Developing mentors to support students in practice, supporting students in practice, Part 10: Leadership (word count 4574)
Summary
There is a strong correlation between effective leadership in nursing and the provision of high quality care to patients (Harris et al 2014). Recent revelations in relation to poor care
practices within the nursing profession, have highlighted the need for strong leadership in the healthcare setting (Francis 2013). Mentors and practice teachers are required to demonstrate
leadership as part of both their nursing and facilitative role. In addition they are responsible for developing effective leadership skills within their students who once registrants, will be expected to demonstrate these skills in practice.
This article aims to provide guidance for both new and established mentors and practice teachers in relation to the domain of Leadership, specifically stage 2 Mentor and stage 3
Practice teacher, (the specific outcomes can be found in Box 1). How mentors can foster these skills will be discussed in relation to leading by example; the text will be interspersed with these outcomes for mentors and practice teachers where they apply. The activities
indicated within this article will provide the opportunity for mentors and practice teachers to generate evidence in order to map this on-going development against the NMC Standards to
Support Learning and Assessment in Practice (SSLAP 2008a).
Introduction
Although there are many definitions of leadership one which lends itself well to the mentor
and practice leadership standard, is that of Rafferty (1993) who suggests that leaders inspire, facilitate, help and praise’. These are important facets of leadership when supporting student
practice teachers. O’Driscoll et al’s (2010) study suggests that although other members of the team have responsibilities in terms of student learning, the mentor/practice teacher is the one
who is primarily concerned with leading this on a day to day basis. Such skills involve effective communication and interpersonal skills, self-awareness and being able to time manage, prioritise and delegate appropriately (Craig and Smith 2015). Brimblescombe (2009)
suggests resilience, empathy and trustworthiness are important in developing leadership skills. Moreover, these skills should be developed within students in order to enhance their
own practice when they become registrants and then mentors / practice teachers themselves. More specifically students can observe and learn from those who facilitate their learning, identifying certain attributes which are influential in effective leadership (Ousey, 2009).
Craig and Smith (2015) emphasise the need to equip students of healthcare with the skills to recognise poor practice and to ensure good practice through change. Leadership is a skill
crucial to the role of the nurse/practice teacher in clinical settings in that they are responsible for all aspects of the organisation of care; this organising of care allows the mentor/practice teacher to demonstrate clear leadership skills and behaviours (Craig and Smith 2015). Ailey
et al (2015) assert that through the observation leadership skills in their mentor/practice teacher and others, students are able to learn and practice such skills within the context of a
clinical environment. Furthermore, they are able to see how leadership can move from leading on individual patient care to that of the nursing team. Indeed Lord Willis (2012) identified the need to prepare future nurses for what would be expected of them in relation to
Why are effective leadership skills important?
The NHS’s forward view into action: planning for 2015/16 (2014) identifies effective clinical
leadership as a necessity in implementing new care models in response to the changing needs of patients. Manley (1997 in Gopee 2010 pg 131) identifies a correlation between quality of care and effective nursing leadership; in addition successful leadership can enable practice
development, and the empowerment of staff. In relation to practice teachers this applies to not only the delivery of evidence based practice (discussed in article 9 in this series), but also
how practice teachers (and mentors) deliver and be a role model of best practice (Gopee 2010). The suggestion here is that leadership is not exclusive to leading teams in a managerial capacity, but rather can exist on an individual level. This involves working effectively with
patients, being aware of and innovating to improve practice, and to also lead by example. The Chief Nursing Officer Jane Cummings (2015) asserts the need for nurses and midwives to
work with and lead their patients in improving their health, by understanding what motivates their patients as well as offering support and advice to achieve this. Ousey (2009) suggests that through observation, students can learn the attributes of leadership as demonstrated by
their mentor or practice teacher
(Ousey, 2009). Students observing the application of leadership skills in this context can provide a valuable learning opportunity. At this point is may be beneficial for the mentor/practice teacher to undertake time out activity 1 below , in order to establish their
Time out Activity 1
Pause now and consider how students you support have thought of leadership to date.
Do they see this as the remit of managers? Do they understand that all registered nurses lead, for instance patients through an understanding of their illness? What if anything needs
correcting in how leadership is thought about then?
Time out activity 2
Reflect on your leadership style and how you role model this approach.
How might your style impact on students within the learning environment ?
Improving care may be borne out of poor or inadequate practice and leaders must be in possession of the skills and confidence to initiate the required changes. Furthermore those
who facilitate student learning must demonstrate confidence as a leader in order to give effective instruction and support to the learner (Craig and Smith 2015). It is expected that students through observation of such behaviours in practice, will adopt these through
emulating the practitioners to whom they seek to be like (Perry 2008). Although students may be taught leadership theory and skills within the academic setting by those with a clinical
background, the influence from the academic perspective is less well documented (Baldwin et al 2014) , therefore emphasising the need for strong demonstration in the practice setting.
By undertaking Time out activity 2 below the mentor/practice teacher can provide evidence
What makes the mentor/practice teacher an effective leader?
The literature presents a plethora of characteristics or traits within an individual which are a
prerequisite for the effective leader. Maxwell (1999) suggests there are 21 qualities including positive attitude, charisma and competence, however Mullins (2002) argues there is not a set or list of traits common to all effective leaders. He goes on to suggest that general
characteristics can be identified, such as self –confidence, intelligence and initiative as being those which contribute to effective leadership. In terms of leadership style there is a broad
classification, examples being autocratic, democratic and lassez-faire. Mullins (2002) describes these as follows:
Autocratic- The focus of power is with the leader who is the one who makes the
decisions and exercises authority.
Democratic- The focus of power is with the group, there is a greater interaction
within the group and the leader is much more part of the team. Group members
involved in the decision making process.
Laissez-faire-Focus of power is passed onto the group members; the leader will not
interfere but is available if help is needed.
Goleman (2000 cited in Gopee 2010 p 134) asserts that to be an effective leader one must be
able to adopt and combine any one of these styles depending upon the situation. However mentors and practice teachers need to be aware of their own leadership style in terms of how this may influence learning (Kinnell and Hughes 2010). Students therefore may benefit from
observing adaptable leadership styles in differing situations, which Sellgren et al (2006 p. 349) refer to as ‘situational leadership’ whereby a leader’s behaviour adapts to certain
In addition Gallagher and Tschudin (2009) suggest the leadership styles conveyed by staff may, have a lasting impression on students in terms of the institution; it is therefore of some
importance that fairness and justice are interwoven whatever the leadership style. It is fair to suggest that the leadership styles displayed in the practice setting by the mentor/practice teacher can have an impact upon the learning environment and subsequently the students
learning. Kinnell and Hughes (2010) assert that an autocratic approach can convey an environment which is controlled; students may feel at risk of feeling devalued in that their
opinions or suggestions are overlooked, similarly some students may well feel intimidated by this approach. Furthermore a Laissez-faire style, although may present a relaxed atmosphere, may lead to a disorganised placement area. This seemingly disordered approach potentially
could have a negative impact on student learning and give rise to anxieties about placement and therefore not be conducive to learning. Finally the democratic approach is one which
could be viewed as one which is based on team decisions, can have a positive effect on student learning (Kinnell and Hughes 2010). Here the student could experience being part of the team and be involved in the decision making process, therefore feeling they have some
value within the team.
Having established the merits and pitfalls of each style of leadership there will be situations
where one style will be more effective than another. In the healthcare context, emergency situations may require an authoritarian style, where risk and safety is not an issue a more democratic approach may be just as effective (Gopee and Galloway 2009). Whichever
approach is adopted and in whichever circumstance, it is important for the mentor/practice teacher to explore with their students the reasons for a particular leadership style, given that
behind a particular approach, but to also observe how this is delivered in practice.
Theories and models of leadership applied to the roles of mentors/ practice teachers
Leadership can be described as either transformational or transactional, Burns (1978) noted that transactional leadership highlights the relationship between the leader and their followers, and whereby there is a basis of authority, work tasks, outcomes and as a
consequence rewards and punishments for followers (Mullins 2002). An example is where promotion or bonuses are exchanged for loyalty and effort in achieving objectives by the
followers; instilling self-esteem and personal fulfilment in followers is less of a feature in this leadership style (Chemers 2009). Here the mentor/practice teacher, when working with students and their specific learning objectives, they are in position to motivate the student
with the promise of reward (passing their outcomes) or censure depending on the students’ performance whilst in placement. Whilst we can see this approach to leadership may apply
according to Burns explanation, to adopt this approach in isolation could be detrimental to the student’s development. Barr and Dowding (2008) highlight criticisms in that the transactional approach to leadership is much less effective where there is a necessity for creativity in
complex working environments. Here alternative approaches to leadership would be more effective in engaging followers in exceeding their own interests and undertaking more than
was expected (Hartley and Bennington 2010)
Transformational leaders in contrast are much more encouraging and motivating towards their followers. Gopee and Galloway (2009) suggest that these leaders aim to engender in
their followers, commitment to an organisations ideals, as well as their own aspirations and aims for the organisation. Furthermore Sellgren et al (2006, p.349) portrays transformational
Time out activity 3
Having read about transactional and transformational leadership styles, decide where your strengths lie. How does (or would) it feel to work very closely indeed with the students own beliefs and values around learning, as well as what is required in terms of skill acquisition? Have there been times when you have gone the extra mile to help students make sense of their experiences, to ascertain what can work best in a given clinical situation?
dynamic process within teams, students are exposed to the values and behaviours associated with this approach to leadership.
Transformational leadership therefore is seen as a desirable feature in healthcare where there is a perpetual need for creative problem solving (Barr and Dowding 2008). This is in response to perpetual change, some of which is stipulated by the Department of Health,
however ‘emergent’ change where, for example, reviews of nursing practice may identify areas for change (Kinnell and Hughes 2010). Transactional and transformational theory of
leadership can seem less than concrete, however it becomes important when facilitating learning as we consider what will best demonstrate the sort of leadership to be emulated in our learners upon registration. Will they simply implement care, or will they attempt to work
with and lead on that care closely with the values and concerns of patients. If transformational leadership is preferred in clinical practice, then it is necessary to discuss
with students and explore exactly why this is. We must also consider the style of leadership that we use with the student when supporting them in practice. Transformational leadership requires us to learn a great deal more about student values and beliefs than a transactional
style of leadership would. The transformational mentor/practice teacher would seek to work closely with the student’s learning agenda, and blend this with what is professionally required
The transformational approach could be described as ethical leadership. Gallagher and Tschudin (2009 p. 224) describe this approach as one which ‘aspires to good ends and to the
kind of change that contributes to the flourishing of other human beings, as well as towards the good of other species and the environment ‘From a mentor/practice teacher perspective this includes not only applying this assertion to work colleagues and the organisation, but to
that of facilitating student learning and development’.
Effective leadership for Mentors and Practice Teachers
In order to lead, a leader requires at least one other follower, and to lead effectively is to have a greater influence on those followers (Stanton and Chapman 2010). Within the clinical
setting Stanley (2006) identified through his study into effective clinical leadership, a number of attributes demonstrated by effective leaders. These qualities include clinical knowledge
and competence, an effective communicator and decision maker, and one who is approachable. Hayes (2011) highlights some of the minimal attributes for an effective leader including having a goal, having respect for others and being able to recognise and utilise the
resourcefulness within the team. Such resources may not just be found within the placement area, but also external to the organisation, University Link Lecturers (ULL) can provide
valuable support to individual facilitators or the practice team as a whole. Their role is primarily related to supporting placements with issues, but also to discuss and share good practice. The opportunity arises here for the individual mentor and practice teacher to forge
stronger links with the university through the ULL (Demonstrate the ability to lead education on practice, working across practice and academic settings -Practice Teacher). This function
Time out Activity 4
If you don’t already know, find out who the ULL is for your practice area. Are you aware of their role, as these may vary depending upon the university they work in?
Consider the benefits of a strong partnership with the
university through the ULL, for example this could mean you having a greater knowledge of the academic side of the
programme
relation to completing the audit and receiving and disseminating allocations and student evaluations. Now complete time out activity 4
Through observation students do not only learn tangible skills but also those which involve
the actions and reactions within their learning environment (Craig and Smith 2015). Bandura (1977) in his early work suggested that the patterns of the behaviour of one person can be copied by another, also known as role modelling. Most nurses and midwives can recall
encountering an individual with whom they have worked who values and behaviours have impacted upon their own. Donaldson and Carter’s (2005) study into the value of role
modelling found that students expected to be able to identify a good nurse as a role model and one which they would copy behaviour and attitudes from. Furthermore, students in Watson and Harris’ (2000) study that good practice is reinforced by an effective role model.
The potential for student learning here is not to be overlooked. One mentor in Perry’s (2008, p.40) study into role modelling in clinical practice commented ‘I am constantly reminded by
Learning Activity 5
Examine your organisations values and identify areas where you may have role modelled these to students.
Ask the student for feedback to establish how self-aware you are/were in how this was delivered.
practice teachers through role modelling and explanation can help as student make sense of sometimes confusing situations where the way to proceed is less than obvious to the student.
Mentors and practice teachers when offering explanation and reasoning for certain actions can demonstrate effective leadership. Now undertake time out activity 5 in order for you to examine a situation where you may have been role modelling informally.
Managing the learning experience
Effective leadership skills can ensure an effective learning environment. The availability of inspirational role models who can make a difference to and lead care, but who also influence
the learning environment is pivotal to student learning. However managing the learning experience can be a challenge to a busy mentor or practice teacher; time constraints and
competing priorities have been well documented as barriers to effective mentoring. Pulsford et al (2002) conducted a mentorship study and found some mentors experienced difficulty in finding time to spend with students, whilst others felt they lacked link tutor support from
universities. The study however concluded that notwithstanding these challenges, mentors carried out their role regardless. Although anecdotally, these issues remain in some practice
concerned with the capacity (number of students), quality and capability of learning
environments and can offer support to mentors/practice teachers or learning environments as
a whole in ensuring a quality learning experience for students. As such their advice and support should be sought in such circumstances.
Other options may be available to individual mentors/practice teachers in that forward
planning could bear fruit, in terms of organising activities with other members of the team within the department. The NMC (2008) stipulate that a minimum of 40% of a student’s time
in practice must be under supervision by a mentor or practice teacher. The guidance here is that student can either work independently with indirect supervision or under the direct supervision of others, thus being part of the students learning experience; it is the mentor /
practice teachers responsibility to plan this and should be commensurate to the student’s stage in the programme. This applies to the following outcomes manage competing demands
of practice and education related to supporting different practice levels of students (Practice
teacher) and Prioritise work to accommodate support of students within their practice roles
(Mentor)
Kinnell and Hughes (2010) advocate planning a student’s learning experience on a week by week basis during their placement and apply to mentor stage 2 ‘Plan a series of learning
experiences that will meet students’ defined learning need’. This allows the mentor/practice
teacher and the student to remain focussed on the tasks and activities to facilitate learning. Furthermore, this can help ensure that the three formal interview stages, initial, midpoint and
final take place at the required junctures in the student placement, in relation to timely feedback and action planning, thus Providing feedback about the effectiveness of learning
and assessment in practice (Mentor). McNair et al (2007) stress the importance of a student
Time out activity 6
Devise a weekly plan for a student you are about to support and consider what you as a mentor/practice teacher will undertake each week to enable them to meet their learning needs.
Ensure you try to map them to the student outcomes so that the student can see that the activity is meaningful. Also reflect upon which other professionals work in your area of practice who might enhance the students learning though their
much greater detail in article 6 Assessment. In terms of planning student activity, undertake time out activity 6 below,
Part of the planning process in relation to the students learning experience could involve the
‘mentorship team’. Kinnell and Hughes (2010) describe this as a team of a number of individuals working together in facilitating students and enhancing the learning environment.
Moreover, involving other members of the team in the learning experience of students has benefits which are twofold. There could be positive effects in terms of team dynamics and team cohesion; in addition the student can link with any one of these other team members if
their mentor is not available. Although this may present a challenge for a number of reasons, consider the activity below in exploring possibilities within your area of practice. In addition
to other stage one registrants, who would be supporting student learning by ‘sharing experience and knowledge’ (NMC 2008b) others within the team could offer valuable support and guidance. Here the mentor would be undertaking the following, be an advocate
for students to support them accessing learning opportunities that meet their individual
Time out activity 7
Consider who you could ask to be involved in the mentorship team and the role they may play in supporting your student. You may want to include this in the plan undertaken in the previous activity
Some universities offer peer support or peer mentoring schemes whereby third year students are involved in the more junior student learning experience. Indeed there are potential
benefits, studies undertaken have identified reduced anxiety in clinical settings where junior students have been provided with support and guidance from more senior students (Aston and Molassiotis, 2003; Sprengel and Job, 2004). Furthermore senior students would start to
develop the skills required in facilitating students, skills very much a feature of a Stage One Mentor within SSLAP (2008a) Other members of the team are not to be overlooked in terms
of their contribution to the student learning experience. Health Care Assistants (HCAs) can prove to be an invaluable source of fundamental knowledge with the placement and are seen as a ‘vital linchpin’ in the orientation process (Kinnell and Hughes 2010). Moreover in
O’Driscoll et al’s (2010) study into who leads and contributes to the student learning experience, the evidence suggest that in terms of acquiring bedside care skills, the HCAs play
a significant role. Now complete time out activity 7
In order of the student to see the patient journey through health care services, opportunities for them to spend time in other areas should be seized upon. These opportunities allow the student to learn about the roles of other professionals who form part of the multidisciplinary
team, which serves to go some way to preparing students for their future role within that team. Modernising Nursing Careers (DH 2006) states ‘nurses will take responsibility for care
multidisciplinary teams (MDT)’, it would be advantageous therefore for mentors and practice teachers to consider supporting students to take up these opportunities. The benefits also
extend to other members of the MDT to contribute to the assessment process whilst they are supervising the students and this approach is acknowledged within SSLAP. Indeed as Anderson (2011) suggests the contribution of other practitioners in the assessment process
can ensure a limit of bias as well as transparency and equity.
Maintaining the quality of the learning environment.
In order for Practice Teachers and indeed mentors need to be aware of how students perceive their placement experience, they will need to examine and respond to recent evaluations of practice. Evaluations which students undertake are a collection of information about a
particular part of a programme which is subject to analysis; this insight allows those facilitating students, to establish areas for improvement (Neary 2000). However, on a positive
note it also highlights what is right. The specifics of evaluation are discussed in further detail within another part of this series of articles. However within stage 3 practice teachers are expected to lead and contribute to the evaluation of the effectiveness of learning and
assessment in practice. This may be from a personal perspective by reflecting upon your own
performance as facilitator, but also by examining the evaluations students undertake, usually
at the end of the placement and via the university. Evaluation will be examined in more detail in part 11 of this series. This should be an ongoing process and Elcock and Sharples (2011) advocate that asking your student for feedback throughout the placement, allows the student
to raise concerns which can be addressed at the time rather than at the end of the placement. Furthermore by asking for student feedback throughout is good practice and ensures the
Learning Activity 8
Think about a student whose learning you have recently facilitated and reflect upon the experience in relation to:
What went well and what did not go so well. What do you think were the reason/s for this?
What could have been improved upon and how?
What have you gained from this experience and how might this improve your skills as a facilitator?
Summary
Effective leadership is important within a healthcare setting which dictates constant change in order to keep abreast of the developments within contemporary health care. Mentors and
practice teachers are required to both lead within their own practice as part of a clinical, lead on the student learning experience, also to make visible and inspire such skills within the
student. As such, the element of leadership is multifaceted and potentially complex, given the diversity of both team members and situations requiring leadership. It is vital that student learning is managed effectively by the mentor/practice teacher, with the involvement of other
members of staff as a resource demonstrating effective leadership skills. Similarly, through role modelling it is key that students can identify leadership styles and skills within a variety
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Box 1. Nursing and Midwifery Council (2008a) ‘Standards to
Support Learning and Assessment in Practice’
Domain 8 Leadership- Stage 2- Mentor
Plan a series of learning experiences that will meet students’ defined learning need
Be an advocate for students to support them accessing learning opportunities that meet their individual needs, involving a range of other professionals, patients, clients and carers
Prioritise work to accommodate support of students within their practice roles
Provide feedback about the effectiveness of learning and assessment in practice
Domain 8 Leadership- Stage 3- Practice Teacher
Provide practice leadership and expertise in application
of knowledge and skills based on evidence
Demonstrate the ability to lead education on practice,
working across practice and academic settings
Manage competing demands of practice and education
related to supporting different practice levels of students
Lead and contribute to the evaluation of effectiveness
