The role of mentorship in trainee advanced clinical practitioner development

Abstract

Advanced Clinical Practitioners (ACPs) are a rapidly growing workforce worldwide with the USA showing the highest absolute number and rate per population, followed by the Netherlands, Canada, Australia, Ireland, and New Zealand (Maier, Barnes, Aiken, & Busse, 2016). Whilst many practitioners are nurses by background, the development of the role has encouraged the inclusion of other professions such as physiotherapists, pharmacists, and paramedics. The progression of the ACP role involves the acquisition of new skills alongside postgraduate academic education at Masters level and peer support (Aguilard, Colson, & Inthavong, 2017, Health Education England 2017; NHS Education for Scotland 2012). The Department of Health (2010) supports this underlying principle with the inclusion of self-development as one of the four pillars of advanced practice. Despite awareness of this, trainee ACPs can find initiating self-development difficult without appropriate support when transitioning from competent to expert practitioner, yet a supportive environment can influence this transition positively (Sharrock, Javen, & McDonald, 2013). The obstacles to achieving interprofessional team collaboration in a surgical care environment in Sweden have been explored, with recommendations to optimize the role (Andregard & Jangland, 2015). Lack of confidence and a sense of inadequacy is common amongst trainees, which can be overwhelming (Hill & Sawatsky, 2011). The transition of socialization into the new working environments may be challenging with adaptation to new processes and methods of practice becoming stress inducing (Feng & Tsai, 2012). Harrington (2011) concurs and suggests a mentoring programme would help to alleviate these negativities. A mentor is suggested to be someone who: “facilitates learning and supervises and assesses students in a practice setting” (Nursing & Midwifery Council, 2008). Eller, Lev, and Feurer (2014) identified effective mentoring included aspects of open communication, passion in exchange of knowledge, mutual respect and trust and role modelling. Whilst it is important for the mentee to be willing to learn it is also imperative that the mentor has a standard of excellence in this role, which they are keen to execute (LaFleur & White, 2010). The absence of this, results in negative feedback from trainees about their mentorship experience (Jack et al., 2018). To minimize this, De Campli, Kirby, and Baldwin (2010) suggests the mentor and mentee should be encouraged to select each other to enable a positive relationship to develop. The Nursing & Midwifery Council (2008) identifies mentors for nursing students should be on the same part of the register to enhance the learning experience. Trainee ACPs, however, may receive mentorship from those of a different professional background. The consequence of this may be the development of a wider knowledge base both for the mentor and trainee and increased skill sharing and interprofessional mentorship can aid socialization (Rohatinsky & Ferguson, 2013). Mentorship of trainees may also be supported by other staff members; consultants, senior practitioners, and medical staff who can acts as a coach, mentor, support, and educator to enhance the learning experience (Health Education East Midlands, 2014). However, primary research by Barton (2006) identified nurse and medical mentor relationships to be challenging due to the crossover of professional boundaries and for this reason medical mentors are recommended in addition to the stability of the supervising clinician (Health Education East Midlands, 2014). Negativity may also present when learner feedback delivery is required. Ten Cate (2013) suggests feedback to trainees whilst important to development, is often difficult to receive and can be demotivating. French, Colbert, Pien, Dannefer, and Taylor (2015) recommend progression of performance over time must also be emphasized, yet the trainee must have awareness of plateaus, rapid progression, and setbacks as being recognized elements of learning development (Dreyfus, 2004). The role transition for ACPs has been analysed by Moran and Nairn (2017) who have identified appropriate mentorship, clinical supervision and supported development alongside formal education programmes to be essential for the trainee both pre and postqualification. Senior ACPs therefore, should apply their leadership skills to facilitate learning (Department of Health 2010) which in combination with ongoing supervision, will ensure continued support and high-quality patient care.