Indicaciones de declaraciones y garantías dadas al emisor en relación con los activos

All participants were asked about the processes involved in introducing the policy and getting sign- off mentors into post. Responses covered initial discussions and decisions about taking the policy forwards and work at ground level on informing staff about the policy and nominating and training individual mentors. Perceptions of how the process had progressed as a whole were discussed as were specific challenges that had been encountered.

5.8.1 Initial discussions and decisions

Participants in both HEIs described initial work undertaken to inform trust colleagues about the requirements of sign-off mentorship. At HEI-1, participants said that staff had spent a lot of time discussing the process with trusts and getting over the message about the difference between mentors and sign-off mentors; the Practice Education Support Unit had put together a set of resources about sign-off mentorship upon which trusts could draw. At HEI-2, one of the senior educationalists described a series of presentations to key HEI staff followed by a road show to the various departments in the trusts they linked with accompanied by discussions with the nurse in charge at each.

Some of the PEFs and the practice-based link lecturers described the procedures that they had developed to inform colleagues about sign-off mentorship such as making notes on the

requirements to give to staff; visiting all the key personnel; writing articles for the trust newsletter; including the topic in mentor updates; and sending sign-off mentors reminder notes when they had their first final destination placement. One of the HEI programme directors attributed the smooth implementation of sign-off mentorship in the trust they linked with to the work of the PEF in preparing trust staff.

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Participants at both HEIs said that criteria for becoming a sign-off mentor was a trust decision and that policies had varied in this respect; examples were given of trusts that had said that everyone at Band 6 should be a sign-off mentor and others opting for making all mentors sign-off mentors. In relation to the former policy, a PEF working in one such trust had said that there had been little response from managers when asked to designate which of their staff could become sign-off mentors; hence the trust made a blanket decision that all staff at Band 6 would take on this role. In a primary care trust, it was decided that all community practice teachers would be designated as sign-off mentors. Decisions about which individual members of staff in each practice area should become sign-off mentors were made either by the PEF, or by the PEF and the HEI link lecturer jointly where the two worked closely together; one link lecturer described the latter thus:

“We have to look at it with the trust, is it viable for everyone to be a sign-off mentor? Do you need that many sign-off mentors at this point? It’s got to be in discussion with them.” (HPL1)

One HEI participant with a practice link however, said that in a transition period between PEFs, she had taken responsibility for nominating the mentors whom she thought were suitable to be sign-off mentors.

5.8.2 Providing training for sign-off mentorship

There was also variation over which staff were involved in running the training for sign-off mentorship, a training that comprised attending workshops and being observed while making a judgement about competence of students in their final destination placement. In some trusts in the study, the PEF described running the sign-off mentor workshops themselves; in others they

described joint working with HEI staff. This joint working was corroborated by a link lecturer who described running courses in a primary care trust with the trust education lead. In the trust which had had a break in having a PEF in post, the HEI practice link had taken on the task and had run some 30 workshops attended by over 200 mentors.

The independent sector provided challenges of its own with staff in the nursing care home component of this sector scattered over a wide geographical area and managers and mentors initially reluctant to take on the responsibilities of sign-off mentorship although happy to take first and second year students. An HEI participant who linked with this sector stressed that more work was needed in selling the concept of sign-off mentorship to nursing care homes as a worthwhile activity in which they should be engaged and described the system that they had devised to this end with the support of the home managers. A good mentor who wanted to be a sign-off mentor was placed in a home with an established sign-off mentor from whom they could learn and be

supervised. Once the three supervisions were complete they returned to their own home and became established as a sign-off mentor themselves. In time the link lecturer then brought other mentors to learn from the second sign-off mentor. This policy was adopted for a cluster of homes at a time. This participant observed that this work went beyond their role and remit as a link lecturer, but undertook it on the grounds that it was an investment in the long term for the HEI as the more sign-off mentors available in the independent sector, the wider the range of settings in which final destination students could be placed. If the number of mentors and sign-off mentors were to be increased sufficiently however, this participant said that a designated person was required to oversee this process and that it could not be dependent on a single link lecturer in the long run.

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Community settings provided similar challenges of scattered sites and small numbers of final

destination students at present. A PEF for one of the primary care trusts stated that the trust had to have sign-off mentors and it was up to her to get some of those on her mentor register through the sign-off course with the aim of having at least one, ideally two in each setting. But demands on her time and that of the mentors made it difficult to achieve even with input from the link lecturer. The challenges of demands on staff time frustrating the drive to ensure sufficient numbers of sign- off mentors was described by the senior educationalist and the PEF at one trust as well as by their HEI practice link. The senior educationalist observed that while staff came to the half day training session, many did not complete the workbook that drew together the evidence that they had completed three supervised assessments.

“..there are other demands in the clinical areas, they have staff to manage, they have scenarios, they have very, very busy shifts so it can be difficult…they were committed to come to the class room.. but going away and sitting down and taking out the time to do it this was the challenge.” (TSE2)

From the HEI lecturer’s perspective, the frustration lay in having no authority herself to insist on the workbook’s completion and return. Following an amnesty, a second chance to complete the workbook and the appointment of a new PEF to provide support with the process, the numbers successfully completing began to rise.

Changing requirements for all the supervisions to be undertaken in practice being replaced with some undertaken in the format of classroom-based scenarios, together with views about the impact this has on the time taken to qualify as a sign-off mentor and its robustness or otherwise are

discussed in Chapter 7, Section 7.8.

5.8.3 Success in getting sign-off mentors into post

Participants were asked how well the process of introducing sign-off mentors had gone and

responses varied in detail and depth. Two HEI participants expressed uncertainty and two had heard that there had been difficulties. The largest group (14) however which included HEI and trust

participants from Groups A and B said it had gone well in the main, with some adding a rider that they at least had not been aware of any problems and others that it had gone well after a slow start.

“The process of introducing them has gone well. I don’t think anybody has turned a hair which is interesting and maybe it can be done and I’m over cautious and it can be done.” (HSE3)

A further three participants drew a distinction between the introduction of first and second wave sign-off mentors. The first wave had gone more easily since these were the more experienced mentors; as a primary care trust PEF put it:

“The first wave went well because we had a lot of experienced mentors – who were experienced practitioners, community matrons, community practice teachers.” (TPEF4)

A facilitating factor in a mental health trust was allocating all third-year students to a clinical supervisor who also acted as their sign-off mentor.

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The challenge lay in training the less experienced mentors to assume the role; however the

proposed change in introducing simulated assessments as opposed to direct observation in practice was identified as making this process easier in the future.

“Our new competency portfolio to be introduced in May 2011 will reduce the burden on practice educators to do all the observed assessments as we are including in the portfolio that assessment can be simulated.” (MPL2)

One of the HEI participants stressed the importance of advance planning on the part of the trust personnel; they needed to think through for each area that was expecting final destination students whether there were sufficient numbers of sign-off mentors in place; a situation she felt was not always the case. Looking at this from a trust perspective, participants highlighted the importance of the PEFs detailed knowledge of practice settings for advance planning. As one PEF put it:

“You know as fast as you train people up there’s issues where people have either moved, or they’ve gone onto new jobs, or they’ve got promotion so they say ‘Oh I don’t really think I can have students in this new role’. So it’s kind of keeping ahead of all that and we’re kind of very focused (on it).” (TPEF7)

And another:

“You get the odd one leaving and you’ve just spent all that time preparing them. It’s most

frustrating. So then you have to think about well okay what I would tend to do then is try and find someone else in the department and then I will supervise them while they’re learning to sign-off.” (TPEF6)

5.8.4 Key point on processes involved in introducing sign-off mentors

Introducing sign-off mentors was a fairly resource intensive affair entailing: providing information about the new policy and its requirements; making decisions about which staff would become sign-off mentors, and providing the requisite training.

Challenges were encountered in developing sign-off mentors in small scattered settings, having sufficient time to provide and take the training, and having relevant information to facilitate advance planning of the numbers required in specific settings.

The role of staff who were practice-based as PEFs or link lecturers was shown to be pivotal in: informing colleagues about the policy and its requirements; making or contributing to

decisions about which staff should be put forward for sign-off mentorship; providing the training; and keeping aware of changing staff circumstances so that new sign-off mentors could be developed to maintain capacity.