title: 'Seeking authorization': a grounded theory exploration of mentors' experiences of assessing nursing students on the borderline of achievement of competence in clinical practice.
abstract: OBJECTIVE
  To develop a substantive theoretical explanation of how mentors make sense of their experiences where nursing students are on the borderline of achievement of competence in clinical practice.
  
  
  BACKGROUND
  The reluctance of Registered Nurse mentors to fail nursing students in clinical practice despite concerns about competence remains a contemporary issue in international healthcare education. Mentors' assessment decisions have considerable impact for a variety of key stakeholders, not least for students in these circumstances.
  
  
  METHODS
  Grounded theory qualitative study.
  
  
  METHODS
  Phase one involved 20 individual semi-structured interviews with nurse mentors in one United Kingdom National Health Service Health Board (July-October 2009). Phase two included eight individual semi-structured interviews and seven focus groups with mentors and practice educators (n = 38) in four further Health Boards (June 2011-February 2012). Data were analysed using open, axial and selective coding consistent with grounded theory method.
  
  
  RESULTS
  Three categories 'the conundrum of practice competence,' 'the intensity of nurturing hopefulness,' and 'managing assessment impasse,' led to the study's substantive theoretical explanation - 'Seeking authorization: Establishing collective accountability for mentorship.' This demonstrates how mentors are dependent on key sources of support and feedback to validate their assessment decision-making, notwithstanding substantial personal, professional and organizational pressures.
  
  
  CONCLUSIONS
  We conclude that management of borderline assessment situations is considerably developed by recognition of the authorizing effects of a wider community of assessors. Consequently, we identify the personal, professional and organizational implications involved in the preparation, support and regulation of mentors specifically during borderline assessment circumstances.
authors.affiliation: Abertawe Bro Morgannwg University Health Board, Swanesa, Wales, UK.
authors.forename: Simon
authors.identifier: http://orcid.org/0000-0002-1098-5873
authors.initials: S
authors.lastname: Cassidy
authors.affiliation: Public Health, Policy and Social Sciences, Swansea University, Wales, UK.
authors.forename: Michael
authors.identifier: http://orcid.org/0000-0002-0380-4704
authors.initials: M
authors.lastname: Coffey
authors.affiliation: Department of Nursing & Midwifery, Faculty of Education & Health Sciences, University of Limerick, Ireland.
authors.forename: Fiona
authors.initials: F
authors.lastname: Murphy
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards*; D004508:Education, Nursing, Baccalaureate / Q000592:standards*; D004521:Educational Measurement / Q000592:standards*; D005260:Female; D017144:Focus Groups; D066296:Grounded Theory; D006801:Humans; D008297:Male; D008611:Mentors / Q000523:psychology* / Q000706:statistics & numerical data*; D008875:Middle Aged; D036301:Qualitative Research; D013338:Students, Nursing / Q000523:psychology* / Q000706:statistics & numerical data*; D006113:United Kingdom
keywords: assessment; borderline decision-making; clinical practice; competence; grounded theory; mentor; nurse education; nursing; qualitative; student