INFORMACIÓN POSTEMISIÓN

Many of the studies mentioned thus far raise issues about the capacity of organisations to provide mentorship for student nurses such as time, staffing levels, providing placements, and the

preparation and support of mentors and other post-holders. The last group of studies included in this review focused specifically on capacity in relation to clinical placements.

2.8.1 Studies focusing on decision-making about placement capacity to support students Decision making about the number of students that could be supported in clinical placements was explored from the perspective of key stakeholders in a study by Hutchings et al (2005). A purposive sample of mentors, nurse managers, and modern matrons, recruited from a diversity of clinical areas

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in one English NHS trust, were invited to take part in focus group interviews. The response rates for each group were low at 28% (n=4), 18% (n=4) and 25% (n=4) respectively and, as the authors acknowledge, meant a potential lack of representativeness. Factors identified as impacting on placement capacity included: student numbers were decided through an educational audit but regarded as not always matching the number respondents felt could be supported; audits were sometimes out of date and did not reflect the ‘current operational climate’; difficulties in supporting students as well as newly registered staff at busy times especially when the skillmix comprised a high proportion of bank and agency staff; and having insufficient numbers of mentors to implement recommended mentor-learner ratios. Other findings reflected those in some of the studies on practice support roles (Section 2.7). Thus all participants believed that an increased amount of dedicated academic support from HEI staff would improve the learning environment by providing mentors with advice about assessment issues and helping them with ‘difficult’ students; and participants in areas which had appointed a trust-based education facilitator commented positively on their support for mentors.

Murray & Williamson (2009) also explored decision-making in relation to the numbers of students that can be supported per placement. A sample of 29 mentors in one strategic health authority, purposively sampled to include adult, mental health and child branch nursing from various acute and community settings, were recruited into three focus groups. Questions built on those developed by Hutchings et al (2005) and similar findings emerged. While mentors most often reported that decisions about the number of students an area could support were made by ward managers, the majority thought that such decisions should be made jointly by the placement manager and clinical team and the HEI. Concerns were expressed about peaks and troughs in the numbers of students in practice and short notice of anticipated student arrivals. The ratio of mentor to students featured prominently in responses and factors perceived as hindering mentoring included: constraints of staffing levels and workload, students being unwilling to work night duty or weekend shifts, and the time consuming nature of assessment processes and associated paperwork. Mentors thought that students as well as themselves had a responsibility for making the relationship work and that mentors would benefit from an occasional break from having a student.

2.8.2 Studies focusing on enhancing and increasing placement capacity

As part of a wider project to map clinical placement provision for students at four universities in the south-east of England and then identify and explore opportunities to enhance such provision, Magnusson et al (2007) captured the views of seven Clinical Placement Managers (CPMs) on the subject. This post was funded by the local Workforce Development Confederation (WDC) and had a remit to: manage the provision of placements; support managers, supervisors and assessors in practice; and provide strategic links between the WDC, HEIs and their associated trusts. In-depth interviews were held with a purposive sample of seven of the 27 CPMs in post, selected to represent a diversity of practice settings.

Clinical Placement Managers were seen as having a bridging role between the placement, HEI and student. Their detailed knowledge of the trust and its clinical areas facilitated the management of placement allocation and this knowledge, combined with the use of forums, networks and mapping exercises, helped them to identify new areas to develop for placements. There was a strong feeling among CPMs that educational audits did not provide an accurate reflection of a placement’s actual

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capacity; a finding also reported by Hutchings et al (2005). Factors hindering expansion of capacity included: HEI staff being slow to respond to requests to audit new areas that CPMs had identified; placements not being accessible for students without private transport; student reluctance to work evening and night shifts; increases in numbers of part time staff; and reluctance of some mentors to have students after a gap in doing so.

Some of the problems about capacity to accommodate student nurses identified in the foregoing studies were addressed by a hospital in Australia and the three educational institutions with which it was associated through the development of a collaborative education model (Barnett et al 2010). Using a participatory action approach, a group of senior staff delineated the key attributes of the model that included: leadership; commitment and regular face to face communication by all key stakeholders; a common support and reward programme for mentors (called preceptors in Australia); a dedicated clinical facilitator; greater use of different shifts and weekends for placements; a reconfiguring of student placement timetables from each education provider; expanded number of placement weeks available at the hospital; and the education providers developing common clinical objectives, skills sets and student evaluation tools. The model was phased in over two years and evaluated by an assessment of placement metrics and a survey, focus group discussions and interviews with students, mentors and senior education and management staff. Findings showed that all aspects of the model were viewed positively by participants and the placement metric data for the three-year project period showed an increase of 58% in the number of students placed at the hospital and a 45% increase in the number of placement weeks available. 2.8.3 Study of broader aspects of organisational capacity

A broader perspective on organisational capacity for mentorship emerged from a study by Jokelanien et al (2011) in which a purposive sample of mentors from Finland and the UK were interviewed in focus groups (five groups in Finland (n=22) and four groups in the UK (n=17). While the paper indicates that the mentors were drawn from a diversity of practice settings, information is not given on the geographical or institutional spread of the sample. The interviewees were asked for their conceptions of how to build organisational capacity for providing effective mentorship for students during placements. Three categories of organisational capacity emerged from the data analysis, each at a different hierarchical level, and demonstrated the complexity of organisational resources, strategy and commitment that mentors perceived as necessary to underpin their support of student learning in practice.

The highest level focused on the organisation as ‘an optimizer of sufficient executive investment in providing mentorship’ and this included: a clear, co-operative strategy for placement provision; sufficient human and financial resources (numbers of mentors, protected time for mentorship, education and updates during work time, and financial rewards for mentorship); and a culture that valued mentors and supported their work and professional development. The second level focused on the organisation as a creator of a supportive culture in placements and this included: professional and enthusiastic attitudes to work; positive attitudes to mentorship; a student centred atmosphere; and a focus during work on students’ learning objectives. The third level focused on the organisation as a provider of well prepared placements and included: appropriate staffing levels and workloads; matching student numbers to placement capacity; preparation for arrival of and allocation of students; and attention to providing learning opportunities.

32 2.8.4 Key points from studies of organisational capacity

Limitations of the studies, often author acknowledged, include: lack of information of size of group from which the sample was drawn; low take up of requests to participate in study; recall of interview content when note-taking as opposed to audio-recording is used; researchers known to participants; and generalizing from one site and/or small groups.

Considered together, the studies highlighted a wide range of factors that can influence

organisational capacity to provide and support placements for student learning and these include: accuracy of audits to determine placement capacity; insufficient numbers of mentors for students; high proportions of temporary staff; peaks and troughs in student numbers in practice; and short notice of students’ arrival. The importance of joint decision-making about placement capacity and the need for posts that support student learning in practice were both identified. The interest of the Australian study is in demonstrating that a different and collaborative approach to some of these problems can result in enhancing the capacity of healthcare organisations to support student learning in practice.