Developing mentors to support students in practice, Part 8 Assessment and Accountability: 3 –Accountability and Sign Off mentors
Summary
Responsibility and accountability are essential concepts that mentors and practice teachers need to explore as part of their role in supporting learning and assessment of students in practice. Mentors and practice teachers within the United Kingdom (UK) are required by the Nursing and Midwifery Council (NMC 2008a) to demonstrate that they have met NMC (2008a) Standards to Support Learning and Assessment in Practice (SSLAP). This article is part of a series of eleven which relates to these standards of which this is part 8 and the final part that considers assessment in practice. It will provide a brief recap on the history of the development of the SSLAP followed by exploration of the responsibility, accountability and ethical issues of the mentor and practice teacher in relation to the assessment process along with application of the ethical principles. The sign off mentor role as well as ‘due regard’ will be discussed. The meaning of competence and partnership working when making assessment decisions will finally be explored. Much like the other two articles on assessment the issues discussed directly relate to the third domain and outcomes of the NMC (2008a) SSLAP named ‘Assessment and Accountability’.
Recap on the history of the development of the Standards to Support Learning and Assessment in Practice (SSLAP).
the standards had a minor review to bring them in line with the new register (NMC 2008a). Following on from this in August 2006 the NMC (2008a) published the Standards to Support Learning and Assessment in Practice (SSLAP). This was due to a complete review of the previous standards that took place in 2003 along with consideration of the NMC (2005) consultation on fitness to practice at the point of registration. There were overlapping issues from both consultations in relation to quality and support for learning and assessment in practice (NMC 2008a). Since the publication of the SSLAP all students whom are on an NMC approved programme from September 2007 have been required to be supported and assessed in practice by the relevant practitioners who have attained the relevant qualifications (NMC 2008a). An in-depth account of the SSLAP (2008a) can be found in part one of the series named Developing Mentors to Support Students in Practice. Part 1: Standards to Support Learning and Assessment in Practice. Supervision, support and assessment of student performance remain an important part of the work of registered nurses, midwives and specialist community practitioners (Casey and Clark 2011).
Learning Activity 1
Take some time to reflect on the above discussion.
What does ‘to be responsible’ mean to you? Explain what it means to be accountable – who are practitioners accountable to and in what ways? Now locate and read your relevant professional code of conduct. How does this apply to your role and responsibilities in terms of being a mentor or practice teacher?
Make a note of all of the elements within the code that relate to your role as a mentor and practice teacher and how they apply.
Responsibility and Accountability
In accepting the role of a mentor and practice teacher, Gopee (2011 pg. 224) states that they are implicitly accepting responsibility and accountability for maintaining the standards of supervision and assessments. Now complete learning activity 1.
Learning Activity 2
Read through and take some time to reflect on the given mentor and student scenario below.
A mentor or practice teacher had been mentoring a student for a number of weeks. The student was half way through their programme of study and the mentor or practice teacher had arranged to complete the student’s midpoint assessment. The mentor or practice teacher had some concerns regarding the student’s abilities with a number of specific competencies at this time but did not highlight any of these to the student. During the final assessment the mentor or practice teacher provided
feedback to the student regarding their strengths in relation to the competencies. The mentor then discussed the areas of concern with the student and informed them that they had not met the minimum standard. The student became very distressed and expressed to the mentor or practice teacher that they had always performed well previously in practice but during this placement had been experiencing some personal difficulties at home which had affected their performance. The student went onto to explain that they did not want to fail the placement. Nursing is all they have ever wanted to do. The mentor or practice teacher listened to the student’s issues and concerns and then gave them the benefit of the doubt. By the end of the final assessment the mentor or practice teacher passed the student.
What are the ethical issues that may arise within this scenario?
Ethical Principles
Ethics is a generic term for various ways of understanding and examining the moral life (Beauchamp and Childress (2001). Butts and Rich (2013) explain that ethics is the study of ideal human behaviour and existence, focussed on understanding the concepts of and distinguishing between right and wrong. There are five widely accepted sets of principles of ethics which apply directly to mentoring. According to Gopee (2011), these include: The value of life, goodness and rightness, justice and fairness, truth telling and honesty and individual freedom; see Table 1 for how these apply to mentorship. Two other main ethical principles from Beauchamp and Childress (2001) can also be applied when supporting learning and assessment in practice; Non-maleficence and Beneficience. Non maleficence is the ethical norm that advocates no harm to service users (Wheeler 2012). Beneficence is the ethical principle in relation to ensuring that service users benefit from the caring relationship. It is about balancing the benefits against the risks, costs and ensuring that all things considered service users receive the best possible care (Wheeler 2012).
your decisions’. Therefore Casey and Clark (2011) purport that it is vital the student – mentor or practice teacher relationship remains a professional partnership and one that has clear boundaries that differentiate the differing roles a mentor and practice teacher plays. There is a need to balance the supportive nurturing role with that of the assessor role in order to make objective, unbiased assessment decisions (Casey and Clark 2011). Practitioners are accountable to the professional bodies regarding the decisions they make in relation to the student’s competence. Thus there is acknowledgment by the NMC that mentors and practice teachers especially the sign off mentor who are signing off proficiency need to recognise their additional accountability and be aware of their obligations to protect the public. Reassuringly Middleton and Duffy (2009) in their qualitative study with a small number of community nurses found that mentors appeared to be acutely aware of their accountability but did have some concerns about being held accountable.
need to be assessing a student’s enthusiasm, compassion, along with the student’s attitude towards caring, dignity, respect and integrity of patients (Gopee 2011).
Nurses and midwives are accountable to themselves, the public and have a duty of care which they need to consider carefully when delegating work to someone who is not on the NMC register. Even though they may delegate the responsibility for caring for a particular service user the mentor or practice teacher remains accountable for ensuring the student performs the delegated interventions to the required standard and should ensure appropriate levels of supervision or support are in place (Gopee 2010). The NMC (2008b) affirms that the interest of the service user is paramount and they must come first. Thus accountability to the service user is more important than accountability to the student. It is the quality of patient care which is at stake and it is this that the mentor or practice teacher is ultimately accountable for (Walsh 2010). Mentors and practice teachers must balance the benefits of delegating clinical interventions to students and the level of supervision required so that they ensure a service is not put at risk at any time whilst in their care, thus linking to the ethical principle of beneficence. To summarise it is around maintaining the safety of those in care (NMC 2008b pg. 5).
The NMC have introduced and enforced the SSLAP (NMC 2008a) which clearly confirms those who can support and assess students who are on an NMC approved programme that they have the relevant qualifications and are prepared to do so. More importantly the NMC have introduced the sign off mentor role who is responsible for confirming that students have met the required standards of proficiency (NMC 2008a).
Sign off mentors and Due regard
Learning Activity 3
What do you understand by the term ‘due regard’. Make some initial notes of your first thoughts regarding this and what it entails.
mentor. Conversely, the number of focus groups and participants within the focus groups are somewhat small.
To become a sign off mentor a qualified mentor is required demonstrate that they have met additional criteria as listed in box 2. Once they have provided this evidence they can have this role annotated next to their name on the live register of mentors and practice teachers and thus are entitled to sign off a student’s proficiencies. Durham et al (2012) stress though that a sign off mentor must have the knowledge and skills to undertake a robust, equitable and fair assessment. The NMC (2008a) assert that the sign off mentor should be allowed protected time equating to one hour per week in addition to working with the student at least 40 per cent whist undertaking this role. However, the NMC recognises as part of interprofessional learning other practitioners and various placements will contribute to the students learning and assessment in practice (NMC 2008a). These practitioners will enable students to gain a breadth of experience but do not normally involve an assessment of the students practice that relates to the competencies related to the profession they intend to enter. In such placements the most appropriate person would assess the related outcomes which would be the professional who has the knowledge and experience in that area of practice. Now complete learning activity 3.
Learning Activity 4
What do you understand regarding the term ‘sign off’ mentor? Explain your thoughts regarding this role and what you understand this role entails, including the roles and responsibilities. In the given scenario below if you were a ‘sign off’ mentor what action would you take?
You are mentoring a student in their year 3 final placement. Unfortunately the first interview did not occur until day 10 of the placement which was then rushed due to the business of the placement area. At the midpoint assessment you check the students ‘On-going Record of Achievement' you notice that the previous 2 years have been exemplary. You have worked with them on numerous occasions and you have spoken to the team regarding their progress and they state that the student is not progressing well in relation to their attitude, communication skills and not taking responsibility for their own learning. You have also gathered feedback from a small number of patients regarding their progress. At the midpoint assessment you briefly discuss your concerns but the student informed you that they felt they had not settled well during this placement and they have struggled with their objectives. You then set an agreed action plan in order to assist the student to improve and progress.
1. What would you include in this action plan? Whom should you contact for support and advice?
2. What documents should you look at within week 1 of the practice placement in order to make an accurate assessment of the student’s previous progress and learning needs.
The student continued in the placement and you worked with them at every opportunity. At the final assessment you fail the student on several domains, but the student felt aggrieved and stated that they felt unsupported.
3. In your role as the sign – off mentor explain what should do in this situation?
4. What went wrong in the above scenario? What should have been done to ensure the student had a better assessment process?
Learning Activity 5
What do you understand regarding the term ‘competency’? Provide a definition of ‘Competency’
Accountability for confirming students have met or not met the required standard of proficiency for registration.
In order for mentors, sign off mentors and practice teachers to be fully aware of their responsibility and accountability regarding the decisions they make the need to understand the term competency is essential. Now complete activity 5
Defining competence
been reached. It is vital that the mentor or practice teacher identify the level the student is to be taught and assessed in order to maximise learning (Hand 2006). Nevertheless according to Cassidy (2009) judgments about what it means to be competent may be complicated by the mentors or practice teachers subjective interpretations. According to Sherwin and Muir (2011) assessment is subjective as it is concerned with the relationship of the mentor or practice teacher as the observer and the student being observed (Sherwin and Muir 2011). Therefore, there is an imbalance of power which may cause a number of ethical dilemmas. Assessment can be seen as a threat, intrusive and generate uncertainty. However, assessment is essential because it will create opportunities for students to develop, realise their potential, but also highlight deficits (Sherwin and Muir 2011) therefore a necessity for mentors and practice teachers. Essentially though mentors and practice teachers should use multiple methods of assessment before confirming a decision of whether a student is competent or not and ideally should be seeking feedback from colleagues. For a more in-depth discussion on methods of assessment see part 6 of the series named; Developing mentors to support students in practice, Part 6 Assessment and Accountability; 1 – Assessment in practice.
Partnership working with other members of the teaching team
part in student assessment thus the named mentor or practice teacher must consult with others. During this consultation it is important to enquire fully about the student’s progress, where they active in patient care, did they appear to be learning and developing (Price 2012). Price (2012) went on to say that this will help eliminate any possible bias, appraise student performance in a variety of situations, obtain several views of the student’s ability and determine whether the student understands the issues and professional behaviour. Asking several colleagues will enable the mentor or practice teacher to make a decision about the student’s competence. Kinnell and Hughes (2010) also support the need to liaise with colleagues regarding student progress especially as the placement end approaches. However it is the sign off mentor that makes the final decision.
Portfolio development
The third domain of the SSLAP includes ‘Assessment and Accountability’ (Box 3). By completing the above ‘learning activities’ included in this article the work produced will provide appropriate evidence towards this domain and outcomes. In addition, if you have also read and completed the learning activities within the previous two articles from the series on assessment and accountability you should have already generated evidence towards this domain. Once you have completed all the learning activities you should map and cross reference these against the relevant NMC (2008a) SSLAP (see box 4) as the evidence will also meet a number of the other eight domains.
Summary
References
Beauchamp T.L, Childress J.E (2001) Principles of Biomedical Ethics, Fifth edition, Oxford University Press, New York
Brown L, Douglas V, Garrity J, Shepherd C.K (2012) What Influences Mentors To Pass Or Fail Students, Nursing Management, 19, 5, 16-21
Butts J. B, Rich K.L (2013) Nursing Ethics across the curriculum and into practice, Third edition, Jones & Bartlett Learning, Burlington.
Casey D C, Clark L. (2011) Roles and responsibilities of the student nurse mentor: an update. British Journal of Nursing, 20, 15, 933-937.
Cassidy S (2009) Interpretation of competence in student assessment, Nursing Standard, 23, 18, 39-46
Duffy K (2003) Failing Students: A qualitative study of factors that influence the decisions regarding assessment of students competence in practice, NMC London
Durham W.J, Kingston P, Sykes C (2012) Implementing a sign off mentor preparation workshop – A tripartite approach, Nurse Education Today, 32, 273-277
Francis R (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Enquiry: Executive Summary, The Stationary Office, London
Griffith R, Tengnah C (2010) Law and professional issues in nursing, second edition, Learning Matters, Exeter.
Gopee N (2010) Practice Teaching in Healthcare, London, Sage.
Gopee N (2011) Mentoring and Supervision in Healthcare. 2nd Edition, London Sage. Hand H (2006) Assessment of learning in clinical practice, Nursing Standard, 21, 4, 48-56 Kinnell D, Hughes P (2010) Mentoring Nursing and Healthcare Students, Sage London. Luhanga F, Yonge O, Myrick F (2008) ‘Failure to assign failing grades’, issues with grading the unsafe student. International Journal of Nursing Education Scholarship, 5,1, 11-14
Middleton R, Duffy K (2009) Mentoring a student immediately prior to registration: a qualitative study. British Journal of Community Nursing, 14, 11, 481-486
Nursing and Midwifery Council (2004), Standards for the preparation of teachers on nurses, midwives and specialist community public health nurses. NMC, London.
Nursing and Midwifery Council (2008a) Standards to Support Learning and Assessment in Practice. Second edition, NMC, London.
Nursing and Midwifery Council (2008b) The Code- standards of conduct. Performance and Ethics for Nurses and Midwives. NMC, London
Price B (2012) Key principles in assessing students’ practice-based learning, Nursing Standard, 26, 49, 49-55
Quinn F.M, Hughes S,J (2007) Quinn’s Principles and Practice of Nurse Education, Fifth edition, Nelson Thornes, Cheletenham
Sherwin S, Muir F, (2011) Assessing and evaluating students on placement. British Journal of School Nursing, 6, 5, 233-236
Walsh D (2010) The Nurse Mentor’s Handbook. Supporting Students in Clinical Practice, Open University Press, Berkshire.
Box 1
Role and responsibilities
The NMC (2008a pg. 19 and pg. 22) clearly state that mentors and practice teachers are responsible for:
Organising and co-ordinating student learning activities in practice
Supervising students in learning situations and providing them with constructive feedback on their achievements
Assessing the total performance – including skills, attitudes and behaviours
Liaising with others to provide feedback, identify any concerns about student’s performance and agree action as appropriate.
Setting and monitoring achievement of realistic learning objectives in practice. (Practice Teachers)
Provide evidence as required regarding the student’s achievement or lack of achievement. (Practice Teachers)
Providing evidence for, or acting as, sign off mentors with regard to making decisions about achievement of proficiency at the end of a programme. (Mentors)
Signing off achievement of proficiency at the end of the final period of practice learning or a period of supervised practice. (Practice teachers)
Box 2
Criteria to become a sign off mentor (NMC 2008a)
To have clinical currency and capability in the field of practice in which the student is being assessed.
A working knowledge of the current programme requirements, practice assessment strategies and relevant changes in education and practice for the student they are assessing
An understanding of the NMC registration requirements and the contribution they make to the achievements of these requirements.
An in-depth understanding of their accountability to the NMC for the decision they must make to pass or fail a student when assessing proficiency requirements at the end of a programme.
Been supervised on at least 3 occasions for signing off the proficiency by an existing sign off mentor.
Table 1
5 ethical principles relating to mentorship (Gopee 2011)
Principle How it relates
The value of life Ensuring that students develop the necessary competencies and acquiring the necessary knowledge, skills and attitudes to register as a nurse and midwife
Goodness and rightness Doing good to the students and patients and service users and doing the right things Justice and fairness Ensuring that students acquire the necessary
knowledge, skills and attitudes in appropriate depth
Truth telling and honesty Ensuring correct information is given Individual freedom Students having freedom in deciding the
amount and type of learning and with
Box 3
NMC (2008a) SSLAP
Domain 3 – Assessment and Accountability Stage 2 - mentor
• Foster professional growth, personal development and accountability through support of students in practice
• Demonstrate a breadth of understanding of assessment strategies and ability to contribute to the total assessment process as part of the teaching team.
• Provide constructive feedback to students and assist them in identifying future learning needs and actions. Manage failing students so that they may enhance their performance and capabilities for safe and effective practice or be able to understand their failure and the implications of this for their future.
• Be accountable for confirming that students have met or not met the NMC
competencies in practice and as a sign-off mentor confirm that students have met or not met the NMC standards of proficiency and are capable of safe and effective practice
Stage 3 – Practice teacher
• Set effective professional boundaries whilst creating a dynamic constructive teacher – student relationship
• In partnership with other members of the teaching team use knowledge and experiences to design and implement assessment frameworks.
• Be able to assess practice for registration and also at a level beyond that of initial registration
• Provide constructive feedback to students and assist them in identifying future learning needs and actions, manage failing students so that they may enhance their performance and capabilities for safe and effective practice or be able to understand their failure and the implications of this for their future.
Box 4
Domains (NMC 2008a)
Establishing effective working relationships Facilitation of learning
Assessment and accountability Evaluation of learning
Creating an environment for learning Context of practice
