Mentor in supporting students within clinical practice

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Susan is a first year first placement student nurse. Critically analyse the role of the mentor when integrating her into the practice learning environment.

The Nursing and Midwifery Council (NMC, 2006) suggest that the word mentor is used to represent the role of a registered nurse who facilitates learning and performs the role of supervising and assessing the competence of students in the clinical environment.

The mentor is a nurse or midwife on the NMC register who, following successful completion of an NMC approved mentor preparation programme, is entered on a local register and is eligible to supervise and assess students in a practice setting (NMC, 2010).

It is suggested that qualified nurses have a duty to facilitate nursing students to develop their competence (NMC, 2004) and teaching is seen as an important part of the health professional's role as during their career, members of most healthcare professions are expected to assume a teaching role with other staff, students, patients and relatives (Hand, 2006).

It is widely recognized therefore that the teaching standards of mentors available in the practice place will have a major impact on the quality of future practitioners, consequently making an improvement in patient care.

Most students and many professionals note that learning acquired from the placement experience is much more meaningful and relevant than that acquired in the lecture room (Quinn 2000), this is a relevant point of view particularly as practical training on placements comprises a substantial and important part of student education (Beskine, 2009).

This assignment aims to examine and critically analyze the role of the mentor in supporting students within clinical practice and will aim to specifically examine the role of the mentor in relation to facilitating the first clinical placement of a student nurse to a ward environment.

Focus will be made on how the mentor can provide a meaningful learning environment in an effort to maximize the positive outcomes of the student's first clinical placement, with reference being made in particular to what methods can be adopted by mentors to reduce student anxiety.

The role of the mentor will also be examined and critiqued, particularly as this is the student's first exposure to the clinical environment and their first opportunity to obtain an understanding and form an opinion of the qualified registered nurse in the role of mentor.

Clarke et al. (2003) suggests that within nurse education high value is placed learning within the clinical environment and this in turn can place numerous demands on clinical areas and staff to ensure the clinical placement has a positive influence on the learning experience of students.

One practical way of reducing the pressure on the qualified staff is to share the responsibility of the training needs of students. An example of this would be for mentors within the clinical area to work on a rotational basis in assuming the responsibility of mentor to students, however contrary to expectation

This potentially would benefit both the student and mentor, for the mentor it would ensure the responsibility of clinical work load and mentor responsibilities are shared amongst the team and for the student it would increase the opportunity for a positive learning experience if their mentor is not exhausted by their professional role, organisational constraints (Mosley and Davies, 2007) and the repeated and recurrent expectation to be mentoring a procession of students.

Prior to the student even starting on clinical placement it is important that the placement area is aware that the student's arrival is imminent and that a mentor has been nominated from within the qualified and assessor approved nursing team.

This process facilitates the beginning of relationship building between the clinical area and the student and Davidson (2005) notes that students can be made to feel welcome by someone simply knowing their name and being expected.

It has been reported that prior to commencing a first placement student nurses may experience a range of emotions, not all positive; there is evidence which suggests that fear and anxiety are the prominent emotions reported by students (Philips et al., 2000).

The mentor should try to support the student through the difficulty of emotional upheaval that may arise during the course of the first placement therefore one strategy would be for the mentor to arrange some one to one time with the student early on their first day to address any anxieties of issues the student may have prior to the actual clinical commencement of the placement.

Anxiety is an appropriate response when being confronted by new and unfamiliar experiences and anxiety is experienced by everyone in varying degrees (Barker and Kerr, 2001), when individuals become more pre-occupied with worries about potential experiences then their ability to function may become impaired and the value of the learning experience may also encounter problems in addition to learning goals being abandoned (Stuart, 2007).

The impact of anxiety on the student should not be underestimated by the mentor as it is well documented in the literature that clinical education is an environment where the student is more vulnerable to experience stress and anxiety and the reason for this may be attributed to the advances in medical care and nursing suggests Moscaritolo (2009).

Interestingly in the current climate there is also reported to be a sense of anxiety that exists within qualified nursing team. It is well reported in the media that financial cuts and investment in the NHS is under ongoing review and a recent publication by the royal college of nursing has highlighted the mood of the nurses surveyed was one of heightened anxiety. Nurses were deeply concerned about the impact that cuts and recruitment freezes may have on their job security and potential to develop and progress (RCN, 2009).

With students new to the clinical area experiencing anxiety it would be useful for the mentor to focus on alleviating the anxiety of the student even if the mentor has issues regarding the financial cuts, recruitment freezes and job security as the students exposure to the political elements of nursing practice may be as limited as their knowledge of clinical practice.

Entering an environment where there are other people with anxiety issues, particularly individuals who are perceived to be teachers and experts would probably do little to reduce the students own levels of anxiety.

It has been acknowledged that if the mentor and the student do not collaborate to reduce the issues surrounding the students level of anxiety then their learning and ability to perform in clinical practice may become affected (Moscaritolo, 2009).

Nursing is widely acknowledged as a stressful profession as it requires the expenditure of a lot of energy on many different physical, mental and emotional levels (RCN, 2005), therefore it is important for the student to begin their clinical placement at a functioning level before they are exposed to the clinical stressors (Moscaritolo, 2009) that are commonplace within the profession.

A preliminary interview between the mentor and student would be an appropriate way of addressing any anxieties the student may have about the placement and may familiarise the student with some of the current issues faced by the nursing team within the clinical environment, in addition to providing a forum for the student to be orientated to their placement environment and nursing colleagues who will be responsible for their development for the duration of the clinical placement.

Exploring the reasons behind the student's anxiety may also give the mentor some ideas in relation to what approach to take towards the students learning pathway during the course of the placement.

For example, the student may be anxious about a certain skill or activity they may be anticipating they need to perform, they may be anxious about having to become involved in tasks that they feel very uncomfortable about, such as the laying out of deceased patients or being exposed to extremely poorly individuals.

The mentor may face these kinds of activities on a frequent basis and by understanding the student's anxiety steps can be taken to offer support the student and expose them to less anxiety provoking tasks during the first placement experience.

In addition to the management of the student's anxiety, orientation is also an important part of the preliminary phase of the clinical placement and although this can be a lengthy process it is vital to the competent care and safety of patients (Harrelson, 2007).

Including the student in ward issues, familiarising them to other staff, the environment, ward routines and by setting out goals and targets for the learning journey during the course of the placement may address some of the anxiety that the student is experiencing. The collaboration between mentor and student is an important factor in setting out a learning journey, can have a positive impact on students self esteem, which in turn can improve students confidence and reduce anxiety (Chesser-Smyth, 2005).

In supporting the student to foster a sense of belonging within the clinical environment by including them in ward issues and by meeting with members of the clinical team, in addition to setting out goals for learning may support the student to feel valued and improve esteem.

Maslow (1970) suggests that individuals who are able to experience a sense of belonging, who are supported to learn and who are enabled to improve esteem are more likely to reach a state of self actualisation, a phenomena that Maslow (1970) indicates is the ultimate goal of all human beings.

In addition to including students and encouraging esteem building; another method of reducing the student's level of anxiety is for the mentor to adopt humour in their teaching.

Having a light-hearted attitude can benefit learners by enhancing self-esteem, and decreasing stress and anxiety (Moscaritolo, 2009). Use of humour in the classroom has been found to increase students' retention of content. Its use in the clinical setting has helped reduce anxiety which in turn enriched performance and confidence (Moscaritolo, 2009).

This is an interesting suggestion as although the literature advocates that humour can put students at ease (Moscaritolo, 2009) and can improve performance and learning (Ulloth, 2002) it may be difficult for mentors to incorporate humour into clinical practice particularly if staffing levels are low, work pressure is mounting and job security is under review.

Another difficulty for the mentor may be that injecting humour into clinical situations may not always be appropriate and it may be something that as an individual they do not feel comfortable using within a clinical setting; it should also be considered that although humour is beneficial for students, it may be interpreted differently and the mentor may need to consider when it is appropriate to incorporate humour into the students learning as it can be misinterpreted and viewed as inappropriate in certain circumstances.

Mentors are reported to have a positive attitude towards their role and are reported to enjoy this element of their qualified role (Moseley and Davies, 2007). This positive view will possibly be reflected in their teaching approach and will hopefully be picked up by the student which in turn may contribute towards ensuring the student on an initial placement has a positive experience.

This assignment has looked at the role of the mentor and what skills and elements within the clinical environment can be utilised to improve the quality of the student's first clinical placement.

It is acknowledged that the role of a mentor is difficult as they have a significant responsibility towards meeting the learning needs of the student in a positive manner in addition to addressing the high levels of anxiety that many students encounter during the early stages of their clinical training.

The role of mentor is complex, demanding and runs parallel to their existing clinical responsibilities which in the current climate presents its own challenges. Fortunately it has been identified that mentors remain positive about their teaching responsibilities in spite of the daily clinical challenges they face.