I work in a critical care unit and one of my roles is to organize the overall support and mentoring for student nurses on placement on my unit. Having undertaken this role for a number of years. I know that there are different types of learners, auditory (hear), visual (see) and kinesthetic (touch) (Honey and Mumford, 2006) and some learners can present a combination of these learning types. I believe that each student learn and develop at a different pace. I have also found that auditory learners tend to be natural listeners and may oftentimes speak slowly, visual learners on the other hand tend to be speak quickly, interrupt the speaker and their language exhibit words that evoke visual images and the kinesthetic learners tend to be the slowest talkers of all they are not quick to make decisions like the previous two but are slow in the decision making processes. I put this down to the fact that they may be engaging all their senses to make the best decision. My take is that auditory learners learn best by listening and verbalizing, visual learners learn by seeing and visualizing and kinesthetic learners learn by doing and solving or trial and error they prefer the ‘hands on’ approach, which most mentors probably prefer i.e. a student who gets on with it! (Albeit safely as they would have engaged all their sense).

Taking this reflective stance further I am beginning to wonder why it is that with some students I encounter in their 3^rd year or final placements who have been awarded a C, D or B, or what ever scale system you use for grading a skill will try and negotiate for a higher grade. Don’t misunderstand me, I want nurses, as students to question what is happening around them if they feel uncomfortable with the situation and it’s great that this starts at the student level. This will give them confidence to question and search for answers in their nursing career. It’s something that doesn’t happen often enough, sometimes much to the detriment of patients that are placed in their care. The sooner learnt the better!

There have been times when listening to the students rationale for a higher score, I’d take a step back and decide they have a point and on talking through and redoing the particular skill I’ll award them a higher grade because they have proven their ability.

It is the reasons (note they are reason not academic or clinical discussions based on the skill assessed) that student nurses provide for a higher score that I find difficult to understand here are some I have had, ‘well its not really that difficult so I think I should be awarded an A’; ‘I’ve consistently had ‘A’ in my 1^st and 2^nd year if you don’t give me an A now I wont be awarded a good degree and it’ll be your fault’ (yes I have had this!) and ‘My colleague got an A so I should get one too’.

When you are confronted by such statements you may begin to doubt yourself I certainly started to doubt myself as a mentor, asking those reflective questions: was I too strict? Had I misunderstood the guidelines? I have after all been a mentor for many years and I continue to attend regular updates (I hear some of you groan) but I enjoy doing it.

Working in a critical care setting I feel that the students placed with us are privileged to be able to have a large amount of essential and non-essential skills achieved in the time they spend with us. I want to nurture them and build in them an appetite that will encourage them to want to return to critical care as they will have left with a large amount of unanswered questions (as there is only so much they can learn in such a short space of time) and they may want to return to find those answers and investigate what else there is to learn in this stimulating field.

But at the same time I have to be sure that the student I send away is safe and competent in the skills that have been signed off. I need to make their next mentor aware that although the skill has been signed off they will still have to build on that skill as it’s not perfect thus the ‘B’ ‘C’ or ‘D’ and a student can easily become complacent and lapse in a skill achieved at an A or let’s not get into the debate assessed as an A by a mentor under duress by said learner fuelling the failing to fail debate.

If I have awarded an ‘A’ the next mentor can believe that I have sent a student who is wholly competent and understands the rationale in that particular skill or task and most importantly their patients will be safe.

I have come across students who have been awarded ‘A’ and ‘B’ for skills in their 1^st and 2^nd year placements and when performing these skills in the 3^rd year fail miserably.

Surely our nursing training, and beyond involves ongoing assessment and learning? Or do we assume, what’s done is done, assessed, signed off, that’s it. I hope not as this attitude will not bode well for our profession and patient care and safety. I would like to believe that the criteria for awarding ‘A’ ‘B’ ‘C’ or ‘D’ is the same whether the students are in the very 1^st or final placement.

I am looking forward to a couple of students in the next few months again. I will not be looking to failing to fail but to be fair to the student, their course, the protocols set up by the University and sending them to the next and in some cases the final stage of a long and fulfilling course and a wonderful and exciting career ahead of them.

If you are a mentor and experienced similar situations when assessing student nurses please feel free to leave a comment.

References

Honey, P & Mumford, A (2006). The Learning Styles Questionnaire, 80-item version. Maidenhead, UK, Peter Honey Publications