Final Clinical Practicum Research Articles

Evaluation of a psychological readiness program and final clinical practicum among final year nursing students: A mixed methods study

BackgroundFinal year nursing students may experience higher levels of stress owing to the increasing complexity and expectations from their clinical practicums. Enhancing psychological readiness may be a potential strategy to enhance nursing students' transition to the clinical area. ObjectiveTo evaluate the effects of a psychological readiness enhancement for transition to professional practice program and a 10-week clinical practicum on students' psychological wellbeing, resilience, practice readiness and confidence. DesignA sequential mixed-methods approach comprising of a single-group evaluation and descriptive qualitative study. SettingFinal year nursing students enrolled in an undergraduate nursing program from one autonomous university in Singapore was recruited. Participants148 final year nursing students participated in the single-group evaluation study. A total of 24 participants who completed the psychological readiness program were recruited in the qualitative study. MethodsThis study included two phases. Phase I comprised of an evaluation of a blended psychological readiness program and clinical practicum. Data was collected across three waves to assess nursing students' psychological wellbeing, resilience, practice readiness and confidence. In Phase II, a qualitative study using individual semi-structured online interviews was conducted to examine students' experiences of the psychological readiness program and clinical practicum. ResultsThe psychological readiness program led to significant changes in students' anxiety and patient centeredness scores. The accumulated effects of the psychological readiness and clinical practicum showed significant improvements in students' practice readiness and confidence. Although there were no significant improvements in depression, stress and resilience scores, there were improvements in the trend across three waves. Students attributed these improvements to the psychological readiness program and sharing by the alumni. ConclusionsThe findings of this study laid the foundation for the development of psychological readiness programs. However, larger scale studies using randomized controlled trial designs should be used to confirm the effects of these interventions.

Abusive supervision and nursing students’ intention to leave the nursing profession: a moderated mediation model of emotional exhaustion and the nurse-patient relationship

BackgroundExploration of the relationship between nursing students’ abusive supervision and their future intention to leave the nursing profession before completing the final clinical practicum is critical to the issue of nursing staff shortages and how to alleviate them. In order to further dissect the factors influencing turnover intention among student nurses in clinical practice, our study used the conservation of resources theory and job demands-resources model to explain the specific pathways that influence student nurses’ intention to leave the nursing profession, with particular focus on nursing students’ personality traits and certain organizational factors.MethodThis study followed a cross-sectional design. Between March and May 2022, a convenience sampling method was used to select 531 nursing students from two medical universities in Fuzhou. The Abusive Supervision, Emotional Exhaustion, Nurse-Patient Relationship, and Turnover Intention Scales were employed to collect data. The PROCESS macro (Models 4 and 7) for SPSS 25.0 by Hayes and 5,000 bootstrap samples were used to examine the moderation and mediation impacts.ResultsAbusive supervision was found to significantly positively predict nursing students’ intention to leave the nursing profession. Emotional exhaustion significantly mediated the relationship between abusive supervision and an intention to leave the nursing profession. The moderating effect of the nurse-patient relationship in the mediation model was also found to be significant.ConclusionsAbusive supervision by clinical teaching staff is a work-related stressor that leads to emotional exhaustion, consequently decreasing nursing students’ future intention to work as a nurse. A nurse-patient relationship based on trust could buffer the negative effect of abusive supervision on emotional exhaustion. Healthcare organizations and nurse educators should implement programs that educate and train individuals about abusive supervision, emotion regulation, and positive nurse-patient relationships; this would serve to decrease nursing students’ intention to leave the nursing profession. This study provides relevant implications for helping nursing instructors develop effective intervention strategies to retain talented nursing personnel.

Nursing students’ readiness towards the ‘new normal’ in clinical practice: a distributed cognition qualitative perspective

BackgroundClinical practicums are a core component of baccalaureate nursing education. Following the coronavirus pandemic, there have been extensive changes in the workforce environment that may potentially affect nursing students’ experience and readiness for clinical practicums.MethodsA qualitative study was conducted to explore final-year nursing students’ experiences and readiness for their final clinical practicum before becoming a registered nurse. A purposive sample of 24 final-year baccalaureate nursing students was included in this study. Individual semi-structured interviews were conducted face-to-face via Zoom. The data was analysed using an inductive thematic analysis approach.ResultsThree themes depicting students’ experiences and clinical readiness were elucidated. The themes included: (1) Experiencing multiple concerns, (2) requiring a network of support, and (3) easing the transition to professional practice. Students considered the final clinical practicum as challenging and demanding which evoked numerous concerns.ConclusionsConsidering the stress that final-year nursing students experience, it will be important to devise strategies ranging from personal, relational, and environmental protective factors to enable their successful transition and completion of clinical practice.

Surface acting, emotional exhaustion, career calling and turnover intention among student nurses: A cross-sectional study

AimThis study aims to explore the mediating role of emotional exhaustion and the moderating role of career calling in the linkage of surface acting and turnover intention among student nurses in the final clinical practicum. BackgroundTurnover rates are especially high for graduating nursing students. Surface acting is considered an important factor that affects this rate among nurses. However, little is known about the relationships between surface acting and turnover intentions among graduating nursing students in the final clinical practicum. DesignThe current research is a cross-sectional study, and the data were collected from 8 January 2022–22 January 2022. MethodsA survey was completed by 275 graduating nursing students. This survey included Chinese translations of scales measuring surface acting, emotional exhaustion, career calling and turnover intentions. ResultsBoth surface acting (r = 0.47, p < 0.001) and emotional exhaustion (r = 0.59, p < 0.001) correlated positively with turnover intentions. Both surface acting (r = −0.41, p < 0.001) and emotional exhaustion (r = −0.62, p < 0.001) correlated negatively with career calling and career calling (r = −0.72, p < 0.001) correlated negatively with turnover intentions. The association between surface acting and turnover intention was mediated by emotional exhaustion. In addition, career calling moderated the relationship between surface acting and emotional exhaustion. ConclusionsSurface acting results in higher emotional exhaustion and higher turnover intention among graduating nursing students, which was more pronounced among nursing students with a lower sense of career calling.

Impact of art and reflective practice on medical education in the emergency department.

There is heightened intrigue surrounding the application of arts-based pedagogy in medical education. Art encompasses multiple forms of expression and is used to convey specific meaning and emotion, whereas provoking critical reflection. Our aim was to explore the effectiveness of art and reflective practice in medical education, in the context of the ED. Longitudinal methodological study design. Prior to the first, and after the final clinical practicum, medical students watched a 3-min film: 'The Art of the ED'. Written reflections focused on changing perceptions towards the film during their medical education programme. Data were thematically analysed. Three themes were collected from 25 written reflections and included: 'professional growth' exploring personal and professional development across the medical programme; seeing 'patients are people'; and the purpose, structure and function of an ED exposed in 'the reality of ED'. Results highlight that arts-based pedagogy can facilitate meaningful and critical reflection in medical students, whereas also fostering professionalism. Reflecting on the film broadened their perspective into a realm of new possibilities, challenging them to identify implicit bias around ED, and promote professional identity formation. The combination of art and reflection in medical education enhances reflective learning and can lead to transformative change, including the development of core doctoring values of service, empathy and respect for patient. There are clear benefits to medical education incorporating more arts-based pedagogy that promotes reflective exploration and interpretation of the psychosocial context of health and illness, delivery of more holistic models of care and their role as doctors.

Undergraduate nursing students' mentoring experiences in the clinical practicum: The United Arab Emirates (UAE) perspective.

This study explored undergraduate nursing students' mentoring experiences during their final clinical practicum as they prepared to enter the workforce. We used a qualitative case study design with data collected in two focus group discussions involving 19 students. Data were analysed using inductive thematic analysis. Students' descriptions of their mentoring experiences fell under three themes: 'great experience', 'being treated like part of the family', and 'gaining confidence and skills'. Students described their mentors as having critical roles in providing feedback and learning opportunities to interns. Students also reported that ungraded initial assessment, friendlier workplaces, and mentors with patience were required to strengthen their professional learning at the workplace. These results suggest that prompt and constructive feedback, warmer workplace environments, and passionate mentors' involvement may help enhance students' mentoring experiences during their clinical practicum. Management and academia should work jointly to develop mentorship programs to achieve better student outcomes. Doing this will lead to role clarity, higher levels of satisfaction, and increased productivity. Management needs to consider compensating mentors for their time in student learning and select experienced nurses willing to mentor others to promote enjoyable relationships and effective mentoring engagements. Management needs to find creative ways to build mentoring into appraisals, for at present, it is considered a voluntary activity for educating the next generation of nurses. Management should ensure adequate training and ongoing support for mentors and mentees in clinical mentoring.

The nurse teacher’s pedagogical cooperation with students, the clinical learning environment and supervision in clinical practicum: a European cross-sectional study of graduating nursing students

BackgroundA supportive clinical practicum experience may enhance the successful transition and socialization to working life of graduating nursing students. Nurse teachers have the main responsibility of supporting and guiding nursing students with their pedagogical expertise during the students’ clinical practicum. Thus, the clinical role of nurse teachers is seen as an essential part of a high-quality clinical practicum. Nursing students appreciate the nurse teacher’s cooperation with students, but it is often reported to be unattainable. The aim of this study was to explore and compare graduating nursing students’ experiences of the nurse teacher’s pedagogical cooperation with students, the clinical learning environment and supervision in their final clinical practicum, and to analyze factors associated with these experiences in six European countries.MethodsA cross-sectional comparative international survey design was used. The modified Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) Scale, with a new subscale measuring the nurse teacher’s pedagogical cooperation with students, was used. A convenience sample of graduating nursing students in Finland, Germany, Iceland, Ireland, Lithuania and Spain completed the online survey in 2018–2019. The data were analyzed using a Chi-Square test, Pearson’s correlation coefficients, and linear models.ResultsA total of 1796 (response rate 49%) nursing students completed the survey. Overall, students had positive experiences of the nurse teacher’s pedagogical cooperation, the clinical learning environment and supervision in their final clinical practicum. Students in Spain had the most positive experiences. Educational background factors appeared to be associated with the students’ experiences of the nurse teacher’s pedagogical cooperation with students, the clinical learning environment and supervision. The relationships between the subscale Nurse teacher’s pedagogical cooperation with students and the Clinical Learning Environment and Supervision Scale were perceived as weak to strong depending on the country.ConclusionsThis study reveals that nurse teachers play an essential role in supporting and guiding nursing students’ final clinical practicum. In this light, researchers, educators, and leaders should collaborate seamlessly between educational institutions and healthcare organizations to establish the nurse teachers’ pedagogical cooperation role within the clinical learning environment.

Digital Transformation in Nursing Education: During Covid Pandemic Challenges

Abstract: When the COVID-19 pandemic started to spread around the world, the situation became difficult for many educational institutions. The objective of this study was to discover the learning experiences and the expectations about the changes in education, in light of the abrupt change from face-to-face to e-learning education, of nursing students enrolled in Bachelor’s degree of governmental universities, This study aimed to examine nursing students attitude toward e-learning. This study utilized a descriptive cross-sectional design with 50 nursing students as study participants. Data were collected via an online survey tool. The imposition of e-learning sets limitations for older students, Students expressed concern about what an interruption in their nursing education would mean for their future careers as Registered Nurses. Many students in clinical placements were in their final focus clinical practicum, and thus close to successfully completing their program. Some learners were only one or two courses away from completion of their Bachelor of Nursing degree. In addition to canceling their current clinical placement, they had concerns about progressing in the rest of their program. Digital Health Insights provide healthcare leaders and experts with the latest artificial intelligence and digital transformation news, trends, and strategies in healthcare today. Our goal is to empower you with innovative ways to collect, pool, and analyze high-quality data from which you can extract actionable insights. Through artificial intelligence and digital trends in healthcare, we can use these insights to create efficiencies that improve patient care while reducing or streamlining healthcare costs.

Final clinical practicum shapes the transition experience and occupational commitment of newly graduated nurses in Europe-A longitudinal study.

AimsThe aim of the study was to examine the association between the characteristics of a nursing student’s final clinical practicum and the success of transition of newly graduated nurses (NGNs) in six European countries.DesignA longitudinal design with two data collections points (pre‐ and post‐graduate).MethodsThe data were collected with an online survey between May 2018 and April 2020 from graduating nursing students (n = 1796) in Finland, Germany, Iceland, Ireland, Lithuania and Spain. Altogether, 642 NGNs responded to the second questionnaire 1 year after graduation. Logistic and linear regression analyses were used to examine the associations between five clinical practicum characteristics and three indicators for the success of transition (ease of transition, turnover intentions and occupational commitment). Models were adjusted for demographic and background/workplace factors and professional competence.ResultsSeveral associations were observed between the different clinical practicum characteristics and the indicators for a successful transition. Good pedagogical atmosphere and good supervisory relationship were associated with higher likelihood of an easy transition. Good leadership style of the ward manager, good premises of nursing care on the ward and a good supervisory relationship were associated with higher occupational commitment. No consistent association with turnover intention was found.ConclusionHaving a good final clinical practicum before graduation can contribute to an easier transition experience for newly NGNs and strengthen their commitment to the nursing profession.ImpactThis study adds to the limited existing knowledge about the importance of final clinical practicums in shaping the transition process and occupational commitment of NGNs. Investing in creating a good final practicum experience could help healthcare organizations engage new nursing professionals and thus alleviate the existing shortage of nurses.

The associations between the final clinical practicum elements and the transition experience of early career nurses: A cross-sectional study

The final clinical practicum before graduation prepares nursing students for the transition from a student to a nurse, but the essential elements of the final clinical practicum that enhance successful transition are not known. We examined the associations of five elements of the final clinical practicum with four indicators of the transition experience in new nurses. We also tested whether psychosocial work characteristics modified these associations. The study sample comprised 712 Finnish nurses who had graduated within the previous two years before the data collection (response rate: 18%). The data were collected using a questionnaire survey in 2018. The elements of the final clinical practicum included (1) the systematicness of the practicum, (2) teacher involvement, (3) the quality of supervision, (4) preparing for the demands of a nurse's work and (5) being part of a professional team. Our results, based on linear regression analysis, showed that all the elements except the quality of supervision were associated with indicators of the transition experience (beta range: from 0.08 to 0.35). Job demands modified several of these associations. The findings of this study highlight the potential for well-implemented final clinical practicums to promote a smoother transition for new nurses.

Final clinical practicum of nursing education and transition experience of new nurses

Abstract Background Challenges in transitioning from a student to a registered nurse may contribute to new nurses high turnover rates. Final clinical practicum (FCP) before graduation is known for its importance in preparing students for the transition but little is known about the specific elements of FCPs essential for successful transition. We examined the associations between multiple FCP elements and transition experiences in new nurses and whether work characteristics modified these associations. Methods The data were collected in 2018 with electronic survey. The sample comprised 712 Finnish nurses graduated within the last two years. Linear regression analyses was used to examine the association of five FCP elements (Preparing for demands; Being part of team; Systematicness of FCP; Teacher involvement; Quality of supervision) with the transition experience that was measured with four scales demonstrating its emotional, physical, socio-developmental and intellectual domains. Work characteristics were defined based on demand-control -model and multiple potential confounders were considered. Results Several associations were found between the FCP elements and the four transition indicators (psychological distress, sleep problems, role conflict/ambiguity and perception of transition/educational preparation). Systematicness of FCP was, however, the only element associated with all the transition indicators, whereas quality of supervision was not associated with any. Multiple interactions were also detected between the FCP elements and job demands. Conclusions Our results suggest that FCP experiences reflect to new nurses’ first years of employment. Especially systematic planning and implementation of FCP, collegial work atmosphere and an opportunity for students to become an active member of the work community should be ensured for promoting a smoother transition from student to nurse. This could increase the chances to retain new nurses in the health care workforce. Key messages Well planned and implemented final clinical practicums with an opportunity to become an active member of professional team could help nursing students to obtain a smoother transition into nurses. The benefits of having a good final clinical practicum experience may be squandered if considerably high level of job demands (e.g. timepressure) is experienced in the first years of employment.

Final clinical practicum, transition experience and turnover intentions among newly graduated nurses: A cross sectional study

BackgroundThe shortage of nurses is a global issue, and turnover rates are especially high for newly graduated nurses. The transition from student to nurse is often described as challenging, and the final clinical practicum before graduation is suggested to be important in preparing graduating students for the transition. However, little is known about the actual relationships between the final clinical practicum, transition and turnover intentions. ObjectivesTo examine whether the final clinical practicum experience is associated with the transition experience and turnover intentions of newly graduated nurses, and whether the transition experience mediates the potential relationship between the practicum and turnover intentions. DesignCross-sectional survey study. SettingsThe study was carried out in Finland (October–December 2018). ParticipantsRegistered nurses graduated within the past two years (n = 712). MethodsA new survey instrument with five subscales was developed for measuring the final clinical practicum experience. Transition experience was measured on four scales that demonstrated the emotional, physical, socio-developmental and intellectual domains of the transition: Psychological distress, sleep quality, role conflict/ambiguity, perception of transition and educational preparation. Turnover intentions from job and profession were asked about with two questions. Structural equation modelling was used to explore the associations between the variables. The models were adjusted for multiple potential confounders. ResultsFinal clinical practicum experience was associated with all domains of the transition experience and turnover intentions. The association between the practicum and turnover intentions was partly mediated by the emotional (psychological distress) and socio-developmental (role conflict and ambiguity) domains of the transition. ConclusionsOur findings provide new evidence about the associations between the specific final clinical practicum dimensions and turnover intentions and the specific mechanisms linking this association. These results highlight the importance of final clinical practicums and suggest targets for improving nurses' transition processes during their first years in practice.

Readiness for practice: The views of New Zealand senior nursing students

The concept of ‘readiness to practice’ of nursing students is not well understood even though being ‘ready for practice’ is the focus of undergraduate programs. The aim of this study was to critically explore senior student's views about their readiness to practice as a registered nurse. This study was undertaken in a school of nursing in the South Island of New Zealand. The participants included all senior nursing students assigned to their final clinical practicum from five cohorts across two and half years.The response rate for the survey across five cohorts was 46% (n = 245). The majority of students were New Zealand European females aged 30 years or younger. Students felt they were confident with their professional responsibilities and considered that they had prepared well for the profession. They agreed that they were confident with their communication skills. Areas of concern were; caring for a dying patient and caring for more than four patients at one time. This study suggests that senior nursing students feel they are work ready.

Newly graduated nurses’ perceptions of a final clinical practicum facilitating transition: A qualitative descriptive study

BackgroundThe transition from nursing student to registered nurse is known to be difficult. However, the experiences gained from clinical practicums help graduating nursing students to prepare for practice and can influence the intensity of the transition process. Nevertheless, little is known about how the upcoming transition process can be best facilitated by a final clinical practicum. AimTo describe newly graduated nurses’ perceptions of a final clinical practicum that can facilitate the transition from nursing student to registered nurse. MethodologyTaking a qualitative descriptive approach, the participants in the study were newly graduated registered nurses (n=20) from nine Finnish universities of applied sciences. Semi-structured, individual interviews were conducted to examine what elements of the final clinical practicum influenced their transition experiences. The Framework method was used to analyse the content of the data. FindingsThree main types of benefit were identified in relation to how well the final clinical practicum facilitates the transition to registered nurse: (1) the possibility to prepare for the transition, (2) resources for support and (3) quality of the final clinical practicum. ConclusionA final clinical practicum can provide valuable opportunities for graduating nursing students to have a more positive and beneficial transition experience. However, more attention should be paid to the design and implementation of final clinical practicums to ensure adequate educational and professional support for the transition.

Facilitating the transition from a nursing student to a Registered Nurse in the final clinical practicum: a scoping literature review.

Transition from a nursing student to a Registered Nurse is a stressful and challenging process. Different postgraduate residency and orientation programmes have been developed to ease the first year of employment, but less attention has been paid to pregraduate programmes and how the final clinical practicum of nursing education should be conducted to facilitate this transition. To review the empirical studies concerning interventions that aim to facilitate the transition from nursing student to Registered Nurse in the final clinical practicum of nursing education. The aim was to scrutinise the structures and contents of the interventions and factors connected with the facilitated transition. A scoping literature review was conducted with systematic searches in three electronic databases: CINAHL, MEDLINE and ERIC. The searches were limited to studies that were written in English, had available abstract and were published between 2005 and 2016. Two researchers assessed the studies regarding their eligibility with reference to the inclusion and exclusion criteria, and 17 articles were included in this review. Inductive content analysis was used to categorise the contents of studies. The structures of the interventions described included: the participation, learning environment, amount of clinical work, supervisor criteria and supervision methods. The contents of the interventions included supervisor support, transition supportive learning activities and the student's practicum duties. The factors that were connected with facilitated transition were the quality of the supervision, adjusting to a professional nurse's role, achieved comfort and confidence and achieved competence. This scoping review offers insight into the diversity of interventions facilitating transition implemented in the final clinical practicum of nursing education. In order to unify these practices and determine the elements necessary to include, studies with stronger designs need to be conducted.

Mentoring and Self-Efficacy: Implications for the Neonatal Nurse Practitioner Workforce.

Mentoring facilitates positive self-efficacy. Individuals with high self-efficacy emulate professional resiliency and possess a strong sense of optimism in their ability to adapt, overcome, and persevere in the professional arena. The purpose of this study was to identify characteristics that encourage mentoring relationships between neonatal nurse practitioner (NNP) students and preceptors, as well as student perceptions of mentoring relationships. A 29-item survey composed of demographic items, the Freeman Mentoring Survey, the Self-Efficacy Scale, and the Confidence Scale, along with qualitative questions, was disseminated to NNP students enrolled in their final clinical practicum course from August to October 2014. Students who sought out their own preceptor "by choice" reported higher self-efficacy scores (P = .046) and mentoring scores (P = .047). Students who perceived their preceptor as a mentor (91%) expressed readiness to assume the role of advanced practice registered nursing after graduation. An average of 37.2 hours is required for a student to adapt to a clinical site and preceptor. Mentorships between preceptors and NNP students, grounded in the provisions of trust, stability, encouragement, and hope, facilitate positive self-efficacy for the student learner. All NNPs must commit to the integration of mentoring programs in the clinical setting as well as seek out teaching-coaching opportunities with NNP students to demonstrate their unwavering commitment to the NNP workforce. Further investigation of the impacts of mentoring relationships upon job satisfaction, recruitment and retention, the teaching-coaching role, and scholarship activities of actively practicing NNPs is indicated.

Reality Check: Are We Truly Preparing Our Students for Interprofessional Collaborative Practice?

Many academic settings offer interprofessional education (IPE) experiences that are of short duration and situated in safe, controlled environments such as classrooms or simulation labs. The purpose of this study was to examine the effects of a 10-week IPE strategy that was incorporated into the final clinical practicum of a BScN program. A mixed methods design was chosen, in the belief that qualitative data would help explain quantitative data from pre-test/post-test design (n = 268). Quantitative results revealed that participants disagreed more with statements on interprofessional collaboration (IPC) after completion of the strategy (p = 0.00). Qualitative findings reinforced these results, revealing a theme of common sense is not so common when it comes to IPC in the health-care setting. When student nurses are being prepared for IPC, IPE strategies should be as "real" as possible, with exposure to some of the realities of interprofessional team functioning.

Assessment in the final year clinical practicum of an Australian osteopathy program

Assessment of students is a cornerstone of health profession education programs. It is essential assessment methods are valid, reliable, fair, defensible and evidence-based. Assessment is a popular topic in health professions literature, although discussions specifically relating to assessment in osteopathic education are limited. This commentary provides an overview of the current assessment methods utilised to assess clinical competency and fitness-to-practice in the final year clinical practicum subjects in an Australian osteopathy program. This summary may be useful to other osteopathy programs in the development and implementation of assessments. Further, this commentary also introduces the concept of programmatic assessment and discusses its application in an osteopathy program.

The Professional Practice Knowledge of Nurse Preceptors

Significant research has been conducted and disseminated on preceptorship as an essential component in teaching and evaluating student learning in the final clinical practicum. The preceptorship triad-formally defined as an equilateral relationship among a nurse preceptor, faculty member, and undergraduate nursing student-overlooks the contextual challenges preceptors encounter. Preceptors develop relationships in the clinical setting to enhance teaching, and more importantly, to ensure student practice reflects the depth of clinical reasoning and skill acquisition necessary for safe and competent practice. Using descriptive surveys and qualitative focus groups, a research collaborative among academia, practice, and professional regulating bodies was established in southern Alberta, Canada, to research the types of knowledge nurses acquire and integrate to successfully assess, evaluate, and teach undergraduate nursing students in the clinical environment. This article describes the research findings and highlights the professional practice knowledge of nurse preceptors.

Keeping the Center of Nursing Alive: A Framework for Preceptor Discernment and Accountability

This research served to explicate the profile of the nurse preceptor and illuminate the knowledge that nurse preceptors accrue while teaching students in the final clinical practicum. The analysis of the descriptive survey, sent to approximately 770 preceptors, along with the interpretive analysis of 16 focus groups and 5 interviews, revealed understandings of discovering, learning, and engaging as central to the relational elements of professional discernment and accountability. Preceptor discernment is essential to ensuring competent nursing practice for student nurses preparing for entry-level practice. Dissemination of the findings is suggested through the creation of an educational framework reflective of, relevant to, and used by nurse preceptors that may be used in both practice and academic settings.