How mentors can influence the values, behaviours and attitudes of nursing staff through positive professional socialisation

Author

Kay Norman, Senior lecturer in the Faculty of Health and Social Care, Nursing Department, Open University.

Short description

Read this module and improve your awareness of professional socialisation and how mentors and nurse managers can foster high quality patient care.

Detailed description

This module explores the concept and processes involved in professional socialisation and how mentors and nurse managers can help to foster positive aspects of this in their practice. Positive professional socialisation needs champions to instil fundamental professional values and behaviours in nursing staff, and managers need to support mentors to influence and lead the way in promoting standards of excellence in the nursing profession to assure public trust and confidence, and ultimately patient safety. The time out activities will ask you to consider and develop possible strategies to help support mentors and staff, and aim to encourage you to explore the potential benefits of positive professional socialisation for your team in delivering high quality patient care.

Module overview

This module explores the concept and processes involved in professional socialisation and how mentors and nurse managers can help to foster positive aspects of this in their practice. Positive professional socialisation needs champions to instil fundamental professional values and behaviours in nursing staff, and managers need to support mentors to influence and lead the way in promoting standards of excellence in the nursing profession to assure public trust and confidence, and ultimately patient safety. The time out activities will ask you to consider and develop possible strategies to help support mentors and staff, and aim to encourage you to explore the potential benefits of positive professional socialisation for your team in delivering high quality patient care.

Keywords

education, image of nursing, leadership, management, mentoring, mentors, mentorship, professional development, professional issues, professional socialisation, staff attitudes

Aims and intended learning outcomes

This module aims to encourage readers to explore the benefits of positive professional socialisation in supporting teamwork and delivering improved patient care. After reading this module and completing the time out activities, you should be able to:

• Understand and apply the concept of positive professional socialisation to your practice.
• Develop possible strategies for supporting mentors to promote positive professional socialisation within their teams.
• Reflect on current evaluative processes used in appraisal reviews to consider nursing peer review as a method to evaluate professional behaviours, attitudes and values.

Introduction

The concept of professional socialisation and how this can be facilitated to improve and support positive teamwork and nurture high standards of nursing care is gaining momentum, helping to reduce negative staff attitudes and instil values fundamental to compassionate nursing care (Thomas et al 2015). Professional socialisation also helps to instil the Nursing and Midwifery Council (NMC) code for professional standards of practice and behaviour for nurses and midwives (NMC 2015).

Nurse managers and mentors can lead the way in enabling positive professional socialisation by encouraging and monitoring robust mentorship strategies for new and more experienced members of staff. The following discussion will not provide all the answers, but will help trigger responses from you and members of your team about how you might want your practice area to function in terms of cultural environment, standards, professional values and team working.

Within current healthcare policy, there is a need to identify clearly how culture, values, behaviours and standards are maintained and monitored (Department of Health (DH) 2013). The concept of professional socialisation can be used to develop and evaluate these outcomes.

Professional socialisation

The public image of the nursing profession has continued to be shaped by media reports concerning poor standards of care, in particular the report into care failures at Mid Staffordshire NHS Foundation Trust (Francis 2013). The traditional public image of a nurse as a caring, kind, competent, compassionate individual has been challenged, and this may influence the development of nurses’ self-concept and professional identity (Hoeve et al 2013).

Despite these challenges, it is imperative that public trust and confidence in the nursing profession are maintained, as recognised in the recommendations from the Report of the Mid Staffordshire NHS Foundation Trust Public Enquiry (Francis 2013), which focus on nurse management, education, development and leadership. An earlier report encouraged team working, effective mentorship and positive role models (Willis Commission 2012).

Additionally, NHS ‘champions’ are promoted to lead compassionate care and suggest innovations in practice for improvement of services (NHS Improving Quality 2015). However, all nurses need to see themselves as champions of patient care and adopt a continuous improvement approach to healthcare services. For this to be achieved, there must be a strong sense of professional identity, collegiate working and a reflexive approach to all care activities. Even when nursing morale is low, it is important to inspire staff to share knowledge and expertise meaningfully and positively. Students, and new and more experienced staff, need role models and mentors to whom they can aspire, who demonstrate excellence in their clinical practice and in their support and development of others. Awareness of promoting positive professional socialisation can help here.

According to Rejon and Watts (2013), professional socialisation can be understood as characterised by four attributes:

• Learning.
• Interaction.
• Development.
• Adaptation.

A review of the concept of professional socialisation by Rejon and Watts (2013) suggests that the process begins on entry as a nursing student and continues through joining the NMC register and subsequent employment as a registered nurse. It is a complex concept and can have positive and negative consequences.

Definition

Mackintosh (2006) defines professional socialisation as the process by which individuals take on the characteristics, attitudes and values of a given profession and the subconscious process by which individuals internalise behavioural norms and standards, forming a sense of identity and commitment to a professional field.

Dinmohammadi et al (2013) support this definition and suggest that individuals learn, develop and adapt to these behavioural norms and standards to be ‘accepted’ into the particular profession. Therefore, professional socialisation needs to have a high priority in all care settings and should incorporate a strategy that all staff own. Examples of situations where professional socialisation may be introduced or encountered include:

• Opportunities for formal education such as training courses or NMC nurse preparation programmes.
• Role models in educational settings and in practice.
• Mentorship in healthcare environments.
• Preceptorship after initial employment as a registered nurse.
• Interdisciplinary learning, respect and understanding of each other’s roles, and standards expected of the professions.
• Informal learning, for example through conversations with nurses, dialogue with other peers, discussions and reflections, and reading professional journals.
• Team working, and learning to work together for a common outcome.
• Working environments, their culture, management and leadership.

Research studies suggest that poor mentorship, poor role models, poor practice experiences and inadequate support when adjusting to registered nurse status can lead to negative feelings about the nursing role (Levett-Jones et al 2009, Higgins et al 2010). If nurses are socialised into negative values, beliefs and practice, their perceptions of an accepted professional identity may affect their own behaviours.

Positive professional socialisation can facilitate growth, support, innovation, pride, confidence and a sense of belonging to a nursing profession, which fosters the values, beliefs and attitudes fundamental to planning and delivering excellent patient care. This not only encourages a sense of professional identity but also helps to develop positive role models.

Learning Points

1. Professional socialisation aims to reduce negative staff attitudes and to instil values fundamental to compassionate nursing care to nurture high standards of nursing care.
2. Nurse managers and mentors can lead the way by encouraging and monitoring robust mentorship strategies.
3. The media reports of care failures at Mid Staffordshire NHS Foundation Trust have challenged the traditional public image of a nurse as a caring, kind, competent, compassionate individual. This may influence the development of nurses’ self-concept and professional identity.
4. The Royal College of Nursing states that professional socialisation is characterised by four attributes: learning, interaction, development and adaptation.
5. Professional socialisation is defined as the process by which individuals take on the characteristics, attitudes and values of a given profession and the subconscious process by which individuals internalise behavioural standards, forming a sense of identity and commitment to a professional field.

The mentor role

The mentor is crucial to supporting the professional socialisation process and supporting new and more experienced staff in sharing, demonstrating and understanding the values and standards of the profession, and how these are integrated into the culture of an area of practice.

• Kaihlanen et al (2013) suggest that mentorship should commence in a student nurse’s final placement to set the scene for future professional responsibilities and discuss the transition from student to registered nurse.
• For existing staff, mentors should act as role models who display the values and standards to which staff aspire.
• Jones et al (2015) identify that early-career practitioners expect the nursing profession, through its leaders, to support them professionally and emotionally, with feedback and guidance from mentors and preceptors.
• Mentors’ perceptions of the nursing profession need to be understood because their experiences will have influenced their beliefs and viewpoints on the standards, roles, beliefs and values of nursing and what they consider the future of the profession.
• In an area of practice, mentors may have different ideas of how to support students and staff best in professional socialisation.
• McIntosh et al’s (2014) research, exploring mentors’ perceptions and experiences of supporting nursing students in practice, highlights that adjusting to placement areas and integrating into a team, as well as clinical skill development, are the main areas where mentors think students need support. Therefore, it is important that a consensus of values, behaviours and attitudes is reached by the practice team to avoid inconsistent approaches, with the values and standards of the nursing profession underpinning all considerations.
  An awareness of how the nursing profession is portrayed in the profession, the wider healthcare arena and in the public domain is essential for mentors to remain confident in their professional identity and to be able to challenge assumptions of nurses and the nursing profession. Hoeve et al’s (2013) literature review suggests that nurses are in danger of adopting their professional identities from current public images of nursing, the work environments they happen to be in and traditional cultural values.

  Responsibilities of mentors

  Mentors have a role in encouraging staff to have greater communication with the public to promote understanding of the profession, which includes the use of social media and involvement in political discourse to ensure stronger visibility. This could then help to inform the positive professional socialisation of nurses through a consistent understanding of the profession.

  All recorded mentors will have completed an NMC-approved mentorship-preparation programme that sets out required standards for learning and assessment in practice (NMC 2008).

  Many of the competences involve activities that can encourage positive professional socialisation so a review of these standards may be a good starting point to review the role responsibilities of a mentor. It may be useful to review these standards with your team to discuss how the eight NMC domains for mentorship are perceived and applied in practice, with specific focus on how mentors role model, inspire and motivate others, assess professional values and behaviours, and reflect on their own practice.

  Box 1 suggests how mentors can foster professional socialisation with their students, as well as with new and more experienced staff. It is by no means an exhaustive list, and managers and mentors may have other methods they would want to negotiate in their particular areas of practice.

• Box 1. Ways that mentors can foster professional socialisation

  • Acknowledging their areas of knowledge, competence and expertise.
  • Being committed to self-development and continuing professional development.
  • Valuing and encouraging team contributions in the planning and delivery of care.
  • Instilling the importance of collaborative working with practice and wider multiprofessional teams.
  • Displaying motivation and enthusiasm for a learning and continuous improvement culture.
  • Taking an interest and encouraging others’ ideas to improve care.
  • Encouraging reflection.
  • Planning time to discuss and address issues arising and helping others to solve problems.
  • Having the confidence to identify and challenge areas of performance with staff to develop ongoing improvement.
  • Using methods of learning such as social media and e-learning to discuss professional socialisation as a way of complementing formal and informal learning.
  • Enlisting the help of colleagues who can act as positive role models for staff and who display the values and standards of the profession and leadership attributes.
  • Contributing to a welcoming, supportive culture where self-esteem and confidence are nurtured.
  • Being clear, concise, constructive and honest when evaluating performance and care delivery.
  • Being consistent and fair in feedback approaches.
  • Asking for feedback on their own performance.
  • Engaging in peer review.
  • Reflecting and developing personal action plans as appropriate.

Learning Points

1. The role of a mentor is crucial in supporting the professional socialisation process.
2. Early-career practitioners expect mentors and preceptors to support them professionally and emotionally with feedback and guidance.
3. Mentors should have an awareness of how the nursing profession is portrayed in the profession, the wider healthcare arena and in the public domain to be able to challenge assumptions of nurses and the nursing profession.
4. Mentors have a role encouraging staff to have greater communication with the public to promote understanding of their profession, which includes the use of social media and involvement in political discourse to ensure stronger visibility.

The nurse manager role

Nurse managers are the overarching leads in supporting professional socialisation, developing and inspiring staff in practice environments that promote the values of the NHS constitution.

The concept of organisational culture is difficult to define, although much healthcare literature and NHS policy refer to the importance of culture in embedding the values and behaviours deemed necessary for improving and delivering good care (Parmelli et al 2011, Francis 2013, DH 2015). It is argued that organisational culture can affect professional socialisation in that ‘the process of becoming a professional requires or includes a process of socialisation into this professional culture’ (Newman and O’Keeffe 2013).

Nurse managers are responsible for fostering organisational cultures on a micro-level in practice areas, based on macro-level organisational values. However, it can be difficult to ‘measure’ organisational culture and the ultimate effect it has on patient care, although assessment tools that cover working environment, shared beliefs, practice norms, values and visioning, for example, are available (Robbins et al 2014).

Nevertheless, it is this culture that can affect how students, newly registered nurses and more experienced staff portray and perceive the nursing profession and ultimately take on values and behaviours through professional socialisation (Parmelli et al 2011).

The document, Raising the Bar, Shape of Caring: A Review of the Future Education and Training of Registered Nurses and Care Assistants (Willis 2015), focuses on the importance of organisational culture in promoting the future of nursing, and of the role of mentors and managers in modelling the values and behaviours needed to sustain public confidence in care delivery.

Complete time out activity 

• To consider how you can influence strategy as a nurse manager, examine the mechanisms you use to ensure consistency of mentorship in facilitating professional socialisation.
• Gather feedback and ideas from all staff and students to discuss at your next team meeting so that you can develop an action plan to ensure consistency of mentorship. Develop a strategy that is owned by the team to facilitate professional socialisation.
• You may agree that each mentor will have a specific role, for example responsibility for disseminating current evidence, leading mentor meetings, evaluating progress, student mentor lead, or mentor lead for existing staff.
• Consider staff involvement and responsibility for professional socialisation as an integral part of staff appraisal. You may need to explore ways of managing staff who do not have the integral values and behaviours of nursing agreed in your placement area.

Managerial support for mentorship is fundamental to embedding positive learning and working relationships in practice areas (McIntosh et al 2014).

If mentors do not receive support and leadership for their own development in the role, their values, perceptions and behaviours may change to those less conducive to promoting positive professional socialisation. Nash and Scammell (2010) identify that students perceive poor mentors as those who are disliked by colleagues, do not want to be mentors or do not like their job, lack confidence in their abilities, and are unfriendly and unapproachable.

As part of annual and interim appraisals, mentorship should be placed high on the agenda for development and evaluation. Poor mentors need to:

• Be constructively challenged.
• Encouraged to reflect.
• Be allocated experienced mentors themselves.
• Negotiate realistic and goal-specific action plans.
• Evaluate progress.

Complete time out activity 

• Following discussion and negotiation with mentors in your practice area, write a list of what you propose to achieve as a manager to help support mentors in facilitating professional socialisation.
• What are the proposed benefits to you, staff, students and patients? How will this be evaluated? It is important that benefits are articulated clearly and understood, therefore, the methods you choose to adopt need to be inclusive and transparent.
• Reflect on how you instil the ‘culture’ of the organisation in your practice area; you may want to incorporate 360° feedback methods in your own and staff appraisals to encourage self-awareness. You may need to identify a role model and mentor for your own development. You may consider anonymous evaluations from staff or team discussions depending on your approach.
• Acting on suggestions and implementing changes will need to be planned and negotiated within an agreed time frame. You may want to think about introducing nursing peer review in your team.

Learning Points 

1. Nurse managers are responsible for fostering organisational cultures on a micro-level in practice areas that are aligned to the macro-level organisational values.
2. Managerial support for mentorship is fundamental to embedding positive learning and working relationships in practice areas and therefore mentorship should be placed high on the agenda for development and evaluation.

Nursing peer review

Nursing peer review can be a way of evaluating professional behaviours and attitudes, alongside knowledge and skills (Morby and Skalla 2010). When monitoring the effect of professional socialisation in a team, nursing peer review can help to identify positive outcomes and highlight where improvements can be made. This can be used by mentors to review colleagues and also for reviews of mentors themselves.

Where peer review is introduced to a practice area, there is potential for staff to feel threatened and fear they are failing in some way. Instilling an open and continuous improvement culture where staff feel confident and safe to discuss areas of concern is paramount. Adopting constructive feedback methods, role modelling and mentorship, and reviewing negotiated action plans, are all fundamental components of instilling the nursing peer review process.

Figure 1

The role of nurse managers in helping to implement this process is crucial to its success, although specific outcomes need to be defined and communicated to all staff. These can be based on the ‘contemporary areas of nursing peer review model’ (Figure 1), which relates to professional socialisation.

As role models, nurse managers can help to demonstrate the values and behaviours expected of mentors and encourage their continual development.

Complete time out activity 

• Think about how you would introduce nursing peer review in your practice area. Use the ‘contemporary areas of nursing peer review model’ (Figure 1) to structure possible outcomes and expected benefits of using this approach in each of the three areas: quality and safety, role development and practice advancement.
• Complete a strengths, limitations, opportunities and threats (SLOT) analysis of this process. Allocation of time to engage in peer review may be an identified limitation; how would you address this? What would your strategy be to reduce fear and apprehension among staff embedding peer review in the placement area? Are there development needs for staff in providing constructive feedback for improvement? Will staff be allocated a peer reviewer or will they be able to choose one themselves? What documentation will be used for staff appraisal and will this be informal or formal?
• Nursing peer review should not be seen as a ‘tick-box’ exercise but should be embraced as continuous development that improves care. How would you encourage this?

Nurse managers are ultimately responsible for assuring the quality and safety of nursing in their practice areas, delivering appropriate standards of care and incorporating current evidence-based practice.

George and Haag-Heitman (2011) identify the following nurse manager behaviours in supporting peer review:

• Providing the necessary resources and protected time for staff to participate in peer review through their professional practice models.
• Engaging all staff in quality and safety initiatives at the point of care by translating and being transparent with all quality, safety and cost data.
• Facilitating and coaching professionals because they develop the structures of peer-reviewed clinical-advancement programmes, credentialing and privileging.
• Supporting the growth of the profession by establishing performance reward and recognition programmes that reinforce the goals of professional role actualisation and practice advancement.
• Providing resources for staff and management education to enable effective peer review, through skilled communication, conflict management and negotiation.
• Establishing a peer process for all levels of management to ensure that the previously described behaviours are developed and measured.

The mentoring strategies employed after nursing peer review should focus on identified development needs and goals, help to modify negative forms of professional socialisation and create an environment for positive team working and continuous learning and improvement.

Learning Points

1. Nursing peer review can help to identify positive outcomes and highlight where improvements can be made when monitoring the effect of professional socialisation in a team.
2. Adopting constructive feedback methods, role modelling and mentorship, and reviewing negotiated action plans, are all fundamental components of instilling the nursing peer review process.
3. The mentoring strategies employed after nursing peer review should focus on identified development needs and goals, help to modify negative forms of professional socialisation and create an environment for positive team working and continuous learning and improvement.

4. Conclusions

   • Professional socialisation is a concept that can be used in your practice area to influence behaviours, attitudes and values relating to the provision of compassionate, safe and high quality care.
   • Nurse managers and mentors have a crucial role to play in fostering positive professional socialisation for current and future workforces including students and existing staff.
   • All staff need positive role models who inspire and motivate through example.
   • Where they perceive leadership of the practice area to be fair and just, feel supported, valued and safe, and are encouraged to challenge and reflect, they can learn a positive approach to embedding the professional values and standards required in their practice.
   • An important aspect to remember is that professional socialisation is an ongoing process and not something that can be achieved and then ignored. It has to be continual and evaluated, particularly after periods of organisational upheaval, specific media influence, or changes in leadership or staff.
   • Developing appropriate strategies as discussed in this module will be specific to your particular practice area.
   • As values, attitudes and behaviours relating to standards of care in the nursing profession continue to be scrutinised, positive professional socialisation is essential in shaping how the profession is viewed and perceived by itself and members of the public for whom nurses care.

   • Acronyms

     DH: Department of Health
     NHS: National Health Service
     NMC: Nursing and Midwifery Council
     RCN: Royal College of Nursing

   • References

     Department of Health (2013) Patients First and Foremost: The Initial Government Response to the Report of the Mid Staffordshire NHS Foundation Trust Public Enquiry. www.gov.uk/government/uploads/system/uploads/attachment_data/file/170701/Patients_First_and_Foremost.pdf (Last accessed: July 15 2016.)
     Department of Health (2015) The Handbook to the NHS Constitution for England. www.gov.uk/government/uploads/system/uploads/attachment_data/file/474450/NHS_Constitution_Handbook_v2.pdf (Last accessed: July 15 2016.)
     Dinmohammadi M, Peyrovi H, Mehrdad N (2013) Concept analysis of professional socialisation in nursing. Nursing Forum. 48, 1, 26-34. MEDLINE •CROSSREF
     Francis R (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Enquiry: Executive Summary. tinyurl.com/lcsocyg(Last accessed: October 28 2015.)
     George V, Haag-Heitman B (2011) Nursing peer review: the manager’s role. Journal of Nursing Management. 19, 254-259. MEDLINE•CROSSREF
     Higgins G, Spencer RL, Kane R (2010) A systematic review of the experiences and perceptions of the newly qualified nurse in the UK. Nurse Education Today. 30, 6, 499-508. MEDLINE •CROSSREF
     Hoeve Y, Jansen G, Roodbol P (2013) The nursing profession: public image, self-concept and professional identity. A discussion paper. Journal of Advanced Nursing. 70, 2, 295-309. MEDLINE •CROSSREF
     Jones K, Warren A, Davies A (2015) Mind the Gap: Exploring the Needs of Early Career Nurses and Midwives in the Workplace. tinyurl.com/qbht787 (Last accessed: October 28 2015.)
     Kaihlanen AM, Lakanmaa RL, Salminen L (2013) The transition from nursing student to registered nurse: the mentor’s possibilities to act as a supporter. Nurse Education in Practice. 13, 418-422. MEDLINE •CROSSREF
     Levett-Jones T, Lathlean J, Higgins I et al (2009) Staff-student relationships and their impact on students’ belongingness and learning. Journal of Advanced Nursing. 65, 2, 316-324. MEDLINE •CROSSREF
     Mackintosh C (2006) Caring: the socialisation of pre-registration student nurses: A longitudinal qualitative descriptive study. International Journal of Nursing Studies. 43, 8, 953-962. MEDLINE •CROSSREF
     McIntosh A, Gidman J, Smith D (2014) Mentors’ perceptions and experiences of supporting student nurses in practice. International Journal of Nursing Practice. 20, 360-365. MEDLINE •CROSSREF
     Morby SK, Skalla A (2010) A human care approach to nursing peer review. Nursing Science Quarterly. 23, 4, 297-300. MEDLINE•CROSSREF
     Nash S, Scammell J (2010) How to use coaching and action learning to support mentors in the workplace. Nursing Times. 106, 3, 20-23. MEDLINE
     Newman M, O’Keeffe C (2013) Professional Socialisation: Insights from Reviews of Organisational Culture and Performance. University of London, London.
     NHS Improving Quality (2015) NHS IQ. www.nhsiq.nhs.uk/. (Last accessed: October 10 2015.)
     Nursing and Midwifery Council (2008) Standards to Support Learning and Assessment in Practice. tinyurl.com/nuskmug (Last accessed: October 28 2015.)
     Nursing and Midwifery Council (2015) The Code: Professional Standards of Practice and Behaviour for Nurses and Midwives. tinyurl.com/ozogs2u (Last accessed: October 28 2015.)
     Parmelli E, Flodgren G, Beyer F et al (2011) The Effectiveness of Strategies to Change Organisational Culture to Improve Healthcare Performance: A Systematic Review. tinyurl.com/qfgafzl (Last accessed: October 28 2015.)
     Rejon JC, Watts C (2013) Supporting Professional Nurse Socialisation: Findings from Evidence Reviews. tinyurl.com/hc5gajk (Last accessed: May 13 2016.)
     Robbins S, Judge T, Millet B et al (2014) Organisational Behaviour. Seventh edition. Pearson, London.
     Thomas J, Jinks A, Jack B (2015) Finessing incivility: the professional socialisation experiences of student nurses first clinical placement, a grounded theory. Nurse Education Today. doi.org/10.1016/j.nedt.2015.08.022 (Last accessed: October 28 2015.) .
     Willis G (2015) Raising the Bar, Shape of Caring: A Review of the Future Education and Training of Registered Nurses and Care Assistants. tinyurl.com/mnmxc7w (Last accessed: October 28 2015.)
     Willis Commission (2012) Quality with Compassion: The Future of Nursing Education. tinyurl.com/cvugp8t (Last accessed: October 28 2015.)