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SSSA – Standards for Student Supervision and Assessment Overview�NURSING - ADULT - BSC (HONS)��Sue Brookes – Clinical and Deputy Training Hub Lead�Shelly Caines – Healthcare and Nurse Associate Facilitator and Practice Educator

Birmingham and Solihull Training Hub�

Sue Brookes

Practice Nurse Facilitator

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NMC Standards

Sue Brookes

Practice Nurse Facilitator

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��What are the seven platforms?��Being an accountable professional�Promoting health and preventing ill health�Assessing needs and planning care�Providing and evaluating care�Leading and managing nursing care and working in teams�Improving safety and quality of care�Coordinating care�

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Key Differences – for ‘Registered Staff’

2008	2018
New registrants not expected to have formal mentoring role until 12 months post qualification Mentors required an NMC approved SLAiP course	Role split into Practice Supervisors (PS) and Practice Assessors (PA) All registered health and social care professionals will automatically become PSs for nursing students PS Preparation begins in Undergraduate nurse/midwifery programmes – no formal course required
Mentors expected to be a ‘named mentor’ for up to 3 students supervise their student for 40% of placement time and assess competence Responsible for student competence and pastoral support	PS - any registered Health Care Professional supervising a skill within their scope of practice PA – ‘suitably prepared’ to sign competency of ‘allocated student ‘within same scope of practice for final assessment part/year
A Sign Off Mentor needed additional training after 12 months of mentorship All Midwifery mentors were automatically trained Ratio 1:1 student/SOM	PAs will be required to Sign Off Student Proficiency Experienced SOM will become PAs Non- experienced staff will require local preparation No ratio but can not be PA and PS for same student
Mentors required an annual update and 3 yearly Triennial Review Mentor /SOM dictated student capacity	A local database will be kept of all PAs and PSs. All areas can supervise students – no cap on student numbers
NMC Teachers were recorded on NMC register - often worked in AEIs	Personal Tutor Role Split to separate pastoral and assessment Academic Assessor (AA) - created for assessment validation Personal Tutor (PT) - for student pastoral support
PPMs supported the assessments, students, mentors in practice	PPMS - role unchanged, identified as ‘Nominated person’ in SSSA

KEY DIFFERENCES – for Registered Staff

2008 SLAiP

Newly qualified staff required 12 month consolidation period prior to becoming a mentor – leading to a waiting list for approved courses

Staff could not become a mentor until attending an NMC Approved 10 day course – increasing time out for staff, increasing course waiting times, reducing mentors available, reducing student capacity due to mentor ratio of 3:1.

Staff needed to complete additional SOM training post 12 months of becoming a mentor to become a “Sign Off Mentor” in order to prepare for the requirement to sign a students proficiency to join the register – this was for the whole 3 years. Emerged due to the ‘failing to fail’ research completed by Duffy

All Midwifery mentors automatically completed the additional training at point of mentor preparation, to become a ‘Sign Off mentor’

SOM ratio had to be 1:1, with protected learning time given of 1 hour per week for all SOM activity – rarely happened.

Mentors required an annual update or else their role could be withdrawn – which could negatively affect student assessment and the numbers of students a ward/department could accommodate – be it 1^st or final placement students.

Triennial Review was a requirement for staff to mentor at least 2 students in 3 years and keep a record of activity – rarely happened, could reduce capacity for students if staff failed to comply (better served by revalidation)

Local mentor database was required by organisations to ensure their departments had enough mentors to support students – was a main factor within Education Audits and Capacity planning.

NMC Teacher Status was recorded as an additional qualification on the NMC Register e.g. QTS – Qualified Teacher Status, in order to reward and recognise the input nurse/MIDWIFE educationalists provide to the learning environment. PTS – Practice Teacher Status was a requirement to sign off any Community Based Course, e.g. Health Visiting or School Nursing.

Practice Placement Managers part of the support mechanism in organisations – working in between Organisations and AEIs on behalf of students and mentors

2018 SSSA

Newly Qualified Nurses and Midwives will automatically become Practice Supervisors – with preparation beginning in their programmes as early as January 2020.

The role has now been split into 2 separate roles – why? Research suggested concerns with the quality of decisions made regarding student assessment. Despite many staff being fantastic mentors, who supervise and teach students the skills they need, some less experienced or unconfident staff feared the failing student, which is the part that requires an assessment judgement to be made. Many mentors invariably struggled with this, as they felt they either lacked confidence, or conviction of the difficulty in fail them, essentially ‘caring’ emotions ‘got in the way’. Also there might have been a lack of objectivity due to ‘mentors’ familiarity with students – i.e. ‘failing to fail’ Duffy (2003)

SOM will automatically become Practice Assessors (as per SLIP GUIDANCE) and a student will be assigned to them for the duration of the placement. PPMs are currently suggesting that a PA can not have any more that 3 students assigned to them at any one time due to working conditions and time restraints, however the NMC no longer recognise this as a mandate.

PA has to be experienced and qualified in the same field as the student they are assessing.

Organisations have agreed to keep a local database of PA and PS – however this will diminish once all staff become PS over the next few years.

PA will have responsibility to escalate issues or concerns to the Nominated Person (PPM), who will guide the process of support via the AA. This can be a virtual conversation or a face to face discussion, depending upon the issue or concern. Often, there is no further requirement for the situation, as it can be managed locally with the PPM and PA/PS as staff are well practiced in the art of writing action plans under guidance of the PPM Teams. All that will be required is clear channels of communication, which will be supported by the MYEPAD, communication flow chart and the PPM.

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How did mentoring look previously?

I think I may have to fail him, but he is coming to the works party!

I don’t have to be a mentor, I don’t like students!

This student isn’t my student, why should I work with her?

I don’t feel confident with my student, she undermines my practice but is lovely with other staff. University won’t believe me if I ask for help as she is fine with her Personal Tutor!

My student is fine with me, I don’t believe what the other staff are saying – I am her mentor and its my decision to pass her!

Why didn’t anyone tell me my student was off sick?

This slide can be used for a discussion point and reflection.
Each comment is a well used point made by existing staff regarding common situations they encountered during their mentoring journey.
Please use each point for discussion.

This student isn’t my student, why should I work with her? / Why didn’t anyone tell me my student was off sick?

As mentors were often placed to supervise other mentors students, there was often a lack of engagement and accountability to report their learning concerns or even find the time to work with them, often stating that they were not the students mentor and had other students of their own.

This has now changed to consider how students form part of the whole departmental team, and everyone, including other PAs and PSs have accountability through the ‘Future Nurse Standards’ to supervise students, but most importantly, provide feedback to the students PA about their progress.

This also prevents students from making mistakes and not been picked up earlier as staff can raise concerns straight away, instead of putting it off due to work pressures and logistics of waiting for their ‘mentor’ to come on shift. It also moves away from ‘not my student’, ‘not my patient’ attitude.

I think I may have to fail him, but he is coming to the works party!

Being a ‘mentor’ often led to staff befriending students, whether it be on Facebook or even giving them their personal number. This often led to students being ‘over-familiar’ with mentors, causing difficulties when attempting to provide constructive feedback about their progress if they were in difficulty.
Mentors often felt guilt and blame, and some students would pick up on this and use it against staff when there was a difficult decision to be made about performance – see evidence regarding student types (Hunt, 2017). The role of mentor sometimes became confusing with an assessor, as some mentors liked to be liked. This became worse if the student was invited to all ward based events.

I don’t feel confident with my student, she undermines my practice but is lovely with other staff. University won’t believe me if I ask for help as she is fine with her Personal Tutor!

This is a myth often felt by ‘mentors’ that is not true. Quite often they would feel their decision would be overturned in University by the students personal tutor or other academic staff. Practice decision for the fail is always upheld, however the students may appeal on the basis the assessment was invalid – often called ‘material error’. This occurs when the ‘process’ of assessment is not followed, due to delayed interviews, supervision time and lack of engagement on the part of mentor and student. The new SSSA will alleviate some of this be using a more rounded assessment method, not weighted to one staff member alone.

My student is fine with me, I don’t believe what the NAs are saying – I am her mentor and its my decision to pass her!

Quite often one member of staff will disagree with another's judgement, and the mentor would have the final say. This was not best practice, as often ‘students in difficulty’ would gravitate towards those with a preferred laisse faire teaching style. Feedback from others could also be ignored, as the responsibility rests upon one person. The SSSA prevents staff from making a poor assessment decision by taking into account ALL feedback. This can also help students who are struggling with their PA or PS, as the method enables objectivity, as opposed to subjectivity.

I don’t have to be a mentor, I don’t like students!

A common myth that staff can refuse to supervise students, but as part of the NMC Code and SSSA standards, staff have to impart their knowledge as part of their CPD and revalidation.
Some staff do not like students, and therefore with regards to growing capacity, these staff need to be targeted to ensure they have full understanding of the changes, in order to improve assessment validity.

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Practice Supervisor Role

Registered with a professional regulator- NMC/GMC/HCPC

Newly qualified nurses are able to act as a Practice Supervisor as long as the role is fully understood and appreciated

Students may work with several Practice Supervisors throughout a placement

Encouraged to document in the Practice Assessment Document (PAD)

Awareness of Student Personalised Support Plans

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Practice Assessor Role

Must be a Registered nurse on the same part of the register as the student
Practice Assessor to assess and confirm positive achievements or possible potential failure
Use feedback from the Practice Supervisor to make an overall assessment
The same person can NOT be the practice supervisor and the practice assessor for the student. ‘Direct Observation’. (Emergency Standards)
Practice Assessor to work with Academic Assessor to evaluate and recommend progression through the programme
Educational/Practice Audit responsibilities
Responsible for Introduction/Welcome pack to area of work
Awareness of Student Personalised Support Plans

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What role does the Practice Assessor perform?

Responsible for joint proficiency sign off for each ‘part’ with the AA

Raise concerns to ‘Nominated Person’ or AA

Liaise with PS and AA for feedback regarding practical and academic progress

Validating feedback from other Registered healthcare staff (including AHPs)

Preparation for final assessments – including Episodes of care

Leading Supervision Teams and student allocation to ensure best exposure to skills

Responsible for Summative Signing of the Part or Year in conjunction with AA
Maintaining quality education standards
Liaising with PPMs for advice and guidance regarding student support
Supporting PS in their daily supervision role.

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Why do we need an Academic Assessor?

Student Practical Performance over their placement ‘part’ or ‘year’

Practice Feedback from Practice Assessor and/or Practice Supervisor

Overview of Student Theoretical Performance

Impartial and objective view of the total student progress within their MYEPAD

Final Student Assessment

This role will not be concurrent, and students may have a different AA for every year. The AEIs are working out the detail, however this may occur in teams, where the role of the AA swap each year using a buddy system.

All AEI staff will take on the role.

FINAL STUDENT ASSESSMENT

AAs support the validation of the assessment and incorporate the theoretical training component in order to support a triumvirate decision – which should reduce the likelihood of assessment ‘material’ error or ‘failure to fail’

The AA will have knowledge of the students journey and previous placement/academic history – provides a wider, validated assessment view

The AA will be able to escalate concerns regarding ongoing conduct, competence and achievement due to knowledge of the previous placements.

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What about extended skills in Annex A & B?

Students will need to practice:-

IV therapy including Blood Transfusions
Venepuncture
Cannulation
Using Medical Devices
Chest Auscultation
Blood Gas Monitoring
Blood Glucose Monitoring
Male Catheterisation

Students can be signed off using :-

Simulation in University
Simulation in Practice including skills sessions
PPM Countersignatures
Observations by Health Care Professionals experienced in the skill
Practice Supervisors
Practice Assessors

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Question time…?

What would you do in the following situations:

As a PS - A student has been assigned to you for your shift. She has asked you to sign off her final interview in her PAD as her PA is not available on the day.
As a PA – you are completing your students mid way assessment. The student identifies that he needs to practice chest auscultation. What are your options?

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Myth Busting

TRUE OR FALSE

Students are not allowed to perform Venepuncture on patients
Students can not take any form of Blood Glucose Monitoring
Students will be allowed to supervise other students completing skills without another PS present.
Allied Health Professions can sign student competence at the end of their placements

Students can take blood gases using an arterial stab method
Students will be able to use Medical Devices for the administration of Fluids
Students will not have supernumerary status
Students can have skills such as Cannulation signed off by a radiologist
Unregistered staff can supervise students

Myth Busting

Students are not allowed to perform Venepuncture on patients

Students can practice Venepuncture under supervision and guidance when indicated within the MYEPAD. This is currently within their 2^nd Year.

Students can not take any form of Blood Glucose Monitoring

Students can carry out BLM, however organisations will need to ensure Governance is in place to allow this – currently being reviewed at Senior Level

Students will be allowed to supervise other students completing skills without another PS present.

Students who are in their 3^rd year and completed the PS Preparation at Undergraduate Level will be able to supervise 1^st and 2^nd years

Allied Health Professions can sign student competence at the end of their placements

AHP colleagues can only act as a PS therefore only allowed to sign skills within their scope of practice. They are not responsible for assessing competency at the end of every part.

Students can take blood gases using an arterial stab method

This is classed as a high risk extended role, and therefore will not be appropriate for students to carry this out. The actual skills is the ‘interpretation and management of Blood Gases’ which can be achieved in simulation

Students will be able to use Medical Devices for the administration of Fluids

Students who are taught in the workings of specific Medical Devices will be able to use them under supervision. This may require a change in Governance and training provided by organisations e.g. POCT

Students will not have supernumerary status

Students will always maintain their supernumerary status, but will be encouraged to work independently as they gain their confidence and competence. They will always work under the supervision of the clinical department.

Students can have skills such as Cannulation signed off by a radiologist

Yes, the skill can be signed off by a radiologist who is skilled in cannulation.

Unregistered staff can supervise students

Unregistered staff can support students under delegated supervision of the PA or PS. This is to ensure that staff who are not NMC or HCPC registered can support students in skills that they are employed to do e.g. Phlebotomists, Care home managers. If this has been arranged as a visit by a PS or PA any skill on the MYEPAD it will need to be countersigned

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MYEPAD

An overview of the Pre Registration Placement Assessment Document (PAD) for all courses from 09.19 onwards.

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What is the MYEPAD?

Part means year

Same PAD across all AEIs

What is the MYEPAD?

Please click each document to send you to the website example

Midlands, Yorkshire & East Practice Assessment Document

Emphasise that the MYE PAD is generic for all fields as proficiencies are generic in the new NMC (2018) Future Nurse standards. This may cause issues across fields in gaining the skills, but work is ongoing to review shared field placements, skills sessions for all and reviewing skills within non-traditional placement areas.

Collaborative Practice Assessment Document – originally created by PAN London Practice Learning Group and further created by the PAN Midlands, Yorkshire & East Practice Learning Group.

Each Student now will have A MYEPAD to last the whole year, with the course consisting of 3 parts (or years).

Many AEIs are working towards an online hosting system for the document to become an e-MYEPAD – this will depend upon the local AEI and the chosen system.

PPMs are currently going to workshops regarding the document to learn how to use it. They will be able to support you in the clinical area with the student, just get in touch.

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MYEPAD content �The document has been designed around the following Components of Assessment and Feedback: �

Initial, Mid-Point and Final Interviews per placement

Professional Values

Proficiencies

Episode(s) of Care – students reflections for discussion.

Medicines Management

Patient/Service User/Carer Feedback Form

Record of working with and learning from others/interprofessional working

Record of communication/additional feedback

Record of peer feedback – Parts 2 & 3

Ongoing Achievement Record

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MYEPAD Content

YEAR LONG ASSESSMENT MYEPAD

(Part 1,2,3)

End of Part Assessment

OAR

Orientation to each placement

Formative Interviews

(Initial, Midway, Final)

Professional Values

Episodes of Care – Reflections and Assessment

Service User Carer Feedback

Skills Lists – NMC Annexe A & B, Medicines Management

Assessment Framework

PART 1 – Guided Participation in Care

PART 2 – Active Participation in Care, Minimal Guidance

PART 3 – Practising Independently with Minimal

Supervision, Leading Care

1

2

3

MYEPAD Content

Supernumerary status for students will be maintained throughout the placement, however their supervision status will be guided by the PA as the framework allows students to potentially move to different levels depending upon their proficiency.

The MYEPAD format is the same for all three years.

Induction and clinical area orientation, assessment interviews (Initial, Midway, Final) and educational activities will become the cornerstone for the year long assessment. This will include the feedback from the PS, and a joint discussion between the PA and AA (whether that be virtual if no problems) in order to determine Sign Off to the next level or entry to the Register.

Students will continually be assessed for their Professional Values, and have Service User Feedback every year.

Assessment Framework

Decreasing levels of supervision will be permissible in direct correlation with individual students’ increasing proficiency and confidence. Once a student has been deemed proficient they should be allowed to practice with Minimal Supervision, unless an event warrants them to change their level to Minimal Guidance or Guided Participation.

The decision on the level of supervision provided for students should be based on the needs of the individual student. The level of supervision can decrease with the student’s increasing proficiency and confidence. (NMC, 2018, p 5) ‘…providing some flexibility should provide students with a broader range of opportunities for safely and effectively developing their practice and confidence’. NMC, 2018

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What does this mean in practice?

Guided participation in care and performing with increasing confidence and competence

Active participation in care with minimal guidance and performing with increased confidence and competence

Practising independently with minimal supervision, leading and coordinating care with confidence

Knowledge, Skills, Attitudes and Values

End Part 1

End Part 2

End Part 3

Incremental Assessment Framework

Assessment of each component of MYE PAD and OAR

Yes or No

What does this mean in practice? (I have included links to the MYEPAD and OAR)

What is Guided Participation?

Students will initially guided towards all the skills required to become a Future Nurse within the MYEPAD and have increased levels of supervision by a PA or PS during the 1^st year – especially if they have no experience in care. Fundamentals are very important, as is managing expectations.

Students should be allowed to practice skills under supervision of their PA or PS. It would be expected that the student would be facilitated towards learning opportunities and skills, and may not automatically know what is available in their 1^st year. It will be down to the PA or PS to identify skills to achieve, and the student to work towards achievement.

Ideally students will progress to the next level in the following ‘part’, but this may not be the case. Guidance should be sought immediately if students are not able to perform at this level, despite interventions. An action plan may be needed at this point to ensure objectives are more explicit.

What is Active Participation?

Students by their 2^nd year should have a good understanding of their role and expectations, in particularly relating to the skills they need to achieve. Students should become advocates for their own learning, and offer to complete tasks that they know are required during the patient journey.

Students at this point, should not require constant supervision and guidance for completed skills in Part 1, but it is always best practice for any PA, PS to check they are satisfied. Students will be encouraged to take part in patient care for a number of patients in preparation for their Episode of Care Assessment, and may well be tasked with taking on the supervision of other 1^st year students if applicable.

What is Practicing Independently with Minimal Supervision?

In their final year, students should begin working at a level that prepares them for the role of the Nurse. This will involve the higher level acute skills such as IV therapy and Cannulation but also the more complex communication strategies such as CBT awareness and mental 1^st aid, found in Annex A&B.

Students at this level will be working independently (still under minimal supervision) but expected to practice leadership and management skills, take case loads of patients in preparation for the planning of their final Episode of Care assessment. Clinical areas should be encouraging students at this point to take charge of wards, plan care, discharges and complex cases, whilst becoming a supervisor to other students. Supervisor preparation will begin in their transition module, so it is vital that students work with other students in order to practice this skill.

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Useful link

This is the webpage for the Midlands, Yorkshire, North East and East of England Practice Learning Group (MYNEE PLG). We represent 33 Universities and work collaboratively to support the development and delivery of a regional nursing practice assessment document and the implementation of the NMC Future Nurse standards (2018).

myeweb.ac.uk

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Thanks for attending

Resources to follow….

EPAD Training

Certificate – 2 hours CPD

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Sue Brookes Clinical & Deputy Lead E: bsoltraininghub.nurses@nhs.net M: 07407115108 Shelly Caines Healthcare and Nurse Associate Facilitator and Practice Educator E: shelly.caines@nhs.net M: