Being a mentor who fails a pre-registration nursing student in their final placement: understanding failure

Personal Author: Black, Sharon 
Year: 2011.
Dissertation: PhD Thesis -- London South Bank University, 2011. 

Background

Research Background
Nurse mentors are crucial in ensuring that only students who are competent and fit for practice enter onto the professional nursing register in the UK.  However, the literature reflects a perception that mentors are reluctant to fail student nurses in practice.  There is minimal research focussing on mentors who do fail, and even fewer studies focussing on the mentor experience of failure in the final placement.

Aim

To explore, interpret and develop an understanding of mentors’ experiences of failing pre-registration nursing students in their final placement.  

Principle objectives

  1. Explore why the mentor failed the student and interpret how the mentor made this decision about students’ fitness for practice in their final placement
  2. Elicit how the mentor feels about failing a student at this stage
  3. Develop a deeper understanding of the subjective reality and meanings of the historical conditioning and culture in relation to the phenomenon

Methods

An interpretive, hermeneutic phenomenological study was carried out, guided by the philosophy of Gadamer (2004).  Nineteen mentors were interviewed interviews, and guided through a process of structured reflection; a guide underpinned by Johns’ (2004) reflective cue questions. Interviews were transcribed to form a text, allowing the researcher to engage in the hermeneutic process of understanding (Gadamer, 2004). A four stage process for interpreting text was developed to expand the current horizon of understanding: Familiarisation with the parts and the whole, dialogue with the text, a new horizon: understanding the phenomenon and, the fused horizon: A synthesis with pre-understandings. de Witt & Ploeg (2006) framework for promoting trustworthiness in interpretive phenomenology was adopted to ensure balanced integration, openness, concreteness, resonance and actualisation.

Findings

A hermeneutic textual interpretation revealed four horizons of understanding (Gadamer, 2004) that united the mentor experience.  ‘Mentor expectations of being fit for practice’ included the meanings they attached to their role, which was in a metaphorical sense to ‘polish the rough diamond’, and the meaning of being ‘the whole package’ in order to be deemed fit for practice.  Their reflections revealed ‘the consequences of failure’ which includes the meanings of ‘a failure to act and challenge’ students, and ‘the personal price’ they had to pay in making the decision to fail.  ‘The act of failing in the final placement’ explicates the meanings of an unavoidable ‘subjective dimension’ to the decision, and the ‘perceived barriers and enablers’ of making the decision to fail which include ‘workload and time’, and ‘perceived attitudes towards the mentorship role’.  ‘Self realisation’ illuminated ‘a sense of professional responsibility and accountability’, and ‘personal growth and enlightenment’. 

Discussion

Mentors knew that their role was to facilitate the student’s transition into registered status.  Mentors are there to add the last few tweaks to the student’s practice and this is informed by their expectations that a final placement student is nearly a registered nurse.  They must be able to identify being a nurse and being fit for practice, is about knowledge, attitudes, behaviours and skills; the absence of any one of these elements can mean ‘failure’ in the final placement.

Subjectivity is unavoidable but it is the ability to recognise and justify these intuitive feelings and alarm bells that are important.  ‘Passing’ is about safety and the absence of threat, and therefore ‘failure’ is about being unsafe and posing a threat to self or others.  There is a need to reflect on the why and how of failure to verify that it is the right decision.

Mentors were able to conquer the array of emotions associated with the decision to fail; a moral decision that they felt was right.  This decision requires courage to triumph over the convention of failure to fail.  It is this courage and being a gatekeeper that empowers mentors and gives them the permission to fail their student. 

The subjective reality suggests a less than favourable culture of mentorship: a culture where a failure to challenge students, limited recognition for the demands of the role and negativity toward the role appears to exist.  Wanting to be a mentor and being committed to ensuring fitness for practice underpins a positive culture and having positive attitudes is necessary in overcoming the barriers associated with time and support. The ability and willingness to challenge students sets these mentors apart from those who fail to fail; they were able to fail despite working in an inhibiting mentoring culture and despite the personal cost.  The decision to fail should not be about the mentor and how it affects them as individuals.  It is a decision that requires mentors to give themselves personally to their profession; a philosophical notion with practical application.

Conclusion and contribution

This thesis contributes to practice by demonstrating to mentors that failing a student in their final placement is about a duty of care. It may also guide mentors to reflect on their own mentoring practice and decisions; to question their understanding of what makes a student fit for practice, question their own professional responsibilities and accountability for upholding the standards of the profession and protecting the public, and question for whom they are making the final decision.  They may find the courage to make this difficult decision to fail. 

Policy makers, nurse managers, educators and researchers must give more support to these gatekeepers.  The final sign-off decision must be made jointly between mentors and the university and mentors should themselves be mentored through the early stages of their mentoring practice.  Debriefing following the decision to fail should be provided. Finally, there is a need to address the culture of mentorship that inhibits good mentoring practice

Being a mentor who fails a pre-registration nursing student in their final placement means having the courage to make this difficult decision, despite personal feelings, and in spite of a mentoring culture that often fails to challenge and fails to fail students.  It is about making a decision for the greater good, one that is moral and right, and in doing so advocating for future patients and standards of care, and gate keeping the nursing profession.

References

 

Access the full e-thesis

Black, S (2011) Being a mentor who fails a pre-registration nursing student in their final placement: understanding failure (PDF 4.93MB), PhD thesis, London South Bank University

 

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