The Management of a Student whose Standard of Practice is Cause for Concern - Essay Example

?Critically explore the management of a learner whose standard of practice are cause for concern Introduction Nursing education is one of the most difficult fields of study in the health care field. It is filled with various challenges for the learner, from the academic and theoretical learning to the field of initial clinical exposure as a student learner. These challenges can often prove to be insurmountable challenges for some students who often give up on their dreams to become nurses; on the other hand, it can also hone competent and clinically functional nurses for the practice, those who can transition well into the hospital or actual clinical setting. Although the standards of practice have been set by the academic setting, nurse educators and mentors can however find it difficult to fail students who are actually failing. Some of them often pass these students, sometimes, encouraging them to persist in their studies. This practice can however lead to various issues in nursing where incompetent nurses may be allowed to test their skills in the clinical setting. This paper shall critically explore the management of a student/learner whose standard of practice are cause for concern. This analysis shall include how the individual should be managed in terms of fitness for practice accountability, responsibility of the mentor and how this event would be documented. The implications of failing to fail learners who do not meet with the required standards to practice both personally and professionally will also be discussed. This study shall also consider when an action plan would be developed, whether or not I would get involved, and the assessment strategies which would be considered. This paper is being undertaken in order to establish ways by which the nursing profession can be whittled down academically and objectively in order to ensure that only competent nurses are to be allowed to practice. Body Undoubtedly, failing students can be a difficult and stressful experience for students and mentors. However, a nurse’s knowledge of one’s accountability as a mentor and supervisor and the complex process of crafting failing students imply that these decisions can still be made with utmost confidence (NHS, 2010). Mentors are considered gatekeepers because they guarantee that students who cannot comply with the standards of the practice are not allowed to enter the practice. The crucial stage of the assessment process seeks to protect the general public and the patients from incompetent nurses (NHS, 2010). Various concerns on how effective the gate keeping role is being carried out have been expressed by various practitioners. Failing to fail can have dire consequences to the general public (NHS, 2010). A 2004-2005 survey established that out of about 1400 issues of misconduct, poor practice was cited in majority of these incidents. Incidents of poor practice included errors in drug administration, inadequate record keeping, unsafe clinical practice, and failure to care for basic needs (NMC, 2005). According to the Royal College of Nursing (RCN, 2007), the mentor’s role is to generally offer support and guidance to the student and to help the patient understand the practice and to help him apply theory. The mentor’s role is also to assess, evaluate and provide feedback to the student; and to supervise reflective practice (RCN, 2007). These mentors are also tasked with ensuring that the students: are fit for the purpose of the practice, can fulfil the needs of registration, and have the depth of learning in order to be granted a diploma or a higher degree (RCN, 2007). These mentors are also considered positive role models and are there to assist students in gaining confidence; to promote professional relations with students; to assist appropriate supervision; and to offer honest, yet constructive feedback (RCN, 2007). The registered nurses’ role as a mentor is crucial because it ensures the protection of public health and interest (RCN, 2007). It is the responsibility of mentors to justify their assessments and decisions on students in the practice (RCN, 2007). The role of the mentor in the pre-registration setting is crucial to the credibility of the nursing practice. These mentors are part of the quality control and assurance process for the profession (RCN, 2007). Mentors therefore have to be prepared to take on such a role, and they must share their knowledge of patient care. These mentors must also be familiar with the student’s study programme and practice assessment documentation (RCN, 2007). They also need to identify specific learning areas and they need to plan the learning experience based on learning opportunities. Mentors must also be ready to observe students in the practice of their skills and to ensure time for reflection and monitoring of their student’s progress (RCN, 2007). More importantly, it is also incumbent upon them to report any untoward incidents to the senior managers or any other concerned authorities (RCN, 2007). Assessing the competence of students to practice is a major concern in any profession. The practice for teachers, accountants, and doctors, etc all has these similar concerns (Hunt, et.al., 2011). Regardless of the profession involved, there is an unspoken agreement that those who evaluate the practice are considered the guardians or gatekeepers of their profession and the burden is on them to determine whether the practice they have observe from their students complies or does not comply with the required standard (Hunt, et.al., 2011). If these guardians or gatekeepers do not fulfil such role, it is therefore possible for failing students to enter the practice with potentially disastrous consequences for the clients of the profession concerned (Pellet, 2006). Under these precepts, this study is being undertaken. The International Council of Nurses declares that safety is one of the most crucial concepts in assessing nursing students (ICN, 2006). In most countries, national standards are set in order to indicate the role of safe practice by ensuring that students reach the baseline to start their nursing careers (SANC, 2008). It is therefore expected for newly-qualified nurses to be able to function safely and from such a safe foundation, are able to develop well within the practice (Neary, 2000). However, in some cases, the pass standards in practical assessment of students often seem to be higher than expected and one of the possible reasons is that mentors are sometimes reluctant to fail their students (Gainsbury, 2010). Although many assessors admit to being hesitant in failing students, other assessors report various factors which often compromise their attempts (Gainsbury, 2010). These factors may refer to difficulties in the implementation of various roles in the practice and in some instances, failure to adequately carry out assessment processes in the practice (Hunt, et.al., 2011). The hesitation in failing students who cannot comply with the standards is a major concern among mentors, especially those who are new to the mentoring process and those who believe that they can still help the student reach optimum standards (Hand, 2006). There are various reasons for nursing students failing on work-based assessments. According to Duffy and Hardicre (2003), these reasons may include poor communication skills, limited interest, failing to take part in the learning process, perpetual lateness, limited personal insight, and limited insight into professional limits. In these instances, the student nurse cannot function well and efficiently within the clinical practice. As a result, nurse mentors must consider these as elements in judging competence to practice or lack of fit into practice (Hilton and Pollard, 2005). According to Marsh, et.al., (2005), failing students is however a difficult matter to accomplish. For one, emotions are highly involved in the process of failing. Another issue is that providing support for failing students is often time-consuming (Marsh, et.al., 2005). These mentors often end up feeling very much responsible for the failing students. Some of them even end up having to consider the personal circumstances of the students into account before failing or passing the student; moreover, inexperienced assessors often do not have sufficient confidence in failing to fail students (Marsh, et.al., 2005). The consequences of failing to fail students are numerous. For one, failing students allowed to enter work-based placements even with major doubts on their ability and skills (Lofmark and Wikblad, 2001). Many students often reach the end of their course and then end up failing other courses which causes more disastrous issues for them (Marsh, et.al., 2005). Clients may also be placed at risk because of these incompetent nurses (Sharp, 2000). In these instances, students must therefore fail when they have been given regular and detailed feedback on their performance and assessment which indicate their poor performance (Marsh, et.al., 2005). Students who fail to provide evidence of their compliance with the essential standards where opportunities are available must also be failed (Watson, et.al., 2002). Furthermore, students who act unprofessionally or in an unsafe manner despite feedback and support must also be failed (Marsh, et.al., 2005). There are various actions which nurse mentors can take in order to provide support for students who are failing. Sharp, et.al., (2005) declare that mentors need to establish an early exploration and intervention for the students, calling them in personally to inquire why they appear not to have any interest in the activities, why they are always late, or why they are not complying with the course requirements. The judgments on the student must be based on this discussion. The mentor must therefore avoid jumping to conclusions or making rash decisions about the student’s competence until all elements are properly discussed (Sharp, et.al., 2005). Mentors also need to clearly express their expectations to the students, helping provide basis and guide for the students to follow in their daily activities and interventions (Stew, 2005). Students often fail in their tasks because of the different barriers they encounter in their practice. In these instances, it is the role of the mentors to clear and to remove these barriers in order to facilitate their students’ progress (Walsh, et.al., 2005). These mentors can therefore also try to negotiate learning opportunities for their students in order to give the students a chance to learn, master or even relearn skills and interventions (Seekland, 2002). Mentors also need to respond to the cues which they notice among their students because these cues may serve as alarm bells for students who are not fit to practice (Seekland, 2002). In these instances, the mentors must heed such alarm bells and acknowledge them for what they really are. Assessing students may also work better as a group effort; therefore, there is no harm in asking colleagues for their views, especially the colleagues who have more experience in the practice (Chapple and Aston, 2004). Support and advice from the university staff and other clinical managers can provide support for one’s decision. Their support can provide sufficient evidence and justification for any decision made on any student. Giving consistent and regular as well as constructive negative and positive feedback must also be part of a mentor’s tools (Foster and Hawkins, 2004). Where a student receives positive feedback, he must also receive it for other similar tasks and the same is true for negative feedbacks which must be given for all similar inadequately performed tasks. Such feedback must also apply equally and consistently to all students performing similar tasks (Calman, et.al., 2002). Students must also be asked to self-assess and to reflect on their actions, allowing them to evaluate their actions and to match these with their learning and evidence from literature supporting their work (Burnard, 1990). This assessment or self-reflection process can best be done on individual or specific tasks or interventions. Assistance from other supervisors can also be gained especially in expressing issues on unsatisfactory student attitudes. For the new assessors, it may be difficult to express dissatisfaction about student’s negative attitudes (Andrews, 2000). Older and more experienced nurses can provide tips on how one can carry out this process. Through their guidance, one can be an effective mentor, especially with those who do not have the right attitude to practice the profession (Burgess and Skinner, 1998). It is however important, when narrating to other mentors, to be clear on what the possible issues or problems may be. In other words, specific instances must be cited so that the other health professionals can judge the situation within the context of the incident (Burgess and Skinner, 1998). Examples of behaviours and observations must also be cited. During mentor observations, recording issues and problems must be done the earliest or soonest possible time in order to correct these issues and establish whether changes in attitude or practice can still be made. It is always important for mentors to also establish a plan of action and provide specific goals in order to support students (Andrews and Wallis, 1999). Plans serve as guides for students, and they serve as step by step orderly cues which the students can follow for each intervention. In many instances, it can be their checklist for each patient they handle (Chambers and Donavan, 2004). These plans can be the barometer with which each student can measure their performance and each mentor can assess their student’s performance. Failure to follow and comply with the plan for action would likely mean the failure for the student to fit into the practice (Higgs and Titchen, 2001). It is also important for mentors to recognise their accountability and responsibility in their actions and decisions, whether that decision would be on failing or not failing a failing student (Duffy, 2003). These mentors must be able to support their decisions based on their student’s actions. The above strategies may however still prove to be unsuccessful in supporting and assisting failing students. In these instances, a work-based supervisor has to prepare a formal written feedback on the student at the earliest time possible (Marsh, et.al., 2005). A tripartite meeting with the student and other parties involved in the student’s learning can also be carried out. A plan of action can then be established among all the parties, noting well the areas where the student needs to improve the most (Marsh, et.al., 2005). Formal meetings with students to discuss their progress during the placement can also be regularly carried out in order to provide feedback and to detect errors the soonest time possible. Students must, in other words, be given every chance to improve their practice (Marsh, et.al., 2005). Initial signs of failure must not be considered the only parameters of a student’s progress and ability to practice; more opportunities to manifest their abilities and to improve their knowledge and skills must therefore be provided to them (Quinn, 2008). In the end, with these considerations and if the students still cannot comply or improve, the mentor must accept that some students need to fail. In order to protect the practice, and ultimately, the patients, students who need to fail, must not be allowed to continue in the practice. Heathfield (2006) discusses that although mentors may indeed find it hard to fail students, an opportunity to discuss this possibility with students must be established. Conflict resolution must be carried out in quiet and private work settings in order to prevent any trauma to the student and to make the situation more comfortable for the mentor as well (Heathfield, 2006). Moreover, before any discussion is carried out, the parties must already agree that the purpose of the meeting is to resolve any conflicts. This would prepare all parties for the task and for the meeting. In instances where it may be difficult to carry out the meeting, a colleague who has worked with the student can be invited to join the meeting (Heathfield, 2006). This student must however be made aware ahead of time about the meeting and the persons invited to the meeting. This would prepare them for the situation and not make them feel ambushed during the meeting. The outcomes of the assessment, with details and documentation must be prepared in order to provide support for any decision which would be made on the student (Stuart, 2007). At all times however, the atmosphere created with the student must be informal and not intimidating. It must not be too informal as to create an illusion for the student as to what would be transpiring during the meeting (Heathfield, 2006). It would be cruel to make it seem like the meeting is not a serious discussion when in the end, the meeting is actually meant to deliver bad news. The general goals for the meeting must also be set prior to the meeting in order to establish thoughtful solutions and outcomes (Gopee, 2011). The meeting must not leave either party without any clearly achieved goals or results. The student must leave the meeting knowing why he or she failed and what options and alternatives he or she can then explore. During the meeting, both parties must be allowed to express their viewpoint. It is often best to allow the student to express his own assessment of his performance first. Most times, the student already knows or is aware that he is not performing up to par or that he is not progressing well in the practice (Heathfield, 2006). These comments can serve as starting points for the conversation. At which point, the mentor can then express his own assessment and observations on the student performance. Some students however may not be self-aware of their performance, especially the gaps in their practice (Heathfield, 2006). In these instances, the specific observations made by the mentor would help enlighten the student. These meetings would allow both parties to understand the viewpoint of the other party. The opinions raised during the meetings are no longer just opinions but are well-supported observations (Levett-Jones, et.al., 2009). In effect, the meeting is a constructive meeting and not one which is subjective or personality-based. Conclusion The above discussion indicates the importance of establishing a competent nursing practice and therefore the importance of failing students who are failing their nursing education and placement. The role of the mentor and supervisor in these instances is important. Failing to fail students can be disastrous for the general public and it can undermine the overall efficacy of the profession. Mentors need preparation and support in dealing with underperforming students and where they are confronted with problematic students, they also need the extra time and guidance to carry out their full professional responsibility. More importantly, there is also a need to acknowledge the fact that many students need to fail. If students are to be given a chance to prove that they deserve to be in the practice, mentors must be able to support their decisions with adequate evidence. Moreover, the best interests of the student as well as the profession and the general public must be within the realm of the mentor’s decisions. In effect, students who deserve to fail should not be allowed to enter the practice. Failing students must therefore fail and mentors must keep the gates of the nursing profession well-guarded. This study implies that mentors need to be honest and objective at all times, even when difficult decisions on student’s performance have to be made. For students, it is incumbent upon them to take advantage of the opportunities for learning given by mentors, and to possibly accept that the nursing profession may not be meant for them. Finally, for the organization, opportunities for students to explore and improve their skills must be considered at all times. Specific standards must also be set for students and mentors to follow. References Andrews , C., 2000. Student and mentor perceptions of mentoring effectiveness. Nurse Education Today, 20, 555-652. Andrews, M. and Wallis, M., 1999. Mentorship in nursing: a literature review. Journal of Advanced Nursing, 29 (1), 201 -207. Bayley, H., Chambers, R., and Donovan, C., 2004. The good mentoring toolkit for healthcare. London: Radcliffe Publishing. Burgess, R., Phillips, R., and Skinner, K., 1998. Practice placements that go wrong. Journal of Practice Teaching, 1 (2), 48 – 64. Burnard, P., 1990. The Student experiences: adult nursing and mentorship revisited. Nurse Education Today, 10, 352. Calman, L., Watson, R., Norman, I., and Redfern, S., 2002. Assessing practice of student nurses: Methods, preparation of assessors and students views. Journal of Advanced Nursing, 38, (5), 516 – 523. Chapple, M. and Aston, E., 2004. Practice learning teams: a partnership approach to supporting students’ clinical learning. Nurse Education in Practice, 4 (2), 143 – 149. Duffy, K., 2003. Failing students: a qualitative study of factors that influence the decisions regarding assessment of students' competence in practice. Glasgow: Caledonian University. Foster, T. and Hawkins, J., 2004. Performance of Understanding: a new model for assessment. Nurse Education Today, 24, 333 – 336. Gainsbury, S., 2010. Mentors admit to passing bad students. Nursing Times, 106 (16), 1–3. Gopee, N., 2007. Mentoring and supervision in healthcare. London: SAGE. Hand, H., 2006. Promoting effective teaching and learning in the clinical setting. Nursing Standard, 20 (39), 55 – 63. Heathfield, S., 2006. Why People Avoid Conflict Resolution. About.com [online] Available at: http://humanresources.about.com/cs/conflictresolves/a/conflictcourage.htm [Accessed 09 June 2012. Higgs, J. and Titchen A., 2001. Practice Knowledge and Expertise in the Health Professions. London: Butterworth-Heinemann. Hilton, P. and Pollard, C., 2005. Enhancing the effectiveness of the teaching and learning core clinical skills. Nurse Education in Practice. Hunt, L., McGee, P., Gutteridge, R., and Hughes, M., 2011. Assessment of student nurses in practice: A comparison of theoretical and practical assessment results in England. Nurse Education Today [online] Available at: http://www.wlv.ac.uk/PDF/Assessment%20of%20student%20nurses%20in%20practice.pdf [Accessed 09 June 2012]. International Council of Nurses, 2006. Continuing competence as a professional responsibility and a public right. Geneva: ICN. Levett-Jones, T., Lathleen, J., Higgins, I., and McMillan, M., 2009. Staff- student relationships and their impact on nursing students 'belongingness and learning’. Journal of advanced nursing 65(2), 316-324. Lofmark, A. and Wikblad, K., 2001. Facilitating and obstructing factors for development of learning in clinical practice: a student’s perspective. Journal of Advanced Nursing, 34 (1), 43 – 50. Marsh, S. Cooper, K. Jordan, G. Merrett, S. Scammell, J. and Clark, V., 2004. Assessment of students in health and social care: managing failing students in practice. Practice-based learning [online] Available at: http://www.practicebasedlearning.org [Accessed 09 June 2012]. National Health Services, 2010. Supporting the underachieving student: a guide for mentors. A resource for mentors in practice [online] Available at: http://staff.napier.ac.uk/faculties/fhlss/mentorcentre/Documents/Supporting%20the%20underachieving%20student%20workbook.pdf [Accessed 09 June 2012]. Neary, M., 2000. Supporting students’ learning and professional development through the process of continuous assessment and mentorship. Nurse Education Today 20, 463 – 474. Nursing and Midwifery Council, 2005. Guideline for Records and Record Keeping. London: NMC. Nursing and Midwifery Council, 2008. Standards to support learning and assessment in practice. London: NMC. Pellet, G., 2006. The role of mentors in supporting pre-registration nursing students. British Journal of Nursing, 15(6), 336-340. Quinn, F., 2008. The principles and practice of nurse education. London: Nelson Thornes. Royal College of Nursing, 2007. Guidance for mentors of nursing students and midwives: An RCN toolkit [online] Available at: http://www.rcn.org.uk/__data/assets/pdf_file/0008/78677/002797.pdf [Accessed 09 June 2012]. Seekland, J., 2002. Nursing students with learning disabilities. Journal of Nursing Education, 41 (8), 334 – 339. Sharp, M., 2000. The assessment of incompetence: practice teacher’s support needs when working with failing DipSW students. Journal of Practice Teaching, 2 (3), 5 – 18. Stew, G., 2005. Learning together in practice: a survey of inter-professional education in clinical settings in South East England. Journal of Inter-professional Care, 19(3), 223 – 235. Stuart, C., 2003. Assessment, supervision and support in clinical practice: a guide for nurses, midwives and other health professionals. London: Elsevier Health Sciences. South African Nursing Council, 2008. Nursing strategy for South Africa [online] Available at: http://www.sanc.co.za/pdf/nursing-strategy.pdf [Accessed 09 June 2012]. Walsh, C., Gordon, F., Marshall, M., Wilson, F, Hunt, T., 2005. Inter-Professional capability: a developing framework for inter-professional education. Nurse Education in Practice 5, 230 – 237. Watson, R., et al., 2002. Assessing clinical competence in student nurses. Journal of Clinical Nursing 11, 554 – 555. Read More