a recent report published by the american association of colleges of nursing ( aacn ) noted that over 67,000 qualified applicants were not accepted into baccalaureate and graduate nursing programs in the usa in 2010 .
the report also noted that almost two - thirds of the nursing schools participating in the survey noted that faculty shortage is the primary reason for not accepting all qualified applicants into baccalaureate programs .
the consequence of a nursing shortage is nurses work longer hours under stressful conditions , which leads to nurses being more prone to making mistakes and medical errors .
schools of nursing are increasingly using hospital - based nurses to precept students during clinical rotations .
these nurse preceptors extend the faculty at a time when a shortage of nursing faculty limits nursing school enrollment .
combined with initiatives already in place , such as using master 's prepared nurses at the hospital as loaned faculty , compressing students ' clinical rotations and assigning clinical rotations to off - shifts or , in less popular nursing units , using nurse preceptors as clinical faculty helps in two ways : it increases the number of available clinical nursing slots and it provides qualified clinical instructors . as little quantitative research on the effectiveness of using preceptors as clinical instructors early in a nursing program has been reported , this study looks at the question  given baccalaureate students in their second medical - surgical class , do precepted students perform as academically well as traditionally prepared students ?
 clinical groups in texas traditionally have a ratio of one master 's prepared instructor to 10 students .
the instructor 's role is to monitor students in the clinical setting and instruct them in meeting their educational learning objectives .
when class size is extended to increase enrollment , procuring a sufficient number of qualified clinical instructors is often difficult . that nurses qualified for teaching can make higher salaries working as a nurse in a hospital than as faculty in a university exacerbates the faculty shortage problem
additionally , as the number of clinical slots dedicated to nursing students is limited , schools in the region compete with each other .
students often demand accessible and timely information , and they want flexibility to meet their needs of working , studying , and raising a family .
the younger students rely heavily on technology for learning , entertainment , and life scheduling .
students precepted one - on - one with registered nurses ( rn ) in hospital settings are more likely to find their needs met than is possible under a traditional group model , which permits less interaction between faculty and student , limits student opportunities for learning and skills practice , and provides an inaccurate view of the profession [ 4 , 5 ] .  
according to the texas board of nurse examiners , master 's prepared faculty can oversee the teaching activities of 12 rn preceptors , each of whom can supervise two undergraduate students . using preceptors as clinical faculty alternatives more than doubles the number of students ( n = 12  2 = 24 ) than can be placed in traditional clinical rotations ( n = 10 ) . the policy established by the texas board of nursing states that a precepted student must be visited by a faculty member at least once a month .
faculty conducting the study rounded on precepted students at least twice a month since the students were early in their nursing program .  
hospital - based clinical preceptors , as alternatives to clinical faculty , expect adequate support to function within the educator role . according to
yonge and myrick , preparation of preceptors includes teaching educational principles that help prepare the preceptors beyond their usual staff nurse orientation .
wilkes et al .   identified that continued support materials , beyond orientation , were essential to success .
using hand - held computers allows preceptors to obtain support at the bedside when time is at a premium and desktop services are not available .
the use of hand - held computers with internet access is an effective way for preceptors to obtain information , such as faculty contact information , school policies , and student clinical schedules , prepare anecdotal notes , and search for useful clinical information [ 12 , 13 ] .
use of the precepting alternative also frees up additional nurses and hospital units for clinical training ; nurses on smaller units not able to support a traditional group of 10 students could precept one - on - one and nurses working off - shifts can serve as preceptors .
students participating in precepted groups find that they have more scheduling flexibility , greater opportunities for learning and practicing skills , and more relevant learning experiences . to prepare the nurses for the preceptor role , the researchers developed a 14-module online preceptor education course .
the module units , listed in table 1 , were designed to provide direction on teaching students as adult learners and to promote critical thinking in nursing students .
the project team , including faculty and hospital educators , attended the preceptors ' presentations to offer technical training and support .
upon completion of the preceptor training , nurses received 9.6 continuing education units . having blackboard access also gave the rn preceptors access to the students ' course materials , including syllabi and lecture notes , which permitted the rn preceptors to provide clinical experiences that met the learning objectives and to keep pace with the students learning progression .
as nurses traditionally work with new hire graduates and not students in their second semester of nursing education , it was important that preceptors knew that these students would not perform at the same level as a new graduate nurse .
technology assisted in permitting continuous availability of faculty and in forming a communication net for students , preceptors , and faculty .
communication was via a dedicated web page , e - mail , cellular phones , traditional pagers , and handheld computers .
preceptors working at the bedside could communicate with nursing faculty in the office . using the handheld computers , preceptors had a rapid means of access to relevant nursing and drug information while they were working with the students .
in addition , the research faculty and project staff developed a project - specific website to provide quick access to contact information , school policies , performance issue information , tips and topics , and links for emergencies and needle sticks .
the website was a resource for preceptors and students whether the students were precepted during school hours or on off - shifts .
both preceptors and students could rapidly locate faculty contact information or receive technical support 24 hours a day .
this was necessary as the precepted students worked the schedule their preceptor worked , whether this was a day , night , or weekend shift .
e - mail group links permitted communication to the project staff and the control and experimental student groups . the availability of student performance information and school policies assisted preceptors to take appropriate action in addressing student attendance , dress and appearance , safety , and professionalism issues . using blackboard to deliver the education course online permitted the rn preceptors to complete the training at their convenience
since the students worked all shifts , discussion boards were set up to support communication and submission of assignments .
nursing faculty moderated the discussion postings and responded accordingly . additionally , faculty and hospital educators periodically made rounds when students were scheduled to be with their preceptors to stay in contact , answer questions , and provide support .
the use of technology helped to decrease preceptor resistance in precepting students without the instructor being present and increased faculty assurance in the quality and relevance of the preceptors teaching .
the students had to complete a total of 96 hours in the clinical setting and were permitted to work between 8 and 24 hours per week . for faculty to keep track of student schedule and hours , students posted their clinical schedule at least 48 hours prior to working with their preceptor .
faculty held weekly post - clinical conferences with students at the school to answer questions and reinforce learning objectives . however , faculty were available to the students and preceptors by cellular phone twenty - four hours a day .
the study used a quasi - experimental design where students ( n = 69 ) were randomly assigned to a control group ( traditional clinical group ) or experimental group ( precepted group ) .
the subjects were in the second semester of their nursing education , and instruction that semester included pharmacology , gerontology , pathophysiology , and the second medical - surgical nursing course .
both experimental and control students volunteering to participate in the study submitted an informed consent form in accordance with the university 's institutional review board policy . for experimental and control groups ,
the student 's accumulative numerical course grade in medical - surgical course 1 ( taken in the first semester ) was used as an independent variable .
the dependent variables were students ' numerical grades on unit examinations given throughout the semester , comprehensive final examination grades , and accumulative numerical course grades in both the medical - surgical course 2 and the corequisite pharmacology course . both experimental and control students took a standardized medical - surgical exam . although scores earned on exams administered to measure what the student learned in the classroom does not have established reliability and validity for measuring clinical performance , issues surrounding clinical evaluation exist .
some of the identified issues pertinent to this study include the subjectivity of the evaluation especially when using  novice  clinical faculty .
novice faculty ( bedside nurses serving as preceptors ) may have limited formal education and experience in evaluation of students and often lack confidence in their ability to fairly evaluate students [ 16 , 17 ] . using a grading rubric , two faculty members on the research team reviewed the precepted student 's nursing process papers at weeks 4 , 8 , and 12 and recorded these grades . to increase interrater reliability , the two researchers critiqued one student 's paper prior to week 4 to standardize scoring .  
a clinical evaluation form was developed for preceptor use ( table 1 in supplementary material available online at doi:10.1155/2012/276506 ) .
after each 12-hour shift , the preceptor evaluated the student 's clinical performance and faxed the form to the research team .
if a student is consistently scoring 2 or less on the evaluation , the faculty meets with the preceptor to discuss the weaknesses of the student .
faculty would meet with the student as well to discuss strategies for improving their clinical performance .
the final clinical evaluation was completed by the faculty and was based on data from the preceptor evaluations , the nursing process paper grades , and the faculty 's impressions when rounding on the student in the hospital .  
the students were randomized into two groups , experimental or precepted group ( n = 37 ) and control or traditional group ( n = 32 ) .
the precepted students were assigned clinical rotations at two tertiary - level hospitals , where they worked one - on - one with a baccalaureate - prepared registered nurse ( rn ) on a medical or surgical unit or a surgical intermediate care unit . as per the request of the two hospitals
, precepted students could not work on the days other school of nursing held their traditional clinical .
this meant that there was one day a week in which the precepted students could not schedule a clinical day .
the control students were mixed within the traditional training groups of 10 students , and these groups were assigned to medical - surgical floors at various local hospitals .
the criteria for eligibility were that the rns ( 1 ) have at least one year experience as a registered nurse ; ( 2 ) have a recent satisfactory annual evaluation by their nurse manager ; ( 3 ) have a current bcls and nursing license ; ( 4 ) completed the online preceptor education course ; ( 5 ) graduated from a baccalaureate nursing program .
inclusion criteria for students were that they were in their second semester of nursing school and had not previously withdrawn from or failed a class .
the students ' final numerical course grade from the first semester medical - surgical course was analyzed using an independent sample t - test to determine whether the first semester grade needed to be used as a co - variant .
however , this test showed no significant difference between the experimental and control designated groups .
student 2nd semester medical - surgical examination scores ( 4 units and 1 comprehensive final ) were analyzed using a mixed model approach for repeated measures anova .
final numerical grades from their pharmacology course and a standardized specialty medical - surgical examination ( hesi ) were analyzed using independent sample t - tests .
no significant differences between the experimental and control groups on any measurement were found . for discussion purposes ,
an implication is that precepted students did as academically well as students in the control group .
likewise , this could be stated , as precepted students do no better than traditional students academically despite the one - on - one clinical treatment .
given this , the study supports using hospital - based rn nurses as clinical preceptors . using rns as preceptors not only provides much needed clinical faculty but also frees up clinical slots that previously have not been available .
the four unit examination grades and the final examination grade were analyzed using a mix model approach for repeated measures anova .
there was no statistically significant difference between the precepted and control groups ( f = .936 , df = 63 , p = .449 ) .
an independent sample t test was computed to determine if there was a significant difference between precepted and control groups in academic performance as demonstrated by the final course grade students received in their second semester medical - surgical course .
students in the traditional clinical group had a mean of 83.7 ( sd = 5.9 ) , and the precepted students had a mean of 83.5 ( sd = 4.6 ) .
there was no statistical difference between the two groups ( t = .118 , df = 67 , p = .906 ) .
( hesi , now owned by elsevier ) medical - surgical specialty exam at the end of the semester , this mean score was considered in the analysis .
the mean standard score for the traditional students was 784.19 ( sd = 182.5 ) as compared to a mean standard score of 807.76 ( sd = 136.7 ) for the precepted students . however , there was no statistical difference between the two groups ( t = .612 , df = 67 , p = .543 ) .
students in the traditional clinical groups usually prepared medication cards the day before each clinical session . as students in the precepted group
did not know which patients their preceptor would have until report , they had to take a different approach .
they reviewed each medication and presented the information to their preceptor before administering the medication . in analyzing pharmacology final course grades , there was no statistical difference between the two groups ( t = .786 , df = 67 , p = 434 ) .
the students in the control group had a mean grade of 89.1 ( sd = 3.8 ) , and the precepted group had a mean of 88.3 ( sd = 4.8 ) . on average , the students in the precepted group received ratings of 35 for the clinical competencies listed on the clinical evaluation form .
confident preceptors not only rated the clinical performance , but also provided anecdotal information to justify the given ratings .
preceptors did note that the clinical evaluation process was an added responsibility to their busy clinical day . unlike students in the traditional group , precepted students arrived for their shift with no preparatory work in place .
the student and their preceptor selected one patient as the student 's primary patient for that shift .
although the precepted student was responsible for obtaining the same information as that of a traditional student , the precepted students did this on shift and completed the nursing process papers retrospectively .
the faculty found that the quality of the nursing process papers were similar between the precepted and the traditional groups .
students in both groups struggled with parts of the nursing diagnosis (  related to  statement ) and setting measurable expected outcomes .
the precepted students , instructed to turn in their paperwork within a week of completing the shift , tended to fall behind , allowing the paperwork to accumulate .
the information technology ( it ) member of the research team worked closely with the two hospitals that participated in the study .
the it personnel from the two hospitals and the university had to breech the  firewall  that existed between institutions .
once the two systems were connected , the it member of the research team met with preceptors one - on - one to help them navigate the blackboard site within the university .
the it member held mini tutorials to help the preceptors learn how to use their institution 's intranet , access the university 's blackboard site , and navigate the preceptor course .
this challenge was not anticipated by the research team and did require additional time not planned in the original proposal .  
most preceptors had served in the role in the past , orienting new hires on their respective units .
one occasion arose where a preceptor placed the student in a dangerous situation ( administering medications without being present ) .
the student reported the incident , and working with the institution , the preceptor was replaced with another nurse .
although many of the preceptors have mentored new nurses on their units , they had not participated in a formal evaluation process .
some preceptors would circle all the same number on the likert scale clinical performance evaluation and would not provide any commentary .
the members of the research team would meet with preceptors and ask for a verbal evaluation of the student 's performance .
questions asked included an assessment of the student 's ability to perform a focused review of systems and physical exam , knowledge of medications and their administration , and the potential to use the nursing process to plan appropriate care for the patient , for example .
reviewing the nursing process papers also provided insights as to how the student was performing in the clinical setting .
in the last decade , we have seen an increase in the number of applicants to nursing programs , a decline in the number of nurses in the workforce , and a decline in the number of nurses who pursue a career in academia . with the nursing shortage ,
demands are made on schools to increase enrollment ; however , with the shortage of nursing faculty , this demand has been difficult to meet . as a barrier
to increasing enrollment has been clinical availability , a solution is using nurse preceptors to extend faculty in the clinical setting .
this project examined the use of preceptors , supported by training and technology , to facilitate the clinical experience of students in their second semester medical - surgical course .
precepting students are not a new concept within nursing ; however , a preceptor support model for students early in their nursing education has not been fully studied .
the purpose of the study was to determine whether students who were precepted performed as well as those in a traditional clinical group . as there was no significant difference in performance on grades and hesi scores ,
the results suggest that from an academic perspective , providing clinical education when using qualified and trained preceptors did not interfere with the student 's ability to master the course content . the quality of the nursing process papers produced by students was deemed to be equal between the two groups .
students in both groups were provided feedback on their papers and were asked in equal proportion to resubmit work .
as the main problem encountered was the timeliness of the submission of the paperwork , a solution would be to design a mechanism within the computer - scheduling program that locked out students from posting their schedule until all nursing process paperwork was completed .
 the shortage of nursing faculty has contributed greatly to the nursing workforce shortage , with many schools turning away qualified applicants because there are not enough faculty to teach . despite the faculty shortage , schools are required to admit more students to alleviate the nursing shortage . 
 clinical groups in which preceptors are responsible for student learning extend faculty resources . purpose . to determine the effectiveness of an alternative clinical experience ( preceptorship ) 
 . methods . quasi - experimental , randomized , longitudinal design . 
 students were randomized to either the traditional or precepted clinical group . 
 the clinical experience was a total of 12 weeks . 
 groups were compared according to several variables including second semester exam scores , hesi scores , and quality and timeliness of clinical paperwork . sample . over a two - year period , seventy - one undergraduate nursing students in the second semester medical - surgical nursing course participated . 
 36 were randomized to the experimental group . 
 the preceptors were baccalaureate - prepared nurses who have been practicing for at least one year . setting . 
 two hospitals located in the texas medical center . statistical analysis . 
 descriptive statistics and independent t - test . results . 
 there was no difference between the groups on the variables of interest . 
 conclusion . 
 students in the precepted clinical group perform as well as those in a traditional clinical group . 
1. Introduction
2. Methodology
3. Results
4. Discussion