Nurses' Experiences With Mentoring Nursing Students in Nursing Homes Where an Active, Collaborative Learning Model Is Introduced. A Qualitative Study

ABSTRACT

Aim

To explore the experiences of nurses mentoring nursing students who study in an active collaborative learning model in their first clinical placement in nursing homes.

Background

Clinical nurses play a crucial role in providing a meaningful learning environment when mentoring nursing students. Active collaborative learning models are increasingly being implemented in clinical placements in nursing education and it is important to explore the experiences of mentoring nurses when implementing such models. In our study, a model where one mentor supports a learning cell of two students, again being supported by a team of two persons in joint positions, was explored.

Design

The study had a qualitative design, interviewing mentors in focus groups about their experiences with mentoring nursing students in a new, collaborative model.

Methods

Twenty‐seven mentors were interviewed in six focus groups. The data from the interviews were analysed using thematic analysis.

Results

Two main themes emerged from the analysis: (1) navigating to find the mentor role in a new approach and (2) sharing responsibility for student mentoring.

Conclusions

Mentors in active, collaborative learning models can experience a shift from emphasis on developing a close relationship with one student to emphasis on supporting a learning cell of two students in organising their learning. When introducing new models to practice learning it is essential to also provide a supportive structure for the mentors.

Relevance to Clinical Practice

Active collaborative learning models have the potential to provide more clinical placements of high quality. Nurses who mentor students need support. A supportive environment being facilitated by academic–practice collaboration provide a community of practice on mentoring for nurses.

Patient or Public Contribution

The result of the research was shared and discussed with stakeholders prior to submitting the article for publication.

1. Introduction

Clinical nurses play a crucial role in providing a meaningful learning environment when mentoring nursing students. Models and approaches for clinical teaching have evolved over the years and exist side by side under various labels and names. However, most models build their structure around an individual student supervised by a mentor and emphasise the relationship between mentor and student. The relationship is often depicted as a dyad or triad where one student is mentored by a clinical nurse seconded by an academic–practice teacher (Frøiland et al. 2023; Suliman and Warshawski 2022). Internationally, there is a movement away from approaching clinical learning as an individual endeavour towards more collaborative approaches. Collaborative and peer learning in clinical placement in nursing education is a rapidly emerging field (Markowski et al. 2021), where several different models have been developed and implemented (Hill, Woodward, and Arthur 2020; Jassim, Carlson, and Bengtsson 2022; Williamson et al. 2020; Wilson, Cooper, and Hodge 2020; Zhang and Cui 2018). Many studies find that students benefit from collaborative learning models (Markowski et al. 2021; Tveit et al. 2023). The experiences of mentors with collaborative learning models are also important to explore, as their role and tasks are influenced by the pedagogical model, they mentor in. In this article, a ‘mentor’ is a clinical nurse who mentors, supervises and assesses students in their clinical placement.

In this paper, we explore the experiences of clinical nurses who mentor students in an active, collaborative learning model. The paper reports from a project that piloted a model for active, collaborative learning for first‐year nursing students undertaking their first clinical placement in nursing homes.

2. Background

In the Norwegian setting, most nursing students undertake their first clinical placement in nursing homes, which are long‐term care institutions primarily for elderly people with complex health challenges. One important aim of the first placement is to learn fundamental nursing and basic practical nursing skills. To learn in a clinical environment is a new experience for most first‐year nursing students, and it is essential for students to ‘learn how to learn’ in clinical settings (Tveit et al. 2023). To achieve this, it is of great importance how the clinical placement is set up and configured. However, nursing homes are often ‘marginal settings’ with low staffing, which challenges the facilitation of the nursing home as a good learning arena (Jacobsen et al. 2020). Furthermore, a study from nursing homes in Norway found that clinical nurses assigned to mentoring students were uncertain about the pedagogical approaches that the university required (Frøiland et al. 2021). The mentors called for more pedagogical support from the universities. There is a great potential to improve nursing homes as learning arenas (Husebø et al. 2018; Jacobsen et al. 2020; Tveit et al. 2023), and when introducing new pedagogical approaches, mentors must be included in the process.

One way to improve the clinical learning arena for nursing students is to implement more active and collaborative learning approaches to clinical placements (Clarke, Williamson, and Kane 2018; Hill, Woodward, and Arthur 2020). Although active, collaborative models can allow for a higher density of nursing students in each ward and thereby contribute to facing a shortage of clinical placements, the main rationale for collaborative learning in clinical practice is pedagogical.

Active learning is a term that describes learning and instruction methods that engage students in the learning process (Prince 2004). Active learning involves more than mere activity while learning: Michael states that ‘learning involves the active construction of meaning by the learner’ (Michael 2006, 160), while Damşa, Nerland, and Andreadakis (2019) denote it as construction and co‐construction of knowledge and practices in a way where the learner, ‘through active participation, affects the learning process itself and the knowledge obtained’ (Damşa, Nerland, and Andreadakis 2019, 2079). A common way of ensuring student activity and engagement is through collaborative learning or peer learning, in which students work together in pairs or groups with solving tasks and develop their own knowledge.

Active learning does not entail leaving the collaborative learning unit to themselves, but requires ‘scaffolding’ (Shvarts and Bakker 2019), where the students learning is supported through preconfiguring their learning space (Damşa, Nerland, and Andreadakis 2019). This scaffolding importantly includes the mentor's support of the peer learning unit, which requires that the mentors are familiar with the pedagogical approach and their role within it.

Mentoring students can be challenging. Lea et al. (2017) found that mentors are unprepared to facilitate a learning environment, and other studies have argued for the importance of mentors being prepared for the pedagogical approach when mentoring (Hill, Woodward, and Arthur 2020; Myers et al. 2019; Williamson et al. 2020). The need for support in mentorship in general has been documented by several researchers (Dev et al. 2020; Frøiland et al. 2023), such as the need for more and better information, the possibility to share mentoring experiences and closer collaboration between the university and the practice field. However, few studies emphasise what that support should amount to when mentoring in an active learning model. Trede, Sutton, and Bernoth (2016) argue that research into mentors' perceptions of their role mainly focus on the knowledge and skills needed in mentoring, putting little weight on the mentors' pedagogical understandings and needs for pedagogical support (Trede, Sutton, and Bernoth 2016). In such studies, there is a tendency to emphasise the mentor–student relationship, often conceptualised as a rather confined dyad (as presented in for instance Hilli et al. 2014; Nielsen et al. 2017).

The studies of Hill, Woodward, and Arthur (2020) and Williamson et al. (2020) explored experiences with the Collaborative Learning in Practice model in England and found that the mentoring nurses' experience was that it is important to be prepared for the approach. The researchers reflect on how the model involves a different way of collaborating with students, where they coach rather than demonstrate and instruct. Nygren and Carlson (2017) report that mentors can find peer learning models stressful and demanding. Both their study and a study by Jassim, Carlson, and Bengtsson (2022) found that mentors are required to rethink their approach to mentoring when supervising students in a peer learning approach and that support for the role is important.

2.1. The Project ‘Kickstart in Nursing Homes’

This paper is part of a larger evaluation study of a project, which aimed to improve first‐year nursing students' learning experience in their first clinical placement, which is in a nursing home. Three higher education institutions and five municipals collaborated in testing out a new model for active learning in clinical placement in nursing homes called ‘Kickstart in Nursing Homes’ (Tveit et al. 2023). The main aim of the project was to increase the quality of the clinical placement. A subordinate aim was to increase the number of student placements in the participating nursing homes. Table 1 illustrates the model that was implemented.

TABLE 1.

The Kickstart in Nursing Homes model.

The model provides students with scaffolding for their learning, consisting of the following elements. Students are organised into a learning cell of two students, which makes up their base for learning throughout the placement. Each learning cell is supervised by a mentor, who is a staff nurse. Each nursing home is allocated a team comprising a senior nurse from the nursing home and a teacher from the cooperating university in joint appointments, where each has 20% of their work hours allocated to functioning in the team. The team is responsible for preparing and informing the mentors, supporting the mentors and helping with providing a good learning environment for the students. The teacher is also the university staff member who takes part in the formal assessment of the students, with a separate amount of time allocated for this.

The model involves two students working together in a ‘learning cell’, which is a form of collaborative or peer learning. The students in the learning cell are expected to take responsibility for planning, working together, reflecting together and giving each other feedback as peers. Each learning cell is supervised by one mentor. A team of staff in joint positions between the nursing home and the university supports the mentors. The team consists of a senior nurse from the nursing home and one teacher from the university, each having 20% of their work hours allocated to working in the team. Their support the mentors through preparing and informing them, being available throughout the placement period for guidance and support when needed, following up student with increased need of mentoring, arranging regular meetings between the mentors and arranging sessions with the students to support their learning, for instance, introduction to procedures, thematic sessions and reflection sessions.

3. The Study

3.1. Aim

The aim of this study was to explore the experiences of nurses mentoring nursing students who study in an active collaborative learning model in their first clinical placement in nursing homes in Norway.

4. Methods

4.1. Design

The study has a qualitative design that explores the experiences of mentors working in a model of active learning. Insight into these experiences was generated through focus group interviews, in which the participants discussed and shared their experiences with each other, allowing for co‐construction of meaning (Wilkinson 1998; Morgan and Hoffman 2018).

4.2. Context

The implementation took place during Spring 2021 under COVID‐19 restrictions, which allowed nursing students in Norway to undertake clinical placements, but the length of the period was reduced (typically from 8 to 6 weeks). In some places, neither students nor nurses or teachers could move between wards. Some wards and institutions were highly influenced by quarantine requirements at times during the implementation period. In some places, the teachers were not allowed into the institution; in other places, they could only be present on the entrance floor. Collaborative meetings between teachers and nurses through digital platforms, such as Zoom, was, in many places, tried as a rather unfamiliar mode of communication.

4.3. Data Collection

Focus group interviews were chosen as a method of data collection in order to produce knowledge about how the participants deliberated and co‐constructed their understanding about their experiences when mentoring in the ‘Kickstart in Nursing Homes’ model (Morgan and Hoffman 2018). A semi‐structured interview guide was used, focusing on experiences with different elements of the model. Each interview was moderated by one of the authors, who are all academic staff at a university. In two of the interviews a co‐moderator participated. The moderators were encouraged in preparatory meetings to be attentive to different voices and perspectives.

Due to COVID‐19 restrictions, the interviews were carried out in several forms spanning from wholly digital video conversations (zoom meetings) to the group sitting in the same room. Some interviews were of a hybrid form where some persons were in the same room and some participated digitally. Despite some interruptions due to technical challenges, the main challenge was the busy work schedules of the nurses. The interviews lasted between 30 and 80 min. Table 2 provides an overview of the interviews.

TABLE 2.

Overview over interviews, participants and form of communication.

Inter‐view	Number of participants	Facilitators	Form of communication	Length of interview
# 1	4, all women	1	Hybrid: physical meeting between facilitator and two more participants participated via Teams	54 min
# 2	4, all women	1	Physical meeting	45 min
# 3	4, one man and three women	2	Hybrid: three participants participated over Teams from the same room, the last participant and the two facilitators participated via Teams individually	1 h and 20 min
# 4	2, both women	2	Physical meeting	36 min
# 5	4, all women	1	Physical meeting	36 min
# 6	10, two men and eight women	1	Physical meeting	58 min

Reflections and first impressions were written down immediately after the interview. The interviews were transcribed professionally.

4.4. Participants

Five different municipalities throughout the south of Norway participated in the project, with two nursing homes from each municipality. These data were collected in six focus group interviews in the five municipalities. All mentors participating in the ‘Kickstart in Nursing Homes’ implementation during the spring of 2021, were invited by e‐mail to participate in the study. All the mentors were registered nurses holding a bachelor degree in nursing.

The groups were organised so that mentors from the same municipality took part in the same group. In addition to mere logistical concerns, this composition of the groups ensured that the participants knew of each other and were familiar with each other's context. The number of participants in each group varied from 2 to 10; the total number of participants was 27. In one municipal, it was so difficult to find a time that suited all participants that two focus group interviews were conducted instead of one, whereof one of the interviews had only two participants.

The participants were mainly female; only three male nurses participated in the interviews. Their work experience as nurses varied from 3 months to 35 years. Most of them had previous experience of mentoring nursing students. For many of the participants, mentoring two students at the same time was a new experience. Some of the participants had mentored students in pairs before, but not within a clearly defined collaborative learning framework. Some, but not all, had completed a coursework in mentoring students on clinical placement.

4.5. Data Analysis

We analysed the material by using thematic analysis inspired by Braun and Clarke (2006), with an emphasis on the flexibility and reflexivity of the method (Braun and Clarke 2019). The interaction generated in the groups was a central object of analysis, in addition to the participants' individual statements. The six stages of familiarisation, coding, determining themes and sub‐themes, reviewing, refining and reporting were followed, coding the material manually in Microsoft Word. The process of determining, reviewing and refining themes was followed throughout by referring to the aim of the study, asking analytic questions of the material and going back and forth between aim, previous knowledge, theoretical framework and the material in an iterative process (Braun and Clarke 2019). Table 3 provides an illustration of the movement from data extract via codes to subthemes and themes.

TABLE 3.

Example of coding tree.

Data extract	Code	Subtheme	Theme
When I mentor one person, I cannot focus on two persons. I must concentrate on one so that I mentor that student. And the other one is left to themselves. (Mentor in Interview 1)	When I mentor one I cannot focus on two.	The workload of mentoring two students.	Navigating to find the mentor role in a new approach.
And there is something about them being in pairs; in some way, they achieve a weight and strength between them. I feel that I have been closer to my previous students because they have followed me so closely throughout their placement. These two, on the other hand, were supposed to be more independent, working primarily with each other, but, of course, with support from me as a mentor. (Mentor in Interview 3)	There is a strength in being in pairs. I have been closer to previous students. These two were more independent.	Cooperation with the learning cell.

The authors all read all the interviews and shared their first impressions in a meeting. Anne Raustøl and Kirsten Eika Amsrud coded the entire material, providing an overview of the data, while Anne Raustøl directed the manuscript writing. Simultaneously, we looked for salient issues in the deliberation in the groups, an element that was easier to detect in the conversations with four or more participants than in those with fewer participants. For instance, sometimes there was general agreement about an issue in a group: the participants all seemed to agree with the idea that students seem to benefit from working together in learning cells. At other times, there were instances of clear counter voices when the group seemed to agree that mentoring two students at the same time was challenging, but then one person would state that ‘I actually find it easier this way’, which changed the direction of the conversation somewhat. Such movements can be hard to ‘code’, but nevertheless they importantly informed the final presentation of the findings in the material (Braun and Clarke 2019).

4.6. Ethical Issues

The participants were recruited by the local project leader in each municipality, who emphasised that participation was voluntary and required informed, written consent. The project leader did not work closely with the mentors.

The interviews were recorded on an audio recorder. Written consents and audio recordings were stored in an encrypted server at the main author's institution, in accordance with requirements in Norwegian legislation.

The participants were reminded of their duty of confidentiality about residents and students before the interviews started. They were nurses with competence and experience in balancing confidentiality concerns and expressed being comfortable with managing confidentiality when speaking in the interviews.

The study was registered and approved by the Norwegian Centre for Research Data, registration number 145248, ensuring that the study was conducted in line with personal data protection requirements. Ethical issues were addressed and discussed in the research group as they arose. The main questions discussed were how to secure free consent without experiencing pressure to participate, and how to share the data between researchers from different institutions while respecting privacy and data protection issues.

5. Findings

Through the analysis, the authors identified two themes: (1) navigating to find the mentor role in a new approach and (2) sharing responsibility for student mentoring.

5.1. Navigating to Find the Mentor Role in a New Approach

The mentors described and discussed challenges and advantages of mentoring within new model.

5.1.1. The Process of Mentoring Two Students

Mentoring two students in a learning cell was new to most participants. In all the interviews, challenges related to mentoring two students were discussed: many found it stressful and struggled to find a way of coping with this change. It seemed as if several of them approached mentoring in the same way as when they mentored one student. For instance, one participant said:

When I mentor one person, I cannot focus on two persons. I must concentrate on one so that I mentor that student. And the other one is left to themselves. (Mentor in Interview 1)

Others found mentoring two students easy, both because the students could support each other and because it reduced the pressure of ‘having one on you at all times’.

The participants discussed several moral concerns when mentoring two students, in particular, that of balancing care for patients with their responsibility to mentor students. Some worried about having too many persons in a resident's room, particularly when the patient suffered from dementia. Some also worried about distributing mentoring fairly between the students and adjusting to the level of each individual student.

Nevertheless, a clear pattern in the material is that the participants found it easier to mentor the learning cell after a couple of weeks. The students became more independent and self‐driven, so that the mentors could step back a bit, as illustrated below:

I think that in the beginning, it is a bit more, but in retrospect, it is almost less. Because the two were supposed to constitute a cell, and they can do a lot on their own. They can do morning care, and then the two of them take the responsibility, and there is almost less of a workload for me. (Mentor in Interview 3)

5.1.2. Cooperation With the Learning Cell

The participants reflected on how they cooperated with the learning cells. Several emphasised that they experienced the students as confident in their role when they were working in a learning cell. They also found that the students blended into the work environment more easily, finding their place socially too. The participants discussed how the students used their mentors; they seemed to have a higher threshold for engaging with the mentors because they discussed things between themselves first. Several mentors experienced the students approaching them at a later stage when things were already processed:

They find safety in each other. Of course, this depends on the chemistry between them, but it was so rewarding to see how they cheered each other on, supported and helped each other and how they lifted each other throughout the period. And the threshold for coming to me was higher because they first wanted to check with each other and discuss between them. I think that was a good arrangement. (Mentor in Interview 3)

The interviews explored what this difference from models with one‐to‐one mentoring involved and found that it could influence the mentor–student relationship. They discussed different degrees of closeness in the mentor–student relationships. One said:

And there is something about them being in pairs; in some way, they achieve a weight and strength between them. I feel that I have been closer to my previous students because they have followed me so closely throughout their placement. These two, on the other hand, were supposed to be more independent, working primarily with each other, but, of course, with support from me as a mentor. (Mentor in Interview 3)

Others conceptualised this difference more as form than as degree. One described it as a ‘three‐leaf clover’, where the mentor's role was to take a step back but still be there as support for the learning cell. They emphasised that the students themselves were in charge of their learning and professional formation:

And then they find their own way, in a way, and that is the whole point, I think. They are not supposed to just copy us; they are supposed to find the nursing role for themselves. (Mentor in Interview 3)

5.1.3. Commitment to Mentoring

A clear pattern in the material is that the mentors seemed to be strongly committed to and feel responsible for the students' learning environment and seemed to assume great responsibility even if the students worked somewhat independently. The way they talked about their experiences as mentors shows that it was important for them to give the students a good learning experience. In several interviews, the participants called for more competence in pedagogics and mentoring. They discussed how they wished they had been more involved in the students' assignments and in the meetings that the holders of joint appointments had with the students, ‘because after all, we are the ones responsible for the mentoring’ (Mentor in Interview 2), as one said. In assessment situations, the mentors also took charge, balancing concerns of privacy, learning outcomes, students being at different levels and the possibility for peer assessment.

5.2. Sharing Responsibility for Student Mentoring

The mentors discussed the importance of experiencing support when mentoring students in a new model. Two subthemes were found through the analysis: (1) being supported by someone in a designated role and (2) collegial support.

5.2.1. Being Supported by Someone in a Designated Role

In most interviews, the participants discussed experiences of having support from a senior nurse designated to work as a link between the nursing home and the university. The participants emphasised the value of having an insider who understood their perspective and situation; some even labelled it ‘luxurious’. The participants found that the nurse worked as a bridge between the university and nursing home, making communication between the two easier. Given that the implementation happened 1 year into the COVID pandemic, they also appreciated the mere physical presence of the nurse—‘that she was in the building’, one said.

To have someone to talk to, who is not the teacher, […]. But to talk to the one who is part of the nursing home staff, who easily understands what I mean and has a different look at the problems we are facing. I like that. The teacher is also easy to approach, but we work together in a different way; she has another role. I am actually quite happy with this arrangement. (Mentor in Interview 1)

Some of the mentors reported not taking advantage of a support role but appreciated that someone was there if they needed support. Others, particularly those with less experience in mentoring, reported a need to rely quite heavily on support from the senior nurse. A newly graduated nurse observed:

It was safe for me in a way, to know that when there is something with the student, and I couldn't always answer, I have the nurse in the joint appointment behind me to support me in relation to the mentoring of the students. It was a very good feeling for me to have her behind me. (Mentor in Interview 2)

Many participants emphasised the importance of having someone in a designated role to support the mentors when needed. The nurse in the joint team was seen as an intermediary and insider who understood their perspective and situation, and who had time to deal with challenges that arose.

Here, we had two difficult weeks. We didn't get complaints, but we didn't have much time to supervise the students some days. So I told the nurse in the joint appointment immediately that it's not that I don't want to, but I don't have the time […]. It's good to have a person who understands both perspectives. And afterwards, she met with the students and explained everything to them. (Mentor in Interview 1)

The mentors reported that the organisation with someone dedicated to follow‐up mentors and students made the information flow between the nursing home and university easy. They also found that persons in dedicated roles could provide them with information they needed as a mentor when they needed it. Most mentors emphasised that they had received training and information about the learning model, the learning outcomes the university expected and the assessment tool in organised meetings.

5.2.2. Collegial Support

The mentors experienced that the organisation had facilitated a community where learning and mentoring were on the agenda. Several joint teams organised meetings and forums for them to exchange information and experiences and give each other advice on the mentoring of students. Others stated that they missed this, which had not been possible in all places due to the pandemic. Nevertheless, the participants experienced being part of a community where they shared experiences with mentoring students:

We mentors have mutual use of each other, and perhaps we share our experiences with mentoring with each other, both in this project, but also about earlier experiences […]. I would say we get to reflect a lot with each other through talking together, with the project leader or the nurse in the joint appointment. I wish the mentors had been gathered at the house more than we have been, though. (Mentor in Interview 5)

Several mentors pointed to an experience of mentoring being a shared activity during the placement. They used expressions as ‘more professional’ and ‘more organised’ when comparing this placement period to earlier experiences with mentoring students. The findings indicate that this was related to the support structures offered to the mentors during the implementation of the project. One nurse summarised their experiences with the support in the project in this way:

Usually, before the project, it has been a bit like ‘suddenly the students are here’. While now there have been more people: Lisa [nurse in joint appointment] has been here, Anna [teacher in joint appointment] has been here, so we have had several persons talking about it and working with it (Lisa and Anna are fictional names). (Mentor in Interview 3)

Several mentors pointed to that the common forums involved discussing the pedagogical model and what was expected of them as mentors and that they felt well prepared to mentor students in this particular clinical placement.

As the structure with jointly appointed nurses and teachers in a team was new and not clearly defined, we were curious as to what kind of support the mentors experienced that they received from them. They discussed different kinds of support. Some reported that the team relieved them of their workload in busy periods, taking over the follow‐up of students, for instance, when the ward was understaffed or they were themselves off sick or in quarantine.

6. Discussion

The aim of this study was to explore the experiences of nurses mentoring nursing students who study in an active collaborative learning model in their first clinical placement in nursing homes in Norway.

6.1. Active, Collaborative Learning Requires Re‐Conceptualisation of the Mentor Role

Our findings show that the mentors found mentoring students in the model to be a new experience, particularly mentoring a learning cell rather than one student. Mentoring two students in a collaborative unit differs from one‐to‐one mentoring. The participants in our study reported finding mentoring two students at once overwhelming in the beginning. A Swedish study on nurses mentoring students in peer learning pairs also found that the nurses found the model stressful, experiencing being torn between the two students (Nygren and Carlson 2017). However, the participants in our study found that this became easier after a while, some even reporting that they found mentoring a learning cell easier and less stressful than one‐to‐one mentoring.

One reason why this shift happened seem to be that the mentors re‐conceptualised what their mentoring role was. The mentors reported that the students became more independent and often approached the mentor at a later stage than when one student was mentored because they had already processed the issues between themselves. However, the students were not left to fend for themselves. The mentors in our study reported having a great responsibility to facilitate and support the students' learning but to do so in a way that gave room for the active learners in the cell to take the lead. Mentors have a great responsibility in providing the necessary scaffolding for students, particularly when the students have their first clinical placement. Williamson et al. (2020) also emphasise the importance of supporting active learners.

Making this shift in mentoring style does not come by itself and may represent a rather big turn in how we understand mentoring in clinical placement. Much of the literature on mentoring nursing students seems to focus on developing the nurse–student relationship, emphasising things like a caring attitude (Hilli et al. 2014) and giving of oneself (Wilson 2014), where the dyad of the mentor–student relationship is the pivot. In an active learning model, where the learning cell (or other peer unit) is the pivot, students spend less time developing a relationship with the mentor (Hill, Woodward, and Arthur 2020). The mentor's role is then to support the cell in the learning that the students themselves direct. The participants in our study called for more pedagogical competence and for being more involved and independent in the mentoring and assessment of students. Several studies on clinical mentoring of nursing students in active learning models also report mentors calling for more preparation and training (Jassim, Carlson, and Bengtsson 2022; Nygren and Carlson 2017; Williamson et al. 2020). Trede, Sutton, and Bernoth (2016) found little emphasis on the pedagogical conceptualisations of the mentor role in previous research, which is one of the kinds of support the participants of our study call for.

6.2. The Value of Mentors Having a Community of Practice

In our model, mentors are an important part of the scaffolding for the students' learning. However, to support the students' learning, the mentors themselves need scaffolding. In our study, the mentors appreciated different kinds of support they found in the new initiative, stating that they often had felt alone when mentoring before.

Our study found that the mentors particularly appreciated the possibility to be part of a community of practice. The joint team facilitated forums where mentors could share and discuss issues related to mentoring students with each other and with seniors who had a particular competence and capacity in student learning and mentoring. Trede, Sutton, and Bernoth (2016) argue that mentoring students often becomes an individualistic activity, where the main responsibility for the quality of practice education falls on the individual mentor. They call for more focus on mentoring as a shared activity within a community of practice. Theories of communities of practice, where the learning is socialised into a community, and learns and develops through shared practices, are commonly used as approaches to students learning in practice (Dogan, Terragni, and Raustøl 2021). Trede, Sutton, and Bernoth (2016) point out that such a perspective is less common in studies of mentorship in practice. Our study found that mentors appreciated being more people involved in and committed to mentoring students, and that providing a community for sharing and discussing practices of mentorship is a central support structure that mentors need.

The mentors in our study reported finding the information flow between university and practice placement was easier when a team of joint appointments was in place, and many studies point to the importance of good information flow (Dev et al. 2020; Gronvik and Hauge 2020; Hilli et al. 2014). Gronvik and Hauge's study found that mentors often felt quite confident in mentoring students in nursing, but that they found it difficult to navigate in all the different requirements of the university. In our study we find that the mentors are dedicated to mentoring but see the need for support in how to mentor in line with the pedagogical approach of the university, through communication with the teacher and the senior nurse. They also pointed to the value of having this organisation when facing challenging situations. Following up underperforming students or cooperation challenges is a demanding and time‐consuming task (Hughes, Mitchell, and Johnston 2016). Nurses in nursing homes are particularly pressed for time because of low staffing and a ‘marginal setting’ (Jacobsen et al. 2020). Our participants pointed to the value of having a senior nurse with both the insight and capacity to take hold of challenging situations as soon as they were reported, who would assistance from the university teacher. A close collaboration between university and practice field can prevent nurses spending a lot of time on such challenges.

The arrangement with joint positions in this study is an example of a closer collaboration between educational institutions and the practice field, so‐called academic–practice partnership (Mehigan, Pisaneschi, and McDermott 2019). One reason for implementing this arrangement was to organise the scaffolding around the students' learning in a structured way, strengthening the collaboration between the nursing home and the university. When such a large portion of the nursing education takes place in clinical placements, the practice field and the universities must find ways to share this responsibility (Mehigan, Pisaneschi, and McDermott 2019). What we found in our study was that the mentors themselves also needed ‘scaffolding’ to flourish as mentors in the new model. New approaches to learning require tailored support for mentors, reducing the distance between university and the practice field. One important contribution of our model is that it can help strengthen the practice community in nursing homes, which make up the first clinical placement setting for many nursing students.

6.3. Limitations and Strengths of the Study

This study gathered its data through focus group interviews, aiming at creating space for shared reflection and deliberation among groups of mentors within the same municipality. The focus groups were of varying size and with varying flow in the conversations, and perhaps some participants would have been more open in an individual interview. The interviewers were particularly concerned with encouraging involvement from all participants of the group, in order to achieve a good dynamic and shared deliberation (Morgan and Hoffman 2018). The sample consist of mentors from all participating nursing homes, adding to the richness of the material. The groups consisted of mentors from two different nursing homes, in the same municipality, which also facilitated the dynamic because the participants could refer to different practices, but still knowing of each other's contexts.

We considered the richness of the material by referring to the concept of ‘information power’ (Malterud, Siersma, and Guassora 2016). One important limitation is that the data were collected 1 year into the COVID‐19 pandemic, which influenced both the implementation in the nursing homes (particularly the form of collaboration for the joint teams) and the data collection. One challenge in the collection of data was that some interviews were done over video calls, some in traditional physical meetings and some as hybrids with elements of both. The interviews were conducted by different researchers in each geographic location, using the same interview guide. Face to face settings and a more flexible and iterative approach to data collection could have enriched the material. We consider that central elements strengthening the quality of the dialogue to weigh up for these challenges. Malterud et al. emphasise that high insider or topic knowledge of both researchers and participants typically strengthens the focus and quality of the dialogue. In our study, the mentors shared reflections on a central element of their daily practice and all researchers had in‐depth experiences with mentoring students in nursing home settings.

The implementation of the model was influenced by COVID‐19 in that teachers from universities could not be present in the nursing homes as much as intended. This could explain that the participants pointed more to the nurse than the teacher in the joint teams, and that the teacher's role in such a collaboration was perhaps not optimally tested out. Even so, it is clear from our material that the mentors experienced significant support being added through the model.

The researchers were all experienced nursing education academics, who had been central in the development of the active learning model. There is a risk for researcher bias when researchers are themselves involved in the project, and when being ‘insiders’. However, there is also a strength in researchers knowing the field and the phenomenon explored in depth (Morse 2015). The author group was also concerned about how to balance insider roles with a sound analytic approach in the analysis process. Several rounds of analysis and discussion of the findings in the author group was important to support this balance.

The study was reported following the SPQR guidelines (O'Brien et al. 2014).

7. Conclusion

This study explored the experiences of nurses mentoring students in their first clinical placements in nursing homes, implementing a model for active and collaborative learning. Our study finds that the nurses who mentor nursing students in clinical placement have a high level of commitment and responsibility for providing high‐quality learning experiences, but that they need support in managing to do so, particularly when the approach to mentorship changes. This support must address how to understand and approach mentorship in active, collaborative learning. The mentors in our study see a shift from a close relationship with one student, to supporting the ‘learning cell’ of two students in a more stepped back manner, to make room for collaborative learning. The mentors had to find their place and role within the configured learning space of the students.

In this project, we provided a joint team of a nurse and a university teacher to each nursing home, to provide support for mentors and for the students' learning. The mentors experienced this arrangement as an important support in their mentorship, both by having seniors to rely on in their daily practice and by being part of a community of practice around mentoring.

It is important to increase the capacity for educating nurses in the coming future, and a higher capacity for clinical placements is one important factor. Active, collaborative learning models can contribute to this aim by providing high‐quality clinical placements for nursing education, as well as it may also potentially increase the number of clinical placements. However, it is important that the nurses who mentor nursing students are not left with the bulk of this responsibility on their own but are provided with supportive structures and a community of practice around mentorship.

Author Contributions

All authors contributed to the design of the study, conduction of the interviews, analysis of the material and critical revision of the manuscript. Anne Raustøl directed and administrated the research activities and the writing of the manuscript in close collaboration with Bodil Tveit. Kirsten Eika Amsrud and Bodil Tveit contributed in detail to the coding and structuring of the analysis, which was led by the first author. Anne Raustøl administered data curation in line with legislation and ethical standards. Bodil Tveit directed the funding acquisition and the implementation project. All authors approved the manuscript for submission.

Conflicts of Interest

The authors declare no conflicts of interest.

Consent

Five municipalities in Norway participated in the implementation of the model in 10 nursing homes. The municipalities contributed to the research by participation in the reference group of the project. The nursing homes contributed to the overall implementation of the model in close collaboration with the project group throughout the project. The result of the research was shared and discussed with stakeholders prior to submitting the article for publication.

Relevant Permissions Obtained

The study does not require ethical approval according to Norwegian legislation and practice, as it did not involve persons in vulnerable positions, or patients.

It was the concern for handling of personal data protection that required approval, and the study is reported to and approved by the Norwegian Centre for Research Data, registration number 145248, to secure appropriate data protection.

The data collection was permitted by the collaborating municipalities.

Other Relevant Information

The implementation project is a collaboration between the following universities: VID Specialized University (host of the project), University of South‐Eastern Norway and Østfold University College and five collaborating municipalities in southern Norway: Oslo, Bærum, Bergen, Fredrikstad and Færder. Each of the municipalities had representatives as members of the reference group for the project and gave input to both the implementation and the research project.

Data Availability Statement

The participants of this study did not give consent for the data to be shared outside of the research group.