CHAPTER 8. Supporting the Failing Student
Chapter Aims
The purpose of this chapter is to develop skills for supporting a student who is failing to achieve their learning outcomes at important stages during the practice placement. After reading this chapter you will be able to:
• Identify the early warning signs of failing students.
• Understand the importance of accessing help and support for failing students early in the placement.
• Develop action plans to support the failing student.
What do we mean by failing?
The word fail is a highly emotive word. No one likes to be told they have failed. In reality very few students actually fail their practice assessment. The correct term used by universities to describe a student who has not met the required standard of competence for one or more learning outcomes in their practice assessment at their first attempt is referred. A student is only deemed to have failed when it is their final attempt at an assessment. The main focus of this chapter is on students who are failing to achieve the required standard of competence and the steps you can take to turn this around.
Mentoring challenges – the failing student
Being the mentor of a student who is failing to achieve the required standard is one of the biggest challenges you will face. The nature of the event means that it is never a pleasant experience and can be equally traumatic for mentor and student alike. In fact, a failing student is one of the more common reasons for mentors wishing to disengage from mentoring students. Without adequate preparation, supporting a student who is failing to achieve the required standard through their placement can give rise to a whole series of problems for you, the student, future mentors and the university.
Do not avoid failing students
It is an unfortunate fact of life that at some point in your role as a mentor it is highly likely that you will come across a failing student. While it is certainly true that more students pass practice placements than fail them, the law of averages means that at some point you will certainly come across a student who is failing to achieve the standard expected of them at some point on their placement with you.
If an experienced mentor tells you that they have never mentored a failing student then it is quite possible that they have failed to identify a student in need of help. Unfortunately, the incidence of mentors failing to identify students who require additional help and support is a growing trend; evidenced by the fact that universities are frequently contacted by concerned mentors who have identified a failing student on their final placement who has never been identified as having difficulties in practice before. All too frequently, mentors are not spotting students who are struggling to achieve, and without help and support, these students will be at an increased risk of failure, particularly on their last placement. The good news is that by reading this chapter you will be better prepared for identifying and supporting a failing student when this does happen to you.
What is the student failing?
When faced with a potential ‘failing’ student situation the first step is to ascertain exactly what it is that the student may be failing. This must be done as soon as you first note concerns and not be undertaken lightly. Big decisions call for careful and logical thinking, not spur of the moment conclusions that are given little thought or have little substance.
Failing learning outcomes
A student can only be considered to be ‘failing’ during a practice placement if they are falling short of the standard set by the learning outcomes or objectives that they are attempting on that placement. These are often referred to as competencies, and these are the only aspects of the student’s performance that you are required to assess. This means that if you feel a student may be failing to reach a competent standard, then your concerns must be related to one or more specific learning outcomes within their assessment document. It is not your role or responsibility as a mentor to decide for yourself what the competence of students should be, as this has been pre-determined for you by the NMC (see Case study 8.1).
Case study 8.1
A practice facilitator speaks of her experience with a mentor
‘I had a phone call from a mentor one day where she explained that she thought her student wasn’t competent. Obviously I asked her what her main concern was. She told me that she didn’t think her student should pass because she didn’t know enough about Florence Nightingale! I had to explain to her that knowledge of Florence Nightingale is not a prerequisite for competence as a registered nurse.’
If you have conducted a thorough initial interview at the beginning of the placement then identifying a student who is failing to meet the required standard should be relatively simple as you will have set clear expectations of the standard expected from them right at the start. It should then be obvious to both you and your student when their practice falls short of this standard.
NMC Proficiencies
In the UK it is the NMC that sets the standards of proficiency for entry to the professional register. While mentors are charged with the responsibility of assessing these standards in practice, mentors are not expected to determine these actual standards themselves. As a mentor your role is to judge the competency of students against the standards already determined by the NMC. The standards are provided for you in the form of learning outcomes or objectives that will be pre-printed in the practice assessment documents that the student brings to their placement. While the document itself will have been produced by your affiliated university, the competencies you are assessing will have been based upon the proficiencies set by the NMC and have been interpreted into separate learning outcomes or competencies which the student has to achieve. This means that as a mentor you are professionally accountable and responsible for the assessment decision that you make to the NMC.
As the mentor of a student on placement you are required to fulfil two roles, to facilitate learning experiences related to the learning outcomes and to assess the student’s competence related to those outcomes. Your decision regarding their competence will be related to three themes:
• knowledge
• skill
• attitude.
So, just as you are facilitating learning experiences that relate to these three attributes, you will be determining competence that directly relates to knowledge, skill and attitude.
Make a point of reading the NMC Standards for Pre-registration Nursing Education (available from www.nmc-uk.org) for yourself and discuss these with your colleagues so you are clear regarding the standards of competence to expect from students.
Why is my student failing?
When faced with a failing student situation on a placement, many mentors may conclude that the placement has ‘gone wrong’. It stems from a misguided disbelief that if you are a good mentor your students always pass; only poor mentors have students that fail. This is not true at all. While poor mentorship can contribute to a student’s poor performance, even the best mentors will be faced at some point with a student who is unable to meet the required level of competence. There is no evidence that a student’s ability or success is directly proportional to the skill of a mentor. So when you are faced with a failing student your reaction should never be ‘why me?’ as this would suggest that you have some sort of superhuman ability to attract only students who will succeed every time. Rather you should focus on the influence you have as a mentor to help the student achieve the best level of competence they can.
Failing during the placement
There are two main ways that students ‘fail’ during a practice placement. Some students may initially be judged to be failing to achieve the required standard of competence during the early part of their placement, but may improve their performance and the end result may be a pass. Other students may fail to reach the required level of competence during their placement and despite appropriate interventions fail to improve; with the end result a failure to achieve one or more learning outcomes. Whichever is the case, failing to meet the required level of competence at any stage during a placement means that you have a failing student situation. For a student to be considered to be failing there must be a deficit in their knowledge, skills or attitudes or a combination of all three.
Alarm bells start ringing
If you do have concerns regarding your student’s knowledge, skill or attitude related to any learning outcome during a placement then alarm bells should start ringing. This will be the first warning sign that there may be a potential problem and you should never ignore this. Hoping that a problem will just go away if you don’t think about it or given more time will never be the solution and you will only make matters worse for your student and yourself if you take this approach. You must take action as soon as you realize there may be a problem with competence.
If you have not conducted a timely or thorough initial interview then it may take some time before the alarm bells really start ringing. Even when you do identify concerns, without a well documented initial interview it will be more difficult to nail down the exact aspect of competence that you are concerned about. If you are unsure of, or confused about the student’s learning outcomes valuable time will be lost in trying to identify the actual problem. Case study 8.2 provides an example of how things can go wrong.
Case study 8.2
A mentor’s experience of identifying a student that needs support
Jane is mentoring Peter, a final year child branch student. Jane works in a children’s day treatment centre where there is a high turnover of children every day and staff are constantly busy. Jane is concerned about Peter’s communication skills with the parents of the children they are treating. He lacks confidence when speaking to the parents and avoids eye contact with them. Some parents have commented on his lack of engagement with them. Jane did not get a chance to look at Peter’s learning outcomes during the initial interview and it is the third week of Peter’s placement before she looks at the assessment book during the midpoint interview. To her horror she realizes that there is a specific learning outcome that requires her to assess Peter’s confidence in communicating with children and parents. Jane realizes that Peter is currently failing in this area, but the placement is now halfway over and valuable time has been lost. Jane finds herself having to tell Peter that he is failing a learning outcome with very little time left to improve. She feels guilty and angry that her manager has made her mentor students when the unit is so busy.
If a student is falling short of the required level of competence then they need help. More importantly, it is part of your professional role as a mentor to provide this help. If you do not take steps to identify the problem and assist the failing student then both of you are failing in this situation.
What is the problem?
The first step you must take when identifying a failing student is to ascertain exactly what the concern is. There must be evidence related to your concern not just a hunch or a feeling. In Case study 8.2, Jane had concerns related to Peter’s communication. This needed to be evidenced by examples where his communication had been unsatisfactory. In this case it was verbal communication and evidence could be given related to specific examples of his poor communication with relatives as well as the feedback Jane had received from some of them.
While a one-off event may be a very early warning of a problem with competence, it is rarely a good idea to base your decision on just one example. If your student is weak in an aspect of competence then it is preferable that there are several examples of this to evidence your concerns. However, if the area in which a student is weak could lead to harm then you clearly should not wait for the student to continue in this way.
You must be very clear in your own mind what it is that you are concerned about and what aspect of competence this relates to before addressing the issue with your student. This does not mean that you should wait for weeks before discussing your concerns, rather, you should move very quickly to decide if there really is a problem and if so, the exact nature of your concerns. Try to be very clear about whether you are concerned with a student’s knowledge, skill or their attitude, and have examples of how these concerns have been demonstrated in practice. Once again, if you have completed a thorough initial interview you should have a very clear benchmark on which to base your decision.
Am i being too harsh?
It is poor practice to rely solely on your own opinion when deciding upon a student’s competence. As a mentor you should make every effort to consult with your colleagues to gain their judgements of your student’s ability, particularly if you believe there may be a problem. While one person’s opinion could be subjective, a number of different opinions will dramatically increase the objectivity of an assessment decision. This is referred to as inter-assessor reliability. Ask your colleagues if they have noticed any particular issues or have examples of practice that support your concerns. If no one else has noticed a problem then it may be that you are expecting a higher standard than is required for the student at their particular stage on the programme and you may need to adjust your own expectations. Alternatively, you may like to ask your fellow mentors to undertake their own assessment of the student in the areas you are concerned about. If others are equally concerned regarding a student’s competence then this is the time to discuss your concerns with your student.
Discussing competence with students
Once you have determined that there is a particular area in which your student is failing to reach the expected level of competence in then you must address this as soon as possible with them. You must be very clear regarding what your concerns are, why you are concerned and provide them with evidence of your concerns. This should be based on very identifiable situations or events that have taken place during the placement that support your concerns related to their knowledge, skill or attitude. It is never easy to hear that you are falling short of a standard, so be gentle and considerate in your approach when discussing these problems with a student. However, above all be honest. If there is a problem then your student must be very clear about what it is, as they will need to know exactly what is wrong before they can take steps to improve. Discussing with a student your concerns regarding their level of competence and what can be done may not always get the reaction you expect (see Case study 8.3).
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