Nurse education in the UK involves a combination of campus-based learning in higher education institutions and practice-based learning in clinical settings. Practice placements, where students spend time learning and working alongside qualified practitioners, form an integral and mandatory part of the nurse curriculum (Nursing and Midwifery Council (NMC), 2023a). Practice-based learning on placements forms 50% of the nursing curriculum (Jack et al, 2018). Despite this, there is a dearth of research in the area of student experiences of being supported in practice (Foster et al, 2015). In contrast, a larger body of literature has examined the views and experiences of the qualified staff undertaking the mentoring role (Duffy, 2013; Foster et al, 2015; Clark and Casey, 2016; Christiansen et al, 2020; Wynn et al, 2021).
The change of standards for supporting practice-based learning introduced by the nursing regulator in 2018 (NMC, 2023a) provided an excellent opportunity to carry out research in relation to the student experience. Under the new standards, the previous single role of mentor was replaced by two new roles – practice supervisor and practice assessor (NMC, 2023b).
Under the previous framework for supporting student nurses in practice settings, the standards to support learning and assessment in practice (NMC, 2008) required a student nurse to be allocated a qualified mentor, and to work predominantly with them to meet the requirements of the placement.
The new standards for student supervision and assessment (NMC, 2023b) moved towards a more flexible approach, under which a student nurse is supported by a wider range of people to meet the requirements of practice.
Since 2018, the term mentor has no longer been used in nurse education although the general principles of the position remain, and the responsibilities this role held are now distributed between the practice supervisor and the assessor.
Historical context
The regulation of nursing has changed since 1984, when the previous regulatory body, the United Kingdom Central Council, was created. The role of the mentor was brought to the fore in nurse education in 1999, when a Department of Health report entitled Making a Difference was critical of the competency of newly qualified nurses. The report stressed the importance of placements, and the role that experienced staff should play in the development and support of student nurses.
In 2002, the NMC was established, and this regulates nursing across the UK. A more academic approach to nurse education was adopted, with most theory-based teaching delivered within universities. There was a need to align nurse education with that of other health professions and the author has observed that these measures are regarded as mainly effective.
Nurse education in the UK
To qualify as a registered nurse in the UK, a student nurse must successfully complete an NMC-approved training programme. This is traditionally a 3-year undergraduate course; however, other routes exist, including at postgraduate level.
The NMC regulates the curriculum, which is facilitated by approved higher education institutions and requires a student nurse to spend 2300 hours in a university setting, gaining theoretical knowledge, and a further 2300 hours in a range of placement settings to gain practical experience and skills in caring for patients as well as a greater understanding of the role of a registered nurse.
Almost without exception, clinical settings that accommodate student nurses on placement are used by other health professional students and have done so for many years.
If too many healthcare students are in the same setting, the quality of the learning experience may be compromised because of a lack of mentoring support (MacLaren, 2018). With the health service in the UK working in a more integrated style than it has ever done before (Baxter et al, 2018), with different health professionals working closely to support patient care, there are challenges for placement areas regarding their ability to support students and their associated learning (Hellawell et al, 2018; McBride et al, 2018).
Interprofessional education also provides student nurses and other healthcare students with opportunities to become prepared for learning from and working within integrated teams.
While on a placement, a student nurse should always hold supernumerary status, which means that they cannot be included in the staffing numbers. This is a requirement of the NMC (2023c) and is to protect the developmental status a learner holds in a practice setting. A student nurse will engage in many activities that facilitate their learning, including observation of mentors and participation in clinical care, while being supervised by a qualified member of staff. This qualified employee may be a nurse or could be another member of the wider team.
This article reports the findings of research undertaken as part of a professional doctorate in education with a focus on student nurses’ experience of being supported by the NMC standards (2023c). The research project aimed to explore students’ and nurses’ mentoring experiences under the NMC's (2008; 2023a; 2023b; 2023c) UK standards for practice-based learning.
This article explores the experiences of students; the author intends to write a second paper on the experiences of qualified nurses who provide support to student nurses as either a mentor under the 2008 NMC standards or a practice supervisor or assessor under the NMC standards introduced in 2018 (NMC, 2023b).
Rationale for study
There is scant research exploring the experiences of student nurses in the UK in relation to being mentored (Foster et al, 2015). Foster et al (2015) published one of a small number of overall studies with this aim. This study used semi-structured interviews to explore the experiences of student nurses in the UK regarding mentorship and examined the interactions between mentors and student nurses.
The wider nursing literature suggests that student nurses prefer an environment in which the mentor is welcoming and keen to engage with them (Lambert and Glacken, 2005; Doyle et al, 2017). It is also acknowledged that the clinical learning environment is a fast-paced setting in which learning can be challenging, and a supportive mentor is key to navigating the learning opportunities that are available (Whitehead, 2013; Cusack et al, 2020).
Aim and research questions
The aim of the present study was to explore students’ mentoring experiences under the NMC's (2008;2023a; 2023b;2023c) UK standards for practice-based learning. There were two research questions:
- What are student nurses’ experiences of mentoring under the NMC's 2008 and 2018 (NMC, 2023a; 2023b;2023c) UK standards for practice-based education?
- What are student nurses’ benefits and limitations of mentoring under the NMC's 2008 and 2018 (NMC,2023a; 2023b; 2023c) UK standards for practice-based education?
Research definitions and framework
Mentor definition
While the author acknowledges that many definitions of mentoring exist, the following working definition was adopted for the purpose of the research: mentoring is a supportive process, whereby learning and development is a partnership between someone who is a novice and a more experienced practitioner.
The author's definition of mentoring and the analytical framework (developmental mentoring) used place summative practice-based assessment outside the developmental and educational remit (Clutterbuck, 2004; 2008), with feedback and formative assessment essential components of the developmental process. This approach aligns with the seminal work of Clutterbuck:
‘A mentor is a more experienced individual willing to share knowledge with someone less experienced in a relationship of mutual trust.’
‘Mentoring involves primarily listening with empathy, sharing experience (usually mutually), professional friendship, developing insight through reflection, being a sounding board, encouraging.’
Clutterbuck (2004) provides a further view of mentoring, stating that the relationship between mentor and mentee should be a developmental activity, with an emphasis on empowering and enabling the latter to do things for themselves (Bray and Nettleton, 2007; Hobson, 2020) rather than having the mentor do things for them. This perspective aligns with mentoring in the context of nurse education because a fundamental role of the qualified nurse acting in a practice supervisor role is to support the professional learning and development of student nurses. This may be in the form of one-to-one teaching or through opportunities to engage in professional discussions with the student, and the observation of clinical practice while engaging with patients or service users.
Mentees are recognised in the literature as benefiting from a formal support arrangement in a number of areas. These include receiving feedback and coaching, career and skill development and improved performance (Kram, 1988). Lindgren (2005) also recognises that mentoring improves confidence and self-esteem.
Although the NMC has moved away from using the term mentor in nurse education, the remit of the practice supervisor role could be regarded as the closest to the true definition of a mentor.
Developmental mentoring: an analytical framework
The developmental mentoring framework devised by Clutterbuck (2004) aims to provide a non-directive approach to supporting learning and development through mentoring, rather than a directive one.
This approach arises from the earlier work of Clutterbuck (2004), who argued that a non-directive approach allows for an empowering and developmental experience. Manning and Hobson (2017) agreed that mentoring should be a developmental process that focuses on supporting an individual, helping them to transition to becoming an autonomous practitioner.
Method
As the intention of the research was to explore the experiences of student nurses under two different mentoring/support models, a qualitative design was considered most appropriate. The perceptions and experiences of individuals can vary considerably, and a qualitative approach enables the experiences and perceptions of participants to be heard.
Careful consideration was given as to the most appropriate qualitative method for constructing data, with group interviews, focus groups, observations and action research all considered (Bryman, 2021).
Research interviews are regarded as an effective method of gaining in-depth information relating to the experience or perspectives of an individual (Brinkmann and Kvale, 2014). They involve a researcher taking the lead through the coordination of the conversation and the asking of questions.
Individual, semi-structured, face-to-face interviews were felt to be the most appropriate, given the study's aims and the research questions. Interviews are seen as a positive way of understanding the experiences of participants (Denscombe, 2014; Van Manen, 2016), and in this case were related to placement mentoring experiences of student nurses.
Ethical approval
Favourable ethical approval was given at tier 2 within the author's home institution, followed by approval to undertake the research within two universities in the south east of England that deliver nurse education courses. These were external organisations; the researcher was employed by neither of them.
Tier 2 approval was required as the research involved human participants and, as such, was regarded as carrying more than the minimal risk that is posed at tier 1 in line with institutional policy (University of Brighton, 2022). The universities were given the pseudonyms Lakeview and Willowview to protect participant identities.
Participation was voluntary, and those who volunteered could withdraw at any time. Students were recruited from the second year of their course, and had experience of the 2008 or both these and the NMC (2023c) standards.
Because of the onset of the global pandemic midway through data collection, interviews in this phase of the research were conducted online using Microsoft Teams.
Interviews
The research involved students from two higher education institutions. One university (Lakeview) had transitioned to the standards introduced in 2018 (NMC, 2023a; 2023b; 2023c), while the other (Willowview) had not yet done so. The students at Lakeview had experienced both sets of standards, as the later standards were adopted by their university after their first year. Table 1 shows participant demographics.
| University | Nursing and Midwfiery Council standards | Sex | Age range |
|---|---|---|---|
| Lakeview | 2008 and 2023c | Female | 20–30 |
| Lakeview | 2008 and 2023c | Male | 20–30 |
| Lakeview | 2008 and 2023c | Female | 30–40 |
| Lakeview | 2008 and 2023c | Female | 20–30 |
| Willowview | 2008 | Male | 40–50 |
| Willowview | 2008 | Female | 20–30 |
| Willowview | 2008 | Female | 20–30 |
| Willowview | 2008 | Female | 30–40 |
Interviews were initially conducted with second-year student nurses regarding their experiences of placements under the earlier NMC (2008) standards, which refer to mentors, pertaining to the two research questions above. Interviews were then conducted with students with experience of placements under the later NMC (2023b) standards, which refer to practice supervisors and assessors, again pertaining to the research questions. The interviews with students regarding their experiences of the later NMC (2023b) standards were undertaken towards the end of their second placement, so students would have had time to become accustomed to the new support structures.
Data analysis
After eight interviews had been completed, they were transcribed verbatim by the researcher and a thematic analysis of data undertaken. Data analysis followed a pragmatic approach insofar as it involved two stages and was sufficiently tailored to addressing the research questions.
The first stage of data analysis followed an inductive approach to identify the themes of key importance to the participants. The second stage involved the application of the developmental mentoring framework to identify any data that could be relevant to the research questions that had not emerged via the initial phase of inductive analysis.
Findings and discussion
All student nurses interviewed spoke in a generally positive way of their overall experiences of learning in a practice placement environment and said they had gained significant learning.
Support by interprofessional teams
A key finding within this study is the enhanced support provided by the wider interprofessional colleagues in the placement setting. Under the NMC's (2008) standards, each student was allocated one mentor, and there was evidence from the data in the present study that students found having a single mentor was somewhat restrictive in terms of the support provided as well as in relation to the workload of the nurse acting as the mentor.
Under the NMC (2008) standards, students have to spend at least 40% of their time being supervised directly or indirectly by a mentor, so students and nurses covered by this approach are often allocated the same shifts. The author intends to discuss research with qualified nurses in a second paper.
Findings from this study have identified a new way of working. Since the 2018 standards (NMC, 2023a; 2023b; 2023c) removed the 40% rule, opportunities have opened up for students to work with a greater range of health professionals and created a clear developmental approach to mentoring:
‘The new standards mean that I can work more freely with other people in the team… it doesn't just have to be one, which is good for everyone.’
A key finding from analysis of the interviews was that all student nurses reported benefiting from having assessment and learning being separated and done by different people under the NMC standards. Related to this, they spoke about the benefits of having summative assessment removed from the responsibility of the practice supervisor. This appeared to facilitate a developmental mentoring approach. The removal of formal assessment from the remit of the practice supervisor enhanced the relationship student nurses had with this person and boosted their ability to ask more questions and hold open and honest conversations with qualified colleagues.
The interviewees on placement under the NMC (2023b) standards spoke about what could be termed as freedom of working with a qualified practitioner in the practice supervisor role, as they viewed this person as being in place solely to support their learning and to develop their knowledge and practice. They spoke of a developmental mentoring relationship in this sense, with the ability to hold open and honest conversations with the supervisor they were working with:
‘I truly felt that I could speak to my supervisor about anything… if I had worries about my learning, forthcoming assessments or even more general concerns. They were so supportive, and it felt like they would move mountains to help me. That wasn't always the case with my mentors in the past.’
The removal of the role of summative assessment from the practice supervisor made participants feel more effectively supported and better prepared for the final assessment and perceived that questions could be asked more freely of their practice supervisor.
Transition issues
Student nurses felt the 2018 introduction of the standards (NMC, 2023c) had mainly positive consequences.
Problems identified pertained to the need to gain familiarity with a new way of working, along with revised documentation to be used in the practice setting.
Some participants felt their new practice supervisors and assessors took some time to adapt to the new model of working, and there was some confusion in relation to terminology and where responsibility might lie for support on a day-to-day basis.
Limitations
Limitations of this study include the relatively small sample size, and that the participants were all drawn from two higher education institutions in the south of England. As such, it is recognised that the views expressed may not be representative of all student nurses.
The honesty of participants is also a potential limitation. While they were encouraged to speak openly and honestly, a risk of research interviews will always be that those taking part respond in such a way that they think the interviewer wants them to.
Conclusion
The NMC standards (2023a; 2023b; 2023c) have provided more benefits than drawbacks for student nurses. A central reason for this is that the later standards potentially facilitate a more developmental mentoring approach for student nurses.
Under the previous NMC (2008) standards, there was a potential for a power imbalance between mentor and mentee, with the mentor holding greater responsibility for the relationship. While this has been discussed widely in other fields, teacher training in particular (Hobson et al, 2009; 2017; Manning and Hobson, 2017), the nurse mentoring literature is not as expansive in this area.
This study will reinforce the work of Peiser et al (2018), which spoke of the potential conflict within the NMC's 2008 multifaceted role of the nurse mentor. As this study examines the experiences of the later NMC standards (2023a; 2023b; 2023c), the extend and develop the work of Peiser et al (2018).
KEY POINTS
- While students spend half of their learning time on clinical placements, little research has looked at their experiences of being supported on these
- Student nurses value the support of qualified nurses in placement settings
- The Nursing and Midwifery changed the way in which students are supported in practice in 2018
- Students found the separation of teaching and assessment under the later standards to be of benefit and this helped them to be better prepared for assessment
- Mentoring and support from the wider team is integral to student success.
CPD reflective questions
- As a nurse, what are your experiences of supporting student nurses?
- As a student nurse, how do you like to work and learn in a practice-placement setting?
- What does a good mentor or practice supervisor look like?