Nursing students' raising concerns in clinical practice : a grounded theory study of the mentor-student dynamic

Raising concerns whilst on clinical placement is challenging for student nurses internationally. Until recently, registered nurses (nurse mentors) within the United Kingdom, facilitated learning and assessment in practice. However, limited research exists on how the dynamic between the student nurse and mentor influences decision-making after a student encounters wrongdoing. This constructivist grounded theory study aims to explore the dynamics of raising clinical concerns from the perspective of the student nurse and nurse mentor. Thirty-seven semi-structured interviews were conducted with student nurses' (n=16), nurse mentors' (n=14), and personal tutors' (n=7). Concurrent data analysis and coding resulted in the development of a core category. The key findings from this study indicated that most of the student nurse participants did not perceive the mentor relationship or the organisational context to be a favourable environment in which to raise a concern. Instead, they bypassed the nurse mentor and raised concerns to either a clinical manager or more commonly the personal tutor. These findings generated the grounded theory of 'reading the context' where decisions and behaviours were strongly influenced by their perceptions of the immediate interpersonal, organisational, and educational context. This theory describes the continual, contextual sensemaking that students utilise in, traversing the process of raising concerns, balancing the mentor-student dynamic, and equipping with the right toolkit. This study recommends a renewed focus on enabling student nurses' to confidently raise concerns whilst working in clinical placements. Preparing students to raise concerns within the university should include first-hand accounts from their peers of the reality of raising concerns. Understanding how student nurses evaluate the organisational context of the clinical placement and the implications of this on patient safety should form part of the preparation for nurses involved in supervising and assessing student learning in clinical environments.