Mentorship: Colouring Context of Clinical Practice

Mentorship: Colouring the context of clinical practice
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Welcome
How to navigate the mentor web pages

Welcome to the mentor pages of the Abertawe Bro Morgannwg University Health Board intranet site. The pages contain a
wide range of information and materials relating to mentorship and the assessment of pre-registration student nurses in
clinical practice.

Click on the front page menu bar or whenever you see any coloured icons, pictures or text to take you to specific
information. You can move forward and back and return to home at any point.

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Working in partnership

ABMU Health Board mission statement supports learning, teaching and assessment in order to:
Develop mutually proactive mentorship between registered nurses and pre-
registration nursing students through partnership, support and achievement.

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Effective mentorship is highly prized in Abertawe Bro Morgannwg University Health Board. Both
Swansea and Glamorgan University allocate pre-registration nursing students to clinical placements
across nursing Directorates within the Health Board. The learning environment within these placements is
continually monitored and measured against educational audit standards. Opportunities are
available for student nurses within the context of inter professional learning and working in modern
healthcare.
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Partnership Support Achievement
Clarification:

A mentor is a registered nurse who supports pre-registration student nurses. All mentors will have completed a
Nursing and Midwifery Council approved mentor preparation course and will meet the criteria to act as a mentor
outlined in Standards to support learning and assessment in practice (NMC 2008).

A crucial aspect of contemporary student nurse training is mentorship. Each student is assigned a mentor (a
registered nurse having undergone an NMC approved mentor preparation programme) in every clinical placement.
The mentor acts as a role model and guide as well as being responsible together with colleagues for providing a
credible assessment of students practice outcomes.

A preceptor has become associated with a registered nurse who supports a newly qualified nurse in
their first year post qualification. Principle 8 of the current NMC review of pre-registration nursing is that a mandatory
period of preceptorship will follow initial registration.

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What is a mentor?
A mentor is a registered nurse, midwife, health visitor, or specialist community public health nurse (registrant) who facilitates
learning and supervises and assesses students in a practice setting. Mentors work alongside students in clinical areas
helping them to develop their skills and apply their knowledge. By reflecting both in and on practice mentors help students to
become confident and competent practitioners.

Can anybody mentor students?
It is recognised that staff of all grades across the full range of disciplines within the inter professional Team may be able to
offer a valuable contribution to the students learning in practice. However a named mentor must facilitate this process and
provide an assessment of the students completion of set outcomes as described in their programme.

Can all nurses become mentors?
All nurses can become mentors by undertaking an NMC approved mentor preparation programme. You would need to be
qualified for a minimum of 12 months to be eligible for a place on such a programme. This is to allow registrants to consolidate
their practice and to further develop their own skills and knowledge before passing them on to others.

How do I become a mentor?
To become a mentor you need to undertake an NMC approved mentor preparation programme. These are run in partnership
with local universities (Swansea University and the University of Glamorgan) and involve 10 days of study, 5 days protected
learning time and in practice. You may be eligible for a shorter course if you are granted accreditation for prior experiential
learning, You would need to negotiate this before commencing the course.

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Brief history of recent changes in nurse training

The role of the mentor has gained ever more prominence in nursing in recent years. This reflects a major change in
nurse education training.

In 1999 a commissioned report by Sir Leonard Peach entitled Fitness for Practice made recommendations
including a need to focus attention on the accountability and credibility of mentors decision making.

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An expectation of adult learning between mentors and students

Interpersonal skills which
encourage students and mentors to
reflect more closely on care events,
becomes a way for both parties to
describe, explore, evaluate or
perhaps celebrate their roles in
these encounters.

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The photograph of refracted images in water above
is offered as an analogy for the multi-layered
complexity of clinical experiences students and
mentors encounter within practice settings. Each
clinical episode brings with it a unique set of
interpersonal relationships and attachments with
patients and the wider care team. These multi-
layered ripples and connections leave enduring
thoughts and feelings that all participants in those
episodes attempt to make sense of.
How mentors interpret competence in their assessment of pre-registration student nurses has
taken on increasingly significant importance in recent years. New Standards to support learning
and assessment in practice (NMC 2008) require that students on NMC approved pre-registration
nursing education programmes, leading to registration on the nurses part of the register, must be
supported and assessed by mentors who meet criteria for their role. This is vital when signing off
proficiency at certain stages of students training.

There will be a triennial review of nurses who are on the local register as a mentor, sign-off
mentor or practice teacher. From September 2007 a sign-off mentor who has met additional
criteria must make the final assessment of practice and confirm to the NMC that the required
proficiencies for entry to the register have been achieved. There are five underpinning principles
and eight domains in the NMC Standards framework. Each with identified outcomes at four
developmental stages for registrants, mentors, practice teachers and teachers. The domains are:

1 Establishing effective working relationships
2 Facilitation of learning
3 Assessment and accountability
4 Evaluation of learning
5 Creating an environment for learning
6 Context of practice
7 Evidence-based practice
8 Leadership

Download copy of NMC Standards to support learning and
assessment in practice (2010) from Mentorship Categories page

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Standards and learning

Focus
The mentor role is crucial in facilitating and guiding what otherwise might become
introspective accounts of practice. In order to support such adult style learning, mentors
are seen as needing to facilitate a climate that supports students personal growth.

This often depends on mentors qualities in providing opportunities that might challenge
the resourcefulness of students, whilst at the same time making sure they are well
supported and supervised. Trust, confidentiality and imagining novel solutions,
characterise a mentor/student relationship that permits honest reflection in the
messiness of practice, prompting students to actively engage in live reflection and
supervision with mentors.

The degree of challenge and support between mentors and students has the potential
therefore, to open up the learning experience as a place of possibility (Gillespie 2005).
This also depends on mentors being able to acknowledge and be comfortable about
their own imperfections in becoming facilitators of learning as opposed to simply
handing over expertise to students.

Download copy of RCN toolkit (2007) from
Mentorship Categories page
Mentor Toolkit

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Challenge and support

Focus
References
Accountability and
risk taking
Links:

Failing students
NMC News Summary

Nurses have a duty to teach and mentor others whilst also being accountable for their
assessment decisions. Yet there have been some concerns that mentors are failing to fail
students. Competence has become especially significant to the achievement of clinical
learning outcomes, as 50% of the current Fitness for Practice pre-registration nursing
curriculum is now determined by mentors (UKCC 1999).

From 2007, Nursing and Midwifery Council standards for placement learning have been
further strengthened with an expectation that mentors will have developed their knowledge,
skills and competence beyond registration in order to make credible decisions about the
proficiency of students. Sign-off mentors have been introduced who have clinical currency
and capability in their area of practice as well as an in-depth understanding of their
accountability for assessment decisions).

There are a number of conflicts for students and mentors to negotiate therefore, not least in
maintaining a fair and transparent assessment process.

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Accountability and risk taking

Focus
Mentors
voices
Credible
assessment
Links:
Practice learning flow
chart

Nurses have struggled with the question whether it might be enough simply to have a good heart to
be a nurse. Yet clinical competence involves a sophisticated combination of theoretical knowledge,
practical skill and humanistic endeavour. So how do mentors reach credible conclusions about
students proficiency in clinical practice given the misgivings about failing to fail students (Duffy
2004)? The NMC have consulted on and published new standards for pre-registration nurse
education 2010 detailing generic and field competences student nurses need to achieve.

In part, credible assessment depends on mentors demonstrating a breadth of understanding of
assessment strategies including Clinical Practice Outcomes documentation and Clinical Practice
Assessment Criteria for each year of student training. Mentors documented assessment evidence
needs to stand up to scrutiny.

Equally importantly perhaps mentor/student relationships achieve the greatest credibility when
student learning is situated in a holistic context of care, involving patients experiences and facilitated
by reflective and inclusive mentors (Freshwater and Stickley 2004; Midgley 2005; Van Eps et al.
2006). In so doing, students learning experiences can become
enriched by concentrating on the interrelatedness of knowledge,
skills and attitudes.

The way students are included both personally and professionally
into clinical teams during placements as well as the link between
clinical practice, the University and assessment is vital therefore
(Cope 2000).

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Credible assessment

Focus

Traditional training

Up until the 1990s nurse training was carried out within schools of nursing linked to hospitals. If you had been accepted to
train as a nurse and lived in Bridgend for example, you would have been part of the Mid Glamorgan School of nursing. For
adult nursing you would have received the taught part of your training at Quarella Rd nursing school Bridgend and most of
your clinical experiences would have been within Bridgend General Hospital.

Student nurses had four one off assessments during their training including managing a shift, demonstrating total patient
care, administering medication and performing an aseptic technique. Students would spend 12 weeks on a hospital ward and
two weeks in the school of nursing. An emphasis was placed on clinical knowledge of disease and basic skills, hygiene and
sterile technique as well as the safety and psychological comfort of patients.

1980s
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Nurse education


Project 2000

In 1992 nurse training became associated with Higher Education Institutes rather than hospital based nursing schools.
University affiliation and academic status were seen as strengthening the claim that nursing needed to become a profession
as well as a vocation. The new project 2000 curriculum had a common eighteen month foundation programme after which
students would choose general nursing, childrens nursing mental health or learning disabilities training to complete their three
year programme.

Theoretical work was supplemented by practical experiences in a wide range of clinical settings. The expansion in community
services also influenced the way training was developing. Nurse education explored ideas such as the process of daily living,
the role of the nurse and the importance of self-awareness. Reflective practice became a central theme which extended into
Post Registration Education and Practice (PREP) where nurses were and continue to be encouraged to keep a portfolio of
their professional lives.

By 1995 if you had been accepted for nurse training you would have received theoretical training in a University setting and
had student status. You would have had a funding bursary and become supernumerary to the numbers in your clinical
placements.

1990s
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Fitness for Practice

In 1999 the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (now the Nursing and Midwifery
Council) published a report about nurse training called Fitness for Practice. The report, chaired by Sir Leonard Peach,
followed wide ranging discussion with many relevant groups including education and clinical representatives. The report made
33 recommendations, attempting to encourage proficiency by enabling students to apply knowledge, understanding and
skills in the safe delivery of care and to make the transition from student to registered nurse.

In Wales, representatives from nursing and Higher Education Institutions considered the recommendations contained in the
Fitness for Practice report on an all Wales basis. As a result each Higher Education Institute and NHS Trust in Wales are part
of the All Wales Initiative. Because of this initiative nursing courses are run in very similar ways whether students embark on
nurse training in the University of Glamorgan or the University of Bangor. The first students to experience the Fitness for
Practice pre-registration programme qualified in March 2005.

Students are now assessed on a continual basis throughout their training involving 50% theory and 50% practice. In order to
progress to each successive year, students need to achieve all relevant academic work as well as practice outcomes
assessed in clinical placements. They are also expected to complete a comprehensive personal portfolio detailing their
progress. During the first year all students gain experience on a medical ward as well as experience of each of the four
branch programmes. Importantly this includes experience of all branches of nursing (midwifery, child, mental health and
learning disability services).

2002-present
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Nurse education

2.1.1 Criteria for supporting learning and assessing in practice mentors
Registrants who intend to take on the role of mentor will be assessing that students have achieved NMC competencies/proficiency.
They must fulfil the following criteria:

Be registered in the same part or sub-part of the register as the student they are to assess and for the nurses part of the register be in the same
field of practice (adult, mental health, learning disability or childrens).

Have developed their own knowledge, skills and competence beyond registration i.e. been registered for at least one year.

Have successfully completed an NMC approved mentor preparation programme (or a comparable programme which has been accredited by an
AEI as meeting the NMC mentor requirements).

Have the ability to select, support and assess a range of learning opportunities in their area of practice for students undertaking NMC approved
programmes.

Be able to support learning in an interprofessional environment selecting and supporting a range of learning opportunities for students from
other professions.

Have the ability to contribute to the assessment of other professionals under the supervision of an experienced assessor from that profession

Be able to make judgements about competence/proficiency of NMC students on the same part of the register, and in the same field of practice,
and be accountable for such decisions.

Be able to support other registrants in meeting CPD needs in accordance with The NMC code of professional conduct: standards for conduct,
ethics and performance.

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Review and maintenance of mentor/practice teacher qualifications
Mentors or practice teachers must demonstrate their knowledge, skills and competence on an ongoing basis. Placement providers must ensure that:

Each mentor and practice teacher is reviewed every three years (triennial review) to ensure that only those who continue to meet the
mentor/practice teacher requirements remain on the local register.

Mentors who meet the criteria for signing-off proficiency in practice at the end of a programme are annotated on the local register.

Practice teachers and midwife mentors will automatically be assigned this level of responsibility at the end of their preparation
programme.

Arrangements are in place for appraising mentor/practice teacher performance, addressing concern where appropriate, and for adding
and removing individuals from the local register including mentors identified as having met the criteria to be able to sign-off proficiency.

Triennial review of mentor and practice teacher
The nature of the triennial review of mentors and practice teachers is for the placement providers to determine but may form part of an employer-led
personal development appraisal. To be maintained on the local register the individual must have evidence of having:

Mentored at least two students (practice teachers to supervise at least one student) with due regard (extenuating circumstances
permitting) within the three year period.

Participated in annual updating to include an opportunity to meet and explore assessment and supervision issues with other
mentors/practice teachers.

Explored as a group activity the validity and reliability of judgements made when assessing practice in challenging circumstances.

Mapped ongoing development in their role against the current NMC mentor/practice teacher standards.

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Paragraph 2.1.3
Criteria for a sign-off mentor
Criteria for sign-off mentors in the Standards are underpinned by principle A which states that:

The NMC registrants who make judgements about whether a student has achieved the required standards of proficiency for safe and effective practice
must be on the same part or sub-part of the register as those which the student is intending to enter.

Only sign-off mentors and practice teachers that are on the same part of the register and in the same field of practice may confirm to the NMC that
students have met the relevant standards of proficiency for the particular programme leading to registration or a qualification that is recordable on the
NMC register. Placement providers must ensure that a registrant designated to sign-off proficiency for a particular student at the end of a programme is:

Identified on the local register as a sign-off mentor or a practice teacher.
Registered on the same part of the register.
Working in the same field of practice as that in which the student intends to qualify.

And additionally to be a sign-off mentor that they have:

Clinical currency and capability in the field of practice in which the student is being assessed.
Met the NMC requirements to remain on the local register.
Been supervised on at least three occasions for signing off proficiency at the end of a final placement (or supervised practice placement) by an
existing sign-off mentor or practice teacher.
A working knowledge of current programme requirements, practice assessment strategies and relevant changes in education and practice for the
student they are assessing.
An understanding of the NMC registration requirements and the contribution they make to meeting these requirements.
An in-depth understanding of their accountability to the NMC for the decision they make to pass or fail a student when assessing proficiency
requirements at the end of a programme.

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Sign-off mentor criteria

Signing off practice proficiency
In order to ensure public protection the NMC needs to be assured that students have been assessed and signed off as capable of safe and effective
practice at the end of a programme.

Additional criteria have been defined for the mentor to be able to sign-off proficiency in practice at the end of a programme (paragraph 2.1.3).
Placement providers will determine when a mentor has met the additional criteria and will be annotated as a sign-off mentor on the local register.

The NMC statutory midwifery committee has decided that all midwife mentors must have met the additional criteria to be sign-off mentors.
Confirmation of proficiency (Paragraph 3.2.6). The sign-off mentor, who has met the NMC additional criteria for assessing proficiency, is responsible and
accountable for making the final sign-off in practice confirming that a student has successfully completed all practice requirements.

This confirmation will contribute to the portfolio of evidence considered by the Higher Education Institutes examination or assessment board. The NMC
requires mentors who have not yet met the additional criteria to be supported by a sign-off mentor or a practice teacher if it is the students final
placement, or when failing a student.

NMC requirements Advice and guidance
Mentors should seek advice and guidance from a sign-off mentor or a practice teacher when dealing with failing students. Inexperienced mentors may
require support from a signoff mentor or practice teacher when faced with a failing student to help them to communicate concerns, identify action and
evaluate progress.

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Signing off proficiency
The NMC has identified progression points within each approved
programme where confirmation is required that students have met
specified outcomes and competencies.

Confirmation is required at points where a student may not progress
without a formal decision that they have met the outcomes or
competencies of a previous part of the programme

All mentors may assess specific competencies throughout the
programme.

NMC competencies may be achieved throughout the programme, unless
otherwise indicated in programme standards. A mentor may confirm
achievement of competencies, including those to be achieved at, or
by, a progression point. Only a sign-off mentor, who has met the
additional criteria, may sign-off proficiency at the end of a final period of
practice learning.
Mentors must keep sufficient records to support and justify their
decisions on whether a student is, or is not, competent/proficient.
The NMC considers it important that mentors have an audit trail to
support their decisions. Throughout a placement where a critical
decision on progress is to be made the mentor should ensure that
regular feedback is given to the student and that records are kept of
guidance given.
Mentors must keep sufficient records to support and justify their
decisions on whether a student is, or is not, competent/proficient.

The NMC considers it important that mentors have an audit trail to
support their decisions. Throughout a placement where a critical
decision on progress is to be made the mentor should ensure that
regular feedback is given to the student and that records are kept of
guidance given.

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Signing off proficiency
Sign-off mentors must have time allocated to reflect, give feedback and
keep records of student achievement in their final period of practice
learning. This will be the equivalent of an hour per student per week.
This time is in addition to the 40% of the students time to be supervised
by a mentor (paragraph 3.2.4).Only sign-off mentors, who have met the
additional criteria, must sign-off achievement of proficiency at the end of
the programme, unless the mentor is being supervised by a sign-off
mentor or practice teacher who should countersign that the
proficiency has been achieved by the student.
Sign-off mentors will require allocated time to ensure that students have
effective feedback on their performance so that the ultimate decision on
their proficiency is not unexpected. The time allocated may need to be
greater earlier in the placement and reduced as they become more
confident and competent.
The final assessment of proficiency draws on evidence of assessment
over a sustained period of time. The sign-off mentor may use the student
passport and other evidence to see if competence has been achieved
and maintained previously, as well as demonstrated in the current
placement.

The programme leader/lead midwife for education must confirm to the
AEI Examination/Assessment Board that all NMC requirements have
been met (to the best of their knowledge) for individual students,
presenting evidence of sign-off of practice from a sign-off mentor or
practice teacher.
AEI Examination or Assessment Boards should ensure that confirmation
is received, based on recorded evidence, that all NMC requirements
have been met. The AEI examination board must consider the record of
achievement of practice proficiency, signed at the end of the final period
of practice learning by a mentor who has met the NMC additional
criteria.

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Competence and outcomes for a mentor
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Mentor competencies are achieved by successful completion of an NMC approved mentor preparation programme that achieves all of the outcomes of
stage 2. These outcomes are as follows:

1. Establishing effective working relationships
Develop effective working relationships based on mutual trust and respect.
Demonstrate an understanding of factors that influence how students integrate into practice settings.
Provide ongoing and constructive support to facilitate transition from one learning environment to another.

2. Facilitation of learning
Use knowledge of the students stage of learning to select appropriate learning opportunities to meet their individual needs.
Facilitate selection of appropriate learning strategies to integrate learning from practice and academic experiences.
Support students in critically reflecting upon their learning experiences in order to enhance future learning.

3. Assessment and accountability
Foster professional growth, personal development and accountability through support of students in practice.
Demonstrate a breadth of understanding of assessment strategies and the ability to contribute to the total assessment process as part of the teaching
team.
Provide constructive feedback to students and assist them in identifying future learning needs and actions.
Manage failing students so that they may either enhance their performance and capabilities for safe and effective practice or be able to understand
their failure and the implications of this for their future.
Be accountable for confirming that students have met, or not met, the NMC competencies in practice. As a sign-off mentor confirm that students have
met, or not met, the NMC standards of proficiency in practice and are capable of safe and effective practice.

4. Evaluation of learning
Contribute to evaluation of student learning and assessment experience proposing aspects for change as a result of such evaluation.
Participate in self and peer evaluation to facilitate personal development, and contribute to the development of others.

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Competence and outcomes for a mentor
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5. Creating an environment for learning
Support students to identify both learning needs and experiences that are appropriate to their level of learning.
Use a range of learning experiences, involving patients, clients, carers and the professional team, to meet defined learning needs.
Identify aspects of the learning environment which could be enhanced negotiating with others to make appropriate changes.
Act as a resource to facilitate personal and professional development of others.

6. Context of practice
Contribute to the development of an environment in which effective practice is fostered, implemented, evaluated and disseminated.
Set and maintain professional boundaries that are sufficiently flexible for providing interprofessional care.
Initiate and respond to practice developments to ensure safe and effective care is achieved and an effective learning environment is maintained.

7. Evidence-based practice
Identify and apply research and evidence-based practice to their area of practice.
Contribute to strategies to increase or review the evidence-base used to support practice.
Support students in applying an evidence base to their own practice.

8. Leadership
Plan a series of learning experiences that will meet students defined learning needs.
Be an advocate for students to support them accessing learning opportunities that meet their individual needs involving a range of other
professionals, patients, clients and carers.
Prioritise work to accommodate support of students within their practice roles.
Provide feedback about the effectiveness of learning and assessment in practice.

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Five underpinning principles
The five underpinning principles for supporting learning and assessment in practice apply to mentors of any student
undertaking an NMC approved programme leading to registration or a qualification that is recordable on the register.
A Registrants (mentors) who make judgements about whether a student has achieved the required standards of
proficiency for safe and effective practice must be on the same part or sub-part of the register as that which the student is
intending to enter.
B Registrants must have developed their own knowledge, skills and competency beyond that of registration through CPD
either formal or experiential learning as appropriate to their support role.
C Registrants should hold professional qualifications at an appropriate level to support and assess the students they
mentor/teach, i.e. professional qualifications equal to, or at a higher level than, the students
they are supporting and assessing.
D Registrants should have been prepared for their role to support and assess learning and met NMC defined outcomes.
Also, that such outcomes have been achieved in practice and, where relevant, in academic settings, including abilities to
support interprofessional learning.
E Registrants intending to record their teaching qualification must have completed an NMC approved teacher preparation
programme or have been assessed by the NMC, through its accreditation of prior learning route, as having met the
equivalent of this.
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Encouraging patients to make informed
decisions, the development of person-centred
planning systems and a holistic approach to
health promotion, have become central goals
within humanistic health care (Siddell et al
2003; Priest and Gibbs 2004).

These philosophical changes have been
mirrored in nurse education, notably
influenced by humanistic psychology
(Rogers1969, Mezirow 1981) with adult style
learning founded in self direction, creativity
and personal discovery. Students are viewed
as autonomous individuals taking
responsibility for their own ongoing learning
(Knowles 1984). In this sense, the process of
learning becomes worthy of examination as
much as learning as an end product.
(Morton-Cooper and Palmer (2000).

Perhaps the value of this learning is in the
balance between students personal
reflections and engaging in a critical dialogue
with mentors?

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Adult learning


Despite the pressures mentors may face there is reassuring evidence that mentors are enthusiastic to work with students and
keen to support a learning culture within clinical settings (Gillespie 2005). Landmark et al.s (2003) focus group interviews with
mentors highlight the benefits of shared learning within student/mentor relationships including increased self-confidence,
achieving personal learning goals and a deepening understanding of nursing.

Positive mentor attributes have been identified as professionalism, expert knowledge, good communication skills and the
motivation to teach and support students (Neary 2000). Key elements of the role are seen as including teaching, support and
assessment of student performance. Darling (1984) identified other aspects of an effective mentor as inspirer, investor and
supporter as well as being a role model, energizer, door-opener, idea bouncer, challenger, problem-solver and career
counsellor.

Effective mentorship is also seen as identifying every opportunity to create and maximize learning opportunities. Yet being an
effective mentor has a number of challenges particularly in allocating time to students given the busyness of many clinical
settings. There is a tightrope that mentors need to negotiate therefore between providing pastoral support and being a clinical
assessor.

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Mentor qualities

Establishing a
dialogue with
students

Just as people with blue eyes will
each have a different coloured
hue, people will experience
learning situations in a very
individual way.
The subtle balance between challenge and support

There is the potential for mentor/student relationships to become either oppressive relationships or more appropriately
liberating connections, depending on the nature of support offered to students.

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Support
Challenge
Retreat
Status quo
Growth
Confirmation
Vision
Low
High
High
Fig1. Daloz (1987)
Too much mentor support, for example, with
little in the way of placement challenges
(maintaining the status quo) may leave
students feeling that they had not progressed
their learning in proactive ways. Likewise,
avoiding questioning students about their
rationale behind patient care might simply
confirm what they already know
(confirmation). Challenging students too
much with in at the deep end experiences
alone, may cause students to retreat into
defensiveness about their practice.
Daloz (1987) along with others (Spouse
2001; Freshwater and Stickley 2003;
Ronsten et al. 2005) suggest that it is only
when challenge is balanced effectively with
support that students feel a sense of
personal growth and through role modeling
realize a sense of vision in nursing.


Failing to fail students?

NMC funded research has strongly criticised nurse mentors for not failing students when they show a lack of clinical
competence on placements. The report, entitled 'Failing Students', was written by Kathleen Duffy, a lecturer at Glasgow
Caledonian University. The main findings of the report are that Mentors pass student nurses clinical assessments even when
there are doubts about their performance. Weak students who often had a history of problems in clinical practice have been
given the benefit of the doubt. The report also found that Mentors are too ready to allow failing students' personal problems to
influence their judgements.

The report says that mentors need to be prepared to fail students as well as to pass them. Duffy also calls for improved mentor
preparation programmes and for further research into this area. She says that mentors should contact teaching staff with their
concerns at an early stage and in writing. Failure to voice concerns in writing often means that no action is taken. The report
also points out that responsibility for the problem also lies with lecturers.

Kathleen Duffy said: "The research show that Mentors find it difficult to fail students. Preparing mentors for their role and
responsibility in a fail scenario is vital and must be backed up with adequate support from both education and practice." Janice
Gosby, NMC professional advisor, said: "This report provides important insights into the reasons why students are not failed in
practice and gives a number of recommendations that the Council may wish to implement. Mentors are accountable for their
decisions on fitness for practice that enable entry to the register, and it is the quality of these decisions that protects the public
from incompetent practitioners"

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NMC Press release 2004

Frequently asked questions
Q1. Why should mentors assess students in practice?
An assessment of student competence needs to be made at strategic points during their training. 50% is assessed through
students academic work and 50% during their clinical practice placements. Mentors are best placed to assess competence
in practice because of their close supervision of students. Ultimately this is about the safety of patients and the protection of
the public.
Q2. What should I do if I feel uncertain of what is required of me as a mentor?
Contact a Practice Facilitator in the Trust. They will discuss any concerns you may have or help you map out your training
needs.
Q3. How often should students work with their mentor?
Nursing and Midwifery Standards to support learning and assessment in practice advise students and mentors to spend at
least 40% of placement time working together. In order for mentors to be effective role models and get to know the student
well enough to make an accurate assessment of their performance mentors should work with students for the equivalent of 3
shifts a week.
The amount of time however, needs to be balanced with a number of considerations both students and mentors may have
including the:
-Students level of competence and their need for support.
-Need to get feedback from others about the students performance.
-Multidisciplinary nature of the placement environment.
-Range of teaching and learning opportunities available.
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Q4. What can we do to make sure our team is ready to accept students?
Check to see if your educational audit is current. The audit document will highlight how many students your team should have
at any one time and at what stage of their training. The document also includes a range of Standard statements to measure
yourselves against as a placement team. Contact a Practice Facilitator or Link Tutor from the University for any assistance
with your educational audit.
Q5. What can I do to prepare for a student?
As an individual mentor you can firstly make sure you feel comfortable about acting in this capacity by mapping yourself
against the criteria for being a mentor. It is also good practice to check your rota for the duration of the students placement.
If you know you are on annual leave for a proportion of the students allocation, make some arrangements with colleagues to
cover this period. Collect some helpful documentation ready for the student on their first day. This will normally be contained
within a Student nurse induction pack available within your clinical setting. Construct a loose timetable for the student. This
might include particular clinics, teaching sessions or other learning opportunities occurring regularly in your clinical area which
would be valuable for the student to experience. There is a balance of course as a mentor between enabling a student to
experience a variety of learning opportunities yet ensuring they spend enough time with you for you to make a credible
assessment of their competence.
The RCN have produced a helpful checklist for mentors in preparation for students.


Q6. What should I expect a student to have prepared prior to a placement?
Before each placement students complete a Self-Assessment and Action Plan. These identify a students concerns and
expectations about forthcoming placements as well as their individual strengths and weaknesses. As their mentor you can
ask a student to share these reflections about themselves at the beginning of a placement. There may be particular skills or
needs a student might have highlighted that they need to work on during the placement.

Q7. What should happen on the students first day in a placement?
Make them feel welcome. A consistent theme from students evaluations of placements is the value of a warm welcome in
setting the climate for effective learning. The way a student is introduced to team members, orientated to the environment of
the clinical area, allocated their pattern of work and shown where they can change or leave personal belongings can go a
long way to lessening any anxiety students may feel. Ideally the mentor and the student should set time aside on the first day
(certainly within the first three days) to discuss their expectations for the placement.


Q8. What do I do if there is a lack of co-operation from the student?
Initially discuss this issue with the student. It may be that the reason for the students uncooperativeness is due to shyness or
anxiety as much as it may be due to lack of interest or de-motivation. Once the motives for the lack of co-operation have been
established an action plan can be developed with the student. Nevertheless, as the mentor you have a right to expect a
students co-operation within your agreed learning plan. If this situation is not resolved within the placement by discussions
with colleagues during the early stages of the placement you might want to contact a Practice Facilitator or the students
personal tutor.
Q9. Are students accountable for their actions?
Pre-registration students are not professionally accountable for their actions to the NMC. As far as the NMC are concerned it
is the registered nurse working with the student who is professionally responsible for the consequences of any acts or
omissions students might make. Students should only work within their level of understanding and competence and always
under the supervision of a registered nurse. Students do need to be continually mindful of their professionalism however as
the public will expect this of nurses. Students can be called to account by the University or by the law for the consequences of
their acts or omissions as a pre-registration student.


Q10. What should I do if I have concerns about a students competence?
Firstly discuss these concerns with the student. This might be sensitively discussed as part of the learning contract middle
interview. Document your concerns. This is a good point to involve a Practice Facilitator. They can help set up an Action
Plan to document students progress and meet with you and the student at regular intervals. The Practice Facilitator will
also act as a bridge between your placement and key people in the University.
Q11. How can I celebrate a students exceptional performance?
Each individual student should be recognised for their own personal skills and qualities. Whilst students can never be
compared to one another (hence the Clinical Practice Assessment Criteria mentors use to measure students performance)
there may be occasions when mentors want to recognise a students exceptional effort and achievement.
Personal praise and recognition can be extremely motivating to students, some of whom may undersell themselves. You
could also document these views about a student in the learning contract Statement of Achievement or provide the student
with an additional testimonial which they can add to their personal portfolio.

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Q12. What can mentors use as evidence of their updateness?

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There are many activities mentors engage in that constitute mentoring
activity in addition to acting as a mentor for pre-registration student
nurses. It may be that as a mentor you work as a co mentor, support a
student during a shift, involve yourself in reviewing your clinical areas
student nurse induction pack or educational audit. You may attend
mentor updates, a mentor link forum meeting or mentor conference, or
engage in ongoing dialogue about students within your clinical setting
with other nurse mentors.

You may have completed additional learning about mentorship either
within an academic qualification or distance learning material. You may
also have documented some reflections about your role as a mentor.

All of these activities are legitimate mentoring activities and can be
reflected in a portfolio of evidence (you are invited to use the mentor
portfolio on offer within ABM University Health Board) and discuss this
updateness at your annual PDR review in line with NMC Standards to
maintain you status as a mentor.

Q13. How much information should be passed on from one placement to another about a
student who is on the borderline of achievement in clinical practice?
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A great deal of care and sensitivity is needed in these circumstances. Students
who may be underperforming in practice have the right to opportunities within
each academic year to achieve practice outcomes (as long as their performance
does not constitute a serious breach of safety of patient care). At the same time
mentors are accountable for the delegation of work to students. Here lies the
tension for mentors and students in offering opportunities to engage in clinical
nursing activities whilst carrying out credible student assessment.

Other information about a students underperformance may act to prejudice future
mentors and so should not be passed on wholesale between clinical areas. There
may well be a history and context to a students developing needs such as issues
relating to individual learning styles or perhaps associated with dyslexia or
disability. It would be advisable to contact a Practice Facilitator should mentors be
faced with assessing a student who there are doubts about. They are in a position
to liaise with key University personnel and also provide direct support to student
and mentors in these circumstances.

Q14. How do we know that reliable assessment decisions are being made between different
mentors?

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Given that mentors use their subjectivity as part of the assessment of student
nurses competence there is a need to ensure that mentors are assessing
students in consistent ways.
A number of studies have concentrated on the impact of this aspect of the
mentoring role when making decisions about student competence (Jones
2004; Kneafsey 2007); the inter rater reliability between mentors in their
assessment strategies (Brown 2000; Seldomridge and Walsh 2006;
McCarthy and Murphy 2008), the difficult process of giving accurate feedback
to students (Clynes 2008) and the way key personnel make decisions about
the capacity of clinical placements to support student learning in practice
(Pulsford et al. 2002; Hutchings et al. 2005).
An influential study by Duffy (2003) found that competence assessment was
complicated by mentors not addressing problems early enough in placements
and being swayed by the idea of giving novice students the benefit of the
doubt. The emotional trauma experienced by some mentors at having to fail a
student was a significant finding.

Q15. What affects mentors ability to supervise students for at least 40% of the time during
clinical placements?

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An examination of the mentorship literature identifies a number of issues which
may potentially compromise nurses role as mentors. Depending on the clinical
setting time may become an important factor when supporting and assessing
the learning of pre-registration students. The demands of clinical work for the
registered nurse mentor may limit their ability to spend as much time as they
might like with students.
The student/mentor relationship appears to be heavily influenced by the quality
of this bond (Andrews and Chilton 2000; Jones et al. 2001; Koskinen and
Tossavainen 2003), the frequency of contact between student and mentor
(Lloyd Jones et al. 2001; Wood 2005) and the confidence mentors have in their
own assessment decision-making (Bray and Nettleton 2007; Webb and
Shakespeare 2008).
Clearly, the quality of mentorship and inspirational role modelling student
nurses experience throughout their training is critical (Neary 2000), as is the
standard and availability of mentor preparation programmes (Finnerty et al.
2006; Clemow 2007).
Kathleen Duffy received a UKCC scholarship in 2001 to study the issue of failing students. The results of her
research are summarised in this article. A copy of Kathleen Duffys full report is available on the NMC website. The
following is reproduced from NMC News J uly 2004 Number 8.

Page 1 of 2

In your role as a mentor have you ever had concerns about a student nurse or a student midwifes clinical performance and
been caught in the dilemma of whether or not to fail them? The decision isnt always as straightforward as it might seem.
Kathleen Duffys study showed that most mentors are well prepared and carefully consider the assessment decisions they
make for the students they support, but some of the mentors interviewed had given a pass despite having concerns about a
students clinical performance.

Several reasons were identified as to why students passed when their performance was not up to scratch. Some mentors
disclosed that they had not failed students who were early on in the training programme as they felt that they needed time to
learn and should be given the benefit of the doubt. Mentors felt that the student would pick up the necessary skills in future
placements. Other mentors felt that it wasnt their responsibility to fail students and that it was sufficient for them to raise
concerns about a students clinical performance to lecturing staff. Many felt uncomfortable putting pen to paper - either
because they found the clinical assessment document full of jargon that they could not translate into practice, or they were
worried about repercussions from the university of failing a student.

Other mentors in the study saw failing a student as an uncaring practice. One mentor had given a third year student, who was
close to qualifying, the benefit of the doubt because she did not want to jeopardise the students future when they were so
close to finishing their course. Another allowed a students personal problems and circumstances to influence her judgement.
Some mentors felt they had no choice but to pass a student. As an example, one mentor found that, despite asking, no support
was provided from education staff and she did not feel able to fail the student. Others were told by lecturers that they could not
fail a student because they had not followed the correct procedures to do so.

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Failing to fail

Page 2

Although these reasons are understandable, the consequences of not failing a student can be very serious. Passing students
in the hope that they will improve later in the course has consequences for patients, clients, students and future mentors.
Lecturers who were interviewed during the study indicated that some students were reaching their third year before failing
clinical assessments. The students themselves felt devastated at being failed at this late stage, while mentors involved in
failing them highlighted that it was a horrendous, emotionally draining and time consuming process. There was some anger
that colleagues in earlier placements had passed the buck.

Failing to tell students that they have not reached the required standards also has consequences for the professions. Lecturers
talked about students who had qualified despite having a history of problems. Passing students who should have failed does
not protect the interests of the public and puts the patients who will be under their care at risk. This is not a new problem but
one which, as professionals, we need to acknowledge, discuss and debate. The reality of being a mentor is that it is a complex
and demanding role. Add in the issue of a problematic student and it can be overwhelming. Mentors need effective preparation
and support to deal with under-performing students. Initial mentorship preparation programmes need to address the issue of
failing students, highlighting issues of accountability, as well as the emotional impact and practical aspects of the process.

When faced with a problematic student, mentors need extra time and guidance to fulfil their professional responsibility; help
from experienced mentors and lecturers; and strong line management support. The NMC standards for the preparation of
mentors provides a tool for preparation, but it is the mentors knowledge, skills and competence in effectively carrying out their
role that protects the public by ensuring that students who are lacking in competence do not progress to become registered
nurses or midwives. Most importantly there has to be the recognition that some students need to fail. So if you are thinking of
giving a student the benefit of the doubt then you should consider whether it is in the best interests of the patients, your
clients, the student, subsequent mentors and the profession as a whole.

Kathleen Duffy Lecturer, School of Nursing, Midwifery and Community Health, Glasgow
Caledonian University e-mail: k.duffy@gcal.ac.uk

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Failing to fail

This event involves a client (J ack), a Ward manager, a second year Adult branch student (Lisa) and a mentor (Emma),
in her role as community nurse. Personal details have been disguised.
Page 1 of 3

Jack has a mild learning disability and had been admitted to a medical ward because of respiratory problems. There was going
to be a delay in Jacks discharge back to the community group home where he lived. The problem had arisen because of
funding issues relating to Jacks challenging needs. Delivering this bad news to Jack needed to be sensitively managed as he
was expecting to be discharged shortly. Emma invited Lisa to be a part of this process.

The Ward manager, Lisa and Emma discussed when and where to talk to Jack about the delay. It was decided that Emma
would lead this process. Although by telling Jack the truth, the therapeutic value of hope might be compromised, withholding
news about the funding would only delay his inevitable increased anxiety when his anticipated discharge date came and went.
Emma suggested they went into a side room as a venue for the conversation with Jack. She was aware that responding to
Jack in a supportive and attentive way was made more difficult being the bearer of bad news. Yet at the same time, Emma felt
that she was considered in her approach to Jack especially with her non-verbal behaviour and the words that she used. Lisa
also made some important contributions.

At first, Jack appeared receptive to communication. He seemed to take the news surprisingly well and thanked everyone for
being frank with him. Emma repeated the information again, but Jack seemed comfortable with the idea of a delay and asked
to go for a cup of tea. Initially, Emma and Lisa felt some relief that Jack had apparently accepted his position following their
conversation. At the same time, both the Ward manager and Emma felt uncomfortable about Jacks reaction, as his passive
response seemed out of place with the personal consequences of the information.

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Live supervision

Live supervision continued
Page 2

They both sensed that Jacks reaction did not fit with previous conversations where he had been consumed with an eagerness
to be discharged. Despite a temptation to leave the ward as it was now approaching the end of their shift, Emma, Lisa and the
Ward manager felt that they needed to give Jack more time to digest the information they had discussed with him.

They discussed some of the reasons for these intuitive feelings. There are indications, for example, that nurses overestimate
the comprehensive skills of people with learning disabilities in deciphering more complex issues (Banat et al 2002), that people
with learning disabilities may not be able to recognise the impact of emotionally charged messages and have a tendency
towards compliance during questioning (Richardson 2000).Emma and Lisa felt that some of these issues may have influenced
their discussion with Jack.

The Ward manager, Lisa and Emma had a pertinent discussion about the difficulties of power distinctions between patients
and nurses and how this may have been particularly relevant to Jacks interactions with us, given historical patterns of
institutionalised relationships between people with learning disabilities and professionals. Lisa drew on the point that wearing
her uniform might have subtly reinforced this power discrepancy, contributing to Jacks seemingly passive acceptance of
significant information. He later became more agitated about his situation. Of particular concern during the episode was the
tension between relief that Jack had apparently accepted the bad news, yet intuitive feelings that he had not fully
comprehended his position.

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Live supervision

Live supervision continued
Page 3

Emma and Lisa talked about how their feelings of anxiety might have been alleviated had they left the ward, which they were
entitled to do as it was the end of their shift (self-interest). Yet, this was balanced with a sense of moral duty to see the
situation through partly because of consistency and Emmas prior involvement with Jack, but also because of a beneficent
feeling of doing right by him (selfless obligation). Emma and Lisa made some analogies about how virtue ethics were
influencing the situation with Jack (what kind of people were we being at this moment), whilst also acknowledging that these
principles were fundamental in most nursing situations. Through her participation in these discussions and in the episode as it
was happening, Lisa was attempting to advance her knowledge in waiting into knowledge in use (Schn 1987).

This encounter approaches what Rolfe et al (2001) describe as a reflexive practicum, where reflection in the moment of
messy practice situations becomes visible as a learning experience. In this sense, reflection-in-action stimulates a continual
reframing and re-evaluation of the event, prompting further action and new reflection. For each person involved in delivering
the bad news to Jack, whether as the main actor or legitimate partner members, there was a need to act (sensitive discussion
with Jack), reflect on what was happening (respond to Jacks need for attentiveness and to be left alone) and to reflect on how
the unfolding episode was being dealt with (continually noticing the impact of our presence on Jacks assimilation of bad
news).

As a legitimate partner, Lisa was able to experience some of the contextual realities involved in the episode such as enabling
patients autonomous decision-making. The situation may also have helped Lisa identify the process of being an internal
supervisor of your own practice (Casement 1985), by tracking the evolution of the episode from initial strategy decisions to
ending the contact with Jack.

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Live supervision

Reflection in the messiness of practice
Page 1 of 2

Simply to possess skills and abilities in nursing devoid of a rationale for your actions, may lead to nursing activities being
carried out in efficient but unquestioning ways (Biggs 2005). For example, in one seemingly simple activity such as helping an
older vulnerable person have a bath, a complex world of needs, sensitivities and implications exists in which nursing care
amounts to more than a series of tasks or procedures.

Integrating theory and practice in nursing situations can be seen as requiring a therapeutic blend of technical skills and intuitive
responses to solve particular problems. Perhaps this craft knowledge Titchen & Ersser (2001), where nurses are able to apply
such therapeutic blends in clinical practice is worthy of further exploration. Examining the ideas student and mentors may hold
about their practice through reflection becomes significant therefore, especially as nursing actions are inevitably influenced by
private, cultural or educational experience.

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Reflecting in practice

forward
Before
During After
Pre stage
anticipation
On stage
commitment
Post
performance
review
Figure 1
A reflective cycle
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Page 2of 2
Reflecting in practice

There are 3 Practice Facilitators working within East Abertawe Bro Morgannwg NHS Trust:

home
Simon Cassidy (RMN; RNLD; Bsc (Hons); Dip HE Prof Prac; PGCE) qualified as a mental
health nurse in 1984 and subsequently as a Registered nurse for people with learning
disabilities. He has worked extensively within residential and community health settings. Based
at Princess of Wales Hospital Bridgend, Simon is responsible for mentorship issues within
Surgical Specialities, Anaesthetics & Critical Care, Mental Health & Forensics and Learning
Disability Services (Bridgend area). Simon has an interest in qualitative research about how
mentors interpret competence in their assessment of pre-registration student nurses who are
on the borderline of achievement in practice. He is due to commence an
MPhil/Phd in October 2008 to pursue this topic.

Contact: Tel : 01656 752557/8 Simon.Cassidy@wales.nhs.uk
Kay Jones RGN, BSc(Hons), Dip N, PGCE(PcET) qualified as a general Nurse in 1993. She
has a wide range of experience which includes medicine, palliative care, HDU/ITU and
Practice Nursing. In 2004 she became one of a team of 4 manual handling trainers for ABM
(Bro Morgannwg) and helped to launch the All Wales Manual Handling Training Passport
across the Trust. This sparked her interest in teaching and education. She soon went on to
complete the PGCE in 2007. At present her post is on secondment basis as a Practice
Facilitator for ABM.

Contact:
Tel: 01656 752557/8 kay.jones@wales.nhs.uk
Practice Facilitators

Download a copy of the Practice Facilitators Annual Report 2009/2010
From Mentorship Categories page
Please contact Simon or Kay about Mentor Preparation courses or Mentor Update courses in the
Bridgend areas of the Health Board.

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mentor update sessions

Simon Cassidy

Contact:

Tel : 01656 752557/8

email: simon.cassidy@wales.nhs.uk
Kay Jones

Contact:

Tel: 01656 752557/8

email: kay.jones@wales.nhs.uk

mentor preparation dates

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Mentor training

MENTORSHIP PREPARATION 2009
(For nurses never having undertaken mentor training before).

All sessions are held in the Nurse Education Centre Princess of Wales Hospital and start at 9.30 am.

For nurses wishing to commence Mentor Preparation training an Introductory letter of invitation Download a copy
from ABM Mentorship Categories section which explains the structure of the course.

Overall learning outcomes indicate the content of the preparation programme which includes learning in academic and
practice settings.

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Book a
place
Click to book
Mentor training

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Book a
place
Book a place
Mentor training

Venue: Multi Professional Education Centre POW
Times: 9.30-4pm

These sessions are designed for nurses registered for at least one
year who wish to become mentors.

2011 Cohort dates:

Dec 2
nd
(2010) March 23rd (2011) Seminar room 9

March 24
th
June 17th Seminar room 8

June 16
th
Sept 23rd Seminar room 8

Sept 22
nd
Dec 2nd Seminar room 8

Dec 1
st
March 20th Seminar room 8

Mentorship advice and support is
available for Registered nurses and
pre-registration students from:

Simon Cassidy Practice Facilitator
Multi professional Education Centre
Princess of Wales Hospital

Tel: 01656 75(2557)

MENTORSHIP UPDATES 2011
(For nurses having undertaken mentor preparation training but who want to revisit key aspects of mentorship).

All sessions are held in the Multi Professional Education Centre Princess of Wales Hospital.
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Mentor Update sessions (Recap):
These sessions are designed for existing mentors who have a working
familiarity with assessment processes but who need to recap on
current mentorship issues.
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Click to book
Book a place
Mentor training

Mentor Update sessions (Extended):
These sessions are designed for existing mentors who want extended
opportunity for exploration of mentorship issues.
Click to book
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Book a
place
Book a place
Mentor training



Tel: 01656 75(2557)

All sessions in Seminar room 8
Times: 2 -3.30pm

These sessions are designed for existing mentors who
have a working familiarity with assessment processes
but who need to recap on current mentorship issues.

2011 dates:
January 11
th
/ 18
th

February 8
th
/ 22
nd

March 8
th
/ 22
nd

April 5
th
/ 12
th

May 3
rd
/ 17
th

June 7
th
/ 21
st

July 5
th
/ 12
th

September 13
th
/ 14
th

October 11
th
/ 18
th

November 15
th
/ 22nd

home back
Book a
place
Book a place
Mentor training



Tel: 01656 75(2557)

All sessions in Seminar room 8
Times: 9.30-12.30

These sessions are designed for existing mentors who
want extended opportunity for exploration of
mentorship issues.

2011 dates:
January 14
th

February 11
th

March 11
th

April 15
th

May 20
th

June 10
th

July 8
th

September 16
th

October 14
th

November 18
th


The distance learning material contained here can be used in a variety of ways. The menu enables nurses new to
mentorship as well as those who have supervised students on numerous occasions to choose from a range of refresher
topics. In the spirit of adult learning individuals are invited to work through any aspect of the material enclosed here.
Completion of any part of the distance learning material can also be documented in a Mentor Portfolio format as
evidence of annual and triennial updating .

Download a portfolio from Mentorship Categories page, save the portfolio to your desktop and you
will be able to enter information to add to your evidence of annual updatedness.

As well as providing information about current mentorship issues, distance learning material also sparks discussion about
student assessment that spills over into clinical placement areas. In this way more contentious issues might be explored
as a group activity. This is particularly the case when examining the validity and reliability of judgements made when
assessing practice in challenging circumstances.

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Click here for learning menu
Distance learning menu

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Enabling Mentorship Activities
This workbook has been designed for you to
complete within your clinical area.
The activities can be completed
separately or in their entirety over
a period of time by dipping in and out of
the workbook exercises.
Download the Workbook from
Mentorship Categories page

Units 1-5 Mentorship Preparation Distance Learning material
Download Units from Mentorship categories page

Content description: The Unit s focus on interpersonal skills required
for promoting effective interactions between students and mentors.
Includes key factors that create an effective learning environment.
Assessment documentation quiz:

This quiz asks 10 questions about student
documentation such as:

-What is the purpose of the Professional Attitudes
scale?

- Where does the mentor sign when there is
progress towards achievement of practice
outcome, but this has not been achieved fully?

Questions and responses

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NMC Standards to support
learning and assessment in practice

This presentation explains the main elements
of the Nursing and Midwifery Council standards to
support learning and assessment in practice. There is a
detailed comparison between the NMC Standards
framework and what the processes of student nurse
assessment as it currently exists in Wales.

Completing student assessment documentation

This presentation explains where mentors need to place
signatures in order to sign student documentation. There is also
an explanation of the assessment strategies mentors use to
interpret students performance. If you feel you need a more in
depth explanation and analysis of student documentation you
might want to attend a mentor update session.

Reflective practice
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Distance learning menu

Banat, D. Summers S. Pring T. (2002) An investigation into carers perceptions of the verbal ability of adults with severe
learning disabilities. British Journal of Learning Disabilities 30: 78-81.

Biggs, J (2005) Student Learning Research and Theory where do we currently stand? Available from:
http://www.londonmet.ac.uk/deliberations/ocsid-publications. [Accessed on 5.9.06.]

Casement, P. (1985) On Learning form the Patient. London. Routledge.

Daloz, L.A. (1987) Effective Teaching and Mentoring. San Fransisco. Jossey-Bass.

Darling, L.A.W. (1986) What to do about toxic mentors Nurse Educator 11(2): 29-30

Freshwater, D. and Stickley, T. (2004) The heart of the art: emotional intelligence in nurse education. Nurse Inquiry 11(2): 91-
98.

Gillespie, M. (2005) Student-teacher connection: a place of possibility. Journal of Advanced Nursing 52(2) 211-219.

Knowles, M. (1984) The Adult Learner. A Neglected Species (3rd edn) Houston. Gulf.

Landmark, B. Hansen, G. S. Bjones, I. Bohler, A. (2003) Clinical supervision factors defined by nurses as influential upon the
development of competence and skills in supervision. Journal of Clinical Nursing 12: 834-841.

Mezirow, J. (1990) Fostering Critical Reflection in Adulthood. San Fransisco. Jossey-Bass.
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References page 1

Morton-Cooper, A. Palmer, A. (2005) Mentoring, Preceptorship and Clinical Supervision. London. Blackwell Publishing.

Neary, M. (2000) Responsive assessment: assessing student nurses clinical competence. Nurse Education Today 21: 3-17.

Priest, H. Gibbs, M. (2004) Mental Health Care For People With Learning Disabilities. London. Churchill Livingstone.

Richardson, M. (2000) How we live: participatory research with six people with learning difficulties. Journal of Advanced
Nursing 32 (6) 1383-1395.

Rolfe, G. Freshwater, D. Jasper, M. (2001) Critical reflection for nursing and the helping professions. Bristol. Palgrave
Macmillan.

Ronsten, B. Andersson, E. Gustafsson, B.(2005) Confirming mentorship. Journal of Nursing Management 13: 312-321.

Schn, D. (1987) Educating the Reflective Practitioner. San Francisco. Jossey-Bass.

Siddell, M. Jones, L. Katz, J. Peberdy, A. Douglas, J. (2003) Debates and Dilemmas in health promotion-a reader.
Basingstoke. Palgrave.

Spouse, J. (2001) Bridging theory and practice in the supervisory relationship: a sociocultural perspective. Journal of Advanced
Nursing 33(4): 512-522.

Titchen, A. and Ersser, S. (2001) Explicating, creating and validating professional craft knowledge. In: Higgs, J. Titchen, A.
(eds) Practice Knowledge and Expertise in the Health Professions. Oxford. Butterworth Heinmann.

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References Page 2

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University contacts:

Jill Kneath-Jones is the pre-registration nursing course leader for the University of Glamorgan:
Jill Kneath-Jones Pre-registration nursing course leader
University of Glamorgan Faculty of Health and Sports Science Glyntaf Campus
Pontypridd CF37 1DL
Tel: 01443 480480
jkneathj@glam.ac.uk

Abertawe Bro Morgannwg University NHS Trust has identified education leads within each Directorate. The group is
managed by the Senior Nurse for Education.

Lynne Jones Neath and Port Talbot Hospital, Baglan, Port Talbot.
Lynne.Jones3@wales.nhs.uk
Tel: 01639 683172

Key contacts

How do we know that reliable assessment decisions are being made
between different mentors?

Challenge and
support
Credible
assessment
NMC Standards
and learning
Accountability
and risk taking

home

back
fairness
FAIRNE
SSfairn
Focus

Click for
further discussion
What can mentors use as evidence of their updateness as a mentor?

Challenge and
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Focus

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How much information should be passed on from one placement to
another about a student who may be on the borderline of achievement in
practice?
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What affects mentors ability to supervise students for at least 40% of the
time during clinical placements?
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Which
Practice
outcome
is this?
I wish my
wife was
here
The
pressure is
getting to
me

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Minds are like parachutes, they
work best when open
Sir Thomas Dewar (1864-1930)
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I had this feeling that if I didnt
express my concerns about the
student I wouldnt only be failing
them but also other mentors
I did question myself at the time. I
felt as though it was me. Maybe I
had too high expectations of the
student? There was a sense that I
had failed the student
I looked very carefully at the
standards about being a third year
nurse. At the same time I had this
urge to think well would I want this
person to nurse me or my relatives

home
I found the process intense but
throughout it all I knew I had
support from my colleagues. That
helped me feel more comfortable in
giving constructive criticism to the
student
There are these windows of
opportunity, these six weeks where I
need to get to know the student well
enough to give a credible
assessment

The term competence refers to the overarching set of knowledge, skills and attitudes
required to practise safely and effectively without direct supervision. It has been defined as
the combination of skills, knowledge and attitudes, values and technical abilities that
underpin safe and effective nursing practice and interventions (adapted from Queensland
Nursing Council 2009). The NMC specifies competence as a requirement for entry to the
NMC register. Both generic competence and field-specific competence are required to
practise in a specific field.

The term competencies replaces the term proficiencies that describe the criteria students
must meet in order to complete their programme successfully and apply for registration.
The various competencies are acquired in stages during the pre-registration nursing
programme. Evidence that all competencies have been acquired is used to determine
whether a nursing student is competent to practise as a nurse
(NMC Standards for pre-registration 2010)
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What is meant by competence?
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Overall Learning Outcomes

Theoretical learning outcomes:
Discuss the implications of mentoring pre-registration student nurses in a current health care context.

Drawing on theories of education, examine the qualities involved in positive mentorship when supporting pre-registration student
nurses.

Given practice assessment documentation, explain how accurate completion of competency outcomes can assist students in
developing their personal learning.

Using research literature and case scenarios, examine ways mentors can manage placement experiences when supporting failing
students.

Clinical learning outcomes:
Describe the integration of mentorship principles in the practice of supporting pre-registration student nurses in clinical experiences.

Reflect on the use of mentoring skills in practice, including identifying any limitations in discussions with course supervisor/ clinical
mentor.
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Documentation quiz

Mentorship documentation.

1. How far into the placement should the statement of intent be completed?
2. What essential elements should be included in the Statement of intent?
3. What is the purpose of the middle progress statement?
4. What would you include in the Statement of Progress/ Achievement at the end of the placement?
5. What length of placement requires a short placement record?
6. What is the purpose of the Professional Attitudes scale?
7. During a 6 week placement, how often would the Assessment of Professional Attitudes scale be completed?
8. When completing the Attitudes scale, how does the student and the mentor record levels of achievement?
9. What level of supervision do the following students require? 1
st
year? 2
nd
year? 3
rd
year?
10. Where does the mentor sign when the practice outcome has been achieved?
11. Where does the mentor sign when there is progress towards achievement of practice outcome, but this has not been
achieved fully?
12. What additional support is available for mentors?

Suggested
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Documentation quiz responses

1. How far into the placement should the statement of intent be completed?
Within 3 days. Importance of initial interview providing a foundation for the placement. Set dates for the middle and
end interview.

2. What essential elements should be included in the Statement of intent?
Clarification of learning opportunities in the Practice learning Environment in relation to the students expectations.
Draw on the students prepared Self Assessment and Individual Action Plan in their Ongoing Record of Achievement.

3. What is the purpose of the middle progress statement?
To provide constructive feedback as to how the student is progressing, clarify areas to work on for underachieving
student as well as celebrating the work of students who are performing well.

4. What would you include in the Statement of Progress/ Achievement at the end of the placement?
Telling the story of how the student has performed. Be specific rather than flowery. How has student functioned as a
team member / towards patients, clients, service users / their professional behaviour.

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5. What length of placement requires a short placement record?
Currently three weeks and below.

6. What is the purpose of the Professional Attitudes scale?
Assessing communication / Team working / Responding to individual needs.

7. During a 6 week placement, how often would the Assessment of Professional Attitudes scale be completed?
Once mid way and once at the end of placement.

8. When completing the Attitudes scale, how does the student and the mentor record levels of achievement?
Student completes with cross / mentor with a tick. Red pen for midway scoring and blue for end of placement.

9. What level of supervision do the following students require? 1
st
year? Direct supervision / Demonstrate an
understanding of rationales / using appropriate communication skills/ performing basic skills safely on the instruction of
others. 2
nd
year? Under supervision / Demonstrate initiative and confidence in performing nursing skills / increased
problem solving skills / Communicating and reporting effectively. 3
rd
year? Minimum supervision / Selecting and
performing complex skills consistently and safely / identifying more complex aspects of nursing care / articulating
rationales and justifying decisions.
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10. Where does the mentor sign when the practice outcome has been achieved?
All relevant shaded boxes and the end box.

11. Where does the mentor sign when there is progress towards achievement of practice outcome, but this has not been
achieved fully?
Sign under Progress towards but not achieved and complete progression statement. Sign and date. Importance of
this in relation to overall record of achievement for student.

12. What additional support is available for mentors?
Immediate colleagues within Practice Learning Environment
Practice Facilitators
Link tutor
Link mentor

Clinical Placement Assessment Process
Practice learning 6 weeks and over:
Week 1 Student/Mentor agree learning needs, clinical
learning/practice outcomes and identify learning opportunities.
This is documented in the Statement of Intent section of the
Clinical Learning Contract.
Mid Placement
Student/Mentor review progress of student achievement and
agree Intermediate Progress Statement of the Clinical
Learning Contract.
Student/ mentor individually complete Professional Attitudes
Rating Scale (for 6 week placements and over).
Final Week
Student/Mentor discuss and document achievement of
clinical outcomes.
Complete Statement of Achievement of Clinical Learning
Contract.
Student/ mentor individually complete Professional
Attitudes Rating Scale.
Pre-placement
Student and Personal Tutor
discuss:
Clinical Practice Assessment
Document
Student Self-Assessment
Student Action Plan

Post-Placement
Student presents
documentation to Personal
Tutor as the basis for
discussion about achievement
in clinical placement.

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A dialogue

A reconstructed narrative presented here, identifies counselling skills to assist another
individual orientate themselves to the issues they are conveying. Despite not expressly
promoting therapeutic healing, the dialogue nevertheless incorporates important aspects of
counselling. Although set up as a real conversation the narrative is reconstructed from an
unpremeditated interaction between a Practice Facilitator and a nurse mentor.

This reconstruction followed shortly after the actual discussion with the mentor as part of the
authors ongoing reflective practice. Whilst this does not allow for a literal reproduction of what
was said, key words and phrases convey a representation of important moments in the
dialogue. The narrative acts as a platform to explore the intricacies of assessment decision
making occurring within clinical nursing settings. All contextual information has been disguised
to protect any possible compromise of anonymity of individuals concerned. Likewise,
permission was sought and granted from the mentor to reproduce this version of the
conversation.

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A dialogue continued.

Also, the narrative spotlights one part of an ongoing support network involving relevant Higher Education
Institution personnel, the author, mentors and students. The discussion leads to a suggestion that making
sense of mentoring experiences by examining personal counselling skills helps establish connections between
what may otherwise remain disparate narratives (Rashotte, 2005). Hence, the process of dissection and
reassembly of unique personal stories co-constructed with others assists those involved in reframing their
personal approach. The dialogue highlighted here, focuses on strategies that may assist mentors and other
key players enhance the validity and reliability of their assessment decisions..

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Mentor [Sue]: I really need to speak to you about one of the students. Its a bit delicate.
Practice Facilitator: I can see youre worried Sue. Is there somewhere private we can go?

The dialogue is set in a bathroom area. The bathroom is commonly used for ward handovers as the office is
compact and interruptions more likely. Whilst it might have been logical to arrange another mutually
convenient time and though somewhat unusual, the decision to carry on the conversation in the bathroom is
made more pertinent by Sues frustration.

PF I bet you never thought when you did your nurse training that you would be in a bathroom talking about
the finer points of student assessment?
Sue: Ive been in a lot worse places during my nursing career!
PF: I suppose thats what makes nursing so different from other types of training. Theres something about
having to make pragmatic decisions in order to get things done.
Sue: Yeah, I feel a bit like that having drawn the short straw being the mentor for this particular student . . ...
Its like were sitting on the edge of the bath hoping neither of us falls in.
PF: Im not sure if I will have any easy solutions to the concerns you may have Sue, but I
want you to know that I am a willing participant here. Im offering to help as a confidential
listener and supporter in your role as a mentor.
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Sue: I appreciate that but I just feel Ive been given this student because no-one else wants to act as the
mentor. Lisa [student] is not performing to the level you would expect of
someone who is due to qualify in a couple of months. She has come to me because the
mentor who was assigned to her at the beginning of the placement has gone sick and the
Ward Sister felt I was the most experienced to take her on.
PF: I get a sense that you are a bit disgruntled at being given the mentor role having drawn
the short straw as you put it. Do you want to say a bit more about that Sue?
Sue: Its not that I shy away from giving honest appraisal to students. I realise the importance
of being accountable for my decisions as a mentor and I will go out of my way
to support students. Im just not sure about Lisas attitude to the rest of the team
and Im worried there is not a lot of time left to assess her properly.
PF: Uh hmm. . ..Go on.
Sue: Well, shes safe enough administering medication and is dedicated towards the
patients, she just seems so sure of herself. Its like she knows everything. If I check with
her that she has completed a certain task she immediately becomes defensive, even
hostile.
PF: Hostile?
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Sue: Yes, Ive wondered if its that Lisa is afraid of making a mistake, as though she needs to
be some kind of perfect nurse and thats why she reacts badly when people ask her to
clarify things about her practice.
PF: Im hesitating to jump to any conclusions Sue, but something that really strikes me are
your thoughts about Lisa aspiring to perfection and that this might be a reason for her
defensiveness. Its a tempting theory, almost as if her own anxieties about needing to
be seen to be doing well are actually acting as a barrier to her learning.
Sue: Maybe. Im not sure. You see she does do many things very well. The main concerns are
about how she will be able to work with others should she qualify. Its not just knowing
about the technical stuff in nursing thats important.
PF: Yes......no easy answers.
Sue: I wish there were some.
PF: Youve covered a lot of ground in our conversation already Sue. What does shine
through though is your dedication to Lisa despite the difficulties you have.
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Newsletter

Mentorship Matters: A quarterly newsletter for mentors Issue Sept 2010

Welcome to the September edition of our quarterly newsletter. Our aim is to provide forum where we can
share news, advice and support with mentors across the ABM University Trust. Please contact us with your
news and ideas.

Difficult times
The current financial climate for ABM University Trust has produced particular challenges for nurses to
maintain high standards of care, teaching and assessment. Mentorship of student nurses remains a crucial
aspect for the future workforce of nursing, yet the commitment, time and investment required of mentors is
a challenge given present resource pressures.

At the same time there is substantial evidence (student evaluations, practice facilitator observations,
mentor discussions) that despite current difficulties, mentors continue to have a positive view of mentorship
across all Directorates, want to do right by students and that students are still receiving high quality
mentorship. This is to be commended in a time of increased challenges.

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NMC Standards

The NMC standards to support learning & assessment in practice are now in place.
These standards have introduce some key changes to the way in which nurses meet
and maintain their status as mentors for pre-registration nursing and midwifery students.
Since the original introduction of the standards there have been some revisions in the
form of NMC circulars. These are now incorporated into a revised document with a
different cover.

The Standards can be accessed via the NMC web site or on the Mentor intranet site of
ABM NHS Trust (see below). Significant elements of the Standards include mentors
needing to update themselves on an annual basis, a revised system of mentor
preparation and the introduction of sign-off mentors to support students in the last
three months of their nurse training.

The Health Board has developed a portfolio to support mentors in recording their mentorship activity, copies
of which are available from Practice Facilitators (see contact details below) or from the ABM University Health
Board mentor intranet site.
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Newsletter

Creating a learning environment & educational audit
It is good practice to educationally audit your areas on an annual basis. Audits are formally required every
three years. Should your area be due an educational audit and you are unfamiliar with the process, please
contact a Practice Facilitator who will guide you through the process.

Could you put your hand on your educational audit?
The Educational Audit document needs to be reviewed by a Link Tutor from the
University of Glamorgan every 3 years. This document details the numbers
of students coming to your clinical area and what stage of their training they
are placed with you. There are also a number of educational standards which act as a
benchmark of educational quality.
Mentor Intranet Site.
The Mentor site is now available on the Trust intranet system (Home page below). The mentor pages contain
a wide range of information and materials relating to registered nurse mentor assessment of pre-registration
student nurses and midwives in clinical practice. Training dates for mentor updates and mentor preparation
courses for 2010 are on the site together with distance learning activities related directly to mentorship.
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Newsletter

Mentor Intranet Site.
The Mentor site is now available on the Trust intranet system (Home page below). The mentor pages contain
a wide range of information and materials relating to registered nurse mentor assessment of pre-registration
student nurses and midwives in clinical practice. Training dates for mentor updates and mentor preparation
courses for 2010 are on the site together with distance learning activities related directly to mentorship.

Notice Board
A notice board is also now located at the entrance to the Oasis restaurant on the top corridor of the Princess
of Wales Hospital containing information about available support and advice for mentors as well as training
dates.

Contacts
Each clinical area has a designated Practice Facilitator. They provide the link between the Higher Education
Institutes and the practice placements. They provide direct advice and support when there are issues about
students who are on the borderline of achievement.

Contact Simon Cassidy and Kay Jones Based at Office 4 Multi Professional Education Centre Princess of
Wales Hospital Tel 01656 722557 e-mail: simon.cassidy@wales.nhs.uk ; kay.jones@wales.nhs.uk
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Forum


Download a copy of the latest Mentor Link Forum on the Mentorship
categories page

Partnership
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Mentorship: Colouring Context of Clinical Practice

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