NS6218 Revised
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Developing Mentors to Support Students in Practice. Part 2: Establishing effective
Relationships.
Summary
This article, the second of an 11 part series, will provide guidance and offer advice to new
and existing mentors and practice teachers to enable them to develop within their role and aid
them in developing a portfolio of evidence. It will particularly look at ‘Establishing Effective
Relationships’ and will stress the importance of the student – mentor / practice teacher
relationship. Furthermore, it will examine the essential qualities, attributes and characteristics
of an effective mentor / practice teacher. The article presents a number of suggested ways in
which mentors and practice teachers can meet and maintain the requirements for these roles
as stipulated by the Nursing and Midwifery Council (NMC). More importantly a number of
learning activities and useful tips will be incorporated to aid prospective and existing mentors
and practice teachers to undertake various self assessments. This will enable them to gather
relevant evidence in order to demonstrate how they have met the requirements to become or
maintain the mentor or practice teacher qualification.
Introduction
Nurses and midwives in the United Kingdom (UK) have a professional duty under the NMC
(2008a) code to support students in practice and potentially become mentors or practice
teachers (NMC 2008b). In 2006 the NMC published the ‘Standards to Support Learning and
Assessment in Practice’ (SSLAP) with a second version in 2008 (NMC 2008b). These
standards consist of a single framework which sets out the domains and outcomes for
mentors, practice teachers, and teachers of nurses and midwives. For more in-depth
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information on the NMC (2008b) SSLAP refer to part 1 of the series. This article will address
the first domain and outcomes named ‘Establishing Effective Working Relationships’ see
Box 1. Mentors and practice teachers may wish to develop a portfolio of evidence that
demonstrates they have met the requirements of the relevant domains and outcomes (NMC
2008b) at the appropriate stage, which may be reviewed as part of the triennial review in
order to remain on the local live register.
Importance of Mentorship Relationships
Mentorship is one of the most rewarding components of a qualified healthcare practitioner’s
role (Kinnell and Hughes 2010). It is a big responsibility, clinically and professionally
(Hodges 2009 Pg 34). The terms ‘mentor’ and ‘practice teacher’ are very specific when
applied within nurse education in the UK. A mentor according to the NMC (2008b) is an
experienced nurse or midwife who has successfully achieved a NMC approved mentorship
preparation programme and has met the domains and outcomes at stage 2 of the framework
of the SSLAP (NMC 2008b). They are required to support, teach and assess students that are
on an NMC approved programme, such as, Pre Registration nurse / midwifery education and
Community Specialist Practice Programme. Whereas, a practice teacher is a registrant who
has gained knowledge, skills and competence in specialist practice and in the teaching role
and have met the outcomes and domains at Stage 3 of the framework (NMC 2008b). They are
required to support and assess students enrolled on an NMC approved Specialist Community
Public Health Programme.
Mentoring involves a relationship with a learner and mentors and practice teachers need to be
fully aware of what is required to maintain effective relationships but even more so that they
acknowledge that it is a reciprocal process (Hodges 2009) where both are engaged and
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committed (Wilkes 2006). Effective mentorship enables students to develop the knowledge
and skills to become a competent practitioner and the role of the mentor and practice teacher
is to support student learning and assess student competence (Kinnell and Hughes 2010,
Wilkes 2006). Therefore, it is essential to establish an effective relationship, whereby, the
mentor or practice teacher can be supportive but also objective and analytical due to the dual
role responsibilities of providing guidance and support in addition to acting as an assessor of
clinical competence (Wilkes 2006). Sherwin and Stevenson (2010) stress that this is even
more important for post registration students with their allocated practice teachers, as the
relationship between them is often more intense due to working closely together for the
duration of the year long course. Neary (2000) asserts that an effective mentoring relationship
should help to motivate the student and improve confidence and self esteem. Moreover, good
mentorship can aid critical thinking, reasoning, problem solving and to encourage students to
ask questions about aspects of care (Hodges 2009). Furthermore, Teathersedge’s (2010)
longitudinal survey undertaken in Essex, England, which looked at the changing attitudes of
nurses from being students on the mental health branch to eventually working in professional
practice, found that effective mentoring from a student perspective is about having a mentor
or practice teacher who is able to calm their anxieties, especially in a new placement, this
helps them to settle, focus and enable learning to take place. Thus, the quality of the
mentoring relationship can have an affect on the students’ achievement and progression
(Foster-Turner 2006) especially if the student has increased anxiety which has not been
noticed and addressed by the mentor or practice teacher (Moscaritolo 2009). Consequently,
Pearcey and Elliot (2004) found that bad experiences with mentors or practice teachers whilst
on practice placements were one of the causes of student attrition. Therefore, making a
student feel welcome and establishing a good working relationship as soon as possible is a
priority (Beskine 2009). However, in order for a relationship to be effective a number of
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mentor or practice teacher qualities and attributes are essential. It is helpful for mentors and
practice teachers to be aware of what students perceive as good qualities and attributes.
Establishing Effective and Interprofessional Working Relationships to Support
Learning
Qualities, Attributes and Characteristics of Mentors and Practice Teachers
There is a plethora of research literature regarding the qualities, attributes and characteristics
of mentors, however the research undertaken is predominantly the views of pre registration
students. Much of the findings though can also be applied to post registration students. Gopee
(2010) agrees and concurs that the relationships are similar in that it has to be established
initially, objectives identified but the difference being is that post registration students come
with substantial professional knowledge and competence and are now working to achieve the
competencies of a specialist practitioner. In support of this, Jones and Ewens (2010) found
that post registration students stressed the importance of practice placements acknowledging
that they are students with experience and fully qualified nurses. They go on to say that
therefore it is crucial for these students to be introduced as a post registration student not only
as a qualified nurse but with years of experience. Nevertheless, both pre and post registration
students have described the perceived qualities of a good mentor / practice teacher as being
enthusiastic (Webb and Shakespeare 2008), friendly, approachable, patient, understanding
and having a good sense of humour (Gray and Smith 2000). In addition, Gray and Smith
(2000) in their longitudinal qualitative study undertaken in Scotland to discover the effects of
mentorship with preregistration student nurses following the introduction of the preregistration education which led to a diploma of higher education, found that a good mentor
is a good role model, organised, caring, self confident, good communicator, knowledgeable
and most importantly able to spend time with them. This time factor is especially so for post
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registration students as Carr (2012) asserts that these students demand considerable time due
to their need to develop leadership and higher cognitive skills in practice. Furthermore,
students have expressed that mentors and practice teachers should show genuine concern for
them, involve them in activities and most importantly that they should want to be a mentor
(Webb and Shakespeare 2008).
Moreover mentors and practice teachers need to be
consistent, have genuineness and respect (Andrews and Wallis 1999).
In contrast, Gray and Smith (2000) describe poor mentors as those that break promises, lack
knowledge and expertise, have no structure, chop and change their minds, are over protective,
throw students in at the deep end, delegate unwanted jobs and are often distant and intimidate
students. This mirrors some of the earlier work by Darling (1985) which she called a ‘Gallery
of Toxic Mentors’ the characteristics of which can be found in Box 2. Although this work is
dated it is still very much pertinent today. However, time is universally regarded as the
biggest constraint on effective mentoring due to workload demands (Gray and Smith 2000,
Phillips et al 2000, Pulsford et al 2002, Carr 2012). Later studies undertaken in England
between 2003- 2008 by Kinnell and Hughes (2010) with a number of third year students
asked students ‘what qualities and skills make an effective mentor? Their comments can be
found in Box 3. These findings are not dissimilar to the above but are a reminder to mentors
and practice teachers of what students appreciate when they first enter a new practice
placement. Gray and Smith (2000 Pg 1547) identified other ways in could help constitute a
good and effective mentor / practice teacher relationship:

Support the students rather than breathe down their neck

Encourage and allow involvement in patient care rather than just observation

Show confidence in the students abilities and trust them to do things

Form a relaxed relationship with their students
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
Take time every day to let the student do or observe and not assume prior
knowledge and experience

Regardless of the stage of training that the student is at have a initial
discussion to determine the students present abilities and intended learning
outcomes

Ascertain what the student requires as an individual to meet the learning
outcomes

Remembering that the student is there

Allowing students some independence by giving more guidance at the
beginning of the placement, then standing back and allowing the student to use
their initiative and self motivation.

Allocating another mentor in the named mentors and practice teachers’
absence.

Think carefully about the off duty in terms of arranging shifts to allow the
mentor and student to work together.
As can be seen the foundation of being a good mentor / practice teacher is to build an
effective working relationship with the student. In support of this, Beskine (2009) asserts that
establishing effective working relationships is one of the first responsibilities of a mentor or
practice teacher. It is imperative that this relationship is achieved as quickly as possible.
Below presents a number of suggested ways in which this can be achieved and how mentors
and practice teachers can utilise these methods in order demonstrate and gather evidence to
show they have meet NMC (2008b) SSLAP, domain
Effective Working Relationships’ which are stated in Box 1.
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and outcomes for ‘Establishing
An ideal starting point for any mentor or practice teacher is to undertake a SWOT analysis of
themselves. A SWOT analysis is a self assessment that can be used to examine Strengths,
Weaknesses, Opportunities and Threats (Lawson 2011). It is a simple tool that allows the
individual or teams to explore what can be developed (Pearce 2007). Conversely, Walsh
(2010) asserts that merely identifying is not enough, its value lies in rectifying weaknesses
and threats by establishing goals and developing an action plan. Mentors and practice
teachers can use this tool at any point of their career, especially so when they are approaching
their annual appraisal and triennial review with their manager. Now complete Learning
Activity 1
Learning Activity 1
Reflect on what you have just read. Now complete a SWOT analysis of your
self. Look at your strengths and abilities as a mentor and how you establish
effective relationships.
Make a note of the strengths, weaknesses, opportunities and threats.
You may want to ask a colleague or a student to also complete a SWOT
analysis on your personal strengths and weaknesses.
If you do compare this feedback to your own SWOT and identify / list any
areas for improvement.
What areas can be improved upon and how do you intend to do this?
You can now place your SWOT and other notes in your portfolio and map
these against the relevant domains and outcomes
Factors Enabling Students to Integrate into Practice or Move into Specific Areas of
Practice
Being Prepared.
Establishing effective relationships and enabling students to integrate into practice should
start before the student arrives. Students often report that they do not fit in to practice
placements, especially at the beginning (Loftmark and Wikbald 2001). Gray and Smith
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(2000) assert that this feeling is worsened by unknown environments. Jones and Ewan (2010)
also found that post registration students expressed being accepted and included within the
practice placement as most important. The mentor or practice teacher needs to be prepared
for the arrival of a student and that they portray to the student that they are expected and
welcome (Price 2005a). Therefore, the key to success is advanced planning. Delegation of a
named mentor or practice teacher and substitute mentor or practice teacher before the student
begins the placement is essential. It will allow the mentor or practice teacher to ensure they
are available on the student first allocated day to the placement area, thus enabling the
relationship to commence immediately (Anderson 2011). Normally a student will contact the
placement area in advance. It is at this pertinent time that mentors or practice teachers should
offer a pre placement visit, but the most important aspect is to provide the student with the
start and finish times and allocated named mentor or practice teacher for that particular
practice placement. This can reduce some of the anxieties on the first day if the student
already knows the name of their mentor or practice teacher and can put a face to a name
(Walsh 2010). During a pre placement visit a student should meet with the mentor or
practice teacher, be provided with a welcome letter and placement induction pack, as
recommended by the Royal College of Nursing (RCN 2007). This pack should outline the
practice placement speciality, names of staff, uniform policy, shift hours, placement
expectations, ground rules and potential learning opportunities. However, it will need to be
reviewed and updated on a regular basis due to the rapid change in service provision of health
care (Beskine 2009). Alternatively, if the student is unable to attend a pre placement visit this
information should be sent to the student at a preferred address (which can be ascertained
when they ring the placement area) so that they can read through the information prior to
their arrival. Now complete Learning Activity 2.
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Learning Activity 2
Consider the discussion above.
Now ascertain if your practice placement has a welcome letter and
induction pack. If not - can you devise them?
Are these up to date? Do they contain the relevant information?
How can they be improved? How do you intend to do this? By when?
On completion of this review you can now place the revised pack and letter
and other notes in the portfolio and map these against the relevant
domains and outcomes
Welcoming and Orientation
Students who do not feel a sense of belonging to a placement may not be motivated to learn
and achieve excellence (Worrell 2007). The important element of the first week is to build a
rapport with the student (Walsh 2010). The Royal College of Nursing (RCN) (2007) Mentor
Tool Kit guidelines recommend that the student meets their mentor or practice teacher during
the first week. This is essential as placement lengths may be as short as 4 weeks (NMC
2004). This should start with a planned orientation to the placement area, introduction to
staff, along with setting goals (RCN 2007). Orientation is an essential but lengthy process,
however, it is a gateway to a successful placement (Beskine 2009). Ensuring that the students
first day of placement is one that is not normally too busy and to allow then to start at a
mutually convenient time of the day will enable the mentor or practice teacher and student to
spend time with each other to facilitate a proper orientation. (Walsh 2010, Gray and Smith
2000). It is important that the health and safety issues must be covered on day 1 of the
students placement and if the mentor / practice teacher is not available then another named
person must undertake this with the student.
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Orientation covers the formal, professional, legal, national and local requirements (Beskine
2009). The student should be given a tour of the placement area, including; layout, fire exits,
important equipment and where stored, location of toilets, a discussion of health and safety
issues and procedures (must be on day 1), contact numbers, start and finish times and breaks.
All these aspects need to be discussed at some point either during orientation or during the
initial interview. Worrall (2007) found that a tour of the placement led to feelings of fitting in
and familiarity with the surroundings. In addition, Anderson (2011) believes it provides an
opportunity for students to express any concerns. However, no matter how organised the
mentor or practice teacher is and how much pre planning there are a number of potential
threats, such as, lack of staff on the first day / week, lack of support from managers and busy
workloads. (Wilkes 2006). Another important element of the orientation process should
include an introduction to the rest of the staff / team and other key personnel within the
placement setting (Hutchings and Saunders 2001). Conversely, this may not always be
feasible on the first day of induction, but most take place at a relevant opportunity.
It is well known that within practice placements mentors and practice teachers co-ordinate the
orientation and inductions in many differing ways (Worrell 2007). Jones and Ewan (2010)
stress that a professionally laid out induction into the practice placement sets the tone for
what is expected. Some practice placements have planned formal inductions days for all new
starters at the same time which is facilitated by placement educational lead (the named person
in the practice placement that takes responsibility for student learning). However, in other
areas each individual mentor or practice teacher may welcome, orientate and induct their own
allocated student. This could lead to inequitable inductions as the process will depend on the
individual mentor or practice teacher. Consequently, for some students little is being done to
relieve their stress and anxieties when starting a new placement area (Worrell 2007). Given
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the importance of the orientation day ideally each practice placement area should consider,
decide and agree a standardised format for the welcome and orientation process. The
standardised format should take into account the examples of good practice already
discussed, thus, ensuring equity of provision. A standardised orientation placement check list
could then be devised and worked through for each new student entering the practice
placement, thus, ensuring all important aspects are covered (RCN 2007). This in turn would
prevent differences, enable standardisation and provide a comprehensive welcoming and
orientation process for all allocated students in the practice placement.
Providing Ongoing and Constructive Support to Facilitate Transition From One
Learning Environment to Another.
Initial Interview
The next stage of the orientation process involves the initial interview. Again it is essential
that this takes place within the first week of the students’ placement. Walsh (2010) stresses
that the initial interview is a crucial stage in helping the student set off on the right foot, make
the most of their practice placement and assist them feeling at ease. Similarly, Jones and
Ewan (2010) concurs that the initial introduction, paperwork and administration are crucial at
the beginning of the placement. Allocating adequate time and private place for the initial
interview is essential (Price 2005a). The initial interview should provide an ideal opportunity
to set grounds rules. Some suggested ground rules are listed in Box 4. In addition, the mentor
or practice teacher should go through the induction pack (which should have been given to
the students at either the pre-placement visit or prior to arrival), to identify and check clarity
of understanding of the information in order to prevent disparity in expectations (Hodges
2009). Role, responsibilities and expectations including contact numbers, start and finish
times, breaks, practice placement philosophy should be established and clarified (if not
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already done so during the orientation process along with ensuring clarity on supernumerary
status (Beskine 2009) which is essential for pre-registration students. During the initial
meeting the mentor or practice teacher should enquire about the students well being and
interests, as it is seen as good practice before moving onto discussing and agreeing learning
outcomes and assessment strategies (Price 2005b). Having a common interest can be a
catalyst for achieving a rapport and trust between the mentor or practice teacher and student
(Beskine 2009).
In addition, sharing some of the mentors or practice teachers own experiences and
insecurities can also assist with building a good relationship and can go a long way to enable
the students to feel at ease (Walsh 2010). However, the mentor or practice teacher must
remain on a professional level and caution is aired during such social orientation (Wilkes
2006). It is important that the mentor or practice teacher deals with any anxieties at this point
which may include any aspects of the new placement, child care issues, or any unmet
objectives. In support of this, Walsh (2010) asserts that a mentor who displays a degree of
empathic understanding or insight into the student needs will assist them in feeling at ease.
Potential learning opportunities, outcomes and realistic objectives should now be discussed
by both student and mentor or practice teacher, along with an agreement of when, how these
will be met and how they will be assessed. It is during this discussion that the students’ prior
knowledge and experience should be ascertained. Planned learning opportunities should be
agreed through a learning contract or action plan. Learning strategies, including week by
week learning should be discussed and agreed, along with agreeing any planned visits to
other placement areas or working with other members of the multi-disciplinary team. Most
importantly before the initial meeting comes to an end the mentor or practice teacher should
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set and agree the dates and times for future contacts for the forthcoming meetings (Price
2005a). Now complete Learning Activity 3.
Learning Activity 3
Consider the discussion above. Now complete a SWOT analysis by
reviewing your practice placement and compare this to the above
identified good practice.
What welcome and orientation process is used in your area? Do you
have a set format? Do all mentors and practice teachers practice have
the same welcome and orientation process with new students?
What areas can be improved upon and how do you intend to do this?
Now ask a student to complete a SWOT analysis following their
experience of the welcoming and orientation process
Compare this to you own SWOT and identify and list any areas for
improvement. How do you intend to meet any short comings?
You can now place your SWOT and notes in the portfolio of evidence
and map these against this NMC standard / outcome
Ongoing Relationships
As discussed earlier the relationship between the mentor or practice teacher and the student
starts prior to arrival and starts to build at the welcome, orientation and initial meeting,
however it is imperative for this relationship to be strengthened. Regular contact both
informally and formally with the student is essential. For pre-registration this should include
working informally with the student directly or indirectly for at least 40% of the students time
(NMC 2008b). The relationship will continue to build through the mentor or practice teacher
facilitating the students learning and assessing progress continuously. These two important
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aspects of the roles of the mentor and practice teacher will be addressed in-depth separately
later in the series. The relationship should also be maintained through formal meetings which
need to be planned in advanced (Duffy and Hardicre 2007). The importance of these
meetings can not be stressed enough, as it is through these meetings when any concerns or
anxieties should be addressed immediately. In addition, a review of the student’s progress,
further discussions and action plans agreed by both parties should be included in these formal
meetings so that the student can work towards their objectives.
As can be seen working relationships are constructed over time and need to be maintained
(Gopee 2010). However, relationships can break down if there are substantial differences
between both the student and mentor or practice teacher. According to Gopee (2010) some
areas of conflict may include, personality clashes, differences in perceptions of their roles and
responsibilities, differences in values and beliefs, technical reason regarding the student, such
as, not being punctual due to child care issues, or transport issues due to the distance of
practice placement. From the mentor or practice teacher perspective this may include, role
conflict with other roles and work demands, differing working days to the student or
differences in start and finish times to that of the student (Gopee 2010). Nevertheless, Gopee
(2010) goes onto assert that despite these negative issues in the relationship it can lead to
positive outcomes as new learning can be take place depending on how these negatives are
managed. Establishing effective relationships needs to be maintained throughout the students
practice placement and thus any breakdown or conflict needs to be addressed as early as
possible as this could affect the students learning and progress.
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Evidence Towards Domain 1 - Portfolio Building
As previously discussed mentors and practice teachers are required to demonstrate they have
met the NMC (2008b) SSLAP of stage 2 or stage 3 of the framework through the
development of a portfolio of evidence. By working through the above ‘Learning Activities’
included in this article the worked produced will now provide appropriate and excellent
evidence towards the first domain and stated outcomes. In addition, following a mentors or
practice teachers experience of facilitating a students learning in practice further evidence
would be generated once the welcoming and orientation process for the allocated students has
taken place. Providing the student gives consent, a copy of the students University orientation
checklist and initial interview documentation, ensuring anonymity to maintain confidentiality
(NMC 2008a), along with any other placements orientation checklist (if one has been devised
and completed) is valuable and appropriate evidence. Moreover, the mentor or practice
teacher should reflect on the welcome, orientation process and formal meetings that have
taken place as this too would also provide some excellent evidence towards this domain,
along with demonstrating reflection on experience and consolidation of learning.
Furthermore, through the students own evaluation either via a SWOT, if completed as part of
learning activity 3 or completion of a placement evaluation form may also provide feedback
on the orientation process and would prove valuable evidence in meeting this particular
domain. Finally, copies of the staff rota will demonstrate when the mentor or practice teacher
and student have been able to meet on the first day or within the first week of placement,
along with demonstrating that the student has worked at least 40% of their time with their
allocated mentor or practice teacher and it can be used to identify the scheduled formal
meetings that have taken place. Once these elements have been completed and evidence
gathered it is essential that the mentor and practice teacher map and cross reference the
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evidence gathered against the relevant NMC (2008b) SSLAP and place the generated
evidence in a logical well structured portfolio.
Summary
Effective mentor - student relationships are crucial to student learning. Building a rapport and
successful relationships takes time and effort. Being prepared before hand will demonstrate to
the student that they are expected and welcome. Regular contact with the mentor is essential
and this should begin at the start of a students practice placement. A thorough orientation will
provide a good first impression and help to relieve any initial anxieties. Orientation
programmes should be comprehensive and jointly agreed as this can play a large part in
maximising the students learning. It will provide the foundation of the mentor-student
relationship and will enable a smooth, enjoyable practice placement. For the relationship to
build the initial meeting must take place as soon as possible. Furthermore, in order to
maintain a successful relationship regular contact with the student through formal and
informally meetings must also take place. Mentors and practice teachers should review and
reflect on all aspects of facilitating a students learning within the placement area, such as, the
orientation, welcome process as well as the initial, midpoint and final meeting to aid in
developing and improving their mentoring skills. If mentors and practice teachers complete
the above learning activities, along with gaining experience in practice they should have a
number of fruitful, good quality evidence to place in the portfolio of evidence in order to
demonstrate that they have met a number of the NMC (2008b) SSLAP.
The next issue of ‘developing mentors to support students in practice’ will look at creating an
excellent learning environment.
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Box 1
Domain 1 – Stage 2 - Mentor
1. Establishing effective working relationships.

Demonstrate an understanding of factors that influence how students integrate into
practice

Provide ongoing and constructive support to facilitate transition from one learning to
another.

Have effective professional and inter-professional working relationships to support
learning for entry to the register
Domain 1 – Stage 3 – Practice Teacher

Have effective professional and interprofesional working relationships to support
learning for entry to the register and education at a level beyond initial registration

Be able to support students moving into specific areas of practice or a level of practice
beyond initial registration identifying their individual needs in moving to a different
level of practice

Support, mentors and other professionals in their roles to support learning across
practice and academic learning environments.
(NMC 2008b)
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Box 2
Toxic Mentors (Darling 1984)

Avoiders – simply are never available for a variety of reasons

Dumpers – these are mentors that put students in difficult situations and give them
task that are well out of their depth and offer no assistance (sink or swim)

Blockers – these mentors refuse students’ requests for help or withhold information so
limiting the students development
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Destroyers / Criticisers – mentors who damage the students’ self esteem by being
negative and belittling students.
Box 3
Qualities and skills on an effective mentor (Kinnell and Hughes 2010)
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Accommodating
Appreciates students knowledge
Approachable
Assists students in problem solving
Awareness of students’ limitations
Being aware of the student’s learning objectives
Confident
Does not refer to the student as the ‘student’
Encouraging and supportive
Facilitates student’s learning
Flexible – having time to spend with students
Gives positive feedback
Good communication skills
Good knowledge of branch of nursing
Good flexible teaching skills dependant on what level the student is at
Good negotiator.
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Box 4
Ground Rules – Beskine (2009)
 To agree on the student’s responsibility for his or her actions
 Patient confidentiality
 Informing patients of the students’ status
 Consent – giving patients a choice about accepting care from a student and
understanding that patients’ wishes and rights supersede students’ rights to knowledge
and experience at all times
 The student working under the supervision of a mentor at all times
 Not doing anything that the student is not prepared or confident to do or if there is
inadequate supervision.
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