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Mentors passing students despite doubts over ability

Student nurses often pass clinical placements despite serious concerns from their nurse mentors, a Nursing Times investigation has found.

A survey of nearly 2,000 nurse mentors by Nursing Times has found that 37 per cent say they have passed students whose competencies or attitude concerned them, or who they felt should fail.

37% - mentors who have passed students, despite concerns about competence or attitude, or thought they should be failed

69% - mentors who struggle with or fail to manage paperwork relating to students

17% - mentors who have had their decisions to fail poorly performing students overturned by a university

17% - mentors who have “fudged” paperwork so that students pass, because they do not have enough time to check all the competencies

When asked why they passed these poor students, 40 per cent said they did so because they could not provide the evidence to back up their concerns. Just under a third said they did because they thought the university would just overturn a fail.

The results suggest that suspicion is well-founded, as 17 per cent of all mentors responding to our survey said they had had their “fail” decisions overturned by a university.

The rate is even higher among nurses who described themselves as “sign off” mentors – the most experienced mentors who affectively clear the path for the student to be entered onto Nursing and Midwifery Council register.

One in five sign-off mentors responding to our survey said their decisions had been overturned by the university.

Mentors raised concerns about the “perverse” incentives universities have to avoid failing students, as they are penalised for high attrition rates.

In addition, the survey has also exposed a process which is driven by paper work and requires nurses to provide written evidence in order to fail a student.

Seventeen per cent of survey respondents admitted to “fudging” the paperwork for their students – “ticking off” competencies that have not actually checked in practice.

Nursing Times has been told that even mentors who do not “fudge” the results and instead try to fail poor students struggle to provide the solid evidence that is required – making it easy for the student to challenge the decision and have it overturned.

Louise Lawson, senior lecturer project lead at the University of Hertfordshire, has just completed research for NHS Barnet and the Royal National Orthopaedic Hospital into the support given to nurse mentors.

She told Nursing Times many mentors find it time consuming to fail a student as they are asked to “build a case for failure”. This involves setting out in writing how the student has failed over the course of the placement to meet stated “outcomes” and what constructive feedback the mentor has given the student on improving those areas.

“They have to follow due process,” Ms Lawson said. “If you challenge them and you find they haven’t followed due process, the student can have the failure overturned.”

She said that process often also left mentors feeling “judged themselves” as bad teachers. More than one in 10 mentors who admitted to Nursing Times they had passed poor students cited concern they would be blamed for their failure as a reason.

Christine Stevens, a senior lecturer at the University of the West of England who trains mentors, agreed mentors struggled to keep up with the paper work necessary to fail poor students.

She told Nursing Times: “They don’t have the time to document the issues. They are aware of the importance but it’s about them having time and sadly they don’t always have that.”

A further reason for mentors not failing students is concern about conflict. Jacqueline Fletcher, principal lecturer at the University of Hertfordshire’s  school of nursing, midwifery and social work, told Nursing Times some students were able to easily intimidate their mentors.

“Students can be very challenging,” Ms Fletcher said. “The young adult of these days can be very assertive. [If they know a mentor plans to fail them] they will say ‘why are you doing that?’

“They might mean: ‘Tell me what I’m doing wrong’ but there’s a fine line about how they put that across. It could come across as aggression.”

Ms Lawson – whose research is based on interviews with over 300 nurse mentors – said: “Some [students] use emotional blackmail as a reason to not fail them, saying their husband will leave them [if they fail] or they won’t be able to pay the mortgage.”

Readers' comments (54)

  • im a 3rd year student nurse and i know for a fact there is 1 person on my cause that failed every assignment and got really low grades on placement in year 2 if fact they were told they was a liability yet they are still on the course making the same mistakes and will be qualified in 6 months. mentors need to be able to fail bad students because they are on there own when a staff nurse and could kill someone. then whos fault will it be

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  • As a mentor I too have had to recently fail a student. This student was given ample time to prove herself as from week one I informed her that her knowledge and attitude would result in a fail. On completion of the placement the student was failed. At that point she went to the university and stated the reason she failed was because of lack of support etc from the staff nurses. That students fail was overturned. I just hope that once this student recieves her PIN that none of my family members have the unfortunate luck to become her patient. The system is flawed.

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  • I have failed a student in the past, due to the fact her mathematical aptitude was shockingly bad, her attitude was dreadful, she was always late and used the excuse of going to church to get away early.....i was told by her that i failed her because i was racist!!! Therefore she would report me to the University. I have found other students, not all, of similar ilk to that particular student. I therefore withdrew my role as a mentor.

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  • Hi there,

    I am a third year student nurse and finishing early next year. I am very happy to hear about this concern of mentors. Every time I am going for placment I do worry so much because of the type of attitudes mentros have got. First and foremost they don't want to know about a student. most of them are very rude, have temper and not professional at all. In this way they forget that they were also once a student. I mean this is the UK system of educating healthcare workers. So those ones who studied from abroad are even better than those who study from here. And on the otherhand funny enough doctors behaves in good way to the junior doctors. So what attitude nurses have got and not even willing to help junior nurse student? It surprises me all time. I always work hard whenever I got for placement for example work as a team, but in the end I can't even find a mentor to look at my portfolio and sign activities. It is a real mess and I think this is why most student are let down by their mentors in that way. After working for them doing all the dirty jobs for them, they can't think twice to help to learn as much as you can. I also remember a sister of the ward who was worse since I started my course. I used to greet her especially in morning and afternoon, but she couldn't answer me at all. So I got angry about it and reported her to the placement facilitator and also she ignored it. Can you believe what we go through as student nurses? I have alot to say but I will stop there.
    Thanks, xxxxx

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  • I agree with some of the last comment made, as a first year student, who has just completed my first placement, I have mixed reviews regarding mentors keeness to help students with their paperwork and learning. I never found mentors rude or unapproachable, but I found it extremely challenging to get my paperwork signed off, without sounding like I was continously nagging for their time. I have unfortunately seen mentors, so fed up with it all, that they have said they would be willing to just sign off a students competencies, as they dont have the time to continously observe or sit down with their student and sign them off. I understand after seeing it first hand, the ward enviroment is very busy, but really time needs to be made for the students, this article does paint a rather dim view of students, but honestly mentors need to be looked at aswell...people are quick to judge a student nurses enthusiam and keeness, but what about a mentors?

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  • debra fretwell

    I think some good points have been raised regarding both students and mentors... I am a 1st year student coming up my 3rd placement, the previous two have been on a ward and in the community.
    None of my colleagues or i have found it particularly challenging to have documents signed and quite a few have come back with outcomes not achieved and a valid reason why not, as far as i know none of the students plan to challenge the mentors decision regarding the failure.
    The best approach for us all as a cohort has been to organise clear times for sitting down with mentors at the start of a placement (start, mid and end point discussions) then you are not left 'chasing people around' at the end. Some mentors have been unwilling to apply themselves to the task of teaching a pupil and completing relevant paperwork and have complained about the process, then why be mentors in the first place?????

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  • I think there is a fine line between being so strict on evidence that you can't fail a poor student and allowing mentors to fail students for minor issues. Mentors are in a position where they could potentially ruin a person's career, but at the same time have to prioritise the safety of the patients.
    In my own experience, I reported abuse during a placement and the was bullied by my mentor for the rest of my time there. I reported this (and got very little support from university) and then my mentor tried to fail me. The only reason this was overturned was because he had absolutely no evidence for the accusations he made (mainly because none of it was true!). If it hadn't been for all the paperwork required to fail a student, my career could have been ruined through no fault of my own.
    The paperwork is a necessary evil. I think the issue is with the managers in the placement organisations who fail to appreciate the amount of time that is needed to properly mentor a student and reduce their staff's workload accordingly.

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  • The issue of passing or failing students should not really be an issue. I am involved heavily with the mentoring of student nurses on my clinical area. It is a very fulfilling role to have as a senior staff nurse and nurses should always aim to make time to give their students the best placement opportunity they can offer.
    However, i am realistic in the fact that the current employment climate in some areas is dreadful and this is bound to have an effect upon the students placement experience as a whole. If this is the case i wonder what would happen if we pressed the universitiy nurse tutors to get back into practice and assist the less well staffed areas to assist us to deliver a better "mentorship" experience to those nurses who are having problems.
    Back to the original point- passing or failing shouldnt be a problem, all those of you who mentor all it takes is 40 mins tops to complete the initial paperwork and so long as your student is keen which most are there shouldnt be any issue!
    We should all be prepared to fail students but only if we as mentors cannot find a solution to turn the problem into that solution. (Obviously not counting the Nutters that occasionally get in to this job!)
    Please lets get rid of in-fighting, canabalistic attitude that seems rife in this profession. Its getting embarrasing.

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  • Now in my third year and having completed 7 placements, I feel that,in my case, I haven;t really been mentored as such. Certainly in the later half of the year, mentors suddenly disappeared, went on holiday and so responsibility for my training stopped.In doing so, I became very annoying by watching new techniques and procedures, asking questions and generally volunteering to do things. Off my own back, not because it was being directed. Surely a true mentorship programme has to be guided by qualified and trained people.

    I'm on the flip side of this argument -I want feedback and want to be told how I can improve. At the moment, I am competent in some things but feel at a loss at others. I asumme I'm doing well because no-one has told me otherwise.
    (I'm a mature student and I can take the criticism having worked as a manager for 15 years previously.In order for people to develop,there has to more effort put in to keeping review meetings when scheduled and by giving constructive feedback when required, not simply on the last day of placement)

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  • Unfortunately the work culture in the NHS is 'sink or swim' not just nurses but medics and others. You only get feedback if you messed up - and managed to far enough down the food chain for anyone involved in the disciplinary to avoid any blow back.

    Consequently not many of us have any idea about what we do right.

    The only problem with having universities 'do' the academic part of nurse training is that it has done little to change educational outlook on the wards. Knowledge is patchy, a nursing qualification an inconvience to be endured in order to get a steady job.

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  • im a 3rd year student nurse and i feel that my last placement's mentor was very knowledgeable but failed to teach student properly. My first day on in SHDU, she swore while chatting to another staff regarding a consultant. She often flew away doing stuff lightening fast whithout telling me where she is going or what shes getting. She puts up drips immediately whithough exlaining to me whats she putting up or the drip rates (luckily i have experience already in doing this, if i was a 1st year student i would have no clue even to power on the pumps!). She turns on observation monitors so quickly that i couldnt even see. I had to self-teach myself in tuning the monitors when i was doing it. My other classmates who were in the same place as me saw all this going on and agreed also that my mentor was not supportive. My mentor put me in a lot of great misery!!! Mentors tend to forget that students need things explained properly, and should be given guidance in the first 1-2 weeks, depending on their level.

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  • As another 3rd year student I feel that its half and half really, some mentors are rubbish using us as dogs bodies and we end up performing tasks the HCA's are paid to do whilst they enjoy an easier shift, whilst thismay be ok in the first year it certainly is not so in the 3rd!

    At other times youll get a fab mentor who really loves sharing their knowledge and skills and becomes areal help to the student.

    Nurses should not be forced to mentor and this is where the problem comes in however, mentors need more time given out to enable paperwork and guidance to be given to students and better support to enable failure if needed.

    What a shame nurses feelunable to fail unsafe students.

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  • Hi
    I am a nurse with 27 years experience in the NHS. I had an student 3rd yr student nurse thatwas unable to calculate the simplest of drugs, could not nalyse her patients recordings,(unaware of what a pyrexia could siginfy in a patient) and would be qualified in 2 months. despite lots of input from ard sisters and uni
    she did fail her placement.It was overturned by her university. now she works in a HDUwith vunerable patients.Whats the use f all the extra input into someone who clearly could not do the job.I later found out that there were issues on her previous 2 placements that the university chose to ignore.

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  • Whatever happened to nurse tutors?

    Now it seems it is down to the mentors to teach students how to nurse.
    Students are not included in the staffing numbers per shift but mentors are.... so it is hardly surprising some students get a raw deal with little time being devoted solely to them.
    Being a mentor is like being in a three legged race ....it slows you down.
    As a mentor your prime consideration on duty is to your patients....
    If a mentor had one day a week to 'mentor', to have quality time with students things may be better.... but students also need to realise they are there to nurse ... that means getting stuck in.... doing the dirty jobs.... being with patients...!!

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  • hi. im a newly qualified nurse. Most of my placements as a student were challenging as I found the majority of mentors were not up to date with evidence based practice and when I questioned their practice I was seen to be not one of the clique!I was seen then as a student who thought/reflected too deeply. True, practical skills are not as good but I blame the unis and the placements for not enough practicals!which is NOT the students' fault. I have to say too after completing the preceptorship programme at the local hospital, preceptor's were not even on my shift and I would lend my sign off book (yes students, sadly there's more paperwork!) to my preceptor's, where it would be returned weeks later still not signed off!So, what's the lesson to be learnt here folks?As a mentor, they should remember the NMC about teaching students and should be fully evidence based and competent in their skills to be able to answer firing questions from students; if an answer is unknown, go home and find out or ask the student to and report back! Its not a competition who knows or who can nurse/care the best, but why does it feel like its an uphill struggle all of the time?

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  • For me it is the Universities which are at fault. I have 28 years experience and feel things have never been worse. Lecturers apply huge pressure on mentors not to fail students [their jobs are on the line if numbers fall]. The same lecturers have not touched a patient in decades and are totally out of touch - how are they still nurses? Yet when the NMC came to visit our matron praised the Uni and the lecturing staff to the skies. Why? Well it looks good on her record if everything passes. So no ethical dimension of protecting patients from her! And of course she doesn't see how bad things are anyway.

    I am so disillusioned that I feel that being a staff nurse is to be devalued and demeaned.

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  • I am a Adult Nursing University lecuturer. In our institution there are certainly instances when students do fail practice. However if there seems to be a genuine reason why the student has failed, it would be unfair to ruin their career prospects on the basis of one bad placement, and in such circumstances, students are usually permitted another attempt to pass practice elsewhere.
    However in some case there are genuine and justifiable concerns about the student's performance. In such cases, if the students are considered consistently dangerous/unprofessionsal etc by ward staff, due process is the key to securing and maintaining a fail.
    Mentors need sit down with the student and discuss their concerns; do this as early as possible, in order that the student has a chance to reflect on their practice and try to improve. If they don't know what they are doing wrong it is hard to change! Make sure the discussion is documented and an action plan is devised. Review regularly, and document progress made. If necessary, involve the university or the person who is employed to support mentors and/or students in practice (support mechanisms vary between institutions and Trusts).
    Hopefully this process will result in a resolution of issues and an improvement in the student's practice. But if it does not, following due process and writing everything down will provide not only information for the student about where they are going wrong, but also concrete justification for awarding a fail.
    Similarly, students who feel they are struggling in practice, or feel they are not being supported or assessed appropriately, need to take responsibility for meeting with their mentors and sorting out learning outcomes and goals, and reflecting on areas of practice they need to develop. And again, if, despite their best efforts, this is not happening, they need go through the appropriate chanels to resolve this, and again, document everything.
    Hopefully, if the above steps are followed, students will not feel as though they are being failed unfairly, but also mentors will feel empowered to fail a student who is genuinely unsuitable to become a registered nurse.

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  • if mentors actually worked with you stuednet nurses may actually be the standard they are suposed to be students learn by hands on its ok being A - C grade academically if you have never been in clinical situations. Making beds and wheeling people to the loo seems more important than actually learning about the disease process and how to link it to your patient then when you qualify you are expected to know this how can you iof mentors havent got time for you as they are so over strecthed due to staff shortages dont blame evrying on the students (lack of support on both sides)

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  • This is so sad. I trained 40years ago.We had a little book containing procedures we had to see and do. These were ticked off by our mentor. Important things like dressings, drug rounds etc were assessed by a tutor from the education department. These clinical tutors used to come and work with student nurses on the wards. It worked very well. Indeed the training I received all those years ago was far superior to the training of today. When I qualified I was confident enough to run a ward and do a drug round as I had been doing it all through my third year. When will anyone in nurse education and the government listen to our generation for I know we all feel the same.

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  • Hear Hear Anthea.... i totally agree with you.
    Clinical tutors lets have them back.... they have time to spend 'teaching' students on the ward.
    I remember taking an hour to bed bath a patient under the guidance of a clincal tutor.... yes an hour! every aspect of nursing care was discussed during this time and i felt confident to know how to look after a patient with drips/drains/obs/what adverse things to look for/documentation etc in essence 'total patient care' Mentors do not have that same time to give to students.
    And as for students who think making beds and taking patients to the loo too menial tasks they need to get real. These are important times when chat can take place with patients or just observing the patients for pain, resps, colour, ability to give themselves drinks/what condition their skin is etc, etc
    Patients are people they are not diseases!!

    You learn more about patients and their needs by being with them, talking to them.. you can learn about diseases and the effects of it at home in study time ...ward placements are to learn about patients and how to care for them and that means doing 'nursing'.

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