Traditional Versus Precepted Clinical Experiences for Junior Nursing Students: Is There a Difference in Clinical Competence?

Abstract

This study was conducted using an experimental research design to examine two clinical supervision models for junior level nursing student clinical experiences. The traditional model of one instructor supervising eight to ten students on one unit, was compared with the precepted model where one student was paired with one experienced, practicing registered nurse on a unit with regular visits by a faculty clinical instructor. The precepted model was proposed in this study as a model of clinical education that would be consistent with the Situated Learning Model with an emphasis on learning with a role model through observation and participation in the community of practice in authentic activities. This study included 107 junior level student participants (control group n=54; experimental group n=53), from one school of nursing. Students in both groups were enrolled in the same courses, assigned to general medical-surgical nursing units, in similar hospital settings in the same region, for the same number of hours. The Clinical Competency Rating Scale (CCRS) developed by Scheetz (1988) was used to rate clinical competency in three areas including: problem solving, applying theory to practice, and psychomotor skill development. Clinical competency was compared using t-tests, and analysis of covariance (ANCOVA) was used to control for differences in faculty experience level. The precepted model of clinical education did not yield junior nursing students who achieved higher levels of clinical competence compared to the traditional model. Students having traditional clinical experiences were rated higher in the psychomotor skill development variable with no consistent statistical difference in the other two variables. Suggestions for practice included: improving faculty preparation for rating students’ performance, attention to preparing preceptors to specifically help students with psychomotor skill development when the precepted model is used, and monitoring clinical experiences for the factors that could impede learning in the situated learning model. Suggestions for future research included adding qualitative research methods and adding other quantitative measures of competency.