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Week 4: Relationships – the heart of effective mentoring

Introduction

This week you will explore the factors that can contribute to forming a successful relationship with your students. Setting goals and challenges for them is an important part of the relationship, so your learning from last week about skill acquisition and attainment of competence is essential to determine goals that are realistic, achievable and appropriate to their stage of learning.

You will also look at aspects of the relationship that can cause conflict. Nurse mentors have to assess the students that they are supporting, so being confident to give negative feedback that is constructive and developmental is fundamental to your professional mentoring relationship.

In the following video, Fiona Dobson introduces Week 4 and reminds you about the badge quiz at the end of this week.

Download this video clip.Video player: flip_week_4.mp4
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Transcript

Welcome to Week 4 of your studies and well done for reaching the midpoint of the course.

Whatever you do in life is dependent on the relationships you have with others. Sometimes their contributions will be invisible. For example, the music that you listen to on the way to work or the vegetables that you buy on the way home. But sometimes their contributions are far more evident. Your friend’s arm around your shoulders when you’re feeling sad or the colleague at work who’s willing to put time aside to discuss a knotty problem with you.

Being an effective mentor requires you to be visible and to interact effectively with others. So establishing relationships with colleagues inside and beyond the organisation is just as important as the relationships that you establish with your students.

You’ll have the opportunity to explore this through activities during this week’s learning.

But before you move on to those activities I want to remind you that this is the week where you take the first of the two badged quizzes. This will give you the opportunity to undertake and review your learning across the last four weeks of the course. And don’t forget if you’re using this course as formal preparation to become a mentor then you must undertake the badged quiz.

End transcript
 
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Mentorship programme

If you are completing this course as part of a Nursing and Midwifery Council (NMC) mentor preparation programme, the materials and activities in this week’s study relate primarily to the following NMC domains:

  • Establishing effective working relationships
  • Assessment and accountability.

After this week you should be able to:

  • identify eight key components that contribute to effective mentoring
  • analyse the impact of your own and others’ non-verbal communication on maintaining effective relationships
  • give feedback in a way that is motivational and developmental
  • plan your own support networks that underpin your maintenance of competence as a mentor.

1 Establishing effective mentoring relationships

Recent research involving students, mentees and mentors has explored and identified various elements that contribute to or undermine successful mentoring relationships (Teatheredge, 2010; Straus et al., 2013; Eller et al., 2014). The findings highlight factors that you may consider to be common sense, but this should be viewed positively. First, this confirms that there is nothing mysterious about being an effective mentor. Second, it suggests that you should be able to identify many of the components of successful mentoring relationships by drawing on your own life experiences, which may include being a student, mentee or mentor.

Activity 1 Recognising factors that contribute to effective mentoring relationships

Timing: Allow 15 minutes

Watch the video produced by the NHS local learning platform, which shows two related interactions between a student and his mentor. As you watch, make a note of the factors that might make a positive impact on their mentoring relationship. Play the clip again and add any factors that you missed during your initial viewing. Keep your list of factors to hand, as you will need it again for Activity 2.

Download this video clip.Video player: nurse_mentoring_on_the_ward.mp4
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Transcript

Narrator:
Student nurse, Paul Lawrence had been in training for the past two years. Today, hes working for the elective surgery ward in the Alexandra Hospital in Redditch. He supervised by experienced nursing sister Jane Gascoigne who as is mentor is supporting his learning.
Jane Gascoigne:
Speaking to patient: How's your day Mr, Dry? I'm a sister nurse mentor, and I'm just observing Paul today, taking some blood pressures of patients on the ward.
Mr Dry:
OK.
Paul Lawrence:
Hello, Mr Dry. How are you?
Mr Dry:
I'm good, thank you.
Paul Lawrence:
My name is Paul I'm one of the student nurses. I need to check your blood pressure, if that's OK? Let me just clean this blood pressure cuff, for you.
Jane Gascoigne:
It's quite important, from an infection control point of view, that Paul is cleaning the cuff in between each patient. He's already gelled his hands and he's gained consent, as well, from Mr. Dry.
Paul Lawrence:
Have you had any nausea, Mr Dry?
Mr Dry:
No.
Paul Lawrence:
No? That's lovely.
Paul Lawrence:
So, it's gonna get a little bit tight around the arm, OK?
Mr Dry:
Yes, OK.
Jane Gascoigne:
During this time, Paul is assessing the patient, as well. checking he hasn't got any nausea or pain, and that he is comfortable. Paul is assessing the patient; having a rapport with him, watching his face; any sort of grimace that he might have, experiencing any pain or nausea. It's a crucial time that a nurse has with a patient.
Jane Gascoigne:
So, now Paul has taken Mr Dry's observation chart and he needs to know record this, accurately, making sure he's got the time and the date in the right place. It's important that he is aware that he can take a manual pulse, as well, so he is, hopefully, feeling the strength of the pulse, to make sure it is a regular pulse.
Paul Lawrence:
That's a good, strong, regular pulse.
Mr Dry
Good
Jane Gascoigne:
Paul has reassured his patient that everything is fine. Sometimes, if there isn't feedback, they might be a little bit concerned.
Paul Lawrence:
I'm happy with that, thank you, I'll pass everything on to sister.
Jane Gascoigne:
That was good. How do you feel about it?
Paul Lawrence:
I should have really taken the gentleman's arm out of his sleeve, rather than rolling it up.
Jane Gascoigne:
It would have been easier, but at least you realised. You did your observations, very well. You've checked the patents details are correct, you put the date in, you've timed it, correctly. You've observed that all your parameters are within normal range, for him. You spoke to him while you were taking a manual pulse, as well.
Paul Lawrence:
The pulse was quite strong, and regular.
Jane Gascoigne:
So you're aware of that, that's good. You also looked back at the previous observations so you had an idea of what their climbing at. You signed it at the bottom, as well, so that's very good.
Narrator:
For Jane, being able to inspire students is something she finds very rewarding.
Jane Gascoigne:
I absolutely love it. and I've been quite like, for a long time, so I want a student to appreciate that love, as well. It sounds a bit corny, but I want them to enjoy the job as much as I do.
Narrator:
Mentoring boosts students' reflective learning and encourages best practice.
Paul Lawrence, speaking to a patient:
I can get you some Paracetamol, now, but I'll go check with sister to make sure that's correct, for you.
Narrator:
There's also a mandatory requirement for all pre-registration nursing students.
Jane Gascoigne:
So did you establish, Paul, on what kind of pain level he had?
Paul Lawrence:
No, I didn't, sister.
Jane Gascoigne:
So, you might want to think about what level his pain is, and obviously, what scale it is. Have you checked his wound?
Jane Gascoigne:
No, I haven't, sister.
Jane Gascoigne:
He needs to observe the patients wound because there are lots of complications he needs to be aware of. He also needs to access patient pain threshold.
Paul Lawrence, speaking with the patient:
It doesn’t look inflamed and it's a clean dressing. On a scale of 1 to 3, how painful would you say it is?
Patient:
I'd say it's a 2.
Jane Gascoigne:
I’m glad you went back and talked to him about his level of pain because you just need to be aware of the fact that when a patient says they're in pain you need to establish what threshold of pain he has, does it require morphine.
Paul Lawrence:
That's why I thought I would speak to you first and make sure.
Jane Gascoigne:
Great, that's good. He says that it's not extreme pain, so that's good. Obviously, if the Paracetamol doesn't work, we could perhaps decide later whether he needs an alternative.
Paul Lawrence:
Yes, OK, no problem.
Narrator:
As an experienced mentor, Jane's up to speed with the latest NMC standards to support learning and assessment in practice; something Paul Lawrence is thankful for.
Jane Gascoigne:
No problems there, at all. Good interaction.
Paul Lawrence:
Thank you, sister.
End transcript
 
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Eller et al. (2014) conducted an extensive research study with students and their mentors from various academic disciplines, including natural sciences, nursing/health sciences, engineering, and technology. Using a defined technique for achieving consensus through twelve focused group discussions, the behaviours considered helpful for effective mentoring relationships were organised into eight themes, termed key components (see Figure 1).

Described image
Figure 1 The key components of effective mentoring relationships (adapted from Eller et al., 2014, p. 817)

Activity 2 Linking your observations to the key components of effective mentoring relationships

Timing: Allow 30 minutes

Refer to the eight key components identified by Eller et al. (2014) in Figure 1 and decide whether the factors that you identified from the video clip can be associated with these components. Copy out Table 1 (or download a copy) and add your observations.

Table 1 Linking your observations to the key components of effective mentoring relationships

Key components of an effective mentoring relationship Observed factors from the video clip
Open communication and accessibility
Goals and challenges
Passion and inspiration
Caring personal relationship
Mutual respect and trust
Exchange of knowledge
Independence and collaboration
Role modelling

Were you able to add an observation against each of the components? If not, play the video again with the components in mind and decide whether there are other factors that you either missed or did not necessarily associate with effective mentoring. Add these to the table too.

Discussion

Table 2 shows some possible observations, but you may have others.

Table 2 Possible observations to the key components of effective mentoring relationships
Key components of an effective mentoring relationship Observed factors from the video clip
Open communication and accessibility Jane, the mentor, is available throughout the time the student, Paul, is carrying out the observations. Jane encourages open communication by asking how Paul felt the intervention had gone. There is good eye contact between Jane and Paul during the post-observation discussion, and she uses positive prompts such as nodding and smiling.
Goals and challenges Jane sets Paul a new set of goals when she explores with him whether he has sufficient information to make a decision about appropriate pain relief for the patient. She indicates the need to establish the patient’s reported level of pain and to check his wound.
Passion and inspiration Jane highlights her considerable experience as a registered nurse and her real desire, even though it might sound ‘corny’, to inspire her students so that they enjoy nursing as much as she does.
Caring personal relationship Paul is unsure about the best way of managing the second patient’s pain. He has no hesitation in seeking his mentor’s advice, suggesting that he values the relationship and feels supported by it.
Mutual respect and trust Paul appears to be comfortable when discussing aspects of care that he has initially missed. This indicates that he believes Jane will not respond in a punitive way. Instead, she will enable and encourage him to find solutions to his patient’s pain problem. Jane gives Paul pointers as to his next actions, but she trusts him to know how to assess the patient’s pain level and to check his wound. She trusts and respects that he will carry out the interventions correctly.
Exchange of knowledge Jane discusses the process of recording observations with Paul, which enables him to highlight what he knows – for example, the importance of a strong, regular pulse, and that removing the patient’s arm from his sleeve rather than rolling up the sleeve might have been a better alternative.
Independence and collaboration Jane allows Paul to carry out taking the blood pressure without interruption, encouraging independence. They work closely together to determine the best approach for managing the second patient’s pain.
Role modelling Jane explains to the first patient that she is there to observe the student, thus role modelling the importance of offering explanations to patients. Paul mirrors this approach by explaining to the patient the outcome of taking his pulse manually. Jane consistently presents herself in a professional manner, both in appearance and behaviour. She demonstrates a calm, assured approach that reassures the students she supports.

1.1 Additional roles for nurse mentors

The components identified by Eller et al. (2014) provide a comprehensive insight into the essentials of an effective mentoring relationship and it is likely that you have been able to attribute all of your observed factors to one or more of the components. However, perhaps you have one or two observations that don’t seem to fit very well, or at all. Reading other papers about the nature of mentoring relationships will offer alternative insights and broaden your thinking. Teatheredge (2010), for example, emphasises the importance of reducing student anxiety as a key function of the mentor relationship, whilst Wilson (2014) identifies protecting the student from danger as an integral component.

In Activity 2, you may have identified another key component (Eller et al., 2014) that appears to be missing from the effective mentoring relationship: assessing competence. In many professional spheres this is not typically seen as a function of the mentor role. However, the NMC (2008) specifies ‘assessment and accountability’ as one of the eight domains that nurse and midwife mentors must be competent in, and this specific issue is addressed in Weeks 6 and 7.

Mentorship programme

If you are studying towards an NMC mentor qualification, you should be allocated a nursing student to support in practice. Now you have finished learning about mentoring relationships, you might work through the following suggestions in the practice setting, in order to provide evidence for your portfolio against the NMC domain:

  • Establishing effective working relationships.

At the end of the first five days of your time together, write a reflective summary that explores how you feel you have addressed the eight key components of an effective mentoring relationship, giving examples.

If there are components that you haven’t addressed yet or that you feel haven’t gone particularly well, you can focus on these as the relationship continues.

As your time together nears its end, seek feedback from your student about the achievement of the eight components. What worked well, what could have been approached differently and what would your student have liked more or less of?

Using this feedback, return to your original reflective summary and reconsider the effectiveness of your mentoring relationship. Add any additional examples, thoughts or feelings to your summary to show how your approach to the mentoring relationship has developed or changed.

Identify the one key component that you feel was the least well developed in this relationship and that you will focus on the next time you are supporting a student.

2 Open communication

The way in which you communicate with your students or mentees is fundamental to your mentoring relationship. You may already have well-honed communication skills developed through life experiences including your work role or roles – but if you haven’t thought recently about the factors that make for good communication, now is the time to review these.

As you know, effective communication involves both verbal and non-verbal skills. Although the words that we use and the speed, rhythm and pitch at which we speak all serve to support the meaning and clarity of our communication, it is often our non-verbal skills that will enhance or detract from this clarity.

Watch this short video from YouTube, created by About.com, to remind yourself about the various aspects of non-verbal communication.

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In case you need a prompt for future reference, the eight points are:

  1. facial expression
  2. hand gestures
  3. paralinguistics
  4. body language
  5. proxemics
  6. eye gaze
  7. haptics
  8. appearance.

Being aware of and deliberately using your non-verbal communication skills can make your relationship with your students much more rewarding for them and less stressful for you. In the video in Activity 1, Jane’s facial expressions and gaze are welcoming and indicate enthusiasm; she also uses gestures of positive reinforcement such as nodding and the pitch and rhythm of her voice to create a sense of calmness, suggesting there is ample time for discussion.

One of the mentors who participated in Wilson’s research study into the experiences of mentors commented, ‘I’ll have my approachable face on so people can come and find me’ (Wilson, 2014, p.315). These mentors understand the impact of non-verbal communication on their students’ emotions and deliberately employ strategies that encourage interaction. Consequently, their students feel comfortable to approach them for feedback or advice; this in turn reassures the mentors that their students are practising safely and appropriately, and that the patients/service users are therefore well cared for.

Activity 3 Delivering feedback

Timing: Allow 40 minutes

One of the most important aspects of open communication identified by mentors (Huybrecht et al., 2011) and by students (Foster et al., 2014) is the provision of feedback.

Drawing on your own experiences of giving or receiving feedback, and from reading these extracts from a paper by Clynes and Raftery (2008), answer the questions below and then read the suggested answers.

What is the purpose of giving feedback?

Answer

The aim is to offer the student insights into their performance. You can reinforce practices that are done safely and accurately, and behaviours that are productive. You can also highlight skills that need further development and conduct that is not yet sufficiently professional.

How might you give informal feedback?

Answer

You might do it spontaneously, whilst working alongside the student. This gives you the opportunity to make direct observation and enables you to relate your comments to the specific nursing intervention taking place at that time. Some students may not recognise this impromptu approach as a form of feedback. Informal feedback can also take place away from the practice setting, for example during a conversation on the way to the bus stop or back to the car park. This may be useful, but you need to be careful about confidentiality or potentially leaving the student disheartened at the end of a tiring day if you mention something that hasn’t gone too well just before setting off to your respective homes.

What is formative feedback?

Answer

This feedback usually takes place in a planned way. For example, you might arrange to meet the student every couple of weeks during their practice learning experience in order to review their ongoing progress and reflect on the strengths and limitations of what has been achieved. It should help you and the student plan the focus for the next two to three weeks of experience.

What is summative feedback?

Answer

This feedback usually takes place at defined points in a student’s practice learning journey. You will be providing a summary of all that has been achieved whilst the student has been gaining practice skills and experiences with you and the wider team, and making judgements as to whether the NMC skills and competencies have been achieved at the required level.

When is the best time to give feedback?

Answer

If your feedback is required to correct the student’s performance of a skill, it is best to do this as close to completion of the skill as is feasible. This will allow the student the opportunity to improve their performance the next time the skill is carried out.

Waiting until the end of a practice learning experience to highlight poor practice is not supportive of the student’s development and could potentially put patients at risk. It is preferable not to correct a student in front of a patient, as this can be demoralising and undermine the student’s self-esteem. However, there can be occasions when the student’s intended action will cause harm, so feedback must be immediate.

Nevertheless, there are ways in which you can still make this a positive intervention. There is a difference between saying ‘Stop, not like that!’ in a loud voice compared with a quieter interjection such as ‘Just before you do X, talk me through the possible options here’.

What factors can interfere with giving feedback?

Answer

As a nurse, your priority is always to your patients. In busy everyday practice it can be extremely difficult to find appropriate and sufficient time to provide meaningful feedback to the student. Finding time to give feedback can also be affected by periods when either the mentor or the student are on leave and so not available to either give or receive feedback.

When you consider the key components that contribute to effective mentoring relationships, it is clear that the mentor and the student may become close. As the mentor, this can make it difficult for you to give critical feedback, as you may feel that this will affect your ongoing relationship with the student.

How would you prepare to give formal feedback?

Answer

Allow sufficient time for delivering the feedback. Typically, more time is needed for summative feedback, as there are more elements to discuss. If you have to provide corrective formal feedback, arranging to do this at the end of the working day may raise anxiety in the student, who is then likely to be distracted throughout the day and therefore perform less well. Do think through how you will balance the negative aspects of the student’s performance with the elements that are done well. The student needs to leave the feedback session feeling that they have skills in place that can be built on, whilst recognising that there are particular actions that have to be taken forward immediately in order to become a safe, effective practitioner.

What elements contribute to high-quality feedback?

Answer

Asking the student to analyse their own performance of a particular intervention with a specific patient can prove to be fruitful to you and the student. The student may demonstrate to you an awareness of those elements of the skill that were delivered accurately and highlight areas where there was a lack of certainty or dexterity. This will allow you to concur with and reinforce the student’s perceptions, or suggest other factors that you feel may have been overlooked. The important point is to be specific. An overall comment such as ‘Well, that didn’t go very well’ doesn’t offer the student insight into why you felt it didn’t go well and therefore what to focus on to make improvements.

What might you do to make the provision of feedback easier?

Answer

Allow yourself sufficient time. Ensure the feedback can be given in privacy with no interruptions. You need to ensure that colleagues know that you cannot be interrupted for the next X minutes. Think through what you would like to say to the student, and also how the student might respond. Being prepared for particular types of response such as anger or crying can help you deal with these more appropriately.

The next time you need to offer formal feedback, you should think through the process first:

  • Aim to ensure that you have taken into account the place and timing of your feedback.
  • Make preparations that will help to ensure that the receipt of feedback is a positive experience, even if the feedback itself is negative.
  • Structure the feedback so that it is meaningful and can therefore support personal and professional growth, development and achievement.

Mentorship programme

If you are studying towards an NMC mentor qualification, here is another activity that you might undertake in the practice setting in order to develop evidence for your portfolio, in the following domain:

  • Assessment and accountability.

Observe your student undertaking a nursing intervention and, if appropriate, review any associated records made by the student in relation to the intervention. At the end of your observation, offer feedback to your student.

Make a list of those elements of the feedback process that you feel went well, and note those aspects of the process that did not go as you intended or were missed (whether intentionally or unintentionally).

Identify what you will do differently next time to address those aspects of the process that you felt were less successful or were unintentionally missed.

Finally, give a rationale for those aspects of giving feedback that you intentionally omitted.

3 The mentoring relationship and motivation

A recent study by Foster et al. (2014) identified that, according to students, the most frequently valued behaviours in the mentoring relationship are teaching and explaining. Clearly, these two interrelated activities contribute to students’ learning in practice, but are most likely to have a positive effect when the student feels motivated to learn. Understanding the factors that help to stimulate and maintain this motivation will influence the way in which you approach your teaching.

A well-established, tried and tested model of learning motivation is the Attention, Relevance, Confidence, Satisfaction (ARCS) model (Keller, 2008).

Keller first proposed his holistic theory of motivation to learn in 1983. His comprehensive review and synthesis of motivational literature led him to identify four conditions that need to be in place for a student to be motivated to learn:

  • The learner’s curiosity must be aroused, so therefore the learner gives Attention to the situation.
  • The learner must recognise the Relevance of the situation in terms of achieving desired goals.
  • The learner must feel Confidence that the required learning is achievable.
  • The learner must believe that because personal incentives will be met, Satisfaction will result.

His theory has become represented by the ARCS model of motivation to learn.

Activity 4 The principles of the ARCS model of motivation to learn 

Timing: Allow 20 minutes
  1. Watch the video presentation from YouTube by Professor Lisa Johnson, which explains the principles of the ARCS model. Once you’ve watched the video, you can use the model’s principles to plan a learning opportunity for your students.
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  1. Download the ‘ARCS model of motivation to learn’ template  and read through our examples on the template. Then use the ‘Your example’ column to identify a learning opportunity that commonly occurs in your own workplace environment around which to develop your own strategies for delivering a teaching session that is likely to motivate students to learn and achieve competence in practice. Write down your chosen strategies in the final column. If you can’t identify anything from your own work environment, think about other areas of your life and how you might encourage others to learn.

Discussion

The challenge with teaching and learning in practice settings is that specific learning opportunities are difficult to forward-plan and teaching often takes place spontaneously, within the context of that moment in time. However, by thinking through activities that frequently take place within your practice environment, you can develop a range of motivation strategies that you can use when a day-to-day activity also becomes a learning opportunity for your student.

Whilst the ARCS model focuses specifically on the strategies that motivate learners to engage and achieve, there are other useful educational models that combine some of these strategies with other educational principles (Gagné, 1985). Thomas (2012) provides an excellent example of the practical application of Gagné’s ‘nine events of instruction model’, so is well worth reading if you can access a copy.

4 Potential conflict in mentoring relationships

In any relationship there is always the potential for conflict or relational breakdown, and mentoring is not excluded from these problems. Ensher and Murphy (2011) describe this as ‘the dark side’ of the mentoring relationship, and list a range of behaviours on the part of both the mentor and the mentee that can contribute to such conflict (Table 3).

Table 3 The ‘dark side’ of mentoring (adapted from Ensher and Murphy, 2011)

Negative behaviours of mentors Negative behaviours of students

Bullying

Jealousy

Abuse

Neglect

Betraying trust

Damaging reputation

Ignoring mentor advice

Being ungrateful

Activity 5 Identifying workplace-specific examples of these negative behaviours

Timing: Allow 15 minutes

Drawing on your own experiences within the workplace/practice environment, recall any situations that you have observed or comments that you have heard that could represent examples of negative behaviours.

Discussion

Here are some examples drawn from the academic literature and from our experiences in nursing to illustrate these behaviours.

Mentors
  • Bullying:
    • Constantly correcting a student’s performance in front of patients, undermining the student’s confidence and subsequently impacting on ability and competence.
    • Always sending the student off to carry out tasks that will not contribute to learning about nursing care, such as cleaning the sluice or taking specimens to the laboratory.
  • Jealousy:
    • Failing to answer questions from the student because no one answered your questions when you were a student. Why should it be any different for students today?
  • Abuse:
    • Blaming a student for not carrying out an intervention when there hadn’t been an opportunity for this to take place. For example, asking a student to carry out an observation and then criticising the student for not recording the intervention within one minute of the initial request.
  • Neglect:
    • Deliberately ignoring any attempt by the student to introduce themselves by failing to make eye contact and walking away when they speak.
    • Failing to arrange informal meetings with your student to provide an opportunity for feedback and reflective learning.
Students
  • Betraying trust:
    • Having been assessed as competent by the mentor, failing to practise in a way that demonstrates this competence and therefore calling into question the trust that the mentor has placed in the student.
  • Damaging reputation:
    • When challenged by another registered nurse about the way in which an intervention is being carried out, responding by saying, ‘Well that’s how my mentor taught me,’ knowing full well that it wasn’t.
    • Telling another student who has been allocated to the same mentor how awful the mentor is: ‘Hopeless at teaching and doesn’t know what she’s doing.’
  • Ignoring mentor advice:
    • Insisting a service user has breakfast at their bedside instead of walking to the dining room, as the mentor advised, because the service user is so slow and it will take far too long.
  • Being ungrateful:
    • Not appreciating the time the mentor has taken to arrange an additional learning experience with a colleague in another practice area and failing to turn up.
    • Failing to say ‘Thank you’ for support and advice offered either during or at the end of the practice learning experience.

4.1 Other types of professional conflict

In addition to relational conflict and negative behaviours, for those of you who are studying this course in preparation to become a nurse mentor there are other types of professional conflict that can arise.

Activity 6 Insights into potential conflicts within the mentoring role

Timing: Allow 15 minutes

Watch the interview with Amy Johnson, an experienced mentor who identifies some of the other types of conflict that she has encountered in her role.

Download this video clip.Video player: kg005_week4_640.mp4
Skip transcript

Transcript

Fiona Dobson:
Hi Amy, hi. Could you tell me a little bit about your role as a mentor?
Amy Johnson:
Well I work at Berrywood Hospital which is a mental health inpatient setting. I’ve been a qualified nurse for twelve years now and I’ve been mentoring for ten of those.
Fiona Dobson:
So can you give me an example then of something that you feel causes you to be in conflict in terms of your role, Amy?
Amy Johnson:
Well as mentors it’s important that we give students a chance to practice skills, to reach their competency level. However, sometimes this can take them extra time. So sometimes we might need to intervene in order to get that task completed before the patient becomes distressed and agitated but while still giving the students the learning opportunities that they need.
Fiona Dobson:
Yes, it’s quite a challenge that balance isn’t it between enough time to practice but not sort of distressing the patients really.
Maybe you’ve got another example, Amy, of something that might be sort of causing conflict in the mentor role?
Amy Johnson:
Something that I find quite common actually is that students come to you as their mentor and they expect you to identify all of their learning needs. Whereas actually I feel that a student should take onus of that and identify their own learning needs. Especially as we move on to later stages of the training.
Fiona Dobson:
So how do you try and manage that when it happens and if a student is not sort of being responsible for their own learning?
Amy Johnson:
I actually like to look at their past experiences and say to them, well how did you identify that, you’ve obviously achieved it. What now have we got left to work on? What do we need to achieve now? And guide them to make their own conclusions about where they need to go.
Fiona Dobson:
Yeah. I think that’s so important. It’s really good to hear you sort of guiding them to take responsibility.
Do you find sometimes that students don’t recognise that level of professional responsibility that’s required?
Amy Johnson:
I did have a situation once where I had a student nurse on the ward and whenever relatives were actually admitted to our care I explained to her that you’re going to have to inform your practice tutor. They need to know the situation we’re in because it’s not professional for you to be here providing care to your relative. They didn’t seem to want to do anything and they left the situation. So I actually informed the practice tutor and made arrangements for the student to go and achieve their practice learning opportunities elsewhere.
Fiona Dobson:
And hopefully the student did learn from that and realise that actually they have to recognise those situations and be responsible themselves really.
Amy Johnson:
They did.
Fiona Dobson:
I think one of the other sort of situations that can sometimes happen is you feeling that you need to stand up for your student. So have you come across that as a situation?
Amy Johnson:
Personally it’s never really happened to me. I think I’ve been quite lucky. But I have had a colleague who was mentoring a student on quite a busy ward and the manager just saw that student as an extra pair of hands to complete everyday tasks.
While I agree that it’s important that students do learn the task, such as making beds, we all make beds as nurses, that shouldn’t be at the detriment of other learning opportunities. So if they’re told to make beds when they should be learning medication administration, for example, then that’s when we need to step in.
The mentor did go to the line manager, explained that the student was missing out on vital learning opportunities. Unfortunately it made the mentor quite unpopular and I feel that was really unfair.
Fiona Dobson:
That’s disappointing isn’t it? Because the mentor was really demonstrating their professionalism and accountability weren’t they in supporting that student.
One of the other things that I think can sometimes be a problem is as a mentor you’re there to develop and support the student but also you do have to make judgements about their performance. So do you find that difficult?
Amy Johnson:
It’s important that we judge our students to be safe and to be competent. It’s even more important when you’re a sign off mentor that they are competent in the task that they’re going to be completing.
If you reach that stage and you feel that a student hasn’t reached the desired level for competency you can feel like you’ve let them down and that it’s your fault as a mentor that they’ve not got there. But sometimes by saying to the student, I can’t sign you off for that task yet, they realise the importance of it. And they will go away and they will practice more to make sure that they reach the level they need to be at.
And sometimes students do try to run before they can actually walk. So they’ll see a task, they’ll say well I want to do that. I tend to say to my students, let’s look at the level you need to be at for where you’re at in your training. Let’s ensure that that level is reached to a high standard and then we’ll move on.
Fiona Dobson:
I think that’s a really good way of approaching it isn’t it? It gives them a really solid foundation to sort of move on and then develop the more complex skills and become competent at them.
That’s been so helpful Amy, it’s given a really good insight in to the different sort of challenges that a mentor can face in practice. So thank you ever so much for sharing your thoughts.
Amy Johnson:
Thank you. I hope it helps other nurses become mentors.
Fiona Dobson:
I’m sure it will.
Amy Johnson:
Thank you.
End transcript
 
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Write a short summary of the types of conflict that are described.

Mentorship programme

If you are studying towards an NMC mentor qualification, here is a final activity relating to this week’s learning that you might undertake in the practice setting in order to develop evidence for your portfolio, in the following domain:

  • Leadership.

Arrange a meeting with your own supervisor to discuss the types of conflict described by the experienced mentor.

Share your summary of the types of conflict described (you might do this before the meeting to give your supervisor the opportunity to consider the issues).

Discuss with your supervisor the actions or approaches you feel it would be appropriate to take for each of these conflict types.

Add these actions or approaches to your summary as a reminder of safe, effective and professional mentoring practice.

5 The importance of your relationships with others

Nurses may engage in two very different types of mentoring relationship.

The first is often found among more experienced members of the nursing profession, who seek out another experienced colleague to act as a support and sounding board for their career development. These informal relationships may last for a year or longer, but typically reach a natural point of conclusion when one or both members of the relationship feel that there is no further gain to be achieved.

The second is the relationship between mentor and nursing student. This has defined start and finish points, and typically lasts for considerably less than a year. Whether you are in a mentoring relationship with a colleague or with nursing students or both, each will open you to new experiences and learning of your own. Whether you are inexperienced as a mentor or have some experience in the role, you will continue to benefit from the support and guidance of more masterly colleagues, so do seek out your own support networks.

Activity 7 Identifying and building your own support network

Timing: Allow 20 minutes

Watch the interview with Charlie Austin, a practice development nurse at Guy’s and St Thomas’ Hospital. She describes the types of support for mentors that her own organisation has already put in place along with ideas for other types of support that might also prove useful.

Download this video clip.Video player: flip_640_interview.mp4
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Transcript

Fiona Dobson
So Charlie, you’re a practice development nurse at the Evelina at Guy’s and St Thomas’ in London. Can you tell me a little bit about the practice development nurse role?
Charlie Austin:
Yes, it’s quite a varied role. We work in a team of three and we look after the development from all bands of nurses. So from Band 2 for the nursing assistants up to sort of Band 7 and we look at their continuing professional development. So the academic modules that they can do as well as other things. So we set up study days. We do simulation. We write competencies as well as assessing people with competency. Lots and lots of different things. I’m involved in recruitment at the moment as well so it’s quite a varied role.
Fiona Dobson
And part of that role is about sort of supporting and developing mentors too, isn’t it? So how is your involvement with that?
Charlie Austin:
I look at identifying the people that are newly qualified at the appropriate time for when they would be appropriate to undertake the mentorship course so they have got enough experience from their preceptorship period.
We also look at people that are keen to do it. And also as part of their continuing professional development, where they do it as well so they get the right credits.
Fiona Dobson:
Excellent. So it’s quite, you know, responsive isn’t it really to their needs. And what about the supervisors who are actually supporting the trainee mentors? And what sort of things have they found particularly helpful?
Charlie Austin:
I think they’ve got a lot of support in their ward area. So there’s a key mentor in each ward area. They are also supported by the clinical educator in each ward area. So there’s that level there. And then we can come in as a more management kind of support and a link between the universities or the other staff that can be involved.
We have practice educators involved. There’s mentor zones on each of our university websites as well as a lot of information on our Trust website for people being a mentor as well as training to be a mentor.
Fiona Dobson:
And what happens once a mentor’s actually qualified? What sort of support’s available to them then?
Charlie Austin:
There’s quite a lot of support available. The key mentor will try and allocate them a first year student for their first mentoring experience. So it’s quite a nice lead in to it really. And as they get more experienced they can develop those skills with students further down the programme.
We have a Pan London document so that makes it easier because they’re all assessed on the same document rather than lots of different ones from the different universities. There’s the key mentors there to support them as is the clinical educator. But if they have any difficulties they can come to ourselves. There’s also the practice educator team and there’s other Trust-wide initiatives. There’s a generic email that they can email to get support as well. So there’s quite a lot out there.
Fiona Dobson:
There is, absolutely. And I know you’re involved in identifying a sign off mentor. So what sort of things influence your decisions there?
Charlie Austin:
We would look at how much experience they have as a mentor. How many students they’ve mentored. How positive those experiences have been. We’d want them to have some management experience, so within their ward area, may be just taking charge of the ward.
We’d also really want them to be keen to do it because it’s quite a challenging role. And it is a responsibility. So it’s better if they really want to do it.
Fiona Dobson:
Yes, it’s so important isn’t it, being a sign off mentor. It’s a real responsibility. And what sort of things does your Trust do to prepare the sign off mentor?
Charlie Austin:
There is some face-to-face study time for sign off mentors. And then they have to create a portfolio that then gets signed off and then they become a qualified sign off mentor.
During that time they will be supported and there is a guide to what the sign off sessions for a sign off student are. So the student sign off mentor can use that as their guide for doing their face-to-face meeting times.
Fiona Dobson:
So again lots of support for them. Thank you for sharing those experiences Charlie.
Charlie Austin:
OK, my pleasure.
End transcript
 
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Now develop an action plan for yourself that shows how you plan to address your own ongoing need for guidance. This could include identification of a personal mentor, who will continue to offer you support and feedback as your mentor role develops.

If you have identified a personal mentor, you could share your action plan with them and seek advice about other useful contacts within your organisation. Add these to your plan if they sound useful to you.

There is an increasing awareness of the support that is needed by mentors to enable them to deliver their mentoring role effectively, so you may be surprised by the opportunities that are available to assist you in forming your own supportive relationships.

You will continue to develop and refine your mentoring skills through practice and experience. At some point it is likely that your manager, a continuing professional development nurse, a clinical educator or another colleague with responsibility for organising and supporting students’ practice learning experiences, will feel that you are ready to become a sign-off mentor.

In preparation for this role you might find it useful to read through the following sections of the NMC (2008) standards in order to understand the purpose of the role and the criteria that must be met before undertaking this role:

Talk to your mentor if you have one and find out how the process of becoming a sign-off mentor is delivered within your organisation. You should add the contact details of the relevant individuals or team responsible for supporting sign-off mentor preparation to your action plan for future reference.

6 This week’s quiz

Now it’s time to complete the Week 4 badge quiz. It is similar to previous quizzes but this time, instead of answering five questions, there will be 15.

Go to:

Week 4 compulsory badge quiz

Open the quiz in a new tab or window (by holding Ctrl [or cmd on a Mac] when you click the link).

7 Summary

This week you have reviewed the importance of relationships to effective mentoring, both for yourself and for your students. In addition to exploring the key components of effective mentoring relationships you have also considered how to avoid or manage conflict associated with the relationship, the specific issues of how to give feedback as part of open communication and how to use motivation strategies to stimulate and engage students in practice learning.

Next week you will explore the learning opportunities that are available in your practice environment, so keep the ARCS model in mind because you are likely to find useful relationships between these opportunities and ways to motivate your student.

You can now go to Week 5.

References

Baranik, L.E., Roling, E.A. and Eby, E.T. (2010) ‘Why does mentoring work: the role of perceived organizational support’, Journal of Vocational Behaviour, vol. 76, no. 3, pp. 366–73.
Clynes, M.P. and Raftery, S.E.C. (2008) ‘Feedback: an essential element of student learning in clinical practice’, Nurse Education in Practice, vol. 8, no. 6, pp. 405–11.
Dow, R.S. (2014) ‘Leadership responsibility in mentoring organization newcomers’, Journal of Management Policy and Practice, vol. 15, no. 1, pp. 104–12.
Eller, L.S., Lev, E.L. and Feurer, A. (2014) ‘Key components of an effective mentoring relationship: a qualitative study’, Nurse Education Today, vol. 34, no. 5, pp. 815–20.
Ensher, E.A. and Murphy, S.E. (2011) ‘The mentoring relationship challenges scale: the impact of mentoring stage, type and gender’, Journal of Vocational Behaviour, vol. 79, no. 1, pp. 253–66.
Foster, H., Ooms, A. and Marks-Maran, D. (2015) ‘Nursing students’ expectations and experiences of mentorship’, Nurse Education Today, vol. 35, no. 1, pp. 18–24. Available at: http://dx.doi.org/ 10.1016/ j.nedt.2014.04.019 (Accessed 11 February 2015).
Gagné, R.M. (1985) The Conditions of Learning, 4th edn, New York, NY, Holt, Rinehart and Winston.
Health Education West Midlands (n.d.) ‘Developing your career in healthcare’ (online). Available at http://learning.wm.hee.nhs.uk/ resource/ nurse-mentoring-ward (Accessed 11 February 2015).
Huybrecht, S., Loeckx, W., Quaeyhaegens, Y., De Tobel, D. and Mistiaen, W. (2011) ‘Mentoring in nursing education: Perceived characteristics of mentors and the consequences of mentorship’, Nurse Education Today, vol. 31, no. 3, pp. 274–8.
Keller, J.M. (2008) ‘First principles of motivation to learn and e learning’, Distance Education, vol. 29, no. 2, pp. 175–85.
Lisa Johnson, Ph.D. [YouTube user] (2013) ‘ARCS motivation model - learning design’ (online), YouTube, 20 September. Available at https://www.youtube.com/ watch?v=RpjVprPeSo0 (Accessed 11 February 2015).
Locally Healthy [YouTube user] (2010) ‘Nurse mentoring on the ward’ (online), YouTube, 1 July. Available at https://www.youtube.com/ watch?v=lzyVbUOlH5s (Accessed 11 February 2015).
Nursing and Midwifery Council (2008) Standards to Support Learning and Assessment in Practice, 2nd edn, London, NMC. Available at http://www.nmc-uk.org/ Documents/ NMC-Publications/ NMC-Standards-to-support-learning-assessment.pdf (Accessed 11 February 2015).
Straus, S.E., Johnson, M.O., Marquez, C. and Feldman, M.D. (2013) ‘Characteristics of successful and failed mentoring relationships: a qualitative study across two academic health centers’, Academic Medicine, vol. 88, no. 1, pp. 82–9.
Teatheredge, J. (2010) ‘Interviewing student and qualified nurses to find out what makes an effective mentor’, Nursing Times, vol. 106, no. 48, pp. 19–21.
Thomas, I. (2012) ‘Improving suturing workshops using modern educational theory’, The Clinical Teacher, vol. 9, no. 3, pp. 137–42.
Thomas, S.P and Burk, R. (2013) ‘Junior nursing students’ experiences of vertical violence during clinical rotations’, Nursing Outlook, vol. 57, no. 4, pp. 226–31.
Vivienne Hall [YouTube user] (2013) ‘8 types of nonverbal communication YouTube’ (online), YouTube, 18 February. Available at https://www.youtube.com/ watch?v=csaYYpXBCZg (Accessed 11 February 2015).
Wilson, A.M.E. (2014) ‘Mentoring student nurses and the educational use of self: a hermeneutic phenomenological study’, Nurse Education Today, vol. 34, no. 3, pp. 313–18.

Acknowledgements

Week 4 of Facilitating learning in practice was written by Fiona Dobson.

Except for third party materials and otherwise stated (see FAQs), this content is made available under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 Licence.

The material acknowledged below is Proprietary and used under licence (not subject to Creative Commons Licence). Grateful acknowledgement is made to the following sources for permission to reproduce material in this unit:

Text

Activity 3: extracts from Clynes, M.P. and Raftery, S.E.C. (2008) ‘Feedback: an essential element of student learning in clinical practice’, Nurse Education in Practice, vol. 8, no. 6, pp. 405–11.

Section 5: pages 12, 16, 17, 27 and 28 from: Nursing and Midwifery Council (2008) Standards to Support Learning and Assessment in Practice, 2nd edn, London, NMC.

Videos

Activity 1: Locally Healthy [YouTube user] (2010) ‘Nurse mentoring on the ward’ (online), YouTube, 1 July. Available at https://www.youtube.com/ watch?v=lzyVbUOlH5s. Courtesy of NHS Local.

Every effort has been made to contact copyright owners. If any have been inadvertently overlooked, the publishers will be pleased to make the necessary arrangements at the first opportunity.

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Week 5