Preceptorship of new graduate nurses in Saudi-Arabian intensive care units – An ethnography of relationship dynamics

Abstract

This exploratory qualitative research aims to provide an in-depth understanding of current practice within the relationship between newly-qualified Saudi Arabian graduate nurses and their preceptors during their period of preceptorship in an intensive care setting in Saudi Arabia. Fieldwork was conducted to gather information on the day-to-day working practices of 5 pairs of new graduate nurses (NGNs) and their preceptors in the hospital ward (ICUs) of King Abdulaziz Medical City. Each pair was observed for a period of 5 hours per day over the course of 4 days. Formal and informal conversations with the respondents were also captured as part of the data collection process in addition to face-to-face semi-structured individual interviews. A thematic analysis of the data revealed that the practice of professional values reflects social structures in the Saudi context, which shapes perceptions about professionalism and workplace relations. There were also tensions in the understanding of preceptors clinically and educationally, in terms of what needed to be done and what needed to be learned. In addition, the lack of institutional support and formal processes undermined the value of preceptors' work. This also had implications for commitment and required both preceptors and preceptees to make additional efforts to ensure that the preceptorship is successful. There were no formalised systems for training preceptors to make the preceptorship process more effective. Even preceptors who had been performing their role for more than a decade tended to have chaotic and informal approaches to preceptorship which veered between good practice and being actively unhelpful to preceptees. Preceptors perceived as successful by preceptees relied on their interpersonal skills and nursing ability to provide space and time for preceptors to learn, but this depended on the ability of the preceptor rather than any institutional system to produce effective preceptors. As well as the lack of appropriate training for preceptors, there was also minimal support from the administration for the preceptorship process. This study also revealed that the exertion of power and authority can have negative impacts and caused barriers to effective communication in the workplace, particularly between preceptor and preceptee. Language was used to facilitate learning and provide pastoral care and constructive feedback. Language barriers, on the other hand, played a role in undermining communication and relationships. Communication was used to exert power, humiliate, and reinforce hierarchical roles in ways that hindered the success of the preceptorship relationship via conflict. Some preceptors developed friendly relations with their preceptees, mediated by trust. This study establishes important findings regarding the tensions produced in the preceptor-preceptee relationship by differences of language and culture, as well as the tendency for the Saudization policy to lead to divisions between Saudi and non-Saudi nurses.

More information

Identifiers

ORCID for Amal Ali Alasmari: orcid.org/0000-0002-9457-3242

ORCID for Eloise Monger: orcid.org/0000-0003-2799-0596

ORCID for Ivaylo Vassilev: orcid.org/0000-0002-2206-8247

Catalogue record

Export record