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

2. 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

3. Workforce Expectation
By % 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!

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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.

12. The CLiP model

13. 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

14. What PEBLS looks like

15. 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

16. 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.

17. The development of the STEP themes

18. 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.

19. 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?

20. 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

21. 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

22. 2017 NMC proposalS: new requirements for learning and assessment

23. 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’

24. 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’

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

32. 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

33. Questions?