Nurse Mentor Update Workbook With practice, for practice, transforming practice

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1 Nurse Mentor Update Workbook 2014 With practice, for practice, transforming practice

2 Content The NMC and mentoring student nurses 3 Frequently asked questions 4 Recording your mentor activities 6 Student learning and assessment 7 Grading of practice 9 Supporting success 11 Learning environment 12 Student portfolio development 14 Learning contract 16 Assessment 18 Recording feedback 20 Sign off mentor 23 Support for students and mentors 24 Hot off the press 26 Making sure your update is recorded 27 References This workbook reflects UWE and NMC requirements. The requirements for pre-registration nurse education as written in the NMC document (2010) Standards for pre-registration nursing education and the NMC document (2010) Standards to support learning and assessment in practice. NMC standards for mentors, practice teachers and teachers. These documents can be accessed from the NMC website The UWE regulations for assessment are in the Student s Handbook and can be accessed from 2

3 The NMC and mentoring student nurses (NMC 2010) Mentors are accountable for their decision that students have the necessary knowledge, skills and competence to progress through the practice element of their programme of study and are fit for practice at the end of their training and can become a registered nurse. The NMC considers that all nurses have a role in supporting student s learning but that mentors require post-registration preparation to perform their mentorship role. Following training, mentors must be on either the local NHS Trust mentor database or on the UWE mentor database if employed outside the NHS. The NMC (2010) state that to be an active mentor you must have: Mentored at least two students within the three year period Participated in annual updating to include an opportunity to meet and explore assessment and supervision issues with other mentors including the validity and reliability of judgements made when assessing practice in challenging circumstances A triennial review that is organised by the placement provider Mapped ongoing development in their role against the current NMC mentor standards Been deemed to have met all requirements needed to be maintained on the local register as a mentor or sign-off mentor. Mentors must: Organise and coordinate student learning activities in practice Supervise students in learning situations and provide them with constructive feedback Set and monitor achievement of realistic learning objectives Assess total performance eg skills, attitudes and behaviours Provide evidence as required by programme providers of student achievement or lack of achievement (UWE Student OAR) Liaise with others to provide feedback, identifying any concerns about the student s performance and agreeing action as appropriate Provide evidence for, or act as, sign-off mentors with regard to making decisions about achievement of Replace with competence at the end of a programme for entry to the NMC register. NMC requirement and responsibilities Mentors who supervise and assess competencies in the same field must be on the same part of the register (due regard) Must have developed their own learning beyond registration through CPD Hold a professional qualification equal to or higher than the student they are supporting 3

4 Frequently asked questions What if you have been away from mentoring for a while, for example on The NMC considers that there may be extenuating maternity leave? circumstances when a mentor does not meet the requirement to have two students in a three year time period. You need to discuss this when you return to work and ensure you are fully up to date and able to mentor students. Am I qualified to be a mentor? If you completed a mentor course in the past, you can be a mentor. These courses include the ENB 998, Teaching and Assessing, the Teaching and Assessing in Clinical Practice and the FLAP Facilitating Learning and Assessment in Practice courses. Others might be acceptable, speak to either your academic linked to practice or Trust Educational Link (TEL) and check. What does Due Regard mean? All students have an identified mentor who is on the same part of the NMC register that they are studying to enter. However there are times where it is appropriate for a student to gain experience with a nurse registered in a different nursing field or profession. This person would feedback to the student and mentor. The final decision about if the student has achieved the required learning outcomes is made by their mentor taking due regard of the students evidence and feedback from the nurse or other professional that the student has been working with. What type of activities count as an annual update? There are many ways to keep yourself up to date with your mentoring skills. It is important that update activities are recorded on your NHS Trust or UWE mentor database. Activities that count include: Completing this workbook Attending a UWE mentor update session Attending a session with your academic linked to practice or Trust Educational Link (TEL) Completing a triennial review Completing online mentor update activities 4

5 When do I get to talk about assessment? All the update opportunities have activities built into them to encourage discussion on assessment. Do not skip these activities, they are important. Often AiP meetings in practice focus on discussing challenging situations so make sure these are recorded as updates. Who decides I have met the NMC requirements and am on a mentor register? Whoever manages your mentor database will make the decision with you about how you are meeting the NMC requirement. If you are currently a mentor you almost certainly are on a mentor database. I do not have a degree. Can I support degree students? To be a student nurse mentor you have to hold the nurse qualification that the student is studying. You can assess a degree student nurse s practice if you do not have a degree. You are after all an experienced practitioner. When you say mentors have to provide evidence as required by the programme what do you mean? The evidence you provide UWE is about your decision to pass or fail a student. This means you must complete all assessment documentation at the correct time, accurately, thoroughly and in time to meet student s hand-in dates and times. The written midpoint and end point assessments must reflect your assessment decision. Placement providers and UWE have a What responsibilities do UWE responsibility to ensure placement areas meet the NMC and placement providers have? standards before being used. This means we audit at least biannually based on the educational standards set out by the NMC. You can download the audit documents from the Practice Support Net. Audits are then reviewed by Placement Providers to identify any themes or concerns. The NMC annually monitor audit completion. 5

6 Activity Recording your mentor activities It is good practice for you to keep a record of your mentoring activities as evidence of meeting NMC standards. Write your record below. Keep this together with any other documentation you may have used with students and add details throughout the next year. This can then be filed in your portfolio and used as evidence for your triennial review and annual PDP/Appraisal with your line manager. My professional qualification/s Qualification Date My mentor qualification/s Qualification Date Update activities (eg workbook and or online) Include meetings with the AiP and or education lead/key mentor Type of mentor update activities Date NB: All the update opportunities have activities built into them to encourage discussion on assessment. Often AiP meetings in practice focus on discussing challenging situations so make sure these are recorded as updates. Students mentored (including under Due Regard) Name Branch Year commenced Dates mentored course (cohort) Triennial review Who with Date Next due Educational Placement Audit is an important quality control. Mentors should contribute to audit activities where possible. Find and record the answers to the questions below and get involved in implementing the audit action plan. If the NMC visited your placement area they might ask about audit. The person who completed the last UWE audit It was completed on Name Date I was involved in audit Yes No The action plan points are - list actions from audit 6

7 Student learning and assessment Hours in practice Nursing students have a longer academic year than non-professional programmes at UWE. This is because of the NMC requirement for practice and academic hours to be fulfilled. Students in full time programmes must have attended 2300 hours in practice over the three years training and completed 2300 hours of academic work. Students can take up to 5 years to complete a full time programme and 7 years to complete a part time programme (NMC 2010). The programmes have minimal time built in for occasional sickness or absence and the Professional Practice Office monitors missed hours from practice. Accurate completion of the student timesheet is therefore important so UWE can monitor practice hours and the NMC can be assured that registration requirements for hours have been achieved. Working shifts, weekends and bank holiday Nursing students work the hours appropriate for the placement eg shifts or office hours. They work 37.5 hours a week (30 hours SoLD hours on alternate weeks). Night duty can be worked with their mentor as it offers valuable experience. Students should be available to work one weekend in three if required. Working more weekends is negotiable and in some placements desirable to allow maximum learning opportunities. Students sometimes work bank holidays, please check on Practice Support Net. Working shifts present many learning opportunities for students but also problems including difficulties with shift hours not coinciding with public transport, travelling costs and family caring responsibilities. Mentors tend to allow flexibility and are mindful of the issues facing students. However if these issues start to impact negatively on student learning it is important that advice is sought from UWE. Students experience Student nurses report how much they enjoy working with their mentors. They often comment on mentors being their role models, as having high levels of skills and knowledge and a passion for nursing. Pre-planning is appreciated and access to a range of learning opportunities is valued. Of course students do occasionally report difficulties. General areas for improvement in mentoring include ensuring induction happens and completing the learning contract, midpoint and final assessments in good time as this helps students maximise their learning opportunities. Where this drifts, students can find it hard to focus on their learning and start to worry. Also raising problems with the student s performance early in the placement and helping the student understand what needs to improve and how they can demonstrate improvements in their practice helps reduce the risk of failing in practice. Notes 7

8 Students experience I appreciated how much work was done before I arrived; I had an induction pack with information about my placement and what learning opportunities I would experience. I was able to attend teaching sessions that the qualified nurses ran. These were informal with lots of opportunities to ask questions. I learnt a lot. I was very nervous on my first placement. My mentor was worried that I would not pass and asked the Academic in Practice to participate in a weekly meeting. We talked about what was making me so nervous and drew up a plan to help me build my confidence. It worked really well. I worked with a number of the qualified team. They had different areas of interest and expertise. This was really useful. I was struggling but at the midpoint review I was able to discuss how I felt and my mentor developed a plan to help me focus on the areas that I was finding it hard to learn. This helped me achieve what I needed to. My mentor did my midpoint review two weeks before the end of the placement, she told me I was doing things wrong and gave me some reds. I don t mind getting reds but if I had been told earlier, or had my midpoint review at the right time, I would have had more time to improve. On the SoLD s we were talking about how we were being assessed. I realised I was having to do much more written work than anyone in my group. I felt cross but didn t say anything because I did not want to upset my mentor. My mentor said they did not do any manual handling and so I would get a red for the manual handling skills. It was the last placement in the year which meant I would be referred. We did not move patients but did move trolleys, put away stores, put things into the car boot. That is all manual handling. I was so worried I asked my personal tutor what to do and they phoned my mentor. 8

9 Grading of practice Why is UWE instigating the grading of practice for pre-registration student nurses? The pre-registration education for students has always been 50% theory and 50% practice yet to date practice has only contributed to student registration by the pass (green) fail (red) model. This model meant that clinical practice did not contribute to a student s overall degree classification. Why isn t the Pass/Fail model enough? It doesn t show the range of clinical abilities that our students have at the end of the programme. Whilst some students excel at clinical practice and yet find some aspects of theory difficult, this is not recognised in the previous model. Finally this gives the mentor the opportunity to really contribute to our students further professional development by giving a much more detailed analysis of their performance and abilities. Are students likely to ask more questions following your grading process than the previous Pass/Fail model? Providing students are given clear rationales with examples for each domain they are not likely to ask more questions. However, if there is little explanation for the grades then students are likely to ask why a grade was afforded. This should be evident in your written comments to the student. What happens if a student passes all domains except one? Then grading does not take place and the student is marked overall as a fail. A student must have been awarded a pass in practice before grading takes place. Who should complete the grading process? Year 2: the mentor in the final placement having consulted across the mentoring team. Year 3: the Sign Off mentor in the final placement year 3 having consulted across the mentoring team. How important is the year 2 formative grading? Formative grading (or practice grading) in year 2 is very important as this gives the student a clear idea of their achievement in practice and will also show the student s previous progress to the year 3 sign off mentor. Can a student appeal or dispute their grade? A student cannot dispute the grades you apply to the 4 domains; however, they could suggest the process was not fair. For this reason it is important to be transparent in how you allocate the grade for each domain. You should use the assessment criteria in the Ongoing Achievement Record as a basis for your grading, using similar examples from the student s practice to help you. Your written comments should reflect the grade you have allocated. What is the mentor s responsibility regarding patient/carer feedback within this process? To follow the process set out and ensure there is some form of evidence of patient carer feedback to inform this process. It would be good to look over the three years as well as the final placement to get an overview of this perspective. It is envisaged that students receive two patients or carers feedback on each placement. How do patient carer feedback sheets link into the grading process? The patient carer feedback sheets should be used as contributing evidence towards the NMC domain of Professional Values however they will also be relevant evidence for the Communication and Interpersonal skills domain. Where do I go for help if I am unsure of the grading process? Visit the Practice Support Net practicesupportnet for relevant podcasts and further information or contact your Education Lead or AIP. 9

10 Grading of practice Will the overall grade be worked out for me or will I have to do this? As a mentor you will not need to work out the overall grade. You will give a grade for each domain (4 grades) then once this has been submitted to UWE an overall mark will be calculated. This can be worked out in advance by the student manually if they want to know. How does grading relate to the student s ongoing professional development following registration? This process will enable a clearer professional development plan at registration as a guide to future learning. Notes 10

11 Supporting success Most student nurses progress as expected through their training and their three year journey is challenging, exciting, sometimes stressful, but they do not provide the mentor with unexpected challenges. However not all students have such a smooth learning journey. The student who excels Some students excel. They might have started their training with significant experience, or they might be able to quickly assimilate learning and apply them to practice. These students can offer a challenge though their constant search for why or because they appear to get bored. It is useful to have developed additional learning opportunities for these students. Mentors must ensure the experiences do not step outside what the NMC says the student nurse is permitted to do. If you are unsure, seek advice from your Trust, UWE or the NMC. The student who is not achieving Some students struggle during their training. This can be for a number of reasons, for example personal problems, academic issues impacting on workload, difficulties with working with a team, or issues around meeting learning outcomes and skills. Good support can help these students pass their practice outcomes. If the mentor identifies the possibility of a student failing a placement then the steps below should be followed. If it is necessary to contact UWE the mentor should let the students know that they intend to do this. It is important to stress that this is to maximise the possibility of success and not be punitive or an indication of poor mentoring. It is about effective joint working to support the student. It is important that we support students to pass as far as possible, but equally important that students who are not competent are not passed in practice and we have evidence to support our decisions. 1. Student not achieving 2. Identify any reasons for non-achievement Discuss with student Agree action plan Set dates for review Document meeting and action plan 3. Review Student improved/achieved continue with assessment Student not improved/achieved contact UWE (details on page 21 in the workbook) 4. Agree further action plan with support from UWE member of staff Student achieved continue with assessment Student not achieved If time to re-action plan, then continue working with UWE and student If end of placement, record learning outcomes and skills not achieved as red Mentors in NHS placements can seek support and advice about mentoring from their Trust educational link. In the independent and voluntary sector this support would usually come from an Academic in Practice. 11

12 Learning environment Time with the mentor Student success is linked to providing a positive learning environment in the placement area. It is important that the student knows who their named mentor is and has the opportunity to work with them for 40% of their time at the placement (NMC 2010). Having regular contact with a named mentor who teaches, reflects with and assesses the student improves the learning experience. This takes a commitment in both time and energy and should be rewarding for both the students and mentor. One way to understand your area as a learning environment is to complete a self assessment and ask your students to complete the assessment. Comparing results can help highlight areas for development as well as areas of good practice. Supernumerary Good learning environments provide challenges without unnecessary stress and the requirement for students to be supernumerary is important in providing such an environment. This means that they are additional to the workforce requirement and staffing figures. This is important when the student is learning and might lack knowledge, skills and confidence in their ability to provide the care or services that the placement area offers. This does not mean students are merely observers and the challenge is to ensure that students develop skills and practical knowledge whilst being supervised. Supernumerary also means the student is able to take learning opportunities as they arise because they have flexibility in how their time in placements is used to support their learning. Students must negotiate with their mentor or supervisor to change what they have agreed to do during a shift because learning to be responsible, reliable and professional are essential elements of nurse education. Settling into a placement Good orientation and induction help the student feel settled and able to learn. This should include details of the placement, what learning opportunities might arise, how the students can learn from the multi-professional team and signposting to appropriate reading to understand the evidence base for the care the team provides. Introduction to a staff team who understand the role of the student and are positive about supporting student learning can help the student feel valued. Students with disabilities There are now more students entering nurse training who have an impairment or specific learning need. Students with dyslexia are not uncommon and whilst they may have different support needs they also bring different strengths. An excellent guide to supporting students with dyslexia can be found on the practice Support net or use the web address below to go straight to the document. When your annual audit is completed you are asked to update your ARC profile. This profile contains the information the student receives before they come to your area. It has a section about disabled student access. Updating your ARC profile provides a good opportunity for you to discuss in the team how you might support a disabled student. If you are to be allocated a student with an impairment they would be supported by a student advisor at UWE and may have an access plan. This is agreed with the placement provider before the student commences their placement wherever possible. The document about supporting student nurses who have dyslexia can be found at: studysupport/disabilityservices/ disabilitysupportatuwe.aspx 12

13 Activity Self-assessment of the learning environment Complete the self-assessment below. Completing this with other mentors or supervisors would be preferable and give an opportunity to consider how a team is supporting students. Place this record in your portfolio and use as evidence for your triennial review and annual PDP/Appraisal with your line manager. Good practice Self audit Yes No My action to improve this is: We have an up to date file/resources for mentor and student use which includes who is in our team and the available learning opportunities and resources All mentors are updated annually Details of support for mentors and students is displayed Before the student arrives, the mentor is allocated and induction is discussed with student supervisors The team is aware of student role (1st -2nd -3rd year) Each student has one person designated to work with them on their first day An agreed induction process is used In placements following the 1st placement the mentor reads the students Ongoing Achievement Record so they have an overview of the student s learning so far The learning contract is completed within the first full week on placement Midpoint assessment is completed half way through placement ensuring written assessment reflects students practice and marking grids Students at risk of not passing placement are referred to UWE immediately after completing mid-point review (or earlier if appropriate) Endpoint assessment is completed in good time so student meets hand in deadlines Student feedback on placement is gathered so strengths and weaknesses are understood and can be acted on. Date period this audit was completed: Notes: 13

14 Student portfolio development Nursing students have a longer academic year than non-professional programmes at UWE. The student develops their portfolio throughout their programme. The student decides what to keep in the portfolio but it should demonstrate the student s journey through the 3 year programme. Students may choose to keep a hard or e-copy of their portfolio. The portfolio may include a range of evidence demonstrating learning achieved. This may include all or some of the following: Skills Development sheets Attendance certificates at relevant study days and synopsis of learning from undertaking the study day or activity Academic work and feedback Service User / carer feedback providing data protection is not breached Reflections Copies of online tests undertaken at UWE ie Numeracy, Manual Handling, Basic Life Support Evidence generated from learning in other contexts or at UWE that will support learning in practice eg work undertaken at Supervision of Learning Day (SOLD) or in Midwifery, Work based learning day (WBL) Evidence from practical skills tests at UWE Synopsis of any articles or journals read and the learning achieved from these Annotated bibliography Mentors and supervisors have a key part to play in encouraging students to identify appropriate evidence for learning and assessment. If evidence other than personal observation is required this should be clarified in the action plan so expectations are clearly defined and the student has time to collate the required evidence. Examples include: the student will be observed by [a supervisor] completing the care skills as part of the service users morning routine and the supervising nurse will sign the skills sheets. (Signed skills development sheet). A student should be able to discuss how theory is linked to practice. A portfolio full of journal articles or printed web pages does not demonstrate that they can make the link between what they found and practice. The student should be able to discuss their findings in relation to their practice (Q&As) or demonstrate their knowledge in their practice. Students are expected to have an evidence base for their care. the student will access the legislation identified and produce a bullet point list of the main areas the nurse should be aware of and its implications for their practice, this will be discussed during the mid-point review. the student will identify a key learning experience in relation to ethical practice and write a one page reflection for discussion during a meeting with the mentor. 14

15 Maintenance of competence Where maintenance of competence needs to be demonstrated, a mix of ongoing observation and discussion of existing evidence and its application/adaption to the new practice environment should be sufficient. Maintenance does not mean re-assessment unless either: the context of practice is sufficiently different to require students to demonstrate their understanding of the differences in context Student does not demonstrate sufficient competence in the skill Methods of assessing competence and meeting NMC outcomes Variety of assessment methods is considered best practice and allows for the testing of knowledge or competence in a variety of different ways. Skills Development sheets Should be handwritten unless it has been agreed that the student can complete these electronically. Should be referenced. A skills sheet is not required to meet every learning outcome but should be used to clearly demonstrate how theory supports learning in the context of practice. Reflection It is useful to reflect on a range of experiences, this should include positive experiences, negative experiences and the more mundane experiences. All provide learning opportunities Reflection in learning with a mentor or supervisor is usually verbal and seeks to explore the students practice in real time and immediately following a learning experience Reflection on learning is usually supported with some written materials, although this would not usually be a lengthy piece of written work. The use of a reflective model can help structure written material and discussions about experience Reflective diaries of key learning experiences can be a useful starting point for discussions with the mentor. Certificates from study activities in placement area Some placement areas and NHS Trust offer students planned learning activities such as conflict resolution, positive behaviour management and equipment training. Students should keep evidence of these activities in their portfolio. Observation Students can be directly observed undertaking a specific skill or observed at a distance. Part of observation should include questioning of the student in regard to underpinning knowledge and evidence base, and context of care. SoLD days (2010 curriculum) Students participate in WBL/SoLD days one day each fortnight to reflect on their learning in practice and link theory to practice. The student will generate evidence towards their assessment of NMC learning outcomes during these sessions. Patient carer feedback form With the mentor s permission, students can seek feedback from service users and carers. Students will have a form for this purpose. Question and answer Q&A sessions are usually verbal and are useful for learning outcomes such as demonstrating knowledge of the legislative frameworks, policy and codes of conduct and to identify the underpinning knowledge and evidence base. 15

16 Learning contract Learning contracts are used to acknowledge the students responsibility for their own learning and the mentor responsibilities for providing learning opportunities and clarifying how competence will be evaluated. Developing and recording the learning contract sets the parameters for the students learning, identifies any support requirements and clarifies the evidence that will be needed to demonstrate success. It is therefore important that time is given to ensure learning contracts are well planned and written. Preparing to write the learning contract During induction it is useful to give the student some information on the types of learning opportunities offered and any limitations, for example if a student wants to be assessed giving IM injections and you do not have service users who need IM injections then this is a limitation. Some examples of how the students will be assessed and the type of evidence that is frequently used to assess students in your area can be particularly useful in helping the student plan their learning contract. Also the mentor should use the first week to read the student assessment paperwork. Planning and recording the learning contract The first formal meeting after orientation and induction is to develop and record the learning contract. This process identifies the student s present skills and knowledge in relation to the skills and learning outcomes in their Ongoing Achievement Record (OAR). The learning contract contains both the general statement of the student s learning and the action plan that outlines more specifically what the student will learn, how they will learn it and how it will be evaluated. To get the most from meeting with the students to write the learning contract the mentor should: Read previous record in student OAR Be aware of the learning outcomes and associated skills being assessed Understand how the student can demonstrate skills and learning outcomes in their area Be aware of the types of evidence that are appropriate for each skill or learning outcome. The student records their learning contract and action plan which is signed by the student and mentor. Reviewing the learning contract The contract should be reviewed formally at the mid-point assessment and if required an additional action plan developed. This might be because the student has completed the learning ahead of schedule and can continue with their learning or because the student needs more focus to promote successful completion of their placement. The final review of the learning contract is at the end assessment. Has the student achieved what they set out to? Action planning An essential part of the learning contract is the action plan. This helps the student identify how they will learn and how they will demonstrate their learning. Listing the types of evidence required for evaluation helps the mentor and student discuss workload. It would be expected that most skills are observed with additional evidence e.g. ability to discuss evidence base demonstrated through Q&A. 16

17 Activity Complete the action plan below Individual learning outcomes as identified by the student Action Target date Evaluation Example Demonstrate an awareness of, and apply ethical principles to nursing practice To keep a brief record of experiences in practice where you have considered ethical issues or dilemmas. Read about ethical practice and discuss with supervisors. Think about your own ethical practice Mid-point assessment Feedback to mentor from supervisors. Q&A with student and mentor Demonstrate a range of essential nursing skills, under the supervision of a registered nurse, to meet individuals needs 2.16 washing / bathing and dressing / care of hair, nails and prosthesis Discuss methods of, barriers to, and the boundaries of, effective communication and interpersonal relationships Contribute to the evaluation of the appropriateness of nursing care delivered Demonstrate an understanding of the role of others by participating in inter-professional working practice Key: Types of evidence that may be used to support verification of achievement PO - Practice Observed. N - Narrative, SDS - Skills Development Sheet. R - Reflection (written or verbal). PCF - Patient Carer Feedback Q&A - Question and Answer. SoLD - Supervision of Learning Days. 17

18 Assessment OAR hand in dates ALL placement assessment documentation and attendance records must be handed in by 2pm on the dates set by the practice module leader. Failure to hand in on time may result in removal from the programme. Assessment points The Ongoing Achievement Record (OAR) is used to record all assessment activities over the three years training. This includes retrieval periods at the end of each year if needed. Assessment of skills should be ongoing and not left to the formal assessment points below. Year 1 Placement 1 Midpoint assessment End of placement summary Placement 2 Midpoint assessment End of placement summary (summative) Retrieval if required Midpoint assessment End of placement summary (summative) Year 2 Placement 3 Mid point assessment End of placement summary Placement 4 Midpoint assessment End of placement summary (summative for Child, Mental Health) Placement 5 (Adult only) Midpoint assessment End of placement summary (summative) Retrieval if required Midpoint assessment End of placement summary (summative) Year 3 Placement 5 (6 Adult) Midpoint assessment End of placement summary Placement 6 (7 Adult) - sign off Midpoint assessment End of placement summary (summative) Retrieval if required Midpoint assessment End of placement summary (summative) Competence You use your own evidence base and professional knowledge to assess students. The marking grid (see page 19) can also help in deciding level of competence. A Red grade is a fail and a Green grade is a pass. What constitutes a Red or Green grade and the difference between year 1, 2 and 3 needs careful consideration. Students have found that within a team different nurses can have different ideas about what constitutes competence and differences in how nurses differentiate between grades and years. Where a good action plan has been developed, the student understands what they need to present at their assessment points with their mentor. Where the action plan states the student will be observed and assessed performing a skill by their supervisor they can bring along completed skills sheets to their assessment so their mentor can sign learning outcomes that are linked to skills. Equally where the mentor is to collate feedback from supervisors or other staff they should do this before the assessment point. 18

19 Activity Clarify how you see the differences in competency levels for each grade and each year. To extend this activity discuss with other nurses in practice and see if you have similar ideas and work towards a consistent understanding. Record your ideas/findings in the grid below. It can be useful to copy your completed grid and add it to your practice file because students would find it very useful. Using the grid below record the specific behaviours, attitudes, knowledge and other elements (or lack of them) you look for to give a student a RED or GREEN in each year of their training for the selected communication learning outcome. Consider the difference between each year, especially year 2 and 3. Where the skill is written the same way, would you expect more of a 3rd year student? If you would expect more, what would that be? Student To give a RED To give a GREEN I would expect to see: I would expect to see: I would expect to see: John, 1 st year Demonstrate the ability to listen and attend when interacting with patients, carers and colleagues John, 2 nd year Demonstrate an ability to adapt communication and interpersonal skills to meet the needs of patient/clients and their families John, 3 rd year Demonstrate an ability to adapt communication and interpersonal skills to meet the needs of patient/clients and their families 19

20 Recording feedback The Ongoing Achievement Record (OAR) should contain feedback that the student can use to understand their strengths and areas for improvement. Using the language in the assessment grid can help achieve this. Poor feedback reduces student s opportunity for reflection on their learning and means students might not understand how they can improve. It is also a main area for student dissatisfaction. Well written feedback motivates students, it means they can see how they can improve and enables other mentors to quickly see where they need to be stretching students and where they need to be giving extra support or guidance. Written feedback such as: Emily is a lovely girl, fitted well into the team. Has achieved all she wanted to. I wish her well in the future or Emily tried hard and achieved all ambers, well done (these comments are based on actual final assessment records) leaves the student and other mentors with no clarity about performance or direction for how the students can improve their practice. This can be improved by referring to professional good practice and the learning outcomes and marking grid, for example: Emily has good verbal and written communication skills and both patients and staff have found her easy to be with because of this. She can respond effectively to defined patient care problems and is aware of her own level of competence seeking support appropriately. She could improve her practice by being more assertive gives a better description of competence and indicates what the student can focus on to improve. Notes 20

21 Assessment of practice criteria ongoing achievement record Example BSc (Hons) Nursing (adult) year 1 First progression point The NMC has identified skills and professional behaviours that a student must demonstrate by the first progression point. These criteria must normally be achieved during the student s practice learning but some may be met through simulation. These criteria cover: safety, safeguarding and protection of people of all ages, their carers and their families professional values, expected attitudes and the behaviours that must be shown towards people, their carers, their families, and others. The criteria reflect public expectations about nurses basic skills and their ability to communicate effectively with people in vulnerable situations, ensuring their dignity is maintained at all times. If a student is unable to demonstrate these skills and behaviours by progression point one, through the assessment procedures set by the programme provider and their partners, they will not normally be allowed to progress to the second part of the programme. Most of the assessment will take place when providing direct care but some may be through simulation NMC domain Professional values Communication and interpersonal skills Nursing practice and decision making Leadership management and team-working Description Demonstrates an understanding of how to work within legal and professional frameworks and local policies to safeguard and protect people, especially vulnerable adults, children and young people. Understands the principles of confidentiality and data protection and when sharing information is appropriate. Practices honestly and with professional integrity applying the principles of the NMC Code of Conduct and Guidance on Professional Conduct for nursing and midwifery students. Communicates appropriately to ensure peoples essential needs are met. Demonstrates an ability to listen, seek clarity and carry out instructions safely. Demonstrates safe and effective communication skills both orally and in writing. Recognises signs of aggression and takes appropriate action to keep themselves and others safe. Demonstrates safe, basic person-centred care. Acts in a manner that is attentive, kind, sensitive, compassionate, non-discriminatory and values diversity. Practices with respect and maintains service users dignity at all times. Works within laws governing health and safety at work. Safely and accurately carries out medicine calculations. Meets peoples essential needs in relation to safety, security, wellbeing, comfort, bowel and bladder care, nutrition and fluid maintenance and personal hygiene. Recognises own limitations in knowledge, skills and professional boundaries. Seeks help when a persons needs are not being met. Is able to recognise deterioration in a persons physical or psychological condition. Responds appropriately in an emergency and administers first aid as required. Displays a professional image in behaviour and appearance showing respect for diversity and individual preferences. Acts in a way that values the roles of others in the team. 21

22 Activity You are completing the year 2 final assessment for Emily. Emily has passed all her skills and learning outcomes as green and is performing as you would expect for a 2nd year. Things you have discussed with Emily are: acts professionally, eg turns up on time, language used, working with others etc likes the practical side of nursing, what she does she generally does well, is safe is kind, gets on with people developed competence in many areas has a good knowledge base but room for improvement in some areas not reading enough or asking enough questions does not need to be supervised all the time does as she is asked but is dependent on others if things happen completely out of the ordinary does not always make connections with past learning and current practice worked with one service user who gave her a thank you card when they left (thought she was great) has got very interested in diabetes, the only thing she has really read about in any depth Write the year 2 final assessment statement for Emily s OAR in the box below Include the language from the Green part of the assessment grid (previous page) so Emily can identify her strengths and can clearly see where she needs to improve. Mentor Overall Comments - Please provide specific examples in relation to outcomes and skills eg communication; professional behaviour Final Assessment - end of year 2 Mentor s Comments 22

23 Sign-off mentor The NMC (2008) requires each student to be allocated to a sign off mentor for their last placement in their final year. Sign off mentors do not require additional training but are experienced mentors and are recorded as sign off mentors on the mentor database held either by their employing NHS Trust or UWE if a private or voluntary organisation. New mentors are supported to develop their sign off mentor skills in simulated activities and practice. The sign-off mentor, is responsible and accountable for making the final decision signing-off the student s 3 years in practice and so confirming that a student has successfully completed all practice requirements competently This confirmation will contribute to the evidence/marks considered by UWE s field and award board leading to registration with the NMC The sign off mentor must work (direct/indirect supervision) with the student for a minimum of 40% of the time the students is placed with them The sign off mentor must also spend an additional 1 hour a week discussing the students progress and supporting critical reflection The sign off mentor must keep accurate and timely records within the OAR to support their decision making The sign off mentors must meet the constraints and expectations set by the University and NMC regulations eg timescales and accurate completion of documentation Where a student is not achieving, the sign off mentor must contact UWE immediately a problem is identified so support and guidance can be given to support success Where a student is not considered competent at the final assessment stage the sign off mentor should refer the student, recording the student s strengths and weaknesses with examples Sign off mentors are experienced mentors and are recorded as sign off mentors on the mentor database Where the placement is a retrieval placement the sign off mentor should ensure a clear learning contract and action plan is in place and both midpoint and final assessments take place in good time enabling the student to gain competence and successfully complete their training. However, if competence is not reached the sign off mentor must fail the student. 23

24 Support for students and mentor There are a range of support systems in place for students and mentors. Some of the support is available to only students or mentors, most support systems are open to both. The PRACTICE SUPPORT LINE (PSL) is available 09:30-17:00 Monday to Thursday and 09:30-16:30 Friday (Not available on Bank and Public Holiday). The staff can answer many queries immediately and both mentors and students evaluate this service well. It can be accessed on The PSL can also be accessed via with the same available times. The PRACTICE SUPPORT NET (PSN) is available 24 hours a day 7 days a week (there are planned shut downs for maintenance, these are usually overnight or over a weekend and occur 3-4 times a year). The PSN can be accessed at www1.uwe.ac.uk/students/practicesupportnet. There are a range of resources available, eg extensive frequently asked questions, links to booking mentor updates, CPD links, information about nurse education programmes, assessment documentation, improving the learning environment and best practice examples. Also a blank and completed mentor update workbook so you can see examples of completed activities. Academics in Practice (AiP) Can be contacted by both mentors and students via the PSL. They: Can be involved where a student appears to be having problems that increases the risk of non-achievement Can help develop action plans and if appropriate refer the student to the module or personal tutor Can be involved in student disciplinary processes Provide mentor updates Proved mentor support in the independent and private sector Support the development of the learning environment. Support for students Support for students and mentors The most accessible and most used support is that offered by fellow students or mentors. The importance of this informal support should not be undervalued. Trust Education Facilitators In addition to the above the NHS Trusts have education facilitators that have a role in supporting the mentor and developing learning environment. They have a range of titles including Clinical Education Facilitators and Practice Education Facilitators. They offer practical advice and support to mentors when working with students who are having difficulties (but they do not usually support the students). Many provide group learning opportunities for mentors which can be recorded as mentor updates. Trust links usually ensure their Trust mentor databases, sign of mentors and triennial reviews meet NMC standards. The AiP and Trust Facilitators provide complementary support and often work in partnership when problems occur. In addition to the above, students can also access the Student Support Services at UWE, Academic staff (programme, module and academic personal tutors), and programme administrators. 24

25 New or updated for the 2010 and 2013 curriculum SoLD - Supervision of Learning Days The Work Based Learning days have become SoLD days and will continue to be held once every 2 weeks through a student s practice placement. The SoLD days will include opportunities for groupwork and other learning activities including reflective learning, personal tutor contact, The Graduate Development Programme (GDP) and other relevant activities. Patient- Public Involvement (PPI) The Faculty PPI Strategy and Faculty Learning, Teaching and Assessment Strategy has clear statements concerning SPPI. This has resulted in a more cohesive approach to SPPI in the new curriculum. Patient and Carers are encouraged to comment on students skills, attitudes and knowledge. Simulation/Preparation for Practice Students will participate in Preparation for Practice weeks which aim to help them make the transition from academic study into practice. These include practical aspects such as learning about their assessment documentation and other paperwork, also time to attend induction and orientation in the practice areas and to meet key people such as their mentors and supervisors. For many this will include learning about public transport to placements and finding out about claiming back travel expenses and negotiating shift hours where public transport does not match shift patterns. Simulation hours will allow students to practice skills in a safe and controlled environment. Placements As a response to changes in healthcare provision, new ways of working in health services and capacity issues, placements will be more flexible. Programmes will include more time working in non-traditional placements. This might include working with nurses in new roles, out-patients, specialist community focused teams, and others. In adult nursing, project work is underway to seek out these new learning opportunities. If you know of a possible placement area do let either your Trust educational link or UWE know, you can note it on the bottom of your mentor update return (back page of this workbook) or phone the PSL or speak to your Academic in Practice. Becoming a graduate profession In response to the NMC drive for a graduate profession all Programmes are degree only courses. Nurse Elective Students can apply to have a four week placement in an area outside the region at the commencement of the 1st placement in year 3. Students must self fund this and complete an application process. They also have to be supported by their personal tutor. Some students also take the opportunity to spend some time working in a school for children and young adults with Autism that is in Croatia. This also has to be self funded. 25

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