Sustaining and assuring the quality of student nurse mentorship: what are the challenges?
Providing mentorship to student nurses is the cornerstone of the Nursing and Midwifery Council education standards (NMC, 2008), which ensure nurses are fit for practice at the point of registration.
Assuring the quality of mentorship is a concern to the higher education and healthcare providers who share responsibility for it, particularly at a time when nursing competence is much in the public eye (Francis, 2013). Drawing on National Nursing Research Unit research, this Policy Plus focuses on perspectives of higher education institution and service personnel on sustaining and assuring the quality of mentorship within a difficult economic climate and at a time of debate about its future direction (Robinson, 2013; Robinson et al, 2012).
A quality-assurance framework for mentorship
A quality-assurance framework aims to reassure all stakeholders that a system meets the defined standards. Mentorship sits within several such frameworks. The Nursing and Midwifery Council sets standards for: mentor preparation, course attendance and professional updating; the proportion of time students should spend with mentors and sign-off mentors; and auditing of educational suitability of students’ placements (NMC, 2008). It audits compliance with these standards in higher education institutions and healthcare providers. The mentorship course is also audited by individual HEIs; the Quality Assurance Agency and healthcare providers are regulated by the Care Quality Commission.
Factors facilitating and constraining the quality of mentorship were identified in a study that explored capacity for mentorship provision within the complex network of relationships between organisations and individuals involved in nursing education (Robinson et al, 2012). Semi-structured interviews (n=37) were held with senior personnel whose brief included a remit for mentorship in two London-based HEIs and in seven partner trusts for nurse education (selected to include NHS hospitals, community and primary care trusts and to encompass adult, child and mental health services).
Assuring quality through mentor recruitment
- Sufficient numbers of mentors were in post to meet the requirement that all students have a mentor in practice.
- Most trusts complied with the standard that nurses have one year’s practice before commencing training, but pressure to increase mentor numbers led to staff sometimes being selected before they were perceived as ready to take on the role.
- Requiring nurses to qualify as mentors before accessing other courses or applying for promotion led to concerns that this might be the main motivation for becoming a mentor, rather than a genuine interest in nurse education.
- A great diversity of views existed over whether the current approach of enabling all nurses to become mentors was the best way to achieve high-quality mentorship as opposed to developing a specialist career pathway for mentors (National Nursing Research Unit, 2013).
Assuring quality through preparing mentors
- The mentorship course (study days and supervised practice) was regarded as good or adequate preparation for the role of mentor.
- Anxieties were expressed about the impact of increasing the proportion of online learning; while it was seen as suitable for information sharing, it was not appropriate for topics requiring more discussion, such as managing poor student performance.
- There was considerable variation in organisational compliance with the NMC recommendation of five days’ protected learning time; some expected online sessions to be undertaken in employees’ own time, which was perceived as detrimental to the quality of their learning experience.
- The quality of supervised practice was influenced by the experience of mentor supervisors and practice learning cultures.
Assuring quality mentorship in practice
- When mentors had concerns about student issues, the presence in practice settings of practice education facilitators (PEFs) and link lecturers enabled these to be addressed without delay. However, continuation of this support was uncertain given short-term funding for PEFs’ posts and increasing time pressures on link lecturers.
- Little reduction in workload was reported to accommodate standards on student time with mentors and sign-off mentors; both often completed documentation outside working hours.
- Mentorship in practice was supported by substantial cross-organisational activities (planning and review meetings, developing websites and materials), but some of these working relationships were being disrupted by trust mergers and changes to education contracts and service delivery.
- The requirement for annual updates and triennial reviews was welcomed but reservations were expressed that attendance might measure compliance rather than quality.
Assuring quality through monitoring and assessing learning in practice
- Mentors’ abilities to judge student competence could be limited when placements were short, providing insufficient time to make assessments, and by mentor inexperience.
- Cross-organisation working groups streamlined instruments to measure quality to help ensure consistency of approach. Although welcomed, concerns were raised about the instruments becoming tick-box exercises that failed to capture the quality of learning.
- Governance measures of assessment decisions in clinical practice were seen as less robust than those in higher education. In higher education, several people assessed work through marking, moderating and external examination. In clinical practice, outcomes stemmed from a series of individuals making assessments: the mentor assessing the student; the sign-off mentor assessing the final destination student; and the supervising mentor verifying the learner mentor’s outcomes.
Conclusions and implications
HEI and service personnel worked in partnership to deliver mentorship but were challenged by a range of factors in meeting the standards in the quality-assurance framework.
- Maintaining mentoring partnerships: Partnership working was challenged by growing and conflicting pressures on staff time, and disruption caused by changes to service and education delivery. Clarification of respective responsibilities is needed, as is recognition of the time and commitment required to sustain existing partnerships and develop new ones.
- Resourcing mentorship: The resource-intensive nature of mentorship was under pressure from growing financial constraints. Providers have to respond to short-term demands to reduce costs but which may undermine the delivery of high-quality care that depends, in part, on the long-term commitment required for providing mentorship.
- Debating mentorship: Debates about assuring the quality of mentorship in the future included: length of time qualified before becoming a mentor; alternatives to the current model of all nurses becoming mentors; developing instruments that allow consistency but also measure the quality of learning; and developing assessment systems for practice as robust as those for higher education.