Effective Strategies For Mentors To Address Underperforming Learners In Nursing

Importance of Identifying Underperforming Learners

Question:

Write an essay about the Smart Learning Plan.
 

Mentors are responsible for ensuring that the nursing students are enough capable to conduct required and safe practice in the clinical area. For this, they need to identify the underperforming students and to manage them effectively (RCN, 2007). The mentors have experienced a situation, when learner shows underachievement behaviour. During the assessment, mentors have experienced that some learners were not responding to the feedback and they demonstrated lack of communication, interpersonal, motivational skills and professional behaviour (Duffy and Hardicre, 2007).    

The behaviour of underperforming learners included poor communication and interpersonal skills, unprofessional behaviour, inconsistent clinical performance and poor response. These were the behaviour shown by the learners. After determining underachieving performance of learner, mentor needs to take appropriate actions (Duffy and Hardicre, 2007). The behaviour issues were addressed by taking several steps. The performance concerns were discussed to the colleagues to take their views and opinions. The areas of weak performance were analyzed on the basis of available evidences (Duffy and Hardicre, 2007). These concerns were discussed to the learners for determining their knowledge and self-awareness regarding reasons of failure in achieving the placement standards of Nursing and Midwifery Council (NMC).

Constructive feedback was provided to the learners about their performance. With adequate evidences and supporting materials, mentors are informed learners regarding the areas of development and changes. The role of mentors in terms of accessing the performance of learners and giving them feedback was also discussed with them. Through this, learners were educated about the importance of mentoring in the development and learning process. After this, an action plan is proposed to the learners including development area, learning objectives, learning opportunities, success criteria, knowledge and sources as well as timeline (Sharples and Kelly, 2007). Through this, mentors were communicated the problems of learners with the well-defined solutions. This has allowed then mentors to address the underachieving performance of learners in systematic manner.

High level of anxiety, depression, high absenteeism and lack of interest etc. were some other behaviour of underachieving learner might cause concern for the performance.  This behaviour may cause difficulties for mentor to mentor the learners and to direct them for the developing weak areas. These behavioural cues of the learner may create challenge for mentors to manage the emotional consequences. Emotional reactions of the students are needed to be addressed by the mentor carefully. It creates highly comfortable situitauion in which it might difficult for mentor to guide the leaner (Duffy and Hardicre, 2007). Mentors need to take care of this emotional imbalance of the learner and to make them feel confident. The emotional imbalance behaviour might cause concern for learner’s performance. 

The recommended actions to support the leaner are critical for creating self-awareness among the leaner regarding learning need and difficulties. These would be effective to create sense of responsibility within the leaner for performance improvement. In accordance to (), the offering of time and opportunity for improvement to the learners can be an effective way to create competence to achieve the required level of performance. The recommended actions are quite important for giving opportunity and time for the improvements to the learners. It works as forcing driver to the improvement for the learners (Sharples and Kelly, 2007). Through this, the learning process of learners becomes self-directing.

Effective Strategies to Address Underperforming Learners

The recommended actions are quite important to create sense among learners that they are watching and observing. It may significant to improve the some students. In addition to this, action plan is quite significant to improve relationship between mentor and leaner. It creates clear picture for the expected performance of both that reduces conflicts. This strengthen relation their relation that make positive impact on the improvement level of learners (RCN, 2007). Additionally, recommended actions are also significant to control and manage the improvement process of learners and to guide them for achieving the desired level of performance.

In order to support the learner at this stage, it is important for mentor to identify the learning style of mentee and to make them to feel warm and welcome (Sharples and Kelly, 2007). Mentor’s awareness for the learning style of learner can be effective to choose more relevant action and sources of leaning. Apart from this, an action plan can also be developed to ensure clear communication and supportive relationship with the learners and to support them at this stage. With these actions, mentor can persuade behaviour and actions for developing and learning required knowledge and skills (Duffy and Hardicre, 2007). The action plan is depicted in below figure: 

Learning Outcomes/Areas for Development	Learning Resources/ Actions	Evidences of Achievement	Achievement/ Review Date
Lack of ability to prioritise care	Read the Code for nurses and midwife, provided by NMC Read “Guidance on professional conduct” of NMC guidelines for nursing and midwifery students (NMC, 2008) Discuss with registered midwife/nurse about the procedure of giving care to patients Consider the NMC guideline, while giving care to the patient	Mentor’s observation of practice of the skills and abilities of providing care Theoretical knowledge about prioritise care needs   Conversation with mentor	After 15 days
High absenteeism	Read the Code for nurses and midwives, provided by NMC	Regular presence in register Feedback from the multiple teams	After 30 days
Lack of skills to manage medicines	Observe the registered midwife/nurse during the administration of medicine Communicate and discuss with the registered  midwife/nurse regarding the process of managing drugs Read NMC guidelines the administration of medicine Adhere the NMC guidelines and their application, while managing medicines	Mentor’s observation Feedback from the multiple teams   Obtaining feedback from the patients	After  20 days
Poor documentation of treatment	Observe registered  midwife/nurse in documenting the conditions of patient Read the existing documents to understand way of documenting Perform documentation of treatment with accompanying registered  midwife/nurse	Preparation of mock documents Mentor’s observation	After 25 days

Preceptor Signature:                                                    Learner Signature:

Date:                                                                           Date:

The above action plan is developed to promote self-directing learning attitude in the underachieving learner. This will allow learner to develop improvement areas, which are critical for getting placement.

Mentors face considerable challenges in supporting the underachieving/failing learners. After taking certain improvement efforts, mentor decides to fail/ not fail a learner. According to Duffy (2003), this is one of the most challenging aspects of mentor’s role and due to this it requires special attention. Below are some sentences, which influence on the decision to fail / not fail a learner is also depicted:

1. This statement could influence the way of deciding fail / not fail a learner. It can make mentor to consider the leaner’s attitude and behaviour at the time of giving treatment to the patients. The learner’s performance in the nurse education programme could not only be considered by mentor to give certification of qualified nurse (Skingley et al. 2007). The accurate application of the education in practice is one of the important factors for ensuing safety of patient. Without considering this aspect, it is quite difficult to assess the competency of learner and to provide them nursing certification (Peate et al., 2014). In this way, it could induce mentor to consider practice aspect to fail / not fail a learner.
2. The statement indicates that good assessment is critical aspect of mentor’s role and responsibilities in the clinical field. They are accountable to assess the learner’s capabilities, knowledge and skill in terms of providing safe and effective care to the public. It could influence mentor to evaluate learners’ capabilities and decision to fail/or not fail. It is quite difficult to ensure complete competencies in the learner and due to this it induces mentor’s to access them in considering satisfactory level of performance (Sharples and Kelly 2007). The satisfactory level of learner makes mentor to pass learners and place them as nurse. In this way, this statement could influence decision to fail/or not fail.
3. This statement indicates that failing of some learners in achieving the success in getting placement examination is an obvious aspect. It is an expected result of the assessment in the field of nursing education and practice. Mentors do not ignore to fail incompetent learner for protecting themselves from the related issues. They will face issues in terms of supporting and guiding the fail learners. Mentors need to solve them for the better performance assessment. This could encourage mentor to access the performance of learners more accurately and to fail those have less competency to provide safe and effective care to the public (RCN, 2007). In order to manage situation of leaner’s failure, mentor needs to provide feedback and to develop an action plan with required evidences and documents. 

The main accountability of a mentor is to access the performance of leaner with the described process of NMC for taking decision of failing or passing him/her with having sufficient evidences regarding the decisions. Mentor is responsible for justifying the decision for a leaner with adequate supportive evidences and documents (RCN, 2007). In the given situation, Barbra should access the methods of assessing nursing practice, which both used. It would be useful to determine the reliability of the evidences and to support the decisions. In accordance to Peate et al. (2014) there are several methods such as observation, patient feedback, simulation, etc. used to access performance of the learner in the clinical field. The application of different methods helps to evaluate reliability and validity of results.

After this, Barbra should confirm the evaluation of all factors, which are needed to evaluate the performance of Anne as learner. Several factors such as skill, knowledge, clinical practice, etc. should be considered to evaluate the performance of learner. If disagreement remains than Barbra should take guidance from the senior healthcare professional and other responsible institutes namely Higher Education Institutes (HEI). HEIs are accountable to provide established communication systems to address the issues related to the progress of leaner (Duffy, 2004). The issue can be linked to the lectures and practice education facilitators (PEFs) for getting guidance and support on timely basis. This would be effective for Barbra to collect the required evidences for supporting the decisions of failing learner (Scholes and Albarran, 2005). It could help mentor to give right judgement regarding the progress of learner and to justify it for he is accountable.

Addressing Emotional Imbalance of Learners

The above steps could be used by mentor to solve the issues related to the decision of making a leaner fail. These steps would be useful for mentor to create strong basis of judgement and to justify it to the responsible institutes and authorities. It may help mentor to fulfil responsibilities for the reliable assessment of mentor   

The failing decision can influence the emotions and reactions of mentor and learner both. In accordance to Maloney et al. (1997), frustration, fear, concern, resistance, ambivalence and anxiety are some affects a leaner have on the mentors. These effects can occur, when mentor fails a learner in the clinical field. The type of effect influences the reaction of an individual in the situation. The reaction as mentor might concern, when I had to fail a learner. I experienced stress due to conflict among the roles of teacher, evaluator and supporter. The situation was perceived as reflection of the effectiveness of teaching and supporting methods. At that time, concern for own skills and knowledge in teaching the leaner has developed. Due to this, some nurses pass the clinical assessment without having required knowledge and skills. It creates failing to fail” situation that affect mentor’s ability to fulfil responsibilities (Duffy, 2003).

According to Duffy (2003), personal consequences, personal issues, experience and confidence and late identification of failure are some reasons due to which mentor fail to fail the students.   In the words of Dwyer and McMillan (1970), there is a need to adapt the teaching style that fulfils learning needs of the learners. The match between teaching style and learning approach is critical for the success of learner. Arthurs (2007) supports above views and indicates that teaching style has significant influence on the learning consequences of the students.  By using relevant learning strategies, learning of students can be enhanced by the nurse educators. Tulbure (2011) also states that better learning outcomes can be achieved through the application of teaching strargties relevant to the leaning preferences and needs of students. Teachers’ style of teaching the students influences the outcomes of learning in the effective manner. The concerns for own skills and competencies might the reaction at the event of student failure. The other reaction might include abusing the power to fail a learner. It could have been used as a tool to control and punish the “difficult” learner.  The above reactions might occur in the situation of failing a leaner. 

In the situation of failure, learner reacts in several manners. Stuart (2003) discusses and states that leaner may react in the situation of failure differently. Denial, bargaining, anger, sadness and relief are some reactions of failed leaner at the situation. These are some responses of a failure learner, when they get failure results. Learners may show disagreement for the perception of mentor for their performance due to which they make excuses and shows anxiety. Mentor needs to approach the reactions of learner in differnrnet manner. Denial response might be managed by having discussion on the learning outcome and related evidences that students failed to achieve. It could be effective to influence the reactions of students positively.

Significance of Action Plan in Improving Relationship between Mentors and Learners

Bargaining reaction means student tries to convince mentor for providing pass grade. Mentor might manage this reaction by standing on own opinions regarding the performance of learner and focusing on unachieved learning outcomes. On the other hand, learner may cry after knowing the result. For having meaningful discussion with the learner and managing the situation, mentor allows learner to cry and to express their sad feeling (Duffy and Hardicre, 2007). The learner may abuse the mentor and become aggressive. If mentors expect this behaviour than they ensure existence of other responsible authority such as HEI, PEF, etc. This helps mentor to maintain dignity and respect. Learners may plan to leave the desire of becoming registered nurse. In such situation, mentor encourage learner to do more hard work and to guide them (Stuart, 2003). In contrast to this, some learners takes failure as lesson and make more efforts to achieve success. It is rare reaction of learner at the time of failure. 

1. Mentor provides evidence for demonstrating the level of leaner’s performance. In the given case, mentor might use range of evidences to show reach at the decision of Amanda’s underachievement. The initial learning plan between mentor and learner might be reviewed to determine the use of evidences for making final decision regarding the performance of learner. Observation of practice, pee evaluation, self-assessment, mock documents, etc. some evidences might be used by me to decide the underachievement state of the learner. It could have helped to give enough evidence for showing lack of skill and knowledge in the learners in terms of prioritizing care and co-ordinate needs of the patients (Peate et al., 2014). These documents might be helpful in accessing the performance of Amanda and ensuring underachievement situation.         
2. In the words of Clynes and Raftery (2008), performance feedback is critical component in nursing education as it helps leaner to make required improvement on the regular basis. This allows leaner and mentor to improve clinical practice. The feedback to the learner would be provided in the private for ensuring open communication regarding the performance aspect. The evidences would be provided to support negative or positive feedback about the performance. For example: lack of skills and knowledge of prioritising patients’ needs of Amanda would be explained with the evidences such as observation sheet, peer evaluation, etc. It could be effective in developing trustworthy relationship between Amanda and learner. The whole discussion would be cantered on the performance level and learning needs of the learner. The comparison of learner with the other one would be avoided throughout the discussion.

According to Clynes and Raftery (2008), feedback should include status of current performance and practical advices for the improvement. The feedback session with Amanda will also include the some practical suggestions for helping her in improving the skills of prioritizing and co-ordinating care. Through this, constructive feedback would be given to the learner. In each discussion, behaviour of leaner would be observed to determine the impact of feedback. This could help in determining Amanda’s preferable feedback method. Through this, feedback strategy would be changed for benefiting the student.  Specific and clear feedback would be given to the leaner after the event for ensuring learner’s right understanding about the development needs (RCN, 2007).

3. In the practice of clinical assessment, collaboration with the others in work is critical to identify and address the development needs of the leaner. It allows mentor to guide and support leaner in the best possible way. The major way of working collectively will be the proper documentation of objective evidences as it would be effective to create a basis of discussion with the other members of the team. Through this, the relevant discussion would be conducted to with the team regarding the performance of the learners (Peate et al., 2014). Beside this, the ways of supporting and supervising the performance of learner would be developed by having discussion with the team members. It would be useful to access the leaner’s learning needs and style and to seek the support of team members. On the other hand, HEI support would be taken through different mediums such PEF, education champion, tutor, etc. This would also be effective in attaining support for the assessment of learner’s performance. The clear documentation regarding the learning outcomes, possible process and methods of assessment, description over required evidences, etc (RCN, 2007). would be the key to get support from the team to identify and address learning needs of the student.
4. Below an action plan is developed to improve the performance of Amanda in nursing practice and to enhance confidence level:

Formative Action Plan

Student Name:                                                                                           Mentor Name:
Learning Outcomes/Areas for Development	Learning Resources/ Actions	Evidences of Achievement	Achievement/ Review Date
Prioritising and co-ordinating care needs	Review NMC code of conduct for the nurses and midwife Review professional guidance of NMC for the nursing students NMC guidelines application to give care Take guidance to registered nurses and midwife Observe the practice of registered nurses Discussion with the mentor Gain support and guidance from the HEI	Observation of mentor Observation of other team Considering patient feedback Discussion with the other mentoring team Theoretical knowledge regarding the way of addressing care needs of patient Scheduling the care of patients	After 20 Days

Preceptor Signature:                                                    Learner Signature:

Date:                                                                           Date:

The above action plan could be used by the mentor to improve Amanda’s skills and knowledge of prioritising and co-ordaining care needs of the patients. This may help the leaner to understand the healthcare needs of the patient and to prioritize them carefully. Proper communication would be established with the learner to guide them for understating care needs of patients and to schedule them properly (Peate et al., 2014). This could guide the learner to improve the skills and knowledge and to enhance the performance.

5. If student failed to achieve required level of proficiency in determining, prioritising and co-ordinating needs of patient than other action would be taken. The preferred learning style of learner would be determined by accessing the behaviour and response on feedback. The change in teaching strategy may help to encourage learners for adopting required skills and knowledge. In accordance to Tulbure (2011), three types of learners such as visual, auditory and tactile/kinestic are mainly exist in the clinical practice and each has different preference regarding the learning method. Visual learners prefer to learn from gestures and picturesque language, whereas auditory prefers to learn from aural cues. Tactile/kinestic prefers to learn through practice. By determining learning style of learner, specific teaching and leadership style would be preferred by the mentor to support the learners for the skill and knowledge development. This may play critical role in making the learning process more interesting for the learners that could create positive outcomes.  

References

Arthurs, J.B.  (2007) A juggling act in the classroom: Managing different learning styles. Teaching and learning in nursing, 2(1), pp.2-7.

Clynes, M.P. and Raftery, S.E. (2008) Feedback: an essential element of student learning in clinical practice. Nurse Education in Practice, 8(6), pp.405-411.

Duffy, K. (2004) Mentors need more support to fail incompetent students. British Journal of Nursing 13 (10), pp. 583

Duffy, K. and Hardicre, J. (2007a) Supporting Failing Students in Practice 1: Assessment. Nursing Times 103 (47), 20-21

Duffy, K. and Hardicre, J. (2007b) Supporting Failing Students in Practice 2: Management. Nursing Times 103 (47), pp. 20-21

Duffy,K. (2003) Failing Students: A Qualitative Study of Factors that influence the Decisions Regarding Assessment of Students' Competence in Practice. Glasgow: Caledonian University.

Maloney, D. Carmody, D. and Nemeth, E. (1997) Students Experiencing Problems Learning in the Clinical Setting. In McAllister, L. Lincoln, M. McLeod, S. and Maloney, D. (eds)

McMillan, M. and Dwyer, J. (1990) Facilitating a match between teaching and learning styles. Nurse Education Today, 10(3), pp.186-192.

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

Peate, I., Wild, K. and Nair, M. (2014) Nursing practice: knowledge and care. John Wiley & Sons.

Royal College of Nursing (2007) Guidance for mentors of students nurses and midwives: An RCN Toolkit. Royal College of Nursing: London.

Scholes, J. and Albarran, J. (2005) Failure to fail: facing the consequences of inaction. Nursing in Critical Care 10 (3), pp. 23-27

Sharples, K. and Kelly, D. (2007) Supporting mentors in practice. Nursing Standard 21 (39), pp. 44-47.

Stuart C. (2003) Assessment, Supervision and Support in Clinical Practice: A guide for nurses, midwives and other health professionals. (1st ed) London: Churchill Livingstone.

Tulbure, C. (2011) Do different learning styles require differentiated teaching strategies?. Procedia-Social and Behavioral Sciences, 11, pp.155-159.