Reflective Nursing: Nursing Mentorship

The aim of this assignment is to demonstrate that I can through critical reflection, evaluate my performance as a mentor to a student nurse I have been working with on the ward.

According to the Nursing and Midwifery Council (NMC) (2006) the term mentor is used to denote the role of a registered nurse who facilitates learning and supervises and assesses students in the practice place. They furthermore identify the eight mandatory standards that must be achieved to become a mentor, and within the assignment I shall be referring to the Standards to Support Learning and Assessment in Practice; NMC standards for mentors, practice teachers and teachers, and identifying the standards for mentors required (SM).

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This assignment will first look at the personal and professional reasons why I wanted to undertake the mentorship module. It will also discuss the importance of a supportive learning environment in the workplace, and how essential it is. My role as a mentor to a nursing student will be evaluated, looking at the way in which I supported her on the ward and how I facilitated this. In conclusion, I will identify my own personal development in undertaking and completing this module.

As a registered nurse on a busy Paediatric ward I always enjoy supporting student nurses whilst they are on placement with us. There is an apparent shortage of qualified mentors on the ward, and within my last personal development review with my line manager I identified a need to attain the mentorship qualification. The Nursing and Midwifery Council (NMC) (2004) states, that as a registered nurse, you must keep your knowledge and skills up-to-date throughout your working life. You also have a duty to facilitate nursing students and others to develop their competence. According to Hand (2006), teaching is seen as an important part of the health professional’s role, and at some point in their career, members of most healthcare professions are expected to teach other staff, students, patients and relatives. Therefore, the standard of teachers and mentors available in the practice place will have a major impact on the quality of future practitioners, consequently making an improvement in patient care. Most students and many professionals note that learning acquired from placement experience is much more meaningful and relevant than that acquired in the lecture room (Quinn 2000).

To ensure any learner has a positive learning experience it is essential that the learning environment is practically, professionally, and psychologically supportive to all who work and learn within it. Clarke et al. (2003) notes that current nurse education puts a high value on learning in the clinical environment and this places numerous demands on clinical areas and staff. The quality of these clinical placements has a significant influence on the learning process for nursing students. The ward on which I work aims to foster a good all-round learning experience to students on placement as we are fortunate to be a well resourced ward with many experienced staff. Although we are an extremely busy ward, students are positively received and supported well, the majority wishing to work with us once qualified.

On commencement of the mentorship module it was found that there were no students or learners available to me initially so the time span for my period of mentoring for the purpose of the assignment was limited to just one month. I was however, able to identify my own clinical mentor on the ward, and after analysis of my own strengths, weaknesses, opportunities and threats (SWOT) I decided on my short and long term goals and set a learning contract with my mentor in readiness for the allocation of a student. Jasper (2003) regards SWOT analysis as getting to know yourself. The understanding of our skills and abilities and the awareness of where our limits lie is seen as crucial to being able to act as a professional practitioner.

I was finally allocated a first year child branch student, and was informed by the matron that this would be her first clinical placement. It was important to know where she was in her training for me to plan adequately when supporting her on the ward. A frequently used taxonomy in nurse education is the framework by Benner (2001) in which there are five levels; novice, beginner, competent, proficient, and expert. Benner (2001) suggests that nurses may be at different levels in different areas dependent on their previous experiences.

It was unfortunate that I was not able to work with her on her first shift as I was finishing the nightshift as she was starting with the dayshift. I did however welcome her to the ward and orientated her to it, ensuring she knew who she would be working with on her first ever clinical shift. Davidson (2005) notes that students can be made to feel welcome by someone simply knowing their name and being expected. He also notes that a physical tour is a good start. This allows for brief introductions to other staff that the student will be working with. On this initial meeting I also gave her the ward’s student nurse orientation/resource pack. This provided her with basic information about the ward and the different teams and staff within it, this was to provide a good introduction into the environment that she would be learning in during her placement.

Two days after she began, we had our first clinical shift together. I was pleased to hear that she had found other members of staff supportive during her first two days on the ward. Cahill (1996) acknowledges that the single most crucial factor in creating a positive learning environment is the relationship between staff and nursing students. She also notes that a common problem for students is that they are unable to work regularly with their mentor, so I took this opportunity to discuss and plan her off-duty taking into account any requests she had. Kenworthy and Nicklin (2000) remark that the more comfortable and safe a student feels within the environment, the more likely it is that effective learning will take place and the student will become motivated to learn. I was also able to discuss the learning pack which I had previously given her and she acknowledged that it appeared to be very informative. Morton-Cooper and Palmer (2000) state that although, in practice the mentor acts as a learning resource, it is necessary for the student to become self directed in the development of their learning needs.

An important part of her placement was to establish a learning contract with myself as her clinical mentor. A learning contract is a document used to assist in the planning of a learning project. It is a written agreement negotiated between the learner and the mentor in which learning needs are identified (Lowry 1997). In order to do this successfully we needed to identify her learning objectives which included the learning outcomes of the modules to be assessed in practice. As this was her first attempt to set a learning contract it was important for me to support her through the process. Twentyman et al (2006) discuss assisted learning where the mentor asks the student to identify their goals and aim to secure learning opportunities that support the achievement. Jackson and Mannix (2001) note that amount of interest the nurse shows in the learning needs of the student and the key role he or she plays in their achievement are essential to the student’s development.

During the shifts that I worked with her we discussed her required learning outcomes and during one of our formal meetings we agreed her learning contract. Within this learning contract she had identified that she needed to develop her awareness in the safe use of medical equipment used on the ward and the principles regarding using these. Quinn (2000a) remarks that it is important to have knowledge of the student’s programme and the required outcomes in order to ensure effective learning.

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After discussion with her it was decided that a teaching session surrounding the safe use of blood glucose monitoring equipment would be of benefit to her, as it was a procedure that was often required on the ward. It would cover one of her learning outcomes, and I agreed to facilitate this. Wallace (2003) notes, that it is important to reduce the possibility of exposing student or patient to any risk, until the student has acquired sufficient skill and knowledge when carrying out a practical procedure. The importance of assessment by a mentor is therefore crucial to ensure students become proficient in practical skills. The commonly held principle that accountability comes from training and education, is evident within the student nurse role. According to Pennels (1997) if accountability comes with knowledge, students are rightfully protected from full accountability until trained. Although responsible for their actions their knowledge base may be inadequate to allow accountability. Therefore, professional accountability lies with the registered nurse that a student nurse works with. It was reassuring for me that she and I had quickly developed an effective working relationship in which I had confidence in her ability to always ask if she became unsure about a situation. She appeared to fully understand her role as a student nurse as identified in the NMC guide for students of nursing and midwifery (NMC 2006a).

Before embarking on any programme of teaching it is important to recognise that there are different learning theories and styles to consider. Reece and Walker (2003) state that there is a great deal written about the way people learn and numerous theories on the methods to teach effectively or guide people in learning. They discuss that the main learning theories are Behaviourism, Cognitivism and Humanism.

According to the Behaviourism theory (Skinner 1974), the learning environment is fundamental to learning, and if this environment is right, learning occurs as connections are made between stimulus and response, and response and reinforcement (cited by Quinn, 2000a). The Cognitive theory (Bruner 1966) considers learning as an internal process that involves higher order mental activities such as memory, thinking, problem-solving, perception and reasoning (cited by Hand, 2006). The Humanistic learning theory (Maslow 1968) is based on the belief that humans have two basic needs, a need for growth and a need for positive regard by others. It is seen as the most holistic approach as it takes into account the drive and motivation of an individual to learn. Reece and Walker (2003) suggest that this theory also depends on the overall influence of the environment which may hinder or aid the learning process.

Honey and Mumford (1992) discuss four different learning styles, and whenever possible, it is important to allow the student’s own style to influence your choice of teaching method. They describe learners as activists, pragmatists, theorists or reflectors. They further note that although many people were a mixture they generally had a preference for one style.

To ensure her learning experience on the ward was successful it was important for me as her mentor to be aware of her preferred learning style as clinical education is an essential part of the nursing curriculum. During the shifts that I had worked with her, and with discussion it was established that she preferred a more practical experience therefore she favoured a pragmatist approach to learning. I therefore incorporated her preferred learning style into my planned teaching session.

To enable an effective teaching session to take place, I as the facilitator needed to select an appropriate environment which was safe, clean, private and comfortable. It was also important that my learner, clinical mentor and myself were guaranteed time free from interruptions. The SWOT analysis that I had completed had highlighted the difficulties on the ward often found when teaching sessions were cancelled due to staff being too busy to attend. I therefore negotiated in advance protected time for all parties for this facilitation of learning and assessment. Davison (2005) notes that mentors need to plan ahead as good preparation can ease the experience for all parties. Watson (1999) also states that if teaching opportunities for students are to be meaningful and productive, planning is an important part of the mentor’s role. Although I felt I had established a good relationship with her since she had been working with me, it was important for me as her mentor to be aware of learner anxiety as discussed by Price (2005). Anxiety is seen as disabling and requires mentor support if progress is to be made when learning in practice. Good communication skills are paramount when mentoring students, and diplomacy and tact must be employed when students need extra help in challenging situations. It is also worth noting that as a mentor with good communication and practical skills facilitating a well planned teaching session, I still experienced some anxiety. Price (2005) notes this often happens when your practice is being held up as exemplary and your knowledge may be tested later.

On reflection I felt the teaching session achieved all the objectives set, and she was able to demonstrate this to me in both verbal feedback and the self assessment sheet provided. I also received positive verbal and written feedback from my clinical mentor. McAllister et al (1997) suggest the intention of giving positive feedback is to aid the receiver when developing their clinical and interpersonal skills. Reflective practice in nursing has been encouraged since the 1980’s (Jasper 2003). Johns (1995) describes the process of reflection as a tool we use to assess, understand and learn through our lived experiences. Jasper (2003) also acknowledges that reflective practice is seen as one of the ways we can learn from our experiences, and in education for healthcare professions it is recognised as an essential tool for assisting students to make the links between theory and practice. As an effective mentor it is important for me to understand the value of supporting her in critically reflecting upon her learning experiences in order that her future learning can be enhanced, and when working with her I have actively encouraged her to do so.

In conclusion, through undertaking and completing this module, I have developed an advanced knowledge and critical awareness of mentorship in health care practice. I have been encouraged to look at my own practice, ensuring that it is evidence based at all times, thus enabling me to fully support students in applying evidence base to their own practice. Research into the learning environment has clearly shown the impact that it can have on student learning and I intend to ensure that the ward resources are kept up to date for all learners. The exploration of learning theories and styles within the module has allowed me to acquire valuable understanding of the philosophies and theories surrounding learning, teaching and assessing and when planning learning experiences for students I now feel more equipped to integrate theory into practice. It is also important that once becoming a qualified mentor I attend the regular updates provided by the university, as the role of a mentor will be seen as the gate keeper to the profession. This will in turn enable me to mentor students more effectively on the ward as the importance of the mentor’s role in assessing practice cannot be over-emphasised.