Student nurses in the UK must complete a pre-registration programme approved by the Nursing and Midwifery Council (NMC) to meet the Standards of Proficiency for Registered Nurses, which qualifies them for entry onto the NMC register (NMC, 2023a). A key component of this programme is clinical placement, where student nurses gain practical experience and develop essential skills in a supervised healthcare environment (Vinales, 2015). In May 2018, the NMC introduced the Standards for Student Supervision and Assessment (SSSA), which replaced the traditional mentorship model and established a coaching framework for supervision. This shift introduced three new roles in the supervision and assessment of nursing students: the practice supervisor, the practice assessor, and the academic assessor (Donaldson, 2019; NMC, 2023b).
The practice supervisor is responsible for facilitating and supervising the student nurse's learning during clinical placements, while contributing to the overall assessment of their progress through documented observations. The practice assessor evaluates whether the student nurse has achieved the necessary proficiencies and learning outcomes, informed by feedback from the practice supervisor (NMC, 2023b). The academic assessor, typically a university lecturer, supports this process by collating evidence of the student's progress and offering feedback throughout the practice placement (Drayton and Edmonds, 2020).
The SSSA marked a departure from the former mentorship model, where students were assigned a mentor and sign-off mentor who oversaw their learning and progression. The NMC phased out the mentor role by January 2019, but the full implementation of the SSSA was interrupted due to the COVID-19 pandemic. In response, the NMC introduced emergency standards in March 2020, which temporarily allowed one person to act as both practice supervisor and practice assessor. This temporary measure reverted to the older, more familiar model, where one mentor was responsible for overseeing student practice learning (Bliss, 2021). Higher education institutions (HEIs) resumed full implementation of the SSSA model in September 2021.
Despite its widespread adoption, research on the SSSA model remains limited. Fisher et al (2022) found that the new documentation toolkit they developed for the SSSA enhanced the reliability of supervision and assessment, but the effectiveness of its implementation varied between organisations, often depending on student understanding. Norman et al (2024) identified communication challenges, particularly when working with international students, and recommended enhanced organisational support and collaboration among colleagues. Given the limited research, this study sought to examine the experiences of nursing students, practice assessors, and practice supervisors under the SSSA framework, focusing on training, organisational support, and mutual expectations between students and staff.
Methods
Design
A qualitative research approach was chosen to explore and understand the lived experiences of student nurses, practice assessors, and practice supervisors under the SSSA framework. This methodology was deemed suitable as it enabled the collection of detailed, nuanced accounts from participants, providing insight into their personal experiences with the SSSA system (Bell and Waters, 2018). Qualitative research is particularly valuable when seeking to answer ‘what’ and ‘how’ questions, making it an appropriate choice for exploring this newly implemented regulatory model in nursing education.
Setting and participants
This study was conducted within an acute NHS Trust in London, and nursing students were recruited from a partnering university. A purposive sampling method was used to select participants who met the inclusion criteria: pre-registration nursing students (years 2 and 3, who had sufficient experience in practice), practice assessors, and practice supervisors (Silverman, 2021). Recruitment of nursing students was facilitated through posters on the university's virtual learning platform, while practice assessors and practice supervisors were contacted via the Trust's educational leads. Educational leads acted as gatekeepers, providing matrons with participant information sheets and consent forms. Participants were asked to contact the research team directly if they wished to take part in the study.
Data collection
Data were collected using semi-structured interviews, which allowed for in-depth exploration of participants' experiences while maintaining flexibility to probe into key areas. Interviews were conducted by both researchers and participants had the option of being interviewed face-to-face or via Microsoft Teams video calls. Four interviews were conducted face-to-face, and ten were conducted online. Each interview lasted between 25 and 40 minutes, and all were audio-recorded with participant consent. A total of 14 participants (seven nursing students and seven registered nurses who served as practice assessors and supervisors) were interviewed between May and October 2023.
Data analysis
Interview data were analysed using Braun and Clarke's (2006) six-phase framework for thematic analysis, a method commonly used in qualitative research to identify, analyse, and report themes within data. Face-to-face interviews were transcribed verbatim, whereas Microsoft Teams interviews were transcribed using the platform's automatic transcription function and reviewed for accuracy. Initial coding was undertaken by both researchers, with codes grouped into categories and subsequently organised into themes. The two researchers collaborated to ensure consistency in the analysis process, enhancing the trustworthiness of the findings.
Ethical considerations
Ethical approval for this study was obtained from the university ethics committee (reference number UEP2023MAR03) and the NHS Trust's Nursing and Midwifery Research Committee. Informed consent was obtained from all participants, and they were provided with detailed information about the study before interviews took place. To protect participant anonymity, each individual was assigned a unique identifier, and personal data was stored securely in line with the Data Protection Act 2018. Measures were put in place to ensure that participants could withdraw from the study at any point without penalty.
Results
Three major themes were identified from the data: training related to the SSSA, organisational support, and expectations from students, practice assessors, and practice supervisors.
SSSA-related training
Training related to the SSSA was inconsistent across the participants, with six registered nurses reporting that they had received training specifically concerning the SSSA, while one nurse had only received mentorship training. Nursing students, on the other hand, were introduced to the SSSA system primarily through training sessions about how to complete the electronic/online version of the practice assessment documentation, or ‘ePAD’. These training sessions took place prior to their clinical placements. However, students and nurses alike reported varying experiences regarding the quality and effectiveness of their training.
Several participants described initial confusion about the roles of practice supervisor and practice assessor, as illustrated by one nurse's comment:
‘The initial phase, there was a bit of confusion. Who? What is a supervisor? What is an assessor?’
Other participants missed the face-to-face training that had been available in the previous mentorship model:
‘I do miss the face-to-face teaching … when you complete the assessment online, there's lots of thought that goes into it to make sure you are doing the right thing.’
Although some found the training helpful in assessing students' achievements, others pointed to gaps in the system:
‘I wasn't aware that actually [the Trust was offering SSSA training].’
Student nurses echoed the mixed views about the SSSA-related training, with some recalling the ePAD introduction but others feeling the system change was not adequately explained:
‘It was mentioned prior to our placement, I just remember that they explained it to us about it during an ePAD [introduction] session.’
Both groups identified the ePAD system as a point of frustration. Although it was designed to streamline the assessment process, it was described as cumbersome and difficult to use. One nurse noted:
‘Some nurses we struggle because the ePAD is time consuming. You forget your password sometimes, so you cannot get on to ePAD.’
Students shared similar concerns, with many preferring the older paper-based system:
‘Nurses prefer the paper versions. ePAD is a bit repetitive in the sense of the proficiencies.’
Despite these challenges, the majority of participants reported a preference for the SSSA compared with the mentorship model. One nurse highlighted the increased flexibility of the new model:
‘In the past, they had to work with their mentor for 40% of their practice, but now they don't have to. This gives more flexibility.’
However, not all participants were in favour of the SSSA changes. One nurse expressed concern about the number of supervisors involved:
‘Honestly speaking, I don't see any difference … I'm against too many supervisors … too many supervisors make students confused.’
From the students' perspective, working with multiple supervisors was generally seen as beneficial, as it exposed them to a variety of working styles and approaches.
‘I prefer working with different supervisors because, if you work with one person, you don't gain enough.’
Organisational support
Organisational support, from both the NHS Trust and the university, was another key theme that emerged from the interviews. Participants reported mixed experiences regarding the level of support they received.
Some nurses felt they received adequate support from the Trust's educational leads and practice educators:
‘Educators will work with the staff … Sometimes people get offended by the feedback when you're saying you need support.’
However, others felt the Trust could do more to support both students and registered nurses in their roles:
‘I won't say we get much help from the Trust … We do have a practice educator, but they don't really get involved in the clinical area.’
Students also expressed a range of experiences, with some feeling well-supported, whereas others struggled to receive timely responses from educational leads:
‘There are some wards where the manager is not after student learning but sees you as a spare tyre … I sent an email [to the educational lead] and didn't receive a response.’
Some students reported a lack of communication from the Trust's matrons, whereas others found specific individuals within the education team to be helpful and supportive:
‘The XXX [specific person in the Trust's education team] is nice and supports me if I need.’
Nurses and students also commented on the support they received from the university, specifically practice visitors and placement team visits. One nurse said:
‘Before, we used to see the lecturers more often. I wish the lecturers were around more face-to-face.’
Another nurse felt that university support was generally good:
‘They [practice visitors and placement team from the university] do come regularly. I must say they are involved, and they help.’
Students shared positive feedback about the support from the university, although one student raised concerns about the lack of face-to-face contact:
‘This is the first time I've seen somebody who's come face to face [practice visitor].’
Expectations from students and assessors/supervisors
The final theme that emerged was the expectations that students, practice assessors, and practice supervisors held regarding each other's roles. Many nurses felt that students' expectations of them had increased in recent years, particularly in light of students paying tuition fees. One nurse commented:
‘I don't know what the reason is, but it could be because they [students] are paying, so they are expecting more from us [assessors and supervisors].’
Another nurse observed that some colleagues expected students to know more than they actually did:
‘Some of the staff expect that the students know everything, but they are students.’
Students, meanwhile, expressed clear expectations for their learning during placements. One student, for example, reflected on a missed opportunity to learn more about diabetes while on placement in a specialised endocrine unit:
‘If I was assigned in the endoscopy in the XXX, which is an endocrine gland, then I would have loved to learn more about the diabetes.’
Discussion
This study aimed to explore the experiences of nursing students, practice assessors, and practice supervisors with the SSSA. The findings suggest that although the SSSA system has been generally well received, several challenges persist, particularly around training, time constraints, and the use of the ePAD system. To understand these findings more deeply, it is helpful to consider relevant educational theories that underpin clinical supervision and assessment.
Theoretical underpinning: situated learning and communities of practice
Lave and Wenger's (1991) theory of ‘situated learning’ and their concept of ‘communities of practice’ are highly relevant to the SSSA model. Situated learning theory posits that learning occurs most effectively within a social and practical context, where learners engage in meaningful activities. In this model, students are not passive recipients of knowledge; rather, they are active participants in the learning process, working alongside more experienced professionals within a real-world setting. This mirrors the SSSA approach, where nursing students work with practice supervisors and assessors in clinical environments, gradually moving from legitimate peripheral participation (novice) towards full participation (expert) as they develop their skills and competencies.
In the context of the SSSA, the concept of communities of practice—where groups of people with a shared interest collaborate to enhance their knowledge and skills—becomes particularly significant. Nursing students, practice supervisors, and practice assessors form a community where the goal is the development of professional nursing competence. Practice supervisors support students in real-time, helping them apply theoretical knowledge to clinical practice, while practice assessors evaluate their progression. This structure aligns well with Wenger's (1998) idea that learning is not an individual endeavour but a social process that is embedded within shared practice.
However, as the findings indicate, the efficacy of this model depends on the quality and consistency of support provided to both students and supervisors. When students or assessors lack adequate training or experience confusion regarding their roles, it hinders the development of an effective community of practice. For instance, the confusion some nurses reported about their roles as practice supervisors versus practice assessors, or the frustration with the ePAD system, may disrupt the seamless social learning process that should ideally characterise clinical placements.
The coaching model and constructivist learning theory
The shift from mentorship to a coaching model, as outlined in the SSSA, can also be understood through the lens of ‘constructivist learning’ theory, which emphasises that learners construct knowledge through their experiences and interactions with the world (Piaget, 1977). In the coaching model, practice supervisors guide students through experiential learning in practice settings, encouraging reflection, critical thinking, and problem-solving—all core aspects of constructivist learning.
Constructivism supports the SSSA's focus on flexibility in learning and assessment. As the results showed, students appreciated working with different supervisors because it provided opportunities to observe a variety of clinical styles and approaches. This variety enables learners to construct a more comprehensive understanding of nursing practice, rather than relying solely on one mentor's perspective. Moreover, constructivist approaches encourage students to take ownership of their learning, aligning with the students' perception that the SSSA provides more flexibility compared to the traditional mentorship model.
Nevertheless, the coaching model requires a well-organised structure, with clear role delineations and ongoing support for supervisors. As identified in the study, inconsistent training and a lack of face-to-face interactions can impede the coaching process. If supervisors and assessors are not fully prepared to guide students constructively, the learning environment becomes less effective.
Time constraints and the cognitive load theory
The issue of time constraints, as reported by both students and supervisors in this study, can be further understood through ‘cognitive load’ theory (Sweller, 1988). This theory suggests that individuals have a limited capacity for processing information, and when cognitive load becomes too great—whether due to time pressures, heavy workloads, or insufficient resources—learning and performance can suffer.
Nurses reported that the high demands of clinical work, coupled with their responsibilities as practice supervisors or assessors, left them little time to focus on student learning. This not only affects the quality of supervision but also leads to missed opportunities for teaching and formative feedback. Similarly, students perceived that nurses were often too busy to complete assessments or sign off competencies, which adds to their anxiety and potentially hinders their progression.
To reduce cognitive load and enhance the learning experience, healthcare organisations need to allocate protected time for supervisors to engage with students and complete their assessment responsibilities. This aligns with the recommendation by Myall et al (2008), who found that dedicated time for mentorship activities was crucial in fostering effective learning environments.
ePAD system and the technology acceptance model
The difficulties surrounding the ePAD system, as reported by participants, can be analysed using the ‘technology acceptance model’ (TAM) (Davis, 1989). TAM posits that users' acceptance of technology is influenced by their perceptions of its usefulness and ease of use. When technology is perceived as difficult to use, it is less likely to be adopted or used effectively.
In this study, both students and supervisors voiced frustrations with the ePAD, particularly with regard to its time-consuming nature and technical challenges, such as forgetting passwords or struggling with access. According to TAM, these negative experiences likely affect users' willingness to engage with the ePAD, thereby undermining its potential benefits in streamlining assessment processes.
To address these issues, additional training and technical support are necessary. As Bird (2023) highlighted, when well-implemented, digital platforms such as the ePAD can significantly enhance student learning and assessment efficiency. However, without adequate support, these tools can become barriers to learning rather than facilitators.
Organisational support and theories of leadership in nursing
The need for strong organisational support, highlighted by the participants, aligns with contemporary theories of leadership in nursing, such as ‘Transformational Leadership’ (Bass, 1990). Transformational leaders inspire and motivate staff to work towards shared goals, providing the necessary support and resources to enhance performance and professional development. In the context of the SSSA, transformational leadership is crucial in ensuring that practice assessors and supervisors have the time, training, and resources needed to fulfil their roles effectively.
The mixed responses from participants regarding the level of support they received suggest that leadership and organisational culture play significant roles in shaping the success of the SSSA. Some participants felt supported by educational leads and practice educators, while others reported a lack of engagement from management. Transformational leadership in healthcare settings could address these inconsistencies by fostering a culture of collaboration, open communication, and continuous professional development.
Leadership that prioritises the learning environment can significantly impact the success of supervision and assessment in nursing education. As Fitzpatrick et al (2016) argued, strong leadership is needed to navigate the complexities of clinical education and ensure that both students and supervisors are adequately supported.
Conclusion
This qualitative study explored the experiences of nursing students, practice assessors, and practice supervisors in using the NMC standards. Although the SSSA system offers increased flexibility and the potential for enhanced student learning, the study identified several areas for improvement. These include the need for consistent and accessible training, dedicated time for supervision and assessment, and more support for the use of the ePAD system. Additionally, both students and staff would benefit from enhanced organisational support, including more regular face-to-face contact with educational leads and practice visitors. Addressing these challenges will be critical to ensuring the success of the SSSA system in preparing the next generation of nurses.