Annual Mentor Update for Nurses and ODPs 2013

Clinical Learning Environment What makes an effective learning Environment? Ask the group members to discuss - 10 mins – then feedback 2 2

Clinical Learning Environment The Mentor for Nurses or ODPs The Student The Ward/department The University Preparation for student: mentor allocation induction pack orientation duty rota learning opportunities appropriate support/meetings

What are the professional requirements to remain on the ‘live’ mentor register as stated by the NMC (SLAIP 2008) or CODP(2009)? Have successfully completed an NMC approved mentor preparation programme. Have participated in an annual (12 months) Mentor Update. Have an understanding of ‘due regard’ Participate in a Triennial Review process to ensure NMC standards are met/biannual review (CODP) Support and summatively assess two students within the three year cycle When the group respond ask them to further explain what a triennial review is and alert them to the triennial review document on the mentor portal for both Universities. (Triennial review is on next slide as well) Ask the group do they know if they are on the live register for their organisation

NMC Mentor Standards (SLAIP 2008) Have successfully completed an NMC approved mentor preparation programme Have participated in an annual (12 months) Mentor Update Have an understanding of ‘due regard’ Participate in a Triennial Review process to ensure NMC standards are met Support and summatively assess two students within the three year cycle 5 5

CODP Mentor Standards ( 2009) To be maintained on the local register the individual must have evidence of having: 1. Mentored at least two students within the two year period. 2. Participated in ODP specific update every two years. 3. Undertaken work based / informal learning relevant to their role as a mentor. 4. Undertaken professional activity 5. Develop knowledge and understanding of their role through formal education activity. 6. Undertaken the appropriate mentorship qualifications College for operating department practitioners 6 6

Triennial Review (nurses) Three yearly cycle of reflection of mentor practice against NMC standards The process is a self assessment of your skills as a mentor As a quality process a discussion will be held with your line manager or appropriate other Will need to provide evidence of professional development A checklist is available to support this process. The Mentor Register is then updated Triennial review document is in the handouts from the mentor update box. Triennial review is cyclical. Not all individuals will be at the same point in the process. For example if an individual completed the mentorship course in September 2009,they would then be due for TR in 2012. Documentation used for verification that criteria has been met can be accessed on the mentor portal. Organisations across Essex and Cambs use this tool. However other documents are acceptable. The tool enables the mentor to provide evidence that they have attended an annual update and mentored 2 students in the three year period and have met the 8 domains of mentorship detailed in the standards, either through reflection and or documentation such as witness testimony, annonymised student documentation. Some mentors will have a portfolio for this purpose. TR has been built in to staff PDP/appraisal process in most areas. It is important that TR is completed in a timely fashion to avoid mentors dropping off the register.

Biannual review (ODPs) Two yearly cycle of reflection of mentor practice against CODP standards The process is a self assessment of your skills as a mentor As a quality process a discussion will be held with your line manager or appropriate other Will need to provide evidence of professional development A checklist is available to support this process. The Mentor Register is then updated

Due regard A mentor for nurses has the specialist skills required to support the placement learning outcomes. is from the same part of the register and field of practice as the student in the final year of the programme has completed a mentor qualification can mentor ODPs A mentor for ODPs has completed a mentor qualification can only mentor ODPs not nurses Ask if anyone knows what this means. For the first 2 years of the programme students can be assessed by other health care professionals as well as other fields e.g. mental health insights

Associate mentor Nurses No mentor qualification Cannot sign paperwork ODP’s Minimum 6 months experience Attend mentor update Complete biannual review Performs formative assessment

Mentor Nurses Holds a mentor qualification: at level 2 or 3 Performs summative assessments ODPs Holds mentor qualification: at level 3 (6) or at level 2 (5) and completed level 3 (6) study Performs summative assessments

Practice Educator Nurses Not required ODP’s Minimum 3 yrs experience Holds a degree or working towards a degree Has overall responsibility for students in placement

Sign Off mentors for nursing students (not required for ODP students) Sign Off mentors are required for: All student nurses in their final placement Overseas Nursing programmes Return to Practice students A Sign Off mentor is a nurse who has met the additional criteria Sign Off Mentors make judgements as to whether a student has achieved the required standards for entry on to the NMC register. Sign off mentors need to be supervised by an existing sign off mentor. Trusts were required to identify a critical mass of sign off mentors by September 2009.These were automatically annotated on to the register and are therefore to be involved in the development of subsequent sign off mentors. Sign off mentors have 12 weeks in which to make a judgement. They are required to keep an audit trial of the decision they have made for QA purposes. The sign off mentor will have access to the students past summative assessments and any other resource which they reasonably consider necessary to inform their professional judgement 13 13

Prospective Sign Off Mentor To become a Sign Off mentor you will need: To be supervised by a qualified Sign Off Mentor on 3 occasions assessing a student two via simulation one with an actual student annotated on to the Mentor register following review of evidence of above (NMC 2008, NMC Circular 05/2010) Discuss the importance of ensuring there are enough sign off mentors to support management students and the importance of forward planning regarding this

Sign Off Mentors for nursing students Sign Off Mentors make the final decision as to whether a student has achieved the required standards for entry on to the NMC register Sign Off mentors are required for: All student nurses in their final placement Overseas Nursing programmes Return to Practice students A Sign Off mentor is a nurse who has met the additional criteria A trainee sign off mentors need to be supervised by an existing sign off mentor. To become a Sign Off mentor you will need: To be supervised by a qualified Sign Off Mentor on 3 occasions assessing a student two via simulation one with an actual student annotated on to the Mentor register following review of evidence of above (NMC 2008, NMC Circular 05/2010) Trusts were required to identify a critical mass of sign off mentors by September 2009.These were automatically annotated on to the register and are therefore to be involved in the development of subsequent sign off mentors. Sign off mentors have 12 weeks in which to make a judgement about a student. They are required to keep an audit trial of the decision they have made for QA purposes. The sign off mentor will have access to the students past summative assessments and any other resource which they reasonably consider necessary to inform their professional judgement.

RESPONSIBILITIES OF THE STUDENT 16

Student responsibilities To arrive on duty on time, smartly dressed. To follow the stated sickness/absence procedure. To take responsibility for his/her own learning by coming prepared to meetings with the mentor Ensure that deadlines are met To act professionally at all times Work with their mentor Work the shift patterns such as nights and weekends Fixed annual leave 17 17

YOUR RESPONSIBILITIES WHEN WORKING WITH STUDENTS 18

Francis report Report commissioned by the Secretary of State for Health carried out by Robert Francis QC Published 6th Feb 2013 209 recommendations: Focus on developing the right culture in the NHS through leadership, training, information and transparency What is the Francis report? The Francis Inquiry report is the report of the full public inquiry into the failings at the Mid Staffordshire Foundation Trust. The Inquiry, led by Robert Francis QC, looks at the role of the Commissioning, Regulatory and Supervisory bodies and why serious problems were not identified and acted on sooner What does the Francis report say? The report delivers 290 recommendations to Government. The key message within the report is the need to develop the right culture of care within the NHS, through better leadership, training, information and transparency What are these recommendations? Some of these include: A criminal offence for any doctor, nurse or health professional to mislead regulators An obligation of candour to patients and relatives by health professionals All health care professionals to be trained in compassion A new register for health care support workers which would be able to ‘strike off’ poorly performing staff The creation of a new set of ‘fundamental standards’ for care in the NHS which can be easily understood by patients, staff and the public How does the Francis report affect you as a MENTOR? It is important mentors discuss the findings of this report and its recommendations with their students. Many of these recommendations will be implemented over the coming months and years. As mentors, preparing newly qualified health care professionals within the NHS, patient centred care, which focuses on compassion, dignity and respect must be at the heart of discussions with your students within practice. Please talk to your students about this report and how you can draw on the findings within this report to develop your students to become the competent, compassionate, caring health care professionals of the future, highlighted within the Francis report. 19

NHS constitution Working together to ensure students are supervised and assessed by mentors who support care that embraces the underpinning principles and values of the NHS Constitution and the 6 C’s in Nursing: Care Compassion Competence Communication Courage Commitment Care – the public feel that we need to be able to measure the quality of nursing, midwifery and care giving to ensure that it is delivered on a consistent basis, first time, every time in the right setting and the right way. Compassion – the public speak about the importance of recruiting nurses/midwives and care givers with compassionate values; measuring and assessing compassion; and the processes used to promote compassionate care, for example the use of annual appraisal and feedback Competence – a high level of competence is required to deliver appropriate care, recognise a deteriorating situation, challenge poor practice or decision making of others Communication – good communication involves better listening and shared decision making ‘no decision about me without me’ and making every contact count Courage – many people felt nurses, midwives care givers might be afraid to speak up – it takes courage to stand up to poor care and to innovate, suggest and implement new ways of working Commitment – commitment to take action together as a profession to unlock its potential These 6C’s will be evident throughout the students’ practice assessment documentation.

It is important to ensure that all students: Are supernumerary Are on the duty rota for Health and safety reasons Actively engage in hands on delivery of care as appropriate Have a named mentor who is available for a minimum of 40% of the time Participate in the 24 hour cycle of care Discuss whether there have been any problems with this! Also discuss role in supervising non-nursing students.

You may be supervising: ARU nursing students on the September 07 nursing programme. ARU nursing students on the all graduate programme which commenced in September’11. ARU ODP students on 2 year diploma programme. 22

NURSES This is an example of a September block plan. Talk to the group about the 50% theory 50% practice component. For the new curriculum students are assessed in the community and in acute therefore each year is broken up into 2 parts. The final year is a critical care type placement which is non assessed and the management module – students can choose whether community or acute in year 3 As you see from the block plan students come in to Uni from practice at various points for reflection etc

ODP student journey Trimester 1 Trimester 2 Trimester 3 Year 1 Anaesthetics Surgery Post-anaesthetic care Trimester 4 Trimester 5 Trimester 6 Year 2 (critical Care/ED)

Supporting students What obstacles do you envisage? What support is available? Discuss in two groups, then feedback. 25 25

Assessing students Induction/Initial Meeting Learning Contracts/Action plans Interpersonal skills profile / core professional values Service user views – why? Cause for Concern Fine Grading Formative assessment Summative assessment This is an opportunity to go through the practice documentation with the mentors ,clarifying any queries and reinforcing the importance of timely initial meetings and assessments. These documents can be found in the mentor update box, which needs to be collected prior to the session. All the content on the slide should be discussed. Ask a trigger question e.g. Do you know who is responsible for signing the summative assessment. Important to remember that ARU currently has 2 curricula running ARU has an interpersonal skills profile in the practice skills document Need to consider what support is necessary for students with specific learning needs (see document on ARU mentor portal)

Grading in practice When deciding the grade/score for the individual student assessment consider carefully; How you are going to evidence/explain the reason for your decision 27 27

Supporting the failing student Essential to have robust and transparent processes in place Investigate why your student may be having difficulties Clear action planning Comprehensive documentation as evidence Use of support networks Pick up problems early!!! Talk about why it may be difficult to fail students. 28 28

Learning Contracts /Action Planning Use of Specific, Measurable, Achievable, Realistic, Timely, (SMART) objectives Clear review dates Use of support networks It is essential that the mentor follows due process regarding this documentation to ensure that the student has been afforded the opportunity to address the identified area of concern. PEFs are a good resource. Students without clear action plans or formative feedback may well appeal through the HEI appeal system stating that they were not supported in practice and then may well be given a further attempt 29 29

Support in practice Remember you are not expected to deal with student issues or concerns on your own there is a network of support for mentors available from your own Organisation, the HEI and the Commissioning body Here discuss the importance of partnership working and the need to use the support network to either discuss their decisions or to talk through difficult issues For example – mentor colleagues, the education champion, the link tutors, the local practice education facilitator, the local education Trust lead

RESPONSIBILITIES OF THE HIGHER EDUCATION INSTITUTE 31

To liaise closely with, and support, mentors and placement providers To provide theoretical and practical teaching (skills lab) which will inform students in practice To liaise closely with, and support, mentors and placement providers With placement providers, monitor, develop and evaluate the quality of the learning environment eg audits To respond to driving forces such as statutory bodies , placement providers and the public Discuss points they have raised 32 32

RESPONSIBILITIES OF THE PLACEMENT PROVIDER 33

Local agreement to undertake triennial review Works with the HEI to maintain an up-to-date register of current mentors, sign off mentors and practice teachers. Local agreement to undertake triennial review Supports mentors to access annual updates Ensures mentor works 40% of time with their student Ensure one hour protected time allocated for individuals acting as sign off mentors Supports the triennial review process Individuals acting as sign off mentors need to spend the equivalent of one hour a week with the student and this needs to be documented. Annual updating is mandatory 34 34

Monitoring the quality of the learning environment: Educational Audit NMC require evidence of 2 yearly audits of the learning environment The audit needs to provide evidence of: Orientation/induction for students Professional development of staff Scope of the learning environment Student evaluations and responses to these Action plans in response to issues/concerns Review of capacity 35

The good news: NMC visited ARU in November 2012 Nursing Times award Student focus groups feedback NMC – good collaborative working Nursing Times award – shortlisted for collaborative working award. Student focus groups (1st and 2nd year) – Good points - felt well supported by mentors, good learning opportunities, “brilliant staff” “fantastic teaching” good induction to the hospital Poor points – students not working with their mentors, “my mentor did not know I was coming”, “I felt like a burden”, “my book was an aferthought”

Thank you…. for attending today and for your continued support of students in practice.

On line information www.anglia.ac.uk/mentors To support this presentation please access the link below for the information and guidance included in this presentation www.anglia.ac.uk/mentors

Scenario For Discussion 1st year Student nurse Louise Martin approaches you and is very tearful. She says that her mentor is off sick and her second mentor is on annual leave. Her practice document is due to be handed in to the University in  three weeks time and she does not want to fail. What should you do? 39

Find out who Louise’s mentor and co-mentor are and verify when they went off on holiday/sick leave and when they are likely to be back Look at Louise’s practice document and establish how much has been completed/how much still needs to be completed  Establish when the document is due be handed in and if the formative assessment is due Depending on your seniority, take your findings to the ward manager/student link nurse to resolve the situation Inform the Education Champion/Link Lecturer/PEF of the situation

Scenario For Discussion As Julie’s mentor you have approached a patient anonymously to obtain feedback on the patient experience of being cared for by your student The patient replies that she would ‘never want to be nursed by her again’

Sit down with the patient and ask her why she feels like this? Will You Decide to ask another patient for her views in the hope that they will be more positive? Sit down with the patient and ask her why she feels like this? Go straight to Julie and ask her why she thinks ‘a’ patient might have said this? Ask Julie to reflect on the patient views and all the formative feedback given so far? Fail Julie in this placement because of the effect she has had upon the patient? It would not be productive to actively seek out a positive response as all patients under the student care should feel positive about the care given It is important for the mentor to sit with the patient and clarify what the problem was and assure the patient this would be addressed with the student anonymously as it is important for the student progression and development It would not be appropriate to ask the student to answer to this – it would be more productive to ask her to reflect on this along with all the formative feedback given by the mentor It is important to consider all performance and progression before reaching a summative decision 42

Scenario For Discussion You are mentoring a student nurse who is at the end of the second year of her course. It is the time for her formative assessment and you are very concerned about her attitude and her ability. When you try to discuss this with her, the student becomes very defensive saying that she has never received such negative comments before. This makes you feel very uncomfortable and you do not feel that you can proceed with writing the action plan. 43

E mail your PEF to discuss the problem DO YOU: E mail your PEF to discuss the problem Seek support from your colleagues Seek support from the HEI/link team Decide to give the student the benefit of the doubt and write a more positive formative report. Fill in a ‘cause for concern’ form. Discuss the fact that E mails about a student’s performance should not be sent to any member of the support team without the student’s knowledge. It is important that all discussions take place with the student and face to face or telephone if possible. Sending personal information over the web to PEF’s, link team etc is not respectful of the student data It may well be that a statement has to be made and sent but numerous emails complaining about the same student should not be happening Filling out an ARU cause for concern form will mean that the education champion/link team can be asked to collect the form and read the issues on the form and will also mean the Director of Study will investigate and contact the link area 44 44