Abbreviations Used Within This Document

Alternative

Approaches

Mentorship

An introduction to new models

Contents

Introduction ………………………………………………………………………………………. / 3
The RCN Mentorship Project ……………………………………………………………… / 3
Overview of models from the East of England region: ……………………….. / 3
Collaborative Learning in Practice (CLiP)
Practice Education Based Learning –Suffolk (PEBLS)
Enhanced Practice Support Framework (EPSF)
The STEP project ………………………………………………………………………………… / 5
Key principles from the East of England …………………………………………….. / 6
Direction of mentorship …………………………………………………………………….. / 7
Enhancing the Clinical Learning Environment …………………………………….. / 7
Resources for implementation ……………………………………………………………
Coaching training
Daily Learning record template / 9
Further reading ………………………………………………………………………………….. / 11
References …………………………………………………………………………………………. / 12

Abbreviations used within this document:-

RCN
RN / Royal College of Nursing
Registered Nurse
NMC / Nursing and Midwifery Council
HEE / Health Education England
HEI / Higher Education Institution
AEI / Approved Education Institute
SLAiP / Standards to support Learning and Assessment in Practice
CLiP / Collaborative Learning in Practice
PEBLS / Practice Education Based Learning - Suffolk
EPSF / Enhanced Practice Support Framework
STEP / Strengthening Team-based Education in Practice
NNRU / National Nursing Research Unit
RN
EOE / Registered Nurse
East of England

Introduction

In an environment of depleted Registered Nurse resource,coupled with an expanding range of learners, NMC approved mentors are in high demand. Many areas are reporting ‘learner fatigue’ and the sustainability of the current 1:1 model of supervision is in question (RCN 2015, Shape of Caring Review 2015, NNRU research 2012).

The NMC have been reviewing the Standards to support Learning and Assessing in Practice (2008), and at the NMC Council meeting on 24th May 2017, the decision to proceed with a consultation on the draft education framework for AEIs, practice placement and work placed partners was made. Early suggestions are for a decision on the final standards for publication to be made at the council meeting scheduled for January 2018.

This document aims to give organisations some principles and guidance which can be used to inform changes in practice associated with some of the proposals within the draft education framework.

The RCN Mentorship Project

In 2015 the RCN commissioned a rapid literature review of mentoring models for pre-registration nursing students outside the UK, and models used at similar career stages by other professions. The review found that other models.

Differed from the 1:1 practice in the UK
Offered an increased ratio of students to mentor
Offered tiers of mentorship (including involving students from different levels)
Provided different intensities of mentoring input

The review also found examples of alternative approaches within the UK which are:

Moving away from the 1:1 model

Increasing capacity for mentoring
More time efficient
Advocating a process that is less about teaching and more about using coaching techniques.
Supporting development and confidence of student nurses in practice.

Overview of models from the East of England region

The Shape of Caring review (2015) highlighted the challenges associated with current mentoring practices and showcased a model being piloted by the University of East Anglia known as Collaborative Learning in Practice (CLiP).

It is important to note that three models have been piloted and evaluated in the HEE East of England region as part of a fundamental review into pre-registration nurse education. These models are:

Collaborative Learning in Practice (CLiP)
Practice Education Based Learning –Suffolk (PEBLS)
Enhanced Practice Support Framework (EPSF)

With an overview below, full details of the three models can be found in Developing a Quality Clinical Learning Environment for Nurses - Good practice guidewhich has been produced by HEE East of England,

There are also numerous resources for each of these models available from the internet. These are summarised in the further reading section of this document.

Collaborative Learning in Practice

A new model of practice learning for pre-registration nurse education was pilot-tested in Norfolk. The Collaborative Learning in Practice model (CLiP) was taken from a similar model of practice learning used in the Netherlands.

The model is distinct from the traditional mentorship model both organisationally and philosophically. Organisationally, rather than working individually with a mentor, students work collaboratively alongside other students under the guidance of a coach. Coaching underpins the philosophy of learning so that students are supported to take on greater responsibility for their own learning within a culture that values student identification of solutions to patient focused care.

Practice Education Based Learning –Suffolk (PEBLS)

Practice Education Based Learning (Suffolk) was introduced following a review of practice education in Australasia and early learning from the CLiP model. The model is based on a learning bay comprising 6-8 patients cared for by 3 students one of whom assumes the role of coordinator. A coach supports the students. A clinical educator is in place to support the ward team. Overall capacity of the clinical area increases taking 9 – 12 students in total. This model is also based on the use of coaching to empower students, increase their leadership, problem solving and critical thinking skills and enable a smooth transition to the Registered Nurse role. The model was commenced in both acute and community settings.

Enhanced Practice Support Framework (EPSF)

The Enhanced Practice Support Framework has been developed by AngliaRuskin University and the University of Essex to create a cultural change in practice learning and utilises existing resources in a more effective way. This framework can be placed within the existing infrastructure for practice learning with minimal disruption. THE EPSF is underpinned by the view that the facilitation of learners is every registered nurse’s responsibility and not the sole remit of a registered mentor – a principle supported by the Nursing and Midwifery Council’s Code (2015). It also recognises the need for a role model to support mentors with their decision-making around assessment and development of mentorship skills, as well as to develop and maintain a quality learning environment.

Enhanced Practice Support Framework (EPSF)

The diagram identifies the roles within the EPSF and represents a notional staff ration rather than a hierarchical approach in the support of student learning.

Activity in other regions:

The STEP project: Strengthening Team-Based Education in Practice

Middlesex University has secured funding from HEE to develop a Centre of Excellence for Practice Learning. They have recently commenced a project, involving a number of HEIs and placement partners, entitled Strengthening Team based Education in Practice (STEP). The objectives of the project are to:

Explore student and staff perceptions of practice learning
Develop, pilot and evaluate a range of approaches to support learning in practice
Create a range of resources/toolkits to reflect best practice and support all learners in the environment
Develop placement opportunities in general practice, nursing homes and the voluntary sector

Whilst there is no formal published data from the project at this time, there are five key themes which are being explored.

Key Themes:

Socialisation / Orientation to practice
Team working: The role of “helpful others”
Student peer support
Facilitating students’ expansive learning
Partnerships in Action: Academic-practice partnership working

Key principles from the East of England

Following the introduction and evaluation of the three models in the East of England, it became apparent to the project team that there were principles that could be more widely adopted. The models each promoted local loyalty and ownership, but were essentially based on the same principles and delivered the same improvements. Therefore a core set of universal principles were identified that could be used across providers to enhance the clinical learning environment.

Universal Principles:

A model based on coaching
A model not based only on 1:1 mentor relationship
Learners delivering hands on care
Leadership for education and executive sign up
A sustainable infrastructure
Linking education and workforce supply to trust business

Direction of mentorship

By learning from others across the UK there is a clear direction of travel in regards to the future of mentorship within clinical learning environments.

Coming from / Going towards
A model based on teaching / A model based on coaching
One named mentor for each student / Team approach to supporting learners
Clinical placements for pre-registration student nurses / Clinical placements for a diverse range of students and work-based learners

Enhancing the clinical learning environment:

It is possible to enhance the current clinical learning environment by adopting one or more of the principles (either individually or in combination).

The principles explained

The principles applied

Resources for implementation

Coaching training:

To support organisations who wish to introduce a coaching model, a specifically designed training programme ‘Coaching Learners in Practice’ has been developed for the HEE Wessex region. The workshop has been designed so that it is suitable for all professionally registered healthcare staff supporting learners in the clinical environment.

The one day workshop will introduce registered health care staff to coaching principles and skills that can be used in clinical practice settings.This programme will initially be delivered to nominated Education leads within NHS organisations in a train the trainer approach. A full resource and training pack will be provided to participants to disseminate at local level.

To support any pilot areas for full implementation of a new model a specific number of training days will be provided by Bournemouth University on a one-off basis.

Leaflet: Coaching and mentoring Learners in Clinical Environments:

This trifold leaflet has been designed to provide information for clinical staff about coaching. The leaflet is available electronically and can be adapted at local level. It may also be utilised by HEIs to provide information to students and learners.

Supervision:

To provide ongoing support to organisations, training in the Peer Group Supervision Model (Tietze)has been arranged for Education Leads and their team.

Daily Learning Record:

To support areas who wish to adopt a coaching model and to encourage feedback from others involved in the supervision of students. The template is available electronically and can be adapted at local level.