Mentorship in Professional Practice: Nursing - Essay Example

Name: Course: Tutor: Date: L01 Registered nurses and other specialist community nurse practitioners are tasked with an important role in the supervision and support of student nurse practitioners. Specifically, the Nursing and Midwifery (NMC) Code of Conduct (2008) encourages registered nurse practitioners that they are obligated to assist students and others to nurture and develop their competence in nursing (NMC 2008b, p. 5). Additionally, the NMC (2008) challenges registered nurses to regularly update their knowledge and skills all through their working life, through further studies and/or mentoring opportunities (NMC 2008b). Notably, Hand (2006), identifies teaching as a critical component of the health practitioner’s role, and at certain points in their career, most healthcare practitioners are likely to teach other colleagues, students, patients, as well as their relatives (Hand 2006). Consequently, the quality of teachers and mentors existing in the clinical practice setting have a crucial effect on the quality or standard of future nursing practitioners, subsequently improving the overall outcomes of patient care. Accordingly, it is within this context and a critical professional self-appraisal that identified a knowledge gap in Mentorship that I decided to enrol to the post graduate mentorship course. Indeed, my own experience as a pre-registration nursing student was a mixture of positive and negative encounters with mentors. The most positive experience I had was based in a community mental health team where my mentor at the time was very approachable and supportive. Other qualities she had included a genuine interest in me and ensuring I had every opportunity to meet my learning outcomes. This experience improved my confidence and made it an enjoyable experience. I feel that I learnt a lot during this placement and believe my mentor's approach played a major role in this. This is the type of mentor I would like to role model. Even so, I can recall having a particularly negative experience with a mentor based in a hospital ward. He made little effort to build a working relationship with me and often left me to identify and arrange my own learning experiences. I can remember feeling awkward and isolated. I did meet my outcomes on this placement but I did so by approaching other members of staff. I remember this experience left me with a negative view of working in a ward environment. However, it also made me more determined to succeed. I can recognize now that he was a 'toxic' mentor. Mentoring is defined as the process of supporting and encouraging other individuals to manage their personal learning so that they are able to fully exploit their potential; advance their knowledge and skills; increase their performance and develop into the person they desire to be (Parsole & Leedham 2009). Mentoring is also identified as both a science and an art of guiding another individual using purposeful leadership and direction to an advanced level of cognition. Historically, the concept of mentoring can be traced to Greek mythology where King Odysseus requested his friend, to support, guide and help his son, Telemachus, while he (the king) was away at war in the Trojan War (Carroll 2004). Clinical nursing history recognizes Florence Nightingale as the first known nursing mentor, whereby archival inquiry tells of a mentor-style connection between Nightingale and Rachel Williams, the matron of St. Mary’s Hospital in Paddington, England (Lorentzon & Brown 2003). Notably, in Great Britain, approximately half of student nurses’ preregistration preparation involves clinical practice placements whereby qualified Registered nurses often act as mentors for the nurse students (Beskine 2009). Indeed, mentoring has been applied as a leadership strategy within the nursing profession for years and has been effective in improving the quality of the nursing profession in general (Donner & Wheeler 2007). Mentors are identified as proficient, qualified and registered nurses with concrete professional networks and who have the ability to share their knowledge or expertise and nurture leadership skills among those who are less experienced (Schira 2007). Mentoring mainly occurs either through indirect coaching or through direct supervision to enable the mentee to realize a new professional course in their life. As such, effective mentors are required to demonstrate an ability to lead others by exhibiting professional conduct, concrete knowledge alongside personal balance (Ulrich 2009). The role of mentorship is diverse and may be tailored to the learning requirements and objectives of the mentee. Tobin (2004) recognized seven roles that apply specifically to mentoring, including adviser, teacher, role model, coach, sponsor, agent, and confidante. In addition to these traits and roles, mentors should also exhibit other qualities, such as empathy, self- confidence, maturity, resourcefulness, and a readiness to commit energy and time to develop others (Comte-Sponville 2003). Mentors should also offer constructive criticism to their mentees as they chaperon them in their development (Vanderstam, 2005). In order to develop leadership, Hoffman, Harris, and Rosenfield (2008) posit that mentorship should engage the mentee’s personal values and create, within the mentee, awareness for self-discovery and maturation opportunities (Hoffman, Harris, & Rosenfield 2008). Further, nursing leadership mentoring to should support student nurses in new and different roles as influenced by the organizational culture of the mentor (Bally 2007). Additionally, the NMC framework describes the knowledge and skills required by the nurse practitioners when supporting students in the work place. These include establishing effective working relationships; facilitation of learning; assessment and accountability; evaluation of learning; create an environment for learning; context of practice; evidence based practice and leadership (NMC 2008a). Reflection is useful in the process of mentorship since it enables both the mentor and mentee to intentionally review their performance by capturing and sifting through significant aspects of their experiences. This offers broader opportunities for learning, improvement and change and ultimately advances the quality of learning and professional practice (NMC 2008a). Consequently, using the Driscoll model of reflection (1994) I have assessed my own mentorship skills before I commence mentoring my learner. The What? Model of Structured Reflection by Driscoll (1994) is cyclical in nature and contains trigger questions that aid and support the practitioner to streamline their reflections with the process of reflection (Driscoll 1994). Through this model I have identified a number of areas that I lack knowledge and skills in and hope to improve upon it. Indeed, according to the NMC (2008a) in order to become effective mentors, registered nurses are required to prepare adequately in becoming a mentor develop an understanding of the role requirements and responsibilities, exercise the role of the sign-off mentor and maintain an enduring competence as a mentor (NMC 2008a) Holmes et al. (2010), state that the development of a successful mentor involves an incremental approach that incorporates numerous stages of leadership and learning (Holmes, Hodgson, Simari, & Nishimura 2010). However, the vital elements to be accomplished by mentors include the successful transfer of essential nursing competencies that they have developed over their professional practice to their mentees. The major goal, in the early stages of the development process of a mentor, is basic didactic transfer of information. As the mentor progresses, he or she moves beyond the transference of information to encourage their mentees to develop of clinical decision making skills and other relevant thought processes. This characteristic is often accomplished through a Socratic approach or open discussions of patient care. In the advanced stages of mentor development, the mentor is able to transfer the competencies of patient care, professionalism, and communication to mentees (Metcalfe 2010). The achievement and transference of these competencies necessitate experience and advanced self-confidence from mentors and can only be achieved with time (United Kingdom Central Council for Nursing 2000). Notably, nursing was established on the theory of an apprenticeship; hence, in clinical patient care domains, the mentor must be an experienced nurse who has previously developed these subtle but essential attributes. This can only be achieved through a “role model” or observational learning approach whereby mentors demonstrate and inspire these competencies by example (Holmes, Hodgson, Simari, & Nishimura 2010). This approach is entrenched in the social learning theory which describes human behaviour in terms of constant reciprocal interfaces between behavioural, cognitive, and environmental impacts. The constituent processes underlying role modelling and observational learning include attention, retention, reproduction and motivation (Turnock & Mulholland 2007, p. 16).As such, working with and observing a mentor allows mentees, to adopt their mentor’s behaviour and advance on previous knowledge and experience. L02 The most essential metric of positive and effective mentoring is the guaranteeing the success of the mentee. This can only be achieved through an early identification of learner needs an establishment of the factors for success and those that may affect success (Nash & Scammell 2010). Further, the NMC (2008a) stresses that in order to establish an effective mentoring relationship and learning environment, the mentee must be assisted by the mentor to establish their learning needs and objectives (NMC 2008a). Accordingly, after I had inducted, Mary my mentee, I arranged an initial meeting to clarify her expectations and review her learning outcomes. One of her outcomes related to 'understands the link between lifestyle choices and health', which she wanted to achieve through physical observations with service users. However, this could not be achieved at this placement as it is not a clinical environment. According to Anderson (2011) mentors are required to take early responsibility for the mentee’s learning process (Anderson 2011). This prompted me to complete a SWOT analysis, at the beginning of the placement, to further analyze my work place as a learning environment. Intrinsically, an effective learning setting should be resourced with knowledgeable mentors and experienced clinicians in the mentee’s study area to guarantee applicable learning opportunities (Jokelainen, Turunen , Tossavainen, Jamookeeah , & Coco 2011).I also asked Mary to complete one to provide analysis from the view point of a student (Brugnolli , Perli , Viviani , & Saiani 2011). Notably, student orientation and assessment of the placement setting is beneficial in generating an efficient environment for learning since it familiarizes the student with the placement area (McNair, Smith , & Ellis 2007). The main threat and weakness identified in the analysis were the lack of clinical practice opportunities for students at the unit. Nevertheless, I found this to be an excellent exercise for identifying opportunities to improve our learning environment. The threats and weaknesses identified did concern me but I also viewed them as an important opportunity to improve the learning for my work place. To address the weaknesses and threats identified in the SWOT analysis we (Mary and I) developed an action or learning plan. Anderson (2011) recognizes an agreed learning plan as a tool that enables both mentors and mentee to identify their expectations, appropriate actions and mechanisms for feedback during the course of the placement. In addition, we established a learning contract that would help us in the development of a learning project. Indeed, guided by the andragogy and social constructivism theories, there was need to integrate learning with practice through engagement with community practitioners. According to Ali & Panther (2008) the priority objective is to develop working relationships with local trust services to allow pre-registration students to spend time in clinical areas to meet clinical related outcomes (Ali & Panther 2008). Therefore, to arrange for Mary to spend time in a clinical area and to develop effective working relationships for the unit, I considered what local services would be appropriate. Notably, Jackson and Mannix (2001) underscore the amount of interest displayed by the mentor nurse in the learning needs of the student and the key role the mentor plays in their achievement as critical to the student’s development (Jackson & Mannix 2001). Several service users currently at the unit are prescribed clozaril medication and are required to attend the local clozaril health monitoring clinic to have their blood monitored and receive physical health checks. Consequently, I chose to approach them regarding this issue. During the meeting with the service manager, I explained the circumstances and requested for Mary to spend a day at their service to meet her outcomes. He consented to this and also agreed that future students could also spend time at their service subject to prior liaison and planning, and at appropriate times. We then arranged an appropriate day for Mary to attend their service. I developed a questionnaire for Mary to complete whilst she visited the clinic to evidence her learning (Anderson 2011). L03 After reviewing Mary's learning outcomes I considered what outcome could be chosen to use as my peer reviewed teaching session. The outcome we agreed to use was 'demonstrate the ability to listen, seek clarity, and carry out instructions safely' (Christiansen & Bell 2010). We agreed that she would meet this outcome by administering medication to a service user as the student expressed a desire to gain more knowledge and experience of administering medication, particularly psychotropic drugs. Before facilitating any teaching with Mary I asked her to complete a learning styles assessment using Kolb's learning styles questionnaire to provide me with an idea of how to tailor teaching sessions and general learning experiences so that they appropriate to her needs. Mary scored most marks with being a pragmatist (D'Amore, James, & Mitchell 2012). Consequently, I was able to research this learning style and consider what approaches to take. Following this I formulated a teaching plan (Cornish & Jones 2007) Pragmatists like the link between theory and practice so I decided to integrate this into the teaching plan and use the principles to form the basis of the teaching session. Also, Mary had expressed a desire to not only gain more experience of administering medication but to also improve her knowledge of psychotropic medication. Consequently, I incorporated both the assessment of knowledge and skill into the teaching session (McNair, Smith , & Ellis 2007). I found this to be a very useful tool to utilize as a mentor as it helped me to not only tailor it to meet my mentee's needs but to also provide me with guidance and a plan of how to approach teaching sessions with her. However, I did find the teaching methods I was formulating to plan the session difficult to comprehend. The approach of reviewing theory whilst carrying out practical activities confused me at times and led to me feeling like the session did not flow effectively. To analyse this further I completed a learning styles questionnaire myself and scored highest in the theorists category (Jayatilleke & Mackie 2012).Theorists like to stand back and analyse issues before coming to conclusions about how it is best achieved before doing the action so this might explain why I found it difficult. I will ask all of my future learners to complete a learning styles questionnaire. Although it felt strange to plan the teaching session based on a different learning style to me I feel that it is important to always tailor teaching towards their learning style to maximise their learning experiences. The teaching session took place in the medication room. This room is a private environment with a locked door so this ensured that the session was not disturbed. I introduced Mary to my peer reviewer and explained that she was present to assess me to alleviate any anxiety. I then facilitated the teaching session following the teaching plan. After assessing her prior experience and knowledge I pitched the session at a basic level as she had limited experience of administering medication and no knowledge of psychotropic medication (Gobet & Chassy 2008). I used a variety of communication skills throughout the session. These included closed and open ended questions, listening and paraphrasing back to Mary to check for clarification and observing her body language and facial expressions to assess whether she looked uncomfortable or concerned. I felt nervous being assessed by my peer reviewer. I tried to hide this as I did not want this to translate to my learner and make her feel nervous as well (Mc Carthy & Murphy 2008). Upon reflection I feel that my teaching method was generally effective. Using the NMC (2008) guidelines and BNF whilst administering the medication allowed me to demonstrate best practice guidelines and allowed Mary to link the theory and practice (NMC 2008b). I felt that checking clarification regularly and allowing Mary to ask any questions enabled me to establish if she understood the information I was giving to her and communicate any issues. Feedback from my peer reviewer supports my own evaluation of the session. My peer commented that I referenced teaching to learning style appropriately and structured the session around the NMC guidelines. I also received positive feedback for ensuring the session was not disturbed and well timed. The only negative aspect I can identify is that I did not allow Mary to observe me administering medication more times before the teaching session to gain more experience of the process. I feel this would have provided my learner with an improved prior knowledge and ultimately more familiar with the process. However, I had only worked with Mary for three weeks before the session was facilitated so did not have sufficient time to do so. This has highlighted the difficulties mentors face in practice with regards to time constraints and available resources. Also, I feel that more than one teaching session might have been more beneficial allowing me to analyse learning needs between sessions and being able to focus more on individual aspects of performing the skill in more detail (Nash & Scammell 2010). Before facilitating a teaching session in the future I will ensure my learner observes me performing the skill a number of times. Also, I will plan the teaching session so that it is delivered over two or three session allowing me to gain a better understanding of their learning needs between sessions and be able to focus on individual aspects in more detail. L04 To formally assess Mary administering medication and knowledge of the psychotropic medications she was administering I developed my own assessment tool beforehand based on the NMC (2008) and BNF used in the teaching session (NMC 2008a). When developing the assessment tool I was concerned with whether it would have sufficient reliability and validity with regards to measuring what I wanted it to (Price 2007). As there were no formal researched tools available I decided that I would adapt the NMC guidelines I was using to achieve this. My organisation has a staff medication proficiency assessment but as we do not provide nursing care it is not referenced to the NMC guidelines. As Mary is a pre-registration student I felt that it was important to teach her using the NMC guidelines and I feel that this tool would allow me to effectively assess her based on them. I will retain a copy of this assessment tool and use with all future pre-registration students to assess them administering medication. Following the facilitation of the teaching session it was now the time for Mary to administer medication to a service user. I completed the assessment tool as Mary was administering the medication whilst supervising in order to ensure safety. I once again used my communication skills to observe her body language throughout to assess whether she was experiencing any difficulties. At the end of the session I gave Mary feedback on her performance using the completed assessment tool. Throughout the assessment I was conscious of ensuring Mary was administering the medication safely whilst I was also completing the assessment tool. I found this difficult to do at times and feel that it might have been more effective if I completed the assessment tool immediately after the session had finished in order for me to fully concentrate on each task (Mc Carthy & Murphy, 2008). I found providing feedback to Mary uncomfortable at times as she did not always fully follow the guidelines as discussed. However, I felt that it was important to be honest with her to enable learning from the experience. However, I equally identified the positive aspects of her performance, which I did feel comfortable with and felt was important to maintain and build upon her confidence. My peer reviewer's evaluation mentions that I gave useful feedback to Mary. Based on the assessment outcome Mary is not yet competent in administering medication. Due to her being a first year student it would not be expected of her to be as she will always receive close supervision and support at this stage of her training. However, this prompted me to consider being a sign off mentor and the responsibility that comes with being a gatekeeper to the nursing profession. I think I would find it uncomfortable to fail students in the latter stages of their training. Despite this I am aware I have a responsibility to the NMC, my employer, carers, and family members and to ultimately protect the public. In the future I will concentrate on observing the skill being performed and then complete the assessment afterwards. I will continue to provide honest feedback, even if the message I am giving is difficult. I anticipate this to be an important aspect of the role and one that I hope I become more comfortable with through experience of being a mentor. I am committed to my profession and will always strive to uphold the principles of the NMC standards (2008 a, 2008b) above all else. Mary approached me and reported that a male service had asked for her personal telephone number and asked her to go on a date with him. I asked her how she responded to his requests and she explained that she felt embarrassed by the situation and informed him that she was not allowed to. My initial reaction was to approach the service user and inform him that his behaviour was inappropriate and that if it occurred again he would receive a formal warning. I felt protective towards Mary and concerned that she was affected by this incident. I discussed this with her and she assured that she did not feel upset or concerned by the service user's actions but did feel surprised. We then discussed how situations of this nature are most appropriately managed. I referred back to our discussion of professional boundaries and that this should be referred to when a service user makes an inappropriate comment or behaves in a manner, which makes her feel uncomfortable. We agreed that if this type of incident occurred again then Mary would explain to the service user that she has a duty to maintain professional boundaries and that she is there to learn and provide support only on a professional basis with the focus being on his care. If they persisted with comments then she would inform them that their behaviour is inappropriate and would be discussed with staff. Now that Mary's placement has ended I feel that it is appropriate to reflect on the methods I used and evaluate whether they were effective or in need of changing for my next learner. I enjoyed working with Mary and found the experience to be very rewarding. Some of the methods I used such as using a learning style's questionnaire, developing a learning contract and planning a teaching session were very useful and allowed me to structure Mary's learning. I also found having working partnerships and liaising effectively with other services to be very important in providing an effective learning environment (Anderson 2011). There are no methods that I used, which I found to be ineffective but I recognised that my workplace would benefit from having a specific induction pack for students. I will continue to use the methods I used with Mary for future learners. I plan to develop an induction pack specifically for students in time for the next learner. 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