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Mentoring system: you are the weakest link – goodbye?

November 12, 2013

Asking the question  ‘Should all nurses be mentors?’ the National Nursing Research Unit’s latest Policy Plus paper certainly got people talking. The context in which it was produced was rather drily explained as a debate ‘as to whether all nurses should become mentors…or whether it should be a separate career pathway for a few…[which has] arisen mainly over the issue of mentors’ ability to assess student competence’. My reaction was: yeah, and then some! As anyone who regularly engages with students on social media will know, the problem is actually much, much bigger than that. Assessment’s just a part of it. The real problem is the uneven quality of mentorship, and the voices, too many to ignore, suggesting that some mentors are not only uninterested in teaching, but – even worse – are uninterested in students.

Typifying this reality was the comment made by a student in response to a Nursing Times article on the NNRU document: ‘I’ve had placements with such fantastic mentorship I’ve not wanted to leave and placements with mentors who insist on calling me “the student” and telling me they are glad we only work short days as having a student “under their feet” all day is exhausting’. Alarmingly, this person went on to conclude that ‘my nurse training is a joke and due to qualify shortly, worrying thought that cohort after cohort will be coming through thinking/feeling the same thing’.

The truth is that when we talk about cultural change in nursing, we need to start HERE. It is absolutely absurd that students on degree courses are spending half their time on placements where there has been little attempt to monitor the quality of teaching, little attempt to ensure that what is taught dovetails with what has been learnt in the classroom and little attempt to interact with mentors to find out just who they are and what aspects of nursing they are interested in. I really, really want nursing degrees to be an engine for improvement, but it’s sometimes difficult to have much confidence in programmes that are so appallingly disjointed. How many other higher education programmes are as laissez-faire as this?

From the mentors’ point of view, the difficulties are just as serious. Almost no time is allocated specifically for teaching or reflecting with students, so it isn’t really surprising that mentoring  is  viewed by some as yet another burden in an already dangerously overburdened day. There is little support or recognition for mentors (there is certainly no financial recognition) and the relationship with the university, as outlined above, can seem distant to non-existent.

But behind all this, there is an even bigger concern: what worries me the most about anecdotal evidence of fairly widespread poor quality mentoring is the underlying lack of confidence amongst some trained nurses that it seems to hint at. Setting aside all the (completely understandable) arguments about lack of time and lack of resources, are we seeing traces here of a shadowy routine of mentors offloading students onto the nearest Health Care Assistant and refusing to ‘interact with me or let me do things’ (to quote one contributor to a recent Nursing Times Twitchat about mentorship) because they are so unconfident of their practice that they fear it would not stand up to scrutiny?

This is an extremely uncomfortable question, touching as it does not just on nurses who are in training now but also on the quality of nurses produced by the training of the past and on how well those nurses have gone on to serve patients and the profession. Even to ask it could be seen as disloyal and pandering to tabloid hysteria about ‘uncompassionate nurses’. But it is precisely because it is so difficult that we have to address it. We will never change nursing by ducking the hard stuff.

In many respects, the mentoring system is something that ‘just happened’ – it was introduced many years ago because it seemed like a simple, common-sense way of organising student supervision while out on placement; and apart from small tweaks like the advent of the ‘sign-off mentor’, it has survived the passage of time virtually unaltered. Its very longevity should be enough to alert us to the possibility that it is no longer fit for purpose, and that different models could give better results for trainees and increased satisfaction for mentors.

I believe that making changes to the practice component of nurse education has the potential to revolutionise nursing culture. Forget all those dreamt-up-by-civil-servants-who-know-naff-all-about nursing plans to make prospective students work for a year as Health Care Assistants; this is what holds the key. If we get it right, we can not only improve the student experience but also make evidence-based care the stuff of everyday life, re-energise staff with many jaded years of practice under their belts and – most important of the lot – MAKE NURSES PROUD. To make it happen, all we have to do is chuck out our pre-conceived ideas and ask ourselves one simple question: if we were designing student placements today, from scratch, how would they look? Let’s get some ideas on the board!

  • Better practice-academia links. To make the vision of evidence-driven nursing a reality, academics need to spend time on the wards (or in the community) conducting studies in collaboration with the practice side, advising on how to implement their findings and empowering nurses to ask questions of their own. Far too many nurses view academia as some kind of ‘other planet’ that has no relevance to them. Let’s get them excited about the transformative potential of research.
  • A big fat thumbs-down to the NNRU’s discussion proposal that not all qualified nurses should be mentors. No one should be allowed to opt out of exposing their practice to questioning eyes – although there should be more acknowledgement of just how big a challenge some people find this.
  • Pilot new models of mentorship. How about shared mentorship under a designated ‘learning supervisor’ role taken on by a senior ward nurse. Each member of the mentoring team could specialise in a different area of interest and students could rotate around them according to a schedule designed by the leaning supervisor. Trained nurses would then have the chance to focus on and develop something that really interested them, and students would be exposed to a variety of different approaches and ways of working.
  • Designated teaching and reflection time and opportunities for nurses to sit in on lectures relevant to their speciality or interest so that they have an awareness of the taught component of the undergraduate courses and are better equipped to link it to practice.
  • Experienced and suitably trained Health Care Assistants could have a role in the mentoring team.
  • Regular discussions between the mentoring team and the learning supervisor.
  • Better monitoring of the learning environment.

I know it all sounds a bit idealistic, and I’m expecting plenty of people to pile in with all the objections – but we’re never going to get anywhere unless we first sketch out a map of where want to be and the route that’s going to lead us there. This is a call to arms! I’ve shared my ideas with the entire internet; what does everyone else think?

For the NNRU’s Policy Plus (issue 41) on mentorship, see:
http://www.kcl.ac.uk/nursing/research/nnru/policy/By-Issue-Number/Policy–Issue-41-FINAL.pdf
For the Nursing Times story on the above (with comments), see:
http://www.nursingtimes.net/nursing-practice/clinical-zones/educators/time-for-debate-on-future-of-nurse-mentorship-says-report/5064918.article

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