Although all student nurses are required to meet the NMC standards for pre-registration nursing education (NMC 2010) before progressing to registration, each university has a different method of assessing the level of competency. Benner’s (1984)From Novice to Expert and Bondy’s (1983) ‘skills escalator’ are examples of commonly used assessment strategies. Other universities may have an ‘achieved’ or ‘not achieved’ system. The NMC stipulated that this is not a sufficiently robust method and all pre-registration nursing providers will be expected to introduce a rigorous clinical assessment strategy, in which to measure the NMC Competencies.

Bondy (1983) (Fig. 6.1) uses four levels of achievement, and as students progress through their placements, they have minimum levels to achieve from 1–4. They can, however, meet a higher level in some outcomes or competencies if their mentor assesses they are working at that level. In each placement, they must meet the minimum level or the outcome/competency is not achieved. The levels are indicated in the ongoing achievement record on the corresponding ‘assessment results’ sheet for that semester. The level achieved for each outcome/competency should be recorded rather than merely a tick in the box.

Fig 6.1 Bondy skills escalator

(adapted from Bondy (1983))

Activity

Identify any outstanding learning outcomes from previous placements that you want/need to achieve, as well as the level of competency you need to achieve.

Refer back to the activities you completed earlier in this section. You should start collating all of this as evidence into your portfolio. This will help give you a guide as to which competencies you have achieved and which ones are outstanding, enabling you to concentrate on these.

NMC Domain 1: 1.1; 1.7; 1.8

NMC Domain 4: 4.4

Starting to develop your portfolio from the beginning of the placement is essential to ensure you are prepared for when you meet with your mentor to review and demonstrate your learning and clinical achievements, relating to the NMC Competencies and Essential Skills you need to achieve.

Planning and preparation are competencies in their own rights and, as well as being essential to starting any new placement, learning these organisational and prioritising skills will be worthwhile throughout your training and in your professional role as a registered nurse. Levett-Jones and Bourgeois (2007) offer excellent advice and guidance for students prior to, during and after placements.

Roberts (2010) outlines key things you can do to prepare before starting a clinical placement. These include making sure you attend your planned clinical skills and simulated learning sessions and also, if an opportunity is planned into the timetable, undertaking some additional practice in the clinical skills classroom, either on your own or with a colleague (make sure your skills tutors are aware that you are doing so).

Practising skills prior to undertaking a placement can enhance your confidence when asked to undertake tasks that you have been shown how to do and may have practised a few times, but still possibly lack confidence in. Skills such as taking a blood pressure, for example, will be an essential skill to learn if undertaking a cancer/palliative care placement, given the importance of blood pressure as an indicator of infection in an immunocompromised patient, such as septic shock.

Some universities also have excellent resources for students to use on their student learning Websites, accessible via personal passwords. You can also find useful resources linked to publication of books which also make a valued addition to pre-placement preparation.

A good example is the online clinical skills resource written by Docherty and McCallum (2009), available at:

http://www.oup.com/uk/orc/bin/9780199534456/01student/checklists/(accessed May 2011)

Activity

Log on to your own university learning resource centre (such as Blackboard) and find your online learning material with regards to clinical skills or preparation for practice placements. See the University of Nottingham for an example of practice learning pages:

http://www.nottingham.ac.uk/nursing/practice/ (accessed November 2011).

NMC Domain 1: 1.1

NMC Domain 4: 4.4

A good way to dispel your fears is to make contact with your placement area. Many universities have placement details on the internal Web pages and this can be a good starting point for finding out about the area. Phone or e-mail the placement and arrange to speak with your mentor. You may use the placement checklist in Figure 6.2 to remind you of things to find out or do before starting your placement.

Fig 6.2 Placement checklist

Activity

In preparation for meeting your mentor, check out the online information you can access about your cancer/palliative care placement, as well as the hospital or other environment where it is to be found. Check out the kind of treatment and care that takes place there and write out a draft plan of what you want to experience and learn during the time you are there. This could be a short placement within a larger placement learning pathway (or a ‘hub and spoke’ type placement) or a single placement where there may be opportunities to experience a ‘snapshot’ of a total patient experience.

NMC Domain 4: 4.4; 4.5

Before your placement commences, enquire whether the placement has an induction/orientation package which will highlight the specific learning opportunities that might be available. Some universities will have these available on the Intranet before you start. In other schools, you may be given a pack on your first day or as the placement progresses.

An induction may include the following:

• Introduction to the placement and overview of the services offered.

• Chemotherapy and radiotherapy overview and safety features.

• Understanding spiritual distress in patients and the impact on the professional team.

• Opportunity to meet members of the wider multidisciplinary team, for example the chaplain and practice placement staff.

• Opportunity to explore areas of concern and personal feelings of anxiety.

Activity

Find out if this placement has an induction day. If not, use the above as a checklist to consider how you can prepare for the placement. You can refer back to this section to gather the core information.

What to expect in the first week

Once you have commenced your placement, there will be a number of key things you will need to know and achieve in your first day and your first week.

Within the first week

• Ward routines: visiting times; rest hour; protected meal times arrangements; meal times.

• What learning resources are available in the area: access to specialist resources; can resources be borrowed?

• Multidisciplinary team members in the clinical area: list their names and roles.

• Infection control policies: are flowers allowed in the area? What are the handwashing/rub facilities for visitors?

The first week can often be the most daunting and being prepared can reduce the feelings of anxiety, giving you more energy to establish relationships with team members and absorb important information.

Mapping your own learning needs to NMC competencies

You will probably be undertaking either a programme of study where the course is clearly divided into a 1-year common foundation programme (CFP) and a 2-year branch programme, or one where there is no CFP and branch evident but still requires a programme of study which enables you to achieve outcomes (NMC 2010) which are field specific (adult, child, mental health and learning disability nursing).

Regardless of which NMC outcomes you are having to achieve on this placement, the principles remain the same. You must adhere to both the Guidance on Professional Conduct (NMC 2009) and The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives (NMC 2008). It is very important that you read these and discuss them with your personal tutor before undertaking placement learning and also your mentor when you meet for the first time.

During your first week of placement you should sit down with your mentor and start to review your learning outcomes and identify learning opportunities in the clinical area.

Reflection point

Ask yourself the following questions:

What skills will be completely new to me?

What skills do I need to achieve?

Where do I need to add evidence to my portfolio?

What skills do I need specific practice in to increase confidence?

What skills am I worried about?

NMC Domain 1: 1.1; 1.5; 1.7; 1.8

NMC Domain 4: 4.4

Learning about the team

Establishing a relationship with your mentor or practice learning facilitator is important right from the first day. You should have been allocated a mentor and possibly a co-mentor and you should have your first day interview with one of them. Remember that the placement will have been informed when you are due to arrive and will have allocated you a mentor. Ward staff will be expecting you and will be keen to make you welcome.

As well as being supported by a named mentor, there will be a number of other qualified nurses (now known as registrants) and other healthcare workers and professionals who will help facilitate your learning and will contribute to assessing your knowledge and skills while on placement. It is important for you to consider the specific roles and responsibilities of these individuals. This is covered in Chapter 7.

Key roles linked to student learning in practice

The mentor

Every student who is allocated by their university to gain a clinical placement learning experience has to have a named mentor who will be their main facilitator of learning, supervisor and assessor of their practice (mandatory requirement of the NMC 2008). All mentors should be experienced nurses who will have completed a course of mentorship preparation or have an equivalent qualification in their own field which is recognised as being appropriate to supervise and assess student nurses in practice (this latter individual will only be able to undertake the mentor role in specific placements and not at the major progression points within the new NMC (2010) guidance for curriculum delivery). Your mentor will be responsible for assessing your learning and competence in practice and your practice assessment document, as well as completing and signing your ongoing record of achievement (ORA) (Box 6.1), sometimes known as ongoing achievement record (OAR) (NMC 2007).

Box 6.1 Roles and expectations of you as the student and your mentor in relation to the assessment (ongoing record of achievement (ORA))*

The assessment process

Week 1

1. Student MUST negotiate with their mentor a time for their initial interview to discuss learning needs and goals and agree an action plan for achievement.

2. Student MUST share with their mentors their ORA from any previous placements and any action plans resulting from their last assessment of learning in practice.

3. Student will ensure that mentors are aware of any non-practice assessments they need to complete which may require their support for achieving, such as a client-focused assessment or evidence-based practice on a placement-specific topic.

4. Student may also have additional practice-based assessments to achieve in the placement, such as medicine management, handwashing skills or (ward/patient care) management.

Mid-point placement experience

5. Student and mentor will ensure that they meet to discuss progress at some point half way through their placement experience and also to determine if any actions from previous placement (ORA information) are being achieved. Evidence of progress will be gathered from a range of sources, including student skills record/practice assessment documents, other qualified nursing staff (registrants) and other health workers in direct contact on a regular basis with the student.

6. Student MUST receive constructive feedback from their mentor at this point and also on an ongoing basis. The mentor must ensure that the student is being taught new skills and gaining new knowledge through ongoing evaluation of learning and any deficit from their original agreed action plan can be re-negotiated if required. This mid-point meeting is an essential one for the student who may require additional support from their mentor to achieve successful completion of their practice assessment in this placement.

Final placement period

7. Student and mentor MUST meet during their final week of placement. (The importance of this final placement assessment will be critical for those students in their final placement as their practice will be required to be assessed by the ‘sign off’ mentor’). All evidence must be available about their progress on the placement and all documents available for discussion and signatures. Self-evaluation may be required as part of their practice assessment documents.

8. It is at this stage that the student has to offer clear evidence that they have achieved their goals, met the required NMC Competencies for the placement and a record made of their overall performance during their placement.

9. Ongoing record of practice assessment may either indicate level of achievement (such as the Bondy skills escalator, discussed earlier) as assessed by the mentor, or a simple assessment of:

– Achieved: all outcomes achieved competently, safely and professional behaviour appropriate.

– Not achieved: although some outcomes achieved, the student’s overall performance has not met the required standard nor achieved required NMC Competencies for this placement.

10. Student and mentor discuss the outcomes and agree subsequent actions according to university policies.

^* (Please note that this is a very brief version for illustration purposes only and that all universities will have different and very detailed practice assessment documentation.)

In addition to your mentor, more senior student nurses will take an active role in the teaching and support of other students as part of their role.

The sign off mentor

The role of the sign off mentor is to ‘sign off’ a student’s competence against the NMC standards at the end of their NMC approved programme (Levett-Jones & Bourgeois 2007). This role is undertaken in the final placement only, but this decision will be influenced by the decisions of previous mentors who have recorded and approved the student’s progress in their ORA in the previous placements. These mentors, as noted above, are critical to the assessment of the student’s ‘fitness to practise’ as a safe and effective qualified nurse, and they are responsible and accountable for providing the evidence on which the ‘sign off ‘ mentor makes their final assessment. To be a sign off mentor, the qualified nurse must have undertaken a further course beyond that of mentorship.

As a student in the final placement, it is essential that you meet with the sign off mentor for the equivalent of 1 hour per week, in addition to the 40% of time working with your mentor normally. This is to ensure ongoing and constructive feedback is given as to your progress in that placement, and also builds on your previous ORA.

The practice education facilitator

Please refer to the full NMC guidance on issues of confidentiality and access to your ORA:

www.nmc-uk.org/Documents/Circulars/2007circulars/NMC%20circular%2033_2007.pdf (accessed May 2011).

In some areas there are practice education facilitators; this is a relatively new role in practice education. These facilitators provide support for mentors and act as a link between mentors and colleagues in universities (Carlisle et al 2009).

Some practice education facilitators will work with mentors to develop supplementary learning opportunities for students in practice, such as student study days, workshops and shared learning opportunities with other healthcare professionals.

Practice education facilitators also work with mentors and link teachers/tutors from the university to develop and ensure that student placements are quality learning environments. They will also be involved in evaluation of your learning experience in the placement and also the educational audit, whereby a specific tool is used by the placement area to evaluate the quality of the overall learning environment to which you also will have contributed.

Link teacher

The link teacher role was introduced to strengthen links between education and service areas when nursing education was transferred into the higher education sector in the UK. Initially this role was key to the successful development of the learning environment in clinical practice, working with ward managers and mentors to develop placement learning opportunities and experiences for students as well as ensuring their quality. Of late, this role has become less visible but the link teacher still has a key role to play in ensuring that the areas which they link with support student learning (Arkell & Bayliss-Pratt 2007). You can check the identity of your placement link tutor through the placement learning information on your university Website and also when you arrive in your allocated placement.

The link teacher in many areas works closely with the practice education facilitators in ensuring good learning experiences for students, and some still retain ‘hands on’ clinical care and case loads. Some are also employed as lecturer–practitioners by NHS organisations, where they work half time in the university and half time in a clinical specialty (Buchan et al 2009)

It is important to make a note of your link teacher’s name in your student diary because there may be a time when you need to contact the university directly, for example to speak with your personal tutor who may not be available and the placement link teacher may be able to help you instead.

The personal tutor

The role of the personal tutor is central to successful transition and journey through your specific field of practice (branch) pathway and programme of study.

It is expected that all students are allocated a personal tutor, normally from their own field of practice such as mental health, learning disability, adult or children and young people’s nursing. Por and Barriball (2008:100) highlight that lecturers who undertook this role provided a range of activities from the ‘provision of pastoral care and acting as a referral agent to other services such as student support networks, to monitoring student progress and giving academic support when required’. The main type of support that most students required was linked to these issues.

Your personal tutor will play a key role in helping you to achieve your personal and professional development goals or similar processes, which involves discussion of overall progress on your programme, including placement learning and achievements and academic achievements.

Activity