Preceptors' considerations when entrusting professional activities to postgraduate nursing students: A qualitative study

Abstract

Background: Nurse-preceptors regularly struggle to evaluate students' readiness to take care of patients unsupervised, even with sophisticated workplace-based assessment tools. Preceptors' gut feelings are not always captured well, but are critical for judgement of readiness for learner entrustment with care tasks. Studies in medical education report features that clinicians consider important when trusting students with clinical responsibilities that might also apply in nursing. Objectives: To unravel preceptors' considerations when entrusting professional activities to postgraduate nursing students. The findings may contribute to the improvement of workplace-based assessments and the training of preceptors. Methods: Thematic analysis of semi-structured interviews with sixteen nurse-preceptors from three postgraduate nursing specialisations in Dutch hospitals. Results: Three themes emerged: 1) Preceptor's' expectations of students: being competent, being aware of risks and how to tackle these, being truthful, having a proactive attitude, seizing opportunities to learn and develop, and being socially and communicatively sensitive. 2) Preceptor's own role in entrustment decisions: awareness of a subjective influence in assessment, shared responsibility for patient care, and imagining students as future colleagues. 3) Preceptors' use of information sources to arrive at entrustment decisions: briefing and debriefing with students, direct observation, reports, and judgements of colleagues. Conclusions: For preceptors of postgraduate nursing students, entrustment requires more than merely insight into objectively measurable competencies. Entrusting is accompanied by subjectivity related to what preceptors expected of students. These expectations are in line with suggested factors in the literature—capability, integrity, reliability, agency, and humility—considered before entrusting students with clinical responsibilities identified in medical training. Entrusting is also accompanied by what preceptors realise about their own role in entrustment decisions. Combining different information sources made assessment more transparent and the implicit more explicit.