Facilitator versus preceptor: Which offers the best support to undergraduate
Sandra Walkera,⁎, Trudy Dwyera,1, Lorna Moxhamb,2, Marc Broadbentc,3, Teresa Sanderd,4
aSchool of Nursing & Midwifery, Faculty of Sciences, Engineering & Health, CQUniversity Australia, Bruce Highway, Rockhampton Q 4702, Australia
bOffice of Research, CQUniversity Australia, Bruce Highway, Rockhampton Q 4702, Australia
cSchool of Nursing & Midwifery, Faculty of Sciences, Engineering & Health, CQUniversity Australia, Po Box 1128, Noosaville DC 4566, Australia
dSchool of Nursing & Midwifery, Faculty of Sciences, Engineering & Health, CQUniversity Emerald, PO Box 197, Emerald QLD 4720, Australia
s u m m a r y a r t i c l ei n f o
Accepted 9 December 2011
Introduction: There is an abundance of literature regarding factors that influence student learning within the
clinical environment. Within this discourse, there is a paucity of research on the impact of supervision
models on the learning support needs of students. This paper presents the results of research that focused
on nursing students' perceptions about the effectiveness of the support they received during their work
integrated learning (WIL) experience.
Background: The majority of students placed within health care facilities are in groups. The group model in-
corporates a facilitator who supervises the students who are placed across a number of wards. At the ward
level students are then assigned a Registered Nurse (RN) who is their mentor. This occurs on a shift by
shift basis. Another model of clinical supervision involves preceptorship. This approach is via a one-on-one
supervision of students. Within the preceptorship model, students are supervised by a RN who is responsible
for supporting them during their WIL experience and for completing their assessment.
Methods: This study compared two models of clinical supervision to better understand the learning support
needs as perceived by undergraduate nursing students during their WIL experience. Survey method using a
self reporting online questionnaire developed by the researchers was used to collect data.
Results: 159 undergraduate nursing students enrolled in a Bachelor level programme of study completed the
on-line survey. When comparing the two models of supervision, students supervised within the facilitator
model were statistically more likely to be challenged to reflect, think, build on existing skills and knowledge
and to problem-solve issues. Notably, all factors integral to RN education. Overall, students considered the
quality of support to be the most important facet of supervision.
Conclusions: The findings of this study demonstrate that the facilitator model is the better approach for the
development of critical thinking, but both models enable the development of a student's professional identity
and the development of their role within nursing. This highlights the significance of clinical experiences
during undergraduate nursing education.
© 2012 Elsevier Ltd. All rights reserved.
In Australia, undergraduate nursing education for registered
nurses (RN) consists of three years of full time study in an accredited
degree programme. The structure of most undergraduate nursing
programmes in Australia enables students to elect to study either
full or part time and to complete their degree within a six year period.
Such flexibility facilitates equity and enables those students who may
not be able to attend tertiary studies on a full time basis due to family
or work commitments the opportunity to participate in an educational
programme of study.
Off campus clinical learning or clinical practicum is an important
part of an undergraduate nursing programme in preparing students
for their role as registered nurses (Corkhill, 1998). Clinical learning,
also known as clinical clerkships internationally and more recently
in Australia as work integrated learning (WIL) (Keleher et al., 2007),
has formed an integral component of nursing programmes since
registered nurse education moved en masse to the higher education
sector in Australia in 1985. Prior to this, nurses were educated in an
apprenticeship style nurse training model that was hospital based.
Work integrated learning within nursing is the co-dependent
Nurse Education Today 33 (2013) 530–535
⁎ Corresponding author. Tel.: +61 7 49232176.
E-mail addresses: firstname.lastname@example.org (S. Walker), email@example.com (T. Dwyer),
firstname.lastname@example.org (L. Moxham), email@example.com (M. Broadbent),
firstname.lastname@example.org (T. Sander).
1Tel.: +61 7 4923 2180.
2Tel.: +61 7 49309894.
3Tel.: +61 7 54407018.
4Tel.: +61 7 49820424.
0260-6917/$ – see front matter © 2012 Elsevier Ltd. All rights reserved.
Contents lists available at SciVerse ScienceDirect
Nurse Education Today
journal homepage: www.elsevier.com/nedt
relationship between theory and practice and occurs within the off
campus clinical environment.
In 2008 Health Workforce Australia (HWA), an initiative of the
Council of Australian Governments (COAG) was established to ad-
dress the challenges of ensuring a skilled, flexible and innovative
health workforce that meets the current and future needs of the
Australian community. The HWA (2008) released a report detailing
their analysis and identified policy options aimed at increasing stu-
dent supervision capacity during their work integrated learning expe-
rience. The HWA report identified a number of models of clinical
supervision in nursing including; the preceptor model, facilitation/
supervision model, combined facilitation-preceptorship model and
the Dedicated Education Unit model. The HWA report defined the fa-
cilitation supervision (Facilitator) model (FM) as one where a regis-
tered nurse who is paid for by the education provider, supervises a
group of six to eight students. Alternatively, the preceptorship
model (PM) was described as where a student was assigned to a RN
who was employed by the placement organisation (e.g. the hospital).
Yet another model, the mentor model (MM), is similar to the precep-
tor model, but involves a longer term relationship between the stu-
dent and the supervisor. HWA also described a combined facilitation
preceptorship model which involves students being ‘buddied’ with a
registered nurse on a day to day basis and a facilitator who is respon-
sible for the overall supervision or management of a group of
students. Finally, the Dedicated Education Unit model is an example
of the combined facilitation preceptorship model.
Given that the aim of the HWA through the Clinical Support
Program (CSP) was to expand clinical supervision capacity and com-
petence across each health professional area, research regarding the
support needs of nursing students is paramount. Given that nursing
education is changing and is now accompanied by an ever increasing
use of technology in both on-campus and off-campus learning envi-
ronments, an understanding of the learning support needs of stu-
dents during their work integrated learning experience, is becoming
increasingly important. Although much has been written about the
learning needs of undergraduate nursing students, little is known
about the best way to support their learning needs during the work
integrated learning experience from their perspective. This is particu-
larly important given that clinical placements can often be a vast dis-
tance from the home institution. Therefore, the purpose of this
research study was to undertake a comparative analysis of two clini-
cal supervision models, the facilitator model (FM) and the preceptor
model (PM) to better understand the learning support needs of un-
dergraduate nursing students during their work integrated learning
A review of the more recent literature published from 2003 to
2011 was undertaken through a search of number of databases in-
cluding ScienceDirect, CINAHL, Health Source: Nursing/Academic
Edition and Academic Search Complete. In addition, the websites of
professional bodies related to nursing were searched to locate rele-
vant reports. The literature analysed related to the support needs of
undergraduate students during their work integrated learning expe-
riences and the support provided by the various clinical supervision
A number of studies highlighted the need for students to feel a
sense of belonging to the area where they are undertaking their
work integrated learning experience. Vallant and Neville (2006) un-
dertook an interpretative study using focus groups to interview elev-
en student nurses at the end of the third year of their programme.
Although these researchers used a small sample the outcome of
their research added to current knowledge as they found that al-
though students valued clinician engagement in their learning, they
felt marginalised, disempowered and invisible within the area
where they are undertaking their work integrated learning experi-
ence. Participatory action research undertaken by Russell et al.
(2011) across two surgical wards in a large Australian hospital
found that students within the Team Leader Model of clinical supervi-
sion felt an increased sense of belonging to the ward as opposed to
the other models of supervision that they had previously experi-
enced. The Team Leader Model approach incorporates a team leader,
usually a senior RN, who coordinates a team of staff including a RN,
graduate nurse and a student nurse to support the learning of student
nurses. The impetus for the introduction of this model was the in-
creasing demands on a diminishing number of preceptors leading to
poor student experiences (Russell et al., 2011). Within the Team
Leader model students are rostered and allocated client loads like
other ward staff thus promoting the students' sense of belonging.
Bourgeois et al.'s (2011) research provided a descriptive account of
the introduction of a group supervision model that involved the
placement of eight students on the same ward and shifts, supervised
by an experienced RN from the ward who was an employee of the
university. Under this model the students reported an increase in
their sense of belonging which enhanced their learning in the clinical
setting as opposed to the other models of supervision that they had
previously experienced (Bourgeois et al., 2011).
Literature surrounding the support of students in the clinical envi-
ronment demonstrates that students do value clinician role model-
ling. Barber (2006) used a case study approach to detail how role
modelling by a skilled preceptor in respect to caring for a difficult cli-
ent changed a student's abilities and perceptions while the Team
Model of clinical supervision has been shown to provide students
will multiple role models and insights into the roles of nurses within
a team structure (Russell et al., 2011). These studies offer insight into
the value of clinical modelling and sense of belonging but did not ad-
dress which model of clinical supervision best supports undergradu-
ate nursing students during the work integrated learning experience
from the students perspective.
A number of researchers have attempted to identify which model
best supports undergraduate nursing students during the work inte-
grated learning experience (Bourgeois et al., 2011). One such study
was undertaken by Australian researchers Croxon and Maginnig
(2008) who surveyed twenty second year undergraduate nursing stu-
dents and asked them to compare their experiences in a previous
clinical placement involving preceptorship with their most recent
clinical placement involving group facilitation. The study was under-
taken in response to the trialling of the group facilitation model fol-
lowing reports that the preceptorship model was problematic. The
findings of the study indicated that the group facilitation model pro-
vided greater levels of support than the preceptorship model (Croxon
and Maginnig, 2008). In contrast, a Finnish study of 411 nursing stu-
dents across eight European schools of nursing identified that the stu-
dents in an individual supervision relationship reported significantly
higher levels of satisfaction than those in group supervision relation-
ships (Saarikoski et al., 2006). While adding value to what is known
about this important area in nursing education there was little con-
sensus amongst the research as to which model best supports under-
graduate nursing students during the work integrated learning
experience, highlighting a need for further research in the area.
Several studies suggest that structure and climate factors influ-
ence students' perceptions of support during their work integrated
learning experiences. Lindgren et al. (2005) investigated forty-three
Swedish nursing students' perceptions and satisfaction of a group fa-
cilitation model during their clinical placements. Group supervision
in this case entailed a monthly meeting with a non-clinical based su-
pervisor. The focus of the sessions was reflection on clinical situations
that the students had recently encountered. Outcomes of this study
revealed that both structure (continuity, confidentiality, responsibili-
ty, and environment) and climate factors (genuineness, acceptance,
empathy, critical reflection through support and challenge) are
S. Walker et al. / Nurse Education Today 33 (2013) 530–535
important to the success of this model. In yet another Scandinavian
study involving 104 Norwegian nursing students on final placement,
researchers found that a supportive yet challenging relationship
with clinical supervisors was identified as a positive factor influencing
students' perceptions of support during their work integrated learn-
ing experiences (Severinsson and Sand, 2010). Little research was
available on the impact of the concepts of structure and climate fac-
tors within the Australian context. One Australian study that did at-
tempt to address this was undertaken by Zilembo and Monterosso
(2008) where survey methods were used to investigate the leader-
ship qualities of preceptors. These researchers received only 23
completed surveys but despite working from a small sample, drew
conclusions which indicated that student's perceived effective leader-
ship from their preceptor was a positive supportive factor (Zilembo
and Monterosso, 2008).
There is ample evidence within the literature on the support
needs of nursing students in general, and several factors emerge
which influence student work integrated learning experiences
(Durak et al., 2008). These factors include the knowledge and skill
of the clinical educator (Kelly, 2007), acceptance by clinical agency
staff (Mannix et al., 2009), opportunities available to apply skills
learned in the off-campus setting to real world clinical experiences
(Henderson et al., 2009) and the presence of students from multiple
universities in the one clinical area. The latter created uncertainty
about the particular theoretical model to be used (Happell, 2009). Al-
though several researchers have attempted to address the issues sur-
rounding the supervision of students during their work integrated
learning experience, no research was able to report which model of
clinical supervision best supports undergraduate nursing students.
This research then, undertook to fill this gap in the knowledge by
comparing the learning support needs of a group of undergraduate
nursing students so as to determine which model of clinical supervi-
sion offers better support in their opinion.
The aim of this study was to compare the facilitator (or group su-
pervision) model (FM) and the preceptor (or individual supervision)
model (PM) of clinical supervision to understand the learning sup-
port needs of undergraduate nursing students during their work inte-
grated learning experience. The research question addressed by this
study was: ‘Which model of clinical supervision provided better sup-
port as perceived by undergraduate nursing students during their
work integrated learning experience?’
A purposive sample of undergraduate nursing students enrolled in
a Bachelor level programme of study, who were applying their theo-
retical knowledge to the work integrated learning setting as part of
their clinically oriented courses was invited to participate in the re-
search project. This included students studying in both full and
Students in the sample were being supported by a facilitator or a
preceptor. The model of supervision was dependent on the number
of students able to be placed in a particular health care facility. The
majority of students were placed within health care facilities that
catered to large number of students at any one time. As such, these
students were in a group or facilitated supervision model and were
placed across a number of wards within the health care facility. At
the ward level students were assigned to a RN on a shift by shift
basis. This RN, who may change every day, is sometimes referred to
as a mentor. Students placed in facilities that were only able to ac-
commodate small numbers at any one time, were supervised by the
individual or preceptored model. In this case individual students
were supervised by a RN acting as a formal preceptor. This RN was
responsible for supporting the student and for completing their
Recruitment of participants to the study was via the university in-
tranet website. The purposeful selection of participants ensured a
study cohort that was best able to assist the researchers understand
the problem and address the research questions (Creswell, 2009).
This cross sectional survey approach enabled the researchers to uti-
lise a systematic method for data collection which is a strategy
employed where participants use self-report to express their atti-
tudes, beliefs and feelings toward the topic of interest (Teddie and
Tashakkori, 2009). According to Teddie and Tashakkori (2009) using
a survey method is the most common and widely used technique
employed by researchers when exploring sociological questions, as
it provides a quantitative or numerical description of a sample of a
particular population through the questioning of people. The use of
survey method to collect data for this project enabled the researchers
to ensure that a structured data matrix was generated providing a de-
tailed data set for analysis based on the comparison of cases.
Prior to the commencement of the study approval to conduct the
research was received from the University Human Research Ethics
Committee (HREC). The project conformed to the principles outlined
in the Australian Code for Responsible Conduct of Research (National
Health and Medical Research Council, 2007). Students opting to par-
ticipate in the research study were provided with a link to the online
survey and accompanying information letter. Students were informed
of the aims of the study, the voluntary and anonymous nature of par-
ticipation and that their decision to be involved or not to be involved
in the study would not influence grades, clinical placement opportu-
nities or course outcomes. Participants were required to complete an
online anonymous survey at a time that was most convenient and
suitable to them. Completion and submission of the anonymous on-
line survey considered consent therefore no written consent forms
were required which further safeguarded participants' privacy.
The online survey was developed by the researchers after an ex-
tensive review of the literature and piloted amongst the research
group for consistency, reliability and validity. Following the pilot
test, the survey was refined in association with the information gen-
erated and with further reference to the literature. The finished sur-
vey consisted of three sections: demographics; mode of supervision
and supervision experience (22 closed-ended and three open-end re-
sponse items). Participants were asked to rate their current clinical
supervisory experience using a four point Likert scale ranging from
“strongly agree” (1) to “strongly disagree” (4). These were subse-
quently collapsed to dichotomous scales of “agree” and “disagree”.
Completed questionnaires were organised and analysed using Sta-
tistical Package for the Social Sciences (SPSS version 17). Descriptive
statistics including frequencies, means and standard deviations
were computed to obtain a profile of the participating student cohort.
Chi square analyses were performed to examine the differences in ex-
periences between students supervised by a Facilitator and a Precep-
tor. A p-value of b0.05 was considered statistically significant. Study
sample size was calculated using open Epi Version2 calculator
(Dean et al., 2010). Using a design effect of 1, a confidence limit of
+/− 5% of 100 and a population size of 416, a sample size of 165 is
required for a 90% confidence level.
A total of 159 undergraduate nursing students from a possible
sample of 416 completed the questionnaire comprising an overall re-
sponse rate of 38%. The majority of the participants (63%, n=100)
were enrolled by distance education mode and had no prior nursing
experience (48%, n=48).
S. Walker et al. / Nurse Education Today 33 (2013) 530–535
Just under half of all participants (internal and distance students)
had prior nursing experience, as either an endorsed enrolled nurse
(EEN) (20.8%, n=33) or as an assistant in nursing (AIN) (26.4%,
n=42). All undergraduate nursing students were sampled with rep-
resentation from all 3 years of study. Participants comprised of 35%
(n=56) first year, 38% (n=61) second year and the remaining 26%
(n=42) in their third year of study (Table 1). The ages of participants
ranged between 18 and 58 years (mean 35.3 years, SD 10.7).
The majority of the participants (76.1%, n=121) had a facilitator
with them during their placement, consistent with the ability to
gain more clinical placements in large health care facilities. Whilst
the students supervised by the facilitator were slightly younger
(35 years vs 36 years, t(157)=.753, p≥.05) there was no significant
differences in ages between the two groups or the year of enrolment.
In contrast, there was a difference between the groups in terms of
prior nursing experience and mode of enrolment. Half (54.5%,
n=66) of the participants with a facilitator were enrolled by distance
education compared to 89.5% (n=34) of those with a preceptor
Participants with a facilitator were slightly more likely (64.5%
(n=78) vs 58% (n=22); p>.05) to also have a mentor allocated to
them during the clinical placement. This mentor was usually allocat-
ed at the beginning of the shift from the RN pool working in the clin-
ical unit. Participants indicated that the mentor was allocated by the
Nurse Unit Manager (NUM), facilitator, listed on the roster or self se-
lected by the students (Table 2). On average participants in the facil-
itator group had three (SD 2.21) mentors during their placement
term compared to the preceptor group who had 2.2 (SD 1.37) men-
tors (t(102)=2.33, p=.022). Qualitative responses elicited that
availability of staff as dictated by the staff skill mix and staff working
on a part-time basis, was the determining factor that influenced the
number of mentors allocated to the students.
The responses to the attitudinal questions were collapsed from a
four point Likert-type scale into two ordinal categories of Agree and
Disagree. A series of Chi-Square analyses was conducted to compare
differences between the two independent groups for individual atti-
Generally, students supervised by a facilitator were more likely to
express positive attitudes about the type of support they received
from their clinical supervisor whilst on their off-campus clinical
placement (Table 3). Participants in were less positive if the facilitator
was perceived to be distant, aggressive or to mother them. Although
most of the responses were not statistically significant, participants
being supervised by a facilitator were significantly more likely to
agree that the clinical supervisor:
• Challenged them to think and problem-solve issues (94% (n=114)
vs 84% (n=32); p=.05)
• Encouraged them to reflect on my learning experiences (97.5%
(n=118) vs 86.8% (n=33); p=.009)
• Enabled them to build on existing skills and knowledge (91%
(n=110) vs 84.2% (n=32); p=.027)
In addition, participants agreed that the facilitator provided accu-
rate information about incidents that happened in the clinical setting
when compared to students in preceptored relationships (94%
(n=114) vs 84% (n=32); p=.05). The majority (91%, n=110) of
participants who were supervised in the facilitator model met with
their facilitator individually. However, when asked ‘how would you
prefer to meet with your supervisor’, more than half of the partici-
pants (59%, n=71) in the facilitator group preferred to meet in a
group as opposed to meeting individually (41%, n=50).
The research question for this study focused on which model of-
fers better clinical supervision to undergraduate nursing students
during their work integrated learning experience, as perceived by
the students. The results indicate that both the preceptor and the fa-
cilitator models of clinical supervision are viewed as important by
students studying their undergraduate nursing degree. Results indi-
cated though, the facilitator model was more likely to encourage stu-
dents to critically think through clinical problems with the assistance
of mentors. This outcome is in contrast to finding of other research
studies who found that the preceptor or one-on-one model of super-
vision promoted critical thinking and self confidence (Berry, 2005;
Students in the current study demonstrated a clear preference for
group facilitation. This finding supports the observations of previous
international research that identified that nursing students value
group supervision and thought it promoted both personal and profes-
sion development (Holmlundm et al., 2010). Australian researchers
Croxon and Maginnig's (2008) study of clinical teaching models also
found that students preferred cluster or facilitator models over the
preceptor models (Croxon and Maginnig, 2008). Reasons for student
preference for the facilitator model and group supervision in this
study indicate that constraints such as staff shortages and ‘busyness’
of the clinical environment correlated with the number of mentors.
Students felt that too many different mentors were difficult. Poten-
tially, the facilitator could better draw on the student interaction
with the multiple mentors to link theory and practice but preceptor
consistency has been identified as a critical element for ensuring op-
timal learning outcomes (Zilembo and Monterosso, 2008; Callaghan
et al., 2009). In contrast, Canadian researchers Sedgwick and Yonge
(2008) found that students felt supported by a preceptorship model
in developing skills and knowledge needed for rural practice. This
view was upheld by Australian researchers Henderson et al. (2009)
who found that by building capacity of staff to undertake the precep-
torship role student learning was enhanced. The important aspect of a
preceptorship model is though, a consist preceptor. Even though the
findings of this current study show that the Facilitator model chal-
lenged students to reflect, think, build on existing skills and knowl-
edge and to problem-solve issues more effectively than the
Prior nursing or health related experience.
Total % (n)Facilitator
Mentor support during the clinical placement.
Total % (n) Facilitator
RN/mentor each shiftYes
How is the mentor
S. Walker et al. / Nurse Education Today 33 (2013) 530–535
Preceptor model the difference was minimal. Students' qualitative re-
sponses indicate that it was the quality of support being offered that
was of most importance to them during their work integrated learn-
Limitations of the current study are a small response rate from sin-
gle study site. In addition the study may have an under powered sam-
ple, so results need to be interpreted with caution (Dean et al., 2010).
To verify results, a wider cross institutional sample is warranted and
researchers would welcome collaborative involvement from other
universities. Furthermore the survey tool was developed by the re-
searchers and although pilot tested, further work on refining the con-
cepts may have yielded different results. The use of 18 positive and 4
negative questions to collect the data was intentional in an attempt to
change the responders thought patterns, however this may have
influenced the results and a revised tool using only positive questions
or an equal number of positive and negative questions would be
recommended for further research in this area.
Despite some limitations, this research does have implications for
practice by identifying that both the facilitator or preceptor models
are considered effective in supporting undergraduate nursing stu-
dents during their work integrated learning experience. Therefore
recommendations from this study are:
1. Replication of the study in different clinical contexts to explore if
the facilitator model facilitates greater critical thinking and reflec-
tive practice of students.
2. With the current focus of clinical placements being a user pay
model, the use of the facilitator may be more cost effective than
the preceptor model.
This study undertook a survey of undergraduate nursing students'
perceptions of clinical supervision styles and found that there was little
differencein their perceptions of support received. Students supervised
as supported as those supervised within the context of a preceptor
model. Participants being supervised by a facilitator were significantly
more likely to believe that the clinical supervisor challenged them to
think and problem-solve issues, encouraged them to reflect on their
learning experiences and that this model of supervision better enabled
them to build on existing skills and knowledge.
Overwhelmingly though, students reported that it was the quality
of support they received that was most important to them. Quality of
supervisions was not linked to quantity of supervision. Such findings
are important for universities and indicate hours of supervision are
not perceived by students to be an important consideration. This re-
search demonstrated that either model was considered by students
to provide necessary support and that the clinical experience enabled
them to develop their sense of what it means to be a nurse. Universi-
ties need to consider their institutional circumstances when deciding
on the model of clinical supervision for their undergraduate nursing
clinical curriculum taking into consideration consistency of student
The research team would like to thank the research assistant
employed to assist with the study and the students who participated
in the project.
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