‘Seeking authorization’: a grounded theory exploration of mentors’ experiences of assessing nursing students on the borderline of achievement of competence in clinical practice

Abstract

Aim To develop a substantive theoretical explanation of how mentors make sense of their experiences where nursing students are on the borderline of achievement of competence in clinical practice. Background The reluctance of Registered Nurse mentors to fail nursing students in clinical practice despite concerns about competence remains a contemporary issue in international healthcare education. Mentors’ assessment decisions have considerable impact for a variety of key stakeholders, not least for students in these circumstances. Design Grounded theory qualitative study. Methods Phase one involved 20 individual semi‐structured interviews with nurse mentors in one United Kingdom National Health Service Health Board (July–October 2009). Phase two included eight individual semi‐structured interviews and seven focus groups with mentors and practice educators (n = 38) in four further Health Boards (June 2011–February 2012). Data were analysed using open, axial and selective coding consistent with grounded theory method. Findings Three categories ‘the conundrum of practice competence,’ ‘the intensity of nurturing hopefulness,’ and ‘managing assessment impasse,’ led to the study's substantive theoretical explanation – ‘Seeking authorization: Establishing collective accountability for mentorship.’ This demonstrates how mentors are dependent on key sources of support and feedback to validate their assessment decision‐making, notwithstanding substantial personal, professional and organizational pressures. Conclusion We conclude that management of borderline assessment situations is considerably developed by recognition of the authorizing effects of a wider community of assessors. Consequently, we identify the personal, professional and organizational implications involved in the preparation, support and regulation of mentors specifically during borderline assessment circumstances.

Reluctance to fail nursing students in practice-implications for nurse managers

“…Fear of legal repercussions or criticism from colleagues also supported lenience (Nugent et al., ). Our co‐authors from Wales yielded similar findings (Cassidy, Coffey, & Murphy, ). Interviews with mentors and practice facilitators revealed the assessment of practice competence to be a “conundrum” (Cassidy et al., ).…”

“…Our co‐authors from Wales yielded similar findings (Cassidy, Coffey, & Murphy, ). Interviews with mentors and practice facilitators revealed the assessment of practice competence to be a “conundrum” (Cassidy et al., ). Nurses with concerns about students performance looked more favourably upon weaker students who appeared to get involved, participating in and interested in the reality of practice; for example, taking an active interest in dressing odorous wounds.…”

“…However in some circumstances while it is obvious to the mentor (and perhaps others) that the student requires additional knowledge, skills and attitudes to achieve the required competencies, conferring a fail on the student can be difficult for a variety of reasons (Duffy, ). Consequently reluctance to fail nursing students is extensively written about in the literature as an ongoing dilemma for mentors and preceptors over the past 25 years (Cassidy, ). Yet at the same time this reluctance persists despite this awareness and the need to safeguard the public and ensure adequate standards of practice (Cassidy, ; Nugent et al., ).…”

“…Consequently reluctance to fail nursing students is extensively written about in the literature as an ongoing dilemma for mentors and preceptors over the past 25 years (Cassidy, ). Yet at the same time this reluctance persists despite this awareness and the need to safeguard the public and ensure adequate standards of practice (Cassidy, ; Nugent et al., ). Gainsbury () for example drew attention to a UK‐based Nursing Times study of 1945 nurses which highlighted that many nurses would permit nursing students to pass even if they were concerned about their competence.…”

“…There appears to be an evolving history of failing to fail among the nursing profession despite awareness of the phenomenon and knowledge of the key barriers (Cassidy, ). Recently in the Republic of Ireland (ROI) we found that the main factors supporting preceptors failing students included the presence of written evidence, perception of dangerous practice, behaviour and attitude of student and support from other hospital staff and management (Nugent et al., ).…”