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.”