Nursing and Midwifery Council (NMC) Accountability and Leadership

This essay is a critical reflection on the NMC mentor outcomes of assessment and accountability and Leadership. The changes brought about by development of nursing education was explored as well as NMC providing guidance through standards. Assessment and accountability and leadership was examined extensively. A practical observation of assessment in my clinical area was critically discussed and the exercise was appraised for what went well and challenges encountered. The writer also identified action plans for her future development as an NMC mentor.

The Nursing and Midwifery Council (NMC) has an important role of safeguarding member of the public by supporting the health care professionals on its register deliver better and safer care. Hence NMC set standards of education, training, conduct, and performance so that nurses and midwives are regulated and expected to deliver high- quality healthcare consistently throughout their careers. Nurse training has undergone some changes over the years in response to changing needs for care.

Nurse training is made up of academic and practical training to enable nurses to gain the skills required for their duties as nursing care professionals. Previously nursing training was not formalized and nurses were not respected(Thomas,2016) until in 1860 when Florence Nightingale opened a nursing training school in London. In the 1900s, nurses were taught in more hospitals but they had to give the hospitals 2-3 years of free nursing care in exchange for their training. In 1961, the Royal College of Nursing was founded and Nurses Act 1919 established the first professional register of nurses. NHS was launched in 1948 to provide free treatment for all at the point of care. Now registrants to the register are university degree holders, evolving from Project 2000 started in 1986 which moved the training of nurses out of hospitals and into universities. The change raised concerns that increasing academic content of nurses training may curtail the practical care training and nurses may become too posh to wash Driscoll, Allan and Smith,2009. Nurses and Midwifery Council(NMC) issued Standards to Support Learning and Assessment in Practice, (SLAiP) to ensure the concerns on the nurses’ competencies are assessed during their training by competent registrants. On clinical placements, students are provided with opportunities to gain knowledge as well as pick up and master practical skills while working alongside their mentors (Emmanuel and Pryce-Miller, 2013). Henderson,2011, agreed that learning in placements are important as practice learning is weighted fifty percent of the nursing curriculum.

The NMC described competence as the skills and ability to practice safely without the need for direct supervision(NMC,2002). Competency is important to assess the knowledge, skills, and attitude required for carrying out the task as a nurse and is the base for nursing education. Nursing practice requires the application of combined knowledge, performance, skills, values and attitudes (Cowan, Norman and Coopamah,2005). NMC has made mentors accountable for confirming that students have met or not met the NMC standards for proficiency in practise for registration.

In general terms, assessment denotes tests and examination, judgement or evaluation of written or oral coursework. Stuart,2013. Specifically, in the reference to healthcare, Gopee 2010 likened assessment to collecting and interpreting evidence of learning and competence given by a student and making decisions on the appropriateness and quality of the evidence against pre-determined criteria. Rowntree agreed with this and his definition was: Assessment occurs whenever one person in some kind of interaction, direct or indirect, with another, is conscious of obtaining and interpreting information about the knowledge and understanding or abilities and attitudes of this other person. These definitions indicate assessment as being an elemental part of learning ascertaining quality, quantity, and appropriateness of learning, Gopee 2010. The NMC places the responsibility of guidance and support for students to prepare them for registration on mentors to enable students on clinical placements to maintain a high-quality standard of practice at all times Stuart, 2013. Mentors are responsible and accountable for evaluating students’ competencies. Assessments can be used to motivate students which will impact on their attitudes and possibly reduce anxiety faced by students who are mindful that they are being watched all the time by others. Most importantly assessment can be used to support teaching and learning in the clinical placement. Students are assessed to identify their strength and weaknesses Howard 2006, to determine the extent student have achieved specified learning goals and objectives or to promote students’ future learning and progress, Allin and Turnock,2007.

My practice setting affords the opportunity for students to learn about the care of neonates. Clinical areas provide students with an ideal environment for learning, Houghton, 2016 I have a third-year nursing student, C who had just started her placement on my ward. I welcomed her to my ward and performed a local induction for her and she was introduced to the other team members. I encouraged her interacting with the patients and their families. Ali and Panther 2008 said this experience will help students develop technical, interpersonal and communication skills. Kilgallon and Thompson, 2012. As she had just begun her placement and did not have the knowledge of nursing care of neonates with hypoglycaemic episodes

I discussed with the student about my intention to give her some teaching on hypoglycaemia and she consented to being taught the topic. I asked her what her choice of desired topics was and she chose to learn about hypoglycaemia in neonates. We also agreed to a suitable place and time for the teaching. This gave me time to prepare for the session. I was able to determine the learning style of the student and provided teaching tailored to her preferred learning style. I was able to get a trained mentor to observe the teaching session and got her make comments and provide a feedback in my Mentorship Assessment observation record. The domains of learning used to assess this competency are knowledge of policy for treatment of hypoglycaemia in neonates, how to access the policy on the intranet, knowledge of the risk factors for hypoglycaemia and knowledge of the management of hypoglycaemia in neonates. The knowledge of the use of Glucoboost gel, which contains 40% glucose for treatment and control of hypoglycaemia. The nursing skills to be assessed was blood glucose monitoring from pre-feed heel pricks, monitoring total fluids or feeds requirement. Other skills assessed were the acceptable ranges of blood glucose(BM) and when interventions of the medical team are required if low BM persists. This learning provided the student the opportunity for her personal development and will hopefully increase her confidence in providing safe care for neonates with hypoglycaemia. After the teaching, I set aside some time to ask questions that I had developed to test the full extent of competence taught in the session. I asked for verbal feedback from the student and requested written feedback in a couple of days.

 On reflection, the planning and execution of the teaching session. Time was needed to make give quality teaching. I had time to prepare and teaching was not spontaneous and was able to consider a topic desirable to the student. I was able to determine the learning style of the student and the teaching was tailored to that style. The student preferred visual and auditory style. The student gave a valuable feedback, she felt supported, motivated and would seek opportunities to pass on the knowledge gained to other students. A challenge that was encountered was in respect of location. The teaching was planned in the seminar room but due to staff shortage we could not leave the ward and stayed by the nurses’ station and we were interrupted by parents making enquiries and had to attend to alarms on monitors during the session. In future, teachings would be rescheduled and done in locations away from the ward or distractions. I could have done a prestudy assessment of knowledge of the student as well as post – study to assess the knowledge gained in the teaching.

According to the Thesaurus dictionary, Leadership is the ability to lead, it is an act of guiding, directing and leading others. A nurse leader like the ward manager, senior nurses and experienced nurses guide novices or student’s in the clinical area. In the clinical environment, good leadership is evident in nurses who are knowledgeable in patient care and patient needs. Thompson and Kenward, 2012.Hence in the clinical environment, nurses are likely to engage in a range of leadership activities in their daily routine. Creating and sustaining a positive learning environment for students is the responsibility of the entire nursing team. Although there are many factors that contribute to effective learning, the quality of learning is affected by the environment. Practice placement has been noted in an earlier study to be difficult to control and constantly changing (Papp et al,2003). This feature of clinical placement was experienced in the cause of this study when I had planned with an assessment activity with a student to carry out a planned admission procedure. However, the admission arrived after our shift and this teaching session was carried out instead. Studies show that students gave feedback about their feelings of vulnerability and anxiety when the environment is unpredictable, unstructured or overwhelming. Ongoing issues of staff shortages, increased workload, increased acuity or lack of mentors have aggravated students’ anxieties. This was reflected by the findings of Masoumi and Sharif in 2005 cited by Emmanuel and Pryce-Miller, 2013. Another study by Chan 2004 revealed that students’ anxieties are reduced by feelings of familiarity, acceptance, trust, support, respect, and recognition of their contribution to patient care, emotional and clinical support, opportunities to practice and teachings based on current evidence was cited by Emmanuel and Pryce-Miller, 2013.

Teaching students and novices is a vital aspect of a mentor’s role. Emmanuel & Pryce-Miller 2013. I was able to identify a learning need and responded by providing a teaching session. The feedback from the student confirms changes in her knowledge status and as a practitioner am a leader having caused change no matter how small. This model of leadership held by Thompson and Kenward, 2012. Leaders have plans and steer their teams to their desired goals Mahoney, 2001. Bray and Nettleton (2007) suggested that to be an effective mentor needs adequate preparation and teaching and assessing skills. Leaders in clinical placement should review regularly the learning opportunities available to maintain optimum learning experiences.

A mentor should be an advocate for students to access learning opportunities that meet their individual needs. The placement is obliged to assess additional adjustments necessary for students. Efforts should be made to identify the learning styles of students. I had to find the time to spend with the student immediately after the teaching to enable the student to reflect on the learning and provide feedback. I encouraged her to write a reflective piece for her portfolio. I gave feedback to her main mentor on the experience about the effectiveness of learning and assessment in practice of care of a neonate with hypoglycaemia.

 My action plans for future development include liaising with the ward management a review of the student welcome pack. I noted the welcome pack was last reviewed over three years ago and some of the information is outdated. I will involve existing students in the task. This will hopefully ease their anxieties and help the mentor-student relationship set off on a good note. This will empower the old students and make them feel valued and new students will be made to feel welcome(Walsh,2014). I will also involve students in healthcare audits carried out on the ward. This will familiarise them with excellent standards of care. I will encourage students to take responsibility for their learning, seek opportunities within and out of the ward for learning. I will advocate for them to access the opportunities identified. A mentor has a responsibility to promote comfort, share ideas assist in their inclusion in ward based activities and their skill development based on honest and open communication, trust and self-respect among team members (Senge ,2006) as cited in Henderson et al,2011.

In conclusion, a student was taught the knowledge of nursing care of a neonate with hypoglycaemia while on a clinical placement. We able to identify a learning need and provided learning opportunity. This alleviated her anxieties and she gained confidence and is keen to pass on knowledge gained to other student. I was able to set professional boundaries and provide her with constructive feedback which will help her identify her future learning needs.

References

• Enabling learning in nursing and midwifery practice [electronic resource] : a guide for mentors / edited by Sue West, Tim Clark, Melanie Jasper
• https://www.dictionary.com/browse/leadership assessed 06/08/19