Nurse Educatmn Today (1991) 11.225-229 0 Longman Group UK Ltd 1991

‘WORK Mentors or preceptors? Narrowing the theorypractice gap Paul Armitage and Philip Burnard

The use of mentors in the clinical field has been debated in the recent nursing literature. The notion of the preceptor has also been considered. This paper compares the roles of the mentor and preceptor and offers some suggestions as to how those roles may help to narrow the theory/practice gap in nursing.

Ever since research reports appeared suggesting that a theory-practice gap existed in nursing (Alexander 1983; Ogier 1982; Orton 1981) a search has been in progress for new roles for nurses in clinical practice and in nurse education which might ensure that what is taught in the theoretical component of nurse education corresponds, at least to some degree, with what happens in clinical practice. In this paper, two of these roles are reviewed and compared: the mentor role and that of the preceptor.

MENTORS The concept of mentorship had its genesis in the USA. A product of the feminist movement, the development of a new entrepreneurial spirit in the 1970s and of the business schools of the American universities, the idea of the mentor was taken up by some American nurse educators, notably, Lou Ann Darling (1984). It seems

Paul Annitago BA (Hans) PhD RGN RMN AFBPS C. Psychol, Philip Burnard PhD Msc RMN RGN DipN Cert Ed RNT, Lecturers in Nursing Studies, University of Wales College of Medicine, Heath Park, Cardiff, Wales (Requests for offprints to PB) Manuscript accepted 20 January 1991

to have slipped into the folk-law of nurse education almost unnoticed and quickly became part of the educational language of the 1980s and 1990s (Burnard & Chapman 1990).

ROLES AND FUNCTIONS One of the problems surrounding the issue of mentorship is that there appears to be no common agreement as to the role and function of the mentor (Morle 1990). Hagerty ( 1986) has referred to this as the ‘definition quagmire’. If we do not have an agreed definition, we cannot assume that we are all talking about the same thing when we refer to mentorship. If this is the case, we cannot have an unified system of mentorship training nor can we develop general policies of organising mentorship. At this point, some may want to argue for a variety of approaches to mentorship. Indeed, it seems likely that various forms of mentoring have been taking place in a variety of nursing situations over the years. On the other hand, it seems reasonable to call for some uniformity if the English National Board for Nursing, Midwifery and Health Visiting is to continue to recommend the development of mentors (ENB 1987, 1988). Clearly, the ENB must have had some notion of mentoring in mind when they 225

226

NURSE EDUCATIOK

recommended significant

TODA\r

it. If mentoring

is to become

part of the education

a

and training

nurses, then it wouid seem reasonable

of

to call for

‘an individual

day practice

some clarification of the concept. The notion of the mentorship

teaching/learning

method

in

which each student is assigned to a particular preceptor. . so that she can experience day to with a role model and resource

tied to concepts such as ‘wise, reliable counsellor’

immediately available within the person clinical setting’ (Lutz and Chickerella cited by

(ENB

Morle

is sometimes

19871, or a close relationship

‘attraction,

action

and emotion’

1984). The suggestion an experienced

is that the mentor

practitioner

lesser degree

looks after

phyte

An objec:ion

nurse.

in which

meet (Darling will be

who to a greater and guides

or

the neo-

to this is that the

1990 p 102)

The main and important the mentorship preceptor

difference

and preceptorship

between is that the

is more clinically active and more of a

role-model

than the’ mentor.

more concerned

The

preceptor

with the teaching

is

and learning

notion of being looked after and guided in this

aspects of the relationship,

way may not be compatible

with the notions of

although

also concerned

adult education. Adult learning theory encompasses the needs of adults as autonomous learners who need to learn at their own pace and in

a closer

and more

their

students learn ‘on the job’ by copying the skills of the clinical practitioners. This is only acceptable

own

Knowles point

way (Burnard

1978,

1984).

to identify

Adults

learn

Jarvis

It may be useful

the

stages

between adult learning -

1990;

in the

1987; at this

disparity

theory and mentorship.

in a variety of ways and no

single theory of adult learning to be developed,

seems likely

given the complexity

of the

issue. -

Given this apparent encourage

diversity,

their autonomy

one should

in the learning

encounter. -

The mentorship

relationship,

given that the

mentor is ‘older an wiser’ than the student, is less likely to encourage

autonomy

likely to foster dependence

and more

and conformity.

preceptor

concept

relationship is a benign one in which the mentor stands back and allows the individual nursing student to develop in autonomous ways. In this relationship, the mentor is more of a facilitator

much is still dependent

This seems more in on adult learning but

on how mentorship

to learning,

if ‘Nellie’ has the required

The

the ‘sitso that

skill levels. All the

gap’ suggests that this may not necessarily case. Just

to add to a further

discussion,

dimension

may be a more appropriate

developed (1989)

role for the qualified in training

This concept of supervision in detail

by Hawkins

who write convincingly

those in training offered

to the

Kolfe (1990) suggests that supervision

nurse who ‘looks after’ students education.

be the

and

Shohet

of the need for

in the health professions

the sort of supervision

been available

to those

nurses

to be

that has so far

only to trainee Supervision

and

has been

counsellors

and

does seem to be working

in the

mental health field, given its focus on the inter-

It may be argued, of course, that the mentorship

than a surrogate parent. keepir,g with the literature

relationship.

work that has been done on the ‘theory-practice

appropriate

OR SUPERVISORS?

personal

seems to encourage

ting with Nellie’ approach

psychotherapists.

PRECEPTORS

whilst the mentor,

with these things, seeks

is to

be defined. Morle (1990) has suggested that preceptorship is a more valuable concept in nursing than mentorship and quotes Lutz and Chickerella’s definition of preceptorship:

personal developing

relationship

and

their therapeutic

on

the

student’s

skills. Whether

or

nat it is also a suitable framework for nurses in other fields remains more debatable. In attempting to tease out the differences between mentorship and preceptorship, it may be useful to consider more closely.

the preceptor

role a little

PRECEPTORS Nursing theory and practice is changing

rapidly.

NURSE EDUCATION

The increase discrete

of interest in the development

body

of nursing

theory,

of a

nursing models (Meleis 1985) and the take up of the idea of primary

nursing

(Manthei

1980) has

to change

in the

clinical

setting

a

change agent is needed at that level (Fairweather et al 1974;

Lewin

1958;

skilled intervention

Wright

1989).

of a nurse preceptor

used in order to create the conditions factory implementation Fairweather

The

in the change.

activating

the process of change.

Benner

(1984)

Kramer

preceptor

nurses should

sponsor

(1985)

situations.

that

less experi-

considered

that

‘clinical facilitators’

Beckett

should be employed

ence

by drawing

that

pathway appropriate clinical facilitators commitment

to

at ward

a

to the learner’s needs. are those who have

a

education;

.

they

from their own expertise,

and autonomy’.

They

also believed

tion,

mutual

nurse

defined

and all staff

(Beckett

‘the process

support

and

preceptor

introduced

who

and work

has

the

ability

strategies

for

developed.

Such a relationship

values

resolving

to integrate

so that conflict

realistic may

trainee to work and identify with a competent role model. This involves not only observation trainee.

but

also

planned and

and Riley (1985)

two-way

evaluation.’

were not satisfied

clinical nurse teacher’s

for

training

and

educating

tunity to observe

giving learners

her working

of

nurse

requirements

and Riley found that the

preceptorship

when practised

suited

as nurse

their

precep-

tors in a care of the elderly ward. They defined the responsibilities of the nurse preceptor as follows:

*Teach patient-centred care *Be responsible for patient care

to narrow

*Act as a role model for all staff

differences

gap. The idea was that a clinical should become responsible for

patient care, thereby

concept

all style

of the

the concept

between what is taught in schools of nursing and what occurs in nursing practice - the so-called theory-practice nurse teacher

role

to be

acceptance’

to be the increasing

be

allows for the

*Possess a strong clinical base and up-to-date knowledge of nursing practices and management

of communica-

role in an attempt

what appeared

may

8c Wall

in the idea of facilitation. (1974)

who

setting

the role of the nurse

education

and practices’. Raichura

1985 ~68)

Kramer

1983)

‘A nurse

‘responsibility

along

ongoing

derive their strength self-worth

individual

&

as they wanted a ro!e for a clinical nurse who had

upon their own experi-

another

have

transition

nursing staff, for nursing care management

to guide

intrinsic

(1974)

with the traditional

level to give ‘direction

the

as follows:

Raichura

and Wall

it was essential

programmes

to ease

exchange of approaches (Kramer 1974 ~32)

enced nurses as they move toward competence in actual practical

(Edmunds

by the

the use of a nurse

in this way when she proposed

experienced

role

is to act as a catalyst in

supported

modelling

preceptor

The outsider’s

successfully

Jennings 1990). The nurse preceptor is expected to demonstrate good nursing practice by role

can be

of the changes.

to Fairweather

used

for satis-

needs to be a change agent or ‘outsider’ who should have an active, personal and frequent involvement

been

observe this practice in the care improve their practice as a result.

et al (1974) pointed out that there

according

nurse and a neophyte’. nurse preceptor

from nursing student to staff nurse (Allanach

led to the need for change at the point of delivery of care. In order to facilitate a ‘bottom up’ approach

experienced However,

comprising

227

TODAY

the oppor-

as a practitioner.

Goldenberg (1987) pointed out that ‘preceptorship is a one-to-one relationship between an

*Help

all nursing

advanced

theoretical

staff

to apply

knowledge

*Accept the role of member plinary team

basic

and

to practice

of the multidisci-

*Discuss patient care with all nursing staff and other members of the multidisciplinary team *Implement

change

*Coordinate

and utilise resources

necessary

in the clinical area as and when

228

NURSE EDUCATION TODAY

*Involve cal and

ancillary, administrative, paramedimedical staff in the training pro-

In recent years, there have been many, sometimes confusing and often conflicting sug-

gramme

and gain their commitment.

gestions

However,

Raichura

the personal

and Riley do not include

characteristics

of the ‘ideal precep-

tor’. These were identified by Piemme et al (1986) and included such virtues as: patience, enthusiasm,

knowledge,

organising

maturity,

mastery

the theory-practice

recent evaluative

of a preceptor a primary

research

assisting in the implementation

nursing

system (Armitage

has shown that the theory-practice narrowed

of clinical

of

skills,

The roles of mentor and preceptor The mentor

advocate for learner, able to use self-confident but knows own professional and responsible, weaknesses,

ing after’ the learner

respect for peers. It is difficult to see the practical

role seems to be more concerned

utility of such lists except

clinical competence

of

of the nature the

nurse

that they do give an and complexity

preceptor.

gap can be

CONCLUSION

resources,

role

of

et al 1990)

in this way.

assertive,

indication

gap.

on the use

ability, pos-

itive attitude, non-threatening/non-judgmental, open-minded, objective, sense flexible, humour,

for reducing

However,

*Be involved in all ward duties

This

of the

acknowl-

ing. Whilst

are different.

role seems to be more about ‘looknurse, whilst the preceptor through

the mentor

clinical nursing

with enhancing

direct role-modell-

clearly

has a place in

it can be argued

that, given the

edgement of complexity can help in developing the role of the preceptor from the point of view

clinical nursing emphasis, the preceptor role has more to commend it. This is particularly true

of training

given the increase of interest in primary nursing and in the development of nursing development

and education.

units where clinical skills and competencies

CLINICAL ROLES

paramount

Drawing on the definitions cited, the following the preceptor Through the

roles could be identified

example

and discussion

improvements

defined

clinical

develop high standards

standards

for

of nursing which would

tation of primary

the precep-

in nursing area

care

in order

to

of patient care by peer

group innovation and support. As a result of the preceptor created

so far

in clinical practice.

tor may foster within

and discussion

practice, facilitate

improving

changes could be the implemen-

nursing.

Once a system of primary nursing had been implemented, the preceptor would be in an ideal position to nurture it by giving continued support and encouragement to primary nurses who may experience difficulty adapting to their new roles. Clinical guidance and supervision

-of

the kind which may be offered by a preceptor - is very important when the traditional ward supervisory hierarchy is replaced by the decentralising effects of the primary nursing system (Mac&ire 1989).

When

(Alderman decisions

1989; Wright have

been

are

1990).

made

about

whether or not to develop mentors or preceptors for helping

to bridge the theory-practice

new set of questions mentor

gap, a

arise. First, how should the

or preceptor

be chosen

for his or her

role? Should all trained nurses be considered these tasks, should they be self-selecting should educators and clinicians get together

for or to

identify criteria for selection?

How should men-

tors or preceptors

and once trained,

be trained

how should they be supported Such

questions

are beyond

and appraised? the

remit

of this

paper but are ones that present themselves as soon as a college, school of clinical setting decides to modify the ways in which nurses seek to enhance

the putting of theory into practice.

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