Lessons About Boundaries and Reciprocity in Rural-Based Preceptorships

Abstract

This paper is a report of a photovoice study of rural nursing preceptorship experiences in Western Canada.

Background: Rural preceptorship placements are a vital means of recruiting new nurses to rural settings. Contextual knowledge is essential for students undertaking such preceptorships, as well as for educators, and researchers. It is widely known that rural nurses and their clients share a culture of self-reliance, adaptability and flexible professional boundaries, but the role of preceptors in conveying this culture to students warrants deeper exploration.

Methods: Four nursing students and their four rural preceptors (nurse educators) took part in an eighteen month photovoice study, facilitated by the researchers, between 2009 and 2010. Coding of the data and collaborative thematic analysis with the participants yielded a number of conceptual categories, which formed the basis of a photographic narrative of rural nursing preceptorship.

Findings: Nursing students learn to manage the competing scripts of policy and community ethos during rural preceptorships. Rural nurses track between professional and personal roles both on and off the job. Familiarity with clients as neighbours, friends and family can lend added personal significance to caregiving, but it can also lead to stress and role dissonance. As community members, rural nurses take part in a tacit economy of reciprocal giving.

Conclusion: Rural nurse preceptors teach students that flexible boundaries and reciprocity are aspects of a community code underpinning rural clinical practice. This code, and the social capital it represents, should be factored into nursing curricula as an essential component of rural community wellness.