Role Models, Mentors and Socialisation

As outlined previously, student nurses in the UK are exposed to nursing in practice intermittently within ‘placements’ throughout their 3 year programme, amounting to 50% of their programme activity, and the primary support for student learning and assessment in practice in the UK is through the role of practice mentor (NMC, 2006; NMC, 2010). Exposure to practice involves observing and working alongside role models, such as mentors, and this is seen as an important part of students’ learning and socialisation into professional behaviours (Belinsky and Tataronis, 2007).

Exemplary role models exist in nursing and Perry (2009) identified the traits and behaviours that made nurses excellent role models. Through interviews with eight ‘exemplary role models’, randomly selected from names put fon/vard by their own nursing colleagues as examples of staff they would most want to care for them, the traits and behaviours of the excellent role model emerged. Despite the research only utilising data from eight participants it has concept validity, as the behaviours identified as ‘excellent’ were those identified within NMC and DH guidance on the expected ideals within nursing practice (NMC, 2008; DH, 2008a). Perry’s findings resonated with previous research on the expectations of patients from their nurses (Bridges and Nugus, 2009), such as that they attended to ‘the little things’ that made a difference to patients, qualities and behaviours previously identified within the definitions and expectations of compassionate practice. Other valued behaviours

were ensuring the maintenance of dignity and using ‘gentle hands’. Perry (2009) found it was not ‘what is done’ but ‘how it is done’ that matters when identifying good role models. It is interesting to note that the role models’ behaviour towards students was also a factor, with excellent role models ‘connected’ to those they were working with, having genuine empathy with the learner (Perry, 2009). This finding supports the importance of the learning environment in terms of the people from whom students learn (O’Driscoll et al., 2010; Smith, 2012). It is understandable why students would actively seek out such role models as they were aware that this enabled a better learning relationship to develop, as seen within the ‘belongingness’ literature already discussed.

Despite examples of good role models, there have been many reports of students observing clinical behaviour that served as a poor role model. Observing and being involved in unethical practice can leave students feeling a sense of failure, despair, disappointment, turmoil, agitation, shame, anger and depression (Erdil and Korkmaz, 2009). The study undertaken by Erdil and Korkmaz (2009) in Turkey used open-ended questionnaires with student nurses (n=153) and identified some key features of concern. The students had all witnessed situations where ethical problems arose in practice, such as physical maltreatment by health professionals, psychological maltreatment, ignoring patient privacy, and other acts that were not considered ethical within healthcare practice. Although Erdil and Korkmaz (2009) acknowledged that Turkey’s healthcare system lacked many of the advantages of other healthcare systems around the world, such as environments that were not conducive to privacy within hospital wards, they also emphasised that nursing practice should still maximise adherence to legal regulations and patients’ rights within healthcare institutions and students should still be taught to respect and safeguard their patients. They concluded that student nurses were not internalising the ethical principles taught to them during their professional preparation, and that on-going support was required to ensure on­ going ethical behaviour (Erdil and Korkmaz, 2009). This research indicates a practice reality that is at odds with professional ideals. However, the ethics within their research is

questionable as there appears to have been no protection of the participants’ anonymity, with questionnaires distributed at the end of a class and returned directly to the researcher who was also one of their University teachers. This could have impacted upon the participants’ sense of confidentiality in answering the open-ended questions truthfully (RCN, 2009a). It must however be noted that the researchers acknowledged that their school of nursing in Turkey had no access to an institutional research ethics committee.

Mentor support for UK students in practice has been researched considerably over the last 20 years and links closely with the literature on role modelling already discussed, as mentors provide learning opportunity for students who observe the mentor’s practice. Mentorship has been shown to be an important factor in student nurse socialisation and retention (Pearcy and Elliott, 2004; Donaldson and Carter, 2005; Kilcullen, 2007). However, the delivery of practice based teaching and assessing by mentors can be negatively affected by the increased student numbers that put pressure on mentors (Murray and Williamson, 2009) and a lack of recognition for what they do (Bray and Nettleton, 2006). Mentors have also been shown to find the simultaneous roles of teacher and assessor difficult to enact, leaving them feeling vulnerable or guilty when they need to fail a student (Bray and Nettleton, 2007; Wilkes, 2006).

Support for mentors and student learning in UK clinical environments has been shown to be variable in quality and provided by combinations of staff, some employed within Universities, some within new management and leadership roles such as Modern Matrons, and some within new practice based nurse teaching roles (Chappie and Aston, 2004; Burns and Paterson, 2005; Allan and Smith, 2005; NMC, 2006; Carlisle et al., 2009; O’Driscoll et al., 2010; Smith, 2012). One of the more common collaborative approaches to student nurse learning and mentor support in practice within the UK has been identified as through the role of University based Link Lecturers, but tensions have been shown to exist between the collaborative working of practice staff and university staff (Andrews et al., 2006). Through the use of focus group discussions with current student nurses (n=7) and telephone

interviews with students who had recently completed (n=30), Andrews et al. (2006) found that mentors and RNs felt unsupported and demoralised. According to Smith (1992), feeling supported enables nurses to support their patients, and so this in turn could be another factor in furthering understanding of socialisation in compassionate practice. These feelings of having no support for their mentorship role left mentors unable to provide a positive learning environment for students (Andrews et al., 2006). The research concluded that mentors’ needs must be considered by student nurse education programmes, particularly with regard to improved communication channels with the HEI for accessing support. Despite the variability in the way UK Universities and NHS practice placements structure their student support networks, this study’s findings indicated that practice leaders and the academic staff needed to work more collaboratively if the student experience was to meet their learning needs (Andrews et al., 2006) and thereby possibly the needs of compassionate practice provision.

Mentors have been the target of extensive research over the last 15 years, primarily within small scale studies related to the introduction of their role in the 1990’s (Jinks, 2007). In a critical and systematic review of the literature on research using UK mentors as participants. Jinks (2007) found the approaches used and outcomes from such research raised the importance of reconsidering the implication of mentors as targets for research. The majority of studies had very poor response rates (mostly less than 50%) and this was explained through the mentors’ workload pressures. Some studies encouraged response rates through follow-up phone prompting, although this in turn could be seen as an unacceptable additional extra pressure on already busy people. Jinks concluded that further research with mentors required careful consideration by ethics committees, and the methodological approaches used in any future research using mentors would need to enhance the sample size so more meaningful results were possible. Although research exploring student nurse socialisation could be seen as related to mentor experiences of student nurse support in practice. Jinks (2007) stressed that future research using mentors as participants required

more critical appraisal in terms of ethical research practice, and alternative sources of data found if possible.