Nurse Education in Practice 13 (2013) 506e511

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Nurse Education in Practice

journalhomepage:www.elsevier.com/nepr

A clinical supervision model in bachelor nursing education  Purpose, content

and evaluation
Marie Louise Hall-Lord a, b, *, Kersti Theander a,1, Elsy Athlin a, 2
a Department of Nursing, Karlstad University, Universitetsgatan 2, SE 65188 Karlstad, Sweden
b
Department of Nursing, Gjøvik University College, Norway

article info abstract

Article history: Background: Collaboration between universities and clinical placements has been highlighted as a weak point of the nursing
Accepted 4 February 2013 education. To facilitate a good academic learning environment a clinical supervision model had been developed. The aim of
this study was to evaluate to what extent the goals of the model were met after one and a half years of utilisation.
Keywords:
Clinical practice Methods: A questionnaire was responded to by 30 head nurses, 12 main preceptors, 193 personal pre-ceptors, and 11 clinical
Evaluation nurse lecturers.
Nursing students
Results: Most of the participants perceived that the quality criteria in the model were met to a large extent, the students’
Supervision model
individual goals were achieved, and the supervision model contributed to fulfilment of goals, and assessment of the students.
The nurse lecturers scored highest and the personal preceptors lowest in most of the questions. The conditions stated in the
model were not always fulfilled. The de-ficiencies found were especially related to education level, time for supervision, and
support to the personal preceptors.

Conclusions: Despite some shortcomings the supervision model was considered by most participants as a valuable tool to be
used in an academic nursing education. Improvements of the model in regard to the findings were suggested.

2013 Elsevier Ltd. All rights reserved.

Background
For many years the combination of theoretical and practical learning in
nursing education has been highlighted as necessary in order to equip nursing
students adequately for their future role (Landers, 2000; Gillespie and
McFetridge, 2006). Many studies have reported problems to overcome in
order to reach this pedagogic goal. After the transfer of nursing education to
universities, the students’ time for learning in the clinical setting has
decreased in many Western countries, as has the nurse lecturers’ supervision
of students in direct patient care. The lecturers’ role has changed from
supervising students in ‘hands on nursing’ to focussing more on nursing
theory and research (Humphreys et al., 2000; Barrett, 2007). The clinical
supervision has to a great extent become a re-sponsibility of clinical nurses,
who are overwhelmed with patient
* Corresponding author. Department of Nursing, Karlstad University, Uni-versitetsgatan 2,
SE 65188 Karlstad, Sweden. Tel.: þ46 547002420.
E-mail addresses: marie-louise.hall-lord@kau.se, marie.hall-lord@hig.no (M.L. Hall-
Lord), kersti.theander@kau.se (K. Theander), elsy.athlin@kau.se (E. Athlin).
duties, often insufficiently prepared for the supervisor role and unaware of
educational goals (Landmark et al., 2003; Lambert and Glacken, 2005). Due
to the heavy work-load of clinical nurses stu-dents often are left to themselves
in their clinical placements (Mc Carthy and Higgins, 2003; Brammer, 2005).
Reports about insufficient support to nursing students are frequent both
with regards to management of stressing and demanding events, such as
encounters with severely ill or dying patients (Timmins and Kaliszer, 2002),
and when it comes to using theory in practice and vice versa (Henderson et
al., 2006). Studies have also indicated that nurse teachers’ and preceptors’
experience and competence in reflection is low (O’Donovan, 2006). Chekol
(2003) concluded from her study in a Swedish university nursing college that,
despite being an academic education for 20 years, the clinical courses still
were lacking in ‘academic variables’, such as active learning, reflection,
critical thinking, and research-oriented learning. The collaboration between
universities and clinical place-ments has repeatedly been highlighted as a
weak point of the nursing education, where lack of communication and
agreement between parties involved in the students’ learning is described as a
serious problem (Andrews et al., 2006; Gillespie and McFetridge, 2006).

1 Tel.: þ46 547001930.

2
Tel.: þ46 54700 16 59.

1471-5953/$ e see front matter 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.nepr.2013.02.006
 M.L. Hall-Lord et al. / Nurse Education in Practice 13 (2013) 506e511
As both the academic level and a good learning environment are of great
importance in professional nursing, the deficiencies found in the students’
clinical studies are grave. Many attempts have been made during recent
decades in order to bridge over the obstacles found by means of supervision
models (Lindgren et al., 2005; Andrews et al., 2006; Baxter, 2007; Häggman-
Laitila et al., 2007). A factor highlighted in many models as important to
successful su-pervision is the learning environment, which has been stressed
as imperative for the learning outcome (Chan, 2002; Papp et al., 2003). Other
factors of importance are the health care organisa-tion, workload,
collaboration, competence of the supervisors, and the superviseeesupervisor
relationship (Andrews et al., 2006; Baxter, 2007).
In Sweden as in other countries, the expectation of nursing education is to
assure that bachelor nursing students have the appropriate knowledge and
skills needed for the nursing profession after completing their studies. This
means that the goal of the nursing education not only includes adequate
nursing skills, but also competence in critical thinking, problem solving,
communi-cation, leadership, and utilisation of research in practice (The
National Board of Health and Welfare, 2005). Since 1996 The Swedish
National Agency for Higher Education has performed na-tional audits of the
bachelor nursing programmes showing that in many Swedish universities
these requirements have not been suf-ficiently met (The Swedish National
Agency for Higher Education, 2000). Inspired by these results a systematic
checking-up of stu-dents’ clinical placements was done during 1999 at a
university in the central Sweden (Björkström et al., 1999). Many deficiencies
with regard to academic learning were revealed. Due to a high workload the
clinical nurses were often lacking time for a profes-sional patient care. They
also lacked time for planning of their daily work, and for collegial reflections.
No time was scheduled for su-pervision of students. Collaboration with
faculty members often intruded on patient care, and added to the workload of
colleagues. Most nurses were lacking experience and knowledge about peda-
gogic methods of active learning, and utilisation of research find-ings in
clinical work. Deficiencies regarding the collaboration between the nursing
academy and the clinical field were found. Formal agreements were indistinct
and vague about organisation, goals, structure, and budget for the joint
responsibility to educate future nurses. The transition of the nursing education
to the uni-versity level was found to be not fully accepted by staff nurses and
nurse leaders (Björkström et al., 1999).
Development of a clinical supervision model
After this checking-up a collaborative project was established in 2002
between the University and the County Council. A county council in Sweden
is a regional health service organisation with responsibility to provide care for
the inhabitants, in this region approximately 275 000 inhabitants. The County
Council supplies clinical placements in the hospitals to students during
clinical courses. The purpose with the collaborative project was to develop a
clinical supervision model which could reduce the deficiencies and facilitate a
good academic learning environment in the clinical education.
During the preparation phase of the project the following goals were set
for the supervision model:
combining theory and practice
supporting students in active search for knowledge, critical thinking and
reflective learning
supporting students’ affective learning
supporting clinical nurses in the preceptor role
facilitating assessment of students
507
assuring goal-directed collaboration over time between the university and
the clinical placements
To reach these goals, a contract was drawn up between the Uni-versity
and the County Council about the following quality criteria, which also were
clearly described in The Students’ Handbook:
I. ‘Basic’ and ‘reference’ placements
In order to create a good learning environment characterised by such
factors as wholeness, continuity, time, and trust in the studentepreceptor
relationship, the student was provided a ‘basic placement’ with a duration of at
least five weeks. In addition, op-portunities for shorter auscultations in
‘reference’ wards or clinics were made available according to the students’
learning needs. A combination of these two types of placements was expected
to provide a good opportunity for deep and comprehensive learning.
II. Four supervision levels were established to safeguard the quality of the
students’ cognitive and affective learning, where continuous
collaboration between the different levels of supervisors was the
foundation. The following competence criteria for supervisors at
different levels were stated:
Level A: Personal preceptors. Registered nurse (RN) in the clinical
placement with nursing experience of at least two years.
Level B: Main preceptors. RN in the clinical placement with nursing
experience of at least two years, post-basic nursing courses of at
least 15 ECTS, and a clinical super-vision course of 7.5 ECTS.
Level C: Clinical nurse lecturers (employed by the university). RN, several
years of nursing experiences, Master’s degree in Nursing or Health
teaching methods, and a pedagogic course of 15 ECTS.
Level D: Senior clinical nurse lecturer (employed by the university).
RN, PhD, and a pedagogic course of 15 ECTS.
The personal preceptors were responsible for the daily supervi-sion in
bed-side nursing, supporting the students in practical nursing skills. They
were expected to ensure that the students encountered such situations that
were needed to fulfil the learning goals, stimulate them to reflect upon their
experiences in the daily care, and assess their performance. The main
preceptors mainly provided support to groups of students with regards to
learning goals, supported personal preceptors in their role in the daily work
and in different formal meetings, and took part in assessments of students.
The clinical nurse lecturers were the link between the university and the
clinical placement, served as a pedagogic resource by providing theoretical
and emotional support to stu-dents and preceptors. The senior clinical nurse
lecturer had the overall responsibility for the quality of the clinical education,
and collaborated with and supported the clinical lecturers, arranged meetings
and workshops for the preceptors, and collaborated with authorities in regard
to the supervision model.
III. ‘Triangle meetings’
At the beginning and end of the clinical placement a ‘triangle meeting’
was carried out between student, personal preceptor and clinical nurse lecturer
for goal-setting, planning and assessment of the students.
IV. Academic assignments
The learning in the clinical placement was supported by aca-demic
assignments based on the goals of the clinical course. The
508 M.L. Hall-Lord et al. / Nurse Education in Practice 13 (2013) 506e511

assignments were formulated to stimulate the students’ active learning, inspire persons (84%) responded to the questionnaire; 30 head nurses (88%), 12 main
them to extend their search for experience and knowledge, and to reflect upon preceptors (92%), 193 personal preceptors (82%), and 11 clinical nurse
their experiences in comparison with research findings. lecturers (100%).

Data analysis
IV. Clinical seminars
Data analyses with frequencies, percentages, means, and stan-dard
Clinical seminars were carried out in small groups of students (five to deviations were carried out using the Statistical Package for Social Sciences
seven) led by the clinical nurse lecturer and the main pre-ceptor. The aim of (SPSS Inc., Chicago, Illinois, USA, version 17.0).
these seminars was to integrate theoretical and practical knowledge by means
of reflection and critical thinking. The discussions in the seminar were based Ethical considerations
on the stu-dents’ academic assignments including both cognitive and affective
aspects. The personal preceptors were invited to participate in the seminars. The study was conducted in accordance with the ethical guidelines for
nursing research in the Nordic countries (Northern Nurses Federation, 2003).
Permission was obtained from leaders in the health-care sectors, where
placements for the nursing stu-dents were provided, and from the Head of the
V. Time for supervision Nursing programme at the University. The participants’ contribution in the
study was voluntary and all data were treated with confidentiality.
Protected time for the preceptors was stated in the contract between the
University and the County Council. This meant that at least 4 h/week/student
for the ‘personal preceptor’, and 8 h/week/ group of students (5e7 Results
students/group) for the ‘main preceptor’ should be used for student
supervision. The financing of these provisions was covered by the university. The characteristics of the respondents are described in Table 1. Most of
the respondents were women. Only five percent of the personal preceptors and
23% of the head nurses were men.
The study Many of the respondents had received their registration as nurses before
the transfer of nursing education to university level. Personal preceptors were
This supervision model was put into practice at five hospitals in all the youngest and had fewer years of experience after their nursing education
placements used for students’ training, with the exception of psychiatric care. than the other groups. Nurse lecturers were the oldest and had most years of
After one and a half years of utilisation, the present study was carried out experience since completing their nursing education.
aimed at evaluating to what extent the goals of the model were met.
Twenty-eight percent of the personal preceptors had a specialist
education, 30% had short post-basic nursing courses, four percent had
Methods postgraduate nursing courses, and 39% had a supervision course. More than
half of the main preceptors had a specialisation in nursing.
Design
Fifty percent of the main preceptors had short post-basic cour-ses, 50%
The study had a descriptive cross-sectional design using four study- postgraduate courses, and 75% a supervision course. All the nurse lecturers
specific questionnaires. had a specialist nursing education and postgraduate courses in nursing. Nine
of them had a Master’s degree in nursing or Health teaching methods. Seventy
Questionnaires percent of the head nurses had a specialisation in nursing, 43% had short post-
basic nursing courses, and only three percent postgraduate courses in nursing.
The questionnaires were constructed by two of the authors (EA
& MLHL) in close collaboration with the nursing director in the County The mean scores in Table 2 showed that the quality criteria in the model
Council. The content of the different questionnaires were mainly the same but were met to a large extent according to the respondents. The nurse lecturers
slightly changed to fit the four groups of participants. The questionnaires scored highest and the personal preceptors lowest regarding students’
covered background data (7 questions), questions about quality criteria related opportunity for active learning,
to learning and supervision (14 questions), factors contributing to assessment
and fulfilment of students’ goals (7 questions), collaboration and sup-port (6
questions). The questions had four or six response options: from disagree Table 1
Characteristics of the respondents.
completely (1) to agree completely (4), or six response alternatives: from
never (1) to always (6). One response option was graded yes, partly, and no. Personal Main Clinical Head
The questionnaires were scrutinised in the collaboration group (EA, MLHL preceptors preceptors lecturers nurses
and the nursing director), and discussed with clinical nurse lecturers before n ¼ 193 n ¼ 12 n ¼ 11 n ¼ 30
agreement about final versions. Sex n (%)
Women 183 (95) 12 (100) 11 (100) 23 (77)
Men 10 (5) 0 0 7 (23)
Age m (SD) 42 (9.7) 46 (9.5) 50 (7.8) 49 (7.2)
Years since nursing 14 (10.8) 21 (12.5) 28 (6.7) 23 (8.9)
Informants and procedure education m (SD)
Specialist nursing n (%) 65 (34) 8 (67) 11 (100) 21 (70)
Post basic nursing 58 (30) 6 (50) e 13 (43)
The questionnaire with an information letter was distributed to 294 courses n (%)
persons: 34 head nurses, 13 main preceptors, 236 personal preceptors, and 11 Postgraduate nursing 7 (4) 6 (50) 11 (100) 1 (3)
clinical nurse lecturers. Inclusion criteria were that the head nurses and courses n (%)
preceptors worked in somatic care and at the wards during the project period. Supervision 76 (39) 9 (75) e e
course n (%)
After one reminder 246
 M.L. Hall-Lord et al. / Nurse Education in Practice 13 (2013) 506e511
opportunity for learning in reference placements, and combination of theory
and practice. The personal preceptors supervised the students in learning, by
means of reflection, to a greater extent than what the main preceptors did.
Personal preceptors used evidence-based research more seldom in their work
as nurses than the main preceptors did. The nurse lecturers reported that they
used evidence-based research in clinical seminars to a large extent. Personal
preceptors rarely obtained the prescribed time (4 h/week/ student) for the
supervisor function, while the main preceptors could use their time (8
h/week/group of students) more often. Personal preceptors participated
frequently in triangle meetings, but less often in clinical seminars, in which
the main preceptors very often took part. The head nurses considered that the
pre-ceptors could use the prescribed time for supervision to a higher degree
than did the preceptors. The head nurses scored higher than the personal
preceptors concerning their participation in clinical seminars. All respondents
agreed to a great extent that the infor-mation given from the nursing college
about the nursing education was sufficient.
The respondents’ perception of factors contributing to assess-ment of
students and to students’ fulfilment of goals are presented in Table 3. All
groups of respondents perceived that they could contribute to the students’
fulfilment of goals to a large extent, where the personal preceptors scored
highest. The main preceptors and the clinical lecturers perceived to a large
extent that the tri-angle meetings and the clinical seminars contributed to the
assessment of students. The study guide and academic assignments were
considered to contribute.
Furthermore, the respondents perceived to a large extent that the students’
individual goals were achieved, and the supervision model contributed to
fulfilment of goals. In all these items the personal preceptors scored lowest.
The respondents’ perceptions of collaboration and support are presented in
Table 4.
The collaboration between and support from clinical lecturers, main
preceptors and personal preceptors was perceived as well- or rather well-
functioning. The clinical lectures and main preceptors scored highest in these
items. The collaboration between the uni-versity and clinical practice was
scored higher by nurse lecturers and main preceptors than by personal
preceptors and head nurses.
Discussion
The findings indicated that the supervision model evaluated in this study
could contribute to the fulfilment of goals for the clinical nursing education
and to the assessment of students. There was a high agreement among all
groups of participants, but as in other
Table 2
The respondents’ perceptions of to what extent the quality criteria in the model were met.
Personal preceptors
n ¼ 193 m (SD)
Opportunity of reference placements (1e6)a 4.6 (0.9)
Opportunity of active learning (1e6)a 4.5 (0.9)
Supervision by means of reflection (1e4)b 3.6 (0.7)
Combining theory and practice (1e6)a 4.6 (0.7)
Personal preceptors e 4 h/week for supervision (1e6)a 3.0 (1.4)
Personal preceptors’ participation in triangle meetings (1e6)a 5.3 (1.1)
Personal preceptors’ participation in clinical seminars (1e6)a 1.7 (1.2)
Main preceptors e 8 h/week for supervision (1e6)a e 4.8 (1.6)
Main preceptors’ participation in clinical seminars (1e6)c e 5.3 (1.0)
Utilization of evidence-based research (1e6)a 3.0 (1.2)
Information about the education (1e4)c 3.0 (0.8)
a Scores could range from 1 (never) to 6 (always).
b
Scores could range from 1 (always) to 4 (never).
c
Scores could range from 1 (disagree completely) to 4 (agree completely).
509
studies where both clinical nurses and nurse lecturers are used as respondents
(Athlin et al., 2012), the nurse lecturers in general reported a slightly more
positive attitude to the model than the clinical nurses. Deficiencies in
academic level of the clinical edu-cation led to the development of the
supervision model. Nurse lecturers are probably more concerned about this
than clinical nurses, which may have biased the nurse lecturers’ attitudes.
The idea of four supervision levels in this model was meant to
compensate for the fact that many clinical nurses who are assigned to students
as preceptors are lacking academic competence in nursing (Mc Carthy and
Murphy, 2010; Borch et al., 2012). Our study revealed that the personal
preceptors had many years of nursing experiences, but most of them lacked
specialisation, as well as ac-ademic and pedagogic courses. The main
preceptors and clinical lecturers were considered to be the more experienced
and more highly educated nurses, who should provide support and knowl-
edge, both to students and personal preceptors. Our findings showed that these
expectations were only partly met, as half of the main preceptors were lacking
post-graduate courses, and one quarter lacked a pedagogic course. This was
both remarkable and discouraging, since the competence of the main
preceptors was stated to be at post-graduate level together with a supervision
course. This must be seen as a great failure, since this group of preceptors was
expected to bridge over the lack of academic and pedagogic competence of
the personal preceptors in the daily care. The most probable reason for the
low competence of the main preceptors is that there are still too few clinical
nurses with higher education working in clinical practice (Josefsson et al.,
2007; Gardulf et al., 2008).
Notable was that two of the clinical nurse lecturers were lacking in formal
qualifications, which indicates difficulties in recruitment of academically
competent nurses also in the university (Smith and Crookes, 2011).
It was interesting that the personal preceptors scored higher than both the
main preceptors and the nurse lecturers regarding their own contribution to
the students’ fulfilment of goals. They scored higher than the main preceptors
regarding their opportunity to support students in learning by reflection. This
conviction among preceptors of being very important for nursing students is
found elsewhere, and may be understood as a consequence of their
commitment to their role (Danielsson et al., 2009; Courthney-Pratt et al.,
2012). However, as personal preceptors are often lacking both academic and
pedagogic competence, the risk is that they only take the practical aspects of
nursing in consideration in their supervi-sion, and focus merely on practical
issues in their reflection together with the students. If so, there is a risk that
these pre-ceptors with low academic and pedagogic competence may serve
Main preceptors Clinical lecturers Head nurses
n ¼ 12 m (SD) n ¼ 11 m (SD) n ¼ 30 m (SD)
4.9 (0.9) 5.2 (0.9) e
4.7 (0.7) 5.0 (0.9) e
2.7 (0.8) 3.5 (0.5) e
4.8 (0.5) 4.6 (0.9) e
e e 4.1 (1.5)
e 5.6 (0.7) 5.3 (1.2)
e 2.3 (1.0) 3.9 (1.6)
e 5.1 (1,3)
5.7 (0.5) e
4.1 (0.8) 4.5 (1.4) e
3.3 (0.5) e 3.1 (0.5)
510 M.L. Hall-Lord et al. / Nurse Education in Practice 13 (2013) 506e511

Table 3
The respondents’ perceptions of factors contributing to assessment of students and students’ fulfilment of goals.

Personal preceptors Main preceptors Clinical lecturers

n ¼ 193 m (SD) n ¼ 12 m (SD) n ¼ 11 m (SD)
Triangle meetings contributed to assessment (1e6)a 4.4 (1.1) 5.0 (0.7) 5.1 (1.2)
Clinical seminars contributed to assessment (1e6)a e 4.8 (1.3) 5.3 (0.8)
Study guide contributed to fulfilment of goals (1e6)a 4.4 (0.7) 4.8 (0.5) 4.7 (0.7)
School assignments contributed to fulfilment of goals (1e6)a 4.3 (0.7) 4.4 (0.7) 4.6 (0.7)
Respondent contributed to fulfilment of goals (1e6)a 4.5 (0.6) 4.0 (1.0) 4.4 (0.7)
The students’ fulfilment of the goals of the clinical courses (1e6)a 4.5 (0.69) 4.8 (0.6) 4.9 (0.5)
Supervision model contributed to students’ fulfilment of goals (1e3)b 2.3 (0.6) 2.6 (0.5) 2.8 (0.4)
a Scores could range from 1 (never) to 6 (always).
b Scores could range from 1 (no) to 3 (yes).

as a conserving factor in nursing, instead of being proactive in their
supervision and role-modelling (Allan et al., 2011). The main pre-ceptors
rather low scores concerning support to students in reflection highlight what
other studies have already shown (Braine, 2009; Duffy, 2009), namely that
preceptors need further training in this area.
The personal preceptors scored somewhat lower than both the main
preceptors and nurse lecturers concerning utilisation of research findings in
their daily work and participation in clinical seminars. This is easily
understood in light of both their lower ac-ademic education, and what we
know about nurses’ heavy work-load in general. Even if they were invited to
the clinical seminars, they did not have time reserved for these seminars as
the main preceptors had. Our findings showed that despite the agreement that
time should be set aside for supervision of students, this was not always
fulfilled especially for the personal preceptors. It was interesting that the head
nurses in the wards scored higher with regards to the opportunity for the
preceptors to get the time agreed upon for supervision. As also nurse leaders
are very busy during their working days (Johansson et al., 2010), it may be
assumed that the head nurses thought that the contract was followed, but in
reality many preceptors had not been able to use all their ‘protected time’ for
supervising students. This lack of time in the preceptor role, which has been
reported in many years (Mc Carthy and Murphy, 2010), must be stressed as
an important issue to focus upon in further development of student
supervision.
emotional support to nurses in their preceptor role was a driving force, when
this supervision model was devised, and it still is (Williams and Irvine, 2009;
Omansky, 2010). The support from nurse lecturers to main preceptors was
mostly reported as working well, which may be understood as a consequence
of their time together in clinical seminars and frequent collaboration
concerning students’ clinical studies.
Our study illuminated the need of improvement of the super-vision model.
The findings indicated that one way could be to extend the main preceptor
role, in line with previous trials using so-called clinical facilitators
(Henderson et al., 2009) or link-teachers (Williams and Taylor, 2008) with a
clear super-numerous status. The present study showed that the main pre-
ceptors’ protected time of 8 h/week/group of students mostly could be used.
As they also had higher academic and pedagogic compe-tence than the
personal preceptors, they would better contribute to the goals that were set in
the nursing education. The personal preceptor role could be replaced with
‘daily supervisors’; nurses responsible for patients assigned to nursing
students on each shift basis. The expectation on these nurses would mainly be
to super-vise students in clinical skills together with the inevitable and
important role-modelling (Perry, 2009).
Methodological considerations

Some important limitations must be addressed. The sample used,

Our study confirms what has been stressed in other previous studies
(Andrew et al., 2009; Hallin and Danielsson, 2009; Saarikoski et al., 2009)
that collaboration and partnership between nursing institution and nursing
practice is of utmost importance for students’ learning in the clinical
placements. Collaboration be-tween the different supervision levels in our
supervision model was meant to be the foundation and ‘binder’, in order to
improve the students’ learning in the placements (Barnett et al., 2010). Our
findings showed that this mostly functioned well or rather well between the
parties involved. However, the support to personal preceptors was reported as
less satisfactory. Many personal pre-ceptors considered that they did not get
sufficient support from main preceptors and clinical lecturers. This finding
must be regar-ded as a serious flaw, since the need of both pedagogic and
comprised the total population with few participants in some of the groups,
but the response rate was satisfying in all groups, which strengthened the
validity of the findings (Polit and Beck, 2008).
Nursing students should have been included in the question-naire survey.
Their opinions and experience about the supervision model would have
provided additional understanding about the pros and cons of the model.
However, in addition to current study, ten nursing students in clinical
placements during the same period were interviewed about their experiences
of the supervision model, its impact on their clinical learning, and the
supervision they had received.
The findings, which accorded well with the findings of this study, are
reported elsewhere (Hall-Lord and Athlin, 2005).

Table 4
The respondents’ perceptions of support and collaboration.

Personal preceptors Main preceptors Clinical lecturers Head nurses

n ¼ 193 m (SD) n ¼ 12 m (SD) n ¼ 11 m (SD) n ¼ 30 m (SD)
Support from nurse lecturer (1e4)a 2.8 (1.0) 3.8 (0.5) e e
Support from main preceptor (1e4)a 2.9 (1.1) e e e
Collaboration with nurse lecturer (1e4)a 3.3 (0.8) 3.8 (0.4) e 3.3 (0.6)
Collaboration with main preceptor (1e4)a 3.2 (1.0) e 3.9 (0.3) 3.5 (0.8)
Collaboration with preceptors (1e4)a e 3.3 (0.6) 3.6 (0.5) e
Collaboration between university and clinical practice (1e4)a 2.7 (0.7) 3.0 (0.7) 3.3 (0.7) 2.8 (0.7)
a Scores could range from 1 (disagree completely) to 4 (agree completely).
 M.L. Hall-Lord et al. / Nurse Education in Practice 13 (2013) 506e511
Conclusions
The supervision model evaluated was considered by a majority of
participants, to be a useful tool for clinical supervision of stu-dents in an
academic nursing education. However, the conditions stated in the model
were not always fulfilled, despite the agree-ment between the University and
the County Council, responsible for the students’ placements. The deficiencies
found were espe-cially related to education level, time for supervision,
collaboration and support given to personal preceptors. Improvements of the
model with regards to the findings were suggested.
Conflict of interest statement
There are no conflicts of interest to declare.
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