Since the introduction of undergraduate nursing programmes in 2002 (Hegarty et al, 2008), Ireland has increased its reputation for producing highly qualified, competent and motivated nurses. This has been supported by its ability to provide adequate mentorship for student nurses during their clinical placements, which make up over 50 per cent of their course (Department of Health (Ireland), 2012).
The Nursing and Midwifery Board of Ireland (NMBI) is the governing body for nurses and midwives practising in the Republic of Ireland. They oversee many aspects of continuing professional development, including mentorship preparation. Nurses must have 6 months' post-registration experience before enrolling on locally designed short courses. These courses should meet the seven national core learning outcomes; however, there is no standardisation as to how this training is delivered.
In Ireland, the term ‘preceptor’ is the preferred term to ‘mentor’ and refers to a registered nurse who supports undergraduate nursing or midwifery students during their clinical placements. These preceptors assume the role of supervisor and assessor of students in terms of the achievement of learning outcomes and competence (NMBI, 2015). The preceptor's role is similar to the UK equivalent of a mentor (McSharry et al, 2010), although participants in this study preferred to use the term mentor.
The role of a mentor/preceptor involves both clinical and educational responsibilities (Heffernan et al, 2009).
Whereas mentorship and supervision of students the UK has evolved in recent years, the picture is a little less clear in Ireland. This study sought to discover Irish student nurses' experiences of mentorship.
Aim of the study
The aim of this study was to explore undergraduate nursing students' experiences of mentorship while in hospital clinical placements.
Method
Given that the study was concerned with individual experience, an interpretive methodology was chosen (Cohen et al, 2011). Newell and Burnard's (2011) six-stage pragmatic approach to qualitative data analysis was used to manage data collection and analysis. Semi-structured interviews were used to collect data and the interview schedule was derived from a review of the literature.
Final-year students were deliberately recruited as they had accumulated significant experience of mentorship and therefore were able to reflect upon and articulate their experiences. These were fourth-year student nurses who had a minimum of 3 years' experience in the field. They were invited to participate in the study by email. A participant information sheet (PIS) was included in the email.
Ethical considerations
Ethical approval was granted by Ulster University in Northern Ireland and the higher education institute (HEI) in the Republic of Ireland, where the participants were recruited.
Data collection and analysis
A total of 30 fourth-year student nurses were contacted by email and seven agreed to participate in the study. Individual interviews were conducted. Each interview lasted approximately 45 minutes and was digitally recorded. Field notes were made during each interview as an aide-mémoire, after the process described by Newell and Burnard (2011). This helped in capturing non-verbal aspects of communication not picked up during the recording. Following interviews, transcripts were typed verbatim and the content analysed. An audit trail added to the rigour of the study by recording analysis decisions and interpretations of transcripts. The process is described in Table 1.
Table 1. The six-stage process of data analysis applied in the study
| Stage 1. Note taking | Notes are taken immediately after each interview to record initial ideas, similar to field notes |
| Stage 2. Reading transcripts | Transcripts are read and notes made about general themes. Getting to know the data |
| Stage 3. Re-reading | Re-reading again and again. Similar to open coding stage. Data are categorised |
| Stage 4. Rationalisation | Categories are collated or collapsed to account for more of the data |
| Stage 5. Return to transcripts | Data are assigned to categories identified in Stage 4 |
| Stage 6. Writing up | Data are used to form the basis of a qualitative research report |
Results
A total of six themes emerged, summarised in Table 2.
Table 2. The six themes identified in the study
| ▪ Reality versus expectation of mentorship |
| ▪ Students' perception of self |
| ▪ Personal feelings and expectations of mentorship |
| ▪ Perception of workload |
| ▪ Barriers and enablers of mentorship |
| ▪ Student perception of mentor preparedness |
Reality versus expectation of mentorship
When asked what they understood about the term mentorship, participants expressed ideas of how they expected their mentorship experience to unfold based on the information given to them by the HEI. Participants used words such as ‘support’, ‘advice’, ‘help’, ‘teaching’, ‘specially trained’ and ‘person put in charge of you’ to describe their expectations. They understood that they would be assigned a mentor who would ‘look after them’ during their hospital clinical placement. This theme was summed up by one student, who talked about how her expectations of mentorship were not met. All names are pseudonyms:
‘I just remember in one placement I was just given a mentor and I was never introduced to this person, um … and they never introduced themselves to me and I just didn't feel as if I was working … I feel that sometimes you might go on to a ward and a nurse doesn't even know that they were assigned a student.’
Aileen
On time spent working with mentors, one student said:
‘There could be wards where I would only work with my preceptor once or twice and I'd end up getting my interview signed off by a completely different staff nurse and it's, you're thinking “Oh God, OK, well there's no point in having a preceptor then” … so the majority of times I'm not working with them …’
Sarah
Students' perception of self
All participants expressed how they felt the experience of mentorship affected them psychologically and emotionally. Positive experiences seemed to have a direct positive impact on confidence, and this was found when working with a mentor who put the student at the centre of their learning. This positivity was summed up by one student, who said:
‘Personally I felt that, like, in a specific department, if you had a good preceptor, you know they allow you to do more … because I was exposed to more in those areas so now I maybe want to specialise in it.’
Katie
One student's feelings on mentorship reflect those of someone who is without power and influence when she said:
‘… they [mentors] have their own patients to look after and their own responsibilities and we're just, sometimes I think we're just seen as like a [pause] like a shadow in the background sometimes especially in your younger training years …’
Sarah
However, mentors who demonstrated trust in students and allowed them independence promoted student confidence and a happier feeling on placement. In contrast, negative experiences of mentorship are linked to reduced confidence levels (Thomson et al, 2017).
This perception of self was highlighted by another respondent when she described chasing mentors to get practice learning documentation completed:
‘You don't want to be running after people, you know, as a student nurse I suppose … you know that you're annoying them by running after them and you kind of feel … I think inferior nearly … you feel you are just being a plague.’
Lauren
Personal feelings and expectations of mentorship
Participants expressed the feeling that the relationship with a mentor was adversely affected by the amount of time spent working with them. In some cases, participants worked less than 50% of the time with their mentor. It was seen as important to work with a mentor, particularly in the first and second year, when it was felt extra support was needed. It was felt that the more time spent working with a mentor, the better the relationship and the better the learning experience.
One student felt a lack of time spent with mentors can have a detrimental impact on the student-mentor relationship:
‘They have not worked with you and they don't know where you stand … That's the only thing I would say is really bad about it, that you don't really get to work as often …’
Lauren
Another student experienced an absence of mentors due to annual leave, working nights and days off. Although the student accepted that this was not the mentor's fault, they felt they had lots of different personalities to work with on the various wards:
‘Usually once bitten, twice shy, like you know, if you do go up to a nurse and she does not have time for you … you learn, you know, the people to talk to and you know the people to go to if you are badly stuck.’
Pat
Without a mentor, students felt that their learning would suffer. Their mentor is the gatekeeper of their learning as they allow or disallow students to do and see things that will enhance their learning (Gray and Smith, 2000).
Another student felt that wards need to be more understanding of the impact mentorship has on student nurses:
‘Some do and some don't. There are wards that just see students as an extra pair of hands rather that people that are learning.’
Katie
Perception of workload
Staffing levels, workload, time and the nurses' own responsibilities are justifiable reasons given by one student as to why workload affects mentorship:
‘… it's not their fault, it's all to do with staffing levels, they don't have the time to be going around and holding my hand and organising a time to sit down …’
Sarah
There was a sense of acceptance that it was not the fault of the mentor when they were unable to provide mentorship. It seems that participants accepted the fact that mentorship only becomes important after all the nursing care has been taken care of.
‘… I think they have their own responsibilities, they have 12 patients or 6 patients or whatever. They have their own, like it's not really their fault really to be honest.’
Lauren
The fact that mentorship is seen as an extra role for a registered nurse also impinges on the mentorship process:
‘… and I think it's an extra role and nothing is taken away to take its place do you know, they're given these extra jobs and expected to do it all at the same time and I think it's hard, like, it's tough.’
Dee
One student had the impression of mentors looking at student nurses and thinking:
‘… “Oh God, here's another job to do now and I have to take this person under my wing and sure I have enough to do”…’
Sarah
This feeling is in keeping with previous studies where students felt like they were an inconvenience or imposition on their mentor, such was the mentor's workload (Myall et al, 2008). One student commented that:
‘… nurses have enough work to do and you feel like you are putting extra pressure on them to maybe get an interview done and they already have their own paperwork and everything to do and it is hard to even get the time on the busy wards.’
Aileen
Barriers to mentorship
Participants commented on numerous obstacles within the clinical environment that created barriers to effective mentorship.
One student made the point that, in her experience, time and staffing issues have acted as a barrier to mentorship:
‘… yet I think most of the time the preceptors don't have the time to do that [help] and it's not their fault it's just that they have enough on their plate.’
Sarah
Time constraints were also an issue for one student in relation to the busy day-to-day nature of the ward environment. However, she had a degree of empathy for the mentors:
‘You realise how busy you are. You do wonder sometimes how mentors actually have time to sit down and write in a student book, like.’
Katie
In terms of time constraints, participants seemed reluctant to blame mentors for not making time to carry out mentorship duties. There is an acceptance that mentors are busy and that mentorship slips down their list of priorities.
Enablers of mentorship
In terms of changes they would make in relation to mentorship provision, Sarah felt it would perhaps be beneficial to meet with a mentor before attending for placement, where expectations could be laid out and the first steps in building a relationship could commence.
Communication and a professional friendship were important aspects of mentorship since the student and mentor spend time in each other's company, as one student said:
‘I think a professional friendship is very important, um, because you have to work with this person. Communication is so important especially if you are working alongside someone.’
Katie
Student perceptions of mentor preparedness
Study participants referred to there being a perceived lack of training on the part of the mentor. Inadequate mentor preparation is seen as a barrier to successful mentoring (O'Driscoll et al, 2009; Dickson et al, 2015), and all participants highlighted inadequacies in feedback received from mentors.
In terms of mentors' assessments, one student nurse commented:
‘Well I think half the time they don't know what is expected of them to say … they say “What have your previous mentors been saying and what am I supposed to say?” and [we] were like “You're not supposed to say anything, you're just supposed to say what we should improve on”…’
Sarah
Sarah experienced mentors looking back over her portfolio booklet at what previous mentors had written and writing the same things again.
‘They're asking us “What do we write here?” and it's like well I don't know, well you got the training … and they'd be looking back at what other mentors did say and then, it's like a waterfall then, they just say what the previous person said.’
Sarah
One student, Dee, found that some mentors would be better than others in conducting assessments. However, she found lots of mentors tended not to understand the portfolio booklet, despite saying they had received the required training.
Another student believed that a revalidation process in terms of mentors re-doing the mentorship course could be of value so that mentors can be confident in their decision making.
‘… and maybe redo the course in two years or something like that …’
Pat
Discussion
There was a general consensus from the participants in this study about the function and role of mentorship. They highlighted that mentorship should offer support, advice and be facilitated by an experienced nurse who would optimise the students' learning expectations.
However, all participants described experiences of not being allocated a mentor or not working either directly or indirectly with their mentor. Support is primarily facilitated by mentors (Jokelainen et al, 2013) and when mentors were supportive, this has been found to have a positive impact on the students' perceptions of their experiences (Gidman et al, 2011).
Participants described a central focus of many of their placements involving the completion of portfolio documentation. There is a requirement that a mentor would interview a student at the beginning, half-way through and at the end of the placement to inform and assess the students' performance. However, all participants described the stress they felt when trying to secure time with their mentor to facilitate the completion of these interviews. In the literature, the workload and resulting time pressures for mentors has been highlighted as a barrier to mentoring students (Myall et al, 2008; Setati and Nkosi, 2017) and all the participants in this study made reference to the busy nature of nursing in the clinical environment. Jokelainen et al (2013) found that some British and Finnish mentors undertook mentorship activities in their own unpaid time.
There is a delicate balancing act at play with the finite resources and available time pitted against the extra demands placed upon nurses in terms of productivity. It should not be forgotten that the primary role of the nurse is to always act in the best interests of the patient, according to Ireland's Nurses and Midwives Act 2011. Increased demands placed upon nurses has, in some cases, diluted their ability to provide effective mentorship. Some students in the present study said they felt like an extra pair of hands while others have felt like an imposition on their mentor.
There were mixed views on whether or not the time spent with a mentor affected the relationship positively. Despite this, there was a general consensus that a genuine and respectful mentor had a major impact on students' overall experience of that placement and of mentorship in general. There was a desire for mentors to understand the huge impact mentorship has on a student nurse's placement experience.
Participants in the study said there was a lack of structure and consistency to mentorship, and when provided, feedback was generally verbal and positive in nature. Participants expressed a desire for honesty in the feedback they received, irrespective of whether it was positive or negative. They also expressed a desire for meaningful assessments that took knowledge and learning during placement into account. This point was highlighted by Nash and Scammell (2010), who found that students wanted details about how they could improve their practice, and in what areas they were not doing so well.
This sentiment echoes the point made by Duffy (2003) when she stressed the importance of constructive feedback for students so that strengths and areas for improvement could be highlighted. Students perceive giving feedback, both positive and negative, as part of the mentor's role (Chow and Suen, 2001), although not all feedback is constructive (Thomson et al, 2017). Perhaps there is conflict and confusion surrounding the dual roles of mentor and assessor as noted by Bray and Nettleton (2007). This may go some way to explaining why mentors apparently struggled with the student's practice learning documentation. Recent changes to the Nursing and Midwifery Council (NMC) standards have separated the roles of practice supervisor and practice assessor and may go some way in minimising this dual role conflict in a UK context (NMC, 2018).
An improvement in the status of the mentor may act as an enabler to effective mentorship. Voluntary or opt-in systems could allow for the most willing nurses to undertake this role (Jokelainen et al, 2013). However, an opt-in system may see many potential mentors elect not to take on this role because of its added time commitments and responsibilities.
The role of the mentor comes with added responsibilities and there was a perception of a perceived lack of training and preparation on the part of the mentors in this study. This is where the role of the clinical placement co-ordinator comes to prominence, because they are seen as a key enabler of mentorship by student nurses. They are the link between the student and clinical nursing manager if there are any issues such as difficulty in getting practice learning documentation completed. They are seen as a safety net from the student's viewpoint. They also work in association with the mentor by listening, questioning, developing effective strategies, monitoring and reviewing student progress in the achievement of their planned learning (NMBI, 2020)
Being a mentor has the inherent demand of involving a teaching role. There is an expectation by students that mentors will fulfil this demand, which is in keeping with the findings of a study by Foster et al (2015) in that the most valued of mentor activities included teaching and explaining.
Participants felt that not having interviews in a timely manner acted as a barrier to further mentorship during their placement. This issue of time has been highlighted as one of the barriers that impedes mentorship. This is primarily caused by the mentor's existing work commitments (Gopee, 2011; Veeramah, 2012).
It was felt that learning was enhanced and confidence improved when acceptable levels of additional responsibilities were given to the student. When more responsibility is forthcoming, confidence is enhanced and learning achieved.
However, not feeling like part of the team had an impact on one participant and their ability to push themselves during their training. The student stated that they were just ‘going through the motions’ until the fourth year when they felt a desire to become part of the team. This is a worrying finding as Crombie et al (2013) found that first-year students, in particular, may leave the programme if they do not feel like part of the team while on clinical placement. BjØrk et al (2014) found that students who are not accepted or feel alienated can develop low morale and reduced motivation to learn during their placement.
Support, in terms of mentorship provision, is a common theme throughout the nursing literature. It is a multifaceted concept incorporating mentor support of students, creation of a supportive learning environment and management support for mentorship.
The retention of nurses to the profession was found to be an unexpected consequence of effective mentorship (Block et al, 2005). Further research has shown that positive mentorship experiences are leading to the retention of nurses (Ferguson, 2011). A clear strategy for mentoring students has been mooted as one opportunity to enhance recruitment of student nurses (Jokelainen et al, 2011). First-year students in particular may leave the programme if they do not feel part of the team while on clinical placement (Department of Health, 2006; Crombie et al, 2013).
Limitations
Only fourth-year general nursing students were included in this study. Due to the small numbers involved, it would be difficult to draw conclusions from the wider student nurse body in Ireland. Results may not be transferable to other fields of nursing such as mental health or learning disability nursing. The study would have been enriched by a multi-site enquiry that took account of mentors' perspectives on mentorship for comparative purposes.
Conclusion
This study set out to explore the mentorship experiences of student nurses in an Irish hospital. Although participants viewed mentorship as a positive concept, they were unable to recall many positive experiences during their 4 years as a student nurse. Also, there appears to be little by way of standardisation in the approaches to mentorship adopted by mentors. A clear link emerged between mentorship and the student nurses' self-confidence. Essentially, a good experience involved a mentor who gave regular feedback and who was an effective communicator. Effective mentors were also proactive in their teaching, promoted trust and independence in their student and conducted timely interviews with their student. Participants described these factors as promoting self-confidence in them as a student nurse, ultimately enhancing their learning.
There is an undertone of a power struggle in the mentorship relationship whereby the balance of power lies with the mentor in terms of their ability to give favourable assessments at the end of a placement. Students' placements seem to revolve around the timely conducting of their placement interviews and this is a source of considerable stress for them. However, participants expressed the feeling that there was only a limited assessment of their knowledge and that interviews were not given the time or importance they deserve. Participants felt that they were in a subordinate relationship to their mentor and that they were not accepted as part of the team, at least until their fourth year.
This study suggests a need for a reassessment of mentorship practices so that a more standardised approach can be taken. There is a need to ensure the quality of the placement experiences of student nurses so that nursing can strive for continuous improvements in student mentorship and support into the future.
Recommendations
The following recommendations can be made for mentors, mentees and HEIs. Mentors must examine their own practice in order that mentorship can be accommodated more effectively.
It would seem that the ward culture will affect the importance given to mentorship. Mentorship is often seen as an extra job that is undertaken after the business of nursing has been taken care of. Mentorship slips down the list of priorities on a busy ward and this perception of its importance must change so that it is seen as a priority. Therefore, management should consider facilitating this by rostering student nurses to work with their mentors a minimum number of days during their placement.
In a busy clinical environment, consideration should be given to providing protected time for mentors to conduct student assessments and interviews.
Support systems should be implemented on every clinical area that students attend. For example, a link nurse could be allocated who would act as a ‘go-to’ person for students and mentors should problems or issues arise. They would then communicate directly with the clinical placement co-ordinator in the event of an issue arising, who could support the initiation of an action plan.
Students should take responsibility for their own learning and organise a specific time for completion of portfolio documentation with their mentor a number of days in advance. Students should identify specific learning requirements for each placement and communicate these to their mentor at the beginning of their practice learning experience. This will help ensure students are developing and building on existing knowledge and skills and meeting the particular learning outcomes of their course.
Higher education institutions must continue to have a close relationship with their clinical partners to ensure the quality of the process of student supervision. The role of a link lecturer could be explored further in terms of providing support for both students and mentors to ultimately ensure that all students are fit for practice at the point of registration.
KEY POINTS
- When done well, mentorship is viewed overwhelmingly as a positive feature of student learning from the student nurse's perspective
- Mentors' workloads were identified as a barrier in terms of effectively providing mentorship to student nurses
- There was a mismatch regarding the information received from the higher education instution on mentorship and the realities in the clinical setting
- Students desire structure, consistency and standardisation in mentoring
- There is a direct link between positive mentorship experiences and student self-confidence
CPD reflective questions
- Are there processes in place in your clinical area that quality assure the experience of student nurses?
- Considering workload pressures in the clinical environment, what steps could you take to ensure student teaching and feedback is appropriately conducted?
- Does your clinical environment have a dedicated student nurse link nurse who can oversee the process of student nurse training and deal with issues that arise? If not, would be a useful asset to your area