GUIDANCE FOR COMPLETING THE PRACTICE ASSESSMENT DOCUMENTS SECTION 1 This section this section includes information relating to the: practice assessment process completion of the practice development plan the initial placement interview record of placement pathways and testimony sheets. In year three the sign-off mentor pages are also included in section one. The blue text boxes provide guidance related to the assessment process.
School of Health and Wellbeing Pre-Registration Nursing B Nurs (Hons) Practice Assessment Document Cohort: Year 1 Adult Field All documents must be submitted on or before the date indicated. Non-submissions will be awarded a fail grade. Students are advised to submit extenuating circumstances if they are unable to submit on the date indicated. If the submission date occurs on the last Friday of a student s placement, the final interview must be completed on or before this date and the student should be allowed to leave placement early if necessary to submit the document on time. Submit to Student Office on: Date inserted here, must be submitted by 5pm Student Name:. Student Number: Students are advised to photocopy the practice learning plan, Progress Interview, Final Interview pages and the timesheet, as evidence of achievement in the event of loss of this document. Practice Learning Unit: Email: PLU@wlv.ac.uk Telephone: 01902 518630
Student Details Name: Student Number: Field: Cohort: Personal Tutor: Contact Number Subject Head: Contact Number Hub Placement Details Name of Ward/Department: Speciality: Contact Number Trust or Organisation: Mentor Details Associate Mentor Details Name: Title: Name: Title: Date mentor update: Date The practice mentor team update: consists of academic (University) and placement (Trust) staff. N.B. An associate mentor must be a Registered Healthcare Professional who may, or may not, have They work as a team to support students a mentorship qualification. The Associate Mentor may assess the student in relation to individual and mentors in practice. You can contact skills but cannot complete the overall assessment or approve progression to the next stage of the course. any member of the practice team with a student assessment query. Support Available: Practice Team Details Practice Placement Manager/Clinical Placement Facilitator: Email: Phone: University Practice Representative: Email: If you have any queries Phone: relating to assessment in practice and are not Practice Learning Unit: sure who to contact please contact the Practice Learning Unit (PLU). Email: PLU@wlv.ac.uk Phone: 01902 518630 Address: MH Mary Seacole Building, City Campus North, University of Wolverhampton, WV1 1AD
Guidelines on How to Use the Practice Assessment Document (PAD) for Students and Mentors/Supervisors 1. Confidentiality This must NOT be breached; care plans must NOT be photocopied and used for evidence. Where additional evidence is required, it MUST respect the confidentiality of ALL of those involved in the health care episode, not just the service user. Any breach of confidentiality will result in an instant fail in practice. The student should bring their PAD with them every day to placement. If a student persistently fails to produce their PAD the mentor should contact the Practice Team for further advice. The Ongoing Achievement Record should be produced at the start of the placement and then whenever requested by the mentor/supervisor. 2. Safe Keeping of PAD - You must ensure the safekeeping of this document and should NOT leave it with anyone else. As practice outcomes are now an integrated part of module assessment, you will be recorded as a non-submission grade for the module if the PAD is not submitted on time. This document MUST NOT be separated, as it is an assessment document. Any additional evidence needs to be clearly crossreferenced against the assessment criteria. Details of student off-duty including sickness/absence should be kept at placement level as well as being documented in the student s PAD. This is a health and safety requirement for all placement areas. This information may be requested retrospectively to confirm whether or not a student was on duty, e.g. in the event of a patient/carer complaint or incident 3. Working with your Mentor/Supervisor you MUST work with your mentor/supervisor for a minimum of 40% of any period of practice learning, either hub or pathway placement (this equates to an average of 15 hours per week two 7.5 hour shifts). This is a NMC requirement and therefore MUST occur and must be verified by the mentor/supervisor, for each practice learning period, on your time sheet. The level of supervision required will be determined by your mentor/supervisor. If a mentor needs to allocate a student additional study time e.g. placement area is closed for bank holiday in a community placement, the student should be given specific work to do during this study time and must provide evidence of completing this to their mentor. Failure to undertake the work will result in an absence being recorded on the timesheet. 4. Study Time - you are not entitled to take any study time whilst on placement. Study time has been planned into the placement programme to allow you sufficient time to complete any written evidence required for your assessment in practice and will occur before the final four weeks in the hub placement. Failure to complete the evidence during the study time will result in the commencement of an action plan and if not completed by the final interview will result in a not achieved grade. 5. Sickness/absence - It is your responsibility to report all sickness/ absence to the Practice Learning Unit on 01902 518630 or email: PLU@wlv.ac.uk and it is essential that you inform the placement area immediately, in accordance with the organisation s sickness/absence policy. Mentors/supervisors must also report absences of three days or more to a member of the Practice Team or Practice Learning Unit.
If you have more than 3 occasions of sickness/absence in any one year you will be interviewed by your mentor/supervisor to establish if there are health or personal problems affecting your fitness to practise. You do not have to disclose the details of any health problem, but if there are concerns, your mentor/supervisor will refer to the Practice Team to ensure appropriate referral to occupational health or counselling services. Poor attendance and timekeeping without legitimate reason has a negative impact upon teamworking and may result in the commencement of an action plan, and if not resolved, in failure of the placement. When undertaking the final assessment, mentors should take into account any practice hours that need to be retrieved and make arrangements for this during the retrieval period Any practice hours not completed due to sickness/absence must be retrieved during the retrieval period at the end of the year. If the sickness/absence amounts to more than the 4 weeks allocated for retrieval, you will be required to use your holiday weeks to retrieve these hours. You may not be able to progress to the next year if you have not retrieved all of your practice hours. Whilst on placement retrieving practice hours only, you are required to work to the same level of competence that was assessed at the progression point. Failure to do so may result in the commencement of an action plan, which will be carried forward into year 2 or referral to the Suitability panel to consider your continuation on the course. Information regarding completion of a portfolio is available to students on the preregistration nursing placement learning support WOLF topic. Students are advised to discuss this with their personal tutor 7. Portfolio Evidence You are required to complete a portfolio of evidence related to practice learning. The evidence required is clearly identified within each domain and within some essential skills clusters in this practice assessment document. You may complete additional evidence in support of practice learning if you wish to do so or if your mentor/ supervisor requests this. 8. Feedback regarding evidence in PAD You must inform your Personal Tutor of the date of your Progress Interview with your mentor on your hub placement. If your Personal Tutor is able, he/she may attend this meeting with you and your mentor. If your Personal Tutor is unable to attend the meeting with your mentor you must meet with your personal tutor within four weeks of the Progress Interview and this meeting with your Personal Tutor must be recorded in your PAD. If your personal tutor is unable to meet with you within four weeks of the Progress Interview you will not be penalised but you need to demonstrate that you have contacted your personal tutor well in advance to arrange this meeting. At your final interview, your mentor will decide whether or not you have achieved all placement outcomes for the year and can progress to the next year. 9. Support Available - The Practice Team is available for mentors/assessors/ supervisors and students to contact at any time during the practice learning period. The Practice Team can offer guidance and support with difficult and/or complex situations to try to ensure that you have every opportunity to achieve the expected outcomes. The mentor/supervisor must contact the Practice Team if there are concerns regarding a student s attendance and/or performance. Students may also contact their personal tutor for advice. 10. Submission of PAD you MUST submit this PAD to the relevant Student Office on the date given and attach the relevant barcode sheet from evision. If the PAD has
not been completed for a specific reason you may request a 1-week extension through E:vision but you will require evidence to support your application. If your mentor is not available to complete your assessment a member of the Practice Team may be able to provide evidence to support this. This will allow you time to meet with your mentor and complete the documentation. It does not allow an extra week on placement. If having an extension will not resolve your problems or if you were off sick/absent at the end of the placement, you should consider applying for Extenuating Circumstances, as any incomplete or non-submitted documents will be recorded as a refer (fail) in practice. You will only be allowed one further attempt at practice. For further information regarding any aspect of placement learning please refer to the Placement Handbook, a copy of which is available through a member of the Practice Team or on the WOLF topic Pre-Registration Nursing Placement Learning Support. I have read and agreed the guidelines above: Mentor Print Name Mentor Sign Name Date Associate Mentor Print Name (if appropriate) Associate Mentor Sign Name (if appropriate) Date (if appropriate) Student Print Name Student Sign Name Date
Practice Assessment Process The assessment of practice is a continuous process and should not just happen during formal interviews. Mentors/supervisors should provide continuous verbal and written feedback to each student regarding performance; this may include positive feedback and identification of areas that require further development. In order to increase the reliability of the assessment of the student s practical ability a wide range of evidence should be reviewed: A team approach should be used to review the student s progress and the views of all members of the inter-professional team that the student has had contact with should be taken into consideration. The views of service users and their families must be taken into consideration where possible. Self-assessment is also an important part of the learning and assessment process and students must ensure that they reflect on their own progress and achievement throughout each placement experience. Sections within tables that need to be completed by the mentor/supervisor are indicated by a triple border. Students with Disclosed Disabilities This practical assessment document must be completed in line with all reasonable adjustments to which students may be entitled if they have a diagnosed disability which has been disclosed, assessed and recognised by the University. The student will require evidence of such entitlement. The reasonable adjustments applied to student placement learning must not detract from the competences to be met in order to successfully complete the learning outcomes required of the placement. Please see initial interview pages for disability disclosure statements. Using Service user/carer s Comments Service users /carers views must contribute to the assessment of student nurses, where possible. In consulting with service user/carers mentors should be guided by the following: The service user/carer will only be approached by the mentor for comments Contribution by the service user/carer will be entirely voluntary Verbal consent will be sought from the service user/carer The identity of the service user/carer will be anonymised wherever possible If anonymity is not possible the service user/carer can choose not to participate Any lack of service user/carer contribution will not prejudice the practical assessment of the student The mentor will use professional judgement to determine the quality, significance and meaning of the verbal accounts they receive. Mentors will record in the student s practice assessment document that service user/carers experiences have been taken into account in assessing the student s practice at the Final Assessment point. The service-user/carer should not be required to write comments in the document. Students practice assessment documents are retained by the student at the end of the course. It is therefore very important that individual patient/carer details are not printed in these documents. Introduction to Practice A staged introduction to practice has been planned for first year students. Students will attend placement for two days per week for the first three weeks of placement learning. During this time the student will be supported either on a one to one basis by their mentor or by a senior second year or third year student. There is no structured format to this period
of learning, as this will depend upon the placement area and learning opportunities available. The purpose of this introductory period is to familiarise the student with the environment, the usual routines and with some of the basic aspects of care that are undertaken in the area. The first year student should be given guidance as to the limitations of their role during this first placement experience. They should not be left unsupervised during this time but are expected to begin to participate in care activities. Senior second year and third year students can use this experience as an opportunity to practice supporting and teaching a junior colleague. Practice Learning Each period of practice learning (each year) will consist of an identified hub placement and pathway (spoke) placements. A nurse mentor who has completed specific preparation in assessing students is responsible for ongoing supervision and assessment in practice settings and in simulation (the Hub mentor). Other registered professionals (pathway mentors/supervisors) who have been suitably prepared can supervise and contribute towards the assessment of nursing students (NMC, 2010). Mentor(s) on the hub placement are responsible for completing the interview/assessment schedules and deciding whether or not the student has achieved everything for progression to the next level. Following the Progress Review the hub placement mentor will decide whether or not an action plan is required to support the achievement of remaining outcomes. Concerns identified prior to the Progress Review should be action planned as soon as they occur by the mentor/supervisor in whatever practice learning setting the student is in, it is not necessary to wait for the Progress Review. Support should be sought from the Practice Team when concerns are raised and action planning is required. Supervisors on pathway (spoke) placements can contribute towards the assessment process through the assessment of individual aspects of the Essential Skills Clusters (ESC) relevant to their practice area. Supervisors who have concerns regarding a student s performance or conduct must contact the Hub Placement Mentor or a member of the Practice Team to discuss these concerns and must document all concerns in the student s Practice Assessment Document. The student will attend pathway (spoke) placements during the weeks between the hub placement dates. These pathway placements will usually be between one and four weeks and are designed to give the student breadth of experience. The mentor/supervisor during these pathway placements can assess competence on individual aspects of the Essential Skills Clusters. The assessment level required is specified in the Levels of Performance, Supervision and Practice criteria detailed on page 12. Any supervisor on a pathway placement who is not a registered nurse mentor should have received guidance regarding the completion of the assessment document and should seek support from the Practice Team when any queries arise. The student must maintain consistency in their level of performance. If they have previously been assessed as competent in one or more of the Essential Skills Clusters by a pathway supervisor, this decision can be changed by the hub placement mentor at a later date if the mentor has sufficient evidence to support this decision. The Practice Team should be contacted when this occurs. Forms of Evidence to Support Practice Assessment It is important that mentors/supervisors do not assess competence based on observation alone, as this does not necessarily demonstrate understanding. At least one other form of evidence should be used to demonstrate competence. More information regarding the types of evidence is available in the Placement Handbook
Direct observation is an important, convenient and immediate way of evaluating a student s performance. However, it is usually necessary to combine this with another method of evidence to ensure full understanding. For example, whilst observation of client documentation will give an indication of the standard of record keeping, this does not provide assurance that the student understands the legislation relating to record keeping and this aspect will need to be assessed by an alternative method. Some forms of evidence will demonstrate achievement of multiple essential skills clusters. One or two forms of evidence may demonstrate competence in a whole domain. It is not necessary to have one individual piece of written evidence for each separate essential skill. In year 1 students are expected to have a grasp of underpinning theory and show an awareness of how nursing knowledge and research influences the way care is planned and delivered, see Levels of Performance, Supervision and Practice on page 12. For more information regarding the different forms of evidence please refer to the Placement Handbook.
Interview Schedule Timing Practice Assessment Process for Student Nurses (First Attempt) in Year 1 Content Troubleshooting Action This flowchart is useful for troubleshooting at each review point Introduction to Practice Weeks 1 3 Initial interview if working in Hub Placement Student to attend Trust/Organisation induction Student to attend placement for 2 days per week (15 hours), supported by a senior student if 1:1 mentorship is not available. Complete initial interview if this placement is in the Hub Placement area. If not complete a Pathway Placement Record. Has the student attended an induction? YES NO Contact the Practice Team immediately Initial Interview Week 3 full time practice in Hub Placement Complete initial interview if not completed during Introduction to Practice Discuss the student s Practice Learning Plan. Practice Learning Plan should be reviewed on a weekly basis by the mentor/supervisor in the placement area Has the Practice Learning Plan been commenced? YES NO Contact the Practice Team immediately Progress Interview In Hub Placement At least 2 weeks prior to commencing final 4 weeks of practice in this year Student to inform Personal Tutor of date of Progress Review. If Personal Tutor is unable to attend, student to meet with Personal Tutor within four weeks of Progress Review. Mentor in hub placement to review progress in relation to the Practice Learning Plan and provide feedback. Discuss ongoing learning needs. Complete Progress Review pages in Practice Assessment Document. Is the student progressing in accordance with the Practice Learning Plan? Is the student progressing satisfactorily in relation to achievement of the four competency domains? YES NO Contact the Practice Team immediately Commence an action plan to enable the student to achieve the required outcomes. Monitor and record progress in relation to the action plan on at least a weekly basis. Final Assessment Last week of Placement Assess progress in relation to Practice Learning Plan. Assess progress in relation to each of the four competency domains and provide feedback to the student. Complete the final interview pages, the final assessment sheet, timesheet and progression statement. Have all requirements for each of the four competency domains been achieved? Have all requirements from action planning been achieved? YES NO Contact the Practice Team immediately Inform the student and provide detailed feedback indicating the reasons for non-achievement. Retain the Practice Assessment Document and give it to the Practice Team member Student passes the Placement
Practice Learning Plan to be completed by the student during Preparation for Practice and reviewed with the Mentor(s) in the Hub Placement during the initial interview. The purpose of the Practice Learning Plan is to ensure that the student is able to meet all requirements of the NMC competency domains by the end of the year long period of practice learning. Achievement in relation to the plan will be monitored at the Progress Review What do you need to learn? Complete and submit the written evidence required for linking knowledge to practice within each domain: 1. Professional Values: Complete before the Final Assessment 2. Communication & Interpersonal Skills: Complete before the Progress Review 3. Nursing Practice & Decision Making: Complete before the Progress Review 4. Leadership, management & Teamwork: Complete before the Final Assessment Target date for review and completion Identify which placement(s) this can be achieved on and any resources required Mentor/Supervisor comments on progress Students must plan their learning so that they are able to achieve all of the required outcomes by the end of the year. In the first year students will need support from the Practice Team and/or the mentor to recognise the learning opportunities available in the placement areas they are allocated to. Students can access the placement profiles in E:vision for all areas that they are allocated to. Each profile indicates the learning opportunities available in that placement area; which is very useful for planning achievement of outcomes. The written evidence indicated in each domain (see Essential Skills Cluster pages) must be completed by the end of year. The level of detail required depends upon the student s current level of knowledge and is determined by the mentor, who is assessing whether or not the student has acquired the correct knowledge level for the stage on the programme. Date achieved Mentor signature Complete all shaded essential skills before the Progress Review and at least two of the written pieces of evidence. Complete all essential skills before the Final Assessment and the remaining two written pieces of evidence
Practice Learning Plan - continued It is a requirement that student nurses in the adult field experience practice in the following settings at some point during the course. You should provide some written evidence in support of your learning in these areas. Once you have experienced practice in a particular setting and completed some written evidence as evidence of achievement, this should be recorded in your ongoing achievement record and verified by your Personal Tutor What do you need to learn? Identify any opportunities for the areas listed below during this year By the end of the three year course you must have experience of: General and specialist surgery: Target date for review and completion Identify which placement(s) this can be achieved on and any resources required Mentor/Supervisor comments on progress Date achieved Mentor signature Adult students must have experience of all of these areas by the end of the programme (not each year). The ongoing monitoring of this is maintained within the student s Ongoing Achievement Record. General and specialist medicine: The student is required to record any of these experiences and identify the learning opportunities accessed. Care of the older person: Home nursing: One or more of the above subjects may be experienced in the same practice learning setting. Record which experiences you have had during this year.
Practice Learning Plan - continued What do you need to learn? Identify any practice learning opportunities available for achievement of the following: Target date for review and completion Identify which placement(s) this can be achieved on and any resources required Mentor/Supervisor comments on progress Date achieved Mentor signature By the end of the three year course you must have experience of caring for: Children & Young People (usually year 3) Mental health (usually year 1) Learning disability (usually year 2) Maternity care (usually year 3) Identify which experiences you will gain from the placements planned for this year. If you experience any of these placements earlier than planned this evidence can be used to support your achievement of these Students from all fields must have experience of the other fields of nursing and maternity care by the end of the programme. There is no minimum or maximum length of experience required for each field but the student should be able to demonstrate that they are able to care for people from the other fields of nursing. The ongoing monitoring of this is maintained within the student s Ongoing Achievement Record. With regard to maternity care, students are required to have a basic understanding of this subject enabling them to refer a patient/client to the appropriate services if they have a pregnant or post-natal woman in their care. Practice in any of the above settings must be recorded in your ongoing achievement record and verified by your personal tutor. Other learning opportunities identified for this placement including Interprofessional Learning opportunities: It is very important that nurses are able to work with other health and social care professionals to ensure the best quality of care delivery. Students must therefore gain an understanding of the roles of other health and social care professionals that they come into contact with during their placements.
The student may require more help with this in year 1 Initial Interview and Induction to Hub Placement Area The Practice Learning Plan on the preceding pages should be commenced prior to commencing placement and discussed at the initial interview. If this plan has not been commenced please contact the Practice Team for further advice. This plan should be agreed between the student and mentor at the initial interview in the first week of placement. Contact the Practice Team if you need assistance with these risk assessments THE FOLLOWING INFORMATION MUST BE COMPLETED: Student to complete Disability disclosure: you are advised that failure to disclose a disability may affect your progress on placement. If you decide not to disclose a disability, the disability will not be considered in any request for mitigation if you are unsuccessful on placement. Do you wish to disclose a known disability to your mentor/supervisor? YES/NO* Do you have a placement awareness sheet, from the Student Enabling Centre, detailing reasonable adjustments required? YES/NO* You are also advised to disclose any change in health status (in accordance with NMC requirements) or pregnancy, as soon as this arises during the year. You are advised to discuss this with your personal tutor prior to placement or to contact a member of the practice team whilst on placement. Disclosure of Ill Health or Pregnancy - please specify: The following questions MUST be completed by the student and mentor/supervisor together during the interview or when any change in health status or pregnancy occurs Reasonable adjustments required? Yes/No* If yes, please provide detail: Risk assessment required Yes/No* If yes: date completed completed by Signature Date * delete as appropriate
Initial Interview and Induction to Hub Placement Area (continued) I am aware of the following and have discussed them with my mentor: Action to be taken in the event of an emergency, including fire and evacuation procedures Location and access to policy and procedure manuals. In particular: Manual handling policy/resources Infection prevention and control policy Health and safety at work regulations Safeguarding of vulnerable individuals Placement information for students How to contact the Practice Team I have also discussed the following with my mentor: Student emergency contact details Policy for telephone enquiries Reporting sickness and absence understanding of policy Dress/uniform code Shift patterns (You must work an average of 37.5 hours each week) It is a legal requirement that all staff take a minimum 30 minute break after six hours at work, as students are supernumerary mentors should ensure that this occurs. This break does not count within the total hours worked for the shift. Grade to be achieved during this placement (see page 12) Ongoing achievement record Student Declaration: I agree to abide by local policies and procedures, make known as soon as possible any concerns I have regarding my placement experience and take responsibility for my own learning. Student Signature Print Name Date Yes No It is an NMC requirement that a local induction is undertaken at the start of all new placements to ensure that the health and safety of staff and clients is not compromised. The initial Yes interview No should preferably be completed on the student s first day in placement or as soon as possible after this date. Review dates: should be provisionally agreed at this interview Progress Review date: this must occur at least 6 weeks prior to progression point Final assessment date: must occur at the progression point at the end of the practice learning period for the year Mentor Declaration: I agree to provide ongoing support and constructive feedback to you throughout the placement and make known any concerns regarding your practice at the time. Hub Placement Mentor Signature Print Name Date Date of Last Mentor Update 1 : 1 If you are not on the live mentor register you cannot complete the full assessment of the student, contact the Practice Team/Link Tutor immediately It is essential that all mentors are live on the mentor register. A mentor update must be completed every year and triennial review requirements met every three years to remain live on the register. Any assessment undertaken by a mentor who is not live will be invalid.
YEAR 1: LEVELS OF PERFORMANCE, SUPERVISION & PRACTICE To achieve the competency level required The for levels each of NMC performance, domain supervision and to progress and practice to year 2 the student must be consistently change achieving for each at year. the It level is essential indicated that students below: are assessed against the required level. Level of Supervision: Close Level of Practice: Observes, participates, assists in practice Competence Achieved Practice Actively participates Delivers care safely Does not require prompting in routine situations Responds effectively to individual situations in a timely manner Performs with an awareness of legal and professional limitations adhering to the NMC Guidance on professional conduct for nursing and midwifery students (2010) Competence Not Achieved Practice Does not routinely participate in care Unsafe, uncoordinated care delivery requires direct supervision Requires repeated prompting in familiar tasks Evades new experiences Slow to respond Unaware of legal and professional limitations, therefore not adhering to the NMC Guidance on professional conduct for nursing and midwifery students (2010) Knowledge Asks questions when unsure Can offer explanations for the activities undertaken demonstrating a grasp of underpinning theory Shows an awareness of how nursing knowledge and research influence the way care is planned and delivered Attitude Demonstrates a professional attitude towards service users, staff and work Recognises appropriateness of own actions Commitment to professional development Knowledge Accepts all practice without question Does not ask questions Has no awareness of the rationale for care Lacks essential knowledge Attitude Demonstrates an unprofessional attitude towards service users, staff and/or work Does not consider the service user first Unprofessional response to feedback This table has been adapted from the taxonomy and criteria devised by Stuart (2007). Reference: Stuart, C. C. (2007) Assessment, supervision and support in clinical practice: a guide for nurses, midwives and other health professionals. 2nd ed. London, Churchill Livingstone
Registered Practitioner Signatory Information Any practitioner who is involved in the assessment of this student is required to complete the relevant information below. REGISTERED PRACTITIONER NAME (PRINT) REGISTERED PRACTITONER SIGNATURE PROFESSIONAL QUALIFICATION
Log of all Day Visits (including exposure to other fields) Please list all visits undertaken during this year, testimony pages can also be completed in relation to these visits if required Name and address of placement area Name of Practice Mentor/ Supervisor Date attended placement Supervisor Signature confirming attendance on date specified Students are advised to use these pages to demonstrate the varied experience they have had. Evidence of exposure to other fields of nursing should also be provided on this page Copies of additional pages can be obtained from the WOLF topic Pre-Registration Nursing Placement Learning Support. Number of Additional Pages used:
Record of Placement Pathways (usually between 1 and 4 weeks) These pages must be completed for every Name of placement: Pathway (Spoke) placement. Trust or Organisation: Mentors/supervisors must document any concerns that they have about a student s Dates from: To: conduct or performance level and should contact either the Hub Placement Mentor or Initial Interview must be completed by the supervisor, with the student, within the the Practice Team first three days of the placement. Have you discussed the following with the student? Tick as appropriate Yes No Risk Assessment Health and Safety Policies/procedures Emergency Contacts Off-duty requests Any requirements of the Action Plan on page 53 Practitioner Signature: Print Name Date Student Signature: Print Name Date In relation to the student s Practice Learning Plan (see initial interview) and/or Action Plan (see Progress Review pages) and the four NMC competency domains, identify which Essential Skills Clusters could be achieved in this area: These outcomes should be assessed against the practice grade required for this level on page 12 Student Self-Assessment at the end of the placement experience Comment on progress, areas of new learning and any aspects that you felt were particularly supportive/helpful to your practice learning. Placement Pathway Registered Practitioner Feedback MENTOR/SUPERVISOR PLEASE CONTINUE ONTO THE NEXT PAGE
Supervisor s Assessment at the end of the placement experience, this page must be completed Comment on the student s progress during this pathway in relation to the four domains: professional values, communication and interpersonal skills, nursing practice and decision making, and leadership, management and team working. If any concerns/potential difficulties are identified, these should be discussed directly with the student s hub mentor or a member of the Practice Team and an action plan commenced (see page 53) as soon as the concerns/potential difficulties are identified. Concerns/potential difficulties identified during placement pathway? Yes/No* If Yes, was an action plan commenced? Yes/No* Was the Practice Team informed? Yes/No* If yes, who was contacted? Name Date If an action plan was not commenced, please indicate why. Review Date Comments: Supervisor Signature and Date Which Essential Skills Clusters were achieved on this pathway? Sickness/absence during this placement: number of days number of occasions Practitioner Signature Print Name Date Practitioner Professional Qualification: Student Signature Print Name Date * delete as appropriate
Record of Placement Pathways (usually between 1 and 4 weeks) Name of placement: Trust or Organisation: Dates from: To: Initial Interview must be completed by the supervisor, with the student, within the first three days of the placement. Have you discussed the following with the student? Tick as appropriate Yes No Risk Assessment Health and Safety Policies/procedures Emergency Contacts Off-duty requests Any requirements of the Action Plan on page 53 Practitioner Signature: Print Name Date Student Signature: Print Name Date In relation to the student s Practice Learning Plan (see initial interview) and/or Action Plan (see Progress Review pages) and the four NMC competency domains, identify which Essential Skills Clusters could be achieved in this area: These outcomes should be assessed against the practice grade required for this level on page 12 Student Self-Assessment at the end of the placement experience Comment on progress, areas of new learning and any aspects that you felt were particularly supportive/helpful to your practice learning. Placement Pathway Registered Practitioner Feedback MENTOR/SUPERVISOR PLEASE CONTINUE ONTO THE NEXT PAGE
Supervisor s Assessment at the end of the placement experience, this page must be completed Comment on the student s progress during this pathway in relation to the four domains: professional values, communication and interpersonal skills, nursing practice and decision making, and leadership, management and team working. If any concerns/potential difficulties are identified, these should be discussed directly with the student s hub mentor or a member of the Practice Team and an action plan commenced (see page 53) as soon as the concerns/potential difficulties are identified. Concerns/potential difficulties identified during placement pathway? Yes/No* If Yes, was an action plan commenced? Yes/No* Was the Practice Team informed? Yes/No* If yes, who was contacted? Name Date If an action plan was not commenced, please indicate why. Review Date Comments: Supervisor Signature and Date Which Essential Skills Clusters were achieved on this pathway? Sickness/absence during this placement: number of days number of occasions Practitioner Signature Print Name Date Practitioner Professional Qualification: Student Signature Print Name Date * delete as appropriate
Record of Placement Pathways (usually between 1 and 4 weeks) Name of placement: Trust or Organisation: Dates from: To: Initial Interview must be completed by the supervisor, with the student, within the first three days of the placement. Have you discussed the following with the student? Tick as appropriate Yes No Risk Assessment Health and Safety Policies/procedures Emergency Contacts Off-duty requests Any requirements of the Action Plan on page 53 Practitioner Signature: Print Name Date Student Signature: Print Name Date In relation to the student s Practice Learning Plan (see initial interview) and/or Action Plan (see Progress Review pages) and the four NMC competency domains, identify which Essential Skills Clusters could be achieved in this area: These outcomes should be assessed against the practice grade required for this level on page 12 Student Self-Assessment at the end of the placement experience Comment on progress, areas of new learning and any aspects that you felt were particularly supportive/helpful to your practice learning. Placement Pathway Registered Practitioner Feedback MENTOR/SUPERVISOR PLEASE CONTINUE ONTO THE NEXT PAGE
Supervisor s Assessment at the end of the placement experience, this page must be completed Comment on the student s progress during this pathway in relation to the four domains: professional values, communication and interpersonal skills, nursing practice and decision making, and leadership, management and team working. If any concerns/potential difficulties are identified, these should be discussed directly with the student s hub mentor or a member of the Practice Team and an action plan commenced (see page 53) as soon as the concerns/potential difficulties are identified. Concerns/potential difficulties identified during placement pathway? Yes/No* If Yes, was an action plan commenced? Yes/No* Was the Practice Team informed? Yes/No* If yes, who was contacted? Name Date If an action plan was not commenced, please indicate why. Review Date Comments: Supervisor Signature and Date Which Essential Skills Clusters were achieved on this pathway? Sickness/absence during this placement: number of days number of occasions Practitioner Signature Print Name Date Practitioner Professional Qualification: Student Signature Print Name Date * delete as appropriate
Record of Placement Pathways (usually between 1 and 4 weeks) Name of placement: Trust or Organisation: Dates from: To: Initial Interview must be completed by the supervisor, with the student, within the first three days of the placement. Have you discussed the following with the student? Tick as appropriate Yes No Risk Assessment Health and Safety Policies/procedures Emergency Contacts Off-duty requests Any requirements of the Action Plan on page 53 Practitioner Signature: Print Name Date Student Signature: Print Name Date In relation to the student s Practice Learning Plan (see initial interview) and/or Action Plan (see Progress Review pages) and the four NMC competency domains, identify which Essential Skills Clusters could be achieved in this area: These outcomes should be assessed against the practice grade required for this level on page 12 Student Self-Assessment at the end of the placement experience Comment on progress, areas of new learning and any aspects that you felt were particularly supportive/helpful to your practice learning. Placement Pathway Registered Practitioner Feedback MENTOR/SUPERVISOR PLEASE CONTINUE ONTO THE NEXT PAGE
Supervisor s Assessment at the end of the placement experience, this page must be completed Comment on the student s progress during this pathway in relation to the four domains: professional values, communication and interpersonal skills, nursing practice and decision making, and leadership, management and team working. If any concerns/potential difficulties are identified, these should be discussed directly with the student s hub mentor or a member of the Practice Team and an action plan commenced (see page 53) as soon as the concerns/potential difficulties are identified. Concerns/potential difficulties identified during placement pathway? Yes/No* If Yes, was an action plan commenced? Yes/No* Was the Practice Team informed? Yes/No* If yes, who was contacted? Name Date If an action plan was not commenced, please indicate why. Review Date Comments: Supervisor Signature and Date Which Essential Skills Clusters were achieved on this pathway? Sickness/absence during this placement: number of days number of occasions Practitioner Signature Print Name Date Practitioner Professional Qualification: Student Signature Print Name Date * delete as appropriate Copies of additional pages can be obtained from the WOLF topic Pre-Registration Nursing Placement Learning Support. Number of Additional Pages used:
Record of Student Visits TESTIMONY SHEET Description of area/activity and reason for student to visit: What did I get out of this visit? What have I learnt from this experience: Testimony sheets should be used to record day visits to certain areas. This is particularly important for demonstrating achievement of other field outcomes but should also be used to demonstrate a student s breadth of experience. How will this help/improve my care in the future: Student Signature. Date. Practitioner summary of the student s ability: (You may wish to include such things as communication of the student, knowledge of the student, attitude of the student, engagement by the student) Practitioner signature Date... Print name.. Job Title... Professional qualification....
Record of Student Visits TESTIMONY SHEET Description of area/activity and reason for student to visit: What did I get out of this visit? What have I learnt from this experience: How will this help/improve my care in the future: Student Signature. Date. Practitioner summary of the student s ability: (You may wish to include such things as communication of the student, knowledge of the student, attitude of the student, engagement by the student) Practitioner signature Date... Print name.. Job Title... Professional qualification.... Copies of additional pages can be obtained from the WOLF topic Pre-Registration Nursing Placement Learning Support. Number of Additional Pages used: