Putting knowledge to work in clinical practice: understanding experiences of preceptorship as outcomes of interconnected domains of learning

摘要

Aim: To understand newly qualified nurses’ learning during the preceptorship period.\ud\udBackground: Newly qualified nurses’ learning during their transition to confident professional practice is facilitated by effective and supportive preceptorship. Several studies have alluded to, but not directly investigated or addressed contextual factors which may prevent the delivery of effective and supportive preceptorship.\ud\udDesign: Two-phase ethnographic case study design in three hospital sites in England from 2011-2014.\ud\udMethods: Phase One included participant observation, interviews with 33 newly qualified nurses, 10 healthcare assistants and 12 ward managers, the design of a tool to develop newly qualified nurses’ delegation skills during their preceptorship period. This tool was piloted in Phase Two with thirteen newly qualified nurses in the same sites. Data were analysed using thematic analysis. \ud\udFindings: Constraints on available time for preceptorship, unsupportive ward cultures, and personal learning styles may limit effective preceptorship if time for learning and knowledge recontextualisation is restricted. For newly qualified nurses in supportive ward cultures, limited access to formal preceptorship can be bolstered by team support. Newly qualified nurses in less supportive ward cultures may have both a greater need for preceptorship and have fewer compensatory mechanisms available to them when formal preceptorship is not available. We argue that organisational learning contexts and individual learning styles which facilitate recontextualisation of knowledge in this group of nurses are key to understanding effective preceptorship.\ud\udConclusions: This study reports constraints to effective preceptorship which affect newly qualified nurses in their early careers. We recommend a need for greater prioritisation and ‘ring-fencing’ of time for formal preceptorship to ensure newly qualified nurses are appropriately supported in their transition to confident professional practice.\ud\udRelevance to clinical practice: We discuss ways to improve preceptorship at ward and organizational level through policy, practice and education and suggest future research in this area