PROFESSIONAL
The role of the sign-off mentor
in the community setting
Karen Cooper
Karen Cooper is Lecturer in Adult Nursing, School of Health and Social Care, Bournemouth University
 Email: kcooper@bournemouth.ac.uk
N ursing is a practice-based discipline, and 50% of
current pre-registration nurse education takes
place in the practice settingacknowledging the
fact that practice experience is one of the most important
aspects of preparation for registration (Pellatt, 2006). Studies
have consistently shown that students also perceive these
experiences to be the most valuable aspect of their nursing
programme (Papp et al, 2003; Shen and Spouse, 2007;Wood,
2010) and that experience influences their choice of future
employment (Shelton and Harrison, 2011; Marshall and
Shelton, 2012). It is also recognised as a valuable resource
in preparing students for the profession and for the acquir-
ing of knowledge, skills and attributes to become a safe and
competent practitioner (Midgley, 2006; Chan and Ip, 2007;
Salamonson et al, 2011).
Nursing education
Recent changes to pre-registration nurse educationas set
out in the Nursing and Midwifery Council (NMC) Standards
(2010a)aim to equip nurses to lead and deliver care within
a modern health-care system whereby the minimum aca-
demic award for pre-registration nursing programmes is a
degree. A report by the Prime Ministers Commission on the
Future of Nursing and Midwifery in England (2010) speci-
Abstract
In an move to identify nursing as an all-graduate profession, the Nursing and
Midwifery Council standards identified that future nurses need to be equipped
with the skills and knowledge to lead and deliver high-quality care. In order
to have these skills within the changing context of health care, students need
to experience care delivery across a range of community, hospital and other
settings. Students have to undertake a final clinical placement of 12weeks
at the end of their programme, commonly called a consolidation placement,
and are allocated a sign-off mentor to confirm they meet the requirements
for entry to the register. Placement capacity within primary care settings
continues to be a challenge alongside the need for providing a sign-off
mentor. This article discusses some of the challenges and opportunities of
the role of the sign-off mentor and the potential impact for encouraging newly
qualified recruitment in this area.
KEY WORDS
w Mentorship w Sign-off mentor w Consolidation placement
w Community placements w Quality assurance
192
fies that degree programmes should equip nurses and mid-
wives to work better in many settings and roles, and enable
them to draw on a wider repertoire of knowledge and skills,
including the capacity to make complex assessments, clinical
decisions and deliver therapeutic interventions in a variety of
situations. Newly qualified nurses should be able to practice
safely and effectively to meet the needs of the people in
their care as the delivery of health-care services continues to
evolve (Glasper, 2010), recognising that health-care delivery
is continually becoming more complex and extends beyond
acute care settings (Lavizzo-Mourey, 2012).
The NMCs (2010a) commitment is that newly qualified
nurses will be critically thinking, caring and competent prac-
titioners, enabling the delivery of high-quality care. Nurses
will be able to meet the challenges of an ageing population,
managing long-term conditions effectively and handling the
increased care delivery outside of the hospital setting.
Mentorship
Mentorship became integral to pre-registration education
in the late 1980s (Andrews and Wallis, 1999) alongside
Project 2000 and the Governments policy statement on
the direction of nursing in the UK (UK Central Council
for Nursing, Midwifery and Health Visiting, 1986). Prior
to this, little attention was given to student learning, with
the focus being on getting the work done (Melia, 1987).
The new model of education marked a shift from training
to educating so that a knowledgeable doer (Bradshaw and
Merriman, 2008) would be produced. All students have a
designated mentor who is responsible for the learning and
assessing in practice. A mentor is a nurse who has undergone
specific preparation and is defined as someone who facili-
tates learning, supervises and assesses students in a practice
setting (NMC, 2008, p.45).
Mentorship is viewed as being pivotal to the learning
experience of the student (Gopee, 2011) and an essential
resource in supporting and facilitating the development of
future nurses (Royal College of Nursing (RCN), 2007).
All mentors have a major role in assessing the competence
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of students, ensuring they are fit for practice, purpose and
award during the programme and at the point of regis-
tration (NMC, 2010a). They serve as gatekeepers to the
profession (Luhanga et al, 2008), with demonstration of
competence being a requirement for entry to the NMC
register. This is a holistic concept that was defined by the
British Journal of Community Nursing April 2014 Vol 19, No 4

NMC (2010a, p.11) as follows:
the combination of skills, knowledge and attitudes,
values and technical abilities that underpin safe and
effective nursing practice and interventions.
As Black (2011) has highlighted, the absence of any one of
these elements can mean failure in the final placement.
It has been shown that effective mentoring and supervi-
sion of students contributes to a positive experience that
enhances students learning (Brammer, 2008). Effective men-
toring has been shown to benefit individualsboth student
and mentorin fostering professional growth in knowledge,
skills, attributes and practice (Carr, 2008; Nettleton and Bray,
2008; Casey and Clark, 2011) and is essential in developing
the future generation of nurses (RCN, 2007). The Willis
Commission (2012) report clearly identified the importance
of high-quality mentorship when discussing the future of
nurse education, and observed that students believe their
placement experiences to be directly related to the quality
of their mentorship.
Sign-off mentor
The NMC (2008) agreed mandatory requirements for nurs-
ing, whereby sign-off mentors who have met additional
criteria (Box 1) must make the final assessment of practice. A
sign-off mentor is:
a nurse or midwife designated to sign off pro-
ficiency for a particular student at the end of
a programme must have been supervised on at
least three occasions for signing off proficiency by
an existing sign-off mentor or practice teacher.
(NMC, 2008, p.7)
Nurses are required to confirm that they have met all the
requirements for safe and effective practice for entry to
the register, being fit for practice, purpose and award (Platt,
2002). This is defined as follows:
w Fitness for practicestudents have developed the requi-
site skills for professional registration
w Fitness for purposestudents are fit for employment,
including attendance
w Fitness for awardstudents have met the required aca-
demic standards.
Judging this requires an overall decision to be made,
informed by evidence from a variety of sources and docu-
mented in the ongoing achievement record, together with
the mentors own observations of working with the student.
The sign-off mentor has to be undertaken once all of the
hours of the programme have been completed. This is done
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in order to address situations where students had previously
passed their proficiencies, had hours outstanding or where
concerns were raised.
Robinson et als (2012) report on sustaining mentorship
identifies some key skills and desirable attributes for a sign-
off mentor (Table1).
British Journal of Community Nursing April 2014 Vol 19, No 4
PROFESSIONAL
Challenges
One immediate challenge is ensuring that enough sign-off
mentors are made available to students in their final place-
ment. Glasper (2010) identified that this was a challenge for
trusts, and difficulties have been experienced in coordinat-
ing three people (the student, the trainee sign-off mentor
and the observing sign-off mentor) to meet together, par-
ticularly in community settings (Robinson, 2013).
In response to these difficulties, the NMC (2010b) has
clarified that future sign-off mentors have to be signed off
on at least three occasions, but the first and second supervi-
sions could be undertaken by a variety of other methods
(for example, simulation or role play) determined by local
education providers. The final supervision for signing off
proficiency remains the same and must be with an actual
student in practice.
The NMC (2008) also set the requirement for the sign-
off mentor in relation to the time needed to reflect, give
feedback and document students achievements in the cur-
rent placement. The NMC (2008) requirement for all stu-
dents is that, when giving direct patient care in the clinical
setting, 40% of the time is spent being supervised directly
or indirectly by a mentor. In addition to this 40%, when
students are in their final placement, the sign-off mentor
is required to undertake a minimum of 1 hour per week
of protected time with the student (Gopee, 2011). This is
to ensure that any decision on the students proficiency
is not unexpected.The standards allow that the time may
be reduced later in the placement as the student becomes
more confident and competent. The issue of time con-
straints has been documented as an issue (Rooke, 2013),
acknowledging the emotional aspects involved if students
are underachieving in the final placement. Rookes (2013)
evaluation of the role identified some concerns that deci-
Box 1. Criteria for sign-off mentor
w Identified on the local register as a sign-off mentor or a practice teacher
w Registered on the same part of the register
w Working in the same field of practice as that in which the student intends
to qualify
w Clinical currency and capability in the field in which the student is being
assessed
w A working knowledge of current programme requirements, practice
assessment strategies and relevant changes in education and practice for
the student they are assessing
w An understanding of the NMC registration requirements and the contribu-
tion they make to the achievement of these requirements
w An in-depth understanding of their accountability to the NMC for the deci-
sion they must make to pass or fail a student when assessing proficiency
requirements at the end of a programme
w Been supervised on at least three occasions for signing off proficiency by
an existing sign-off mentor, two of which can be undertaken by simulation
Source: NMC (2008)
193
PROFESSIONAL
sions may be left for the sign-off mentor, rather than address-
ing concerns at an earlier stage. This would support Duffys
(2003) findings, which showed that students may be given
the benefit of the doubt, with responsibility and account-
ability being passed on to other parties.
Middleton and Duffy (2009) also found that there were
concerns regarding the emphasis placed upon the sign-off
mentor in terms of accountability and the feeling of being
pressurised that resulted. Glasper (2010) also highlights the
reliance on the sign-off mentor who sanctions the students
entry onto the NMC register. However, Blacks (2011) study
found that although anxiety was present, mentors were able
to manage this situation when they felt it was morally right.
The most important factor was wanting to be a mentor and
commitment to ensuring fitness to practice, offsetting the
barriers of time and support.
It therefore seems that clear documentation regarding
how the student is progressing is essential, particularly at the
mid-point interview. This documentation is vital for any
student, both for their own development and as evidence for
any appeals or fitness-for-practice proceedings. Heaslip and
Scammell (2012) found in an evaluative study that student
and mentor perceptions did not always match in terms of the
feedback given. Clynes and Rafferty (2008) also found that
feedback was often given towards the end of the placement,
meaning that students found it difficult to make improve-
ments in the time remaining. Clynes (2008) recognises that
giving feedback is challengingparticularly as it can impact
Table 1. Skills and desirable attributes for
sign-off mentors
Skills Desirable attributes
Good communication and interper- Having an interest and aptitude for
sonal skills teaching
Supporting the student in skill Being self aware and reflective
development
Providing constructive feedback Being fair, consistent, encouraging
and thoughtful towards students
Identifying areas that need further Having a high level of commit-
development ment in view of the requirement
of a 1-hour meeting every week
throughout the placement
Prioritising and planning action Keeping aware of changing staff
with students carefully considering circumstances so that new
their progress sign-off mentors could be
developed to maintain capacity
Managing difficult situations such
as behaviour regarded as
unacceptable by the third year
To be able to stand back and
recognise that students who
appear overconfident might be
covering up a lack of competence
Source: Robinson et al (2013, p.1067)
194
on the mentoring relationshipbut reinforces that it is
essential for any feedback to be specific, timely, and both
verbal and written.
Community nursing scenario
Within the community setting, students can work with
several members of the team, which enhances the learning
opportunities, broadens experiences and enables students
to greater exposure of practitioners expertise (Lofmark et
al, 2008). However, this can mean that the mentor has less
control and that potential conflict can occur (Hall, 2006).
This reinforces the need to ensure there are clear objec-
tives and opportunities for feedback to be obtained by all
involved, including patients and carers. Miller and Archer
(2010) reinforce the importance of any assessment proc-
ess, emphasising the need for multi-source feedback to
be obtained. This enhances the rigour of assessment and
reduces subjectivity.
Caseload and accountability
One challenge identified by Middleton and Duffys (2009)
study with regard to mentoring students within the com-
munity setting was the problem of students having a smaller
caseload, and the need to balance accountability with
students developing skills as autonomous practitioners. It
was found that the allocation of a caseload appeared to be
dependent on students ability and stage of the programme,
the mentor themselves and also on the caseload and patients
needs. Therefore, assessment and development of the stu-
dents competence requires skilful planning.
Lone workers
Hall (2006) also highlights the complexity in acknowledging
being a lone worker and not having easy access to colleagues
for advice. McVeigh et al (2009) acknowledge that effective
and equitable mentor support is much more challenging
within a community setting due to a reduced number of
available mentors, and this can lead to people feeling isolated
and unsupported. Support is provided for mentors by the
academic institution and local trust initiatives such as place-
ment support facilitators, learning advisors and link lecturers
(Carr, 2008), alongside mentor updates and support groups.
Mentors need to identify the support mechanisms available
within their own area, which will enable knowledge, skills
and experience to be shared.
The NMC (2008) identifies that the mentor is account-
able for their decision to allow the student to work inde-
pendently, and Brown (2013) reinforces the need for careful
consideration regarding how this is applied in a community
setting. The NMC (2011) discusses the benefits of indirect
supervision in facilitating students to work more independ-
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ently, developing their confidence and skills. They also give
guidance in terms of the caseload being well defined, ensur-
ing that the mentor or supervisor is easily contactable and has
the ability to delegate supervision to another colleague. The
mentor remains accountable for such decisions and must
ensure public protection.
British Journal of Community Nursing April 2014 Vol 19, No 4

Quality assurance
As discussed by Robinson et al (2013), the rigour applied to
assessment processes within higher education, such as second
marking, external examiners, assessment boards and modera-
tion is not always seen to be as robust within the practice
setting. While recognising that assessment and moderation
processes can be subjective activities, Schroder et al (2011)
support a moderation process where opportunities for shared
interpretations can be discussed with a move towards shared
understanding and setting good practice guidance. This has
been undertaken locally, with practitioners and academic
staff identifying good practice and giving feedback. It has
enabled comparisons across a variety of practice settings,
which has informed part of a moderation report and has
been used for mentor updating.
Some issues that have arisen when reviewing sign-off
mentor documentation relate to clarity and understand-
ability. When reviewing documents, at times there is no clear
audit trail, particularly when students are underperforming,
with limited justificatory comments being given for the final
assessment. Development plans when issues have been iden-
tified are also not always evident.
Clarity of written confirmation
The sign-off mentor also needs to ensure that the written
confirmation at the end of the placement clearly confirms
that the student has met all the requirements for entry to
the register. All too often, the documentation is vague and
subjective, with terms such as will make a good staff nurse
in the future being used where it might be questioned how
long in the future this might be! The NMC (2008) requires
confirmation that both practice and theory have been suc-
cessfully achieved and that the student is considered profi-
cient in meeting the competencies that have been set for
safe and effective practice. Sign-off mentors and/or practice
teachers are not required to directly inform the NMC of the
practice assessment. The programme leader, or lead midwife
for education, confirms to the approved education institution
assessment board that both the theoretical, practice elements
and good health and character have been achieved on com-
pletion of the programme. These parties are therefore reliant
on the quality of the practice documentation.
This also determines whether the student can be support-
ed in repeating their consolidation placement (in a different
area) if it has been identified that they have the potential to
meet the required competencies but had not achieved this at
the first attempt. This has been successful in several respects:
for some students, facilitating a further consolidation place-
ment has resulted in achievement of the final practice assess-
ment and entry to the register. For a small number it has not
been achievable but has demonstrated a rigorous, fair process
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in terms of quality assurance.
Opportunities
Limited research has been undertaken on supporting
students in their final placement within the commu-
nity. However, Middleton and Duffy (2009) explored
British Journal of Community Nursing April 2014 Vol 19, No 4
PROFESSIONAL
the experiences of community nurses in mentoring a
student prior to registration. They found that having
longer placements whereby students had the opportuni-
ties to consolidate their practice provided benefits for
all involved. In such cases, this provided the opportunity
to influence and support students prior to entering the
register, as well as enhancing personal mentoring skills
through assessment, feedback and documentation. Rookes
(2013) recent evaluation has shown that the introduction
of a sign-off mentor has been viewed positively, ensuring
a robust mechanism for students confirmation of entry to
the register and safeguarding the public. Robinson et al
(2012) also emphasised that mentoring a student in their
consolidation is valuable in terms of being able to support
students in the transition and helping them to get ready
for the role of registered nurse. Sign-off mentors play a
pivotal role in guiding students during the final placement
where safe passage into the nursing profession is ensured
(Bourbonnais and Kerr, 2007).
Community placements
The NMC (2010a) has argued that the current pre-
registration programmes have greater opportunities for
practice learning in primary care. There is a need to
promote district nursing as a dynamic career pathway for
nurses who want to make a difference and offer a quality
service to patients and carers in the community (Bennett
and Nicholson, 2013). This is reflected in the RCN (2012)
report on the community nursing workforce and the
urgent need to build future capacity.
One way to do this would be to promote the provision
of final consolidation placements in the community set-
ting and the availability of employment for newly qualified
nurses. Baglin and Rugg (2010) found that the majority
of students were still undertaking placements within the
acute trust setting. This may partly be due to traditionalist
attitudes that students need to get acute experience prior
to a role within the community setting, which may in
turn influence students beliefs about their employability.
Marshall and Shelton (2012) and Shelton and Harrison
(2011) discuss several myths and misconceptions about
students being unable to secure posts in the community
which again influence their potential choice of a consoli-
dation placement.
KEY POINTS
w The sign-off mentor role is challenging and complex, but is necessary for
students transition to registered practice
w Quality assurance processes can be enhanced through effective
feedback, support and documentation ensuring students are fit for practice,
purpose and award
w Community placements offering a consolidation placement and a sign-off
mentor can promote future recruitment upon qualification
195
PROFESSIONAL
These perceptions need to be changed: health-care
delivery is complex, and the idea that care is predominant-
ly given in primary settings is false. Marshall and Shelton
(2012) discuss the potential benefits for students undertak-
ing their placements within the community setting. These
include communication, negotiation skills and the ability
to prioritise and make decisions effectively.
Conclusion
The sign-off mentor role can be challenging and reward-
ing, and provides the opportunity to observe the transition
and development of students prior to entry to the register.
Community sign-off mentors also have the opportunity
to influence and support future nurses to develop their
knowledge and skills in primary care and to develop their
career in this field of practice. Furthermore, the role offers
the opportunity to raise the profile of the practice setting
(Carr, 2008). The sign-off mentor is the gatekeeper to the
profession, promoting fitness to practice and changing
cultures and expectations in terms of preparing students
for newly qualified roles in the community setting. BJCN
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British Journal of Community Nursing April 2014 Vol 19, No 4
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