CHAPTER 12. Mentoring Challenges
Chapter Aims
The purpose of this chapter is to explore the different challenges that you may encounter as a mentor. After reading this chapter you will be able to:
• Identify mentoring challenges in your clinical learning environment.
• Reflect on how you manage challenges.
• Identify practical measures to address challenges without compromising the assessment of learning.
Introduction
In the course of mentoring students you will experience a number of situations that may impact on the learning experience you aim to provide and on your perception of students. These situations may leave you feeling frustrated at times with your role as a mentor. This chapter endeavours to cover a variety of the situations that you may encounter, allowing you to assess your mentoring skills and offer practical solutions to help you support the student effectively.
Mentoring students on a second attempt
One of the biggest challenges you will face as a mentor will be associated with the need to fail a student at the conclusion of a practice placement. We looked at the support for a failing student in Chapter 8. This section looks at failing a student at their final attempt at their practice assessment.
When a student submits their theory assignment there will be a delay before the results are officially released to the student. However, practice assessment is very different; the student will know the outcome immediately. If a student has failed an aspect of their practice assessment then they will know that you have failed them. It is likely that both of you will feel especially awkward about this, as you will have worked together over many weeks and no doubt built up a rapport. There may even be the added potential for conflict if there is disagreement about your assessment decision. The accuracy and reliability of feedback that you have provided throughout the placement will be especially valuable here. If a student has been prepared and supported for the likelihood of not achieving placement learning outcomes then the final decision will not come as a shock; however given that failing at a second attempt is likely to lead to discontinuation from the programme this is probably the most difficult situation you will face (see Case study 12.1).
Case study 12.1
A link lecturer speaks of her experience of failing a student
‘I got a call from a mentor one Friday afternoon telling me that she had just failed a student who had taken the news very badly and had locked herself in an interview room. I rushed to the clinic and found the student sitting in the dark sobbing and crying. It became clear that the mentor had had misgivings about the student’s competence during the previous eight weeks of the placement, but had felt unable to speak with the student as she didn’t want to upset her. On the final day, the mentor had simply signed a number of outcomes as ‘not achieved’ and hoped that the student would understand. The student was devastated, she had no warning that she was likely to be failed and all trust in her mentor had gone. It was just a terrible situation, desperately trying to pick up the pieces of this student whose world had just collapsed. I wouldn’t wish that on anyone.’
What is a second attempt?
All university students are usually entitled to at least one further attempt of any assessment they have failed to pass. In this case a student is referred by the university which usually entitles a student to a second attempt at the learning outcomes they failed to achieve. The location, time and length of a practice placement to undertake the second attempt are decided upon by the university and dependent on the needs of the individual student. The student may not undertake their second attempt in the same placement as the first attempt as usually both mentor and student benefit from a fresh start. If a student were to request a second attempt in their first placement then this would be considered by the university, but only if the mentor and placement area were also in agreement.
The mentor’s role for a second attempt
As students will usually be given a second attempt at any failed learning outcomes you may come across a student who did not pass on a previous placement and requires a second attempt with you. This could be quite challenging, as the student may enter the placement with low self-esteem or feeling very anxious and worried. Essentially, your role as a mentor will not alter and you will still be expected to provide a range of learning opportunities and provide a fair and accurate assessment. All the advice given in earlier chapters around the assessment process applies. To recap these are:
• undertake the initial interview as soon as possible in the first week.
• look at the mentor’s comments from the placement where the student failed at the first attempt and at the comments in the ongoing achievement record.
• identify the learning outcomes to be achieved and agree a clear action plan with SMART objectives to help the student achieve those learning outcomes.
• meet regularly and give honest feedback on their progress.
• if the student is not meeting the required level of competence seek help from the university for you and the student as soon as possible.
Clear and consistent feedback is probably one of the most essential elements as the student will need to be informed of their progress and to be informed early on if they are not making the required progress. As the second attempt is a student’s opportunity to demonstrate that they have developed and improved on the first attempt you should have a very clear benchmark to work from. The content and accuracy of the ongoing achievement record will be invaluable as you should be able to pick up from where the last mentor left off.
First and second attempts together
In some circumstances students may be required to undertake their second attempt at failed learning outcomes at the same time as undertaking a new placement with new learning outcomes. This will usually happen when only a small number of learning outcomes are outstanding and it is not in the student’s interest to restrict their progression. When you are mentoring a student who needs to undertake a second attempt on a practice assessment, remember you will only be assessing the student on the learning outcomes which they have not achieved during their first attempt. Students who are completing first attempts of one module and second attempts of another may have two practice assessment books and two sets of learning outcomes to be assessed. This means you will need to be very organized in your mentoring role to support this student. Remember however, that you should have the ongoing achievement record written by the mentor of the first attempt placement as a reference point. This should give you a good indicator as to what the student’s areas for development and any issues and concerns are. Reflecting on the contents of the ongoing achievement record with the student will help the development of the action plans for the placement.
Assessing multiple learning outcomes
In those circumstances where you are being asked to assess the student on learning outcomes from both first and second attempts, your skills of planning for and facilitating learning will come to the fore. It is advisable to undertake an initial, midpoint and final interview for each set of learning outcomes. This will help distinguish what is required for each assessment and though a little more documentation is involved it will enable the student to focus on what needs to be done for each learning outcome. An ongoing achievement record should also be written after a second attempt, regardless of the outcome. Box 12.1 summarizes the terminology used by universities in the assessment process.
Box 12.1
Understanding university language
The language used by universities to indicate assessment processes may be confusing for mentors who are not used to the terminology. The following list includes some examples of such terms.
12-week rule | Nursing students have to pass all first year theory and practice assessments within 12 weeks of starting the branch programme in order to progress any further on the programme. |
5-day rule | Submitting assessments within 5 working days after the deadline. |
Appeal | Option available to a student if they do not agree with a decision made by assessment/mitigation boards but requires certain conditions to be met. |
Applying for mitigation | The student submits evidence of extenuating circumstances which they believed affected their academic performance and therefore the outcome of the assessment. |
Deferred | Results have yet to be released until additional requirements are submitted for the assessment. |
Extension request | Option available to the student to apply for an extension to the submission date of the assessment – usually no more than 10 working days. |
Fitness to practice/disciplinary hearing | A panel of academic staff and practice representative(s) who consider an allegation of a breach or breaches against university regulations or the Student Code of Conduct which bring into question a student’s fitness to practice. |
Mitigation | Defined as the taking into account of any circumstances which were not within the foresight and control of the student and which the university believes might adversely affect the academic performance of a student. |
Ratified results | Final results released by the university assessment board. |
Referred | Did not pass first attempt. |
Second first attempt | The student is permitted to undertake another first attempt of the practice placement due to accepted mitigating circumstances or due process not being followed. |
Making the final assessment decision
The final assessment decision should never come as a surprise to the student. Throughout their placement with you, you will have given regular feedback on their progress and so they will know what the final outcome will be. As long as you have followed due process with documented evidence of a clear action plan with regular feedback, if the student has still been unable to achieve the required level of competence then your final decision has to be to fail the student. Always seek support from the university in this situation. This will be a difficult interview to undertake and so having a link lecturer sitting in on the final assessment will provide support to you and the student. Afterwards you may find it helpful to discuss the whole process with the link lecturer to assure yourself that you did all that was required and identify what you have learnt from this process.
The work–life balance
The student population is changing and in many parts of the country the majority of students starting preregistration nursing courses are aged over 25. Many students will have non-traditional qualifications such as NVQ, Access in Healthcare, or may not have been in education for some time. Not all will have worked in healthcare before. We are also seeing more students coming into nurse education after starting a family or having decided on a significant career change.
All of the above can lead to challenges as the student is faced with juggling the demands of family, friends, shifts and coursework commitments. The student may request changes to shifts or decline to do certain shift patterns during their practice experience. While you may feel very tempted to allow students to request a specific rota out of kindness, this can result in the student not being on duty with you therefore limiting your opportunity to assess their performance.
As difficult as it may be, reinforcing the need for the student to be on duty with you for at least 40% of the time that they are delivering patient care and undertaking a variety of shifts is necessary. The NMC requires students to participate in the full range of care across 24 hours, including weekends and night duty and students can feel frustrated by what they may perceive as strict rules and regulations. It’s a good idea to confirm with the university the expectations they have regarding students’ working patterns and ensure these policies are maintained in your practice area.
Consistency is as important between placements as it is between mentors and this is not easy to achieve. Attending education meetings at organization and local level and discussing such issues is an ideal way to share good practice and agree approaches to enhance continuity. Of course there will be times that you exercise your professional judgement and allow the student to choose or swap shifts but this must not be at the expense of their learning needs. Students must complete a minimum number of hours across the 24-hour period and failure to achieve this is not in keeping with course requirements or professional in behaviour. Persistent and consistent changes to off-duty or refusal to do certain shifts can be assessed against the relevant learning outcome and involvement of the academic link is advisable. See Case study 12.2.
Case study 12.2
A mentor’s experience of planning an off-duty
‘A few years ago I was sitting with my student at the end of the initial interview and we were completing her off duty for the month. I knew that the student needed to do two weekends and one week of nights and I wanted her to do these with myself. The student explained she had small children and wanted to be at home at the weekends, she said her previous placements had always let her work more early shifts and gave her weekends off. Because the placement was 8 weeks long we eventually came to the agreement she would do the weekends and nights during the fifth and sixth weeks to allow her time to arrange childcare. It wasn’t an easy conversation, I felt like I was being the bad guy and our relationship didn’t get off to the best start. I found out later that the other ward had not given her weekends off at all; she was just testing me to see if I would give in. Now our Trust just makes it clear to all students that we follow the university policy for student placement and we don’t have any more problems.’
Bereavements
There could be a time when you are informed by the student that a relative or friend has died and they would like time off to grieve and travel to the funeral. In these situations the student could need more time off than they initially requested. Leave from the course, including from placement, on compassionate grounds can only be authorized by the university. As a mentor your role is to support the student to follow the correct reporting procedures, as well as offer the student an empathetic ear.
There may be times when the student does not wish to take time off from the placement or programme, believing that studying will provide a distraction and a way to cope with the loss. In these instances it is advisable to liaise with the academic link as additional support can be put in place for the student, this may be via occupational health or extra meetings with the student and yourself. Either way, the assessment process must be followed and your empathy for the student must not impact on the quality of your assessment. The academic link will also be available to support you and the student if you’ve identified poor performance.
Finance and income
Financial hardship is a reality for many students. Some students may find themselves in significant debt and for obvious reasons this may impact on their ability to learn on placement. Students who are concerned about paying bills will not be in the best frame of mind to take advantage of the learning experiences on a placement. Under these circumstances it is not uncommon to discover that students are undertaking paid work as bank or agency care assistants, which may lead to increased tiredness, reduced concentration and poor performance.
If a student discloses financial difficulties to you as a mentor this must not cloud the assessment process or decision. You can suggest that your student could do one of the following:
• access the students’ union for advice and support
• meet with their personal tutor to discuss the impact of the financial hardship on their studies and the options available
• contact Citizens Advice Bureau or the National DebtLine.
If you suspect the student of working extensive hours on bank, agency or other paid employment but do not have the evidence you are advised to assess the student on the behaviour which is causing concern. For example, if the student is witnessed to fall asleep or found asleep whilst on duty you should do the following:

• ensure a minimum of two staff have observed the student to be asleep and witness statements are prepared
• meet with the student to discuss the behaviour; do not get into a heated ‘he said, she said’ discussion as this is unproductive; highlight which learning outcome the lack of professionalism is being assessed against and how this incident will be monitored
• record the incident in the student’s practice assessment document

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