Clinical preceptor performance in Indonesian hospitals: A longitudinal analysis of workforce-related determinants

Preceptor performance is a key driver of clinical education quality; however, the influence of organizational factors on preceptor effectiveness remains understudied. The aim of this study was to examine whether communication quality mediates the relationships of organizational trust and supervisory support with preceptor performance and whether self-efficacy moderates the communication quality-performance pathway. A three-wave longitudinal study was conducted among clinical nursing preceptors in 12 teaching hospitals in Aceh and Lampung, Indonesia. The final analytic sample comprised 452 preceptors with complete data across all three waves. Organizational trust and supervisory support were measured at baseline, communication quality three months later, and preceptor performance six months after baseline. Multi-source performance data included preceptor self-report, student/preceptee evaluations, and supervisor ratings. Structural equation modeling tested direct and indirect effects, and PROCESS Model 14 tested moderated mediation. Internal consistency was high across instruments (Cronbach's alpha=0.86–0.93). Organizational trust (standardized β=0.31, p<0.001) and supervisory support (standardized β=0.28, p<0.001) significantly predicted preceptor performance. Communication quality partially mediated both relationships, with standardized indirect effects of β=0.14 (95% bootstrap CI: 0.08–0.21) for organizational trust and β=0.11 (95% bootstrap CI: 0.06–0.18) for supervisory support. Self-efficacy significantly moderated the communication quality-preceptor performance relationship (unstandardized B=0.18, p=0.003), with stronger conditional indirect effects at higher self-efficacy. Model fit was adequate (comparative fit index (CFI)=0.95; root mean square error of approximation (RMSEA)=0.04). These findings support structured mentoring and supervision, transparent trust-building practices, regular bidirectional feedback, and preceptor development activities designed to strengthen teaching self-efficacy.