Nurse Mentorship; Knowledge and Skills; Experiential Learning

Abstract

Following the introduction of a regional nurse mentor preparation programme, research was undertaken within a Health and Social Care Trust to explore both the trainee mentors’ and their supervisors’ perception of this new programme. A qualitative study involving focus groups comprised of a total of 12 participants including five trainee mentors and seven supervisors, known as experienced mentors, who had recently completed a mentor preparation programme was undertaken. Data were analysed using Braun and Clarke’s (2006) thematic analysis. Three themes were identified from the data, personal investment: including the emotional impact of mentoring, contextual perceptions: environmental factors such as time, and intellectual facets related to personal and professional growth. Comprehensive preparation of mentors would appear to be effective in developing mentors with the ability to support nursing students in practice. However, further study would be warranted to explore how to support mentors in balancing the demands of their mentoring role with the delivery of patient care.

Keywords:

Nurse mentorship; knowledge and skills; experiential learning

Research article

Introduction

The Standards to Support Learning and Assessment in Practice (SLAiP) (Nursing and Midwifery Council (NMC), 2008), developed as a result of research (Duffy 2003), resulted in the recommendation for greater training and support for mentors. The development and dissemination of these Standards assumed that they would be applied to practice and that practice would thus progress and be enhanced. However, the findings of Duffy (2003) and contemporary literature are replete with the difficulties mentors face in undertaking their restructured role in complex and pressurised environments (Gainsbury 2010; Jokelainen et al2013;Black et al 2014). This suggests that the quality of learning is heavily influenced by the quality of the clinical experience and the culture and context in which learning occurs (Koh 2002; Brown and McCormack 2011).

The NMC (2008) requires that all mentors who support pre-registrationnursing students must provide feedback and undertake assessment ofproficiency.Nevertheless, in contrast to the NMC stance, the literature suggests that mentors consistently experience difficulty in meeting the demands of teaching, assessing, supervising, supporting and guiding students in practice (Casey and Clark 2011; Wells and McLoughlin 2014). Consequently, students may receive inconsistent and negative practice learning experiences, resulting in their failure to achieve the necessary competencies to practice safely at the point of registration (Castledine 2005; Andrews et al 2006). The literature also continues to report that mentors remain reluctant to fail students with Black et al(2014 p234) claiming that ‘a new horizon of moral courage in mentorship’ is required. Nurse leaders should therefore develop a culture that promotes courage and integrity in mentorship so that mentors feel able to undertake their role. They are also ideally placed to provide the support, which new mentors require in the early stages of their role development, in order to facilitate the application of knowledge and skills gained during the mentor preparation into practice(Black et al 2014).

Despite challenges persisting, research since the introduction of SLAiP (NMC 2008), suggests that mentors do benefit from the preparation, resources and support mechanisms currently in place (Mead et al2011).It is arguedthat although formal teaching potentially increases knowledge, it is teaching integrated into the reality of clinical practice that is most likely to enhance skill development and influence practice change (Coomarasmy and Khan 2004; Hughes and Quinn 2013).Additionally, Walsh (2010) argues that the responsibility for a good placement rests upon the mentor. Therefore, for pre-registration nurses to achieve the knowledge and skills they require, mentors need to balance heavy clinical workloads, which take precedence over learning (McGowan, 2006; Evans et al 2010), with their role as primary providers of student education in practice (Watson, 2006). Arguably what is required is additionally support.

Taking on board the challenges outlined above, the regional programme that was developed aimed to provide enhanced training and support for mentors and meet he NMC requirements (Table 1). Spanning a period of three months, the new programme incorporated both theory and experiential learning which involved an experienced mentor supervising and supporting a student mentor. It was designed in partnership with the regional Health and Social Care organisations and three Higher Educational Institutes and approved by the NMC. This article considers whether mentors are able to transfer the knowledge and skills gained from the mentor preparation programmes to mentorship practice?

Aims:

The aims of the study were to:

1)Gain an understanding of how experienced mentors viewed the new training in comparison to their own experience in a previous programme.

2)Gain in-depth knowledge of factors that enhanced or inhibited mentors’ ability to meet the requirements of their role.

3)Evaluate how, from the mentors perspective, the mentor preparation programme influenced the quality of mentorship practice.

Method

A qualitative study using four focus groups (FG)provided an opportunity to facilitate reflection and debateamong the participants (Table 2).This data wasaudio-recorded, transcribed verbatim, anonymised and thematically analysed using the six step approach to data analysis promoted by Braun and Clarke (2006). This approachis non-linear and instead provides a “recursive process, where you move back and forth as needed, throughout the phases” (Braun and Clarke 2006, p16). As the researcher worked closely within the mentor preparation programme, reflexivity was used (Coghlan and Brannick, 2005). To enhance the rigour and trustworthiness of the data and ensure that the study accurately reflected the participants’ experience, member checking of the subsequent transcription with a volunteer from each group and discussion with an independent experienced supervisor was undertaken(Streubert and Carpenter 2011).

Ethics

To satisfy Trust requirements, local Research Governance and Ethics Committee approval was sought and granted prior to commencement of the study (11/NIR02/11). In addition, permission was obtained from the ward sisters/charge nurses to approach the mentors eligible to participate. Confidentiality was assured and written consent obtained.

Sampling

Research inclusion criteria required participants to have undertaken a mentor preparation programme either as a trainee mentor (TM), (n=5) or an experienced mentor (EM), (n=7).All twelve mentors worked in the secondary care setting and volunteeredfrom fields of nursing practice (NMC 2010) that included adult, children’s and mental health. No participants volunteered from the field of learning disability.

Findings

This research illustrates the impact that theintroduction of a regional mentorship programme, alongside the Standards to Support Learning and Assessment in Practice (NMC 2008), had on progression of mentorship practice. Evaluation of the data led to the identification of a number of tentative sub-themes which were refined under four headings (Figure 1). Re-examination and member checking of the data revealed common themes which could be grouped together under three key headings: intellectual facets, contextual perceptions and personal investment (Figure 2).

Intellectual facets

“Intellectual facets” relates tothe positive effect the new programme had on theoretical knowledge development and the growth of self-awarenessof both trainee and experienced mentors. For example, there was an assumption made that an experienced mentor had all the knowledge necessary to support the development of the trainee mentor, whereas in reality experienced mentors described how they ‘were never really told how to deal with a problem student (EM, FG 2)……. we just winged it’ (different EM, FG 2). In contrast, mentors cited how the new programme not only developed their appreciation of accountability but also provided guidance on identification and management of struggling students. Those who experienced a struggling student since completion of the programme considered they were able to apply their new theoretical and experiential learning, as “... you’re able to justify your actions more....” (EM, FG2), and “it’s very hard to tell somebody that they’re not what they should be, so it was just making sure there was evidence for that” (TM, FG3).

All participants described the theory component of the new programme in a positive manner,they reported ‘it’s helped me get more confidence’ and being taught new skills helped them achieve a clearer understanding of ‘how to offer advice and constructive criticism” (TM, FG4). Working through the required portfolio with the trainee mentor appears to have acted as a form of reflection for the experienced mentor. The data suggested this has resulted in raised self-awareness leading to a more person-centred approach and change of practice: “…it did make me take a stand back and realise... not everybody does that...” (EM, FG2).This application of knowledge to practice and growth of self-awareness was also identified by the experienced mentor when observing the trainee mentors after the programmein that “she seemed to …maybe change things round when she could see people didn’t click [with] what she said...so would be able to use different tactics” (EM, FG2).Furthermore, there was a suggestion that role-modelling reflective behaviours positively influenced other mentor colleagues within the practice area:“They’ve seen him [TM] do it [reflect] and me do it so, you know, well, this would be a good idea, and it’s just learning from other people” (EM, FG1).

Contextual perceptions

“Contextual perceptions” relates to factors within the practice setting that mentors perceived enhanced or inhibited their ability to carry out their role (for example, time, managerial and team support, and challenge in relation to accountability). All mentors acknowledged anenhanced appreciation of their accountability in relation to verifying students as safe and effective practitioners. They reported that the mentor role carries much “… more responsibility now… yes, we signed our name [before] but the ultimate responsibility wasn’t with us” (EM, FG2). Further support for Duffy’s (2003) notion that accountability was previously perceived as not being the responsibility of the mentors in practice was evidenced by an experienced mentor who stated:“…it was the university, somebody else’s responsibility, never yours” (EM, FG2).However, a developed appreciation of accountability was perceived by one participant to have the negative effect of causing some nurses to be reluctant to become mentors,claiming it “... makes people, I think, ‘I don’t want anything to do with this’ ... because they don’t want to have that conversation, you know, failing them...” (EM, FG1).

A developed appreciation of accountability appeared to be linked to a drive to fulfil the requirements of their role more thoroughly: “People think just because... it’s a management student… you have an easier time... it’s probably ten times harder because you’re trying to make sure that nurse is ready ... to not just qualify but... to practise for years” (TM, FG4).Several mentors contended that some nurse colleagues and managers failed to recognise the responsibilityand effort that is involved in mentoring a student:“… so we’re not paid any extra for it and we rarely get the recognition for it but we have all this big responsibility” (EM, FG1). Also, “… our sister hasn’t been a mentor in a long time... it’s like, ‘you take extra ... patients ‘cause you’ve got the student’, whereas ... that’s not really what it’s about... you have to teach them...” (EM, FG2).

The main concern for allparticipants during the programme was in relation to securing time within the practice environment to focus on the mentorship role. Even an experienced mentor who was also a manager“found it very difficult to let the student have the time with their mentor ... because we’re used to having those 37.5 hours a week hands-on. ... in truth a lot of it was probably... done at home or after your shift...” (EM, FG2). A trainee mentor supported this, stating: “… your first priority is those patients, you know, then comes the student” (TM, FG4).

The level of managerial support varied but personal experience as a mentor, either current or past, was considered a positive influence. All participants were consistent in acknowledging the need for the practice area to be an effective learning environment. Discussion highlighted mentorship teamwork and support within practice - for example: “… the mentor obviously has responsibility for them... but the team adopts the student and looks after them...” (EM, FG1).

Personal investment

“Personal investment”, recognisedthe emotional impact of mentorship practice, ranging from the challenges encountered to events that acted as a source of fulfilment. Many stressors were identified (Figure 1) but these would appear to be balanced by the personal satisfaction of supporting the development of others.

Allparticipantsnegatively described their initial impressions of what was required to complete the programme - words such as “scary” and “daunting” were used. However, engagement with the mentorship programmepromoted the development of new learning and transformed these views to positive affirmations such as “… it was worth it though in the end because I did get a lot of confidence out of the programme ...” (TM, FG4) and “It really made me feel much more at ease as a mentor” (EM, FG2). Additionally trainee mentors identified their experienced mentor as a positive influence and their main source of practical advice and support. Trainee mentors articulated the significant time and effort invested by their experienced mentors:“[discussing a struggling student] he [EM] talked it through first of all... before we went and spoke to the student, you know, how I would deal with it ...it was nice because he backed me up first of all and let me go and do it [agree an action plan with the student]” (TM, FG4).

To manage aspects of emotional burden, resourceful ways to address the time challenges in completing the programme portfolio were identified:“I’d stay an hour after shift or she’d come in early for her shift and then we’d e-mail each other quite a bit” (TM, FG3).One experienced mentor indicated an altruistic reason for the effort involved:“…’you want to get the person through it because you need more mentors” (EM, FG1).However, this altruismwas outweighed by personal satisfaction as the mentor clarified that “… it was really a joy to do it [sounds of agreement from others] in many ways, even though it was extra work” (EM, FG1). Trainee mentor attributes, such as motivation and having a desire to learn, were identified by the majority of experienced mentors (n=4) as factors that resulted in feelings of satisfaction as “… it was nice to see somebody progress...” (EM, FG1).

All participants described various stressors in their mentorship role in general, includingfeelings of guilt at trying to balance commitments between patients, colleagues and students.Finding sufficient time to support the nursing students was identified as challenging for all participants, both in completing the students’ documentation and in practice learning:“what do they need that [teaching] session for? Sure get them to go home and read up on it, and maybe they have went [sic] home and read up on it but actually don’t understand it, so you actually need that time to sit and go through it with them” (TM, FG4).This lack of understanding on the part of colleagues for what the mentor role entailed also resulted in feelings of frustration: “… sometimes it’s just: ‘well you can do more ’cause you’ve got the student’…” (EM, FG2).

Conclusion.

The research findings highlightedthat the introduction of a regional mentor programme, combining experiential understanding with theory and critical analysis (Cooper, 2011) was advantageousin developing and supporting mentors. Transformative learning (Deleuze, 2001), where practice is modified based on a change in perspective, incorporates theory, experience and feeling and can be evidenced in this study through development within the three themes: intellectual facets, contextual perceptions and personal investment.

Achieving the required elements of the programme enabled the trainee mentor and experienced mentor to work closely together, withsubsequentpositive outcomes such as increased theoretical understanding and the development of professional confidence resulting in competency in the mentorship role (intellectual facets).

The challenges of working in pressurised ward environments concerned mentors as they considered it resulted in inconsistent learning experiences (Castledine 2005; Andrews et al. 2006). Mentors described feelings of guilt when balancing their nursing workload with their mentor role. In part this feeling of guilt was aggravated by pressure (real or perceived) from colleagues and also pressure from themselves to complete their nursing duties within the same timescale as would be achieved without a student. However, mentors considered that in practice areas where ‘the team adopts the student’, both patients and students gained a better experience (contextual perceptions).

The data suggests that leadership and a supportive culture need to be created to ensure that this mentor programme and the experience of being a mentor are embedded in practice environments.Study findings suggested that practice areas with line managers who were themselves mentors, or who had current knowledge of the mentor role, were deemed to be more supportive. Where line managerslacked insight into the mentors’role, participants reported more stressors and negative aspects to their mentor practice, although not with their personal satisfactionin the mentor role (personal investment). Arguably,there is a need for line managers to actively promote team work and support mentors in the development of student nurses’ learning in practice.

Limitations and recommendations

Due to the limited number of participants and the potential bias towards positive thinkers, which the voluntary approach of this study employed, it is recommended that future studies should be conducted to explore the identified issues in more depth. This may confirm the findings of this study within different cultures and contexts.

Recommendations

1. Consideration needs to be given to how to bring the knowledge and skills of existing mentors up to the same level as those who have completed the programme.
2. Practice Education Facilitators must work with line managers to support the growth of person-centred cultures, raise awareness of the requirements of the mentor role and explore creative ways within individual practice areas to support the mentors’ needs.
3. Explore the issue of “reluctance to mentor” and if necessary identify strategies to address and manage this.

Conflict of interest: the authors declare no conflict of interest.