Enabling Learning in Nursing and Midwifery Practice: A Guide for Mentors - Softcover

Softcover

ISBN 10: 0470057971 ISBN 13: 9780470057971

Publisher: Wiley, 2008

Synopsis

With current Government targets to increase health and social care practitioners, there is an increased need for informed mentors and preceptors to support the development of the students and new health professionals.



Enabling learning in nursing and midwifery practice: A guide for mentorsseeks to underpin recent mentoring initiatives, exploring the impact of mentoring, supervision and preceptorship on professional practice, covering principles that underpin effective learning and providing practical guidance on mentoring and assessment strategies within practice settings.



Enabling learning in nursing and midwifery practice: A guide for mentorsaddresses the inter-professional and policy context for mentorship, examines the nature of effective learning environments and provides mentors with the necessary tools to assist students in their development within a practice setting. It explores the use of reflective practice, virtual learning and other core resources to enhance and support learning in practice and addresses assessing practice, making correct judgements about student competence and the development of competence in newly qualified practitioners.



Enabling learning in nursing and midwifery practice: A guide for mentorsis an important resource text for practitioners seeking to support learning in practice as well as experienced mentors and preceptors seeking to update their skills and understanding.



Key features
* Evidence-based, practical guide to effective mentoring and preceptorship
* Integrates theory and practice
* Addresses the context of learning in practice and the challenges of clinical supervision
* Promotes understanding of the importance of assessing practice and managing the mentoring process
* Equips mentors to enable students and newly qualified staff to gain confidence and expertise
* Includes activities, points for reflection and examples from practice

About this title

About the Author

Sue West is Senior Lecturer in Adult Nursing at Canterbury Christ Church University.

Professor Melanie Jasper is Head of School of Health Science, University of Wales Swansea.

Dr Tim Clark is Senior Lecturer in Nursing and Applied Clinical Studies at Canterbury Christ Church University.

From the Back Cover

With current Government targets to increase health and social care practitioners, there is an increased need for informed mentors and preceptors to support the development of the students and new health professionals.

Enabling learning in nursing and midwifery practice: A guide for mentorsseeks to underpin recent mentoring initiatives, exploring the impact of mentoring, supervision and preceptorship on professional practice, covering principles that underpin effective learning and providing practical guidance on mentoring and assessment strategies within practice settings.

Enabling learning in nursing and midwifery practice: A guide for mentorsaddresses the inter-professional and policy context for mentorship, examines the nature of effective learning environments and provides mentors with the necessary tools to assist students in their development within a practice setting. It explores the use of reflective practice, virtual learning and other core resources to enhance and support learning in practice and addresses assessing practice, making correct judgements about student competence and the development of competence in newly qualified practitioners.

Enabling learning in nursing and midwifery practice: A guide for mentorsis an important resource text for practitioners seeking to support learning in practice as well as experienced mentors and preceptors seeking to update their skills and understanding.

Key features

• Evidence-based, practical guide to effective mentoring and preceptorship
• Integrates theory and practice
• Addresses the context of learning in practice and the challenges of clinical supervision
• Promotes understanding of the importance of assessing practice and managing the mentoring process
• Equips mentors to enable students and newly qualified staff to gain confidence and expertise
• Includes activities, points for reflection and examples from practice

Enabling learning in nursing and midwifery practice: A guide for mentorsseeks to underpin recent mentoring initiatives, exploring the impact of mentoring, supervision and preceptorship on professional practice, covering principles that underpin effective learning and providing practical guidance on mentoring and assessment strategies within practice settings.

Enabling learning in nursing and midwifery practice: A guide for mentorsaddresses the inter-professional and policy context for mentorship, examines the nature of effective learning environments and provides mentors with the necessary tools to assist students in their development within a practice setting. It explores the use of reflective practice, virtual learning and other core resources to enhance and support learning in practice and addresses assessing practice, making correct judgements about student competence and the development of competence in newly qualified practitioners.

Enabling learning in nursing and midwifery practice: A guide for mentorsis an important resource text for practitioners seeking to support learning in practice as well as experienced mentors and preceptors seeking to update their skills and understanding.

Key features

• Evidence-based, practical guide to effective mentoring and preceptorship
• Integrates theory and practice
• Addresses the context of learning in practice and the challenges of clinical supervision
• Promotes understanding of the importance of assessing practice and managing the mentoring process
• Equips mentors to enable students and newly qualified staff to gain confidence and expertise
• Includes activities, points for reflection and examples from practice

Excerpt. © Reprinted by permission. All rights reserved.

Enabling Learning in Nursing and Midwifery Practice

A Guide for Mentors

John Wiley & Sons

Copyright © 2007 John Wiley & Sons, Ltd
All right reserved.
ISBN: 978-0-470-05797-1

Chapter One

CONTEMPORARY ISSUES IN MENTORING PRACTICE

Margaret Andrews Faculty of Health and Social Care, Canterbury Christ Church University

LEARNING OUTCOMES

By the end of this chapter it is expected that the reader will be able to:

Identify the role of the mentor in current contemporary nursing and midwifery practice

Compare the ways in which the role of the mentor has evolved over the last 10 years

Broadly outline the Nursing and Midwifery Council (NMC) Standards to Support Learning, with particular attention to the concept of the sign-off mentor

Acknowledge the complexities of mentoring and the need for more formal, structured approaches to mentoring practice.

INTRODUCTION

The purpose of this chapter is to introduce the concept of mentorship in contemporary health practice, and to outline some of the complexities surrounding policy change in the National Health Service (NHS) and health professional education and how this impacts on mentoring for preregistration students. The chapter is meant to both challenge and be challenging; to challenge particular current policy and at the same time confront the reader.

The key to successful practice learning lies in the level of support and guidance students receive from practitioners and academics, suitably qualified to assess their competence. There is some general confusion and tension surrounding the shift of responsibility for practice learning and practice assessment, from the academic to the practitioner, which came about in the early 1990s. With this came the demise of the clinical teacher and the renaissance of the concept of mentorship in the health professions. Student expectation of their mentors has changed over the last 10 years and as a result contemporary mentoring practice has evolved to encompass the broader elements of learning and teaching.

At the end of the preregistration programme students must be fit for practice, fit for purpose and fit for award. It is unlikely that they will meet these requirements if they do not have a knowledge base that allows them to practise in an informed way; therefore the responsibility on those who are assigned to supporting and guiding students in this is immense. Gone are the days when students only require friendly or emotional support in practice settings, they demand and deserve good quality, appropriately delivered practice learning that challenges the professionals delivering it and develops practice, based on sound theoretical principles. This is a challenge to us all; it is not an optional one, but a requirement of contemporary professional practice.

The notion of mentorship for health professional students is not new and has existed in a variety of forms for a number of years. In nursing, the introduction of the diploma of higher education and the first Project 2000 (United Kingdom Central Council for Nursing, Midwifery and Health Visiting, 1986) programmes, acted as the driver for ensuring that mentorship became a mainstream activity within the preregistration curriculum. Although there is now some acknowledgement that mentoring is a complex activity, it was introduced in a quiet way, with little fuss. Burnard (1990) eloquently points out that mentorship 'slipped into the folklore of nurse education almost unnoticed and quickly became part of the educational language of the eighties and nineties' (p. 352). Little thought was given at this time to how mentoring would work in practice or, indeed, how it was to be sustained. These aspects have become more important as students' expectations of mentors have increased, alongside the growing numbers of students. In most cases, mentors have a role in assessing students' practice competence; it is not the intention to present the arguments for and against this as they have been rehearsed elsewhere (Andrews and Wallis, 1999; Neary, 2000; Pellatt, 2006), though Duffy's (2004) work on failing students will be of interest to mentors. Duffy clearly feels that the distinction between unsafe practice (in relation to students) and the determination of failure need further exploration, especially in relation to students who are thought of as 'borderline'. In order to safeguard professional standards, and in turn the public, it must be recognized that some students need to fail, but mentors, for a variety of reasons, may be reluctant to do this.

Much has been written about the support mechanisms for students in practice settings, with both qualified staff and students favouring the mentoring approach. There is common agreement that supporting students in practice is an important part of the overall educational process, yet there is little consensus in the literature as to what constitutes support. Since the 1980s there has been a growing body of literature about mentorship in preregistration education and it has been highlighted as the most common, and preferred approach to student support (Andrews and Wallis, 1999; Andrews and Chilton, 2000; Neary, 2000; Pellatt, 2006).

The nature and purpose of mentorship in this context is related to the role of the clinician in providing student support and guidance, and, in many cases, encompasses the activities associated with learning, teaching and the assessment of practice. Although in more recent years, nursing has embraced mentorship alongside other developments, other professions have offered alternatives. There is, however, a common acceptance that the mentoring (or equivalent) of students in practice settings and all that this entails is firmly the responsibility of practitioners.

There are a number of challenges for the future around the support of students in practice settings, including the plethora of language used across the professions to denote someone who takes on a mentoring role, the interchangeable nature of the terms, the lack of acknowledgement of the interprofessional context and the changing nature and pace of health-care delivery.

DEFINING THE TERMS

There is no common view amongst health professionals and the associated regulatory and professional bodies about the most appropriate role title to call someone who is responsible for supporting, guiding and supervising preregistration students in practice. A range of terms are in common use including mentor (nursing, midwifery and teaching), supervisor/mentor (radiography) practice educator (occupational therapy) and practice supervisor/teacher (social work). Mentorship is a term used more often in midwifery, nursing and teacher education than any of the other professions, with little of the supporting literature found in the associated professional journals relating directly to the other health professions (Mulholland etal., 2005).

The English National Board for Nursing, Midwifery and Health Visiting/Department of Health (ENB/DH) (DH, 2001) defined a mentor as an individual 'who facilitates learning and supervises and assesses students in the practice setting' (p. 6). More recently this is 'a registrant who has met the outcomes of stage 2 (of the standards for mentors) and who facilitates learning, and supervises and assesses students in practice settings' (NMC, 2006, p. 44). In five years there has been little shift in emphasis except in relation to the more general acceptance of defined standards associated with the role.

In contrast, over the same five-year period the role of the practice educator in nursing as depicted in the ENB/DH (DH, 2001) Preparation of Mentors and Teachers guidance document has been replaced by the practice teacher within the 2006 NMC standards' document. The practice educator was defined as someone 'who makes a significant contribution to education in the practice setting, co-ordinating student experiences and assessment of learning' (ENB/DH, 2001, p. 6). Practice educators were also responsible for leading the development of practice and providing support and guidance to mentors and others, to enable students to meet learning outcomes and competencies. The term practice teacher, appearing in the 2006 NMC standards document, denotes someone who has fulfilled the requirements to be a mentor, having received further preparation to achieve 'the knowledge, skills and competence in both their specialist area of practice and in their teaching role, meeting the outcomes of stage 3 (of the new standards), and who facilitates learning, supervises and assesses students in a practice setting' (NMC, 2006, p. 45).

Many preregistration programmes are developed on either a partial or full interprofessional model, which demands an interprofessional approach to practice mentoring. The lack of acknowledgement amongst the professional and regulatory bodies for common terminology to denote individuals who support students in practice settings makes the notion of interprofessional mentoring more difficult to grasp and implement. For example the College of Occupational Therapists (COT) make reference to a practice placement educator, indicating that this is a practice-based staff member who is involved in the day to day management of a student on placement and who is responsible for the assessment of a student against agreed learning outcomes. Practice educators also facilitate the student's achievement of learning outcomes and are responsible for monitoring and evaluating the student's learning outcomes in partnership with the university (COT, 2003). This is more akin to the role of the mentor in nursing and midwifery. Whatever the differences in role title across the professions, there is general agreement about the nature of the role associated with supporting, guiding and assessing students in practice settings.

In the latter part of 2006 the NMC introduced the notion of the 'sign-off' mentor, as part of a much wider reform of the standards to support learning and assessment in practice. The 'sign-off' mentor is responsible for making the final assessment of practice on the last placement and confirming with the NMC that the required proficiencies for entry to the register have been achieved (NMC, 2006, p. 9). To be a 'sign-off' mentor individuals must meet additional criteria to those for mentors and be on the same part of the register as the students they are assessing. (The role and preparation of the sign-off mentor will be considered more fully in Chapter 13.)

The whole question of the role of mentorship in interprofessional learning programmes is a particularly thorny one. The new standards to support learning and assessment in practice (NMC, 2006) indicate that for nurses undertaking advanced nursing practice there are additional requirements relating to practice teachers. There is concern that the standard associated with practice teachers will present some difficulty. This is because of the wide spread of nurse practitioners, most of whom are nurses and entered advanced practice by learning knowledge, skills and competence that were previously the domain of other professional groups, especially medicine. At present, assessment is undertaken by doctors, who currently practise those skills. For example, nurses who undertake preparation to prescribe are required by legislation to be assessed by a Designated Medical Practitioner (DMP). A DMP is a registered practitioner who provides supervision and support, assesses application of theory to practice and signs off satisfactory completion of the period of learning and assessment (in practice). The new standards will throw what, to date, has been a recognized model of interprofessional mentoring into question, as on the introduction of the standards, assessment must be by an individual from the same profession.

There are several preregistration, interprofessional programmes in the United Kingdom and others that have an interprofessional flavour, less overt but still evident. In the main, the interprofessional elements are integrated into the theoretical components rather than practice learning. Students do undertake placements where they are exposed to interprofessional working but there is no strong evidence to suggest that practitioners are confident enough to accept readily the responsibility for learning experiences of students from professions other than their own. This is especially so in relation to making judgements about competence, even in relation to generic skills. This raises an interesting dilemma - should interprofessional students continue to be supported and assessed using uniprofessional models? Although, in the main, the associated professional bodies support the concept of interprofessional learning, they have yet to address interprofessional assessment clearly within their practice standards or guidance. This could be done by identifying a common terminology, developing multiprofessional standards for the learning and assessment of students in practice, together with universal preparation programmes for all mentors.

THE PRACTICE CONTEXT

Until recently, the overall picture in the NHS was one of growth, both in the numbers of patients receiving care and in the number of health-care professionals employed. In the early part of this decade the Department of Health (DH) predicted a need for an increasing number of health professionals together with changes in the way they are prepared (DH, 2000). In the NHS plan (DH 2000), the Government set out the policy for modernizing the NHS; a radical programme of reform was planned which included additional health-care personnel, and new roles and responsibilities for nurses, midwives and therapists together with improved training and increased numbers of nurses and other health-care professionals in training. This trend continued until 2005/2006, four years short of the time period for the NHS plan. More recently, in the light of financial pressures, the numbers of health professionals entering training are reducing (2006/2007). The picture currently is one of regression, with many nurses and other health professionals working with the threat of posts being made redundant alongside the 'freezing' of key posts. There is no indication that this trend will not continue, at least in the short term, although the forecast for workforce capacity by 2010/2011 shows a shortfall of 14000 whole time equivalent (WTE) nurses (Mooney and Donnelly, 2007). If the present recession does continue there will be a shortage of practitioners to support the future nursing and midwifery students in practice. Current restraint in employment practice may be a false economy if the future workforce is ill prepared to deliver the services that patients need. In addition, the toll this has on attrition, because students are left feeling unsupported, unsure and unsafe, is a financial cost that the NHS can ill afford.

Against this backdrop there is an increasing reliance on practitioners to provide care in an increasingly complex health context and at the same time to take a more active role in the learning, teaching and supervision of students in practice settings. It is clear that if mentors are to support students in a chaotic workplace then the process and tools they use must be fit for the situation they find themselves in and assist rather than hinder the mentoring process. In addition, given the time constraints on practitioners, the support mechanisms for students must be easy to integrate with professional practice and not antagonistic to it. As far back as 1999 the United Kingdom Central Council for Nursing, Midwifery and Health Visiting stressed the importance of dedicated time for teachers and mentors so that they could remain confident and competent in their teaching and mentoring roles.

The NMC has, for some time, expressed concern about the perceived variation in competence and fitness to practise at the point of registration, particularly in relation to student nurses. This led in 2006 to the publication of the Standards to Support Learning and Assessment in Practice, the NMC standards for mentors, practice teachers and teachers (NMC, 2006). The standards indicate that at least 40% of a student's placement time should be spent directly with their mentor and that achievement of competency at key points in the programme must be confirmed by a 'sign-off mentor'. Sign-off mentors will meet additional criteria and, when supervising students in their final placement, will have protected time for providing feedback to students.

(Continues...)

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Edition details

• Publisher: Wiley
• Publication date: 2008
• Language: English
• ISBN 10: 0470057971
• ISBN 13: 9780470057971
• Binding: Paperback
• Edition number: 1
• Number of pages: 268
• Editor: West Sue