Mentor Handbook 2011 - Mentors

Defining Mentors and guidance on Mentoring

In August 2006 the NMC published the 'Standards to support learning and assessment in practice' which became operational in September 2007. A 2nd edition of these standards was released in July 2008. These standards define Mentors and Sign-Off Mentors.

MENTORS

"A Mentor is a mandatory requirement for pre-registration nursing and midwifery students"

"Nurses and Midwives who intend to take on the role of mentor 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 practice1 (adult, mental health, learning disability or children's).
  • 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 requirements2).
  • 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 inter-professional 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 nurses and midwives in meeting CPD needs in accordance with the Code: standards for conduct, performance and ethics for nurses and midwives (NMC 2008).  

Source: Standards to Support Learning and Assessment in Practice (2nd Ed), NMC, 2008.  

1 In a supplementary document published by the NMC in February 2009, a significant addition is made to this requirement. It has been acknowledged that co-professionals, including nurses from other branches, have a significant role in the teaching and assessing of students. This means that nurses can validly take on the role of mentor to a student who is studying to enter a different part of the register. It is required that confirmation of the students learning under these conditions is confirmed either by their performance in a subsequent practice experience supervised by a mentor from the same part of the register or by involving the students tutor in the final interview of the placement. (a 'tri-partite' review). 

 2 Mentors who have completed the ENB 997/8 or an equivalent course do not need to 'upgrade' to the current 'Preparation for Mentorship'. All courses of preparation that have been recognised as valid preparation for this role remain valid. (ENB/DoH, 2001b) 'Standards to support learning and assessment in practice' requires all mentors to map their experience and abilities against the above competencies and use the insights they gain to inform their continuing professional development. 

SIGN-OFF MENTORS

'Standards to support learning and assessment in practice' also introduced the role of 'Sign-Off Mentor' - in place from September 2007. This is a practitioner who takes responsibility for confirming to the NMC that a student has met all the requirements for practice by the end of their pre-registration programme.

"Placement providers must ensure that a nurse or midwife 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 and
  • Working in the same field of practice as that in which the student intends to qualify.

Additionally, to be a sign-off mentor they must have:  

  • Clinical currency and capability in the field in which the student is being assessed.
  • 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 the achievement of these requirements.
  • An in-depth understanding of their accountability to the NMC for the decision they must make to pass or fail a student when assessing proficiency requirements at the end of a programme.
  • Been supervised on at least three occasions for signing off proficiency by an existing sign-off mentor (up to two occasions may be simulations but the final occassion must relate to a final student placement - contact Nickey Rooke for details of the approved simulation activity - n.rookeucs.ac.uk )

Source: Standards to Support Learning and Assessment in Practice (2nd Ed), NMC, 2008.

  • For courses commencing from September 2007 the NMC will require a 'Sign-Off Mentor' to confirm a nursing students satisfactory completion of practice assessment at the end of the Branch Programmes.
  • For midwifery students the requirement is that for courses commencing from September 2007, students can be supported and assessed only by mentors who have met the additional sign-off criteria.
  • UCS provides half-day preparation sessions for those undertaking the responsibilities of a sign-off Mentor.

In addition to these criteria for Mentors and Sign-Off Mentors, Standards for Learning and Assessment in practice also requires that: 

  • Every student has a named mentor for each period of practice learning
  • Mentors should not normally support more than three students, from any discipline, at any point in time.
  • Whilst giving direct care in the practice setting at least 40% of the students time must be spent being supervised (directly or indirectly) by a mentor/Practice Teacher. When in a final placement, this 40% of the students time is in addition to the protected time to be spent with a sign-off mentor.

REGISTRANTS

The Code: Standards of conduct, performance and ethics for nurses and midwives (NMC 2008) specifies that all registrants "must facilitate students and others to develop their competence" 

  • 'Standards for Learning and Assessment in Practice' makes no comment on whether or not registrants can sign student's skills sheets and learning outcomes. It is, though required that all aspects of a students learning and assessment take place under the supervision and guidance of a Mentor.
  • Mentors are the only authorised signatories for student interview forms and the only people with authority to assess a student against the criteria set out for the successful completion of practice outcomes. These functions cannot be delegated to registrants who are not mentors under any circumstances.
  • The position held by UCS is that registrants may sign a students practice records to confirm that they have seen the effective performance of a discrete skill but that this must be done under the supervision of and with the approval of the students mentor. That mentor must countersign the registrants entry in the students practice record to verify that these conditions have been met. 

TRIENNIAL REVIEW

In order to retain their place on the local register of mentors, mentors need to have included in their performance review evidence of having:  

  •  Mentored at least two students (Practice Teachers to have supervised at least one student) with due regard (extenuating circumstances permitting) within the three year period. Supervisors of midwives are required to mentor at least one student undertaking a supervisor of midwives programme during the three year period relating to triennial review as outlined in NMC Circular 01/2008.
  •  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.
  •  Been deemed to have met all requirements needed to be maintained on the local register as a mentor, sign-off mentor or practice teacher. 

The nature of the triennial review is for the placement providers to determine but it may form part of an employer led personal development appraisal. 

Source: Standards to Support Learning and Assessment in Practice (2nd Ed), NMC, 2008


 

KEY ACTIVITIES FOR MENTORS

Role Modelling

Role modelling is an important part of any relationship where one individual leads another. The communication of attitudes, values and beliefs through this is often subtle, so awareness of the fact it is happening can be lost.

Many of the values communicated can have been learned so subtly that they are invisible. Take for example the term "off-duty", common and universally understood, but it could be suggested that to tell staff when they are off-duty implies their natural state is to be on-duty. Also, the title "Sister" (in some settings) is still in common use, a hangover from the days when nursing was associated with religious orders. Both are examples of attitudes and values that might be considered old-fashioned.

This highlights the need to be aware of how the student sees the practitioner and therefore what they are learning. Students do not have the experience necessary to share widely held professional perceptions and understanding. They interpret what they observe in the light of previous experience, much of which could be inappropriate vicarious learning taken from role models from the media.

Vicarious learning means to 'learn', or more properly 'assume an understanding' from observing the experiences of another without direct experience. Copying behaviour without being given information on its purpose is mimicry rather than effective learning. Practitioners should give thought to what they do that they would be happy for students to mimic, and what they do that they feel should be explained.

Facilitation of Learning

Learning can be described as a more or less permanent change in behaviour that results from deliberate experience. Also, it can be assumed that some learning is about committing facts to memory.

A more contemporary view is that learning is about improving effectiveness in a given environment, in this case the professional environment.

Professional preparation will move students away from any expectation that they will characteristically be handed facts by others to absorb. Instead, they will move towards taking responsibility for their own learning. This means that the student will seek information from texts and other reliable sources of established knowledge and learn from the practitioner the intricacies of the delivery of care.

In the early stages of skills development it may appear that a simple psychomotor skill, of say taking a blood pressure, is a focus of effort. As students develop the dexterity required they must rapidly learn how to use this skill in a variety of surroundings. Then they must gain an appreciation of the implications of different results, and then to multi-task; to achieve two or more care objectives at once. So, facilitation of learning is not just about instruction. It is about appreciating what the student already knows, what they must learn and what of that they can teach themselves.

Mentors must assist students to learn what they cannot access for themselves. This involves helping the student make sense of the environment. This requires a co-operative effort in challenging, questioning and exploring by mentor and student together.

Sustaining motivation can be very hard. The inclination to stop learning when it is believed that competence has been achieved neglects the need to examine and re-examine the familiar that drives innovation and improvement. Helping a student to sustain their motivation to learn is a vital factor in the facilitation of learning.

For students, being accepted on merit into the company of nurses or midwives is a powerful motivator, and therefore a powerful reward. It represents what they most want to be. Mutual recognition and appreciation should be built into all mentor / student relationships.

TEACHING STRATEGIES

There are many strategies for teaching available, however, before organising formal or informal learning opportunities it is important to consider certain things.  

  • Students will identify objectives for each of their clinical placements. Some will be drawn from the formal part of the curriculum and be aspects of student development in practice that need to be assessed. These must be discussed with the student and plans laid and to how they may be achieved.
  • The student will also have personal objectives to achieve. These may have been identified through previous experience or they could be interests linked to a specific area. Their placement may be their first ever exposure to that particular area and so the student may not be fully aware of the experience available.
  • It is important to encourage students to identify what they would like, but it is vital that any wish list is tempered by realistic expectations. Mentors will have very well informed views on what a student should learn whilst on placement. They are expert in their practice and should make clear to the student what they believe is acheivable in the placement.

    These three issues will form the basis of initial discussions with the student. The interviews at the start, in the middle, and at the end of every placement of twenty days duration or more are absolutely essential.

    At the start it is necessary to establish and document the purpose of the placement and ensure the student is aware of the expectations of their mentor and the wider team.

    At the mid-point the student needs to be made aware of their progress. He/she will want discussion; achievement reinforced and areas for further development identified.

    The final assessment/report interview should be a celebration of achievement for both student and mentor and a chance for the student to give feedback.

    Students should be prompted to invest their own time to read up on a subject or make notes on an issue for further discussion. This is expected and encouraged but should make due allowance for the assessment workload of the student and kept within realistic limits. All theoretical assessments associated with practice will benefit greatly from any assistance the mentor can offer the student as they prepare them. 

    Being with a skilled practitioner, becoming increasingly more involved and learning through action is of great value but it is important that the student is not left to absorb learning by osmosis. Explanations must be made and rationales given to ensure that the student understands the decision-making processes. The following range of strategies can be used and the utilisation of a variety of approaches will keep both the student and the mentor fresh and well motivated.

     

  • Demonstration.  The demonstration of a skill is a valuable introduction. When appropriate it should be used to start the process of helping the student achieve the skill personally. Before a demonstration all the component activities that have to be linked to complete the outcome required should be identified. This is often harder than it seems. The activities will occur in three phases - preparation, event and finishing.

    Students should be shown the complete activity first as one flowing presentation. Next they should see it broken into stages with the critical activities highlighted. They may be given a chance to complete instances of the skill themselves; this is a good time to allow the student to practice difficult activities separately in a safe environment, e.g. unsheathing a needle or putting a limit on another's behaviour. Next they can take a stage, or stages, then a phase and finally the whole event.

    Remember the importance of differential reinforcement, praising small successes at the outset and then slowly reducing the frequency of rewards.

  • Discussion.  The commonest strategy to employ is discussion, informal is best. Start by exploring the students understanding. This helps everyone to focus on what needs to be learned and reduces repetition. Stimulate discussion by asking open questions. Encourage questions. Keep it short or intermittent. Twenty minutes is ample unless interspersed with other activity. At the end suggest how the subject can be followed up by reading or other further learning opportunities.

  • Skill Practice.  Skill practice is essential. Rehearsal lays down strong memory traces and must be promoted. Students enjoy putting their learning into practice and need to learn to include increasingly sophisticated skills in even routine activities. They all want to give care and contribute purposefully. Rehearsal promotes increasingly sophisticated performance.

  • Observation.  Lasting longer than a demonstration, observation may cover a range of activities. It is important to prime the student on the purpose of the activities that they are observing and critical events to look for. This helps the student develop skills in being alert to what is important. Observation should always be followed by discussion.

  • Care Conference or Ward Round.  Care conferences or ward rounds give the student an opportunity to witness inter-professional working. They will learn about decision-making, planning processes and elements of evaluation. 

  • Lecture.  Occasionally it is useful to take a small group of students and teach them formally on a subject. Many Mentors avoid this because of the relative formality and the need for detailed preparation. It is a useful way of covering a subject and ensures that students share an essential knowledge base before another type of learning experience. It can also be used in the consolidation of an experience. There are some useful points that might aid your delivery.

    • The aims and objectives of the session must be specified and clear.

    • The environment must be conducive to learning.

    • The session should be kept short and the medium of presentation should change at least every twenty minutes.

    • The learning achieved should be assessed; the easiest way of doing this is to question the students.

    • Subjects that can be covered by reading should not be taught in this way - students should be directed to read a particular text.

  • Seminar.  A seminar consists of the presentation of a subject by a seminar leader, often from a paper, followed by a discussion. The all participants are equally responsible for the seminar is often forgotten and they become lectures to a passive audience. All participants should do preparatory reading if they do not have prior knowledge. All should engage in the debate. A seminar is an efficient way of stimulating engagement with complex issues that may have less than clear solutions.

  • Visit.  It may be useful to send the student to a particular person or department to gain further insights. This can show the continuity of care, the contributions of others or critical events that occur outside the placement. They can also be used to give the Mentor and student a break from each other. The objectives of a visit must be specified, and the visit should be long enough to achieve them. Students can be very innovative regarding visits, but it is important that the Mentor retains control and does not allow the placement to become disjointed by numerous visits that compromise the integrity of the placement and fragments the students learning experience.

Go back to Mentor Handbook 2011 Index|