Abstract
Background:
A shared understanding of teaching needs is fundamental for effective clinical nursing education. In clinical settings, discrepancies in perception between preceptors and students can hinder learning effectiveness and student satisfaction.
Objective:
To investigate the differences in how clinical nursing preceptors and nursing students perceive teaching needs.
Methods:
An explanatory sequential mixed-method study was conducted with 152 preceptors and 386 nursing students from 5 hospitals in China, utilizing questionnaires, interviews, and focus group discussions.
Results:
Significant differences were observed in the perceptions of teaching needs across 5 dimensions: professional skills, theoretical knowledge, humanistic care, critical thinking, and career development (P < .05). Preceptors prioritized professional skills and theoretical knowledge, while students valued humanistic care and career development more highly. These discrepancies underscore a tension between the evolving pedagogical emphasis on critical thinking and humanistic care in nursing education and the persistent traditional apprenticeship model in clinical settings.
Conclusion:
The multidimensional differences in perceived teaching needs are rooted in this pedagogical tension. To address it, we recommend not only fostering regular communication but also actively innovating teaching models to better align clinical teaching with contemporary educational goals.
Keywords: clinical education, clinical practice, educational models, mixed-methods research, preceptorship
Nursing education combines theoretical knowledge with experiential learning to cultivate professional skills for nursing practice.1 In the clinical internship environment, nurses and teachers are jointly responsible for educating nursing students. The quality of clinical learning is vitally important for preparing for professional practice.2-4 Nursing preceptors are professionals who guide and support the learning process of nursing professionals. In this study, the term “nursing preceptor” refers to a professional who voluntarily assumes responsibility for facilitating clinical student learning and supports, educates, and assists them in transitioning to clinical practice.5-7 This mentorship system is different from other educational methods in that it requires a formal task by a third party, usually a unit supervisor, to establish a student-mentor pair.8,9
Clinical teaching and learning are key processes in nursing practice, cultivating nursing talent and, aiming to help nursing students translate theory into practice, and improve clinical thinking and professionalism.10,11 As the main teachers, preceptors are responsible for important responsibilities, including knowledge transmission, skill guidance, and career direction.12,13 However, because career orientations, professional backgrounds, and development goals differ, perceptions of teaching needs may also diverge between teachers and students, which may impact the teaching effect and the professional identity of nursing students.
Relevant research mainly focuses on a single dimension, such as teaching evaluation,14 teacher ability,15 or learning experience,16 while systematic investigations of the differences in perceptions between teachers and students’ needs are lacking. Therefore, this study adopted a mixed-methods design to examine both the differences between teachers’ and students’ views on clinical teaching needs and the factors influencing these views, focusing on dimensions such as professional skills, theoretical knowledge, humanistic care, critical thinking, and career development. The study aimed to provide a theoretical basis and practical guidance for optimizing teaching modes and improving teaching quality.
Methods
This was an explanatory sequential study using both quantitative and qualitative methods. In this design, qualitative data from interviews and focus group discussions provide a deeper understanding of the initial quantitative data produced from questionnaire responses.17 The complementary nature of these methods effectively addresses the limitations and weaknesses of each research method.18 The study was approved by the Ethics Committee of Changzhou Second People’s Hospital and was registered with the China Clinical Trial Center (Approval No.: [2024]KY002-01; registration number: MR-32-24-025610). All participants provided written informed consent.
Data Collection
Quantitative data
This study was conducted in 5 grade A tertiary general hospitals in Jiangsu Province, China, using multistage stratified sampling. Participants were recruited from selected departments. Inclusion criteria were: (a) preceptors: registered nurses (RNs) with ≥ 3 years of clinical and ≥ 1 year of teaching experience; (b) students: full-time undergraduate nursing students with ≥1 month of clinical internship.
Data were collected from March to May 2024. A total of 170 questionnaires were distributed to preceptors and 420 to students. Questionnaires were deemed invalid if they contained inconsistent responses or if all selected answers were identical. Valid responses were obtained from 152 preceptors (89.4% response rate) and 386 students (91.9% response rate).
A demographic and professional characteristics questionnaire was developed to collect participant information. The researchers developed a preliminary questionnaire on perceptions of clinical teaching needs through a process that included a literature review, expert interviews, and focus group discussions. The questionnaire was modified and improved using the Delphi method, and 2 versions were generated—an instructor and a student version. It contains 45 items across 5 dimensions (professional skills, theoretical knowledge, humanistic care, critical thinking, career development), rated on a 5-point Likert scale (1 = very unimportant to 5 = very important), plus 10 items on teaching method preferences.
Qualitative data
Students were purposefully selected from the quantitative phase participants using maximum variation sampling until information saturation was achieved. A total of 35 participants engaged in the qualitative phase. Qualitative data were collected from May to July 2024. All sessions were conducted in person by trained researchers after obtaining informed consent, which included permission for audio recording and confidentiality assurances.
Individual interviews were conducted with 35 participants, comprising both preceptors and students, using a semi-structured guide. Each interview lasted between 30 and 60 minutes and was held in a private setting, with probing questions employed to facilitate in-depth exploration of the topics. Questions for the interview are available in the Supplemental Digital Content, Interview Questions available at: http://links.lww.com/NE/C237. Subsequently, focus group discussions were held with a subset of recontacted participants, who were randomly assigned to 7 groups—3 for preceptors and 4 for students, each containing 4 to 5 individuals. These sessions, lasting 60 to 90 minutes, were designed to explore several key areas. The discussions addressed primarily: (1) clinical teaching needs and experiences, (2) perceived differences in teacher-student needs, (3) an analysis of root causes of these discrepancies, and (4) recommendations and strategies to coordinate needs.
Data Analysis
Quantitative analysis
Quantitative data were analyzed using SPSS 26.0 software (IBM Corp, Armonk, NY, USA) after being verified by 2 researchers. Measures with normal distribution are expressed as (), and intergroup comparisons were made using independent samples t-tests. Categorical data are presented as frequency (n) and percentage (%), with a χ2 test for group comparisons. Ordinal data were analyzed using rank-sum tests. Multivariate analysis employed multiple linear regression, with a P-value of < .05 considered statistically significant.
Qualitative analysis
The interview results with each participant were summarized. Qualitative data (individual interviews and focus group discussions) were managed and thematically analyzed using NVivo 12.0 software (QSR International, Burlington, MA, USA). Within 24 hours after the interview, 2 members of the research group independently converted the recorded content into text and also recorded nonverbal behavior.
Results
Participant Characteristics
This study included 152 preceptors, of whom 139 were female (91.4%), with an average age of 32.7 ± 5.6 years. One hundred twenty-eight teachers had a bachelor’s degree (84.2%), and 24 had a master’s degree or above (15.8%). They had an average working duration of 9.4 ± 4.2 years, and an average of 4.8 ± 2.5 years of teaching experience. There were 386 nursing students, including 354 females (91.7%) and 32 males (8.3%), with an average age of 21.9 ± 1.2 years and an average internship duration of 5.2 ± 2.7 months.
Quantitative Findings
Significant differences were found in the 5 dimensions of needs between preceptors and nursing students (P < .05) (Table 1). The preceptors placed greater emphasis on professional skills (4.72 ± 0.31) and theoretical knowledge (4.56 ± 0.42) compared to nursing students (4.35 ± 0.47 and 4.12 ± 0.53, respectively). Conversely, nursing students showed a stronger demand for humanistic care (4.81 ± 0.29) and career development (4.63 ± 0.38) than instructors (4.43 ± 0.45 and 4.21 ± 0.50, respectively). Statistically significant differences were observed in critical thinking requirements between the 2 groups (preceptors: 4.38 ± 0.48; nursing students: 4.26 ± 0.51), but they were relatively minor.
Table 1.
Comparison of Teaching Needs Between Preceptors and Nursing Students
| Group | Professional skills | Theoretical knowledge | Humanistic care | Critical thinking | Career development |
|---|---|---|---|---|---|
| Preceptor | 4.72 ± 0.31 | 4.56 ± 0.42 | 4.43 ± 0.45 | 4.38 ± 0.48 | 4.21 ± 0.50 |
| Nursing Student | 4.35 ± 0.47 | 4.12 ± 0.53 | 4.81 ± 0.29 | 4.26 ± 0.51 | 4.63 ± 0.38 |
| t | 9.46 | 9.19 | −10.07 | 2.52 | −9.81 |
| P | <.001 | <.001 | <.001 | <.012 | <.001 |
Significant differences were found in teaching method preferences between preceptors and nursing students (P < .05) (Table 2). Preceptors tended to prefer bedside demonstrations (68.4%) and case teaching (61.8%), whereas nursing students preferred scenario simulations (72.5%) and group discussions (65.2%).
Table 2.
Comparison of Teaching Method Preferences between Preceptors and Nursing Students, N (%)
| Group | Bedside demonstrations | Case teaching | Problem teaching | Method of lecture | Scenario simulation | Group discussion | Autonomic learning | Reflection journal | Media instruction | Project learning |
|---|---|---|---|---|---|---|---|---|---|---|
| Preceptor | 104 (68.4) | 94 (61.8) | 86 (56.6) | 73 (48.0) | 65 (42.8) | 58 (38.2) | 43 (28.3) | 39 (25.7) | 37 (24.3) | 28 (18.4) |
| Nursing student | 183 (47.4) | 196 (50.8) | 154 (39.9) | 113 (29.3) | 280 (72.5) | 252 (65.2) | 237 (61.4) | 182 (47.2) | 173 (44.8) | 165 (42.7) |
| x2 | 19.37 | 5.46 | 12.54 | 17.01 | 41.09 | 32.50 | 47.28 | 21.05 | 19.41 | 27.54 |
| P | <.001 | <.019 | <.001 | <.001 | <.001 | <.001 | <.001 | <.001 | <.001 | <.001 |
The results of the univariate analysis of preceptors’ perceptions of teaching needs are presented in Supplemental Digital Content Table 1, available at: http://links.lww.com/NE/C218. Variables including age, educational background, working seniority, and teaching experience showed statistically significant differences (P < .05). The corresponding analysis for nursing students’ perceptions is shown in Supplemental Digital Content Table 2, available at: http://links.lww.com/NE/C219. Statistically significant differences were found for gender, internship duration, future career planning, and undergraduate academic ranking (P < .05).
Multiple linear regression analyses were conducted using the scores from the 5 need dimensions as dependent variables and the 4 variables that showed statistical significance in univariate analyses as independent variables. For preceptors, educational background, working seniority, and teaching experience were significant factors for both the professional skills and theoretical knowledge dimensions; educational background, working seniority, and age for the humanistic care dimension; educational background and teaching experience for the critical thinking dimension; and educational background and age for the career development dimension (see Supplemental Digital Content Table 3, available at: http://links.lww.com/NE/C239). For nursing students, internship duration and gender were significant for the professional skills and humanistic care dimensions; internship duration and undergraduate ranking for the theoretical knowledge dimension; undergraduate ranking and future career planning for the critical thinking dimension; and internship duration, future career planning, and undergraduate ranking for the career development dimension (see Supplemental Digital Content Table 4 available at: http://links.lww.com/NE/C221).
Qualitative Findings
The empirical data from 35 interviews and 7 focus group discussions were organized into 3 key findings that explain the root causes of discrepancies in teaching needs between preceptors and nursing students, along with practical solutions. The results indicated that differences in teaching priorities exist between preceptors and nursing students, evolving professional trajectories contribute to perception gaps, and effective communication can mitigate these differences.
Differences in Teaching Priorities between Preceptors and Students
Differences in learning focus
The preceptors emphasized the standardization of basic nursing skills and the mastering of nursing procedures for common diseases, whereas the nursing students emphasized the opportunity to operate special nursing techniques and the integration and application of interdisciplinary knowledge. One respondent said: “In the ward, I often see preceptors performing procedures with great proficiency, but when asked about the theoretical basis behind them, their explanations are not sufficiently in-depth. I want to know ‘why do this’ rather than just ‘how to do it’.”
Expectations for instructional methods
The preceptors tended to use the traditional teaching model of “demonstrate, imitate, and feedback,” emphasizing learning in practical work; whereas the nursing students expected more interactive and participatory teaching activities, and considered the opportunities for reflection and discussion. A preceptor stated: “The pace of clinical work is fast, and there are so many patients that we don’t have much time to organize discussion activities. The most efficient way is to show them and let them practice under our supervision.” A student commented: “I wish we could have more opportunities for discussion instead of just following the preceptor’s instructions. Last week, our department encountered a complex wound care case. I reviewed some literature and found different treatment options, but we didn’t get the chance to discuss them in depth with the preceptor.”
Evaluation criteria
The preceptors attached importance to operational standardization and work efficiency, whereas the nursing students felt that cultivating comprehensive ability and personalized growth was more important. One preceptor stated: “When evaluating an intern’s performance, I prioritize whether their operations follow standard procedures and complete tasks according to established protocols. This directly impacts patient safety and allows no room for carelessness. The second consideration is work efficiency. Given the heavy workload in clinical nursing, sluggish execution could disrupt the team’s workflow.” A student commented: “I hope preceptors can see my progress and efforts, not just the final results. Everyone starts from a different point and has different learning styles. I may not be as fast as other students in some operations, but I am better at communicating with patients and can get better cooperation.”
Evolving Professional Trajectories
Career progression stages
The preceptors were mindful of standardization, safety, and efficiency. However, the nursing students were in the period of professional exploration and consider their own interests. One respondent said: “We hope to explore different fields and discover our interests and strengths. I particularly like innovative content…but preceptors prefer us to follow a routine and focus on routine nursing work.”
Educational background changes
The transformation of the nursing education model has led to a new generation of nursing students who are being taught more critical thinking and humanistic care than previously, while many preceptors have experienced traditional education focused on skills training. A student said: “We were taught holistic and evidence-based nursing in school, emphasizing critical thinking and humanistic care. However, when we entered the clinical setting, we found that many preceptors still followed traditional task-oriented models in their teaching and practice.”
Environmental pressures
The pressure of the medical environment encourages teaching preceptors to pay more attention to the practical skills nurses need immediately, while allowing the nursing students to share part of the work. In contrast, the students expect to develop professional abilities, which can lay a strong foundation for their future career development. One preceptor stated: “On average, each nurse in our department is responsible for 10-12 patients. The work is very intense. Under such circumstances, we need students to be able to quickly master the basic skills and share part of the work.”
Effective Communication can Mitigate Differences
Promote interactive communication
Teaching and learning based on the needs of both parties can help improve the teaching enthusiasm of preceptors, stimulate the learning of nursing students, and promote mutual understanding. A student said: “At last month’s exchange meeting, I learned about the work pressure and assessment requirements of my preceptors for the first time, which gave me a new understanding of their teaching methods.”
Build a flexible teaching plan
A teaching plan should be developed that considers the expectations of both parties, including core competency requirements and individual needs. A student said: “The new teaching plan gives us more space to choose. For example, I am particularly interested in wound care. The preceptor will arrange for me to participate in the care of some special wounds. This targeted guidance is very helpful to me.”
Innovate the teaching evaluation system
A diversified and developmental evaluation system, combining process and outcomes evaluation, should be established. A student commented: “The new evaluation system is more comprehensive and objective, focusing not only on the final results but also on the learning process.”
Discussion
Several key findings emerged from our analysis. Significant differences were found in the perceived needs of preceptors and nursing students in 5 dimensions: professional skills, theoretical knowledge, humanistic care, critical thinking, and career development, revealing distinct multidimensional characteristics. The preceptors emphasized professional skills and theoretical knowledge more than the nursing students, whereas the nursing students emphasized humanistic care and career development more than the preceptors.
In terms of teaching method preferences, the preceptors tended to prefer traditional and teacher-led methods, whereas the nursing students preferred interactive and participatory teaching methods. The interview results further revealed that different professional stages, educational backgrounds, and clinical environment pressures were underlying reasons for these differing perceptions. The traditional internship evaluation system is characterized by its one-sided and summative nature, based primarily on preceptors’ subjective assessments of students’ test results and daily performance. However, the nursing interns emphasized the need for more comprehensive evaluations that encompass professional knowledge, practical skills, communication abilities, teamwork, and innovative thinking. They emphasized the need for open communication.
The findings of this study align with current understanding. Preceptors engage in demanding clinical practice while being responsible for teaching, thus facing greater work pressure.19 With limited time and energy for targeted, participatory teaching approaches, they tend to favor time-efficient traditional lecture-based instruction that prioritizes professional skill development and theoretical knowledge. In contrast, nursing students focused on patient experiences and long-term career growth, as well as delivering high-quality care services. This creates a gap in instructional needs between educators and trainees.20 The results indicate that students generally prefer interactive and participatory teaching methods over passive lecture delivery, emphasizing the need for diversified teaching strategies rather than single traditional approaches.21
The observed differences stem from the distinct experiences, roles, and responsibilities of preceptors and students. With greater teaching experience and familiarity with clinical work, preceptors tend to prioritize foundational skills and standardized training. Furthermore, China’s nursing shortage often prevents the assignment of dedicated preceptors, resulting in students “following a shift schedule rather than a consistent preceptor.” This disrupts teaching continuity and impedes structured educational planning.22 In such settings, students may be expected to quickly acquire technical skills to support clinical workloads—an approach at odds with the educational goal of fostering comprehensive professional development. In recent years, nursing education has increasingly emphasized critical thinking, humanistic care, and professional autonomy.23 This focus has created tension between the learning expectations of new-generation nursing students and traditional clinical teaching models. If preceptors do not continually update their knowledge amid rapid technological and medical advances, they may struggle to meet students’ growing demand for new competencies.24
To bridge the identified gap, we suggest a shift towards an interactive communication teaching model. This student-centered approach, built on 2-way interaction,25 would require practical strategies such as scheduled meetings to discuss needs, continuous feedback, and the systematic use of reflective journals and needs questionnaires. These measures would help develop mutual expectations, promote shared understanding, and provide preceptors with concrete references for tailoring their teaching.26
Limitations
This study has several limitations: First, the sample was limited to 5 tertiary hospitals in China, which may not fully represent all medical institutions. Second, because this was a cross-sectional study, which collects data at a single time point, we are unable to assess how understandings of teaching needs might change over time. Third, it did not explore differences in demand perception across specialized nursing fields. Future research should expand the sample size, conduct longitudinal tracking studies, and develop tailored approaches for different medical specialties.
Conclusion
Multidimensional differences were found in the understanding of teaching needs between preceptors and nursing students. Preceptors focused more on professional skills and theoretical knowledge, and preferred traditional teaching methods. In contrast, nursing students emphasized humanistic care and career development, and the need to participate in interactive teaching. These disparities stemmed from multiple factors, including career stages, educational backgrounds, and clinical environments. Thus, we recommend fostering structured communication, designing adaptive teaching and evaluation methods, strengthening mentorship training, and optimizing a learner-centered clinical education model.
Supplementary Material
Footnotes
Early Access: February 9, 2026
First author: Guiling Liao, RN
We also thank the funding support from the Key project of cooperation between colleges and universities of Changzhou University (CDHL202401), Changzhou Municipal Health Commission Science and Technology Project (ZD202410), Science and Technology Project of Changzhou Health Commission (QN202356). Education Research Project of Nanjing Medical University (2023ZC087). Nursing program of Changzhou Medical Center, Nanjing Medical University (CMC2024HL03).
All authors confirm that they have no conflicts of interest.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.nurseeducatoronline.com).
Cite this article as: Liao G, Liu Z, Zhang Z, et al. Differences between preceptors and nursing students in understanding teaching needs: a mixed methods study. Nurse Educ. 2026;51(3):E188–E193. doi:10.1097/NNE.0000000000002114
Contributor Information
Guiling Liao, Email: guilingliao@hunnu.edu.cn.
Zhiqun Liu, Email: 283712332@qq.com.
Zhiqiao Zhang, Email: 17775819638@163.com.
Jingjing Shang, Email: shang0308@126.com.
Huan Wan, Email: wanhuan1125@hunnu.edu.cn.
Jiapei Yao, Email: yaojiapei@njmu.edu.cn.
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