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Are the demands of nurse mentoring underestimated?

  • 20 Comments

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

  • 20 Comments

Readers' comments (20)

  • rovergirl6@hotmail.com

    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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  • 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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  • 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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  • 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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  • 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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  • 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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  • 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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  • 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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  • 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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  • 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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