for these failing students, yet they did not contribute to the concerns raised by the mentor with the university, nor appear to play a part in the final decision taken. One mentor’s comments clearly illustrates this separate and limited role
commenting that, ‘I mean her book was never completed and we gave her some
leniency on that’. (Student N, Mentor 14: 405).
6.2.2 Managing learning and development
Mentors plan and oversee student development through a process whereby learning objectives are agreed and learning opportunities identified; mentors set targets and then judge student development against these. Agreeing learning objectives may be directed by student needs arising from the stage of their programme, a
development plan set by university, as well as influenced by previous experiences. For example:
‘At the sign off placement we always focus a lot on drug administration. We try to do a lot of drug rounds with them because obviously there is a lot to do. And we try to start this after the first week after we have identified that, well after they have got their PIN they are doing it by themselves... Some might want to spend more time working in bay looking after their patients, doing the washing particularly if they are coming into the second year where they might not have had a great deal of ward experience.’ (Student M,
Mentors 13a & b: 93-99)
‘Well you sit down and you find out exactly what her objectives are, what she needs to achieve, while she's here. And also working in the different areas of the Department, what she is needing. It's getting the feel for what her needs are. And obviously we need to make sure as well that she is capable of looking after patients, assessing patients and it's obviously
making sure that she understands the processes as well.’ (Student I, Mentor
9: 49-54)
‘I like to set them together. I've seen a university where they set all the objectives with a guide for the students, but I think it's equally important for the student to set their own objectives as they might have got to that final stage and not done something and like IM injections.... So they might have specific objectives that they want to meet, but you should also set some objectives together, that are tailor-made to your practice area.’ (Student
AO, Mentor 41: 33-39)
However some learning objectives that students come with may not be readily achievable in the area:
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‘The classic one is I need to look after a dying patient... (laughs)...we will do our best!! Can't promise... quite a few of the patients survive (laughs) or we send them to ICU... But the students still seem to….., and I can understand it, with their workbooks and things, have it in their head I need to, I need to give an IM injection, I need to do this and……if they're last placement they come to us with a lot of it being filled in and there's just these odd ones. And as I say they can be very, the ones that are left to the end... and I think how we going to get through that?’ (Student G, Mentor
7: 137-144)
This process of agreeing learning objectives is important for mentor decision making as it not only sets outcomes which fit the practice area, but it also
contributes to initial judgements that the mentor may form about their student as illustrated below:
‘I think, this student was really good and she identified exactly what she felt she needed to do to equip her with the skills to be a qualified nurse.’
(Student P, Mentor 17: 155-156)
‘She did show me her book with her development plan from the university….. briefly she did, but she didn’t comment on the things she needed to do.’ (Student Z, Mentor 41: 415-417)
‘I think generally we look a lot at the skills book, to see where they are at with their skills, because you would get a lot... Especially for the final placement you would expect them to be more or less completed. She was quite vague about why they weren't done....' I thought I'd get round to it' or... It was always she hadn't got round to it or she seemed a little bit disorganised in her approach to everything... We were concerned from the start that the skills book was so empty.’ (Student N, Mentor 14: 87-93)
Students who are organised and clear in what they need to achieve in practice provide the mentor with a positive image of themselves, with the converse also holding true. In particular noting a lack of organisation and past achievement of clinical skills when agreeing learning objectives, contributes to any initial concerns that a mentor may have about the student.
It would appear then, that a mentor’s management of learning and their initial judgements are inextricably linked. This remains the case as the placement
progresses, with judgements formed and student’s moved on as a result of regular reviews as indicated:
‘And then I'll say if they are a final placement student, at the end of two or three weeks, we'll see how you are and then you'll be able to look after one patient with support. And then as we go, as we progress, and see if they're doing that, or go back a step, and if they're not, go back another step. And if they are, we will progress on to 2 patients.’ (Student G, Mentor 7: 109-
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‘You set the target more at your interviews and say that maybe you will go out with this nurse specialist, and learn about this or whatever or we are going to start working towards your managing a bay of patients. I suppose on a daily basis, as time goes on, if they get more competent and you say right you take these four patients and tell me what you are going to do today and get them to start learning how to plan their day and deliver the care. We do that daily and then see if things are going all right.’ (Student AI,
Mentor 35: 101-108)
For final placement students, these reviews may occur formally or informally as part of the NMC requirement for weekly meetings (3.2.6, NMC 2008a).
‘It may be a five-minute chat for one of the weekly meetings, the next one
might be 20 min you know, depending. It is me really asking 'how are you getting on? What have you learnt? What are your objectives going forward? Are you on track? You know do you feel you are on track? And then giving any feedback that I have had.’ (Student Y, Mentor 26: 106-110)
‘I think the weekly meetings are good, although from experience I don't think you can do a weekly meeting, it's just not (laughs)... You just can't do it, but you set objectives each week and you can say this week what are you going to concentrate on, what you think most important? Looking at the ward, so-and-so is going for a PEG, what do you think is most important about that, so let's concentrate on that this week. See what you can learn from it. Look at how endoscopy works... You know and just try and set objectives week by week.’ (Student AO, Mentor 41: 74-87)
Overall mentor comments suggest a continuous process of managing a student’s development, informed by initial impressions of a student and based upon a review and identification of learning needs. Judgements are then made in relation to student achievement against agreed learning objectives and new targets set. As a placement continues the pace of target setting may slow down from midpoint interview, particularly in the final placement, with targets more focussed upon
‘Consolidating everything so that actually they are ready to just be let loose’.
(Student G, Mentor 7: 330) so that the student ‘Feels comfortable that they can do
it’. (Student AO, Mentor 41:290). Talking with the mentor of student ‘AK’ illustrates
clearly this continuous process of target setting and the impact upon judgements and the final decision taken:
‘But I found it very difficult because if I said to her, right you need to
concentrate, and you need to do this, go away and do it and I knew that she would go away and do it and that's why at the end of the day I passed her because she did everything that I asked her to do. But I don't think that she will have continued that in practice. Particularly when you have asked someone to do something and they do, how do you fail them on…….. I don't know, it was hard. She was a very hard person I mean... .’ (Student AK,