The key to preceptoring nursing students
11 Hallin and Danielson/Being a personal preceptor for nursing students: Registered
nurses' experiences before and after introduction of a preceptor model
12 Hallin and Danielson/Preceptoring nursing students: Registered Nurses' perceptions
of nursing students' preparation and study approaches in clinical education
13 Hilli, Melender, Salmu, and Jonsen/Being a preceptor—A Nordic qualitative study
14 Hyrkas and Shoemaker/Changes in the preceptor role: Re-visiting preceptors'
perceptions of benefits, rewards, support and commitment to the role
15 Lillibridge/Using clinical nurses as preceptors to teach leadership and management
to senior nursing students: A qualitative descriptive study
16 Luhanga, Myrick, and Yonge/The preceptorship experience: An examination of
ethical and accountability issues
17 Luhanga, Yonge, and Myrick/Precepting an unsafe student: The role of the faculty
18 McCarthy and Murphy/Preceptors' experiences of clinically educating and assessing
undergraduate nursing students: An Irish context
19 Monareng, Jooste, and Dube/Preceptors' and preceptees' views on student nurses'
clinical accompaniment in Botswana
20 Ockerby, Newton, Cross, and Jolly/A learning partnership: Exploring preceptorship
through interviews with registered and novice nurses
21 Paton and Binding/Keeping the centre of nursing alive: A framework for preceptor
discernment and accountability
22 Raines/Nurse preceptors' views of precepting undergraduate nursing students
23 Smit and Tremethick/Preceptorship in an international setting Honduran nurses and 2014
American nursing working together
24 Yonge/Meaning of boundaries to rural preceptors 2009
25 Yonge, Ferguson, and Myrick/Preceptorship placements in western rural Canadian
settings: Perceptions of nursing students and preceptors
274
F. Trede et al. / Nurse Education Today 36 (2016) 268–
preceptorship research specifically related to the area.
2011 Cameroon/Pan African Medical Journal To describe the major challenges faced by clinical nurse educators in Cameroon.
2011 New Zealand/Nursing Praxis in New Zealand To better understand the experiences of being a preceptor and the factors that impact on the
nurse preceptor role.
2009 Sweden/Journal of Advanced Nursing To compare registered nurses' experiences of acting as personal preceptors for nursing
students in the year 2000 with the year 2006 and explore relationships between preceptors'
experiences and personal/clinical characteristics.
2010 Sweden/Nurse Education Today To describe registered nurses' perceptions of nursing students' preparation and study
approaches at hospital workplaces, and to explore relationships between registered nurses'
perceptions and their personal/clinical characteristics.
2014 Sweden and Finland/Nurse Education Today To gain a deeper understanding of the perceived experiences of preceptorship, which is used
to support the process of learning and development amongst student nurses during their
clinical education.
2007 Canada/Journal of Advanced Nursing To explore the relationships between preceptors' perceptions of benefits, rewards, support
and commitment to the preceptor role.
2007 USA/Nurse Education in Practice To gain a better understanding of the nurse preceptors' experience.
2010 Canada/Journal of Professional Nursing To examine ethical and accountability issues that emerged from a study exploring the
challenges for preceptors when working with nursing students whose clinical practice is
unsafe.
2008 Canada/Nurse Education Today To construct a grounded theory to explain the processes preceptors use to manage students
engaging in safe practices.
2010 Republic of Ireland/Journal of Nursing Management To explore preceptors' views and experiences of preceptoring undergraduate nursing
students.
2009 Botswana/Africa Journal of Nursing and Midwifery To describe the role of the preceptor in selected clinical practice settings.
2009 Australia/Mentoring & Tutoring: Partnership in Learning To explore the concept of preceptorship from novice nurses' and preceptors' perspectives.
2009 Canada/The Journal of Continuing Education in Nursing To describe the knowledge, expertise and wisdom preceptors acquire as they work through
challenging, complex and unpredictable situations with students in everyday practice.
2012 USA/Nursing Education Perspectives To provide nurse faculty with insight into preceptors' needs and desired level of support. To
explore what factors facilitate and/or inhibit nurse preceptors' willingness to precept
pre-licensure nursing students in the clinical setting.
Honduras/Nurse Educator To describe the anticipated rewards and barriers of Honduran nurses working as preceptors
for students from the United States.
Canada/Online Journal of Rural Nursing and Health Care To explore the professional boundaries you create in the rural preceptorship experience and
to explore how rural-based nursing preceptors create and maintain professional boundaries
when teaching undergraduate nursing students.
2006 Canada/Online Journal of Rural Nursing and Health Care To describe one theme emerging from a grounded theory study, whereby the authors
studied preceptors and students in rural settings.
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274
preceptors' perceptions of their own supervision practices to 20 the aims of preceptoring was “the development of professional
research teams. This seemingly limited research activity could have identity and hence
been the result of our selection of search terms which did not include socialization into the discipline”, theorists were not referenced in
‘mentor’, ‘teacher’ and ‘assessor’. Although internally consistent our support
short list of search terms can be interpreted as a limitation of this of this notion. Luhanga et al. (2010, p. 267) discussed ideas that
scoping review because papers (particularly from UK where the term could
‘mentor’ is used) would have been
missed.
To answer our research question what is known about how
undergrad- uate nursing student preceptors' supervision practices are
conceptualised and perceived we posed four analysis questions to our
literature set: (1) How do the articles conceptualise preceptorship? (2)
What pedagogical frame- works are used to understand
preceptorship? (3) What are the messages for preceptorship
practices? (4) What are the recommendations for future research?
We developed these four analysis questions in the process of fine-
tuning our selection criteria.

Results

The results of our scoping review are ordered into four sections in
line with these analysis questions: role conceptualisations,
pedagogical frameworks, messages about preceptoring and
recommendations for further research.

Role Conceptualisations of
Preceptorship

Preceptorship was viewed as a strategy to prepare nursing

students for the reality of practice (Eta et al., 2011); to integrate
theory and prac- tice (Carlson et al., 2010b); to gain a sense of
professional identity (Carlson et al., 2010a) and as a transitionary
programme (Bourbonnais and Kerr, 2007). Preceptorship was
reported as a dynamic, complex, rewarding, engaging and
consuming strategy and studies were adept at teasing out these
elements of the preceptor role. Yet, researchers tended to focus on
preceptoring as an individual rather than a collective responsibility.
Few studies explored how preceptoring can differ depending not
only on preceptors themselves but also on peers and managers who
together shape the workplace environment. Studies tended to focus
on the preceptor role from a university perspective
and strongly focused on the individual preceptor–student
relationship
without giving preceptors voice to their own individual practice
includ- ing perceptions of how their specific workplace cultures
influence the way they precept.
In line with this, there was limited discussion of the complex
nexus between learning and working that comprises preceptorship
from theoretical perspectives. Studies tended to be based on
preceptors' perceptions of student learning and less so a reflection
of their own preceptoring. Articles tended to focus on the challenges
(Carlson et al.,
2010b) and rewards (Charleston and Happell, 2005b; Hyrkäs and
Shoemaker, 2007) of preceptoring, how preceptorship occurs—skills
and qualities needed (Hallin and Danielson, 2009), and the role of
sys- tems (both hospital and university) in clinical education
(Charleston and Happell, 2005a). Although some articles
described personal reflections of being a preceptor (e.g.,
Bourbonnais and Kerr, 2007; Lillibridge, 2007), no article described
what shaped the preceptors' practice or referred to preceptors
having a self-reflective component
of their role in allowing them to analyse why they precept the way
they do. This is not to say that preceptors do not have this
theoretical underpinning or reflective component to their role, but
rather, that these aspects of preceptorship are often not visible in
research exploring preceptorship.
When researchers did refer to theoretical ideas such as
conceptualising preceptorship as a social, cultural or individual
practice, very few references were provided to support these concepts.
For exam- ple, while Carlson et al. (2010a, p. 763) stated that one of
 F. Trede et al. / Nurse Education Today 36 (2016) 268– 273
274 273
relate to communities of practice when they wrote “[preceptors] within a theoretical foundation. Carlson et al. (2010a, p. 766) referred
consulted with colleagues who had worked with a student to to Eraut's work in noting that “enhancing the students'
confirm their observations”, however, this activity was not explicitly communicative
acknowl- edged as a social aspect of preceptorship practice nor was
it discussed why this practice occurred and how preceptors learnt to
be preceptors. Carlson and Bengtsson (2014) were the only
researchers who located their views on preceptorship explicitly in a
socio-cultural perspective, referencing Lave and Wenger (1991).
Carlson and Bengtsson (2014, p. 572) viewed nursing students as
active participants to communities of practice and argued that
preceptorship enables students to “gain new
knowledge, learn professional skills and construct professional
identities”.
Clinical learning was perceived as a professionalisation process that
occurs within complex existing social relations and practices. The
authors stated that it is preceptors' responsibility to invite students
into the com- munity of practice and help them navigate these
relations and practices.
Taken as a whole, however, there is overall limited theorisation
of the preceptorship role at organisational and policy levels. As
reported, this is problematic for both the individual preceptor and
preceptorship in general, demonstrated by the lack of remuneration
for preceptoring, the absence of additional hours to dedicate to the
role, a dearth of educational preparedness (Hallin and Danielson,
2010), derision by nursing peers and an absence of contact between
the preceptor and the academics based at the student's university
(Bourbonnais and Kerr, 2007; Carlson et al., 2010b; Charleston and
Happell, 2005a).

Pedagogical Frameworks for

Preceptorship

Researchers were adept at exploring and reporting professional

attributes for preceptors and the aims of preceptorship. Preceptors
aimed to guide safe practice (Bourbonnais and Kerr, 2007),
accomplish connectedness (Charleston and Happell, 2005b), create
positive learn- ing experiences (Charleston and Happell, 2005a),
teach through talking (Lillibridge, 2007), deliver feedback (Yonge,
2012) and create a positive relationship with the student through
learning, teaching, engagement and compassion (Paton and Binding,
2009). However, again, preceptoring tended to be viewed as a
general teaching and learning strategy with researchers focusing on
preceptors' perceptions of their student's practices rather than on
their own pedagogical foundations for preceptoring (e.g., Brammer,
2006; Carlson and Bengtsson, 2014; Charleston and Happell, 2005b).
While researchers were adept at iden- tifying the necessary qualities
and skills for a preceptor, they were less proficient at exploring why
these skills and qualities were important for some preceptors and
not others, and what guided preceptors' approaches to practice.
For example, while Charleston and Happell (2005a) and Lillibridge
(2007) viewed the preceptor as director and protector no
pedagogical foundation was provided for these roles and different
perceptions of the preceptorship role were not discussed.
This is not to say that preceptors do not have pedagogical
foundations for their practices. The studies that did explicitly explore
pedagogical frameworks for preceptoring viewed workplace learning
as reflective, critical, lifelong and located within a community of
practice. For example, Bourbonnais and Kerr (2007, p. 1547) noted
that “the preceptors' de- scriptions of their role indicated they were
attempting to help students reflect on their practice and instil
professional values”. Other articles emphasised the importance of
preceptors questioning and reflecting on their own practices. For
example, Carlson et al. (2010b) explored the need for preceptors to
reflect on their previous experiences of being a student, nurse and
preceptor and seek out critical and constructive feed- back to guide
their future precepting strategies and techniques. Luhanga et al.
(2010) also discussed a preceptor's own community of practice, and
the importance of a preceptor being able to consult with supportive
colleagues for advice and guidance.
Two studies discussed ideas related to philosophies of care and
attempted to place pedagogical frameworks for nurse preceptorship
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274
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274 275
skills and language development will facilitate students'… 2008).
propositional knowledge (knowing that) and process knowledge Workplace environments and systems were identified as a final
(knowing how)”. However, the researchers did not detail the make-or-break factor for preceptorship. Workload pressures, insuffi-
teaching strategies that would achieve these goals nor why cient time, restricted communication with other preceptors, lack of
preceptors choose certain structure, lack of clear protocols, poor preparation for the role and
preceptoring methods over others. In addition, Hallin and Danielson
(2009) discussed Dewey's ideas of action, reflection, theory and
practice in viewing students as active, reflective learners and, in a
later article, described how “in the academic curriculum, emphasis
is placed on teaching students to be life-long learners and to have a
holistic view of the RN's professional work” (Hallin and Danielson,
2010, p. 296). However, the concept of preceptors having a
theoretical foundation for their practice was not widely discussed
across articles, and indeed, McCarthy and Murphy (2010, p. 634)
claimed that “preceptors did not detail or demonstrate a specific
philosophy of care”.

Messages about
Preceptoring

The key messages from our literature set outlined implications for
preceptorship practices that focused on the student–preceptor
relation- ship, the relationship between the university, the workplace
site and the workplace environment and aimed to distil preceptor
views about the factors involved in effective preceptoring.
A number of articles focused on the importance of the student–
preceptor relationship, in particular Haitana and Bland (2011) and
Hilli et al. (2014). The latter paper asserted that good preceptorship
is the basis for student learning and the former paper found that
getting to know the student and developing a sense of trust were
essential prerequisites for building good relationships. Nurse
preceptors viewed themselves as taking on a number of roles with
students; these included protectors, influencers, initiators, role
models, teachers, friends, asses- sors, evaluators and supervisors
(Carlson et al., 2010a; Paton and Binding, 2009; Yonge, 2012). At the
same time, however, preceptors acknowledged that nursing was
their primary responsibility over preceptoring, with patient safety
their foremost focus (Yonge, 2012).
The importance of promoting a safe, supportive, permissive and
wel- coming learning environment was a theme reiterated by
preceptors across all articles. Building relationships, trust and
empathy, and accomplishing connectedness with students promoted
such an environ- ment and encouraged student learning (Charleston
and Happell, 2005a; Haitana and Bland, 2011; Ockerby et al.,
2009). Only one paper discussed explicitly that good preceptors
learn both from and with
their students, with “sharing of knowledge with students [identified]
as the anticipated and actual primary reward of being a preceptor”
(Smit and Tremethick, 2014, p. 94). The preceptor–student
relationship was thus perceived as a two-way learning and growth
process for both
the student and the
preceptor.
Students were expected to take on an active role in their learning;
“all preceptors indicated that it was crucial for students to come pre-
pared and willing to learn” (Lillibridge, 2007, p. 50). However, it was
also observed that universities needed to better prepare students for
their workplace experiences (Eta et al., 2011; Raines, 2012). This
point relates back to the common theme that preceptorship is a
shared responsibility between “the educational institution, the
health care agency, the faculty, the preceptor, and the student”
(Luhanga et al.,
2010, p. 265). Across a number of studies, preceptors stated that
there needs to be a two way information exchange between
universities and workplace sites, with the necessity of “improved
communication on a broader, systemic level, between and amongst
major stakeholders” (Charleston and Happell, 2005b, p. 1172).
Preceptors noted that they felt more comfortable in their teaching
role when they had the support of the university and were able to
turn to faculty members for advice
and guidance (Luhanga et al.,
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274
insufficient formalised training act as systemic stressors and can professional identity development (Carlson and Bengtsson, 2014).
constrain the preceptor role (Bourbonnais and Kerr, 2007; Carlson In contrast, the role of workplace
et al., 2010b; Charleston and Happell, 2005a). In contrast sufficient
work hours, collaboration, reciprocity, policy and organisational sup-
port, critical and constructive feedback, formal role
acknowledgement and professional development in the form of role
clarification, training and supervision were all viewed as
instrumental to a positive experi- ence for both preceptors and
students (Brammer, 2006; Eta et al.,
2011; Hallin and Danielson, 2009; Hyrkäs and Shoemaker, 2007;
Raines, 2012). Carlson et al. (2010b, p. 438) discussed the importance
of universities providing preceptors with feedback asserting that
“[Preceptors] declared how they valued and needed feedback from
stu- dents and clinical teachers to develop their preceptor
competence”, while Charleston and Happell (2005a, p. 56) noted the
importance of well-functioning systems when they wrote “it was
important that the system worked in a consistent and coherent
manner in regards to stu- dent practicum processes”. Training and
support improved preceptors' experiences and their confidence in
the role and, in turn, lead to improvements in student learning
(Hallin and Danielson, 2010).

Recommendations for Further

Research

Researchers from our reviewed literature rarely discussed recom-

mendations for future research in this area beyond replicating or
extending their current methodologies and studies. Of the 25 articles,
ten offered no future research recommendations. Of those articles
that did offer recommendations, the majority discussed extending
samples to students (Hallin and Danielson, 2010; Charleston and
Happell,
2006), faculty (Carlson et al., 2010a), hospital management
(Lillibridge, 2007), different health services (Brammer, 2006) and
other disciplines (Ockerby et al., 2009), in addition to exploring the
effectiveness of education tools (Hilli et al., 2014), and the influence
of collaborative (Hallin and Danielson, 2009) and person-centred
care models (McCarthy and Murphy, 2010).
Three studies did offer research recommendations explicitly
focused on further exploring preceptoring from the perspective of
the nurse preceptor. Hyrkäs and Shoemaker (2007) stated that
additional research should be focused on exploring how perceived
rewards relate to a preceptor's background, while both
Brammer (2006) and Monareng et al. (2009) stated that a study
should be conducted to explore the lived experiences of preceptors
in clinical practice settings and understand their role in student
learning.
In line with our previous comments on theoretical
conceptualisations and pedagogical frameworks for preceptoring, this
was again an often neglected focus for future research
recommendations. McCarthy and Murphy (2010) and Carlson and
Bengtsson (2014) were the only researchers who recommended
researching preceptorship within the broader context. The former
recommended to explore the construct of providing person-centred
care and Carlson and Bengtsson (2014, p. 572) indicated that
there is a need to explore preceptorship links
between nursing theory and practice and that, in future, “preceptors
[should] use reflection as a teaching strategy” to facilitate
enhancement of this theory-practice nexus.

Discussion

This scoping review has revealed the diversity and complexities of

the preceptor experience at the personal, interpersonal,
organisational and policy levels. The significance of the preceptor
to the student remained unquestioned with research findings
indicating the role of the preceptor in supporting the student as they
prepare for their future work role and experience the professional
socialisation process. The preceptors acknowledged their role in this
process, by initiating the student into the community of practice,
building relationships with stu- dents and supporting them in their
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274
cultures and learning environments was only fleetingly mentioned
as an influential factor of the student experience and the way
preceptors experienced and perceived their role. Although the
significance of the preceptor role for the host organisation was
acknowledged it remained an under-researched focus in our
literature set.
The predominant research focus of our reviewed articles was on
the preceptors' perceptions of their supervision skills and how
helpful university training programmes were in supporting them in
their role. No article provided a place for the preceptors to articulate
the evolution of their preceptor practices. There were only limited
opportunities provided for preceptors to reflect on their perspective
of the preceptor role, what nursing or educational theorists they use
as their pedagogical foundation and what they have learnt through
informal education, including what they learnt from students.
Mirroring the absence of a theoretical framework as a basis for
the practice of the preceptors, the literature set we reviewed had
limited conceptual and pedagogical underpinnings. Although some
articles mentioned the practice context, preceptorship was not
framed as a socio-cultural practice in complex workplace cultures.
The risk of narrowing the preceptor role to an individualistic
activity with the responsibility placed solely on the preceptor lies in
burn out and lack of organisational and collegial support. Power
issues were alluded to by the preceptors in relation to peers, the
institutions and the university but these were not related to
particular theorists. A central foundation for a research project
should be its theoretical framework, with all con- clusions of a
research paper reverting back to theory in demonstrating the
contribution of the research to existing knowledge (Higgs and
Trede, 2010). Yet, as Parahoo (2014) decries, acknowledging a
theoret- ical base is too infrequently practised by nursing
researchers. A reluc- tance of nursing researchers to engage in
theory jeopardises nursing knowledge and practice as a distinct
health discipline and the rightful place of nursing in the academy.
A recurring theme in the articles was the partnership between
the clinical setting, the preceptor and the university (Luhanga et al.,
2008; Yonge et al., 2012). Universities were at a distance from the
clinical in- stitution leaving the preceptor often unsupported in
critical aspects of student development. Preceptors in articles of this
review felt further isolated, anxious and uncertain when they
encountered a difficulty with a student and were unable to contact
the university to receive timely support (Luhanga et al., 2008).
Functional and sustainable university industry partnerships are the
basis to the success of the pre- ceptor experience (Buys and Bursnall,
2007). Establishing partnerships between the university and the
clinical facility should be envisaged as more complex than a signed
contract. The university has an integral role in all aspects of the
transition of its students from the academy to the clinical thus
involvement in all stages of the preceptoring experience is crucial.
This partnership incorporates the education of preceptors, attending
the clinical sites, being available to assist with problematic
situations, the support of preceptors as they assess clinical
competence and the evaluation of the experience by preceptors and
students (Hallin and Danielson, 2010).
Conclusions
From this review we can make the following concluding
comments. Given the expected shortage of preceptors in the very
near future (Siggins Miller Consultants, 2012) it is timely to review
how this role is conceptualised and supported by universities and
host placement or- ganisations alike. Training and support
programmes for preceptors with a focus on micro teaching, although
important, may remain incomplete and unsustainable. Such a focus
may not even be desirable considering the risk for preceptors of burn
out and sense of non recognition includ- ing inadequate career
pathways and remunerations (Hallin and Danielson, 2010). The
discussion highlights that a socio-cultural lens on preceptorship
would conceptualise this role as a shared responsibil- ity shaped by
workplace cultures and university support.
The limitation of a scoping review is that it does neither offer
research outcomes nor a quality review of the pertinent literature.
However, the value of scoping reviews is that they identify current
discourses on a research phenomenon. With this paper we can
conclude that the conceptualisation discourse of preceptorship has
not been expanded to include theoretical perspectives from
socio-cultural practice and learning paradigm. The way the role of
the preceptor is conceptualised reveals what is expected of this
role and in what theoretical perspective it is located. Exploring the
mechanisms for the establishment of mutually respectful and
reciprocal professional relationships between preceptor and student
is a significant area for future research as it was not investigated in
the articles included in this scoping review. We call for future
research to explore preceptors' perceptions of how their colleagues
and managers can contribute to a better preceptor experience.
Preceptorship professional development programme should raise
awareness and build the leadership capacity required to create
conducive learning environments for all, students, preceptors and
their colleagues.
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