‘Fit for Registration’ Mentor judgements and decision making regarding student competence in practice. A mixed methods study.

Current pre-registration nursing programmes in the United Kingdom (UK) require students to spend 50% of their programme time in practice, with this practice learning and assessment supported through the process of mentoring. Concerns have been expressed both locally and reflected in the wider literature regarding mentoring, with a specific concern that mentors fail, or may be reticent, to judge student performance as unsatisfactory. However to date few empirical studies have examined how mentors reach an assessment decision. Thus this study set out to examine the concerns expressed using judgement and decision making theoretical frameworks, and investigate how mentors form judgements and reach a decision regarding an assessment of student competence in practice.
An embedded mixed methods design was employed for the study. In the first phase student practice assessment documents (PADs) relating to a whole cohort of students (n =41) completing a three year undergraduate pre-registration nursing programme were collected following the final exam board. Documentary analysis of the mentor decisions (n =330) was undertaken to examine mentors’ use and conduct of assessment interview processes, with data contributing to a sampling frame used to identify final placement mentors (sign-off mentors) to invite for interview. In phase two, mentor comments in student PADs were thematically analysed using Braun & Clarke’s (2006) six phase process. Stimulated recall interviews were conducted with the selected sign-off mentors (n = 17) and data analysed thematically.
Assessment strategies and documentation were shown to have limited effect on mentor judgements and decisions. Instead mentors formed impressions regarding a student and their practice, which led the management of the assessment process, and formed the basis of formative judgements and the summative decision. Key to any judgement was an evaluation of the student’s ability to function as a reliable member of the team. Mentor judgements were informed by mentor expectations of a student appropriate to the practice area and stage of the student’s programme. Judgements were accumulated over the placement and combined to inform the final decision taken, in a manner that can best be understood and conceptualised with reference to Brunswik’s lens model of social judgement (1952).
Recommendations are made for supporting and developing mentor decision making within current assessment systems, and for further work on assessment tools and strategies. Finally recommendations are proposed for research to test the criteria and decision making model developed as well as further understand mentor decision making in the difficult areas identified.