Case Study For Nursing Of Values And Modern Nursing

Role of Leadership and Mentorship in Nursing Profession

Discuss about the Case Study for Nursing of Values and Modern Nursing.

This is a reflective piece of work dealing with the themes of leadership and mentorship in the context of developing personality and professionalism as a degree level student preparing to become a registered nurse in the field of adult nursing. This paper discusses my role, responsibility, changing personal and professional values, accountability, my practice experience, and related theory. There are eight principles essential and central in nursing profession outlined by “The Nursing and midwifery council” (Alligood, 2014). The eighth principle refers to leadership and mentorship which are essential skills required by nurses. According to the department of health a nurse is required to act as a leader or an agent of change irrespective of position, qualification, for improving and enhancing care services for well being of patients (Fawcett & Desanto-Madeya, 2012). Mentorship is the ability to facilitate learning, supervise and contribute towards professional development of others (Chen, Watson & Hilton, 2016). Every nurse has to assume the role of mentoring sooner or later in the professional life. This concept highlights the fact that a nurse as a mentor fosters academic and clinical growth of novice nurse. A nurse leader is always pro-active in creating environment that is safe, positive and facilitates empowerment of nursing staff. This is also effective in minimizing barriers to process and perception of mentorship (Monaghan, 2015). In order to advance in the field of nursing with knowledge and skill sets requires support and nurture from senior and experience nurses. This helps facilitate safe, accountable and competent standard care (Jokelainen et al., 2013). According to Page & McDonnell, (2015), for a nursing student development of self-concept and proper implementation of the theoretical knowledge into practice needs acceptance from nursing leader and senior staff. A positive learning experience helps develop attributes of a good mentor and leader. A negative experience effects learning process due to increase in stress, anxiety, and feeling of un-acceptance by instructors (Chen et al., 2016). Consequently, it effects perceptions and attitude of nurses towards their job and themselves.  

The purpose of this refection is to examine the leadership qualities and relate with my personal experience. This assignment is to identify my developmental needs and leadership strength. The study will consider the learning environment and how well the techniques to facilitate learning have been incorporated in my professional practice and analyze the areas needing more evaluation to develop. The same is included in the personal development plan given in appendix together with SWOT analysis based on the experiences. Gibbs reflective cycle will be used in this assignment for self evaluation as it is prompted by Gibbs that taking action is the key strategy for a practioners.  The new understanding obtained by formulating an action plan can be implemented in the practice. The reflection is written in first person and the names have been has changed to maintain confidentiality and protect patient identity as per NMC code of professional conduct.  This study does not include all the leadership theories in great depth but is mainly centered on those that are required for future practice and applies to experiences as student nurse.

The concept and definition of Mentorship in Nursing

The concept of Mentorship has been present in health care sector since several years.  It is developing and evolving since 1970s but have been adopted by the operating department practioners and nurses in 1980 (Walsh, 2014). It is an effective and important role that has to be adopted by nurses at one point in their profession. The term mentorship is defined in various ways and it is believed by Page & McDonnell, (2015) that these definitions add to the “ambiguity of the role of mentor in today’s nursing press.” According to the “Nursing and Midwifery Council” or NMC the practioners who has met the eligibility criteria for becoming a qualified mentor and the one who supervises, assesses and facilitates learning in practice setting is the best mentor (Yoder-Wise, 2014). The reports of Cone, & Giske, (2013) showed that 50% of the nursing students who are qualified has registered nurse is mainly the “outcome of assessment conducted” by the work-place mentor. Fallatah & Laschinger, (2016) argues that the concept of mentorship in nursing involves a nurse to apply a variety of learning approaches to assist the development of others. MacPhee et al., (2012) stated that mentorship is the relationship between the mentor and mentee where the former encourages the later to take responsibility of their learning needs to accomplish their goals.

Currently, mentorship has become an “integral part of nursing” as well as other roles of healthcare practioners (Marquis, & Huston, 2009). According to Jokelainen et al., (2013) a mentor is responsible to “The NMC standards of codes” for assessing the competencies of a student to uptake the role of registered nurse. They are accountable because they pass only those students whom they consider competent enough for nursing practicing. This signifies the mentorship role and the critical role played by a mentor in shaping a career of the students. Ultimately, the NMC is playing a vital role in protecting the standards set by the people for “pre-registration theory and practice competency” (Fawcett & Desanto-Madeya, 2012). These standards require students to best suit the practice and for purpose at the point of registration (Laschinger et al., 2014). In my experience, I have come across different types of mentors playing their role in various ways. Some apply well-structured approach to the attainment of the placement outcomes (Page & McDonnell, 2015), whereas as some other mentors have more relaxed style in completing the paper work (DeNisco & Barker, 2012).  These mentors emphasize more on building rapport with the students as well as allowing them to recognize their own learning priorities.

The Importance of Mentorship in Nursing Profession

According to Yepes-Roi et al., (2015), the effective mentorship skills include empathy, communication, approachable, and non-judgmental. Further, Schoening, (2013) agrees that believing in mentees ability and motivating students is a best attribute of an effective mentor. Fallatah & Laschinger, (2016) has put forward his idea of mentorship, which says that an effective mentor knows to strike a balance between educating student and fulfilling the responsibility of assigned duties.  Giltinane, (2013) described that a toxic mentor is the one who avoid mentee and never makes them feel belonged. They are unavailable to their students most of the time after placing them in the new situation. They intentionally or unintentionally obstruct the learning process of the students. This decreases the self-esteem, confidence, and this negative experience leads to stress, anxiety and depression (Wong et al., 2013). Such students in turn fail to become effective mentors. Observational studies of Giltinane, (2013) revealed that the problem arises when the mentee fails to openly communicate or challenge the mentor for the fear of adverse outcomes and mentor too fails to meet different expectations of the students. This fits a scenario where my friend Sarah could not express her concerns, as she never received evidence based backup. Huber, (2013) adds to this saying that an effective mentor is able to create a learning environment where students can explore their ideas involve voluntarily. This fact is consistent with “the theory of facilitation” proposed by Carl Rogers (MacPhee et al., 2012). The theory states that a mentee learns voluntarily when a teacher facilitates appropriate learning environment taking into consideration the learning wishes of the students and breaking any barriers to learning Giltinane, (2013).

I have been fortunate enough to work under seniors who have tried to bring the best out of me and have demonstrated the best mentorship skills outlined by NMC. I was able to work in a positive environment and I have felt accepted by my mentor. I would definitely play a similar role in future after I turn to be an experienced registered nurse. Fortunately, I have never received any toxic mentorship. As a student I have experienced different situation where nurses have played an excellent role as mentor. I have been under one such registered nurse who can clearly identify the students with high incompetence and those who are on borderline in attaining competence. She gave the students a benefit of doubt and was quick in addressing the non-competence issues from the very moment she identified. She tended to give her students the benefit of doubt and well back up their concerns. I was blessed to have such pro-active mentor and I will bring these qualities to the role in the future. As a student I have observed that a mentor with strong knowledge base is better able and more willing to share the information than the opposite counterparts. During my second year I was mentored by a nurse with whom I could build a strong rapport. She was always positive in her attitude, sharing views and resolved my queries with great patience. However, she did not have similar bonding with other students in my team. The reason could be probably my purposeful involvement with her to obtain best learning outcome. With this experience I can conclude that students too should involve to their fullest with the mentors to obtain best of their knowledge. It may not be always possible for a mentor to realize student’s potential and proceed accordingly as no individual can be flawless in every role they play in life (Kelly, 2011). Therefore, a little conscious decision to “continue to learn” taken by student will help to avoid the negative experience from a toxic mentorship described by (Wong et al., 2013).

Attributes of an Effective Mentor

Julnes & Jensen, (2016) believes that effective mentor engages in providing feedback to the students to make them aware if they failed to meet the required standards. Cone & Giske, (2013) recommends a constructive feedback should be a part of assessment and progression and it should be objective and nonjudgmental as well as based on specific observation. This will promote student involvement in discussions and allow future learning to takes place (Julnes & Jensen, 2016). A negative feedback is necessary to motivate students where as a negative feedback is essential to enhance or improve the performance by giving the student knowledge of what is going wrong (Yoder-Wise, 2014). The Royal College of Nursing advises a regular meeting between the mentor and students (Laschinger et al., 2014). It is necessary to discuss the progression and modify the action plan accordingly (Vaismoradi et al., 2016). This information is also consistent with the objectives set for mentors by the Nursing and Midwifery Council. It includes mentor to identify the level of knowledge a student has and assess the learning needs and expectations of the students (Fallatah & Laschinger, 2016). Yoder-Wise, (2014) believes that this will help to best facilitate the learning opportunities, activities and integrate their practice experience. A student should also be aware of their own learning style and mange their academic experience (Galletta et al., 2013). I personally believe that it is difficult to teach without understanding the learners’ preference. Several times not only in first year but also in third year, I was unsure of my progress. This is where I have taken feedback from my teammates and mentor demonstrating “accountability for my own development” (see appendix –Reflection1). It helped me in identifying my drawbacks such as exhibiting over confidence, disorientation, mismanagement of time due to laziness, and others. I remember the case of John where I could not collect all the details that were relevant. I was appreciated by mentor on several occasions for engaging in positive discussion with her.

 DeNisco & Barker, (2012) believes that a student must engage in the process of continuous self-assessment and development. Just as patient empowerment is central to the patient-centered care, student empowerment is central to the student mentorship (McCallum et al., 2016). I could better self-assess myself when I was aware of my mentor’s expectations and had a good plan to track my progress (appendix 1). It helped me in defining my role clearly; hence, I could integrate into the team confidently. From my experience, I believe that the mentors also must take feedback from the student, as sometimes mentor tend to consider that all the students are on same page. Feedback helps a student to make a mentor aware about the changes required to create a suitable environment and enhance the learning experience (Huber, 2013). I have experienced that in Operation Theater we students were many a times left like a “spare part”. We had less opportunity to work with the mentor, which made us feel like an irrelevant to their practice as a “theater nurse”. It leads to feeling of “feel disempowered and under-valued”. In short, I want to explain that not only the students who must reflect on their practice but also mentors, as “learning is a lifelong practice” (Schoening, 2013).  The NMC also advocates using reflection as a tool to improve one’s self knowledge (Giltinane, 2013). This is something I would definitely incorporate in my future role as a mentor to improve the results by designing a plan to meet the student’s specific needs.

Toxic Mentorship in Nursing Profession

There are several different theories existing for best learning outcomes. However, every individual has different intellectual capacity and learning style, so; one theory may not be applicable for all cases. According to the Skinner’s reinforcement, theory the reward and punishment system of learning is best to motivate the students (Alligood, 2014). This is also the quality of a transactional leader (Chen, Watson & Hilton, 2016). I can best explain this with my personal experience where I have less than desirable experiences when I was not meeting the requirements of my domains such as preparing extra set of assignment or suspension from next practical for an hour.  However, this did not discourage me rather; it motivated me to strive more hard to prove my competence. I was rewarded with books or small mementos when I excelled in the given responsibility. Chen et al., (2016) emphasized the importance of “role- modeling”. It is not only refers to “observing practice” but also involves considered linkage between “acquisition of practical skills and its underlying knowledge” as opined by (Fawcett & Desanto-Madeya, 2012). For example, my mentor Helen, in the first year ensured that I was aware of the then current guidelines and information related to effective surgical hand-washing. She also demonstrated me the correct scrubbing method in the format used in our department. She was always there when I failed to understand particular protocol and acknowledge my learning style. This is consistent with the “David Kolb’s experiential learning model” (Monaghan, 2015). It describes that an effective nurse acknowledges the learning style of the mentee and carries out majority of the learning by role modeling. Page & McDonnell, (2015) agrees with David Kolb’s model stating that best learning outcomes are difficult to achieve in a “formal teacher to student scenario”. From my personal experience I can say that one can better learn by observing and adopting the values and beliefs of others. The theory of role modeling is highly relevant to mentors due to their busy workload dealing with patients. Therefore, they are left with teaching students by demonstrating their best skills and students are left with observe and learn option (Giltinane, 2013). I have implemented this model when I was a third year student and have been instructed to mentor first year students (see appendix-reflection 2).

There are barriers to delivering high quality mentorship to the students. These barriers were identified to be lack of time due to high clinical workload (Page & McDonnell, 2015).  Consequently, mentors are too stressed to involve in open discussion with the students. Alligood, (2014) demonstrated that it leads to false judgment and the phenomenon of “failing to fail” students. The cause of this phenomenon was the emotional challenge faced by the mentors. They are not able to recognize the student’s problem on time and are highly unsure of student’s competency as registered nurse (Monaghan, 2015). Therefore, Chen, Watson & Hilton, (2016) recommends that there is a need of effective leadership and management to support mentors and minimize the barriers. There is clear difference between leadership and management although both are used interchangebly. The former includes doing a right thing whereas the later is about doing things right (Galletta et al., 2013). It is specified by NMC under the domain of leadership that mentors also need to exhibit the leadership skills in the practice environment (Wong et al., 2013). To ensure sufficient time and support the students in learning phase demands a mentor to plan series of learning activities and prioritize the busy workload (Schoening, 2013).

The NMC demands a nurse to act as a leader or an agent of change irrespective of position, qualification, for improving and enhancing care services for well being of patients (Yoon & Shin, 2016) There is a saying that “Good leaders were made rather born”. MacPhee et al., (2012) defines leadership as a skill possessed by an individual to influence others to work passionately in accomplishing their predetermined goal. Laschinger et al., (2014) believes that effective leadership ensures the quality of care delivered and professional development. The main criteria for career development in rapidly growing health care environment are the changes in the leadership (Fallatah & Laschinger, 2016).

The manner in which a leader approaches or provides direction, implements plans and motivates people refers to leadership style (Chen, Watson & Hilton, 2016). The three main leadership style as evident from a thorough literature review includes “Autocratic, Democratic and Laissez-Faire”. The autocratic leaders can make independent decisions and are efficient in controlling situation but they are dictatorial (Giltinane, 2013). This type of leader does not involve mentees to express their concerns for the fear of outcome and lack of motivation. A democratic manger is the one who encourages group participation creating a positive and motivating environment but retains the ultimate decision-making power (Vaismoradi et al., 2016). These types of leaders are effective in communication, honest, motivating and trustworthy and mentees enjoy to work under such leadership. Followers feel free to share their vision and concerns in presence of such leaders.  On the other hand, a Laissez-Fair leader gives the decision-making power to his subordinates and does not participate to guide or motivate the mentees (Young et al., 2015). A mentor can adopt any leadership style depending on the situational demand. In our department, mainly democratic leadership is adopted. All the students are encouraged to share their views and opinions during the “clinical area visits”. As per the literature review, here are eight main leadership theories identified two of which are discussed in the subsequent sections.

A “Transactional theory of leadership” lays importance on the ultimate results and includes the “reward and punishment policy” (Fawcett & Desanto-Madeya, 2012) where as the “transformational theory of leadership” deals with building relationships between the mentor and mentees (Chen et al., 2016). A transformational leader motivates the followers to accomplish their goals. The nurse Charlotte who was my mentor in the plaster unit always motivated me. She always encouraged the students to believe in their vision and meet their set goals. I realized working under her that motivation is critical to “learning and professional development”. Her mentorship has helped me in enhancing my knowledge and skills. According to Kelly, (2011) the transformational leadership is effective for successful professional practice. A health care organization is not a profit making body therefore, Wong et al., (2013) suggests that nursing leaders may require different set of qualities. They must possess the characteristic such as integrity and the ability to work amidst several constraints from external agencies. As per “Trait theory of leadership”, a particular set of traits possessed by a leader makes him or her successful such as self-confidence, intelligence and others (Cone, & Giske, 2013). However, in UK, transformational leadership is not well established (Saccomano & Zipp, 2014). Prior to my admission as a nursing graduate, I have worked in range of industries that has developed my perspective on leadership skills. Based on my overall experience as nursing student, I believe that the core competent skills required for leading in any profession or organization are motivating, integrity, honesty, courage and continuity. Personally, I also prefer transformational leadership.

There are different theories of effective leadership and mentorship; however, there exists a similarity between the two. A good mentor relies on certain leadership skills such as communication when mentoring student (Cone & Giske, 2013). Julnes & Jensen, (2016) agrees that effective leaders do mentoring to their students to their fullest potential. Employing mentorship is essential for improving nurse leadership skills (McCallum, Duffy, & McGuinness, (2016). I envision my leadership role as a “transformational leader” as a leader of this style has skills to motivate their team, share their vision, and gain commitment, which improves the overall performance results (Julnes & Jensen, (2016). I am passionate to motivate my staff by giving them objectives which is in their capability to fulfill as well as broaden their perspectives. This will sustain and increase their interests as it will give them an inspiring work life. The same is also envisioned by the “Department of Health” about how the leadership will ensure the success of the NHS improvement plan (Marquis, & Huston, 2009). In extreme challenging situation I may prefer to be a “transactional leader” particularly in the situation where my juniors are resistant towards objectives I have passed. This leadership is effective in this case as it involves the policy of “reward and punishment” (Vaismoradi et al., 2016).

Conclusively, the experiences that I have gained through my practice have assisted in professional development. I have identified the areas that I need to improve as a leader and mentor by reflecting on the period during my placement. There are many leadership and mentorship theories related to nursing practice which have been discussed in the assignment, however I personally believe that a nurse should adopt one leadership style and mentoring approach that best suits the working condition as well as the newly entered nurses. Depending on the situation and the demand from my profession I would utilize the theories and best concept for improving my leadership and mentorship role. The leadership philosophy that I would prefer is to strive to become a leader with credibility and inspiring skills. This also includes being trustworthy, competent, hardworking and supportive, which are the attributes I expected in my mentor and team leader. I want to evolve as a competent and confident leader. There is a need of “self-assessment” and understanding of the “self-knowledge” to be a successful leader (Jokelainen et al., 2013). Identifying personal strength in any area is required to set realistic goals and be able to capitalize on persona capabilities, strength and interests. It involves developing and action plan, which is a “must achieve” instrument to identify competences required to be accomplished during a practice placement in a specified time. This is recognized as a crucial task for nursing students preparing themselves to become registered nurses. It is essential because the future of profession, in both “its integrity and knowledge are in the hands of students currently under training to become registered nurses”. As a mentor I will incorporate evidence based practice in my area and I believe that assessing my personal strength and weakness will help me gain confidence in my abilities as future nursing mentor. I did face negative experiences as well toxic mentorship but I could get through this situation by staying focused on my nursing excellence and patient-centered. From my experience I can say that giving the best efforts is the only way to win respect from future colleagues which does include mentorship. It is beneficial to aware the clinical instructor about one’s own kind of education preferred. This ensures building good rapport with nurses willing to mentor. It also allows the mentee to practice without stress and anxiety.

In summary, the mentor-mentee relationship is significant and relevant in providing the “surety of confidence” in practice. I believe in change and continuous evolution without which stagnation is inevitable. It ultimately decreases the stability and viability of an individual irrespective of one is professional or not. It is sensible for nursing students to invest in programs that are developed with the concept of the “mentorship in learning” a it nurtures and fosters the bright minds of learners who are future’s registered nurses. One must make a constant effort to move forward continuously and develop new education strategies such as mentorship. It will strengthen our profession and empowers the learner to make evidence based ethical decisions.

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