In the Irish healthcare system ward staffing is not matched with client acuity. With the recession came a moratorium on staffing and this combined with reduced length of stay for clients impacted significantly on nursing staff. Added to this a large number of front-line staff took early retirement leading to burnout of existing staff. Clear guidelines have been laid down by HIQA (2012a, 2012b) on the appropriate governance structure to ensure that client care is delivered safely and is of a high quality. The environment where nursing students undertake their clinical placement can have a positive or negative effect on them depending on the ratio of staff nurses to clients. The undergraduate nursing degree programme has been in place in Ireland since 2002. Nursing students register their qualifications with Bord Altranais agus Cnáimhseachais na hÉireann (Nursing and Midwifery Board, Ireland) upon successful completion of the programme. Nursing students are supported and facilitated on clinical placement by a qualified staff nurse named a preceptor. The term “preceptor” is the term used in Ireland to refer to a registered nurse who supports, guides and assesses nursing students on practice placement; the terms “mentor”, “practice placement supervisor” and “clinical supervisor” are also used in the literature to refer to the same role (Mead, 2012). For the purposes of this study the term “preceptor” will be used throughout this document. The quality of the nursing programme depends on the experience and level of supervision the nursing students receive in the clinical learning environment. This qualitative study explored current standards of the preceptorship model of nursing, to determine how preceptors perceive their role and the values preceptees place on the level of support they receive from preceptors during their clinical placements. I also needed to determine the level of support and training preceptors received from lecturers in higher education and management in the teaching hospital. The theoretical frameworks I used in the study were the Legitimate Peripheral Participation Theory (Lave and Wenger, 1991), which describes how newcomers become experienced members and eventually old-timers of a community of practice, and Social Learning Theory (Bandura, 1977), which proposes that learning takes place as a result of social interaction with other staff, including preceptors, through both verbal and non-verbal language. The literature implied that the role of the preceptor is stressful and the training inadequate (Haggerty et al., 2012; Eley, 2010; McCarthy and Murphy, 2010). This study set out to explore the tripartite relationship between preceptors, nursing students and lecturers. Using a qualitative approach, I conducted 24 semi-structured interviews with nursing students (n=8), preceptors (n=8) and lecturers (n=8). The study findings suggested that the preceptor’s role is difficult owing to time constraints, ward acuity and lack of resources. Part of the remit of a nurse working on a ward necessitates working different shifts and preceptors identified that it can be difficult to match the duty of a staff nurse with that of a nursing student. Preceptors found it challenging to give enough quality time to the students. Client care is always a priority with staff nurses, and must come first; the time they can spend with nursing students therefore tended to be ad hoc in nature. According to the preceptors they need on-going support from management of the hospital and lecturers in higher education. Those interviewed suggested they loved their role but felt they could not give enough quality time to the students. They would like more support from clinical placement coordinators (CPCs), from lecturers in higher education, and from management of the hospital. The preceptors also suggested that the training they receive needs to be more comprehensive, and to include more refreshers on curricula, teaching and assessing nursing students and providing feedback. The nursing students valued the time they spent with their preceptor, but this was sometimes limited owing to resources, ward acuity and working different shifts. They latched on to any available nurse when their preceptor was busy elsewhere or off duty. Overall, they would much prefer to have their named preceptor with them for support and guidance and because the preceptor was their assessor for their final interview on the clinical placement. The lecturers acknowledged the wonderful work the preceptors do in facilitating the nursing students in the clinical area. They believed that the preceptors should be given more support in the form of refreshers and “protected time” to precept the students. The lecturers would like to be more visible in the clinical area, but because of their teaching, research and administrative role their time is limited to quick visits to the ward. Some lecturers acknowledged that to remain current it is important for them to spend more time in the clinical area. Preceptors, employed by health care institutions, undertake the responsibility of supporting nursing students without protected time or remuneration. The nursing students are also supported by clinical placement co-ordinators (CPCs) on a 1 : 30 ratio. CPCs are employed by health care institutions to co-ordinate clinical placements. They assist with teaching and learning of students but do not formally assess them. They were not included in this study as there were insufficient numbers to match the sample size. To conclude, if there is insufficient time to precept nursing this can be a lost learning opportunity for the students. The nursing students miss the direct support and feedback from their preceptor and their learning is limited. They can finish their clinical placement not having reached their potential and maximised their learning. Despite the current climate of austerity there is a need to retain our highly qualified and capable nursing workforce.

This longitudinal study explored the experiences of six dyslexic nursing students, in their final six months of their nursing course, re-visiting them again in their first six months as registered nurses. The study also explored the experiences of those who support them from student nurse to registered nurse, namely their tutors and their mentors and preceptors in practice. A semi-structured interview method was used to interview each participant additionally adopting an iterative interview method. An interpretative case study design was adopted for this study using interpretative phenomenological analysis to analyze the data. The nursing students expressed degrees of negative self-perceptions of themselves, some carried these negative self-perceptions as registered nurses. Some of the mentors, tutors and preceptors lacked knowledge and understanding of dyslexia with some expressing concerns over the safety of a nurse with dyslexia in practice. The results presented evidence of a dyslexic self-stigma and the fear of others perceptions surrounding dyslexia amongst the nursing students, but also evidence of a full acceptance of dyslexia amongst some of the nurse participants. Dyslexia was perceived differently amongst the tutors and preceptors showing a positive understanding amongst some, but also that dyslexic is misunderstood and linked to concerns surrounding patient safety.

Report (Ed. D.)--Teachers College. / Issued also on microfilm. Includes bibliographical references.

<p> Within the health care system, patient safety outcomes have been criticized for many years. Medical malpractice, common errors, and nosocomial infections (i.e., hospital-acquired infections) are safety concerns, and represent a public health problem. Since the Institute of Medicine (1999) published To Err is Human: Building a Safer Health System in 1999, changes have been made to improve the use of technology and leverage advancements in research that improve patient safety. Nurse leaders can also help to facilitate process improvements in the patient safety culture. The purpose of this capstone project was to explore the nursing leader role in improving patient safety in a hospital setting. The method utilized for this study was a literature review. Prominent articles identifying the role of nursing leadership were included. Seven drivers of patient safety were identified (Sammer, Lyken, Singh, Mains, &amp; Lackan (2011), and subsequently informed this project. The targeted populations were patients, families, nurses, nurse administrators, and medical personnel. Findings regarding the nurse leader role, patient improvements, and barriers to improvements were reviewed. Nurse leaders were found to be of critical importance to patients, medical personnel, and the health care system. The limitations of this review and implications for policy and practice are discussed. </p>

Thesis (Ph.D.)--George Mason University, 2008. / Vita: p. 162. Thesis director: Jeanne Sorrell. Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Nursing. Title from PDF t.p. (viewed July 8, 2008). Includes bibliographical references (p. 152-161). Also issued in print.

Thesis (M.S.)--University of Michigan, 1972.

Thesis (M.S.)--University of Michigan, 1972.

Report (Ed. D.)--Teachers College. / Issued also on microfilm. Includes bibliographical references.

This research examines the transition from student nurse to Registered Nurse (child). Earlier studies suggest the transition always involves a period of discomfort and uncertainty. However, there is a dearth of longitudinal studies of children‟s nurses, revealing a gap in the evidence that this study aims to fill. This longitudinal study commenced in one HEI in England where the six participants were completing their undergraduate programme in child nursing. A phenomenological interpretive design was used to answer the research question: „What is the experience of making the transition from student to RN (child) like?‟ Data was collected using focused qualitative interviews at three stages: mid final year, and at 3–4 months and 12–14 months post-employment as an RN. The data was analysed using descriptive and interpretive methods. The thesis draws out the changes in the participants experience over time and suggests the transition extends beyond the first year of practice. It involves development within four overarching themes: Personal and Professional Identity, Primacy of Practice, Working with People, and Managing Newness. These key themes are present across the participants‟ experience but their importance changes over time. The transition is characterised by the visibility of being a nurse and the invisibility of being a „new‟ nurse. This study supports the findings of some earlier studies and introduces some new evidence in relation to children‟s nursing, such as responding to crises, coping with grief and the difficulties and challenges of working with parents. The main limitations are that this is a small-scale study within a specific branch of nursing, with participants drawn from one HEI and conducted by a single investigator. However, because the participants took up employment in different locations in England, the findings may have some resonance with other neophyte children‟s nurses beyond the original setting of the research. Recommendations are made for undergraduate programme providers and employers to strengthen and develop the preparation of RN (child) pre- and post-qualification, particularly in the areas of preceptorship, prioritising care and managing time, working with parents, and coping with emergencies or the death of a child

This study focuses on the practice component of United Kingdom (UK) pre-registration nurse education. In particular, the research has concentrated on one school of health - part of a larger higher education institution, in the UK and has explored how the institution ensures the quality of the practice component of two of its pre-registration nurse education programmes, the Adult and Mental Health branch programmes. A ‘Major Review’ inspection of these programmes was undertaken in 2005 as part of the requirement of the Quality Assurance Agency (QAA) (2001). The research analysed whether the precepts that relate to the practice component of the school’s pre-registration programmes were being implemented, enacted and experienced by those engaged in them. To achieve this Yin’s (2003) qualitative case study approach was adopted, involving interviewing senior lecturers (n=9), mentors (n=7) and student nurses (n=8) and undertaking in depth analysis of relevant documentation. The findings identified that the precepts themselves did not directly influence what the link tutors and mentors did. As a result, the student nurses experienced different levels of support from link tutors and mentors. This prevented students from experiencing a standardised approach to the practice component of the programmes studied. From this it has been concluded that the ethos of the Major Review process has had no long term impact with regards to standardising and quality assuring the practice component of the programmes studied, a finding that has not been formally reported elsewhere. Instead individual values, beliefs and practices dominated the way in which the players studied operated. The study also highlights how broad and non-descript the precepts themselves are in guiding the school towards a standardised approach to the practice component of the programmes in question. All but one of the precepts ‘Staff Development’ were evidenced as being implemented and/or experienced. Having researched the placement learning precepts (QAA 2001) in their entirety, which has never been done before, it became evident that whilst the content of all of the precepts had been included in the documentary data studied (Clinical Assessment of Practice Documents, School Plan and Pathway Guide), this did not guarantee that all of the precepts were fully implemented and enacted by relevant players. This was because the instruction and guidance within the documents studied were often broad and non specific, to which the design of the precepts allowed. The outcome of this enabled a) link tutors to interpret their roles and responsibilities in different ways; b) theory practice gaps to emerge, which ranged from weak partnership relationships between link tutors and practice placement mangers; c) mentors and link tutors interpreting the CAPD differently and d) mentors mentoring and assessing students in different ways. This resulted in students nursing experiencing different types of learning opportunities and assessment practices that did not always match the learning and development that may be needed in order to practice as a competent and confident registered nurse, at the point of registration. Additionally, there was a lack of understanding by all players about local quality assurance systems and processes. This ranged from none of the participants being familiar with the complaints procedures, or being clear about how placement learning experiences were monitored and evaluated. As a result of these findings the competence of the personnel (link tutors and mentors) studied has been questioned. A phenomenon that highlighted that precept 6 ‘Staff Development’ (which required institutions to ensure that staff who are involved in placement learning are competent to fulfil their role), was not being demonstrably implemented or enacted. A series of recommendations have been designed to meet both the needs of the school studied and others similar. Some of the recommendations relating to the school studied have already been implemented with positive effect. This was evidenced when the researched school was confirmed as having an ‘Outstanding Level of Achievement’ for practice learning following a more recent quality assurance inspection by HLSP on behalf of the Nursing and Midwifery Council.