Professional values form part of the student nurse journey while on placement. Staff and educators can help nursing students meet these
Abstract
Professional values are a key element of student nurses’ development and form part of assessment on every placement. Failure to meet these standards can result in students being referred to their education institution, leading to involvement from academic tutors. This article explores potential reasons for such failure, from the perspective of nursing students’ health and wellbeing. It makes suggestions to assist students who are struggling with the placement aspect of their programme.
Citation: Nel K (2024) Supporting student nurses to demonstrate professional values. Nursing Times [online]; 120: 3.
Author: Kerry Nel is university practice learning advisor, Bournemouth University.
- This article has been double-blind peer reviewed
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Introduction
In 2018, the Nursing and Midwifery Council revised its standards of student supervision and assessment (NMC, 2023). One-to-one supervision has been replaced by student support being delivered as a team effort by practice supervisors and practice assessors, thereby reducing the reliance on individual clinicians. The revised standards have allowed approved education institutions (AEIs) to develop and deliver innovative education for student nurses and midwives, while maintaining accountability to preserve the NMC’s standards of care delivery at a local level (NMC, 2023).
The revised standards include the upholding of professional values for student nurses while on placement. However, they do not stipulate how values are measured: flexibility is permitted, allowing programme design at a regional level. Nevertheless, standards must be adhered to, to ensure “student assessments are evidence-based, robust and objective” (NMC, 2023). Therefore, education providers and practice partners have a duty of care to ensure nursing degree programmes are quality-assured. Professional values form part of the evaluation process for each student placement; failure to pass all professional values results in a referral to their AEI. However, students are ordinarily offered a further opportunity to retrieve a failed placement (Royal College of Nursing, 2023).
This article explores what it means to be a professional and why values are an integral part of nursing. It discusses how students’ own health and wellbeing affect how these values are demonstrated in practice, and the reasons why they may fail to meet these competencies in their training.
Being a professional
Professionalism has definitions including appearance, behaviour, communication, honesty, punctuality and attitude.
Globally, the nursing profession is bound by ethics, both professional and value-based (Poorchangizi et al, 2019). In the UK, ethical values in nursing and midwifery encompass the six Cs: care, compassion, competence, communication, courage and commitment (Department of Health and NHS Commissioning Board, 2012).
Nursing professional practice is underpinned by values (Baillie and Black, 2014). Practitioners must uphold the reputation of the profession and continuously demonstrate their fitness to practise (NMC, 2018).
Although there are numerous internationally published papers about professional nursing values (Devakani et al, 2019; Drayton and Weston, 2015), limited numbers discuss this at length in relation to UK nursing students. Professional values are of global interest; however, there is insufficient qualitative data to carry out a literature review that would truly reflect UK students. This could, in part, be due to variances in cultures and professional values between countries. Due to the lack of UK-based research, this article offers international perspectives on potential reasons for student nurses’ failure to fulfil professional values while on placements, which are also pertinent to UK students.
Learners’ health and wellbeing can be adversely affected if they are under high levels of stress (He et al, 2018). This can manifest as low self-efficacy and lead to psychological disorders including low mood, anxiety and depression, as well as physical illness (Devakani et al, 2019). This can all have a direct impact on academic and clinical performance; Zandvliet et al (2019) suggested a link between student wellbeing and rates of retention and course completion. A survey by Health Education England (2022) found that 35% of nursing students in England had considered leaving their course; and 47% of these cited feeling “overwhelmed by the situation” as a reason.
Professional values
A review by Parandeh et al (2015) identified that professional values are measured through the appraisal of beliefs and attitudes that influence behaviour. They highlighted that values add impetus to collaboration, communication and critical thinking; they support quality of patient care, job satisfaction and workforce retention. Timpson et al (2019) suggested that professionalism is built on behaviour, attitude, self-awareness and having the capability to act with professional conduct in any given situation. This is reinforced by the regulatory bodies in the UK: the NMC and General Medical Council’s (2022) guidance sets out health professionals’ duty to respect others, be honest, have integrity and be an aspirational role model.
During training, student nurses develop values associated with professional conduct through theoretical learning and placements. The UK’s BSc and MSc nursing programmes are demanding, requiring students to employ emotional intelligence and resilience to juggle course requirements. There is an expectation that graduates can join the nursing register as safe, competent practitioners, who are able to work independently to professional standards (Hughes et al, 2019). Upholding the values of the profession is a key requirement of registrants worldwide (Poorchangizi et al, 2019).
McAllister (2015) argued that some nursing values have become more nuanced and challenging to demonstrate consistently. Shea (2017) concurred, suggesting that personal values can alter over time, due to both extrinsic and intrinsic factors. Adverse personal experiences can have a detrimental effect on student learning, potentially resulting in failure to provide adequate care (McAllister, 2015).
There are many reasons why some students struggle in practice and risk failing to meet their course requirements. The four domains of the NMC’s (2018) Code that can be used as a benchmark in such situations are explored below. Although these domains are not an exhaustive list, they are some of the more common factors in students who find the nursing course challenging.
Prioritise people
This requirement to always act in the best interests of patients and carers involves being polite, respectful and compassionate, and employing effective communication skills with service users and staff (NMC, 2018).
On entering a new practice environment, students want to feel welcome. This can be promoted by practice partners via a welcome pack that students can review before starting their placement. AEIs should encourage students to contact their placement provider prior to commencement to organise shifts and learn who their assigned supervisor and practice assessor will be.
If students show signs of poor communication, including failing to report absence, the practice area should alert the AEI as soon as possible. This enables tutors to follow up with the student, giving advice and support where appropriate.
Practise effectively
The NMC’s (2018) Code stipulates that staff communicate effectively, work cooperatively and behave accountably. To achieve this, it advises that open communication channels are used. Students should actively seek feedback on their progress and professionalism. Students who are struggling in practice might avoid relationships with their co-workers and physically and mentally withdraw from the team. The basis for this could be a negative ward culture or a misconception around working relationships. Students who believe they have an insufficient knowledge base or skill set may feel inadequate and/or lack enthusiasm; this could present as an apparent lack of interest.
In any of these scenarios, practice assessors should address them at the earliest opportunity with both the student and the AEI to find a solution and monitor progress. The student may be unaware of staff members’ concerns about their conduct. Staff should:
- Manage issues honestly, tactfully and diplomatically;
- Involve the AEI;
- Engage in tripartite meetings to plan the student’s ongoing development.
Students may also experience personal problems, which, if shared with staff, should be dealt with sensitively. The AEI will provide guidance and support for the student.
Preserve safety
This domain of the NMC’s (2018) Code addresses human factors, which can affect students’ ability to recognise and work within their competence. The NMC’s (2018) standards and the joint guidance published by the NMC and the General Medical Council (2022) set out expectations that concerns are raised promptly and health professionals are open about their own health.
Mental or physical ill health and/or undue stress can affect how students react to their environment and situation. Changes in a student’s attitude or behaviour, including poor self-awareness or reaction to feedback, can be viewed unfavourably and result in a negative assessment of practice performance. Staff should be mindful of any uncharacteristic changes to a student’s conduct and communicate any concerns with the student. The student’s permission is needed if staff wish to share any personal information with their AEI.
Promote professionalism and trust
This domain of the NMC’s (2018) Code involves setting clear professional boundaries, acting with honesty and integrity, and maintaining the reputation of the profession; this promotes trust in patients and service users. Priority identification and time management are required to support and improve person-centred care.
For students on a placement, poor time management includes failing to arrive on time or swapping allocated shifts without notifying the team. Arriving late means missing valuable information that is given during handovers; as a consequence, patient care is compromised.
If there is a concern about a student’s lateness or absence, the supervisor or practice assessor should speak to them to identify the reason and offer a solution if appropriate. If no solution is available, the supervisor or practice assessor should seek assistance from the AEI to support the student. Students should follow absence protocol and actively seek feedback from practice area staff to ensure they are meeting the standards of professionalism.
Box 1 shows a case study of a nursing student at Bournemouth University. They struggled with this domain of the Code, also compromising the university’s requirement that “the student maintains an appropriate professional attitude regarding punctuality and communicates appropriately if unable to attend placement” (Shepherd, 2022).
Box 1. Student nurse case study
What happened?
“At the start of my placement, I struggled with the shift pattern and was late several times. I did not let the placement team know that I would not attend one day. I was upset [that] they reported it to the university, as I thought – being supernumerary – it would not be a problem.”
How was it resolved?
“My practice supervisor and university link [who] I spoke to explained that, although I was supernumerary, I am still a member of the team. The team spent time to ensure that I was safe. They encouraged me to think about how not communicating and being late could impact on the team. They also asked if I was worried about anything. I told them about how I was struggling with shift patterns. We revised my schedule, which helped. This situation also helped me to be more confident to ask for help.”
What’s next?
“In the future, I will talk to my supervisors sooner about any concerns. I am working on managing my sleep patterns so that I can manage the shifts. I will also remember the importance of communicating and following policy for absence reporting.”
Key learning
“This value is about more than attendance. I have realised the impact my conduct can have on the team. As a nurse, I need to ensure that I speak to my team when I am struggling. I need to be aware of the policies. Also, I realise that my practice supervisor was concerned that my poor attendance was a sign of needing help. This experience helped me to appreciate that I am a student and that I am learning about my profession. Recognising when I need help is an important aspect of my professionalism.”
Emotional intelligence
Student nurses need emotional intelligence and resilience to engage with the programme’s demands. Emotional intelligence requires motivation, self-awareness, empathy, social awareness and self-regulation (Goleman, 2020). Students also need resilience to face the challenges of academic work and clinical practice (Lin et al, 2023).
Emotional intelligence in the workplace has been linked to factors including strong teamwork and positive work attitudes and performance (Esteban-Gonzalo and Esteban-Gonzalo, 2021), all of which are attributes expected of nursing students. If students are struggling to meet the programme’s demands, they should be encouraged by their AEI to seek assistance with their academic studies and/or clinical practice at the earliest opportunity.
Students are on placement for a relatively short period of time in any one area. A healthcare culture that stipulates and acts on its values enables staff to feel part of a group (Drayton and Weston, 2015; Muls et al, 2015). When students are made to feel part of the team, engagement is heightened, boosting confidence and self-esteem (McSherry et al, 2017).
Conclusion
Professional values are an integral part of the nursing profession. Nursing students should seek out opportunities to portray and abide by the standards and values expected of them in readiness for their future career. Staff supporting students on placement need to maintain open channels of communication and report any unresolved concerns to the AEI. Students should be regularly advised about the support available to them via their AEI and be offered the opportunity to speak to their tutors confidentially about any concerns. This will help students who are struggling with any aspect of the programme.
Key points
- Professionalism is a principal element of nursing, which begins during undergraduate study
- The values set out by the Nursing and Midwifery Council are to prioritise people, practise effectively, preserve safety, and promote professionalism
- Some student nurses struggle to demonstrate these values and require support
- There is an expectation on nursing students to act in an appropriate manner while on placement
- Staff and educators should keep communication open and signpost to support
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