Alternative approaches to mentorship Juliet Borwell Lead for Learning Environments & Professional Development

Mentorship with Future Health Care Demand Challenges Ageing and diversifying demographic profile Increase in complexity of health and social care needs and incidence of multiple pathology Increase in combined mental and physical care challenges Increased acuity, throughput and use of technology Increase in long term conditions Increased consumer expertise and expectation = Escalating demand for expert nursing care

Workforce Expectation By 2020 50% of our workforce will be from Generation Y Highly ambitious – Need frequent recognition and feedback Career motivated, not company loyal – Work life balance highly important Team orientated, part of a community – Collective success, embrace diversity Seeking mentorship, coaching and reassurance – Looking to ‘be’ developed Highly productive and efficient – But I need the right tools for the job; Technology enabled and Generation Z are on the way!

Supporting learners is important because... We need to ensure graduates are competent AND CONFIDENT New programmes are being introduced We need to retain all the students we can throughout training We need to retain and develop staff Applications to nurse training are not going up (yet) There is a national shortage of nurses

Mentorship – the National context NMC: 2008 Standards to Support Learning and Assessment in Practice Predominant model in the UK is currently based on a 1:1 teaching relationship RN Mentor:student depleted Registered Nurse resource + expanding range of learners = ‘learner fatigue’ ? Sustainability of this approach: National Nursing Research Unit 2012: Sustaining and managing the delivery of student nurse mentorship: Shape of Caring Review: the Willis report: 2015 RCN mentorship Project 2015 NMC: 2017: Proposals for a new education framework

Direction of mentorship Coming from   Going towards A model based on teaching A model based on coaching One named mentor for each student Team approach to supporting learners Clinical placements for pre-registration student nurses Clinical placements for a diverse range of students and work-based learners

Fundamental Review (2013) – what HEE East of England found Over 500 Staff, students, service users and HEI staff involved CLE/mentorship was most frequently cited theme Too much variability in practice education Not enough focus on students delivering care Variable assessment of skills and practice was not seen as being as important as theory Mentors not valued and supported Students were seen as competent but not confident upon graduation Capacity was as important as quality and interdependent

Fundamental Review (2013) – what HEE EoE did High quality CLE is key - piloted some new approaches: Collaborative Learning in Practice (CLiP) Practice Education Based Learning (Suffolk) PEBL(S) Enhanced Practice Supoprt Framework AND reviewed national and international literature to try to establish what works in improving the quality and capacity of the CLE

What works A model based on coaching A model not based only on a 1:1 mentor relationship Learners delivering hands-on care Leadership for education and executive sign-up A sustainable infrastructure Linking education and workforce supply to Trust business

Other benefits A focus on coaching skills changes the culture of care A focus on quality of CLE improves the quality of care Some evidence of reduced pressure ulcers and length of stay Students learn to lead care and learn in a multi- professional environment

Collaborative Learning in Practice A new model of practice learning for pre-registration nurse education was pilot-tested in Norfolk. The Collaborative Learning in Practice model (CLiP) Based on a similar model of practice learning used in the Netherlands. The model is distinct from the traditional mentorship model. Rather than working individually with a mentor, students work collaboratively alongside other students under the guidance of a coach. Coaching underpins the philosophy of learning so that students are supported to take on greater responsibility for their own learning within a culture that values student identification of solutions to patient focused care.

The CLiP model

Practice Education Based Learning (Suffolk) PEBLs Practice Education Based Learning (Suffolk) was introduced following a review of practice education in Australasia and early learning from the CLiP model. The model is based on a learning bay comprising 6 to 8 patients cared for by 3 students one of whom assumes the role of coordinator. A coach supports the students. A clinical educator is in place to support the ward team. Overall capacity of the clinical area increases. This model is also based on the use of coaching to empower students, increase their leadership, problem solving and critical thinking skills and enable a smooth transition to the RN role

What PEBLS looks like

Enhanced Practice Support Framework (EPSF) The EPSF is underpinned by the view that the facilitation of learners is every registered nurse’s responsibility and not the sole remit of a registered mentor. It also recognises the need for a role model to support mentors with their decision-making around assessment and development of mentorship skills, as well as to develop and maintain a quality learning environment

STEP – Strengthening Team-based Education in Practice. This is just to put WBL in context. Why I think its particularly important to modern HE education in light of its history, pedagogy and its future.

The development of the STEP themes

STEP Project Objectives To develop, pilot and evaluate a range of approaches to support learning in practice capitalising on existing resources. To create a range of resources that reflect best practice to support all learners in the environment. To develop placement opportunities in general practice, nursing homes and the voluntary sector.

The Helpful Other Questions Perception of the role of ‘helpful others’ including the HCA? Structure of the student experience of working with the HCA’s? How students feel about working with the HCA and whether/ how it differs from working with their mentor? If/ how feedback is received? Ideas/ Resources for Toolkit?

If we don’t know something we learn together Key Findings: Students Role Relationships Role Development (Over time) Understanding role of the HCA Where the nurse fits in Role Definition Accessibility Pastoral Support Busy/Ratio Orientation Experience HCA experience & knowledge Skills Learning Together Feedback Student Development I really find it difficult to differentiate nurses and HCA’s…the only difference I realise is that the HCA doesn’t give medication Mentors are mentors, and HCA’s are HCA’s. They want to make sure they teach you, but in a different way and a different style They gave me the tour to show me where everything was…it was very thoughtful If we don’t know something we learn together HCA’s never said anything to me, I don’t know if it’s an inferior thing because I’m a student nurse and they are just an HCA, but some of them are like nurses, so knowledgeable but they aren’t being told how well they are doing , they are just told what to do They just know everything, they know it inside out…the wealth of knowledge is just vast…and it’s not written down it’s in their heads

Key Findings: HCA’s Friendly Approach Make them feel welcome We need to work more together instead of having this divide I want to make them feel comfortable , which makes it easier for them to ask questions I usually show them around, then I will take them to the nurse they are working with, but they end up working with me We have to be acknowledged, it is so important Friendly Approach Care is not about one thing, it’s a package Make them feel welcome Some students come on the ward knowing that our role is to wash and toilet the patient and make beds and that’s it As the time progresses into weeks and months the realise they can learn something from you If the student knows that we will be going back to the mentor and giving our feedback…they will put their heads down and learn

2017 NMC proposalS: new requirements for learning and assessment

NMC proposals: evidence findings Standards to support learning & assessment in practice (SLAiP) are overly focused on processes and inputs in comparison to other regulators Variability of quality of student learning and support in practice Confusion over roles, titles and responsibilities Not enough time and not enough mentors ‘Failure to fail’ Lack of institutional support for ‘mentors’

Positive international models of mentorship show the following features: The role of the clinical supervisor is valued and supported Partnership working is encouraged between practice and educational environments Supports inter-professional care Increased student led supportive environments Increased ratio of students to ‘mentor’

Principles for NMC new requirements for learning and assessment The NMC aim to: Separate supervision and assessment roles Enhance clarity over roles and responsibilities Increase consistency in assessment judgments Improve interprofessional working Enhance joint working between AEI’s and practice Align with other professional regulators Improve ‘buy in’ to the supervisor and assessor roles Potentially improve availability of practice supervisors

Practice supervision: principles All students should be supervised in practice All nurses and midwives should be responsible for the supervision of students in accordance with the Code Other registered health and social care professionals can supervise students All students should have a “go to” professional Supervision proficiency to be included in pre-registration Practice supervisors to be: Registered health and social care professionals based in practice Supervisory, not assessment role

Assessment: principles All students assigned to a nominated practice assessor and a nominated academic assessor Both nominated assessors must be NMC registrants with high level due regard Joint responsibility for undertaking assessment at specific points in the programme Assessment decisions evidenced by PAD, practice supervisor and service user feedback, peer feedback, academic learning, reflective learning by student

Working assumptions Learning and assessment requirements aligned for all approved programmes Due regard at high level for those undertaking assessment No NMC approved preparatory course No NMC competencies set for assessors and educators Removal of triennial review requirements for mentor register Joint working (including assessments) between AEI and practice environments Supporting information produced for the assessor and practice supervisor roles Removal of standards for NMC teacher

Programme outcomes completed (entry to register) Pre-registration student journey under the proposed model of learning and assessment Practice assessor 3 Practice supervisor Practice assessor 2 Practice supervisor Practice assessor 1 Practice supervisor Year 1 Year 2 Year 3 Programme outcomes completed (entry to register) assessor 1 Academic Academic educator assessor 3 Academic Academic educator assessor 2 Academic Academic educator

HEE Wessex Mentorship Fellow Task and finish group: Jan – June 2017 Coaching Learners in Practice training Sharing event 6th June Peer group supervision training Start up guide/resource pack June 2017 onwards: Revise terms of reference Leading regional work towards implementing NMC proposals

Salisbury NHS Foundation Trust Practice Education Based Learning (Salisbury!) Pilot commenced in July. On 2nd cohort. Project in 2018 to expand at scale Supporting Learners is everyone’s responsibility – HCAs to Specialist Nurses Increasing involvement of Specialist Nurses via ‘flipped hub and spoke’ approach

Questions?