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Application of Leadership in Mentoring: Analytical Essay
According to NMC(2008), Mentor is a registered nurse who has attained the standard to support learning and assessment in practice (8 domains of SLAIP standards) criteria and again NMC,(2008) recognizes standards for mentors as they should complete mentoring or equivalent course, and should have 12 months post registration experience and have developed their professional skills beyond registration, and should be experienced in a similar area of practice as the student they are to assess. More names like mentor, preceptor, coach, practice and academic assessor, clinical supervisor, practice teacher, link lecturer, protege, and so on are used simultaneously. I quote, the Department of Health(DH),(2010) definition of a preceptor who is a registrant practitioner who has been given a formal responsibility to support a newly registered practitioner through preceptorship. However, coaching comprises goal-oriented instruction and support in order to bring off the certain skills of an individual learner in the clinical area. This is beneficial when students fail to attain certain learning outcomes to focus on a particular skill (Charlisle et al, 2009). Hodgson and Scanlan(2013), asserts that mentoring has an enormous effect on staff continuing their workplace, and carrier gratification which in turn positively impact mentors, mentee, departments, organizations, and eventually patients’ safety. In this reflective journal, I use the word mentor which facilitates learning, supervising, and assessing the students during their practice placements and I repeat the word mentee or student who is being mentored. UKCC(1999) suggests mentors are in great demand for students to acquire practical skills and to link between theory and practice thereby, students can be fit for practice to enhance public safety similarly NMC(2006) states mentor is a pre-requisite for pre-registration of nursing and midwifery students and mentors are liable to NMC for their action taken for students and they have to make sure that student nurses are fit to practice and met all preregistration criteria before they are registered with NMC.
Patient safety and professional development of both mentor and mentee are the major output of mentorship. RCN(2012), implies that the foremost principles of nursing education are patient safety, respect dignity, and value for the public. NMC,(2015) suggests mentoring offers mutual benefits to both mentor and mentee. While mentors attain job satisfaction and feel responsible and valuable, mentees are exposed to wide opportunities to learn skills by observing experienced nurses and other inter-professional teams and can develop their competence under clinical supervision and get competence as Bandura’s,(1986) four learning processes: monitor skilled performance, memory and re-creation of the skill and reinforcement and adoption.
Patient safety has become a key feature in all healthcare settings. The role of the mentor is to provide guidance and support to students to build confidence and the mentor enables students to develop acceptable and safe behavior. This is supported by Ali et al(2008), as students interact with staff, patients, and their relatives, they learn technical, psychomotor, interpersonal, and communication skills and help them to correlate theory and practice and in turn help them to emulate professional identity. In Nutshell, mentors are the bridge between theory and practice. NMC(2015,9.4) stated every registered nurse irrespective of whether they wish or not, needs to support students for patients’ safety and their personal development. High-quality, practice-based education is the key for student nurses to enter in NMC register. Mentors too need deliberate preparation to learn, reflect and keep up-to-date practice knowledge for effective care delivery(NHS England,2016). Mentors can be role models in showcasing professional values and behaviors and to inculcate professional candor. Again, mentors have to make sure the students are fit to practice, and awarded for their achievements. Quinton(2007), stated that mentors are the gatekeepers for student nurses and protect public safety. According to RCN 2017 publications, mentors have an incredible role to disseminate knowledge, acting as positive role models, knowing the student’s curriculum and preregistration criteria, identifying learning outcomes, supervising and assessing students whether they are fit for practice, providing constructive feedback, debrief if necessary, make students work with inter professionals, assess competence, public safety and liaise with link lecture in case any concerns. Francis Report, (2013)recommendations include openness, transparency, the duty of candor, compassionate care, and stronger leadership. As per this report, organizations are forced to improve patients’ safety and reduce harm. Eller et al.(2014) state components such as open communication, accessibility, mutual trust, respect, and role modeling lead to successful mentor-student relationships. NMC (2008) reiterates the student should be allocated to a mentor at least a week prior to their actual placements as this help both party to prepare for the experience. As per NMC,(2008), code of practice, to protect confidentiality I refer to my student as a student nurse itself. As a registered nurse in critical care, I always cherish the moment of supporting student nurses, and recently, a 3rd-year student was allocated with me. Philips et al(2000), found out that mentors are interested in getting students so that they can disseminate their competence to the future workforce. Price(2005), stated that mentor-mentee start their relationship as strangers and go through different stages. Similarly, Morton- Cooper et al.(2000) too suggested that mentor-student relation goes through the initial phase, working phase, and termination phase. An introductory meeting between mentor and mentee is imperative to bring forward the information about the student’s past experience and learning outcome (Quinn,2007). Similarly, Borges and smith,(2004) recommend setting expectations at the very beginning of the mentor-mentee relationship. I remember Gibb’s reflective cycle(1988), which says after an introductory meeting, an action plan can be made on the basis of the learning outcome of the student’s education programs and the mentor should know the curriculum of the student(Spouse,1996). A SWOT(strength, weakness, opportunity, and threat) analysis of the learning environment is helpful to assess whether any action plan can be made in particular to enhance effective learning. As, a nurse undergoes 5 levels of proficiency, from novice, advanced beginner, competent, proficient, and expert(Benner’s stages of clinical competence,1984), during the initial meeting with my 3rd-year student, I assumed my student is in between advanced beginner and competent level, and I know my assumptions can be changed as we get more time together. Welcoming and introducing mentees to the learning environment, both clinical and nonclinical interprofessional team is vital to familiarise the learning environment and help the student to feel welcomed and make feel at ease the same view is shared by Kutilek et al(2001) and supports Maslow’s 2nd(safety) and 3rd(belongings) Hierarchy needs too. Mentors need to take initiative to solve the problem they encounter during the placements by identifying the problem, brainstorming solutions, making a plan, implementing it, assessing the outcome together, finding alternative solutions if needed, and celebrating the successful results(Podsen & Denmark,2000). For effective working relationships, a professional, friendly environment, student participation, and continuity of mentoring need to be attained(Rogers and Freiberg,1994).
Facilitation of Learning
NMC(2008) states students should spend 40%of their learning hours with mentors in order to facilitate effective learning. Both NMC(2008a) and DH(1999) reiterate the need for protected time for mentoring. However, RCN,(2016) finds it difficult to manage protected time due to work overload. Nurse has to facilitate learning for nursing students in order to attain competence through professional and development skills. (ibid,2010a). Hallin and Danielson,(2009) reiterate the effectiveness of mentoring mainly depends on the mentor’s interest in mentoring, Race,(2014) reminds learning starts from the brain of learners which is again supported by Knowles et al(2011) by saying besides mentors interest, students should have their own aim on specific knowledge and competencies which they like to obtain during practice placements. According to NMC(2010a), students need to spend 50% of their 4600 hours learning within a practice setting in preregistration nursing education. Goppe(2015) in his book Mentoring and Supervision in Healthcare suggests three ways of teaching which are teacher-centered, student-centered and problem-based learning. According to Brunner(1960), student-centered teaching is more efficient where students to plays a vital role though some drawbacks like time consumption and structure may suffer, times table and deadlines may not be achieved. Mentors’ role in the facilitation of learning is to help them with the learning resources and share knowledge, skill, and experience with the learners and their rapport is crucial to enhance learning. Here, the mentor’s self-confidence, self-awareness, genuineness, trust, competence, acceptance empathetic understanding are essential to facilitate learning. In the facilitation of learning, the mentor makes students practice skills, finally, a summative assessment of competence is done and when a mentor is confident in students, they are even permitted to perform skills without direct supervision. Neary (2000) states as what we do we understand, what we see, we remember, what we hear, we forget. Besides all mentor’s efforts, learning starts from the learner’s brain. Mentors should be ready to accept new ways of challenges exhibited by smart students. Dealing with challenging students can often be a threat in mentoring thereby conflict arises. These can be well avoided by the prudent and proactive action of mentors. Mentors need to know their own learning styles. Honey & Mumford (2000) suggests 4 types of learners. Activists who like to involve in new experiences, reflectors who analyze thoroughly before taking part in the experience, a theorist who likes to observe and correlates with theory, and pragmatists who take part in the experience and then encounter theory later. I myself find my learning style between reflectors and theorists. I gave the Honey&Mumford(2000) questionnaires to my mentee to understand her learning styles.
Assessments
One of the challenges mentors faces when taking up their role as assessors is to award students a pass or fail with their achievements. Price(2007) suggests periodic assessments of competencies to be done during the practice placements. For better assessments, mentors should plan objectives at the beginning of the placements, and mentees are taught the skills on an academic level and given enough time to prepare and practice skills during the assessment, appropriate communication should be used and a prompt and safe environment should be enabled for the student to relax and act at their best. After the skills are performed, as per Grey & Smith(2000), constructive and honest feedback both intrinsic which students assess themselves, and extrinsic which assessors give input, needs to be given and finally, students need to be awarded a pass or fail on the basis of the pre-registration criteria. The sandwich method of feedback which starts with positive points are highly acceptable and asking students to express how they did their skill before coming to the mentor’s conclusion is imperative to alleviate the unwanted stress and can introspect themselves. The importance of both verbal and non-verbal communication is essential when giving feedback. According to RCN,(2007), following feedback, an action plan can be made on mutual agreements. Proper timely documentation is another essential component in mentoring activities, documentation of assessments in particular(NMC,2010d). Mentors themselves need to be familiarised with students’ placements competencies and assessments strategy of the course. Another important factor for assessments is careful planning which helps with systematic placement assessments and prevents problems.However, patients’ unwillingness to consent to students for skill performance on them, students’ health or situations, and unexpected events such as admissions are some of the hindrances of assessments. Thereby, the importance of responsive assessments prevails which embeds assessments in accordance with changing situations(Philips et al,2000). Mentors need to inform the university of any concerns they encounter during placements. From NMC(2007) publications onwards, Sign-off mentors are required to assess students on final year placements and they inform NMC whether the students achieved NMC pre-registration criteria(NMC,2010). Sign-off mentors are nurses who met SLAIP standards(2008) and have clinical excellence in the same field as the student’s need assessments, their knowledge should be up-to-date and be supervised by an existing sign-off mentor on at least 3 occasions of signing off. However, NMC(2018) replaced the role of the mentor with a supervisor and assessor. In revised NMC publications in 2018, part 2 contains standards for student supervision and assessments. Public safety is the paramount aim of these standards. The level of supervision solely depends on an individual level and their proficiency and confidence. The role of the supervisor is to support learning and students to meet their learning outcomes, act as a role model for safe and effective practice in accordance with the NMC code of conduct, and provide feedback, and up-to-date knowledge about areas where they work. Supervisors should document the student’s ongoing achievements, conduct, and proficiency on the pebble pad and these can be used by practice assessors to share their documents about students and can raise concerns in case of students’ proficiency and conduct. Practice assessors make the assessments on the basis of documentation made by clinical supervisors and these assessors make documentation on the student’s assessments. Practice assessors have the opportunity to lease with other assessors in their decision on students’ achievements and they should have good interpersonal communication skills relevant to students learning and assessments providing constructive feedback based on their assessments is a major role.The purpose of the divided role is to make consistent and fair assessments based on Duffy(2016), and Hunt et al(2016). However, Morley et al(2017) suggest this role change can leave qualified mentors disappointed. According to Agnew(2018) with the changing role, all registrants are supervisors. Students who do not meet NMC criteria of pre-registration need to be identified earlier at the best and the university link lecturer needs to be informed. It is advisable to get feedback from the mentor’s colleagues, and other inter-professionals before encountering students regarding their failure to achieve, and documentation is necessary. Duffy(2003) points out that effective assessments are crucial for public safety, and safeguard professional standards, Luhanga et al,2008 also support this. Mentors should have the courage and confidence to fail the students who are unable to meet NMC pre-registration criteria. Though named mentors are responsible for final decisions, NMC mention the plan of action, the sign-off mentors need to follow and they can seek help and support so that their decision will not be entirely theirs, feeling of guilt can be avoided and assessments decision should be evidence-based. This is supported by Cassidy et al,(2017). Sufficient records and documentation are necessary to avoid further implications. Lawson’s(2010) study showed that 37% of mentors make students pass though they doubt students’ achievements. Lack of constructive feedback, confidence or support, staff shortage, poor documentation, and feeling of guilt about terminating a student’s career is considered the cause of failure to fail.(Gainsbury,2010; Vinales, 2015; wells and McLoughlin,2014). Nugents et al(2017) found that good documentation, early detection of dangerous practices, behavior, and attitudes, and support from other staff and management helped to overcome failure to fail. Nurses need support in taking decisions about failing students (Duffy,2013; Black, Curzio, and Terry, 2014; Cassidy,2017).
According to the equality Act(2010), disability denotes he/she has either physical or mental impairments like epilepsy, diabetes, physical or mental disorders, dyslexia, hearing or visual impairments, and so on which hinder or reduce his/her day-to-day activities. Mentors need to be aware of moral obligations to support disabled students and maintaining confidentiality is another sensitive concern. Mentors should be legal to provide reasonable adjustments during placements and assessments without changing the learning outcomes. RCN guidelines published in 2017, implies reasonable adjustments like giving extra time to prepare for viva, use of colored paper and pen to highlight the content, giving verbal instructions, allowing plenty of time for reading, frequent breaks, or flexible hours. Every university has Student Disability Services for help where they are obliged to present a medical certificate showing their disability and mentors to be given extra time to prepare for placements. NMC is keen to promote equality and diversity irrespective of race, gender, and disability. Mentors can have disability equality training to play a crucial role in establishing equality and diversity by treating students with fairness, respect, and understanding. Tee et al(2010) suggest disabled students need to get an extra 20% of their time with their mentors.
Application of leadership in mentoring
According to Gainsbury(2010), mentors at times find it difficult with assessments and end up awarding pass grades to students who may not even achieve curriculum standards. Vigilant assessment is essential as times mentors feel difficulty finding time for facilitating learning and fulfilling the role of the mentor owing to work overload(O’Driscoll et al,2010). These problems can be to an extent overcome by mentors’ leadership qualities, by taking the responsibility of being a mentor and planning ahead their own workload and students’ learning needs. NMC(2008a) suggests mentors as leaders should plan learning experiences to meet students’ learning outcomes, advocate for students to support learning with inter professionals, patients, and carers, prioritize work to indulge students within their practice roles and provide constructive feedback and assessments in practice. Prioritizing the work is an important component of a mentor’s leadership quality(NMC,2008a). I quote the definition of leadership from the book ‘Mentoring and Supervision in Healthcare’, as leaders’ ability to influence activities, behavior, or action of followers toward goal achievements. Gopee et al, (2014) also define leadership almost the same way. The good leadership quality of a mentor is essential for professional development and patient safety. The leadership trait of a mentor help to influence mentee to achieve the desired objectives. Burns (1978), suggests two types of leadership theories which are transactional and transformational. Transactional where mentees are directed to perform clinical skills and are appreciated with rewards. Transformational leaders are those who work with followers to achieve the predetermined goal thus truly motivating students and enabling them to believe their vision. Effective communication is paramount for effective leadership in mentoring. Leadership is the 8th domain of mentorship(NMC, 2008a). Leadership is an integrated role of a mentor to help students during their training to manage their time, and balance practice and theory. Mentors can create a Buddy System in some healthcare systems where it is applicable. This includes allocating third-year students to guide junior students during their placements. This will enable new students to alleviate anxiety in new placements, gain more essential skills to integrate theory to practice, and helps to reflect knowledge(Alison,2005). Here, mentors need to make sure the third-year students have high standards of clinical skills, they have support, and give productive feedback on their buddy role. At the same time, the junior students should get assessments and evaluations and monitor third-year students to be confident and relaxed in their roles. According to Pettinger(2007), leadership styles can be autocratic, consultative, democratic and laissez-faire. In autocratic leadership, the leader makes the decision and do not consider students’ opinion. In most cases, it may not facilitate learning though it is well organized. This environment is not conducive to changing NMC recommendations. In a consultative leadership style, the mentor communicates with students and maintains good rapport and mentors are more accessible and more open-minded to questions. It is the most acceptable leadership style for mentors as it reduces friction between mentor and mentee with effective communication. Yet, both parties can take time to reach a final decision, as negative points. In a democratic leadership style, any changes in assessments and learning outcomes can be discussed with the mentor and mentee and changes can be made. Here, students are more valued and feel like team members. However, as it is not well goal-oriented, a clear vision can be missing in this leadership style. In the laissez-faire style, mentors don’t take much responsibility, and mentors let students get on with things. Here, students may find the placement is less effective in achieving learning outcomes.
The mentor should have knowledge about all these leadership styles and need to evaluate which one can be suitable to achieve learning outcomes. Students too, need to be aware of these leadership styles so that they can adopt the most suitable and effective style once qualified. The main goal of the leadership styles is to bring out the best during the practice placements to attain the learning curriculum. According to NMC(2010a,2018b), leadership and management are some of the important skills students need to acquire during final year placements. Megginson et al(2006) remind us that these traits can be even taught with coaching.
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