title: Failing securely: The processes and support which underpin English nurse mentors' assessment decisions regarding under-performing students.
abstract: BACKGROUND
  This study was undertaken in response to concerns that mentors who assessed practical competence were reluctant to fail student nurses which generated doubts about the fitness to practise of some registered nurses. Limited evidence was available about the experiences of mentors who had failed underperforming students and what had helped them to do this.
  
  
  OBJECTIVE
  To investigate what enabled some mentors to fail underperforming students when it was recognised that many were hesitant to do so.
  
  
  METHODS
  An ethically approved, grounded theory approach was used to explore thirty-one nurses' experiences of failing student nurses in practical assessments in England. Participants were recruited using theoretical sampling techniques. Semi-structured interviews were conducted. Analysis was undertaken using iterative, constant comparative techniques and reflexive processes. The theoretical framework which emerged had strong resonance with professionals.
  
  
  RESULTS
  Five categories emerged from the findings: (1) Braving the assessment vortex; (2) Identifying the 'gist' of underperformance; (3) Tempering Reproach; (4) Standing up to scrutiny; and (5) Drawing on an interpersonal network. These categories together revealed that mentors needed to feel secure to fail a student nurse in a practical assessment and that they used a three stage decision making process to ascertain if this was the case. Many of the components which helped mentors to feel secure were informal in nature and functioned on goodwill and local arrangements rather than on timely, formal, organisational systems. The mentor's partner/spouse and practice education facilitator or link lecturer were identified as the key people who provided essential emotional support during this challenging experience.
  
  
  CONCLUSIONS
  This study contributes to understanding of the combined supportive elements required for robust practical assessment. It presents a new explanatory framework about how mentors formulate the decision to fail a student nurse and the supportive structures which are necessary for this to occur.
authors.affiliation: Birmingham City University, Faculty of Health, Education and Life Sciences, City South Campus, Birmingham B15 3TN, United Kingdom. Electronic address: Louise.Hunt@bcu.ac.uk.
authors.forename: Louise A
authors.initials: LA
authors.lastname: Hunt
authors.affiliation: Birmingham City University, Faculty of Health, Education and Life Sciences, City South Campus, Birmingham B15 3TN, United Kingdom. Electronic address: Paula.Mcgee@bcu.ac.uk.
authors.forename: Paula
authors.initials: P
authors.lastname: McGee
authors.affiliation: University of Wolverhampton, Faculty of Education Health and Wellbeing, Gorway Road, Walsall WS1 3BD, United Kingdom. Electronic address: Robin.gutteridge@wlv.ac.uk.
authors.forename: Robin
authors.initials: R
authors.lastname: Gutteridge
authors.affiliation: Birmingham City University, Faculty of Health, Education and Life Sciences, City South Campus, Birmingham B15 3TN, United Kingdom.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Hughes
mesh_terms: D002983:Clinical Competence; D004508:Education, Nursing, Baccalaureate; D004739:England; D005246:Feedback; D066296:Grounded Theory; D006801:Humans; D007407:Interviews as Topic; D008611:Mentors / Q000523:psychology*; D015402:Nursing Education Research; D036301:Qualitative Research; D012944:Social Support; D013332:Student Dropouts / Q000523:psychology; D013338:Students, Nursing / Q000523:psychology*; D014477:Underachievement
keywords: Clinical competence; Failing students; Mentor; Practical assessment