The Experiences of Nursing Students for their Mentoring in Clinical Practice in Kosovo

Kosovo in the post-war period has undergone an important and intensive phase of its development. An important part of these reforms is nursing. The establishment of the Faculty of Nursing at the Faculty of Medicine and the establishment of private higher education institutions in the field of nursing has increased the need to make the academic staff bigger and create opportunities for conducting clinical practice at the University Clinical Center of Kosovo. 

The curricula approved by the various Nursing Faculties in Kosovo define a large number of practical classes performed in health institutions. A part of this practice is supervised by same clinical mentors. Therefore, the mentoring of internship students in clinical practice is conceived as an essential interactive process, which is generally related to the achievement of specific clinical practice objectives. 

But mentoring students presents a problem in the process of education and work process at the University Clinical Center of Kosovo. Despite its importance, mentoring students still shows a challenge to the educational process and the process of clinical practice. According to Kosovo Accreditation Agency there are eight nursing faculties in Kosovo, two of them are public and 6 private. The actual number of students is around 4000 [1]. The large number of students compared to the number of mentors, jobs and organization, the way of choosing nursing mentors can affect the formal mentoring of students and the lack of proper attention. 

Improving the mentoring quality of nursing students will result in a graduate degree with a high degree of competence and a higher labor market preparation. This would have an impact on increasing the quality and safety of providing nursing services to new nurses.

According to online dictionary Merriam-Webster, the word ‘’mentor’’ is defined as "a trusted or guide advisor"; and someone who is mentored is defined as "mentoree” or "the favored person" [2] defines mentoring as a "personally and professionally.’’ 

The concept of mentoring is not new to nursing, as Florence Nightingale was known to have mentored a lot of nurses in her days [3]. 

Poronsky CB [4] states that "mentoring in nursing had begun to be examined in the Nurse's Register Nurse transition periods in the Family Nurse Practitioner, Nick JM, et al., [5] emphasize that mentoring was developed with faculty development. Mentoring nursing students is a very important part of their education. Mentoring is not taught in most schools nor is it included in nursing curricula [6]. 

Huybrecht with coworkers found that nursing students benefited from hospital staff instructors to fit in that environment and recommended that instructors should have considerable knowledge to properly assess their students [7]. 

Student mentoring has moved from a teacher-centered paradigm to a student-centered paradigm [8]. 

In this relationship, acquisition and transfer of knowledge are not unilateral but reciprocal between the two participants.There are considerable evidences in the literature that mentoring is generally beneficial for both mentors and students in terms of success and retention of nursing program [9]. 

Moreover, it is suggested that later mentored students are likely to become mentors themselves in their careers [7]. Equally important, it is that mentoring plays a role in the development of quality nursing by increasing the competences of graduates [10]. 

Important mentoring aspects of the students are the positive attitude of the mentor, motivation, sensitivity, attraction, respect and trust [11]. 

Nursing students’ clinical experiences are important for their learning, professional development and preferences for future workplaces [12,13]. Nursing practice is agreed to be an essential part of nursing education [14]. Nursing practice comprises 50% of the nursing curriculum [15]. 

The European Union sets standards for nursing education, for instance, through stating that the duration of clinical training should include at least one half of the minimum duration of the nursing program. In addition, clinical training must be completed under the supervision of qualified nursing staff (Directive 2013/55/EU of the European Parliament and of the Council) [16]. 

Qualitative mentoring brings results to the practice of nurses. Clinical learning also produces important affective outcomes—beliefs, values, attitudes, and dispositions that are essential elements of professional nursing practice [17]. Providing quality mentoring to a nurse can also be challenging. The role of the mentor has been demonstrated to be essential to student clinical learning but mentors may often feel unprepared for mentoring [18]. 

Different authors emphasize the importance of the mentors' qualities. Assistance and support seem to be central to mentoring [19]. Another feature of effective mentors is enthusiasm and sense of humor [20]. 

The influence of effective mentoring has been reported to be an important element in nurses’ education. Boyle and James found that nurses who reported that mentors had strongly influenced their careers were significantly affected during the early years of their careers. 

A successful mentor must be accessible, approachable, nonjudgmental, intuitive, and empathic [21]. Watson states that “the nurse who is sensitive to feelings is able to make another person feel understood, accepted, and capable of moving toward a more mature level of functioning and growth [22]. 

The knowledge that mentors need to mentor their students are different in different countries. In the UK, mentors have an academic, legal, and professional responsibility to teach, supervise and evaluate students’ clinical performance [23]. 

Gignac-Caille AM, et al., [24] describe five competencies that mentor should have: Clinical competence and subject knowledge; Interpersonal relationships with students; Teaching skills; Evaluation strategies and Personal characteristics. 

It has been suggested that a good and effective mentor is enthusiastic, understanding, approachable and someone with a good sense of humour. Good clinical mentors help students apply their theoretical knowledge to practice, provide learning opportunities, and help students to do their best [25]. It is important that the mentor be a seasoned faculty member who exudes enthusiasm, portrays professionalism, and has an extensive knowledge of nursing education as well as a working knowledge of the policies, procedures, and the goals of the institution [21]. 

The main goal of mentoring among peers is to create an organizational environment that simplifies teamwork, the consolidation of projects, and the achievement of academic and personal goals [26]. 

The perception of nurses for clinical mentor is influenced by various factors. Communication between mentors and students affects students’ success in clinical practice. Mentors' performance may not be satisfactory. Mentors report that they are often unwilling to perform their work and role [18,27]. 

Mentoring can affect the employer. The findings suggested that private sector nurses are significantly more satisfied with their supervision, enjoy greater morale and are more committed to their organizations [28]. 

The effectiveness of mentoring does not seem to depend on many factors. Mentorship type did not have a direct relationship with mentorship effectiveness, but did interact with mentorship duration [29]. Therefore, the effectiveness of mentoring depends on the time when mentors spend with their students. A successful relationship between mentor and resident-mentor requires adequate time for the connection to grow through face-to-face meetings on a regular basis [30].

Problem 

Nursing students may have different experiences during clinical practice and clinical mentors may not have the mentoring or mentoring skills of nursing students. No research has been carried out on the mentoring process of nursing students in Kosovo. Mentoring is largely formal and is not standardized. Public and private universities have contracts for their students to perform clinical practices at the University Clinical Center of Kosovo. Students’ groups who practice UCCK practice are often great. Mentors also may often overwork in the clinic and do not have the time to get well with mentoring students. 

In recent years, private universities have begun to choose and pay their clinic counselors who are employees of the University Clinical Center of Kosovo, but mentors do both jobs at the same time. 

Goals 

The purpose of this study will be to explore the experiences of second and third year nursing students during clinical practice at the University Clinical Center of Kosovo. Specifically, the research aims to explore the perceptions for mentored clinical, what are their positive and negative experiences and the barriers they have during clinical practice.

Research questions 

What are the experiences of nursing students about their mentoring in clinical practice?

A qualitative approach was used to assess the experiences of nursing students during the development of clinical practice at the University Clinical Center of Kosovo in Pristina. 

Participants 

The interview was conducted with 10 nursing students from public and private universities in Prishtina. The average age of respondents was 19 years to 21 years. By gender, 8 were female and 2 were males. There were 5 nursing students at public faculty and 5 in private faculty. Two nursing students were in clinical practice at the Department of Internal Medicine, 3 were in the Surgery Clinic, 3 were in practice at the Infectious Clinic and 2 in the Neurology Clinic. In the second year of study there were 6 students and in the third year 4 students. There were not any students in the first year because they develop clinical practice at the primary health care level. 

Interview 

Data was collected through an interview consisting of a research questionnaire and it had four parts reflecting the primary role of mentoring [31]. The designedquestionnaire tried to find information on nursing student’s experience related to the main role of mentors: knowledge and skills transmission, feedback and evaluation, psychosocial support and role modeling. 

Procedure 

Participants prior to each interview had instructions on the interview and after the briefing the participants had been admitted to participation. Interviews were recorded (audio) and before being analyzed for recording, they were transcribed. Interview lasted 20 to 24 minutes. Interviews with participants took place within a week from 11^th March to 15^th March 2019. The entire interview was conducted by the author of this paper. 

Statistical analysis 

The data analysis is performed by a qualitative method by reading the data from the transcribed data. Then interviews were made by generating starting codes, searching topics, defining and encoding themes. The results are structured according to the main topics that arise from the interview.

The results have answered the research question. Nursing students have different experiences during mentoring clinical practices. Most of them believe that clinical practice mentoring is the key to their professional development related to clinical skills and problems in patient care. "We learn more in the clinic than in faculty laboratories" (participant 2). The students are of the opinion that the part of the clinical practice is very important for their professional development. "We try very hard to practice skills because it makes us want to become independent in our profession" (participant 1) 

During the mentoring process, nursing students cite many of the obstacles they have during their mentoring, which they strive to achieve positive results in clinical practice. The lack of literature on mentoring in the Albanian language suggests that nurses should be familiar with other languages to enhance mentoring knowledge. "We have not learned about mentoring nursing students in our plans, nor have our mentors taught at the faculty for the mentoring process" (participant 6). 

Mentors are heavily charged with the work of the clinic and do not have time to deal with the student. "My team's mentor is very much in charge of the clinic's work and he has little time for us and we are helped more by the shift nurses." (Participants 8) Students reported that their involvement in practice is low. "In most cases, we only observe and have no chance to practice" (participant 4). They also think that they are in large groups and have little chance of practicing nursing skills. "We are a group of 9 students and during the week we rarely practice any skill" (participant 2). 

Students think that clinical practice should be organized in a timely manner and their practice should be included in the planning of the clinic's work. "We start the practice from 11 am to 15 pm, clinic work is done before this time" (participant 10) 

Mentors often do not have the support of their managers, and most managers are less skilled than their subordinates, which is even more difficult to mentor nursing students. "What kind of support can I expect from my mentor when she is not supported by the manager and carries a lot of work to the clinic '' (participant 9). 

But students think they were supported by their mentors. "... my mentor supports me as often as I feel excited or when I'm not sure about the work I do" (participant 8) 

Also, the lack of guidance and organizational culture for initiating changes in clinical practice, referring to the traditional approach to mentoring students, indicates the need for reorganization of nursing care: "... not only because of lack of guidance, but one unplanned organizational culture to mentor students with an organized plan" (participant 2). 

When students were asked about how they collect information about mentoring, they said the source of information was internet and had no curricula in the nursing curriculum "... I never learned at the faculty for mentoring" (participant 1) 

The study results are comparable to the results of international studies. Many authors support the idea that one of the most influential factors in mentoring nursing students is previous training in mentoring students [32]. Jokelainen with co-workers stress that professionals need to receive curriculum training and student assessment [33]. 

While Broadbent with associates suggests that university curriculum recognition can boost higher levels of nursing involvement in mentoring [34]. Student overload and lack of space are reported as problems during student mentoring. Although a number of clinical practices have dedicated spaces for nursing staff at work, spatial limitations continue to be reported for impact on nursing practice [35] 

Also, our results are supported by research conducted by different authors. A lot of work and poor planning affect the mentoring process of nursing students. Study results show that students’ mentors face barriers to their role. Mentors need extra time from job assignments to support and evaluate students and attend regular mentor training [36] 

Research shows that students’ support and motivation is paramount. Important aspects of students’ mentoring are:  positive attitude of the mentor, motivation, sensitivity, attraction, respect, and faith [11]. The students in this research thought they were supported by their mentored. 

The results of this research will help decision-making people in charge at the University Clinical Center in Pristina to identify the obstacles to the implementation of proper mentoring and the tasks that will be required to develop programs to prepare clinical mentors for mentoring students.

To sum it all up  majority of nursing students admit that quality mentoring is important for the development of their clinical practice, but they all find that to acquire clinical skills should be mentored by trained mentors who are not in charge of other jobs, have small groups of students and more space in the clinics.

Three recommendations of the survey: 

• Organized trainings for clinical mentors to develop mentoring skills
• Development of student mentoring plans by adapting curricula and mentoring process to clinical areas
• Introducing mentoring as a module in the vocational education curriculum

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