1. Update for Nursing Mentors 2011 Supporting Undergraduate Pre- registration nursing students in practice

2. 2 Current Practice documentation (for programmes from 2006)  One Year CFP and two year Branch programme  Based on the NMC Outcomes for Branch Entry (4 domains & 20 outcomes) and Proficiencies for Entry to the Register (4 domains & 62 outcomes) Four Domains (for both CFP and Branch) Professional and ethical practice Care delivery Care management Personal and professional development  All outcomes to be achieved on placement of over 4 weeks

3. 3 Key principles of Assessment documentation  Development plans  Use of NMC standards of proficiency  Emphasis on intermediate review / action plans  Monitoring of clinical hours  Documenting of evidence  Opportunity for feedback  Skills workbooks

4. 4 Student evidence records for existing programmes  Students have to provide written evidence to support one element of the NMC outcomes or proficiency per placement  Evidence for the remaining elements must be provided on subsequent placements  Evidence should be evidence based, hand written and legible (unless documented by university that student may type - as a reasonable adjustment for dyslexia)  Encourage professional language /rationale  All elements must be completed by the end of each stage of practice

5. 5 Skills workbooks for existing programmes  Students must be signed as taught prior to being deemed competent. Teaching may be provided within university and/or the practice setting.  Students have to demonstrate competency of key skills within a certain timeframe  Students should aim for a breadth of skill attainment across the programme, practice settings and clients.  Some students also have an OSCE – objective structured clinical examination to test key skills.

6. 6 Student hours in practice  Norm for daytime placement = 7.5 hours (plus 0.5 hour meal break)  Norm for night shift = same number of hours as mentor (plus two x 0.5 hour meal breaks) Must do night shift with mentor or associate mentor  Dependent on stage of programme / university students may work long shifts to ensure adequate contact time with mentor.

7. 7 Please report absences  for Leeds Met students call course administrator on 0113 2832600 ext. 1912 who will inform the appropriate lecturer.  For University of Leeds students ring the absence line and leave a recorded message on 0113 3431357 or send an e- mail to absence@healthcare.leeds.ac.uk. If you would like to speak to someone directly call the Practice Placement Unit on 0113 3431375.absence@healthcare.leeds.ac.uk

8. 8 The assessment process for existing programmes  Orientation in first shift and preliminary interview during first week. Set development plan and consider how you and your student will manage the completion of the document. Set date for intermediate interview.  At intermediate interview evaluate progress to date and set development goals for remainder of programme. If any goals address an area of concern the relevant university lecturer from the student’s programme must be informed.  Final interview in the last week of experience which should identify achievements of student and future development needs. A Pass/Fail decision must be reached (Fail = lecturer attendance required)

9. 9 Standards to support learning and assessment in practice (NMC 2007)  New guidelines from September 2007  40% of time to be spent with mentor  Most assessment should be through direct observation of practice  Evidence from various sources when making judgement (use of ALPS tools available at http://www.alps- cetl.ac.uk/maps.html )http://www.alps- cetl.ac.uk/maps.html  Sufficient records kept to support assessment decisions, including student held Ongoing Achievement Record to support Sign off Mentor decisions.  Sign Off Mentor for final placement  All mentors and practice teachers have an annual update and triennial review  Locally held registers of mentors and practice teachers

10. 10 Standards to support learning and assessment in practice (NMC 2007) Sign Off Mentor  Decisions about whether a student has achieved the required standards of proficiency for safe and effective practice for entry to the register must be made by a sign- off mentor.  ‘..a nurse or midwife designated to sign off proficiency for a particular student at the end of the programme must have been supervised on at least three occasions for signing off proficiency by an existing sign-off mentor or practice teacher (NMC 2.1.3, 2007)  First and second supervisions may be achieved through simulation / OSCE and final supervision in practice. (NMC 2010)  Sign off mentors should have one hour per week allocated to reflect, give feedback and keep records of students achievement during final placement in addition to the 40% already identified

11. 11 A sign-off mentor should:  Be a registered nurse from the same branch of nursing as the student  Have a recognised mentor qualification  Be able to make effective decisions regarding student progress and achievement  Have attended an annual mentor update  Have a triennial review  Have clinical currency and capability  Have knowledge of student practice assessment requirements  Understand NMC registration requirements (i.e. proficiencies and skills)  Be accountable for their decisions  Be identified by the placement provider on the mentor register as sign-off mentor

12. 12 Scenario A student does not appear to be using any iniative in finding learning opportunities and is constantly hanging about the nurses’ station complaining that there is nothing to do. She reports to her module manager that there is nothing to learn from the placement. How do you proceed?

13. 13 Scenario  A very likeable student entering his/her third year is very capable of helping patients with hygiene needs and communicating with patients and relatives but has little insight and capability into the wider knowledge and skills required as a senior student. How do you proceed?

14. 14 Reasons for giving students the benefit of the doubt (Duffy 2004) ‘Failing to fail’  Mentors had not failed students who were early on in their training programme as they felt they needed time to learn and should “be given the benefit of the doubt”. Mentors felt that students would pick up the necessary skills in future placements.  Some mentors felt that it wasn’t their responsibility to fail students and that it was sufficient for them to raise concerns about a student’s clinical performance to lecturing staff.  Some mentors felt uncomfortable “putting pen to paper” either because they found the clinical assessment document full of jargon that they could not translate into practice, or that they were worried about repercussions from the University for failing a student.

15. 15 ‘Failing to fail’ Reasons continued  Other mentors saw failing a student as an uncaring practice.  Giving failing students who are close to qualifying the “benefit of the doubt” so as not to jeopardise their future.  Allowing a student’s personal problems and circumstances to influence their judgement  Some mentors felt that they had no choice but to pass a student, either through lack of support from educational staff or where they had not followed the correct procedures to be able to fail them.

16. 16 Consequences of giving students the benefit of the doubt  Some students reached 3rd year before being failed and were devastated at being failed at this late stage  Mentors were angry that colleagues in earlier placements had “passed the buck”.  Passing students who should have failed does not protect the interests of the public and puts the patients who will be under the care at risk. Duffy (2004)

17. Mentor resources  On-line updating available at www.mentorupdate.co.uk www.mentorupdate.co.uk  Range of mentor information and student assessment documentation available at www.healthcareplacements.co.uk and www.healthcareplacements.co.uk www.practiceplacements.leeds.ac.uk Contains resources for mentors and students Copies of documentation Contact details for the Universities 17

18. Quality Assurance of Practice Learning www.healthcareplacements.co.uk www.healthcareplacements.co.uk  Placement Profiles and on-line educational audit  Student evaluations accessible to placement areas  Mentor evaluations of students allocated (6 monthly) 18

19. Standards for Pre-registration nursing education (NMC 2010)  Available at: http://standards.nmc- uk.org/Pages/Welcome.aspxhttp://standards.nmc- uk.org/Pages/Welcome.aspx  Apply to programmes validated from September 2010.  Required minimum outcome award for a pre- registration nursing education programme is a degree in nursing.  Four fields: adult, mental health, learning disabilities and children’s nursing.  Removal of CFP / Branch structure. Instead progression points at end of Stage 1, Stage 2 and Entry to the professional register. 19

20. Standards for Pre-registration nursing education (NMC 2010)  The standards for competence identify the knowledge, skills and attitudes the student must acquire by the end of the programme, as set out in the degree-level competency framework. This framework comprises four sets of competencies, one for each field of practice: adult, mental health, learning disabilities and children’s nursing. Each set comprises both generic competencies and field-specific competencies. 20

21. Standards of Competence (NMC 2010) The competencies are organised in four domains:  professional values  communication and interpersonal skills  nursing practice and decision making  leadership, management and team working. The context in which the competencies are acquired in relation to the field of nursing defines the scope of professional practice at the point of registration. 21

22. Standards for Pre-registration nursing education (NMC 2010)  New assessment documentation will be introduced for pre-registration nursing programmes in Leeds commencing from September 2011.  Practice Assessment Document  Ongoing Achievement Record and Skills Log.  Mentor Handbook will be available from websites to support student assessment in practice. 22

23. 23 Some useful references  Duffy, K (2004) ‘Failing Students’ London, NMC  English National Board and Department of Health (2001). Placements in Focus: Guidance for Education in Practice for Health Care Professionals. London: ENB/DOH.  Hinchliff, S. ed (2001) The Practitioner as Teacher 2nd ed. London, Balliere Tindall.  Howard, S. and Eaton, A. eds (2003) The Practitioner as Assessor. London, Bailliere Tindall  Morag G. (2000) The qualities of an effective mentor from the student nurse’s perspective: findings from a longitudinal study. Journal of Advanced Nursing. 32(6), 1542-9  Neary, M (2000) Teaching, assessing and evaluation for clinical competence: a practical guide for practitioners and teachers. Nelson Thornes, Cheltenham  NMC. (2006). Standards to support learning and assessment in practice. London: NMC  Royal College of Nursing 2002. Helping Students Get The Best from their Practice Placements: A RCN Toolkit. London: RCN  Royal College of Nursing (2005). Guidance for mentors of student nurses and midwives: An RCN Toolkit. London: RCN  Stuart, Ci Ci. (2007) 2 nd ed Assessment, supervision and support in clinical practice: a guide for nurses, midwives and other health professionals. London, Churchill Livingstone.