3.3.1 The Nursing and Midwifery Council
Those who choose to embark on a career as a student nurse in the UK are challenged to recognise and adhere to the professional expectations of what it is to be a nurse. According to the regulatory nursing body, the NMC, although student nurses work under the supervision and support of a qualified professional they must still provide a high standard of practice and care at all times, take responsibility for the care they personally provide and also recognise their essential, wider contribution to the aims of the teams that they are part of, and the National Health Service as a whole (Nursing & Midwifery Council, 2012). There is a professional expectation that student nurses develop into practitioners who are able to advance practice and be key change agents and decision makers with an ability to think analytically, problem solve and make, and act upon, judgements (Nursing & Midwifery Council, 2010). Such demands and expectations highlight the complexity facing nursing students, irrespective of their background and experience, whether novice or more experienced in healthcare, as they further explore their understanding of nursing identity and attempt to establish and confirm what it means ‘to become a nurse’.
All nursing practice and experience is undertaken within a setting of an externally prescribed professional context. To become a nurse - or at least be deemed appropriate to legitimately utilise and practice with that title - all student nurses must fully understand the nurses’ various roles, responsibilities and functions, and adapt their practice to meet the changing needs of people, groups, communities and populations. They must practise autonomously and be responsible and accountable for safe, compassionate, person-centred, evidence-based nursing
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that respects and maintains dignity and human rights (Nursing & Midwifery Council, 2012; 2010).
The NMC Standards for pre-registration nursing education, relevant to current student nurses, (Nursing & Midwifery Council, 2010) also speak of the necessity for students to be able to respond autonomously and confidently to situations that they may experience in their practice, whether that be planned or spontaneous, in uncertain and fast changing situations. According to the NMC, it is essential that any student nurse is able to build partnerships and therapeutic relationships through safe, effective and non-discriminatory communication; whilst also being self-aware and cognisant of how their own values, principles and assumptions may affect their practice.
The fulfilment of such important responsibilities requires an environment that promotes a legitimate confidence, competence and ability in the student; along with the proficiency to analyse complex problems and make sound clinical judgements. This ability to judge and analyse comes via advanced and up-to-date knowledge and also requires a setting that develops and sustains a significant level of, what the RCN describe as ‘self-confidence and self-esteem’ (Royal College of Nursing, 2004).
The NMC acknowledge the influence of the European Tuning project (Tuning Educational Structures in Europe, 2009) in their discussions of the standards that student nurses should eventually achieve and be assessed or judged against. According to the European Tuning project the student nurse must eventually become ‘a safe, caring, and competent decision maker willing to accept personal and professional accountability for his/her actions and continuous learning’ (Tuning Educational Structures in Europe, 2009). To evidence this the NMCutilise a competency framework that students must meet to achieve registration on the professional register (Nursing & Midwifery Council, 2010). To be deemed suitable to use the title ‘nurse’ each student is presently assessed against the four domains: professional values, communication and interpersonal skills, nursing practice and decision-making and leadership, management and team working.
3.3.2 NMC Standards 2018
The students who participated in this research are assessed against the previous standards of competence; however in 2018 the NMC published new Standards of Proficiency for Registered Nurses and Education Framework: Standards for Education and Training for all UK providers of nursing and midwifery education (Nursing & Midwifery Council, 2018a; Nursing & Midwifery Council, 2018b). These standards may be used from 28th January 2019.
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Interestingly in relation to my research aims; one of the key findings from an independent evaluation included the need to improve the confidence of newly registered nurses along with the requirement to address variable quality and consistency in practice placements and mentorship (Nursing & Midwifery Council, 2018a; Nursing & Midwifery Council, 2018b). The new proposed Education Framework uses a model of five pillars of education and training: 1) Learning culture – valuing learning in all settings
2) Educational governance and quality 3) Student learning and empowerment 4) Educators and assessors
5) Curricula and assessment
The new standards reiterate several key principles that are priorities for future students – including: that they are protected from behaviour ‘that undermines their performance or confidence’ (Nursing & Midwifery Council, 2018. Part 1:3.12) and are supervised and supported in practice learning by practice supervisors ‘who serve as role models for safe and effective practice’ (Nursing & Midwifery Council, 2018. Part 2:3.1) and with current knowledge and experience’ (Nursing & Midwifery Council, 2018. Part 2:3.8).
It appears that the traditional responsibility and key role of the mentor – or at least the actual title - is being challenged in the new NMC guidance. Each education institute, practice placement and work placed learning partner must now have ‘a nominated person for each practice or work placed learning setting to actively support student issues and address student issues and concerns’ (Nursing & Midwifery Council, 2018. Part 2:1.5). There are now different roles such as practice supervisor and practice assessor which will play significant roles in the support and assessment of student nurses where previously the mentor took a central role. Lord Willis in ‘Raising the Bar’ (Health Education England, 2015) had proposed that the nursing regulatory bodies may need to radically rethink the philosophies of mentorship and amend the standards requiring one-to-one mentor support for students – not least due to the lack of sustainable funding to ensure the provision of good mentorship. This has challenged the fundamental principle that all registered nurses should eventually take on the responsibility of being a mentor as a clear role expectation ‘regardless of whether they function as informed role models or are motivated to fulfil this role’ (Health Education England, 2015 p.46). This adjustment in principle is resultant from evidence of the poor supervision that many student nurses experience. If the role of a mentor is simply an expectation of all registered nurses rather
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than for those with commitment and enthusiasm for the role, it is unsurprising that the quality of student supervision is variable. The degree to which the mentor and the practice-learning environment value and respect practice based learning will inevitably impact significantly upon student outcomes, both in terms of learning and progression and also in the desire to complete the course and achieve professional registration (Royal College of Nursing, 2017).
3.3.3 The ‘Mentor’ according to Nursing and Midwifery Council terminology
It is important to recognise that the NMC previously, and indeed currently until the initial implementation of the new standards in 2019, have a very specific definition and criteria for use of the term ‘mentor’. An NMC mentor is a registrant who must have successfully completed an NMC approved mentor preparation programme and has achieved the knowledge, skills and competence required to meet the defined outcomes. They must also be on the same part of the professional register as the student they are to assess and have been registered for at least one year and developed their own knowledge, skills and competence as identified through a Personal Development Planning (PDP) review. The specific role of a mentor is further articulated as a person who ‘facilitates learning and supervises and assesses students in a practice setting’ (Nursing & Midwifery Council, 2008 p.45). Assessment of a student’s competence is part of the NMC mentors’ role which is not necessarily the case in many definitions of a mentor.