Once enrolled in any programme, a person has some expectations and perceptions of the specific programme. The following literature discusses and illustrates examples of expectations and perceptions of preceptorship programmes. There are many programmes aimed at the development of personnel, as there are for preceptorship, and each one is chosen to address a need. A review of literature findings has recommended that preceptorship programmes lead to improved satisfaction of newly graduated nurses and also staff retention. These programmes may help overcome the worldwide shortage of nurses and in view of this, preceptors and leaders need to offer a conducive environment in which newly graduated nurses feel content with their workloads and their tasks (Arbabi, Johnson & Forgave 2018:48). Preceptors need to create an environment in which preceptees will excel during their preceptorship programme. That is why the teaching style, knowledge and experience of the preceptor are important to the preceptorship programme. A qualitative study by Dias et al. (2015:53) conducted in Pakistan, interviewing nine students and six preceptors in focus group discussions found that students reported that preceptors are an invaluable resource. Miller, Vivona and Roth (2016:2020) found in their study that a majority of respondents reported positive experiences with their preceptors. Furthermore, in a study in the US with 34 preceptors and 30 novice nurses as participants, Hickerson, Terhaar and Taylor (2016:61) found that the preceptor support programme was associated with positive assessments by the novice nurses of their preceptors’ teaching and support. It can be seen that students appreciate the preceptorship model as an innovative way of teaching pedagogy (Dias et al. 2015:53). In a study conducted in Ethiopia with 109 respondents, Teferra and Mengistu (2017:86) found that of the respondents who are familiar with the clinical preceptorship concept, 96.3% of the respondents were classified as having a favourable attitude towards clinical preceptorship.

A large body of nursing education research has repeatedly described the role of nurse preceptor, in particular, as a ‘vital part of nursing students’ clinical learning’ (Ryan & McAllister 2016:267).

The preceptor role includes the following positive factors:

A preceptor must portray certain qualities (Dornblaser et al. 2016:3). The following are some key characteristics, according to various authors:

The following literature discusses how Benner (1982:402) used the Dreyfus Model of Skill Acquisition to differentiate between a more skilled and knowledgeable nurse and a less experienced. The five levels of development that she derived from the Dreyfus model are outlined here.

According to Dreyfus and Dreyfus (1980:7) the original model proposes that a student passes through five distinct stages, namely novice, competence, proficiency, expertise and mastery. Each step builds on the previous one as abstract principle is distinguished by experience and the learner gains clinical experience. Benner (1982:402) clarified the five levels of development as outlined here. The steps as they build on each other are described as follows:

Newly qualified nurses often experience, amongst others, unhappiness at work, stress and anxiety, new job-hunting, absenteeism, negativity, medico-legal issues and trying to pursue a different career. These are experienced often because of the lack of supervision and support, which can be provided by a preceptor. This statement has been supported by various researchers such as Cloete and Jeggels (2014:2), Webster (2016:2) and Zaayman (2016:9), as well as by the comments, discussions and feedback made by colleagues in the clinical field of the hospitals and clinics. Additionally, the need for newly qualified nurses to be clinically and academically supervised and guided is crucial to guarantee that they can subsequently provide safe and competent care, which enables them to continuously grow in the profession from being novices to becoming experts. Given this background and the limited number of preceptors employed in South African hospitals, it can be argued that sufficient preceptor support by academically and clinically prepared nurses is still lacking and that the role of the preceptor is at present vague and needs clarification. This statement is consistent with the views of a number of researchers such as Cloete and Jeggels (2014:6), Hofler and Thomas (2016:135) and Morgan (2017:23). Also, Quek and Shorey (2018:420) assessed the perceptions of preceptorships of newly qualified nurses and found that in the Western Cape, South Africa, the perceived benefits and rewards for the preceptor role and a heavy workload had an impact on commitment to fulfil the preceptor. Despite all the benefits of preceptorship no evidence was found that a preceptorship model was developed in the Western Cape (Makie 2021).

The purpose of this study was to assess the perceptions of newly qualified nurses on the guidance given by their preceptors towards becoming experts in practice at a Level II regional hospital in the Western Cape.

The objectives of this research were to:

The findings of this study could emphasise the importance of ongoing support programmes for all categories of nurses after obtaining a new qualification and being a new nurse. The findings could be of significant assistance to healthcare managers, healthcare workers and others involved in striving to deliver a highly efficient service, a good experience and quality to clients visiting their facilities.

A positivist paradigm or approach, using a non-experimental, quantitative, descriptive and cross-sectional design was adopted in this study. The study was descriptive, as it attempted to assess and describe ‘what’ the perceptions of newly qualified nurses are of guidance by preceptors towards becoming experts in practice. There was no manipulation of any variables or interventions, hence, the study was non-experimental. It was cross-sectional, because the data were collected only once. The design was quantitative, because the description was in the form of measurement (numerical).

In this study the target population was all the categories of nurses who are registered with the South African Nursing Council and who are employed on a full-time basis by a selected level II regional hospital in the Western Cape. In this study, the population comprised all nurses employed at the time by the selected health care facility. This study recruited newly qualified nurses to participate, which are defined as persons who qualified and were found capable to practice nursing in the way prescribed (South African Nursing Council (SANC) 2005:25). At the time the study was carried out the total number of nursing personnel was 315 as indicated on the employment register of the institution.

In this research, convenience sampling was selected by the researcher to select the hospital because of the most readily available persons as participants (Polit & Beck 2017:724).

The study sample consisted of a subsection of the population. Non-probability sampling was used. Purposive sampling was used to choose the nursing population. Based on the criteria that all respondents must be permanently employed at the selected research site and registered at South African Nursing Council (SANC) and completed their training between January 2013 and April 2018. three categories of newly qualified nurses were used. These categories included: registered nurse, enrolled nurse and enrolled auxiliary nurse. This method was chosen because participants were selected based on the purpose of the study.

According to Creswell and Creswell (2018:147) quantitative approaches focus on carefully measuring variables. A self-administered questionnaire was used to collect data. The instrument was divided into different sections to address questions related to the study problem, aim and research objectives. The advantages of a questionnaire are as follows: large amounts of data can be collected, data for a big sample of participants can be collected by post and is relatively cheap, and questionnaires are easy to compile and analyse. The researcher developed the instrument information obtained from the literature and personal experiences of the researcher.

Pretesting of a instrument allows the research team to identify problems in the design of questions, sequence of questions and procedure for recording responses (Gray et al. 2017:405). The researcher conducted a pre-test study with four registered nurses, who qualified between January 2013 and April 2018, from another hospital. The selected hospital was purposefully chosen for the pre-test. The data gathered throughout the pre-test were analysed cautiously to determine whether the respondents had answered the research questions and to determine if the questions were clear to them. After evaluation of the questionnaire, their suggestions were discussed in a meeting. Adjustments, unclear words and questions were reconsidered and changed.

According to Polit and Beck (2017:725), the systematic organisation and synthesis of research data analysis is the structured planning and the combination of study data and in quantitative studies, the testing of hypotheses using those data. In this study a research assistant entered the data on a spreadsheet that was then posted to the qualified statistician, who used the Statistical Analysis System (SAS) Software, version 9.3 for data analysis. The level of significance was set at 0.05 and the two-sided test was used for prevalence and the one-sided test of significance for adherence. Data analysis consisted of descriptive analysis and the findings were summarised by means of descriptive analysis. According to Creswell and Creswell (2018:157), this analysis should indicate the means, standard deviations or range of scores.

In this study, respondents had to complete a questionnaire anonymously and could do so at their convenience. Permission was requested from the chief executive officer of the hospital, which was duly granted. Thus, the hierarchy of the system was upheld for gaining permission for the study. The relevant information included details on the purpose, procedures, methods, benefits of the study, and the provision of individual consent. The researcher endorsed the participants’ rights to participate and revoke their decision at any time during this study without providing justification, explanation or incurring any penalty/coercion. The researcher’s email address and telephone number were also included. Thus, through veracity, a trustworthy and transparent relationship was established amongst all the stakeholders. Therefore, the researcher respected the participants’ autonomy by ensuring that they received all the information required to make a knowledgeable decision (Pera & Van Tonder 2017:54).

This study aimed to investigate, discover and determine the views of newly qualified nurses on the support by the guidance of a preceptor during their transition from novice to expert; the role of the preceptor; the preceptorship programme; and provide recommendations. In this process, sufficient care was taken in upholding privacy, confidentiality and anonymity of the respondents and the research site. In addition, provision was made for all the stakeholders to avoid inconvenience because of loss of time and economy. Moreover, non-interference during the research in the routine of the nursing and hospital service made this research very practical and feasible. The study fulfilled another objective of non-maleficence by spurning physical, emotional, social, economic and psychosocial insult.

In the adherence to this principle in this study, non-probability sampling was used. Purposive sampling was used to choose the nursing population. Confidentiality was assured by assigning numbers rather than names to questionnaires. Thus, it can be seen that the researcher applied the principle of justice in this study for all the stages. The researcher acknowledged all references. Proper citations have been given wherever warranted and a full bibliography was submitted in accordance with the policies and guidelines of the University of South Africa (UNISA) to avoid plagiarism.

According to Pera and Van Tonder (2017:382), reliability is a degree to which a measure of a concept is stable. To increase reliability, the questionnaire in this study was pre-tested on participants who did not participate in the main study. Moreover, precise and cautious wording of each question to avoid vagueness and leading respondents to particular answers ensured the reliability of the questionnaire. The respondents were also informed of the purpose of the study and the need to answer honestly. The questionnaire was evaluated and approved by the study supervisor and a statistician. The researcher compiled a preliminary questionnaire and then consulted an expert before compiling the final questionnaire.

In this study, the researcher considered face and content validity (Gray et al. 2017:376). According to Gray et al. (2017:375) while examining validity, the types of evidence examined are based on response processes, internal structure, relationships on other variables or based on consequences of testing. Creswell and Creswell (2018:251) posited that validity refers to whether inferences can be made on a particular instrument. In this research, the researcher consulted the literature and obtained critique from experts when developing the questionnaire to achieve high quality data and to ensure that the questions meet the objectives.

The study found that, of the respondents, 48.2% (n = 78) were registered nurses, whilst 32.7% (n = 53) were registered as staff nurse and 19.1% (n = 31) were registered as enrolled nursing auxiliaries (see Figure 1). According to the Nursing Act, Act No. 33 of 2005 (SANC 2005):

For the type of nursing undergraduate programme followed by the respondents, 17.9% (n = 29) had followed a 4-year bachelor degree, 16.7% (n = 27) had followed a 4-year diploma in general nursing, 13.6% (n = 22) had followed a 2-year bridging programme from enrolled nurse to general nurse diploma, 32.7% (n = 53) had followed a certificate for an enrolled nurse programme and 19.1% (n = 31) had followed a certificate for an enrolled nursing auxiliary programme (see Figure 2).

Blaauw, Ditlopo and Rispel (2014:5) found that the main nursing qualifications that have been recognised in South Africa since 1985 are Enrolled Nursing Auxiliary: 1-year certificate at a training hospital; Enrolled Nurse: 2-year certificate at nursing college; Registered Nurse: 4-year diploma at a nursing college or a 4-year baccalaureate degree at a university. Furthermore, the bridging programme also made it possible for enrolled nurses to finish a 2-year diploma at a nursing college and qualify as a registered nurse. This is consistent with this study, as this is the programmes that the respondents followed (see Figure 2).

Respondents were asked about perceived roles and characteristics of the preceptor by indicating the following: always met expectation, frequently met expectation, neutral, sometimes met expectation or never met expectation (see Figure 3), in the following questions: The most significant aspects of the preceptor as indicated with the first data point in Figure 3 and had the highest percentage on, met expectation: Was knowledgeable 83.3%, behaved professionally 81.5%, contributed to a teamwork environment 80.9%, helped me to learn from errors or near misses: 79.6% indicated met expectation, displayed effective interpersonal skills: 78.4% indicated met expectation, helped me to determine appropriate patient priorities: 76.5% indicated met expectation and demonstrated problem solving skills 75.9%.

The lowest percentage with regard to the expectation of the preceptor role is displayed in the last two horizontal bars of Figure 3. In each of the individual bars it is indicated in the first data point. The expectations with the lowest percentage were: encouraged me to engage in self-reflection 69.1% and encouraged me to use evidence-based practice 66.7%. In this study, therefore, expectations were most frequently met at > 80% n = 129, and it was found that expectations were least frequently met at < 60%, n = 97.

In an analytical cross-sectional study conducted by Bahmanbijari et al. (2017:4129) to determine the viewpoint of students within the division of health, regarding the roles and features of a clinical role model at Kerman University of Medical Sciences in Iran, with 185 participants, the authors found that the results of their study emphasised the importance of the characteristics and roles of a clinical teacher as perceived by the participants in their study. A descriptive comparative study was conducted by Omer, Suliman and Moola (2015:4) to define the prospects of nurse preceptors’ roles and responsibilities as held by preceptors and their preceptees and the results indicated the following roles as important: protector, evaluator, educator and facilitator. A descriptive cross-sectional study conducted by Teferra and Mengistu (2017:87) to assess the knowledge and attitude towards clinical preceptorship found that in questions concerning the features for selection of preceptors, the response rate to a question asking what the minimal education of a preceptor should be, 50.9% of the respondents indicated a bachelor’s degree and in response to a question about years of clinical experience, two years (70.4%) was the minimum. The given results are consistent with the findings of this research. By determining the roles and characteristics of preceptors, expectations were most frequently met for: knowledgeability, professionalism and contribution to teamwork. However, this study also determined the use of evidence-based practice and self-reflection by preceptors, and it was found that these expectations were least frequently met.

The role of the preceptor, the participants highest level of response, met expectation, are displayed in Table 2. The table displays the category with the highest value to the different aspects of the preceptor’s role.

Regarding the most helpful support from the preceptor, recommendation of preceptorship and in-service training 66.7% (n = 108) of the respondents indicated clinical support; 95.7% (n = 155) of the respondents indicated recommendation of preceptorship; 82.1% (n = 133) of the respondents indicated that they attend in-service training, whilst 21.0% (n = 34) of the respondents indicated that they do not need preceptorship because of in-service training (see Table 3).

Table 4 displays the values of each nursing category within this study, as respondent to each question.

As the research was conducted at a Level II regional hospital in the Western Cape. therefore, the findings cannot be generalised. The setting under study is a teaching hospital, which provides care in a larger area than a rural hospital, but less than a Level III hospital. In addition, the findings may differ from what may be obtained from a Level III hospital. The study also involved only 162 respondents whose backgrounds, education levels and areas of assignment differed. Despite the limitations, the study provides valuable information that could help in the promotion of preceptorship.

Benner’s (1982) Novice to Expert model gives advice for job and information growth in nursing practice. It shows that continuous development is paramount in maintaining quality service to clients. The support from organisational structures for ongoing development programmes such as preceptorship within the clinical area is vital in achieving a skilled workforce. Preceptorship programmes need to be implemented and introduced from onboarding of newly qualified nurses. Preceptors need to be identified and encouraged by line managers to fulfil the preceptor role to achieve the objectives of their specific assignment areas. Nominated preceptors need formal training to fulfil their role as preceptor effectively.