Enhanced Practice Support Framework

Transcription

1 Enhanced Practice Support Framework Lead Mentor Mentors Coaches Information for Registered Practitioners

2 The Enhanced Practice Support Framework In 2014, Anglia Ruskin University and the University of Essex completed a research project, looking at the experiences of mentors, student mentors and educational managers, in their support of student nurses. Our findings identified the benefits and challenges experienced by mentors in their role and helped us to devise an alternative way of supporting students in placement, known as the Enhanced Practice Support Framework. This has been piloted in a number of practice areas across Essex, Cambridge and Peterborough, with a positive outcome for those involved. What is the Enhanced Practice Support Framework? This approach to practice learning is based on a framework which is composed of three key roles: A lead mentor, mentors and coaches. Lead Mentor Mentors Coaches How will the Enhanced Practice Support Framework change the way in which learners are supported in practice? This framework will bring in a number of small but, significant changes to the way in which students are supported in practice and will involve every registered professional in the clinical area. Indeed, the Nursing and Midwifery Council (NMC) Code (2015) requires all nurses to facilitate the learning of others and act as a professional role model, so this approach will help you to meet this requirement. Mentors will be spending more of their time directing the learning experiences of students and every area will have a Lead Mentor who is responsible for overseeing every aspect of practice learning and embedding the framework. Students will use a coaching log (ARU) / progress sheet (UoE) and will develop a daily goal for the shift which is aligned to their practice competencies and will use their log to record their progress following feedback from registered practitioners.

3 Will this mean more work for me? This should not mean more work for anyone. This framework was constructed from the experiences of mentors and is very much mindful of the context of practice learning in terms of resources and time and has been designed to be implemented with a minimum amount of upheaval and yes, work. What will my role be in the Enhanced Practice Support Framework? The framework recognises that practice learning is everyone s responsibility and therefore every registrant will be expected to play an active part in supporting students in practice. There are three key roles involved and it is important that everyone knows what these are and how they will work in practice, so let us look at each of these in turn. Coaches What is a coach? According to Whitmore (2009), a coach is a term used to describe someone who helps to unlock people s potential to maximize their learning. The Chartered Institute of Personnel and Development (CIPD) (2013) describe coaching as a process that: Helps to improve individuals performance and specific skills Provides feedback on individuals strengths and weaknesses Supports learning and development Usually lasts for a short period only When students are not working with their mentor they will be allocated to a coach. All coaches must be registered health care practitioners, who will have undertaken a workshop to help prepare them to perform the role of coach in this framework. Coaches will be responsible for teaching, supporting and giving feedback to the student, with the aim to improve the student s performance around skills and competencies. The coaching model used in this Framework is called TGROW (adapted from Whitmore 2009) and this is described in further detail in Appendix One. Registered practitioners do not need a mentorship qualification to coach students and may be from disciplines other than nursing e.g. Physiotherapists, Occupational Therapists etc.

4 What will coaches in the Enhanced Practice Support Framework do? On a daily basis, each pre-registration student will be assigned to work with one coach. The student will negotiate a goal for that day with their coach and this will be linked to one of their practice competencies. The coaching relationship will be relatively short term and may only span one shift every 1-3 weeks (depending on the number of registered staff available in the practice area so you may not be supporting students every day). The student will have a coaching log / progress sheet which they will be required to complete each day. The coach will only be required to sign this to confirm accuracy of the student s entry. Supporting students through coaching will involve the use of skillful questioning. This approach to learning promotes higher order thinking skills that all nurses need to use when, for example, leading, prioritising, critiquing, delegating and delivering care. This style of learning will therefore assist students to prepare for their future role as a Registered Nurse.. Please note that as a Coach you will not be responsible for the formative or summative assessment of a student and are only required to sign the student s the coaching log / progress sheet. What coaches said about the coaching role: Helped to keep me up to date. Developed my confidence to get involved with supporting students. Encouraged conversations in our area about student learning. Nice to be more involved in shaping the future workforce

5 So what will coaching a student actually look like in practice? The coach will have a short conversation with the student to agree a goal at the beginning of each shift. This should take no more than 5 minutes and might go something like this Coach James Good Morning Mary. I will be working with you today as your coach. Which of your practice competencies are you hoping to work towards and have you thought about a goal? Good Morning James and thank you for your support. I would like to do something around the practice competency Consistently takes a person centred, individualised approach to care (TOPIC). I would like to learn more about approaches to dignity and respect for patients (GOAL). Well, patients are vulnerable and rely on us to make sure they are treated appropriately. Do you have much experience of delivering care to vulnerable Coach James Student Nurse Mary Not really. This is my first ward experience and I have only ever helped to look after my gran at home. (REALITY). I understand the importance of respecting people, but would like to learn more about maintaining the dignity of patients in this type of Ok- That will be straightforward as I am working with some patients today who require significant support with their personal hygiene needs (OPTIONS) and dignity and respect are essential to this. If you want to take a few moments to go off and write down your goal in your log, we can then meet up in bay 6 in a few Student Nurse Mary Coach - James

6 Before the shift is over the coach will have a short meeting with the student.. Hi James, are you able to give me some feedback please on how I did with my goal around dignity and respect? Student Nurse Mary Sure, but firstly tell me how you think you got on. Coach James Well, I learned how personal the care can be and that patients have to put a lot of trust in us as nurses. It really made me think about how I would like to be treated and I tried to make sure that the patients I was working with, were made to feel comfortable, had privacy and were not made to feel embarrassed. I tried not to let anyone come behind the curtains when patients were getting washed but that was hard. Student Nurse Mary That s good- trying to see it from the patient s perspective is a good start and you are also thinking about how the environment might impact on maintaining dignity and respect. Try to think about ways of stopping people wandering into the patient s bed space when they are receiving personal care e.g. Look up the red peg initiative. Also, remember the curtains around the bedside are not sound proof and patients need privacy when discussing personal issues so try not to raise your voice. This is also important for confidentiality (WAY FORWARD). Now, please go and write up what we have said in your log, I will check it for accuracy and sign it before you finish today. Coach James When working with the student, skillful questioning will be applied to enhance learning. See Appendix 1 for full description of the role of the coach and the T-Grow model within the Enhanced Practice Support Framework.

7 I am already a mentor, so what does the Enhanced Practice Support Framework mean for me? Mentors Students will continue to be allocated to a live mentor who has undertaken mentorship training, and is up to date with their triennial review and annual updating. (NMC 2008). You might also be a sign off mentor, or working towards this. The current role and expectation of mentors/ sign-off mentors outlined in the Standards to Support Learning and Assessment in Practice (NMC 2008) remains unchanged and you will continue to retain entire responsibility and accountability for the assessment of learners and the completion of the learner s formative and summative assessment. As a mentor you must continue to ensure that you directly or indirectly supervise a minimum of 40% of the learner s practice experience. This 40% may comprise a combination of working directly with the learner or facilitating the learner to work with a coach. For final placement learners, the additional one hour per week must be spent with their sign-off mentor. The time spent working with students must be sufficient for you to make an informed judgement of their level of competency.

8 So what will change then? In the facilitation of the learner, as a mentor/sign-off mentor you will be responsible for allocating the learner to individual coaches and will retain accountability for your decisions to let the learner work independently or with others. Careful consideration of allocation of a coach (who will be a registered professional) will enhance the learner experience and you will need to consider which coach is most appropriate for which competencies and arrange allocation accordingly. For example, an infection control lead in the practice setting would be appropriate to coach the learners in competencies related to infection control. In order to make the student s practice assessment as fair as possible, you will be required to consult with the coaches that your student has worked with. Entries in the students coaching log / progress sheet will also provide a basis for assessment discussions between you and your student, and inform your assessment decisions. Whilst this feedback may indicate that the student has practised a competency, it is not the role of the coach to confirm competence. Mentors in the pilot project considered the evidence in the coaching log and discussions with the coaches to be a valuable resource in informing their assessment decisions. As a Mentor, if you are working with your student, you can undertake the skill of coaching for that shift and negotiate their goal and sign their coaching log/ progress sheet. If you have not been allocated a student to mentor, you will support students in a coaching capacity. What mentors said about their role in the Enhanced Practice support framework: I was able to make more informed assessment decisions. Shared responsibility for facilitating learning Less personalised I felt better supported and the role seemed more manageable. See Appendix 2 for full description of the role of the mentor within the Enhanced Practice Support Framework

9 I am a Lead Mentor- what does this involve? Lead Mentor Firstly, congratulations if you are to become a Lead mentor. This role is absolutely central to the framework and if you have been identified as having the knowledge and skills to be able to perform this role effectively, you should consider this a great achievement. This is no time to rest on your laurels, however, as the role involves a number of key responsibilities which underpin the entire framework. As a Lead Mentor you will be responsible for promoting and monitoring the quality of education in the practice setting, ensuring students have been allocated to a live mentor and to a coach on a daily basis (when the student s mentor is not available to do this). You will oversee and ensure that all registrants are using a skillful questioning approach with learners and be able to role model this skill for the team. As a lead Mentor, you will also act as a support for mentors, sign-off mentors and coaches and provide a point of communication for Education Managers within their organisation. Acting as a lead mentor you will be in an ideal position to recognise registered staff who demonstrate the potential to become quality mentors and who want to mentor.

10 So what does this mean in practice? Essentially, it means the ability show leadership in practice learning, role model good mentoring practice and to promote and sustain the core principles of the framework in your area. Lead mentors in the pilot areas reported that this role can be undertaken alongside their other roles fairly easily as long they have planned accordingly. Organising the student off duty to ensure that students are not only allocated to a live mentor, but also to a coach and ensuring that all appropriate individuals are acting and functioning as a coach, using skillful questioning and delivering constructive feedback to students, is an important aspect of your role. Some key things to bear in mind: Students must know in advance, who their coach will be for the shift as this will give them time to consider their goal prior to the start of the shift. You will need to ensure that the coaching process is followed appropriately and that goals are formulated at the beginning of the shift, following the five minute conversation and not retrospectively at the end of the shift and that all registrants are allowing the students to go and write up their goals and feedback. You need to make sure that the allocation of learning activities is appropriate. For example, it is not expected that students will be allocated to health care assistants on a regular basis, but only when the goals is appropriate, for example the delivery of personal care. Health care assistants will not undertake coaching in this model as this is the role of the registered practitioner. What Lead mentors said about their role in the Enhanced Practice support Framework: It makes you feel valued An important role that should be formally recognized. It was exciting to be at the forefront to something new. Lead mentoring is something that can be done in conjunction with my current role and as long as the off duty is organized and everyone knows what they are doing, it ticks along quite nicely I like to hear the questioning of students and patients have remarked on how this can help students develop their knowledge in the real world. See Appendix 3 for full description of the role of the lead mentor within the Enhanced Practice Support Framework

11 Enhanced Practice Support Framework Lead Mentor Mentors Coaches Working together to support learners and prepare the future workforce The Enhanced Practice Support Framework does not represent a hierarchical approach to supporting students in practice, but more realistically depicts the proportion of staff in each of the roles within most practice settings. In each area, there will only be one lead mentor (with support from a deputy lead). The number of coaches will be greater than the number of registered mentors. The key message is that supporting learners in the practice setting is everyone s responsibility and the preparation of the future workforce is in all of our hands.

12 FAQs 1. What do the students have to do? The students will follow the usual process prior to placement contacting the placement area, introducing themselves, and getting their shifts. When they start the placement, they will have an initial interview with their mentor, where a learning contract is drawn up. The mentor will then allocate the student to a coach in advance of each shift, unless they have specifically chosen to work directly with their student themselves. At the beginning of each subsequent shift, the student will negotiate their goal for the day and document this in their ARU coaching log or UoE progress sheet. Before the end of the shift the student will reflect on their learning, receive feedback from their coach and have their log entry signed by the coach. 2. Who will assess the students in placement? A mentor will still be responsible for signing off the students skills books, as in any other placement. The students will meet with their mentor at least once per week where possible, at mid-way point and at the end of the placement, so that the relevant documents can be completed. If they are on their final placement, then they will also meet at regular intervals with their sign-off mentor (one hour per week). 3. Should a student on an insight placement be engaging with this process? Yes, when all areas are prepared for this framework insight placements will also adopt the same approach. Students will continue to set a goal for each day and target some of the key learning they would like to achieve on this placement. In the ARU coaching log, students will use the personal goal section of the coaching document when on insight placements. 4. Do students have to work through their practice competencies in order when setting a daily goal? No. It is unlikely that students will address their practice competencies in any particular the order.this will be dependent on the types of opportunities for learning that are available on the shift. With their coach they will identify a practice competency related to these on which to base their goal for the day. It is important that students learn to take responsibility for their learning. 5. Who can sign the student s coaching log / progress sheet? Any registered practitioner from any discipline, who has been allocated as a coach, can sign the log at the end of the shift. 6. What if a coach doesn t agree with the student s reflective account? To avoid any disagreement, students should have a short discussion with their coach about how their performance related to their goal prior to documenting their reflection. 7. Who can complete a student s practice assessment? The student s mentor is responsible for all formative and summative assessment. ARU students have two books: a practice assessment document completed by mentors (or another professional for the interprofessional section) and a coaching log completed by students and signed by coaches.

13 Essex students have a single book: The formative/summative assessment pages should be completed by mentors; the progress sheets are completed by student and signed by coaches. 8. If the student misses the opportunity to set a goal every day will they fail their placement? No, the coaching system is not about passing or failing students. However, it is important that students engage with this aspect of practice learning. Students who have already done so have experienced particularly positive benefits. 9. Can a mentor negotiate a goal with their student? Yes, when working with their student mentors can apply the skill of coaching and therefore will negotiate a goal for the shift with their student. Mentors will then also sign the coaching log / progress sheet at the end of the shift. 10. Can a health care assistant (HCA) / health care support worker (HCSW) act as a coach? No, the role of the coach is undertaken by a registered professional only. The coach may decide that their student should spend some time working with an HCA / HCSW as part of their experience but feedback will come from the coach. 11. Will students complete the coaching log / progress sheet during the shift? Yes- all coaches and mentors will need to give students some time to complete this during the shift. It should only take a few minutes at the beginning and the end of the shift to do this. 12. Who will be the point of contact for practice staff? Please contact your Education Champion (Anglia Ruskin University) or Link Tutor (University of Essex) if you have any queries about this framework. The list of Education Champions can be located in the Student Placement page on MyAnglia or by using the following link: References Chartered Institute of Personnel and Development (2013) Coaching and Mentoring. Available at (Accessed ). Nursing and Midwifery Council (2015). The Code; Professional standards of practice and behaviour for nurses and midwives. London: NMC. Nursing and Midwifery Council (2008) Standards to support learning and assessment in practice. London: NMC. Whitmore, J. (2009) Coaching for Performance: GROWing Human Potential and Purpose - the Principles and Practice of Coaching and Leadership (4th Edition) (People Skills for Professionals). London: Nicholas Brealey Publishing.

14 Appendix 1 Role of the Coach within the Enhanced Practice Support Framework The learner will be allocated to a coach on a daily basis in the practice setting. This will ensure that the learner is supported by a range of health care practitioners who have specific knowledge and skills relevant to their practice outcomes. What is a coach? A registered health care professional who facilitates the development of knowledge, skills and professional attitudes of pre- registration learners under the direction of a named mentor/sign-off mentor who is currently live on the local register. Who will be a coach? All NMC professionals are required to facilitate learning (NMC, 2008) and this will be achieved through their role as coach. Registered allied health professionals may also act as a coach if they have undertaken the workshop. A mentorship qualification is not required to undertake the role of a coach. All NMC registered practitioners who are not actively functioning as mentors /sign-off mentors or Lead Mentor s will be coaches, supporting learners to meet their goals and to embrace a culture of collective professional responsibility for developing all learners. What do coaches do? A coach will be able to offer their individual expertise to support learners to meet their practice competencies. A coach will be responsible for liaising with mentors /sign-off mentors to establish the learning needs of the learner and associated opportunities for learning. The coaches within the learning environment will contribute to the preparation of learners for the assessment of practice competencies over the duration of the placement. Coaches will be required to provide the mentor/ sign-off mentor with feedback. This may inform the formative and summative assessments of the learner but the mentor/sign-off mentor retains entire responsibility for the assessment of the learner. A coach will act as a role model for professional body and NHS Constitution values. Coaches will not be responsible for any aspect of the learner s practice assessment.

15 Coaching model The coaching model used in this project is called TGROW. This is an adaptation of the GROW model (Whitmore 2009). Topic Way forward Goal Options Reality TOPIC The first step of the model requires the student to meet with their coach at the beginning of a shift and decide on a topic they would like to work on. This topic will arise from the skills /competencies identified in the student s practice assessment document. GOAL The coach and the student will then decide together on a goal related to the chosen topic. The coach will help guide the student on what is possible within that placement area on that shift. REALITY This step helps the student, with the coach, to identify their previous experience, knowledge and current level of skill, so that a personally tailored plan of action can be devised. OPTIONS Next the student needs to write in the student coaching record, the goal to be achieved during the shi ft, and how this will be achieved (i.e. what opportunities are available within the practice area to support this goal?). It is also important to state when the goal will be reviewed e.g. at the end of the shift. WAY FORWARD At the end of the shift, the student will meet with their coach to reflect on what went well during the shift, and to identify any further learning, practice, or training required. The coach will need to sign the student s coaching log / progress sheet at the end of each shift to confirm the accuracy of the information documented.

16 Appendix 2 Role of the Mentor /Sign-Off Mentor within the Enhanced Practice Support Framework What is the role of the mentor/sign-off mentor within this framework? The current role and expectation of mentors/ sign-off mentors working within the Standards for Learning and Assessment in Practice remains unchanged. The mentor must ensure that they directly or indirectly supervise a minimum of 40% of the learner s practice experience. This 40% may comprise a combination of working directly with the learner or facilitating the learner to work with a coach. For final placement learners, the additional one hour per week must be spent with their sign-off mentor. What do mentors / sign-off mentors do within the enhanced practice support framework? The mentor /sign-off mentor will primarily act as facilitator and assessor of learning. In the facilitation of the learner, the mentor/sign-off mentor is responsible for allocating the learner to individual coaches and retains accountability for their decisions to let the learner work independently or with others. The mentor/sign-off mentor may direct the activity of the coach responsible for the learner if they require a particular focus to the student s learning. The mentor/sign-off mentor retains responsibility for initiating and monitoring the learner s learning contract. The mentor/sign-off mentor will be required to obtain regular feedback from individual coaches. Whilst this feedback may indicate that the student has practised a competency, it is not the role of the coach to confirm competence. The mentor/sign off mentor retains entire responsibility and accountability for the assessment of learners and the completion of the learner s formative and summative assessment. The mentor /sign-off mentor will be required to alert the Lead Mentor of any pre-registration student or mentorship student who is at risk of failing the practice element of their course, at the formative stage of their practice assessment. A mentor/sign-off mentor will act as a role model for professional body and NHS Constitution values. To obtain a clear and personal understanding of the learner s level of competence, the mentor must spend appropriate time working directly with the learner (the actual amount of direct working will be determined by professional judgement). The time spent working with students must be sufficient to make an informed judgement of their level of competency.

17 Appendix 3 Role of the Lead Mentor within the Enhanced Practice Support Framework This role has been developed to support and promote practice learning at a local level within each organisation and to ensure education of the future workforce is afforded the priority and recognition it requires. What is a lead mentor? A lead mentor is an existing mentor or sign -off mentor, currently in practice, who has demonstrated excellence in the mentor role. What do lead mentors do? Lead mentors are responsible for quality mentorship in practice learning settings whilst supporting and developing an ethos of education in every clinical area. A lead mentor will provide readily accessible support for mentors /sign-off mentors in the practice setting. Lead mentors will oversee the allocation of coaches to learners to ensure optimum learner experience. Lead mentors will ensure that the minimum requirement of 40% direct or indirect mentor supervision is adhered to. Lead mentors will monitor the quality of mentorship provided within the practice setting. This will include monitoring the completion of practice assessment documentation. Lead mentors will act as advisors to support mentor /sign-off mentors in action planning, assessment decisions and assessment processes of pre-registration students (where requested). Lead mentors will be expected to communicate with all mentors who are actively supporting learners at the following points: prior to formative and summative assessment, post summative assessment in the event of a failing student when a cause for concern has been raised Lead mentors will provide support and advice to professionals preparing for triennial review, where necessary. Lead mentors would be responsible for confirming the assessment decisions of mentors for students undertaking the mentorship course. Lead mentors will identify and develop coaches deemed to be suitable candidates for mentorship preparation programmes. Lead mentors would be responsible for communicating issues around mentorship and mentor support to lead managers within their organisation. A lead mentor will act as a role model for professional body and NHS Constitution values..