Nursing Integrative Practicum Program Establishing an Effective CTA to Student Relationship

Research into nursing preceptorship has identified several variables affecting the development of the preceptorship relationship. Each of the following variables will be discussed in terms of student and clinical teaching associate (CTA) participation.

  • Trust
  • Honest communications
  • Encouragement
  • Mutual respect and acceptance
  • Clearly defined expectations
  • Disruption of usual support systems
  • Mutual sharing of self and experience


Trust is crucial to all of the above variables. The attainment of trust, both by the student and the CTA nurse, is usually the turning point of the relationship. Integral to the development of your trust in the student is the amount of self confidence (self-trust) s/he exhibits. If a student is highly anxious it takes a greater amount of direct observation and feedback to not only calm the student but also to calm your fears that the student's skills may be as shaky as his/her affect. If your student seems unduly anxious after the first few shifts consult with the faculty member. Trust will be gained as you see the student "perform" procedures and evaluate how s/he answers your "what if" questions. Through the observation of the student's clinical behaviors (skills, priority setting, honesty and self-awareness of own limits) confidence and trust established.

The student will sense your support and gain trust in you when you don't expect the student to be perfect, and give honest feedback (both positive and negative). A characteristic of adult learners is that they avoid situations where they will be publicly seen as "wrong" or inadequate. How and where you provide feedback is important to the formation of trust the student will build in you as their mentor.

Honest Communication

Honest communication is as important as trust in establishing an effective preceptor relationship. Without honest communications the establishment of trust is not possible.

Before spring term begins, the faculty will specifically stress to the students the importance of honest and open communications with their CTAs. They will know that any attempt to under-report their own problems or mistakes will severely compromise the establishment of trust.

They are aware that in any clinical situation frank dishonesty is grounds for dismissal. The majority of students are very open and find greater fault in their actions than we ever do.

It will also be stressed that they can be an equal partner in this relationship only if they are willing to share their own thoughts and feelings.

The faculty would like to remind CTAs that students pay close attention to the non-verbal communications of their CTAs. Realize how important any kind of feedback is to the student, especially at first when the student's confidence may be low.

The following guidelines for giving feedback are ones you probably use every day in delegation activities, so accept them as a review:

  • Positive feedback about specific student behaviors ("You calmed that patient's mother well") is more valuable than global statements ("good job today").
  • Ask the student's perception of any behavior that concerns you. Encourage the student to analyze the situation and problem-solve corrective actions for themselves.
  • Don't criticize in front of the patient or other staff. Pick a private moment and space.
  • Watch your non-verbal communication - A negative mannerism or tone can easily undue any positive verbal feedback.
  • Identify the behavior to be improved specifically as possible. Avoid judgmental terms. Focus on the behavior, not the person.

Ex: "You made three trips to the med cart to give Mrs. J. her 0900 meds. You will need to eliminate some of those extra steps in order to get all your am meds passed on time"
NOT: "You're really slow. How did you ever get to be a second year student?"

  • Don't give feedback when you are angry. Anger distorts our view and interferes with effective communication. Remember to use "I" language, not the accusative "you" language.
  • Focus your critique on only one issue at a time. Don't bring in the "baggage" of past behaviors.
  • Recap the positives as well as the negatives. Try to end on a positive note with goals being set for improvement. That way the student will know you are still willing to work with them on this issue.


Encouragement maintains the energy for student growth and exploration. Those brief yet frequent short phrases acknowledging the little successes of a clinical day provide a boost in a student's drive for improvement. Encouragement is also conveyed in a less direct but often more powerful means as the CTA's attitude increasingly conveys confidence in the student's abilities.

Mutual Respect and Acceptance

The CTA is expected to be a resource person, a participant in the student's learning process, and not so much an authority figure "in charge" of the learning process. Viewing the student as an adult learner responsible for his/her own learning process greatly enables a relationship of mutual respect and acceptance. Most students begin their integrative practicum with a great appreciation for the gift of the time and talents that the CTA gives. The student is most frequently in awe of the CTA and may be timid in speaking of his/her personal life and professional goals. It is often the CTA's first move to begin the process of mutual sharing of self, personal and professional experiences, and feelings/ emotions regarding the clinical experiences you two share. The sense of trust between student and CTA often increases in proportion to how much they are willing to share with each other. Discussing the usual feelings of anxiety at the prospect of a first RN job and the typically volatile feelings of euphoria to dread as nursing school ends can help acknowledge the student's professional growth.

Clearly Defined Expectations

Clearly defined expectations are vital for reducing the uncertainty of both roles. For CTAs new to this role questions will persist even after the workshop about time commitments, requirements for giving verbal feedback and written evaluations, themselves as role models. Even experienced CTAs may question the expectation to help guide this unknown student into an entry-ready graduate nurse with the realities of current nursing staffing patterns. You have read the CTA Roles and Responsibilities but faculty always find that the excellent caliber of nurses who volunteer to precept take on more than our expectations. Remember how you felt as you graduated and don't expect this student to feel any more prepared. The students are not expected to have your level of skill at the completion. Students need a clear understanding of your expectations. Many have not done Cooperative Education or had a long-term working relationship with one nurse. Discussing what you expect of them and what s/he can expect from you is vital early in the integrative practicum experience. The student needs to hear that you do not expect them to be perfect, to never make a mistake, just as they cannot hold that expectation of you. The student needs to hear that their performance is not expected to equal that of yours. Such would be unfair to student and indirectly insulting to you as an experienced nurse.

Disruption of Usual Support Systems

Disruption of usual support systems can occur for both CTA and student. For the CTA, the usual co-worker support system may not function adequately if the co-workers do not understand the realities of being a CTA. Confidentiality issues regarding student progress also limit interchange with co-workers. Faculty will try to be an added source of support.
Students usually miss the support of their peers if they are the only student in the agency, or on that shift and unit. This disruption can add to their anxiety about their progression and experiences. Encourage students to occasionally coordinate their meal break with other students on different units. Once a week the students will meet at LCC to discuss their experiences and hopefully regain some peer support.


The development of trust and mutual respect along with the use of honest communication, mutual sharing, ongoing encouragement, and clearly defined expectations can help foster a rewarding CTA/student relationship. This allows the focus and energy of the experience to be directed toward greater learning experiences for the student and greater satisfaction on the part of the CTA nurse.