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In relation to the SOMS this theme relates to the most difficult aspect of SOM role. During interviews and discussions mentors commented that although they had always been accountable for decisions about students, there was a difference in decision making about whether the student nurse would pass or fail at sign-off stage. The interviewees focused on the responsibility, the weight of this decision and on the physical,

111 psychological feelings and emotions that resulted from this experience. The insights of participant’s experiences provided meaning to what it was actually like being a mentor who has the responsibility and makes final sign-off decisions at this stage.

Amy discussed her experience as a staff nurse within an area for children admitted with acute conditions. She stated that the department was very busy and patient turnover was often rapid. Amy had been a children’s nurse SOM for two years and had supported three students during the sign-off stage. At first Amy, simply described her experience as different to that of being a mentor to other students:

‘It is different being a sign-off mentor, a big responsibility.’ (Amy, Individual interview, participant 1)

When asked to continue about why it was different she hesitated for a moment and then she went to describe her experiences in more detail:

‘I worry that the student nurse may be fine when I assess them but may go on to do something later on. Nervous... yes, I definitely feel nervous about them (the students) potentially doing something wrong in the future. I think I would feel responsible and would not forgive myself.’ (Amy, Individual interview, participant 1)

This concern for the ongoing safe practice of the student nurse in the future was not isolated and it was discussed by a number of other participants during interviews. Carol worked in the community setting and had been a mentor for many years and a SOM for four years. She expressed her continued nervousness at undertaking assessments at the sign-off stage and described the constant checking process she goes through from the start of the student’s sign-off practice learning experience to its completion. She provided a profound account of what she does and expressed her concern that the potential effect these decisions may have on her future as a SOM:

‘I approach it by thinking this is about the whole thing, not just this practice placement. I constantly think about the student nurse and push them a lot more to do things ....I also keep little notes to remind me. I talk to the student nurse and find out what they know; I talk to others who have mentored her to find out what I can about them over the last three years. I feel nervous about them doing something in the future. I would be devastated, feel responsible and would definitely give up the

112 role, actually probably give up nursing.’ (Carol, Individual interview,

participant 3)

At this point Carol behaved very nervously, then continued, she explains because she was an experienced mentor and loved working with students, taking the next step to becoming a SOM was just expected of her. When she was first approached she explained that she had initially said no as she did not want the additional responsibility. Then a few weeks later she was asked again as the community practice setting needed more SOMs and so she felt guilty and somewhat obliged. She therefore agreed to do it, although she still had feelings of doubt as she was assured the preparation process would be rigorous and would be fully supported at all times. She then continued:

‘I think I worry too much really as I make big decisions all the time about all sorts of things. It is about safety and standards and they will hopefully be one of us in the future won’t they?’ (Carol, Individual interview, participant 3)

The link between children’s nurse SOM decision making and the ongoing effect these decisions may have on them as a SOM was shared by a number of participants. Debbie described how she continues to think about her decisions to pass or fail a student:

‘ ... Every time I have made my decision I continue to think about it long after they have gone. I mean what happens if they do something later, after they qualify?’ (Debbie, Individual interview, participant 4)

The theme was explored within the focus groups and at first there was hesitance to discuss the matter. After a few moments a SOM referred to the crimes of the nurse Beverley Allitt in terms of who assessed her and who was subsequently deemed

responsible after the events. This aspect of the interview was briefly a very tense part of the discussion between the SOMs. Ellen revealed her personal concerns about what could happen and then commented that she had a sense of relief that now SOMs were in post this would most likely not happen again. A lot of nodding happened around the room. The need for a SOM to undertake this final assessment of practice learning was defended by Ellen:

‘I’m old enough to remember Beverley Allitt and the damage she did to children’s nursing, those poor parents and public confidence? She was somehow let through so yes it scares me that it could happen again. I

113 take my role of sign-off mentor very seriously.’ (Ellen, Focus Group 1,

participant 5)

SOMs in the focus group had been nodding, but had remained looking at the floor during these tense few minutes. They looked up and agreed that they felt the introduction of the SOM role had improved the assessment process through the preparation required for the SOM role and how they felt their previous experience as a nurse and mentor had helped strengthen the assessment process at the end of nurse training. There was a strong sense of SOMs wanting to make the right decision and having a clear sense of the

consequences of getting it wrong:

‘We all do (referring to Beverley Allitt) but it was different then so I don’t think that will happen again... (Carol, Focus Group 1,

participant 3)

The perceived enormity of decision making in order to ensure the children and families were safe were shared by other participants, Amy shared the following:

‘I agree ... but still when I‘m about to sign I take a big breath, think it’s the responsibility that flashes in my mind for a moment? But I think the sign-off mentor role has helped make it better and much safer for the kids. Before you just had to be a mentor and that depended on who the student got, we are better prepared and more experienced.’ (Amy, Focus Group 1, participant 1)

There is a perception that students who were pleasant managed to progress further because they were perceived as nice people and therefore liked by children, parents and staff. This alone was considered insufficient to be passed by SOMs if the student nurse was not progressing in all other areas:

‘I expect them to be professional all the time and that includes being nice. Saying that it’s not enough just for them to be nice ... even though some students are really nice to parents and the kids; they also have to come up to the mark and know lots of things, how to do things, be safe. But they must be harder on a sign-off to fail.’ (Helen, Individual interview, participant 8)

Other participants agreed with the view that professionalism was important, they also agreed this aspect alone was not enough to warrant passing, but they acknowledged that a student nurse displaying either of these qualities consistently, would be harder to fail:

114 ‘Being a staff nurse is so much more than being nice. So unfortunately

some really nice students sometimes fail, I think this makes the decision harder still.’ (Katy, Individual interview participant, 10)

Whilst a high standard of practice is clearly expected of those student nurses wanting to be a registered children’s nurse, all SOMs agreed that students must reach this standard. One participant in particular expressed her frustration that anything less was just not acceptable:

‘I think the kids deserve more than just a nice nurse, I mean being nice but just being OK in other areas as a standard to become a registered children’s nurse is not enough.’ (Joanne, Focus Group 2, participant 9)

Despite all the support, guidance and encouragement SOMs provide, some students do not pass their assessments. Katy, an experienced SOM explained that sometimes even constant encouragement provided to a student was not always enough to ensure a student would succeed:

‘It was a bit of a shock as I had to give her quite a lot of direction to even do every day routine stuff like remembering to brush teeth and remember things were due, much more than you would normally expect to give at this stage. I really tried to help her by going through things again and again, even giving her a first year student nurse to look after. By her midway point she was still the same and I knew then she was not going to make it, so I contacted the university. Still it was hard to do at the time.’ (Katy, Individual interview, participant 10)

In summary of this theme, this aspect caused worry and concern for children’s nurse SOMs even long after decisions had been made. SOMs had a clear sense of failure at sign-off stage and how it was perceived in terms of the student nurse not being safe or ready to enter the register and therefore not fit for practice. Although there was a sense that SOMs wanted student nurses to succeed and achieve their ultimate aim of becoming a registered nurse, they all agreed that as a SOM they always wanted to make the right decision and that they had a clear understanding of the consequence of getting their sign- off decision wrong. Children and their families must be cared for safely and a student nurse must reach standard expected of a registered nurse. There was no evidence that children’s nurse SOMs were failing to fail’.

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