Exploring Nursing Students’ Expectations on Preceptoring and Preceptorship Program: A Mixed Method Study

Introduction: This study addresses the imperative in contemporary nursing education to prepare students for diverse healthcare settings by exploring nursing students’ expectations and perceptions of preceptorship programs, emphasizing the role of evidence-based educational strategies. The research aims to bridge the existing literature gap and contribute valuable insights into strategically designing preceptorship programs aligned with nursing students’ needs, preferences, and aspirations, ultimately enhancing precepting practices and relationships within nursing education. Methods: Employing a sequential explanatory mixed method, 140 nursing students, from various colleges in the United Arab Emirates (UAE) participated in the study. A structured questionnaire, encompassing demographic information, a need assessment survey, and a survey on expectations on preceptors was administered. A focus group discussion was conducted to identify perceived barriers to the utilization of preceptorship practices in nursing colleges. Data analysis involved descriptive statistics, the chi-square test, exploratory factor analysis, and content analysis of the focus group discussion. Results: The majority of participants expressed a high need for a preceptorship program, providing empirical evidence to support the development of a nurse educator preceptorship program in colleges and institutes. Preceptorship was identified as a significant contributor to career growth and achievement for nursing students, serving as a valuable tool to establish professional competency throughout their careers. Conclusion: There is a complex demand and high expectations for the core role of nurse educators as preceptors in the field of nursing education. This pioneering study sheds light on the need and perception of nursing students for a preceptorship program in the nursing curriculum.


Introduction
In contemporary nursing education, the imperative lies in preparing students to navigate diverse healthcare settings with a focus on health, reliability, and compassion. 1 However, the evolving healthcare landscape of the 21 st century poses a significant challenge effectively instructing student nurses to operate within intricate healthcare systems. 2 This challenge is particularly pronounced in developing countries facing a myriad of healthcare obstacles, including a shortage of human resources, insufficient training, limited opportunities, and an escalating patient ratio. 3ddressing these challenges calls for the implementation of evidence-based educational strategies such as case reflection, simulation, case-based learning, and problem-based learning. 3,4In this context, the training of nursing students becomes pivotal, especially in environments like the United Arab Emirates (UAE), where students start their education immediately after high school with limited life experience. 5The ensuing stress, attributed to demanding courses, high academic standards, and uncertainty about the future, underscores the need for a methodological approach facilitating a seamless transition from high school to nursing education. 6,7receptorship emerges as a significant element in nursing education, recognized for its role in fostering career growth and success. 8,9In the multifaceted role of preceptors, they serve as educators, evaluators, protectors, and role models, playing a crucial part in instilling professional values, confidence, goal-setting skills, and guiding clinical decision-making processes among trainees. 10,11he term "preceptoring" encompasses various facets, including appraisal, supervision, precepting, and coaching, forming a dyadic, long-term, and reciprocal process between experienced and junior nurses or nursing students. 12In nursing education, clinical practice is essential for fostering confidence and competence, emphasizing students' learning needs over the health facility's services.Effective clinical learning, crucial for nursing students' preparation and competence, has been hindered by poor collaboration between academic and healthcare facilities, resulting in inadequate clinical supervision.A preceptorship model is widely endorsed as an effective approach, providing individualized support under skilled guidance, enhancing professional socialization, building confidence, and easing the transition from student to nurse. 13n the past three decades, preceptorship has emerged as the preferred method for clinically preparing undergraduate nursing students, involving a teaching and learning approach where students are paired with expert nurses (preceptors) in the practice setting to gain experience on a one-to-one basis, benefiting from the immediate availability of a role model and resource person. 14The role of preceptors, as highlighted by Luhanga et al., is crucial in facilitating students' transition to safe and competent practice through a one-to-one relationship. 15n the dynamic healthcare landscape, preceptorship becomes indispensable for nurturing the growth, development, and professional formation of aspiring nursing professionals. 16,17Preceptors, serving as crucial mentors and role models, play a multifaceted role in supporting the transition of graduate nurses to independent practitioners. 18,19Despite its acknowledged importance, there exists a gap in the literature concerning nursing students' expectations and perceptions of preceptorship programs.
Preceptorship is widely utilized in nursing education to facilitate clinical learning, but its understanding and support are lacking.Preceptors, vital for socializing students in clinical nursing, often lack training and face challenges in their role, emphasizing the need for relevant preceptorship models.There is no existing model or program to guide and improve preceptorship, highlighting the necessity for structured approaches to strengthen clinical nursing education. 8he theoretical foundation for this research draws upon Swanson's Theory of Caring Approach, as articulated by Swanson, defining caring as "a nurturing way of relating to a valued other toward whom one feels a personal sense of commitment and responsibility".20 The preceptorship program for novice nursing faculty, discussed in the literature review, aligns with a caring theoretical perspective based on Swanson's philosophy.This approach fosters a caring atmosphere, enabling new faculty to acquire essential skills and competencies, facilitating a smooth transition into their role.The utilization of Swanson's caring philosophy guides the understanding of caring principles in planning the preceptorship program.21 This model shapes the preceptor-preceptee relationship and guides the development of the nurse educator preceptorship program.Emphasizing essential qualities in preceptor-preceptee dynamics and fostering transparent communication, this model contributes to the establishment of a formal nurse educator preceptoring program within the nursing curriculum.
Swanson's Model of Care comprises five caring processes: Knowing, Being With, Doing For, Enabling, and Maintaining Belief.Each process contributes to the understanding and implementation of the nurse educator preceptorship program: Knowing: Identification of an appropriate preceptorship model is essential for successful implementation and evaluation, ensuring quality education for nursing students; Being With: The preceptorship program emphasizes pairing the right preceptor with the preceptee, fostering a dynamic and supportive relationship for mutual professional growth.Doing For: After pairing, preceptors and preceptees collaboratively set realistic goals and objectives within a specified timeframe, providing direction and clarity for the preceptorship journey; Enabling: A well-structured communication schedule for preceptors and preceptees, along with the identification of facilitators and obstacles, ensures timely goal achievement and strengthens the dyad relationship; Maintaining Belief: This process emphasizes the importance of respect, empathy, trustworthiness, encouragement, and constructive criticism in the preceptor-preceptee relationship, contributing to personal and professional growth.Throughout the study, alignment of beliefs and expectations between nurse educators and undergraduate nursing students is crucial for cultivating positive preceptoring relationships.
This study seeks to bridge this gap by delving into the unique and nuanced expectations that nursing students hold regarding preceptorship and preceptorship programs.By exploring these expectations, we aim to shed light on how preceptorship programs can be strategically designed to align with the needs, aspirations, and preferences of nursing students.The findings of this study will contribute to the discourse on effective preceptoring practices within nursing education, providing insights into the dynamics influencing the success of preceptorship relationships.Additionally, the research explores perceived barriers to implementing a preceptorship program among undergraduate nursing students and provides a framework for developing a nurse educator preceptorship program.This framework aims to enhance the professional, personal, and work satisfaction of nurse educators and students, fostering increased self-confidence, self-esteem, and preparation for leadership roles.

Aims
The primary objective of this study was to comprehensively assess the necessity for and expectations of preceptorship and preceptoring programs among nursing students.

Design
To fulfill the study's objective, we employed a sequential explanatory mixed method of study.The selection of this design aimed to explore the necessity for a preceptorship program in nursing colleges and to clarify the expectations of undergraduate nursing students and to elucidate the expectations of undergraduate nursing students.In the initial phase, quantitative data was collected through a semi-structured survey.Complementing the survey, a focus group discussion was conducted in the qualitative phase, to provide a deeper understanding.

Sample/Participants
The study population consisted of undergraduate nursing students from various colleges in the UAE.The sample size, determined using Cochran's formula, resulted in 140 participants recruited through purposive sampling.Inclusion criteria included proficiency in English and a willingness to participate.

Data Collection Instruments
Data were collected through a comprehensive set of instruments, including a demographic proforma, a need assessment survey, an expectations survey on preceptors and preceptorship programs, and a focus group discussion guide.Questionnaires were crafted from pertinent literature sources. 22,23The demographic proforma covered population characteristics, the needs assessment survey utilized the tailored design method, and the expectations survey comprised twenty-five items rated on a 5-point Likert scale.The focus group discussion guide consisted of sixteen open-ended questions. 24

Data Collection Procedure
Initially intended for in-person distribution, the questionnaires were adapted for online administration via Google Forms due to the pandemic.Participants were provided with the participant information sheet and informed consent forms.Permissions were obtained from the Administrative Heads of the respective Colleges of Nursing.A purposive sampling method was employed to recruit eight nursing students for the focus group discussion.
While conducting interviews using a recording device, the students' behaviors and reactions during the interviews were documented simultaneously, noting their observed states and experiences.The interviews ranged from 35 to 45 minutes in duration.Following each interview, the participants' statements were attentively listened to, and the transcripts were meticulously examined word by word.

Data Analysis
Data analysis involved the utilization of SPSS Statistics 20 to process information gathered from the questionnaire and compute descriptive statistics for the focus group sample.The Chi-square test determined associations.Exploratory Factor Analysis identified factors crucial for preceptorship program development.
For the focus group data, an inductive thematic approach was employed using a coding system (content analysis).Codes with similar themes were aggregated into more comprehensive concepts (subcategories) and further organized into primary categories.The encoding of all quotes was executed using the qualitative software program NVivo9.The interview manuscripts were promptly examined line by line and assigned codes.Similar-meaning codes were grouped into classes, and subclasses were further organized based on similarity, compatibility, appropriateness, and relevance.Ultimately, the analysis process concluded with the identification and specification of patterns.

Validity, Reliability and Rigour
Content validity was ensured through expert evaluation.Reliability, assessed using Cronbach's Alpha, yielded high internal consistency (α = 0.80) for both the preceptorship needs assessment and expectation survey instruments.Pretesting ensured tool clarity and survey duration feasibility.The qualitative data from focus group discussions were until data saturation.The collected information was transcribed and translated for the identification of themes and sub-themes.
To ensure data reliability of the qualitative data, researchers consistently engaged with the data mentally and employed expert checking.Continuous comparative data analysis was employed to enhance data validity and reliability.Researchers also reviewed interviews, initial coding, and themes.The observer review method was utilized to control information consistency, involving sending interview text excerpts, and the relevant codes to different observers for feedback on the accuracy of information analysis.To enhance rigor and the consistency of findings, data was collected until saturation on a specific topic was achieved.

Assessment for Needs and Expectations of Undergraduate Nursing Students
Approximately 69.3% of students expressed a moderate need (score 15-22), while 30.7% showed significant need (score 23-30) for a preceptoring program.Notably, 89.3% exhibited high expectations (score range: 101-125) for such a program.

Association between Needs and Expectations of Undergraduate Nursing Students
A Chi-square test revealed no statistically significant relationship between students' need and expectation for a preceptorship program (χ2 (1) = 0.54; P value = 0.816), rejecting the hypothesis of dependency between 'need' and 'expectation' (Table 2).

Exploratory Factor Analysis for Factor Extraction 1. Need assessment survey:
The six-item survey yielded three factors: Accessibility, faculty support, and institutional support, explaining 71.6% variance (Table 3).

Expectations on preceptors and preceptorship program
survey: Nine factors, including preceptoring goals, personality development, professional development, effective communication, preceptorship evaluation and feedback, preceptor characteristics, preceptor role, career development, and preceptorship skills, explained 68.4% variance (Table 4).

Content Analysis of Focus Group Discussion
The perceived facilitators and barriers to the preceptorship program as identified by the nursing students were classified into five themes by content analysis (Table 5).These themes are explored in further detail below:

Discussion
The demographic characteristics observed in our study are in concordance with those identified in a contemporaneous inquiry conducted at a polytechnic university in Hong Kong, which was conducted in two sequential phases.Initially, 76% of the undergraduate nursing cohort participated, with representation from the second (37.2%), third (31%), and fourth (31.8%) academic years.The female demographic predominated, constituting 84% of the participants, while males accounted for 16%.In the subsequent phase, student participation increased to 87%, with 42% from the second year and 58% from the third year, thereby maintaining a predominantly female composition at 78%, contrasted with 22% male representation. 25ur study reveals a substantial consensus among undergraduate nursing students, emphasizing a moderate need and a high expectation for the implementation of a preceptorship program.Moreover, it underscores the program's significance in facilitating career progression and ensuring a seamless transition from student nurse to registered nurse.These findings align with a Finnish study among sixteen graduating student nurses, emphasizing the preceptor's supportive role during this transition, particularly in providing guidance during role changes and exhibiting essential preceptor attributes. 26Further support for preceptorship in nursing education is found in studies elucidating its significance in knowledge and skill transmission, psychosocial support, instilling selfconfidence, addressing ethical issues, and supporting preceptees with research-related activities. 12ndergraduate student nurses express a preference for one-to-one coaching by preceptors, a sentiment corroborated by previous research advocating the effectiveness of one-to-one preceptoring for both preceptors and preceptees.The benefits include preceptors systematically monitoring learning activities and rectifying teaching method shortcomings while fostering meaningful preceptor-preceptee relationships. 27,28elson et al investigated faculty and student expectations on preceptoring, identifying involvement, enablement, transparency, and teamwork as crucial success factors.The study emphasized the foundational roles of enablement and participation in fostering excellent preceptoring relationships, defining engagement as a shared partnership expectation.Students perceive preceptoring relations as vital for team effort, commitment, professional and personal development, and role modeling, emphasizing the dyadic connection's importance. 29Also, nursing students perceive preceptoring relations as a core concept that encourages team effort, commitment, professional and personal development, and role modeling. 30The dyadic connection, which should be built on good communication, connectivity, teamwork, and a collaborative understanding between the preceptor, the preceptee, and the organization, determines the effectiveness of the preceptoring relationship. 12he literature associates preceptorship programs with outcomes such as problem-solving skills, autonomy, and career development for nursing students.][33][34] Students' perceived benefits of preceptoring encompass positive experiences, learning opportunities, improved communication skills, and the development of meaningful preceptor relationships, contributing to knowledge base growth and increased self-sufficiency in studies. 35Students recognize networking, career guidance, and engagement as significant advantages of preceptorship programs for future academic or professional planning. 31espite these positive aspects, our study identifies perceived barriers to preceptorship, including a lack of preceptoring skills, time constraints, and unavailability due to virtual classes, academic overload, and criticism.Previous research findings on barriers align with preceptor workload, dictatorial attitudes, poor communication, time and place of meetings, and incompatibility. 4,30,36Challenges also include a focus on employment demands, undefined expectations in the early stages, a preceptor's poor availability, awareness, and training. 36Organizational support, learning culture, and trainer shortages present additional barriers, making preceptorship training programs challenging. 37Studies also suggest that preceptorship experiences may enhance student-lecturer value alignment, facilitating individual and professional growth in clinical training. 38he primary implication of our study lies in the development of a toolkit for nurse educator preceptorship programs.This comprehensive manual provides guidance on implementing a successful nurse educator preceptorship program, offering valuable resources for preceptors, preceptees, and program champions in their respective institutions.
Despite these positive outcomes, our study recognizes its own limitations.The non-probability purposive sampling technique did not fully represent the entire population, limiting the generalizability of the study and also the broad applicability.Additionally, nonprobability sampling precludes the calculation of confidence intervals or margins of error.
To enhance the educational journey, this study advocates for the early integration of a preceptorship program, commencing from the first academic year of nursing students.Furthermore, extending this program to encompass the post-graduate and doctoral nursing students is also recommended.In order to comprehensively evaluate the program's efficacy and to identify any areas of improvement, a suggested course of action involves employing a mixed-method research study approach after the initial year of implementation.This would provide a robust assessment of the program's strengths and weaknesses, guiding future enhancements and ensuring its continued alignment with the evolving landscape of nursing education.

Conclusion
In conclusion, our study contributes to the understanding of preceptorship programs in nursing education by highlighting a significant consensus among undergraduate nursing students regarding the necessity and expectations for such initiatives.This underscores the pivotal role of preceptorship in facilitating the transition from student nurse to registered nurse and supporting career progression.Our findings resonate with previous research, emphasizing the importance of preceptors in guiding students through role changes and embodying essential attributes crucial for their professional development.

Table 3 .
Factor loadings from principal component analysis with varimax rotation for three-factor solution for need assessment survey for nursing students (n = 140)

Table 1 .
Frequency and percentage distribution of demographic variables of undergraduate nursing students (n = 140)

Table 2 .
Chi-Square test of association between need score and expectation score of undergraduate nursing students(n = 140) Note: χ2-Chi-Square value; df-Degrees of Freedom; * P > 0.05.

Table 4 .
Factor loadings from principal axis factor analysis with varimax rotation for nine-factor solution for expectation survey of nursing students (n = 140)

Table 5 .
Perceived facilitators and barriers for mentorship programme identified by nurse educators and undergraduate nursing students (n = 8) Due to online classes in this crisis situation, we are unable to meet the teachers in person and get direct guidance from them.A mentorship program will help build a stronger relationship with the teachers".There should be a formal mentorship programme so that we can know what the teachers expect from us and what our roles are during this process."