Are the demands of nurse mentoring underestimated?

13 June, 2010

I have met some excellent, dedicated mentors since I’ve been doing my research for my PhD. However, reading the storm of comments in response to the Nursing Times articles on mentors “failing to fail” makes me think they are exceptions rather than the rule.

I would prefer to believe that they are representative of the majority.

All my mentors were very different in their approach, but fundamentally they really cared about their students, their patients and the profession. They were driven by desires to shape students into caring, reliable and resourceful colleagues and to ensure that excellent nursing practice continues long after they themselves have retired from nursing. They fully understood what was at stake if they wrongly allowed a student to pass, but they were also sensitive to what was at stake for the student by failing them. This is an unenviable balancing act.

We are in danger of underestimating the skills and demands of mentoring. We may be familiar with the Nursing and Midwifery Council lists of mentor standards and competencies, but they do not really do justice to the complexities of the mentor role. There are many things to take into account. If you were to consider the transitions of students between the different learning environments, this alone places complex challenges upon mentors.

Mentors see only a fragment of the student’s learning journey and have to imagine where and how it fits into the whole. They experience a succession of students entering and leaving their workplace and witness each student’s ability to adapt and function in that microcosm of practice. To varying degrees, they put what they see in context of the student’s biography, previous clinical experience and aspirations for learning, depending also on what the student chooses to reveal about themselves. Balancing all these factors, they must make a judgement as to whether the student should progress to the next stage.

A list of competencies is a pale representation of the real world. Yet, student nurses in all their variety of personalities, backgrounds, future ambitions and learning trajectories need to shape themselves into this mould, and be seen to have done it, in order to be deemed competent. It should come as no surprise then when mentors are seen to give students the “benefit of the doubt”, such as when practice learning opportunities do not quite come together to fully meet the needs of these individuals at a particular time.

The benefit of the doubt might also be exercised at times when a student does not quite fit the mould in the ways expected. Sometimes mentors need to challenge themselves about any stereotypical assumptions they might hold when they encounter students who are different.

I would not want to make excuses for poor mentoring, but I think it is important for nurses and students to understand these complexities. Both befriending and assessing is a difficult act to pull off, but mentors everywhere have to manage this balance. In doing do, they risk accusations of betrayal when they fail a student they have befriended and they need to maintain their authority in difficult assessment situations where their judgements might be challenged. However, it is much easier to learn in a friendly environment where you feel accepted as a person and where you feel comfortable to ask those “silly questions” or admit to a mistake. The mentors in my study understood this very well and went to great lengths to make their students feel welcome.

Sometimes, when hovering over which box they should tick, they simply asked themselves the question “would I trust this person to look after me or mine?”

About the author

Anthea Wilson is a lecturer for the faculty of health and social care at The Open University

Readers' comments (20)

Sandra Joyce Powell | 13-Jun-2010 10:48 am
I feel that staff who have the role of mentor ,have too heavy a workload.
Perhaps we should have mentoring teams. and allow the staff nurses on he wards complete their very important tasks looking after the patients in their care.
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Anonymous | 13-Jun-2010 11:31 am
I am a Staff Nurse, Sign Off Mentor and Key Mentor for an extremely busy surgical ward where we can have up to 10 nursing and midwifery students on placement with us at any one time. In order to provide the supportive teaching environment I believe they deserve I find I often end up adding to the amount of unpaid overtime the NHS already gets from me. It really is so difficult to actively teach when you have 7 or 8 eight acutely unwell patients to look after and the ward phone constantly rings.

Whilst I do not condone poor mentoring, I do understand why, under these circumstances, our professional responsibility to facilitate students' learning and assist those performing below the required standard to improve can sometimes take a back seat.

My advice to anyone mentoring is this: Ask yourself would you want to be looked after by this person? If the answer is I'm really not sure or a straight no, then irrespective of your workload you must acknowledge your professional responsibility to formulate and document an action plan with that student and ultimately, not pass someone who you believe is not fit or suitable to practise.
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Anonymous | 13-Jun-2010 11:40 am
As Anthea Wilson pointed out, a mentor may feel that she has a responsiblity to a nursing student (to the extent that the student might feel 'betrayed' if her competence is challenged by the mentor). However, the mentor also has a responsibility to the hundreds or thousands of patients for whom the student will later be responsible. If she permits a less than competent student to graduate, the harm could be wide-spread and long-lasting.

When faced with the decision to fail or not to fail, the mentor's first responsibility is to those future patients. She has a responsiblity to the student, but it is a lesser one. The fact that the student is on the spot while the future patients are invisible and unidentifiable does not alter that fact. The student will get a second chance. The patients will not.

The mentor's motto should be "When you have any doubt about the student's competence, fail them".
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Anonymous | 13-Jun-2010 12:01 pm
It is not easy to fail a student as when you do the university comes right back and smacks you in the face so to speak!
What a mentor has to go through when a student is failed is unbelievable.
Some mentors become mentors without training and can be unsure of what they actually need to do...not their fault entirely but the fault of the trust for allowing it to happen.
Some of these poor mentors workload is never ending and on top of that they have to find time that is not built into their hours.
More teaching, support and time is needed for mentors
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mike | 13-Jun-2010 12:45 pm
It is hard to say wether bad mentors are a minority or a majority I think, because they are such a mixed bag, and it is completely down to luck wether a student gets a good one or not.

I think one of the problems is the fact that ALL Nurses are expected to be mentors. Not all Nurses are teachers. Some actively hate having students to teach, yet are constantly thrust on unsuspecting students. This is wrong.

But perhaps the biggest problem is the time and workload, as others have suggested.

If Nurses are expected to mentor, then staffing levels need to be sorted out, and time should be protected to a) take slightly longer with tasks when explaining or supervising a student, and b) sitting down and going through the ridiculously repetitive paperwork. This isn't rocket science is it.

And as for Anonymous | 13-Jun-2010 11:40 am, shouldn't the Nurse Mentors motto read "When you have any doubt about the student's competence, teach them???" Just a thought!
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Anonymous | 13-Jun-2010 3:37 pm
I work in the private sector and have had to fail students. I have yet to have the uinversity challenge my decision. This could be because I am able to articulate in university speak why the student has failed, whereas my colleagues will just say ' your student's rubbish, sort it!' without stating the particular problem. I have also had the problem of colleagues refusing to give a bad testimony. This has resulted in me being the bad mentor giving the only adverse opinion of the students performance, but verbally they may be scathing sbout the student. Everyone is responsible for assessing a student and as such should give an open and honest tesimony. Finally I recommend the mentors use the tools they have. At the first sign of problems (usually within the first 2 weeks) my Learning Environment manager is aware a problem is brewing and I have been in contact with the university liaison officer. If the problem resolves, no harm done, but if it escalates you have the comfort of knowing the uni were aware at the first opportunity!
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Anonymous | 14-Jun-2010 10:18 am
I quite agree with this article. I have seen cases whereby mentors failed students and stated the reasons with evidences and witnesses in such cases the university can not override the decision except if the university itself do not value having competent nurses graduating from their institution.

I have also seen a case whereby mentor failed a student, stating the reasons why. Then wrote to the school advicing them on the student's total lack of competence and how she would be a danger to patients if she was allowed to carry on and she would not be a party to such. Instead of the university to take actions after their so called investigation, they only told the student to take time off and decide if she was ready to have nursing as a career or means to meeting ends.
After a year or two the student came back and it is the same story again, with mentors complaining bitterly about her performance and attitude but nobody is yet to fail her. She is presently in final year and i wonder what sort of a nurse she woould make after qualifying.
The only comment i hear is when she qualifies and managed to get a job, she would be lucky not to be in front of the NMC panel within a year and struck off within three years. I believe it should not come to that as actions needed to be made now not later when whatever takes her to the NMC panel might be a bad news for a family.

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Anna Lincoln | 14-Jun-2010 10:55 am
One nurse caring for 20 patients by herself on an acute medical ward is not in a position to mentor properly. I dom't care how caring and determined to do a good job mentoring (or nursing) she is. She isn't going to win.

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Anonymous | 14-Jun-2010 11:37 am

I am in the middle of my Teaching and Assessing course now known as FLAP Facilitating Learning Assessment in Practice

We have already come up against a number of problems:

First:
The NMC state that before we can be signed off as Mentors we must have assessed a 'FINAL 3RD YR STUDENT'.

Second:
It has already been established that some placement area such as Critical Care A&E and ITU DO NOT have 3rd yr students never mind a ‘Final 3rd yr student’

Third:
The NMC suggested that we assess one of these students from another dept.

Excuse me for probably making a very SILLY COMMENT but are we not supposed to build a rapport with our student to enable us to assess them correctly and 'SIGN THEM OFF'?

Fourth:
In addition to this, we have to have a 'BUDDY' who assesses us as we assess the Final 3rd yr student.

Surely the NMC appreciate the issues that they have caused? In addition to this,, the extra pressures they have just put on new mentors?

As Anonymous (13th June 11:31 a.m) states ...."often end up adding to the amount of unpaid overtime the NHS already gets from me"

Mike (13-Jun-2010 12:45 pm) also makes a very valid comment "If Nurses are expected to mentor, then staffing levels need to be sorted out, and time should be protected to a) take slightly longer with tasks when explaining or supervising a student, and b) sitting down and going through the ridiculously repetitive paperwork. This isn't rocket science is it"?

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Anonymous | 14-Jun-2010 11:51 am
Reffering back to this comment is it 'Legal' or even 'Safe Practice'??

"One nurse caring for 20 patients by herself on an acute medical ward is not in a position to mentor properly. I dom't care how caring and determined to do a good job mentoring (or nursing) she is. She isn't going to win"

According to the web page below: SEE 'RISK AMANGEMENT'

NURSING & MIDWIFERY COUNCIL - The code in full., 2009. [online]. Available from: http://www.nmc-uk.org/aArticle.aspx?ArticleID=3056
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Anonymous | 14-Jun-2010 1:27 pm
i am a mentor and sign off mentor as well working part time in a busy team in the community, it is difficult at times to find time to give the student nurses the time they deserve, recently i said no to having another student nurse so soon after the last one, it wasnt easy, but why should we be made to feel guilty when i want the students to have the best possible experience in a learning enviroment.
perhaps this is the route to go if nursing schools dont recognise, the pressures we are under, and keep rolling out student nurses at the present rate.
as it stands nurses will and are getting resentful this is another case of we have always done it and and alot of goodwill is used soon there wont even be that

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Anonymous | 14-Jun-2010 1:40 pm
How wonderful to read an article in praise of the ,ajority of mentors recognising the hard and challenging role. I am an academic and have to agree with comments from all. It is worth bearing in mind though that 2 separate processes are playing a part here, one clinical and based in practice, the other within the academic system. I would hope I have never been unsupportive if mentors seek to fail the student but I have had to work hard at ensuring the process is seen to be fair. To me it is similar to working with someone who is hopeless for whatever reason in practice as a qualified nurse and the mangement being unab;e to just 'get rid' because employment law processes have to be followed. I totally agree though that good mentors seek to develop the students as well as ensuring our good practice and skills is passed on.I just wish there was sufficient recognition for them
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jjjez@hotmail.com | 14-Jun-2010 2:04 pm
I think that the idea of mentoring whilst essentially cost free is only of limited importance to the both student, mentor and the profession itself.

Two of the mentoring systems crucial flaws are that it relies on the individuals personalities themselves to gel well together in every student-mentor partnership at any given time. It relies on the mentors style of nursing as being mtutually agreeable to the students own philosophies and choices. Some mentors with a more conservative approach may restrict what their students do regardless of the individuals knowledge or potential whilst others may throw open the entire hospital for the student to legitimately visit .

In short it ignores the individuals involved.

Secondly the structure of the placement and paperwork itself relies on mutually agreed goals between student and mentor many of which fall widely short of the mark is gaining a full and in depth understanding.
The goals set by the universities themselves also in no way demand that the student gains knowledge that makes their practice there comparable to a qualified nurse. Many mentors are fixated on the students participation in basic care despite the fact that there is little to be learned overall from such activities and a rather wide corpus of these activities are tasks and nothing else.

For the free sharing of knowledge amongst nurses floating clinical instructors must be made available to directly and indireectly supervise work alongside the regular nursing staff who should all be considered mentors and educators by value of their experience (preceptees excused).

Many mentors may do good work but the system is effectively hemmed in by not applying a reliable enough philosophy of the motivating factors behind the mentoring theory and this is the crux of the argument.

Nursing knowledge should not be handed down like recipies or old wives tales. It should be laid down in stone and made readily available to those before they encounter the clinical area.
This would make mentoring far more balanced.
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Anonymous | 15-Jun-2010 7:51 am
anna lincoln(14 june 10 10:55)
wow! super woman all on your own no wonder mistakes are made and plenty of errors too i am sorry you are to full of yourself where are your h c a's and trying to to mentor students on how to work alone with 20 inmates your the one who is giving other staff a bad name i suggest you sit down and think of your job?
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Anonymous | 15-Jun-2010 4:36 pm
As a sign off mentor I do believe what we do is underestimated and I sometimes don't think the universities help. I work in a very demanding clinical setting and student placements can be as short as 5 weeks, then take into account that they are having 2 study days per week, this is then practically a 3 week placement as a result, then consider a majority of staff work long days, as a sign off mentor you may only be working with that student for as little as 7-9 shifts and we are expected to sign these students off as competent in the setting. It is also difficult in such a setting to find continuity for the student when you can't work with them because we often have 5 or more students at a time.
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Anonymous | 17-Jun-2010 9:56 pm
Far better to have a staff nurse looking after 20 patients and trying to mentor a student than not. Why? Because the student may realise that the disneyland portrayed in the university is far away perfumed dream than the unpleasant reality of the occupation of ward nursing in an NHS hospital.
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Anonymous | 17-Jun-2010 11:01 pm
I think a lot of the issues of mentoring lie in the fact that students are only allowed to 'observe' for a time before they can practice under supervision, before becoming competent in a particular practice/task. This system means that this process is undertaken by different mentors in different settings over a period of time. If students were allowed to complete the process in one setting, if they have the ability, then it would be more evident that they are actually achieving their competencies (this may not be appropriate for every student, I hasten to add). Their progression would be far more realistic, instead of the mentor having to rely on what they think the student has already learned from what has been commented about them in previous placements and the students interpretation. This is why mentors and students are finding the problems too far into the training. In my experience it is towards the end of student training when the issue of failure occurs, which is both unfair to the student and mentor, not to mention the patients. This makes it more difficult to convince the universities, as the student has appeared to have performed well until then.
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Anonymous | 18-Jun-2010 1:41 am
Anna Lincoln (14 June) is absolutely right. 1 nurse for 20 patients. For those who didn't understand HCA's were not included as they do not count as mentors (although they do a great supporting role). As well as supervising all the HCA's and 20 patients, the only qualified nurse on duty is supposed to mentor 1 or sometimes 2 students?
I am not surprised by this ratio!
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Anthea Wilson | 23-Jun-2010 9:10 am
Thanks to all who have commented on this article so far - I've really enjoyed hearing your views and finding out about your experiences.
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Anonymous | 12-Jul-2010 11:11 am
It doesn't make sense that the 50% of a student nurse's assessment that takes place in the university is assessed by lecturers who have colleagues they refer to for help; a robust moderation system and external examiners who provide a check. Whilst the 50% assessed in practice is assessed by mentors who are doing it as a sideline besides their usual jobs; with no time allocated; with no moderation; on their own with, it seems from the experiences I hear, very little support or understanding from managers.
I know sometimes mentors look to universities to solve these problems for them but universities are very limited in what they can demand from the NHS, who they rely on to buy courses.
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