Mentoring: Looking after yourself

Are learners a source of energy and inspiration, or are you in a spiral of fatigue?

The Launderesses 1884 Edouard Manet (1832-1883 French) Musee du Louvre, Paris, France

Working with newcomers and helping them to learn can be highly satisfying. Many people would say that learners add vibrancy to a workforce and help people to keep up to date. There can be nothing so stagnant as a workplace lacking in new blood.

Nevertheless, mentoring and supervising take time and energy. Perhaps instead of taking a coffee break you help a learner to fill in a part of their portfolio of evidence. Perhaps you need to find time in your day for meeting with a representative from the education provider. Perhaps your student is quite anxious about making mistakes and demands a lot of your attention. And what if you have a ‘high-confidence, low-competence’ student who you don’t feel you can entirely trust? These time and energy demands are all legitimate and important.

I’ve brought together a few useful ways of thinking about the pressures and rewards of mentoring. Below, I discuss concepts of self-regulation, stress and trust in the workplace learning context. ‘Professional will’ is an invaluable personal resource that can help carry you through the challenges.

Professional will in mentoring

Are mentees a stimulus and source of inspiration that carries you forward as a mentor?

How do you manage if the opposite happens?

Professional will is one of your personal resources as a mentor. It can involve:

  • energy
  • mastery
  • concentration
  • determination
  • persistence
  • initiative
  • organisation
  • caring

When learners inspire you, the professional will is easily supported and sustained.

However, you may find that not all learners provide you with sufficient inspiration. In these cases, you may need to ask for additional support and inspiration from elsewhere in the organisation.

What managers need to know

Employers and managers need to be prepared to facilitate an atmosphere that values, inspires and supports mentors.

Self-regulation

  • Do you sometimes sacrifice your own needs for food or recuperation, in order to complete tasks or maintain work relationships?
  • Do you sometimes find yourself actively regulating your emotions and behaviour when you are heavily pressed, directly challenged by learners or colleagues, or frustrated by lack of personal time?

 The need for restraint in a given situation is linked with the idea of self-regulation. An associated idea, which has become very popular, is emotional labour. Emotional labour worked its way into professional discourses following the publication in 1983 of Arlie Hochschild’s seminal work ‘The managed heart’. Fundamentally, emotional labour is a social act that involves regulating one’s feelings and emotion display in order to induce the desired feelings in others.

Those situations that require you to exercise self-control in remaining respectful and professionally poised – appearing outwardly serene and confident, can easily lead to fatigue. This partly because acts of self-regulation and emotional labour require you to expend psychological resources (e.g. self-esteem, optimism, as well as the ability to self-regulate), which may lead to exhaustion, burnout or counterproductive behaviour.         

Opportunities for recovery, including sufficient rest, are important, and even short breaks in the working day can help you to recover these depleted resources.

What managers need to know

Ensure there are sufficient opportunities for your mentors to take breaks during a working day.

Mentors may need some respite from mentoring over the longer term.

Mentors may need additional provision for emotional support during challenging periods.

Stress

  • Does your mentee’s livelihood depend on them achieving goals or outcomes under your supervision?
  • Are there professional body requirements for the standard of your mentorship practice?
  • Is it difficult or time-consuming to obtain all the information you need about a mentee a) in order to support them to meet their objectives or b) to judge or assess the quality of their work?
  • Do mentoring responsibilities threaten your ability to complete work in acceptable timescales, or make you feel emotionally exhausted?

The high stakes often attached to mentoring and the additional demands of working with fragments of time and information seem to emphasise a mentors’ susceptibility to work-related stress.

Job demands, such as physical workload and time pressure can initiate a spiral of energy loss that makes it increasingly difficult to engage productively in work.

Such exposure to stress and the accompanying fatigue can clearly create situations where you need to seek support in your workplace.

What managers need to know

Be aware of any pressures associated with professional regulation to which your mentors may be subject.

Ask whether your mentors are finding it difficult to obtain all the necessary information about their mentees or their learning and assessment needs to be effective.

Offer a sympathetic ear if a mentor appears to be challenged by job demands.

Trust

  • Do you ever feel personally vulnerable when working closely alongside a learner?
  • Do you ever feel protective towards your customers or service users

Trust is a fundamental feature of professional life, and is also inherently fragile. Mentors are acutely sensitive to events that could jeopardise service user/customer trust, since any breakdown could threaten the basis of your practice.

The complex web of relationships in which mentors exist appears to multiply the risk. This is because leaners as third parties can pass on information that may (albeit unwittingly) misrepresent the mentor’s actual practice.

Reflect on your feelings in relation to your professional relationships, and confide in trusted colleagues about your vulnerabilities.

Organisations can actively promote psychological safety in teams through ‘servant leadership’ behaviour (being openly supportive towards individuals, minimising conflict, and nurturing individuals’ potential and a sense of community).

What managers need to know

Managers also need to recognise the skills, attributes, commitment and vulnerability of mentors. Such open recognition, along with paying attention to mentors’ well-being, has the additional potential to strengthen mentoring practice.

The fragile frontiers of trust in healthcare

Have you ever been in the situation of vulnerability, perhaps as a hospital patient, in which you felt able to trust some clinical staff more than others? As I have previously studied trust in the nursing context (see. http://oro.open.ac.uk/29954/ ), I have decided to explore whether there are any recognisable patterns at the personal level in feelings of trust or distrust. What leaps out at me more than anything else is my observation that the issue of trust doesn’t become relevant until the moment you encounter someone you feel you can’t trust entirely.

As this is a sensitive issue, I am keeping my personal sources private. And I should make clear that this blogpost, being drawn from highly personal experiences, cannot claim to be generalisable. Despite these caveats, I hope that my observations find resonance with readers.

I have tried to find useful starting points in the trust literature. The most helpful source I have found is an academic paper by Liz Bell and Anita Duffy published in 2009 in the British Journal of Nursing.

They identified the following four characteristics of trust in a nursing context:

  • Expectation of competence
  • Goodwill of others
  • Fragility/vulnerability
  • Element of risk.

I’ll organise my thoughts around this list.

Expectation of competence

It is not easy for patients to know whether the people caring for them are competent. One patient might be impressed that a care worker is wearing gloves to do finger-prick tests, and another might be very concerned to notice that the gloves are not changed between patients.

Healthcare Support Workers (HCSWs) and housekeeping staff are the people who have the most sustained contact with patients, maintaining the routine ‘servicing’ work. Between them, they make sure the beds, bodies, floors and so on, are clean. They serve up food and drink. They maintain the routine patient observations of ‘vital signs’, enquire whether patients have any pain, and record food and drink intake and bowel movements. In a recent hospital stay, I was surprised that the only person who asked me how I was feeling ‘in myself’ was a doctor.

From the vantage point of a patient, it is hard to know whether or not someone is good at their job. So much of the work happens out of sight. With the divisions of labour on a hospital ward, it is difficult even to know what people’s jobs are. How do you know if someone is stepping outside the boundaries of their competence? Some members of the housekeeping staff might be very keen to engage the patients in conversation about their conditions and their anxieties, and others quietly get on with cleaning tasks. Which is more competent? Can you trust a housekeeper to handle your anxieties sensitively as much as you can a nurse?

Much of this expectation of competence is an expression of hope. Expecting confidence and goodwill from those who care for you is based on hope for a good recovery and/or the best possible care at a time of need.

Goodwill of others

Do healthcare staff have the best interests of their patients at heart? Are they diligent? Do they have the personal capacity to care?

Body language

Why would a patient sense a lack of trust in someone who, as far as they can tell, is perfectly competent? Part of the answer here is that healthcare is not just about getting things done, although this is of course vital. Trust is important because people are not simply machines to be serviced and repaired. Trust also hinges on attitude. Body language could give clues.

Some people look as though everything is just too much effort. Perhaps they are preoccupied with their own tiredness, discomfort, or boredom. If they are in a caring role in these circumstances, it can be difficult for a patient to feel confident about their capacity to care.

By contrast, some people exude a kind of flamboyance clearly aimed at cheering patients and colleagues with their sunny and congenial disposition. Whilst it’s reassuring to know that people are putting positive energy into their work, patients may be left wondering whether this behaviour is masking a lack of knowledge or a fundamental lack of confidence. Most concerning – is this flamboyance a sign of over-preoccupation with ‘jollying people along’ at the expense of the more sober work of caring for people who are in a vulnerable position? Now, I suddenly realise this perceived capacity to care could be at the root of trust.

GKEkt

Diligence and capacity to care

I am starting to feel some better insight into the elusive nature of trust. Patients need to know that a person who has a key role to play in their care is taking a solicitous and diligent approach to their work. A telling proxy for care and diligence is hand hygiene. Who do you trust better? A flamboyant high-octane worker who does not change gloves between patients, or a very reserved care worker, who has a downtrodden air about him, going quietly about his work, sanitising his hands in a well-rehearsed fashion at all the appropriate times? Perhaps the more concrete concerns about cross infection can override the initial impact of body language.

The strange thing is, if you trust someone intuitively, you probably wouldn’t bother to monitor their hand hygiene. I remember the badges that were all the rage just a little while ago – the ones that stated ‘Clean hands? It’s OK to ask’. Whatever happened to them?

If body language sparks distrust, I know that trust is repairable. The person just needs to show that patient’s recovery, dignity, or relief of suffering is their prime concern as they carry out their work. Patients don’t want to feel that we are inconveniencing the staff. On the whole, they want to be ‘good’ patients – not excessively demanding, grateful for the care and thankful that the NHS still exists. In return, they want the staff to see them as individuals.

Fragility/vulnerability

To encourage a trusting relationship with patients, staff need to let down their defences just a little.

#HelloMyNameIs

Imagine I’m lying in a hospital bed. You appear at my side. I’ve never seen you before, I don’t recognize your uniform, I don’t know on what basis I can trust you. Tell me who you are when you first come to my bedside. What is your name? What is your role? Are you qualified for the tasks you are performing? Are you responsible for my care today, or are you just performing the one task? It makes a difference. Without this knowledge, I am left wondering. I don’t understand how the team fits together and how the communication is working behind the scenes. I don’t know whether I should trust you or not.

Does someone have my back?

Now I feel I’m really getting somewhere in my efforts to understand the trust or distrust felt by hospital inpatients. They want to know that someone has their back. If things aren’t getting done properly, they want to know that someone in a position of authority will notice. They need to know where the accountability lies. A clear sense of leadership is missing sometimes. Patients need to know who is in charge. Managers and leaders need to be making some visible effort to communicate with patients person to person.

If I said to a nurse that I am expecting a blood sample to be taken today and am concerned that it hasn’t happened, it is only mildly reassuring to be told that the phlebotomist will turn up at some point if they want the blood. I want the nurse to check. Perhaps I misunderstood what the doctor said yesterday. Taking initiative at this one-to-one level would go a long way in restoring trust. Patients are afraid of appearing too bossy, too interfering, too self-important. They want nurses to be able to ‘read’ situations and respond appropriately.

Will you respond appropriately in an emergency?

It takes a position of vulnerability to raise your sensibilities regarding trust. If you’re not feeling vulnerable, trust isn’t important. Sudden life-threatening events expose vulnerability at its most extreme. If a patient observes a care worker not responding with sufficient urgency, either to a patient’s call for help, or a dangerous change in vital signs, any trust they have in that worker is likely to crumble.

Element of risk

There is an element of risk on both sides of a relationship based on trust. From a worker’s point of view, letting down one’s defences could open the way to overfamiliarity. Worse, giving away ‘too much information’ could lead to misinterpretation on the part of a patient. Healthcare staff are constantly aware of the risk of litigation. Taking time to follow up the concerns of one patient will have to be balanced with competing priorities – something has to give.

From the viewpoint of a patient, their very vulnerability adds an element of risk. For example, they have to trust nurses to administer medications correctly. Any routine medications they could normally manage themselves are now in the hands of someone else. Hospital acquired infections loom large as constant threats. Invasive treatments such as surgery or the insertion of needles, cannulas and tubes carry risk. Sick patients are at risk of developing pressure ulcers. I can go on.

Patients want to trust

I’ll conclude by drawing together the strands I have woven here. Patients want to trust healthcare staff. It goes with the hope they hold at a time of extreme need: hoping for recovery, or simply tender loving care. Body language gives important signals, but perhaps the more concrete demonstration of diligence and capacity to care hold sway. The vulnerability of patients can make them look for signs that someone has their back. They need to know that there is a trustworthy figure who is accountable. They need to see that staff respond appropriately in an emergency. Healthcare is a risky business. Risk is present on both sides. Everyone, including patients, needs to pull together to minimise these risks. I hope the steady, caring, trustworthy people get the recognition they deserve.