Supervision and assessment: the new Nursing and Midwifery Council standards.

In the UK, mentors of pre-registration nurses must achieve the stage 2 outcomes of the Nursing and Midwifery Council (NMC) ( 2008 ) standards to support learning and assessment in practice. Approval for new standards for student supervision and assessment was granted at the NMC meeting in March 2018 ( NMC 2018a ). The introduction of the new standards will see the dissolution of mentorship and the emergence of new roles to support students in academic and practice environments. This article gives an overview of these standards and, drawing on the recommendations from a collaborative event hosted by NHS Education for Scotland and some of the findings from a rapid literature review undertaken for that event, provides nurse managers with information to help inform their discussions as they work in partnership with approved education institution colleagues to realise, support and sustain the roles outlined in the new standards. The article concludes with some questions to consider during these collaborative discussions.

Keeping support and clinical supervision on your agenda.

Support and clinical supervision can benefit staff and service users. Inquiries have highlighted lack of support and clinical supervision as potential contributory factors for adverse care events. For support and clinical supervision to be embedded effectively, leaders and managers must value and promote them in their organisations. This article describes practical steps to support implementation of clinical supervision. By examining the main stages of supervision and preparation, evaluation of process and outcomes, and practical considerations, the article supports healthcare managers to encourage staff engagement and to implement a clinical supervision process.

Preparing registrants for mentor roles: the chicken or egg conundrum.

The Nursing and Midwifery Council's (NMC) Standards to Support Learning and Assessment in Practice ( 2008 ) outline requirements for the preparation of those who support nursing and midwifery pre-registration students in practice, formally known as mentors. Pre-registration nursing and midwifery programme providers, and practice learning environments (PLEs), work collaboratively to prepare registrants to undertake this role, and to help them maintain mentor status. An important NMC requirement is that registrants, when undertaking mentor preparation programmes, must be supported by experienced mentors in their workplace. This is challenging for programme providers and PLEs if there is lack of experienced mentors in the area concerned. This article discusses support for registrants when preparing to become mentors, suggests some alternative solutions and makes recommendations for the future of mentor preparation in the UK.

Are theoretical perspectives useful to explain nurses' tolerance of suboptimal care?

AIM: This paper explores two theoretical perspectives that may help nurse managers understand why staff tolerate suboptimal standards of care. BACKGROUND: Standards of care have been questioned in relation to adverse events and errors for some years in health care across the western world. More recently, the focus has shifted to inadequate nursing standards with regard to care and compassion, and a culture of tolerance by staff to these inadequate standards. EVALUATION: The theories of conformity and cognitive dissonance are analysed to investigate their potential for helping nurse managers to understand why staff tolerate suboptimal standards of care. KEY ISSUES: The literature suggests that nurses appear to adopt behaviours consistent with the theory of conformity and that they may accept suboptimal care to reduce their cognitive dissonance. CONCLUSION: Nurses may conform to be accepted by the team. This may be confounded by nurses rationalising their care to reduce the cognitive dissonance they feel. IMPLICATIONS FOR NURSING MANAGEMENT: The investigation into the Mid Staffordshire National Health Service called for a change in culture towards transparency, candidness and openness. Providing insights as to why some nursing staff tolerate suboptimal care may provide a springboard to allow nurse managers to consider the complexities surrounding this required transformation.

Enhancing the collaborative review of NHS Education for Scotland's mentor preparation framework.

Service review and redesign across the UK are moving towards an integrated health, social and third sector care system, and at the heart of the integration agenda is improving patient care through multistakeholder engagement and collaboration. Nurse managers are integral to supporting, sustaining and embedding this agenda by co-operating with the various stakeholders involved and at times managing them. Stakeholder analysis is a core aspect of stakeholder management.This article offers some insights and recommendations for managers by describing how Bunn et al's (2002) five-step stakeholder analysis process was used to support successful stakeholder collaboration in the revision of the core curriculum mentorship framework for Scotland.

Role development: barriers, enablers and the function of a national organisation.

Successful implementation of any role development relies on strong partnership working between employers, managers, education providers and clinicians in the short and longer term to ensure sustainability. Drawing on the experience of NHS Education for Scotland (NES), this article highlights how one national organisation has supported role development. The article also explores enablers and barriers to proposed workforce changes and the education and learning considerations required for role development. It then outlines the contribution made by NES in providing national guidance for role development to support managers and individual practitioners.

Providing constructive feedback to students during mentoring.

The need to provide students with regular feedback on their performance is integral to the assessment process, but not all mentors feel confident to do this. This article highlights the benefits of providing constructive feedback for both the mentor and the student. Five principles associated with giving constructive feedback are discussed. The importance of preparing for feedback, ensuring it is provided in a timely manner and being specific are emphasised. Development opportunities to enhance mentors' skills in giving feedback that is beneficial to the student are also discussed.

Newly qualified staff's perceptions of senior charge nurse roles.

Nursing roles have been recognised as pivotal to the delivery of good quality, patient-centred care. At the centre of this debate are the leadership roles of the senior charge nurse (SCN), which in recent years have come under great scrutiny. However, research suggests that these roles have become decreasingly popular as a career pathway. The aim of this study was to develop a clearer understanding of leadership as experienced by newly qualified staff nurses in the acute hospital setting by exploring their perceptions and beliefs of SCN roles. The study supports the view that SCNs remain central to setting standards of care, but suggests that the SCN leadership role appears unattractive to newly qualified staff, who cite responsibility, lack of trust and negative feedback as the most offputting factors.

Supporting and mentoring nursing students in practice.

Decision making is a fundamental skill required by the Nursing and Midwifery Council (NMC) for entry to the nurse register. It is required for the completion of the essential skills clusters - skills identified by the NMC that must be achieved in pre-registration nursing programmes. Often students do not recognise that many of the tasks they perform on clinical placement involve decision-making skills and therefore find it difficult to show their attainment in their record of achievement. This article explores how students can demonstrate their decision making and suggests techniques for mentors to support students.

Menstrual Cycle Changes in Vagally-Mediated Heart Rate Variability are Associated with Progesterone: Evidence from Two Within-Person Studies.

A recent meta-analysis revealed that cardiac vagal activity (mostly indicated by vagally-mediated heart rate variability; HRV) decreases significantly from the follicular to luteal menstrual cycle phase in naturally-cycling participants. However, the question remains as to whether cyclical changes in estradiol (E2), progesterone (P4), or both are responsible for HRV fluctuations. We present the first studies to use repeated measures of E2, P4, and HRV across the cycle to model both the unique and interactive effects of person-centered E2 and P4 on HRV in multilevel models. In study one, 40 naturally-cycling participants were assessed weekly across four weeks, and were blind to the cycle focus of the study. In study two, 50 naturally-cycling participants were examined in three precisely defined cycle phases via ovulation testing. Both studies revealed that only P4 was correlated with HRV, such that higher-than-usual P4 significantly predicted lower-than-usual HRV within a given participant. In line with this, cycle phase comparisons revealed lower HRV in the mid-luteal phase (characterized by elevated P4) than in other phases. No significant main or interactive effects of E2 on HRV were found. Future female health studies should investigate individual differences in these effects and potential consequences of cyclical HRV changes on daily functioning.

Mentoring a student immediately prior to registration: a qualitative study.

A literature search revealed limited research exploring the experience of the community nurse mentoring the student nurse immediately prior to registration. This qualitative study was undertaken in order to describe the lived experience of the community nurse when mentoring a final placement student. The study was conducted in compliance with relevant ethical procedures and institutional guidelines. Three focus groups were convened and the experiences of twelve community nurses working within a large city-based community health practice in Scotland who had mentored a student nurse immediately prior to registration were explored. Analysis suggests the community nurse mentors require support and development opportunities in relation to mentoring and assessing final placement pre-registration students.

Understanding the role of chaplains in supporting patients and healthcare staff.

AIM: To investigate attitudes towards chaplaincy in NHS Scotland, including the role of the chaplain in supporting healthcare staff. METHOD: This was a qualitative study that involved semi-structured interviews with four chaplains working throughout NHS Scotland. The research transcripts were analysed, and themes were identified and examined. FINDINGS: Two main themes were identified from the interviews: understanding the role of the chaplain; and understanding the future role of the chaplain. The sub-themes identified were: healthcare staff members' perceptions; chaplains' perceptions; generic chaplaincy services; and becoming an allied healthcare profession. CONCLUSION: The findings of this study suggest that chaplains are increasingly providing support to healthcare staff, alongside their role in providing support to patients. The researchers also identified that chaplains in Scotland are adopting an increasingly educational role and that, in the future, they may adopt reflective practice programmes to assist them in managing increased requests for chaplaincy support from healthcare staff. It was also acknowledged that chaplaincy services may also be required to become an allied healthcare profession in the future, which may require chaplains to provide an increasingly generic and less religious service.

Prolongation of cardiac allograft survival by rapamycin and the invariant natural killer T cell glycolipid agonist OCH.

BACKGROUND: Invariant natural killer T (iNKT) cells are glycolipid-responsive cells with potent immunomodulatory properties. Although iNKT cells have been implicated in cardiac allograft tolerance, whether in vivo triggering of iNKT cells with Th2-promoting glycolipids offers a therapeutic benefit in heart transplantation remains unexplored. METHODS: C3H (H-2k) hearts were transplanted into C57BL/6 (H-2b) mice. The recipients were left untreated or received the Th2-promoting iNKT cell agonist OCH, the antirejection agent rapamycin, or both. Allografts were recovered on postoperative day 8 or at endpoint, stained with hematoxylin-eosin, and analyzed for intragraft transcript levels of effector cytokines and iNKT cells' invariant T-cell receptor segment Valpha14-Jalpha18. The presence of circulating alloantibodies was assessed in recipients' sera at similar time points. A second fully mismatched cardiac allograft model (BALB/c-to-C57BL/6) was used to further validate the efficacy of our treatment regimens. RESULTS: Combination immunotherapy with OCH and rapamycin significantly enhanced C3H allograft survival and led to nearly normal graft histology with minimal vascular changes and mononuclear cell infiltration, and an almost normal IgG1:IgG2a ratio in recipients' sera. These were accompanied by elevated intragraft mRNA levels of interleukin (IL)-4, and to a lesser extent IL-10 and IL-13, and high transcript levels of Valpha14-Jalpha18 T-cell receptor gene segment. Furthermore, when used alone or together with rapamycin, OCH delayed allograft rejection in our BALB/c-to-C57BL/6 model. CONCLUSIONS: In vivo administration of OCH may deviate alloimmune responses towards a Th2 phenotype and prolong allograft survival. Select iNKT cell glycolipid agonists can therefore be used in monotherapy or combination immunotherapy of transplant rejection.

Supporting failing students in practice. 1: Assessment.

This two-part unit examines the issue of nursing students who fail in clinical practice. Part 1 explores reasons for failure, assessment and the emotional challenges mentors may face when supporting failing students.

Supporting failing students in practice 2: management.

This two-part unit examines the issue of students who fail in clinical practice. Part 1 explored reasons for failure, assessment and emotional challenges mentors may face when supporting underperforming students. This part, part 2, discusses the management of failing students.

Mentors in waiting.

A four stage framework, developed by the Nursing and Midwifery Council for the preparation of nurses and midwives who support learners within practice and educational settings was implemented in the United Kingdom in September 2007. Since then the focus of debate and discussion within the literature has centred on stage 2 of the developmental framework i.e. the mentor role. The three other stages of registrant, practice teacher and teacher have received little attention. This paper argues that currently, the provisions made within the developmental framework in relation to the stage 1 registrant's role in supporting students within practice settings, has yet to be realised. The paper begins by contemplating both the pros and cons of the 'should all nurses be mentors' debate. The argument for embracing and utilising the stage 1 role more fully in practice is then presented. The paper concludes by underlining the need to recognise the stage 1 registrants as 'mentors in waiting' and the need to support the full potential of their contribution to students' learning and assessment in practice.

Mentorship practice and revalidation.

Nurses and midwives who are registered with the Nursing and Midwifery Council (NMC) are required to renew their registration with the NMC. In April 2016, the NMC introduced revalidation, which replaces the requirements for renewal of registration set out in the post-registration education and practice standards. Every registrant should be aware of the revalidation process and requirements. Revalidation is linked to the professional standards for nurses and midwives set out by the NMC and known as The Code. Mentorship is an essential component of The Code; therefore, mentorship practice will assist registrants in meeting some or all of their revalidation requirements. As registered nurses, mentors will be required to reflect on their practice and update their preparation for mentorship. This article provides guidance on how mentorship preparation and practice can contribute to meeting revalidation requirements.