Update for Nursing Mentors 2016 Supporting Undergraduate Pre-registration Nursing Students in practice

NMC Mentor Update – the basics 1.How do you become a mentor? And stay on the mentor register? 2.Where is the register of NMC approved mentors and what information must be 3.held? 4.What is a sign off mentor, how do you become one, why were they introduced? 5.How much time in practice must student nurses spend with a mentor? 6.What resources are available to support mentors? 7.What are the obligations of the mentor: – First day – First week – Half way through – End of placement – Making fair judgements about NMC Practice Standards AND Clinical Skills – Dealing with a potentially failing student

Common questions about placements Can students do long days, weekends and night shifts? Can a student be left without direct supervision in a patient/service user homes on a community placement? Are all placements assessed i.e. must be passed? Can students work extra shifts to ‘make up’ hours in a placement? Does NHS Professional or agency work count as practice hours? How are practice placements quality assured? Is there is a list of what students can and cannot do in practice? What is a hub and spoke model?

What is new? Lord Willis (2015) The Shape of Caring Review report – Raising The Bar

Recommendations: Patient involvement to increase NMC to consider year model and explore the development and implementation of a year-long preceptorship programme for newly qualified registered nurses NMC to consider different fields of practice e.g. community NMC should review its current mentorship model and standards, informed by the outcome of the RCN review Universities should work with Health Education England (HEE) to explore in greater depth the causes for leaving the pre-registration programme HCA Role - HEE should set the competency standards for care/ Care Certificate mandatory/ Access to nursing easier

In Leeds: Leeds Beckett University and the University of Leeds have started to consult on NMC revalidation for our pre- registration nursing courses (due during 2016 – 17) All aspects under review : Taught element of programmes Practice placements Student practice assessment documents

To consider: Grading of practice Electronic practice assessment documents Feel free to feedback via me or course teams

NMC (2008) “Mentors are responsible and accountable for …providing…constructive feedback” We know that students: Value feedback Want specific not generic feedback Want negative as well as positive feedback Need formative as well as summative feedback Can find feedback :motivating, increases their confidence, promotes personal development, improves self esteem, reduces stress, develops competence We know that mentors: Find giving feedback stressful at times Difficult to give to weaker students Duffy, K Providing constructive feedback to students during mentoring. Nursing Standard. 27, 31: 50 – 56

Reflect on students who you have recently mentored… How do you give constructive feedback to students?

Value of formative (v. summative) feedback: “ Assessment discussions can help students develop ‘situational understanding’ that will help them…. negotiate their way through the competing and contradictory values that they encounter as they perform care.” Phillips et al, Practice and assessment in nursing and midwifery: doing it for real. London. ENB.

Principles: Set realistic goals Gauge students expectations of feedback by self assessment Ensure it is informed by evidence (prepare) Be timely -give as close as possible to events Be specific and balanced Document feedback discussions Invite student to contribute Involve university if risk of failing or mentor needs support Adapted from: Walsh, D The Nurse mentor handbook. OUP. Maidenhead.

Feedback Models A = Ask for self-assessment R = Reinforcement C = Correct H = Help by building improvement plan with learner Praise sandwich(!) with caution

Being fair and transparent:  Reliability:  Would different assessors award same mark/result/grade? i.e. consistency  Validity:  Does the assessment method measure what it is supposed to measure?  How do you ensure assessment is fair?

Making fair judgements on students : Direct observation by you Working alongside you Discussions with you Indirect observation They work with others in team who give you feedback Evidence of work completed

Think about stage student is at: Stage 1 novice Stage 2 care of single client & family/carer – non- complex cases Stage 3 – care of groups of clients & families/carers and for complex cases Consider importance of assessing against objective criteria rather than subjective or normative criteria

Transactional analysis (Eric Berne) How we respond to each other 3 states: Parent Voice of authority Directive Controlling Adult Self determined Deliberation over actions Child Emotional feelings Spontaneous reactions Compliant/ resistant

Key principles of feedback and assessment 1.Interview process: preliminary, intermediate and final 2.Development plans Emphasis on intermediate review/feedback/action plans 3.Evidence of achievement in practice of practice standards

Professional Behaviours in Practice The student maintains confidentiality at all times The student is respectful and courteous to others The student is sensitive to the needs of others The student is non judgemental The student’s personal hygiene and appearance is in accordance with the organisations dress code / uniform policy The student maintains appropriate levels of client/patient privacy and dignity The student’s timekeeping is satisfactory and he/she communicates appropriately if unable to attend placement The student demonstrates openness, trustworthiness and integrity The student makes consistent effort to achieve the requisite standards of care and learning.

What makes an effective learning environment? Consider the obligations of: The placement area team The mentor Resources for learning The host organisation

Practice placement evaluation The following statements are considered by the students when completing an evaluation of a practice placement and rated either: Yes, No, Not Applicable 1.I felt my education provider prepared me for the placement experience. 2.I was informed of my placement allocation with sufficient time for me to make contact with the placement. 3.I found the information I needed on the placement profile at 4.I had an induction and orientation to my environment, including health and safety information 5.I had somewhere safe to store my belongings whilst on placement. 6.The placement provided me with access to resources which helped me with my learning 7.There was sufficient access to internet and IT facilities whilst on placement 8.The learning opportunities available in this placement enabled me to achieve my learning outcomes 9.I was encouraged to take part in practice activities appropriate to my level of experience 10.I had sufficient opportunities to receive feedback after being observed in practice 11.The placement provided me with the experience of working inter-professionally 12.I received timely support from my course/programme team whilst on placement when I needed it 13.Early in the placement my learning needs were discussed with my mentor / practice educator 14.My named mentor(s) / practice educator(s) and the wider team were able to facilitate my development and recognised the importance of my learning needs 15.With the support of my mentor(s) / practice educator(s) I was able to work towards my placement learning outcomes 16.Staff in the practice area were friendly, helpful, included me as part of the team and had time to answer my questions 17.I understood the process for raising concerns within the placement 18.My mentor(s) / practice educator(s) understood and followed the student assessment process 19.My development in practice was informed by on-going constructive feedback 20.Where applicable, the placement encouraged service users/carers to provide performance feedback during my practice placement 21.My final assessment was fairly assessed and focused on feedback about my performance across the whole placement 22.I would recommend the placement setting to friends and family if they needed similar care or treatment 23.I was satisfied with the standard of patient/client care on my placement 24.I was satisfied with the standard of my educational experience on my placement 25.Any concerns I raised were dealt with appropriately 26.I would recommend this placement as a valuable learning experience

“ I felt included in the team during my placement”. a)What is the role of the mentor in ensuring students feel part of the clinical team? b)How would you deal with negative feedback from students about your clinical area? c)Discuss how you evaluate your own your effectiveness as a mentor

Scenario Generally your clinical area receives positive feedback from students… However, recently 3 students have provided an evaluation of their placement in your area. Although agreeing with all other statements, 2 students answered, yes, and 1, no, to the question: 16. Staff in the practice area were friendly, helpful, included me as part of the team and had time to answer my questions a)What is the role of the mentor in ensuring students feel part of the clinical team? b)How would you deal with negative feedback from students about your clinical area? c)Discuss how you evaluate your own your effectiveness as a mentor?

Student Experiences “ Nursing students’ self-concept, confidence, resilience, self efficacy, the extent to which they were willing to question or conform to poor practice, motivation to learn and future career decisions were influenced by the extent to which they experienced belongingness.” Levett – Jones,T., Lathlean, J., Higgins, I. & McMillan, M Staff – student relationships and their impact on nursing students’ belongingness and learning. Journal of Advanced Nursing, 65, 2,

Contacts and Resources Practice Placement website: Contains resources for mentors and students Copies of student documentation Contact details for the Universities Leeds University Placement Unit: Responsible for allocations of students for University of Leeds and Leeds Beckett University, contactable at: or Health Care Placements website: Profile of all practice placements in Yorkshire Mentor register Student online evaluation facility Educational audits

August 2015 LTHT guidance: “ It has come to our attention at recent mentor updates that there is confusion around whether or not students are able to be involved in prepping and mixing up IV drugs while under supervision… we have sought clarity about this from Lesley-Ann, Clinical Educator in Pharmacy, and she has confirmed that as long as the student is a final year student, competent in ANTT, and is DIRECTLY supervised, they can reconstitute drugs. Under no circumstances can they be the second checker or administer these.” Source: Debbie Casey, Leeds Beckett University (2015)

Scenarios: 1.You are mentoring a first year student in your practice learning environment. Another student discloses that they have seen a discussion on a social networking site posted by the student you are mentoring stating that the student does not feel supported by you, as the mentor. 2.Mark is a 2nd year pre-registration student. He is 4 weeks into his placement. When he sees his personal tutor in University, he complains that his preliminary interview did not occur until 2 weeks into the placement, that Jane, his mentor, ….. has not updated herself recently…..” and she is frequently working different shifts to him. What should his personal tutor do? 3.You are mentoring a second year student who is in week 3 of an 8 week practice learning experience. Based on your observations and questioning, you notice that the student’s underpinning knowledge is poor when undertaking a particular intervention. As part of your support strategy you give the student a workbook previously developed which you ask to be completed within a week. You then receive a telephone call from a lecturer in the University who states that the student feels that you (mentor) have unrealistic expectations of them.