As gatekeepers of high-quality nursing care, who ensure only competent students pass their placements, mentors must be able to assess them correctly and fairly
Pre-registration students are bound by the Nursing and Midwifery Council’s code of conduct, and must meet the expectations for performance laid out in the NMC’s standards for competence. When a student is not achieving the relevant competencies and is regarded as at risk of failing a clinical placement, it is paramount that the mentor acts promptly, bringing forward interim interviews where appropriate. Good interview technique will help mentors and students to address difficulties in placements. Mentors should receive adequate support to address problems during the remainder of the student’s placement or, if a student does not reach the required level of competency or professional behaviour, ensure that they do not pass.
Citation: Stevens E (2013) Conducting interviews with failing students. Nursing Times; 109: 8, 22-24.
Author: Emma Stevens is safeguarding adults practitioner (formerly practice learning facilitator) at City Health Care Partnership CIC, Hull.
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To maintain high standards of nursing care, it is essential that only competent students are allowed to enter the profession. As responsibility for passing or failing students in clinical practice rests with registered nurse mentors, they perform an important role in assessing their students’ competence (Chambers, 1998).
A mentor is defined as “a registrant who has met the outcomes of stage 2 and who facilitates learning, and supervises and assesses students in a practice setting” (Nursing and Midwifery Council, 2008). Mentors are accountable to the NMC for their decisions to pass or fail students, so the validity of these decisions is paramount. However, assessment of clinical practice has long been recognised as problematic (Watson et al, 2002), and Duffy (2003) has also identified that mentors are “failing to fail” students.
High-profile cases such as those of Colin Norris and Beverly Allitt highlight the most serious consequences that can arise from allowing students to register, despite concerns about their competence. Following an investigation into unexplained patient deaths at Leeds Teaching Hospitals Trust, Colin Norris was convicted of the murder of four older patients. The independent inquiry report highlighted that during Norris’ nurse training he was frequently absent from clinical placements, had difficulty dealing with authority and did not enjoy working with older patients (Cantrill et al, 2010). The report into Beverly Allitt’s practice at Grantham and Kesteven Hospital also highlighted that problems identified in Allitt’s practice during her nurse training should have indicated that she was not suitable to enter the nursing profession (Anisfeld, 1992).
Mentors should not work in isolation and should use their colleagues’ skills to contribute to their assessment of students’ competence. They should use specialist support offered by practice learning facilitators (PLFs), who should also be fundamental to the interview process when a student is deemed to be at risk of failing. Protocol and best practice also dictates that the mentor should raise concerns with the student, the PLF and higher-education institution (HEI) tutor in a timely manner so issues can be resolved and action plans written at the interim and final interviews.
Scanlan et al (2001) found it can take two to three weeks to recognise a student nurse who is failing. Although mentors identified problems in the first week of their students’ placement, they gave them time to familiarise themselves with the clinical area before addressing the concerns (Scanlan et al, 2001). This delay in addressing issues has the potential to lead to further problems if it results in students not having enough time to improve and develop their practice. Stevenson et al (1992) suggested that people need sufficient time to practise skills before any demonstrable improvements can be identified, so it is essential to ensure students are given enough time to improve.
The NMC’s Standards to Support Learning and Assessment in Practice state that at least 40% of the time a student spends on placement should be spent with their mentor; however, mentors may need to spend additional time in direct observation of a failing student’s practice to ensure that any assessment that has been made is fair (NMC, 2008).
Core interview skills
Students should receive timely feedback, and it is important that feedback is offered continuously throughout their placements; there should be no waiting for formal meetings. Before conducting an interview with a failing student, it is important for the mentor to reflect on whether there are any potential personality clashes between mentor and student. It is imperative that assessment is fair and objective and, although personality clashes may trigger conflict, they are not grounds to fail a student. Box 1 contains some key areas to consider within all formal student interviews.
Best practice indicates that the interim interview should be scheduled in advance, at a pre-arranged date midway through the student’s placement. Depending on individual circumstances, this date may be brought forward (particularly if possible failure is identified early) to provide an opportunity to discuss the student’s progress. If a mentor has concerns about a student’s behaviour or progress, these should be discussed with the PLF or HEI tutor. The concerns must also be communicated to the student and recorded in the assessment document, and a SMART (specific, measurable, attainable, realistic, time-limited) action plan must be devised to support the student.
Burgess et al (1998) identified that, when students are faced with difficulties in placement, they react in different ways, including displaying anger, frustration, disappointment and shock. When conducting these interviews, it is important that the mentor allows the student to react, as this is a normal part of coming to terms with, and accepting, that there are problems in their practice. Only when the student has accepted that there are problems can they move forward and begin to address them. Box 2 sets out the important points to consider.
The final interview and beyond
Before the final interview, it may have been necessary to hold additional meetings to review the student’s progress and amend action plans to incorporate any additional learning needs. Through ongoing feedback, students at risk of failing should already know whether their practice has improved enough to pass or if there are still concerns to be addressed. It is useful for the mentor to prepare a statement beforehand, which can be used to structure the feedback given to the student within the interview. The final meeting should not hold any surprises for the student and should also be attended by the PLF and/or HEI tutor if they attended the interim interview. It should include the points listed in Box 3.
Duffy and Scott (1998) suggested that mentors may interpret failing a student as a failing on their own part. However, if they have correctly followed the process and fairly assessed the student, mentors should not feel personally responsible for students’ failures.
After the final meeting, it is useful for mentors to reflect on their own mentorship practice and identify elements of good practice, as well as aspects upon which they could improve. It is important to capture this learning before it is lost; it can be discussed within clinical supervision, supervision with the PLF or through individual reflection.
Mentors should offer regular constructive feedback to students, which should be communicated clearly and honestly. If a student is failing, the mentor should utilise support from the PLF so they can openly discuss their concerns over the student’s practice as well as ensuring procedures are followed and documentation is correct. Interviews should be conducted in a timely manner, with SMART action planning and dates to review progress set in advance.
While mentoring a failing student can be both stressful and time-consuming, mentors perform an essential role as gatekeepers to the nursing profession. In spite of this, Watson and Harris (1999) found students were sometimes allowed to pass when their performance was unsatisfactory. It is essential that only suitably competent students pass each clinical placement, so as to promote high-quality nursing care and avoid risk to patients.
Although there will always be students who do not achieve the required standard, mentors must have the confidence in their professional and assessment skills to ensure such individuals fail their placement. However, they should also be aware that through timely interventions and action planning, many students at risk of failure can be effectively supported by their mentors to achieve the required level of competency.
- Nurse mentors are vital in determining whether student nurses are competent
- Reports have highlighted that mentors are “failing to fail” students
- Documentation as well as good communication skills are essential when conducting placement interviews
- Students should be given a robust final assessment
- Mentors should review their own practice on a regular basis
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