Reflection on Student Mentor Relationship

Reflective Journal

As a mentor, my role according to Casey and Clark 2011 is to be a good and competent role model my students. The NMC (2008), states that a mentor is a registrant who facilitates learning, supervises and assesses students in a practice setting. I was informed by my manager that I would be co-mentoring a student nurse who was in his final year and this placement also being his final placement. My first thoughts were, what do I know about mentoring? Then the next thing was am I going to teach them the right things? I panicked a bit but reminded myself that this wasn’t the first time there’s been a student on their final placement, I guess it was more the fact that this time around, because I was starting my mentorship training, the role seemed a bit more daunting. I knew from the onset that this was going to be a learning curve for me and the student as well, but I knew I had someone to support me should I get stuck.

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Fortunately for me, the student was someone familiar and that reduced the anxieties of the first contact. First impressions count, so it is important to introduce yourself, smile and have eye contact with your student (C. McCabe, F. Timmins 2013) to build that rapport. On the first day, I had to remember that Jay (not real name, protecting student’s identity) was on placement and not working as an HCA and had to make the rest of the team aware of this. Levett-Jones, Lathlean, Higgins and McMillan (2009) discussed that students need to feel like they belonged which makes them comfortable and engage in learning opportunities and in this case, Jay already belonged to the team but this time around as a student nurse and he was familiar with the learning environment.

It is good to establish a good rapport with your student but according to Wilkes (2006), tread with caution during social development as professional boundaries need to remain clear as getting involved with a student socially and emotionally outside of work can influence your integrity when performing assessments. Jay had his initial meeting to discuss his learning outcome with my manager who was his mentor and I was included in this meeting to know which direction we were going to take. According to Lowry (1997), it is important to identify learning needs with the leaner from the beginning and have a learning contract. Right from the onset, Jay stated that he needed support with administering medication as this was one of his learning outcomes which he was still struggling with as he hadn’t had enough exposure to it in previous placements.

The Nursing and Midwifery Council (2008a) states that as a registered professional, you are responsible for public safety, therefore by mentoring, you are accountable for ensuring that students fulfil their learning outcomes and develop practice competence. The Nursing and Midwifery Council (NMC 2008) encourages that mentors should empower students in identifying their learning needs and seek out opportunities and experiences appropriate to their level of learning and should be able to motivate themselves to be self-directed learners. As adult learners, some students may have other objectives and competencies that they would like to achieve in additional to practice competencies and they should take initiative and be assertive and seeking opportunities to achieve these.

Our hospital has adapted a new way of signing for medication online to reduce medication errors and omissions, I had to request access for Jay to be able to administer medication on his own settings and I would counter-sign for them. This took a few days to be activated but, in the meantime, Jay was able to shadow myself and other nurses whilst administering medication and had the chance to see how the system worked and to ask any questions where he didn’t understand. Once his log-in details came through, Jay was able to administer medication under supervision and was encouraged to ask questions and do some research himself about the different medication that was used on the ward. Jay needed to achieve some clinical skills including administering injections. We agreed that he would call around the other units and find out if any of them had Depo clinic which he could attend to observe and with time, possibly could administer one as well as none of the patients on our ward required these. Jay was able to identify a ward that had this clinic and managed to book in to go and observe and after a few weeks of going to observe, he was able to administer a Depo and achieve one of his learning outcomes.

Encouraging students to seek out opportunities on and off the ward, attending meetings, forums and other health departments, working with the other disciplines (MDT) to acquire more expertise and knowledge to further develop themselves is something essential for a good mentor to facilitate. Mentors also need to be mindful of the quality of learning experiences available to develop the student’s learning experience through teaching and providing the appropriate knowledge base for nursing interventions. According to Gopee (2011), mentors need additional skills through structured learning and teaching skills to utilise in an environment designed for this purpose. Whilst Quinn (2000) states that mentors can enhance a student’s performance and development by providing the student with feedback and reinforcement.

Jay had his own learning styles and they were not always the same, depending on the task at hand but they were consistent. Reece and Walker (2003) state that there are different learning styles to consider before embarking on any programme of teaching, it is important to recognise that. As a mentor, you might have to teach according to the student’s learning style and as much as many people have more than one style, they always have a preferred style. Working with Jay and observing him, I picked up that he preferred practical experiences and therefore I had to attempt to incorporate these when the opportunities came.

There ae several internal and external factors that affect student learning and a mentor can identify these by conducting a SWOT Analysis with their student (strength, weaknesses, opportunities, threats). The SWOT Analysis is a useful tool that is used to assess the environment, person or situation and Mentors can use this in their own environment to help identify the strengths and weaknesses and the internal factors that affect the efficiency of mentoring (Murray and Rosen 2010). A mentor has to actively seek input from the mature leaner, brainstorm together to come up with ideas of how the student’s learning needs will be met and encouraging them to actively seek out learning opportunities and help were required.

We talked about the risks that could be faced on the ward as some of our patients can present with challenging behaviours leading to sometimes them being physically aggressive towards staff or other patients and requiring them being restrained and had to remind Jay that for the next few months whilst on placement, he unfortunately could not assist in restraining patients but he could record where each member of staff was during the restraint or redirect the other patients away from where the incident was happening. I reminded Jay that it was my professional duty to ensure his safety and that of the patients as well. We agreed that if he was unsure about a situation, he shouldn’t hesitate to ask myself or any other nurse he would be working with.

We discussed the importance of report writing and recording and that they are principles that we follow to help with this. I asked Jay to look at the hospital policy regarding information governance and informed him that it can be summed up by saying that anything you write or enter must be honest, accurate and non-offensive and must not breach patient confidentiality RCN (2009). As nurses we are accountable for what we document, and it must be factual.

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We also talked about having out mid-point feedback and then agreed a date for the final feedback whereby we would talk about the final grade. I informed Jay that if he felt he needed extra support prior to the dates he should let me know and I informed him that if I had worries about how the placement was going, I would also request to see him to support him for him to progress well with the placement.

Giving feedback is an important and essential component of effective student assessment. Kinnell and Hughes (2010) state that “feedback must be constructive and not destructive”. Feedback should be able to highlight the students strengths and also their weaknesses (Kinnell and Hughes 2010). Kinnell and Hughes (2010) also state that feedback should be able to emphasise areas for improvement and include praise where praise is due and achievements have been met. When students are given constructive criticism by their mentors and other members of the MDT, it helps them grow and development as a future professional (Levett-Jones and Bourgeois 2011). Elcock and Sharples 2011 suggest using the feedback sandwich which means putting negative feedback between two positives therefore avoiding hurting the student’s feelings and self-esteem.

Whilst assessing a student’s performance, it’s my accountability as the mentor that includes making sure that all the possible opportunities for learning have been exhausted and that I gave Jay some time to master the skills that he would be assessed on. It would have been unfair for the Jay to be assessed on skills which he was never taught or even given a chance to learn or improve on. There is also the accountability of theme as the mentor towards the public as I would be mentoring the future generation of nurses to come into the field. As a nurse/mentor, I should be prepared and able to explain and justify my professional practice and if I see a student failing to meet the requirements of being competent even when given support and opportunities to improve, as a mentor, I should not hesitate to give a failing mark.

A study conducted by Duffy (2003) revealed that failing a student is a difficult thing to do for majority of mentors and this is because it raises emotional issues for the mentor. Mentors ended up feeling guilty and start thinking of about the what ifs and questioning themselves as to whether they gave the student enough time, spent enough time teaching them. Then there’s also fear of litigation and at times there’s benefit of the doubt, thinking the student was nervous, they’ll get better in the next placement. The emotional stress of failing a student sometimes overcomes some mentors stopping them from being fair and objective. Some mentors do not want conflict with the students due to lack of confidence and with others it’s inexperience, still starting out and not sure of the role of how to identify an unsafe student. Mentors should be able to detach themselves from personal sentiments and objectively assess a student’s performance, making sure that they met the standards required for them to practice safely.

According to the study by Duffy (2003), in the first-year mentor’s give students the benefit of the doubt when grading them and where some students whose practice was evidently weak and identified at an early stage, they should be given the necessary support and removed from programme if there is no improvement. By the time a student gets to their final year and there’s no improvement, according to Black (2011) they would be unsafe to be in practice. However, it is accepted that some management skills cannot be tested until this stage and it is probably necessary to have some level of failure in year three. If a student is failing, they should seek out support from their mentor and a mentor should also pick it up before the student gets to the end of placement and they can support them. The mentor can have a meeting with the student and the University tutor to discuss the concerns. If the student gets to the end of placement and there’s still no improvement, then the mentor has no choice but to fail the student and it shouldn’t come as a surprise to the student if they have been made aware during the duration of the placement.

In conclusion, having completed this module and being co-mentor, I learnt and developed new skills and exploited my mentoring qualities. It made me look more at my own practice and made sure that it is evidence based and I can apply it when mentoring student nurses. Having learnt and explored more on learning styles and theories has made me aware of the different styles people learn and has made me more aware when planning learning experiences for students. I am determined to make sure I will attend regular mentor’s updates, so I can mentor students effectively. It would give me the chance to meet up with other mentors and share ideas and discuss any issues that I may be facing or have faced, and I would find out how others dealt with such a situation and the University would also share with mentors any new regulations and expectations that mentors should be aware of. As a mentor, I also received feedback from my manager who was mentoring me and from the student that I was mentoring as this was also a learning curve for me. Receiving this feedback made me reflect on my own practice and I got to learn which areas I needed to develop and improve on.

References

Aston, L. & Hallam, P. (2011) Successful Mentoring in nursing. Exeter: Learning Matters Ltd.

Black, S., 2010. Gate keeping the profession: mentors who fail student nurses in their final placement. Conference Paper, RCN Education Forum. Blackpool.

Casey, D.C. & Clark, L. (2011) Roles and responsibilities of the student nurse mentor: an update. British Journal of Nursing (Mark Allen Publishing), 20 (15). pp.933 – 937. 

Duffy, K. (2004) Failing Students. London: NMC

Duffy, K. (2013) Providing constructive feedback for students during mentoring. Nursing Standard. 27(31), pp.50-56

Elcock, K. & Sharples, K. (2011). A Nurse’s Survival Guide to Mentoring. 1st Edition. Edinburgh: Churchill Livingstone.

Gopee, N. (2008) Mentoring and supervision in Healthcare. London: Sage.

Hawe, E. (2003) It’s pretty difficult to fail. Assessment in Higher Education. 28 (4), pp.371–382.

Hunt, L. A. McGee, P. Gutteridge, R. & Hughes, M. (2016) Manipulating mentor’s assessment decisions: Do underperforming student nurses use coercive strategies to influence mentor’s practical assessment decisions? Nurse Education in Practice. 20, pp.154 – 162

Kinnell, D. & Hughes, P. (2010). Mentoring nursing and healthcare students. London: SAGE Publications Ltd.

Levett-Jones, T. Lathlean, J. Higgins, I. & McMillan, M. (2009) Staff-Student Relationships and Their Impact on Nursing Students’ Belongingness and Learning. Journal of Advanced Nursing. 65, pp.316-324. 

Lowry, M. (1997) Using Learning Contracts in Clinical Practice Professional Nurse. Nursing Times. 12(4), pp.280-283.

McCabe, C. & Timmins, F. (2006) Communication Skills for Nursing Practice. 2nd Edition. Basingstoke: Palgrave

Murray, C. & Rosen, L. (2010). Mentor updating: Other activities/sources of evidence. In: C. Murray, L. Rosen and K. Staniland (Eds.). The nurse mentor and reviewer update book. Open University Press. Maidenhead: pp.95-111.

NMC (2007) Guidance to Mentors of Nursing Students

Nursing & Midwifery Council (NMC) (2008a). Standards to support learning and assessment in practice. London: NMC.

Nursing & Midwifery Council (NMC) (2008b). The code: Standards of conduct, performance and ethics for nurses and midwives. London NMC.

Reece, I. & Walker, S. (2000) Teaching, training and learning a practical guide. 4th Edition. Sunderland: Business Education Publishers Limited.

Royal College of Nursing (RCN) (2009). Guidance for mentors of nursing students and midwives: An RCN toolkit. London: Royal College of Nursing

Walsh, D. (2010) The Nurse Mentor’s Handbook: Supporting Students in Clinical Practice. Oxford: Oxford University Press

Wells, L. & McLoughlin, M. (2014) ‘Fitness to practice and feedback to students: a literature review’. Nurse Education in Practice. 14 (2). pp.137-141.

Wilkes, Z. (2006) The Student-Mentor Relationship: A Review of the Literature. Nursing Standard. 20(37), pp. 42-47.