Assessment and Accountability in Nursing

Mentors have responsibility to assist students to develop their clinical skills and knowledge on placements. As well as developing clinical skills, students also develop their interpersonal skills and as a result of this experience gain maturity. (NMC, 2008) .To determine students have achieved the professional standards or competence, mentors must make assessments while their placement. This is vital to protect the public from unsafe and incompetent practitioners.

Assessment is an essential role of a mentor. A good assessment process gives the students valuable feedback, it helps them to identify where they are, highlights, deficits in their learning ,identifies what they need to do and enables them to set realistic future goals.(Danny Walsh 2010). A good assessment process help us to predict future behaviour of the nurse we train. However we can cut down the risks by ensuring that the assessment processes itself meets certain standards and criteria which are considered best practice. Proper assessments of students are essential because, they are the future nurses are responsible for protecting the public in patient care, (Necklin and Kenworthy, 2000:108).Through assessment mentor can identify the strength and weakness, knowledge and practical skill of a student.

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According to (Walsh 2010) student nurses are assessed for variety of reasons in their clinical practice. Examples of this; to monitor the students’ progress to give feedback, to discover learning needs, to encourage students, to monitor their progress, to assess students level of competence, to assess knowledge, skills and attitudes, to measure the effectiveness of the teaching and to safeguard the patient and protect the public. As students work alongside with mentors, need to encourage students to perform patient care through instructions, guidance and supervision. While they are caring the patients mentors can observe and give feedback, this means while student is learning she is being assessed.

Managing the process of assessment and feedback is hugely important. Students fail their placements for a wide range of reasons, but certain key factors can help minimise this happening. The student needs to feel welcomed and wanted to be able to perform into the placement quickly and so get on with meeting their competencies. Duffy (2003) cited several reasons for students failing and the key aspect was the lack of a good mentor/student relationship. Mentors must be meeting with students regularly can identify the problems or deficits the students going through.

Learning needs should then be identified and action plan must be put in place. Mentors and assessors have the right and responsibility of making professional judgements about the performance of their student. (ENB and department of Health, 2001).Students needs to be respected while maintaining their professional standards, it is important to recognise the rights and to be supported to succeed in clinical practice. Monitoring progress is about finding the students quality and quantity of learning and any difficulties students may experiencing that can be identified and action plan to be applied.

There are different methods of assessment like observation of patient care, questions and answers, reflection, briefing, self assessment peer assessment, testimonies, portfolios.(Stuart 2003). Duffy and Hardicre (2007) identify the reasons of a failing student are lack of insight, lack of interest poor communication or interpersonal skills, personal issues, being over confident. The Nursing and Midwifery Council (NMC2004a) states that nurses are accountable for their own practice. The public has a right to expect competence from the qualified professional in healthcare. With the purpose of assessment as a form of quality control for the healthcare professions, assessors should be able to identify failing students and provide enough support and resources to overcome the difficulties.

As Maria was a first year student the initial priority was observations of the patient. At the beginning, I asked the questions about blood pressure ,heart rate(pulse) ,respirations, oxygen saturations ,pain scores etc…Then explained to Maria the theory, significant changes and if she notice any changes who to inform, then I demonstrated how to check observations and how to enter in a patient track or observation chart. The procedure was repeated in many situations under supervision which made her confident and also Maria received constructive feedback from other staff. A high level of a motivation and assessment is necessary for learning, (Gipps1994).

During mid interview it was identified that student has achieved the skills to do the observations by using dyne map or manually, and also able to understand the significant changes and to report to the staff nurse. The Nursing and Midwifery Council (NMC 2006a) specifies the responsibility and accountability of NMC registrants who supports and make summative assessment decisions are referred to as assessors. As part of summative assessment (Stuart 2003), I arranged final interview with Maria on last day of her placement. I reviewed all her progress and evidences recorded in her practice book. Maria’s portfolio, feedbacks from other colleagues and Maria’s behaviour while her placement in the unit, attitude towards the patients and colleagues, knowledge , skills and performance in order to determine whether, she is fit for practice without supervision.

Constructive feedback has an impact not only on the teaching/learning process but also gives messages to students about their effectiveness and self esteem (Gipps1994).Feedback sessions should be designed to help students grow in their clinical skills and professional competence. It is not possible for the named assessor to work with the student on enough occasions to monitor the progress of students with validity and reliability, so that it is important that the mentor seeks the views of other practitioners who have worked with the student. The assessment activities of working alongside the student and observing practice, discussion with the student and examination of the student’s portfolio, discussion with other assessors are done both informally and formally to monitor progress (Phillips et al 2000).

Lifelong learning is the term used to refer to the planned or unplanned learning occurs throughout the life ,usually the working life ,of an individual (Hinchliff1998).The mentor is advised not to give all the answers ,which deprive the student of the opportunity of carrying out some of the problem –solving and decision making activities (Stengelhofen1993).These cognitive processes foster deep learning ,and thus help the student extract more meaningful learning through experiences.Dreyfus model (Benner 1989) describes the five levels of proficiency the students pass during their placement .They are novice, advanced beginner competent, proficient and expert .The author believes that this model can be applied in assessing the students in placement area because this will help students to access frequent feedbacks that can help to improve clinical skills and become more self- aware.

Every good placement should be gathering feedback from the student’s inorder to improve the student experience and enhance learning opportunities. Accountability involves responsibility, knowledge and being able to justify actions. It is always challenging for mentors to deal with failing student’s .However if planned in advance and strategies in place, it can be overcome without too much pressure on the student .In the mid-interview, if the student is not performing up to the standard it’s important to provide the student more support and inform the personal tutor. It is essential to note that few students unable to meet the criteria whatever the circumstances are, the mentor should act appropriately in order to fail the poor performing students rather than the fail to fail situation which may affect the public (Duffy2007).

To succeed in placement assessments and achieve competencies the student cannot afford to leave it until later in the placement .It is the responsibility of the mentor to ensure that they give the student regular reviews and feedback to ensure that they keep on top of meeting their learning objectives (Walsh2010).Mentors needs to evaluate students time to time and it is important to provide constructive feedback .Mentors should focus to create a safe learning environment for the students and it is their accountability. When Maria started placement in my unit I ensure she has done all the mandatory trainings like moving and handling, fire training, health and safety, infection control.

If Mentor takes the decision to fail a student, it should not come like a surprise to the student. Students who are not progressing or failing their placement mentors need to identify the learning needs and support them with available resources. Discuss any issues or concerns with the student and inform university tutor, and also make sure student understands the problem.