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EMOTIONAL INTELLIGENCE AND THE SOCIALIZATION OF NEW GRADUATE
NURSES DURING A PRECEPTORSHIP PROGRAM
by
Michelle Marie Rita Lalonde
A Thesis submitted in conformity with the requirements
for the degree of Doctor of Philosophy
Graduate Department of Nursing Science
University of Toronto
© Copyright by Michelle Marie Rita Lalonde (2013)
ii
ABSTRACT
Emotional Intelligence and the Socialization of New Graduate Nurses during a
Preceptorship Program
Michelle Marie Rita Lalonde,
Graduate Department of Nursing Science, Lawrence S. Bloomberg Faculty of Nursing,
University of Toronto
Doctor of Philosophy 2013
The literature on new graduate nurses is reflecting concern with turnover rates within
the first two years of practice ranging from 13% to 61.5% (Kovner et al., 2007; Lavoie-
Tremblay et al., 2008). The under preparation of and lack of support for new graduate nurses
during their early work experiences are often reported reasons for these high turnover rates.
Preceptorship programs, as a method of organizational socialization, have been implemented
to specifically address the challenges faced by new nurses. Research suggests that the social
elements of socialization, such as working closely with a more senior colleague, has a great
impact on new employee outcomes. Although the literature identifies that preceptors, who
are acting as socialization agents, are important to the process of new employee
socialization, little is known about this relationship, particularly the individual differences of
the preceptor. One such individual difference is emotional intelligence (EI). The literature
on EI suggests that it may play a role in the work environment and in predicting work-
related outcomes. Preceptors are aptly situated to have a direct impact on new nurses. Thus,
the focus of this study was to explore the impact of preceptors’ EI on new graduate nurses’
iii
socialization during a preceptorship program and was guided by Van Maanen and Schein’s
Theory of Organizational Socialization (1979).
A multi-site cross-sectional design was used to examine the proposed relationships
between a preceptor’s EI and new graduate nurses’ socialization outcomes. A sample of 51
dyads of new graduate nurses and their primary preceptor participated in this study. New
graduate nurses in this study experienced low role ambiguity, role conflict and turnover
intent and high job satisfaction. New nurses’ job satisfaction was associated with their role
conflict and ambiguity. The proposed hypotheses about the relationships between
preceptors’ EI and new nurses’ transition outcomes were not supported in this sample. The
results provide some insight into how these new graduate nurses are adjusting to their role at
the end of a preceptorship program. Additionally, the results provide a greater understanding
of three preceptor characteristics that have not yet been studied: EI, personality and
cognitive intelligence.
iv
ACKNOWLEDGEMENTS
The journey through my doctoral studies would not have been possible without the
support and encouragement from a number of individuals. First and foremost, I would like
to acknowledge and sincerely thank my doctoral supervisor, Dr. Linda McGillis Hall. Linda
inspired me to pursue doctoral studies, and it was through her mentorship, guidance, support
and encouragement, that this accomplishment was possible. Linda’s patience through
endless reviews of my thesis and generous opportunities for learning are so greatly
appreciated. I am grateful to have had the opportunity to learn from and be mentored by
such an international leader in nursing and research.
I would like to acknowledge my committee members, Dr. Diane Doran and Stéphane
Côté for their expert contribution to my thesis development over the years. I would like to
also acknowledge my external examiners, Dr. Dorothy Pringle and Dr. Florence Myrick, as
well as my internal examiner Dr. Margaret Blastorah, for their thoughtful review of my
dissertation and interesting questions.
I would like to thank the many nurses who were kind enough to spend some of their
precious time completing participating in my doctoral study; without them, this thesis would
not have been possible. As well, I would like to thank my hospital site primary investigators
for believing in this study and for all of their help along the way, from facilitating meetings
with staff, to assisting in the recruitment process. Thank you!
I would like to thank my fellow student colleagues at the Lawrence S. Bloomberg
Faculty of Nursing. Special thanks to Era Mae Ferron, Dr. Jessica Peterson, Dr. Sheri Price,
Dr. Barbara Wilson-Keats, Dr. Joan Almost and Dr. Lisa Seto. I am so grateful for the
friendships that I have made over the years, as well as your support and encouragement.
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I would also like to thank Maureen Barry, Dr. Francine Wynn, Dr. Jody MacDonald,
Dr. Kate Hardie and Dr. Sioban Nelson for their support and mentorship during my doctoral
work. I would especially like to thank my dear friend, Sarah Johnston. Thank you for the
many long nights (and endless days) listening to my rambling thoughts about my thesis!
Last but not least, I would like to thank my family; without them this thesis would
not have been possible. To my parents, Claude and Phyllis Lalonde, and my sister, Carole
Lalonde. Your endless support and encouragement provided me with the strength to
persevere. Mom and dad, you instilled in me a curiosity and desire for lifelong learning. I
share this accomplishment with you.
To my dearest husband Adam. Words cannot explain how thankful I am that you
were by my side during this journey, through the good times and hard times! Your
unwavering belief in my capabilities kept me going during the hard times. None of this
would have been possible without you. This journey was made even more special as we
welcomed our first child. Sebastien, thank you for always knowing when mommy needed a
kiss and a smile. I hope that this accomplishment will inspire you to aim high.
vi
TABLE OF CONTENTS
CHAPTER I: INTRODUCTION............................................................................................
1
CHAPTER II: LITERATURE REVIEW................................................................................
5
Search Strategy……………………………………………..…….………….........….….. 5
Literature Review………………………………………………..………………….........
5
Preceptorship……......…………………………………..…………......……………
7
Preceptorship Programs for New Graduate Nurses........................................... 11
Outcomes of Preceptorship Programs............................................................... 29
Limitations of the Preceptorship Literature.......................................................
40
Conclusions....................................................................................................... 46
Emotional Intelligence……………...………......……..…......…….……..…………
48
Limitations of the Emotional Intelligence in Nursing Literature...................... 54
Conclusion…….......……………………….......………………………………..……….. 56
CHAPTER III: CONCEPTUAL FRAMEWORK................……………………………….. 59
Van Maanen and Schein’s Theory of Organizational Socialization…….…………….....
59
Preceptor’s Emotional Intelligence..…………………………………..…………………
66
Hypotheses......................................................................................................................... 68
CHAPTER IV: METHODS....................................................................................................
73
Purpose and Design............................................................................................................ 73
Setting and Sample............................................................................................................. 73
Setting......................................................................................................................... 73
Sample........................................................................................................................ 76
Sample Size................................................................................................................ 76
vii
Procedure for Data Collection…..………….......…………....………….………………..
77
Initial Contact with Study Sites.................................................................................. 77
Participant Recruitment.............................................................................................. 78
Compensation......................…………….........…………………………………….. 80
Performance Feedback on Tests……………..……………………………………... 80
Informed Consent....................................................................................................... 81
Ethical Considerations……………………….……….......……...………….……… 82
Instrumentation…………………………..……………………………………………… 82
Preceptors’ Independent Variable and Measure.........................................................
83
Demographic Data.............................................................................................. 83
Emotional Intelligence........................................................................................ 83
Development of the Nursing EI Scale................................................................. 84
Preceptors’ Control Variables and Measures.............................................................
85
Cognitive Intelligence......................................................................................... 85
Personality...........................................................................................................
85
New Graduate Nurses’ Dependent Variables and Measures......................................
86
Demographic Data.............................................................................................. 86
Role Ambiguity................................................................................................... 86
Role Conflict....................................................................................................... 80
Job Satisfaction................................................................................................... 87
Intent to Turnover............................................................................................... 87
New Graduate Nurses’ Control Variables and Measures.........................................
88
First Job of Choice............................................................................................... 88
viii
Previous Experience on the Unit......................................................................... 88
Core Self- Evaluations......................................................................................... 88
Potential Risks and Benefits............................................................................................... 89
Data Collection................................................................................................................... 89
Data Analysis.....................................................................................................................
91
Pilot Study of the NEIS...................................................................................................... 94
Setting and Sample.................................................................................................... 94
Procedure for Data Collection……………………………………………………... 95
Compensation...................................................................................................... 95
Face Validity....................................................................................................... 96
Survey of Experts................................................................................................ 96
Psychometric Testing.......................................................................................... 97
Data Analysis............................................................................................................ 98
CHAPTER V: RESULTS........................................................................................................
100
Pilot Study.......................................................................................................................... 100
Missing Values.......................................................................................................... 100
Descriptive Information for Complete Pilot Sample................................................ 101
Face Validity Results…………………………………............................................
102
Survey of Experts: Scoring of the NEIS Results...................................................... 103
Survey of Nurses: Assessment of Psychometric Properties of the NEIS Results….
105
Qualitative Results..............................................................................................
106
Psychometric Assessment of CEIS and Personality Measurement Instruments. 107
Psychometric Assessment of the NEIS: Exploratory Factor Analysis………....
109
ix
Psychometric Assessment of the NEIS: Discriminant and Concurrent Validity
113
Preceptorship Study Results…………………...………………………………………… 114
Response Rate……………………………………………………………………... 114
Missing Values………………….…………………………………………………. 115
Demographic Characteristics of Study Respondents……………………………… 117
Assessment of Instrument Psychometric Properties………………………………. 119
Results……………………………………………………………………………... 121
Characteristics of Preceptorship Programs……………………………………. 123
New Graduate Nurse Outcomes……………………….………………………. 125
Preceptor Variables……………………………………………………………. 126
Comparability of Groups by Number of Preceptors…………………………... 127
Correlational Analysis…………………………………….…………………… 128
Hypothesis Testing…………………...……………….…...…………………... 132
CHAPTER VI: DISCUSSION………………………………………………………………
133
Discussion Related to Hypothesis Testing.....…………...…...……...…………………... 133
Discussion Related to Correlational Analysis…………...……...…………………...…... 134
Discussion Related to Sample Characteristics……..……………………………………. 138
Discussion Related to Preceptors………………………………………….…………….. 140
Discussion Related to New Graduate Nurses………………………...…...……………... 144
Implications for Research and Practice…………...…………………...………………… 150
Limitations of the Study.....................................................................................................
157
CHAPTER VII: CONCLUSION.……………………………………………………………
162
REFERENCES........................................................................................................................ 165
x
LIST OF TABLES
Table
1. Van Maanen & Schein’s Six Bipolar Organizational Socialization Tactics..................
62
2. Jones (1986) Reconceptualization of the Classification of Socialization Tactics.......... 63
3. Description of study sites................................................................................................
74
4. Cronbach’s Alpha for IPIP and Split-Half Reliability for CEIS……………………… 108
5. Descriptive Statistics for IPIP and CEIS……………………………………………… 109
6. Two Factor Model (Pattern Matrix)……………...…………………...…………..…... 112
7. Descriptive Statistics for the NEIS and CEIS…………………………………………. 114
8. Workplace Characteristics of the Sample……………………………………………...
117
9.
Cronbach’s Alpha (Pilot Study).……………………………………………………... 120
10. New Graduate Nurses’ Perceptions of their Current Work Setting……………………
122
11. Characteristics of the Preceptorship Programs in this Study…………………………..
124
12.
New Graduate Nurse Outcomes………………………………………………………. 126
13. Descriptive Statistics of Preceptor Measures…………………………………….…… 127
14. Reliabilities and Correlations for Preceptor and New Graduate Nurse Variables…….. 130
xi
LIST OF FIGURES
Figure
1. Conceptual model guiding this research study.........................................................
72
2. Data collection times.................................................................................................
90
xii
LIST OF APPENDICES
Appendix
A. Glossary of Terms………………………………………………....................................
186
B. Preceptorship Interventions/ Programs for New Graduate Nurses..................................
189
C. Preceptor Characteristics, Selection and Preparation.......................................................
199
D. New Graduate Nurse Outcomes Associated with Preceptorship Programs.....................
207
E.
Qualitative Studies/ Literature Reviews..........................................................................
212
F.
Power Analysis Table...................................................................................................... 216
G.
Power Analysis Calculations........................................................................................... 217
H.
Recruitment E-Mail from Site PI (New Graduate Nurse Preceptorship Study)……….. 218
I.
Preceptor Letter of Explanation (New Graduate Nurse Preceptorship Study)................
219
J. Preceptor Consent Form (New Graduate Nurse Preceptorship Study)............................
220
K. Survey of Preceptors (New Graduate Nurse Preceptorship Study).................................
224
K.1 Demographic Information..................................................................................... 224
K.2 NEIS...................................................................................................................... 225
K.3 International Personality Item Pool......................................................................
233
k.4 Cattell Culture Fair Intelligence Test……………………………………..…….. 235
L.
New Graduate Nurse Letter of Explanation (New Graduate Nurse Preceptorship
Study)…………………………………………………………………………………...
236
M.
New Graduate Nurse Consent Form (New Graduate Nurse Preceptorship Study).........
237
N. New Graduate Nurse Survey (New Graduate Nurse Preceptorship Study)…….............
241
N.1 Demographic Information………………………………………………………. 241
N.2 First Job of Choice & Previous Experience on Unit.............................................
242
N.3 Core Self-Evaluations........................................................................................... 243
xiii
N.4 Role Ambiguity and Role Conflict.......................................................................
244
N.5 Job Satisfaction.....................................................................................................
245
N.6 Turnover Intent.....................................................................................................
245
O.
Certificate of Participation............................................................................................... 247
P. Participant Contact Information Card: Raffle………………………………………….. 248
Q. Participant Contact Information Card: Feedback on Test Performance……………….. 249
R. Letter of Explanation for Face Validity and Expert Surveys (Pilot Study)..…………...
250
S. Consent Forms for Face Validity and Expert Surveys (Pilot Study).……..……….…...
251
T. Nursing Emotional Intelligence Scale: Face validity Survey (Pilot Study)...………..… 255
T.1
Demographic Information..................................................................................... 255
T.2 NEIS...................................................................................................................... 256
T.3 Participants’ Comments........................................................................................ 262
U. Nursing Emotional Intelligence Scale: Survey of Experts (Pilot Study).........................
264
U.1 Demographic Information..................................................................................... 264
U.2 NEIS...................................................................................................................... 265
V. Letter of Explanation to Nurses: Assessment of Psychometric Properties of the NEIS
(Pilot Study) …………………………………………………………………………...
272
W. Nurse Consent Form: Assessment of Psychometric Properties of the NEIS (Pilot
Study)…………………………………………………………………………………...
273
X. Survey of Nurses: Assessment of Psychometric Properties of the NEIS (Pilot Study)... 277
X.1 Demographic Information..................................................................................... 277
X.2 Consumer Emotional Intelligence Scale............................................................... 278
X.3 International Personality Item Pool...................................................................... 284
X.4 NEIS...................................................................................................................... 286
xiv
Y. Demographic and Employment Characteristics for Complete Pilot Sample………... 293
Z. Demographic and Employment Characteristics for Face Validity Sample……...….. 296
AA. AA.1 Changes to the NEIS Instructions………………………………………….. 298
AA.2 Change to the NEIS Question Number 20…………………………………. 299
BB. Demographic and Employment Characteristics for Nurse Experts…………………. 300
CC. Comparison of Demographic and Employment Characteristics for Nurse Experts
and Psychometric Assessment Sample………………………………………………
302
DD. Experts’ responses to 15 NEIS Items………………………………………………... 303
EE. Demographic and Employment Characteristics for Psychometric Sample…………. 307
FF. Final Changes to the NEIS instructions……………………………………………... 309
GG. Final Changes to the NEIS Photos…………………………………………………... 310
HH. Exploratory Factor Analysis………………………………………………………… 311
II. Reliabilities and Correlations for Pilot Study Measures……………………………..
314
JJ. Demographic and Employment Characteristics for the Preceptor Sample………….. 315
KK. Demographic and Employment Characteristics for the New Graduate Nurse
Sample………………………………………………………………………………..
317
1
CHAPTER I
INTRODUCTION
Organizational socialization is the process through which new employees learn about
and adjust to new jobs, roles, the culture of their working environment, and become part of
the workplaces’ patterns of activities (Ashforth, Sluss & Harrison, 2007; Ashforth, Sluss, &
Saks, 2007; Klein & Weaver, 2000). Organizational socialization has been linked to several
outcomes, such as role conflict and ambiguity (Ashforth & Saks, 1996; Jones, 1986),
intentions to quit (Ashforth & Saks; Jones; Saks & Ashforth, 1997b), and job satisfaction
(Ashforth & Saks; Jones; Saks & Ashforth, 1997b). Successful socialization transforms the
employee into a contributing member of the organization, thus replenishing the organization
as a system (Ashforth, Sluss & Harrison). An organization’s survival depends, to a degree,
on its ability to concurrently integrate new employees while encouraging organizational
change (Ashforth, Sluss & Harrison).
Nurses, as the largest group of health care providers in Canada, are central in the
provision of patient care (Health Canada, 2007). The alarming nursing shortage and aging
nursing workforce has led to an increased recognition by researchers, policy makers, and
practitioners that efforts need to be directed toward the new generations of nurses to ensure
that they remain within the profession (Almada, Carafoli, Flattery, French, & McNamara,
2004; Baggot, Hensinger, Parry, Valdes, & Zain, 2005; Beecroft, Kunzman, & Krozek,
2001; Health Canada; O’Malley Floyd, Kretschmann, & Young, 2005). For example, the
Ontario Ministry of Health and Long-Term Care launched an initiative in the mid-2000’s to
promote the full-time employment of new graduate nurses, improve their integration into the
workplace, and promote recruitment and retention of Ontario new graduate nurses
2
(Baumann, Hunsberger, Idriss, Alameddine, & Grinspun, 2008). This program allowed new
graduate nurses and Ontario hospitals to be matched through an on-line portal and provided
funding to hospitals for temporary full-time above staff complement positions for new
graduate nurses for a 26 week period (Baumann et al.). The literature on new graduate
nurses is concerning with reported high turnover rates within the first two years of practice,
ranging from 13% to 61.5% (Baltimore, 2004; Beauregard, Davis, & Kutash, 2007; Kovner
et al., 2007; Lavoix-Tremblay, O’ Brien- Pallas, Gélinas, Desforges, & Marchionni, 2008;
Scott, Engelke, & Swanson, 2008). In the United States, Kovner and Djukic (2009) analyzed
national nursing datasets and reported a 26.2% turnover rate for new nurses within their first
two years of practice. A study of 41 hospitals conducted in 2005 and 2006 reported that the
mean turnover rate of Canadian nurses was 19.9% (O’Brien- Pallas, Tomblin Murphy, &
Shamian, 2008). In Canada and the United States, the under-preparation and lack of support
for new graduate nurses during their early work experiences are often reported reasons for
these high turnover rates (Beauregard et al.; Godinez, Schweiger, Gruver, & Ryan, 1999;
Loiseau, Kitchen, & Edgar, 2003). The transition from student to nurse is difficult, with new
nurses reporting feelings of insecurity, uncertainty and being overwhelmed (Casey, Fink,
Krugman, & Propst, 2004; Feng & Tsai, 2012). As the survival of the health care industry
rests partly in its ability to recruit and retain new nurses, organizational systems and
processes need to be in place to ensure that these new nurses remain in the work force. The
process of preceptorship may be particularly important to new nurses’ socialization and
integration into an organization, as well as to the profession.
Preceptorship programs have been implemented to specifically address the
challenges faced by new nurses. Formal training programs, such as preceptorship programs,
3
have become synonymous with organizational socialization (Saks & Ashforth, 1997a). The
preceptorship and socialization literature highlights a lack of understanding of the role that
individual differences play in affecting new employee socialization. Researchers have
demonstrated that the social elements of socialization programs, such as working with more
experienced coworkers, have the greatest impact on new employees’ outcomes (Allen &
Meyer, 1990; Anakwe & Greenhaus, 1999; Jones; Kowtha; Saks et al., 2007). Thus,
although researchers agree that preceptors, as socialization agents, are important to the
socialization of new employees, this relationship has not been fully examined empirically.
As preceptors are one of the means though which the organization socializes its new
employees, it is important to consider the individual differences of the socializing agents in
order to gain a better understanding of what distinguishes a poor preceptor from an excellent
one. One such individual difference is emotional intelligence (EI), which is the ability to
monitor one’s own and others’ emotions, to differentiate between them, and to use the
information to direct one’s thinking and actions (Salovey & Mayer, 1990). The business,
management, psychology, education and nursing literature suggests that emotional
intelligence may play a role in the work environment, predicting work-related outcomes,
such as job satisfaction, improved interpersonal relationships, and teachers’ and leaders’
effectiveness (Bar-On, Handley, & Fund, 2006; Boyatzis, 2006; Chan, 2004; Côté &
Miners, 2006; Lopes, Salovey, & Straus, 2003; Ramo, Saris, & Boyatzis, 2009; Sy, Tram, &
O’Hara, 2006). Preceptors, as the main socializing agents, are likely to have a direct impact
on new nurses. Knowledge of the role that emotional intelligence plays in nursing practice is
limited. More specifically, there is no published research linking preceptors’ emotional
4
intelligence and new graduate nurses’ socialization outcomes during a preceptorship
program.
Purpose of the Study
The purpose of this study is to examine the relationships between preceptors’
emotional intelligence and new graduate nurses’ socialization outcomes during a
preceptorship program.
5
CHAPTER II
LITERATURE REVIEW
Search Strategy
This literature review was conducted through searches on the Cumulative Index to
Nursing and Allied Health Literature (CINAHL), Scholars Portal Search, Medline, PubMed,
PsychInfo, ERIC (education), and Proquest. The following keywords were used:
‘preceptorship’, ‘preceptor’, ‘preceptee’, ‘orientation’, ‘internship’, ‘mentor’, ‘mentee’,
‘mentorship’, ‘novice’, ‘new graduate nurses’, ‘socialization’, ‘organizational socialization’,
and ‘emotional intelligence’. Each publication was reviewed for relevance. Next, the
references of the identified publications and books were obtained and reviewed for
pertinence. These searches yielded 185 documents. Additionally, a review of the relevant
grey literature was conducted by a search on Google with the above-mentioned key words.
To be included in this review, grey resources were required to meet the University of
Toronto’s guidelines for evaluating internet resources; authority, affiliation, audience level,
currency, and content reliability/accuracy (University of Toronto Mississauga Library,
2007). Therefore, grey resources must come from a trusted provider, be kept up to date by
the provider, be at a graduate or research level, and content must be deemed reliable and
accurate (University of Toronto Mississauga Library). This search yielded an additional 7
documents available on-line, for a total of 192 documents included in this literature review.
First, a high level examination of the articles located took place to identify common
themes; four themes emerged. Next, each article was read in depth and notes were taken on
their content in the form of tables. The tables presented in the appendices were then
6
developed and refined. The articles were then reread to ensure the appropriate four themes
were identified and that the summary presented in the tables was accurate.
This chapter reviews the history of preceptorship and the current state of knowledge
on preceptorship programs for new graduate nurses. The literature is reviewed in relation to
the four common components of preceptorship programs that emerged from this review (1)
program duration, (2) clinical practice, (3) didactic sessions, and (4) preceptors. As this
thesis will focus on the role of a preceptor’s emotional intelligence in the socialization of
new nurses during a preceptorship program, the literature on preceptors and preceptorships
in nursing is reviewed. Although the focus of this thesis is not with undergraduate nursing
students, 12 articles that examined preceptorship with nursing students were included
because the findings were pertinent to this thesis. Additionally, this section will include an
examination of the literature from the education and business management fields that
hasexplored emotional intelligence in roles with similar elements to preceptors. The
evidence on new graduate nurse and organizational outcomes associated with preceptorship
programs is critically reviewed.
Also, included in the section on new graduate nurse outcomes is the emotional nature
of the of the adjustment process that occurs during a preceptorship program and throughout
the new nurses early work experiences, as well as an overview of the common outcomes of
organizational socialization. The limitations and gaps in the preceptorship literature are then
discussed. Following this, the literature on emotional intelligence with a specific focus in
nursing is presented. This review will provide the foundation for the theoretical framework
chapter that will demonstrate how preceptors’ emotional intelligence influences the
socialization process of new nurses into organizational settings. Conclusions are
7
summarized following the review of the literature. Appendix A provides a glossary of
common terms discussed in this thesis. There are four appendices associated with this
literature review. Appendix B provides a summary of the review of 34 studies that examined
the implementation and evaluation of various preceptorship programs; Appendix C reviews
25 studies that examined preceptor characteristics, selection and preparation; Appendix D
reviews 11studies that examined new graduate nurse outcomes associated with
preceptorship programs; and Appendix E discussed 11 literature reviews/ qualitative studies.
Preceptorship
Preceptorship is not specific to nursing and is used in a variety of disciplines, for
example medicine (Harbottle, 2006; Steinwald & Steinwald, 1975), pharmacy (Dalton et al.,
2007), veterinary sciences (Barker, 1993), dentistry (Retzlaff, 1995), and other allied health
professionals, including physiotherapists, occupational therapists, dieticians, and
audiologists (Shewan, 2008). Similar concepts of fellowship, clerkship, apprenticeship, and
field education, are used to describe the practical or workplace education of students and
new professionals in social work (Raschick, Maypole, & Day, 1998) and law (Billay &
Yonge, 2004). In the United States, the preceptorship method of teaching medical students
and new physicians has been occurring since colonial times and was based on the
apprenticeship system in Scotland and England (Steinwald & Steinwald).
Terms such as orientation or formal training are used in the business and
management literature (Billay & Yonge, 2004). Formal training programs, including
preceptorship programs, have become the predominant organizational socialization method
for many new employees (Saks & Ashforth, 1997a). Preceptorship programs are the process,
or the medium, through which organizations can provide new graduate nurses with the
8
social knowledge and skills they need to take on their roles as nurses. For example, a new
nurse who has completed her preceptorship program has a clear understanding of the
philosophy of patient care espoused by the organization and incorporates this philosophy
into daily patient care practices. This nurse has learned the goals and values of the
organization and has adopted the behaviours that the organization expects into his/ her work
role.
Preceptorship is the experience between a preceptor or more experienced employee,
and a student or an employee new to the organization (Altman, 2006). A preceptorship
program is a formal teaching and learning method for new employees whereby an
experienced nurse and a new nurse work together for a specified duration of time to assist
the new nurse in effectively adjusting to and performing a new role, being socialized into
practice and the organization, while bridging the gap between theory and practice (Canadian
Nurses Association [CNA], 1995; Stokes, 1998; Yonge, Billay, Myrick, & Luhanga, 2007).
One of the underlying assumptions of a preceptorship program is that a consistent
relationship with one preceptor will assist with the socialization of the new nurse into the
practice setting, as well as with bridging the theory and practice gap (Stokes). Upon entry
into the organization, new graduate nurses are assigned a preceptor. The preceptor and the
new graduate nurse then work together as a dyad to provide patient care for the duration of
the preceptorship program. For example, a new graduate nurse in an acute care setting may
work rotations of twelve-hour day and night shifts, following their preceptor’s full-time
work schedule. Preceptorship typically involves the new graduate nurse gaining a basic level
of knowledge, skills, and personal attributes, while being socialized to the profession and to
9
the employing organization (CNA, 2004). Preceptorship-type programs have been
documented in the nursing literature as early as the 1960s (Beaulieu O’Friel, 1993).
In the 1960’s and 1970’s in the United States, Kramer (1974) examined the
phenomenon of new nurses’ leaving the profession. Kramer described the concept of “reality
shock” that new nurses face upon entry into the practice setting, experiencing conflicting
values between those learned in their educational setting and those found in the practice
setting. Kramer conceptualized “role deprivation” as the subjective degree of conflict
between the professional role expectations and behaviours and the organizational role
expectations, as the underlying cause of reality shock. To address these issues, Kramer
designed an “anticipatory socialization program” to expose nursing students to the
professional realities of clinical practice. This program exposed students to the clinical
practice of nursing under the supervision of practising nurses and was specifically designed
to “sociologically immunize” nursing students to the values encountered in the work setting.
Thus, mild reality shock was introduced to the nursing students while they were in school.
Kramer anticipated that nursing students participating in the program would experience
higher levels of role deprivation during their education. During this time, these students
would be provided with the support necessary to work through these challenges. As such, it
was expected that these students would have reduced levels of role deprivation during their
early work experiences (Kramer). Additionally, it was anticipated that students participating
in this program would remain employed in the same setting two years after graduation,
compared with those who did not participate in the program.
Kramer’s (1974) program was delivered to two groups of baccalaureate students over
the course of three years during their university education, and included formal classes,
10
seminars and teaching-learning activities. The control group consisted of nursing students
(N=45) who entered the School of Nursing in 1965 and graduated in 1968. Two
experimental groups were included in this study; the first group consisted of nursing
students (N=57) who entered the school in 1966 and graduated in 1969, and the second
group consisted of students (N=59) who entered the school in 1967 and graduated in 1970
(Kramer). Both the control and experimental groups were pre-tested, tested just prior to
graduation and tested one and two years after graduating (Kramer). As expected, the
experimental groups had higher levels of role deprivation while in university, lower levels of
role deprivation during their early work experiences, and remained employed in their first
employment setting for a greater length of time than those in the control group (Kramer,
1974). Kramer’s seminal work provided the nursing profession with a greater understanding
of the concept of reality shock and the importance of well designed preceptorship programs
for the socialization of both nursing students and new graduate nurses alike.
Kramer (1974) uses “sociologically immunize” (p. 68) to describe the process of
introducing the values of the work world during the education of nursing students to reduce
the reality shock expected during the first working experiences of newly graduated nurses. A
similar concept, vaccination or dose, has been discussed in the context of realistic job
preview (RJP) in the management literature (Phillips, 1998; Popovich & Wanous, 1982).
Realistic job preview occurs when the organization presents the applicant with unbiased
information of both the positive and negative sides of working within the organization
(Phillips). The intention is to provide potential employees with a dose or vaccination of
accurate information about the new job and the organization, thus lowering their high
expectations to more realistic ones, in hopes of reducing entry shock and employee turnover
11
(Meglino, DeNisi, Williams, & Youngblood, 1988; Phillips; Popovich & Wanous).
Kramer’s work is similar to RJPs in that her program provided nursing students with
realistic expectations of the work environment. One dissimilarity between the two methods
is that Kramer provided this during nursing students’ educational preparation, instead of it
being provided by organizations during the pre-entry or post entry phases, as does RJPs.
Preceptorship Programs for New Graduate Nurses
Preceptorship programs offered to new graduate nurses vary based on, and are
typically tailored to, the type of clinical unit, such as the emergency department (Gurney &
Mass, 2002; Loiseau et al., 2003), neurosurgery (Dilorio, Price, & Becker, 2001), critical
care (Bérubé et al., 2012; Chesnutt & Everhart, 2007; Herdrich & Lindsay, 2006; McKane,
2004; Messmer, Jones, & Taylor, 2004; Phelan, 1999), paediatrics (Beecroft et al., 2001;
Halfer, 2007), medicine (Marcum & West, 2004), and cardiology (Fey & Miltner, 2000).
Although the types of programs themselves vary in implementation strategies and content,
they all have four components in common: (1) a specified duration, (2) a clinical practice
component, (3) didactic sessions, and (4) preceptor (s). Appendix B reviews 34 studies that
examined the implementation and evaluation of preceptorship programs for new graduate
nurses in various clinical settings.
Duration of Preceptorship Programs
One component of preceptorship is the length or duration of the program. Van
Maanen (1976) emphasizes that the training needs of certain professionals, such as pilots,
lawyers and physicians, typically require long periods of socialization since the work is
complex, challenging, and can result in severe consequences when errors are made.
12
The time frame for which nursing preceptorship programs are delivered varied
greatly, from 8 weeks to one year, with the average length reported as four to six months.
Salt, Cummings, and Profetto-McGrath (2008) conducted a systematic review of 16 studies
on organizational retention strategies aimed at new graduate nurses. The results revealed that
the average length of a preceptorship program is between three to six months (Salt et al.). A
study of 40 new graduate nurses explored the impact of an 11-week preceptorship program
that included one week of didactic sessions, two weeks of visiting clinical specialty units,
and new graduates working one-on-one with a preceptor, on new graduate nurses’ program
satisfaction, reasons for leaving the organization, and organizational turnover and vacancy
rates (Almada et al., 2004). The standard time frame for a preceptorship program at this
facility prior to the study was eight weeks. Participants felt that one of the most important
aspects that contributed to their overall ‘high’ satisfaction with the program was its duration.
Additionally, the authors attributed the increased retention rate of new graduate nurses, from
25% pre-program to 93% one year after program implementation, to participants’
satisfaction with the extended length of the preceptorship (Almada et al.).
Similarly, a longitudinal exploration of new graduate nurses’ (N=1598)
preceptorship expectations revealed that 51% of respondents wanted a preceptorship
program that lasted six months and 25% wanted one that lasted four to five months
(Hardyman & Hickey, 2001). Participants (N=16) in a qualitative study exploring nurses’
experiences of their role transition during their first year of practice suggested that the length
of a preceptorship program was an important element in easing role transition (Thomka,
2001). The participants discussed the preceptorship duration that would be ideal in easing
role transition, with most participants proposing time frames that were longer than what they
13
had as new graduate nurses (Thomka). Scott et al. (2008) conducted a secondary data
analysis on new nurses (N= 329) in North Carolina and reported that the duration of
orientation was significantly related to new graduates’ turnover. The mean duration reported
was 8.6 weeks and new nurses that quit their first job had an average of 2 weeks less
orientation when compared to those that did not turnover.
Although the literature reviewed suggests that the average length of preceptorship
programs is about three months, there are inconsistencies in the reported duration of such
programs with the longest being one year (Bérubé, et al., 2012). While the literature
proposes that the length of a preceptorship is important to new nurses’ transition and that
new nurses would prefer longer programs, the most beneficial length of time remains
unclear, as well as its relationship with transition and socialization outcomes.
Clinical Practice
The second component of preceptorship programs apparent in the literature relates to
clinical practice. The most common area of clinical practice during a preceptorship program
for new graduate nurses is the primary unit of hire. Nurses employed on a hospital’s float
team do not have a specific unit as a home base as they are sent daily to various patient care
units to fill staffing needs. New graduate nurses hired on a hospital’s float team participate
in a preceptorship program that consists of several shorter preceptorships on each unit that
they will be expected to work on (Almada et al., 2004; Crimlisk, McNulty & Francione,
2002). For example, an inner-city hospital in Boston traditionally did not hire new graduate
nurses into their float team. To meet increasing staffing and patient care needs, the
organization conducted a study to examine if the use of a preceptorship program to prepare
new graduate nurses to work on a float team could be successful (Crimlisk et al.). The
14
preceptorship program, which included 32 hours of didactic sessions, and 18 weeks of
clinical practice in medical, surgical, and specialty units, was developed and implemented
with a sample of new graduate nurses (N=39). Upon completion of the program, 100% of
the participants felt that they were able to provide safe competent care and that the program
was successful. Four to five months after completion of the preceptorship program, 82% of
the participants remained employed within the facility and 69% remained employed in the
float team.
The review suggests that the clinical practice components of preceptorship programs
vary based on and are tailored to the area of practice and the patient population. The most
common clinical practice area included was on the unit of hire. Although clinical practice
was an emerging theme as an important element of preceptorship programs, no explicit
recommendations were found in terms of the types of clinical practice experiences that
should be included in preceptorship programs. Institutions have been creative in how best to
meet the needs of the new nurses and particular patient population, such as providing new
nurses with experiences on other units to improve their understanding of the different
patients they may be caring for, to enrich their learning and expose these new nurses to
different patient populations (Almada et al., 2004; Beecroft et al., 2001; Crimlisk et al.,
2002; Marcum & West, 2004; Orsini, 2005; Schmidt, Giovanelli, & Palazollo, 2003;
Woodworth, 2012). However, these studies did not empirically relate the clinical practice
component to new nurse transition outcomes.
Didactic Sessions
Didactic sessions are important components of a preceptorship program, as they
provide new graduate nurses with up to date knowledge specific to their specialty area. The
15
duration of the didactic sessions varied widely from 36.25 to 224.5 hours or 5 to 31 days
(Beecroft et al., 2001; Bérubé, et al., 2013; Blanzola, Linderman, & King, 2004; Crimlisk et
al., 2002; Dilorio et al., 2001; Gurney & Mass, 2002; Loiseau et al., 2003; McKane, 2004;
Newhouse, Hoffman, Suflita, & Hairston, 2007; O’Malley Floyd et al., 2005; Owens et al.,
2001; Woodworth, 2012). The didactic sessions also varied in content, depending on the
nurses’ area of work. The nursing knowledge, skills, policies and procedures covered during
didactic sessions are tailored to the type of unit of hire. For example, some of the specialized
knowledge and skills required to work on a general medicine unit will be different than
those required for surgery or critical care units. Of the 34 studies reviewed in Appendix B,
two studies included didactic sessions along with practice in a skills laboratory to provide
new nurses with hands on learning. For example, Beecroft et al. (2001) included 224.5 hours
of classroom and skill laboratory time, specifically focusing on the knowledge and skills
required to practice on a paediatric unit.
Although the majority of the preceptorship studies reviewed included didactic
content, there were wide variations in the number of hours and content covered. No studies
examined the relationships between the content and number of didactic hours and new
graduate nurse and organisational outcomes, as well as at what point during the
preceptorship program they should be delivered and the optimal delivery format.
Preceptors
A preceptor is an experienced nurse who acts as a teacher in the clinical setting to
either student nurses or new nurses (Altman, 2006; Speers, Strzyzewski, & Ziolkowski,
2004). Preceptors provide on-site supervision, often in a one-to-one relationship with the
new nurse (Ohrling & Hallberg, 2001). Common facets of the preceptor role include role
16
modeling, socialization and educating (Baltimore, 2004; CNA, 2004; Henderson, Fox, &
Malko- Nyhan, 2006). To assist the development of beginner competencies in the new
graduate nurse, a preceptor should have novice-level competencies themselves (CNA,
2004). Also, the type of work setting will further delineate which additional competencies a
preceptor will require (CNA, 2004). For example, a preceptor working in the emergency
department will require the skills associated with performing and interpreting
electrocardiograms, whereas a preceptor in the labour and delivery unit must be able to
assess and respond to the stages of labour. Appendix C reviews 25 articles that examined or
theoretically described preceptor characteristics, selection, and preparation.
The Canadian Nurses’ Association (2004) has developed five categories of preceptor
competencies representing the knowledge, skills, judgement, and personal attributes needed
for preceptors to practice safely in their role: (1) collaboration, (2) personal attributes, (3)
facilitation of learning, (4) professional practice, and (5) knowledge of the setting.
Preceptor preparation. Preceptor preparation is vital to the success of any
preceptorship program (Baltimore, 2004). Adequately preparing preceptors for their role
ensures that they have the knowledge and skills necessary to assist new nurses in their role
transition from student to safe and competent clinical nurse (Baltimore). The preceptor
preparation program should be based on adult learning principles and the content should
cover how preceptors can assist new graduate nurses’ socialization, skill building, facilitate
their critical thinking, management of a patient assignment, and how to provide support
during this transition (Baltimore; CNA, 2004; Hartline, 1993; Henderson et al., 2006; Speers
et al., 2004). For example, Henderson et al. conducted a longitudinal descriptive study to
evaluate preceptors’ perceptions (N=36) of a two-day educational workshop on being a
17
preceptor and the organizational support offered to prepare them for their roles as
preceptors. The participants reported that they were satisfied with the preparation that was
offered to them by the organization prior to undertaking their role. Participants perceived a
lack of organizational recognition of their role and a lack of organizational structures set in
place for them to perform their role as a preceptor, such as having allocated time away from
direct patient care. Other studies have reported similar findings (Cooper Brathwaite &
Lemonde, 2011; Dibert & Goldenberg, 1995; Pulsford, Boit, & Owen, 2002; Sandau et al.,
2011; Usher, Nolan, Reser, Owens, & Tollefson, 1999; Yonge, Krahn, Trojan, Reid, &
Haase, 2002). By contrast, Speers et al. reported descriptive results from the implementation
of a new preceptor preparation and rewards program for nurses employed on a surgical unit.
The authors report anecdotally that preceptors had greater job satisfaction and a greater
sense that they were prepared to fulfill this role after the implementation of this program.
Several innovative preceptor development strategies that have been reported to be effective
have been described in the literature, such as through online learning (Larsen & Zahner,
2011; Parsons, 2007; Myrick, Caplan, Smitten, & Rusk, 2011) and simulation (Adoryan,
2011; Foy, Arnold, & Chesak, 2011; Picconi, 2011). Two studies that examined the
effectiveness of online preceptor training modules reported an increase in preceptors’ self-
efficacy and knowledge post intervention (Larsen & Zahner; Parsons).
The literature suggests that preceptor development programs are valued and may
impact preceptor outcomes, such as job and role satisfaction and confidence in their abilities
as a preceptor. The main goals of preceptor development programs are to provide preceptors
with the knowledge and skills required to be effective in their role, and to ultimately have a
positive impact on the preceptees. Although preceptor training programs were discussed in
18
many of the studies reviewed, there were wide variations in the number of hours, content
and delivery methods. No studies examined the relationships between the preceptorship
training programs and new graduate nurse outcomes, as well as which training strategies
would be lead to improved new nurse outcomes.
Number of preceptors. A number of studies set out to explore new graduate nurses’
perceived benefits of being assigned to one or many preceptors and the impact of the
number of preceptors on new nurses outcomes. Meyer and Meyer (2000) explored nurses’
(N=59) perceptions of the beneficial learning experiences during a preceptorship program
and report that all of their respondents believed that they needed to have one preceptor. A
study conducted in a US acute care military hospital examining the relationship between
new graduate nurses having either one (N=35) or several (N=53) preceptors and new nurses’
perceptions of their performance, transition, satisfaction, and intent to remain employed
reported no differences (Smith & Chalker, 2005). Eighty- four percent of the participants
reported that they believed having the same preceptor would be beneficial. The most
common theme that emerged from the qualitative analysis was that new nurses believed
having the same preceptor would help build their trust and bond with their preceptor and the
continuity would assist them in developing their confidence as a novice nurse. More
recently, Beecroft, McClure Hernandez, and Reid (2008) conducted a six year longitudinal
study, from 1999 to 2005, to examine the use of a team preceptorship approach as an
alternative to a single preceptor model. New graduate nurses were assigned to a team of
either two or three senior preceptors (n=99 new graduates and preceptors) who shared the
responsibilities of preceptoring. Preceptors indicated satisfaction with their role and the
program received positive comments from the new graduate nurses. New graduates nurses
19
indicated they preferred no more than two preceptors (Beecroft et al., 2008). The team
preceptor approach has also been examined in other studies with new graduate nurses
(Sandau et al., 2011; Woodworth, 2013) and with student nurses in public health (Cooper
Brathwaite & Lemonde, 2011). Sandau and colleagues reported that the new nurses in their
study (N= 92) experienced higher satisfaction levels when they were assigned 3 preceptors.
One study (Boyle, Popkess- Vawter, & Taunton, 1996) found a significant difference
between new nurses’ job satisfaction, role conflict, role ambiguity and professional
commitment based on the number of preceptors they worked with. These authors concluded
that new nurses benefited from working with fewer preceptors.
The current recommendation is the 1:1 preceptorship model. However, there are
challenges with this type of model, such as staffing and preceptor burnout. Recently, a team
preceptorship model has been explored and the results suggest that new graduates and
preceptors are satisfied with this approach. However, the relationship between the number of
preceptors and new graduates’ outcomes is unclear. All but one study reviewed examined
preceptors and new nurses’ satisfaction with the model as opposed to exploring causal
relationships between the model and measurable outcomes. Luhanga, Billay, Grundyz,
Myrick, and Yonge (2010) conducted a literature review on the 1:1 preceptorship model
within the context of undergraduate education. These authors report that although there are
challenges with this 1:1 model, there is evidence to support its effectiveness.
Preceptor characteristic and selection. Commonly recommended preceptor
characteristics are: patience, enthusiasm, strong knowledge base and skills, competence,
being respected by their peers, interpersonal skills, and having a willingness to learn and to
change (Baltimore, 2004; Hartline, 1993; Speers et al., 2004; Wolfensperger Bashford,
20
2002). It has been reported that preceptors are often selected based purely on their
availability (Bain, 1996; Baltimore; Myrick & Barrett, 1994). In the management literature,
Ashforth, Sluss, and Harrison (2007) describe more experienced employees in roles such as
preceptors as the main socializing agents of new employees. These socializing agents
provide new employees with a first glimpse into the organization, as well as representing the
organization (Ashforth et al.).
There is awareness in the management literature that the individual differences or
characteristics of the socializing agents may be important to the socialization of new
employees (Jones, 1986; Saks & Ashforth, 1997a). In nursing, there have been few
empirical studies conducted explicitly examining which individual preceptor characteristics
would be most beneficial for new graduate nurses’ and students’ transition (Anderson; 1998;
Barrett & Myrick, 1998; Finger & Pape, 2002; Giallonardo, Wong, & Iwasiw, 2010;
Kaviani & Stillwell, 2000; Zilembo & Monterosso, 2008). For example, Anderson explored
whether matching new graduate nurses’ (N=26) learning style to their preceptor’s (N=25)
teaching style was related to new graduate nurses’ preceptorship and job satisfaction.
Anderson found that new graduate nurses who are more introverted, or prefer individual
work, lecture format of learning, and need time to think and problem-solve, are more
satisfied with their preceptorship program and their job when their preceptor is similar to
them. By contrast, new graduate nurses who are extroverts, or think and learn the most when
talking and enjoy more interactive group work learning, are more satisfied with similar
preceptors. Those new nurses that were matched with preceptors that had opposite teaching
style were less satisfied. The results of this study suggest that preceptor characteristics may
21
have an impact on new nurses’ outcomes and that decisions about preceptor selection should
not be arbitrary.
In a study of Canadian nursing students during their last consolidation placement,
Barrett and Myrick (1998) found no relationship between preceptor (N=35) job satisfaction
and preceptee (N=33) clinical performance. Finger and Pape (2002) examined the attitudes
that preceptees (N=57) had towards their preceptors and reported that 42% of preceptors
were rated as experts and preceptees believed that their preceptors were sensitive to their
needs and encouraged self-confidence. However, these authors did not empirically examine
causal relationships between preceptor characteristics identified and new nurse outcomes.
Myrick and Yonge (2002) discuss four preceptor behaviours that emerged as promoting
student nurses’ critical thinking abilities, such as role modeling, facilitation, guidance, and
prioritization. More recently, Giallonardo et al. (2010) examined the relationship between
new graduate nurses’ (N= 170) perceptions of their preceptors’ authentic leadership and new
nurses’ job satisfaction and work engagement. The authors reported that new graduate
nurses’ working with preceptors with perceived high levels of authentic leadership were
more satisfied and engaged with their jobs. A few studies with undergraduate nursing
students have found that they value preceptors’ leadership, clinical competence and being
available to the nursing students (Kaviani & Stillwell, 2000; Zilembo & Monterosso, 2008).
There may be any number of preceptor individual differences or characteristics that
could influence new graduate nurses’ socialization. Although a few preceptor characteristics
have been examined, such as teaching style and authentic leadership, it remains unclear
which particular preceptor characteristics are important to new nurse outcomes during a
preceptorship program.
22
When determining which individual differences may be important, it is necessary to
consider that nursing itself can be very emotionally laden. Examples include: dealing with
difficult or violent patients and family members, bearing witness to patients and families at
their most vulnerable, dealing with life threatening crises, and helping patients and families
through the grieving process during palliative care and in cases of sudden death. As will be
discussed in a later section, the new graduate nurse transition period is described as one of
uncertainty, replete with feelings of anxiety and being overwhelmed. Preceptors with strong
emotional abilities may be in a better position to help new graduate nurses navigate these
difficult situations, as well as ease this transition period. There is no literature examining the
effect of a preceptor’s emotional intelligence on new nurses’ outcomes during a
preceptorship program. Thus, to build support for the proposition that a preceptor’s
emotional intelligence is important, the literature examining the impact of emotional
intelligence on the effectiveness of professionals in roles that share similar elements to that
of preceptors is examined, such as teachers, coaches, and leaders.
Nurse researchers have proposed that emotional intelligence (EI) may be an
important characteristic for effective nursing leaders (Bennett & Sawatzky, 2013; Muller-
Smith, 1999; Simpson & Keegan, 2002; Stichler, 2006; Strickland, 2000; Vitello-Cicciu,
2002; 2003). There is evidence that a leader’s emotional intelligence may have a positive
impact on the work outcomes of their subordinates, such as performance and job
satisfaction. It has been theorized that a leader’s emotional intelligence may foster
employees’ creativity (Zhou & George, 2003). Additionally, emotionally intelligent leaders
may have more positive work attitudes, altruistic behaviour, and greater task performance
(Carmeli, 2003). For example, Sy et al. (2006) examined the interactions between managers’
23
emotional intelligence (N=62), their employees’ (N=187) emotional intelligence, and
employees’ job satisfaction and performance in a sample of food service workers. Emotional
intelligence was measured using Wong and Law’s (2002) self-report Emotional Intelligence
Questionnaire, which measures four different dimensions of EI: (1) appraisal and expression
of emotion in the self, (2) appraisal and recognition of emotion in others, (3) regulation of
emotion in the self, and (4) use of emotion to facilitate performance. It was found that a
manager’s emotional intelligence was more positively associated with the job satisfaction of
employees with lower emotional intelligence than for employees with higher levels of
emotional intelligence. It was also found that an employee’s emotional intelligence
positively predicted their own performance.
Wong and Law (2002) examined the relationship between a leader’s emotional
intelligence and their subordinates’ job performance, satisfaction and organizational
citizenship behaviour. The sample consisted of 146 dyads of leaders and subordinates
employed in the Hong Kong government. Leaders’ emotional intelligence was measured
using Wong and Law’s self-report questionnaire. It was found that the leader’s EI was
significantly related to their employee’s job satisfaction and organizational citizenship
behaviour, but not performance. Similarly, Wu, Liu, Song and Liu (2006) examined the
moderating effect of a leader’s emotional intelligence on the relationship between
organizational leadership and subordinates’ organizational commitment. The sample
consisted of 95 managers and their 241 subordinates across six organizations. Emotional
intelligence was measured using Wong and Law’s Emotional Intelligence Questionnaire. It
was found that leaders with high EI heightened the effects of transactional and
transformational leadership styles on employees’ organizational commitment.
24
Cummings, Hayduck and Estabrooks (2005) developed and tested a theoretical
model of the mitigating role of the emotional intelligence of nurse leaders on the impact of
hospital restructuring on staff nurses. The authors conducted a secondary data analysis on a
dataset that was collected in Alberta, Canada in 1998 after the restructuring of health care
that resulted in the layoff of nurses. The sample consisted of 6,526 nurses. The authors
chose 13 questions from the original survey that reflected Goleman’s emotional intelligence
competencies in resonant and dissonant leaders. Nurses’ working with resonant leaders
reported greater workgroup and team relationships, greater satisfaction with their jobs and
supervision, and less unmet patient care needs, than those nurses who worked with a
dissonant leader. Although preceptors are not leaders in the managerial sense, they are in a
position of authority throughout the preceptorship program and are responsible for guiding
and evaluating the new nurse’s progress and practice. Thus, given the findings of the
influence of a leader’s emotional intelligence on their subordinates’ work outcomes, it is
reasonable to suggest that a preceptor’s emotional intelligence may affect new graduate
nurses’ outcomes.
Although there is a paucity of studies examining the role of emotional intelligence in
teachers, the five articles located will be reviewed. The training of preservice teachers is
similar to the preceptorship programs implemented for new nurses. Preservice teachers are
university students studying education who must complete a placement wherein they are
assigned a mentor, an experienced teacher, whom they shadow for the duration of their
placement, slowly taking on more autonomy and responsibility for the mentor’s teaching
assignment (Hawkey, 2006). Hawkey examined the literature on emotional intelligence in
education and discussed the applicability of this concept within the mentoring of pre-service
25
teachers, through a practice and policy lens. It is proposed that emotions are important
elements in the early work experiences of teachers and in the mentoring that occurs between
a preservice and experienced teacher. The author concluded that there is a lack of research in
the role that emotional intelligence might play in the education of preservice teachers, as
well as the role of the mentor’s emotional intelligence on the learning of preservice teachers.
A study examining the relationship between emotional intelligence and self-efficacy
in a sample of Chinese teachers (N=158) utilized Schutte et al.’s (1998) emotional
intelligence scale to measure teachers’ emotional intelligence (Chan, 2004). This scale
measures participant self-reported appraisal and expression of emotions and emotion
regulation in self and others, and the use of emotions in problem solving. Teachers’ general
self-efficacy beliefs were significantly predicted by the emotion regulation component and
teachers’ self-efficacy beliefs about helping others were significantly predicted by appraisal
of emotions in others. Similarly, Penrose, Perry, and Ball (2007) examined the relationship
between emotional intelligence and teachers’ (N= 211) self-efficacy. Emotional intelligence
was measured using the Reactions to Teaching Situations, a measure developed by one of
the authors for use with teachers. The authors report that 14% of the variance in teacher’s
self-efficacy was explained by emotional intelligence. Similarly, Di Fabio and Palazzeschi
(2008) examined the relationship between emotional intelligence and teacher self-efficacy in
a sample of Italian teachers (N=169). Emotional intelligence was measured using the self-
report Bar-On Emotional Quotient Inventory, which measures four dimensions of EI: (1)
intrapersonal; (2) interpersonal; (3) stress management; and (4) adaptability. Global
emotional intelligence was positively related to teachers’ self-efficacy (r=.39). The
26
intrapersonal (β=.44) and adaptability (β=.15) dimensions of EI both predicted teachers’
self-efficacy.
Allen, Ploeg and Kaasalainen’s (2012) study examining the relationships between
the EI of undergraduate nursing faculty engaged in clinical teaching and teacher
effectiveness is the first attempt in nursing to explore these relationships. Nursing faculty
(N= 47) completed the BarOn Emotional Quotient Inventory, a self-report measure of EI, as
well as a modified Nursing Clinical Teacher Effectiveness Inventory (NCTEI), a perceived
teaching effectiveness self-report. The NCTEI was developed based on the literature and
from students’ descriptions of effective teaching behaviours. The results indicate that there
is a positive relationship between faculty’s EI and perceived teaching effectiveness. The
main limitation of this study was that EI and teacher effectiveness was measured using self-
reports and did not include objective measures of nursing students’ outcomes.
Collins, Lane, Jones and Galloway (2007) explored the relationship between judo
coaching and emotional intelligence among British judo coaches (N=130). Coaches’
emotional intelligence was measured using Schutte et al.’s (1998) Emotional Intelligence
Scale. Developing positive relationships with judo players was positively correlated with EI.
Similarly, Thelwell, Lane, Weston, and Greenlees (2008) examined the relationship between
emotional intelligence and coaching efficacy in a sample of British sports coaches (N=99).
Coaches’ EI was measured using Schutte et al.’s Emotional Intelligence Scale. The authors
report that coaches’ efficacy had a significant and moderate relationship with EI. The
findings from both the teacher and sports literature suggest that emotional intelligence may
play a role in teachers and coaches’ effectiveness through its influence on self-efficacy.
Given these findings, it is reasonable to assume that if emotional intelligence contributes to
27
the efficacy of both teachers and coaches, then it is plausible to suggest that it may also
affect how preceptors perform their role.
Although there is empirical support that leaders’ EI may positively impact employee
outcomes, the literature examining the effects of teachers’ and coaches’ emotional
intelligence is unclear as student outcomes have not been empirically included in the studies.
However, the literature suggests that perhaps higher levels of EI may have a positive effect
on students’ and subordinates’ outcomes. The review provides preliminary support for the
contention that the emotional intelligence of a preceptor may be an important individual
difference to consider as an influencing factor on new graduate nurses’ socialization
outcomes.
Nursing Graduate Guarantee Initiative
In 2005, the Ontario Ministry of Health and Long-Term Care implemented the
“Nursing Graduate Guarantee” initiative (NGG) which provided funding to hospitals for
full-time supernumerary positions for new graduate nurses, with the expectation that these
temporary positions would lead to permanent full-time positions (Nursing Secretariat, 2008).
This initiative has several objectives, such as providing new graduates who wish to work
with full-time positions, promoting recruitment and retention in all sectors, assisting in
finding a match between new graduates and employers through use of an on-line portal, and
supporting new graduates’ transition and integration into the workplace by ensuring they
receive a minimum of 12 weeks orientation with a preceptor (Baumann et al., 2008; Nursing
Secretariat). An evaluation of the new graduate nurse guarantee was conducted in 2007
using data from employers (N=230), new graduate nurses (N=1780), staff nurses (N=5), and
union representatives (N=5) from surveys, focus groups and interviews (Baumann et al.).
28
New graduates and employers believed that the extended orientation was a benefit of the
program and new graduates reported feeling supported while in their supernumerary
positions (Baumann et al.). Since the NGG began in the summer months, not all
organizations were able to provide the traditional 1:1 preceptorship model due to vacations,
staffing shortages and the availability of nurse preceptors. Thus, employers had to find
creative ways of providing either the 1:1 model or variations of it, such as staggering when
new graduates were hired to accommodate the need for preceptors, use of two preceptors,
and by providing new nurses experiences on other units- all strategies reported as successful
by employers and new graduate nurses (Baumann et al.).
Maintaining new graduates as supernumerary was at times challenging, such as
during instances of staff shortages from unreplaced sick calls or higher patient workloads. In
such cases, new graduate nurses were occasionally removed from their supernumerary
position and given a separate patient assignment. During these times, new graduate nurses
reported feeling confident in their ability to provide care independently. There were also
some reports of occasions when the new graduate did not feel confident in his or her ability
to provide care autonomously and were not supported by the nursing staff. The response to
the NGG has been positive, 84.6 % of staff nurses and 95.9% of administrators were
receptive or very receptive to the initiative. This program has had several positive outcomes
for both new graduates and organizations, including the increased availability of full-time
employment for new nurses, the extended orientation which allows new nurses more time to
transition, organizational-wide enhancement of educational programs offered, increased
organizational efforts to retain these NGG nurses, improvement in human resource planning,
and cost effectiveness with sick time and overtime. Additionally, since 2005, this new
29
graduate nurse program has increased full-time employment from 42.5% to 64.7%
(Baumann et al., 2008).
Outcomes of Preceptorship
A review of the literature on the new graduate nurse and organizational outcomes
associated with preceptorship is now described. As preceptorship is a method of
organizational socialization, the common outcomes of socialization will be reviewed.
Appendix B reviews 34 studies that specifically examined the implementation and
evaluation of preceptorship programs, including the outcomes associated with such
programs. Appendix D reviews 11studies that report the new graduate nurse outcomes
associated with preceptorship programs, but do not provide any program details.
New Graduate Nurse Outcomes of Preceptorship
The challenges that new graduate nurses face, such as assuming a new role,
development of clinical skills and judgment, developing a positive self-concept, and learning
about the organization as a system, are frequently not addressed in practice and in the
literature (Beauregard et al., 2007). These challenges must be faced within a short time
frame after commencing employment (Baltimore, 2004; Owens et al., 2001). Newhouse et
al. (2007) report that it may take as long as 12 to 18 months before new graduate nurses feel
confident and comfortable in their role as staff nurses. Furthermore, Hoffart, Waddell and
Young (2011) defined the new nurse transition period to be the first two years of practice.
Nurse researchers and practitioners have examined a variety of new graduate nurse
outcomes associated with the implementation of preceptorship programs, such as transition
from student to new nurse (Allanach & Jennings, 1990; Beecroft et al., 2001; Boychuk
Duchscher, 2008; Boyer, 2002; Bradley, 1999; Casey et al., 2004; Godinez et al., 1999;
30
Marks- Maran et al., 2013; Thomka, 2001), confidence in performing the role (Beecroft et
al.; Blanzola et al., 2004; Casey et al.; Dilorio et al., 2001; Godinez et al.; Loiseau et al.,
2003; Marks- Maran et al.), competence as a nurse (Beecroft et al.), increase in nursing
knowledge (Dilorio et al.; Herdrich & Lindsay, 2006), stress (Bratt & Felzer, 2011),
enhancement of critical thinking (Forneris & Peden-McAlpine, 2007; Herdrich & Lindsay;
Marcum & West, 2004; Sorensen & Yankech, 2008), and satisfaction with the program
(Anderson, 1998; Crimlisk et al., 2002).
To meet the staffing needs of a busy downtown Montreal emergency department,
Loiseau et al. (2003) implemented and evaluated a new 16-week preceptorship program
aimed at integrating new nurses (N=18) into the work environment. The preceptorship
program included one hour a week of didactic sessions covering emergency nursing specific
content. The authors reported that upon program completion new graduate nurses had high
self-efficacy scores, indicating that they were confident in their ability to provide care in the
emergency setting.
To ease the transition process of new graduate nurses into that of confident,
competent and safe staff nurses, Beecroft et al. (2001) implemented and evaluated a
preceptorship program in a paediatric unit. The program consisted of 716 hours of clinical
practice with one preceptor and 224.5 hours of didactic sessions with skills development in a
skills laboratory. Two groups were included in this study, an experimental group consisting
of new graduate nurses who participated in the preceptorship program (N= 50) and a control
group consisting of new nurses who were hired prior to the implementation of the new
program (N=28). The authors reported no statistically significant difference between the
experimental and control group in terms of their professional autonomy. Additionally, both
31
groups had a comparable continuous increase in self-confidence at twelve months. There
were some demographic differences between the experimental and control groups as the
nurses in the control group had higher education, were older, and 79% of the group had 1.5
years of nursing experience. The experimental group had an average of 8 months of nursing
experience. The authors concluded that the experimental group transitioned at a greater
speed due to the preceptorship program. As the authors did not control for education and
experience, it is difficult to ascertain if the experimental group did indeed transition at a
greater speed due to the preceptorship program or if their education and previous working
experience may have been a factor.
Similarly, researchers at an American navy hospital evaluated the implementation of
a new 16-week preceptorship program that included 20 hours a month of didactic sessions
and skill development in a skills laboratory (Blanzola et al., 2004). Two groups were
included in this study, an experimental group (N=8) consisting of nurses who participated in
the new program and a control group (N=10) consisting of nurses who were hired prior to
the implementation of this program. The authors reported statistically significant differences
between the pre and post program self-evaluations for the experimental group, suggesting an
increase in clinical comfort and confidence in the role after the program was completed.
Also, there was a statistically significant difference in the peer evaluations between both
groups, with participants in the control group having lower peer evaluations both at program
completion and six months post program completion. Similarly, Dilorio et al. (2001)
implemented and evaluated a six-month preceptorship program for new graduate nurses
(N=54) employed on a neurosciences unit which included clinical practice and 104 hours of
32
didactic sessions. The authors reported an increase in knowledge and confidence from pre to
post program.
A study of 10 new graduate nurses hired within one organization on various patient
care units participated in a six to 12 month preceptorship program which included didactic
sessions tailored to their practice setting (Herdrich & Lindsay, 2006). The authors reported
that the participants demonstrated a 12% improvement in basic knowledge and critical
thinking from pre to post preceptorship program (Herdrich & Lindsay). Struggling with high
turnover rates on their medical units prompted leaders at three American hospitals to
restructure their preceptorship programs for new graduate nurses with the aim of improving
retention rates (Marcum & West, 2004). An 18 bed inpatient unit in one of the hospitals that
had previously been closed was reopened to function as the site of the new preceptorship
program. Staff nurses from each of the three hospitals were chosen to act as preceptors and
became the unit staff. New graduate nurses (N=20) hired on medical units across the three
hospitals were collectively preceptored for 13 weeks on this new unit. Once the
preceptorship program was completed, the new graduate nurses returned to their primary
unit of hire. Marcum and West reported that their new graduate nurses demonstrated a
statistically significant difference in critical thinking and interpersonal skills between pre
and post preceptorship program and after one year, 83.3% of these new nurses demonstrated
very strong critical thinking abilities. The turnover rate one year prior to the implementation
of the program was 41% and decreased to 24% at 18 months after the completion of the
program.
The majority of the studies reviewed had small sample sizes and did not control for
potential important confounding variables, such as experience and education. Therefore, it is
33
difficult to conclude if the results were indeed due to the preceptorship program, or due to
the effects of other confounding variables.
Emotional nature of new nurses early work experiences. The socialization process is
one that produces anxiety, stress, and uncertainty on the part of the new employee (Boychuk
Duchscher, 2009; Duclos- Miller, 2011; Feng & Tsai, 2012; Miller & Jablin, 1991; Reio &
Callahan, 2004; Saks & Ashforth, 1997a; Saks, Uggerslev, & Fassina, 2007). Examining the
causal influence of affect, curiosity, socialization learning, and job performance in a diverse
sample of US employees (N=233), Reio and Callahan reported that higher levels of state
anxiety lowered levels of employee curiosity which negatively impacted on socialization
learning and perceptions of job performance. This study provides some insight into how
emotions may affect socialization learning and performance in employees.
The transition from student to practicing nurse can be an emotionally difficult time,
accompanied by a substantial increase in responsibility and accountability, with very little
time to adapt to these changes (Allanach & Jennings, 1990; Boychuk Duchscher, 2009).
New graduate nurses’ have reported “feeling alone”, “feeling overwhelmed”, as well as
experiencing feelings of “guilt” and “frustration” due to the increased workload they had
because they did not feel comfortable delegating work to support staff (Casey et al, 2004).
Allanach and Jennings examined the process of new graduate nurses’ transition during a
preceptorship program and explored whether the transition from student to staff nurse is an
emotionally-laden experience. Forty-four new graduate nurses participating in an eight week
preceptorship program in an American military hospital were surveyed over a two year
period. The authors reported that although the new graduate nurses verbalized feelings of
psychological discomfort during this transition process, no statistically significant affective
34
state changes over time were noted. The authors hypothesized that this finding may be due
in part to the sample being dominantly internal in their locus of control, representing their
belief that rewards are due to their own behaviours.
By contrast, Thomka’s (2001) sample of new graduate nurses (N=16) described
emotional responses, such as feeling “anxious”, “nervous” and “overwhelmed”, in their
early work experiences. Similar findings have been reported by Duclos- Miller (2011) and
Feng and Tsai (2012). The results of Hardyman and Hickey’s (2001) study of new graduate
nurses (N=1598) revealed that new nurses were anxious and uncertain about the
responsibilities they would have as registered nurses, and with their own abilities to cope.
Boychuk Duchscher (2008) conducted a qualitative study of new graduate nurses (n=14)
over the course of 18 months after graduation to examine the stages through which new
nurses transition. For these participants, the first three to four months of practice were
characterized by a great variety of and changes in emotions as they worked through the
transition process. They reported being surprised by the workload, disappointed by the low
value attached to their contribution, and felt they had to hide their feelings of inadequacy.
Boychuk Duchscher (2009) developed a “Transition Shock Model” based on her
program of research with new graduate nurses and summarizes the emotional nature of the
transition process as: “The range, overwhelming intensity and labile nature of the emotions
expressed by participants during this initial stage of transition was truly impressive. Using
words and phrases or expressions such as ‘terrified’ and ‘scared to death’, these participants
claimed that relentless anxieties were routine during those initial weeks.” (p. 1106).
35
Organizational Outcomes of Preceptorship
Researchers have included turnover and retention rates of new graduate nurses as the
predominant organizational outcome measure or indicator of the success of new
preceptorship programs (Almada et al., 2004; Atlier & Krsek, 2006; Beauregard et al., 2007;
Beecroft et al., 2001; Boyer, 2002; Casey et al., 2004; Crimlisk et al., 2002; Dilorio et al.,
2001; Godinez et a., 1999; Gurney & Mass, 2002; Herdrich & Lindsay, 2006; Lavoix-
Tremblay et al., 2008; Loiseau et al., 2003; Newhouse et al., 2007; O’Malley Floyd et al.,
2005; Orsini, 2005; Owens et al., 2001; Pine & Tart, 2007; Woodworth, 2012). These
preceptorship programs have been designed and implemented to specifically target, in hopes
of affecting, new graduate nurse turnover and retention. These studies are described below.
New graduate nurse turnover. New graduate nurses have high turnover rates within
the first two years of practice (Baltimore, 2004; Beauregard et al., 2007; Kovner et al., 2007;
Kovner & Djukic, 2009). Although there is no consensus in the literature regarding exact
turnover figures for new graduate nurses, in the United States, they can range anywhere
from 13% (Kovner et al., 2007) to 61% (Beauregard et al.; Casey et al., 2004). Kovner et
al.’s (2009) reported new nurse turnover rate of 26.2% in the first two years of practice
provides a stronger estimate as it was derived from a secondary analysis of large American
nursing datasets. High turnover rates during early working experiences have been attributed
to new graduates nurses’ feeling under prepared and under supported by the nursing staff
(Beauregard et al.; Godinez et al., 1999; Meyer & Meyer, 2000). Lavoix- Tremblay et al.
(2008) studied new graduate nurses in Quebec (N= 309) who were under the age of 24 and
reported that 61.5% of the sample intended to leave their current position and 12.9%
intended to leave the profession. Nurse leaders in health care organizations have
36
implemented preceptorship and internship programs for new graduates specifically to
address these issues and to assist in their work environment transition (Godinez et al.;
Owens et al., 2001).
Beecroft et al. (2001) evaluated the implementation of a new one- year paediatric
internship program in an American children’s hospital, which included didactic sessions,
practice in the skills laboratory, and a one-to-one relationship with a preceptor (Beecroft et
al., 2001). Included in this study was an experimental group of new graduate nurses (N= 50)
and a control group of nurses (N=28) who were hired as new graduate nurses two years prior
to the implementation of the program. The experimental group was surveyed at the
beginning of the program, in the middle, and at 12 months. The control group, who had been
working as nurses for two years at the start of this study, were surveyed at the start of the
experimental program. The authors reported that organizational commitment and anticipated
turnover of the experimental group at 12 months was comparable to that of the control
group. These results suggest that the new graduate nurses in the experimental group at 12
months were comparable to the control group that had two years of experience. The turnover
rate for the program participants after one year was 14%, compared with 36% for the control
group.
Newhouse et al. (2007) conducted a quasi-experimental study comparing three
groups of new graduate nurses after the implementation of a one year internship program,
the Social and Professional Reality Integration for Nurse Graduates (SPRING). The first
group consisted of the comparison group of new graduate nurses who were hired one year
prior to the implementation of the SPRING program (N=73), while the experimental group
consisted of the new graduate nurses who participated in the program (N=237). The third
37
group was hired at the same time as the experimental group, but did not participate in the
program (N=212). The study findings suggest that those hired one year prior to the SPRING
program were more likely to consider leaving their job than the experimental group.
New graduate nurse retention. The retention of nursing staff has several
organizational benefits, such as improving the work environment and culture, maintaining
organizational knowledge, reducing costs associated with advertising and recruiting,
vacancies, hiring and training (Jones & Gates, 2007). The literature reveals that the
improvement in retention rates of new graduate nurses after the implementation of a
preceptorship program ranges from 37% (Altier & Krsek, 2006; Beauregard et al. 2007;
Beecroft et al., 2001; Boyer, 2002; Bratt 2009; Crimlisk et al., 2002; Dilorio et al., 2001;
Herdrich & Lindsay, 2006; O’Malley Floyd et al., 2005; Owens et al., 2001; Pine & Tart,
2007) to 100% (Almada et al., 2004; Gurney & Mass, 2002; Loiseau et al., 2003; Orsini,
2005).
Salt et al’s (2008) systematic review of organizational retention strategies aimed at
new graduate nurses reported that the single most common strategy employed is the
implementation of a preceptorship program and that the highest retention rates were
associated with preceptorship programs lasting between 3 to 6 months. Beecroft et al. (2001)
evaluated the implementation of a paediatric internship program, which included an
experimental group of new graduate nurses (N=50) who participated in the program and a
control group (N=28), and reported that the retention rates increased by 20% over a two year
period in the experimental group; from 63% to 83% after the implementation of the
program. A Vermont Community Hospital implemented a new preceptorship program to
improve retention rates. The program matched a new graduate nurse (N= 40) with one
38
preceptor for eight-weeks and included one week of didactic sessions and a two-week
rotation in various specialty units (Almada et al. 2004). The average retention rate prior to
the implementation of the program was 25%, whereas the one year retention rate for the
participants was 93%. The authors concluded that the changes in the preceptorship program,
such as one-to-one preceptorship, increased program length, and satisfaction with the
program were responsible for the improved retention rates (Almada et al.). Newhouse et
al.’s (2007) quasi-experimental study comparing three groups of new graduate nurses, one
experimental group (N=237) who participated in the preceptorship program and two control
groups (N=73, N=212), identified that the experimental group had higher retention rates at
twelve months than the control groups. However, there was no statistically significant
difference between the groups’ retention rates at 18 and 24 months post program
completion. The authors suggest that perhaps the program should be extended into the
second year to provide additional support to the new graduate nurses.
The results of the studies reviewed suggest that preceptorship programs may have an
impact on new graduate nurses’ turnover and retention after program implementation.
However, these studies have not controlled for the potential effects of confounding
variables, such as new graduate nurses’ first job of choice, job satisfaction, as well as other
organizational or unit practices that might also impact turnover and retention of new nurses.
Organizational Socialization Outcomes
The outcomes that are the most common indicators of organizational socialization
reported in the literature include: (1) role conflict; (2) role ambiguity; (3) job satisfaction;
and (4) turnover intent. Studies have demonstrated that high quality socialization programs
decrease new employees’ role ambiguity and role conflict (Ashforth & Saks, 1996; Jones,
39
1986). Researchers have also demonstrated that these programs are associated with greater
levels of job satisfaction (Ashforth & Saks, 1996; Ashforth, Saks, & Lee, 1997; Cooper-
Thomas & Anderson, 2002; Jones; Kowtha, 2008; Saks & Ashforth, 1997b) and lower
intentions to turnover (Ashforth & Saks; Ashforth et al.; Jones; Kowtha; Saks & Ashforth,
1997b). Research has demonstrated that the social elements of socialization, such as
working closely with a more experienced colleague, were the most important factors in
affecting new employees’ socialization (Allen & Meyer, 1990; Anakwe & Greenhaus, 1999;
Jones; Kowtha; Saks et al., 2007).
Socialization Over Time
There is evidence suggesting that new employees may adjust rapidly after starting
their first job, as early as four weeks (Major, Kozlowski, Chao, & Gardner, 1995). Cooper-
Thomas and Anderson (2002) examined the relationship between organization socialization,
socialization learning, adjustment outcomes, and the role of time in a sample of British army
recruits (N=214) during their first eight weeks of training and found significant adjustment
at the end of the eight weeks. It has been suggested that this relatively fast adaptation may
occur as a result of the early reduction in uncertainty provided by the structured program
(Ashforth & Saks, 1996; Cooper-Thomas, et al., 2002; Saks & Ashforth, 1997a). This early
reduction in new employees’ uncertainty may have a great positive impact on later
outcomes.
The literature in nursing suggests that new graduate nurses face many challenges
while adapting to their new role, such as the development of clinical skills and judgment, a
positive self-concept, and learning about the organization as a system. They also must face
these challenges rather quickly upon entry into the organization (Baltimore, 2004;
40
Beauregard et al., 2007; Owens et al., 2001). The preceptorship and new graduate nurse
transition literature suggests that the greatest adjustment period is between three months to
one year (Casey et al., 2004; Newhouse et al., 2007; Pfeil, 1999; Thomka, 2001).
Researchers have reported that new graduate nurses’ critical thinking (Herdrich & Lindsay;
Marcum & West, 2004) and confidence (Blanzola et al., 2004; Casey et al., 2004; Leigh,
Douglas, Lee, & Douglas, 2005) increased over time after completion of the preceptorship
program. Casey et al. conducted a study examining new graduate nurses’ (N=270) transition
over two years and reported that new nurses confidence levels were lowest between the third
and 12th
month of practice. Additionally, between the sixth to 12th
months of practice, the
new nurses reported feeling overwhelmed with the workload and having continued
difficulties with organizational and prioritizing skills, and they did not feel comfortable
performing certain skills, such as phlebotomy, blood transfusion, and caring for patients
with chest tubes and epidurals. The authors concluded that the most difficult role adjustment
period is between six to 12 months of practice.
Limitations of Preceptorship Literature
There is a great deal of literature on the implementation of preceptorship programs
for new graduate nurses, although the outcomes reported are often anecdotal, without
detailed descriptions of program development, implementation, and evaluation methods.
Additionally, these programs vary in how they have been developed, delivered, evaluated,
and their outcomes. Ohrling and Hallberg (2001) suggest a need for further research on
various types of preceptorship models as they are being used increasingly in the practice
setting with new nurses.
41
Preceptorship Programs for New Graduate Nurses
The literature suggests that new graduate nurses’ satisfaction with preceptorship
programs is influenced by the length of the program. However, there are inconsistencies in
the literature on the length of time preceptorships are delivered. Similarly, didactic sessions
are common components of a preceptorship program, yet many nursing studies did not
provide specific details regarding these (Allanach & Jennings, 1990; Almada et al., 2004;
Anderson, 1998; Goode & Williams, 2004; Herdrich & Lindsay, 2006; Marcum & West,
2004; McKane, 2004; Meyer & Meyer, 2000; Smith & Chalker, 2005). At the same time,
the literature is inconsistent regarding the number of hours that should be included and the
content that should be covered in the didactic sessions of a preceptorship program. No
studies have been conducted to examine the relationships between the specific length of the
preceptorship program, the content and number of didactic sessions and new graduate nurse
and organizational outcomes.
Preceptors
Although it is recognized in the literature that preceptors are important, there remains
a lack of empirical and theoretical understanding of the relationship between preceptor
characteristics or attributes and new graduate nurses’ socialization and transition. There is a
need to examine in more detail and understand what it is exactly about the preceptor that
may assist new nurses in their transition during a preceptorship program. There is evidence
from the education, leadership and management fields that the emotional intelligence of
individuals in roles that share similar elements to preceptors may have a beneficial impact
on those they work with, such as students and subordinates. These results, coupled with the
findings from the nursing literature that new graduates’ transition period is replete with
42
uncertainty and anxiety, support the proposition that a preceptor’s emotional intelligence
may be an important variable to consider.
Outcomes
There are a variety of preceptorship outcomes that have been measured, including
turnover and retention rates, satisfaction, confidence, performance, and knowledge and skill
development. The findings to date have been both inconsistent and contradictory. In 1996,
Bain conducted a review of the preceptorship literature and reported a lack of definition and
clarity in the literature regarding what a preceptorship program is. Bain concluded that no
studies specifically examined which skills and characteristics a preceptor requires, and that
the reported outcomes of preceptorship programs are inconsistent. A systematic review of
organizational retention strategies for new graduate nurses revealed similar findings (Salt et
al., 2008). A recent literature review on new graduate nurse transition programs (Rush,
Adamack, Gordon, Lilly, & Janke, 2013) reported that although there is evidence that formal
new nurse transition programs are associated with improved retention and new nurse
competency, the variability in study designs limited the authors ability to draw substantive
conclusions and recommendations.
The majority of the common outcomes associated with organizational socialization
have not been used in the study of new nurses’ adjustment during a preceptorship program.
It has been suggested that the socialization of new employees, regardless of the setting, is
similar (Van Maanen & Schein, 1979). Thus, these outcomes are as pertinent for the study
of organizational socialization for new employees in the business management fields as they
are for health care.
43
Methodological Considerations
The review of the nursing preceptorship literature highlights several methodological
challenges with the research conducted to date, such as a lack of use of theoretical
frameworks (Almada et al., 2004; Anderson, 1998; Beecroft et al., 2001; Beecroft et al.,
2008; Beyea et al., 2007; Casey et al., 2004; Crimlisk et al., 2002; Hardyman & Hickey,
2001; Henderson et al., 2006; Herdrich & Lindsay, 2006; Loiseau et al., 2003; Marcum &
West, 2004; McKane, 2004; Owens et al., 2001; Schmidt et al., 2003; Smith & Chalker,
2005; Speers et al., 2004; Thomka, 2001; Usher et al., 1999); small sample sizes (Blanzola
et al., 2004; Gurney & Mass, 2002; Herdrich & Lindsay; Loiseau et al.; Marcum & West);
no report of the psychometric properties of the measures used (Allanach & Jennings, 1990;
Almada et al.; Anderson; Beecroft et al., 2008; Dilorio et al., 2001; Herdrich & Lindsay;
Marcum & West; Owens et al.); predominant use of self-reports (Almada et al.; Anderson;
Beaulieu O’Friel, 1993; Blanzola et al.; Crimlisk et al.; Gurney & Mass; Hardyman &
Hickey, 2001; Henderson et al., 2006; Meyer & Meyer, 2000; O’Malley Floyd et al., 2005;
Smith & Chalker; Yonge et al., 2002); and minimal reports of the statistical analyses
employed (Allanach & Jennings; Anderson; Beecroft et al., 2008; Herdrich & Lindsay;
Loiseau et al.; Owens et al.; Smith & Chalker).
Additional weaknesses lay in the designs of these studies, all of which examined
simple and direct relationships rather than more complex relationships, including the
possibility of interactions between various variables or complex models. As more complex
relationships have not been examined, it is difficult to ascertain whether or not the effects
reported are indeed true reflections of the state of preceptorship in nursing. Salt et al.’s
(2008) systematic review (N=16) and Rush et al.’s (2013) integrative review (N= 47)
44
reported similar methodological weaknesses. In addition, there was minimal use of control
variables in these studies. Three potentially important confounding variables not included in
the new graduate nurse preceptorship and turnover literature have been identified; first job
of choice, previous experience on unit of hire, and core self-evaluations.
First job of choice is a variable that reflects the new graduate nurse’s preferred area
of employment upon graduation, which may or may not be where they are currently
employed. This may be an important confounding variable requiring control in studies
examining preceptorship programs and turnover rates in new graduate nurses because it may
affect new nurses’ retention on the unit of hire. The second potential confounding variable is
previous experience on the unit, which is when a new graduate nurse’s first job as a nurse is
on a unit they either did a clinical placement at some time during their nursing education or
were employed on the unit in another role. This variable is important to consider because the
exposure to the unit and the nursing staff that occurred during their previous experience on
the unit may act as a confounding variable when examining the socialization that occurs
during the preceptorship program.
The third variable worth considering is core self-evaluation. Core self-evaluation
(CSE) is a higher order construct that is composed of four traits: self-esteem, an overall
appraisal of one’s worth as a person; general self-efficacy, an individual’s beliefs about their
abilities and capabilities to perform across a variety of circumstances; locus of control, an
individual’s beliefs about their ability to control the events in one’s life or one’s
environment; and emotional stability or low neuroticism, a person’s inclination to be
confident in oneself and secure (Judge & Bono, 2001; Judge, Erez, Bono, & Thorensen,
2003).
45
Core self-evaluations have been empirically demonstrated to be related to several
important work behaviours, such as goal setting and motivation (Erez & Judge, 2001), job
satisfaction (Best, Stapleton, & Downey, 2005; Erez & Judge; Judge et al., 2003),
performance (Erez & Jedge; Judge et al.), and burnout in a sample of health care workers
including nurses (Best et al.). In a meta-analysis, Judge and Bono (2001) reported that core-
self evaluations were related to job satisfaction and performance, and provided evidence that
these four traits may help predict employees’ job satisfaction and performance. In nursing,
three studies examining the role of CSE were located. Laschinger, Purdy, and Almost (2007)
tested a model examining the effect of CSE on the relationships between nurse managers’
(N=141) perceptions of the quality of their relationship with their supervisors,
empowerment, and job satisfaction and reported that CSE had a direct positive relationship
with managers’ job satisfaction (β=.37).
In a study examining the effects of CSE and effort-reward imbalance on Ontario
nurse managers’ (N= 134) burnout over a one- year period, the authors reported that CSE
had a weak negative effect (β= -.166) on emotional exhaustion after one year (Laschinger &
Finegan, 2008). Finally, Siu, Laschinger and Finegan (2008) tested a model examining the
relationships between Ontario nurses’ (N= 678) perceptions of their practice environments,
quality of conflict management, CSE, and unit effectiveness. These authors reported that
within their model, CSE had a positive effect on conflict management (β=.10) and on the
practice environment (β=.22). The results of these studies all suggest that CSE, or an
individual’s belief about their own worth, abilities and capabilities, affects how employees
see, interpret and react to situations within their work environment, and may play an
important role in predicting employees’ job satisfaction and performance. Thus, controlling
46
for new nurses’ CSE may be important in order to make more confident conclusions
regarding the effect of a preceptorship program on new graduate nurse outcomes.
Conclusions
Despite the methodological limitations, the literature review suggests that
organizations may benefit from implementing preceptorship programs that are specifically
designed to meet the unique needs of new graduate nurses. The majority of studies reported
improvements in the retention rates of their new graduate nurses within the 12 months
following the completion of the preceptorship program (Almada et al., 2004; Beauregard et
al. 2007; Beecroft et al., 2001; Crimlisk et al., 2002; Dilorio et al., 2001; Gurney & Mass,
2002; Heirdrich & Lindsay, 2006; Loiseau et al., 2003; Newhouse et al., 2007; O’Malley
Floyd et al., 2005; Owens et al., 2001; Salt et al., 2008). Two studies examined retention
rates at 24 months after program completion (Gurney & Mass; Newhouse et al.). Gurney
and Mass report a 100% retention rate two years after the completion of the preceptorship
program while Newhouse et al. found no statistically significant differences between the
two-year retention rates of the new nurses who participated in a preceptorship program and
those who did not. One important difference between these two studies is the sample size;
Gurney and Mass’s sample consisted of 13 new nurses, whereas Newhouse et al.’s larger
study had two control groups and an experimental group that consisted of 237 new nurses.
Newhouse et al.’s findings may suggest that new graduate nurses face additional challenges
once the support provided in a preceptorship program is terminated.
There is a lack of empirical work on the relationships between a preceptor’s
individual differences and new nurses’ socialization during a preceptorship program.
Ashforth, Sluss, and Harrison (2007) suggest that researchers should focus not only on how
47
new employees are socialized, but also on the sources of socialization, such as more senior
employees. Preceptors, as the main socializing agents, have a direct impact on new
employees. The literature suggests that preceptors should have certain characteristics, such
as patience, strong knowledge base and skills, and strong interpersonal skills, yet few have
empirically examined this (Anderson, 1998; Barrett & Myrick, 1998; Finger & Pape, 2002;
Giallonardo, Wong, & Iwasiw, 2010; Kaviani & Stillwell, 2000; Zilembo & Monterosso,
2008). The nature of the relationship between the preceptor and new nurse, as well as the
importance of the preceptor for the new graduate’s transition is often not captured in the
literature. New graduate nurses work side by side with and learn how to nurse from their
preceptor for 12 hours a day full-time for the duration of the program, anywhere from four
weeks to one year. During this time, new graduate nurses must learn how to be independent
and competent practitioners. The transition period from student to new nurse is a difficult
one, fraught with conflict, feelings of insecurity, uncertainty and being overwhelmed
(Boychuk Duchscher, 2009; Casey et al., 2004; Duclos- Miller, 2011; Feng & Tsai, 2012;
Kramer, 1974). Preceptors are the ones who assist new nurses through this difficult
transition on a daily basis. To accomplish this, preceptors must be able to understand how
difficult this transition period is, and understand and anticipate what the new nurse might
need. For preceptors to be able to do this, they must have an understanding of their own
feelings and must be able to use this knowledge to facilitate thinking and actions, not only in
themselves but with their new nurse. There is evidence to suggest that an individual’s
emotional intelligence may have a positive impact on teachers’, coaches’ and leaders’
effectiveness. Thus, the emotional intelligence of the preceptor may be an important variable
to consider as influencing new nurses’ socialization during a preceptorship program. There
48
are no studies that have explored the relationship between the socializing agent’s level of
emotional intelligence and a new employee’s socialization. The following section will
provide a review of the literature on emotional intelligence, with a focus on emotional
intelligence in nursing.
Emotional Intelligence
Emotions and their effects have been depicted in the arts and literature for centuries
(Oatley, 2004). Darwin was one of the first scientists to identify the importance of emotions
(Lopes, Côté, & Salovey, 2006; Oatley). In his book the expression of emotions in man and
animals (1872), Darwin concluded “expressions of emotions in human adults can occur
whether or not they are any use” (as cited in Oatley, p.22). Several decades later,
psychologists began studying the role that emotions may have on an individual’s adjustment
and functioning. In 1948, Leeper faulted the psychological community for their
understanding of emotions as “a disorganized process”, instead arguing that emotions
produce organization. In the 19th
and 20th
centuries, interest in emotional intelligence
increased from the seminal work of Gardner (1983) on a theory of multiple intelligences,
Salovey and Mayer’s (1990) theory of emotional intelligence, and the popular mainstream
book on emotional intelligence by Goleman (1995).
Salovey and Mayer (1990) define emotional intelligence as “the ability to monitor
one’s own and others’ emotions, to discriminate among them, and to use the information to
guide one’s thinking and actions” (p. 189). Mayer and Salovey (1997) conceptualize
emotional intelligence as comprising four abilities: the ability to: (a) perceive, appraise, and
express emotion accurately; (b) access and generate feelings when they facilitate cognition;
(c) understand affect-laden information and make use of emotional knowledge; and (d)
49
regulate emotions to promote emotional and intellectual growth and well-being (Druskat,
Sala, & Mount, 2006; Mayer & Salovey). Mayer, Roberts, and Barsade (2008) state that the
primary focus of emotional intelligence “has to do with reasoning about emotions and the
use of emotions to enhance thought” (p. 511).
Research on emotional intelligence has been occurring in various disciplines
including psychology, child education, and business and management, since the 1980s.
Sports researchers have recently started examining the potential role of emotional
intelligence in athlete performance (Lane, Gill, & Thelwell, 2007; Perlini & Halverson,
2006). Research in health care, particularly nursing, began emerging in the late 1990s and
early 2000s (Bellack, 1999; Cadman & Brewer, 2001; Freshwater & Stickley, 2004;
McQueen, 2004; Muller- Smith, 1999; Simpson & Keegan, 2001; Strickland, 2000; Vitello-
Cicciu, 2002; 2003).
The literature on emotional intelligence emerging from the business and
management fields suggests that emotional intelligence may play a role in the work
environment (Sy et al., 2005). It has been reported that EI can be an important predictor of
work-related outcomes, such as job satisfaction and performance (Bar-On, Handley, &
Fund, 2006; Boyatzis, 2006; Ramo, Saris, & Boyatzis, 2009; Sy et al.). Côté and Miners
(2006) examined the relationship between emotional intelligence, cognitive intelligence, job
performance, and organizational citizenship behaviour in 175 full-time university
employees. Participants completed emotional and cognitive intelligence testing and
supervisors completed job performance and organizational citizenship behaviour ratings on
their employees. The authors report that cognitive intelligence moderated the relationship
between emotional intelligence, supervisor-rated task performance, and organizational
50
citizenship behaviour directed at the organization, such that the relationships became more
positive with decreasing levels of cognitive intelligence (Côté & Miners). These results
suggest that higher emotional intelligence may compensate for lower levels of cognitive
intelligence in relation to task performance (Côté & Miners). Studies have also demonstrated
that emotional intelligence may positively impact leader success (Bar-On et al.; Cummings
et al., 2005; Sy et al.; Wong & Law, 2002; Wu et al., 2006; Zhou & George, 2003).
Recently, the nursing profession has begun to look at the role that emotional intelligence
might play in nursing and emotional intelligence has been examined within the contexts of
leadership, professional practice and education (Bellack, 1999; Cadman & Brewer, 2001;
Freshwater & Stickley, 2004; Hurley, 2008; Muller- Smith, 1999; Simpson & Keegan, 2001;
Stichler, 2006; Strickland, 2000; Vitello- Cicciu, 2002; 2003).
Emotional Intelligence and Nursing Practice
A systematic review on emotional intelligence, with a particular focus on studies
relevant to nursing (N= 16), revealed that emotional intelligence includes emotional
awareness of self and others, professional efficiency, and emotional management
(Akerjordet & Severinsson, 2007). Additionally, emotional intelligence may have relevance
for nurses’ clinical practice by affecting their worklife quality and leading to more positive
attitudes, adaptability, and enhanced relationships (Akerjordet & Severinsson). The
literature also suggests that nurses need to draw on emotional intelligence skills to provide
patient care and the nursing curriculum should reflect this need (McQueen, 2004).
Kooker, Shoultz, and Codier (2007) applied Goleman’s framework of emotional
intelligence to analyze nurses’ stories (N=16) about their practice to discover if there were
factors in the stories that may potentially improve nurse retention rates and patient
51
outcomes. The authors analyzed the stories using Goleman’s emotional intelligence domains
and their respective competencies, and reported that all four domains and competencies were
identified across the 16 stories. The most commonly demonstrated domain was social
awareness at 30%, followed by social management at 28%, self-awareness at 27%, and self-
management at 15%. The authors conclude that the integration of emotional intelligence
concepts in the workplace may provide new insights into how to keep nurses engaged in
their practice, and to improve retention rates and patient outcomes.
A qualitative study of 22 hospice workers, including 14 employees involved with
training, six clinical nurse specialists, and two managers from 20 hospices in the United
Kingdom aimed at exploring the development of emotional abilities within the context of
workplace learning (Clarke, 2006). Two emotional abilities consistent with Mayer and
Salovey’s (1997) abilities model were identified as being linked with the performance of a
caring role within the hospice context, namely, the ability to manage and use emotions for
thinking and for acting. Key findings of this study are that specific learning strategies within
the workplace are important in developing emotional abilities, such as work experience, the
emotional knowledge transfer that occurs with relationships with colleagues and managers,
dialogue and reflection, and workplace-supported learning.
An exploratory study by Codier, Kooker, and Shoultz (2008) provided the first
quantitative evidence of a relationship between emotional intelligence and performance of
staff nurses. The authors conceptualized emotional intelligence using Mayer and Salovey’s
(1997) abilities model in a sample of staff nurses (N=27) from three American hospitals
whose emotional intelligence was measured using the Mayer- Salovey- Caruso Emotional
Intelligence Test version two (MSCEIT V2). The authors reported a significant positive
52
correlation between nurses’ emotional intelligence and performance (p≤ 0.05). The authors
also indicated that 37% of the participants scored below average on the total EI score, with
below average scores found in each of the four branches of Mayer and Salovey’s model.
Specifically, 41% of the sample had below average scores in the perceiving branch, 22% in
the managing emotions branch, 26% in the using branch, and 11% in the understanding
branch. These results suggest that a third of the nurses in this sample have emotional
intelligence levels that are below that of the general population. This is a finding that is
contrary to what one might expect in nurses. More recently, Codier, Freita and Muneno
(2013) examined the impact of an emotional intelligence training program on developing the
EI of oncology nurses (N= 33). Participants’ EI was measured using the MSCEIT V2 pre
and post- intervention. Although the authors were not able to statistically analyze the data
due to a small sample size, they report that in this sample of nurses the mean EI was 99
which is considered average.
Güleryü, Güney, Aydin, and Aşan (2008) examined the mediating role of job
satisfaction between emotional intelligence and organizational commitment in a sample of
staff nurses (N= 267) in Turkey. Nurses’ emotional intelligence was assessed using Wong
and Law’s (2002) ‘Emotional Intelligence Questionnaire’, measuring four different
dimensions of emotional intelligence: (1) appraisal and expression of emotion in the self
(SEA), (2) appraisal and recognition of emotion in others (OEA), (3) regulation of emotion
in the self (ROE), and (4) use of emotion to facilitate performance (UOE). The authors
utilized structural equation modeling to test their proposed mediation model which they
report was supported by the model fit indices (χ²=19.151, p=0.085, χ²/d.f.=1.473, RMSEA=
53
0.047, GFI=0.980). The authors found that job satisfaction mediated the relationship
between emotional intelligence and organizational commitment.
Landa, Lopez-Zafra, Martos and Aguilar-Luzon (2008) measured nurses’ EI in Spain
(N= 180) using the Trait Meta Mood Scale to investigate the relationship between EI, work
stress and health. The authors report that in their sample, emotional intelligence had a
protective effect on nurses’ stress and facilitated health.
The main limitations to the literature on emotional intelligence in nursing are small
sample sizes, use of self-report measures, and the lack of controlling for the effects of
potential confounding variables. Therefore, it is difficult to make substantive conclusions on
the impact of emotional intelligence within nursing practice.
Emotional Intelligence and Interpersonal Relationships
There is evidence to suggest that emotional intelligence may influence interpersonal
relationships. Individuals with higher emotional intelligence report having more positive
relationships with others (Lopes, Salovey, & Straus, 2003), greater self-perception of social
competence in men (Brackett, Rivers, Shiffman, Lerner, & Salovey, 2006), having
cooperated more with others, greater marital satisfaction, and higher social skills (Schutte et
al, 2001). Additionally, in a sample of nurses, higher emotional intelligence was associated
with greater group cohesion (Quoidbach & Hansenne, 2009). Lopes, Grewal, Kadis, Gall,
and Salovey (2006) found that, in a sample of finance staff (N=44), employees’ emotional
intelligence was associated with both peer and manager ratings on several of the following
six indicators of interpersonal facilitation: (1) interpersonal sensibility; (2) sociability; (3)
positive interaction; (4) negative interaction; (5) contribution to a positive work
environment; and (6) liking. Emotional intelligence was associated with peer-rated
54
sociability and contributing to a positive working environment and with supervisor-rated
sociability, liking and contribution to a positive work environment. Given these findings, it
is possible that emotionally intelligent preceptors will have greater interpersonal
relationships with their new nurses.
The current level of knowledge on the concept of emotional intelligence within the
field of nursing is limited. However, nurse researchers are recognizing the important work
that has occurred in other disciplines and have begun theorizing and investigating the
potential role of emotional intelligence in nursing. Recent nursing literature indicates that EI
is relevant to nursing practice (Codier et al., 2008; Kooker et al., 2007). Emotional
intelligence abilities are linked with the performance of a caring role within the hospice
context (Clarke, 2006), and may have relevance for nurses’ clinical practice by affecting
their worklife quality leading to more positive attitudes, adaptability, and enhanced
relationships (Akerjordet & Severinsson, 2007). Additionally, the integration of EI concepts
in the workplace may provide new insights into how to keep nurses engaged in their
practice, to improve retention rates, and patient outcomes (Kooker et al.). This literature
review suggests that there is a growing interest in applying emotional intelligence awareness
in nursing education and in the workplace.
Limitations of the Emotional Intelligence in Nursing Literature
In the psychology and management science literature, there are researchers who
question the utility and distinctiveness of emotional intelligence as a construct (Locke, 2005;
Schulte, Ree, & Carretta, 2004; Zeidner, Roberts, & Matthews, 2004; Zeidner, Matthews, &
Roberts, 2004). For example, Schulte et al (2004) examined the relationships between
emotional intelligence, as measured by the MSCEIT, personality and cognitive intelligence.
55
The authors reported a strong relationship between emotional intelligence and cognitive
intelligence and agreeableness. Thus, the authors question the uniqueness of emotional
intelligence as a construct. There are several possible alternative explanations to the
hypothesis that it is an individual’s emotional intelligence that has an impact on his/her work
outcomes, such as that it is really because they are smarter, friendlier, or more open to
experiences.
There are two important confounding variables that nursing researchers have not
accounted for in their examination of emotional intelligence in nursing, namely cognitive
intelligence and personality. Positive findings in the study of the role of emotional
intelligence in nursing practice may be plagued with an alternate explanation; it is a nurse’s
cognitive intelligence, rather than emotional intelligence that has an effect on their practice.
Schulte et al. (2004) reported a moderate correlation between cognitive intelligence and
emotional intelligence, r= .45, as measured by the MSCEIT. The second important
confounding variable to consider is personality. McCrae and Costa (1997) propose that
“personality traits represent variations in basic human ways of acting and experiencing” (p.
509). The big five personality traits include: (1) extraversion- the propensity to be social,
assertive, and eager (Hirschfeld, Jordan, Thomas, & Feild, 2008); (2) agreeableness-
involves being friendly and cooperative (Hirschfeld et al.); (3) conscientiousness- involves
being reliable, hardworking, and thorough (Côté & Miners, 2006; Hirschfeld et al.); (4)
openness to experience- involves being curious and open to different ways of thinking
(Caligiuri, 2000; Hirschfeld et al.); and (5) emotional stability- “describes individuals who
display self-control in being emotionally secure, remaining calm under stressful conditions,
and mitigating persistent negative feelings” (Hirschfeld et al., p. 389). Brackett and Mayer
56
(2003) reported correlations between the MSCEIT, openness (r= .25) and agreeableness
(r=.28). These authors also reported correlations between two other measures of emotional
intelligence and the big five personality traits. Similarly, Mayer, Salovey, and Caruso (2004)
have reported correlations between the MSCEIT and agreeableness (r=.21), openness
(r=.17), and conscientiousness (r=.11). If personality is not accounted for in the study of
emotional intelligence, then a possible alternate explanation for any study findings may be
that it is a nurse’s personality that has an effect on their practice, such as how friendly or
how thorough they are in their role, as opposed to their emotional intelligence.
Conclusions
The relationship between a preceptor and new nurse is an important one as it will
help facilitate new nurses’ socialization during a difficult transition. The literature review
reveals a gap in our understanding of the role that a preceptor’s individual differences might
play in the socialization process of new nurses during a preceptorship program. The
literature in the field of emotional intelligence suggests that it may play an important role in
educators’ teaching self-efficacy, the effectiveness of leaders, and interpersonal and group
relationships. Knowledge of the role of emotional intelligence in nursing is limited. The few
nursing studies that examined emotional intelligence did not account for the confounding
effects of personality and cognitive intelligence. Thus, the results of these studies must be
interpreted with caution. There are alternative explanations for the findings that could not be
ruled out, including that it is: (1) the nurses’ cognitive intelligence that explains the
outcomes or (2) because the nurses were friendlier or more conscientious. There are no
studies exploring the relationship between the emotional intelligence of a preceptor, or
socializing agent, and a new employee’s socialization. Examining a preceptor’s emotional
57
intelligence is important as it will increase our understanding of how preceptors affect new
graduate nurses’ socialization during a preceptorship program (Baltimore, 2004).
Additionally, the outcomes associated with organizational socialization have been studied
since the 1970s. Since that time, the results have provided some consistent evidence that role
conflict, role ambiguity, job satisfaction, and turnover intent are important indicators of
socialization. As preceptorship programs are modes of socialization, these outcomes are just
as relevant for nursing.
The addition of more novel and complex relationships and the use of more rigorous
methodologies to the study of preceptorship and socialization has several important
theoretical and empirical implications, such as preventing researchers from drawing
incorrect conclusions about the relationships under study, providing information on the
boundary conditions for the relationships under study, preventing the implementation of
interventions which may lead to different or opposite effects than planned, and leading to the
advancement of theoretical and empirical knowledge (Aguinis, 2004). Perhaps one of the
reasons why the findings to date are so inconsistent and contradictory is that the
relationships between the antecedents’ and outcomes are not as simple and direct as nursing
researchers have traditionally conceptualized them, but are instead more complex.
This study addressed many of the limitations identified in the literature review by
controlling for the potential effects of several confounding variables. First, this study
controlled for preceptors’ personality and cognitive intelligence. Second, this study also
included three important new graduate nurse control variables, core self-evaluations, first
job of choice and previous experience on unit. Third, this study also included measures of
new nurses’ variables demonstrated in the literature to be important socialization outcomes.
58
The addition of these variables has strengthened the likelihood of being able to draw
substantive conclusions on the impact of preceptors’ EI on new nurses’ outcomes.
59
CHAPTER III
CONCEPTUAL FRAMEWORK
Van Maanen and Schein’s (1979) theory of organizational socialization provides the
conceptual foundation for the exploration of the impact of a preceptor’s emotional
intelligence on new graduate nurses’ socialization outcomes during a preceptorship program.
Van Maanen and Schein’s theory is one of the most widely recognized organizational
socialization theories and has been extensively researched in the business and management
fields. Formal newcomer training programs, such as orientation or preceptorship programs,
have become the predominant organizational socialization method for many new employees
(Saks & Ashforth, 1997a). Therefore, the use of this theory will provide a new lens through
which the socialization process of new graduate nurses will be examined and may deepen
the theoretical understanding of this process.
Theory of Organizational Socialization
Organizational socialization is defined as “the process by which an individual
acquires the social knowledge and skills necessary to assume an organizational role” (Van
Maanen & Schein, p. 211). Preceptorship programs are the process, or the medium, through
which organizations can provide new graduate nurses with the social knowledge and skills
needed to take on their role as a nurse. Saks, Uggerslev, and Fassina (2007) expanded Van
Maanen and Schein’s (1979) definition to include a focus on how new employees adjust to
their new environment and role so that they may become a contributing member of the
organization. Organizational socialization not only involves the organization’s impact on
new employees, but also the impact new employees have on the organization. Additionally,
successful socialization occurring early in the new employee’s entry into the organization
60
will affect the long-term adjustment of the employee (Ashforth, Sluss, & Harrison, 2007).
For example, the review of the preceptorship literature suggests that the implementation of
preceptorship programs for new graduate nurses’ may have an impact on the long term
adjustment of these new nurses through increased retention rates.
Van Maanen & Schein’s (1979) theory has six main underlying assumptions. The
first assumption recognizes that organizational transitions are anxiety producing situations.
Thus, employees’ going through organizational transitions are motivated to diminish this
anxiety by quickly learning the social and functional requirements of their new role. The
second assumption is that the employee who is undergoing an organizational transition is
vulnerable to the influences of the individuals immediately surrounding them, such as
colleagues, supervisors, and preceptors. These individuals provide the employee with
support and guidance on how to perform the new role, and finally with a sense of
accomplishment and competence, or failure and incompetence. The third assumption
recognizes that the stability, productivity and survival of an organization is dependent on
how employees undergoing transition eventually perform their new roles. Fourth, although
there is considerable similarity in the way individuals adjust to new situations, there is great
variation in the type of adjustments achieved, or not achieved. However, employees
undergoing an organizational transition will inevitably experience at least some reality shock
as their original understandings of the new role will change during this transition. A period
of adjustment is expected. Fifth, this theory does not outline how organizations must
socialize employees to specific roles. However, the ways in which the socialization is
structured, using various combinations of tactics, may lead to different new employee
outcomes. Thus, recognizing individual uniqueness; what may be functional for one
61
employee may be dysfunctional for another. The final assumption of this theory is that it is
generalizable to any work context and organizational role. These assumptions, all applicable
to the health care setting, make Van Maanen and Schein’s theory particularly well suited for
the examination of new nurses’ socialization during a preceptorship program.
Van Maanen & Schein (1979) propose that “what people learn about their work roles
in organizations is often a direct result of how they learn it” (p. 209). They argue that
organizations, therefore, implement six bipolar tactics to integrate newcomers (see Table 1).
Organizational socialization tactics “refer to the ways in which the experiences of
individuals in transition from one role to another are structured for them by others in the
organization” (Van Maanen & Schein, p. 230). These tactics exist along a continuum with
substantial range between the two ends. Each of the six bipolar socialization tactics uniquely
organizes a new employee’s learning experiences to a particular role and shape the way
information is provided to new employees. Organizations can thus influence what new
employees learn and how new employees take on their new role, based on the socialization
tactics used.
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Table 1. Van Maanen & Schein’s Six Bipolar Organizational Socialization Tactics
Six Bipolar Organizational Socialization Tactics
Vs.
Collective Processing new employees together as a group through a
common set of experiences Designed to produce standardized responses to situations
↔ Individual Processing new employees individually through unique
experiences
Formal Separating new employees from the rest of the organization
while undergoing specific experiences designed for them Tends to occur in professions or settings in which there are
high levels of risk for the new employees, co-workers, the
organizations, and/or their clients
↔ Informal Separating new employees from each other while undergoing
unique sets of experiences On the job learning
Sequential New employees are provided with specific and explicit
knowledge of the expected sequence of events and stages that
they will need to go through
↔ Random New employees are not provided with specific and explicit
knowledge of the expected sequence of events and stages
Fixed Set timetable to get from one stage to the next. ↔ Variable
No set timetable; variable New employees are not provided with information about when
they may reach a certain stage
Serial New employees being actively role-modeled by more
experienced colleagues
↔ Disjunctive No active role-modelling
Investiture Accepting the identity, personal characteristics, and
experiences that the newcomer brings to the organization New employees receive positive social support
↔ Divestiture New employees receive negative social communication from
others until they begin to fulfill expectations.
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Jones (1986) further differentiates these socialization tactics into either an
“institutional socialization” or an “individual socialization” (Table 2). Institutional
socialization is characterized as including collective, formal, sequential, fixed, serial, and
investiture tactics which provide new employees with information that reduces the
uncertainty in early work experiences and reflects a more structured and formal socialization
process. By contrast, “individual socialization” includes individual, informal, variable,
random, and disjunctive tactics that reflects an absence of structure, where new employees
are socialized more by default than by design, which may increase anxiety and uncertainty
(Jones). This reconceptualization has been empirically supported in a number of studies
since that time (Cooper- Thomas & Anderson, 2002; Jones, 1986; Saks & Ashforth, 1997b;
Saks et al., 2007).
Table 2. Jones (1986) Reconceptualization of the Classification of Socialization Tactics
(p. 263)
Jones (1986) also delineated Van Maanen and Schein’s organizational socialization
tactics into three categories (Table 2). Those tactics concerned with (1) the contexts in which
Institutional Socialization Individual Socialization
Collective
Formal
Individual
Informal
Sequential
Fixed*
Random
Variable
Serial
Investiture*
Disjunctive
Divestiture
Tactics mainly
concerned with:
CONTEXT
CONTENT
SOCIAL ASPECTS
*Indicates reverse of effects hypothesized by Van Maanen and Schein (1979)
64
organizations provide information to their new employees are collective vs. individual and
formal vs. informal, (2) the content of the information provided to new employees during
socialization, sequential vs. random and fixed vs. variable, and (3) the social or interpersonal
elements of the socialization process of new employees are serial vs. disjunctive and
investiture vs. divestiture. The social elements involve the new employee being paired one-
on-one or working closely with a more experienced employee.
Van Maanen and Schein’s (1979) second assumption asserts that new employees’ are
vulnerable to the influences of the individuals immediately surrounding them, as they
provide important information and support on how to perform the new role. Jones (1986)
postulated that the social aspects of the socialization tactics would be the most important of
the three tactics categories in facilitating new employees’ socialization into an organization
because they provide the necessary social cues and assistance throughout the learning
process. Jones’ results demonstrated that these social aspects had a greater effect on new
employees’ socialization than did the context or content tactics. This finding has been
supported by others (Allen & Meyer, 1990; Anakwe & Greenhaus, 1999; Jones, 1986;
Kammeyer-Mueller & Wanberg, 2003; Klein, Fan, & Preacher, 2006; Kowtha, 2008; Saks
et al., 2007). Thus, preceptors are aptly situated to influence how new nurses are socialized
during a preceptorship program.
Although there is evidence that these more experienced colleagues, or socializing
agents, are important to new employees’ socialization, there is a lack of understanding of the
mechanisms through which socializing agents influence new employees. Additionally, there
is a lack of evidence on the specific characteristics or individual differences that may be
important and how they influence new employees (Ashforth et al., 2007; Jones, 1986; Saks
65
& Ashforth, 1997a; Van Maanen & Schein, 1979). The nursing preceptorship literature also
suggests that there is something about a preceptor as an individual that is important to
assisting new nurses’ through their transition during a preceptorship program (Baltimore,
2004; CNA, 2004; Hartline, 1993; Myrick and Barrett, 1994; Speers et al., 2004;
Wolfensperger Bashford, 2002).
Although there may be a number of preceptors’ individual differences that might
influence new graduate nurses’ socialization, a preceptor’s emotional intelligence is an
important one to consider for several reasons. First, the nursing literature suggests that the
transition from student to new nurse is one fraught with anxiety, uncertainty and feelings of
being overwhelmed. Van Maanen and Schein (1979) also assert that new employees
experience anxiety during their transition period. New graduate nurses have reported that
they need a preceptor who will be able to provide them with the support, advice, and
reassurance they need to cope with the challenges of transitioning from student to nurse
(Finger & Pape, 2002; Hardyman & Hickey, 2001; Thomka, 2001). Additionally, new
nurses report wanting a closer relationship with their nurse preceptor (Thomka). Second, the
literature suggests that emotional intelligence may have a positive effect on interpersonal
relationships, as well as teachers’ and leaders’ effectiveness. Thus, this thesis proposes that a
preceptor’s emotional intelligence will influence new graduate nurses’ socialization
outcomes in two overarching methods, through the development of a positive relationship
with the new nurse and through how preceptors teach in the clinical setting. Within each of
these, there are specific mechanisms by which the preceptors’ emotional intelligence
abilities will function.
66
Preceptor’s Emotional Intelligence
Development of a Positive Relationship
The first method through which a preceptor’s emotional intelligence will influence
new nurses is through the relationship that is built with the new nurse. When providing
patient care, nurses do not solely rely on their technical skills, but much of their work
requires personal interactions with patients, their families, and other health care team
members. Additionally, much of what is involved in a preceptorship program centers around
the interpersonal relationship that is developed between the preceptor and the new nurse.
Highly emotionally intelligent preceptors may be expected to develop more positive
relationships with the new graduate nurse in several ways. First, these preceptors will use
their ability to accurately perceive and understand the emotions displayed by the new
graduate nurses, which will in turn inform how these preceptors will interact with the new
nurses. For example, the preceptor may recognize that the new nurse is scared or anxious
about speaking to the family members of a critically ill patient, thus implying that the new
nurse may need some extra support from the preceptor. Second, emotionally intelligent
preceptors will develop more positive relationships with new nurses through their expression
and generation of authentic emotions (Côté & Miners, 2006). For example, a preceptor who
demonstrates real happiness for a new nurse who successfully performs an intervention for
the first time or shows concern if the new nurse is upset because of the death of a patient
will foster a more positive relationship with the new nurse than one who does not. Lastly,
emotionally intelligent preceptors will develop positive relationships with new nurses
through how they manage their own emotions. For example, a preceptor who is having a
particularly difficult and busy day may become upset and angry when the new nurse
67
interrupts to ask a question about something that they should already know. However, an
emotionally intelligent preceptor would control their feelings of anger and would direct the
new nurse to the appropriate source of information.
Effective Teaching in Clinical Setting
Acting as clinical teachers, preceptors may be important in assisting new nurses to
adjust to their new role by facilitating the development of their confidence and clinical
skills. Another method by which a preceptor’s emotional intelligence will affect new nurses’
socialization is through how they teach within the clinical setting. Emotionally intelligent
preceptors will be more effective teachers in a variety of ways. First, emotionally intelligent
preceptors will use their ability to accurately perceive and understand the emotions
displayed by the new graduate nurses. These preceptors will use this knowledge to inform
how they will further proceed. For example, the preceptor may recognize that the new nurse
is scared or feeling overwhelmed prior to performing a procedure for the first time, thus
implying that the new nurse may need some positive reinforcement or extra guidance from
the preceptor. Second, emotionally intelligent preceptors will be able to access and generate
feelings to facilitate how they think and act with the new graduate nurse, thus affecting how
they teach. For example, when getting prepared to teach a new nurse how to assess a patient
for the first time, an emotionally intelligent preceptor may access how they felt the first time
they had to perform a patient assessment when they were a new nurse. These preceptors
would use these emotions to validate the new nurses’ likely similar feelings, as well as direct
how they will most effectively teach the new nurse to perform the clinical assessment.
Finally, emotionally intelligent preceptors will be more effective teachers through how they
manage their own and the new nurses’ emotions (Zhou & George, 2003). This will be
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demonstrated with two examples. A preceptor who discovers that their new graduate nurse
is visibly upset and frightened because they made a medication error knows that hostility
and anger directed at the new nurse is not effective. Instead, reacting calmly, assessing the
patient together for any adverse events, and then discussing with the new nurse what went
wrong and how to prevent further errors, would be a more productive learning experience.
Alternatively, a highly emotionally intelligent preceptor may understand that patient care
may be negatively affected if the new nurse is afraid or overwhelmed when performing a
procedure for the first time. Thus, the positive reinforcement or extra demonstration that the
preceptor provides the new nurse prior to performing this procedure may change the new
nurse’s emotions from fear and overwhelmed to excitement and joy at having this learning
opportunity, which is more productive.
Hypotheses
The following section delineates the relationships between preceptors’ emotional
intelligence and four new graduate nurses’ socialization outcomes. The outcome variables
that will be examined in relation to a preceptor’s emotional intelligence are new graduate
nurses’ role conflict, role ambiguity, job satisfaction, and turnover intent at the end of the
preceptorship program. Van Maanen and Schein’s (1979) theory is particularly well suited
for the study of the impact of preceptors’ emotional intelligence on the socialization of new
nurses during a preceptorship program. This theory has been used to understand the
adjustment of new employees in the field of business/ management for 30 years and has
acquired solid empirical support. It may enrich our understanding of new nurses’
socialization by providing a structured lens through which the effect of a preceptor’s
emotional intelligence can be examined, as well as through the measurement of well-defined
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and traditional organizational outcomes. Figure one represents the model of the
hypothesized relationships between the concepts under study in this thesis.
Miller and Jablin (1991) contend that new employees rely on more experienced
employees for the information they need to perform their role and develop role clarity.
However, when these new employees do not receive the information they need, they may
experience elevated levels of uncertainty, which is reflected in high levels of role ambiguity
and conflict (Miller & Jablin). In a sample of Canadian university nurse faculty (N=33),
Acorn reported that the social support provided by colleagues and supervisors decreased role
conflict. Acorn defined social support as the resources that were provided by others, such as
informational, emotional, and appraisal. As preceptors with higher emotional intelligence
will be more effective as clinical teachers, they will provide new graduate nurses’ with the
information and guidance that they need to reduce their uncertainty during the preceptorship
program, thus lowering new graduate nurses role ambiguity and conflict. Therefore, it is
hypothesized that:
Hypothesis 1: A preceptor’s emotional intelligence will be negatively related to new
graduate nurses’ role ambiguity at the end of the preceptorship program.
Hypothesis 2: A preceptor’s emotional intelligence will be negatively related to new
graduate nurses’ role conflict at the end of the preceptorship program.
The development of a positive relationship with the new nurse during the
preceptorship program will positively affect new nurses’ job satisfaction and will lower their
intent to turnover because the preceptor provides the new nurse with a first glimpse into the
work life of the organization (Ashforth et al., 2007). Thus, this will positively influence how
the new nurse feels about the unit of hire and the working environment. In a sample of new
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engineers (N=135), Kowtha (2008) found that supportive behaviour from colleagues and
supervisors was the strongest predictor of high job satisfaction and lower intent to turnover.
This finding has also been supported by a meta-analysis (Saks et al., 2007). Therefore, it is
hypothesized that:
Hypothesis 3: A preceptor’s emotional intelligence will be positively related to new
graduate nurses’ job satisfaction at the end of the preceptorship program.
Hypothesis 4: A preceptor’s emotional intelligence will be negatively related to new
graduate nurses’ turnover intent at the end of the preceptorship program.
Miller and Jablin (1991) argue that new employees’ role ambiguity and conflict are
important because they in turn may affect job satisfaction and turnover. Previous research,
including two meta-analyses, has demonstrated that role ambiguity and conflict are related
to job satisfaction and turnover (Acorn, 1991; Ashford & Cummings, 1985; Fisher &
Gitelson, 1983; Jackson & Schuler, 1985). In a sample of Canadian university nurse faculty
(N=33), Acorn reported that role ambiguity and conflict had a negative effect on job
satisfaction and was related to intent to leave. There is also evidence to suggest that new
employees’ role ambiguity and conflict may partially mediate the relationship between how
a new employee is socialized in the workplace and new employees’ job satisfaction and
turnover intent (Kammeyer-Mueller & Wanberg, 2003; Saks et al., 2007). Thus, it is
hypothesized that:
Hypothesis 5: New graduate nurses’ role ambiguity will partially mediate the
relationship between a preceptor’s emotional intelligence and new graduate nurses’
job satisfaction.
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Hypothesis 6: New graduate nurses’ role ambiguity will partially mediate the
relationship between a preceptor’s emotional intelligence and new graduate nurses’
and turnover intent.
Hypothesis 7: New graduate nurses’ role conflict will partially mediate the
relationship between a preceptor’s emotional intelligence and new graduate nurses’
job satisfaction.
Hypothesis 8: New graduate nurses’ role conflict will partially mediate the
relationship between a preceptor’s emotional intelligence and new graduate nurses’
turnover intent.
A meta-analysis on job satisfaction and turnover in nursing demonstrated that job
satisfaction had a small negative relationship with nurse turnover (Irvine & Evans, 1995).
Thus, it is hypothesized that:
Hypothesis 9: New graduate nurses’ job satisfaction will be negatively related to new
graduate nurses’ turnover intent at the end of the preceptorship program.
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Figure 1. Conceptual Model
73
CHAPTER IV
METHODOLOGY
Design
This study utilized a cross-sectional design to examine the hypothesized relationships
between a preceptor’s emotional intelligence, and new graduate nurses’ role ambiguity, role
conflict, job satisfaction, and turnover intent following a preceptorship program.
Setting and Sample
Setting
Primary data collection took place using purposeful sampling at five hospitals (see Table
3 for a detailed description of each site). Three of the hospitals were large teaching hospitals
affiliated with the University of Toronto and the other two were large community hospitals in the
greater Toronto area. These hospitals were chosen in order to increase the likelihood of obtaining
the sample.
The total projected sample of new graduate nurses available in these five hospitals was
expected to be between 245 and 360. All five settings stated that although the content and
structure of preceptorship programs may vary from unit to unit, they all provided their new
graduate nurses with a three month preceptorship program. All five sites aimed to provide new
graduate nurses with continuity using the same preceptor during their preceptorship program.
However, since preceptorship programs for new nurses often occur during the summer months,
vacation and sick time can be barriers to providing preceptor continuity. In such cases, new
graduate nurses may be assigned to a main preceptor and will have one or two other nurses that
may fill in as preceptors during vacation and sick time.
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Table 3. Description of Study Sites
Hospital Number of
Inpatient
Beds
Number of
NGNs Hired in
2008
Number of
NGNs Hired in
2009
Number of NGNs
Hired in 2012
Type of Preceptorship Program
Community
hospital 1 Over 400
inpatient beds
Community
hospital
50 to 90 NGNs
hired a year in the
past two years
50 to 90 NGNs
hired a year in the
past two years
(Site PI, personal
communication,
August 10th
, 2009).
12 NGNs Participate in a one week hospital orientation.
NGNs’ hired with the Nursing Graduate
Guarantee Initiative receive a three month unit
preceptorship program and work one to one
with a preceptor.
NGNs’ hired in the emergency department
participate in a three month 4:1 preceptorship
program, where four new graduate nurses
work with one preceptor
Community
hospital 2
574 inpatient
beds
Community
Hospital
Consistently hire
between 40 to 60
NGNs every year
60 NGNs
(Site PI, personal
communication,
August 11th
, 2009).
Unknown
Estimated at about
1-2 NGNs a month
(will include RPN
NGNs)
NGNs spend one week in classes
A three month one on one preceptorship
program
Affiliated
hospital 1 671 inpatient
beds
Teaching
hospital
95 NGNs
(Site PI, personal
communication,
April 10th
, 2009).
90 NGNs
(Site PI, personal
communication, June
19th
, 2009).
25- 30 NGNs Participate in an eight day Hospital
orientation.
Called Mentorship Programs.
NGNs’ hired with the Nursing Graduate
Guarantee Initiative receive a three month one
on one mentorship program.
NGNs’ hired in critical care units may receive
up to six months of training.
Affiliated
hospital 2 370 inpatient
beds
Teaching
hospital
60-90 NGNs
(Site PI, personal
communication,
September 24th
,
2010).
60-90 NGNs
(Site PI, personal
communication,
September 24th
,
2010).
82 NGNs Participate in a hospital orientation.
Participate in didactic sessions
NGNs are assigned one preceptor and may
spend some clinical time rotating to related
clinical areas.
NGNs in critical care areas are provided with
a six months to a year preceptorship program.
NGNs hired in all other specialty areas are
provided with a three months preceptorship
program
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Affiliated
hospital 3 472 inpatient
beds
Teaching
hospital
25 NGNs
(Site PI, personal
communication,
March, 2012)
25 NGNs
(Site PI, personal
communication,
March, 2012)
Unknown
Estimated at about
20- 25
Participate in a hospital orientation.
Participate in didactic sessions
A three month one on one preceptorship
program
Estimated Number of New
Graduate Nurses Hired:
245- 360
260-355
151- 173 NGNs = New Graduate Nurses
RPN= Registered Practical Nurse
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Sample
The target population comprised dyads of new graduate nurses and their preceptors
employed in a sample of acute care teaching and community hospitals in Toronto, Canada. A
new graduate nurse was defined as a nurse who had graduated from an accredited university
nursing program within the last six months and was within either: (a) the last month of the
preceptorship program or (2) the first month after completing the preceptorship program for
his/her first job in nursing. A preceptor was defined as a nurse who was acting as the unit-based
teacher that has been assigned to partner with the new graduate nurse for a pre-determined length
of time. Only new graduate nurses and their preceptors were recruited.
The inclusion criteria for this study were: (1) new graduate nurses’ that had a main
preceptor who is most responsible for their preceptorship program and ongoing evaluation; (2)
preceptors who were assigned to partner with a new graduate nurse for clinical teaching and
evaluation; and (3) participants were able to read and write English.
Sample Size
Cohen’s power analysis methodology for multiple regression and correlational analysis
was used to calculate the required sample size (Cohen, 1988; 1992). To determine the expected
effect size for the proposed relationships, a review of studies examining similar relationships was
conducted. Appendix F reviews the and effect sizes ( ) reported in six studies and two meta-
analyses. The majority of the effect sizes reported in these studies are moderate effects by
Cohen’s standards. The present study includes one independent variable, emotional intelligence,
and eight control variables: (1) preceptors’ cognitive intelligence; (2) preceptors’ emotional
stability; (3) preceptors’ openness; (4) preceptors’ agreeableness; (5) preceptors’
conscientiousness; (6) new graduate nurses’ core-self-evaluations; (7) new graduate nurses’ first
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job of choice; and (8) new graduate nurses’ previous experience on unit. Based on the
reported in similar studies, the magnitude of the proposed relationships in this study will be =
.15. A sample size of 98 dyads of new graduate nurses and their preceptors is needed to detect a
medium effect with a power of 0.80 and of 0.05 to explain 13% of the variance (Cohen, 1988).
A detailed calculation of this sample size is provided in Appendix G. According to the nursing
studies that recruited dyads, the lowest response rate was 30%. If a 30% response rate is
anticipated for this study, 315 dyads of new graduate nurses and their preceptors within the study
sites would need to approached for recruitment to ensure that this study would have enough
power to detect a medium effect with an of 0.05. Several strategies were included in the study
design to increase the likelihood of obtaining greater response rate. First, potential participants
received three information emails from the site PIs several weeks prior to the end of their
preceptorship program. Second, the student recruited participants in the clinical setting as
opposed to using mail-in surveys and was available during both the day and nights shifts. Third,
the student made the preceptors’ test results available to them at the end of the study period.
Lastly, a $100 raffle at each site was included to increase interest in participating. A total of 196
dyads will need to be approached for recruitment to ensure an adequate sample size to detect a
medium effect with a power of .80.
Procedure for Data Collection
Initial Contact with Study Sites
In January 2012, the directors of nursing education at the five participating hospitals were
approached to determine: (1) the number of new graduate nurses that were hired in the fall 2011
and that were eligible for participating as of January 2012 and (2) the expected number of new
graduates that will be hired in the summer of 2012. Additionally, the student discussed the
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implementation of this study at their sites. Once ethics approval was obtained from the Research
Ethics Board of the University of Toronto and the five participating hospitals, the student
attended a nurse manager and educator meeting at three sites to introduce the study and discuss
the recruitment procedures, timelines, and staff involvement. Following this, at one of the sites
the student was able to meet individually with several nurse managers and educators to
determine the number of new graduate nurses hired as well as their anticipated start dates on the
units. Although the student anticipated attending nursing staff meetings on the units in each site
to introduce the study to the nursing staff, this was not made possible by the sites.
Participant Recruitment
Participant recruitment began in January 2012. At each hospital, the site primary
investigator (site PI) communicated with human resources and unit managers to determine the
number of eligible participants, their names and preceptorship end date. One month prior to the
anticipated end date of the preceptorship program, the site PI sent an information letter by email
describing the study and asking interested individuals to contact the doctoral student (Appendix
H). The same email was re-sent two weeks and one week prior to the end of the preceptorship
program. Additionally, the site PI communicated with unit managers and educators informing
them of the study.
The site PIs attempted to reach all of the new graduate nurses and their preceptors within
their institution. In the two hospitals where the doctoral student was allowed to approach
potential participants, the student presented an overview of the study during the new hires’
orientation day at the hospital prior to starting their preceptorship and was then available on units
at different times during the day and evening shifts to recruit new graduate nurses and their
preceptors. In such cases, the student explained the purpose of the study, determined their
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interest in participating, as well as a mutually convenient time to administer the surveys. During
this recruitment phase, the student emphasized to the dyads that participation is voluntary on
both parts, the surveys do not involve evaluations of the other’s work, the unit and hospital will
not have access to the data, and that choosing not to participate will not have any impact of their
employment status or their evaluations as new nurses or preceptors. The dyads were provided
with as much time as they needed to discuss their interest in participating. An additional
recruitment method was initiated at one of the sites mid-way through the September 2012
preceptorship program. These new graduate nurses had to complete a mandatory health
assessment simulation, where groups of seven new graduate nurses rotated through the
simulation over the course of one day. The doctoral student had a recruitment station outside of
the simulation room and provided new graduate nurses with a study information letter and
contact information card to be completed if they were interested in receiving further information
about the study or participating. The doctoral student then approached these interested new
nurses during their specified work days to further discuss the study with them and their preceptor
and their interest in participating.
Once the dyads indicated interest in participating in this study, the student invited them,
one at a time, into a quiet room on the unit to complete the surveys, at a convenient time.
Preceptors and new nurses completed their surveys at different times during the day so that they
could cross-cover to ensure safe patient care at all times. It is important to note that the new
graduate nurses were supernumerary during their preceptorship program and thus participating in
this study did not affect patient care.
Once in the quiet room, preceptors were provided with a survey package that included an
explanation letter (Appendix I), two consent forms, one copy for the student and one copy for
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their records (Appendix J), and a survey (Appendix K). The preceptor survey, including the
Cattell Culture fair Cognitive Intelligence Test, took on average 30 minutes to complete. The
new graduate nurses’ survey package included an explanation letter (Appendix L), two consent
forms (Appendix M), and a survey (Appendix N). The new graduate nurses’ survey took
approximately 10 minutes to complete. When possible, the student sat with the participants as
they completed their surveys, to be available should they have any questions. In several
circumstances, the nurses were too busy to complete their surveys at work. Thus, they took them
home to complete and the doctoral student collected the surveys during another shift. However,
the Cattell Culture Fair cognitive intelligence test was always performed with the doctoral
student present. The student continued this recruitment process until the fall 2012 cohort of new
graduate nurses completed their preceptorship program at the end of December 2012.
Compensation
Each participant was provided with a certificate of participation (Appendix O).
Participants may include this certificate in the College of Nurses’ of Ontario yearly Quality
Assurance program. A $2.00 coffee gift card was attached to each survey as a token of
appreciation for participation in this study. To increase interest in participating, a raffle for $100
at each participating site was included in the research protocol in the summer of 2012.
Participants that were interested in being included in the raffle were asked to complete a contact
information card (Appendix P).
Performance Feedback on Tests
Participating preceptors were offered the option of receiving feedback on their
performance on the tests that they completed in the survey. The preceptor survey package
included a contact information card for test results (Appendix Q) which was coded with the
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corresponding survey codes. Preceptors that participated who were interested in receiving their
performance on their tests were asked to complete a contact information card and include it with
their completed survey so that the doctoral student could match up their contact information with
their results at the end of the study period. Surveys and feedback on test performance contact
information cards were coded with corresponding ID numbers. Those who did not wish to
receive their results did not complete the contact information card and therefore their surveys
remained anonymous. At the end of the study period, the participants who completed the contact
information cards were contacted by email to determine if they were still interested in receiving
feedback on their performance on the survey tests. The student provided interested preceptors
with the results of their tests in person during a convenient time during their work day.
Informed Consent
Eligible new graduate nurses were emailed three study information letters at around one
month, two weeks and one week prior to completing the preceptorship program describing the
study purposes. New graduate nurses and their preceptors were approached as dyads, were
provided with more detailed information on this study in person, and given time to discuss
together their interest in participating. Once the new nurse and preceptor expressed interest in
participating in this study, they were recruited for participation. They were provided with an
explanation letter (Appendix I and L) and two consent forms (Appendix J and M), one to be
signed for the student and one to be kept by the participant. The student explained to the
participants that they may withdraw from the study at any time without penalty, choose not to
answer any question in the survey, and keep the token of appreciation, even if they chose to
withdraw.
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Ethical Considerations
Ethics approval was obtained from the Research Ethics Board of the University of
Toronto and each participating hospital. New graduate nurses and their preceptors were recruited
toward the end of the preceptorship program, and were approached as dyads. Information
regarding the study was provided in writing and verbally and any questions or concerns were
answered. The student emphasized that participation was voluntary, the surveys did not involve
evaluations of the other’s work, the unit and hospital would not have access to the data, and that
choosing not to participate would not impact their employment status or their evaluations as new
nurses or preceptors. The student provided the new graduate nurses and preceptors with time to
discuss and consider their interest in participating. Surveys and consent forms were distributed at
the time of recruitment, at the end of the preceptorship program.
All data were treated as confidential. Survey participants’ names were not recorded on
any of the forms. Each questionnaire was assigned a code number for data entry purposes only.
Participants are not individually identified in any way in this thesis. The completed
questionnaires are kept in a locked file cabinet at the University of Toronto and will be retained
for six years then destroyed, in accordance with the University of Toronto protocol. The data are
stored on a secure University of Toronto server and the computer is password protected.
Instrumentation
The following section describes the variables and measures that were used in this study.
First, the preceptors’ independent variable and measure, emotional intelligence, as well as the
preceptor control variables, cognitive intelligence and personality, are outlined. Following this,
the four new graduate nurses’ dependent variables and measures, role ambiguity, role conflict,
job satisfaction, and turnover intent are described. Lastly, the three new graduate nurses’ control
83
variables, core self-evaluations, first job of choice and previous experience on unit, are
examined.
Preceptor Independent Variable and Measure
Demographic Information
The demographic variables included in this study were: age, gender, years of experience
as a nurse, current unit of employment, and highest level of nursing and non-nursing education.
The demographic data that was collected from the nurse preceptors provided a description of the
study participants (Appendix K.1).
Emotional Intelligence
Preceptors’ emotional intelligence was measured using the Nursing Emotional
Intelligence Scale (Appendix K.2), which is a measure that was adapted by the student from the
Consumer Emotional Intelligence Scale (Kidwell et al., 2008) and was pilot tested by the student
prior to use with nurse preceptors. Emotional intelligence is defined as “the ability to monitor
one’s own and others’ emotions, to discriminate among them, and to use the information to guide
one’s thinking and actions” (Salovey & Mayer, 1990, p. 189). The Consumer Emotional
Intelligence Scale (CEIS) is theoretically based on Salovey and Mayer’s (1990) abilities model
of emotional intelligence and consists of 18 items measuring the four branches of emotional
intelligence using three different scales. Kidwell et al. conducted five different studies during the
development of this scale to assess the validity and the reliability of the CEIS, including
confirmatory factor analysis to ascertain construct validity. The test-retest reliability of the CEIS
was 0.84. The split-half reliability for the global CEIS score was .83, and for each of the four
branches: .78 for perceiving, .68 for facilitating, .69 for understanding, and .81 for managing
(Kidwell et al.).
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This scale was scored based on expert judgments, where experts establish the weights
that each response choice gets (Kidwell et al., 2008). For example, if 90% of the judges
designate the correct response was “C,” then any participant choosing “C” would receive .90/
1.00 toward the overall CEIS score. To obtain individual scores for each of the four emotional
intelligence dimensions, items representing these four dimensions are summed and an overall
emotional intelligence score results when the four dimensions scores are summed (Kidwell et
al.).
Development of the Nursing Emotional Intelligence Scale. The CEIS was developed
according to Mayer and Salovey’s (1997) four branch abilities model of emotional intelligence,
which includes the perceiving, facilitating, understanding, and managing emotions branches. As
the CEIS was developed for a consumer population, this scale was adapted to measure emotional
intelligence in a nursing population. Although the CEIS is not copywrited and is public domain,
the student received approval to adapt this scale, as well as add six extra items from the original
CEIS pool of items, from Dr. B. Kidwell, the author of the CEIS (Personal communication,
March 5th
, 2009). The adaptation of this scale was based on the student’s 12 years of experience
as a clinical nurse in acute care hospitals.
The CEIS was first examined in detail as a whole measure. Next, the items were
separated according to the four ability branches. There are five items for perceiving, four for
facilitating, five for understanding, and four for managing emotions. Each item within each of
the four branches on the CEIS was examined in detail to obtain a deep understanding of the
scenario in question, the wording, the emotion, the possible response options, and how each item
was scaled. The scaling and the emotions in the questions and response options of the modified
CEIS remained unchanged. For the first four items, the pictures were changed to reflect items
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used in nursing, but the questions themselves remained the same. The fifth item on the scale was
not modified. For each of the remaining items, the student adapted the scenarios to reflect
nursing, while maintaining the integrity of the emotion within the item. The wording of each of
the modified items remained as close to the original as possible.
Preceptor Control Variables and Measures
Cognitive Intelligence
The Cattell Culture Fair Intelligence Test scale 3 form A was used to measure
preceptors’ IQ. Reliability of scale 3, as per the publisher’s website is α= .85 (Hogrefe, 2008).
This test requires 12.5 minutes to complete (Hogrefe). The Cattell Culture Fair Intelligence Test
is not included in this thesis because it is copyrighted (Appendix K.4).
Personality
Four preceptors’ personality traits, agreeableness, openness, conscientiousness and
emotional stability, were measured using Goldberg’s (1999) International Personality Item Pool
(IPIP) short scale (Appendix K.3). This is a forty item tool (10 items for each of the four Big
Five personality traits) on a five- point Likert scale ranging from very inaccurate to very
accurate. The alpha coefficients for the IPIP subscales are: α=0.82 for agreeableness, α=0.84 for
openness, and α=0.79 for conscientiousness (Goldberg). Previous research has demonstrated that
emotional intelligence has a small to moderate correlation, between r= .1 and .3, with the
personality traits of openness and agreeableness (Brackett & Mayer, 2003; Mayer, Salovey, &
Caruso, 2004).
86
New Graduate Nurses Dependent Variables and Measures
Demographic Information
The demographic variables included in the survey were: age, gender, experience as a
nurse, current unit of employment, and highest level of education (Appendix N.1). The
demographic data were collected from the new nurses to provide a description of the study
participants. The new graduate nurses’ survey can be found in Appendixes N.
Role Ambiguity
Role ambiguity is defined by Rizzo, House, and Lirtzman (1970) as “(1) the
predictability of the outcome or responses to one’s behaviour, and (2) the existence or clarity of
behavioural requirements, often in terms of inputs from the environment, which would serve to
guide behaviour and provide knowledge that the behaviour is appropriate” (p.156). Role
ambiguity was measured using Rizzo et al.’s six item tool (items 1, 2, 4, 6, 9, and 13) on a seven-
point scale ranging from very false to very true (Appendix N.4). The reliability estimates of this
tool are α=0.78 by the developers of the measure (House & Rizzo, 1972), 0.78 (Ashforth & Saks,
1996) and 0.74 in a sample of acute care nurses in Ontario (McGillis Hall, 2003). A global score
was obtained by summing the items, with higher total scores reflecting less role ambiguity and
lower scores correspond to higher role ambiguity.
Role Conflict
Role conflict is defined by Rizzo et al. (1970) as “the dimensions of congruency-
incongruency or compatibility-incompatibility in the requirements of the role, where congruency
or compatibility is judged relative to a set of standards or conditions which impinge upon role
performance” (p.155). Role conflict was measured using Rizzo et al.’s eight item tool (items 3, 5,
7, 8, 10, 11, 12, and 14) on a seven-point scale ranging from very false to very true (Appendix
87
N.4). The reliability estimates are α= 0.816 as reported by the developers (House & Rizzo,
1972), 0.76 (Ashforth & Saks, 1996), 0.77 (Kowtha, 2008), and 0.74 in a sample of acute care
nurses in Ontario (McGillis Hall, 2003). A global score was achieved by summing the items,
with higher total scores representing higher levels of role conflict and lower scores reflecting
lower levels of role conflict.
Job Satisfaction
New nurses’ job satisfaction was measured using the Michigan Organizational
Assessment Questionnaire Job Satisfaction Subscale or MOAQ- JSS (Appendix N.5) (Cammann,
Fichman, Jenkins, & Klesh, 1983). The MOAQ- JSS asked respondents to answer three
questions regarding their job satisfaction using a seven-point Likert scale, ranging from strongly
disagree to strongly agree; the second item is reverse- coded. A global score of job satisfaction
was obtained by averaging the three items with higher scores representing higher job satisfaction.
Previous studies using the MOAQ- JSS have reported a reliability of .93 (Ashforth & Saks,
1996; Ashforth, Sluss & Saks, 2007).
Intent to Turnover
Intent to turnover, or intention to quit, is conceptualized as comprising three domains:
thinking of quitting, intending to leave, and searching for new employment (Mobley, Horner, &
Hollingsworth, 1978). Mobley et al.’s (1978) intent to turnover scale was used in this study; it
consists of seven items using a 5-point Likert scale ranging from strongly agree to strongly
disagree, with higher scores representing higher intent to turnover (Appendix N.6). A global
score of intent to turnover was obtained by averaging the three items.The reliability of this
questionnaire has been reported as 0.86 (Castle, 2006).
88
New Graduate Nurses’ Control Variables and Measures
First Job of Choice
First job of choice is conceptualized as the new graduate nurse’s preferred area of
employment upon graduation, which may or may not be where they are currently employed. First
job of choice may be an important confounding variable requiring control in studies examining
preceptorship programs and turnover rates in new graduate nurses. This item consists of one
question to be answered with yes or no “Was your current unit of hire your first choice of
employment?” (Appendix N.2).
Previous Experience on the Unit
Previous experience on the unit addresses whether a new graduate nurse was either
employed on the unit in another role or if he/she did a clinical placement or consolidation at any
time during their nursing education. This variable was controlled for in this study because the
socialization that may have taken place during previous experiences on the unit may act as a
confounding variable when examining the socialization that occurs during the preceptorship
program. This item consists of the following question “Have you previously worked on or
completed a clinical placement/ consolidation on your current unit of hire?” Respondents were
asked to answer this question with a yes or no option (Appendix N.2).
Core Self- Evaluation
Core self-evaluation is defined as “a basic, fundamental appraisal of one’s worthiness,
effectiveness, and capability as a person” (Judge et al., 2003, p. 304). Core self-evaluations have
been empirically demonstrated to be related to several important work behaviours, such as job
satisfaction (Best et al., 2005; Erez & Judge, 2001; Judge et al.). Core self-evaluations was
measured using Judge et al.’s 12 item scale with responses ranging on a 5-point Likert scale from
89
strongly disagree to strongly agree, with higher scores representing higher CSEs (Appendix
N.3). Items 2, 4, 6, 8, 10, and 12 are reverse coded. The authors reported reliabilities ranging
from .81 to .87 (Judge et al.). In a sample of Ontario nurses, the CSE scale had a reported
reliability of .77 (Siu et al., 2008). Two studies with nurse managers reported reliabilities of .77
(Laschinger et al., 2007) and .75 (Laschinger & Finegan, 2008).
Potential Risks and Benefits
The level of risk and group vulnerability for this study was determined to be low. There
were no known risks associated with the proposed methods and surveys used and types of data
collected relating to the effects of preceptors’ emotional intelligence on new graduate nurses
socialization.
While there was no direct benefit to participants, the study results may benefit the nursing
workforce through the advancement of empirical and theoretical knowledge. Nursing’s
knowledge of the role that emotional intelligence plays in nursing practice is limited. More
specifically, there is no published research to date linking emotional intelligence and the process
of new graduate nurses socialization during preceptorship. The theoretical and empirical
knowledge gained through this study may have a future affect on how preceptorship programs
are implemented, how preceptors are chosen, and how new nurses are socialized to health care
organizations, thus improving new nurses’ first working experiences and retention of the new
generation of nurses.
Data Collection
Data were collected at one time, at the end of the preceptorship program (Figure 2). This
data collection time was chosen based on the existing literature on new employee socialization.
Although there is no consensus regarding the most appropriate measurement times for
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organizational socialization research, it has been suggested that the majority of the organizational
socialization that a new employee experiences occurs early in a new employee’s entry into an
organization (Ashforth & Saks, 1996; Ashforth et al., 1998; Cooper-Thomas & Anderson, 2002;
2005; Saks & Ashforth, 1997). It has also been suggested that new employees adapt quickly
upon entry, as early as within the first four to eight weeks (Cooper-Thomas & Anderson, 2002;
Major et al., 1995). Additionally, all five of the study sites provided their new graduate nurses
with a three month preceptorship program, as specified by the Ontario New Graduate Nurse
Initiative.
Surveys were distributed to the new graduate nurses and their preceptors during the month
preceding or following the end of the preceptorship program. The preceptor survey consisted of
demographic data, personality, IQ, and the NEIS (Appendix K). The new graduate nurses’
survey consisted of demographic data, CSE, first job of choice and previous experience on unit,
role ambiguity, role conflict, job satisfaction, and turnover intent (Appendix N).
Figure 2. Data collection
At the end of the preceptorship program
Preceptor Variables
Demographic data
Nursing Emotional Intelligence
Cognitive Intelligence
Personality
New Graduate Nurse
Variables
Demographic data
Core- Self Evaluations
First Job of Choice
Consolidation in Current Setting
Role Ambiguity
Role Conflict
Job Satisfaction
Turnover Intent
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Data Analysis
Data were entered and analyzed in SPSS version 21 (2012). Analysis included descriptive
statistics, such as means and standard deviations, for both the preceptors’ and new graduate
nurses’ demographic data and independent, dependent and control variables. Frequency
distributions were examined to determine if the variables were normally distributed. Quartile
plots were used to determine the existence of outliers. Each identified outlier was examined to
ascertain if it was due to error. A matrix with descriptive statistics and item intercorrelations was
computed to examine the correlations amongst measures.
The internal consistency of the measures of personality, role ambiguity, role conflict, job
satisfaction, intent to turnover, and core self-evaluations were computed using Cronbach’s alpha
coefficient. As the NEIS and cognitive intelligence measures are heterogeneous, the split-half
measure of reliability was obtained (Kidwell et al., 2008; Mayer et al., 2003). The split-half
reliability was calculated by dividing the items of the scale into two halves and correlating these
two halves. This correlation was corrected by using the general form of the Spearman-Brown
Prophecy Formula to obtain a correlation for the whole test (Nunnally, 1978). These reliabilities
are also presented in the matrix.
Hierarchical regression analysis was be used to test the nine hypotheses. Hierarchical
regression analysis is used to evaluate the relationship between the independent and dependent
variables, while controlling for the effects of control variables on the dependent variable (Cohen,
Cohen, West, & Aiken, 2003). The independent variables are entered in a predetermined and
ordered sequence of blocks, with each block containing more variables than the previous block
(Cohen et al.). The independent variables entered in later blocks should not have an anticipated
causal relationship with any independent variables entered in previous blocks (Cohen et al.).
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Once the variables are entered in blocks in the specified order, the overall model as well as the
contribution of each block is evaluated in terms of how well it predicts the dependent variable.
To determine the contribution and significance of each block to the explanation of variance in
the dependent variable, the change, with its statistic, is examined (Pallant, 2003).
Additionally, each independent variable was examined to determine if it was a significant
predictor of the dependent variable.
Hypothesis one posits that a preceptor’s emotional intelligence will be negatively related
to new graduate nurses’ role ambiguity at the end of the preceptorship program. Hypothesis two
proposes that a preceptor’s emotional intelligence will be negatively related to new graduate
nurses’ role conflict at the end of the preceptorship program. For each of the two dependent
variables, step one consisted of entering the control variables preceptors’ cognitive intelligence
and personality, and new graduate nurses’ core self-evaluation, first job of choice and previous
experience on unit. In step two, the preceptors’ emotional intelligence was entered. Hypothesis
three proposes that a preceptor’s emotional intelligence will be positively related to new graduate
nurses’ job satisfaction and hypothesis four posits that it will be negatively related to new
graduate nurses’ turnover intent at the end of the preceptorship program. For each of the
dependent variables, step one consisted of entering the control variables preceptors’ cognitive
intelligence and personality, and new graduate nurses’ core self-evaluation, first job of choice
and previous experience on unit. In step two, the preceptors’ emotional intelligence was entered.
Hypothesis five posits that new graduate nurses’ role ambiguity will partially mediate the
relationship between a preceptor’s emotional intelligence and new graduate nurses’ job
satisfaction. To demonstrate mediation for this hypothesis, the following three criteria need to be
met: (1) the independent variable must be related to the mediator; (2) the independent variable
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must be related to the dependent variable; and (3) full mediation when the relationship between
the independent and dependent variables become nonsignificant when the mediator is introduced
or partial mediation when the relationship between the independent and dependent variables is
reduced (Baron & Kenny, 1986). To test hypothesis five, the control variables cognitive
intelligence, personality, core self-evaluation, first job of choice and previous experience on unit
was entered in step one. In step two, the preceptors’ emotional intelligence was entered. In step
three, the control variables and the preceptors’ emotional intelligence was retained and the
mediator, role ambiguity was added. A comparison of step three with step two should
demonstrate that: (1) the mediator, role ambiguity, should be related to the two dependent
variables and (2) if the partial mediation hypothesis is to be supported, the relationship between
the preceptors’ emotional intelligence and the dependent variable, job satisfaction, should be
reduced or become non-significant.
The same methodology was used to test the remaining three partial mediation hypotheses.
Hypothesis six proposed that role ambiguity partially mediates the relationship between a
preceptor’s emotional intelligence and new graduate nurses’ turnover intent. Hypothesis seven
posits that role conflict partially mediates the relationship between a preceptor’s emotional
intelligence and new graduate nurses’ job satisfaction, and hypothesis eight proposes that role
conflict partially mediates the relationship between a preceptor’s emotional intelligence and
turnover intent.
Finally, hypothesis nine posits that a new graduate nurse’s job satisfaction will be
negatively related to their turnover intent. Step one consisted of entering the control variables
core self-evaluation, first job of choice and previous experience on unit. In step two, the new
graduate nurses’ job satisfaction was entered.
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Pilot Study of the Nursing Emotional Intelligence Scale
As the CEIS was modified and used in a different population than it was intended for, the
face validity, scoring and psychometric properties of the Nursing Emotional Intelligence Scale
(NEIS) was assessed in a sample of nurses (Pedhazur & Pedhazur Schmelkin, 1991). This
section discusses the setting and sample of the pilot, procedures for data collection, assessment
of the NEIS for face validity, determination of the expert scoring, assessment of the instrument’s
psychometric properties and data analysis for this pilot study.
Setting and Sample
The NEIS was piloted in a sample of nurses who work at a downtown Toronto teaching
hospital. First, a sample of 10 nurses with more than two years’ experience were surveyed to
assess the face validity of the NEIS. Next, to determine the scoring according to nursing experts,
a sample of 16 nurses with a minimum of five years of nursing experience were surveyed as the
expert judges. Benner (1982) defines an expert nurse as one that has a deep and intuitive
understanding of clinical situations and of what needs to be done, as well as having a substantial
amount of experience. Additionally, Benner and Tanner (1987) quantify substantial experience
as a nurse who has been practicing for at least five years. Finally, although there is no consensus
on sample size calculations for conducting psychometric testing of an adapted measure, De Vaus
(1993) suggests that there should be between 75 to 100 participants. Thus, a sample of 81 nurses
with more than two years’ experience was recruited. The total sample size for the pilot testing of
the NEIS was 107 nurses. Ethics approval was obtained from the Research Ethics Board of the
University of Toronto and one Toronto acute care hospital.
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Procedure for Data Collection
Data collection for the pilot study took place in an acute care hospital with six medical
surgical units. Data collection to assess the face validity of the NEIS started on a Monday. Data
collection to determine the expert scoring of the NEIS began the following Thursday and data
collection to assess the psychometric properties of the NEIS began two weeks later once the
expert scoring surveys had all been returned. The procedures for the recruitment of the nurses as
well as the administration of the surveys followed the same procedures. The student started by
approaching nurses on the unit during their shift to determine eligibility and interest in
participating in this study. The student was available for recruitment on both the day and night
shift and also on the week-ends to obtain the greatest number of potential participants, as some
nurses only work certain shifts. The pilot study was explained to the nurses and interested nurses
were invited to participate at a time that was convenient for them. Once a time was established,
the student brought the nurses into a quiet meeting room and information letters and consent
forms were distributed. The student provided the participants’ with time to carefully read these
forms and ask questions as needed. The student was present throughout to observe the
participants during completion of the surveys to note their reactions or any difficulties that arose.
This process continued until ten nurses completed the face validity of the NEIS, 16 completed
the expert scoring of the NEIS, and 81 participated in the assessment of the measure’s
psychometric properties. Data collection for the pilot of the NEIS took approximately two
months to complete.
Compensation
Each participant in this pilot study received a certificate of participation (Appendix O)
which may be included in the College of Nurses’ of Ontario yearly Quality Assurance program.
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Participants were also provided with a token of appreciation, a two dollar gift card for a coffee
shop.
Face Validity of the Nursing Emotional Intelligence Scale
Face validity is the extent to which the items appear on the surface to measure what they
are supposed to measure (Nevo, 1985; Nunnally, 1978; Streiner & Norman, 2003). As face
validity concerns how participants perceive the measure, it should be assessed by the same
population for which the measure is intended for (Nevo; Streiner & Norman). Participants were
asked to comment on: (1) how suitable they think the questions are for capturing how nurses’
perceive/recognize, understand and manage their own and others’ emotions in their daily nursing
practice and how they use this knowledge to guide how they think and act when interacting with
patients, families, and colleagues; (2) readability of the measure; (3) the quality of the
instructions; (4) if there are any ambiguities in the questions; and (5) how long it takes to
complete it (Streiner & Norman). The survey package included: an information letter explaining
the purpose of the study (Appendix R); two consent forms, one for their records and one to be
signed and returned to the researcher (Appendix S); and the survey which included the NEIS
(Appendix T.2) and 5 open ended- questions on the overall quality of the survey (Appendix T.3).
Survey of Experts: Scoring of the NEIS
Scoring for the NEIS followed the same methods as the original CEIS (Kidwell et al.,
2008) and the Mayer- Salovey- Caruso- Emotional Intelligence Test (Mayer, Salovey, Caruso, &
Sitarenios, 2003) where experts determined the weight that each response choice will get. The
original CEIS obtained expert scoring from 16 experts in behaviour and emotion research
(Kidwell et al.). The Mayer- Salovey- Caruso- Emotional Intelligence Test obtained expert
scoring from 21 experts in emotion research (Mayer et al.). As the NEIS was intended for use in
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a sample of nurses, nurses made up the expert judges. The survey package included: an
information letter explaining the purpose of the study (Appendix R); two consent forms, one for
their records and one to be signed and returned to the student (Appendix S) and the survey
(Appendix U) which included: demographic information, such as age, gender, area of practice,
and years of experience in nursing (Appendix U.1); and the NEIS (Appendix U.2).
Assessment of the Psychometric Properties of the NEIS
The validity of a measure refers to whether an instrument is actually measuring the
theoretical construct that it was designed to measure (Streiner & Norman, 2003). Discriminant
validity concerns the degree to which two scales designed to measure two distinct and unrelated
constructs do not highly correlate (Pedhazur & Pedhazur Schmelkin, 1991; Streiner & Norman,
2003). In line with Salovey and Mayer’s (1990) ability model, emotional intelligence should be
mostly distinct from the Big Five personality domains (Brackett & Mayer, 2003; MacCann &
Roberts, 2008). To establish the discriminant validity of the NEIS, three of the Big Five
personality traits, agreeableness, openness, and conscientiousness, of pilot participants was
measured using Goldberg’s (1999) International Personality Item Pool (IPIP) short scale.
Previous authors have demonstrated that emotional intelligence is related to agreeableness and
openness (Brackett & Mayer; Brackett, Mayer, & Warner, 2003; MacCann & Roberts; Mayer,
Roberts, & Barsade, 2008). For example, correlations between emotional intelligence, measured
with the MSCEIT, and agreeableness are r= .24 (Brackett et al.,) and r= .28 (Brackett & Mayer),
and with openness r= .25 (Brackett & Mayer).
The criterion validity of a measure concerns the degree to which a new scale correlates
with another scale purporting to measure the same thing (Pedhazur & Pedhazur Schmelkin,
1991; Streiner & Norman, 2003). Concurrent validity is a type of criterion validity that is
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assessed by correlating the new scale with the criterion measure (Streiner & Norman).
Concurrent validity was assessed by correlating the NEIS with another measure of EI, the CEIS.
Since both measures of emotional intelligence should be measuring the same construct, it was
expected that there would be at least a moderate association between the NEIS and the CEIS
(Streiner & Norman).
The internal structure of a scale can be determined by conducting factor analysis. Factor
analysis concerns the grouping of variables to underlying factors, as well as the relationships
between variables (Nunnally, 1978). Factor analysis is important in the assessment of construct
validity because it provided evidence that the items in the scale are measuring the same
construct, as opposed to dividing into different clusters that measure different constructs
(Nunnally). Exploratory factor analysis was used to examine the structure of the scale.
The survey package included: an information letter explaining the purpose of the study
(Appendix V), two consent forms, one for their records and one to be signed and returned to the
student (Appendix W) and the survey which includes (Appendix X): demographic information
(Appendix X.1); CEIS (Appendix X.2); the International Personality Item Pool (Appendix X.3);
and the NEIS (Appendix X.4).
Data Analysis for the Pilot Study
Once all of the surveys from the face validity assessment were returned, comments from
the participants were examined in detail for trends and commonalities and were organized into
themes. Any items that were found to be difficult to understand or ambiguous were clarified.
Participants’ comments about the adequacy of the instructions and the survey were reviewed and
modified accordingly. Thus, suggestions made by the participants were incorporated into the
final survey.
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Data were entered and analyzed in SPSS 17.0.2 (2009). Descriptive statistics, such as
means and standard deviations, were compiled for the participants’ demographic data, the NEIS,
CEIS and the International Personality Item Pool (IPIP).
The NEIS was scored according to the scoring weights determined from the expert
judges. The scoring key as determined by the experts was obtained by calculating the
percentages of experts that chose each response item for each individual question, thus providing
expert weights for each item.
The split-half reliability was obtained for the CEIS and the NEIS. To determine
discriminant validity, the NEIS was correlated with each of the three domains of the Big-Five
personality traits. Concurrent validity was assessed by correlating the NEIS with the original
CEIS.
The internal structure of the NEIS was examined by conducting an exploratory factor
analysis using AMOS 7.0. The correlation matrix was inspected to assess the correlations
between the items. Next, the data were factor analyzed using Principle Component Analysis
(PCA) with a direct oblimin rotation. The Kaiser-Meyer-Olkin measure of sampling adequacy
and Bartlett's test of sphericity were examined to ensure that proceeding with factor analysis was
appropriate (Pallant, 2007; Pett, Lackey, & Sullivan, 2003). Following this, the communalities,
Eigenvalues above 1.00, scree plot, and anti-image correlation matrix were reviewed to
determine which items should be deleted and the number of factors to retain. The factor analysis
was rerun each time an item was deleted and the above indices were reviewed. This process
continued until a parsimonious and theoretically meaningful number of factors were found which
explained the most variance.
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CHAPTER V
RESULTS
The following chapter presents the results of the pilot study that assessed the
psychometric properties of an adapted measure of emotional intelligence (NEIS) in a sample of
nurses and the study aimed at examining the relationships between preceptors’ emotional
intelligence and new graduate nurses’ role ambiguity, role conflict, job satisfaction and turnover
intent. This chapter is structured as follows: (1) the results of the pilot study of the NEIS are
presented first and next (2) the results of the preceptorship study are presented.
Pilot Study
A total of one hundred and seven nurses working at a large university affiliated teaching
hospital in Toronto, Canada were recruited in the pilot study; ten nurses participated in the face
validity of the NEIS, 16 nurses considered expert nurses made up the expert scoring key, and
finally 81 nurses were included in the psychometric testing of the NEIS. The following sections
describe the pattern of missing values, provide descriptive information for the pilot sample, as
well as for the sub-samples of nurses included in each of the three phases of this pilot study, the
face validity, expert scoring and psychometric testing, as well as the results of the pilot data
analyses.
Missing Values
Double data entry was used to ensure that the data for the 107 participants were entered
accurately into SPSS version 17.0.2 (2009). Descriptive statistics were examined to confirm that
all data were entered within the appropriate ranges.
In the CEIS, NEIS and personality measures, 11 items had 1% missing data, 3 items had
2% missing data, 2 items had 3% missing data, and 1 item had 4% missing data. The chi-square
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statistic for testing whether values are missing completely at random (MCAR) is referred to as
‘Little’s MCAR test’ (Tabachnick & Fidell, 2007). The Little's MCAR test obtained for this
study’s data resulted in a chi-square = 750.044 (df= 715, p=.18), which indicates that the data are
missing completely at random.
The CEIS, NEIS and personality measures had a total of 26 missing data points. The
missing values were replaced using multiple imputations. The means and standard deviations for
each of the items were examined in detail to ensure that there were no differences between the
data set with the missing values and the data set with imputed missing values. There were no
differences between the item means and standard deviations.
Descriptive Information for Complete Pilot Sample
This section reports the descriptive statistics for the full sample of 107 nurses that
participated in the pilot study. This sample was further divided into the sub-sample of nurses that
participated in the face validity (N=10), the nurse experts (N=16), and the nurses that
participated in the psychometric assessment of the NEIS (N=81).
The nurses in this pilot study ranged in age from 22 to 63 with a mean age of 35.4 years.
The median age was 31 and the mode was 27. This suggests that the majority (58.8%, N= 47) of
the sample fell below the mean. The nurses had an average of 10.2 years of nursing experience,
7.1 years of service within this organization and 6.0 years of practice on their current unit. A
summary of these descriptives can be found in Appendix Y. According to the latest Canadian
Institute for Health Information’s report (CIHI, 2013) on Canadian nurses, in 2011 the average
age of Canadian nurses was 45.3, which is ten years older than the sample in this pilot.
Additionally, in 2005 the mean years of experience for nurses in Canada was 18.3 (CIHI, 2005)
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which is just over eight years more experience than the nurses in this pilot study. Therefore, the
nurses in this pilot study were younger and less experienced than the national averages.
The majority of the nurses in this sample were female (N=98, 91.6%), worked full-time
(N=84, 78.5%) with an adult population and had baccalaureate degrees in nursing (N=73,
68.2%). The two most common areas of employment were medicine (N=45, 43%) and surgery
(N= 29, 27%). A small percentage of nurses (N=8, 7.5%) in this sample were enrolled at the time
of the study in either a baccalaureate or master’s degree in nursing. Eleven percent (N=12) of the
sample held a certificate in nursing and 53% (N=57) held either non-nursing certificates or
university degrees. A summary of the descriptive information on these categorical variables can
be found in Appendix Y. In Canada, 94.5% of nurses were female in 2011 which is similar to the
participants in this study (CIHI, 2013). The percentage of nurses with baccalaureate degrees in
this study was much higher than found in 2011 in Canada at 38.8% (CIHI, 2013). The percentage
of nurses working full-time in this study was also higher than the 58.6% reported across Canada
(CIHI, 2013).
Face Validity
Descriptive Information
This section reports on the descriptive statistics and results from the sub-sample of ten
nurses who work at an acute care hospital that were recruited to complete a questionnaire to
determine the face validity of the NEIS. The mean age of the sample was 37, with a range of 25
to 57 years old. The sample was comprised of females. The mean nursing experience of this
sample was 10.3 years with a range from 22 months to 25 years. The majority of the sample
(N=9) were employed full-time. Three participants held diplomas in nursing, four baccalaureate
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nursing degrees, while three had master of nursing degree. This information is summarized in
Appendix Z.
Results
The participants were asked to complete the NEIS and to provide their comments on five
questions on the readability and quality of the questionnaire. The mean length of completing the
NEIS was 10 minutes, with a range from 5 to 20 minutes. As the student was present during
completion of the questionnaire, the participants also shared verbal feedback throughout and
after completion of the questionnaire. Three respondents requested additional instructions for the
different set of questions. Further instructions were added to the NEIS as well as the CEIS
(Appendix AA.1). These instructions were obtained from Dr. Kidwell’s original pool of items.
Participants verbally suggested keeping the language consistent in the demographic data
section (i.e. using “years/ months” consistently). This change was also made. Although one
respondent wrote that question 20 was unclear, four others verbally identified their difficulties
with understanding and answering the question. Thus, question 20 was rephrased to add clarity
(Appendix AA.2).
Survey of Experts: Scoring of the NEIS
Descriptive Information
The descriptive statistics and results from the sub-sample of sixteen who worked at one
acute care hospital that were recruited to complete a questionnaire to determine the expert
scoring of the NEIS are described. Scoring for the NEIS follows the same methods as the
original CEIS (Kidwell et al., 2008) and the Mayer- Salovey- Caruso- Emotional Intelligence
Test (MSCEIT; Mayer, Salovey, & Sitarenios, 2003) where experts determine the weight that
each response choice will get. The original CEIS obtained expert scoring from 16 experts in
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behaviour and emotion research (Kidwell et al.). The MSCEIT obtained expert scoring from 21
experts in emotion research (Mayer et al.). As the NEIS is intended to measure the emotional
intelligence of nurses, a sample of nurses made up the expert judges.
Benner (1982) defines an expert nurse as one that has a deep and intuitive understanding
of clinical situations and of what needs to be done, as well as having a substantial amount of
experience. Additionally, Benner and Tanner (1987) quantify substantial experience as a nurse
who has been practicing for at least five years. Thus, to determine the scoring according to
nursing experts, a sample of 16 nurses with at least five years of nursing experience and a
baccalaureate degree in nursing were surveyed as the expert judges. Once data collection for the
face validity survey was complete, the doctoral student began recruiting the expert nurses. These
expert nurses were recruited prior to those nurses that participated in the psychometric
assessment of the NEIS. To locate these nurse experts, the doctoral student spent time on the
units with the nurses engaging them in discussions about their nursing practice, their clinical
experience and their education. The majority of these expert nurses were nominated by their
colleagues as the nurse on the unit that everyone else consults if they have practice questions or
require expert and experienced nursing knowledge. All of the experts chosen also take on the
role of charge nurse or team leader on their unit.
The majority of the expert nurse sample was female and all held a baccalaureate degree
in nursing. The mean age of the sample was 40, with a range of 30 to 54 years. This is five years
younger than the national average in Canada (CIHI, 2013). The mean nursing experience of this
sample was 16.1 years with a range from 7 to 32 years, which is two years less than the national
average in 2011 of 18.3 reported by CIHI (2013). The average length of employment within the
organization was 12.7 years, with a range of 3 to 30 years and the average length in their current
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nursing position was 10.7 years with a range of 2 to 24 years. This sample of expert nurses were
employed full-time, worked with an adult population in a variety of settings, with the majority on
medical and surgical units, and held baccalaureate degrees in nursing. Fifty percent of this
sample held non-nursing degrees and one participant was enrolled in a masters of nursing
program. A summary of this information is presented in Appendix BB.
The sample of nurses that made up the experts were on average older, had greater years
of nursing experience, more years of service with the organization and in their current position
than did the nurses that made up the sample that participated in the psychometric assessment of
the NEIS (Appendix CC). This greater level of experience is consistent with Benner’s (1982) and
Benner and Tanner’s (1987) definition of an expert nurse.
Results
The results of the exploratory factor analysis (EFA) of the NEIS are presented in a later
section of the thesis. However, the EFA resulted in a two factor model comprising 15 items on
the NEIS. The frequencies of the expert nurses’ responses to the NEIS items can be found in
Appendix DD. From the frequencies it can be seen that the majority of the experts tended to
converge on the response items. A few items, such as item 1 and 5, had at least one expert
endorse each possible response option. However, for these items the majority of the experts, for
example, identified that the emotion expressed in the image was either slightly or moderately
present, as opposed to quite or extremely present.
Third Sample: Nurses that Participated in the Final Survey for Psychometric Testing
Descriptive Findings
The descriptive statistics and results from the sub-sample of 81 nurses who worked at a
Toronto acute care hospital that were recruited to complete the questionnaire to determine the
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psychometric properties of the NEIS are reported. The nurses in this study ranged in age from 22
to 63 with a mean age of 34.3 years. The median age was 29 and the two modes were 26 and 27;
just under 65% of the sample fell below the mean age. The nurses had an average of 8.9 years of
nursing experience, 6.0 years of service within this organization and 5.1 years of practice on their
current unit. A summary of this information can be found in Appendix EE. Compared to the
latest CIHI report on Canadian nurses (2013), the nurses in this sample were younger and had
less nursing experience.
The majority of the nurses in this sample were female (N=75, 92.6%), worked full-time
(N=59, 72.8%) with an adult population (N=80, 98.8%) and had baccalaureate degrees in nursing
(N=53, 65.4%). The two most common areas of employment were medicine (N=38, 46.9%) and
surgery (N=22, 27.2%). A small number of nurses (N=6, 7.4%) in this sample were enrolled in
either a baccalaureate (N=2) or masters (N=4) degree in nursing. Eight percent of the sample
held a certificate in nursing and 53.1% held either non-nursing certificates or university degrees.
A summary of the descriptive information on these categorical variables can be found in
Appendix EE.
Qualitative Results
As the doctoral student maintained a presence on the nursing units while participants
completed the questionnaires, the nurses shared their experiences of completing the NEIS and
the CEIS, and the student answered any questions the participants had. The most common
question was what participants should do if the emotion they felt was not a response option. The
student explained that in such cases, participants should choose the option that would best
represent the emotion. To address this common question, the final version of the NEIS was
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adapted to include further explanations and instructions at the beginning of the survey, as well as
underlined and bolded key words in the instructions for each of the sub tests (Appendix FF).
Although the participants in the face validity commented that the pictures in questions 1
to 7 in the NEIS were clear and easy to see, the participants in this sample requested that the
pictures be enlarged slightly. Thus, in the final version of the NEIS, the pictures were enlarged to
improve clarity (Appendix GG). Participants also commented that they felt the way in which the
questions were posed in both the CEIS and NEIS were different than the types of survey
questions that they are used to answering, they felt that the NEIS was easier to understand than
the CEIS because the content was nursing related and more applicable to them. The student
explained to participants that the CEIS and NEIS were similar to cognitive intelligence tests in
that they are assessing abilities related to emotions. Many of the participants also commented
that the set of questions measuring emotional understanding in the CEIS were particularly
complex and difficult to understand. The participants also commented that they thought the
content of the NEIS was interesting and made them think about how emotions affect thinking
and actions in a new way.
Psychometric Assessment of CEIS and Personality Measurement Instruments
The Cronbach’s alpha for each of the three personality traits measured by the IPIP tool
are presented in Table 2. The Cronbach’s alphas were all above .75 for the IPIP measures of
agreeableness, conscientiousness and openness, which indicates good internal consistency of the
tools. The split-half reliabilities for the CEIS ranged between .53 and .83 and are presented in
Table 4. The particularly problematic reliability is for the “understanding” sub-test, which
resulted in an α= .01. The coding of these items was rechecked to ensure it was appropriate. The
correlation matrix revealed that these items were not related to one another. Additionally, these
108
were the five items that participants had a particularly difficult time understanding and
answering.
Table 4. Cronbach’s Alpha for IPIP and Split-Half Reliability Alpha for CEIS
Instrument α Number
(N)
Number of Items
International Personality Item Pool (Goldberg, 1999)
Agreeableness .85 81 10
Conscientiousness .79 80 10
Openness .76 81 10
Consumer EI Scale (Kidwell et. al, 2008) .64 81 18
Perceiving .53 81 5
Understanding .01 81 5
Facilitating .83 81 4
Managing .67 81 4
The descriptive statistics for the three personality traits measured by the IPIP tool and for
the CEIS are presented in Table 5. The means for the three personality traits, agreeableness,
openness, and conscientiousness, were moderately high in this sample, suggesting that the nurses
tended to be agreeable, open and conscientious. The CEIS was scored using Dr. Kidwell’s expert
scoring key. To ease interpretability, the CEIS was normalized to standard scores with a mean of
100 and a standard deviation of 15.
109
Table 5. Descriptive Statistics for IPIP and CEIS
Instrument
(Scale range)
Median
Mode
Mean (SD)
(Range)
Number
(N)
International Personality Item Pool (Goldberg, 1999)
Agreeableness
(Scale range 1-5)
4.20
3.80
4.18 (.56)
(1.70-5.00)
81
Conscientiousness
(Scale range 1-5)
3.65
3.60
3.74 (.56)
(2.50-5.00)
80
Openness
(Scale range 1-5)
3.50
3.30
3.53 (.50)
(2.00-4.70)
81
Consumer EI Scale (Kidwell et. al,
2008)
102.6
76.0
100 (15)
(65.4-129.9)
81
Perceiving 102.6 102.6 100 (15)
(69.9-126.8)
81
Understanding 103.3 106.4 100 (15)
(62.7-117.1)
81
Facilitating 95.2 125.3 100 (15)
(74.8- 137.2)
81
Managing 101.4 65.4 100 (15)
(65.4- 121.4)
81
Psychometric Assessment of the NEIS: Exploratory Factor Analysis
The first step in assessing the psychometric properties of the NEIS and in determining the
number of items to be included in the final measure consisted of examining the correlation
matrix. This evaluation resulted in the deletion of items number 7, 15, and 16 as they were not
significantly correlated with the other items. Next, the data were factor analyzed using Principle
Component Analysis (PCA) with a direct oblimin rotation. The Kaiser-Meyer-Olkin Measure of
110
Sampling Adequacy (KMO) was .53 and the Bartlett’s Test of Sphericity was = 479.96, df=
253, p< .00. Although the Bartlett’s Test of Sphericity was appropriate, normally the KMO
should be greater than .60 prior to commencing factor analysis (Pallant, 2007; Pett, Lackey, &
Sullivan, 2003). The communalities ranged between .460 and .776 and the eight Eigenvalues
above 1.00 explained 64.6% of the variance. The anti-image correlation matrix yielded several
Measure of Sampling Adequacy (MSA) values under the suggested .60 cut off for acceptability
(Pett et al.). Items number 2, 3, 10, 12, 17 and 20 had particularly low MSA values below .50.
Thus, these items were further examined and the correlation matrix demonstrated that these six
items were correlated with only one to two other items, such as item 2 was correlated with item
4; item 3 with items 4 and 5; item 10 with item 17; and item 20 with item 8. These items were
deleted. The eight factor PCA model is presented in Appendix HH.
The analysis was rerun after these items were deleted and this resulted in a 6 factor model
(Appendix HH). The KMO was .63 and the Bartlett’s Test of Sphericity was = 334.6, df= 136,
p< .00. The communalities ranged between .50 and .79 and the six Eigenvalues above 1.00
explained 64.0% of the variance. The MSA values for all items but two increased above the
suggested .60 for acceptability. Items 13 and 14 were lower than the .60 cut-off. Further
examination of the correlation matrix demonstrated that these two items were correlated with
only one to two other items, such as item 13 was correlated with items 8 and 11 and item 14 was
correlated with item 9. Therefore, items 13 and 14 were deleted.
Since a six factor model of emotional intelligence does not make sense theoretically, the
scree plot was examined to help determine the number of factors to retain (Tabachnick & Fidell,
2007). Two changes in slopes were found in the scree plot, one change occurring at 2 and
another change occurring at 4, suggesting that the number of factors to retain should be either 1
111
or 3 as these number of factors contribute most to the explained variance (Pallant, 2007).
Therefore, the analysis was run with a three factor model as suggested by the changes in slopes
(Pallant). This 3 factor model explained 46.4% of the variance (Appendix HH).
Upon examination of the three factor model, it was noted that there were only a few items
loaded on factor 3. As well, those items in the NEIS questionnaire are dissimilar. Therefore, a
two factor model was examined and it explained 36.3% of the variance (Table 6). The items that
loaded on factor one reflected the experiential questions and those that loaded on factor two
reflected the strategic questions. There is literature supporting a two factor EI model (Mayer,
Salovey, Caruso, & Satarenios, 2003).
112
Table 6. Two Factor Model (Component Matrix)
Items Component
1 2
NEIS 1 .466
NEIS 4 .547
NEIS 5 .503
NEIS 6 .548
NEIS 8 .616
NEIS 9 .631
NEIS 11 .563
NEIS 18 .516
NEIS 19 -.514
NEIS 21 .586
NEIS 22 .655
NEIS 23a .562
NEIS 23b .501
NEIS 24a .536
NEIS 24b .696
Only loadings > .30 presented
The next step in the factor refinement process was to examine the instrument’s reliability
and modification indices. The split-half reliability of this 15 item measure was .70. The Item-
Total Statistics demonstrated that the Alpha would not increase significantly if any of the items
were removed. Therefore, a two factor model with 15 items explaining 36.3% of the variance
was retained.
113
Psychometric Assessment of the NEIS: Discriminant and Concurrent Validity
The assessment of the discriminant and concurrent validity of the NEIS using the two-
factor model comprised of the 15 items that was obtained from the exploratory factor analysis is
described. The reliabilities and correlations between the CEIS, NEIS, agreeableness,
conscientiousness, and openness are presented in Appendix II.
To assess the discriminant validity of the NEIS, participants were asked to complete three
of the Big Five personality traits, agreeableness, openness, and conscientiousness, as measured
by Goldberg’s (1999) International Personality Item Pool (IPIP) short scale. The NEIS was
distinct from the constructs of openness and conscientiousness, and had a small positive
correlation with agreeableness (r= .24, p< .05). Similarly, the correlations between the CEIS and
agreeableness, openness, and conscientiousness were nonsignificant.
To assess the concurrent validity of the NEIS, participants also completed one other
measure of EI, the CEIS. As expected, the total NEIS was moderately correlated with the total
CEIS (r= .32, p< .01). The total NEIS was moderately correlated with only the managing subtest
of the CEIS (r= .44, p< .01). The experiential factor of the NEIS had a small correlation with the
CEIS’ perceiving subtest (r= .29, p< .01) and the strategic factor of the NEIS had a moderate
correlation with the managing subtest of the CEIS (r= .46, p< .01). These results further
strengthen the two factor NEIS as the experiential factor includes perceiving and the strategic
factor includes managing.
The descriptive statistics for the NEIS and the CEIS are presented in Table 7 for
comparison. To ease interpretability, both the NEIS and CEIS were normalized to standard
scores with a mean of 100 and a standard deviation of 15. The medians for the NEIS and CEIS
are similar, however, the mode for the NEIS (101.1) is greater than that of the CEIS’s (76.0). The
114
range of scores between the NEIS and CEIS is also similar, however, the minimum score on the
NEIS is lower than that of the CEIS.
Table 7. Descriptive Statistics for the NEIS and CEIS
Instrument
Median
Mode
Mean (SD)
(Range)
Number
(N)
Nursing EI Scale 102.2 101.1 100 (15)
(54.7- 124.4)
81
Experiential
104.2 110.9 100 (15)
(56.1-125.2)
81
Strategic
104.5 99.4 100 (15)
(53.6- 119.8)
81
Consumer EI Scale (Kidwell et. al,
2008)
102.6
76.0
100 (15)
(65.4-129.9)
81
Perceiving 102.6 102.6 100 (15)
(69.9-126.8)
81
Understanding 103.3 106.4 100 (15)
(62.7-117.1)
81
Facilitating 95.2 125.3 100 (15)
(74.8- 137.2)
81
Managing 101.4 65.4 100 (15)
(65.4- 121.4)
81
Preceptorship Study
Response Rates
A total of 164 nurses were approached to participate in this study. Four of the sites
emailed the study information letter to the preceptors, whereas one site emailed the letter to the
new graduate nurses. Forty-five new graduate nurses and forty-one preceptors participated in this
115
study and together they made-up fifty-one dyads. Therefore, fifty-one dyads of preceptors and
new graduate nurses working at five Toronto and greater Toronto area hospitals participated in
this study. The sites included two affiliated adult teaching hospitals, one pediatric and two
community affiliates. The response rate for this study was calculated based on the number of
returned dyad surveys and was 31.1% (N=51).
The response rate in this study is similar to response rates reported in previous
preceptorship studies using dyads, which ranged between 24 to 58% (Barrett & Myrick, 1998;
Fox, Henderson, and Malko- Nyhan, 2006; Mamchur & Myrick, 2003). Three preceptorship
studies using dyads did not report the total number of dyads approached for participation,
including those that chose not to participate (Anderson, 1998; O’Malley Floyd et al., 2005;
Sorenson & Yankech, 2008). By contrast, emotional intelligence studies using dyads have
reported response rates ranging from 23 to 92% (Brackett, Warner & Bosco, 2005; Côté &
Miners, 2006; Ramo et al., 2009; Wu et al., 2006).
Of the five sites included in this study, one had a centralized office that was aware of the
number of new graduate nurses hired within the organization, where they were employed, the
name of the preceptor, and the start and end dates of the preceptorship program. The other four
sites did not have this information. Therefore, it was not possible to obtain the total number of
eligible new graduate nurses hired within the study sites.
Missing Values
Of the fifty- one dyads, thirty-eight had complete data; twelve had missing data in either
a preceptor or new graduate nurse survey, or a preceptor cognitive intelligence test. One survey
had data that was not usable as the participant crossed a straight line through each page.
Univariate missing values for the measures in this study ranged from 10% to 12% on the new
116
graduate nurses variables and 18% to 22% on the preceptor variables. The missing variables
were handled through pairwise deletion to maximize the sample size.
Distribution of Variables
The distributions of the dependent variables were examined to ascertain if the linear
regression model assumptions were met. Of the new graduate nurse dependent variables, role
conflict was normally distributed; role ambiguity and job satisfaction were negatively skewed
and turnover was positively skewed. As role ambiguity and job satisfaction were negatively
skewed, they were transformed to conform to the normality assumptions of regression. Role
ambiguity was reflected and log transformed, thus now representing the log of role clarity. Rizzo
et al. (1970) discussed the positively worded items in the role ambiguity scale to be in the
direction of role clarity. Job satisfaction was reflected and square rooted, with the variable now
representing the square root of job dissatisfaction.
The new graduate nurse variable of turnover intent was positively skewed demonstrating
that in this sample the study participants had a low intent to turnover. As this variable was not
normally distributed, transformations as suggested by Tabachnick and Fidell (2007) were
conducted. These failed to create a normal distribution thus violating the normal distribution
assumption of regression. Consequently, the variable was dichotomized (Pallant, 2007). The
turnover intent scale consisted of seven items, with lower scores indicating lower intent to
turnover. The highest score on this scale was 4 out of 7. Thirty two percent of the new graduate
nurse sample chose the lowest option, indicating that there was a very low likelihood that they
would leave their current job. Thus, these participants were coded as “0” on the turnover intent
scale and the remainder 68% were coded as “1”.
117
Demographic Characteristics of Study Respondents
The following section provides descriptive information on the workplace characteristics
of the sample, and preceptors and new graduate nurses’ demographics.
Overall Sample Work Characteristics
Over half of the sample of dyads were recruited from a pediatric setting, while the
remainder of dyads came from adult acute care hospitals. The most common work settings were
surgery (N=11, 22%), medicine (N=9, 18%) and a combination of these (N=8, 16%). Table 8
provides a summary of the characteristics of the work settings.
Table 8. Workplace Characteristics for the Sample
Workplace Characteristics Number
(N)
Percent
(%)
Hospital site Site 1 29 58
Site 2 8 16
Site 3 7 14
Site 4 6 12
Site 5 0 0
Patient population Pediatric 29 58
Adult 21 42
Work setting Surgery 11 22
Medicine 9 18
Medical/ Surgical 8 16
Cardiology 5 10
Oncology 4 8
Intensive Care 3 6
Mental health 3 6
Recovery Room 2 4
Outpatient Clinic 1 1
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Preceptor Demographic Characteristics
Preceptors in this study ranged in age from 23 to 53 with a mean age of 31.6 years. The
median age was 30 and the mode was 30, suggesting that the majority of the sample fell below
the mean (i.e. 65% of the sample was below the mean age). The nurses had an average of 7.0
years of nursing experience, 5.2 years of service within their current organization and 4.8 years
of practice on their current unit. The preceptors in this study were younger and had less nursing
experience than the Canadian average (CIHI, 2013).
The majority of the preceptors in this sample were female (N=38, 76%), worked full-time
(N=37, 74%) in pediatrics (N=26, 52%), and half had a baccalaureate degree in nursing (N=25,
50%). A small percentage of nurses (N=7, 14%) in this sample were enrolled in either a
baccalaureate or master’s program in nursing. Twenty percent (N=10) of the sample held a non-
nursing baccalaureate degree. A summary of the preceptors’ demographic and employment
characteristics can be found in Appendix JJ.
New Graduate Nurse Demographic Characteristics
The new graduate nurses in this study ranged in age from 21 to 29 with a mean age of
24.5 years. The median age was 24 and the mode was 24; 53.5% of the sample was below the
mean age. The new graduate nurses had an average of 4 months of nursing experience. The
majority of the new graduate nurses in this sample were female (N=39, 78%), had graduated
from a university program in Toronto and were hired as a temporary employee (N=29, 58%)
under the New Graduate Nurse (NGN) initiative (N=44, 88%). The detailed summary of the new
graduate nurses’ demographic and employment characteristics can be found in Appendix KK.
119
Assessment of Instrument Psychometric Properties
The Cronbach’s alpha for each of the measures used in this study are presented in Table
9. Each of the Cronbach’s alphas were above .80 for both the preceptor and new graduate nurse
measures utilized in this study, which indicates good internal consistency of the tools. The
Cronbach’s alpha for the NEIS was .62, which is below the .70 cut-off and lower than the α= .70
found in the pilot study.
120
Table 9. Cronbach’s Alpha
Instrument α Number
(N)
Number of Items
Preceptor Measures
International Personality Item Pool (Goldberg, 1999)
Agreeableness .87 40 10
Conscientiousness .84 40 10
Openness .80 40 10
Emotional Stability .87 40 10
Nursing Emotional Intelligence Scale (NEIS) .62 40 15
IQ (Hogrefe, 2008) .78 41 50
New Graduate Nurse Measures
Role Ambiguity (Rizzo et al., 1970) .83 44 6
Role Conflict (Rizzo et al., 1970) .85 44 8
Michigan Organizational Assessment
Questionnaire Job Satisfaction
Subscale (Cammann et al., 1983).
.93 45 3
Intent to turnover (Mobley et al.,
1978)
.89 45 7
Core self-evaluation (Judge et al.,
2003)
.88 44 12
121
Results
At the time of this study, over half of the new graduate nurses (N=27, 54%) had not
received an offer of full time employment once the NGN initiative contract was completed. The
majority of the new graduate nurses in this sample reported that they were working in their
preferred hospital (N=42, 84%) and practice area (N=34, 68%). Of the small number (N=11,
22%) that were not working in their area of choice, five would have preferred working in the
emergency department and the majority (N=9) planned on pursuing their first job of choice.
Fifty-eight percent (N= 29) of the new graduates reported that they had either previously worked
on or completed a placement on their current unit and 38% (N= 19) had completed their
consolidation placement on their current unit. Table 10 provides a summary of employment
characteristics and perceptions of current work environment for the new graduate nurses in this
sample.
122
Table 10. New Graduate Nurses’ Perceptions of their Current Work Setting
Work Setting and Perceptions of Current Work Setting Number
(N)
Percent
(%)
Hired with New Graduate Nurse
initiative
Yes
44
88
No 1 2
Missing 5 10
Received offer for full-time
employment once NGN Initiative
contract complete
No 27 54
Yes 15 30
Missing 8 16
Was this hospital your first choice of
employment?
Yes 42 84
No 3 6
Was this setting your first choice of
employment?
Yes 34 68
No 11 22
Missing 5 10
What was your first choice of
employment?
Adult 7 63.6
Pediatrics 4 36.4
Emergency Department 5 45.5
Oncology 3 27.3
Intensive Care 1 9.1
Outpatient Clinic 1 9.1
Chose more than 1 setting 1 9.1
Do you plan on pursuing your first
choice of employment?
Yes 9 81.8
No 2 18.2
Have you previously worked on or
completed a clinical placement on your
current unit of hire?
Yes 29 58
No 16 32
Did you do your final clinical
practicum/ consolidation on your
current unit of hire?
Yes 19 38
No 26 52
123
Characteristics of the Preceptorship Program
The characteristics of the preceptorship programs were derived from both the preceptor
and new graduate nurse surveys. Newly graduated nurses provided the start and end date of their
preceptorship program and the average length was 3 months (SD.13). The median and the mode
were also 3 months, suggesting that the majority of the sample fell around the mean. The shortest
preceptorship reported was one month and the longest was 10 months. The new graduates
sampled were asked how many preceptors they were assigned over the course of their
preceptorship program. Over half of the sample (N=26, 52%) reported that they had one
preceptor, 24% (N=12) had two, 2% (N=1) had 3 preceptors and the remainder 12% (N=6) had
four or more.
To gain an understanding of the preceptors’ experience in the role and preparation for the
role, four specific questions were included in the preceptor survey. The majority of the
preceptors in this sample had experience in the role (N=33, 66%) with an equal number reporting
having been a preceptor twice (N=11, 22%) or three times (N=11, 22%) in the last two years.
Over half reported that they had preceptored a nursing student in the past (N=28, 56%), while
sixty percent had experience precepting a new graduate nurse (N=30), and fewer a new staff
member (N=14, 28%). The majority of the sample had participated in a preceptor training
program (N=27, 54%) provided by their employer (N=26, 52%). A summary of the
preceptorship program characteristics is presented in Table 11.
124
Table 11. Characteristics of the Preceptorship Programs in this Study
Preceptorship Programs Number
(N)
Percent
(%)
First time in the preceptor role Yes 7 14
No 33 66
Missing 10 20
Number of Times as a Preceptor 1 2 4
2 11 22
3 11 22
4 4 8
5 or more times 3 6
Other 7 14
Missing 12 24
Who have you preceptored? Nursing Student 28 56
New Graduate Nurse 30 60
New Staff Nurse 14 28
Missing 11 22
Formal preceptorship training Yes 27 54
No 8 16
Missing 13 26
Provided by employer 26 52
Other 3 6
Number of preceptors during
preceptorship program
1 26 52
2 12 24
3 1 2
4 or more 6 12
Missing 5 10
125
New Graduate Nurse Outcomes
Table 12 displays the results for the new graduate nurse outcomes examined in this study.
Role ambiguity is measured on a scale from 1-7 with higher scores reflecting lower role
ambiguity. The new graduate nurses’ average scores on this scale are above the mid-point and
reflect low levels of role ambiguity with a mean of 5.75 (SD .84). Thus, the new graduate nurses
in this sample appear to have a good understanding of their role as a nurse. Role conflict is
measured on a scale from 1 to 7 with lower scores representing lower role conflict. The new
graduate participants reported having low levels of role conflict, with a mean of 3.21 (SD 1.17)
which is below the mid-point. These findings were unexpected as the literature reports that new
graduate nurses’ tend to experience higher levels of role ambiguity and role conflict than those
found in this study (Chang & Hancock, 2003). In this sample, the new graduate nurses also had
low intent to turnover with a mean of 1.70 (SD .83) on a scale from 1 to 5, and high job
satisfaction with a mean of 6.36 (SD .99) on a scale from 1 to 7. New graduate nurses’ core self-
evaluations were measured with a scale ranging from 1 to 5, with higher scores representing
higher CSEs. In this sample of new graduate nurses, the mean was slightly above the mid-point
(Mean= 3.90, SD .59) suggesting that these nurses had moderate self-confidence in their
abilities.
126
Table 12. New Graduate Nurse Outcomes
Instrument
(Scale range)
Median Mode Mean (SD)
(Range)
Number
(N)
Role Ambiguity (Rizzo et al., 1970)
(Scale Range 1-7)
5.75 5.83 5.55 (.84)
(2.67-7.00)
44
Role Conflict (Rizzo et al., 1970)
(Scale Range 1-7)
3.00 2.00* 3.21 (1.17)
(1.00-6.25)
42
Job Satisfaction (MOAQ- JSS;
Cammann et al., 1983)
(Scale Range 1-7)
6.67 7.00 6.36 (.99)
(1.00-7.00)
45
Intent to Turnover (Mobley et al., 1978)
(Scale Range 1-5)
1.29 1.00 1.70 (.83)
(1-4)
44
Core Self- Evaluations (Judge et al.,
2003)
(Scale Range 1-5)
4.00 3.50 3.90 (.59)
(2.42-4.92)
44
*multiple modes; the smallest value is shown
Preceptor Variables
The descriptive statistics for the preceptor measures are presented in Table 13. The means
for two of the four personality traits measured by the International Personality Item Pool
(Goldberg, 1999) were high in this sample, suggesting that the preceptors in this sample tended
to be agreeable and conscientious. The means for the other two personality traits, openness and
emotional stability, were just below the mid-point, suggesting that this sample of preceptors were
moderately open and emotionally stable. These results are slightly higher than those found in the
pilot study sample. The NEIS was scored using the scoring key developed from the expert nurses
in the pilot study. To ease interpretability, the NEIS was normalized to standard scores with a
127
mean of 100 and a standard deviation of 15. The nurses in this sample had a similar range of
scores on the NEIS as those in the pilot study, but the median was slightly higher in this sample.
Table 13. Descriptive Statistics of Preceptor Measures
Instrument
(Scale range)
Median Mode Mean (SD)
(Range)
Number
(N)
Cattell Culture Fair Intelligence Test
(Hogrefe, 2008)
(Scale Range 0-50)
24 24 24.6 (3.61)
(11-34)
41
Agreeableness (IPIP, Goldberg, 1999)
(Scale range 1-5)
4.40 4.20 4.36 (.57)
(1.80- 5.00)
40
Conscientiousness (IPIP, Goldberg,
1999)
(Scale range 1-5)
4.15 3.70* 4.10(.55)
(2.30-5.00)
40
Openness (IPIP, Goldberg, 1999)
(Scale range 1-5)
3.70 3.30* 3.63 (.50)
(2.00-4.70)
40
Emotional Stability (IPIP, Goldberg,
1999)
(Scale range 1-5)
3.40 3.60 3.35 (.65)
(2.00-4.70)
39
Nursing Emotional Intelligence Scale
(NEIS)
104.6 110.5 100 (15)
(63.6- 125.1)
40
*multiple modes; the smallest value is shown
Comparability of Groups by the Number of Preceptors
Multivariate Analysis of Variance (MANOVA) was performed on the new graduate
nurses’ outcome variables role conflict, role ambiguity, job satisfaction and intent to turnover to
compare the responses grouped by the number of preceptors they were assigned to. Levene’s
Test of Equality of Error Variances was non-significant indicating that the assumption of
128
homogeneity was not violated (Pallant, 2007). There were no significant differences between the
groups on the new graduate nurse outcomes based on the number of preceptors [F (8, 68) = 1.70,
p= .11; Wilkes’ Lambda= .69, partial eta squared= .17).
Correlational Analysis
Table 14 provides the correlation matrix and reliabilities for the measures of the
dependent and independent variables included in this study. Preceptors’ emotional intelligence,
as measured by the NEIS, was not significantly correlated with any of the other variables in this
research study. The lack of significant correlations suggests that in this sample, preceptors’
emotional intelligence may not have had an impact on new graduate nurses’ outcomes at the end
of a preceptorship program. As the sample size in this study was small, the correlations must be
interpreted with caution.
Preceptors’ personality traits, agreeableness, openness, conscientiousness and emotional
stability, were measured with Goldberg’s (1999) International Personality Item Pool (IPIP) short
scale. Agreeableness was moderately correlated with openness (r= .44, p < .05), more highly
correlated with conscientiousness (r= .65, p < .01), and moderately correlated with emotional
stability (r= .38, p< .05). Openness also had a moderate correlation with conscientiousness (r=
.39, p < .05). The relationships between these personality traits are as expected and similar to
those found in the pilot study and existing literature.
In this sample, there were three preceptor variables that were correlated with new
graduate nurse outcome variables. Preceptors’ conscientiousness was moderately correlated with
new graduate nurses’ turnover intent (r= .37, p < .05). This finding is opposite to the relationship
expected, that new graduate nurses would have lower intent to turnover when working with a
preceptor who was conscientious. Preceptors’ openness was moderately correlated with new
129
graduate nurses’ job dissatisfaction (r= .37, p< .05) and role conflict (r= .40, p< .05), which was
also opposite to the relationships hypothesized. Preceptors’ emotional stability was positively
related to new graduate nurses’ role ambiguity (r= .34, p< .05). This finding was unexpected and
contradicts what was initially hypothesized.
New graduate nurses’ job dissatisfaction had a moderate relationship with their role
clarity (r= .43, p < .05) and a large correlation with role conflict (r= .72, p < .01). This finding
suggests that the new nurses in this study with greater role ambiguity and conflict are less
satisfied with their job. New graduate nurses job dissatisfaction was positively related with
working on a unit that was not their first job of choice (r= .45, p< .001). This suggests that new
graduate nurses that are not currently working in their first job of choice are less satisfied with
their job.
New graduate nurses’ core self-evaluations had a strong association with their job
dissatisfaction (r= -.54, p < .01). The negative correlations between core self-evaluations and role
clarity (r= -.71, p < .01) and role conflict (r= -.54, p < .05) suggest that new graduate nurses who
are more confident in their abilities are less likely to be ambiguous about their role and may
experience less role conflict.
New graduate nurses’ first job of choice was positively correlated with their role conflict
(r= .43, p< .01) and their role clarity (r= .34, p< .05). These findings suggest that new nurses that
are employed other than in their first job of choice experience greater role conflict and
ambiguity. Additionally, new graduates’ role conflict and role clarity are positively related (r=
.32, p< .05) suggesting that higher role conflict and role ambiguity tend to go hand in hand.
130
Table 14. Reliabilities and Correlations for Preceptor and New Graduate Nurse Variables
Preceptor Measures NGN Measures
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.
Preceptor
Measures
1. NEIS (.62)
(40)
2. Agreeableness
-.04
(40)
(.87)
(40)
3. Conscientiousness
.28
(40)
.65**
(40)
(.84)
(40)
4. Openness
.23
(40)
.44**
(40)
.39*
(40)
(.80)
(40)
5. Emotional Stability
-.18
(39)
.38*
(39)
.03
(39)
.04
(39)
(.87)
(39)
6. IQ -.27
(38)
-.11
(38)
-.16
(38)
-.07
(38)
-.21
(37)
(.78)
(41)
NGN
Measures
7. Job Dissatisfaction
(square root)
.27
(38)
.09
(38)
.02
(38)
.37*
(38)
.02
(37)
-.22
(37)
(.93)
(44)
8. Turnover intent
(Dichotomized)
.10
(37)
.31
(37)
.37*
(37)
.21
(37)
.02
(36)
-.14
(37)
.24
(43)
(.89)
(44)
9. Role Conflict
.31
(35)
.22
(35)
.12
(35)
.40*
(35)
.29
(34)
.02
(35)
.72**
(41)
.10
(42)
(.85)
(42)
10. Role Clarity
(Log)
.07
(38)
.24
(38)
.11
(38)
.15
(38)
.34*
(37)
-.29
(38)
.43*
(43)
-.00
(43)
.32*
(41)
(.83)
(44)
11. Core Self-
Evaluations
-.20
(37)
-.23
(37)
-.10
(37)
-.30
(37)
-.31
(36)
.22
(37)
-.54**
(44)
.05
(43)
-.54**
(41)
-.71**
(43)
(.88)
(44)
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Preceptor Measures NGN Measures
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.
12. First Job of Choice .31
(38)
.18
(38)
.05
(38)
.20
(38)
-.12
(37)
-.08
(38)
.45**
(44)
.17
(44)
.43**
(42)
.34*
(44)
-.44*
(44)
n/a
(44)
13. Previous Experience
on Unit
-.10
(38)
-.12
(38)
-.27
(38)
-.06
(38)
.23
(37)
.07
(38)
.05
(44)
.00
(44)
.09
(42)
.30
(44)
-.29
(44)
.18
(45)
n/a
(45)
Note: Pearson Correlations (N)
*p< .05; **p< .01
132
Hypothesis Testing
To demonstrate mediation, the following three criteria need to be met: (1) the
independent variable must be related to the mediator; (2) the independent variable must be
related to the dependent variable; and (3) full mediation when the relationship between the
independent and dependent variables become nonsignificant when the mediator is introduced or
partial mediation when the relationship between the independent and dependent variables is
reduced (Baron & Kenny, 1986). In this study, the independent variable, emotional intelligence,
was not related to the dependent variables or the mediators. Therefore, Baron and Kenny’s
(1986) criteria have not been met and thus conducting a regression analysis is not supported.
Additionally, since there was no mediation, Sobel’s test was not conducted.
133
CHAPTER VI
DISCUSSION
The relationship between a preceptor and new nurse is an important one as it will help
facilitate new nurses’ socialization during what has been described as a difficult transition. There
is a gap in our understanding of the role that a preceptor’s individual differences might play in
the socialization process of new nurses during a preceptorship program. As the literature
suggests that emotional intelligence may have an important role in educators’ teaching self-
efficacy, leaders’ effectiveness, as well as interpersonal and group relationships, this may also be
an important characteristic to consider in preceptors. Therefore, the purpose of this study was to
examine the relationship between preceptors’ emotional intelligence and the socialization
outcomes of new graduate nurses during a preceptorship program. More specifically, the impact
of preceptors’ emotional intelligence on new graduate nurses’ role conflict, role ambiguity, job
satisfaction and turnover intent was explored while controlling for the effects of preceptors’
cognitive intelligence and personality, as well as new graduate nurses’ core self-evaluations, first
job of choice and previous experience on unit of hire. Van Maanen and Schein’s (1979) theory
of organizational socialization provided the conceptual framework underpinning this study and
provided a new lens through which preceptorship was examined. This chapter discusses the
results of this study while considering recent literature on preceptors, new graduate nurses, and
nurses, discusses the limitations and finally the implications for practice and research.
Discussion Related to Hypothesis Testing
This thesis examined the impact of preceptors’ emotional intelligence on new graduate
nurses’ socialization outcomes during a preceptorship program. Nine hypotheses were proposed
based on the literature and Van Maanen and Schein’s (1979) theory. It was hypothesized that
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preceptors’ emotional intelligence would be negatively related to new graduate nurses’ role
ambiguity, role conflict, and intent to turnover at the end of the preceptorship program; that
preceptors’ emotional intelligence would be positively related to new graduate nurses’ job
satisfaction at the end of the preceptorship program; new graduate nurses’ role ambiguity and
role conflict would partially mediate the relationships between preceptors’ emotional intelligence
and new graduate nurses’ job satisfaction and intent to turnover; and new graduate nurses’ job
satisfaction would be negatively related to their turnover intent. As the independent variable,
“preceptors’ emotional intelligence”, was not correlated with the dependent variables, the
proposed hypotheses were not supported.
Discussion Related to Correlational Analysis
Correlational analysis provided insight into the relationships between several of the
variables. Three of the preceptors’ personality traits had significant correlations with new
graduate nurse outcomes. First, preceptors’ openness was positively correlated with new graduate
nurses’ job dissatisfaction and role conflict suggesting that new graduate nurses that are working
with preceptors who are more open are less satisfied with their job and are more likely to
experience role conflict. These relationships are opposite to what one would expect. It is possible
that such preceptors are able to have more open and honest discussions with their new graduate
nurses about their progress and about nursing, and therefore the new graduate nurse is able to
realize that they are not satisfied with their job. Additionally, perhaps these preceptors are more
focused on new clinical experiences than on their new graduate, which could lead to the new
nurse feeling less satisfied with their job. Additionally, new graduate nurses who are working
with more open preceptors may be more aware of the complex and intricate subtleties inherent in
a nurse’s role, leading to role conflict in the new nurse. Second, preceptors’ conscientiousness
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was positively related to new graduate nurses’ turnover intent. This suggests that these new
graduates that have more conscientious preceptors are more likely to want to leave their current
job, another unexpected finding. Perhaps these new nurses see how hard their preceptors work
and decide that they do not want to be in a job that requires that much effort or that they feel the
expectations are too high. Third, preceptors’ emotional stability was positively related to new
graduate nurses’ role ambiguity. Therefore, new nurses that are paired with preceptors that are
calmer and less reactive to stress are more likely to experience role ambiguity. Although this
relationship was opposite to what was expected, it may be that these preceptors provide less
direction to the new nurse. Additionally, since these preceptors are more likely to stay calm and
composed, perhaps they are too calm and therefore the new nurse might not get a good
understanding of expectations and priorities.
Job satisfaction has long been demonstrated to be an important predictor of turnover
intent (De Gieter, Hofmans and Pepermans, 2011; Irvine and Evans, 1995). It was expected that
this relationship would be the same in this study. However, new graduate nurses’ job satisfaction
was not significantly related to their intent to turnover. This might be because the current job
market, in terms of hiring, for new nurses is different than it was several years ago. There was an
obvious change in new graduate nurse hiring patterns between 2009 and 2012 as evidenced in
Table 1 on page 62. In several of the sites included in this study, there was a decline in the
number of new nurses hired. It is plausible that new graduates that are dissatisfied with their
employment are aware of the current job market and perceive that there may not be many
alternative options. Although the job market might not impact their job satisfaction, it could
impact on their intent to turnover. Van Maanen (1976) proposed that environmental conditions,
such as availability of alternate positions, as well as social and economic factors, may influence
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the organizational socialization process and its outcomes. For example, employees may resist
organizational socialization efforts when many alternate jobs are available. During such times,
organizations could intensify their socialization practices to increase a sense of loyalty in their
new employees. In this sample, a limited job market coupled with a formal three- month
preceptorship program may be sufficient to retain this cohort of new nurses.
In a large Canadian study, O’Brien-Pallas, Tomblin Murphy, Shamian, Li, & Hayes,
(2010) reported that nurses’ role conflict and ambiguity are related to higher turnover. There was
no relationship between new nurses’ intent to turnover and role conflict and ambiguity in the
current study. In this study, intent to turnover was not related to any of the other new graduate
nurse variables. This may be in part due to the current economic times where there were few new
nurse positions available, as there were limited options for movement.
New graduate nurses’ job satisfaction was related to several other new nurse variables. In
this sample, new nurses’ job dissatisfaction was related to higher role conflict (r= .72, p< .01)
and role ambiguity (r= .43, p< .05). This suggests that with these new nurses, higher role conflict
and ambiguity leads to less job satisfaction. This relationship between role ambiguity and job
satisfaction is supported in the literature (Chang and Hancock, 2003). New graduate nurses’ job
dissatisfaction was also positively related to their first job of choice (r= .45, p< .01). For these
new nurses, job satisfaction was impacted if they were not working in their first job of choice.
Beecroft, Dorey and Wenten (2008) found a similar relationship.
The findings in this study about the relationship between new graduate nurses’ core self-
evaluation and job dissatisfaction (r= -.54, p< .01) supports what has been reported in previous
research (Best et al., 2005; Erez & Judge, 2001; Judge et al.). An interesting finding was the
relationships between new nurses’ core self-evaluation and role conflict (r= -.54, p< .01) and role
137
ambiguity (r= -.71, p< .01). This suggests that an employee’s assessment of their effectiveness
and abilities may also be associated with their role conflict and ambiguity. Therefore, new
graduates with higher core self-evaluations may have more confidence in their ability to
effectively interact with their colleagues and work environment, as well as adapt their own
behavior to decrease their role conflict and ambiguity; for example, asking questions, seeking
information and clarification about their role.
The majority of the new nurses surveyed had previous experience on the unit they were
currently working on, either in the form of a job or clinical placement. However, previous
experience on the unit was not related to new graduate nurses’ job satisfaction, turnover intent,
role conflict and role ambiguity. Van Maanen and Schein’s (1979) fourth theoretical assumption
proposes that regardless of the previous knowledge and information an individual has about a
work role, their understanding of this role will change once they undergo their transition.
Therefore, this finding may reflect the differences in roles, purposes and outcomes of the
socialization that takes during clinical placements and those of new nurse preceptorship
programs. The transition experienced during clinical placements and early work experiences may
be different and unrelated. As such, it would be important for staff nurses and nursing leaders to
understand that new graduates working on a unit where they completed a clinical placement may
require the same amount and type of socialization as someone who has not. New nurses’ that are
working in their first job of choice experience less role conflict (r= .43, p< .01) and ambiguity (r=
.34, p< .05). It is likely that new nurses spend time reflecting about what specialty they are
interested in and where they would like to practice, and that this is an important consideration
when choosing where they would like to work.
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Discussion Related to Sample Characteristics
Preceptorship Programs
Program Duration
The average length of the preceptorship programs in this study was 3 months (SD .13),
consistent with what is reported in the literature review and the requirements of the Ontario New
Graduate Nurse Guarantee (Health Force Ontario, 2011). One respondent had a preceptorship of
one month; however, this participant was not hired under the New Graduate Nurse Guarantee.
The study results also support the findings in the literature that the length of preceptorship
programs varies by nursing specialty, with critical care areas having a much longer time
dedicated to preceptorship. Van Maanen and Schein (1979) emphasize that the duration of
socialization programs should commensurate with the complexity and risk involved in the work.
As such, individuals whose work is complex and errors may have severe consequences, should
have longer socialization periods. In this study, the new graduate nurses that were hired in
critical care areas, such as ICU, PACU and cardiology, received longer than three months and up
to 10 months for their preceptorship. Additionally, Van Maanen and Schein (1979) propose that
new employees’ anxiety will be reduced if they have a clear understanding of the timetable and
boundary passages associated with the formal socialization process. For example, new nurses
that are provided with a priori knowledge that the organization provides a minimum
preceptorship program of 3 months and the expectation of independent practice once the
program has completed, will likely experience less anxiety. This is one benefit of the NGG as
new hires arrive into the organization with a clear understanding of the length of the
preceptorship program.
139
Number of Preceptors
The Canadian Nurses Association (1995; 2004) and the literature recommend that new
graduate nurses have one assigned preceptor for the duration of the preceptorship program. The
preceptorship literature has highlighted that although a 1:1 model is preferred, there are
organizational challenges to this model, such as lack of available preceptors. In this sample, over
half of the new graduate nurses (N=26, 52%) had one preceptor and 24% (N= 12) had two
preceptors. Fourteen percent (N= 7) of the new graduates reported having three or more
preceptors. Recently, Brakovich and Bonham (2012) reported that fifty percent of their sample of
new graduates (N= 157) reported having one preceptor, whereas 46% reported having two or
three preceptors. The purpose of the 1:1 model is to ensure consistency in learning, evaluating,
and relationship building. This can be difficult to achieve when working with multiple
preceptors. In this sample, there were no differences in means on new graduates’ job satisfaction,
role ambiguity, role conflict and turnover intent based on the number of preceptors. Van Maanen
and Schein (1979) argue that for organizational socialization to be effective when there are
multiple socializing agents, the values, motivators, and role understanding of the agents must be
in common with each other and the organization, otherwise, the new employee will receive
conflicting information. Therefore, in settings where it may be impossible to maintain preceptor
continuity, the leadership team may need to ensure that the nurses on the unit are aware of the
values of the organization and unit, as well as the goals of a preceptorship program. Ensuring this
knowledge may lead to a greater congruency between preceptors.
Preceptor Experience and Training
Over half of the preceptor sample (N= 27) reported that they had received some type of
preceptor training and for the majority of these preceptors (N= 26) the training was provided by
140
their organization. There is a substantial body of literature on preceptor preparation and training
programs. There are numerous benefits for organizations to invest in preceptor preparation
programs, such as being vital to the success of any preceptorship program (Baltimore, 2004),
ensuring that preceptors have the knowledge & skills necessary to perform their role (Al-
Hussami, Saleh, Darawad, & Alramly, 2011; Baltimore, 2004; Sorensen & Yankech, 2008),
increasing preceptor satisfaction with the role (Henderson et al., 2006), may be related to
preceptor role commitment (Dibert & Goldenberg , 1995; Speers et al, 2004; Usher et al. 1999),
and improving preceptors’ and new nurses’ adoption of the program content in the clinical
setting (Speers et al., 2004).
There are many challenges to taking on the preceptor role. It is reported that nurses feel
they are preceptors too often and they do not have a choice in being a preceptor (Carlson et al.,
2009; Dibert & Goldenberg, 1995). The majority of the preceptors in this sample had previous
experience (N=33, 66%) in the role with an equal number reporting having been a preceptor
twice (N=11, 22%) or three times (N=11, 22%) in the last two years. Fourteen percent (N= 7)
had been a preceptor four or more times in the last two years. If, on average, a preceptorship
program is three months, then these nurses had spent a minimum of 12 of the last 24 months as
preceptors. Although this might seem like a burden and consistent with the literature, none of the
preceptors surveyed reported feeling that they spent too much time teaching new staff or
students.
Discussion Related to Preceptors
Cognitive Intelligence
The mean of the surveyed preceptors’ cognitive intelligence, as measured by the Cattell
Culture Fair Test, was a normalized standard score of 108 at the 69th
percentile (Hogrefe, 2008).
141
No studies examining nurses’ cognitive intelligence were found, however, the results from this
study are compared to Côté and Miners’ (2006) study. These authors surveyed managerial,
administrative, and professional staff at a university and reported that the mean IQ scores, as
measured by the Cattell Culture Fair Test, of their sample (N= 175) was 102.8 at the 55th
percentile. Over 50% of both samples had an undergraduate degree; however, the preceptor
sample had a higher percentage of Master’s degrees (24%) than in Côté and Miners’ sample
(10%). The preceptors in this sample had higher cognitive intelligence scores than in Côté and
Miners’ study. Additionally, there was little variation in the preceptors’ cognitive intelligence
scores. These are interesting findings that could perhaps be explained by the particular types of
individuals that are attracted to the profession of nursing and by the nature of nurses’ educational
preparation. Half of this sample of preceptors had a baccalaureate degree (N= 25) and another
24% (N= 12) had a graduate degree. In 2005 in Ontario, a baccalaureate degree in nursing
became the entry to practice requirement and all nurses in Ontario write the same entry to
practice registration exam, which sets a minimum standard requirement for all nurses in the
province. It is also possible that the dynamic and complex profession of nursing attracts a certain
type of individual that tends to have higher cognitive intelligence.
Although education and cognitive intelligence have been reported to be positively
correlated, the type and direction of the causal relationship is controversial and complex to
measure (Ceci, 1991; Deary & Johnson, 2010). As stated by Deary and Johnson: “So, it is
possible that intelligence causes differences in educational outcomes, or that education causes
intelligence differences, or a bit of both. Indeed, it is probably more complex than this.”(p.
1363). Therefore, it is difficult to draw a conclusion about the relationship between preceptors’
cognitive intelligence and their level of education.
142
Personality
Few studies have examined nurses’ personality traits. Two studies that measured nurses’
personality were located and both measured personality using the NEO Five Factor Inventory
(Gutierrez, Jimenez, Hernandez, & Puente, 2005; Zellars, Perrewé, & Hochwarter, 2000).
Although these two studies were from different countries, they both had similar participant
demographics; both samples were older and more experienced than the preceptors included in
this study. Gutierrez et al.’s sample (N= 236) mean age was 35.23 (SD 8.03) and the nurses had
an average of 13.18 years of experience (SD 7.80). Zellars et al.’s participants (N= 188) was on
average 40 years old (SD 8.00) and had 15 years of experience (SD 9.00). Gutierrez et al.’s study
participants were moderate on agreeableness (M 31.28 SD 6.20) and conscientiousness (M 33.26
SD 6.20), and low on openness (M 28.47 SD 6.87) and neuroticism (M 18.80 SD 7.11).
Gutierrez et al.’s participants had lower scores on all four traits compared to Zellars et al.’s
sample. These differences could be explained by the differences in culture between Spain and the
US. Zellars et al.’s sample of nurses from the US had personality scores comparable to those in
this study; agreeableness M 3.86 SD .44, conscientiousness M 4.11 SD.44, openness M 3.37 SD
.47, and emotional stability M 2.52 SD .61. Additionally, the personality results of the pilot study
were also comparable to those in the preceptorship study and Zellars’ study, suggesting that they
may be generalizable to a North American nursing population. As volunteering for the preceptor
role was not explored in this study, it is not possible to determine if there were differences in
personality between the preceptors that volunteer for the role and those that do not.
Emotional Intelligence
In the current study, 32% (N= 16) of preceptors had EI scores that fell below the mean
while the remainder 48% (N= 24) were above the mean, similar to the results of the pilot study
143
(N= 81). Although there are no studies examining the EI of nurse preceptors, there are a few
studies that have measured the EI of nurses and one study that examined the EI of faculty nurses
that engage in clinical teaching with undergraduate nursing student (Allen et al., 2012). Allen
and colleagues found that 70% of the nurse faculty (N= 33) were situated within the effective EI
range as measured by the BarOn EQ-i:S self-report tool, 25.5% (N=12) in the enhanced skill
range, whereas 4.3% (N=2) were in the areas for enrichment range. By contrast, Codier et al.
(2008) measured the EI of their sample of nurses (N= 27) using the MSCEIT and they found that
37% of their sample was below the mean, while the remaining 63% were at or above the mean.
Saeed, Javadi and Nouri (2013) measured Iranian nurses’ (N= 212) EI using the self-report
Brasberi and Greaves questionnaire published in 2005. These authors found that 48.6% (N= 103)
of the sample were categorized as “good” and “excellent” EI skills, whereas 51.5% (N= 109) fell
in the low EI categories. The results of these studies are similar to what was found in the current
pilot and preceptorship studies; the majority of the nurses fell above the mean, therefore
suggesting that the preceptors in this sample had similar emotional intelligence scores as those
reported in a more general nursing population. These findings suggest that there may not be
differences between the emotional intelligence of nurses that are preceptors and those that are
not. Although some nurses opt to be preceptors, the literature reports that preceptors are often
chosen by management instead. In this study, preceptors were not asked if they had volunteered
for the role. Therefore, it is not possible to determine if there was a difference between the EI of
nurses that volunteer to precept versus those that do not.
144
Discussion Related to New Graduate Nurses
New Graduate Nurses’ Work Characteristics
In 2005, 75% of new graduate nurses surveyed by Baumann, Blythe, Cleverly, and
Grinspun (2006) reported that they preferred to obtain a full-time (FT) position in nursing.
However, 43% of those new nurses were actually employed full-time (Baumann et al.). In
response to improving the FT to part-time ratios and the hiring and retaining of new graduate
nurses, the Ontario Government funded the Nursing Graduate Guarantee (NGG) in 2007. In this
study, 88% (N= 44) of respondents were hired with the NGG and thus working FT. This is much
higher than the rate reported in the literature. For example, Laschinger (2012) reported that 55%
of her sample of new graduates was working FT within their first year of practice and 68% in
their second year. Similarly, 62% of Laschinger, Wong and Grau’s (2012) sample of new nurses
at their first year of practice were working FT. The higher rate of FT employment in this study
likely reflects the NGG practices and that this sample was still within the NGG timeframe at the
time of recruitment. However, over half of this subgroup had not received an offer of full-time
employment (N= 27, 54%) once the NGG contract ended. Although at the time of recruitment,
the new nurses were about half way through their 6 months as part of the NGG and thus it was
not possible to ascertain if this subgroup did receive a full-time offer of employment. The NGG
guarantees the hiring organization funding for six months, after which, the organization can
either bridge to a FT position or not.
Over 80% (N= 42) of this sample of new graduate nurses was employed in their job of
choice. Further, 68% (N= 34) were working in their preferred nursing specialty. For these new
graduate nurses, being employed in their job of choice was positively related to their job
satisfaction (r= .45, p< .01). This finding intuitively makes sense as these new nurses are
145
working where they wanted to be. Of the number of new graduates (N=11, 22%) that were not
working in their preferred area, almost 82% (N= 9) reported that they were planning on pursuing
their first job of choice. However, it is not clear when they were planning on seeking
employment in their preferred area.
Nearly 60% (N= 29) of this sample of new nurses had experience on their unit of hire, in
the form of either a clinical placement or a job. This number is higher than the 30.6% (N= 71)
reported in Peterson, McGillis Hall, O’Brien- Pallas and Cockerill’s (2011) study of Ontario new
graduate nurses. Furthermore, of those with previous experience on their current unit, 34.5% had
completed a consolidation on the unit. These findings have implications for organizations that
are interested in recruiting new graduate nurses. Recruitment strategies could be aimed at nursing
students that are completing a placement within the organization. Additionally, hiring nursing
students to work on a unit, for example as an extern, could also lead to long term recruitment of
nurses. Partnerships between the university and hiring organization could be established to create
innovative placement programs, where students choose to spend the majority of their placements
at a specific institution. This may have an impact on recruitment and hiring of those nursing
students for summer externship positions, as well as upon graduation for staff nurse positions.
There are several benefits, both for the organization and the new nurse, to recruiting from
students that completed a placement on the unit. The new nurse is already familiar with the
organization, the unit, the policies and procedures, as well as the patient population. Although
the socialization that occurs while completing a placement may be different than the one that
occurs in early work experiences, there may be some overlap. Additionally, perhaps this
familiarity with the unit would facilitate the transition during the early work experiences.
146
Job Satisfaction
New graduate nurses’ job satisfaction was measured using the Michigan Organizational
Assessment Questionnaire Job Satisfaction Subscale (Cammann et al., 1983). This three item
tool asks respondents to rate their job satisfaction using a seven-point Likert scale, ranging from
strongly disagree to strongly agree. The sample of new nurses surveyed reported having high job
satisfaction (M= 6.36, SD .99). This finding was surprising given the literature on the challenges
new graduate nurses face during their early work experiences. For example, Parker, Giles, Lantry
and McMillan (2012) examined new nurses’ (N= 282) experiences during their first year of
practice in Australia and found that the mean job satisfaction in their sample was 2.91 using a 5-
point Likert scale. Laschinger’s program of research on new graduate nurses in Ontario surveyed
new nurses with less than two years’ experience (N= 342). She measured new graduates’ job
satisfaction using a four item tool rated on a 5-point Likert scale from 1, strongly disagree, to 5,
strongly agree. She reported that the sample of new nurses’ had moderate job satisfaction (M=
3.07, SD .88) (Laschinger, 2012). Similar results are reported from other analyses in this
program of research (Laschinger, Wong, and Grau, 2012; Read and Laschinger, 2013). Another
Ontario study of new graduates nurses (N= 232) found a mean job satisfaction of 16.2 (SD 3.8)
(Peterson et al., 2011). As with the current study, Peterson et al. measured new nurses’ job
satisfaction using the Michigan Organizational Assessment Questionnaire Job Satisfaction
Subscale. Therefore, the item corrected mean in Perterson et al.’s study was 5.4 (SD 1.27), which
is lower than in the current study. However in this study, more than three quarters of the new
graduate nurses were employed in their first job of choice and this was found to be positively
related to their job satisfaction (r= .45, p< .01).
147
Laschinger (2012) and Peterson et al. (2011) have similar samples; both surveyed new
nurses within their first two years of practice, the majority were female, worked on medical
surgical units, and all had university degrees. The mean age of Peterson et al.’s sample was 26.8
years, which is slightly older than in this sample (M 24.5, SD 1.8). Similarly, the new nurses in
Laschinger’s study were on average 28.2 years old. The mean experience in Peterson et al.’s
study was 18 months, whereas in this study it was 4 months. These differences are likely due to
the different sampling timing between these studies. In this preceptorship study, the sample of
new graduates was surveyed during their early work experiences while they were being
preceptored. Conversely, in Peterson et al. and Laschinger’s studies, the sample consisted of new
graduate nurses with less than two years’ experience. In Peterson et al.’s study, 30.6% (N= 71)
had previous experience on their current unit, which is lower than the 58% (N= 29) of the sample
in the current study. It is not surprising that the new graduates in these samples had university
degrees in nursing as this reflects the 2005 Ontario policy change to the new entry to practice
education requirement.
Intent to Turnover
In Canadian hospitals, the mean turnover rate for nurses has been reported to be 19.9%
(O’Brien Pallas et al., 2010). In the current study, the new graduates’ intent to turnover was
measured using Mobley et al.’s (1978) tool which consists of seven items on a 5-point Likert
scale, with higher scores representing higher intent to turnover. This sample reported low intent
to turnover (M= 1.70, SD .83). This is much lower than what is reported in the literature with
similar samples. For example, in Peterson et al.’s study of new graduates, propensity to leave
was measured using a 3 item tool on a 5- point Likert scale, with lower scores reflecting lower
propensity to leave. The item corrected mean in Peterson et al.’s study was 2.27 (SD .09).
148
Laschinger (2012) reported a sample mean of job turnover intent of 2.72 (SD 1.26) using a 3
item tool on a 5-point Likert scale. Therefore when compared to other Canadian samples, the
new graduates nurses in this study are not likely to leave their current job. As mentioned
previously, the low intent to turnover found in this study may be due to several environmental
and economic factors (Van Maanen, 1976). Van Maanen and Schein (1979) also propose that the
duration, formality and commitment required during the socialization process may impact the
new employee’s turnover. Therefore, providing new nurses with a formal and extended 3 month
preceptorship may lead to improved long term retention.
Role Ambiguity
In a large Canadian cross-sectional and longitudinal nursing study (Time 1 N= 4481;
Time 2 N= 3844), O’Brien-Pallas et al. (2010) found that the nurses had low levels of role
ambiguity as measured by Rizzo et al.’s scale (time 1: M= 31.46, SD 5.56; Time 2 M= 31.58, SD
5.58). This six- item, seven-point Likert scale ranges from very false to very true, with higher
scores reflecting less role ambiguity. This sample consisted of nurses with an average age of 38.9
and with a mean of 14. 5 years of nursing experience. By contrast, the literature suggests that
new graduate nurses experience role ambiguity in their early work experiences (Boyle, Popkess-
Vawter, and Taunton, 1996). For example, Boyle and al. found that, in their sample of new
graduates employed in critical care, the mean for role ambiguity was 17.51 (SD 4.65) using
Rizzo et al.’s (1970) scale. They also found no significant change between 3 months (N=44) and
6 months (N= 40). In the current study, new graduate nurses reported low role ambiguity (M=
5.55, SD .84) as measured by Rizzo et al.’s (1970) scale. This is comparable to the results
reported by Chang and Hancock (2003) that examined role ambiguity in a sample of Australian
new nurses (N=110) at three and 10 months experience. Additionally, the results in this current
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study are similar to those reported in an older more experienced sample of nurses (O’Brien-
Pallas et al.). The timing of recruitment and survey administration may have impacted these
results as the majority of the new nurses were still working with and being supported by their
preceptors. Additionally, Van Maanen (1976) and Van Maanen and Schein (1079) proposed that
the small group immediately surrounding the new employee, such as the nurses working on the
same shift line, are also key in the new employee’s learning and may influence the socialization
process. This group may shelter the new nurse from the impact of reality shock by providing
support and assisting the new graduate to understand the job and role demands. New employees’
understanding of their role is also dependent on the degree to which the organization and its
members have defined the expectations to the new employees (Van Maanen; Van Maanen and
Schein). Therefore, it would be expected that preceptorship and orientation programs that
provide their new nurses with role expectations clearly and early on in their entry into the
organization would likely experience less role ambiguity. Since this information about the
preceptorship programs was not collected during this study, it is unknown if this relationship
exists.
Role Conflict
New nurses’ role conflict was measured using Rizzo et al.’s eight item tool on a seven-
point scale ranging from very false to very true, with higher scores representing higher role
conflict. In this study, the new graduates reported low to moderate role conflict (M= 3.21, SD
1.17). The new graduate nurses’ role conflict in this study are higher than previously reported by
Boyle et al. (M= 23.72, SD 5.74; 1996) with new nurses as measured by Rizzo et al.’s (1970)
scale. However, these results are similar to those reported in a Canadian sample of more
experienced and older nurses than those in this study (M= 31.03, SD 8.76; 2010) (O’Brien-Pallas
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et al.). As mentioned above with role ambiguity, the new graduate nurses were working with
their preceptors at the time of survey completion and this continued support may have impacted
these results. As well, the relatively low role conflict experienced by the new nurses in this
sample could be explained by Van Maanen’s (1976) and Van Maanen and Schein’s (1979)
assertion of the potential sheltering and supportive effect of the small group immediately
surrounding the new employee. As with role ambiguity, the speed and clarity with which the
organization may have delineated the role expectations could have positively influenced the new
nurses’ role conflict in this sample.
Implications for Research and Practice
Preceptorship Programs
The majority of the new graduate nurses in this study reported an average preceptorship
program of three months and all had a preceptor. This finding was consistent across all sites.
This is likely due to the implementation of the Ontario Nursing Graduate Guarantee and the
minimum orientation requirements set by the initiative. The Nursing Graduate Guarantee has
been evaluated in terms of employer and new nurse experience with the initiative, as well as with
full-time employment rates (Baumann et al., 2008; Baumann, Hunsberger, & Crea- Arsenio,
2011). However, it would also be important to empirically evaluate the effectiveness of this
initiative and the extended preceptorship on new nurses’ transition outcomes, such as job
satisfaction, role conflict, role ambiguity, turnover intent, and actual turnover. The manner in
which organizations implement their preceptorship programs could be explored through Van
Maanen and Schein’s (1979) theory measuring the socialization tactics to further our
understanding of the impact of the structure of preceptorship programs on new nurse outcomes.
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Just over three quarters (N= 38) of the new graduate nurses reported having no more than
two preceptors. This is consistent with what the literature considers best practice. However,
nearly 14% (N= 7) reported having three or more preceptors. There has been some work
examining the effectiveness of a team preceptorship model (Beecroft et al., 2008; Cooper
Brathwaite & Lemonde, 2011; Sandau & Halm, 2011). The purpose of a team preceptorship
model is to address the challenges inherent in the 1:1 model, such as the possibility of preceptor
burnout and lack of available preceptors. An additional purpose of a formalized team
preceptorship model is to address the gap in preceptor consistency that can occur when a
preceptor goes on vacation or is absent. These team preceptorship models have an assigned staff,
such as nurse educator, to oversee the daily management of the preceptorship programs. The
other commonality of these programs is that the team preceptors work together throughout the
preceptorship, maintain communication about progress of the preceptee and all participate in the
evaluative component. A team preceptorship model could be designed to include a primary
preceptor who is responsible for the majority of the program and secondary preceptor, who
would take over if the primary preceptor is absent. Although the majority of the new graduates
had one preceptor, perhaps a team preceptorship approach might be an effective model for those
units that are not able to consistently maintain the 1:1 model.
There is a need to further examine the effectiveness of a formal team preceptorship model
for nurses in the acute care Canadian context. The questions to explore include: could this model
be an appropriate alternative for those areas that are not able to provide a 1:1 model? What are
the barriers to implementing such a model? Is a team preceptorship model as effective as a 1:1
model?
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Preceptor Characteristics
This study included the measurement of three preceptor characteristics, emotional
intelligence, cognitive intelligence and personality. The results provided some interesting
descriptors not only of preceptors, but of nurses in general. This is the first study to specifically
measure cognitive intelligence in a sample of nurses. Although the sample size was small and not
representative of the general nursing population, the results indicate that the preceptors included
in this study had above average cognitive intelligence. Given that the entry to educational
practice requirement is an undergraduate degree in nursing and that all nurses practicing in
Ontario write the same standardized registration exam, this finding is not surprising. Similarly,
preceptors’ scores on the four personality traits measured were similar to those reported in other
nursing studies. This provides some evidence that the personality findings in this study may be
generalizable to a North American nursing population. However, future research could explore in
a larger sample if there are personality differences between nurses that volunteer to be preceptors
and those that do not, as well as if certain personality traits are related to new graduate
satisfaction with and outcomes of the preceptorship program.
Similarly, the preceptors surveyed had high emotional intelligence and these results are
consistent with those of other studies. The literature review on emotional intelligence suggests
that it may have an impact on several important work related behaviours, such as performance,
teaching self-efficacy and interpersonal relationships. Research in the field of emotional
intelligence in nursing is still relatively new and many of the studies suffer from methodological
flaws, such as small sample sizes and lack of controlling for personality and cognitive
intelligence, which makes drawing conclusions challenging and limits generalizability of the
results. In terms of the effect of emotional intelligence on teaching, very few studies have been
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conducted. Of those that have, they have not explored the impact of emotional intelligence on the
effectiveness of the teacher and the impact it may have on students learning outcomes. Therefore,
further research in nursing is needed to deepen our understanding of the impact that emotional
intelligence may have on nursing practice and teaching in the clinical setting
The relationship between preceptors’ individual characteristics and new graduate nurses’
socialization outcomes may not be as simple as originally proposed. Certainly, preceptors are
important to this process, but it is still unclear how. This study did not include an exploration of
the relationship and dynamics between the new nurse and their preceptor. Perhaps the quality of
the relationship also has an impact on the new nurse’s socialization. It would be important for
future research to consider exploring the elements of this dyad relationship, such as the
development of the relationship over time, trust, the supportiveness of the preceptor, and the
quality of the relationship. This study did not explore the potential impact of preceptors’
willingness to take on the role, as well as their interest in clinical teaching, on new nurse
outcomes. These may be important factors to consider when exploring the relationships between
preceptor characteristics and the socialization of new graduate nurses. Additionally, this study
did not include any organizational and unit characteristics. The dyad of preceptor and new
graduate do not work in isolation from other members of the nursing team and the culture of the
unit and organization (Van Maanen & Schein, 1979). There is a body of literature on student
nurses’ experiences learning within a clinical practice setting. The clinical learning environment
is defined as “an interactive network of forces within the clinical setting which influence the
students’ clinical learning outcomes” (Dunn & Burnett, 1995, p.1167). This complex learning
environment is comprised of a set of characteristics that are unique to a particular unit and impact
those that are working on that unit and may affect students’ attitudes, skills and knowledge
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development (Dunn & Hansford, 1997). There are many factors that influence students’
perception of their clinical learning environment, such as positive atmosphere, positive work
relationships and relationships with staff, a feeling of support and being appreciated, as well as
the quality of the practice on the unit (Papp, Markkanen and von Bonsdorff, 2003; Saarikoski &
Leino-Kilpin, 2002). These unit characteristics may be important elements in the new nurse’s
transition process. Therefore, further research in this area is needed to gain a greater
understanding of the role of the unit on new graduate nurses. There may be an interaction effect
between preceptors and the unit characteristics on new nurses’ socialization outcomes.
In this study, preceptors’ emotional intelligence was measured using the NEIS, which is a
scale that was adapted for this study and pilot tested. The results of the pilot test suggested that
the NEIS was reliable and valid. Additionally, factor analysis found that the items loaded
appropriately on two factors, which is consistent with the emotional intelligence literature.
However, the reliability decreased from .70 in the pilot study to .63 in the current preceptorship
study. This decrease in reliability may be a result of the small sample size. Further research is
needed to examine the validity and reliability of the NEIS in a large sample of nurses. To date,
there are no other tools that specifically measure the emotional intelligence of nurses. Therefore,
a valid and reliable measure of nurses’ emotional intelligence would be a significant contribution
to the field.
New Graduate Nurses’ Socialization Outcomes
The results of this study suggest that new graduate nurses’ role conflict and ambiguity are
related to their job satisfaction. This may have important implications at the management level.
First, although job satisfaction was not related to new nurses’ intent to turnover in this study, this
relationship has been reported (Irvine and Evans, 1995). The lack of association in this study may
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be explained by the current economic situation and the decreased number of available positions.
Nurses’ job satisfaction continues to be of concern as it may also impact patients’ experiences.
McHugh, Kutney-Lee, Cimiotti, Sloane, and Aiken (2011) reported that patients tended to be less
satisfied with their care in hospitals that had higher rates of nurse job dissatisfaction.
Role conflict and ambiguity imply that new nurses do not have clear expectations and
understanding of their role, as well as conflicting role expectations. As such, it could be more
difficult for them to transition into their new role as staff nurse and become a productive and
efficient team member. These two variables have also been found to be related to new nurses’
role stress (Chang and Hancock, 2003). At a unit level, the implications for the leadership team
are to ensure that new nurses are provided with clear role descriptions and expectations. This
could be included in the unit orientation or as part of the preceptorship program. New nurses
need to be made aware that these are common feelings during early work experiences and be
provided with strategies to help them work through these feelings. Preceptors would also have to
be knowledgeable about the experiences of role conflict and ambiguity so that they would be able
to recognize them and further discuss with the new nurse, or bring to the attention of the
leadership team if there is a concern.
The majority of the new nurses in this study were hired as part of the Ontario Nursing
Graduate Guarantee. To increase our understanding of the impact of this initiative on new nurses’
transition and work outcomes, it would be important to conduct a longitudinal and comparative
study of those hired through the NGG and those that were not. These new nurses could be
surveyed at several time points, such as at the start of their preceptorship and then followed
during their first year of practice to explore the effects of this initiative on their socialization and
work outcomes.
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New Graduate Nurse Recruitment Strategies
Although previous experience on the unit was not related to new nurses’ first job of
choice, nearly 60% of the new nurses surveyed had some experience on their unit, either in the
form of a clinical placement or pre-nursing job. This finding has implications in terms of
recruitment strategies for use with new graduates. If nursing unit managers are aware that many
of their new hires have previously been on their unit, they could then develop active recruitment
strategies aimed at the students currently placed on their unit. This could include meeting with
the group of students at the start of the placement, engaging with the students throughout their
placement, and perhaps even meeting with each student briefly to further get to know them and
determine if this is a student that they would like to recruit upon graduation. Unit managers could
encourage strong students to apply for externships or clerical positions for the remainder of their
program to hopefully retain them as staff nurses once they have graduated. Additionally,
managers could approach the most promising senior students on their unit to offer them an
interview several months before graduation, thereby hiring them before another unit has the
opportunity to do so. As well, encouraging promising students to complete a consolidation on
their unit is another option. Recruitment strategies could start even earlier, such as early on in a
program. For example, organizations could develop innovative placements for students
throughout the program to encourage interest in their hospital. Providing students with support
through their placements is another strategy for consideration, such as a student placement
centre.
New nurses’ job satisfaction, role conflict and role ambiguity were all related to whether
they were working in their first job of choice. Those new nurses that were working in their first
job of choice experienced less role conflict and ambiguity and greater job satisfaction. These
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findings have implications for the recruitment of new graduate nurses, suggesting it would
advantageous for managers to hire new nurses in their first job of choice and find creative ways
of increasing students’ interest in their organization.
Research is needed to further explore the association between student clinical placement
location, first job of choice and new graduate hiring location, as well as intent and actual
turnover in those that did not obtain employment in their first job of choice. In this study, a small
number of new nurses were not employed in their first job of choice and they reported that they
were planning on pursuing that option. However, it is unclear when they were planning to do
this. Further understanding of students and new nurses’ employment plans and decisions making
related to choosing a job will assist organizations in their recruitment and retention strategies.
Limitations of the Study
The design weaknesses as well as strategies that were implemented to decrease these
limitations are described. These include recruitment of participants and sample size, common
method variance, timing of the surveys, and the use of the Nursing Emotional Intelligence Scale.
Recruitment of Participants and Sample Size
Although a 31.1% response rate in this study was similar to those reported in the
literature examining dyads and was expected, the number of available participants was a
challenge. The estimated number of available new graduates calculated prior to the start of the
study was based on data provided by the sites from 2008 and 2009. When recruitment for this
study started, several sites reported a decrease in the number of new graduate nurses hired in
2011- 2012, therefore limiting the pool of new graduates to sample from.
Of the five study sites, one had accurate numbers of new graduate nurses hired within the
study time period, whereas the other four did not have access to this information, as the hiring
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and organization of preceptorship programs was done on a unit basis. In these four organizations,
the site PI was dependent on email communication from individual unit managers on a monthly
basis to obtain names of new graduate nurses and preceptors. Therefore, it is likely that some
eligible new graduate nurses were not approached to participate and it is not possible to
determine those numbers. This may limit the generalizability of the results of this study as it is
not possible to determine if the sample included differed in important ways from those that did
not participate.
A sample size of 98 dyads of new graduate nurses and their preceptors was needed to
detect a medium effect with a power of 0.80 and of 0.05 to explain 13% of the variance
(Cohen, 1988). As 51 dyads were recruited, this study did not achieve the minimal sample size
required to have sufficient power to detect an effect of preceptors’ emotional intelligence on new
graduate nurses’ socialization outcomes. The significant and non- significant correlations could
be due to a Type 1 and Type 2 error as a result of the small sample size. Therefore, the results of
the correlation analysis must be interpreted with caution.
Common Method Variance
Measurement error is problematic in research as it can jeopardize the validity of the
conclusions drawn about the relationships between measures (Podsakoff, MacKenzie, Lee, &
Podsakoff, 2003). There are two types of measurement error, random or unsystematic error and
systematic error (Pedhazur & Pedhazur Schmelkin, 1991; Podsakoff et al). Random errors are
those that occur inconsistently and unpredictably upon repeated measurements (Pedhazur &
Pedhazur Schmelkin). By contrast, systematic errors are those errors that recur over repeated
measurements (Podsakoff et al.). Systematic errors can be particularly problematic because they
can lead to alternative explanations for the relationships found (Podsakoff et al.). One of the
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sources of systematic error is common method variance (Doty & Glick, 1998; Podsakoff et al.).
Common method variance is the “variance that is attributable to the measurement method rather
than to the constructs the measures represent” (Podsakoff et al., p.879).
The first source of common method biases in this study are common rater effects, which
occur when the same participant provides the measure for both the dependent and independent
variables, thereby producing artificial covariation between the variables (Podsakoff et al., 2003).
Participants may be inclined to maintain consistency in how they respond to survey items
(Podsakoff et al.). Additionally, as the items on the survey refer to potentially sensitive areas
related to their work, such as performance, how their preceptorship was structured and what they
have learned during the preceptorship, participants may answer questions based on what they
believed was socially desirable instead of how they truly felt (Podsakoff et al.). The second
source of common method biases are related to the item characteristic effects. Item characteristic
effects occur as a result of how the items on the survey are presented, such as through the use of
the same scale format, i.e., Likert scales, and use of the same scale anchors (Podsakoff et al.).
The effects of common method biases were minimized through the design of the study in
various ways. First, the independent variable and the dependent variables were not provided by
the same participants (Podsakoff et al., 2003). Second, it was reinforced to respondents that the
organization and preceptors or new graduate nurses will not have access to these data, that
confidentiality will be maintained at all times, and that there were no right or wrong answers to
these questions.
Timing of Survey Administration
One limitation of this study was that it was difficult to survey all participants during the
last two weeks of their preceptorship programs, thereby potentially introducing biases. For
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example, data collected after the last day of preceptorship may be contaminated with
socialization that occurred after the new graduate nurse completed the program; this type of
socialization is different than the one that occurs during a formal socialization. The student took
great care to ensure that the surveys were administered as close as possible to the end of the
preceptorship program, however, this was not always possible. To increase the number of
available potential participants, the eligibility criteria were changed to include new graduates that
were within one month of finishing their preceptorship program. This led to an increase in
participants, but may have led to the introduction of biases in the results. It is not possible to
determine if there are differences in the results from those that were surveyed while still being
preceptored to those that were surveyed after the preceptorship had been completed.
Nursing Emotional Intelligence Scale
The main independent variable in this study, nurses’ emotional intelligence, was
measured using a scale that was adapted for a nursing population and pilot tested with a sample
of 107 nurses working in a downtown Toronto hospital. The psychometric properties of the
NEIS were assessed in the pilot study; face, discriminant and concurrent validity was
established. In the pilot study, the alpha coefficient was .70 thus confirming the reliability of this
scale. In the preceptorship study, the alpha coefficient was .62. The sample size of preceptors in
the preceptorship study (N= 38) was much smaller than in the pilot study (N=81). Therefore, it is
likely that the small sample size impacted the alpha coefficient in the preceptorship study.
Although the NEIS was piloted in a different sample than those surveyed in the
preceptorship study, the scale descriptives were similar. As well, during the factors analysis, the
scale items each loaded appropriately between two factors. The two factors, with their associated
scale items are consistent with the emotional intelligence literature (Mayer et al., 2003).
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The literature reports that EI has a small to moderate positive correlation with cognitive
intelligence. In this study, preceptors’ EI was not related to their cognitive intelligence.
Furthermore, the direction of the correlation was negative. Previous research has demonstrated
that emotional intelligence has a small to moderate correlation, between r= .1 and .3, with the
personality traits of openness and agreeableness (Brackett & Mayer, 2003; Mayer, Salovey, &
Caruso, 2004). In the pilot study, the NEIS had a small positive correlation with agreeableness
(r= .24, p< .05) which was expected. However in the current study, the NEIS was not
significantly related to the personality traits measured; as well, two of the coefficients were in the
opposite direction. It is possible that the NEIS was not truly measuring emotional intelligence.
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CHAPTER VII
CONCLUSION
The purpose of this thesis was to examine the impact of preceptors’ emotional
intelligence on new graduate nurses’ socialization outcomes during a preceptorship program.
This study was guided by Van Maanen and Schein’s Theory of Organizational Socialization
(1979). The main assumption of this theory is that “what people learn about their work roles in
organizations is often a direct result of how they learn it” (p. 209). The “how they learn it” was
key for the development of this thesis and the understanding that the socializing agents, the
preceptors, are integral to the socialization of new nurses. A model based on Van Maanen and
Schein’s theory was developed to explain the proposed hypotheses and relationships. The
hypotheses and proposed model were not supported in this sample of new graduates and their
preceptors. However, the correlational results support what has been reported in previous
research examining new employees’ socialization with this theory; new employees’ role
ambiguity and conflict tend to be experienced simultaneously and are associated with job
dissatisfaction.
This study provided some interesting descriptions of novel preceptor characteristics, such
as personality, emotional intelligence and cognitive intelligence. The results suggest that the
nurses in this sample had above average cognitive intelligence, as well as emotional intelligence
as measured by the NEIS and further our understanding of the nursing population practicing in
these five hospitals in Toronto. However, the small sample size limits the generalizability of the
findings outside of this specific sample. This doctoral work adds to the literature by being the
first study to examine the relationships between preceptors’ emotional intelligence and new
graduate nurse socialization outcomes during a preceptorship program and is a step towards
163
increasing the nursing profession’s understanding of the impact that preceptors may have on new
nurses. It is likely that the relationship between preceptors’ individual differences and new
nurses’ outcomes is more complex than the model proposed. Preceptors are supporting, guiding
and teaching new nurses within complex settings, such as the organization, patient care unit, and
group sub-units. These likely have an impact on new nurses’ transition and may even interact
with preceptor characteristics. Future research is needed to further explore the role of the work
environment on new graduates’ transition in their early work experiences.
There are currently several measures of emotional intelligence available for use, many of
which are self-reports. Although the gold standard is considered to be Salovey and Mayer’s
MSCEIT, it is not easily accessible, it can take up to 90 minutes to complete and nurses have
reported that it is difficult to use. This doctoral thesis adapted and pilot tested a measure of
emotional intelligence that is specifically for nurses, the NEIS, which is the first of its kind.
Continued research with the NEIS may lead to a reliable and valid measure of nurses’ emotional
intelligence.
The results of this study have several implications at a practice level and point to
potential organizational recruitment strategies specifically aimed at nursing students. A large
number of the new nurses in this study had previous experience on their current unit, either in the
form of a placement or work experience. Nursing leaders within hospital settings could use this
information to target their recruitment strategies at nursing students, such as creating
partnerships with the university to recruit within the organization the promising students early on
during their nursing education. Additionally, increasing the number of student placements within
organizations and hospital information sessions could lead to greater student interest in working
within that hospital.
164
This study provided insight into the early work experiences and socialization outcomes in
a sample of new graduate nurses working in Toronto. Despite the reports that new graduate
nurses are experiencing high turnover intent, poor job satisfaction, high role conflict and role
ambiguity, the new nurses in this study were experiencing the opposite. This may be a result of
several factors. First, the new nurses were enrolled in this study while they were still working
with their preceptor, as opposed to one or two years post-graduation. The support and safety
provided by their preceptor may have had an impact on their role conflict, role ambiguity, job
satisfaction and turnover intent. Perhaps at that time, the reality of nursing and practicing
independently had not set in yet. Finally, these results may also reflect the effect of the provincial
New Graduate Guarantee initiative, as these new nurses were provided with a minimum of a 12
weeks structured orientation with a preceptor. This may be an example of the positive impact that
policy change can have on practice. However, future research exploring the impact of the NGG
on new nurses’ work outcomes is needed to increase our understanding of the short and long
term effects of this initiative on new graduates’ early work experiences.
165
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Appendix A:
Glossary of terms
TERM DEFINITION
The Big Five Personality
Traits (Preceptor variable)
The big five personality traits include:
(1) Extraversion: the propensity to be social, assertive, and eager
(Hirschfeld, Jordan, Thomas, & Feild, 2008);
(2) Agreeableness: involves being friendly and cooperative
(Hirschfeld et al.);
(3) Conscientiousness: involves being reliable, hardworking, and
thorough (Côté & Miners, 2006; Hirschfeld et al.);
(4) Openness to experience: involves being curious and open to
different ways of thinking (Caligiuri, 2000; Hirschfeld et
al.); and
(5) Emotional stability- “describes individuals who display self-
control in being emotionally secure, remaining calm under
stressful conditions, and mitigating persistent negative
feelings” (Hirschfeld et al., p. 389).
Cognitive Intelligence (IQ)
(Preceptor variable)
“A mental ability (or set of mental abilities) that permit the
recognition, learning, memory for, and capacity to reason about
a particular form of information” (Mayer et al., 2008, p. 509).
Core self-evaluations (CSE)
(New graduate nurse
variable)
A higher order construct that is composed of four traits:
(1) Self-esteem: an overall appraisal of one’s worth as a
person;
(2) General self-efficacy: an individual’s beliefs about their
abilities and capabilities to perform across a variety of
circumstances;
(3) Locus of control: an individual’s beliefs about their ability
to control the events in one’s life or one’s environment;
(4) Emotional stability or low neuroticism, a person’s
inclination to be confident in oneself and secure (Judge &
Bono, 2001; Judge, Erez, Bono, & Thorensen, 2003).
187
Consumer Emotional
Intelligence Scale (CEIS)
The Consumer Emotional Intelligence Scale (CEIS) is
theoretically based on Salovey and Mayer’s (1990) abilities
model of emotional intelligence and consists of 18 items
measuring the four branches of emotional intelligence using
three different scales. The CEIS was developed by Kidwell et al.
(2008). Dr. Kidwell provided the doctoral student with
permission to adapt the CEIS.
Emotional Intelligence (EI)
(Preceptor variable)
“The ability to monitor one’s own and others’ emotions, to
discriminate among them, and to use the information to guide
one’s thinking and actions” (Salovey and Mayer, 1990, p. 189).
Comprised of four abilities:
(1) Perceive, appraise, and express emotion accurately;
(2) Access and generate feelings when they facilitate
cognition;
(3) Understand affect-laden information and make use of
emotional knowledge; and
(4) Regulate emotions to promote emotional and intellectual
growth and well-being (Druskat, Sala, & Mount, 2006;
Salovey & Mayer, 1990).
First Job of Choice
(New graduate nurse
variable)
First job of choice is the new graduate nurse’s preferred area of
employment upon graduation, which may or may not be where
they are currently employed.
Intent to Turnover
(New graduate nurse
variable)
Intent to turnover, or intention to quit, is conceptualized as
comprising three domains: thinking of quitting, intending to
leave, and searching for new employment (Mobley, Horner, &
Hollingsworth, 1978).
New Graduate Nurse (NGN)
A nurse who has graduated from an accredited university
nursing program within the last six months and is completing a
preceptorship program for his/her first job in nursing.
Nursing Emotional
Intelligence Scale (NEIS)
An EI measure adapted from the Consumer Emotional
Intelligence Scale (Kidwell et al., 2008). This measure was
adapted by the doctoral student and pilot tested in a sample of
nurses. Dr. Kidwell provided the doctoral student with
permission to adapt the CEIS.
188
Organizational Socialization
“The process by which an individual acquires the social
knowledge and skills necessary to assume an organizational
role” (Van Maanen & Schein, 1979, p. 211).
Preceptor
A nurse who is acting as a clinical teacher to a new graduate
nurse for a pre-determined length of time.
Preceptorship Program A formal teaching and learning method for new employees
whereby an experienced nurse and a new nurse work together
for a specified duration of time to assist new nurses in
effectively adjusting to and performing a new role, being
socialized into practice and the organization, while bridging the
gap between theory and practice (Canadian Nurses Association,
1995; Stokes, 1998).
Previous Experience on the
Unit
(New graduate nurse
variable)
A new graduate nurse’s first job as a nurse is on a unit that they
either did a clinical placement at any time during their nursing
education or if they were employed on the unit in another role.
Role Ambiguity
(New graduate nurse
variable)
Defined as “(1) the predictability of the outcome or responses to
one’s behaviour, and (2) the existence or clarity of behavioural
requirements, often in terms of inputs from the environment,
which would serve to guide behaviour and provide knowledge
that the behaviour is appropriate” (Rizzo et al., 1970, p.156).
Role Conflict
(New graduate nurse
variable)
Defined as “the dimensions of congruency-incongruency or
compatibility-incompatibility in the requirements of the role,
where congruency or compatibility is judged relative to a set of
standards or conditions which impinge upon role performance”
(Rizzo et al., 1970, p.155).
189
Appendix B.
Preceptorship Interventions/ Programs for New Graduate Nurses
Authors
Sample Previous Program
Preceptorship Program Data
Collection
Times
Measures Findings Limitations Duration Clinical Didactic
Sessions
Allanach &
Jennings
(1990)
N=44
NGN
n/a 8 weeks n/a
n/a
Over 2 ½
years:
Baseline, wk
8, 13, & 24
The Multiple
Adjective
Affect Check
List.
-No significant
changes in
affective states
over time
-No control group
- Not report of
psychometric
properties
–Minimal report
of stat results
Almada et
al. (2004)
N=40
NGN
4-6 weeks
with 1-2
weeks
didactic
11 weeks Float
Team
Incl.
Specialty
units
1 wk
-At end of
program & 3
months later
Satisfaction &
program
feedback.
-Turnover &
vacancy rates
- Length &
preceptor matching
most important
aspects
-“High” program
satisfaction
-A 68% increase in
NGN retention
rates
- No report of
psychometric
properties of
measures
-No control
Altier &
Krsek (2006)
N=111
NGN from
6 academic
health
centers
(N=316
demo/
retention
data used)
n/a 1 year Unit of
Hire
No content
provided
-Upon hire
and
completion of
program
-Demographic
survey
-
Organizational
characteristics
-McCloskey-
Mueller
Satisfaction
Survey
-Retained 87%
(275/316) at end of
program
-Satisfaction
remained consistent
for 8/10MMSS
elements
–↓ in the scores of
satisfaction with
praise & with
professional
opportunities
-No control group
-Low response
rate (35%)
-Attrition
190
Anderson
(1998)
N=51
26 new
RNs & 25
preceptors
n/a
n/a
n/a
n/a
-Baseline & at
end of
orientation.
-Myers-Briggs
Type Indicator
-Satisfaction
Index
-Perceived
satisfaction with
orientation is >
with matching of
the attitudes of
introversion/
extraversion
- No report of
psychometric
properties
-No report of
analysis
-Included new
nurses with less
than 5 years’
experience
Beaulieu
O’Friel
(1993)
n/a n/a 12 weeks 3 unit
rotations
-6 days
Content
provided
-First week,
upon
completion, &
six months
post
Performance
Based
Development
System
-Higher retention
rates for BScN
NGNs
-No report of
psychometric
properties
Beecroft,
Kunzman &
Krozek
(2001)
Sample:
N= 50
NGN
Control:
N=28 NGN
hired 24
months
prior
n/a 12 months Paeds
716 hours
(Incl.
Other
areas)
-224.5
hours of
class &
skill lab
time
Beginning,
middle, & end
of program
Control group:
Beginning of
experimental
program
-Corwin’s
NSG Role
Conception
Scale
-Professional
NSG
Autonomy
Scale
-Slater NSG
Competencies
Rating Scale
- OCQ
-A similar
continuous in
confidence at 12
months.
-OC comparable
-1 year turnover
rates: control group
36% & interns 14%
-1 year retention
rates by 23%
from 2 years earlier
-Control group’s
response based on
recall
Bérubé et al.
(2012)
Sample:
N= 47
NGN
n/a 1 year At least
500 hours
of clinical
practice
in ICU
- 200 hours
of courses
&
simulation
-Content
provided
-100 hours
reflective
days
-Program
started in 2008
-Examined
HR data pre
and post
program
-Pre and post
HR data
Focus groups
with
preceptors
Recruitment &
retention rates
-Program
evaluation
Access to
critical care
services
-46% increase in
NGN recruitment
71% 1 year
retention rate
-The ICU has 50%
more open beds
than in 2005 prior
to the program
implementation
-NGNs reported
being satisfied with
the program
-Sample
descriptives not
provided
-No description of
previous program
-Measures not
describes
191
Beyea et al.,
(2007)
N=42
NGN
-Up to 26
weeks
-Varied
12 weeks -Unit of
hire
-Weekly
use of
human
patient
skill lab
-Weekly
-No
content/
time
provided
Beginning,
middle, & end
of program
-Nurse
resident’s
readiness for
entry to
practice
competence
questionnaire
-Feedback
from NGNs,
managers, &
administrators
-Increase in self-
rating levels of
confidence,
competence, &
readiness from pre
to post
-No report of
psychometric
properties
-No control group
-No demographic
data provided
Blanzola,
Lindeman,
& King
(2004)
N=18
NGN
Control
N=10
Sample
N=8
6 weeks
clinical
16 weeks Med/surg
& various
other
units
-20 hrs/mo
& Skills
lab
Content
provided
-Baseline,
after each
rotation, 6 mo
post program
-New grad
internship self,
peer &
manager
evaluation
-Experimental
group evaluations
suggest an
clinical comfort &
confidence with
role; scored higher
on organizational
core competencies
-Instrument
development
unclear
-No demographic
data provided
Boyer
(2002)
-First pilot
in 2000
with 54
new nurses
in 4
different
facilities
n/a n/a Acute
care
hospital
n/a n/a - Competency
measure based
on Lenburg’s
Competency
Outcomes and
Performance
Assessment
model
(COPA)
-Qualitative
data-
Transition to
work process
-Greater than 40%
improvement in the
‘transition to
practice’ process
compared to the
previous process
-One facility
tracked retention;
prior to program
retention of new
grads was 75%,
first year of
internship,
retention was 93%
- No sample
demographics
-Maturation:
compared to
previous years
- Lack of details
192
Bratt (2009)
NGNs
Program
description
n/a -15
months
-All
clinical
areas
-Monthly
education
sessions
for 12
months.
-Content
provided
n/a -NGN
retention
-Professional
growth=
qualitative
data
-Cost-Benefit
Ratio
-One year retention rates: varied from 79% to 97%, with a mean= 84%. -2 year retention rate: 83% -Authors believed
that if the program
prevented even one
NGN from
turnover, then it
became “cost-
neutral”
-Program
description, no
data
-Unknown
number of hours
of didactic
sessions
Chesnutt &
Everhart
(2007)
N=14
NGNs
-6 months
-40 hour
critical
care course
-varied
-2
preceptors
-1 year -Surgical
ICU
-16 hours
-Content
provided
-After each of
the 5 stages
-Preceptor &
NGN
evaluation
after each
stage.
-NGNs appear to
have an easier
transition to the
typical patient
assignment.
-Of the 14
participants, 1 was
unable to pass one
of the stage
competencies and
left.
-Small sample
size
- No report of
psychometric
properties
-No control group
Crimlisk,
McNulty, &
Francione
(2002)
N=39
NGN
NGN were
not hired
in float
pool
4-5
months
-Float
Pool
-18
weeks
-Inc.
Various
units
-32 Hours
Content
provided
-At end of
each group (4-
5 months)
-Weekly
evaluations
-Interviews
-Survey
adapted from
the University
of Pittsburgh
Medical
Center
Evaluation
tool (UPMC)
-100% felt: class
time beneficial,
able to provide safe
competent care, &
that program
successful
-82% remain in
facility; 69%
remain in float pool
-No report of
psychometric
properties
-No control group
193
Dilorio,
Price, &
Becker
(2001)
N= 54
n/a
6 months Neuro 104
lectures
Content
provided
Baseline, first
& last day of
NNIP, end of
each series of
lectures
-Knowledge
Assessment
test
-Neuroscience
NSG SE Scale
-Attitudinal
questionnaire
-29/54 remain in
hospital
- Knowledge &
Confidence from
pre to post
-No report of
psychometric
properties
-Minimal report
of preceptorship
program
-No control group
_included RNs
with previous
experience
Fey &
Miltner
(2000)
-N=18
NGNs
-6 weeks
-No
evaluation
12 weeks Cardio &
high-risk
OB
-2 weeks
-Content
provided
-Biweekly -Biweekly
progress
meetings &
evaluations
- Almost 90%
retention rate one
year after the
program.
-Organizational
benefits
-Small sample
size
-Lack of
evaluation
-No control group
Goode &
Williams
(2004)
N=259
NGN
n/a 1 year n/a Content
provided
At hire, 6 &
12 months.
-MMSS
-The Gerber
Control over
Nursing
Practice
-Casey-Fink
Graduate RN
Experience
Survey
n/a -No program
results reported.
-Minimal program
information
provided.
Gurney &
Mass
(2002)
N= 13
NGN
n/a 16 to 20
weeks
ER
14 days
(112 hrs)
(1 day/
wk)
Content
provided
Over 2 years n/a -100% retention 2
years later.
-Anecdotal report
of positive
feedback.
-Program
evaluation
methods not
discussed.
-Small sample
size
194
Halfer
(2007)
Number of
NGNs
hired per
year:
2003 N=84
2004
N=117
2005 N=95
-6 weeks
to 4
months
-no
specific
program
for NGNs
-1 year -Paeds
-80 hrs of
general
content
-32-72 hrs
specialty-
specific
content
-PALS
-Skills lab
n/a n/a
-Increased
recruitment by 28%
the first year after
program
implementation.
-Decrease vacancy
rates
-Decreased
turnover
-Cost savings
-History threat:
something else
could have been
occurring in the
setting at the same
time.
Herdrich &
Lindsay
(2006)
N= 10
NGN
n/a
6 months
to 1 yr
Med-surg
&
cardiac/
critical
care
Content
provided
-From
baseline,
monthly, 3
& 6 months
MBPI
-Knowledge
Assessment
Test
-Competency
Self-Rating
Scale
-OC tool
-Watson-
Glazer Critical
Thinking
Appraisal
-90% retention at
12-24 months
-12% improvement
from pre to post
basic knowledge
assessment
-Critical thinking
improved pre to
post
-Small sample
size
-No report of
psychometric
properties
-Minimal results
reported
Leigh, et al.
(2005)
N=27
NGN
n/a 6.75
months
UK Trust Some
content
provided
1 year after
program
completion
European
Foundation for
Quality
Management
Model
(EFQM)
-General self-
reported increase in
confidence levels
-Decreased 1 year
turnover rates from
24% in 2002 to 1%
in 2004.
-Data collection
methods unclear
195
Loiseau,
Kitchen,
& Edgar
(2003)
N=18
NGN
n/a 4 months ER -1 hour
lectures/
shift.
-Content
provided
-During or at
program
completion
-Student Self-
Efficacy
(alpha= 0.97-
0.99)
-The Gallup
Organization
Employee
Attitude
Survey
-High average Self-
efficacy scores:
“confident”
-Felt supported in
the program
-83% remained in
ER 1 yr post
program
completion
-Many results not
reported.
-Insufficient info
on program
implementation &
evaluation
Marcum
& West
(2004)
N=20
NGN
n/a 17.5-18.5
weeks
Medical
Unit
(Inc.
Practice
on other
units)
Weekly Baseline, end
of program, &
1 year later
RN
Competency
Assessment
Tool; The
American
Society of
Training &
Development
Eval Tool
-↑ critical thinking
& interpersonal
skills
-Turnover rates
from 41% in 2000
to 24% in 2001.
-Small sample
size
-No report of
psychometric
properties of
measures
McKane
(2004)
New
critical care
nurses
n/a 12 weeks Critical
Care
n/a After each
four week
block
-Critical Care
Needs
Assessment &
Competency
Tool
n/a -Do not report
program
evaluation
-Do not report
sample info
-May include RN
with experience
Messmer ,
Jones, &
Taylor
(2004)
N=12
NGNs
Did not
hire NGNs
- 6 weeks ICU
(adult &
peds)
-1 week +
4 days
-content
provided
-Pre and post - Watson
Glaser Critical
Thinking
Appraisal
- Toth’s Basic
Knowledge
Assessment
Exam;
- Neonatal
ICU Nursing
Assessment
Competency
Exam
- journals
-Knowledge ↑, but
critical thinking did
not
-Participants scored
higher than
preceptors on
critical thinking
-Themes: theory-
education gap-
practice gap;
theoretical &
practical aspects of
ICU; self-
confidence /
-Selection:
participants
nominated by
their schools; no
control group
-Small sample
size
196
esteem; RN role
Meyer &
Meyer
(2000)
N=59
NGNs
n/a n/a n/a n/a -1 point in
time
-2 surveys on
the orientation
program
-Perceptions
of beneficial
learning
experiences.
-Felt orientation
does not provide
enough time to
practice new skills
(46%); did not
prepare NGN to be
safe nurses (22%).
-Need to have 1 on
1 preceptor
-No report of
psychometric
properties
-No program
information
provided
-Based on recall
Newhouse et
al. (2007)
N= 522
NGNs
Experiment
al group;
2 Control
groups
n/a 1 year n/a 10 sessions
Content
provided
Over 3 years -OCQ
-Anticipated
Turnover
Scale
- Modified
Hagerty-
Patusky Sense
of Belonging
Instrument
-No significant
difference in OC
-Experimental
group had lower
anticipated
turnover at 6 mo.
- 6 mo. Nurses had
a lower antecedent
sense of belonging
overall
-Control group
had to rely on
recall
-No report of
demographic data
O’Malley
Floyd et al.
(2005)
-N=67
NGN
(N=37).
Preceptors
(N=30)
n/a 4 months
n/a 9 sessions
Some
content
provided
Upon program
completion
-Evaluation
forms
developed by
authors
New grads:
-Identified lack of
confidence,
knowledge &
experience
-94.5% 1 year
retention rate
Preceptors
-Needed support
- No report of
psychometric
properties of
measures
-Lack of program
information
Orsini
(2005)
N=3 NGNs n/a 12 weeks -Ortho
-Includes
practice
in other
areas
“minimal” n/a -Turnover
-Hospital
employee
satisfaction
survey
-Hospital
patient
satisfaction
-100% retention 1
year post
-Authors attribute
increase in patient
& unit staff
satisfaction to new
preceptorship
program (2001 to
2002)
-Small sample
-Changes in
satisfaction may
be due to other
variables not
measured/
controlled for.
-Descriptive stats
only.
197
Owens, et al.
(2001)
N=49 in
July
N=26 in
Sept.
NGN
n/a 8 wks n/a 5 sessions
Content
provided
-End of each
education
offering
-3 month post
-Kirkpatricks
4 eval
domains
-Behavioral
performance
eval tools
developed
-Managers scored
new grads lower
than did new grads
& their preceptors
-July group: 74%
remained after 1 yr.
-September group:
73% remained
employed.
-RN vacancy
from 7.3% in 1997
to 6% in 1999
-No report of
psychometric
properties
-Low response
rate
-No report of
demographic,
performance, 3
month post data
Phelan
(1999)
n/a -Did not
hire NGNs
6 months Critical
care areas
n/a -3 and 6
months
-clinical
evaluations;
written tests,
skills
inventory
- 12/14 of first
cohort were
retained
-Authors report that
program improved
“morale”
- Program
description
lacking
Pine & Tart
(2007)
n/a n/a 1 year -unit of
hire
-Acute
care
hospital
-hours not
reported.
-Content
provided
n/a -Return on
investment
equation
-Program
evaluation
-Improved turnover
rates
-Cost savings
- no report of
participants
-No report of
psychometric
properties of
measures
Schmidt,
Giovanelli,
& Palazollo
(2003)
N=11
NGNs
n/a -16 weeks -ER
-Includes
time on
other
units
-Yes, but
no hours/
content
provided
n/a n/a -91 % retention rate
after 90 days
-↓ agency use
-91% first attempt
RN exam pass rate
-small sample size
-No demographic
data
Smith &
Chalker
(2005)
N=93
NGN
(53 no
assigned
preceptor
& 35
NGN had
multiple
preceptors
4 months Medical/
Surgical
-1 or
multiple
preceptor
n/a 1 point in time -“Preceptor
Continuity in
the Nurse
Intern
Program”
developed by
authors.
-No group
differences in
perception of
clinical
performance, role
transition,
satisfaction, &
-No report of
psychometric
properties of
measures
-Only reported
descriptive
statistics.
198
having 1
assigned
preceptor)
retention.
-NGN believed that
having the same
preceptor is
beneficial (84%);
assisted them in
taking on more
patient
responsibility
(69%); assisted
them in instilling
confidence in skills
& decision making
(62%); affected
decision to remain
in nursing (48%)
-Rely on recall.
Woodworth
(2012)
N= 4
NGNs
Clinical
group
model with
4 NGNs
and 1
educator
-1:1
preceptor
model
-No other
details
provided
8 weeks -Clinical
practice
in all
areas:
medical-
surgical,
OR,
PACU,
ICU and
ER.
-Hospital
orientation
“Skills
Day”
classroom
lecture
-1 year after
hire in the
form of
comments
-Retention
rates after 1
year
-Retention
rates
-100% retention at
1 year post
-positive comments
from NGNs and
managers
-small sample size
-No demographic
data
-Little data
reported
199
Appendix C.
Preceptor Characteristics, Selection and Preparation
Author (s) Purpose Design Sample Data Collection Findings Limitations
Al-Hussami et
al. (2011)
To implement &
evaluate a preceptor
training program to Promote RNs’
knowledge of
preceptorship
-experimental
design
Pre & post test
-random as-
signment of
subjects to either
the experimental
or control group.
The experimental
group attended a
preceptor
training program.
N= 68 -Experimental
group: beginning of
the preceptor
training program
and after the
completion of the
program.
-Data were
collected over a
period of 1 week
-Control group
received survey
once only during
same week
-Statistically significant
differences between the
experimental and control groups’
knowledge.
-Suggestive that preceptor training
programs improve RNs’
knowledge of teaching and
teaching strategies.
No
psychometric
properties of
measure
presented
Altman (2006)
To determine the
following:
-Use of preceptor
selection criteria
-Preceptor
orientation offerings
-Use of preceptor
evaluations
Exploratory
descriptive &
comparative
study (replicating
Myrick &
Barrett, 1992)
-N=137
Deans &
directors of
undergrad
nursing
programs
-Survey (by Myrick
& Barrett, 1992)
-Reliability 0.66
-85.9% used Preceptorships
-79.1% required at least a BScN
for role
-32.3% stated preceptors must
have at least 2 years experience,
30.8% at least 1 year.
-83.7% not required to have
clinical teaching experience.
-The two most common factors
when selecting a preceptor are
clinical competence and
commitment to role
-Low reliability
of survey
Baltimore
(2004)
To discuss the
importance of
implementing
preceptor
preparation
Discussion/
Theoretical
n/a n/a -Need to be based on adult
learning principles
-Content should cover:
socialization, skill building
techniques, critical thinking
facilitation, & assignment
management.
n/a
200
Beecroft,
McClure
Hernandez, &
Reid (2008)
To examine the
implementation of a
team preceptorship
approach during a
nurse residency
program as an
alternative to a
single preceptor
model.
Mixed-methods/
exploratory
descriptive
1999 N=36
2000 N=52
2005 N=11
Preceptors and
new graduate
nurses
From 1999 (start of
program) to 2005
-With preceptors from the 1999-
2000 cohort, 94% indicated
satisfaction with role, meeting with
the new nurse to discuss progress,
and staying in touch with new
nurse throughout the program
-the 2005 cohort also indicated
satisfaction with role.
-Participants preferred no more
than 2 preceptors.
-Positive comments from new RNs
-low response
rates
-measures not
discussed
-no
demographic
data
Cooper
Brathwaite &
Lemonde
(2011)
To examine the use
of a team
preceptorship model
in public health with
undergraduate
nursing students
Program
evaluation
Qualitative
N= 9
undergraduate
nursing students
N= 14 preceptors
-Separate preceptor
and student focus
groups at week 12
of the placement
Preceptor themes:
-There was support for preceptors
and students
-Increased team collaboration and
communication
-Continue to experience high
workload
Student themes:
-Accessibility and expertise of
preceptors
-small sample
size
-sample of
undergraduate
nursing students
Dibert &
Goldenberg
(1995)
To examine the
relationships among
preceptor’s
perceptions of
benefits, rewards,
supports, and
commitment to the
role.
-Descriptive
correlational
-Conceptual
-59 preceptors
-90% had
attended a
preceptor-
training program
in last 10 years.
1) Preceptor’s
Perception of
Benefits & Rewards
2) Preceptor’s
Perception of
Support Scale
3) Commitment to
the Preceptor Role
Scale (Adapted
from OC
Questionnaire)
-Positively associated with role
commitment
-No statistical significance
between years of nursing
experience & preceptors’
perceptions of benefits, rewards,
supports, or commitment to the
role.
-Number of times positively
related to role commitment.
-Preceptors felt that they had
functioned as a preceptor too often.
-Small sample
size
-Psychometric
properties of
measures
questionable.
Finger & Pape
(2002)
To determine
preceptees attitudes
towards preceptors,
& preceptors
professional practice
characteristics.
n/a N=57 Invitational
Operating Room
Teaching Survey
(IORTS)
-Preceptees rated 42% of
preceptors as experts
-Believed preceptors were
sensitive to their needs, &
encouraged self-confidence
-Based on recall
-Small sample
size
-No control
group
201
Fox,
Henderson, &
Malko-
Nyhan (2006)
To compare
preceptor and
preceptee‘s
perception about the
effectiveness of how
the preceptor role
was undertaken
Survey N=14 receptors
N=17 NGNs
2 points in time
during the
preceptorship (2-3
months and 6-9
months)
-Survey
- the NGNs were more satisfied
about the availability and
contribution of the preceptor than
the preceptors were.
-small sample
size
- Psychometric
properties of
measures not
reported
-no sample
demographic
data
Hartline (1993) To discuss the
development of a
preceptor selection
& evaluation tool.
Discussion Cardiac
stepdown unit
n/a n/a No report of
whether or not
this tool was
effective.
Henderson,
Fox, & Malko-
Nyhan (2006)
To evaluate RN
preceptors’
perceptions of a 2-
day educational
workshop &
subsequent
organizational
support offered to
prepare them for
their roles as
preceptors.
Longitudinal
Descriptive
N= 36 -Focus groups
-Focus groups at 2-
3 & 6-9 months
- Data analyzed
thematically
1) Overall satisfaction with
preparation prior to undertaking
the role; 2) satisfaction with
personal growth & from learning
opportunities; 3) Lack of
satisfaction with practice support,
organization recognition,
organizational structures &
allocation of time (need time away
from direct clinical activities)
-Only volunteers
in focus groups
-No
demographic
data provided
-Minimal info
on workshop
content
Kaviani &
Stillwell (2000)
To explore
preceptors, student
nurses and
managers
perceptions of the
role of the preceptor
and what influences
preceptor
effectiveness
Evaluation of a
preceptorship
program
N= 6 preceptors
N= 13 nursing
students
N= 2 nurse
managers
Focus groups with
nursing students
and preceptors
Individual
interviews with
nurse managers
-Organizational factors emerged as
having an impact on preceptor
effectiveness
-Preceptors believed that clinical
competence, interest in the role,
self-confidence and teaching skills
were important to being effective
preceptors
-Nursing students valued preceptor
availability, clinical competence
and self-confidence in preceptors
-No
demographic
data provided
-Sample of
nursing students
202
Larsen &
Zahner (2011)
To evaluate the
effect of an online
public health nurse
preceptor
preparation session
on preceptor
knowledge of the
role and confidence.
Pretest- posttest
quasi-
experimental
design
N= 31 preceptors Pre-intervention
tests: Self-efficacy
and preceptor role
knowledge test
developed by
authors.
Post-intervention
test and 3 months
later: Self-efficacy
and preceptor
knowledge test
developed by
authors.
-Significant increase in self-
efficacy at post-intervention and
after 3 months.
-Significant increase in preceptor
role knowledge only at post-
intervention
-No correlation between self-
efficacy and knowledge scores.
-Preceptors of
nursing students
-Originally
recruited 133
preceptors.
Myrick &
Barrett
(1994)
To discuss the
preceptor role and
the impact of
preceptor selection.
Discussion paper Nursing Students n/a -One-to-one relationship most
effective
-Preceptors mainly selected based
on availability
-Preceptor qualities: expertise,
knowledge, communication skills,
organizational abilities, previous
teaching experience, BScN,
interest in research, participation in
professional development, and role
commitment.
-Preceptors & preceptees should be
‘matched’
-No theory
-Sample of
nursing students
Myrick &
Younge (2002)
To explore and
explain the four
preceptor
behaviours that
promote critical
thinking: role
modeling,
facilitation,
guidance, and
prioritization
Discussion paper
based on doctoral
thesis
N= 6 fourth year
undergraduate
nursing students
N= 6 preceptors
-not presented
-further exploration
of doctoral findings
-Preceptors can promote students’
critical thinking through their own
behaviours
Discussed and explored the four
attributes
-limited
description of
original study
-Sample of
nursing students
203
Parsons (2007)
To examine the
effectiveness of an
online preceptor
education model on
community nurse
preceptors’ self-
efficacy
Pretest- posttest
N= 48 preceptors
in 5 States
-32 item knowledge
test developed by
Zahner et al.,
(2004)
-Preceptor self-
efficacy instrument
developed and pilot
tested by author
-Measured
administered at 3
points in time: pre-
intervention, post-
intervention and 1
month post-
intervention
-Significant increase in self-
efficacy & knowledge test scores
from pre to post to 1 month post
intervention.
-Previous preceptor experience
was no related to self-efficacy.
-Appears to be
preceptors of
nursing students
Pulsford, Boit,
& Owen (2002)
To gain a profile of
mentors, to explore
their views on the
support of their role,
& their experiences
of update sessions.
-Descriptive -N=198
-Mentors of
nursing students
-Survey
-Pilot tested
-35% have been mentors for 6-10
years
-32% have been mentors for 0-5
years
-Mean number of students in past
year was 3.3
-The greatest percentage of
respondents stated they received
‘sufficient’ support
-35% stated last attended preceptor
‘update’ was within last 12 months
-Large percentage stated they need
more time to do role
-No
psychometric
properties of
survey
-No info on pilot
test of survey
Sandau &
Halm (2011)
To explore the
impact of a
mandatory hospital
wide 8 hour
preceptor workshop.
-Mixed- Methods
-Report of
qualitative
findings based on
the number of
participants who
provided
comments in the
Pre-intervention:
N=20 orientees
N=42 preceptors
N=110
preceptors that
would
participate in
Pre-intervention:
(1) Orientees &
preceptors from
traditional
orientation process
(2) Orientees &
preceptors that
would be
Themes that emerged:
-limit the number of preceptors to
3-4
-preceptors lack time due to
workload
-No significant improvement in
orientee satisfaction
-Increased preceptor understanding
-lack of
qualitative
design with
focus groups as
this might have
yielded richer
discussions.
204
surveys intervention
Post-
intervention:
N=24 orientees
N=34 preceptors
participating in the
intervention
3-6 months post-
intervention
of their and orientee role
-Preceptors’ understanding of
learning styles
-Preceptor experienced increased
enthusiasm for their role
Preceptors believed that they
learned the knowledge and skills
necessary for their role
Preceptors learned how to promote
critical thinking
-Discussed challenges of heavy
patient assignment on ability to
teach
Sandau et al.
(2011)
To explore the
impact of a
mandatory hospital
wide 8 hour
preceptor workshop.
-Mixed- Methods
with a quasi-
experimental
design
-Report of
quantitative
findings
Pre-intervention:
N=39 orientees
N=74 preceptors
N=131
preceptors that
would
participate in
intervention
Post-
intervention:
N=53 orientees
N=131preceptors
Retention rates 1
year before and
after intervention
were compared
Pre-intervention:
(1) Orientees &
preceptors from
traditional
orientation process
(2) Orientees &
preceptors that
would be
participating in the
intervention
3-6 months post-
intervention
-Increased preceptor confidence
and comfort 3-6 months after the
intervention.
-There was no significant
difference between preceptor
cohorts on comfort and
confidence.
-no increase in orientees’
satisfaction with the preceptors
that were part of the intervention
vs those that were not.
-Preceptors ability to coach critical
thinking increased
-Orientees with 3-4 preceptors
reported the highest satisfaction.
Improved retention rate post-
intervention
-no sample
descriptives
-lack of control
for previous
experience in
the role
-new nurses and
transfers were
included
together in the
analysis
Sorensen &
Yankech
(2008)
To examine whether
a theory-driven
preceptor
educational program
could improve the
critical thinking of
new nurses and the
learning outcomes.
- non-equivalent
control group
using pre-
existing groups
-controlled for
age, length of
preceptorship, &
N=31
[Control group,
N=16, hired on
or after July 1st
2004;
Experimental
group, N=15,
hired on or after
-California Critical
Thinking Skills
Test (CCTST)
-demographic
survey
-No significant differences found
between groups in terms of age,
length of preceptorship, years of
non-nsg educ, & years of HC
experience.
-Contributed to the evaluation
subscale of critical thinking skills
Small sample
size
External
validity: as most
of sample had
previous HC
experience may
205
previous HC
experience
January 1st 2005] of the experimental group not be
representative
Speers,
Strzyzewski, &
Ziolkowski
(2004)
To evaluate the
implementation of a
preceptor
preparation and
reward program.
Descriptive Surgical staff n/a -Identified areas that need to be
included in future program:
conflict resolution, goal setting, &
dealing with challenging learners.
- Preceptor job satisfaction
- Preceptor sense of role
preparedness
-Anecdotal
description of
program
Usher et al.
(1999)
-To replicate Dibert
& Goldenberg
1995) study
-Descriptive
correlational
-Conceptual
-N=134
Preceptors of
undergrad RN
students
Same as Dibert &
Goldenberg (1995)
-Findings same as Dibert &
Goldenberg (1995)
-No theory
Wolfensperger
Bashford
(2002)
To discuss the
precepting
experience of one
nursing unit
Discussion paper Orthopaedic
nursing staff
n/a -Desired preceptor characteristics:
1) Interpersonal skills 2) Clinical
Skills 3) Role Modeling &
Professionalism opportunities.
No theory
Yonge, et al.
(2002)
To explore if
preceptors felt
adequately
supported in their
role and the nature
of their support.
Descriptive
exploratory
survey
N=295
Alberta
-Mailed survey
(Pilot tested with 25
preceptors)
-73% responded they received
enough support
-1/2 of those that said no, desired
more guidance in teaching &
evaluation, & more instructor
contact.
-The following reasons were cited
for those were felt they did not
receive enough support: needed
more guidance & feedback,
instructor not available,
insufficient communication with
instructor, poor instructor conduct,
& insufficient time
-No report of
survey
psychometric
properties
Zilembo &
Monterosso
(2008)
To explore nursing
students’
perceptions of the
valued preceptor
leadership qualities
Mixed- methods N= 23 nursing
students
-“Qualities of
Leadership Survey”
developed by
authors and pilot
tested
-96% (N= 220 reported that
preceptors’ leadership was
important
-The following themes emerged as
important: clinical competence and
-Small sample
size
-Sample of
nursing students
206
that would
positively impact
their clinical
learning
experiences.
knowledge, teaching skills, and
being socialized to the nursing
culture.
-61% (N= 14) valued preceptor
continuity
207
Appendix D.
New Graduate Nurse Outcomes Associated with Preceptorship Programs
Authors Purpose Design Sample Measures Findings Limitations
Barrett &
Myrick
(1998)
To examine the
relationship
between
preceptor/Preceptee
job satisfaction &
Preceptee clinical
performance.
-Exploratory
correlational
design
-N=68
35 staff
nurses & 33
preceptees
(students)
Canadian
-Job Descriptive
Index (JDI)
-Six Dimension
Scale of Nursing
Performance (6-D
Scale)
-Mean preceptor years of nursing
experience 11.5
-Mean years of preceptor experience 2.6
-No relationship between preceptor job
satisfaction and preceptee clinical
performance
-Low response rate
- Minimal report of
psychometric
properties of JDI
- Scales not
designed for
students
-Nursing students
Beauregard
et al. (2007)
To examine the
implementation of
the Graduate Nurse
Rotational
Internship
-12 months
-New grads
worked on
several of the
15 specialty
units
-Included time
with preceptor
and alone
NGNs
2002 N=12
2003 N=62
2004 N=46
2005 N=41
n/a -One-year retention rates:
2002: 100%
2003: 90%
2004: 93%
2005: 95%
-Minimal info on
program
-No participant
data
-No program
evaluation data
-Provided
anecdotal feedback
on program
Boyle et al.
(1996)
To examine the
socialization of
new nurses
employed in
critical care.
-Descriptive
comparative
-NGNs
surveyed at 3
points in time
post-hire.
N= 50 NGNs
N= 89
experienced
RNs
-Precepting
(preceptorship
program survey)
-Group Cohesion
Scale
-The Friendship
Scale
--Assignment
Congruence Scale
-Role Conception
-Self-Confidence
-The Spielberger
State-Trait anxiety
Inventory
-Organization and
professional
-Average number of preceptors= 3.15
-Number of preceptors was negatively
related to job satisfaction and commitment
to the profession
-Number of preceptors was positively
related to role conflict and ambiguity.
- Significant differences between NGNs
and experienced nurses at time 1
Significant differences on NGNs outcome
variables at 6 months
-Findings may not
be generalizable to
NGNs outside of
critical care.
-Recall bias of
experienced nurses
-Did not control
for different types
of preceptorship
programs
208
commitment using
a modified Price
and Mueller
instrument
Price and Mueller’s
Job Satisfaction
instrument
-Rizzo et al.’s role
conflict and
ambiguity scale.
Bratt &
Felzer
(2011)
To examine NGNs
perceptions of their
competence &
work environment
during a residency
program.
“Wisconsin Nurse
Residency Program
(WNRP)”
-repeated
measures
design
N=468
NGNs
working in
50 urban &
rural
Wisconsin
hospitals
between
2005- 2008
- Clinical Decision
Making in Nursing
Scale
- Modified 6-D
Scale of Nursing
Performance
- Nurse Job
Satisfaction Scale
- Job Stress Scale
- Organizational
Commitment
Questionnaire
-Tested at baseline
(3 months after
hire), 6 months
later (midpoint),
and 12 months after
baseline (endpoint)
-Clinical Decision-Making: scores were
significantly > at 12 months than at 6 months.
-Job Satisfaction: Significantly > at 12
months.
-Job Stress: scores were significantly < at
endpoint than at baseline or midpoint.
“Stress related to team respect subscale &
perceptions of individual competence,
clinical knowledge, and judgment ↓
significantly over time.”
-“stress related to physical environment
subscale staffing subscale ↑ from baseline
to midpoint. Staffing-related stress declined
from the 6-month midpoint to the 12-month
endpoint.”
- Commitment to the organization was
significantly > at baseline.
- Quality of Nursing Performance: a
significant upward trend in mean scores
between all measurement points.
n/a
Casey et al.
(2004)
To identify the
stresses &
challenges
experienced by
new grads
Descriptive
comparative
design using
survey
N=270
NGN
working in 6
Denver
Acute Care
hospitals
-Casey-Fink
Graduate Nurse
Experience Survey
-Tested at baseline,
3, 6, & 24 months
-Comfort & confidence scores were higher
at hire, then at 3-12 months, then after
1 yr of practice.
-6 themes about difficulty with role
transition: (1) Lack of confidence in skills,
deficits in critical thinking & clinical
knowledge; (2) Relationships with peers &
preceptors; (3) Struggles with dependence
on others yet wanting to be independent; (4)
-Low response rate
-No details on
those who did not
participate/dropped
out
209
Frustrations with work environment; (5)
Organization & priority setting skills; (6)
Communication with physicians
-Most difficult role adjustment period is
between 6-12 mo
Giallonardo,
Wong, &
Iwasiw
(2010)
To explore the
impact of new
nurses’ perceptions
of their preceptors’
authentic
leadership on
NGNs work
engagement and
job satisfaction
Predictive
non-
experimental
survey design
N= 170
nurses with
>3 years’
experience
-The Authentic
Leadership
Questionnaire
(ALQ) (Avolio et
al. 2007)
- Utrecht Work
Engagement Scale
(UWES)
(Schaufeli &
Bakker 2003)
- Part B of the
Index of Work
Satisfaction
scale (IWS)
(Stamps 1997).
-Preceptors’ authentic leadership (as rated
by NGN) accounted for 20% of the
variance in NGN job satisfaction
- Preceptors’ authentic leadership (as rated
by NGN) was positively associated with
NGN work engagement
-NGN work engagement was positively
related to their job satisfaction
-Recall bias
-RNs had less than
3 years’ experience
Hardyman
& Hickey
(2001)
To explore new
grads expectations
of preceptorship.
Part of a larger
study examining
careers.
Longitudinal
questionnaire
N=1598
NGN
UK
Surveys sent at
qualification
-Questionnaire pilot
tested
-97% stated wanted a preceptor during their
1st job
-51% wanted a preceptorship that lasted 6
months, 25% that lasted 4-5 months, 17% 3
months or less, & 7% greater than 6
months.
-Pilot testing demonstrated 11 aspects of
preceptorship that are important to new
grads: constructive feedback on skills,
teaching new clinical skills, confidence
building, ‘helped me to settle into the work
environment’, advise on prof issues.
-No report of
psychometric
properties of
measures
-No demographic
data
Marks-
Maran et al.
(2013)
To evaluate a NGN
preceptorship
program to
determine if it
impacts NGN
engagement with
the program, and
the value and
Mixed-
methods
N= 44 NGNs -Demographics
-52 Likerts
questions about the
program
-3 open- ended
questions
-Report improved communication skills
-73% reported feeling supported and that
the program improved their ability to
manage stress
-66% reported that the program assisted
them in transitioning into their new role
-63% reported the program assisted their
ability to manage difficult work
-Provided limited
information on
scales used
210
sustainability of the
program.
relationships
75% reported that the program improved
their ability to manage difficult patient care
challenges with more confidence
54% reported that the program was critical
to their practice
-59% stated that their preceptor is important
to their career development.
-15% discussed that the program was not
valuable for them
Murray
(1998)
To evaluate the
extent that new
home health care
nurses understand
their role, using
Van Maanen &
Schein’s (1979)
theory
Cross-
sectional
N= 75 new
home
healthcare
nurses
Jones (1986) Role
Orientation
Demographic data
New home health care nurses only had a
moderate understanding of their new role
and adjustment to new role requirements
with 24 months or less HCC experience.
Role orientation not related to demographic
data.
Increased role orientation with increased
experience.
-Types of
preceptorship
programs not
collected.
-No data collection
on tactics
Scott et al.
(2008)
To examine the
impact of
anticipatory and
organizational
socialization on
new graduate
nurses’ work
outcomes.
Secondary
data analysis
of data from
the North
Carolina
Center for
Nursing
(NCCN)
N= 329
NGNs in
North
Carolina
with 6
months to 2
years of
nursing
experience.
-The surveys used
were developed by
the NCCN.
Included:
-Quantity of
orientation in
weeks
-perceived quality
of orientation
-job satisfaction
Intent to turnover
-54.1% were dissatisfied with their job
-55% had already resigned in their first job
58.7% reported that their orientation did not
completely meet their needs.
-Orientations ranged from 1 week to 1 year
-The duration of orientation was
significantly related to turnover. NGNs that
quit their first job had an average of 2
weeks less orientation when compared to
those that did not turnover.
-NGNs that were satisfied with their job
was associated with being 2.4 times more
likely to be satisfied with their orientation
-The variable
“quality of
orientation” was
measured by “met
needs/ did not
meet needs” using
a Likert Scale.
This may be
measuring the
NGNs perception
of the orientation
as opposed to
actual quality
Sorensen &
Yankech
(2008)
To examine
whether
preceptor
educational
program could
improve the critical
thinking of NGN,
explore how
Quasi-experimental, mixed-methods design
N=31 NGNs
-Control
group N=16
Hired 2004
-
Experimental
group N=15
-California Critical
Thinking Skills
Test (CCTST)
-demographic
survey
-Focus group
-Contributed to the evaluation subscale of
critical thinking skills of the experimental
group
-Three themes from preceptor interviews:
identified need for the education, valued
educational program, and identified benefits
to new graduate nurses.
Selection:
convenience
sample
External validity:
as most of sample
had previous HC
experience may
211
program
participation would
influence
preceptors, and
evaluate the
learning outcomes
of NGN.
Hired 2005
N=47
Preceptors
interviews with
preceptors
not be
representative
212
Appendix E.
Qualitative Studies/ Literature Reviews
Study Purpose Design Sample Data Collection Findings Limitations
Bain
(1996)
To examine the literature
& identify important
themes
Literature review n/a n/a Themes
1) Defining the Role: Lack of
definition & clarity in
literature; Offers a period of
support & attempts to ease
transition into professional
practice or socialization into a
new role
2) Selection of Preceptors:-
None of the lit specifically
addressed issue of skills
required, only suggestions
3) Preceptor Programs:
Inconsistent & contradictory
findings
4) Preceptor Experience &
Relationship: Lack of
empirical data regarding the
experience & relationships
-Suggesting individualized
experience
-Lit review
search? -
Inclusion/
exclusion?
-How many
articles?
Bradley
(1999)
To examine the
experiences of NGNs
following Project 2000
Child Branch education
in the UK
- interviews, content
analysis - 6 newly
qualified
nurses (5
months post-
qualification)
-Interviews
-Content analysis
-For 4 NGN contributed
positively to their transition.
-Need criteria to assess staff
performance at the end of the
preceptorship period.
-lack of formal structure and it
was unclear
- no member
checking, peer
debriefing or
triangulation of
researchers, no
evidence of audit
trails
-Limited report
of methodology
213
Connelly
& Hoffart
(1998)
To evaluate the nursing
orientation program at an
Urban Medical Center.
Emergent, naturalistic
inquiry design
Study occurred 2 yrs
after hospital
restructured
orientation program
N=64
(45 RNs, 8
managers, 5
educators, & 6
administrators)
-Interviews, field
observations, &
comparative
analysis
344 hrs of field
observations over 5
months
-Grounded survey
-Total of 43
interviews
-Transcribed &
coded
-Orientation model developed
-Model includes (with areas of
overlap):
(a) Individual, (b) Individual
characteristics, (c) Overall
goal, (d) Affective, (e) Clinical
competency, (f) Organizational
activities, (g) Educational
component, (h) Management
component, (i) Preceptor, (j)
Leadership (k) communication
-No detailed
description of
model
development
process
-No demographic
data
Forneris &
Peden-
McAlpine.
(2007)
To determine if a
reflective Critical
Learning Intervention
would improve new
nurses’ critical thinking
skills during the first 6
months of their practice.
Qualitative case study
intervention
-N=6
dyads of
NGN & their
preceptors
-Narrative
reflecting
journaling during 6
months
-Individual
interviews prior to
intervention, and
then at 3 & 6
months
-Preceptor coaching
for first 3 months
-Leader facilitated
discussion groups,
biweekly for 4
months, then
monthly for 2
months
-The case study analysis
suggests that the CLI assisted
in the development of critical
thinking; analysis of narratives
from the new nurses’
experiences illustrated clear
changes in their critical
thinking over time.
-Small sample
size
Godinez et
al. (1999)
To describe the process
of role transition from
new graduate nurse to
staff nurse.
-Qualitative
-N= 27
(13 from
BScN, & 14
diploma)
-Content analysis
-Coding of logs by
each author until
group obtained
100% inter-rater
reliability
-Completed for first
3 wks of orientation
-299 logs
-5 themes:
(1) Real RN work, (2)
Guidance,(3) Transitional
processes,(4) Institutional
context, (5) Interpersonal
dynamics.
-Identified activities that
assisted transition: changing
from student to RN uniform,
successfully completing an
-Study context:
new grads not
being hired
during study
period; hospital
actively closing
214
orientation program.
-The continuous shaping of
experiences by the preceptor &
success from new grad led to
opportunities for competence,
leading to confidence.
Luhanga et
al. (2010)
To review the literature
on the 1:1 preceptorship
model for undergraduate
nursing students.
-Literature review -N= 57
(40 research
articles and 17
theoretical
papers)
n/a The authors concluded that a
1:1 preceptorship model was
important for nursing students’
safe and competent transition.
-Within the
context of
undergraduate
nursing students’
clinical education
Ohrling &
Hallberg
(2001)
To illuminate nurses’
lived experiences of the
process of preceptoring
Phenomenology
(Phenomenological-
hermeneutic analysis
method)
-N= 17
-Preceptors of
nursing
students
-Tape recorded
interviews
-Interviews took
place in week 5 and
the 10th
week of the
preceptorship
-Two themes
1) Sheltering the students when
learning
2) Facilitating the students’
learning.
Meanings of Preceptorship:
-Support for the student in their
learning & in avoiding the risk
of failure.
-Preceptors of
nursing students
Pfeil
(1999)
To explore the role of
preceptorship in new
nurses transition from
student to accountable
clinician and in the
development of clinical
safety and competence.
Phenomenological-
Qualitative survey
N= 16 NGN
N=18
preceptors
In 3 UK
hospitals
-Semi-structured
interviews
-Tape recorded
-Interviews took
place between week
2 and 6, and 6
months later
-Preceptorship helped to
highlight and address arising
problems.
-Substantial increase in
competence and responsibility
levels at 3 months.
-New grads often regressed
during difficult situations.
-Two units chose preceptors
based on nursing experience
-Three units allowed new grad
to choose preceptor.
-Most new grads found
transition difficult.
-Need to match on personality
and learning styles.
-Study conducted
after the
implementation
of mandatory
preceptorship in
the UK (1993).
215
Rush et al.
(2013)
To determine best
practices in new graduate
nurses’ transition
programs.
-Integrative literature
review
-47 articles
were included
in this review
n/a -Limited ability to draw
substantive conclusions and
recommendations due to the
varied methods used
-The presence of a program for
NGNs appears to improve
retention and competencies
-There is stronger evidence on
the importance of skills
development, preceptor
training programs, availability
of formal support during the
first 9 months of practice,
contact with peers and healthy
work environments.
-
Thomka
(2001)
To describe the
experiences &
perceptions of RNs
resulting from their
interactions during the
time of role transition
from graduation through
the 1st year of practice &
to explore what the
participants’ ideal
transition from new grad
to RN would be like.
-Anonymous
qualitative survey
-Coding for keywords
N=16
RNs with 15
years or less
nursing
experience
-Survey developed
by researcher -15/16 had specific ideas
regarding the ideal “role
transition”:
-Mentor characteristics
(encouraging, non-judgmental
guidance, would like to have a
closer relationship with an
RN).
-Important time element for
role transition; all participants
proposed time frames that were
longer than they had had.
-Lack of consistency in how
they were assisted in their role
socialization.
-RNs must rely
on recall to
remember what
their experiences
as new grads
were like; this
recall might bias
results.
Whitehead
et al.
(2013)
To conduct a systematic
review of the literature
on preceptorship
programs for new
graduate nurses in the
UK.
-Systematic review N= 24 papers
(included
international
articles)
-Systematic review
based the
“Preferred
Reporting Items for
Systematic Review
and Meta-Analysis”
statement.
Three main themes:
(1)Management Support for
preceptors, new nurses, and
preceptorship programs
(2)Preceptorship programs may
be a recruitment and retention
strategy for both new nurses
and preceptors.
(3)Improvement of critical
thinking and reflection skills
-The definition of
preceptorship
differs in the UK
according to the
authors.
216
Appendix F: Power Analysis
Power Analysis Table
Author Sample Role Conflict Role Ambiguity Organizational
Commitment
Job Satisfaction
ES
ES
ES
ES
Allen & Meyer
(1990)
N= 132 - - - .25 .33 - -
Ashforth, Saks,
& Lee (1997)
N=222 .18 .22 .14 .16 .05 .05 .20 .25
Bauer et al.
(2007)
Meta- analysis
N= 12,279 - - - - .13 .15 .30 .43
Cooper-Thomas
& Anderson
(2002)
N=214 - - - - .12 .14 .08 .09
Jones
(1986)
N= 102 .24 .27 .14 .16 .16 .19
Kowtha
(2008)
N=135 - - - - .12 .14 .17 .20
Saks & Ashforth
(1997b)
N= 154 - - - - .24 .32 .21 .27
Saks, Uggerslev
& Fassina
(2007)
Meta- analysis
N= 6104 .24 .31 .17 .21 .24 .32 .25 .34
ES calculated with
217
Appendix G:
Power Analysis Calculations (Cohen, 1988)
Alpha= .05
Power= .80
Beta= .20
Effect size ( ) = .15
Number of independent variables (u) = 6
Degrees of freedom of the denominator of the F ratio= v
Noncentrality parameter= λ
A trial value for v is set at 120 with λ= 14.3
N= λ (1- R )
R
= 14.3 (1- .13) = 96, thus v= 96-6-1= 89
.13
The interpolated value of λ for v= 89 is:
λ= 15.0 - 1/60- 1/89 (15.0-14.3) = 14.54
1/60- 1/120
Thus, the N is:
N= 14.54 (1- .13) = 98
.13
2
2
218
Appendix H:
Recruitment E-Mail from Site PI (New Graduate Nurse Preceptorship Study)
Dear Preceptors and new Graduate Nurses, I am sending you this letter to inform you of a study that will be taking place at “Hospital” over the next few months. I am working as the “Hospital” Site Primary Investigator on a study conducted by Michelle Lalonde, a doctoral nursing student, under the supervision of her dissertation supervisor Linda McGillis Hall, RN, PhD, of the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto. The study has been reviewed by the Office of Research Services at the University of Toronto and “Hospital” Research Ethics Board. The purpose of the study is to gain a better understanding of the role of preceptors’ emotional intelligence on how new graduate nurses adjust to their new role as a nurse and the process through which new graduate nurses’ are socialized during a preceptorship program. This research will involve 98 pairs of preceptors and new graduate nurses from four different Toronto and greater Toronto area acute care hospitals. As you will soon be involved in a preceptorship program as a preceptor or as a new graduate nurse, your insight into this process is valuable and your participation in this study would be appreciated. The study requires that both the new graduate nurse and primary preceptor agree to participate. If interested, you will be asked to complete a survey at the end of the preceptorship program. Participation in the study is confidential and voluntary. If you are interested in participating, you can directly contact Michelle Lalonde, Doctoral student, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto at 416-978-1327 or by e-mail at [email protected]. Please do not hesitate to contact me or Michelle Lalonde if you have any questions. Thank you. Sincerely, Site PI Site PI contact information
[Faculty of Nursing letterhead]
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Appendix I:
Preceptor Letter of Information
New Graduate Nurse Preceptorship Study
________________________________________________________
Preceptor Letter of Explanation
You are being asked to participate in a study conducted by a doctoral student, Michelle Lalonde, under the supervision of her dissertation supervisor Linda McGillis Hall, RN, PhD, FAAN, of the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto. The general purpose of the study is to gain a better understanding of the role of a preceptor on new graduate nurses socialization during a preceptorship program. The study has received ethics approval from the Office of Research Services at the University of Toronto. Your participation involves completing a questionnaire. The questionnaire is expected to take approximately 45 minutes of your time to complete. Participation in the study is confidential and voluntary. Your name will not be recorded on any of the forms. Only code numbers will be used. Your name will not be identified in any report or presentation that may arise from this study and your answers to the questionnaire will remain confidential. You can refuse to answer any questions and you can withdraw from the study at any time. If you have any questions, concerns or would like to speak to the Doctoral student for any reason, please call Michelle Lalonde, Doctoral student, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto at 416-978-1327 or by e-mail at [email protected] or Dr. Linda McGillis Hall by email at [email protected]. If you have any questions about your rights as a research participant or have concerns about this study, contact Rachel Zand, Director, Office of Research Ethics, Health Sciences, University of Toronto, at 416-946-3389, or by e-mail at [email protected]. Thank you. Sincerely, Michelle Lalonde, RN, BScN, MN, PhD Student Lawrence S. Bloomberg Faculty of Nursing University of Toronto 130 - 155 College Street Toronto, Ontario, M5T 1P8 (T) 416- 978-1327 (F) 416-978-8222 [email protected]
[Faculty of Nursing letterhead]
220
Appendix J:
Preceptor Consent Form
CONSENT TO PARTICIPATE IN A RESEARCH STUDY
________________________________________________________
Preceptor Consent Form Title New graduate nurse preceptorship study Investigator Michelle Lalonde, RN, BScN, MN, PhD Candidate
(T) 416- 978-1327 (F) 416-978-8222 [email protected]
Introduction You are being asked to take part in a research study conducted by Doctoral student Michelle Lalonde, RN, BScN, MN, under the supervision of her dissertation supervisor Linda McGillis Hall, RN, PhD, FAAN, Professor, Associate Dean of Research and External Relations at the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto. Please read this explanation about the study and its risks and benefits before you decide if you would like to take part in it. You should take as much time as you need to make your decision. You should ask Michelle Lalonde to explain anything that you do not understand and make sure that all of your questions have been answered before signing this consent form. Before you make your decision, feel free to talk about this study with anyone you wish. Participation in this study is voluntary and you may withdraw from the study at any time. The study is described below. This description tells you about the risks, inconvenience, or discomfort which you might experience. Purpose of the research The purpose of this doctoral dissertation study is to gain a better understanding of the role of a preceptor’s emotional intelligence on how new graduate nurses adjust to their new role as a nurse. As well, it examines the process through which new graduate nurses’ are socialized during a preceptorship program. Socialization is the process through which new nurses learn the social knowledge and skills they need to take on the role of a nurse. Emotional intelligence is someone’s ability to perceive and understand their own and others emotions and to use this information to guide how they think and act. This research will involve 98 pairs of preceptors and new graduate nurses from four different Toronto and greater Toronto area acute care hospitals.
[Faculty of Nursing letterhead]
221
Participation in the study If you agree to participate in this dissertation study, you will be asked to complete a questionnaire that will assess your emotional intelligence, IQ, and personality and is expected to take approximately 45 minutes of your time. Risks related to being in the study You are not obliged to participate in this study and you are free to withdraw from the study at any time without any effect on your employment, work status, or performance evaluation. There are no anticipated risks related to your involvement with this study. Although there are no obvious harms associated with taking part in this study, participating will involve approximately 45 minutes of your time. Benefits to being in the study There is no direct benefit to you for taking part in this study. Your contributions will provide a greater understanding of the importance of preceptors’ to how new nurses adjust to their new role as a nurse and how new nurses are socialized during a preceptorship program. Voluntary participation Your participation in this study is voluntary. You may decide not to be in this study, or to be in the study now and then change your mind later. You may refuse to answer any question you do not want to answer. Compensation There is no cost to you for taking part in this study. You will receive a token of appreciation for participating in this study, a two dollar gift card from a coffee shop and a certificate of participation. At the end of the study period, there will be a raffle for $100. You will be given the option to either keep the $100 or have a donation made in your name to a charity of your choice. If you would like to be included in this raffle, please complete the contact information card included your survey package and return it to Michelle Lalonde. At the end of the study period, the Michelle Lalonde will place the contact information cards for each site in a separate box and will randomly choose one card per site. Only the raffle winners will be contacted. Once returned, the contact information card will be removed from the survey package and kept in a separate location to maintain confidentiality. If you decide to withdraw from the study at any time, you may keep the tokens of appreciation. Privacy and confidentiality Participation in this study is confidential. Your name will not be recorded on any of the forms. Only code numbers will be used. Your name will not be identified in any reports or presentations that may arise from this study and your answers to the questionnaire will remain confidential. No one from your work will have access to the data collected in this questionnaire. The questionnaires will be kept for six years in a locked filing cabinet located at the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto and then destroyed. All computer files will be password protected, which can only be accessed by the doctoral student and her dissertation supervisor.
222
Study findings The results from this study may be shared through publications and presentations at conferences. Withdrawal from study Participation is this study is voluntary. You may terminate your involvement at any time and do not need to give any reason or explanation for doing so without it having any impact on your employment status. Feedback on your performance on these tests If you are interested in obtaining feedback on your performance on these tests, they can be made available to you at the end of the study period once all of the data has been collected. Please complete the participant contact information card included in your survey package and return it to Michelle Lalonde with your survey. The Doctoral student, Michelle Lalonde, will contact you at the end of the study period to determine if you are still interested in receiving feedback on your performance on these tests and if you are interested in meeting with her to discuss your individual results. Questions or concerns If you have any questions, concerns or would like to speak to the Doctoral student for any reason, please call Michelle Lalonde Doctoral student at 416-978-1327 or by e-mail at [email protected] or Dr. Linda McGillis Hall by email at [email protected]. If you have any questions about your rights as a research participant or have concerns about this study, contact Rachel Zand, Director, Office of Research Ethics, Health Sciences, University of Toronto, at 416-946-3389, or by e-mail at [email protected]. The Research Ethics Board is a group of people who oversee the ethical conduct of research studies. These people are not part of the student’s dissertation committee. Everything that you discuss will be kept confidential. Thank you for your time and contribution to our study. Sincerely,
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Michelle Lalonde PhD Student Lawrence S. Bloomberg Faculty of Nursing University of Toronto 130 - 155 College Street Toronto, Ontario M5T 1P8 (T)- 416- 978-1327 (F)- 416-978-8222 [email protected]
Linda McGillis Hall RN PhD FAAN PhD Student Supervisor Professor, Associate Dean, Research & External Relations Lawrence S. Bloomberg Faculty of Nursing University of Toronto 130 - 155 College Street Toronto, Ontario M5T 1P8 (T) 416-978-2869 (F) 416-978-8222 [email protected]
Consent This study has been explained to me and any questions I had have been answered. I know that I may leave the study at any time. I agree to take part in this study. _____________________ ______________________ ______________ Print Study Participant’s Name
Signature Date
(You will be given a signed copy of this consent form) My signature means that I have explained the study to the participant named above. I have answered all questions. _____________________ ______________________ ______________ Michelle Lalonde Doctoral Student
Signature Date
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Appendix K:
Preceptor Survey (New Graduate Nurse Preceptorship Study)
Appendix K.1:
Demographic Information
A. YOUR GENERAL BIOGRAPHICAL INFORMATION Please answer the following questions as accurately as possible. Please note that the information you give will be treated in strictest confidence.
1. What is your age in years? _____________ 2. What is your gender?
(1) ____ female
(2) ____ male
(3) ____ trans-gendered B. YOUR CURRENT WORK 3. How long have you been a nurse (in weeks/months)? _______________________ 4. What is your current job status? (Please check one answer only): (1) ____ permanent full-time (2) ____ permanent part-time (3) ____ casual or temporary employee (4) ____ contract position 5. What type of setting do you work in? (Please check (√) one response): ____ Adult ___ _ Pediatrics (1) ____ surgery (10) ____ recovery room (2) __ __medicine (11) ____ neonatal (3) ____ emergency (12) ____ long-term care (4) ____ labour & delivery (13) ____ rehabilitation (5) ____ operating room (14) ____ cardiac (6) ____ ICU (15) ____ oncology (7) ____ medical/surgical (16) ____ IV/patient access (8) ____ float team (17) ____ clinic (9) ____ mental health
6. How long have you been at your organization in any nursing capacity (in
years/months)? _________ years _________ months
7. How long have you been in your current nursing position? __________ years
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C. YOUR EDUCATION
8. What is the highest level of nursing education you have attained?
(1) _____ Hospital-based education for job
(2) _____ Certificate (please specify) __________________________________
(3) _____ Diploma
(4) _____ Baccalaureate
(5) _____ Masters
(6) _____ Doctorate
9. What is the highest level of non-nursing education you have obtained? (Please
specify.)
(1) _____ None
(2) _____ Certificate
(3) _____ Diploma
(4) _____ Baccalaureate
(5) _____ Masters
(6) _____ Doctorate
10a. Are you currently enrolled in a university educational program?
(1) _____ yes (please answer question 10b)
(2) _____ no (please skip to question 11)
10b. If you answered yes to question 11a, what university nursing program are you
currently enrolled in? (Please specify.)
(1) _____ Baccalaureate
(2) _____ Masters
(3) _____ Doctorate
Appendix K. 2:
Nursing Emotional Intelligence Scale
D. NURSING EMOTIONAL INTELLIGENCE
11. The following questionnaire is aimed at examining how nurses perceive and understand
their own and others emotions and how they use this information to guide how they think and
act.
For each question, you will be asked to choose the one option that best corresponds or
represents the emotion expressed in the scenario or what you think is happening in the question.
If the emotion or answer that you think of is not a possible option to choose from, please choose
from the available answers the one option that best corresponds or most closely represents your
answer.
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For the following questions, please circle the number that best corresponds to the emotion
expressed in the pictures and faces.
1. Indicate the amount of sadness expressed by this picture.
1) _____ Not at all present 2) _____ Slightly present
3) _____ Moderately present 4) _____ Quite present 5) _____ Extremely present
2. Indicate the amount of anger expressed by the person in
this picture.
1) _____ Not at all present 2) _____ Slightly present 3) _____ Moderately present 4) _____ Quite present 5) _____ Extremely present
3. Indicate the amount of excitement expressed by this
picture.
1) _____ Not at all present 2) _____ Slightly present 3) _____ Moderately present 4) _____ Quite present 5) _____ Extremely present
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4. Indicate the amount of surprise expressed by this picture.
1) _____ Not at all present
2) _____ Slightly present 3) _____ Moderately present 4) _____ Quite present 5) _____ Extremely present
5. “Indicate the amount of disinterest expressed by the
person in this picture.”
1) _____ Not at all present 2) _____ Slightly present 3) _____ Moderately present
4) _____ Quite present 5) _____ Extremely present
6. “Indicate the amount of guilt expressed by this picture.”
1) _____ Not at all present 2) _____ Slightly present
3) _____ Moderately present 4) _____ Quite present 5) _____ Extremely present
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7. “Indicate the amount of surprise expressed by the person
in this picture.”
1) _____ Not at all present 2) _____ Slightly present 3) _____ Moderately present 4) _____ Quite present
5) _____ Extremely present
For questions 8 – 13, please indicate how helpful/ useful each emotion listed would be relative
to each of the situations described below.
8. How useful might it be to feel tension when interacting with an aggressive/pushy patient
or family member?
Tension
Useless 1 2 3 4 5
Useful
9. How useful might it be to feel frustration when interacting with an aggressive/pushy
patient or family member while trying to provide patient care?
Frustration
Useless 1 2 3 4 5
Useful
10. How useful might it be to feel joy when readmitting a patient that you had previously
developed a great therapeutic relationship with?
Joy
Useless 1 2 3 4 5
Useful
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11. How useful might it be to feel frustration when readmitting a patient that you had
previously developed a great therapeutic relationship with?
Frustration
Useless 1 2 3 4 5
Useful
12. How useful might it be to feel joy when giving a patient a bed bath and interacting with
an incompetent patient attendant?
13. How useful might it be to feel hostility when giving a patient a bed bath and interacting
with an incompetent patient attendant?
Hostility
Useless 1 2 3 4 5
Useful
For questions 14 – 16, please select the emotional response that is the most likely to be felt in
the situations described below.
14. Joe felt anxious when he thought about having to prepare a new medication for the
first time. When the doctor became pushy and began aggressively asking why it was
taking so long, Joe then felt ____.
1) _____ Self-conscious
2) _____ Depressed
3) _____ Ashamed
4) _____ Overwhelmed
5) _____ Happy
Joy
Useless 1 2 3 4 5
Useful
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15. John was in a hurry to eat lunch before returning to work. When John stopped at the
cafeteria, he was happy to see Nadia, a recently discharged patient. After talking with
Nadia about how great she has been feeling since she was discharged, he was even
more pleased about the care he gave, he felt ____.
1) _____ Depressed
2) _____ Content
3) _____ Unsure
4) _____ Fatigued
5) _____ Active
16. Karen thought long and hard and did a lot of research about what kind of community
resources were available to her patient who was being discharged home. When she
gave her patient all this information, the patient didn’t seem to appreciate all of the
effort put into gathering this information. Karen then felt ____.
1) _____Envious
2) _____Anxious
3) _____Disappointed
4) _____Overwhelmed
5) _____Dissatisfied
For questions 17 – 20, please select the option that best represents the actions that preceded
and then followed the emotions described in each scenario below.
17. A nurse went into work feeling rested and then felt anxious. What happened in
between?
1) _____He couldn’t find his stethoscope
2) _____He saw a colleague that he hadn’t worked with in weeks
3) _____He found that he was working with a close friend
4) _____He was approached by an aggressive patient
5) _____He received report from a nurse he though he recognized
18. A young nurse went into work happy and left at the end of her shift feeling sad. What
happened in between?
1) _____ A patient that she had developed a great therapeutic relationship with was
discharged home
2) _____ One of her patients passed away
3) _____ She did not get a diner break
4) _____ She realized she had a lot of work to do tomorrow
5) _____ She was treated rudely by a patient
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19. A nurse brought her patient their morning medications. She felt embarrassed and then
she felt angry. What happened in between?
1) _____ She wished that she had not brought the medications
2) _____ She saw another nurse near the patient’s room who was in a hurry and couldn’t
talk
3) _____ She realized that she dropped one of the pills on the floor on the way to the
patient’s room
4) _____ She realized that she had made a mistake and the patient became angry and
suspicious of her intentions
5) _____ She realized that she was ten minutes early in administering her morning
medications
20. The family member of a patient previously on the unit where Marc works came to
bring flowers. He felt sad and then he felt guilty. What happened in between?
1) _____ The family member was offensive and made him not want to be in the nursing
station anymore
2) _____ Marc remembered the patient and the therapeutic relationship they had
3) _____ Marc remembered that the patient passed away and that he had made a medical
error the day before
4) _____ The family member was acting strange and made him think about other strange
patients
5) _____ The visit from the family member was interesting and made him think about an
new career path in palliative care.
For questions 21 – 22, please circle the number for each action that you feel best represents
how the individuals described in each of the scenarios would preserve, reduce, or maintain
his/ her emotions.
21. Debbie just came back from a great day at work on a surgical unit. She was feeling
peaceful and content. How well would the following behavior preserve Debbie’s
emotions?
Behavior: She decides it is best to ignore the feeling since it wouldn't last.
Very
Ineffective Very
Effective 1 2 3 4 5 6 7
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22. John went to work on his surgical unit where he works full-time. He felt stressed and
frustrated because his patient assignment was heavier than his colleagues. What
behavior could John perform to reduce his frustration?
Behavior: He should discontinue working on this unit.
Very
Ineffective Very
Effective 1 2 3 4 5 6 7
For questions 23 – 24, please circle the number for each action that you feel best represents
how the individuals described in each of the scenarios would preserve or maintain the
relationships between them.
23. Becky and Steve both want to go on the same morning break. They have a good
relationship but are stubborn about the break that they each want. How effective
would Becky be in maintaining a good relationship with Steve if she performed the
following behaviors?
a) Behavior 1: She should be sarcastic so that Steve will back down and let her go on the
break she wants.
b) Behavior 2: She should give in and accept whatever break Steve wants since he is so
determined.
Very
Ineffective Very
Effective 1 2 3 4 5 6 7
24. Sarah is a nurse on a medical unit where she cares for patients with a variety of medical
conditions. These patients and their families are very important to her and her hospital.
She has a great relationship with her patients, although today, one of her patients is
very rude and made an offensive comment to her. How effective would Sarah be in
maintaining a good relationship with this patient if performing the following behaviors?
a) Behavior1: She should become rude and offensive back to the patient.
Very
Ineffective Very
Effective 1 2 3 4 5 6 7
Very
Ineffective Very
Effective 1 2 3 4 5 6 7
233
b) Behavior 2: She should ignore the comments and act as if nothing was wrong.
Very
Ineffective Very
Effective 1 2 3 4 5 6 7
Appendix K. 3:
International Personality Item Pool
E. YOUR PERSONALITY
12. The following are phrases describing people's behaviors. Please use the rating scale
below to describe how accurately each statement describes you. Describe yourself as
you generally are now, not as you wish to be in the future. Describe yourself as you
honestly see yourself, in relation to other people you know of the same sex as you are,
and roughly your same age. So that you can describe yourself in an honest manner,
your responses will be kept in absolute confidence. Please read each statement carefully,
and then circle the number that best reflects your response.
Very
Inaccurate
Moderately
Inaccurate
Neither
Inaccurate nor Accurate
Moderately
Accurate
Very
Accurate
(1) Am interested in people. 1 2 3 4 5 (2) Sympathize with others'
feelings.
1 2 3 4 5
(3) Have a soft heart
1 2 3 4 5
(4) Take time out for others.
1 2 3 4 5
(5) Feel others' emotions.
1 2 3 4 5
(6) Make people feel at ease.
1 2 3 4 5
(7) Am not really interested
in others.
1 2 3 4 5
(8) Insult people.
1 2 3 4 5
9) Am not interested in
other people's problems.
1 2 3 4 5
234
(10) Feel little concern for
others.
1 2 3 4 5
(11) Am always prepared.
1 2 3 4 5
(12) Pay attention to details.
1 2 3 4 5
(13) Get chores done right
away.
1 2 3 4 5
(14) Like order.
1 2 3 4 5
(15) Follow a schedule.
1 2 3 4 5
(16) Am exacting in my work.
1 2 3 4 5
(17) Leave my belongings
around.
1 2 3 4 5
(18) Make a mess of things.
1 2 3 4 5
(19) Often forget to put things
back in their proper place.
1 2 3 4 5
(20) Shirk my duties.
1 2 3 4 5
(21) Have a rich vocabulary
1 2 3 4 5
(22) Have a vivid imagination.
1 2 3 4 5
(23) Have excellent ideas.
1 2 3 4 5
(24) Am quick to understand
things.
1 2 3 4 5
(25) Use difficult words.
1 2 3 4 5
(26) Spend time reflecting on
things.
1 2 3 4 5
(27) Am full of ideas.
1 2 3 4 5
(28) Have difficulty
understanding abstract
ideas.
1 2 3 4 5
(29) Am not interested in
abstract ideas.
1 2 3 4 5
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(30) Do not have a good
imagination.
1 2 3 4 5
Appendix K. 4:
Cattell Culture Fair Intelligence Test
F. YOUR IQ
Cattell Culture Fair Intelligence Test
Please contact psychtest.com a division of M.D. Angus & Associates Limited.
www.psychtest.com
Fax: 604-357-3113
Phone: 604-464-7919
Copyright © 2008, Hogrefe, Ltd., Oxford.
Thank You!
I am interested in any further comments you may wish to make about these or related issues. If
you have any comments, please write your comment below.
Thank you.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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Appendix L:
New Graduate Nurse Letter of Explanation
New Graduate Nurse Preceptorship Study
________________________________________________________
Letter of Explanation
You are being asked to participate in a study conducted by a doctoral student, Michelle Lalonde, under the supervision of her dissertation supervisor, Linda McGillis Hall, RN, PhD, FAAN, of the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto. The general purpose of the study is to gain a better understanding of the role of a preceptor’s emotional intelligence on new graduate nurses socialization during a preceptorship program. The study has received ethics approval from the Office of Research Services at the University of Toronto. Your participation involves completing a questionnaire at two points in time, at the beginning of your preceptorship program and at the end of your program. Each of the questionnaires is expected to take approximately 20 minutes of your time to complete. Participation in the study is confidential and voluntary. Your name will not be recorded on any of the forms. Only code numbers will be used. Your name will not be identified in any report or presentation that may arise from this study and your answers to the questionnaire will remain confidential. You can refuse to answer any questions and you can withdraw from the study at any time. If you have any questions, concerns or would like to speak to the Doctoral student for any reason, please call Michelle Lalonde, Doctoral student, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto at 416-978-1327 or by e-mail at [email protected] or Dr. Linda McGillis Hall by email at [email protected]. If you have any questions about your rights as a research participant or have concerns about this study, contact Rachel Zand, Director, Office of Research Ethics, Health Sciences, University of Toronto, at 416-946-3389, or by e-mail at [email protected]. Thank you. Michelle Lalonde, RN, BScN, MN, PhD Student Lawrence S. Bloomberg Faculty of Nursing University of Toronto 130 - 155 College Street Toronto, Ontario, M5T 1P8 (T) 416- 978-1327/ (F) 416-978-8222 [email protected]
[Faculty of Nursing letterhead]
237
Appendix M:
New Graduate Nurse Consent Form
CONSENT TO PARTICIPATE IN A RESEARCH STUDY
________________________________________________________
New Graduate Nurse Consent Form Title New graduate nurse preceptorship study Investigator Michelle Lalonde, RN, BScN, MN, PhD Candidate
(T) 416- 978-1327 (F) 416-978-8222 [email protected]
Introduction You are being asked to take part in a research study conducted by Doctoral student Michelle Lalonde, RN, BScN, MN, under the supervision of her dissertation supervisor, Linda McGillis Hall, RN, PhD, FAAN, Professor, Associate Dean of Research and External Relations at the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto. Please read this explanation about the study and its risks and benefits before you decide if you would like to take part in it. You should take as much time as you need to make your decision. You should ask Michelle Lalonde to explain anything that you do not understand and make sure that all of your questions have been answered before signing this consent form. Before you make your decision, feel free to talk about this study with anyone you wish. Participation in this study is voluntary and you may withdraw from the study at any time. The study is described below. This description tells you about the risks, inconvenience, or discomfort which you might experience. Purpose of the research The purpose of this doctoral dissertation study is to gain a better understanding of the role of a preceptor’s emotional intelligence on how new graduate nurses adjust to their new role as a nurse. As well, it examines the process through which new graduate nurses’ are socialized during a preceptorship program. Socialization is the process through which new nurses learn the social knowledge and skills they need to take on the role of a nurse. Emotional intelligence is someone’s ability to perceive and understand their own and others emotions and to use this information to guide how they think and act. This research will involve 98 pairs of preceptors and new graduate nurses from four different Toronto and greater Toronto area acute care hospitals.
[Faculty of Nursing letterhead]
238
Participation in the study If you agree to participate in this dissertation study, you will be asked to complete a questionnaire at two points in time, at the beginning of your preceptorship program and at the end. Each questionnaire is expected to take approximately 20 minutes of your time to complete. Risks related to being in the study You are not obliged to participate in this study and you are free to withdraw from the study at any time without any effect on your employment, work status, or performance evaluation. There are no anticipated risks related to your involvement with this study. Although there are no obvious harms associated with taking part in this study, participating will involve approximately 20 minutes of your time. Benefits to being in the study There is no direct benefit to you for taking part in this study. Your contributions will provide a greater understanding of the importance of preceptors’ emotional intelligence to how new nurses adjust to their new role as a nurse and how new nurses are socialized during a preceptorship program. Voluntary participation Your participation in this study is voluntary. You may decide not to be in this study, or to be in the study now and then change your mind later. You may refuse to answer any question you do not want to answer. Compensation There is no cost to you for taking part in this study. You will receive a token of appreciation for participating in this study at the beginning of the study period, a two dollar gift card from a coffee shop and a certificate of participation. If you decide to withdraw from the study at any time, you may keep the token of appreciation. Privacy and confidentiality Participation in this study is confidential. Your name will not be recorded on any of the forms. Only code numbers will be used. Your name will not be identified in any reports or presentations that may arise from this study and your answers to the questionnaire will remain confidential. No one from your work will have access to the data collected in this questionnaire. The questionnaires will be kept for six years in a locked filing cabinet located at the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto and then destroyed. All computer files will be password protected, which can only be accessed by the the doctoral student and her dissertation supervisor. Study findings The results from this study may be shared through publications and presentations at conferences.
239
Withdrawal from study Participation is this study is voluntary. You may terminate your involvement at any time and do not need to give any reason or explanation for doing so without it having any impact on your employment status. Questions or concerns If you have any questions, concerns or would like to speak to the Doctoral student for any reason, please call Michelle Lalonde at 416-978-1327 or by e-mail at [email protected] or Dr. Linda McGillis Hall by email at [email protected]. If you have any questions about your rights as a research participant or have concerns about this study, contact Rachel Zand, Director, Office of Research Ethics, Health Sciences, University of Toronto, at 416-946-3389, or by e-mail at [email protected]. The Research Ethics Board is a group of people who oversee the ethical conduct of research studies. These people are not part of thestudent’s dissertation committee. Everything that you discuss will be kept confidential. Thank you for your time and contribution to our study. Sincerely, Michelle Lalonde PhD Student Lawrence S. Bloomberg Faculty of Nursing University of Toronto 130 - 155 College Street Toronto, Ontario M5T 1P8 (T)- 416- 978-1327 (F)- 416-978-8222 [email protected]
Linda McGillis Hall RN PhD FAAN PhD Student Supervisor Professor, Associate Dean, Research & External Relations Lawrence S. Bloomberg Faculty of Nursing University of Toronto 130 - 155 College Street Toronto, Ontario M5T 1P8 (T) 416-978-2869 (F) 416-978-8222 [email protected]
240
Consent This study has been explained to me and any questions I had have been answered. I know that I may leave the study at any time. I agree to take part in this study. _____________________ ______________________ ______________ Print Study Participant’s Name
Signature Date
(You will be given a signed copy of this consent form) My signature means that I have explained the study to the participant named above. I have answered all questions. _____________________ ______________________ ______________ Michelle Lalonde Doctoral Student
Signature Date
241
Appendix N:
New Graduate Nurse Survey (New Graduate Nurse Preceptorship Study)
Appendix N.1:
Demographic Information
A. YOUR GENERAL BIOGRAPHICAL INFORMATION Please answer the following questions as accurately as possible. Please note that the information you give will be treated in strictest confidence.
1. What is your age in years? _____________ 2. What is your gender?
(1) ____ female
(2) ____ male
(3) ____ trans-gendered B. YOUR CURRENT WORK 3.. Was this hospital your first choice of employment? (1) ____yes (2) ____ no 4. How long have you been a nurse (in weeks/months)? _______________________ 5. Name of the university where you obtained your undergraduate degree in nursing:
___________________________________________________________________ 6. What is your current job status? (Please check one answer only): (1) ____ permanent full-time (2) ____ permanent part-time (3) ____ casual or temporary employee (4) ____ contract position 7. What type of setting do you work in? (Please check (√) one response): ____ Adult ____ Pediatrics (1) ____ surgery (10) ____ recovery room (2) ____ medicine (11) ____ neonatal (3) ____ emergency (12) ____ long-term care (4) ____ labour & delivery (13) ____ rehabilitation (5) ____ operating room (14) ____ cardiac (6) ____ ICU (15) ____ oncology (7) ___ _ medical/surgical (16) ____ IV/patient access (8) ____ float team (17) ____ clinic (9) ____ mental health
242
Appendix N.2:
First Job of Choice, Previous Experience on Current Unit, and Consolidation on Current Unit
C. YOUR THOUGHTS ABOUT YOUR CURRENT WORK
8. Was this setting your first choice of employment? (1) ____ yes (please proceed to question 10) (2) ____ no (please proceed to questions 8 and 9) 9. If you answered no to question 9, what was your first choice of employment? (Please
check (√) one response): ____ Adult ____ Pediatrics (1) ____ surgery (10) ____ recovery room (2) ____ medicine (11) ____ neonatal (3) ____ emergency (12) ____ long-term care (4) ____ labour & delivery (13) ____ rehabilitation (5) ____ operating room (14) ____ cardiac (6) ____ ICU (15) ____ oncology (7) ___ _ medical/surgical (16) ____ IV/patient access (8) ____ float team (17) ____ clinic (9) ____ mental health 10. Do you plan on pursuing your first choice of employment? (1) ____ yes (2) ____ no 11. Have you previously worked on or did a clinical placement on your current unit of
hire? (1) ____ yes (2) ___ _no
12. Did you do your final clinical practicum/ consolidation on your current unit of hire? (1) ____ yes (2) ____ no
243
Appendix N. 3:
Core Self-Evaluations
D. HOW YOU SEE YOURSELF
13. Please indicate how much you agree or disagree with the following statements by
circling the number that best represents your answer.
Strongly
Disagree
Disagree Neutral Agree Strongly
Agree
(1) I am confident I get the success I deserve in
life.
1 2 3 4 5
(2) Sometimes I feel depressed. 1 2 3 4 5
(3) When I try, I generally succeed. 1 2 3 4 5
(4) Sometimes when I fail I feel worthless.
1 2 3 4 5
(5) I complete tasks successfully. 1
2 3 4 5
(6) Sometimes, I do not feel in control of my
work.
1 2 3 4 5
(7) Overall, I am satisfied with myself.
1 2 3 4 5
(8) I am filled with doubts about my competence.
1 2 3 4 5
(9) I determine what will happen in my life.
1 2 3 4 5
(10) I do not feel in control of my success in my
career.
1 2 3 4 5
(11) I am capable of coping with most of my
problems.
1 2 3 4 5
(12) There are times when things look pretty bleak
and hopeless to me. 1 2 3 4 5
244
Appendix N.4:
Role Ambiguity and Role Conflict
E. ROLE AMBIGUITY AND ROLE CONFLICT
14. Please indicate how you feel by circling the number that best reflects your response.
Very
False False Slightly
False
Neutral Slightly
True
True Very
True
(1) I feel certain about how much authority I
have.
1 2 3 4 5 6 7
(2) I have clear, planned goals and objectives
for my job.
1 2 3 4 5 6 7
(3) I have to do things that should be done
differently.
1 2 3 4 5 6 7
(4) I know that I have divided my time
properly.
1 2 3 4 5 6 7
(5) I receive an assignment without the
manpower to complete it.
1 2 3 4 5 6 7
(6) I know what my responsibilities are.
1 2 3 4 5 6 7
(7) I have to buck a rule or policy in order to
carry out an assignment.
1 2 3 4 5 6 7
(8) I work with two or more groups who
operate quite differently.
1 2 3 4 5 6 7
(9) I know exactly what is expected of me.
1 2 3 4 5 6 7
(10) I receive incompatible requests from two
or more people.
1 2 3 4 5 6 7
(11) I do things that are apt to be accepted by
one person and not accepted by others.
1 2 3 4 5 6 7
(12) I receive an assignment without adequate
resources and materials to execute it.
1 2 3 4 5 6 7
(13) Explanation is clear of what has to be
done. 1 2 3 4 5 6 7
(14) I work on unnecessary things.
1 2 3 4 5 6 7
245
Appendix N.5:
Job Satisfaction
F. YOUR JOB SATISFACTION
15. Please indicate how much you agree or disagree with the following statements by
circling the number that best represents your answer.
Strongly
Disagree Moderately
Disagree
Slightly
Disagree
Neutral Slightly
Agree
Moderately
Agree Strongly
Agree
(1) All in all I am satisfied with
my job.
1 2 3 4 5 6 7
(2) In general, I don’t like my
job.
1 2 3 4 5 6 7
(3) In general, I like working
here.
1 2 3 4 5 6 7
Appendix N.6:
Turnover Intent
G. YOUR TURNOVER INTENT
16. Please indicate how much you agree or disagree with the following statements by
circling the number that best represents your answer.
Strongly Disagree
Disagree Neutral Agree Strongly Agree
(1) All things considered, I would like to find a
comparable job in a different organization.
1
2
3
4
5
(2) I am thinking about quitting. 1 2 3 4 5
(3) It is likely that I will actively look for a
different organization to work for in the
next year.
1
2
3
4
5
(4) The results of my search for a new job are
encouraging.
1
2
3
4
5
(5) I will probably look for a new job in the
near future.
1
2
3
4
5
246
Thank you!
I am interested in any further comments you may wish to make about these or related issues. If
you have any comments, please write your comment below.
Thank you.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
(6) At the present time, I am actively searching
for a job in another organization.
1
2
3
4
5
(7) I intend to quit.
1 2 3 4 5
247
Appendix O:
Certificate of Participation
This certifies that
_________________________
Participated in a Research Study
Date
_________________
Michelle Lalonde, RN, BScN, MN, PhD Candidate Lawrence S. Bloomberg Faculty of Nursing
University of Toronto
[Faculty of Nursing logo]
248
Appendix P:
Participant Contact Information Card: Raffle
Contact Information for Raffle
At the end of the study period, there will be a raffle for $100 at your
hospital. The winner may choose to keep the $100 or make a donation to
their charity of choice. Only the winner of the raffle will be contacted. If
you are interested in participating in the raffle, please complete the
following contact information card and return it with your completed survey
package
Yes! I would like to be included in the raffle!
Name:
email address:
Site Code:________
249
Appendix Q:
Participant Contact Information Card: Feedback on Test Performance
Contact Information
Are you interested in receiving feedback on your performance on the tests
that you completed in this survey? If so, please complete the following
contact information card and return it with your completed survey package
Yes! I would like to receive feedback on my test performance
Name:
Phone number:
email address:
Code:________
250
Appendix R:
Letter of Explanation for Face Validity and Expert Surveys (Pilot Study)
Nursing Emotional Intelligence: A Pilot of a New Measure ________________________________________________________
Letter of Explanation
You are being asked to participate in a study conducted by doctoral student, Michelle Lalonde, under the supervision of her dissertation supervisor, Linda McGillis Hall, RN, PhD, FAAN, of the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto. The purpose of the study is to test a new measure of emotional intelligence specifically designed for nurses. Emotional intelligence is someone’s ability to perceive and understand their own and others emotions and to use this information to guide how they think and act. The study has received ethics approval from the Office of Research Services at the University of Toronto and Mount-Sinai Hospital. Your participation involves completing a questionnaire that will measure nurses’ emotional intelligence. This questionnaire is expected to take approximately 20 minutes of your time to complete. Participation in the study is confidential and voluntary. Your name will not be recorded on any of the forms. Only code numbers will be used. Your name will not be identified in any report or presentation that may arise from this study and your answers to the questionnaire will remain confidential. You can refuse to answer any questions and you can withdraw from the study at any time. If you have any questions, concerns or would like to speak to the Doctoral student for any reason, please call Michelle Lalonde at 416-978-1327 or by e-mail at [email protected] or Dr. Linda McGillis Hall by email at [email protected]. If you have any questions about your rights as a research participant or have concerns about this study, contact Rachel Zand, Director, Office of Research Ethics, Health Sciences, University of Toronto, at 416-946-3389, or by e-mail at [email protected]. Thank you very much for helping with this important study. Sincerely, Michelle Lalonde, RN, BScN, MN, PhD Student Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 130 -155 College Street, Toronto, ON, M5T 1P8 (T) 416 978-1327/ (F) 416-978-8222 [email protected]
[Faculty of Nursing letterhead]
251
Appendix S:
Consent Form for Face Validity and Expert Surveys (Pilot Study)
CONSENT TO PARTICIPATE IN A RESEARCH STUDY ________________________________________________________
Nurse Consent Form
Title Nurses’ Emotional Intelligence: A Pilot of a New Measure Investigator Michelle Lalonde, RN, BScN, MN, PhD Candidate
(T) 416- 978-1327 (F) 416-978-8222 [email protected]
Introduction You are being asked to take part in a research study conducted by Doctoral student Michelle Lalonde, RN, BScN, MN, under the supervision of her dissertation supervisor, Linda McGillis Hall, RN, PhD, FAAN, Professor, Associate Dean of Research and External Relations at the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto. Please read this explanation about the study and its risks and benefits before you decide if you would like to take part in it. You should take as much time as you need to make your decision. You should ask Michelle Lalonde to explain anything that you do not understand and make sure that all of your questions have been answered before signing this consent form. Before you make your decision, feel free to talk about this study with anyone you wish. Participation in this study is voluntary and you may withdraw from the study at any time. The study is described below. This description tells you about the risks, inconvenience, or discomfort which you might experience. Purpose of the research The purpose of this doctoral dissertation study is to test a new and shorter measure of emotional intelligence that is designed specifically for nurses. Emotional intelligence is someone’s ability to perceive and understand their own and others emotions and to use this information to guide how they think and act. This research will involve registered nurses working at Mount-Sinai Hospital with more than two years experience completing the survey.
[Faculty of Nursing letterhead]
252
Participation in the study If you agree to participate in this pilot study, you will be asked to complete a questionnaire that will measure nurses’ emotional intelligence. This questionnaire is expected to take approximately 20 minutes of your time to complete. Risks related to being in the study You are not obliged to participate in this study and you are free to withdraw from the pilot study at any time without any effect on your employment, work status, or performance evaluation. There are no anticipated risks related to your involvement with this study. Although there are no obvious harms associated with taking part in this pilot study, participating will involve approximately 20 minutes of your time to complete. Benefits to being in the study There is no direct benefit to you for taking part in this study. Your contributions will help in the development of a new measure of nurses’ emotional intelligence that will be used in a larger study at a later date. Voluntary participation Your participation in this study is voluntary. You may decide not to be in this study, or to be in the study now and then change your mind later. You may refuse to answer any question you do not want to answer. Compensation There is no cost to you for taking part in this study. You will receive a token of appreciation for participating in this study, a two dollar gift card from a coffee shop and a certificate of participation. If you decide to withdraw from the study at any time, you may keep the token of appreciation. Privacy and confidentiality Participation in this study is confidential. Your name will not be recorded on any of the forms. Only code numbers will be used. Your name will not be identified in any reports or presentations that may arise from this study and your answers to the questionnaire will remain confidential. No one from your work will have access to the data collected in this questionnaire. The questionnaires will be kept for six years in a locked filing cabinet located at the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto and then destroyed. All computer files will be password protected, which can only be accessed by the doctoral student and her dissertation supervisor. Study findings The results from this study may be shared through publications and presentations at conferences. Withdrawal from study Participation is this pilot study is voluntary. You may terminate your involvement at any time and do not need to give any reason or explanation for doing so without it having any impact on your employment status.
253
Questions or concerns If you have any questions, concerns or would like to speak to the doctoral student for any reason, please call Michelle Lalonde at 416-978-1327 or by e-mail at [email protected] or Dr. Linda McGillis Hall by email at [email protected]. If you have any questions about your rights as a research participant or have concerns about this study, contact Rachel Zand, Director, Office of Research Ethics, Health Sciences, University of Toronto, at 416-946-3389, or by e-mail at [email protected]. The Research Ethics Board is a group of people who oversee the ethical conduct of research studies. These people are not part of the study team. Everything that you discuss will be kept confidential. Thank you for your time and contribution to our study. Sincerely, Michelle Lalonde PhD Student Lawrence S. Bloomberg Faculty of Nursing University of Toronto 130 - 155 College Street Toronto, Ontario M5T 1P8 (T) 416- 978-1327 (F) 416-978-8222 [email protected]
Linda McGillis Hall RN PhD FAAN PhD Student Supervisor Professor, Associate Dean, Research & External Relations Lawrence S. Bloomberg Faculty of Nursing University of Toronto 130 - 155 College Street Toronto, Ontario M5T 1P8 (T) 416-978-2869 (F) 416-978-8222 [email protected]
254
Consent This study has been explained to me and any questions I had have been answered. I know that I may leave the study at any time. I agree to take part in this study. _____________________ ______________________ ______________ Print Study Participant’s Name
Signature Date
(You will be given a signed copy of this consent form) My signature means that I have explained the study to the participant named above. I have answered all questions. _____________________ ______________________ ______________ Michelle Lalonde Doctoral Student
Signature Date
255
Appendix T:
Nursing Emotional Intelligence Scale: Face Validity Survey (Pilot Study)
Appendix T.1
Demographic Information
DATE ________________ A. YOUR GENERAL BIOGRAPHICAL INFORMATION Please answer the following questions as accurately as possible. Please note that the information you give will be treated in strictest confidence.
1. What is your age in years? _____________ 2. What is your gender?
(2) ____ female
(3) ____ male
(4) ____ trans-gendered B. YOUR CURRENT WORK 3. How long have you been a nurse (in weeks/months)? _______________________ 4. What is your current job status? (Please check one answer only): (1) ____ permanent full-time (2) ____ permanent part-time (3) ____ casual or temporary employee (4) ____ contract position 5. What type of setting do you work in? (Please check (√) one response): Adult Pediatrics (1) ____ surgery (10) ____ recovery room (2) ____ medicine (11) ____ neonatal (3) ____ emergency (12) ____ long-term care (4) ____ labour & delivery (13) ____ rehabilitation (5) ____ operating room (14) ____ cardiac (6) ____ ICU (15) ____ oncology (7) ____ medical/surgical (16) ____ IV/patient access (8) ____ float team (17) ____ clinic (9) ____ mental health
6. How long have you been at your organization in any nursing capacity (in
years/months)? _________ years _________ months
7. How long have you been in your current nursing position? __________ years
256
C. YOUR EDUCATION
8. What is the highest level of nursing education you have attained?
(1) _____ Hospital-based education for job
(2) _____ Certificate (please specify) __________________________________
(3) _____ Diploma
(4) _____ Baccalaureate
(5) _____ Masters
(6) _____ Doctorate
9. What is the highest level of non-nursing education you have obtained? (Please
specify.)
(1) _____ None
(2) _____ Certificate
(3) _____ Diploma
(4) _____ Baccalaureate
(5) _____ Masters
(6) _____ Doctorate
10a. Are you currently enrolled in a university nursing program?
(1) _____ yes (please answer question 10b)
(2) _____ no (please skip to question 11)
10b. If you answered yes to question 11a, what university nursing program are you
currently enrolled in? (Please specify.)
(1) _____ Baccalaureate
(2) _____ Masters
(3) _____ Doctorate
Appendix T.2:
Nursing Emotional Intelligence Scale
D. NURSING EMOTIONAL INTELLIGENCE
11. Please indicate how you feel by checking (√) the option that best reflects your
response.
1. “Indicate the amount of sadness expressed by this picture.”
1) _____ Not at all present
2) _____ Slightly present
3) _____ Moderately present
4) _____ Quite present
5) _____ Extremely present
257
2. “Indicate the amount of anger expressed by the person in this
picture.”
1) _____ Not at all present
2) _____ Slightly present
3) _____ Moderately present
4) _____ Quite present
5) _____ Extremely present
3. “Indicate the amount of excitement expressed by this picture.”
1) _____ Not at all present
2) _____ Slightly present
3) _____ Moderately present
4) _____ Quite present
5) _____ Extremely present
4. “Indicate the amount of surprise expressed by this picture.”
1) _____ Not at all present
2) _____ Slightly present
3) _____ Moderately present
4) _____ Quite present
5) _____ Extremely present
5. “Indicate the amount of disinterest expressed by the person in
this picture.”
1) _____ Not at all present
2) _____ Slightly present
3) _____ Moderately present
4) _____ Quite present
5) _____ Extremely present
6. “Indicate the amount of guilt expressed by this picture.”
1) _____ Not at all present
2) _____ Slightly present
3) _____ Moderately present
4) _____ Quite present
5) _____ Extremely present
258
7. “Indicate the amount of surprise expressed by the person in this
picture.”
1) _____ Not at all present
2) _____ Slightly present
3) _____ Moderately present
4) _____ Quite present
5) _____ Extremely present
8. How useful might it be to feel tension when interacting with an aggressive/pushy patient
or family member?
Tension
Useless 1 2 3 4 5
Useful
9. How useful might it be to feel frustration when interacting with an aggressive/pushy
patient or family member while trying to provide patient care?
Frustration
Useless 1 2 3 4 5
Useful
10. How useful might it be to feel joy when readmitting a patient that you had previously
developed a great therapeutic relationship with?
Joy
Useless 1 2 3 4 5
Useful
11. How useful might it be to feel frustration when readmitting a patient that you had
previously developed a great therapeutic relationship with?
Frustration
Useless 1 2 3 4 5
Useful
259
12. How useful might it be to feel joy when giving a patient a bed bath and interacting with
an incompetent patient attendant?
Joy
Useless 1 2 3 4 5
Useful
13. How useful might it be to feel hostility when giving a patient a bed bath and interacting
with an incompetent patient attendant?
Hostility
Useless 1 2 3 4 5
Useful
14. Joe felt anxious when he thought about having to prepare a new medication for the
first time. When the doctor became pushy and began aggressively asking why it was
taking so long, Joe then felt ____.
1) _____ Self-conscious
2) _____ Depressed
3) _____ Ashamed
4) _____ Overwhelmed
5) _____ Happy
15. John was in a hurry to eat lunch before returning to work. When John stopped at the
cafeteria, he was happy to see Nadia, a recently discharged patient. After talking with
Nadia about how great she has been feeling since she was discharged, he was even
more pleased about the care he gave, he felt ____.
1) _____ Depressed
2) _____ Content
3) _____ Unsure
4) _____ Fatigued
5) _____ Active
16. Karen thought long and hard and did a lot of research about what kind of community
resources were available to her patient who was being discharged home. When she
gave her patient all this information, the patient didn’t seem to appreciate all of the
effort put into gathering this information. Karen then felt ____.
1) _____Envious
2) _____Anxious
3) _____Disappointed
4) _____Overwhelmed
5) _____Dissatisfied
260
17. A nurse went into work feeling rested and then felt anxious. What happened in
between?
1) _____He couldn’t find his stethoscope
2) _____He saw a colleague that he hadn’t worked with in weeks
3) _____He found that he was working with a close friend
4) _____He was approached by an aggressive patient
5) _____He received report from a nurse he though he recognized
18. A young nurse went into work happy and left at the end of her shift feeling sad. What
happened in between?
1) _____ A patient that she had developed a great therapeutic relationship with was
discharged home
2) _____ One of her patients passed away
3) _____ She did not get a diner break
4) _____ She realized she had a lot of work to do tomorrow
5) _____ She was treated rudely by a patient
19. A nurse brought her patient their morning medications. She felt embarrassed and then
she felt angry. What happened in between?
1) _____ She wished that she had not brought the medications
2) _____ She saw another nurse near the patient’s room who was in a hurry and couldn’t talk
3) _____ She realized that she dropped one of the pills on the floor on the way to the
patient’s room
4) _____ She realized that she had made a mistake and the patient became angry and
suspicious of her intentions
5) _____ She realized that she was ten minutes early in administering her morning
medications
20. The family member of a patient previously on the unit where Marc works came to
bring flowers. He felt sad and then he felt guilty. What happened in between?
1) _____ The family member was offensive and made him not want to be in the nursing
station anymore
2) _____ Marc remembered the patient and the therapeutic relationship they had
3) _____ Marc remembered that the patient passed away and that he had made a medical
error the day before
4) _____ The family member was acting strange and made him think about other strange
patients
5) _____ The visit from the family member was interesting and made him think about an
new career path in palliative care.
261
For questions 21 – 24, please indicate how you feel by circling the option that best reflects
your response.
21. Debbie just came back from a great day at work on a surgical unit. She was feeling
peaceful and content. How well would the following behavior preserve Debbie’s
emotions?
Behavior: She decides it is best to ignore the feeling since it wouldn't last.
Very
Ineffective
Very
Effective
1 2 3 4 5 6 7
22. John went to work on his surgical unit where he works full-time. He felt stressed and
frustrated because his patient assignment was heavier than his colleagues. What
behavior could John perform to reduce his frustration?
Behavior: He should discontinue working on this unit.
Very
Ineffective
Very
Effective
1 2 3 4 5 6 7
23. Becky and Steve both want to go on the same morning break. They have a good
relationship but are stubborn about the break that they each want. How effective would
Becky be in maintaining a good relationship with Steve if she performed the following
behaviors?
a) Behavior 1: She should be sarcastic so that Steve will back down and let her go on the
break she wants.
Very
Ineffective
Very
Effective
1 2 3 4 5 6 7
b) Behavior 2: She should give in and accept whatever break Steve wants since he is so
determined.
Very
Ineffective
Very
Effective
1 2 3 4 5 6 7
262
24. Sarah is a nurse on a medical unit where she cares for patients with a variety of medical
conditions. These patients and their families are very important to her and her hospital.
She has a great relationship with her patients, although today, one of her patients is
very rude and made an offensive comment to her. How effective would Sarah be in
maintaining a good relationship with this patient if performing the following behaviors?
a) Behavior1: She should become rude and offensive back to the patient.
Very
Ineffective
Very
Effective
1 2 3 4 5 6 7
b) Behavior 2: She should ignore the comments and act as if nothing was wrong.
Very
Ineffective
Very
Effective
1 2 3 4 5 6 7
Appendix T. 3
Participant Comment
E. YOUR COMMENTS
How long did it take you to complete the survey?
________________________________________________________________________
Were the instructions and definition adequate? Is there anything that you like to see added or
removed from the instructions/ definition?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
The overall quality of the survey: how suitable you think the questions are for capturing how
nurses’ perceive/recognize, understand and manage their own and others’ emotions in their daily
nursing practice and how they use this knowledge to guide how they think and act when
interacting with patients, families, and colleagues?
263
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Are there any ambiguous questions? ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Did you find the survey easy to complete? Did anything prevent you from being able to answer
questions?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
I am interested in any further comments you may wish to make about these or related issues. If
you have any comments, please write your comment below.
Thank you.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
264
Appendix U:
Nursing Emotional Intelligence Scale: Survey of Experts (Pilot Study)
Appendix U.1
Demographic Information
A. YOUR GENERAL BIOGRAPHICAL INFORMATION Please answer the following questions as accurately as possible. Please note that the information you give will be treated in strictest confidence.
1. What is your age in years? _____________ 2. What is your gender?
(1) ____ female
(2) ____ male
(3) ____ trans-gendered B. YOUR CURRENT WORK 3. How long have you been a nurse (in weeks/months)? _______________________ 4. What is your current job status? (Please check one answer only): (1) ____ permanent full-time (2) ____ permanent part-time (3) ____ casual or temporary employee (4) ____ contract position 5. What type of setting do you work in? (Please check (√) one response): ____ Adult ____ Pediatrics (1) ____ surgery (10) __ __recovery room (2) ____ medicine (11) ___ _neonatal (3) ____ emergency (12) ___ _long-term care (4) ____ labour & delivery (13) __ __rehabilitation (5) ____ operating room (14) __ __cardiac (6) ____ ICU (15) ____ oncology (7) ____ medical/surgical (16) ____ IV/patient access (8) ____ float team (17) ____ clinic (9) ____ mental health
6. How long have you been at your organization in any nursing capacity (in
years/months)? _________ years _________ months
7. How long have you been in your current nursing position? __________ years
265
C. YOUR EDUCATION
8. What is the highest level of nursing education you have attained?
(1) _____ Hospital-based education for job
(2) _____ Certificate (please specify) __________________________________
(3) _____ Diploma
(4) _____ Baccalaureate
(5) _____ Masters
(6) _____ Doctorate
9. What is the highest level of non-nursing education you have obtained? (Please
specify.)
(1) _____ None
(2) _____ Certificate
(3) _____ Diploma
(4) _____ Baccalaureate
(5) _____ Masters
(6) _____ Doctorate
10a. Are you currently enrolled in a university nursing program?
(1) _____ yes (please answer question 10b)
(2) _____ no (please skip to question 11)
10b. If you answered yes to question 11a, what university nursing program are you
currently enrolled in? (Please specify.)
(1) _____ Baccalaureate
(2) _____ Masters
(3) _____ Doctorate
Appendix U. 2:
Nursing Emotional Intelligence Scale
D. NURSING EMOTIONAL INTELLIGENCE SCALE
11. Please indicate how you feel by checking (√) the option that best reflects your
response.
1. “Indicate the amount of sadness expressed by this picture.”
6) _____ Not at all present
7) _____ Slightly present
8) _____ Moderately present
9) _____ Quite present
10) _____ Extremely present
266
2. “Indicate the amount of anger expressed by the person in this
picture.”
1) _____ Not at all present
2) _____ Slightly present
3) _____ Moderately present
4) _____ Quite present
5) _____ Extremely present
3. “Indicate the amount of excitement expressed by this picture.”
1) _____ Not at all present
2) _____ Slightly present
3) _____ Moderately present
4) _____ Quite present
5) _____ Extremely present
4. “Indicate the amount of surprise expressed by this picture.”
1) _____ Not at all present
2) _____ Slightly present
3) _____ Moderately present
4) _____ Quite present
5) _____ Extremely present
5. “Indicate the amount of disinterest expressed by the person in
this picture.”
1) _____ Not at all present
2) _____ Slightly present
3) _____ Moderately present
4) _____ Quite present
5) _____ Extremely present
6. “Indicate the amount of guilt expressed by this picture.”
1) _____ Not at all present
2) _____ Slightly present
3) _____ Moderately present
4) _____ Quite present
5) _____ Extremely present
267
7. “Indicate the amount of surprise expressed by the person in this
picture.”
1) _____ Not at all present
2) _____ Slightly present
3) _____ Moderately present
4) _____ Quite present
5) _____ Extremely present
8. How useful might it be to feel tension when interacting with an aggressive/pushy patient
or family member?
Tension
Useless 1 2 3 4 5
Useful
9. How useful might it be to feel frustration when interacting with an aggressive/pushy
patient or family member while trying to provide patient care?
Frustration
Useless 1 2 3 4 5
Useful
10. How useful might it be to feel joy when readmitting a patient that you had previously
developed a great therapeutic relationship with?
Joy
Useless 1 2 3 4 5
Useful
11. How useful might it be to feel frustration when readmitting a patient that you had
previously developed a great therapeutic relationship with?
Frustration
Useless 1 2 3 4 5
Useful
268
12. How useful might it be to feel joy when giving a patient a bed bath and interacting with
an incompetent patient attendant?
Joy
Useless 1 2 3 4 5
Useful
13. How useful might it be to feel hostility when giving a patient a bed bath and interacting
with an incompetent patient attendant?
Hostility
Useless 1 2 3 4 5
Useful
14. Joe felt anxious when he thought about having to prepare a new medication for the
first time. When the doctor became pushy and began aggressively asking why it was
taking so long, Joe then felt ____.
1) _____ Self-conscious
2) _____ Depressed
3) _____ Ashamed
4) _____ Overwhelmed
5) _____ Happy
15. John was in a hurry to eat lunch before returning to work. When John stopped at the
cafeteria, he was happy to see Nadia, a recently discharged patient. After talking with
Nadia about how great she has been feeling since she was discharged, he was even
more pleased about the care he gave, he felt ____.
1) _____ Depressed
2) _____ Content
3) _____ Unsure
4) _____ Fatigued
5) _____ Active
16. Karen thought long and hard and did a lot of research about what kind of community
resources were available to her patient who was being discharged home. When she
gave her patient all this information, the patient didn’t seem to appreciate all of the
effort put into gathering this information. Karen then felt ____.
1) _____Envious
2) _____Anxious
3) _____Disappointed
4) _____Overwhelmed
5) _____Dissatisfied
269
17. A nurse went into work feeling rested and then felt anxious. What happened in
between?
1) _____He couldn’t find his stethoscope
2) _____He saw a colleague that he hadn’t worked with in weeks
3) _____He found that he was working with a close friend
4) _____He was approached by an aggressive patient
5) _____He received report from a nurse he though he recognized
18. A young nurse went into work happy and left at the end of her shift feeling sad. What
happened in between?
1) _____ A patient that she had developed a great therapeutic relationship with was
discharged home
2) _____ One of her patients passed away
3) _____ She did not get a diner break
4) _____ She realized she had a lot of work to do tomorrow
5) _____ She was treated rudely by a patient
19. A nurse brought her patient their morning medications. She felt embarrassed and then
she felt angry. What happened in between?
1) _____ She wished that she had not brought the medications
2) _____ She saw another nurse near the patient’s room who was in a hurry and couldn’t talk
3) _____ She realized that she dropped one of the pills on the floor on the way to the
patient’s room
4) _____ She realized that she had made a mistake and the patient became angry and
suspicious of her intentions
5) _____ She realized that she was ten minutes early in administering her morning
medications
20. The family member of a patient previously on the unit where Marc works came to
bring flowers. He felt sad and then he felt guilty. What happened in between?
1) _____ The family member was offensive and made him not want to be in the nursing
station anymore
2) _____ Marc remembered the patient and the therapeutic relationship they had
3) _____ Marc remembered that the patient passed away and that he had made a medical
error the day before
4) _____ The family member was acting strange and made him think about other strange
patients
5) _____ The visit from the family member was interesting and made him think about an
new career path in palliative care.
270
For questions 21 – 24, please indicate how you feel by circling the option that best reflects
your response.
21. Debbie just came back from a great day at work on a surgical unit. She was feeling
peaceful and content. How well would the following behavior preserve Debbie’s
emotions?
Behavior: She decides it is best to ignore the feeling since it wouldn't last.
Very
Ineffective
Very
Effective
1 2 3 4 5 6 7
22. John went to work on his surgical unit where he works full-time. He felt stressed and
frustrated because his patient assignment was heavier than his colleagues. What
behavior could John perform to reduce his frustration?
Behavior: He should discontinue working on this unit.
Very
Ineffective
Very
Effective
1 2 3 4 5 6 7
23. Becky and Steve both want to go on the same morning break. They have a good
relationship but are stubborn about the break that they each want. How effective would
Becky be in maintaining a good relationship with Steve if she performed the following
behaviors?
a) Behavior 1: She should be sarcastic so that Steve will back down and let her go on the
break she wants.
Very
Ineffective
Very
Effective
1 2 3 4 5 6 7
b) Behavior 2: She should give in and accept whatever break Steve wants since he is so
determined.
Very
Ineffective
Very
Effective
1 2 3 4 5 6 7
271
24. Sarah is a nurse on a medical unit where she cares for patients with a variety of medical
conditions. These patients and their families are very important to her and her hospital.
She has a great relationship with her patients, although today, one of her patients is
very rude and made an offensive comment to her. How effective would Sarah be in
maintaining a good relationship with this patient if performing the following behaviors?
a) Behavior1: She should become rude and offensive back to the patient.
Very
Ineffective
Very
Effective
1 2 3 4 5 6 7
b) Behavior 2: She should ignore the comments and act as if nothing was wrong.
Very
Ineffective
Very
Effective
1 2 3 4 5 6 7
I am interested in any further comments you may wish to make about these or related issues. If
you have any comments, please write your comment below.
Thank you.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
272
Appendix V:
Letter of Explanation: Assessment of Psychometric Properties of the NEIS (Pilot Study)
Nurses’ Emotional Intelligence: A Pilot of a New Measure
________________________________________________________
Letter of Explanation
You are being asked to participate in a study conducted by a doctoral student, Michelle Lalonde, under the supervision of her dissertation supervisor Linda McGillis Hall, RN, PhD, FAAN, of the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto. The purpose of the study is to test a new measure of emotional intelligence designed for nurses. Emotional intelligence is someone’s ability to perceive and understand their own and others emotions and to use this information to guide how they think and act. The study has received ethics approval from the Office of Research Services at the University of Toronto and Mount-Sinai Hospital. Your participation involves completing a questionnaire that will specifically measure nurses’ emotional intelligence. The questionnaire is expected to take approximately 30 minutes of your time. Participation in the study is confidential and voluntary. Your name will not be recorded on any of the forms. Only code numbers will be used. Your name will not be identified in any report or presentation that may arise from this study and your answers to the questionnaire will remain confidential. You can refuse to answer any questions and you can withdraw from the study at any time. If you would like to receive a certificate of participation in this study, please let the researcher know at any time during the study. If you have any questions, concerns or would like to speak to the Doctoral student, please call Michelle Lalonde, Doctoral student, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto at 416-978-1327 or by e-mail at [email protected] or Dr. Linda McGillis Hall by email at [email protected]. If you have any questions about your rights as a research participant or have concerns about this study, contact Rachel Zand, Director, Office of Research Ethics, Health Sciences, University of Toronto, at 416-946-3389, or by e-mail at [email protected]. Thank you. Michelle Lalonde, RN, BScN, MN, PhD Student Lawrence S. Bloomberg Faculty of Nursing University of Toronto 130 -155 College Street, Toronto, ON, M5T 1P8 (T) 416 978-1327/ (F) 416-978-8222 [email protected]
[Faculty of Nursing letterhead]
273
Appendix W:
Consent Form: Assessment of Psychometric Properties of the NEIS (Pilot Study)
CONSENT TO PARTICIPATE IN A RESEARCH STUDY ________________________________________________________
Nurse Consent Form
Title Nurses’ Emotional Intelligence: A Pilot of a New Measure Investigator Michelle Lalonde, RN, BScN, MN, PhD Candidate
(T) 416- 978-1327 (F) 416-978-8222 [email protected]
Introduction You are being asked to take part in a research study conducted by Doctoral student Michelle Lalonde, RN, BScN, MN, under the supervision of her dissertation supervisor Linda McGillis Hall, RN, PhD, FAAN, Professor, Associate Dean of Research and External Relations at the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto. Please read this explanation about the study and its risks and benefits before you decide if you would like to take part. You should take as much time as you need to make your decision. You should ask Michelle Lalonde to explain anything that you do not understand and make sure that all of your questions have been answered before signing this consent form. Before you make your decision, feel free to talk about this study with anyone you wish. Participation in this study is voluntary and you may withdraw from the study at any time. The study is described below. This description tells you about the risks, inconvenience, or discomfort which you might experience. Purpose of the research The purpose of this study is to test a new measure of emotional intelligence that is designed specifically for nurses. Emotional intelligence is someone’s ability to perceive and understand their own and others emotions and to use this information to guide how they think and act. This research will involve comparing another existing measure of emotional intelligence intended for consumers with the new measure of nurses’ emotional intelligence. This research will involve nurses with more than two years experience completing the survey.
[Faculty of Nursing letterhead]
274
Participation in the study If you agree to participate in this pilot study, you will be asked to complete a questionnaire that is expected to take approximately 30 minutes of your time. Risks related to being in the study You are not obliged to participate in this study and you are free to withdraw from the pilot study at any time without any effect on your employment, work status, or performance evaluation. There are no anticipated risks related to your involvement with this study. Although there are no obvious harms associated with taking part in this pilot study, participating will involve approximately 30 minutes of your time. Benefits to being in the study There is no direct benefit to you for taking part in this study. Your contributions will provide a new measure of nurses’ emotional intelligence that will be used in a larger study at a later date. Voluntary participation Your participation in this study is voluntary. You may decide not to be in this study, or to be in the study now and then change your mind later. You may refuse to answer any question you do not want to answer. Compensation There is no cost to you for taking part in this study. You will receive a token of appreciation for participating in this study, a two dollar gift card from a coffee shop and a certificate of participation. If you decide to withdraw from this study at any time, you may keep the tokens of appreciation. Privacy and confidentiality Participation in this study is confidential. Your name will not be recorded on any of the forms. Only code numbers will be used. Your name will not be identified in any reports or presentations that may arise from this study and your answers to the questionnaire will remain confidential. No one from your work will have access to the data collected in this questionnaire. The questionnaires will be kept for six years in a locked filing cabinet located at the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto and then destroyed. All computer files will be password protected, which can only be accessed by the doctoral student and her dissertation supervisor. Study findings The results from this study may be shared through publications and presentations at conferences Withdrawal from study Participation is this pilot study is voluntary. You may terminate your involvement at any time and do not need to give any reason or explanation for doing so.
275
Questions or concerns If you have any questions, concerns or would like to speak to the Doctoral student for any reason, please call: Michelle Lalonde at 416-978-1327 or by e-mail at [email protected] or Dr. Linda McGillis Hall by email at [email protected]. If you have any questions about your rights as a research participant or have concerns about this study, contact Rachel Zand, Director, Office of Research Ethics, Health Sciences, University of Toronto, at 416-946-3389, or by e-mail at [email protected]. The Research Ethics Board is a group of people who oversee the ethical conduct of research studies. These people are not part of the student’s dissertation committee. Everything that you discuss will be kept confidential. Thank you for your time and contribution to our study. Sincerely, Michelle Lalonde PhD Student Lawrence S. Bloomberg Faculty of Nursing University of Toronto 130 - 155 College Street Toronto, Ontario M5T 1P8 (T) 416- 978-1327 (F) 416-978-8222 [email protected]
Linda McGillis Hall RN PhD FAAN PhD Student Supervisor Professor, Associate Dean, Research & External Relations Lawrence S. Bloomberg Faculty of Nursing University of Toronto 130 - 155 College Street Toronto, Ontario M5T 1P8 (T) 416-978-2869 (F) 416-978-8222 [email protected]
276
Consent This study has been explained to me and any questions I had have been answered. I know that I may leave the study at any time. I agree to take part in this study. _____________________ ______________________ ______________ Print Study Participant’s Name
Signature Date
(You will be given a signed copy of this consent form) My signature means that I have explained the study to the participant named above. I have answered all questions. _____________________ ______________________ ______________ Michelle Lalonde Doctoral Student
Signature Date
277
Appendix X:
Survey: Assessment of Psychometric Properties of the NEIS (Pilot Study)
Appendix X.1:
Demographic Information
A. YOUR GENERAL BIOGRAPHICAL INFORMATION Please answer the following questions as accurately as possible. Please note that the information you give will be treated in strictest confidence.
1. What is your age in years? _____________ 2. What is your gender?
(1) ____ female
(2) ____ male
(3) ____ trans-gendered B. YOUR CURRENT WORK 3. How long have you been a nurse (in weeks/months)? _______________________ 4. What is your current job status? (Please check one answer only): (1) ____ permanent full-time (2) ___ _permanent part-time (3) ___ _casual or temporary employee (4) __ __ contract position 5. What type of setting do you work in? (Please check (√) one response): ____ Adult ____ Pediatrics (1) ____ surgery (10) ____ recovery room (2) ____ medicine (11) ____ neonatal (3) ____ emergency (12) ____ long-term care (4) ____ labour & delivery (13) ____ rehabilitation (5) ____ operating room (14) ____ cardiac (6) ____ ICU (15) ____ oncology (7) __ __medical/surgical (16) ____ IV/patient access (8) ____ float team (17) ____ clinic (9) ____ mental health
6. How long have you been at your organization in any nursing capacity (in
years/months)? _________ years _________ months
7. How long have you been in your current nursing position? __________ years
278
C. YOUR EDUCATION
8. What is the highest level of nursing education you have attained?
(1) _____ Hospital-based education for job
(2) _____ Certificate (please specify) __________________________________
(3) _____ Diploma
(4) _____ Baccalaureate
(5) _____ Masters
(6) _____ Doctorate
9. What is the highest level of non-nursing education you have obtained? (Please
specify.)
(1) _____ None
(2) _____ Certificate
(3) _____ Diploma
(4) _____ Baccalaureate
(5) _____ Masters
(6) _____ Doctorate
10a. Are you currently enrolled in a university educational program?
(1) _____ yes (please answer question 10b)
(2) _____ no (please skip to question 11)
10b. If you answered yes to question 11a, what university nursing program are you
currently enrolled in? (Please specify.)
(1) _____ Baccalaureate
(2) _____ Masters
(3) _____ Doctorate
Appendix X.2
Consumer Emotional Intelligence Scale
D. CONSUMER EMOTIONAL INTELLIGENCE SCALE
11. Please indicate how you feel by checking (√) one response. Choose the option that
best reflects your response.
1. “Indicate the amount of sadness expressed by the product in this
picture.”
1) _____ Not at all present
2) _____ Slightly present
3) _____ Moderately present
4) _____ Quite present
279
5) _____ Extremely present
2. “Indicate the amount of anger expressed by the person in
this picture.”
1) _____ Not at all present
2) _____ Slightly present
3) _____ Moderately present
4) _____ Quite present
5) _____ Extremely present
3. “Indicate the amount of excitement expressed by the
product in this picture.”
6) _____ Not at all present
7) _____ Slightly present
8) _____ Moderately present
9) _____ Quite present
10) _____ Extremely present
4. “Indicate the amount of surprise expressed by the product
in this picture.”
1) _____ Not at all present
2) _____ Slightly present
3) _____ Moderately present
4) _____ Quite present
5) _____ Extremely present
5. “Indicate the amount of disinterest expressed by the person
in this picture.”
1) _____ Not at all present
2) _____ Slightly present
3) _____ Moderately present
4) _____ Quite present
5) _____ Extremely present
280
6. “Indicate the amount of guilt expressed by the product in
this picture.”
1) _____ Not at all present
2) _____ Slightly present
3) _____ Moderately present
4) _____ Quite present
5) _____ Extremely present
7. “Indicate the amount of surprise expressed by the person in
this picture.”
1) _____ Not at all present
2) _____ Slightly present
3) _____ Moderately present
4) _____ Quite present
5) _____ Extremely present
8. How useful might it be to feel tension when interacting with an aggressive/pushy
salesperson when making a purchase?
Tension
Useless 1 2 3 4 5
Useful
9. How useful might it be to feel frustration when interacting with an aggressive/ pushy
salesperson when making a purchase?
Frustration
Useless 1 2 3 4 5
Useful
10. How useful might it be to feel joy when consuming unhealthy food when maintaining a
healthy diet?
Joy
Useless 1 2 3 4 5
Useful
281
11. How useful might it be to feel frustration when consuming unhealthy food when
maintaining a healthy diet?
Frustration
Useless 1 2 3 4 5
Useful
12. How useful might it be to feel joy when purchasing something expensive and interacting
with an incompetent salesperson?
Joy
Useless 1 2 3 4 5
Useful
13. How useful might it be to feel hostility when purchasing something expensive and
interacting with an incompetent salesperson?
Hostility
Useless 1 2 3 4 5
Useful
14. Joe felt anxious when he thought about having to negotiate the price with a car dealer
when buying a new car. When the dealer became pushy and began aggressively
negotiating the price, Joe then felt ____.
1) _____ Self-conscious
2) _____ Depressed
3) _____ Ashamed
4) _____ Overwhelmed
5) _____ Happy
15. John was in a hurry to eat lunch before an afternoon meeting. When John stopped at a
fast food restaurant, he was happy to see that there were healthy food choices on the
menu. After reading the nutritional information he was even more pleased about the
choice he made, he felt ____.
1) _____ Depressed
2) _____ Content
3) _____ Unsure
4) _____ Fatigued
5) _____ Active
282
16. Karen thought long and hard about what to get for her best friend’s birthday. When
she gave the gift to her friend, the friend didn’t seem to appreciate all of the effort put
into picking out the gift. Karen then felt ____.
1) _____Envious
2) _____Anxious
3) _____Disappointed
4) _____Overwhelmed
5) _____Dissatisfied
17. A nurse went into work feeling rested and then felt anxious. What happened in
between?
1) _____He couldn’t find his stethoscope
2) _____He saw a colleague that he hadn’t worked with in weeks
3) _____He found that he was working with a close friend
4) _____He was approached by an aggressive patient
5) _____He received report from a nurse he though he recognized
18. A young woman went into a grocery store happy and left the store feeling sad. What
happened in between?
1) _____ She noticed an elderly lady passing out free samples of food
2) _____ She went to buy her favorite product and it wasn’t there
3) _____ She was buying products that made her feel uncomfortable taking to the cashier
4) _____ She realized she had a lot of things to do in the afternoon
5) _____ She was treated rudely by the cashier
19. A young man was returning expensive clothes. He felt embarrassed and then he felt
angry. What happened in between?
1) _____ He realized that he should not have bought the clothes in the first place
2) _____ He saw an old friend in the store who was in a hurry and couldn’t talk
3) _____ He decided that he couldn’t afford the clothes after all
4) _____ He was encountered by a salesperson who was suspicious of his intentions
5) _____ He realized that he lost one of the items he wanted to return
283
20. A man watched a TV commercial. He felt sad and then he felt guilty. What happened
in between?
1) _____ The commercial was offensive and made him not want to watch anymore
2) _____ The commercial was inspiring and made him think about an old relationship
3) _____ The commercial was thoughtful and made him think about losing touch with an
old friend
4) _____ The commercial was strange and made him think about his years growing up
5) _____ The commercial was interesting and made him think about an new career path
For questions 21 – 24, please indicate how you feel by circling the number that best reflects
your response.
21. Debbie just came back from a day of clothes shopping. She was feeling peaceful and
content. How well would the following behavior preserve Debbie’s emotions?
Behavior: She decides it is best to ignore the feeling since it wouldn't last.
Very
Ineffective
Very
Effective
1 2 3 4 5 6 7
22. John went to his favorite clothing store where he saw a shirt that he wanted to buy last
week. He felt stressed and frustrated because the shirt that he wanted was no longer
there. What behavior could John perform to reduce his frustration?
Behavior: He should discontinue shopping at that store.
Very
Ineffective
Very
Effective
1 2 3 4 5 6 7
23. Becky and Steve want to buy a new car. They will share the car and both have specific
preferences in the type of car to be purchased. They have a good relationship but are
stubborn about the car that they each want. How effective would Becky be in
maintaining a good relationship with Steve if she performed the following behaviors?
a) Behavior 1: She should be sarcastic so that Steve will back down and they buy the car
she really wants.
Very
Ineffective
Very
Effective
1 2 3 4 5 6 7
284
b) Behavior 2: She should give in and accept whatever car Steve wants since he is so
determined.
Very
Ineffective
Very
Effective
1 2 3 4 5 6 7
24. Sarah has a job in which she interacts with many of her clients. These clients are very
important to her and her company since they represent large accounts. She has a great
relationship with her clients, although today, one of her clients is very rude and made
an offensive comment to her. How effective would Sarah be in maintaining a good
relationship with this client if performing the following behaviors?
a) Behavior1: She should become rude and offensive back to the client.
Very
Ineffective
Very
Effective
1 2 3 4 5 6 7
b) Behavior 2: She should ignore the comments and act as if nothing was wrong.
Very
Ineffective
Very
Effective
1 2 3 4 5 6 7
Appendix X.3
International Personality Item Pool
E. YOUR PERSONALITY
12. The following are phrases describing people's behaviors. Please use the rating scale
below to describe how accurately each statement describes you. Describe yourself as
you generally are now, not as you wish to be in the future. Describe yourself as you
honestly see yourself, in relation to other people you know of the same sex as you
are, and roughly your same age. So that you can describe yourself in an honest
manner, your responses will be kept in absolute confidence. Please read each
statement carefully, and then circle the number that best reflects your response.
Very
Inaccurate
Moderately
Inaccurate
Neither
Inaccurate nor Accurate
Moderately
Accurate
Very
Accurate
(1) I am interested in people. 1 2 3 4 5
285
(2) I sympathize with others'
feelings.
1 2 3 4 5
(3) I have a soft heart
1 2 3 4 5
(4) I take time out for others.
1 2 3 4 5
(5) I feel others' emotions.
1 2 3 4 5
(6) I make people feel at ease
1 2 3 4 5
(7) I am not really interested
in others.
1 2 3 4 5
(8) I insult people.
1 2 3 4 5
(9) I am not interested in
other people's problems.
1 2 3 4 5
(10) I feel little concern for
others.
1 2 3 4 5
(11) I am always prepared.
1 2 3 4 5
(12) I pay attention to details.
1 2 3 4 5
(13) I get chores done right
away.
1 2 3 4 5
(14) I like order.
1 2 3 4 5
(15) I follow a schedule.
1 2 3 4 5
(16) I am exacting in my work
1 2 3 4 5
(17) I leave my belongings
around.
1 2 3 4 5
(18) I make a mess of things.
1 2 3 4 5
(19) I often forget to put
things back in their
proper place.
1 2 3 4 5
(20) I shirk my duties.
1 2 3 4 5
(21) I have a rich vocabulary
1 2 3 4 5
286
(22) I have a vivid
imagination
1 2 3 4 5
(23) I have excellent ideas.
1 2 3 4 5
(24) I am quick to understand
things.
1 2 3 4 5
(25) I use difficult words.
1 2 3 4 5
(26) I spend time reflecting on
things.
1 2 3 4 5
(27) I am full of ideas.
1 2 3 4 5
(28) I have difficulty
understanding abstract
ideas.
1 2 3 4 5
(29) I am not interested in
abstract ideas.
1 2 3 4 5
(30) I do not have a good
imagination. 1 2 3 4 5
Appendix X.4:
Nursing Emotional Intelligence Scale
H. NURSING EMOTIONAL INTELLIGENCE
13. Please indicate how you feel by checking (√) the option that best reflects your
response.
1. “Indicate the amount of sadness expressed by this picture.”
1) _____ Not at all present
2) _____ Slightly present
3) _____ Moderately present
4) _____ Quite present
5) _____ Extremely present
287
2. “Indicate the amount of anger expressed by the person in this
picture.”
1) _____ Not at all present
2) _____ Slightly present
3) _____ Moderately present
4) _____ Quite present
5) _____ Extremely present
3. “Indicate the amount of excitement expressed by this picture.”
1) _____ Not at all present
2) _____ Slightly present
3) _____ Moderately present
4) _____ Quite present
5) _____ Extremely present
4. “Indicate the amount of surprise expressed by this picture.”
1) _____ Not at all present
2) _____ Slightly present
3) _____ Moderately present
4) _____ Quite present
5) _____ Extremely present
5. “Indicate the amount of disinterest expressed by the person in
this picture.”
1) _____ Not at all present
2) _____ Slightly present
3) _____ Moderately present
4) _____ Quite present
5) _____ Extremely present
6. “Indicate the amount of guilt expressed by this picture.”
1) _____ Not at all present
2) _____ Slightly present
3) _____ Moderately present
4) _____ Quite present
5) _____ Extremely present
288
7. “Indicate the amount of surprise expressed by the person in this
picture.”
1) _____ Not at all present
2) _____ Slightly present
3) _____ Moderately present
4) _____ Quite present
5) _____ Extremely present
8. How useful might it be to feel tension when interacting with an aggressive/pushy patient
or family member?
Tension
Useless 1 2 3 4 5
Useful
9. How useful might it be to feel frustration when interacting with an aggressive/pushy
patient or family member while trying to provide patient care?
Frustration
Useless 1 2 3 4 5
Useful
10. How useful might it be to feel joy when readmitting a patient that you had previously
developed a great therapeutic relationship with?
Joy
Useless 1 2 3 4 5
Useful
11. How useful might it be to feel frustration when readmitting a patient that you had
previously developed a great therapeutic relationship with?
Frustration
Useless 1 2 3 4 5
Useful
289
12. How useful might it be to feel joy when giving a patient a bed bath and interacting with
an incompetent patient attendant?
Joy
Useless 1 2 3 4 5
Useful
13. How useful might it be to feel hostility when giving a patient a bed bath and interacting
with an incompetent patient attendant?
Hostility
Useless 1 2 3 4 5
Useful
14. Joe felt anxious when he thought about having to prepare a new medication for the
first time. When the doctor became pushy and began aggressively asking why it was
taking so long, Joe then felt ____.
1) _____ Self-conscious
2) _____ Depressed
3) _____ Ashamed
4) _____ Overwhelmed
5) _____ Happy
15. John was in a hurry to eat lunch before returning to work. When John stopped at the
cafeteria, he was happy to see Nadia, a recently discharged patient. After talking with
Nadia about how great she has been feeling since she was discharged, he was even
more pleased about the care he gave, he felt ____.
1) _____ Depressed
2) _____ Content
3) _____ Unsure
4) _____ Fatigued
5) _____ Active
16. Karen thought long and hard and did a lot of research about what kind of community
resources were available to her patient who was being discharged home. When she
gave her patient all this information, the patient didn’t seem to appreciate all of the
effort put into gathering this information. Karen then felt ____.
1) _____Envious
2) _____Anxious
3) _____Disappointed
4) _____Overwhelmed
5) _____Dissatisfied
290
17. A nurse went into work feeling rested and then felt anxious. What happened in
between?
1) _____He couldn’t find his stethoscope
2) _____He saw a colleague that he hadn’t worked with in weeks
3) _____He found that he was working with a close friend
4) _____He was approached by an aggressive patient
5) _____He received report from a nurse he though he recognized
18. A young nurse went into work happy and left at the end of her shift feeling sad. What
happened in between?
1) _____ A patient that she had developed a great therapeutic relationship with was
discharged home
2) _____ One of her patients passed away
3) _____ She did not get a diner break
4) _____ She realized she had a lot of work to do tomorrow
5) _____ She was treated rudely by a patient
19. A nurse brought her patient their morning medications. She felt embarrassed and then
she felt angry. What happened in between?
1) _____ She wished that she had not brought the medications
2) _____ She saw another nurse near the patient’s room who was in a hurry and couldn’t
talk
3) _____ She realized that she dropped one of the pills on the floor on the way to the
patient’s room
4) _____ She realized that she had made a mistake and the patient became angry and
suspicious of her intentions
5) _____ She realized that she was ten minutes early in administering her morning
medications
20. The family member of a patient previously on the unit where Marc works came to
bring flowers. He felt sad and then he felt guilty. What happened in between?
1) _____ The family member was offensive and made him not want to be in the nursing
station anymore
2) _____ Marc remembered the patient and the therapeutic relationship they had
3) _____ Marc remembered that the patient passed away and that he had made a medical
error the day before
4) _____ The family member was acting strange and made him think about other strange
patients
5) _____ The visit from the family member was interesting and made him think about an
new career path in palliative care.
291
For questions 21 – 24, please indicate how you feel by circling the option that best reflects
your response.
21. Debbie just came back from a great day at work on a surgical unit. She was feeling
peaceful and content. How well would the following behavior preserve Debbie’s
emotions?
Behavior: She decides it is best to ignore the feeling since it wouldn't last.
Very
Ineffective
Very
Effective
1 2 3 4 5 6 7
22. John went to work on his surgical unit where he works full-time. He felt stressed and
frustrated because his patient assignment was heavier than his colleagues. What
behavior could John perform to reduce his frustration?
Behavior: He should discontinue working on this unit.
Very
Ineffective
Very
Effective
1 2 3 4 5 6 7
23. Becky and Steve both want to go on the same morning break. They have a good
relationship but are stubborn about the break that they each want. How effective would
Becky be in maintaining a good relationship with Steve if she performed the following
behaviors?
a) Behavior 1: She should be sarcastic so that Steve will back down and let her go on the
break she wants.
Very
Ineffective
Very
Effective
1 2 3 4 5 6 7
b) Behavior 2: She should give in and accept whatever break Steve wants since he is so
determined.
Very
Ineffective
Very
Effective
1 2 3 4 5 6 7
292
24. Sarah is a nurse on a medical unit where she cares for patients with a variety of medical
conditions. These patients and their families are very important to her and her hospital.
She has a great relationship with her patients, although today, one of her patients is
very rude and made an offensive comment to her. How effective would Sarah be in
maintaining a good relationship with this patient if performing the following behaviors?
a) Behavior1: She should become rude and offensive back to the patient.
Very
Ineffective
Very
Effective
1 2 3 4 5 6 7
b) Behavior 2: She should ignore the comments and act as if nothing was wrong.
Very
Ineffective
Very
Effective
1 2 3 4 5 6 7
Thank You!
I am interested in any further comments you may wish to make about these or related issues. If
you have any comments, please write your comment below.
Thank you.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
293
Appendix Y:
Demographic and Employment Characteristics for Complete Pilot Sample
Demographic and Employment Characteristics Number
(N)
Mean Standard
Deviation
Age 102 35.4 10.6
Experience as a nurse 105 10.2 10.1
Years of service with organization 106 7.1 7.5
Length in current nursing position 107 6.0 6.2
294
Demographic and Employment Characteristics for Complete Pilot Sample (continued)
Demographic and Employment Characteristics Number
(N)
Percent
(%)
Gender Female 98 91.6
Male 9 8.4
Employment status Full-time 84 78.5
Part-time 13 12.1
Casual/ temporary part-time 4 3.7
Contract 3 2.8
Patient population Adult 105 98.1
Pediatric 2 1.9
Work setting Medicine 46 43.0
Surgery 29 27.1
Medical/ Surgical 8 7.5
Recovery Room 5 4.7
Cardiology 5 4.7
Maternity/ Post-Partum 5 4.7
Intensive Care 4 3.7
More than 1 setting 2 1.9
Operating Room 1 .9
Outpatient Clinic 1 .9
Nursing Certificate Cardiovascular 3 2.8
Critical Care 5 4.7
Emergency 1 .9
Gerontology 1 .9
Medical/ Surgical 1 .9
Nephrology 1 .9
Highest level of nursing education Diploma 24 22.4
Baccalaureate 73 68.2
Masters 10 9.3
Highest level of non- nursing education None 50 46.7
Certificate 15 14.0
Diploma 14 13.1
Baccalaureate 24 22.4
Masters 4 3.7
295
Demographic and Employment Characteristics for Complete Pilot Sample (continued)
Demographic and Employment Characteristics Number
(N)
Percent
(%)
Currently enrolled in a university
nursing program
Yes
8
7.5
University nursing program currently
enrolled in
Baccalaureate
2
1.9
Masters 6 5.6
296
Appendix Z:
Demographic and Employment Characteristics for Face Validity Sample (Pilot Study)
Demographic and Employment Characteristics Number
(N)
Mean Standard
Deviation
Age 10 37.2 11.1
Experience as a nurse 10 10.3 8.3
Years of service with organization 10 7.0 5.5
Length in current nursing position 10 6.2 5.6
297
Demographic and Employment Characteristics for Face Validity Sample (Pilot Study)
(continued)
Demographic and Employment Characteristics Number
(N)
Percent
(%)
Gender Female 10 100
Employment status Full-time 9 90
Contract 1 10
Patient population Adult 9 90
Pediatric 1 10
Work setting Medicine 4 40
Medical/ Surgical 4 40
Intensive Care 1 10
Outpatient Clinic 1 10
Nursing Certificate Cardiovascular 1 10
Nephrology 1 10
Highest level of nursing education Diploma 3 30
Baccalaureate 4 40
Masters 3 30
Highest level of non- nursing education None 4 40
Certificate 1 10
Diploma 1 10
Baccalaureate 2 20
Masters 2 20
Currently enrolled in a university
nursing program
Yes
1
10
University nursing program currently
enrolled in
Masters
1
10
298
Appendix AA.1:
Changes to the NEIS Instructions from Pilot Study
Original version of instructions for questions 1 to 7:
Please indicate how you feel by checking (√) the option that best reflects your response.
Adapted version of instructions for questions 1 to 7:
For the following questions, please circle the number that best corresponds to the emotion
expressed in the pictures and faces.
Original version of instructions for questions 21 to 24:
For questions 21 – 24, please indicate how you feel by circling the option that best
reflects your response.
Original version of instructions for questions 21 to 24:
For questions 21 – 22, please circle the number for each action that you feel best
represents how the individuals described in each of the scenarios would preserve, reduce,
or maintain his/ her emotions.
For questions 23 – 24, please circle the number for each action that you feel best
represents how the individuals described in each of the scenarios would preserve or
maintain the relationships between them.
Adapted version of instructions for the measure:
For questions 8 – 13, please indicate how helpful/ useful each emotion listed would be
relative to each of the situations described below.
For questions 14 – 16, please select the emotional response that is the most likely to be
felt in the situations described below.
For questions 17 – 20, please select the option that best represents the actions that
proceeded and then followed the emotions described in each scenario below.
299
Appendix AA.2:
Changes to question 20 on the NEIS
Original version of question 20:
20. The family member of a patient previously on the unit where Marc
works came to bring flowers. He felt sad and then he felt guilty. What
happened in between?
6) _____ The family member was offensive and made him not want to be
in the nursing station anymore
7) _____ Marc remembered the patient and the therapeutic relationship
they had
8) _____ Marc remembered that the patient passed away and that he had
made a medical error the day before
9) _____ The family member was acting strange and made him think
about other strange patients
10) _____ The visit from the family member was interesting and made him
think about an new career path in palliative care.
Adapted version of question 20:
20. While Marc was in the nursing station, a family member of a patient
previously on the unit came to bring flowers to the staff. When Marc
saw the family member, he felt sad and then he felt guilty. What
happened in between?
1) _____ The family member was offensive and made him not want to be
in the nursing station anymore
2) _____ Marc remembered the patient and the therapeutic relationship
they had
3) _____ Marc remembered that the patient passed away while on the unit
and that he had made a medical error the day before the patient
passed away
4) _____ The family member was acting strange and made him think
about other strange patients
5) _____ The visit from the family member was interesting and made him
think about an new career path in palliative care.
300
Appendix BB:
Demographic and Employment Characteristics for Nurse Experts (Pilot Study)
Demographic and Employment Characteristics Number
(N)
Mean Standard
Deviation
Age 15 40.2 6.9
Experience as a nurse 16 16.1 7.3
Years of service with organization 15 12.7 8.5
Length in current nursing position 16 10.7 7.1
301
Demographic and Employment Characteristics for Nurse Experts (Pilot Study)
(continued)
Demographic and Employment Characteristics Number
(N)
Percent
(%)
Gender Female 13 81.3
Male 3 18.8
Employment status Full-time 16 100
Patient population Adult 16 100
Work setting Surgery 7 43.8
Medicine 4 25.0
Maternity/ Post-Partum 3 18.8
Cardiology 1 6.3
Operating Room 1 6.3
Nursing Certificate Critical Care 2 12.5
Medical/ Surgical 1 6.3
Highest level of nursing education Baccalaureate 16 100
Highest level of non- nursing education None 8 50
Certificate 3 18.8
Diploma 2 12.5
Baccalaureate 2 12.5
Masters 1 6.3
Currently enrolled in a university
nursing program
Yes
1
6.3
University nursing program currently
enrolled in
Masters
1
6.3
302
Appendix CC:
Comparison of Demographic and Employment Characteristics for Nurse Experts and Psychometric Assessment Sample (Pilot Study)
Expert Nurse Sample (N=16) Psychometric Assessment Sample (N=81)
Demographic and Employment
Characteristics
Mean (SD) Range Mean (SD) Range
Age 40.2 (6.9) 30 to 54 34.3 (10.9) 22 to 63
Experience as a nurse 16.1 (7.3) 7 to 32 8.9 (10.4) .4 to 40
Years of service with organization 12.7 (8.5) 3 to 30 6.0 (7.11) .4 to 40.3
Length in current nursing position 10.7 (7.1) 2 to 24 5.1 (5.8) .1 to 31
303
Appendix DD:
Experts’ responses to 15 NEIS Items (Pilot Study)
Item Response
Option
Percent of Experts
Endorsing Each Response Option
Item Response
Option
Percent of Experts
Endorsing Each Response Option
1 1 25.0 4 1 68.8
2 31.3 2 12.5
3 31.3 3 18.8
4 12.5 4 0
5 0 5 0
5 1 43.8 6 1 62.5
2 31.3 2 25.0
3 6.3 3 12.5
4 12.5 4 0
5 6.3 5 0
8 1 43.8 9 1 43.8
2 18.8 2 31.3
3
4
5
18.8
12.5
6.3
3
4
5
0
18.8
6.3
304
Item Response
Option
Percent of Experts
Endorsing Each Response Option
Item Response
Option
Percent of Experts
Endorsing Each Response Option
11
1
12.5
18
1
0
2 25.0 2 81.3
3 56.3 3 0
4 6.30 4 0
5 0 5 18.8
21 1 43.8
19 1 0 2 6.30
2 62.5 3 18.8
3 25.0 4 18.8
4 6.30 5 0
5 6.30 6 0
7 12.5
305
Item Response
Option
Percent of Experts
Endorsing Each Response Option
Item Response
Option
Percent of Experts
Endorsing Each Response Option
22
1
50.0
23a
1
50.0
2 31.3 2 37.5
3 12.5 3 6.3
4 6.3 4 6.3
5 0 5 0
6 0 6 0
7 0 7 0
23b 1 25.0 24a 1 81.3
2 18.8 2 12.5
3 12.5 3 0
4 18.8 4 6.3
5 6.3 5 0
6 18.8 6 0
7 0 7 0
306
Item
Response
Option
Percent of Experts
Endorsing Each Response Option
24b 1 31.3
2 12.5
3 31.3
4 0
5 25.0
6 0
7 0
307
Appendix EE:
Demographic and Employment Characteristics for Psychometric Sample (Pilot Study)
(N=81)
Demographic and Employment Characteristics Number
(N)
Mean Standard
Deviation
Age 77 34.3 10.9
Experience as a nurse 79 8.9 10.4
Years of service with organization 81 6.0 7.11
Length in current nursing position 81 5.1 5.8
308
Categorical Demographic and Employment Characteristics for Psychometric Sample (N=81)
Demographic and Employment Characteristics Number
(N)
Percent
(%)
Gender Female 75 92.6
Male 6 7.4
Employment status Full-time 59 72.8
Part-time 13 16.0
Casual/ temporary part-time 4 4.9
Contract 2 2.5
Patient population Adult 80 98.8
Pediatric 1 1.2
Work setting Medicine 38 46.9
Surgery 22 27.2
Recovery Room 5 6.2
Medical/ Surgical 4 4.9
Cardiology 4 4.9
Intensive Care 4 4.9
Maternity/ Post-Partum 2 2.5
More than 1 setting 2 2.5
Nursing Certificate Critical Care 3 3.7
Cardiovascular 2 2.5
Emergency 1 1.2
Gerontology 1 1.2
Highest level of nursing education Diploma 21 25.9
Baccalaureate 53 65.4
Masters 7 8.6
Highest level of non- nursing education None 38 46.9
Certificate 11 13.6
Diploma 11 13.6
Baccalaureate 20 24.7
Masters 1 1.2
Currently enrolled in a university
nursing program
Yes
6
7.4
University nursing program currently
enrolled in
Baccalaureate
2
2.5
Masters 4 4.9
309
Appendix FF:
Final Changes to the NEIS Instructions (Pilot Study)
Adapted version of instructions for the NEIS:
The following questionnaire is aimed at examining how nurses perceive and understand
their own and others emotions and how they use this information to guide how they think
and act.
For each question, you will be asked to choose the one option that best corresponds or
represents the emotion expressed in the scenario or what you think is happening in the
question.
If the emotion or answer that you think of is not a possible option to choose from, please
choose from the available answers the one option that best corresponds or most closely
represents your answer.
Adapted version of instructions for questions 1 to 7:
For the following questions, please circle the number that best corresponds to the
emotion expressed in the pictures and faces.
Adapted version of instructions for questions 21 to 24:
For questions 21 – 22, please circle the number for each action that you feel best
represents how the individuals described in each of the scenarios would preserve,
reduce, or maintain his/ her emotions.
For questions 23 – 24, please circle the number for each action that you feel best
represents how the individuals described in each of the scenarios would preserve or
maintain the relationships between them.
Adapted version of instructions for the measure:
For questions 8 – 13, please indicate how helpful/ useful each emotion listed would be
relative to each of the situations described below.
For questions 14 – 16, please select the emotional response that is the most likely to be
felt in the situations described below.
For questions 17 – 20, please select the option that best represents the actions that
proceeded and then followed the emotions described in each scenario below.
310
Appendix GG:
Example of Changes to the Pictures in the NEIS (Pilot Study)
Original version of picture in question 1 of the modified CEIS:
Adapted version of picture in question 1 of the modified CEIS:
311
Appendix HH:
Pilot Study of NEIS PCA Factor Models (Pilot Study)
Eight Factor PCA Model (Pattern Matrix)
Items Component
1 2 3 4 5 6 7 8
NEIS 1
.649
NEIS 2 .817
NEIS 3 -.434 .519
NEIS 4 -.392 -.304
NEIS 5 -.522 .340
NEIS 6 .475
NEIS 8 .730 .312
NEIS 9 .728
NEIS 10 .785
NEIS 11 .663 -.302 -.321
NEIS 12 .717
NEIS 13 .588
NEIS 14 .518 -.545 -.319
NEIS 17 .306 .679
NEIS 18 .359 .355 -.368
NEIS 19 .817
NEIS 20 -.705
NEIS 21 .563
NEIS 22 .782
NEIS 23a .617 .344 -.312
NEIS 23b -.765
NEIS 24a .590
NEIS 24b -.813
Only loadings > .30 presented
312
Six Factor PCA Model (Pattern Matrix)
Only loadings > .30 presented
Items Component
1 2 3 4 5 6
NEIS 1
-.368
.398
.374
NEIS 4 .656 .325
NEIS 5 .822
NEIS 6 .665
NEIS 8 .789
NEIS 9 .796
NEIS 11 .448 .598
NEIS 13 .561
NEIS 14 .498 .358
NEIS 18 -.345 .524
NEIS 19 .797
NEIS 21 .768
NEIS 22 .706
NEIS 23a .304 -.640
NEIS 23b .811
NEIS 24a .475 .394
NEIS 24b .700 .446
313
Three Factor PCA Model (Pattern Matrix)
Items Component
1 2 3
NEIS 1 .347 .534
NEIS 4 .640
NEIS 5 .499
NEIS 6 .343 .119 .459
NEIS 8 .559
NEIS 9 .605 .367
NEIS 11 .791 -.357
NEIS 18 .385
NEIS 19 -.530
NEIS 21 .645
NEIS 22 .764
NEIS 23a .658
NEIS 23b -.706
NEIS 24a .622
NEIS 24b .368 -.711
Only loadings > .30 presented
Upon examination of the three factor
314
Appendix II:
Reliabilities and Correlations for CEIS, NEIS, Agreeableness, Conscientiousness, and Openness (Pilot Study)
NEIS CEIS Personality
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.
Nursing EI
Scale
1. NEIS Total (.70)
2. Experiential
.64** (.66)
3. Strategic .88** .20 (.68)
4. Perceiving
.13 .29** -.06 (.53)
CEIS 5. Facilitating
.18 .11 .16 .11 (.83)
6. Understanding
.08 -.09 .15 .12 .13 (.01)
7. Managing
.44** .66 .46** .23* .07 .28* (.67)
8. CEIS Total .32** .15 .31** .49** .54** .72** .64** (.64)
9. Agreeableness
.20
.02 .24* -.04
.12
.02
-.01
.04
(.85)
Personality 10. Conscientiousness
.08 -.14 .19 -.07
.15
.13
-.05
.10
.26*
(.79)
11. Openness
.17
.07 .20 -.10
.13
-.10
.10
.01
.28*
.14*
(.76)
*p< .05, **p< .01
315
Appendix JJ:
Demographic and Employment Characteristics for the Preceptor Sample (New Graduate Nurse Preceptorship Study)
Demographic and Employment
Characteristics
Number
(N)
Minimum Maximum Mean Median Mode Standard
Deviation
Age 40 23 53 31.60 30.00 30.00 6.05
Experience as a nurse 40 1.30 20.00 7.02 5.95 6.00 5.07
Years of service with organization 40 1.30 16.60 5.20 4.55 5.00 3.28
Length in current nursing position 40 1.00 12.00 4.76 4.00* 3.00* 2.66
Missing
10 - - - - - -
* Multiple modes exist. The smallest value is shown
316
Demographic and Employment Characteristics for Preceptor Sample (continued)
Demographic and Employment Characteristics Number
(N)
Percent
(%)
Gender Female 38 76
Male 3 6
Missing 9 21
Employment status Full-time 37 74
Part-time 3 6
Missing 10 25
Highest level of nursing education Diploma 3 6
Baccalaureate 25 50
Masters 12 24
Missing 10 25
Highest level of non- nursing
education
None 20 40
Baccalaureate 10 20
Certificate 4 8
Diploma 4 8
Masters 1 2
MD 1 1
Missing 10 25
Currently enrolled in a university
nursing program
Yes
7
14
Type of nursing program currently
enrolled in
Baccalaureate
1
2
Masters 6 12
317
Appendix KK:
Demographic and Employment Characteristics for the New Graduate Nurse Sample (New Graduate Nurse Preceptorship Study)
Demographic and
Employment Characteristics
Number
(N)
Missing Minimum Maximum Mean Median Mode Standard
Deviation
Age
45 5 21 29 24.51 24.00 24 1.82
Experience as a nurse 41 9 .15 2.00 .42 .30 .30 .30
318
Demographic Characteristics for the New Graduate Nurse Sample (continued)
Demographic Characteristics Number
(N)
Percent
(%)
Gender Female 39 78
Male 5 10
Missing 6 12
Graduated from a University In Toronto 32 76.2
Outside of Toronto 10 23.8
Missing 8 16
Employment status Temporary 29 58
Full-time 15 30
Part-time 1 2
Missing 5 10