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A Clinical Teaching Project
Evaluation of the Mentor-Arranged Clinical Practice by RN Mentors This paper explores the relationship between nursing students and mentors and its influence on nursing students' development of professional knowledge during their clinical practice. The paper is based on an evaluation of a new initiative supplementing other clinical experiences for students of nursing, Mentor-Arranged Clinical Practice (MACP), by registered nurse mentors. Sixty-five (95.6%) mentors returned their questionnaires in a self-addressed envelope. Results of the study indicated that there were benefits and rewards for both students and mentors. The mentors felt that students gained more practicum time, confidence and independence in their practice, time management skills, rapport between staff and student, and better integration into the hospital environment. Mentors indicated that the most compelling reasons for becoming mentors were the opportunity to assist mentees to integrate into the nursing unit, to teach, share knowledge, promoting and improving the professional image of nurses, and gain job satisfaction from mentoring. The findings in this study suggest that there is a need for development of mentor relationships in the clinical setting of undergraduate nursing courses. By Ruth Lo and Ron Brown. T H E PURPOSE O h this sludy was to
basic nursing skills, and the students'
evaluate a new initiative supplementing
requests for more clinical experiences. A
other clinical experiences for students of
comprehensive evaluation of the program
nursing. The (Vlentor-Arranged Clinical
was carried out which involved feedback
Practice (MACP) was introduced to sec-
from the mentors, students, and Clinical
ond-year nursing students for the first
Director, a senior nurse academic who is
time in 1998 in o r d e r to f u l f i l l ihe
in charge of the clinical program for the
requirements of the New South Wales
three years of undergraduate course. This
Nurses' Registration Board to incorporate
paper w i l l only evaluate the feedback
more clinical experience to reinforce
given by Registered Nurse (RN) mentors.
Ruth Lo RN, PhD, Senior Lecturer in Nursing and Ron Brown RN MEd, Senior Lecturer in Nursing, School of Nursing and Health Care Practices I Southern Cross University, Australia. 8
Collegian Vol 7 Nn4 2000
more a working partnership. At the end of
A s u b s e q u e n t p a p e r will e v a l u a t e t h e
motes another's career and training. T h e
feedback given by the nursing students of
relationship between m e n t o r and mentec
the MACP, a form was given to the men-
their experiences in this program.
is described as intense and emotional.
tors to evaluate the students in their per-
Clinical education is considered a vital
Vance (1994 p3) summarised the ben-
c o m p o n e n t of pre-regislration curricula!"
efits of establishing a m e n t o r i n g program
T h e preparation for M A C P began in
and provides students-with an opportuni-
in the nursing profession as contributing
February 1998, when the Head of School
ty to c o m b i n e c o g n i t i v e , p s y c h o m o t o r
to c a r e e r s u c c e s s a n d
and affective skills (Hart & Rotem 1994).
increased
professional
formances in basic clinical skills.
advancement,-
and Clinical Director visited all 26 hospital
satisfaction,
venues associated with MACP. T h e area
It also provides students with opportuni-
e n h a n c e d self-esteem a n d self-satisfac-
Directors of Nursing, Nurse Unit Managers
ties to a c q u i r e p r o f e s s i o n a l skills a n d
tion,- improved preparation for leadership
(NUMs), and Directors of Nursing of the
practical k n o w l e d g e in the professional
roles, and overall s t r e n g t h e n i n g of the
private hospitals were all supportive.
situation (Elzubeir & Sherman 1995). As
p r o f e s s i o n . In a d d i t i o n , V a n c e ( 1 9 9 4 )
Hardy (1990 p328) states:
stales that m e n t o r i n g
relationships
The path to nursing knowledge is through
empower and inspire individuals to take
practice, constant observation and study and a
risks, to reach full potential, to make sub-
focus on the patient which is safe, knowledgeable,
stantial contributions to their workplaces
effective, efficient, creative, thoughtful, caring,
a n d professions, Ehrich ( 1 9 9 5 ) argues
interdisciplinary, participatory and enriching for
that m e n t o r s h i p is a significant tool in
all participants.
determining, and even a prerequisite for
In the practice setting, prominence is given to the ability to 'do' and knowledge
c a r e e r s u c c e s s for b o t h f e m a l e s a n d males.
These N U M s were requested
to
approach their RNs to ask for their participation in, and willingness to p r o v i d e additional clinical educational experience for second year student nurses. T h e RNs were to provide two to four weeks additional clinical e x p e r i e n c e for s t u d e n t s through MACP. T h e most suitable times for M A C P w e r e t h e four-week p e r i o d between lirsl and second semesters (mid-
is derived from e x p e r i e n c e in p r a c t i c e
A Scottish study has shown that stu-
( E l z u b e i r & S h e r m a n 1995). ' D o i n g ' is
d e n t s w h o w e r e given s u p p o r t from a
b e t w e e n t h e e n d of S p r i n g s e m e s t e r , November, and the end of February the
y e a r b r e a k ) or t h e f o u r - m o n t h
period
important as patients expect nurses to pro-
m e n t o r were more likely to feel part of
vide efficient nursing care (Bjgrk 1997).
the ward team and to value demonstra-
following year, h e n c e s t u d e n t s had 16
Developing confidence in the performance
tion and supervised practice than those
weeks to lit in their M A C P
of practical, task-oriented nursing skills is
w h o did not ( M c K c n z i e 1991). T h e s e
an important component of clinical nurs-
findings were s u p p o r t e d by H a r t and
ing practice (Elzubeir & Sherman 1995).
Rotem (1994), which found that feeling a c c e p t e d by the clinical staff, w o r k i n g
The mentoring role
with a practitioner who was familiar with
Mcnlorship is considered as being possi-
the clinical setting, and having opportu-
bly the most important development too!
nities to question practice were signifi-
lor the progression of a professional in
cant influences on students' learning.
increasing support of mentoring programs
Planning of the MACP Program
has been documented, especially in busi-
Following a course review with representa-
ness, academia, and overall career devel-
tives from the nursing students, academics
opment (Galicia et al 1997). Pelletier and
and the nursing profession, including nurse
Duffield (1994) argued that in Australia,
advisers
t h e c o n c e p t of m e n t o r i n g is n o t v e r y
Registration Board (NRB), a decision was
familiar to nurses and there has been little
made to include an extra four weeks of
d e b a t e or research regarding its impor-
clinical e x p e r i e n c e in t h e form of the
from
the
NSW
Nurses'
MACP. T h i s was a c o m p u l s o r y clinical
1 he term mentoring has become a 'buzz' word of the nineties. Several terms have b e e n used by C o n w a y ( 1 9 9 5 ) , Barbuto
shifts. T h u s , students worked t h e same rosters as their mentors, which involved all different shifts. It was suggested that as far as practicable, the students remained with the same mentors (or two) for the 24 weeks duration of their clinical practice.
training. In r e c e n t years, progressively
tance for nurses and nursing.
Students were assigned to a RN, and w o r k e d alongside that RN for all their
experience for second year students, as the
About 50 per cent of students chose to split their M A C P e x p e r i e n c e by d o i n g two weeks during the mid-year break, and t w o w e e k s at t h e e n d of t h e S p r i n g semestei". M o s t s t u d e n t s a t t e m p t e d to c o m p e t e the M A C P program by end of N o v e m b e r . O t h e r issues p e r t a i n i n g to M A C P , such as, affiliation
agreement,
indemnity insurance, accommodation and clinical settings were also addressed.
completion of MACP was needed in order
There were few student complaints in
to pass their Clinical Nursing Studies Unit.
having the M A C P program during nons e m e s t e r t i m e d u e to t h e
continual
(1992), Watts (1996) and Bain (1996) to
Prior to MACP, the students had com-
d e s c r i b e t h e m e n t o r in the o n e - t o - o n e
pleted their normal clinical assessments,
requests for more practicum. T h e s e stu-
relationship: peer supporter,
coach,
which included a t t e n d a n c e , punctuality,
dents had a choice of 26 hospitals and 20
teacher, guide, preceptor, sponsor, boss
physical assessments, case study and
weeks to complete their MACP, so they
and relative. All of these terms imply rela-
Objective Structured Clinical Examination
were able to choose hospitals that were
tionships where the mentor is sought after
(OSCE) for this unit of study. T h e clinical
closer to h o m e . T h e student union was
for advice and/or protection (Smit 1998).
teachers assessed competencies and made
aware of the program during non-semes-
However, the mentor's role is highly spe-
judgments on students' progress. Within
ter time, but because the Spring semester
cific. Vance (1982) describes a mentor as
the MACP, no formal assessment was car-
c o m p l e t e d at the end of O c t o b e r , stu-
someone who serves as a career role model
ried out by the mentors. Thus, the atmos-
d e n t s were given flexibility of lime to
and who actively advises, guides, and pro-
phere for both students and mentors was
complete their MACP. Collegian Vol 7 No4 200(1 9
Economic Factors in Conducting MACP
Method
from the hospitals where they worked, so
T h e questionnaire was developed based on
hence were not able to fill this part of the
T h e economic factors were major reasons
the literature on mentoring and preeeptor-
questionnaire. As seen from Table I, there
for the introduction of M A C P due to the
ing, and some of the questions were devel-
was a positive evaluation of the m e n t o r
costs of the usual 1.8 clinical teacher / stu-
oped by the researchers based on experi-
guidebook. Sixty-three percent of mentors
dent ratio during the semesters. It was also
ences. T h e questionnaire consisted of four
agreed or strongly agreed that the mentor
agreed by all parties involved in M A C P
sections: (I) the evaluation of RN mentor
guidebook was well organised,- 64.6 per
that RNs, who participated in the MACP
guidebook; (2) evaluation of mentor's role,
cent found the guidebook provided them
(3) evaluation of student's clinical perfor-
with helpful information of student's prior
mance and (4) open-ended questions relat-
learning,- 44.6 per c e n t s t a t e d that the
ing to positive and negative aspects of the
guidebook provided them with informa-
program, would be provided with educational incentives without charge from the School of Nursing. Furthermore, senior a c a d e m i c s from the S c h o o l of N u r s i n g
MACP scheme, and their reasons for par-
tion lor planning their day, and 66.2 per
ticipating in the mentoring role. Questions
cent found that the guidebook gave them
1-3 consisted of statements which the par-
sufficient understanding of MACP.
provided w o r k s h o p s on research, stress management, conflict resolution and any relevant topics needed in enhancing RNs' careers, without charge. These workshops were carried out in their workplaces.
ticipants circled a n u m b e r on a 5-point Likcrt scale, where 1 equals (strongly dis-
(2) Evaluation of mentor's role
agree) and 5 (strongly agree). Participants
Results in Table 2 indicated that the men-
were able to complete the questionnaire in
tors were positive about the m e n t o r i n g
10 minutes and names of the participants
role. Thirty-five mentors agreed or
were not written on the questionnaires,
s t r o n g l y a g r e e d t h a t t h e y w e r e well
thus preserving anonymity.
informed about the m e n t o r i n g role.
were given to participating hospitals for
Subjects
that the mentoring role was well accepted
RN Mentor
Guidebooks
Before the c o m m e n c e m e n t of the MACP, c o p i e s of t h e RN M e n t o r G u i d e b o o k s
Eighty-three per cent ol mentors stated
RNs i n v o l v e d in M A C P . T h e M e n t o r
T h e subjects consisted of RNs working in
by their peers, whereas 73.9 per cent stat-
G u i d e b o o k s p r o v i d e d i m p o r t a n t back-
26 h o s p i t a l s in n o r t h e r n N e w S o u t h
ed that the hospital
g r o u n d i n f o r m a t i o n to t h e m e n t o r s in
Wales. T h e r e were a total ol the 68 RNs
e n c o u r a g e d RNs to p a r t i c i p a t e in t h e
administrative planning for MACP (affili-
who participated in the M A C P scheme,
mentoring role. 89.2 per cent mentors felt
ation a g r e e m e n t , i n d e m n i t y insurance,
of which 65 (95.6%) returned the com-
that they were a d e q u a t e l y e x p e r i e n c e d
a c c o m m o d a t i o n , travel and clinical set-
pleted questionnaires.
for this role, 95.4 per cent stated that the
administration
mentoring role gave them job satisfaction
tings), guide for mentors and suggestions Data
ing student nurse clinical experience, and
All mentors were given a self-addressed
a synopsis of content and skills required
envelope with a questionnaire, which was
For s t a t e m e n t 7, t h e m e n t o r s w e r e
in the six clinical nursing units. Some of
given to them by the students when com-
asked overall, did they find the mentor/stu-
these mentors had already worked as clin-
mencing their practicum. T h e completed
dent partnership: very poor, poor, less than
questionnaires were returned to the
satisfactory, satisfactory, good, very good
Clinical Director. T h e RN mentors were
or excellent. The results indicated that 2
given evaluation questionnaires so that
( 3 . 1 % ) m e n t o r s r a t e d s a t i s f a c t o r y ; 12
ical t e a c h e r s d u r i n g t h e s e m e s t e r s and know the clinical curriculum well.
Workshops for Potential
Mentors
collection
and 98.4 per cent would accept the men-
(or planning their day, protocols govern-
toring role in the future.
their feedback would help improve the
(18.5%) rated good,- 31 (47.7%) rated veiy
new M A C P program.
good, and 20 (30.8%) rated excellent.
Ethics
(3) Evaluation of student's clinical performance
T h e Clinical Director held training workshops for potential RN mentors in different hospitals prior to the M A C P program.
Clearance
T h e ethics committee is familiar with the
Walts (1996) argues that training serves
process that all University units are evalu-
two main purposes: first, it enables the
Results in Table 3 show that students' clini-
ated, and in regards to clinical units, eval-
consistent understanding and implemen-
cal performances were good as evaluated
uation includes both clinical teachers and
by their mentors. Ninety-seven percent of
tation
students. T h e mentors were aware ol this
mentors agreed or strongly agreed that the
study.
students were professional
of
the
program,-
second,
it
enhances the communication skills necessary to fulfill the mentor role. Beattie and
in
their
approach towards nursing practice,- 95.4
Holden (1994) stress that one of the most
Results
per cent of mentors stated thai the stu-
i m p o r t a n t lessons from m e n t o r i n g pro-
dents performed basic nursing care compe-
grams established over recent years is that
(1) The evaluation of RN mentor guidebook
m e n t o r s are most successful when they
For the following 5-point Likert scale:
c o m m u n i c a t e d effectively with patients,
receive a p p r o p r i a t e training. T h e r e is a
l = S D , 2 = D, 3 = Unsure, 4 = Agrec, and
96.9 per cent also slated that students were
need to harness people's initial enthusi-
5 = Strongly Agree.
eager and willing to learn, and 90.7 per
asm and ensure they are clear about the
There were 12 (18.5%) mentors who did
cent of mentors indicated lhat students
goals and processes involved.
not receive t h e RN m e n t o r g u i d e b o o k
were prepared well for basic nursing care.
10
Collegian Vol 7 No-t 20(10
tently,- 96.9 per cent stated that students
For s t a t e m e n t 6, t h e m e n t o r s w e r e asked overall, how would they judge the students' performance: very poor, poor, less than satisfactory, satisfactory, good, very good or excellent. T h e results indicated that 2 (3.1%) mentors rated less than satisfactory,- 2 (3.1%) rated satisfactory,- 9 (13.8%) rated good,- 23 (35.4%) rated very good, and 29 (44.6%) rated excellent. (4) Open-ended
questions
"
planning and implementing of patient
secure relationship with t h e team. It
care.
encourages good rapport between slaff
It gives a greater idea to students about
•
Students get to work full shifts for con-
d y n a m i c s e a c h d a y a n d feel
secutive days, which help them with
belong as part ol the team.
daily routine and understanding what is required of them in the nursing roles. •
and students. • It enables students to understand ward
the actual process of nursing.
they
Hart and Rotern's (1994) study indicated that students enjoyed the opportunity
W o r k i n g all shifts with the m e n t o r
to work closely with staff and experience
e n a b l e s t h e s t u d e n t to 'fit i n t o t h e
a sense of belonging. T h e students found
ward s i t u a t i o n s ' easier. T h e s t u d e n t
that the staff had a lot lo offer them and
T h e following are the results of the open-
e x p e r i e n c e s a realistic impression of
involved them in all practical work.
ended
what being a RN is all about and also a
questions,
which
would
be
addressed one at a time.
real workload.
In y o u r v i e w , w h a t a s p e c t s o f t h e
Exposing students to the realistic view
M A C P needs improvement?
In y o u r view w h a t are the positive aspects of the MACP?
ol nursing is imporlanl so that they will
There were only a few suggestions given
T h e four identified c a t e g o r i e s t h a t
b e a b l e to c o p e w h e n t h e y e n t e r t h e
by t h e m e n t o r s r e g a r d i n g t h e M A C P
e m e r g e d from the data were c o n c e r n e d
workforce after completion of their edu-
s c h e m e as m o s t of t h e m e n t o r s w e r e
with the mentor-student relationship and
cation. T h e two clays a fortnight clinical
happy with the M A C P as it stands. T h e
the quality of their educational activities.
practice during the semesters did not pro-
12 mentors who did not receive the RN
These four categories were: (a) befriend-
vide students with a realistic view of nurs-
CiLiidebook from the hospitals felt they
ing, (b) realistic view of nursing, (c) valu-
ing. Infante et al. (1989) c o n c l u d e that
would have liked lo have received them
able practicum lime, and (d) familiarity
providing o p p o r t u n i t i e s for students to
before c o m m e n c i n g t h e p r o g r a m . T h e
with the environment.
work closely with role models will result
mentors fell that hospital administration
Benefits to students
in the acquisition of a realistic u n d e r -
needs to support the mentors in providing
(a) Befriending
s t a n d i n g of t h e s k i l l s a n d
adequate time to educate the students.
T h e characteristics of befriending are:
required within the work environment.
• An opportunity to interrelate and share
(c) valuable
practicum
demands
time
T h e mentor needs lo be working in a p r e d o m i n a n t l y clinical role rather than
knowledge, ideas, experiences and
Characteristics of valuable practicum time
being in charge of the ward. Rxtra time
insights.
are:
needs to be allocated to the m e n t o r or
• T h e m e n t o r allows the student the
• It gives more practical lime for students
c h a n c e to e x p r e s s fears and d o u b t s
lo understand ward routine, objectives,
without being put down.
protocols, and time lo be able to form
• T h e mentor initiated social interaclions designed to promote trust and a sense of warmth and interest.
lighter caseload in order to have time to explain all procedures to ihe students.
relationships with patients and to
Please give reasons
understand them in a holistic way.
f o r p a r t i c i p a t i n g in
• It gives t h e s t u d e n t s g o o d practical
t h e m e n t o r i n g role.
B e f r i e n d i n g s e e m s to b e t h e m o s t
experience under the supervision of an
Six identified c a t e g o r i e s t h a i e m e r g e d
important aspect to all the other learning
expert or very experienced practitioner.
from the data were c o n c e r n e d with the
a c t i v i t i e s in t h e c l i n i c a l e x p e r i e n c e .
• ll e n h a n c e s students' c o n f i d e n c e and
students' education and ihe benefits for
Students feel isolated and lost in an envi-
independence in their nursing role and
t h e RN m e n t o r s . T h e s e six c a t e g o r i e s
ronment with which they are not familiar.
also helps them apply theory they have
w e r e : (a) h e l p i n g s t u d e n t s l e a r n a n d
T h e y seem to b e c o m e invisible, ignored
learned in their practice.
and idle or left to roam the wards looking
T h e meniorship role has demonstrat-
d e v e l o p their skills,- (b) increasing students' confidence and giving support, (c)
for something to do or someone to talk to
ed benefits, particularly in the area of
improving mentors' skills and education,-
(Spouse 1996). T h e social and emotional
s e l l - c o n f i d e n c e a n d role s o c i a l i s a t i o n ,
(d) j o b satisfaction,- (e) p r o m o t i n g and
security provided by such caring relation-
whether they are nursing students or RNs
improving professional image ol nursing,
ships e n a b l e d s t u d e n t s to express their
(Ferguson and Calder 1993). Developing
and (f) desiring to share past experiences.
w e a k n e s s e s and to receive h e l p and to
confidence in the performance of practi-
mature both professionally and personal-
cal, t a s k - o r i e n t e d n u r s i n g skills is an
ly. Being a l l o c a t e d m e n t o r s w h o w e r e
important c o m p o n e n t of clinical nursing
familiar w i t h t h e c l i n i c a l s e t t i n g was
practice (Klzubeir and Sherman 1995).
advantageous to students' learning.
(d) Integration to hospital environment
(b) Realistic
view of
nursing
C h a r a c t e r i s t i c s of realistic view of
Discussion T h e results from the questionnaires completed by the RN mentors were positive. T h e benefits and rewards were meaningful as expressed by the m e n t o r s . T h e y
Characteristics ol integration to hospital
indicated that the most compelling rea-
nursing arc:
environment are:
s o n s for b e c o m i n g m e n t o r s w e r e t h e
•
• It allows students to integrate gradually
opportunity lo assist students lo integrate
It allows students more consistent view of total patient care, and time management skills, with emphasis on students'
12
Colk-gian Vol 7 Nn4 2000
into the hospital environment. • T h e s t u d e n t s are able to d e v e l o p a
i n t o i h e n u r s i n g unit, to t e a c h , s h a r e knowledge, promoting and improving the
w h a t n u r s i n g skills were c o v e r e d b y the
Table 1 : EVALUATION OF RN M E N T O R GUIDEBOOK SD
D
U
A
SA
s t u d e n t s , h o w e v e r , if t h e s e R N s w e r e
I . T h e book is well organised.
1 {1.5%}
1 (1.5%)
10(15.4%)
35 (53.8%)
6 (9.2%)
g o o d r o l e m o d e l s f o r the s t u d e n t s , t h i s
2 . The book provided information of student's prior learning.
1 (1.5%)
4 (6.2%)
6 (9.2%)
37 (56.9%)
5 (7.7%)
3 . The book provided useful information for planning m y day.
1 (1.5%)
4 . Background information in the book provided sufficient understanding of MACP.
1 (1.5%)
Statements
w o u l d greatly enhance the students' learning. A study conducted by M o r g a n and K n o x in 1987, and r e p l i c a t e d
by
N e h r i n g ( 1 9 9 0 ) a n d Davies ( 1 9 9 3 ) , f o u n d 5 (7.7%)
18(28.7%}
28(43.1%)
1 (1.1%)
t h a i b o t h students a n d f a c u l t y p e r c e i v e d that the 'best' c l i n i c a l teachers were g o o d role m o d e l s , a n d the 'worst' c l i n i c a l teach-
4 (6.2%)
5 (7.7%)
39(60.0%)
4 (6.2%}
ers w e r e n o t g o o d r o l e m o d e l s . D o t a n and Associates (1986) argued that the i n f l u e n c e o f r o l e m o d e l s is used b y students t o internalise values related to p r o -
Table 2 : EVALUATION OF M E N T O R ' S ROLE SD
Statements
D
U
A
SA
8(12.3%}
17(26.2%)
2(3.1%)
2(3.1%)
7(10.8%)
40(61.5%}
14(21.5%)
3. Hospital, admin. encourages RNs to participate in mentoring role.
0
6 (9.2%)
11 (16.9%}
31 (47.7%)
17(26.2%)
4 . 1 felt adequately experienced for this role.
0
0
7(10.8%)
35 (53.8%)
23 (35.4%}
5. The mentoring role gives me job satisfaction.
0
0
3 (4.6%)
39 (60.0%)
23 (35.4%)
1 . 1 w a s well-informed about the mentoring role. 2 . The mentor role is well accepted by my peers.
6. I will accept the mentoring
5 (7.7%)
26(40.0%)
9(13.8%}
fessional c o m p e t e n c e and the h u m a n i s t i c approach. Results o f t h i s s t u d y i n d i c a t e d t h a t 73.9 per cent o f m e n t o r s stated t h a t t h e hospital administration encouraged RNs t o p a r t i c i p a t e i n the m e n t o r i n g role. T h i s was i m p o r t a n t as the R N s h a d s u p p o r t not o n l y f r o m academic members o f the nurs-
0
3 (4.6%)
0
42"(64"6%) "22(33.8%)
i n g s c h o o l b u t also f r o m t h e i r w o r k p l a c e s .
Recommendations T h e f i n d i n g s i n the study suggest the need for m e n t o r relationships w i t h i n nursing.
role in the future.
H a v i n g an assigned m e n t o r at the onset of c l i n i c a l p r a c t i c e a n d k e e p i n g t h e same
T a b l e 3: E V A L U A T I O N OF S T U D E N T S ' C L I N I C A L P E R F O R M A N C E Statements 1. Professional approach towards nursing practice.
SD
D
U
A
SA
0
1 (1.5%)
1 (1.5%)
30 (46.2%}
33 (50.8%)
0
2(3.1%)
1 (1.5%)
26(40.0%)
36 (55.4%)
t i c e is i m p o r t a n t i n t h e c o n t i n u a t i o n o f
0
4 . Eager and willing to learn.
R N w i t h w h o m they can develop trust, rapp o r t , a n d gain corrective feedback if neces-
3. Communicated effectively w i t h patients.
p a t i e n t care a n d the l e a r n i n g o f s t u d e n t nurses. T h e students w i l l have a designated
2. Performed basic nursing care competently.
m e n t o r for the duration of the clinical prac-
1 (1-5%}
0
2(3.1%)"
1 (1.5%) Q"
26 (40.0%) 19(29.2%
37 (56.9%)
sary. It is n o t suggested that M A C P replace
44(67.7%)
the clinical practice cycles under the superv i s i o n o f the c l i n i c a l teachers rather t h a t
5. Prepared well for basic nursing care.
1 (1.5%)
3 (4.6%)
2(3.1%)
27(41.5%)
32 (49.2%)
they enhance further based practice skills. In o r d e r to have a successful m e n t o r i n g
professional image o f nurses a n d gain j o b
m e n t o r i n g role in the f u t u r e .
satisfaction f r o m m e n t o r i n g , w h i c h were
D e s p i t e the extra load o f m e n t o r i n g the
also expressed b y m e n t o r s / p r e c e p t o r s in
s t u d e n t s , the R N s felt t h a t t h e students'
c l i n i c a l p r o g r a m , support f r o m academics and hospital
administrators
is v i t a l .
S u p p o r t f o r mentors in the f o r m of prepa-
o t h e r studies (Spouse I 9 9 6 , D i b e r t a n d
needs were important a n d t h e y w a n t e d to
r a t i o n f o r t h e r o l e has been i d e n t i f i e d as
Goldenberg
assist t h e m i n d e v e l o p i n g t h e i r c l i n i c a l
essential of m e n t o r programs (Fehm 1990).
1995, Carey & C a m p b e l l 1985). T h e
skills, b u i l d i n g their c o n f i d e n c e , g i v i n g
S u p p o r t a n d a c k n o w l e d g m e n t f r o m hospi-
m o s t f r e q u e n t l y c i t e d b e n e f i t s arc the
1994, Shamian & Inhaber
support and o r i e n t a t i n g the students in
tal a d m i n i s t r a t i o n in w o r k l o a d adjustment
o p p o r t u n i t y t o teach a n d i n f l u e n c e prac-
ward environment and protocol. Gomez
and rewards w i l l enhance the role.
t i c e , increase o w n k n o w l e d g e base, s t i m u -
a n d G o m e z (1987) f o u n d that practice in
late o w n t h i n k i n g , a n d i n d i v i d u a l i s e d o r i -
the c l i n i c a l setting was m o r e effective, in
e n t a t i o n t o meet students' l e a r n i n g needs
regard t o accuracy and c o n f i d e n c e in per-
(Bizek & O e r m a n n
and
formance of a practical s k i l l , t h a n practice
G o l d e n b e r g ( 1 9 9 5 ) stated that these v a l -
i n the s c h o o l l a b o r a t o r y . L e a r n i n g takes
ues s h o u l d be a c k n o w l e d g e d a n d n u r t u r e d
t i m e . T h e l i m e element i n l e a r n i n g is a fac-
so that m e n t o r s w i l l c o n t i n u e t o invest in
t o r of importance a c c o r d i n g t o research on
the r o l e . Because of t h e p o s i t i v e e x p e r i -
novice and expert nurses (Bcnner 1984).
1990). D i b e r t
ences p e r c e i v e d , 9 8 . 4 per c e n t of
the
T w e l v e R N s d i d n o t r e c e i v e the R N
m e n t o r s i n this s t u d y w o u l d a c c e p t t h e
G u i d e b o o k a n d hence t h e y d i d n o t k n o w
Early reports from clinical
teachers
have been e n c o u r a g i n g . T h e y c o m m e n t e d o n the remarkable i m p r o v e m e n t in students' confidence and independence
in
the nursing role, time management, intera c t i o n w i t h clients and h e a l t h professionals a n d a f a m i l i a r i t y w i t h the a t m o s p h e r e a n d the e n v i r o n m e n t o f the h o s p i t a l . References
continued
on page
42
Collegian Vol 7 No4 2000
13
A Clinical Teaching Project continued from page 13 References Bain I. I 9 9 6 Preceptorship: A review oi the literature. Journal of Advanced Nursing 2 4 ( 1 ) : 104-107 Barbuto S 1992 I he m e n t o r i n g p h e n o m e n o n : A b r i e f h i s t o r i c a l v i e w . Australian Journal of Advanced Nursing 2(4): 1-12 Beanie A & I lofden R 1994 Young person m e n t o r i n g in schools: T h e D o n c a s i e r Experience. Education & Training 36(5): 8-15 Bizek K & O e r m a n n M 1990 Study of educational e x p e r i e n c e s , s u p p o r t , and ] o h s a t i s f a c t i o n a m o n g critical care nurse preceptors. Hetiit and Luntj: The Journal of ( rtttcal (..arc 19: 439-444 Bj0rk I T 1997 C h a n g i n g c o n c e p t i o n s of practical skill and skill acquisition in nursing education. Nurshu} Inquiry 4. I 84-195 Carey SJ & C a m p b e l l ST 1994 Perceplor, mentor, and sponsor roles: Creative strategies for nurse r e t e n t i o n . Journal of Nursing Administration 24(12): 39-48 C o n w a y C 1995 M e n t o r i n g managers in o r g a n i s a t i o n s . Equal Opportunities International lournal 14(3-4): 1-52 Davics E 1993 C l i n i c a l m o d e l l i n g : U n c o v e r i n g h i d d e n k n o w l e d g e . lournal of Advanced Nut sing 18=627-636 D i b e r t C & C o l d e n b e r g D 1995 Preceptors' perc e p t i o n s of benefits, rewards, supports and c o m m i t m e n t t o t h e p r e c e p t o r r o l e . Journal of Advanced Nursing 2 1 : I 144-1 I 5 1 D u t a n M , K r u l i k T, Bergman R, E c k c r l i n g S & S h a l z m a n H 19S6 R u l e m o d e l s in n u r s i n g . Nursing Times 87(7): 5 5 - 5 7 Ell r i c h L C 1995 P r o f e s s i o n a l m e n t o r s h i p t o r w o m e n e d u c a t o r s in g o v e r n m e n t s c h o o l s . Journal of Educational Administration 33(2): 69-83 Elzubeir M & Sherman M 1995 Nursing skills and practice. British Journal of Nursing 4 ( i 8 ) : 1087-1092 Fehm P 1990 T h e r o a d m a p t o a m e a n i n g f u l n u r s e p r e c e p t o r s h i p p r o g r a m . Nursing and Healthcare- The Supplement. N a t i o n a l League for N u r s i n g , N e w York, #41-2365 Furguson L M & Calder !il_ 1993 A c o m p a r i s o n of preceptor and educator v a l u i n g of nursing stud e n t c l i n i c a l p e r f o r m a n c e c r i t e r i a . Journal of Nursing Education 32(1): 30-36 C a l i c i a A R , K l i r n a RR & D a t e ES 1 9 9 7 M e n t o r s h i p in physical medicine and rehabilit a t i o n residencies. Amaican Journal of Physical Medicine & Rehabilitation 76(4): 268-275 G o m e z C E & C o m c z EA 1987 Learning of psyc h o m o t o r skills: Laboratory versus patient care setting, lournal of Nursing Education 26. 20-24 H a r d y L 1990 T h e path to nursing k n o w l e d g e : Personal reflections. Nuise Education Today 10(5): 325-332 H a r t G & Rotem A 1994 T h e best and the worst: s t u d e n t s ' e x p e r i e n c e s of c l i n i c a l e d u c a t i o n . Australian Journal of Advanced Nuning I 2(3): 26-33 I n f a n t e M , l o r b e s E, H o u l d i n A & N a y l o r M 1989 A clinical l e a c h i n g project: E x a m i n a t i o n o f a c l i n i c a l t e a c h i n g m o d e l . Jour Hill of Professional Nursing 5(3): 132-139 M c K c n z i c K M 1991 A study of the perceptions of support and guidance among student nurses with a mentor and student nurses without a mentor in the clinical area. Lin p u b l i s h e d M E d thesis, U n i v e r s i t y of Aberdeen M o r g a n J & K n o x JE 1987 C h a r a c t e r i s t i c s o f 'best' and 'worst' c l i n i c a l teachers as perceived b y u n i v e r s i t y f a c u l t y a n d s t u d e n t s . Journal of Advanced Nursing 12: 331-337. N e h r i n g V 1990 N u r s i n g clinical teacher effectiveness i n v e n t o r y : A r e p l i c a t i o n study o f the characteristics of 'best' and 'worst' clinical teachers as perceived b y nursing faculty and students. Journal of Advanced Nursing 15 (8): 934-940 Pelletier D & D u f f i e l d C 1994 Is there e n o u g h m e n t o r i n g i n n u r s i n g ? Australian Journal of Advanced Nursing 1 1(4). 6-1 I. S h a m a i n J & I n h a b e r R 1985 T h e c o n c e p t and practice of preceptorship in c o n t e m p o r a r y nursing: A review of pertinent literature. International Journal of Nursing Studies 22(2)-. 79-88 S m i t A 1998 i\\eutoring in the organisation- Study Guide. S c h o o l o f S o c i a l a n d W o r k p l a c e D e v e l o p m e n t , Southern Cross University, Lismore, N S W Spouse j 1996 T h e effective mentor: A m o d e l tor s t u d e n t - c e n t r e d learning. Nursing Times 9 2 ( 1 3 ) : 32-35 Vance C N 1982 T h e m e n t o r c o n n e c t i o n . Journal of Nursing Administration 12(4): 7-13 V a n c e C N 1994 M e n t o r i n g f o r career success and satisfaction. Guest Editorial 2(4): 3 W a l t s I D 1996 A guide lo mentoring. Report t o the N a t i o n a l Staff D e v e l o p m e n t C o m m i t t e e for the Australian National Training Authority, ISroucck, I l o b a r t Young S, T h e r i a u l t I & C o l l i n s D 1989 T h e nurse p r e c e p t o r . P r e p a r a t i o n a n d needs. Journal of Nursing Staff Development 5: 127-131.
basic nursing skills, and the students'
evaluate a new initiative supplementing
requests for more clinical experiences. A
other clinical experiences for students of
comprehensive evaluation of the program
nursing. The (Vlentor-Arranged Clinical
was carried out which involved feedback
Practice (MACP) was introduced to sec-
from the mentors, students, and Clinical
ond-year nursing students for the first
Director, a senior nurse academic who is
time in 1998 in o r d e r to f u l f i l l ihe
in charge of the clinical program for the
requirements of the New South Wales
three years of undergraduate course. This
Nurses' Registration Board to incorporate
paper w i l l only evaluate the feedback
more clinical experience to reinforce
given by Registered Nurse (RN) mentors.
Ruth Lo RN, PhD, Senior Lecturer in Nursing and Ron Brown RN MEd, Senior Lecturer in Nursing, School of Nursing and Health Care Practices I Southern Cross University, Australia. 8
Collegian Vol 7 Nn4 2000
more a working partnership. At the end of
A s u b s e q u e n t p a p e r will e v a l u a t e t h e
motes another's career and training. T h e
feedback given by the nursing students of
relationship between m e n t o r and mentec
the MACP, a form was given to the men-
their experiences in this program.
is described as intense and emotional.
tors to evaluate the students in their per-
Clinical education is considered a vital
Vance (1994 p3) summarised the ben-
c o m p o n e n t of pre-regislration curricula!"
efits of establishing a m e n t o r i n g program
T h e preparation for M A C P began in
and provides students-with an opportuni-
in the nursing profession as contributing
February 1998, when the Head of School
ty to c o m b i n e c o g n i t i v e , p s y c h o m o t o r
to c a r e e r s u c c e s s a n d
and affective skills (Hart & Rotem 1994).
increased
professional
formances in basic clinical skills.
advancement,-
and Clinical Director visited all 26 hospital
satisfaction,
venues associated with MACP. T h e area
It also provides students with opportuni-
e n h a n c e d self-esteem a n d self-satisfac-
Directors of Nursing, Nurse Unit Managers
ties to a c q u i r e p r o f e s s i o n a l skills a n d
tion,- improved preparation for leadership
(NUMs), and Directors of Nursing of the
practical k n o w l e d g e in the professional
roles, and overall s t r e n g t h e n i n g of the
private hospitals were all supportive.
situation (Elzubeir & Sherman 1995). As
p r o f e s s i o n . In a d d i t i o n , V a n c e ( 1 9 9 4 )
Hardy (1990 p328) states:
stales that m e n t o r i n g
relationships
The path to nursing knowledge is through
empower and inspire individuals to take
practice, constant observation and study and a
risks, to reach full potential, to make sub-
focus on the patient which is safe, knowledgeable,
stantial contributions to their workplaces
effective, efficient, creative, thoughtful, caring,
a n d professions, Ehrich ( 1 9 9 5 ) argues
interdisciplinary, participatory and enriching for
that m e n t o r s h i p is a significant tool in
all participants.
determining, and even a prerequisite for
In the practice setting, prominence is given to the ability to 'do' and knowledge
c a r e e r s u c c e s s for b o t h f e m a l e s a n d males.
These N U M s were requested
to
approach their RNs to ask for their participation in, and willingness to p r o v i d e additional clinical educational experience for second year student nurses. T h e RNs were to provide two to four weeks additional clinical e x p e r i e n c e for s t u d e n t s through MACP. T h e most suitable times for M A C P w e r e t h e four-week p e r i o d between lirsl and second semesters (mid-
is derived from e x p e r i e n c e in p r a c t i c e
A Scottish study has shown that stu-
( E l z u b e i r & S h e r m a n 1995). ' D o i n g ' is
d e n t s w h o w e r e given s u p p o r t from a
b e t w e e n t h e e n d of S p r i n g s e m e s t e r , November, and the end of February the
y e a r b r e a k ) or t h e f o u r - m o n t h
period
important as patients expect nurses to pro-
m e n t o r were more likely to feel part of
vide efficient nursing care (Bjgrk 1997).
the ward team and to value demonstra-
following year, h e n c e s t u d e n t s had 16
Developing confidence in the performance
tion and supervised practice than those
weeks to lit in their M A C P
of practical, task-oriented nursing skills is
w h o did not ( M c K c n z i e 1991). T h e s e
an important component of clinical nurs-
findings were s u p p o r t e d by H a r t and
ing practice (Elzubeir & Sherman 1995).
Rotem (1994), which found that feeling a c c e p t e d by the clinical staff, w o r k i n g
The mentoring role
with a practitioner who was familiar with
Mcnlorship is considered as being possi-
the clinical setting, and having opportu-
bly the most important development too!
nities to question practice were signifi-
lor the progression of a professional in
cant influences on students' learning.
increasing support of mentoring programs
Planning of the MACP Program
has been documented, especially in busi-
Following a course review with representa-
ness, academia, and overall career devel-
tives from the nursing students, academics
opment (Galicia et al 1997). Pelletier and
and the nursing profession, including nurse
Duffield (1994) argued that in Australia,
advisers
t h e c o n c e p t of m e n t o r i n g is n o t v e r y
Registration Board (NRB), a decision was
familiar to nurses and there has been little
made to include an extra four weeks of
d e b a t e or research regarding its impor-
clinical e x p e r i e n c e in t h e form of the
from
the
NSW
Nurses'
MACP. T h i s was a c o m p u l s o r y clinical
1 he term mentoring has become a 'buzz' word of the nineties. Several terms have b e e n used by C o n w a y ( 1 9 9 5 ) , Barbuto
shifts. T h u s , students worked t h e same rosters as their mentors, which involved all different shifts. It was suggested that as far as practicable, the students remained with the same mentors (or two) for the 24 weeks duration of their clinical practice.
training. In r e c e n t years, progressively
tance for nurses and nursing.
Students were assigned to a RN, and w o r k e d alongside that RN for all their
experience for second year students, as the
About 50 per cent of students chose to split their M A C P e x p e r i e n c e by d o i n g two weeks during the mid-year break, and t w o w e e k s at t h e e n d of t h e S p r i n g semestei". M o s t s t u d e n t s a t t e m p t e d to c o m p e t e the M A C P program by end of N o v e m b e r . O t h e r issues p e r t a i n i n g to M A C P , such as, affiliation
agreement,
indemnity insurance, accommodation and clinical settings were also addressed.
completion of MACP was needed in order
There were few student complaints in
to pass their Clinical Nursing Studies Unit.
having the M A C P program during nons e m e s t e r t i m e d u e to t h e
continual
(1992), Watts (1996) and Bain (1996) to
Prior to MACP, the students had com-
d e s c r i b e t h e m e n t o r in the o n e - t o - o n e
pleted their normal clinical assessments,
requests for more practicum. T h e s e stu-
relationship: peer supporter,
coach,
which included a t t e n d a n c e , punctuality,
dents had a choice of 26 hospitals and 20
teacher, guide, preceptor, sponsor, boss
physical assessments, case study and
weeks to complete their MACP, so they
and relative. All of these terms imply rela-
Objective Structured Clinical Examination
were able to choose hospitals that were
tionships where the mentor is sought after
(OSCE) for this unit of study. T h e clinical
closer to h o m e . T h e student union was
for advice and/or protection (Smit 1998).
teachers assessed competencies and made
aware of the program during non-semes-
However, the mentor's role is highly spe-
judgments on students' progress. Within
ter time, but because the Spring semester
cific. Vance (1982) describes a mentor as
the MACP, no formal assessment was car-
c o m p l e t e d at the end of O c t o b e r , stu-
someone who serves as a career role model
ried out by the mentors. Thus, the atmos-
d e n t s were given flexibility of lime to
and who actively advises, guides, and pro-
phere for both students and mentors was
complete their MACP. Collegian Vol 7 No4 200(1 9
Economic Factors in Conducting MACP
Method
from the hospitals where they worked, so
T h e questionnaire was developed based on
hence were not able to fill this part of the
T h e economic factors were major reasons
the literature on mentoring and preeeptor-
questionnaire. As seen from Table I, there
for the introduction of M A C P due to the
ing, and some of the questions were devel-
was a positive evaluation of the m e n t o r
costs of the usual 1.8 clinical teacher / stu-
oped by the researchers based on experi-
guidebook. Sixty-three percent of mentors
dent ratio during the semesters. It was also
ences. T h e questionnaire consisted of four
agreed or strongly agreed that the mentor
agreed by all parties involved in M A C P
sections: (I) the evaluation of RN mentor
guidebook was well organised,- 64.6 per
that RNs, who participated in the MACP
guidebook; (2) evaluation of mentor's role,
cent found the guidebook provided them
(3) evaluation of student's clinical perfor-
with helpful information of student's prior
mance and (4) open-ended questions relat-
learning,- 44.6 per c e n t s t a t e d that the
ing to positive and negative aspects of the
guidebook provided them with informa-
program, would be provided with educational incentives without charge from the School of Nursing. Furthermore, senior a c a d e m i c s from the S c h o o l of N u r s i n g
MACP scheme, and their reasons for par-
tion lor planning their day, and 66.2 per
ticipating in the mentoring role. Questions
cent found that the guidebook gave them
1-3 consisted of statements which the par-
sufficient understanding of MACP.
provided w o r k s h o p s on research, stress management, conflict resolution and any relevant topics needed in enhancing RNs' careers, without charge. These workshops were carried out in their workplaces.
ticipants circled a n u m b e r on a 5-point Likcrt scale, where 1 equals (strongly dis-
(2) Evaluation of mentor's role
agree) and 5 (strongly agree). Participants
Results in Table 2 indicated that the men-
were able to complete the questionnaire in
tors were positive about the m e n t o r i n g
10 minutes and names of the participants
role. Thirty-five mentors agreed or
were not written on the questionnaires,
s t r o n g l y a g r e e d t h a t t h e y w e r e well
thus preserving anonymity.
informed about the m e n t o r i n g role.
were given to participating hospitals for
Subjects
that the mentoring role was well accepted
RN Mentor
Guidebooks
Before the c o m m e n c e m e n t of the MACP, c o p i e s of t h e RN M e n t o r G u i d e b o o k s
Eighty-three per cent ol mentors stated
RNs i n v o l v e d in M A C P . T h e M e n t o r
T h e subjects consisted of RNs working in
by their peers, whereas 73.9 per cent stat-
G u i d e b o o k s p r o v i d e d i m p o r t a n t back-
26 h o s p i t a l s in n o r t h e r n N e w S o u t h
ed that the hospital
g r o u n d i n f o r m a t i o n to t h e m e n t o r s in
Wales. T h e r e were a total ol the 68 RNs
e n c o u r a g e d RNs to p a r t i c i p a t e in t h e
administrative planning for MACP (affili-
who participated in the M A C P scheme,
mentoring role. 89.2 per cent mentors felt
ation a g r e e m e n t , i n d e m n i t y insurance,
of which 65 (95.6%) returned the com-
that they were a d e q u a t e l y e x p e r i e n c e d
a c c o m m o d a t i o n , travel and clinical set-
pleted questionnaires.
for this role, 95.4 per cent stated that the
administration
mentoring role gave them job satisfaction
tings), guide for mentors and suggestions Data
ing student nurse clinical experience, and
All mentors were given a self-addressed
a synopsis of content and skills required
envelope with a questionnaire, which was
For s t a t e m e n t 7, t h e m e n t o r s w e r e
in the six clinical nursing units. Some of
given to them by the students when com-
asked overall, did they find the mentor/stu-
these mentors had already worked as clin-
mencing their practicum. T h e completed
dent partnership: very poor, poor, less than
questionnaires were returned to the
satisfactory, satisfactory, good, very good
Clinical Director. T h e RN mentors were
or excellent. The results indicated that 2
given evaluation questionnaires so that
( 3 . 1 % ) m e n t o r s r a t e d s a t i s f a c t o r y ; 12
ical t e a c h e r s d u r i n g t h e s e m e s t e r s and know the clinical curriculum well.
Workshops for Potential
Mentors
collection
and 98.4 per cent would accept the men-
(or planning their day, protocols govern-
toring role in the future.
their feedback would help improve the
(18.5%) rated good,- 31 (47.7%) rated veiy
new M A C P program.
good, and 20 (30.8%) rated excellent.
Ethics
(3) Evaluation of student's clinical performance
T h e Clinical Director held training workshops for potential RN mentors in different hospitals prior to the M A C P program.
Clearance
T h e ethics committee is familiar with the
Walts (1996) argues that training serves
process that all University units are evalu-
two main purposes: first, it enables the
Results in Table 3 show that students' clini-
ated, and in regards to clinical units, eval-
consistent understanding and implemen-
cal performances were good as evaluated
uation includes both clinical teachers and
by their mentors. Ninety-seven percent of
tation
students. T h e mentors were aware ol this
mentors agreed or strongly agreed that the
study.
students were professional
of
the
program,-
second,
it
enhances the communication skills necessary to fulfill the mentor role. Beattie and
in
their
approach towards nursing practice,- 95.4
Holden (1994) stress that one of the most
Results
per cent of mentors stated thai the stu-
i m p o r t a n t lessons from m e n t o r i n g pro-
dents performed basic nursing care compe-
grams established over recent years is that
(1) The evaluation of RN mentor guidebook
m e n t o r s are most successful when they
For the following 5-point Likert scale:
c o m m u n i c a t e d effectively with patients,
receive a p p r o p r i a t e training. T h e r e is a
l = S D , 2 = D, 3 = Unsure, 4 = Agrec, and
96.9 per cent also slated that students were
need to harness people's initial enthusi-
5 = Strongly Agree.
eager and willing to learn, and 90.7 per
asm and ensure they are clear about the
There were 12 (18.5%) mentors who did
cent of mentors indicated lhat students
goals and processes involved.
not receive t h e RN m e n t o r g u i d e b o o k
were prepared well for basic nursing care.
10
Collegian Vol 7 No-t 20(10
tently,- 96.9 per cent stated that students
For s t a t e m e n t 6, t h e m e n t o r s w e r e asked overall, how would they judge the students' performance: very poor, poor, less than satisfactory, satisfactory, good, very good or excellent. T h e results indicated that 2 (3.1%) mentors rated less than satisfactory,- 2 (3.1%) rated satisfactory,- 9 (13.8%) rated good,- 23 (35.4%) rated very good, and 29 (44.6%) rated excellent. (4) Open-ended
questions
"
planning and implementing of patient
secure relationship with t h e team. It
care.
encourages good rapport between slaff
It gives a greater idea to students about
•
Students get to work full shifts for con-
d y n a m i c s e a c h d a y a n d feel
secutive days, which help them with
belong as part ol the team.
daily routine and understanding what is required of them in the nursing roles. •
and students. • It enables students to understand ward
the actual process of nursing.
they
Hart and Rotern's (1994) study indicated that students enjoyed the opportunity
W o r k i n g all shifts with the m e n t o r
to work closely with staff and experience
e n a b l e s t h e s t u d e n t to 'fit i n t o t h e
a sense of belonging. T h e students found
ward s i t u a t i o n s ' easier. T h e s t u d e n t
that the staff had a lot lo offer them and
T h e following are the results of the open-
e x p e r i e n c e s a realistic impression of
involved them in all practical work.
ended
what being a RN is all about and also a
questions,
which
would
be
addressed one at a time.
real workload.
In y o u r v i e w , w h a t a s p e c t s o f t h e
Exposing students to the realistic view
M A C P needs improvement?
In y o u r view w h a t are the positive aspects of the MACP?
ol nursing is imporlanl so that they will
There were only a few suggestions given
T h e four identified c a t e g o r i e s t h a t
b e a b l e to c o p e w h e n t h e y e n t e r t h e
by t h e m e n t o r s r e g a r d i n g t h e M A C P
e m e r g e d from the data were c o n c e r n e d
workforce after completion of their edu-
s c h e m e as m o s t of t h e m e n t o r s w e r e
with the mentor-student relationship and
cation. T h e two clays a fortnight clinical
happy with the M A C P as it stands. T h e
the quality of their educational activities.
practice during the semesters did not pro-
12 mentors who did not receive the RN
These four categories were: (a) befriend-
vide students with a realistic view of nurs-
CiLiidebook from the hospitals felt they
ing, (b) realistic view of nursing, (c) valu-
ing. Infante et al. (1989) c o n c l u d e that
would have liked lo have received them
able practicum lime, and (d) familiarity
providing o p p o r t u n i t i e s for students to
before c o m m e n c i n g t h e p r o g r a m . T h e
with the environment.
work closely with role models will result
mentors fell that hospital administration
Benefits to students
in the acquisition of a realistic u n d e r -
needs to support the mentors in providing
(a) Befriending
s t a n d i n g of t h e s k i l l s a n d
adequate time to educate the students.
T h e characteristics of befriending are:
required within the work environment.
• An opportunity to interrelate and share
(c) valuable
practicum
demands
time
T h e mentor needs lo be working in a p r e d o m i n a n t l y clinical role rather than
knowledge, ideas, experiences and
Characteristics of valuable practicum time
being in charge of the ward. Rxtra time
insights.
are:
needs to be allocated to the m e n t o r or
• T h e m e n t o r allows the student the
• It gives more practical lime for students
c h a n c e to e x p r e s s fears and d o u b t s
lo understand ward routine, objectives,
without being put down.
protocols, and time lo be able to form
• T h e mentor initiated social interaclions designed to promote trust and a sense of warmth and interest.
lighter caseload in order to have time to explain all procedures to ihe students.
relationships with patients and to
Please give reasons
understand them in a holistic way.
f o r p a r t i c i p a t i n g in
• It gives t h e s t u d e n t s g o o d practical
t h e m e n t o r i n g role.
B e f r i e n d i n g s e e m s to b e t h e m o s t
experience under the supervision of an
Six identified c a t e g o r i e s t h a i e m e r g e d
important aspect to all the other learning
expert or very experienced practitioner.
from the data were c o n c e r n e d with the
a c t i v i t i e s in t h e c l i n i c a l e x p e r i e n c e .
• ll e n h a n c e s students' c o n f i d e n c e and
students' education and ihe benefits for
Students feel isolated and lost in an envi-
independence in their nursing role and
t h e RN m e n t o r s . T h e s e six c a t e g o r i e s
ronment with which they are not familiar.
also helps them apply theory they have
w e r e : (a) h e l p i n g s t u d e n t s l e a r n a n d
T h e y seem to b e c o m e invisible, ignored
learned in their practice.
and idle or left to roam the wards looking
T h e meniorship role has demonstrat-
d e v e l o p their skills,- (b) increasing students' confidence and giving support, (c)
for something to do or someone to talk to
ed benefits, particularly in the area of
improving mentors' skills and education,-
(Spouse 1996). T h e social and emotional
s e l l - c o n f i d e n c e a n d role s o c i a l i s a t i o n ,
(d) j o b satisfaction,- (e) p r o m o t i n g and
security provided by such caring relation-
whether they are nursing students or RNs
improving professional image ol nursing,
ships e n a b l e d s t u d e n t s to express their
(Ferguson and Calder 1993). Developing
and (f) desiring to share past experiences.
w e a k n e s s e s and to receive h e l p and to
confidence in the performance of practi-
mature both professionally and personal-
cal, t a s k - o r i e n t e d n u r s i n g skills is an
ly. Being a l l o c a t e d m e n t o r s w h o w e r e
important c o m p o n e n t of clinical nursing
familiar w i t h t h e c l i n i c a l s e t t i n g was
practice (Klzubeir and Sherman 1995).
advantageous to students' learning.
(d) Integration to hospital environment
(b) Realistic
view of
nursing
C h a r a c t e r i s t i c s of realistic view of
Discussion T h e results from the questionnaires completed by the RN mentors were positive. T h e benefits and rewards were meaningful as expressed by the m e n t o r s . T h e y
Characteristics ol integration to hospital
indicated that the most compelling rea-
nursing arc:
environment are:
s o n s for b e c o m i n g m e n t o r s w e r e t h e
•
• It allows students to integrate gradually
opportunity lo assist students lo integrate
It allows students more consistent view of total patient care, and time management skills, with emphasis on students'
12
Colk-gian Vol 7 Nn4 2000
into the hospital environment. • T h e s t u d e n t s are able to d e v e l o p a
i n t o i h e n u r s i n g unit, to t e a c h , s h a r e knowledge, promoting and improving the
w h a t n u r s i n g skills were c o v e r e d b y the
Table 1 : EVALUATION OF RN M E N T O R GUIDEBOOK SD
D
U
A
SA
s t u d e n t s , h o w e v e r , if t h e s e R N s w e r e
I . T h e book is well organised.
1 {1.5%}
1 (1.5%)
10(15.4%)
35 (53.8%)
6 (9.2%)
g o o d r o l e m o d e l s f o r the s t u d e n t s , t h i s
2 . The book provided information of student's prior learning.
1 (1.5%)
4 (6.2%)
6 (9.2%)
37 (56.9%)
5 (7.7%)
3 . The book provided useful information for planning m y day.
1 (1.5%)
4 . Background information in the book provided sufficient understanding of MACP.
1 (1.5%)
Statements
w o u l d greatly enhance the students' learning. A study conducted by M o r g a n and K n o x in 1987, and r e p l i c a t e d
by
N e h r i n g ( 1 9 9 0 ) a n d Davies ( 1 9 9 3 ) , f o u n d 5 (7.7%)
18(28.7%}
28(43.1%)
1 (1.1%)
t h a i b o t h students a n d f a c u l t y p e r c e i v e d that the 'best' c l i n i c a l teachers were g o o d role m o d e l s , a n d the 'worst' c l i n i c a l teach-
4 (6.2%)
5 (7.7%)
39(60.0%)
4 (6.2%}
ers w e r e n o t g o o d r o l e m o d e l s . D o t a n and Associates (1986) argued that the i n f l u e n c e o f r o l e m o d e l s is used b y students t o internalise values related to p r o -
Table 2 : EVALUATION OF M E N T O R ' S ROLE SD
Statements
D
U
A
SA
8(12.3%}
17(26.2%)
2(3.1%)
2(3.1%)
7(10.8%)
40(61.5%}
14(21.5%)
3. Hospital, admin. encourages RNs to participate in mentoring role.
0
6 (9.2%)
11 (16.9%}
31 (47.7%)
17(26.2%)
4 . 1 felt adequately experienced for this role.
0
0
7(10.8%)
35 (53.8%)
23 (35.4%}
5. The mentoring role gives me job satisfaction.
0
0
3 (4.6%)
39 (60.0%)
23 (35.4%)
1 . 1 w a s well-informed about the mentoring role. 2 . The mentor role is well accepted by my peers.
6. I will accept the mentoring
5 (7.7%)
26(40.0%)
9(13.8%}
fessional c o m p e t e n c e and the h u m a n i s t i c approach. Results o f t h i s s t u d y i n d i c a t e d t h a t 73.9 per cent o f m e n t o r s stated t h a t t h e hospital administration encouraged RNs t o p a r t i c i p a t e i n the m e n t o r i n g role. T h i s was i m p o r t a n t as the R N s h a d s u p p o r t not o n l y f r o m academic members o f the nurs-
0
3 (4.6%)
0
42"(64"6%) "22(33.8%)
i n g s c h o o l b u t also f r o m t h e i r w o r k p l a c e s .
Recommendations T h e f i n d i n g s i n the study suggest the need for m e n t o r relationships w i t h i n nursing.
role in the future.
H a v i n g an assigned m e n t o r at the onset of c l i n i c a l p r a c t i c e a n d k e e p i n g t h e same
T a b l e 3: E V A L U A T I O N OF S T U D E N T S ' C L I N I C A L P E R F O R M A N C E Statements 1. Professional approach towards nursing practice.
SD
D
U
A
SA
0
1 (1.5%)
1 (1.5%)
30 (46.2%}
33 (50.8%)
0
2(3.1%)
1 (1.5%)
26(40.0%)
36 (55.4%)
t i c e is i m p o r t a n t i n t h e c o n t i n u a t i o n o f
0
4 . Eager and willing to learn.
R N w i t h w h o m they can develop trust, rapp o r t , a n d gain corrective feedback if neces-
3. Communicated effectively w i t h patients.
p a t i e n t care a n d the l e a r n i n g o f s t u d e n t nurses. T h e students w i l l have a designated
2. Performed basic nursing care competently.
m e n t o r for the duration of the clinical prac-
1 (1-5%}
0
2(3.1%)"
1 (1.5%) Q"
26 (40.0%) 19(29.2%
37 (56.9%)
sary. It is n o t suggested that M A C P replace
44(67.7%)
the clinical practice cycles under the superv i s i o n o f the c l i n i c a l teachers rather t h a t
5. Prepared well for basic nursing care.
1 (1.5%)
3 (4.6%)
2(3.1%)
27(41.5%)
32 (49.2%)
they enhance further based practice skills. In o r d e r to have a successful m e n t o r i n g
professional image o f nurses a n d gain j o b
m e n t o r i n g role in the f u t u r e .
satisfaction f r o m m e n t o r i n g , w h i c h were
D e s p i t e the extra load o f m e n t o r i n g the
also expressed b y m e n t o r s / p r e c e p t o r s in
s t u d e n t s , the R N s felt t h a t t h e students'
c l i n i c a l p r o g r a m , support f r o m academics and hospital
administrators
is v i t a l .
S u p p o r t f o r mentors in the f o r m of prepa-
o t h e r studies (Spouse I 9 9 6 , D i b e r t a n d
needs were important a n d t h e y w a n t e d to
r a t i o n f o r t h e r o l e has been i d e n t i f i e d as
Goldenberg
assist t h e m i n d e v e l o p i n g t h e i r c l i n i c a l
essential of m e n t o r programs (Fehm 1990).
1995, Carey & C a m p b e l l 1985). T h e
skills, b u i l d i n g their c o n f i d e n c e , g i v i n g
S u p p o r t a n d a c k n o w l e d g m e n t f r o m hospi-
m o s t f r e q u e n t l y c i t e d b e n e f i t s arc the
1994, Shamian & Inhaber
support and o r i e n t a t i n g the students in
tal a d m i n i s t r a t i o n in w o r k l o a d adjustment
o p p o r t u n i t y t o teach a n d i n f l u e n c e prac-
ward environment and protocol. Gomez
and rewards w i l l enhance the role.
t i c e , increase o w n k n o w l e d g e base, s t i m u -
a n d G o m e z (1987) f o u n d that practice in
late o w n t h i n k i n g , a n d i n d i v i d u a l i s e d o r i -
the c l i n i c a l setting was m o r e effective, in
e n t a t i o n t o meet students' l e a r n i n g needs
regard t o accuracy and c o n f i d e n c e in per-
(Bizek & O e r m a n n
and
formance of a practical s k i l l , t h a n practice
G o l d e n b e r g ( 1 9 9 5 ) stated that these v a l -
i n the s c h o o l l a b o r a t o r y . L e a r n i n g takes
ues s h o u l d be a c k n o w l e d g e d a n d n u r t u r e d
t i m e . T h e l i m e element i n l e a r n i n g is a fac-
so that m e n t o r s w i l l c o n t i n u e t o invest in
t o r of importance a c c o r d i n g t o research on
the r o l e . Because of t h e p o s i t i v e e x p e r i -
novice and expert nurses (Bcnner 1984).
1990). D i b e r t
ences p e r c e i v e d , 9 8 . 4 per c e n t of
the
T w e l v e R N s d i d n o t r e c e i v e the R N
m e n t o r s i n this s t u d y w o u l d a c c e p t t h e
G u i d e b o o k a n d hence t h e y d i d n o t k n o w
Early reports from clinical
teachers
have been e n c o u r a g i n g . T h e y c o m m e n t e d o n the remarkable i m p r o v e m e n t in students' confidence and independence
in
the nursing role, time management, intera c t i o n w i t h clients and h e a l t h professionals a n d a f a m i l i a r i t y w i t h the a t m o s p h e r e a n d the e n v i r o n m e n t o f the h o s p i t a l . References
continued
on page
42
Collegian Vol 7 No4 2000
13
A Clinical Teaching Project continued from page 13 References Bain I. I 9 9 6 Preceptorship: A review oi the literature. Journal of Advanced Nursing 2 4 ( 1 ) : 104-107 Barbuto S 1992 I he m e n t o r i n g p h e n o m e n o n : A b r i e f h i s t o r i c a l v i e w . Australian Journal of Advanced Nursing 2(4): 1-12 Beanie A & I lofden R 1994 Young person m e n t o r i n g in schools: T h e D o n c a s i e r Experience. Education & Training 36(5): 8-15 Bizek K & O e r m a n n M 1990 Study of educational e x p e r i e n c e s , s u p p o r t , and ] o h s a t i s f a c t i o n a m o n g critical care nurse preceptors. Hetiit and Luntj: The Journal of ( rtttcal (..arc 19: 439-444 Bj0rk I T 1997 C h a n g i n g c o n c e p t i o n s of practical skill and skill acquisition in nursing education. Nurshu} Inquiry 4. I 84-195 Carey SJ & C a m p b e l l ST 1994 Perceplor, mentor, and sponsor roles: Creative strategies for nurse r e t e n t i o n . Journal of Nursing Administration 24(12): 39-48 C o n w a y C 1995 M e n t o r i n g managers in o r g a n i s a t i o n s . Equal Opportunities International lournal 14(3-4): 1-52 Davics E 1993 C l i n i c a l m o d e l l i n g : U n c o v e r i n g h i d d e n k n o w l e d g e . lournal of Advanced Nut sing 18=627-636 D i b e r t C & C o l d e n b e r g D 1995 Preceptors' perc e p t i o n s of benefits, rewards, supports and c o m m i t m e n t t o t h e p r e c e p t o r r o l e . Journal of Advanced Nursing 2 1 : I 144-1 I 5 1 D u t a n M , K r u l i k T, Bergman R, E c k c r l i n g S & S h a l z m a n H 19S6 R u l e m o d e l s in n u r s i n g . Nursing Times 87(7): 5 5 - 5 7 Ell r i c h L C 1995 P r o f e s s i o n a l m e n t o r s h i p t o r w o m e n e d u c a t o r s in g o v e r n m e n t s c h o o l s . Journal of Educational Administration 33(2): 69-83 Elzubeir M & Sherman M 1995 Nursing skills and practice. British Journal of Nursing 4 ( i 8 ) : 1087-1092 Fehm P 1990 T h e r o a d m a p t o a m e a n i n g f u l n u r s e p r e c e p t o r s h i p p r o g r a m . Nursing and Healthcare- The Supplement. N a t i o n a l League for N u r s i n g , N e w York, #41-2365 Furguson L M & Calder !il_ 1993 A c o m p a r i s o n of preceptor and educator v a l u i n g of nursing stud e n t c l i n i c a l p e r f o r m a n c e c r i t e r i a . Journal of Nursing Education 32(1): 30-36 C a l i c i a A R , K l i r n a RR & D a t e ES 1 9 9 7 M e n t o r s h i p in physical medicine and rehabilit a t i o n residencies. Amaican Journal of Physical Medicine & Rehabilitation 76(4): 268-275 G o m e z C E & C o m c z EA 1987 Learning of psyc h o m o t o r skills: Laboratory versus patient care setting, lournal of Nursing Education 26. 20-24 H a r d y L 1990 T h e path to nursing k n o w l e d g e : Personal reflections. Nuise Education Today 10(5): 325-332 H a r t G & Rotem A 1994 T h e best and the worst: s t u d e n t s ' e x p e r i e n c e s of c l i n i c a l e d u c a t i o n . Australian Journal of Advanced Nuning I 2(3): 26-33 I n f a n t e M , l o r b e s E, H o u l d i n A & N a y l o r M 1989 A clinical l e a c h i n g project: E x a m i n a t i o n o f a c l i n i c a l t e a c h i n g m o d e l . Jour Hill of Professional Nursing 5(3): 132-139 M c K c n z i c K M 1991 A study of the perceptions of support and guidance among student nurses with a mentor and student nurses without a mentor in the clinical area. Lin p u b l i s h e d M E d thesis, U n i v e r s i t y of Aberdeen M o r g a n J & K n o x JE 1987 C h a r a c t e r i s t i c s o f 'best' and 'worst' c l i n i c a l teachers as perceived b y u n i v e r s i t y f a c u l t y a n d s t u d e n t s . Journal of Advanced Nursing 12: 331-337. N e h r i n g V 1990 N u r s i n g clinical teacher effectiveness i n v e n t o r y : A r e p l i c a t i o n study o f the characteristics of 'best' and 'worst' clinical teachers as perceived b y nursing faculty and students. Journal of Advanced Nursing 15 (8): 934-940 Pelletier D & D u f f i e l d C 1994 Is there e n o u g h m e n t o r i n g i n n u r s i n g ? Australian Journal of Advanced Nursing 1 1(4). 6-1 I. S h a m a i n J & I n h a b e r R 1985 T h e c o n c e p t and practice of preceptorship in c o n t e m p o r a r y nursing: A review of pertinent literature. International Journal of Nursing Studies 22(2)-. 79-88 S m i t A 1998 i\\eutoring in the organisation- Study Guide. S c h o o l o f S o c i a l a n d W o r k p l a c e D e v e l o p m e n t , Southern Cross University, Lismore, N S W Spouse j 1996 T h e effective mentor: A m o d e l tor s t u d e n t - c e n t r e d learning. Nursing Times 9 2 ( 1 3 ) : 32-35 Vance C N 1982 T h e m e n t o r c o n n e c t i o n . Journal of Nursing Administration 12(4): 7-13 V a n c e C N 1994 M e n t o r i n g f o r career success and satisfaction. Guest Editorial 2(4): 3 W a l t s I D 1996 A guide lo mentoring. Report t o the N a t i o n a l Staff D e v e l o p m e n t C o m m i t t e e for the Australian National Training Authority, ISroucck, I l o b a r t Young S, T h e r i a u l t I & C o l l i n s D 1989 T h e nurse p r e c e p t o r . P r e p a r a t i o n a n d needs. Journal of Nursing Staff Development 5: 127-131.