PSA_1 Practice supervision and assessment in nursing About this free course Find out more about The Open University’s Nursing and Healthcare courses and qualifications: www.open.ac.uk/courses/nursing-healthcare. This version of the content may include video, images and interactive content that may not be optimised for your device. You can experience this free course as it was originally designed on OpenLearn, the home of free learning from The Open University – www.open.edu/openlearn/health-sports-psychology/practice-supervision-and-assessment-nursing/content-section-0 There you’ll also be able to track your progress via your activity record, which you can use to demonstrate your learning.

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All rights falling outside the terms of the Creative Commons licence are retained or controlled by The Open University. Head of Intellectual Property, The Open University Welcome to this free course, Practice supervision and assessment in nursing, which provides you with the opportunity to develop your skills and understanding of the newly defined roles for supervisory practice as indicated within the Standards for Student Supervision and Assessment (SSSA) Nursing and Midwifery Council (NMC) standards for supervision and assessment in education. As a Practice Supervisor and/or Practice Assessor you will be required to offer dynamic and effective supervision. This course offers you a wide range of self-directed learning materials and you will be taken through a series of themes and activities with key resources, designed to support you to develop effective, relational supervisory practice that empowers learners to develop their Professional Practice and to critically reflect on their own potential according to the latest evidence-based practice. This course has been designed to inform and develop knowledge of those who support the supervision and assessment of pre-registration student nurses. Please remember that the shape of your role will be configured upon local policy. This course addresses: The key requirements for those undertaking the Practice Assessor and Practice Supervisor roles from an NMC perspective, based on current evidence-based practice. This course will support you in your personal preparation for undertaking the Practice Assessor and/or Practice Supervisor role. It aims to help you support the effective and dynamic supervision and assessment of others in partnership, which enhances critical self-reflective learning. After studying this course, you should be able to: understand Nursing and Midwifery Council (NMC) requirements for the roles of Practice Assessor, Practice Supervisor and Academic Assessor for conducting assessments understand the knowledge, attitudes, qualities and skills needed in conducting a teaching, assessing and supervisory role use contemporary evidence to prepare students for self-reflection understand the role of the Practice Supervisor, Practice Assessor and Academic Assessor in making fair judgements to ensure safe and competent practitioners give constructive feedback and effectively support others understand how to manage students who are not performing optimally. In this section you will undertake learning which meets the following outcomes: develop an understanding of the NMC Future Nurse Standards 2018 to support student nurse learning be able to explain the roles and responsibilities of Practice Supervisors, Practice Assessors and Academic Assessors be able to describe ways that student nurses can be supported to meet the learning proficiencies; 7 platforms and annex A and B outlined in the NMC (2018) Future Nurse: Standards of Proficiency for Registered Nurses.

An image of two women in conversation. One is dressed a nurse. An image of two women in conversation. One is dressed a nurse.

In May 2018 the Nursing and Midwifery Council (NMC) published new standards which outline the skills and knowledge that nurses of the future will require to care for people. These standards are known as the Future Nurse Future Midwife Standards. Please watch this video outlining The Future Nurse Standards for Proficiency. The NMC (2018) has clear guidance about how student nurses and midwives must be supported in practice learning which can be found on the NMC website. In particular the NMC highlight the following sections of The Code which directs registrants to their obligation to support students in their learning: Section 9: Share your skills, knowledge and experience for the benefit of people receiving care and your colleagues. Section 9.4: Support students’ and colleagues’ learning to help them develop their professional competence and confidence. Section 11: Be accountable for your decisions to delegate tasks and duties to other people. Section 13: Recognise and work within the limits of your competence. Section 14: Be open and candid with all service users about all aspects of care and treatment, including when any mistakes or harm have taken place. Section 16: Act without delay if you believe there is a risk to patient safety or public protection. Section: 20.8: Act as a role model of professional behaviour for students and newly qualified nurses, midwives and nursing associates to aspire to. Section 25: Provide leadership to make sure people’s wellbeing is protected and to improve their experiences of the health and care system. Platform 5: Leading and Managing nursing care and working teams. Outcome 5.8 Support and supervise students in the delivery of nursing care, promoting reflection and providing constructive feedback, and evaluating and documenting their performance. Outcome 5.9: Demonstrate the ability to challenge and provide constructive feedback about care delivered by others in the team, and support them to identify and agree individual learning needs. Outcome 5.10: Contribute to supervision and team reflection activities to promote improvements in practice services. Annex A: Communication and relationship management skills. (NMC, 2018c) At the point of registration, the registered nurse will be able to safely demonstrate the following skills: 1; 4.1: Demonstrate effective supervision, teaching and performance appraisal through the use of Annex A section 4.1.1 to 4.1.5 (NMC, 2018c)

A photograph of two people in conversation. A photograph of two people in conversation.

Key principles of effective student nurse supervision: All student nurses and midwives must be supervised in practice learning environments by a registered professional, for example an NMC registered nurse or midwife, or another registered health or social care professional. All student nurses and midwives must be supported and supervised in practice learning environments to support appropriate learning. Students must be supervised in a manner that supports their level of experience and learning and to protect public safety. Student nurses and midwives’ supervision should encourage them to learn in an independent manner. Student nurse associates can be assigned either to a registered nursing associate or a registered nurse as their practice supervisor. Key principles of practice supervision – role and responsibility: To undertake suitable preparation to prepare practitioners to become Practice Supervisors for student nurses and midwives. Practice Supervisors act as role models working in accordance with the NMC code of conduct. To promote a positive learning culture, enabling and empowering student nurses and midwives to achieve the NMC proficiencies and skills. Have appropriate knowledge and skills to provide support, supervise student practise, provide effective supportive feedback to student nurses and midwives and contribute towards assessment. Activity 1 Watch this animation from the RCN (2020) explaining more about the practice supervisor role: Practice Supervision animation. According to the NMC: ‘Practice supervisors’ role is to support and supervise nursing and midwifery students in the practice learning environment. All students must be supervised while learning in practice environments’. Now you have watched this animation you should reflect on your own skills and readiness for undertaking the role of a Practice Supervisor. Formulate 3–4 key action points for development in order for you to take on the role of a Practice Supervisor. In order to understand your role better in relation to practice supervision and assessment, please also go to the following NMC webpage and read more about the Practice Supervisor and Practice Assessor responsibilities. After you have completed this write down below in the text box the key points that are relevant to your role. Your answers to this activity will be personal to yourself. In capturing the 3–4 action points you can develop these further into a robust action plan. Not only can this action plan be used for your next appraisal, the work you do can also be used as evidence of study hours completed when you next re-validate with the NMC.

A graphic with the words Theory into Practice. A graphic with the words Theory into Practice.

Key principles of effective student nurse assessment: Practice Assessors for student nurses must be registered nurses with appropriate equivalent experience for the field of nursing practice the student nurse is studying. Practice Assessor must undertake suitable preparation to prepare practitioners to become practice assessors for student nurses and midwives. A nominated Practice Assessor can be assigned for a single practice placement or a series of placements. Student nurse associates can be assigned either a registered nursing associate or a registered nurse as their Practice Assessor. Practice Assessors are expected to raise appropriate concerns about student progress regarding student nurse conduct, competence or achievement if required. Practice Assessors will receive support to undertake this role. Watch this animation from Health Education England (HEE) (2020) explaining more about the Practice Assessor role: Nursing and midwifery: Practice Assessors. According to the NMC: ‘Practice assessors assess and confirm the student’s achievement of practice learning for a placement or a series of placements…the practice assessor assesses the students overall performance for their practice learning, taking account of whether or not the relevant proficiencies and programmes outcomes have been met, and if they display the required values of their profession’ Activity 2 Read and reflect on the following mini case studies and consider how you would support the student in your role of practice supervisor or practice assessor in these scenarios. You can write your answer in the box below the scenario. Scenario 1: You are a named Practice Supervisor for a level 1 student nurse. While attending your practice learning area the opportunity arises for the level 1 student to engage with a skill/procedure relevant to their learning outcomes, but the relevant theory has not yet been studied. How would you as Practice Supervisor support the student with this learning opportunity? Ideally students and Practice Supervisors should plan learning opportunities within your practice learning environment and document these in the student’s Practice Assessment Document (PAD). Opportunities for students to develop their learning for the skills/procedures outlined in Annex A and B can be somewhat opportunistic; the NMC outlines that there should be a focus on skills learned in practice rather than simulation when appropriate. Therefore, the student should be given support to engage with this learning opportunity. Encourage the student to access the relevant theory if possible, via their theoretical component including accessing simulation learning in platforms such as clinicalskills.net. Guide the student nurse to learning resources available in your practice learning environment including up to date policies and procedures relevant to your employing organisation. Depending on the skill allow the student nurse to observe competent practice demonstrating the skill/procedure within your practice setting explaining the process used to ensure safe and effective delivery of the skill/procedure. Encourage the student to ask questions and, if the patient consents encourage the student to undertake the skill while supervised, using coaching and enquiring questioning of their rationale for their actions. Simulated practice learning hours The NMC responded to the COVID-19 situation to implement recovery and emergency programme standards. Recovery standard RN5 and RN5.1 required universities to ensure simulation-based learning opportunities and appropriate supervision for student nurses and RN6 (D) outlines the application process for nursing education providers to be approved to offer alternative methods of simulated practice. Read more information about the use of simulation by accessing the following information from the NMC (2019): Simulation The use of simulation to support practice hours is an active development which is changing month by month, therefore registered nurses need to ensure their knowledge about this topic is up to date by accessing current updates from the NMC website. Scenario 2: You are the named Practice Assessor for a student nurse undertaking level 2 of their nursing studies. The named Practice Supervisor has reported to you that the student nurse has been noted to be late for several shifts and at times is found to be more interested in their smart phone rather than what is happening in this practice learning environment. Other staff members and supervisors have commented that they feel the student nurse is not engaged with this learning environment. How will you as a Practice Assessor support the Practice Supervisor and student in this situation? Concerns with behaviour or professionalism should be dealt with in a supportive and prompt manner therefore allowing the student time to improve before their final assessment. Although the supervisor would be expected to speak to the student about these reported observations and provide feedback and/or feedforward, the practice assessor should check that this conversation has happened as the student may be unaware of staff concerns. A supportive conversation should be undertaken considering the reasons why the student is late, this could relate to childcare issues, transport problems or other personal issues that you are unaware of. Is the student using their phone due to problems at home or with caring responsibilities? A conversation could elicit personal reasons why the student is finding this practice learning environment difficult to engage with, e.g. a relative could have previously been cared for in this practice learning environment which has invoked difficult memories. Does the student have a learning difficulty that is affecting their ability to engage with their learning environment? Is the student experiencing physical or mental health issues that are affecting their performance? If the Practice Supervisor has spoken to the student and a problem is still apparent the Practice Assessor can arrange a tripartite meeting to explore the reasons for the student’s behaviour. The Practice Assessor should communicate with the practice education team within the student’s organisation if they are employed as well as the Academic Assessor and/or University link lecturer so that they can help you develop an appropriate development plan. Refer to the local university processes regarding supporting student concerns with practice. A learning plan should be created linked to the NMC (2018c) seven platforms and the placement learning outcomes to help the student understand how they can improve. Using the seven platforms and learning outcomes should guide the student in identifying their own learning needs. Document the plan clearly, identifying realistic goals for the student to be able to demonstrate their learning. Set review dates for student progress. Consider referrals to university disability services or support processes. Advise the student on their progress, provide encouragement and recognise improvement as appropriate. Document the progress in the PAD. When learning has been met record this clearly in the PAD.

A graphic with the following text: Strengths; Learning needs; Opportunities; Threats. A graphic with the following text: Strengths; Learning needs; Opportunities; Threats.

As with any new or evolving role, it is important to feel well-informed, to understand the scope, requirements and responsibilities and to feel adequately prepared to undertake the role effectively and confidently. This section will encourage you to consider what it means to provide effective support to pre-registration students undertaking practice learning as part of their University programme of study. In this section you will undertake learning meeting the following outcomes: to reflect on your development and readiness to undertake the role to consider what effective learning might look like in the workplace to reflect on the benefits and challenges of working to standards of supervision and assessment to explore the regulatory standards for supervision and assessment in the workplace to understand the knowledge and skills required of supervisory and assessing roles in the workplace. Activity 3 It is important to reflect on your own development and how ready you are in taking on the roles/responsibilities of either a Practice Supervisor or Practice Assessor. In preparation for this role, you need to consider what attributes you currently have and where there are areas you need to develop. To help you with this, answer the following four questions and put your answers in the relevant sections of the Strengths, Learning needs, Opportunities and Threats (SLOT) analysis template below. What do you believe you bring to a practice learning role (Strengths)? What development do you require to address any specific learning needs (Learning needs)? What might the role of practice supervisor/assessor add to your own professional (and personal) development (Opportunities)? What barriers might there be for you if taking on this new/evolving role (Threats)?

Strengths	Learning needs
Opportunities	Threats

There are clearly no right or wrong answers here. Anyone preparing to develop into an educational role will bring with them a range of experiences, knowledge, skills, values and attitudes. Below is an example but you may have considered other issues.

StrengthsExtensive professional experienceSignificant interest in educationCompassionate attitudeAbility to act as a role modelStrong leadership skills/experienceKnowledgeableExcellent communicatorStrong collaborative skillsPeople being at the heart of all that I do	Learning needsCurriculumAssessment methodsCoaching techniquesFeedback approachesManaging time
OpportunitiesContribute to workforce developmentProfessional developmentCould provide variety in roleEnhance clinical experience	ThreatsTime pressures - busy professional role and/or home lifeLacking in confidenceDealing with challenging studentsAlready juggling a great many things

Take a few minutes to consider what measures you might be able to put in place to mitigate any ‘threats’ you identified above? This might include, but is not limited to: seeking adequate support from your team shadowing others who have extensive experience of supervising/assessing students seeking further support from your employer’s education team speaking to University colleagues thinking about undertaking further development opportunities yourself effective planning of your day, preparing a ‘to do’ list set yourself realistic goals, objectives and deadlines consider delegation of some duties/responsibilities where viable.

A photograph of a support worker with their client. A photograph of a support worker with their client.

Part of your role as a Practice Supervisor/Practice Assessor will be to support and facilitate learning within a workplace. This workplace may vary significantly depending upon where you work. However, all those supervising and/or assessing students must have an awareness of the learning environment in which students learn to maximise opportunities for student learning. This next activity encourages you to think about the learning environment. Activity 4 What might a ‘quality’ learning environment look or feel like? The Nursing and Midwifery Council (2019) state that: Effective learning places the student at the centre of the learning experience. Students are given the opportunities and space to take responsibility for their own learning, to seek out learning experiences and develop their own practice, without compromising public safety. The level or form of practice supervision can decrease or change with the student’s increasing proficiency and confidence. An effective learning environment is one which provides opportunities for meaningful learning experiences that contribute to a student meeting their learning outcomes. This can mean a variety of things depending on the student’s learning outcomes, their stage of learning, and the environment in which they are learning. An effective learning experience can take place across different environments, allowing students to learn and consolidate a set of skills across different settings and situations. Learning experiences should include the full spectrum of care relevant to the student’s area or field of practice. The culture within an effective learning environment values learning, and all people within the learning environment should understand their role in enabling learning. An effective learning experience also takes account of any equality and diversity considerations, or reasonable adjustments that need to be made to student learning and assessment. Take a few minutes to reflect on this NMC statement (in the discussion above). Do you agree with it? Is there anything missing from it? Were there issues you hadn’t considered? What might a ‘poor’ learning environment look or feel like? Conversely, you might have considered that aspects of a ‘poor’ learning environment could be, an area which: has an inadequately supportive learning culture does not address or meet the needs of students adequately offers a more critical than constructive learning culture neglects to provide feedback regularly, objectively or well lacks a team ethos and the potential for collaborative working is rare does not allow for adequate time for learning does not feel welcoming, inclusive or stimulating does not offer protected time with ‘educators’ rarely celebrates success has limited evidence of effective leadership or management has poor morale among its staff Practice learning using a ‘long-arm’ approach The NMC (2018) supports the use of tailored learning to meet learning outcomes and describes long-arm style learning as indirect supervision. Read more about indirect supervision from the NMC by accessing the following links: Tailored learning The long-arm approach to placement supervision and assessment

In this section you will be asked to review the NMC standards for student supervision and assessment (SSSA) (2018) so that you become more familiar with these standards and start to consider the related quality assurance and governance issues when providing supervision and/or assessment to student nurses and midwives where relevant. Activity 5 Take some time to read, review and reflect on the NMC SSSA (2018) standards, found below:

Used by staff group/discipline	Standards for supervision and assessment	Workplace practice learning role/title
Registered nurses (all four fields) Nursing associateReturn to practice nursingMidwives Non-medical prescribing	NMC Part 2 standards for student supervision and assessment	Governed by NMC Practice Assessor/Practice Supervisor

You will note that these standards are common to all programmes, and as such as per the NMC regulatory requirements, there is a need for all students to receive effective supervision and assessment. You have had the opportunity to read and reflect on the requirements of the NMC SSSA (2018). In this next section you will consider some of the challenges and benefits of implementing and delivering the NMC SSSA (2018) standards within your own learning environment. As a brief introduction, watch this short video from the NMC: How to use our Education Standards. Activity 6 What do you consider the benefits of the introduction of these standards might be for your own learning environment? Jot down some initial thoughts. Some of your thoughts might have included: There is no longer a requirement for students to be supervised by one mentor for 40% of their placement time, as there was with the NMC Standards to Support Learning and Assessment in Practice (SLAiP) (2008), increasing placement capacity. The organisation can benefit from drawing upon a greater number of experienced members of staff to take on supervisory roles. Supervision can be shared between several registrants (not just NMC registrants), facilitating greater levels of inter-disciplinary learning. Students are empowered to be more proactive in their learning, effectively leading their learning in order to develop their knowledge and skills at an appropriate juncture. Service users are more actively involved in the student’s learning journey, providing feedback on their performance throughout. Students should feel very much part of the learning environment team. Activity 7 Now take a few minutes to consider what you perceive the challenges of implementing the NMC (SSSA) (2018) standards might be within your own learning environment? Jot down some immediate thoughts. Some of your thoughts might have been: Succession planning issues leading to inadequate resourcing, i.e. new Practice Supervisors or Assessors are not developed in a timely manner, leaving gaps in adequate support for students. Resistance to change – staff may defer to old standards of teaching (NMC SLAiP 2008 standards) working as a ‘mentor’ rather than Practice Supervisor/Assessor. Learning environments/staff do not empower students to take more responsibility for their learning. Learning environment and university preparation are not adequately aligned. Learning environments are so busy, students do not get adequate time to reflect on or process their learning. Supervisory skills of staff are limited or underdeveloped. Organisational internal communication is fragmented or weak, so Practice Assessors may not receive accurate or complete feedback on student progress to enable them to carry out accurate assessment.

A graphic showing a character jumping over the word ‘Challenge’. A graphic showing a character jumping over the word ‘Challenge’.

Activity 8 Take a few minutes to consider how some of these challenges may be overcome and what actions you might take to ensure these challenges are mitigated where possible, within your own learning environment. Some of your thoughts might have been: Strive to remain open-minded and to embrace the change to NMC SSSA (2018). Remain up to date, share ideas and best practice in terms of embedding and meeting the respective standards. Within learning environments, identify a nominated person, to ensure staff are updated and prepared to adequately support the students placed and respond to student concerns. Within learning environments, create regular opportunities to protect time to work closely with students. Seek ways to improve communication between the university and practice. Encourage all registrants to engage with the supervision of students. Ensure that students are made aware of the support and learning opportunities available to them in every learning environment. Tailor supervision to the needs of the student and stage of learning. Practice supervision is put in place which facilitates independent learning.

Whether you are preparing to supervise or to assess students, it is important to be mindful of the difference between these two roles. Activity 9 As noted earlier, all pre- and post-registration regulated/professional programmes require adequately prepared Practice Supervisors and Practice Assessors. This might appear an obvious question, but it is worth considering the differences in roles and responsibilities of the Practice Supervisor and Practice Assessor. Write down your own thoughts on the differences between the two roles. For the purposes of student workplace learning the distinction between the two roles are outlined below: Supervision – support and provide feedback to students, acting as a role model, facilitating learning through independent participation, contribute to assessment made by assessors, monitor, raise and respond to competency or conduct issues Assessment – make, confirm and record achievement of proficiencies and learning outcomes based upon multiple sources of evidence, collaborating with colleagues to inform the assessment decisions Please note: Providing effective supervision and assessment will be covered later in this course.

Whether you are preparing to be a Practice Supervisor or a Practice Assessor it is of great importance that you understand and are prepared for these roles, in terms of scope, role requirements, responsibilities, skills and competencies. Students on NMC approved programmes will require a Practice Supervisor and Practice Assessor in the practice learning environment. You can find below a brief overview of what these two roles entail. Practice Supervisor

Role

Knowledge and experience required

Act as a role modelFacilitate learning opportunities for students to meet their proficienciesSupport and supervise students, reflecting their learning needs and stage of learningProvide effective and timely feedbackRecord observations on conduct, proficiency and achievementContribute to assessments in collaboration with the student’s Practice AssessorRaise and respond to student conduct and competence concernsEngage with the Practice Assessor and Academic Assessor, for support to ensure safe and effective learningFacilitate independent learning where appropriate

Can be any healthcare professional currently registered with a regulatory bodySupport learning within their scope of practiceCurrent knowledge and experience of healthcare education and supervisionUnderstanding of student proficiencies, programme outcomes and practice assessment documentsEffective supervision, student learning and assessment methodsAwareness of different coaching modelsCPD and ongoing development to support practice learning

Further reading can be found here: What do Practice Supervisors do? NMC SSSA guidance Practice Assessor

Role

Knowledge and experience required

Seek feedback from Practice SupervisorsPeriodically observe studentsDraw on evidence from other sourcesConduct assessmentsProvide supportive, honest and effective feedbackCommunicate and collaborate with the nominated Academic AssessorMake and record objective, fair and evidence-based assessments on student conduct, proficiency and achievementRaise and respond to concerns regarding conduct, competence and achievementAssess and make recommendations for progressionNot simultaneously the Practice Supervisor or Academic Assessor for the same student

Must be a registered nurse, midwife, nursing associate or specialist community public health nurse (SCPHN)Have undertaken role preparation or can evidence prior learning to undertake the roleCurrent knowledge and experience for the programme they are assessingUnderstanding of student proficiencies, programme outcomes and assessment documentationSkills relevant to student learning and assessment, to include coaching models and effective interpersonal skillsConducting objective evidence-based assessmentsEffectively providing feedbackSeek ongoing support to fulfil the role

Further reading can be found here: What do Practice Assessors do? NMC SSSA guidance Watch this short video from Health Education England, which briefly summarises the Practice Assessor role: Nursing and midwifery - Practice Assessors. You will note from the last video and from the NMC SSSA (2018), that there is a third role involved in the assessment of students on NMC approved programmes, that of the Academic Assessor. The Academic Assessor will usually be employed by the University. This role is similar to the Practice Assessor role in many ways; but the academic assessor is expected to ‘collate’ and ‘confirm’ the student’s academic outcomes, as well as their achievement of proficiencies for the part of the programme they are assigned to the student, before recommending them for progression on to the next part of the programme. The nominated Academic Assessor will work collaboratively with a nominated Practice Assessor to make a recommendation for student progression. Academic Assessor

Role

Knowledge and experience required

To continually collate and confirm student achievement in the academic environmentBe able to conduct and record objective, evidence-based assessments and provide constructive feedbackKeep up to date on progress of student and their performanceProvide feedback to the student about their achievement, working with them to review possible areas for improvement, in line with University processesMaintain an understanding of student’s learning and achievementCommunicate and collaborate with the student’s Practice AssessorAssess and make a recommendation for student progression to the next part of the programmeNot simultaneously the Practice Supervisor and Practice Assessor for the same student

Must be registered nurses, midwives, and nursing associates, or in the case of prescribing. programmes any qualified prescriberMust be adequately prepared and supported to take up their roleWill require knowledge of the proficiencies, programme outcomes and assessment processesMaintain relevant knowledge and expertiseReceive ongoing support and proactively develop their knowledge and professional practice

Further reading can be found here: What does an Academic Assessor do? NMC SSSA guidance. Now that you have had an opportunity to consider the three roles involved in supervision and assessment of students, please undertake this short exercise to test your knowledge and understanding. Activity 10 Reflect on your own skills and consider how these will work in your own area of practice. Add an X in the box if the responsibility is relevant to the role.

Responsibility	Practice Supervisor	Practice Assessor	Academic Assessor
Gather and coordinate feedback on student performance
Provides feedback on progress
Shares relevant observations with Practice Assessor and Academic Assessor
Work in partnership with nominated Academic Assessor
Support learning in line with NMC standards
Initial interview per placement
Understand the student’s learning and achievement in practice
Collaborate with Practice Assessors at relevant points in programme structure
Supervision of student’s medicines management
Maintain current knowledge and expertise
Confirm student achievement of proficiencies and programme outcomes in the academic environment
Supervision of student’s episode(s) of care
Completes OAR at end of each placement and at programme progression
Signs off Service User Feedback

Responsibility	Practice Supervisor	Practice Assessor	Academic Assessor
Gather and coordinate feedback on student performance		X
Provides feedback on progress	X	X	X
Shares relevant observations with Practice Assessor and Academic Assessor	X
Work in partnership with nominated Academic Assessor		X
Support learning in line with NMC standards	X	X	X
Initial interview per placement	X
Understand the student’s learning and achievement in practice			X
Collaborate with Practice Assessors at relevant points in programme structure			X
Supervision of student’s medicines management		X
Maintain current knowledge and expertise	X	X	X
Confirm student achievement of proficiencies and programme outcomes in the academic environment			X
Supervision of student’s episode(s) of care		X
Completes OAR at end of each placement and at programme progression		X
Signs off Service User Feedback	X

Once you have completed this course, it is important to note that this is just the start of the journey. Specific role preparation and support will also be managed in partnership between your employer and the relevant local University. You should be provided with adequate information about the curriculum, the student, and the expectations of the role. It is suggested that this process is managed via University briefings, discussion on roles, monitoring of Practice Supervisors and Assessors in the role and ongoing evaluation and feedback from others including students, Practice Supervisors and Practice Assessors and through collaborative work with Academic Assessors. In these roles it is important that staff maintain their professional knowledge and skills and critically reflect on their role, which will be captured as part of their NMC revalidation. Ongoing development may be further monitored as part of staff annual appraisal via a Line Manager and you can contact University colleagues for support and guidance. In the next activity you will reflect on the type of Practice Supervisor/Assessor you would wish to be. Activity 11 Think of someone who has supervised you during your own professional development, who inspired and empowered you to be the best you could be. What was it about this individual that inspired you? What qualities or skills did they possess? Jot down your initial thoughts. Once again, your responses will undoubtedly be unique to you and your own experiences of working with this individual. However, you might have commented that the individual: was an excellent role model and you aspire to be like them had superb leadership skills was approachable and respectful is a great communicator always friendly, supportive, open, straightforward and honest had excellent supervisory skills was hugely knowledgeable. Common to any supervisory role is the need to be a positive role model, always leading by example. But what does it mean to be a good role model?

A colourful graphic alongside the words ‘Enabling professionalism in nursing and midwifery practice’. A colourful graphic alongside the words ‘Enabling professionalism in nursing and midwifery practice’.

The Nursing and Midwifery Council (2018) describe a positive role model in their ‘Enabling Professionalism’ report, as someone who is: Demonstrating and articulating clearly what professionalism looks like in practice Demonstrating positive behaviours and attitudes towards diversity Working within a clear professional career framework Supporting colleagues and students Celebrating personal successes and that of others Developing people to take on senior roles and supporting those in senior roles Treating others with a positive regard Providing meaningful and constructive feedback to others. Note: Keeping the NMC Code: Professional standards of practice and behaviour for nurses, midwives, and nursing associates (2018) at the centre of your supervision and assessment can aid in providing direction. Students should be encouraged to read and refer to the NMC Code regularly. Professional discussions and learning opportunities can then be structured around the different elements of the Code. Finally, the following activity aims to provide you with a range of questions and answers as guidance in support of your preparation for the role of Practice Supervisor or Practice Assessor. Activity 12 Review the following roles that are required to support students in practice. Note the preparation you need to undertake for each role depending on your experience at the time. Practice Supervisor role

What is your experience to date?	Preparation needed
Registration with no previous preparation.	Complete Practice Supervisor preparation programme.
Registrant who has completed practice supervision preparation during their pre-registration programme.	No further preparation is required, although will be revisited during preceptorship period. You are advised to discuss this with your employer for further advice.
Registrant who has successfully completed NMC Standards for Learning and Assessment in Practice (SLAiP 2008) approved course or equivalent.	You are advised to discuss this with your employer and establish if they will require you to attend a local ‘transition to new roles’ session which includes information about new roles and responsibilities and models of supervision and providing evidence to inform assessment decisions.

Practice Assessor role

What is your experience to date?	Preparation needed
Registrant who has completed practice supervision preparation.	The Practice Assessor preparation and length of the course is agreed locally.
Registrant who has successfully completed NMC Standards for Learning and Assessment in Practice (SLAiP, 2008) approved course or equivalent.	You are advised to discuss this with your employer and if they will require you to attend a local ‘transition to new roles’ preparation which includes information about new roles and responsibilities, models of supervision and reviewing evidence to inform assessment decisions.

Academic Assessor role

What is your experience to date?	Preparation needed
Registrant working towards or holds relevant qualifications as required by the academic institution and local and national policies, but with no previous preparation as either a Practice Assessor or Practice Supervisor.	Locally agreed – please contact your Higher Education Institution (HEI).
Registrant who is working towards or holds relevant qualifications as required by their academic institution and local and national policies and has completed practice supervision preparation during their pre-registration programme and has subsequently prepared as a Practice Assessor.	Locally agreed – please contact your Higher Education Institution (HEI).
Registrants working towards or holds relevant qualifications as required by their academic institution and local and national policies and who have completed any approved course under NMC standards for Learning and Assessment in Practice (SLAiP, 2008) i.e. mentor, practice teacher or Lecturer).	Locally agreed – please contact your Higher Education Institution (HEI).

In this section you will examine what the Practice Supervisor and Practice Assessor need to do in assessing student nurses, the process of giving feedback to confirm a student’s proficiency along with how to manage the failing student. On completion of this section you should be able to: demonstrate an understanding of the assessor role in the assessment process understand the responsibilities and accountability in relation to assessing a student in practice identify strategies used for assessment in clinical practice apply the principles of objective setting, assessing learning needs, reviewing and assessing student progress describe the components of a meaningful assessment. 

A photograph of a person writing in a notepad while on their laptop. A photograph of a person writing in a notepad while on their laptop.

The assessment of a student nurse’s practical skills, underpinned by theoretical knowledge is central in ensuring that our future registrants meet the required professional standards of practice and deliver safe patient care. The Nursing and Midwifery Council describe assessment in the following way: as evidence based, robust and objective. Assessments and confirmation of proficiency are based on an understanding of student achievements across theory and practice. Assessments and confirmation of proficiency are timely, providing assurance of student achievements and competence. (NMC, 2018a)

A photograph of a notepad resting on an open laptop. A photograph of a notepad resting on an open laptop.

Assessment is the means by which information is collected to demonstrate that an acceptable standard of practice has been reached by a student on which a decision to declare them competent, can be made. A good assessment is evidence-based, objective and fair. It needs to consider a variety of views and inputs, and needs to consider student diversity, such as different learning styles, cultural backgrounds and communication styles (NES, 2020a). A positive assessment process can be invaluable to the student as it enables them to gain feedback on their achievements along with highlighting areas requiring attention and the process for setting realistic goals going forward.

The Practice Supervisor, Practice Assessor and Academic Assessor all have responsibility for assessing students, however, they all have different roles. Throughout the assessment process the relationship between the student, Practice Supervisor and Practice Assessor is key. The differences between the role of the Practice Supervisor and Practice Assessor in relation to the supervision and assessment of students are described below: The Practice Assessor The Practice Assessor collaborates with the Academic Assessor at relevant points of the programme. The Practice Assessor gathers feedback from the Practice Supervisor and any other Practice Assessors and relevant people in order to be assured about their decisions for assessment and progression. The Practice Assessor is not able to take on the role of Practice Supervisor at the same time as being a Practice Assessor, unless in exceptional circumstances like a prescribing programme where the Practice Assessor can also take on role of Practice Supervisor. The Practice Assessor is expected to appropriately raise and respond to concerns regarding student conduct, competence and achievement. The Practice Supervisor The Practice Supervisor communicates with Practice Assessor and Academic Assessor to share their views on student achievement, underachievement or areas to continue to work on. The Practice Supervisor has current knowledge and experience of the area in which they are providing support, supervision and feedback. The Practice Supervisor serves as a role model for safe and effective practice in line with their code of practice. The Practice Supervisor will input to the student documentation with their views on student achievement. Accountability is the principle that individuals and organisations are responsible for their actions and may be required to explain them to others (NMC, 2018a). The Practice Supervisor, Practice Assessor and Academic Assessor have a responsibility as part of The Code (NMC, 2018b) when making decisions to ensure they have the knowledge and skills to assess learners, and if not then to highlight what areas they need to develop as part of their own development plan. Activity 13 Think about your own experience of assessment from the perspective of being the assessor of another person and being assessed yourself. Give examples of the positive and negative experiences you can recall in the table below.

	Assessor	Being assessed
Positive experience/s
Negative experience/s

You will have your own experiences, but this is an example of the type of thing you need to capture:

	Assessor	Being assessed
Positive experience/s	Being able to tell the student that they are progressing well and being able to give examples of where that was observed.	Feedback on areas where I could improve and how I could do it was carried out in a very supportive way. It was made very clear what I have to do, by when and where I could get the support.
Negative experience/s	Having to fail a student because they are not making the progress expected.	The areas where I needed to improve came as a shock, as this was the first time I heard that there was an issue with this area of my practice. The way I was spoken to when being told I had failed was carried out in a negative way that it upset me and made me feel a complete failure.

It is important to reflect and think about the last time you were assessed and how it made you feel. As this can help you consider how this may make a student feel when roles are reversed.

Assessment should be continuous throughout the time in which a Practice Supervisor/Practice Assessor is assigned to a student. Students are assessed for a range of reasons: to ensure the safety of service users, to ensure they know how to perform certain skills and to support learning. Assessment needs to be designed so that students understand their progress towards course goals and can respond appropriately in order to meet those goals. For this reason, frequent assessment, accompanied with appropriate feedback is critical. Assessment is only as good as the feedback that accompanies it. In order to make assessment as effective as possible, feedback from the Practice Supervisor/Practice Assessor on the student’s performance is required. Feedback will be covered in more detail in Section 4.2. Activity 14 Reflect on the learning opportunities available in your clinical area/accessible outside of your direct clinical area by adding your thoughts to the table below.

Learning opportunities for students in my clinical area	Learning opportunities for students available outside of my direct clinical area

There are many opportunities for students that can be accessed within and outside of your direct clinical area which can provide the student with rich learning opportunities. It does take time to understand where these opportunities are and getting to know the right people to connect with. A Practice Supervisor/Practice Assessor can make these connections in order to facilitate student learning which will make the student experience much more rewarding.

A photograph of two healthcare workers in discussion. A photograph of two healthcare workers in discussion.

The following points outline the characteristics of assessment which promote learning. Assessment should involve: Sharing learning goals with students Clarifying and helping students know and recognise the standards they are aiming for Providing students with support in self-assessment and providing feedback which helps students to recognise their next steps and how to take them Nurture confidence that students can improve and involves both the Practice Supervisor/Practice Assessor and students in reviewing and reflecting on assessment information Assessment is a key component of learning because it helps learners learn. When students can see how they are progressing during their practice learning experience they are able to determine what areas they need to work on. Assessment can help with motivating students and encourages them to work harder. Just as assessment helps students, assessment also can help you as the Practice Supervisor or Practice Assessor. Continuous assessment allows you to gauge if your teaching has been effective and if you need to adjust your teaching style if you feel this will benefit the student’s learning. Assessment also allows the Practice Supervisor and Practice Assessor to ensure students learn what they need to know in order to meet their learning outcomes. Activity 15 Consider in your role as a Practice Supervisor or Practice Assessor what are the kind of skills and attributes you will be assessing your student on? Add your thoughts to the table below.

Skills	Attributes

There are many facets of student assessment but here are some suggestions. They are not exclusive, and you will no doubt have come up with your own ideas: Practical/technical skills Communication/interpersonal skills Organisational skills Knowledge base/theoretical knowledge Safe practice Critical thinking skills Ability to function as a team member Leadership Confidence Professional behaviour and attitude Accountability Autonomy Professionalism (NES, 2000) In your role as a Practice Supervisor or Practice Assessor when assessing skills and attributes it is very important to consider the student’s stage of training when carrying out any form of assessment. A Year 1 student in their first placement will not be performing at the same level as a Year 2 or Year 3 student (NES, 2020). The required standard for each level of student will be made explicit in the student’s practice assessment document (PAD) which you need to make yourself familiar with.

Assessments provide evidence and/or supporting information which can be used in an overall assessment of a student’s learning in practice. A good assessment is evidenced based, objective and fair. There are a variety of forms of assessment, but it is essential that the student is monitored continuously, during day-to-day activities before making a final assessment decision. Continuous assessment is critical and involves a series of assessments, measuring the student’s performance, along with their progress and achievement in relation to skills, knowledge and attitudes. Types of assessment The following forms of assessment fall under the umbrella of continuous assessment and can be carried out in many ways: Self-assessment Formative assessment Summative assessment Criterion-referenced assessment Self-assessment Self-assessment is very useful to carry out at the beginning of a placement. Here the student is expected to make judgements on their own performance, demonstrating personal insight and allows the Practice Supervisor/Practice Assessor an opportunity to further develop what the student already realises or knows. There are many self-assessment tools available, often based on student’s own self-awareness and self-assessment. A SLOT analysis (Stacey et al., 2018) which you completed in Section 2 or SWOT analysis (Carlson, 2016) are useful tools to encourage students to reflect and identify strengths, learning needs (weaknesses), opportunities and threats. It provides a baseline from which learning objectives can be established. Activity 16 Read Morrison’s (2011) article ‘SWOT analysis for Nurses and Health care environments’. Note how Morrison moves the reader through conducting a SWOT analysis to the development of SMART goals and objectives. You should be able to apply this methodology to your students once they have carried out their own SWOT analysis Being able to identify early on where the student feels they are in their development, allows the Practice Supervisor/Practice Assessor an opportunity to further develop what the student already realises or knows. Formative assessment Formative assessment is where the assessor lets the student know how they are progressing. This feedback is essential to enable the student to identify ongoing learning needs in order they meet their learning outcomes at the end of the placement. Your role as a Practice Supervisor/Practice Assessor will be central in the process of formative assessment which is where continuous assessment is carried out involving regular feedback ideally based around learning objectives. Providing regular feedback that motivates and encourages the student is pivotal to the formative assessment process. Direct observation is the most common form of formative assessment activity. This is often carried out by working alongside the student. As a Practice Supervisor/Practice Assessor you will be assessing competence, confidence, attitude and behaviour during episodes of care delivery. Doing this provides opportunities to watch and ask relevant questions related to an activity in order to test a student on their base knowledge and/or theoretical underpinning of the activities they are undertaking. Although depending on how well the Practice Supervisor/Practice Assessor knows the student their presence may have an impact causing the student to be nervous. Conversely the student’s behaviour may be favourable, but it does not give any assurances as to how the student may behave when not being directly observed. Based on this interaction it might be that you feel the student is practicing at the required level or you feel the student needs more guidance or further practice. If that is the case, you may need to consider how you can help the student address this gap, and this can be added to the objectives for the placement. While it is always good to involve the service user in the interaction and the feedback (NES, 2020a) this is not always appropriate where there is a development need identified. This feedback needs to be carried out as soon after the event as possible and in a safe and confidential environment. This information can then be fed into the student’s placement action plan. Alongside direct observation the Practice Supervisor/Practice Assessor will be assessing the students’ performance measured against the criteria set out in their practice assessment documentation which have been derived from the NMC (2018a) education standards. Using criterion-referenced assessments(discussed in more detail below) is a way to ensure that the assessment conducted is based on a common benchmark which all students studying the programme at that level need to achieve. Summative assessment Summative assessment is a formal process and is usually conducted at the end of a placement. An assessment of the student is made by the Practice Supervisor/Practice Assessor against pre-set criteria and a conclusive decision is made as to the students’ level of proficiency against these criteria. Students can provide a range of other evidence to help with the summative assessment process. The following is a list of commonly used activities, but it is not an exhaustive list. Reflective accounts of practice which encourages learning through experience through developing self-awareness and ability to critically analyse and evaluate episodes of care. Demonstrates knowledge and learning while informing future practice. Case studies which may include patient stories demonstrating a student’s understanding of dealing with a situation. Presentations formal or informal on a topic, experience or interest. These encourage student to research, prepare and develop confidence. Testimonials from others not in the role of Practice Supervisor/Practice Assessor on activities a student has undertaken and their achievements. Patient/service user feedback. This also gives an opportunity for the student to produce a reflection of that event and explore what went well. Demonstration of a skill witnessed by the Practice Supervisor/Practice Assessor. Criterion-referenced assessment Criterion-referenced assessment is where assessment is carried out against standards which are ‘referenced’ to criteria (UTAS, 2018). The process of assessing and evaluating the students’ knowledge and skill against a set of pre-specified criteria and not what other students have achieved (UTAS, 2018). These criteria specify what the student needs to achieve and the level (standard) which they need to meet (also known as performance descriptors). A student nurse’s performance is measured against predetermined criterion, in this case the NMC’s (2018c) standards and proficiencies for registered nurses. Achievement or not of these standards are captured in the student’s Practice Assessment Document.

A photograph of a pair of feet surrounded by arrows going in different directions. A photograph of a pair of feet surrounded by arrows going in different directions.

The NMC (2018a) say that ‘assessments and confirmation of proficiency are based on an understanding of student achievements across theory and practice’. Which means that student assessment must be evidence based, robust and objective so providing assurance of student achievements and competence. Practice Supervisors/Practice Assessors must apply un-prejudged reasoning when looking for evidence of professional development and competence in accordance with the NMC’s (2018a) standards for student supervision and assessment. In doing so Practice Supervisors/Practice Assessors must understand the factors that can influence the assessment process to avoid invalidating it (Walsh, 2020, pp. 155–6). These affects can emerge in various ways and the Practice Supervisors/Practice Assessors need to be mindful of these. Take a look at various effects and the potential impacts of these: Halo effect: This occurs when our knowledge and cognitive impression of a student influences the assessment process towards a favourable judgement. Horn effect: Is the opposite of the halo effect. A person’s perception of another is unduly influenced by a negative trait leading to a negative judgement. Hawthorne effect: Derived from experimental studies is a phenomenon where it is thought that a person works harder and performs better when they know they are being observed. It is important as assessors to ensure that we are objective and fair and are cognisant of not ‘being too lenient’; ‘being too soft’ by overlooking mistakes or the opposite of being too severe; ‘being too hard’. Similarly, we need to ensure we are not ‘playing it too safe’ and awarding middle grades and not being willing to award high or low grades. Ultimately as a Practice Supervisor/Practice Assessor you are accountable for the decisions you make and may need to justify the decisions you have made. The NMC (2018d) are very clear that all student assessments should be objective and fair. There is no doubt that assessing competency is a subjective activity and as assessors you need to be very conscious of this. One way to test yourself when making an assessment decision is to ask yourself, ‘if I were to be challenged on the evidence base I used to make this decision, what would I produce/argue’. If you are able to write the ‘evidence’ down, then you are validating the assessment you have made and this will help you significantly when providing feedback to the student (which you will explore further in Section 4.2). Activity 17 Read the NMC (2018d) guidance on objective and fair assessment. The NMC are clear that assessment must be fair, objective and evidence based. List below the type of evidence that you would consider in helping you make an assessment judgement. The NMC (2018e) suggest that there are a range of sources of evidence that can be utilised and that a variety of sources need to be used to inform assessment decisions and can include (but not explicitly limited to) the following: Direct observation of the student Communication with practice supervisors Student documentation, such as a practice assessment document or ongoing record of achievement Communication with any other practice assessors Communication with anyone else who may be involved in the education of the student Communication with the academic assessor Student self-reflection Communication and an ongoing relationship with the student This section has talked about the assessment process and your role in this. Conducting a fair, objective and meaningful assessment requires the assessor to utilise different, but robust strategies to evidence the assessment decisions which are made. This process can be enhanced significantly by planning the students experience by developing and agreeing objectives to be achieved by the end of the placement. However there needs to be time built into the placement, where a review of the students’ progress needs to be carried out and, if necessary, adjustments to the original objectives made. Ultimately the assessor is responsible and accountable for the assessment decisions made on a student and their practice. 

On completion of this section you should be able to: appraise the different models of giving feedback appraise the principles of how to give effective feedback evaluate methods of giving, receiving and documenting feedback.

A graphic with the following text: Goal setting: Specific; Measurable; Achievable; Realistic; Time-bound. A graphic with the following text: Goal setting: Specific; Measurable; Achievable; Realistic; Time-bound.

The focus of the next part of your learning is to understand that the skill of giving feedback is central to effective teaching and supervision. Feedback should be provided in order to support the student to progress. It is important that the student understands what went well and what requires further development. Feedback may often be referred to as feedforward. Before feedback can be given it is really important that both the student and the Practice Supervisor/Practice Assessor know what the aims of the placement/experience are. A key activity is that the student and the Practice Supervisor/Practice Assessor meet preferably on the first day (or even before) the commencement of the placement/experience and most certainly within the first forty-eight hours of placement/experience commencement. This meeting is the opportunity to discuss and agree what learning outcomes/objectives can realistically be achieved in the current work environment and how they match (or not) the students’ expectations and program requirements. From this meeting a learning plan should be developed that details; Specific, Measurable. Achievable, Realistic, Time-bound (SMART) objectives. S – Be specific that the goal can be achieved in the current setting with the resources available and meets the students’ needs. M – Is the end point quantifiable? A – Is the objective achievable in the current environment? There is no point in setting an objective that would be impossible to achieve. R – Are the proposed objectives realistic given the current setting and the students stage of their program? T – Deadlines for review. This needs to be approximately halfway through the experience. For longer placements this can be sooner and more frequent. There will inevitable be a date that marks the end of the experience when the objectives will need to be formally reviewed. However, leaving a review of the objectives until this late stage is neither supportive to the student or wise; especially if it subsequently turns out the student is not performing to the required standard. Taking time to do the above will make the whole assessment and feedback process a whole lot easier as the expectations from the perspective of both parties is set out in a transparent way right from the start. It does not mean that the objectives cannot change (and often they do). Being clear as to what is expected from the outset can do two very important things. It can make the student feel cared for and demonstrates your interest in them and you wanting them to have a successful placement. It gives a very clear message that there is an expectation on the student to play a very active role in their learning if they are to be successful.

A photograph of two healthcare professionals in discussion. A photograph of two healthcare professionals in discussion.

Giving feedback is a skill and like all skills it needs to be practiced in order for the assessor to be confident and competent in carrying it out. Feedback given positively and constructively can be motivating and empowering. Conversely feedback given negatively can be demoralising and can cause distress. Therefore, it is important that feedback is clear, focused and given regularly. Even if that feedback needs to be negative, if it is carried out in a positive and constructive way it will still allow the individual to be comfortable with the person giving the feedback (Moyle, 2020). Feedback/feedforward should also mention specific strategies the student can use to improve their learning and performance, which can then guide their next steps (Matua et al., 2014). Activity 18 Read the following article by Burgess, van Diffele, Roberts and Mellis: Feedback in the clinical setting. The research methodology section is very short but there is very rich invaluable information that follows. List your top three ‘take away’ messages from the discussion presented in this paper. 1. 2. 3. Feedback sources to consider: Begin feedback sessions with the learner’s self-assessment. Provide feedback in a timely manner. Reinforce and correct observed behaviours. Confirm the learner’s understanding and conclude with an action plan. Develop a capacity in learners to self-reflect on their own practice and how it might be improved. Encourage students to reflect on their own assessment and to consider areas of strength and areas of potential development. Activity 19 Watch this video clip of The Office and identify which of the above bullet points you can see displayed and what you thought about them. Feedback may come from a variety of sources including other healthcare colleagues, healthcare professionals, service users and families. This may add credibility as it provides different perspectives on the students’ performance and can be particularly helpful if there are concerns with performance involving service users. This evidence should be written and be unbiased. While it is good to encourage a more active role for patients, service users and carers in having a voice in informing assessments. Whatever the sources of evidence collected there are certain ethical implications which must be considered, such as patients/others must not feel forced to provide feedback on a student. It is very important to remember that students should be assessed against pre-set standards and not against peers or assessor expectations which may be subject to bias.

You’ll start with an activity. Activity 20 Think of the last time you felt you learned something from feedback on your performance or where you received useful, workable suggestions to something you were doing. How was it delivered to you? How did it make you feel and why? What was done well by the person giving the feedback? What was done not so well by the person giving the feedback? Effective feedback delivered in the right way at the right time supports the student in the best way possible and sets the tone for making fair judgements. Each student is different and so the feedback you give needs to be bespoke to that person and the situation at that time. Hardavella et al. (2017) say that when preparing to give feedback, think about: What would you like to achieve through your feedback? What do you want to highlight?What went well?Where could there be some improvements? 

There are many models of feedback which have been published. Not all are suitable for every situation, so they need to be picked selectively and used sparingly the trick is to focus on a couple of key points without overwhelming the learner (Hardavella et al., 2017). Below is just a very small selection which are applicable to a clinical setting. The feedback sandwich The feedback starts and concludes with positive feedback. The area to be improved upon is sandwiched in between two positive pieces of feedback. This is a really useful tool to use in clinical practice but should not be overused as it can lose its effectiveness. This is because the receiver of the feedback can become aware this style is being used and so may consciously be looking for the negative element of the feedback and ignore the positive aspects of the feedback. So, feedback should be supplemented with positive feedback on its own merits when the opportunity presents itself (Hardavella et al., 2017). Pendleton model The Pendleton model promotes a learner-centred conversation where the person receiving the feedback is central and an active participant. The learner has to agree to be an active participant for this model to be effective. It is a process by which the learner and assessor working together reflecting on the action which has occurred. The discussion always commences with the learner (Lucidchart, 2001): Positive areasLearner explains what went wellAssessor compliments learner on what went well This gives the learner an opportunity to explain the situation in terms of what was being assessed. The aim is to create a safe environment first by highlighting positives and consequently this prevents defensiveness. Improvement areaLearner explains what could have been done differentlyAssessor compliments learner on identifying what could be done differentlyThe role of the assessor is to take the area identified as needing improvement and reinforces this as a positive and encourages the learner to suggests what/how the situation could be improved. Action planThe learner and manager agree on an action plan and what could be further improved and how can this be achieved.A mutually agreed action plan is formed. CEDAR feedback model Another positive and motivating model which can be used is CEDAR (Wildman, 2003). C – Context. Give the learner context so as they can see how the feedback fits into their overall performance. E – Example: describe specific examples to illustrate the situation clearly. D – Diagnosis: help the learner explore why they are where they are. Understanding what’s behind their performance is essential to learning, whether the feedback is about an area of strength or a gap. A – Action: explore what actions will be important going forward, let the learner lead this part of the discussion as much as possible. R – Review: following up to support the learner and give recognition for progress. Activity 21 Have a look at these resources, particularly the ones about using CEDAR to give positive feedback, and developmental feedback (Oil in the Engine, 2020). Conversation guides Have a look at this video from the Centre for Creative Leadership which has some very powerful messaging on the common mistakes made when giving feedback: 10 common mistakes in giving feedback. What are your three take away points from having watched this video? 1. 2. 3.

On completion of this section you should be able to: recognise the underperforming student and identify the support available understand why sometimes assessors fail at giving feedback, are dishonestly kind in giving negative feedback and have unconscious bias in providing feedback reflect on why assessors fail to fail and the professional ramifications of doing so recognise the importance of clear verbal and written communication between students, Practice Supervisors and Practice Assessors understand the process to follow when supporting a failing student.

There are times when a students’ performance can become a concern and usually falls into one of two categories: Conduct: Lack of professionalism (poor behaviour). Proficiency: The learners’ ability to demonstrate the required level of knowledge and skill related to their practice. (NES, 2020b) Conduct Professionalism can mean different things to different people although it is generally seen as being essential to good care (NMC, 2018f). A single definition for what it means in nursing and midwifery is difficult to establish. This multifactorial concept was taken up by the NMC (2018f) when it published its enabling professionalism framework. Activity 22 Note down some behaviours that you consider a student nurse could display if their conduct (behaviour) was not at an acceptable standard. There is no definitive list of unacceptable behaviours. This is because context as well as the behaviour itself need to be considered. However, here are some attributes you may have thought of: Wearing uniform incorrectly or wearing of inappropriate clothing where a uniform is not worn Taking shortcuts; not following policies and procedures Showing disrespect, confrontational Offensive language Poor hygiene Lack of motivation/interest Late on duty/frequently absent Unfounded stress/anxiety which affects work performance Untrustworthy Blurring of personal and/or professional boundaries Lack of theoretical knowledge Inconsistency of clinical performance Blames others for identified failings Proficiency This is having the skills and knowledge to competently carry out an activity to the required standard. The NMC (2018c) detail the requirements of the proficiencies that a student nurse needs to obtain before being eligible to join the NMC register. The role of the Practice Assessor and Academic Assessor is to ensure that the student nurse is able to demonstrate they have the requisite skills and knowledge required for their stage/level of practice. Activity 23 In assessing a student nurse in practice note down the types of performance issues that would be of concern to you. There is no definitive list of however it will be clear that the student is not able to deliver care to an acceptable standard. Here are some indicators that you may have considered: Poor/unsafe practice Inability to manage the care needs of a service user Poor time management Inefficient organisation of workload Weak/incompetent clinical performance Unable to accept and respond positively when given developmental feedback from others Deficient communication skills either/or written and verbal Failures such as maintaining contemporaneous records, handing over important information to relevant others Failure to develop skills and competencies identified at review meetings Avoid working with Practice Assessor

Addressing performance concerns informally Occasionally there will be times that a student is unfortunately not achieving the required standards and if current performance continues the student is likely to fail the placement. The sooner this is identified and addressed the less likely this will be the final outcome. There should never be a situation where a student is surprised that they have failed a placement. It is imperative that at the first signs that a student is not performing to the required standard, a dialogue with them as to their performance and the standard required needs to occur. On identifying there may be a problem with a student’s performance, this needs to be addressed and must be carried out discreetly by talking to them informally and constructively as near to the time of the practice event as possible. Doing this can help the student reflect on their practice and make the adjustments required in future practice. Sometimes this approach may not work, and the student needs to be put into a formal process. Addressing performance concerns formally Formal intervention needs to be timely and carried out as early into the placement as possible, in order to allow the student time to address the issue/s of concern (Matua et al., 2014). Leaving the decision until it is too late may prevent the initiation of any ‘rescue strategies’ the practice assessor/academic assessor may attempt to implement at a later date (Hughes et al., 2016) resulting in the student failing the placement, having had no opportunity to correct the concern/s. On deciding to put a student into a formal process a tripartite meeting is required. This meeting will be held with the student, the Practice Assessor and the Academic Assessor (Houghton, 2016). This will then need to be formally documented and escalated to the University and employer. In preparation for the meeting with the student, it is helpful to have recorded in writing, the specific issues that are of concern to you and have this supported by an example or examples of when the practice was not deemed appropriate. Putting the evidence that you have, into coherent discussion points, on paper will help the student and Academic Assessor significantly. In particular doing this will help you to provide robust evidence that supports your concerns, and if shared with the student and Academic Assessor prior to the meeting allows the student some time to reflect on this information and come prepared to the meeting to discuss the issues raised. You also need to consider at this stage what actions you feel could be put in place or that you expect the student to do to help rectify the situation. Being prepared for the meeting will help you keep the subsequent meeting focused and based on fact. As Hardavella et al. (2017) says, generalised feedback is not helpful and can trigger unhelpful thoughts in the student, such as whether there is a hidden agenda. This can be compounded when there is lack of advice on how they can improve that behaviour. When arranging a meeting to discuss the students’ progress it needs to be made clear to the student the purpose of the meeting and who will be present and why. The venue for holding the meeting also needs to be thought through. Providing negative feedback in the middle of a busy clinical area is not appropriate and has the potential to make the student feel embarrassed and/or awkward. At the meeting the feedback needs to outline what the student has done well before introducing the areas of concern as a way of balancing the feedback and not completely demoralise and deflate the student. It is very important that you listen carefully to what the student has to say by listening to their explanations for performing the way they did in the assigned task/s (Matua et al., 2014). Matua et al. also go on to say that listening to the student attentively can help portray a sense of caring for the student as well as give them the opportunity to explain if they have been experiencing a specific issue not known previously. Where relevant and appropriate this gives an opportunity for the assessor/s to address the issue/s and make any reasonable adjustments as required such as an undisclosed/undiagnosed disability (Houghton, 2016). This also provides an opportunity for the assessor/s to adjust their subsequent teaching approaches to facilitate better learning for the student. The outputs from this meeting gives the learner a chance to rectify the situation, and not fail the placement because the student does not know there is an issue or know how to address the issues raised (Duffy, 2013). There are many tools that can be used, with the formal learning contract/action plan probably being the most common. This plan needs to build in time to give the student space to rectify behaviours but must always contain a review date so that progress can be tracked and discussed. The discussions which occur as part of these reviews must be comprehensively recorded and all parties involved (including the student) given a copy.

The role of a Practice Assessors/Academic Assessors is not only to support the development of the student nurse in clinical practice, but also to safeguard the public from incompetent nurses by preventing a failing student nurse becoming an NMC registrant (Bachmann et al., 2019). Unfortunately, there are times when a student nurse does not meet the proficiency standards required and the student needs to be failed. This is an unenviable situation for an assessor, as needing to fail a student nurse is not a pleasant situation. Hughes et al. (2016) in their systematic literature review found that registrants found failing a student nurse to be a difficult and emotional process for both student and assessor. Hughes et al. go on to say that from their work it was recognised that failing a student can provoke strong emotional responses in assessors such as self-doubt, guilt, failure of themselves as an assessor. Assessors also felt that the act of failing a student was against the ‘caring’ nature of belonging to the nursing profession. Alongside this, assessors were cognisant of the personal responses they may get back from the student having made this decision as well as the consequences for the student personally as a result of this failure outcome. As a result of these emotions, failing a student was sometimes avoided. No matter how emotional the situation failing the student when it is right to do so cannot be ignored. ‘Failing to fail’ (Duffy, 2003) a student nurse who does not display satisfactory clinical performance in itself has personal and professional ramifications for the Practice Assessor/Academic Assessor. Activity 24 What do you think are the personal and professional consequences of giving a first-year student nurse the benefit of the doubt and making the decision not to fail them when they need to be failed? Not failing a first stage student nurse has ramifications even though it may at face value may not seem to be too much of an issue as there will be more opportunities for the student to ‘catch up’ later. However not failing a first-year student when they needed to have been failed leaves a problem for others to pick up. If this situation of failing to achieve the required standards of performance continues through subsequent placements until the student is in the final stage of their training leaves this final Practice Assessor with a huge issue; fail the student and they do not join the NMC register or let an incompetent individual join the register. For the student they may feel that they have done well and can overestimate their skill level. If subsequently their practice is questioned and corrected by a subsequent assessor, it can come as a huge shock to the student and it is not unknown for the student to react to this with indignation and even outrage, making it harder for the new assessor to maintain the ‘moral courage’ to fail them, so allowing the student pass and thus the cycle repeats itself (Hughes et al., 2019). The process of supporting students can be made a lot easier with an open and honest dialogue with the student throughout their placement. All supported of course, with good contemporaneous record keeping of the interactions. Not failing a failing student nurse has significant implications for the individual student and assessor involved, as well as for nursing profession and patient safety. Hughes et al. (2016) say in their paper that ‘assessors have an obligation to the profession and to the public, to care for the well-being of patients by ensuring student nurses are safe and competent to practise’. So, failing to fail an incompetent student nurse is not an option.

Ultimately there will be a student that no matter how much support and guidance they have been given they will fail their practice placement. This should not come as a surprise to the student as you should have been having a dialogue with them as to their performance and the standard required over the preceding weeks/months. Even though this failure should not be a surprise to the student, it is the finality of the assessment decision at a key milestone of their progress through the programme which can come as a shock to the student especially if the enormity of the final decision is significant, such as removal from the nursing program. This is where there is a need for all parties to be supported by appropriate others, such as the organisations wellbeing services to help them through this significant event.

In this free course, you have examined the role of the Practice Supervisor, Practice Assessor and Academic Assessor and the functions they carry out in supporting students in clinical practice. The roles are multi-factorial, but they have a significant part to play in making the final assessment decisions on a student’s performance. Should a student’s performance not meet the expected requirements, you have learned about the strategies that can be put in place to support both the student and assessor in a transparent and constructive way. Bachmann, L., Groenvik, C.K.U., Hauge, K.W. and Julnes, S. (2019) ‘Failing to Fail nursing students among mentors: A confirmatory factor analysis of the Failing to Fail scale’. Nursing Open, 6, pp. 966– 73. Available at: https://onlinelibrary.wiley.com/doi/10.1002/nop2.276 (Accessed: 26 September 2022). Carlson, K. (2016) A SWOT analysis for your career. Nurse.com. Available at: https://www.nurse.com/blog/2016/07/19/a-swot-analysis-for-your-nursing-career/ (Assessed 26 September 2022) Centre for Creative Leadership (2014) Common mistakes in giving feedback. Available at: https://www.youtube.com/watch?v=Fovrb4Y6OTI (Accessed 15 September 2022) Duffy, K. (2003) Failing students: a qualitative study of factors that influence the Decisions Regarding Assessment of students` Competence in Practice. Glasgow Caledonian University. Caledonian Nursing and Midwifery Research Centre School of Nursing, Midwifery and Community health. Duffy, K. (2013) ‘Providing constructive feedback to students during mentoring’. Nursing Standard, pp. 27, 31, 50–6. Hardavella, G., Aamli-Gaagnat, A., Saad, N., Rousalova, I. and Sreter, K.B. (2017) ‘How to give and receive feedback effectively’. Breathe (Sheff), 13(4), pp. 327–33. Available at https://breathe.ersjournals.com/content/13/4/327 (Accessed 16 September 2022). Houghton, T. (2016) ‘Assessment and accountability: part 2 – managing failing students’. Nursing Standard, 30, 41, pp. 41–9. Hughes, L., Mitchell, M. and Johnstone, A.N.B. (2016) ‘Failure to fail in Nursing – a catch phrase or a real issue? A systematic integrative literature review’. Nurse Education in Practice. Available at: https://www.sciencedirect.com/science/article/abs/pii/S1471595316300476?via%3Dihub (Accessed 22 September 2022). Knight, K.H.,Whaley, V., Bailey-McHale, B., Simpson, A. and Hay, J. (2022) ‘The long-arm approach to placement supervision and assessment’, British Journal of Nursing, 31(4), p. 247. Available at: https://www.magonlinelibrary.com/doi/abs/10.12968/bjon.2022.31.4.247 (Accessed 16 September 2022). Lucidchart (2021) Powerful Performance Feedback Models and How They Can Help Your Company. Available at: https://www.lucidchart.com/blog/performance-feedback-models?page=1 (Accessed: 16 September 2022). Morrison, M. (2011) ‘SWOT analysis for Nurses and Health Care Environments’. RAPIDBI. Available at: https://www.rapidbi.com/swot-analysis-in-nursing-health-care/ (Accessed: 20 September 2022). Moyle, S. (2020) ‘Giving feedback: 3 models for giving effective feedback’. Available at: https://www.ausmed.co.uk/cpd/articles/giving-feedback (Accessed 26 September 2022). NHS Education for Scotland (NES) (2020a) ‘Preparation for Practice Supervisors and Practice Assessors Supporting Effective Practice Learning’. Unit 5: Assessment. Edinburgh; NES NHS Education for Scotland (NES) (2020b) ‘Preparation for Practice Supervisors and Practice Assessors Supporting Effective Practice Learning’. Unit 6: Supporting learners: Responding to performance concerns and supporting development and progression. Edinburgh; NES Nursing and Midwifery Council (NMC) (2018a) ‘Realising professionalism: Standards framework for education and training. Part 2: Standards for student supervision and assessment’. Nursing and Midwifery Council, London. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/education-standards/student-supervision-assessment.pdf (Accessed 26 September 2022). Nursing and Midwifery Council (NMC) (2018b) ‘The Code. Professional standards of practice and behaviour for nurses, midwives and nursing associates’. Nursing and Midwifery Council, London. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf (Accessed 26 September 2022). Nursing and Midwifery Council (NMC) (2018c) ‘Future Nurse: Standards of proficiency for registered nurses’. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/education-standards/future-nurse-proficiencies.pdf (Accessed 22 September 2022). Nursing and Midwifery Council (NMC) (2018d) ‘Objective and fair assessment’. Available at: https://www.nmc.org.uk/supporting-information-on-standards-for-student-supervision-and-assessment/practice-assessment/what-do-practice-assessors-do/assessment-of-practice/objective-and-fair-assessments/#:~:text=All%20student%20assessments%20should%20be%20objective%20and%20fair.,been%20given%20a%20reasonable%20opportunity%20to%20do%20so. (Accessed 25 September 2022). Nursing and Midwifery Council (NMC) (2018e) ‘Evidence based assessment’. Available at: https://www.nmc.org.uk/supporting-information-on-standards-for-student-supervision-and-assessment/practice-assessment/what-do-practice-assessors-do/assessment-of-practice/evidenced-based-assessment/ (Accessed 25 September 2022). Nursing and Midwifery Council (NMC) (2018f) ‘Enabling professionalism in nursing and midwifery practice’. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/other-publications/enabling-professionalism.pdf (Accessed 16 September 2022). Nursing and Midwifery Council (NMC) (2019) ‘Effective Learning’. Available at: https://www.nmc.org.uk/supporting-information-on-standards-for-student-supervision-and-assessment/learning-environments-and-experiences/safe-and-effective-learning/effective-learning-experiences/#:~:text=Effective%20learning%20places%20the%20student,practice%2C%20without%20compromising%20public%20safety. (Accessed: 12 October 2022). Oil in the Engine (2020) ‘Conversation guides’. Available at: https://oilintheengine.com/resource-category/conversation-guides/ (Accessed: 14 November 2025). Panzieri, J. and Derham, C. (2020) ‘Student nurses’ experiences of receiving verbal feedback within the clinical learning environment: to what extent does this promote sustainable feedback practices?’, in: Gravett, K., Yakovchuk, N. and Kinchin, I. (eds) Enhancing Student-Centred Teaching in Higher Education. Palgrave Macmillan, Cham. Stacey, G., Aubeeluck, A. and Cook, G. (2018) ‘Resilience-based Clinical supervision; A course companion’, Kingsmead: Foundation of Nursing studies. Available at: https://www.fons.org/resources/documents/Resilience-Based-Clinical-Supervision-Course-Companion.pdf (Accessed: 20 September 2022). University of Tasmania and Australia (UTAS) (2018) Criterion Referenced Assessment. University of Tasmania, Australia. Available at: https://www.teaching-learning.utas.edu.au/assessment/criterion-referenced-assessment (Accessed: 22 September 2022). Walsh, D. (2020) The Nurse Mentor’s Handbook. Supporting Students in Clinical Practice. Third Edition. London; Open University Press/McGraw-Hill Education Wildman, A. (2003) The CEDAR model. Available at: https://www.annawildman.com/cedar-feedback-model.html# (Accessed 16 February 2022) This free course was written by Linda Walker, Liz Sturley and Barbara Cochee. 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