Placement learning insights

We have a good idea of how people can learn new skills and there's no shortage of information available about it. Established ways of learning include observation, asking questions to enable understanding, watching and then doing, receiving feedback from others as well as from the experience of actually doing it. And then, you need to practice until it becomes second nature so that you're no longer thinking about what you're doing and all the steps involved, but focused more on what you're using the skill for. A common example often used is that of learning to drive a car. You may start by learning what the different controls are, then how to coordinate your movements between the pedals and the gearstick, for instance, and before you know it, you're using the car to get from A to B rather than thinking what your hands and feet are doing. The rules of the road need to be learnt and adhered to, obviously, as part of being a competent driver, similar to a nurse using her knowledge to decide when to apply a skill and when to adapt her practice to a changing situation.

Nevertheless, it always has a magical feel for me, considering the transformation from a novice to a competent practitioner and onwards to expert. Patricia Benner, of course, did much to further our understanding of the transition from novice to expert, at least what the different levels look like in practice and how to help people make the transition. In her application of the Dreyfus and Dreyfus skill acquisition model, she stated that being a novice is contextual - an experienced nurse could be a novice in a novel situation (e.g. encountering premature babies for the first time) just as much as a student nurse would be a novice going into a practice area for the first time. However, in that case, there must be a difference between purely contemplating skill level and the 'being' of being a qualified nurse, because when a nurse reaches qualification stage they are not in the same place as a new student, even if they lack skills in certain specialised situations.

Student nurses are in a process of becoming a qualified nurse and need mentor support to get there. My research has been investigating the 'being' of mentoring, so not so much concerned with mentoring skills, but what it means to be a mentor for student nurses. Understanding this better can improve the way mentors are prepared, developed and supported. What is becoming clear is that there is no easy way of knowing when learning is happening, or to judge when a student is really competent.

According to Benner, the competent nurse is one who has typically been on the job in similar situations for two to three years. Given that student nurses might spend 8 weeks on a placement and continously move from one speciality to the other during their course, we must be using a different measure of competence for placement students.However, by the end of their three year course, they must be able to demonstrate that they can practise independently. Practising independently must be open to wide interpretation, because we know that nurses are part of a wider network of professionals and a nursing hierarchy, and it is recommended that they have a period of pereceptorship after qualifying. They are always part of a wider system.

The wider system, and what this means to any practising professional, is fascinating. Becoming a nurse means becoming familiar with the world of patients, treatments and care, the required attitudes and qualities expected in a nurse, the networks of professionals, nursing equipment and environments, and so on. All these things carry meaning to a nurse as part of a 'referential whole' to use one of Martin Heidgger's terms. Everything carries meaning to a nurse in a way that someone who isn't a nurse wouldn't see. A mentor's job is partly to enable a student to enter this world and see it with different eyes, as a nurse.