- Email: [email protected]
Student and mentor perceptions of mentoring effectiveness
Article
Student and mentor perceptions of mentoring effectiveness Margaret Andrews and Frances Chilton
Margaret Andrews BSc, MSc, RGN, RCNT, RNT, Head of the School of Health and Community Studies, Plas Coch, Mold Road, Wrexham, Clwyd LL1 2AW, UK. Tel.: 01978 293101 Frances Chilton BSc, Dip N, RGN, Staff Nurse, Robert Jones and Agens Hunt Orthopaedic and District Hospital, Gobowen, Oswestry, Shropshire, UK. (Requests for offprints to: M A) Manuscript accepted: 23 February 2000
The following is an account of a small pilot study conducted over a 3-month period which ascertained the views of staff nurses and students about the mentoring process. In particular, whether the possession of a teaching qualification influences the effectiveness of mentors. The research was conducted in a district general hospital in North Wales. The findings demonstrate that staff nurses with a teaching and assessing qualification consistently rate themselves as more effective and supportive than those without. Other findings show that students consistently rate their mentors positively irrespective of whether they held a teaching and assessing qualification and that students rate their mentors more positively than the mentors themselves. Although these findings are not generalizable in the accepted sense they may be applicable to other practice settings. The findings and discussion indicate several implications for future practice including the need for: • More consistency in practice regarding the nature and purpose of mentorship • Clear criteria and selection processes for potential mentors, including more extensive use of the Measuring Mentor Potential (MMP) scale as a predictive tool • A review of current mentor preparation programmes to align them with the needs of diploma and degree students and to ensure comparability of standards throughout the UK • More discussion regarding the nature and purpose of mentorship including further examination of a range of mentorship models. © 2000 Harcourt Publishers Ltd
Introduction Much has been written about the support mechanisms for students in practice settings, with both qualified nurses and students favouring the mentorship approach. However, although there is acknowledgment that mentoring is a complex and important activity, there is little to explain how mentors are selected or prepared. These aspects are becoming increasingly important as student numbers increase and more qualified nurses are required to act as mentors. Current literature illustrates a lack of consistency regarding definition of the concept, and highlights a variety of interpretations of the
© 2000 Harcourt Publishers Ltd doi:10.1054/nedt.2000.0464, available online at http://www.idealibrary.com on
role. In addition, practice dictates that some nurses are not mentors by choice, it becomes a compulsory part of their job. Having mentors who may not be in that position by choice only serves to compound the difficulties and does nothing to ensure that appropriate standards are consistent. Mentors are prepared in a variety of ways, from observing how others function to more formal arrangements such as mentor training courses. They often feel inadequate in their roles, either because their own training did not equip them for current practice or because they do not wholly understand the aims of the preregistration curriculum. The majority of
Nurse Education Today (2000) 20, 555–562 555
Student and mentor perceptions of mentoring effectiveness
practitioners have not studied at diploma level and their experience does not fully compensate for the lack of theoretical knowledge. Mentors themselves have doubts about their own level of preparation and acknowledge that they have not been adequately prepared (Andrews 1993). The purpose of this paper is to: • Briefly outline some of the appropriate literature • Describe a small pilot study concerning perceptions of mentoring potential from both the mentor and mentee perspective • Discuss the implication of the findings to mentoring practices.
Review of the literature Although much has been written about the qualities, characteristics and core attributes of good mentors, there is little in relation to selection and training (Andrews & Wallis 1998). In practice, no real selection of suitable mentors occurs, and it is assumed that all qualified nurses can be effective in this respect. Some nurses take on a mentoring role because of aptitude, interest or because students have identified them as good role models. Educational preparation is usually in the form of the Welsh National Board Teaching and Assessing in Clinical Practice module (or equivalent, e.g. English National Board 998) or by short courses applicable to the particular setting. Preparation is not common and varies from area to area (Wilson-Barnett et al. 1995). WilsonBarnett et al. (1995) and Neary et al. (1994) found that both teaching and assessing and shorter courses were inadequate preparation and that most mentors learn ‘on the job’. Jinks and Williams (1994) found that those nurses who undertake a shortened version of preparation feel ‘short changed’, thus indicating that the more extensive programmes are perceived by mentors to be better preparation. Jinks and Williams’ (1994) study also highlighted that those mentors who had undertaken a formal teaching and assessing programme felt significantly more able to undertake the role. Some researchers have identified characteristics which can be used as indicators to identify potential mentors (Darling 1984, Goldberg 1987, Donnovan 1990, Ashton &
556
Nurse Education Today
(2000) 20, 555–562
Richardson 1992). The literature highlights characteristics such as having a non-judgmental attitude, patience, being supportive and understanding as positive attributes. Studies focusing on the effects of mentorship on student or pupil nurses include those of Littlejohn (1992), Mackenzie (1991) and Spouse (1996). However, there is little literature concerning qualified nurses’ experiences (Atkins & Williams 1995) or their effectiveness in the mentoring process. An important study which examines a range of views, including that of mentors, was undertaken by Neary et al. (1992) who examined the introduction of mentorship (although this term was avoided in the study) in the Common Foundation Programme (CFP) in a number of colleges in Wales. Neary et al. (1994) describe a good mentor as someone who possesses appropriate professional attributes, knowledge, good communication skills and the motivation to teach and support students. The key elements of the role are seen as teaching, support and assessment of student performance. Mentors in this study found conflict between the competing demands of mentoring and providing direct patient care. However, the presence of a mentor meant that learning was more likely to be planned and was an important influence on how the student perceived the learning experience. Darling (1984) is one of the most commonly cited researchers in the literature concerning mentorship. Over a 2-year period, Darling (1984) interviewed 50 nurses, 20 physicians and 80 health care executives about their experiences with mentors, in particular what they wanted from a mentor. From this she identified indicative characteristics and developed the Measuring Mentoring Potential (MMP) scale. Darling (1984) highlights that an effective mentor has three absolute requirements, three basic mentoring roles and nine action roles. The ‘absolute’ requirements for successful mentoring she identifies as: attraction (mutual), action (time and energy) and affect (mutual respect). From these she highlights 14 roles, three of which are basic to mentoring: inspirer (attraction), investor (action) and supporter (affect) (See Fig. 1). Darling (1984) developed the MMP scale into a questionnaire which enables individuals to evaluate their own or others’ mentoring potential. An overall score is achieved by rating each
© 2000 Harcourt Publishers Ltd
Student and mentor perceptions of mentoring effectiveness
1 Model
}
2 Envisioner
}
3 Energiser
}
8 Teacher
9 Feedback - giver
Inspirer Role
10 Eye - opener
11 Door - opener
4 Investor
Investor Role
12 Idea - bouncer
13 Problem - solver 5 Supporter
Supporter Role
14 Career counsellor
6 Challenger
7 Standard - prodder Fig. 1
Adaptation of Darling’s (1984) Characteristics of effective mentoring.
characteristic from 1 (low) to 5 (high). At least one of the inspirer roles (1–3 in Fig. 1) should achieve a rating of 4 or 5 along with supporter and investor. The higher the overall score, the more well rounded the mentor (Darling 1984). The findings from Darling’s (1984) study demonstrated that there was no difference between what nurses and other professional groups want from a mentor. In the main, the literature reports mentorship as a positive endeavor (Foy & Waltho 1989, Littlejohn 1992, Earnshaw 1995), and experience suggests that in practice this is also the case. However, Merriam (1983) criticizes much of the research on mentorship and highlights inadequate operational definitions, unsophisticated methodology and lack of rigour. Some literature does suggest that it can be a negative experience for some (Cahill 1996, Spouse 1996, Tatum & Marrow 1994). Despite the prolific literature on mentors and the mentoring process (ENB 1987, Morle 1990, Kramer 1993, Cahill 1996), there remains little agreement about the most effective method for mentoring or the selection of mentors. Selection
© 2000 Harcourt Publishers Ltd
poses particular problems, especially as there is a lack of selection criteria and evaluation of effectiveness.
Background to the study The purpose of the study was to: • Evaluate staff nurses’ perceptions of their own aptitude for mentoring • Ascertain students’ perceptions of their mentors’ mentoring ability • Make a comparison of staff nurses’ and students’ perceptions • Identify if the possession of a teaching and assessing qualification influenced the mentoring process. The study took place on two wards in a district general hospital in North Wales. It elicited the views of 22 staff nurses (mentors) involved with the clinical education of student nurse and 11 student nurses (mentees) allocated to the study area. The research was conducted in two parts. The first involved a sample of qualified nurses at
Nurse Education Today
(2000) 20, 555–562
557
Student and mentor perceptions of mentoring effectiveness
staff nurse level who were mentors to students or who had acted in this capacity previously. The second consisted of a group of student nurses allocated to the two wards during a 3-month period. The staff nurses were drawn from a purposive sample, their ages ranged from 21 to 45 years and they had been qualified between 1 and 21 years. They had spent between 1 and 10 years in their present positions. Half of the staff nurses already processed a teaching and assessing qualification, either the WNB, ENB teaching and Assessing in clinical practice (or equivalent) or a shortened version designed for student mentorship purposes. Eleven were mentoring students at the time the study was taking place. A sample of 11 first, second and third year students was obtained (two male, nine female), whose ages ranged from 18 to 45. Data from both response groups were obtained concurrently. Current practice in this area dictated that students did not select their mentors, they were assigned to them on an ad hoc basis (Brennen 1993). Indeed the cases where mutual selection occurs appear to be the exception rather than the rule, despite the literature identifying this as good practice (Kramer 1993, ENB 1995, Burnard 1990, May et al. 1980). The selection of mentors and the pairing of mentors with students in this study was therefore arbitrary but reflects similar practice in other settings (Littlejohn 1992).
Method Questionnaires were used as the main data collecting method for both sets of respondents. These were developed from the major themes emanating from the literature and incorporated Darling’s (1984) MMP scale (see Fig 1). Questionnaires were similar for both sets of respondents, i.e. both asked for general information and both utilized Darling’s (1984) MMP scale. To help respondents, an explanation for each of the characteristics was provided. The questionnaires were personalized for the mentor respondents so that they clearly indicated that that this was a self-assessment. Both sets of questionnaires were piloted using respondents with similar characteristics to the subjects in the study. The questionnaire was well received and piloting resulted in minimal alteration.
558
Nurse Education Today
(2000) 20, 555–562
An overall score from the questionnaire was achieved by rating each of Darling’s characteristics from 1 (low) to 5 (High). The responses were standardized and numerically analysed. Although the numerical values are of little significance as the data are of the ordinal level of measurement, they do demonstrate general trends. In this study it was not the actual numbers that were important, rather how mentoring effectiveness was perceived. Staff nurse included information relating to past and present experiences of mentoring. The students completed the questionnaire at the end of their ward placement and were asked to review the preceding weeks’ experience. The clarification information was given in the past tense encouraging them to review the previous weeks. Mentors completed the questionnaires at the beginning of the mentoring period with a student.
Findings These findings should be seen in light of the following: • Students were asked to complete the MMP one week before their placement ended and prior to receiving their final report • No measures were in place to ‘test out’ mentoring effectiveness from any other perspective, i.e. there was no objective measurement of effectiveness • All students attained the appropriate outcomes associated with practice. These findings should be read with some caution as they are not generalizable in the accepted sense, and are wholly based on the mentors’ and students’ perceptions. They may, however, be applicable to other practice settings.
Mentors The response rate for the mentors’ (staff nurses) questionnaire was 82%. The findings demonstrate that mentors with a teaching and assessing qualification consistently rated themselves higher (total MMP score) than those without (median score of 50 and 41 respectively). The possession of a teaching and assessing qualification did influence mentors’ perception of themselves and indicated that those who held this qualification were generally more confident
© 2000 Harcourt Publishers Ltd
Student and mentor perceptions of mentoring effectiveness
with regard to the principal functions associated with mentoring. They appeared more at ease with their roles. Darling (1984) identified three principal functions of a mentor: inspirer, investor and supporter. She indicates that mentors should score 4 or 5 in at least one of these areas. Seventyeight percent (78%) of mentors who possessed a teaching and assessing qualification achieved ratings of 4–5 in both the investor and supporter roles. Whereas only 44% of mentors without a teaching and assessing qualification achieved 4 or 5 in these categories. Eighty-nine percent (89%) of mentors without a teaching and assessing qualification scored at least one rating of 5 in one of the roles. Although overall the mentors without a teaching and assessing qualification did score less highly than those with, they did fulfill Darling’s requirements. Investor and supporter characteristics are attributes highly valued in the literature, as well as by mentors themselves (ENB 1988, Hyland et al. 1988, Earnshaw 1995, Booth 1992). However, these functions alone are not necessarily the only determinants of good mentoring. Numerous authors (Earnshaw 1995, Booth 1992, ENB 1995) emphasize the importance of guidance and support for students. Mentors in this study scored highly in the supporter category, with qualified mentors scoring the highest. This is indicative of the high level of commitment that all mentors give to the process of mentoring and similar findings are described by Flagier et al. (1988) and Booth (1992). Conversely, some would suggest that mentors are not always cognisant of the need to provide students with guidance and support, which often leads to relationship difficulties between mentor and student (Cahill 1996, Tatum & Marrow 1994, Wilson-Barnett et al. 1995). Other attributes highlighted by Darling are role model, energizer, standard-prodder, teacher, feedback-giver, eye-opener, door-opener, ideabouncer, problem-solver, career counsellor and challenger. Being a mentor requires teaching skills (Atkins & Williams 1995) and the majority of mentor preparation courses acknowledge this. In this study mentors with a teaching and assessing qualification rated themselves a score of 4 or more for teaching and problem solving as they felt more equipped for these elements of the role.
© 2000 Harcourt Publishers Ltd
Mentors consistently scored themselves lower on characteristics such as career counsellor, a function promoted by the ENB (1987) and others (Ashton & Richardson 1992, Goldberg 1987). This may be a reflection of the current instability in practice settings with staff nurses feeling insecure about their own futures and career development, making them less able to advise others.
Students The student (mentee) response rate was 91%. Findings demonstrate that students in the study consistently awarded mentors higher ratings than the mentors awarded themselves. The median score for student responses was 54 and 46 for mentors. It appears that mentorship was a positive experience for the students involved in the study. This is despite the fact that, in general, students report feelings of frustration, lack of feedback, variable contact with mentors and an unsupportive atmosphere (Cahill 1996, Tatum & Marrow 1994, Wilson-Barnett et al. 1995). Of the three principal functions outlined by Darling (1984), 82% of students awarded scores of 4 or 5. This is indicative of findings by Booth (1992) and Earnshaw (1995). Darling’s (1984) notions surrounding the investor and inspirer roles relates closely to the concept of mentoring identified in the literature (MacKenzie 1991, Earnshaw 1995, Foy & Waltho 1987, Atkins & Williams 1995). Since the students in this study rated their mentors highly on these aspects, it is assumed that in the main mentors fulfilled their role. For the remaining mentoring roles, students scored mentors highly. In particular the roles of standard-prodder, teacher, feedback-giver, eyeopener, idea-bouncer and problem-solver were consistently rated highly, regardless of whether the mentor processed a teaching and assessing qualification. This could indicate that mentoring is a personal process and that the formal teaching aspects are less important and that ability to teach and assess are not the sole determinants of effective mentoring. Although in this study the roles of ideabouncer, problem-solver and eye-opener received high ratings, others have found this not to be so (Earnshaw 1995). In recent years there has been heightened awareness of the need for these attributes, together with an emphasis on more
Nurse Education Today
(2000) 20, 555–562
559
Student and mentor perceptions of mentoring effectiveness
participatory teaching methods. For example, the introduction of Project 2000 curriculum highlighted the need for nurses to become knowledgeable do-ers and to incorporate problem-solving skills. Low ratings were seen in the roles of dooropener, counsellor and challenger, scoring 3, 1 and 2 respectively. The notion of door-opening is usually associated with career progression and perhaps mentors in this study did not feel in control of this, especially in the current climate where nurses feel there is little opportunity for development. However, there may also have been an element of ‘gate keeping’ on the mentors’ part and a need to maintain control over learning and progression, especially if they felt threatened by an ‘up and coming’ student. Career counsellor and challenger were rated low by both students and mentors. Generally nurses receive little career counselling either as students or when qualified and this may result in the mentors placing limits on the extent of advice and support they are able to provide. The ability to be a challenger is highlighted by Darling (1984) as an important aspect, necessary for exploring issues and developing critical thinking. Nurses do not generally recognize the importance of challenging, as they are socialized to be compliant. Students may not invite challenge from their mentor, either because they feel threatened or lack confidence (Wilson 1994). Whatever the reasons, this gives rise to a ‘safe’ but less stimulating learning environment. Alternatively, students who are seen to be too questioning may appear to upset the status quo and often become unpopular, rather like Stockwell’s (1984) unpopular patient. Students are often forced to conform and are socialized into the pervading culture. The extent to which students engage in the relationship with their mentor is variable and the usually short-term nature of the partnership mitigates against achieving the intensity advocated by some (Mackenzie 1991, ENB 1987, May et al. 1982). Confiding in the mentor is dependent upon the nature and length of the relationship. Other studies suggest that for the majority, mentors neither perceive nor are perceived as counsellors (Atkins & Williams 1995). This is contrary to the guidance from the ENB (1997) who indicate that counselling is part of the mentors’ role.
560
Nurse Education Today
(2000) 20, 555–562
One student, due to particular circumstances, was allocated two mentors. She was frustrated and generally gave low scores. Similar situations which result in frustration for students being mentored are acknowledged in the literature (Cahill 1996, Wilson-Barnett et al. 1995). The practical difficulties associated with mentorship are sometimes underplayed. For example, in this case mentors were reluctant to take on mentoring in a complete and enthusiastic way as neither was wholly responsible for the overall mentoring package.
Further discussion and implications for practice The personal attributes of mentors influence the way in which they carry out the mentoring role (Burnard 1991, Brennan 1993, ENB 1995, Chickerella & Lutz 1981). In this study students had no influence over the choice of mentor as student and mentor were paired on the student’s commencement on the ward. This type of allocation process is cited in some of the literature (Neary et al. 1994, Kramer 1993) and thought to be common practice, but is not necessarily advocated (Burnard 1991, May et al. 1982). Although a system whereby students and mentors self-select, the practical difficulties of this are many, especially in relation to pre-registration programmes. Students do not necessarily know details about possible mentors prior to a placement and once they are there, the process of getting to know someone before making a selection may be lengthy. In many cases, mentors are also responsible for assessing student performance and a delay in selection may affect this process. It may be possible, however, to introduce this type of selection process (taking into account Darling’s (1984) mutual attraction) into some post-registration programmes where some prior knowledge of the area and staff is available. In this study the procession of a teaching and assessing qualification did not appear to influence the effectiveness of the mentoring process. A large proportion of students’ learning takes place outside of the mentor mentee domain and it is not solely the mentor who is responsible for the student’s learning. Students learn from all they interact with and are influenced by the
© 2000 Harcourt Publishers Ltd
Student and mentor perceptions of mentoring effectiveness
learning environment as a whole rather than specific individuals. Having a teaching and assessing qualification did, however, affect mentors’ perceptions of themselves. Those who had such a qualification rated themselves higher than those who did not. This may be an indication that the qualification was useful in relation to mentor confidence. From this and other studies nurses are shown to be weak in challenging the status quo. Whether this is due to lack of confidence or lack of the necessary skills is difficult to determine. However, preparation courses could focus on this. If nurses do not feel able to challenge knowledge, then this will reflect on their interactions with other professionals and in their ability to push the boundaries to develop nursing practice. Mentorship was not a positive experience for one student in the study. Neither mentor felt responsible for the student and this was reflected in the basic roles being unfulfilled. It could also be said that, because of this, the remaining supporting activities were absent. Mentorship is frequently referred to as a dyadic relationship, developing on a one-to-one basis (Donovan 1990, May et al. 1982), which requires involvement and commitment from both parties involved. The issue of whether students should have one or more mentors requires challenging. There are advantages and disadvantages of either approach. In this study the student who had more than one mentor was disadvantaged. However, whether this was more to do with other variables, such as poor communication, is difficult to determine. Some would argue that students will go to whoever they feel is able to provide the necessary advise and support on any particular occasion. Perhaps students should have an identified assessor and be left to identify a series of mentors which suit their particular needs. This may be one individual or many different individuals. This study set out to ascertain mentors’ perceptions of their own mentoring potential and to compare these with students’ perceptions. In addition, it attempted to examine if having a teaching qualification influenced mentoring. It demonstrated that mentors with a teaching and assessing qualification rate themselves more positively than those without. Overall, students
© 2000 Harcourt Publishers Ltd
rate their mentors more positively than the mentors rate themselves. During the course of the study, several recommendations for practice in this particular setting became evident, including the need for: • More consistency in practice regarding the nature and purpose of mentorship • Clear criteria and selection processes for potential mentors, including more extensive use of the MMP scale as a predictive tool • A review of current mentor preparation programmes to align them with the needs of diploma and degree students and to ensure comparability of standards throughout the UK • More discussion regarding the nature and purpose of mentorship, including further examination of a range of mentorship models.
References Andrews M 1993 A Qualitative Study Exploring the Relationship Between Support, Supervision and Clinical Learning for Project 2000 Students. Unpublished MSc Dissertation, University of Manchester Andrews M, Wallis M 1998 Mentorship in Nursing: a literature review. Journal of Advanced Nursing Ashton P, Richardson G 1992 Preceptorship and PREPP. British Journal of Nursing 3:143–145 Atkins S, Williams A 1995 Registered nurses experiences of mentoring undergraduate students. Journal of Advanced Nursing 21:1006–1015 Booth K 1992 Providing support and reducing stress, A review of the literature. In: Butterworth and Faugier (Eds) Clinical Support and Mentorship in Nursing. Chapman Hall, London Brennan A 1993 Preceptorship: is it a workable concept? Nursing Standard 15(52):34–36 Burnard P 1990 The student experiences: adult learning and mentorship revisited. Nurse Education Today 10:349–354 Burnard P 1991 Mentors or preceptors: narrowing the theory practice gap. Nurse Education Today 11:225–229 Cahill H A 1996 The qualitative analysis of student nurses experiences of mentorship. Journal of Advanced Nursing 24:791–799 Chickerella B G, Lutz W J 1981 Professional nurturance: Preceptorship for undergraduate nursing students. American Journal of Nursing 81(1):107–109 Darling L A 1984 What do nurses want in a mentor? The Journal of Nursing Administration Oct:42–44 Donovan J 1990 The concept and role of mentor. Nurse Education Today 10(4):294–298 Earnshaw G J 1995 Mentorship: the students’ views. Nurse Education Today 15:274–279 English National Board for Nursing, Midwifery and Health Visiting 1987 Circular 1987/28 MAT, Approval
Nurse Education Today
(2000) 20, 555–562
561
Student and mentor perceptions of mentoring effectiveness
process for courses in nursing, midwifery and health visiting. ENB, London English National Board for Nursing, Midwifery and Health Visiting 1988 Circular 1988/39 APS, Institutional and Course Approval/Reapproval Process. Information Required, Criteria and Guidelines. English National Board for Nursing, Midwifery and Health Visiting, London English National Board for Nursing, Midwifery and Health Visiting 1995 Changes in regulations and guidelines for the approval of institutional courses. ENB, London Foy H, Waltho B J 1987 The mentor system: are learner nurses benefitting. Senior Nurse 9(5):24–25 Flagier S, Lopez Powers S, Spitzer A 1988 Clinical teaching is more than evaluation alone. Journal of Nursing Education 27(8):342–358 Gillings B 1998 Evaluationg mentor performance. Nursing Times Learning Curve 2(9):8 Goldberg D 1987 Preceptorship: a one to one relationship with a triple P rating. Nursing Forum 1:10–15 Hyland M, Millard J, Parker S 1988 How hospital ward managers treat learner nurses: an investigation of learners perceptions in a British hospital. Journal of Advanced Nursing 13:472–477 Jinks A M, Williams R H 1994 Evaluation of a community staff preparation strategy for the teaching, assessing and mentorship of Project 2000 diploma students. Nurse Education Today 14:44–51 Kramer N 1993 The Reality Shock, Why Nurses Leave Nursing. Mosby, St. Lois Littlejohn L 1992 Effects of mentorship on learners. British Journal of Nursing 9:452–454
562
Nurse Education Today
(2000) 20, 555–562
Mackenzie H 1991 A smoother path. Nursing Times 87(16):34–35 May K M, Meleis A I, Winstead-Fry P 1982 Mentorship for scholarliness: opportunities and dilemmas. Nursing Outlook 30 (January):22–28 Merriam S 1983 Mentors and Proteges, A Critical Review of the Literature. Adult Education Quarterly 33(3):161–173 Morle KMF 1990 Mentorship – is it a case of the emperors new clothes or a rose by any other name? Nurse Education Today 10:66–69 Neary M, Phillips R, Davies B 1994 The Practitionerteacher: A Study in the introduction of Mentors in the Pre-registration Nurse Education Programme in Wales. School of Education, University of Wales, Cardiff Spouse J 1996 The effective mentor: a model for student centred learning. Nursing Times 92(13):32–35 Stockwell F 1984 The Unpopular patient. Croom Helm, London Tatum S Marrow C E 1994 Student supervision, myth or reality? Journal of Advanced Nursing 19: 1247–1255 Wilson M E 1994 Nursing students perspective of learning in a clinical setting. Journal of Nursing Education 33(2):81–86 Wilson-Barnett J, Butterworth T, White E, Twinn S, Davies S, Riley L 1995 Clinical support and the Project 2000 nursing student: factors influencing the process. Journal of Advanced Nursing 21: 1152–1158
© 2000 Harcourt Publishers Ltd
Student and mentor perceptions of mentoring effectiveness Margaret Andrews and Frances Chilton
Margaret Andrews BSc, MSc, RGN, RCNT, RNT, Head of the School of Health and Community Studies, Plas Coch, Mold Road, Wrexham, Clwyd LL1 2AW, UK. Tel.: 01978 293101 Frances Chilton BSc, Dip N, RGN, Staff Nurse, Robert Jones and Agens Hunt Orthopaedic and District Hospital, Gobowen, Oswestry, Shropshire, UK. (Requests for offprints to: M A) Manuscript accepted: 23 February 2000
The following is an account of a small pilot study conducted over a 3-month period which ascertained the views of staff nurses and students about the mentoring process. In particular, whether the possession of a teaching qualification influences the effectiveness of mentors. The research was conducted in a district general hospital in North Wales. The findings demonstrate that staff nurses with a teaching and assessing qualification consistently rate themselves as more effective and supportive than those without. Other findings show that students consistently rate their mentors positively irrespective of whether they held a teaching and assessing qualification and that students rate their mentors more positively than the mentors themselves. Although these findings are not generalizable in the accepted sense they may be applicable to other practice settings. The findings and discussion indicate several implications for future practice including the need for: • More consistency in practice regarding the nature and purpose of mentorship • Clear criteria and selection processes for potential mentors, including more extensive use of the Measuring Mentor Potential (MMP) scale as a predictive tool • A review of current mentor preparation programmes to align them with the needs of diploma and degree students and to ensure comparability of standards throughout the UK • More discussion regarding the nature and purpose of mentorship including further examination of a range of mentorship models. © 2000 Harcourt Publishers Ltd
Introduction Much has been written about the support mechanisms for students in practice settings, with both qualified nurses and students favouring the mentorship approach. However, although there is acknowledgment that mentoring is a complex and important activity, there is little to explain how mentors are selected or prepared. These aspects are becoming increasingly important as student numbers increase and more qualified nurses are required to act as mentors. Current literature illustrates a lack of consistency regarding definition of the concept, and highlights a variety of interpretations of the
© 2000 Harcourt Publishers Ltd doi:10.1054/nedt.2000.0464, available online at http://www.idealibrary.com on
role. In addition, practice dictates that some nurses are not mentors by choice, it becomes a compulsory part of their job. Having mentors who may not be in that position by choice only serves to compound the difficulties and does nothing to ensure that appropriate standards are consistent. Mentors are prepared in a variety of ways, from observing how others function to more formal arrangements such as mentor training courses. They often feel inadequate in their roles, either because their own training did not equip them for current practice or because they do not wholly understand the aims of the preregistration curriculum. The majority of
Nurse Education Today (2000) 20, 555–562 555
Student and mentor perceptions of mentoring effectiveness
practitioners have not studied at diploma level and their experience does not fully compensate for the lack of theoretical knowledge. Mentors themselves have doubts about their own level of preparation and acknowledge that they have not been adequately prepared (Andrews 1993). The purpose of this paper is to: • Briefly outline some of the appropriate literature • Describe a small pilot study concerning perceptions of mentoring potential from both the mentor and mentee perspective • Discuss the implication of the findings to mentoring practices.
Review of the literature Although much has been written about the qualities, characteristics and core attributes of good mentors, there is little in relation to selection and training (Andrews & Wallis 1998). In practice, no real selection of suitable mentors occurs, and it is assumed that all qualified nurses can be effective in this respect. Some nurses take on a mentoring role because of aptitude, interest or because students have identified them as good role models. Educational preparation is usually in the form of the Welsh National Board Teaching and Assessing in Clinical Practice module (or equivalent, e.g. English National Board 998) or by short courses applicable to the particular setting. Preparation is not common and varies from area to area (Wilson-Barnett et al. 1995). WilsonBarnett et al. (1995) and Neary et al. (1994) found that both teaching and assessing and shorter courses were inadequate preparation and that most mentors learn ‘on the job’. Jinks and Williams (1994) found that those nurses who undertake a shortened version of preparation feel ‘short changed’, thus indicating that the more extensive programmes are perceived by mentors to be better preparation. Jinks and Williams’ (1994) study also highlighted that those mentors who had undertaken a formal teaching and assessing programme felt significantly more able to undertake the role. Some researchers have identified characteristics which can be used as indicators to identify potential mentors (Darling 1984, Goldberg 1987, Donnovan 1990, Ashton &
556
Nurse Education Today
(2000) 20, 555–562
Richardson 1992). The literature highlights characteristics such as having a non-judgmental attitude, patience, being supportive and understanding as positive attributes. Studies focusing on the effects of mentorship on student or pupil nurses include those of Littlejohn (1992), Mackenzie (1991) and Spouse (1996). However, there is little literature concerning qualified nurses’ experiences (Atkins & Williams 1995) or their effectiveness in the mentoring process. An important study which examines a range of views, including that of mentors, was undertaken by Neary et al. (1992) who examined the introduction of mentorship (although this term was avoided in the study) in the Common Foundation Programme (CFP) in a number of colleges in Wales. Neary et al. (1994) describe a good mentor as someone who possesses appropriate professional attributes, knowledge, good communication skills and the motivation to teach and support students. The key elements of the role are seen as teaching, support and assessment of student performance. Mentors in this study found conflict between the competing demands of mentoring and providing direct patient care. However, the presence of a mentor meant that learning was more likely to be planned and was an important influence on how the student perceived the learning experience. Darling (1984) is one of the most commonly cited researchers in the literature concerning mentorship. Over a 2-year period, Darling (1984) interviewed 50 nurses, 20 physicians and 80 health care executives about their experiences with mentors, in particular what they wanted from a mentor. From this she identified indicative characteristics and developed the Measuring Mentoring Potential (MMP) scale. Darling (1984) highlights that an effective mentor has three absolute requirements, three basic mentoring roles and nine action roles. The ‘absolute’ requirements for successful mentoring she identifies as: attraction (mutual), action (time and energy) and affect (mutual respect). From these she highlights 14 roles, three of which are basic to mentoring: inspirer (attraction), investor (action) and supporter (affect) (See Fig. 1). Darling (1984) developed the MMP scale into a questionnaire which enables individuals to evaluate their own or others’ mentoring potential. An overall score is achieved by rating each
© 2000 Harcourt Publishers Ltd
Student and mentor perceptions of mentoring effectiveness
1 Model
}
2 Envisioner
}
3 Energiser
}
8 Teacher
9 Feedback - giver
Inspirer Role
10 Eye - opener
11 Door - opener
4 Investor
Investor Role
12 Idea - bouncer
13 Problem - solver 5 Supporter
Supporter Role
14 Career counsellor
6 Challenger
7 Standard - prodder Fig. 1
Adaptation of Darling’s (1984) Characteristics of effective mentoring.
characteristic from 1 (low) to 5 (high). At least one of the inspirer roles (1–3 in Fig. 1) should achieve a rating of 4 or 5 along with supporter and investor. The higher the overall score, the more well rounded the mentor (Darling 1984). The findings from Darling’s (1984) study demonstrated that there was no difference between what nurses and other professional groups want from a mentor. In the main, the literature reports mentorship as a positive endeavor (Foy & Waltho 1989, Littlejohn 1992, Earnshaw 1995), and experience suggests that in practice this is also the case. However, Merriam (1983) criticizes much of the research on mentorship and highlights inadequate operational definitions, unsophisticated methodology and lack of rigour. Some literature does suggest that it can be a negative experience for some (Cahill 1996, Spouse 1996, Tatum & Marrow 1994). Despite the prolific literature on mentors and the mentoring process (ENB 1987, Morle 1990, Kramer 1993, Cahill 1996), there remains little agreement about the most effective method for mentoring or the selection of mentors. Selection
© 2000 Harcourt Publishers Ltd
poses particular problems, especially as there is a lack of selection criteria and evaluation of effectiveness.
Background to the study The purpose of the study was to: • Evaluate staff nurses’ perceptions of their own aptitude for mentoring • Ascertain students’ perceptions of their mentors’ mentoring ability • Make a comparison of staff nurses’ and students’ perceptions • Identify if the possession of a teaching and assessing qualification influenced the mentoring process. The study took place on two wards in a district general hospital in North Wales. It elicited the views of 22 staff nurses (mentors) involved with the clinical education of student nurse and 11 student nurses (mentees) allocated to the study area. The research was conducted in two parts. The first involved a sample of qualified nurses at
Nurse Education Today
(2000) 20, 555–562
557
Student and mentor perceptions of mentoring effectiveness
staff nurse level who were mentors to students or who had acted in this capacity previously. The second consisted of a group of student nurses allocated to the two wards during a 3-month period. The staff nurses were drawn from a purposive sample, their ages ranged from 21 to 45 years and they had been qualified between 1 and 21 years. They had spent between 1 and 10 years in their present positions. Half of the staff nurses already processed a teaching and assessing qualification, either the WNB, ENB teaching and Assessing in clinical practice (or equivalent) or a shortened version designed for student mentorship purposes. Eleven were mentoring students at the time the study was taking place. A sample of 11 first, second and third year students was obtained (two male, nine female), whose ages ranged from 18 to 45. Data from both response groups were obtained concurrently. Current practice in this area dictated that students did not select their mentors, they were assigned to them on an ad hoc basis (Brennen 1993). Indeed the cases where mutual selection occurs appear to be the exception rather than the rule, despite the literature identifying this as good practice (Kramer 1993, ENB 1995, Burnard 1990, May et al. 1980). The selection of mentors and the pairing of mentors with students in this study was therefore arbitrary but reflects similar practice in other settings (Littlejohn 1992).
Method Questionnaires were used as the main data collecting method for both sets of respondents. These were developed from the major themes emanating from the literature and incorporated Darling’s (1984) MMP scale (see Fig 1). Questionnaires were similar for both sets of respondents, i.e. both asked for general information and both utilized Darling’s (1984) MMP scale. To help respondents, an explanation for each of the characteristics was provided. The questionnaires were personalized for the mentor respondents so that they clearly indicated that that this was a self-assessment. Both sets of questionnaires were piloted using respondents with similar characteristics to the subjects in the study. The questionnaire was well received and piloting resulted in minimal alteration.
558
Nurse Education Today
(2000) 20, 555–562
An overall score from the questionnaire was achieved by rating each of Darling’s characteristics from 1 (low) to 5 (High). The responses were standardized and numerically analysed. Although the numerical values are of little significance as the data are of the ordinal level of measurement, they do demonstrate general trends. In this study it was not the actual numbers that were important, rather how mentoring effectiveness was perceived. Staff nurse included information relating to past and present experiences of mentoring. The students completed the questionnaire at the end of their ward placement and were asked to review the preceding weeks’ experience. The clarification information was given in the past tense encouraging them to review the previous weeks. Mentors completed the questionnaires at the beginning of the mentoring period with a student.
Findings These findings should be seen in light of the following: • Students were asked to complete the MMP one week before their placement ended and prior to receiving their final report • No measures were in place to ‘test out’ mentoring effectiveness from any other perspective, i.e. there was no objective measurement of effectiveness • All students attained the appropriate outcomes associated with practice. These findings should be read with some caution as they are not generalizable in the accepted sense, and are wholly based on the mentors’ and students’ perceptions. They may, however, be applicable to other practice settings.
Mentors The response rate for the mentors’ (staff nurses) questionnaire was 82%. The findings demonstrate that mentors with a teaching and assessing qualification consistently rated themselves higher (total MMP score) than those without (median score of 50 and 41 respectively). The possession of a teaching and assessing qualification did influence mentors’ perception of themselves and indicated that those who held this qualification were generally more confident
© 2000 Harcourt Publishers Ltd
Student and mentor perceptions of mentoring effectiveness
with regard to the principal functions associated with mentoring. They appeared more at ease with their roles. Darling (1984) identified three principal functions of a mentor: inspirer, investor and supporter. She indicates that mentors should score 4 or 5 in at least one of these areas. Seventyeight percent (78%) of mentors who possessed a teaching and assessing qualification achieved ratings of 4–5 in both the investor and supporter roles. Whereas only 44% of mentors without a teaching and assessing qualification achieved 4 or 5 in these categories. Eighty-nine percent (89%) of mentors without a teaching and assessing qualification scored at least one rating of 5 in one of the roles. Although overall the mentors without a teaching and assessing qualification did score less highly than those with, they did fulfill Darling’s requirements. Investor and supporter characteristics are attributes highly valued in the literature, as well as by mentors themselves (ENB 1988, Hyland et al. 1988, Earnshaw 1995, Booth 1992). However, these functions alone are not necessarily the only determinants of good mentoring. Numerous authors (Earnshaw 1995, Booth 1992, ENB 1995) emphasize the importance of guidance and support for students. Mentors in this study scored highly in the supporter category, with qualified mentors scoring the highest. This is indicative of the high level of commitment that all mentors give to the process of mentoring and similar findings are described by Flagier et al. (1988) and Booth (1992). Conversely, some would suggest that mentors are not always cognisant of the need to provide students with guidance and support, which often leads to relationship difficulties between mentor and student (Cahill 1996, Tatum & Marrow 1994, Wilson-Barnett et al. 1995). Other attributes highlighted by Darling are role model, energizer, standard-prodder, teacher, feedback-giver, eye-opener, door-opener, ideabouncer, problem-solver, career counsellor and challenger. Being a mentor requires teaching skills (Atkins & Williams 1995) and the majority of mentor preparation courses acknowledge this. In this study mentors with a teaching and assessing qualification rated themselves a score of 4 or more for teaching and problem solving as they felt more equipped for these elements of the role.
© 2000 Harcourt Publishers Ltd
Mentors consistently scored themselves lower on characteristics such as career counsellor, a function promoted by the ENB (1987) and others (Ashton & Richardson 1992, Goldberg 1987). This may be a reflection of the current instability in practice settings with staff nurses feeling insecure about their own futures and career development, making them less able to advise others.
Students The student (mentee) response rate was 91%. Findings demonstrate that students in the study consistently awarded mentors higher ratings than the mentors awarded themselves. The median score for student responses was 54 and 46 for mentors. It appears that mentorship was a positive experience for the students involved in the study. This is despite the fact that, in general, students report feelings of frustration, lack of feedback, variable contact with mentors and an unsupportive atmosphere (Cahill 1996, Tatum & Marrow 1994, Wilson-Barnett et al. 1995). Of the three principal functions outlined by Darling (1984), 82% of students awarded scores of 4 or 5. This is indicative of findings by Booth (1992) and Earnshaw (1995). Darling’s (1984) notions surrounding the investor and inspirer roles relates closely to the concept of mentoring identified in the literature (MacKenzie 1991, Earnshaw 1995, Foy & Waltho 1987, Atkins & Williams 1995). Since the students in this study rated their mentors highly on these aspects, it is assumed that in the main mentors fulfilled their role. For the remaining mentoring roles, students scored mentors highly. In particular the roles of standard-prodder, teacher, feedback-giver, eyeopener, idea-bouncer and problem-solver were consistently rated highly, regardless of whether the mentor processed a teaching and assessing qualification. This could indicate that mentoring is a personal process and that the formal teaching aspects are less important and that ability to teach and assess are not the sole determinants of effective mentoring. Although in this study the roles of ideabouncer, problem-solver and eye-opener received high ratings, others have found this not to be so (Earnshaw 1995). In recent years there has been heightened awareness of the need for these attributes, together with an emphasis on more
Nurse Education Today
(2000) 20, 555–562
559
Student and mentor perceptions of mentoring effectiveness
participatory teaching methods. For example, the introduction of Project 2000 curriculum highlighted the need for nurses to become knowledgeable do-ers and to incorporate problem-solving skills. Low ratings were seen in the roles of dooropener, counsellor and challenger, scoring 3, 1 and 2 respectively. The notion of door-opening is usually associated with career progression and perhaps mentors in this study did not feel in control of this, especially in the current climate where nurses feel there is little opportunity for development. However, there may also have been an element of ‘gate keeping’ on the mentors’ part and a need to maintain control over learning and progression, especially if they felt threatened by an ‘up and coming’ student. Career counsellor and challenger were rated low by both students and mentors. Generally nurses receive little career counselling either as students or when qualified and this may result in the mentors placing limits on the extent of advice and support they are able to provide. The ability to be a challenger is highlighted by Darling (1984) as an important aspect, necessary for exploring issues and developing critical thinking. Nurses do not generally recognize the importance of challenging, as they are socialized to be compliant. Students may not invite challenge from their mentor, either because they feel threatened or lack confidence (Wilson 1994). Whatever the reasons, this gives rise to a ‘safe’ but less stimulating learning environment. Alternatively, students who are seen to be too questioning may appear to upset the status quo and often become unpopular, rather like Stockwell’s (1984) unpopular patient. Students are often forced to conform and are socialized into the pervading culture. The extent to which students engage in the relationship with their mentor is variable and the usually short-term nature of the partnership mitigates against achieving the intensity advocated by some (Mackenzie 1991, ENB 1987, May et al. 1982). Confiding in the mentor is dependent upon the nature and length of the relationship. Other studies suggest that for the majority, mentors neither perceive nor are perceived as counsellors (Atkins & Williams 1995). This is contrary to the guidance from the ENB (1997) who indicate that counselling is part of the mentors’ role.
560
Nurse Education Today
(2000) 20, 555–562
One student, due to particular circumstances, was allocated two mentors. She was frustrated and generally gave low scores. Similar situations which result in frustration for students being mentored are acknowledged in the literature (Cahill 1996, Wilson-Barnett et al. 1995). The practical difficulties associated with mentorship are sometimes underplayed. For example, in this case mentors were reluctant to take on mentoring in a complete and enthusiastic way as neither was wholly responsible for the overall mentoring package.
Further discussion and implications for practice The personal attributes of mentors influence the way in which they carry out the mentoring role (Burnard 1991, Brennan 1993, ENB 1995, Chickerella & Lutz 1981). In this study students had no influence over the choice of mentor as student and mentor were paired on the student’s commencement on the ward. This type of allocation process is cited in some of the literature (Neary et al. 1994, Kramer 1993) and thought to be common practice, but is not necessarily advocated (Burnard 1991, May et al. 1982). Although a system whereby students and mentors self-select, the practical difficulties of this are many, especially in relation to pre-registration programmes. Students do not necessarily know details about possible mentors prior to a placement and once they are there, the process of getting to know someone before making a selection may be lengthy. In many cases, mentors are also responsible for assessing student performance and a delay in selection may affect this process. It may be possible, however, to introduce this type of selection process (taking into account Darling’s (1984) mutual attraction) into some post-registration programmes where some prior knowledge of the area and staff is available. In this study the procession of a teaching and assessing qualification did not appear to influence the effectiveness of the mentoring process. A large proportion of students’ learning takes place outside of the mentor mentee domain and it is not solely the mentor who is responsible for the student’s learning. Students learn from all they interact with and are influenced by the
© 2000 Harcourt Publishers Ltd
Student and mentor perceptions of mentoring effectiveness
learning environment as a whole rather than specific individuals. Having a teaching and assessing qualification did, however, affect mentors’ perceptions of themselves. Those who had such a qualification rated themselves higher than those who did not. This may be an indication that the qualification was useful in relation to mentor confidence. From this and other studies nurses are shown to be weak in challenging the status quo. Whether this is due to lack of confidence or lack of the necessary skills is difficult to determine. However, preparation courses could focus on this. If nurses do not feel able to challenge knowledge, then this will reflect on their interactions with other professionals and in their ability to push the boundaries to develop nursing practice. Mentorship was not a positive experience for one student in the study. Neither mentor felt responsible for the student and this was reflected in the basic roles being unfulfilled. It could also be said that, because of this, the remaining supporting activities were absent. Mentorship is frequently referred to as a dyadic relationship, developing on a one-to-one basis (Donovan 1990, May et al. 1982), which requires involvement and commitment from both parties involved. The issue of whether students should have one or more mentors requires challenging. There are advantages and disadvantages of either approach. In this study the student who had more than one mentor was disadvantaged. However, whether this was more to do with other variables, such as poor communication, is difficult to determine. Some would argue that students will go to whoever they feel is able to provide the necessary advise and support on any particular occasion. Perhaps students should have an identified assessor and be left to identify a series of mentors which suit their particular needs. This may be one individual or many different individuals. This study set out to ascertain mentors’ perceptions of their own mentoring potential and to compare these with students’ perceptions. In addition, it attempted to examine if having a teaching qualification influenced mentoring. It demonstrated that mentors with a teaching and assessing qualification rate themselves more positively than those without. Overall, students
© 2000 Harcourt Publishers Ltd
rate their mentors more positively than the mentors rate themselves. During the course of the study, several recommendations for practice in this particular setting became evident, including the need for: • More consistency in practice regarding the nature and purpose of mentorship • Clear criteria and selection processes for potential mentors, including more extensive use of the MMP scale as a predictive tool • A review of current mentor preparation programmes to align them with the needs of diploma and degree students and to ensure comparability of standards throughout the UK • More discussion regarding the nature and purpose of mentorship, including further examination of a range of mentorship models.
References Andrews M 1993 A Qualitative Study Exploring the Relationship Between Support, Supervision and Clinical Learning for Project 2000 Students. Unpublished MSc Dissertation, University of Manchester Andrews M, Wallis M 1998 Mentorship in Nursing: a literature review. Journal of Advanced Nursing Ashton P, Richardson G 1992 Preceptorship and PREPP. British Journal of Nursing 3:143–145 Atkins S, Williams A 1995 Registered nurses experiences of mentoring undergraduate students. Journal of Advanced Nursing 21:1006–1015 Booth K 1992 Providing support and reducing stress, A review of the literature. In: Butterworth and Faugier (Eds) Clinical Support and Mentorship in Nursing. Chapman Hall, London Brennan A 1993 Preceptorship: is it a workable concept? Nursing Standard 15(52):34–36 Burnard P 1990 The student experiences: adult learning and mentorship revisited. Nurse Education Today 10:349–354 Burnard P 1991 Mentors or preceptors: narrowing the theory practice gap. Nurse Education Today 11:225–229 Cahill H A 1996 The qualitative analysis of student nurses experiences of mentorship. Journal of Advanced Nursing 24:791–799 Chickerella B G, Lutz W J 1981 Professional nurturance: Preceptorship for undergraduate nursing students. American Journal of Nursing 81(1):107–109 Darling L A 1984 What do nurses want in a mentor? The Journal of Nursing Administration Oct:42–44 Donovan J 1990 The concept and role of mentor. Nurse Education Today 10(4):294–298 Earnshaw G J 1995 Mentorship: the students’ views. Nurse Education Today 15:274–279 English National Board for Nursing, Midwifery and Health Visiting 1987 Circular 1987/28 MAT, Approval
Nurse Education Today
(2000) 20, 555–562
561
Student and mentor perceptions of mentoring effectiveness
process for courses in nursing, midwifery and health visiting. ENB, London English National Board for Nursing, Midwifery and Health Visiting 1988 Circular 1988/39 APS, Institutional and Course Approval/Reapproval Process. Information Required, Criteria and Guidelines. English National Board for Nursing, Midwifery and Health Visiting, London English National Board for Nursing, Midwifery and Health Visiting 1995 Changes in regulations and guidelines for the approval of institutional courses. ENB, London Foy H, Waltho B J 1987 The mentor system: are learner nurses benefitting. Senior Nurse 9(5):24–25 Flagier S, Lopez Powers S, Spitzer A 1988 Clinical teaching is more than evaluation alone. Journal of Nursing Education 27(8):342–358 Gillings B 1998 Evaluationg mentor performance. Nursing Times Learning Curve 2(9):8 Goldberg D 1987 Preceptorship: a one to one relationship with a triple P rating. Nursing Forum 1:10–15 Hyland M, Millard J, Parker S 1988 How hospital ward managers treat learner nurses: an investigation of learners perceptions in a British hospital. Journal of Advanced Nursing 13:472–477 Jinks A M, Williams R H 1994 Evaluation of a community staff preparation strategy for the teaching, assessing and mentorship of Project 2000 diploma students. Nurse Education Today 14:44–51 Kramer N 1993 The Reality Shock, Why Nurses Leave Nursing. Mosby, St. Lois Littlejohn L 1992 Effects of mentorship on learners. British Journal of Nursing 9:452–454
562
Nurse Education Today
(2000) 20, 555–562
Mackenzie H 1991 A smoother path. Nursing Times 87(16):34–35 May K M, Meleis A I, Winstead-Fry P 1982 Mentorship for scholarliness: opportunities and dilemmas. Nursing Outlook 30 (January):22–28 Merriam S 1983 Mentors and Proteges, A Critical Review of the Literature. Adult Education Quarterly 33(3):161–173 Morle KMF 1990 Mentorship – is it a case of the emperors new clothes or a rose by any other name? Nurse Education Today 10:66–69 Neary M, Phillips R, Davies B 1994 The Practitionerteacher: A Study in the introduction of Mentors in the Pre-registration Nurse Education Programme in Wales. School of Education, University of Wales, Cardiff Spouse J 1996 The effective mentor: a model for student centred learning. Nursing Times 92(13):32–35 Stockwell F 1984 The Unpopular patient. Croom Helm, London Tatum S Marrow C E 1994 Student supervision, myth or reality? Journal of Advanced Nursing 19: 1247–1255 Wilson M E 1994 Nursing students perspective of learning in a clinical setting. Journal of Nursing Education 33(2):81–86 Wilson-Barnett J, Butterworth T, White E, Twinn S, Davies S, Riley L 1995 Clinical support and the Project 2000 nursing student: factors influencing the process. Journal of Advanced Nursing 21: 1152–1158
© 2000 Harcourt Publishers Ltd