This assignment will discuss the role of the mentor. It will acknowledge the purpose of accountability as a means of confirming that students have met the requirements of the NMC and are capable of safe, effective practice. It will also identify the need for assessment, using a number of strategies as a method of supporting students in practice. Mentorship Students on an NMC approved pre-registration nursing education programme, leading to registration, must be supported and assessed by mentors (NMC 2008).
Being a mentor is a privileged and rewarding role, which involves teaching, educating and supporting students to help them become more confident and competent in their practice and the RCN (2007) state that the mentor is a key support to students in practice as this is where the students apply their knowledge, learn key skills and achieve the required competence for registration. The NMC (2008) Standards to Support Learning and Assessment in Practice set a framework for mentors with outcomes to ensure “there is a clear accountability for making decisions that lead to entry to the register”.
The framework gives mentors clear guidance about their responsibilities. The mentors role in accurately assessing student’s learning outcomes equates to 50% of the final academic award, enabling access to the professional register so is therefore vital (Hyatt et al, 2008). Accountability The NMC’s Code of professional Conduct (2004) states that nurses have a duty to facilitate student nurses to develop their competence. Therefore, the nurse is accountable for ensuring that the students undertaking tasks are able to do so, that they are given appropriate support and are under supervision.
Nurses are professionally accountable to the public, patients, their employer and their profession (Hinchcliff et al, 2008). So, as a registered nurse, I should be able to give sound rationale for my actions. Professional accountability is at the heart of nursing practice and is based on promoting the welfare and wellbeing of patients through nursing care (Caulfield, 2005). An area of discussion that may encounter problems for nurses is how to balance accountability to follow professional guidance with individual, ethical and moral requirements to do what is felt to be right (Pattison and Wainwright 2010).
An example of this is when my most recent student (Student A) was talking with a patient behind the curtains about her personal life in detail and about her troubled past. In overhearing this conversation, I felt it was an inappropriate discussion to be having with a patient. The NMC Code of Conduct (2008) instructs that nurses are to be open and honest, act with integrity and uphold the reputation of their profession. Although the student was open and honest, she wasn’t being professional.
I never spoke with the student about this but on critically reflecting this event, I realised I was accountable for highlighting the code of conduct to my student. I have learnt that in future, I will emphasise to students the importance of remaining professional with patients. Nurses are accountable to themselves in situations where the ethical and moral position may conflict with recommendations put forward by the NMC (2008).
Although the NMC sets the professional standards, as a Registered nurse, it is through myself as an individual and accountable practitioner, that professional standards are maintained in the workplace. Stuart (2007) states that in exercising our professional accountability, we use our professional knowledge, judgment and skill to interpret and apply professional standards in practice. There are opportunities for harm to occur in almost all tasks performed, but Screvener (2011) explains that by accepting responsibility to perform a task the nurse must ensure the task is performed competently.
If the task is delegated to a student nurse, they must understand the task and how it is performed, have the skills and abilities to perform the task competently and accept responsibility for carrying it out. Student A was in her 3rd year of the pre-registration programme. On a number of occasions under direct supervision, Student A had performed a complex wound dressing. She had previously observed myself perform the dressing. Feeling confident that Student A was competent, I let her perform the task herself.
The next time it needed to be dressed, I observed her to ensure she remained competent to do so. The NMC (2008) outlines that the nurse remains accountable for the delivery of the care and for ensuring that the overall objectives for that patient are achieved, but on the other hand, the nurse has a continuing responsibility to judge the appropriateness of the delegation by re-assessing the condition of the patient and observing the competence of the student, determining if they remain competent and also to evaluate whether not to continue with the delegation of the task.
Therefore as a mentor I need to be conscious of providing safe, high quality patient care whilst supporting student’s participation and learning at all times. Mentors in practice who sign off competencies, are accountable to the NMC for their decisions (NMC 2006). Consequently, as a mentor, I have to ensure that my knowledge and skills passed on to students is correct, up to date and to a high standard, by following an evidence based approach. Assessment I have found that levels of knowledge and understanding vary between students.
Hand (2006) suggests that this level needs to be examined for accuracy, to establish a baseline for teaching. Using Benner’s stages of clinical competence (1984), a student’s stage of learning can be determined. Benner uses the Dreyfus model, which suggests that during the achievement and achievement of a skill there are five levels of proficiency, which are: * Novice * Advanced beginner * Competent * Proficient * Expert In performing male catheterisation, Student A had been taught the theory and had experience in previous placements.
She could demonstrate with acceptable erformance but not be classed as competent to perform the task independently and unsupervised. This ranked her as an advanced beginner. The advanced beginner has an increased awareness of any feedback on performance and pays close attention to the practice of others. They no longer feel that they can always look to other nurses to tell them what to do or to bear their responsibility but will need to ask questions (Benner 1989). Honey and Mumford (1989) state that there are four different styles of learning and it is useful to allow the student’s style influence your choice of teaching method.
The different styles are activists, pragmatists, reflectors and theorists. In my opinion, student A was classed somewhere in between a theorist and a reflector. This was because she liked to listen to others, stood back and tended to postpone reaching conclusions, but she was also a perfectionist and liked to think methodically. When teaching her how to perform a manual blood pressure correctly, I began by explaining the theory behind blood pressure to meet her theorist style of learning before demonstrating on the patient.
Once she grasped this, then I could encourage her to be more of an activist. This seemed to work well and increased her confidence as well as enthusiasm in wanting to progress. This shows that different styles of teaching are important to challenge and motivate students. According to Hinchcliff (1999) there are a variety of student, mentor and environmental factors that can affect the quality of learning. One includes poor motivation or self-esteem. Student A was reserved and lacked self-esteem.
Over the weeks she was on placement, we worked on increasing her confidence, which by the end of the placement wasn’t an issue in a number of areas. Direct observation can be a method of assessing student’s performance, although it has a number of disadvantages. Hand (2006) implies that much of what we learn is unintentional and happens by chance but there are occasions when purposeful learning must take place and must be assessed. As mentors, this is the learning that we expect students to take to obtain their competencies and will often contribute towards qualification.
The observation of a student’s performance has long been the basis for judgments made on progress (Price 2007). Student A stated that she found direct observation nerve racking, however; it should be remembered that, for some people, the deepest learning and best performances have occurred in the most anxiety-provoking situations (Hand, 2006). There should be good supervision in teaching, which promotes accountability while providing feedback in a supportive way (Saravana et al, 2006). Using feedback can be a means of assessing competence.
Race (2001) proposes that feedback tends to be regarded as positive or negative, but in practice, feedback usually contains both. However, constructive feedback is a more acceptable term for the elements of feedback. Nicol and McFarlane (2006) suggest that feedback should help clarify what good performance is, encourage positive beliefs and self-esteem and facilitate the development of reflection in learning. However, Race (2001) suggests that human beings are often not too skilled at making best use of critical feedback.
We may instinctively become defensive, and stop analysing the feedback. Yet learning by trial and error is a perfectly natural way of learning, but depends on making optimum use of feedback about mistakes. Linking this to the earlier example where student A was talking inappropriately to a patient, one of the reasons why I didn’t challenge her on it at the time was that I thought she may become defensive and not use the feedback in a positive way. Reflection is a useful approach that can be used in assessment, learning and development.
Reflection and critical thinking are transferable skills which nurses are expected to develop in clinical practice in order to understand themselves and others and solve problems (Price, 2004). Somerville (2004) describes reflection as the examination of personal thoughts and actions and is a process by which practitioners can better understand themselves in order to build on existing strengths and take appropriate future action and also explains that reflective practice is part of the requirement for nurses to constantly update professional skills.
I asked Student A to reflect on the catheterisation she performed. She highlighted the aspects she could have improved on, such as ensuring all the equipment was opened fully before carrying out the task in order to maintain an aseptic technique. This made her aware of the importance of being prepared and she felt it would improve her skills in this clinical area in future opportunities. Although her reflection was detailed, it would have bee n better to use a reflective framework. Next time I will advise my students to use one such as Gibbs (1989) or Johns (2000).
As described earlier, as a registered nurse I am responsible for my own actions and judgments, providing care to the best of my ability therefore; reflection is important as I can focus on my knowledge, skills and behavior to ensure I meet the demands I am expected to. A disadvantage of using reflection is it can be taken the wrong way in learning. Mentors frequently wonder when to use reflection as a means of challenging or changing practice and when to use it to help the student gain insight into their approach to care (Price, 2004).
In practice, I have conducted reflective pieces after major events and it has made me feel inadequate and demoralised. After reviewing this literature, I could have looked at the positive aspects to the reflection and how to avoid problems occurring in the next major event. Price (2004) states that if students try to reflect on every practice issue or episode they will suffer information overload. Although the mentor should encourage reflection, they could help the student connect their perceptions or thoughts to other accounts of practice.
Cassidy (2009) suggests that making reflections and critical analysis in nursing practice remains a fundamental aspect of student-mentor relationships. It is unavoidable that some students will not meet the requirements to pass the placement. Duffy’s (2003) study found that some of the mentors that had ‘failed to fail’ students early on in their course and explained the reason behind it was they thought these students would improve in subsequent placements. Mentors also thought that making such a big decision, implying the students unsuitability to be a nurse, went against the ethos of caring.
Personally I haven’t had to fail a student but if I came across a problematic student I would aim to identify issues as early as possible in order to rectify the problems and prevent failing. Conclusion This essay has identified the role of the mentor. Accountability in undertaking student nurses has to be considered, as nurses are accountable for their decisions. There are numerous assessment strategies in order to facilitate the student’s learning and it is useful to ascertain the student’s preferred style of learning. It is important that mentors do not avoid the issue of having to fail students, as such actions have consequences.