Increasing concerns about the nursing profession in the U.K.

Concern from NMC over the number of new registrants reported for fitness for practice issues

Concern from patients via Safeguarding the public (Patient’s Association)

Concerns from the profession itself

Concerns from research;

Duffy (2003) report identified that mentors in practice were reluctant to fail students who were not performing.

Hunt(2010) found that in England some students were being allowed to pass clinical assessments without having demonstrated competence

She found that some mentors did not feel that it was their role to fail students

Almost half of mentors in the survey agreed that students were sometimes passed when not competent

In England, failure rates for theoretical assessments outstrip failure rates for practical assessments by 5 to 1…how does a student pass practice if they have insufficient theoretical knowledge?

Students most likely to pass in Yr 3, most likely to fail in Yr 1…but wouldn’t logic indicate that as things get harder less should pass?

The sign-off mentor, is responsible and accountable for making the final sign-off in practice – confirming that a student has successfully completed all practice requirements.

This confirmation will contribute to the portfolio of evidence considered by the University’s examination board.

Only sign-off mentors and practice teachers that are on the same part of the register and in the same field of practice may confirm to the NMC that students have met the relevant standards of proficiency for the particular programme leading to registration or a qualification that is recordable on the NMC register.

Identified on the local register as a sign-off mentor or practice teacher Registered on the same part of the register Working in the same field of practiceAnd in addition have: Clinical currency and capability in the field of practice in which the

student is being assessed Met the NMC requirements to remain on the local register Been supervised on at least 3 occasions for signing off proficiency at

the end of a final placement by an existing sign-off mentor or practice teacher

A working knowledge of current programme requirements, practice assessment strategies and relevant changes in education and practice for the student they are assessing

An understanding of the NMC registration requirements and the contribution they make to meeting these requirements

An in-depth understanding of their accountability to the NMC for the decision they make to pass or fail a student when assessing proficiency requirements at the end of a programme

In order to be identified as a ‘Sign-off’ mentor four activities should be completed.

1.Attendance at a local Sign Off mentor workshop

2.Completion of the scenarios in the sign off mentor workbook

3.Sign-off a final year, final placement student in your area (nursing). Sign off a student at a progression point (midwifery)

4.Completion and return of the Statement of Achievement to the appropriate mentor register administrator (MRA)

Professional accountability remains the same. Currently, as a mentor signing to pass a student in the final placement period you are confirming to the NMC that they are fit to go on the professional register. This is what a sign-off mentor will do, but you will have access to more information to support the decision to pass or fail that student.

Students carry responsibility for their actions:◦ To question if they are unsure◦ To say if they are not happy about something you

have asked them to do◦ To work within their sphere of competence◦ To follow local policies and procedures

All Mentors involved in progression decisions throughout the student’s programme are responsible too;◦ For maintaining safety of clients◦ For supervising students (close or distant

supervision)◦ For making sure students know where to find local

policies and procedures◦ For finding out how competent students are (and not

just by asking them)◦ For enabling students to learn effectively◦ To fail weak students

Professional accountability for the actions of a student rests with an NMC registrant who is supervising the student (whether close or distant supervision) at any time. This may change from day to day depending on the supervision arrangements.

Professional accountability for the decision to pass or fail a student at the end of a placement rests with the mentor who supervises them for that placement.

Aa a sign-off mentor you will not be expected to re-assess decisions made by previous mentors

In order to make a judgement regarding the student’s suitability to progress◦ You must satisfy yourself that the student is

competent in each learning outcome◦ You might need to use different sources of evidence

(observation, question and answer, simulation)◦ You must record any concerns that you have ◦ You must make the student aware of any concerns

you have and give them a chance to make the necessary improvements

◦ You must involve others (mentors, practice supervisors, academic supervisors) if you have concerns

The NMC requires that sign-off mentors have time to reflect, give feedback and keep records of student achievement in their final period of practice learning

The NMC suggests that this should be the equivalent of an hour per student per week

This is in addition to the 40% of the student’s time to be supervised by a mentor

For nursing programmes, yes – there are some additional things expected of a sign-off mentor in the final placement that will mean the assessment will take more time ◦ As a sign-off mentor you will be expected to review

previous practice assessment documentation to ensure any concerns raised earlier in the programme have been appropriately addressed

◦ This does not mean you question the judgements of previous mentors, just that you are satisfied that all appropriate assessments have been made

As a sign-off mentor you were reviewing a student’s practice assessment documentation and you noticed that a concern was raised during a second year placement. It was documented that the student did not always recognise and appropriately report signs of deterioration in a patient’s condition. The student had not failed the placement but the personal supervisor and student had identified this as an area in need of specific attention in the next placement.

You then looked through subsequent assessments and noted that no further problems of this nature had been identified and mentor comments suggested that the student had adequately addressed this issue.

During your own supervision and assessment of the student in the final placement you make sure, through observation, questioning and discussion, that this is no longer a concern about the student’s performance.

Once someone is on the professional register they are accountable for their own actions

As the sign-off mentor (or as a mentor now), you are only likely to face a formal proceeding if:◦ You have taken on the role of mentor/sign-off

mentor without having the appropriate qualification or authorisation for doing so

◦ You have been reckless in your decision-making

Mentors and sign-off mentors should always take account of the input of other members of the team when dealing with assessment decisions

Concerns and worries should always be shared with the link lecturer/PLF/student’s personal supervisor to ensure support from the programme providers

Updates and meetings will provide further advice and guidance – make sure you access regularly

Many placement areas have an identified lead for student issues (e.g. lead nurse for education, learning environment manager). Find out if your area has someone like this.

You are happy with the student’s competence but they have only just scraped through all previous assessments.

How does this knowledge influence your decision to pass or fail?

All the previous assessments are good but you are not happy with the student’s competence.

How do the previous assessments influence your decision to pass or fail?

You are concerned about the student’s competence and your concerns are echoed by the previous mentors.

How does this knowledge affect your decision?

The sign-off mentor has a major role in safeguarding service users, carers, colleagues and the general public from students who are not fit to enter the register.

Duffy. K (2003) Failing Students. London;NMC Glasper.A (2010) Additional options for achieving sign off mentor

status. British Journal of Nursing. 19(11): 716-717 Hunt. L , McGee. P (2011) Assessing Student Nurses in

Practice: A Comparison of Theoretical and Practical Assessment Results in England . UCE Health & Social Care Research Centre

Nursing and Midwifery Council (2008) Standards to Support Learning and Assessment in Practice. London;NMC.