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The contribution of the preceptor to the clinical learning environment is undisputed in the nursing literature and is contingent on exploiting the preceptors’ expertise and experience in order to identify key learning opportunities for the novice (Newton et al. 2009; Butler et al., 2011). The personal characteristics of preceptors who demonstrated an empowered approach to nurse education was evident in some descriptions of what impacted the culture and environment (see section 4.3). In order to belong and feel part of the team, participants expressed the need to be shown respect and trust in order to develop self-worth. Participants in the present study described the importance of respect for their contribution in providing patient care differentiating between working for the qualified nurse (when respect is absent) as opposed to with (when respected). Laschinger and Finegan (2005) found that trust and respect are associated with positive outcomes for both staff and patients. Staff, they argued, who are distrustful engage less with students and contribute to less to their learning than those who experience high levels of trust thus impacting their sense of self-worth and empowerment.

Nursing students also acknowledged mirroring the attitudes and behaviours of their preceptors (section 4.3.2). This type of role modelling is desirable when the behaviours include empathy, caring and compassion. If however nursing students are developing what Mackintosh (2006) refers to as an ‘occupational personality’ where there is a disengagement with emotion in order to survive in nursing/healthcare this poses a serious threat to the development and sustainability of compassion in nursing. This was expressed by nursing students in the present study as they reported not wanting to become less caring. In addition they were cognisant of the likelihood of this happening as their preceptors alluded to this possibility (section 4.3.2). This is a theme that has been raised in contemporary literature, Mackintosh (2006, p. 960), who identified in a British study that nursing students reported learning to “care-less” in order to cope with the demands of the role. There is evidence to support this in the present study,

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where nursing students stated that their preceptors expressed how they too had been like the students at the start of their careers (i.e. full of enthusiasm), but this was a transient stage and staff acknowledged that it does not last.

The findings of the present study found that preceptors are essential to helping nursing students feel more included. Price’s (2009) study acknowledged the importance of the interpersonal relationships between nursing students and their preceptors, coupled with a positive method of communication, as significant contributors to the socialisation processes. Empowerment occurred when preceptors expressed and demonstrated an interest in the nursing students’ learning. When preceptors were empowered, this had a positive influence on participants’ empowerment (section 4.3.2). This demonstrates how empowerment can be encouraged and stimulated within the clinical learning environment. This is supported by other contemporary studies that suggest the role of the preceptor is paramount to the success of the nursing student on placement (Pellatt, 2006). Levett-Jones et al. (2009a), in an Australian study of 18 nursing students, found that staff-student relationships are pivotal to students’ experience of belonging in the creation of a positive experience on placement. This relationship included the provision of emotional support and legitimisation of the nursing student in a learning role. This is supported by the findings of the present study in relation to how the preceptor’s role was so important to the nursing students. Nursing students in the present study valued any interest shown to them by their preceptors in their learning, feedback, of being needed and teamwork as key elements in promoting their empowerment. Cooper et al. (2015) in a recent Australian study of what constituted the facilitators of learning environments for first-year nursing students found that the presence of a positive culture of learning was influenced in the preceptor by the understanding the students’ role. Bradshaw et al. (2012) suggested that further education and support of preceptors in their role is needed. These findings support Chesser-Smyth and Long’s (2013) study that advocated support of nursing students as being pivotal in enhancing their self-confidence while on clinical placement and in addition suggest that the lack of support causes disempowerment which can stifle critical thinking, problem solving and decision making. The importance of the preceptor having a good interpersonal relationship with students was supported in the present study. A

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positive relationship increases understanding of both roles and therefore facilitates greater understanding by both parties. This contention is supported by Newton et al. (2009) and Richards and Bowles, (2012). In addition, Ousey (2009) found a good preceptor, will support, listen, reflect, teach, encourage and respect the nursing student. In the present study (see section 4.3.2) nursing students said they felt that once their preceptor was empowered it augmented their learning and empowered them for future practice.

Positive preceptorship was valuable source of empowerment and was dependent on having a good role model. The present study would strongly advocate that the role of the preceptor be supported and safeguarded in order for the future generations of nursing to reap the benefits of such a relationship. The role of the preceptor would appear to be pivotal to empowerment of nursing students and impacts their socialisation and experience into the nursing profession. Emanuel (2013) suggested that there is an unpredictability in the experiences of nursing students within the clinical learning environment and not all nursing students in this study experienced a supportive preceptor. The challenges to the role of the preceptorship are discussed in the following section.

The role of the preceptor is not without its challenges (McCarthy & Murphy, 2010; Gallagher et al. 2012). The findings of this study suggest that nursing students’ experienced a variety of positive reaffirming preceptorship and also experienced challenges with preceptorship. The challenges of the preceptors’ role highlighted in the study were predominantly attributed to a lack of dedicated time for the support of nursing students this impacted how participants viewed their presence on the wards/units. Some nursing students felt they would be wasting preceptors’ time (section 4.3.2). The nursing students in the present study expressed that their priority was to pass their placement and to “get on” with staff. This needs to be placed within the context of other demands on the nursing students as being learners in a new environment and trying to cope with the emotional demands of nursing. Learning the skills and art of nursing and being part of a learning programme did not appear to be a priority for the nursing students in the study. One nursing student described how she did not feel she could ask a question (section 4.3.2) and also that a student was too much of a burden for the ward to

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contend with. All of these components contributed to a stressful engagement with preceptors for nursing students who were aware of the pressures on preceptors rather than prioritising their own learning.

Many research studies suggest that a lack of time, stress and support are common challenges for preceptors (McCarthy & Murphy, 2010; Natan et al., 2014). No additional rewards or recognition in time or remuneration are given to preceptors in Ireland, unlike other countries such as the United States. This means that teaching and learning are provided in what McCarthy and Murphy (2010) described as an ad hoc approach. The burden on preceptors is considerable, and qualified staff are expected to precept nursing students, irrespective of whether or not they have expressed an interest in the role (NMBI, 2016). The impact of poor preceptorship and lack of empowerment as a result was seen in the present study and supports previous studies such as Newton et al. (2009) and Natan et al. (2014). Exposing nursing students to preceptors who do not or cannot facilitate empowerment in clinical practice incurs a cost to nursing student education and ultimately practice.

The role of the preceptor is important to nursing student learning, while it is acknowledged to be both demanding and complex from the preceptors’ perspective. Myall et al. (2008) found in a study that more than half (68%) of preceptors experienced constraints within their role. Many preceptors are reported according to current literature report being under-prepared for their role (O’Driscoll et al., 2010; Chang et al., 2015). Other studies suggested that preceptors are unsupported in their role, without enough time to fulfil their role in supporting nursing students in the clinical learning environment (Natan et al., 2014). McCarthy & Murphy (2010) found that lack of time and workload were the dominant issues that impacted on the preceptor’s ability to provide support to nursing students. Lack of time, increased patient acuity and increased workload are part of the preceptors’ challenges (Pulsford et al., 2002; Dolan, 2003; Myall et al., 2008). This lack of time is manifest when preceptors did not have time to feedback to participants in the present study. It is clear from the participants’ contribution to the present study (see section 4.3), that the role of the preceptor is difficult and challenging, and there appears to be little recognition of the

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challenges of the role in terms of dedicated time to nursing student education. Some of the difficulties in the preceptors’ role arise from the joint responsibility of the preceptors’ to both patient care and nursing student education without due recognition of the complexity of either role. In addition the environment that the preceptors work in including the culture and the power structure impacts their own empowerment. Findings in the present study support the importance of the preceptor to nursing student empowerment. It is also suggested that the pressure arising from the role of the preceptor (section 4.3.2) impacted the preceptors’ ability to contribute to the empowerment of the nursing students.

Smith (2014) argued it is time to revisit empowerment in order to address the complexities of the nursing environment and suggested that the basic concept of providing care for others cannot be addressed if there are tensions where unmet personal needs of those providing care are causing a personal disconnect. This resonates with the unmet needs of the preceptors raising questions as to whether or not it is reasonable to expect preceptors to provide care for patients while nurturing and supporting nursing students. Cooper et al. (2015) while exploring the key influences of clinical placement for nursing students supported these findings, when they acknowledged the importance of the key influence of the supervising nurse or preceptor. Campbell (2003, p. 426) advocates that the time has now come for qualified staff to accept responsibility for encouraging and supporting nursing students in their role. It is suggested that preceptors need time in order to support learners and nursing students through reconnecting with how they themselves learned, and through being empowered in their practice. This would aid nursing staff in including nursing students in the nursing team, and promote a culture of inclusion and belonging. Time dedicated to preceptors and qualified staff on self-awareness and recognition of self in others may also promote inclusion and belonging, and contribute positively to the socialisation and inclusion of nursing students into the clinical learning environment.

The quality of positive preceptorship and the contribution of the preceptor to the nursing students’ empowerment is a major factor in this study. The education and clinical support of preceptors needs to reiterate and acknowledge how important their contribution is to nursing students. Empowering and protecting the

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empowerment of staff is a worthwhile and beneficial exercise, considering its impact on subsequent generations of nursing students. It is essential therefore, that nursing students are educated in an environment that will promote positive experiences from which nursing students can become empowered and learn. The empowerment of nursing students is fundamental and impacts care delivery, retention, intention to stay on the nursing programme and the nursing students’ confidence and self-esteem. Nursing management needs to be cognisant of the challenges in the role of preceptors, and their struggles within the clinical learning environment, in order to positively impact empowerment for nursing students. Nursing students in the present study reported wanting to “do” something to help, in relation to providing patient care, and in the process provide much-needed help and support to their preceptor. They did this they reported, so that they felt needed. However, on occasions, the contrary experience was also reported by nursing students, who stated that they also felt like a burden. If, preceptors do not have a particular interest in teaching, it is a source of concern. All preceptors currently in Ireland are obliged to precept and teach nursing students (NMBI, 2016). However, it is acknowledged that preceptors require more support with this role and this would benefit the student experience specifically if delivered by academics (McCarthy & Murphy, 2010). Feeling like a burden or an inconvenience has also been reported in international literature and the resultant impact is undisputed. Myall et al. (2008) in a contemporary study from the United Kingdom found that when students felt like an “inconvenience” and “burden” it can have far reaching effects and that this can lead to some nursing students withdrawing from the programme of nursing. In the present study, one nursing student referred to the damage such disempowerment can cause (section 4.3.2). The ‘damage’ of disempowerment to the individual nursing student impacts on how they feel about their role and how they perceive their contribution in terms of the nursing care is received. Nursing students reported the need to feel valued by their preceptors whose attitudes and values they mirrored. It is therefore important that support is put into place for preceptors and due recognition given to those preceptors who are motivated and interested in supporting nursing students on placement.

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