Documente Academic
Documente Profesional
Documente Cultură
Email: kcooper@bournemouth.ac.uk
qualified recruitment in this area. of students, ensuring they are fit for practice, purpose and
award during the programme and at the point of regis-
KEY WORDS tration (NMC, 2010a). They serve as gatekeepers to the
w Mentorship w Sign-off mentor w Consolidation placement profession (Luhanga et al, 2008), with demonstration of
w Community placements w Quality assurance competence being a requirement for entry to the NMC
register. This is a holistic concept that was defined by the
Nurses are required to confirm that they have met all the
requirements for safe and effective practice for entry to Box 1. Criteria for sign-off mentor
the register, being fit for practice, purpose and award (Platt, w Identified on the local register as a sign-off mentor or a practice teacher
2002). This is defined as follows:
w Registered on the same part of the register
w Fitness for practicestudents have developed the requi-
site skills for professional registration w Working in the same field of practice as that in which the student intends
w Fitness for purposestudents are fit for employment, to qualify
including attendance w Clinical currency and capability in the field in which the student is being
w Fitness for awardstudents have met the required aca- assessed
demic standards. w A working knowledge of current programme requirements, practice
Judging this requires an overall decision to be made, assessment strategies and relevant changes in education and practice for
informed by evidence from a variety of sources and docu- the student they are assessing
mented in the ongoing achievement record, together with w An understanding of the NMC registration requirements and the contribu-
the mentors own observations of working with the student. tion they make to the achievement of these requirements
The sign-off mentor has to be undertaken once all of the
w An in-depth understanding of their accountability to the NMC for the deci-
hours of the programme have been completed. This is done sion they must make to pass or fail a student when assessing proficiency
2014 MA Healthcare Ltd
in order to address situations where students had previously requirements at the end of a programme
passed their proficiencies, had hours outstanding or where
w Been supervised on at least three occasions for signing off proficiency by
concerns were raised. an existing sign-off mentor, two of which can be undertaken by simulation
Robinson et als (2012) report on sustaining mentorship
identifies some key skills and desirable attributes for a sign- Source: NMC (2008)
off mentor (Table1).
sions may be left for the sign-off mentor, rather than address- on the mentoring relationshipbut reinforces that it is
ing concerns at an earlier stage. This would support Duffys essential for any feedback to be specific, timely, and both
(2003) findings, which showed that students may be given verbal and written.
the benefit of the doubt, with responsibility and account-
ability being passed on to other parties. Community nursing scenario
Middleton and Duffy (2009) also found that there were Within the community setting, students can work with
concerns regarding the emphasis placed upon the sign-off several members of the team, which enhances the learning
mentor in terms of accountability and the feeling of being opportunities, broadens experiences and enables students
pressurised that resulted. Glasper (2010) also highlights the to greater exposure of practitioners expertise (Lofmark et
reliance on the sign-off mentor who sanctions the students al, 2008). However, this can mean that the mentor has less
entry onto the NMC register. However, Blacks (2011) study control and that potential conflict can occur (Hall, 2006).
found that although anxiety was present, mentors were able This reinforces the need to ensure there are clear objec-
to manage this situation when they felt it was morally right. tives and opportunities for feedback to be obtained by all
The most important factor was wanting to be a mentor and involved, including patients and carers. Miller and Archer
commitment to ensuring fitness to practice, offsetting the (2010) reinforce the importance of any assessment proc-
barriers of time and support. ess, emphasising the need for multi-source feedback to
It therefore seems that clear documentation regarding be obtained. This enhances the rigour of assessment and
how the student is progressing is essential, particularly at the reduces subjectivity.
mid-point interview. This documentation is vital for any
student, both for their own development and as evidence for Caseload and accountability
any appeals or fitness-for-practice proceedings. Heaslip and One challenge identified by Middleton and Duffys (2009)
Scammell (2012) found in an evaluative study that student study with regard to mentoring students within the com-
and mentor perceptions did not always match in terms of the munity setting was the problem of students having a smaller
feedback given. Clynes and Rafferty (2008) also found that caseload, and the need to balance accountability with
feedback was often given towards the end of the placement, students developing skills as autonomous practitioners. It
meaning that students found it difficult to make improve- was found that the allocation of a caseload appeared to be
ments in the time remaining. Clynes (2008) recognises that dependent on students ability and stage of the programme,
giving feedback is challengingparticularly as it can impact the mentor themselves and also on the caseload and patients
needs. Therefore, assessment and development of the stu-
dents competence requires skilful planning.
Table 1. Skills and desirable attributes for
sign-off mentors
Lone workers
Skills Desirable attributes Hall (2006) also highlights the complexity in acknowledging
Good communication and interper- Having an interest and aptitude for being a lone worker and not having easy access to colleagues
sonal skills teaching for advice. McVeigh et al (2009) acknowledge that effective
and equitable mentor support is much more challenging
Supporting the student in skill Being self aware and reflective
development within a community setting due to a reduced number of
available mentors, and this can lead to people feeling isolated
Providing constructive feedback Being fair, consistent, encouraging and unsupported. Support is provided for mentors by the
and thoughtful towards students academic institution and local trust initiatives such as place-
ment support facilitators, learning advisors and link lecturers
Identifying areas that need further Having a high level of commit- (Carr, 2008), alongside mentor updates and support groups.
development ment in view of the requirement
of a 1-hour meeting every week
Mentors need to identify the support mechanisms available
throughout the placement within their own area, which will enable knowledge, skills
and experience to be shared.
Prioritising and planning action Keeping aware of changing staff
with students carefully considering circumstances so that new The NMC (2008) identifies that the mentor is account-
their progress sign-off mentors could be able for their decision to allow the student to work inde-
developed to maintain capacity pendently, and Brown (2013) reinforces the need for careful
Managing difficult situations such consideration regarding how this is applied in a community
as behaviour regarded as setting. The NMC (2011) discusses the benefits of indirect
unacceptable by the third year supervision in facilitating students to work more independ-
2014 MA Healthcare Ltd
To be able to stand back and ently, developing their confidence and skills. They also give
recognise that students who guidance in terms of the caseload being well defined, ensur-
appear overconfident might be ing that the mentor or supervisor is easily contactable and has
covering up a lack of competence the ability to delegate supervision to another colleague. The
Source: Robinson et al (2013, p.1067) mentor remains accountable for such decisions and must
ensure public protection.
in terms of quality assurance. feedback, support and documentation ensuring students are fit for practice,
purpose and award
Opportunities w Community placements offering a consolidation placement and a sign-off
Limited research has been undertaken on supporting mentor can promote future recruitment upon qualification
students in their final placement within the commu-
nity. However, Middleton and Duffy (2009) explored
These perceptions need to be changed: health-care Luhanga F, Myrick F, Yonge O (2008) Failure to assign failing grades: issues
delivery is complex, and the idea that care is predominant- with grading the unsafe student. Int J Nurs Educ Scholarship 5(1): 113
Marshall P, Shelton R (2012) Preparing nursing students to be community
ly given in primary settings is false. Marshall and Shelton health practitioners. Br J Community Nurs 17(2): 6229
(2012) discuss the potential benefits for students undertak- McVeigh H, Ford K, ODonnell A, Rushby C, Squance J (2009) A framework
ing their placements within the community setting. These for mentor support in community based placements. Nurs Stand 23(45):
3541
include communication, negotiation skills and the ability Melia K (1987) Learning and Working: The Occupational Socialization of Nurses.
to prioritise and make decisions effectively. Tavistock Publications, London
Middleton R, Duffy K (2009) Mentoring a student immediately prior to
Conclusion registration: a qualitative study. Br J Community Nurs 14(11): 4816
Midgley K (2006) Pre-registration student nurses perception of the hospital-
The sign-off mentor role can be challenging and reward- learning environment during clinical placements. Nurs Educ Today 26(4):
ing, and provides the opportunity to observe the transition 33845
and development of students prior to entry to the register. Miller A, Archer J (2010) Impact of workplace-based assessment on doctors
education and performance: a systematic review. Br Med J 340(c5064): 16
Community sign-off mentors also have the opportunity Nettleton P, Bray L (2008) Current mentorship schemes might be doing our
to influence and support future nurses to develop their students a disservice. Nurs Educ Pract 8(3): 20512
knowledge and skills in primary care and to develop their Nursing and Midwifery Council (2008) Standards to Support Learning and
Assessment in Practice, 2nd edn. http://tinyurl.com/pqlp4rc (accessed 4
career in this field of practice. Furthermore, the role offers
February 2014)
the opportunity to raise the profile of the practice setting Nursing and Midwifery Council (2010a) Standards for Pre-registration
(Carr, 2008). The sign-off mentor is the gatekeeper to the Nursing Education. http://tinyurl.com/nnk7mdx (accessed 4 February
profession, promoting fitness to practice and changing 2014)
Nursing and Midwifery Council (2010b) Sign-off mentor criteria: circular.
cultures and expectations in terms of preparing students http://tinyurl.com/p7ecg6s (accessed 4 February 2014)
for newly qualified roles in the community setting. BJCN Nursing and Midwifery Council (2011) Advice and supporting information
for implementing NMC standards for pre-registration nursing education.
Andrews M, Wallis M (1999) Mentorship in nursing: a literature review. J Adv http://tinyurl.com/qggncwf (accessed 14 February 2014)
Nurs 29(1): 2017 Papp I, Markkanen M, von Bonsdorff M (2003) Clinical environment as
Baglin MR, Rugg S (2010) Student nurses experiences of community-based a learning environment: student nurses perceptions concerning clinical
practice placement learning: a qualitative exploration. Nurs Educ Pract learning experiences. Nurs Educ Today 23(4): 2628
10(3): 14452 Pellatt GC (2006) The role of mentors in supporting pre-registration nursing
Bennett V, Nicholson W (2013). Care in local communities: a vision and serv- students. Br J Nurs 15(6): 336-40
ice model for district nursing. Br J Community Nurs 18(2): 746 Platt C (2002) Nurses Fit for Purpose: using a task-centred group to help
Black S (2011) Being a mentor who fails a pre-registration nursing student students learn from experience. Teach High Educ 7(1): 3345
in their final placement: understanding failure. Thesis, PhD. London South Prime Ministers Commission (2010) Front Line Care: The Future of Nursing
Bank University. and Midwifery in England. Report of the Prime Ministers Commission on
Bourbonnais F, Kerr E (2007) Preceptoring a student in the final clinical the Future of Nursing and Midwifery in England 2010. Central Office of
placement: reflections from nurses in a Canadian Hospital. J Clin Nurs Information, London. http://tinyurl.com/ne6atqw (accessed 4 February
16(8): 15439 2014)
Bradshaw A, Merriman C (2008) Nursing competence 10 years on: fit for Robinson S, Corbin V, Cornish J, Driscoll C, Knutton S, Stevenson T (2012)
practice and purpose yet? J Clin Nurs 17(10): 12639 Sustaining and Managing the Delivery of Student Nurse Mentorship: Roles,
Brammer JD (2008) RN as gatekeeper: gatekeeping as monitoring and super- Resources, Standards and Debates. Report for the NHS London Readiness
vision. J Clin Nurs 17(14): 186876 for Work programme Kings College London, National Nursing Research
Brown K (2013) Community placements for nursing students. Pr Health Care Unit. http://tinyurl.com/q9lw4lr (accessed 4 February 2014)
23(6): 2830 Robinson S (2013) Sustaining mentorship for student nurses. Nurs Times
Carr J (2008) Mentoring student nurses in the practice. Pract Nurs 19(9): 109(16): 245
4657 Rooke N (2013) An evaluation of nursing and midwifery sign off mentors,
Casey D, Clark L (2011) Roles and responsibilities of the student nurse men- new mentors and nurse lecturers understanding of the sign-off mentor
tor: an update. Br J Nurs 20(15): 9337 role. Nurse Educ Pract 14(1): 438
Chan D, Ip WY (2007) Perception of hospital learning environment: a survey
Royal College of Nursing (2007) Guidance for Mentors of Nursing Students and
of Hong Kong nursing students. Nurs Educ Today 27(7): 67784
Midwives, 2nd edn. http://tinyurl.com/pv29f9h (accessed 4 February 2014)
Clynes M (2008) Providing feedback on clinical performance to student
Royal College of Nursing (2012) The Community Nursing Workforce in
nurses in childrens nursing: challenges facing preceptors. J Child Young
England. http://tinyurl.com/kjfhfgz (accessed 4 February 2014)
Peoples Nurs 2(1): 2935
Salamonson Y, Bourgeois S, Everett B, Jackson D, Peters K, Weaver R (2011)
Clynes M, Rafferty S (2008) Feedback: an essential element of student learn-
Psychometric testing of the abbreviated Clinical Learning Environment
ing in clinical practice. Nurs Educ Pract 8(6): 40511
Inventory (CLEI-19). J Adv Nurs 67(12): 266876
Duffy K (2003) Failing students: a qualitative study of factors that influence
Shelton R, Harrison F (2011) Community placement myths. Primary Health
the decisions regarding assessment of students competence in practice.
Nursing and Midwifery Council, London. http://tinyurl.com/oaglvrb Care 21(2): 268
(accessed 4 February 2014) Schroder C, Brynes V, Chapman C et al (2011) Development and pilot testing
Glasper A (2010) Additional options for achieving sign-off mentor criteria. of the collaborative practice assessment tool. J Interprof Care 25(3): 18995
Br J Nurs 19(10): 6589 Shen J, Spouse J (2007) Learning to nurse in Chinastructural factors influ-
Gopee N (2011) Mentoring and Supervision in Healthcare, 2nd edn. Sage encing professional development in practice settings: a phenomenological
Publications, London study. Nurs Educ Pract 7(5): 32331
Hall A (2006) Mentorship in the community. J Community Nurs 20(7): 10-12 UK Central Council for Nursing, Midwifery and Health Visiting (1986) Project
2014 MA Healthcare Ltd
Heaslip V, Scammell, JME (2012) Failing underperforming students: the role 2000: A New Preparation for Practice. http://tinyurl.com/nbz9cel (accessed 14
of grading in practice assessment. Nurs Educ Pract 12(2): 95100 February 2014)
Lavizzo-Mourey R (2012) The nurse education imperative. Nurs Outlook Willis Commission (2012) Quality with Compassion: The Future of Nursing
60(2): 557 Education. http://tinyurl.com/q6v22re (accessed 4 February 2014)
Lofmark A, Hansebo G, Nillson M, Tornkvist, L (2008) Nursing students Wood S (2010) Mental health nursing students views of pre-registration nurs-
views on learning opportunities in primary health care. Nurs Stand 23(13): ing. Nurs Stand 24(47): 438
3543