5 NMC Sign off mentorSign off Mentors are responsible and accountable for:Assisting students to identify current learning opportunities and future learning needs.Supporting and Supervising students in learning situations.Assessing total performance - including skills, attitudes and behaviors.Assess most aspects of competence through direct observationProvide regular feedback and record any advice given.Leaving it too lateResearch, within Duffy’s study, shows that it can take at least 2 – 3 weeks to identify a weak student, as most clinical staff allow a “settling in time”. This, together with some placements being fairly short or fragmented, it can make it difficult for clinical staff to immediately assess a weak student.Sometimes mentors might be immediately aware of a weak student but are too busy to address it immediately, so the student continues unaware of their failures, and as a result passes by default. (stress importance of Preliminary and mid-term interviews, which pick this up)The study showed that not many students failed early in their programme, through mentors feeling that students needed to “adjust to nursing ” or it would have “dented their confidence”. But it is harder and more stressful for the student to deal with failure towards the end of their programme, particularly if they have been given the hope all through their 1st and 2nd years2. Personal consequencesPersonal consequences can be hard for the student to manage. It can means the end of their career, their dreams… but as a profession we do have a duty to ensure that we only have registrants that are “Fit for Practice”, “Fit of Award” and “Fit for Purpose” (You do have to think objectively – and ensure that however nice the person might be, would they be the person that you would want looking after you …?)For the mentor the personal consequences can be equally as traumatic emotionally. One mentor in the study said that she found the experience to be “unpleasant, messy and emotionally fraught”.In the study – 11% of mentors said that they had failed a student and regretted it.Facing personal challengesFailing the student can be viewed as uncaring practice, which goes against one of the founding tenets of nursing. Reconciling this fact might be one of the biggest personal challenges.As a mentor, you might get a sense of personal failure – and the guilt will lead you to question:Have I failed the student?Could I have done more to support the student?Could I have given the student more time?An example from the study was of a mentor whose student constantly undermined her by talking to her colleagues about her behind her back, which created disharmony within the team in the practice area.A example from a mentor in a recent update related how a student had vandalised her car because she refused to pass her.Feeling unsupported by the HEI (one that was identified within the study). A example from a mentor in a recent update related how she was unsupported by her organisation for failing an Adaptation student – but she stuck by her conviction and was supported by her colleagues.4. Experience and confidenceNew mentors felt ill prepared to deal with failing the student. (Now being addressed within the mentorship course and at updates)“She’s a nice girl / she’s got personal problems/ She has no life experience / She’s a single parent…” These issues are subjective, and should not come into your clinical judgement of the student’s performance.An example from Duffy’s study of the student manipulating the mentor to achieve a pass. Following a talk to the student by the mentor to improve, the student wore the mentor down by constantly asking, “How am I doing? Am I going to pass?) the mentor admitted buckling under the pressure and passing the student.Also mention:Dealing with the student’s, and own emotions, that may include:Anger – at everyone – including the university for recruiting and setting the student up to failSadness – dreams come to an end / crushing someone’s dreamsExhaustionReliefRecording advice creates an audit trail for decision making
6 NMC Sign off mentor Standard Providing evidence as required by programme providers of student achievement or lack of achievement.Liaising with others to provide feedback, identify any concerns about the student’s performance and agree action as appropriate.Providing evidence helps you to make decisions about achievement of proficiency at the end of a programme.You should not normally mentor more than three students at one time. (They should not be allocated at the same time)Look for Learning Outcomes related to the use of initiative and dealing with new situations. If a 3rd year student, with appropriate help, cannot manage a situation that they have not met before, then question whether they are “Fit for Practice“If your comments about the student’s performance does not match up with a pass, then don’t give them the benefit of the doubtAssessment documentation confusing – educational jargon, hard to follow or understandMain concern – mentors not comfortable with highlighted issues put in writingShort placements don’t allow the student time to gain confidence in practice.* Study days and blocks – some mentors see this as a fragmentation of the student’s learning (highlight the positives of the mix of theory and practice days – i.e. helps consolidate the student’s learning, and helps the student to relate theory to practice more)Time – (stress not a criticism on mentors with unrealistic workloads in practice areas) mentors not having sufficient time to spend with students who do present with difficulties, or to work alongside student sufficiently to identify the student’s weakness(es).Lack of practical skills – poor manual dexterity skillsPoor communication – students and mentors. Personality clashes occasionallyLack of interpersonal skills –De-motivation – student and mentor (demoralised staff and students)Professional boundaries – students not always having the awareness to recognise the difference between social and professional boundaries.Others – elicit more
7 Allocated learning time 40% of the students time must be supervised directly or indirectly by a mentorIn addition time for explanation, questions, assessment and keep records. Reflection.Proposed Final placement must have 1 hour a week to discuss above.
8 MidwiferyStudents on NMC approved pre-registration midwifery education programmes, must be supported and assessed by sign off mentors.Midwifery sign off mentors will have met the additional criteria to be a sign-off mentor as part of their preparation programme.From September 2007 sign-off mentors must make the final assessment of practice and confirm to the NMC that the required proficiencies for entry to the register have been achieved
9 AccountabilityEvidence of having passed a Facilitating teaching and assessing mentor programme.Identified on the local register as a sign-off mentor or a practice teacher.Registered on the same part of the register.Working in the same field of practice as that in which the student intends to qualify.Confirmed capable of safe and effective practice
10 And haveA working knowledge of current programme requirements and assessment strategiesAn understanding of the NMC registration requirementsAn in-depth understanding of their accountability to the NMC for the decision they make to pass or fail a student when assessing proficiency requirements at the end of a programme.
11 AccountabilityConfirming with the NMC the final competencies have been achieved via the student assessment documentation.Mentoring 2 students over 3 years.Ensuring that final assessment of competence draws on evidence over a sustained period of time .
12 AccountabilityEvidence to support that the student has met the criteria to sign off practiceSeeking support from another sign off mentor or teacher when dealing with a failing studentOngoing personal development linked to NMC mentor standardsWillingness to be triennially reviewed regarding your sign of status.
13 Managing the process 1 In groups discuss the following Clare your student tells you that you are asking for far more in the way of evidence of meeting learning competency – written reflections, discussions, observations, feedback from other practitioners than her friend in the same cohort is being asked for by her mentor. You feel you are justified as Clare is weak in some of her competencesWhat are the possible implications?What is your response to this and why?Is there anything else you should be considering?Identifying the weak studentWhat might the “weakness” be?Speak to student informally first to raise awareness. BUT be aware that students with no insight will have a total lack of awareness of their weaknesses and will not be able to pick up these cues, however spelt out.Stress importance of the initial interview to formalise this awareness raisingDevelop an action planBe prepared to expect students to work to the required standardsAgree plan with studentWrite it down formally and get the student to sign itEnsure that there is a timeframe written into the planUse a tripartite agreement mentor, student and link tutor to formalise the process.
14 Managing the process 2 In groups discuss the following Sally is the named assessor to a learner called Jo. Jo has struggled considerably to achieve the required standard in three of her competencySally set a clear learning contract and assessment plan with Jo but today has to give her feedback that she has still not met the standard required and in Sally's opinion should fail.What are the possible implications for Jo and Sally?What is your response to this and why?Is there anything else you should be considering?
15 Managing the process 3You are the named assessor for the student and are undertaking the final assessment of the student’s time on your placement. Due to sickness and annual leave you realise that you have only spent 4 days in total with the student.What are the implications?What should you do in terms of signing off their learning outcomes?What action should be taken in the event of a mentor / assessor being absent for extended periods and whose responsibility is it?
16 Standards of Proficiency for Midwives The standards of proficiency for the midwives' part of the register were initially defined as competencies in 'Requirements for pre-registration midwifery programmes', and were an interpretation of the outcomes contained in a Statutory Instrument. The standards are mandatory.Students are expected to work to the required standard.It is essential therefore that the difficult issue of failing the non-achieving student is addressed.NMC (2004) Standards of proficiency for pre-registration midwifery education. London: NMCChange in terminology to proficiency from competence.The standards for proficiency have been set at the point of registration, such that the student would be able tofulfil the requirements of a midwife as laid down in the definition of a midwife and would comply with theEuropean Union Midwives Directive 80/155/EEC Article 4 as follows:' Member States shall ensure that midwives are at least entitled to take up and pursue the following activities:......'The standards of proficiency for the midwives' part of the register were initially defined as competencies in 'Requirements for pre-registration midwifery programmes', and were an interpretation of the outcomes contained in a Statutory Instrument. The standards are mandatory.Students are expected to work to the required standard.It is essential therefore that the difficult issue of failing the non-achieving student is addressed.NMC (2004) Standards of proficiency for pre-registration midwifery education.London: NMC
17 The process of managing a failed clinical assessment Identifying the weak student – what might the “weakness” be? Address it with the student first.Develop an action plan – agree a plan with student, formalise it, ensure a timeframe is written into the plan, all parties to sign.For best practice, Duffy suggests the use of a tripartite agreement with student, mentor and link tutor.Identifying the weak studentWhat might the “weakness” be?Speak to student informally first to raise awareness. BUT be aware that students with no insight will have a total lack of awareness of their weaknesses and will not be able to pick up these cues, however spelt out.Stress importance of the initial interview to formalise this awareness raisingDevelop an action planBe prepared to expect students to work to the required standardsAgree plan with studentWrite it down formally and get the student to sign itEnsure that there is a timeframe written into the planUse a tripartite agreement mentor, student and link tutor to formalise the process.
18 The process of managing a failed clinical assessment The decision to fail – speak to colleagues, PEF, link tutor if you need a second opinion. Inform the universityAfter the deed is done – the student gets the opportunity to resubmit the clinical placement assessmentThe decision to failIt is a decision that you will not take lightly.Use other team members, clinical facilitators, link tutor… if you feel that you need a second opinionSpeak to colleagues, link tutor… for help with time and effort that is involved with failing the studentWrite it down formally. Ask the link tutor for advice. How this is written is important in the appeals process as the panel will scrutinise it. So it needs to be clear, accurate, well evidenced and unambiguous.After the deed is doneStudents get the opportunity to resubmit, and can choose to go back to the same practice area, or a different area. (Most students choose to go back to the same area, as they feel that the mentor will have an understanding of the issues that caused them to fail in the first place)It is policy for the new area not to be informed of the student’s previously failed clinical assessment. This is not to disadvantage the student. However, because the students will need to resubmit the failed component of their practice assessment, the mentor will gain this knowledge by default.If the student fails the clinical assessment for the second time, then they have failed the course and are removed from the programme.The student gets the opportunity to appeal – which is in the form of written evidence submitted to a formal panelThe panel makes the decision and the student is informed.Hopefully with support and guidance from the mentor and the team, we avoid getting to this stage!
19 Proposed changes to programme Clinical competency/proficiency document for each year with clinical skills to be achieved in the yearClinical practice to run through all of the second yearGraduate development programme being introduced for all UWE studentsPALS project for September 2007.
20 Facilitating and Assessing in practice module (2007) NMC approved has a sign off pack for new mentorsRequirement to allow time for midwifery mentors to be supervised as a sign-off mentor on at least three occasionsThe length of this programme will be adjusted to take account of this
21 Buddy supportThe mentor should look at each standard statement and ask the question ‘Am I able to…’ For example: Am I able to develop effective working relationships based on mutual trust and respect? (Standard statement 1. Establishing effective working relationships)
22 Buddy supportThe Mentor should then consider what evidence she/he has to support the statement. For example: the above standard may be supported by a copy of a witness statement (e.g. a student evaluation or statement from an other member of staff), appraisal documentation, a personal statement, a piece of written reflection or a piece of work submitted as part of their original qualification such as the FLAP module or product evidence (e.g. copy of student paperwork or ward student induction document)City and guilds 730
23 Summary Points Mentorship links in with NHS Knowledge and skills New programme of development designed as step on and off. Meets new standards (NMC 2006)Failing to fail students- not easy support available.Local registers of mentors and practice teachers to be maintained by practice, for use by Education providers.Annual update to continueTriennial review – mentored at least 2 students in 3 years. Pg 7/8Sign off Mentors will be required to Buddy new mentors so that they can become Sign off mentors
24 ReferencesDuffy, K. (2003). Failing students: A qualitative study of factors that influence the decisions regarding the assessment of students’ competence to practice. Caledonian Nursing and Midwifery Research Centre: Glasgow Caledonian UniversityDuffy, K (2004). Failing Students’ Report.Nursing and Midwifery Council (2004) Standards of Proficiency for pre-registration nursing education. London:NMC