Mentoring-who has the power?

I am sat here just an hour away from heading out onto placement for a final shift on the ward I have been working on and am pondering the nightmare that is getting paperwork and skills signed off. Finding the time, apologising profusely for the massive amount of writing up of skills I do to justify that I am good enough, hoping the mentor feels the same and signs them…..will the anxiety ever stop?!

Part of my thought process has left me wondering about the power balance in the midwife mentor-student relationship. Ideally there would be no power imbalance and the mentor/student would be engaged in a mutual, respectful and supportive pairing but I feel this is unrealistic and ignores the fact that, as students, we are reliant on our mentors to provide good, honest feedback and ultimately grade us which can mean the passing or failing of our degree. Surely, even with my basic degree in psychology, this puts the power balance very firmly on the side of the mentor?

Students, generally, want to please our mentors and not just for the sake of a ‘good grade’ (I feel this is a little simplistic and patronising) but because we want to do well! As a second year I have not struggled and battled my way this far through a very difficult degree to be mediocre and just ‘ok’….I want to be GOOD and COMPETENT. This means when I am working with mentors I ask a million questions and watch, listen and then ask another million questions because I want to be the best I can be.

I wonder if mentors are trained and updated on the power they hold in the relationship? I am sure they are and every mentor I have been lucky enough to work with has been supportive and encouraging whilst providing excellent constructive feedback when needed. Have I been lucky though or is this standard? I am not so sure……

The issues of boundaries in the midwife mentor/student relationship is interesting. My previous career was in an appropriately, heavily ‘boundaried’ arena and I feel I am acutely aware of boundaries at all times but  there have been occasions when my mentor has been made aware of my personal circumstances when necessary as this will, of course, impact on my practice…..could this be perceived as over stepping a boundary? Or, for example, if I ask a mentor if she is ok because I know her child was ill and she left work early during our previous shift….is this overstepping a boundary?

Is this a little too ‘pally’?

What is ‘too friendly’?

What could be perceived as forging a ‘too close’ relationship with a mentor when you are together 8 hours a day/ 5 days week in a car and in clinic and you have your lunch together and you talk……most people come into this profession because we are compassionate so we reach out to each other as 2 women sharing information about our lives…..is this overstepping a boundary? What should we discuss? Should we limit ourselves to just discussing midwifery at all times? But this feels incongruent and, again, unrealistic.

Also, what of mentor-student relationships that are not nurturing but, dare I say it…..toxic and damaging? Where does that student go? Every student knows that we are reliant on the mentor for passing us therefore, dare we complain if we don’t feel happy? Dare we mention to our PEF, link lecturer, academic adviser, ward manager etc that we are not happy?

We SHOULD do but do we?

What if we are branded a trouble maker?

What if we are considered to not be resilient enough for this degree because we have struggled with a mentor?

What if we still have to work with that mentor and they know we have an issue with them?

What if we don’t have to work with that mentor but one of her colleagues and they know we have complained?

We absolutely MUST speak up if we are struggling as the damage of ‘carrying on regardless’ is insistent and could lead to further issues both psychologically and practically further down the line but I hope that midwife mentors are aware of the power they hold and that forging a good, strong, supportive relationship is tantamount to bringing out the best in a student and that the majority of students just want to be the best midwives we can be!

Thank you to every mentor who has treated me with kindness and compassion-you have modelled how to be an excellent midwife and excellent mentor.

To those students struggling with mentorship-please speak out.

 

Raising Concerns

Whilst in practice, unfortunately, sometimes we can witness bad practice. It’s not a situation I would wish upon any student nurse or registered nurse for that matter as it immediately puts you in a very difficult position.

Yes, in the perfect world, there would be no internal conflict, you would identify the issue, escalate it to your manager or mentor and trust that it will be dealt with appropriately and with discretion and professionalism. However I know in my circumstance, I was/am struggling to trust that sharing my concerns will not impact upon my learning and education within this ward. This isn’t based upon anything other than my own fear of self-preservation, which makes it harder.whistleblowing

You’re faced with a decision, to voice your concerns and risk an uncomfortable and strained time in practice or say nothing and risk patient safety/dignity/pride. It really isn’t a toss up in my opinion.

The process is intended to be as pain-free as possible. Speak to the relevant individual, be it PEF, Ward Manager, Academic Advisor or Mentor and your concern should be dealt with in a professional and serious manner befitting the circumstance.

I have to say that as soon as I raised my concerns I felt an immediate sense of relief and confidence. Confidence that I had done the right thing for my patient, patient’s to come. I had 3 weeks remaining in my practice area and this was rather terrifying as I thought I would be identified somehow and treated poorly for raising concerns in practice, this I am very happy to report WAS NOT THE CASE. I wasn’t treated any differently whatsoever, I felt supported, trusted and above all I felt like the University was proud of me speaking up when I did.

This feeling was reinforced on Monday when placement allocations came out. A very close friend of mine has been allocated the same placement in which I experienced poor practice. I could have easily ignored the issues in the ward. Easily put them to the back of my mind and they would have continued and other Students would have struggled and felt as conflicted as me but because I spoke out – those issues have been resolved.handshake

I was able to say to my friend in confidence that any obstacles I encountered in practice have been resolved. No placement is perfect but if each student that encounters issues keeps quiet – they will never be perfect.

It can be very easy for student nurses to lay the blame for poor practice areas at their mentor’s feet but we have our part to play as well. Be honest in your placement evaluation and be honest with your mentor throughout your training – if they know what works well and what doesn’t that can only lead to improvements in how they teach and how you learn. So BE BOLD and SPEAK UP, who knows the number of people that will benefit from your honesty in the future.

PEF contact details can be found via this link:

http://sites.bmh.manchester.ac.uk/nursing-mentors/contacts

ATTENTION FIRST YEAR STUDENT MIDWIVES… Your PAD, White book and signatures!

I APOLOGISE AS THIS IS LONG…STICK WITH IT….. IT’S IMPORTANT INFORMATION;-)

Ok…you first years are all starting to think about placement right? It’s about a month away for the student midwives so your uniforms will be arriving shortly if you don’t already have them and you will have your documentation staring out of wherever you have hidden it because, if you’re anything like me, the thought of even starting to read that huge PAD document thing on top of all the studying you have to do is so out of the question it’s unbelievable!

Well I am here to hopefully hold your virtual hand through the whole documentation experience and share my many mistakes so you don’t make them!

First of all let’s clarify the difference between your

pad

 

PAD (Practice Assessment Document)……

 

 

 

 

white-book

 

 

……..and your white book (Record of Statutory Clinical Midwifery Experience).

 

 

 

 

 

You may not believe this but it took me a good couple of months to work out who can sign what and how equally important but different these two documents are!

 

So I’ll start with what I think is the easier one-the White Book. This will be held by you for the full 3 years then handed in at the end of your degree. Your AA will look through this during your individual meetings just to make sure you are ‘on track’.

The White book is where you record your statutory skills which every student midwife at every university will have to get signed off before they can qualify. You have the space in here to log your 40 births which seems to be the area of focus for a lot of students but there are A LOT more skills you need to achieve as well as delivering babies. For example, you need to record evidence of  antenatal examinations & care of 100 pregnant women and examinations & care of 100 postnatal women and their newborn babies.

In these midwifery areas any qualified midwife can sign off your evidence. They DO NOT need to be a mentor/sign off mentor. This is important because you will work with a lot of midwives when on placement and you may carry out a beautiful abdominal palpation and listen to the fetal heartbeat with a pinard whilst your mentor is on a break and you are working with another midwife…..WRITE IT IN YOUR WHITE BOOK AND GET IT SIGNED OFF! The white book just needs the woman’s hospital number, the date, what you did and the midwife’s signature. It can be written up in a couple of minutes and signed there and then! Otherwise you will get home, not written down half the hospital numbers for the women you have worked with that day, for the ones you have written down you’ll have forgotten what parity the woman was or the pregnancy gestation and for the ones you can remember you will realize the midwife who you worked with is now on maternity leave and so won’t be around to sign that evidence off (YES…ALL these have happened to me!!!-it’s gutting!).

There’s areas of the white book which can be signed off by qualified Healthcare professionals who work in other areas i.e. neonatal staff  or breastfeeding support  workers but the important thing to get into your heads about the white book is…

ANY QUALIFIED HEALTHCARE PROFESSIONAL CAN SIGN YOUR EVIDENCE FOR THE RELEVANT AREA YOU WERE IN WHEN YOU COMPLETED THE SKILL

AND

GET IT SIGNED THERE & THEN!

 

OKAY…..big, deep, breath…..THE PAD! Unlike the white book your PAD skills and interviews get handed in at the end of each academic year but you keep the folder (mine is already wrecked!). Your PAD skills are handed in through an official process where you are given a deadline (date & time) and you complete a front sheet for each set of skills and hand them into an exams officer (I point this out because this process was much more official than I expected it to be and it unnerved me a bit!). Your AA will probably take your interviews but this does depend  on the AA; I still have my complete set of first year interviews but I know a lot of my cohort have handed theirs in.

Signing stuff- this is a bit trickier than the white book as the people who can sign your skills off are limited. Let’s just talk about the actual documentation as an opener……..

Interviews

Ideally, at the start, mid point and end of each placement you and your mentor need to sit down and do your interviews. These will be read and checked at your AA meetings and are important for all parties involved as they help you assess where you are up to and also help you gather your thoughts on whether you are getting what you need out of the placement and if not how you can be proactive in accessing more opportunities.

During your mid placement interview do not forget to get your mentor to sign the actual interview AND the mid placement interview section on the front sheet of the set of skills you are working on (i.e. in the community this may be ‘Midwifery Care Pregnancy & birth antenatal skills’ section of your PAD. If your mentor has students from different universities they may not be familiar with UoM paperwork as every uni is different so its your responsibility to ensure every thing is completed.

As an aside, I did not realize our skills directly related to the academic units we were doing until about 6 months in…..don’t judge me I was overwhelmed!!!

Also you will have your progression points at week 19 & week 52….these tend to coincide with final placement interviews but not always so stay on top of these dates….get them in your diaries as both your mentor and AA need to write comments and sign these.

Skills

The skills section of your PAD is divided into 4 sections. Familiarise yourself with the sections, notice which sections coincide with your academic units so you can use what you are learning in university to inform your practice and vice versa, then write them up! Sounds obvious but it isn’t always! For example, if you have been learning about abdominal palpation in university and you are out on practice in the community, tell your mentor you have had a session on abdominal palpation and the use of pinards. Let your mentor know that you would really like to practice this in clinical placement. Your mentor will support you in this (if the opportunity arises) then you can write this skill up using all the theoretical knowledge and the practical skills you gained then get your mentor to sign this skill off! This, I recognise, is an ideal world scenario but this is YOUR clinical placement….make it work for you. This is your opportunity to apply what you are learning in theory to your practice; it is NOT your mentors responsibility to work out which skills you need to practice and get signed off!

Mentor/sign off mentor/SIGNATURES

You will be assigned a mentor when you go on placement for every clinical area you will be working in. You need to find out if they are a sign off mentor (they are usually quite forthcoming with this information!). Only sign off mentors can sign your paperwork and assign you a grade. If your mentor is not a sign off mentor ensure you know who the sign off mentors are in that clinical area and try and work at least a couple of shifts with them. Your mentor can sign your skills but the sign off  mentor needs to countersign them. THIS IS NOT THE SAME AS YOUR WHITE BOOK ! So if your mentor signs off that you are amazing at communicating with women the sign off mentor needs to countersign and date this skill as well.

I am going to **star** and bold and italic this next sentence because this caught me out on my placement and meant I spent most of my last shift at my first year trust running around trying to find one member of staff and ringing my AA almost in tears……..

******AS SOON AS ANYONE SIGNS YOUR SKILLS IN YOUR PAD MAKE SURE THEY SIGN THE SAMPLE SIGNATURE SHEET FOR EACH SET OF SKILLS THEY HAVE SIGNED AND WRITES DOWN WHEN THEY LAST HAD A MENTOR UPDATE******

(i.e. if a sign off mentor countersigns a skill in the ‘intrapartum care’ section of your PAD and the ‘tackling health inequalities’ section of your PAD, THEY NEED TO SIGN THE SAMPLE SIGNATURE FOR EACH SET OF SKILLS.

Imagine the scenario….you are finishing a night shift on the midwifery-led birth centre and the midwife you worked with observed you support a couple during a lovely labour & delivery. You had the opportunity to write up the skills you demonstrated during this shift and you got your midwife mentor to sign these skills off and she quickly got the sign off mentor, who’d just come on an early shift to countersign them before both you and your mentor floated off home to sleep…… WITHOUT GETTING THE SAMPLE SIGNATURE SHEET SIGNED BY THE SIGN OFF MENTOR!!! YOU NEED TO GET THE SAMPLE SIGNATURE SHEET SIGNED (yes this is what happened to me!!!) If you don’t, as a first year your PAD will be referred and you will have to return to your old trust to track down the sign off mentor to sign the sample signature sheet and then resubmit the whole skill set. If you do not have all the signatures completed on the sample signature sheet in second and third year YOU WILL FAIL (this makes me feel sick!).

Another starred, bold, italic section coming up……………………….

****YOU NEED TO DATE EVERYTHING YOU SIGN****

A LOT of my cohort got our PAD skills returned to us because we hadn’t dated our signatures on our skills documents! We had ensured our mentors had dated everything but we actually hadn’t! There is no ‘date’ prompt next to the student signature section but you do need to date it! I cannot begin to tell you what a complete pain in the rear it is when you have finally tracked down the sign off mentor to sign your sample signature sheet, hobbled, exhausted and emotional to hand in the PAD documentation hoping you never have to see it again, only to get it ALL handed back as ALL my signatures needed dating! Literally, every single one of the 60 or so skills I needed to go through and date! DATE THEM!!! Believe me you will not want that PAD handed back to you! If you aren’t sure if something needs dating and signing do it anyway! I am very much ‘better to be safe than sorry’ …once bitten and all that!!!

Think that’s all the terrible tales I need to pass on about documentation!! I do wonder how I managed to even get on this degree as reading back over this makes me look a bit lacking but I blame sleep deprivation!

You will be getting your uniforms soon-empty all pockets before you take it off and buy a tub of vanish….white is a TERRIBLE colour! What were they thinking giving nervous, tired students white?!! One night shift my pen had leaked in my pocket and because I was on an antenatal ward and the women were sleeping, all the lights were dimmed ….by the time I realised my pen had leaked I had fingerprints on my uniform, on some lovely white sheets, on a couple of CTG monitors and on my face!

uniform I was very glad I had purchased a tub of vanish big enough to bath a baby in!

Good luck and DATE EVERYTHING!!!!

 

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Learning Curve

Your first placement as a student nurse is meant to give a taster of what your career could be. It’s designed to inspire, help you find your feet and learn some of the basic skills. So what happens if that’s not the case?

There is a known fact amongst student nurses/midwives that everybody has a bad placement, whether that means it’s too intense, not what you expected, or not as exciting as you hoped.

For me, it was very much not what I expected. I was placed on an outpatients’ department. It was incredibly diverse in that I worked alongside many different healthcare professionals and was able to observe a wide range of clinics- which all helped my A&P knowledge a lot! But apart from that, I felt a bit shortchanged. Whilst all my colleagues and friends were off being thrown in at the deep end, I was endlessly calling patients in and observing doctors’ clinics. This wasn’t exactly the way I saw my first experience as a student nurse panning out, and I felt completely hopeless. Fellow students and staff would give me a look of sympathy and tell me it gets better when I told them where I was. I would dread going there, because I wasn’t being challenged. I felt that my time wasn’t being spent in the best way possible.

The best thing to do in a situation like this is to make the most of it. It’s hard, I know. You think “what could I possibly get out of this” but you’d be surprised! A placement like this is a great chance to brush up your knowledge, and it’s fabulous for reflective accounts! I have spent countless hours observing every moment in a consultation, thinking about what went well, what could have been better, and how I could improve that when I am put in a similar situation. You’ll also spend a lot of time talking to patients, which can make all the difference to them. A memorable patient for me was a young woman with a rather excitable young child came into the clinic. I played with the child (using only a curtain, which I’m quite proud of) whilst she discussed her medical problem. When she left, she thanked me so graciously that I knew I’d done her a huge favour. Its moments like that I have to remember that nursing isn’t all exciting stuff and clinical skills. Sometimes it’s about those moments when you make someone’s life just a little bit easier.

 

Note: if you ever feel unsure about your placement, no matter what the problem, talk to somebody! Whether that be your mentor, PEF, friend, AA or another member of staff. Someone can help.

New Placement Nerves

First day on placement today, I was very nervous as I always am! You’d think I’d be used to it by now this being my third year right??

Wrong!! Nervous

I spent most of the night before trying to organise my bag, sort my food, check my clothes were ready, not to mention make sure I was organised with my little boy for morning. Early start then, I hear you ask? I only live 15 mins away from placement, the hours are 9-5 and I drive! So it’s even not like I have to be up early – 7:30am alarm call not bad at all!

But yep here I was arriving early and nervous about the usual… What’s my mentor like? Hope the team are nice, the patients are happy to see a student. Hope I don’t make a fool of myself and say something stupid. What if I hate it? And so on and so on.

nervous2

I met a fellow student in the grounds, purely by chance, they too had arrived a little early and they too were nervous about pretty much all of the above too. And they too were a fellow third year student. A quick reassuring chat and then a good gossip over something completely different to distract us both ad we were off to start what we are sure will be another interesting and inspiring round of placement where after the first day alone we will be wondering what all the fuss was about.nervous3

It was great to know I was not alone in how I felt and I’m sure most of you reading this will have felt something at some point so far in your student nurse journey. So if you do, remember on the run up to your first, fifth or final placement, new placement nerves certainly aren’t a new feeling and you certainly won’t be the only one feeling them!

Off-duty – The folder that conveniently tells you when you’re on duty

Every placement, be it community or ward will have an Off-Duty of sorts (some are actual folders and others are being digitalised) which is the schedule for that placement’s staff including us as students. These should be released at least a week in advance to allow you to make travel plans etc. but that sometimes needs to be chased up.

Generally you work the same shifts as your mentor but if this isn’t possible it should be identified who you’ll be working with to make sure you’re supported and you know who to go to if you have an issue whilst you’re in practice.

Different years have different requirements for how you spend your hours on placement which can affect the off-duty, for example in 2nd and 3rd year the NMC requires you to have evidence of exposure to 24 hour care (aka night shifts) but there is no longer a specific necessity of a certain number of shifts. However you should consult your course handbook for year on year updates of the requirements from the NMC and the University.folder-626334_640

The Importance of being a Mentee

On my previous placement I was on a busy gastro ward that was understaffed and had a constantly changing off-duty (The schedule of nurse’s hours which is released weekly) and an unfortunately timed annual-leave meant I spent more than half my time on the ward without a mentor. I found this both a help and a hindrance in equal measure.

My Mentor’s absence meant that I was a “free agent”, I could help any nurse at any time, I could move between the 3 bays on the 28-bed ward as opposed to being attached to one, I was always asking for jobs that I could do or nurses would offer to teach me new skills if there was an opportunity. I ended up “doing more” than other girls on my placement because I was far more available than if I was more associated directly with a mentor and I loved being kept busy for my whole shift.

However being on my new placement has allowed me to see more clearly the negative aspects of this lack of a clear and constant mentor. I spend my hours between a mixture of clinics and a day surgery ward, specialising in Ophthalmics and Maxillofacial conditions and traumas so each case varies from the next and we move around the hospital quite a bit. My new Mentor (let’s call her Ann for confidentialities sake) really took the time to get to know me in my first shift both personally and professionally which allowed her to get a good feel for my strengths and weaknesses and what I could learn from this new placement. She introduced me to all the staff, showed me round the ward and explained what her working week is usually like and what her duties were.

Since this initial meeting Ann has been constantly feeding back to me about my progression, offering any available opportunities to me like spokes for example (these are days spent in different areas of practice or in extra-curricular educational training organised by your trust). This open dialogue between us has allowed me to learn so much more from her as a one-on-one basis that I didn’t really experience in my previous placement. This placement is much quieter than my last ward so getting acclimatised to this different aspect of nursing has been tricky for me, as I prefer a ward-based layout, but Ann has made me feel so welcome and supported it shows what a difference a good mentor can make and she is a prime example of what a great mentor is.