Mentoring nursing students in clinical placements

R E V I E W
A systematic review of mentoring nursing students in clinical
placements
Merja Jokelainen, Hannele Turunen, Kerttu Tossavainen, David
Jamookeeah and Kirsi Coco
Aim and objective. This systematic review describes mentoring
of nursing students in clinical placements.
Background. Mentoring in nursing has been widely investigated,
but mentoring among students has remained vague. There is
no universal agreement on student mentoring in nursing
placements; therefore, mentoring approaches vary. A unified
description of student mentoring is needed to ensure the quality
of placement learning in nursing organisations.
Design. Systematic review.
Method. The data were collected from nursing research articles
over 20 years (1986–2006). The articles (n = 23) were analysed
using inductive content analysis.
Results. Mentoring of nursing students in clinical placements
was described according to two themes: (1) facilitating nursing
students’ learning by creating supportive learning environments
and enabling students’ individual learning processes, (2)

strengthening students’ professionalism by empowering the
development of their professional attributes and identities and
enhancing attainment of students’ professional competence in
nursing.
Discussion. This description of student mentoring in nursing
clinical placements integrates environmental, collegial, peda-
gogical and clinical attributes. To ensure effective student
mentoring, an individual mutual relationship is important, but
also
essential is organisation and management to provide adequate
resources and systematic preparation for mentors.
Conclusions. The description of student mentoring needs to be
systematically reviewed to reflect changes in nursing and
education and compared within related concepts to achieve and
maintain a workable description. A clear and systematic
strategy for student mentoring in nursing organisations could be
one opportunity to enhance recruitment of nursing students to
the workforce.
Relevance to clinical practice. A unified description of student
mentoring will help improve the quality of placement learning
opportunities and support for students, also for exchange
students. A clear description of student mentoring enables the
development of systematic provisions for mentoring of nursing
students in placements and adequate mentor preparation

programmes for nurses.
Key words: clinical, mentoring, nursing student/undergraduate,
placement, systematic review
Accepted for publication: 17 August 2010
Introduction
Nursing education in Europe has been undergoing changes
based on the European Union’s (EU) education policy that
emphasises the need to modify unified procedures in educa-
tion and training in the EU countries to ensure equal
qualifications of education (CEU 2009). Therefore, nursing
education with a clinical practice component should also
meet this challenge. At the EU level, the clinical practice
component should comprise at least 50% of the total degree
Authors: Merja Jokelainen, MNSc, PHN, RN, PhD Candidate,
Department of Nursing Science, University of Eastern Finland;
Hannele Turunen, PhD, Professor, Department of Nursing
Science,
University of Eastern Finland; Kerttu Tossavainen, PhD,
Professor,

Department of Nursing Science, University of Eastern Finland,
Kuopio, Finland; David Jamookeeah, MEd, FHEA, Cert Ed,
RNT,
BA Hons, RCNT, RGN, Director of Clinical Education &
Quality
Assurance, University of Bradford, Bradford, UK and Adjunct
Associate Professor, University of Mauritius, Reduit, Mauritius;
Kirsi Coco, MHSc, RN, PhD Candidate, Department of Nursing
Science, University of Eastern Finland, Kuopio, Finland
Correspondence: Merja Jokelainen, PhD Candidate, Department
of
Nursing Science, University of Eastern Finland, P.O. Box 1627,
70211 Kuopio, Finland. Telephone: +358 50 526 8610.
E-mail: [email protected]
2854 � 2011 Blackwell Publishing Ltd, Journal of Clinical
Nursing, 20, 2854–2867
doi: 10.1111/j.1365-2702.2010.03571.x
programme in nursing (77/453/EEC), and during these
clinical practice periods, nursing students must be mentored
by a professional nurse in placement, as stated in the

guidelines for nursing education, for example in the UK
(e.g. RCN 2005, NMC 2008) and in Finland (ME 2006).
This kind of 1:1 relationship between a professional nurse
and the student is used nowadays in the UK and Finland, but
because of the shortage of nurses in the UK and Finland as
well as in many other countries (OECD 2008), it will be a
challenge in the future.
The trend towards unifying the approaches used in the
clinical practice component of nursing education enhances
the quality in placement learning. The quality of opportuni-
ties, provision and support for nursing students in placement
learning is well debated, for instance in the UK. However, a
report in the Nursing Standard (Waters 2008) reveals that
26% of all nursing students in the UK interrupt their studies
before graduating and this causes about £99 million (€107
million) in costs a year. Therefore, it is important to reduce
attrition rates of students. Adequate support of students in
placements and positive clinical experiences can increase

students’ enthusiasm and retention in profession (Pearcey &
Elliott 2004, Pellatt 2006).
Furthermore, describing and comparing education and
clinical practice between EU countries requires the use of
unified terminology. Despite this, the term ‘mentoring’ is not
universally used in the clinical practice component of nursing
education; other related terms like supervising, preceptoring
or facilitating are used, instead. Because of the lack of unified
use and understanding of the term ‘mentoring’ in the context
of students in clinical practice, mentoring approaches in
placements vary across EU countries. Consequently, also
mentoring preparation programmes for nursing professionals
acting as student mentors vary considerably in the EU
countries and they are said to be insufficient (Andrews &
Chilton 2000). In the UK, for example, there are national
standards for student mentors, which include requirements
for training, annual updating, local registering, review and
maintenance of qualifications (NMC 2008). In many coun-

tries, Finland among them, there are no nationally agreed
standards for mentor preparation; existing education varies
by country and is voluntary. Thus, there is a need for a
uniform preparation programme for mentoring of students,
which is based on an agreed description of mentoring of
students, at least in the EU countries.
Overall, mentoring has been under discussion in nursing
literature over 25 years (Bray & Nettleton 2007). The earliest
articles have been published in the beginning of the 1980s
(e.g. May et al. 1982, Darling 1984), and after the appear-
ance of the term ‘mentorship’ in nursing in 1987, the amount
of literature on mentoring has increased. In the early 1990s,
there have been debates about mentoring in the context of
nursing education (e.g. Morle 1990, Armitage & Burnard
1991, Fields 1991), but mentoring has mainly been focused
on career development in a long-term relationship among
nursing professionals (e.g. Donovan 1990, Yoder 1990,
Steward & Krueger 1996). In the late 1990s, mentoring

literature started to also focus more on the student’s
perspective and mentoring of students was presented as a
long-term mentorship relationship between a student and an
older, more experienced nurse expert (e.g. Andrews & Wallis
1999). Studies of student mentoring have been done espe-
cially in the UK since 2000 as a result of changes in nursing
education and clinical placements as learning environments.
In these studies, mentoring was seen as the work of a mentor -
a clinical nurse, who supervises, teaches and assesses student
nurses in placements during their clinical practice period
(Neary 2000, Jinks 2007). In addition, in a student–mentor
relationship, positive emotional aspects were considered very
significant (Wilkes 2006).
Despite the many studies of mentoring in nursing, there is
still confusion about the description of mentoring in the
context of students (Bray & Nettleton 2007). It seems that, in
most cases, the focus of previous research has been on nursing
professionals, academics and managers. For example, this has

been seen in North American studies, where mentoring is
mostly used in the context of professionals rather than
students. Overall, mentoring activity related to nursing
professionals and students is presented to be different
(Andrews & Wallis 1999). Therefore, many proposals have
been made (e.g. Andrews & Wallis 1999 Andrews & Chilton
2000, Neary 2000, McKinley 2004) for further investigations
of mentoring of nursing students.
Aim of the study
This study is part of a Finnish–British research project. The
purpose of this systematic review is to develop and provide a
unified understanding of student mentoring in the context of
clinical nursing placements implemented by nursing profes-
sionals. This kind of information is needed in the EU
countries and for example in Finland, where one of the main
goals of a national action plan for nursing for 2009–2011 is
to build up national-level structures and common principles
for mentoring of nursing students in clinical placements

(MSHA 2009). The aim of this study is to describe mentoring
of nursing students in clinical placements by reviewing prior
empirical research articles published in scientific journals
dealing with student mentoring and investigating the topic
from the perspectives of mentors, leaders, students and
Review Mentoring nursing students in clinical placements
� 2011 Blackwell Publishing Ltd, Journal of Clinical Nursing,
20, 2854–2867 2855
educators. The specific review question is: What is mentoring
of nursing students in clinical placements as it is expressed
from diverse perspectives in nursing research literature?
Methods
Systematic review
A systematic review was used in this study to integrate and
provide scientific knowledge from previous studies (Grim-
shaw et al. 2003, Duffy 2005). This review was performed
systematically in phases in line with a scientific research
process where each phase is built on the basis of the previous

one (Hawker et al. 2002, Grimshaw et al. 2003). One broad
review question from the specific topic was identified, and the
relevant literature from empirical research published in
scientific journals was collected, systematised and evaluated
with specific criteria including levels of values with points
(Magarey 2001, Hawker et al. 2002, Whittemore 2005),
which is described in detail in the data evaluation section.
This type of review is empirical and the approach is partly
integrative, because literature from different types of research
designs and multiple research methodologies, both qualitative
and quantitative, was included (e.g. Whittemore & Knafl
2005, Evans 2007, Whittemore 2007).
Data collection
Databases
The literature search was performed systematically, first
widely from different fields of science and electronic data-
bases, where data concerning student mentoring in clinical
practice or training are available. Seven databases were

chosen: CINAHL (Cumulative Index to Nursing, Allied
Health Literature), Medic, PubMed (Medline), ERIC (CSA
Illumine), EBSCOhost and ISI Web in Science. Furthermore,
data were also searched from the Cochrane Library, but no
results focusing on mentoring of nursing students were
obtained.
Inclusion criteria and search strategy
Data collection was carried out using seven inclusion criteria
(Table 1). The data were collected from literature published
over 20 years (January 1986–December 2006). The limita-
tion of years was based on the ‘mentorship’ term, which
became a subject heading in the CINAHL database since
1987. The first three inclusion criteria were used as search
limitations in every database. The search strategy, terms and
search results are presented in Table 2.
Progression of the systematic review
The progression of the systematic review process is shown in
Fig. 1. Each phase of this process was performed by two

scholars. First, a literature search was made based on inclu-
sion criteria in the search strategy (n = 2649). Second, pub-
lications were tentatively selected by title according to the
review question (n = 2018). In the following phase, equiva-
lence was checked from the abstract (n = 489). After that,
hard copies of research articles were searched from Finnish
libraries. Some of the articles were not available with rea-
sonable resources; therefore, they were omitted, as were
duplications (n = 311). Moreover, non-scientific publications
were removed, and only articles published in valid scientific
journals with a referee system (n = 306) were accepted. In the
next phase, data collection and article approval was carried
out on the basis of the valid content of the whole text of the
research articles (n = 82).
Data evaluation
The evaluation of the selected research articles with valid
content (n = 82) was carried out using the evaluation form
described in Table 3. This form was created and formulated

Table 1 Inclusion criteria in the systematic review
Criterion 1: Time duration Literature during 20 years (1986–
2006)
Criterion 2: Language Literature in all languages
Criterion 3: Terms/concepts/Keywords
Terms/concepts/keywords used (based on the database):
‘mentoring’ (mentor*) OR
‘preceptoring’ (precept*) OR ‘supervision’ (supervis*) AND
‘clinical’ (clinic*) AND
‘practice’/‘training’ (pract*, train*) AND ‘student’ (stud*)
Criterion 4: Content Undergraduate/pre-registration student
mentoring in clinical practice or training
(in placement), which is included in their professional education
(bachelor level)
Criterion 5: Fields of science Different fields of science
concerning the human content: Health sciences (Nursing
Science,
Medical Science, Pharmacy, Nutrition, Physical Education),
Social Sciences, Pedagogy,
Science of Economic and Business and Law
Criterion 6: Publication Published research articles in valid
peer-reviewed scientific journals (referee evaluation used,
at least two reviewers)

Criterion 7: Availability Possibility to obtain and handle with
reasonable resources and time
M Jokelainen et al.
Nursing, 20, 2854–2867
on the basis of the assessment form presented by Hawker
et al. (2002). The evaluation form included ten specific
evaluation sections. Each of these sections consisted of eval-
uation criteria on four levels of value with points: good (3),
fair (2), poor (1) and very poor (0). Therefore, each research
article could have a maximum value of 30 points and mini-
mum of 0 points. Research articles that accumulated 30–15
points were accepted for the next phase. Furthermore, two
independent scholars performed the data evaluation by
evaluating the quality of the selected research articles. The
evaluation achieved inter-rater agreement of 84%.
Final data
After data evaluation, the number of research articles was 57.

In the following phase, only research articles in the field of
nursing science (n = 46) were selected. In these articles, the
Table 2 Search strategy and results of the first and last phases
in the systematic review process
Database
Search strategy
Limitations in all databases:
- years 1986–2006 (inclusion criterion 1)
- all languages (inclusion criterion 2)
Terms used based on the database
(inclusion criterion 3)
Search results based on the
inclusion criteria
n
Accepted nursing research
articles on mentoring of
nursing students
n

CINAHL Ovid [(mentor$.mp OR Mentorship) OR preceptor$
OR (supervisor.mp or ‘Supervisors and
Supervision’) OR (Clinical Supervision or
‘Supervisors and Supervision’ OR
supervising.mp)] AND (clinic$. mp OR
train$.mp OR practic$.mp) AND
(student$. mp or Students)
- further limitations: research
633 20
CSA/Eric KW (mentor* OR preceptor* OR supervis*)
AND KW clinic* OR train*) AND KW
student*
- further limitations: published work and journal
article/peer-reviewed article, duplicates
removed
724 2
Medic KT (mentor* OR ohja* OR supervis* OR
precept*) AND KT (harjoittel* OR pract* OR

clinic* OR train*) AND KT (opisk* OR stud*)
- no further limitations
43 0
PubMed/MEDLINE [(mentor* OR preceptor* OR supervis*)
AND
(practic* OR clinical* OR train*)] AND
student*
- further limitations: adults 19+, humans,
different kinds of research/studies/articles,
Medline
484 0
Cochrane library AT (mentor*) OR AT (preceptor*) AND AT
(practic*) AND AT (student*)
- no further limitations
149 0
EBSCO host/Academic
& Business Source
Elite, SocINDEX
(KW mentor* OR KW preceptor* OR KW

supervis*) AND (KW practic* OR KW clinic*
OR KW train*) AND KW stud*
- further limitations: document and publication
type: journal article, case study, literature
review, peer-reviewed journal, duplicates
removed
449 1
ISI Web of Science TI (mentor* OR supervis* OR preceptor*)
AND
TI (practic* OR clinic* OR train*) AND TS
student*
- further limitations: document type: article,
review
167 0
Total n = 2649 n = 23
20, 2854–2867 2857

terms used were mentoring (n = 23), preceptoring (n = 12),
supervising (n = 6) and others (n = 5), like facilitating,
guiding and clinical teaching. The term mentoring was used
in 23 nursing research articles, which were finally accepted
for this review. These research articles (n = 23) were pub-
lished during 1993 – 2006, mostly in year 2000 (n = 5). Most
of these articles were from the UK (n = 14) and others were
from Australia (n = 3), Scotland (n = 2), Hong Kong (n = 2),
Finland (n = 1) and Ireland (n = 1). The methodological
approach in these articles was mostly qualitative (n = 13),
having sample sizes ranging from 3–48. Six of these articles
had triangulation as the research design and four of them
employed quantitative research with sample sizes between
11–300. The list of research articles is available from the
research group.
Data analysis
Data from 23 nursing research articles were analysed using
inductive content analysis (Cavanagh 1997, Holloway &

Wheeler 2002). After becoming familiar with the content of
the data, the analysis started by choosing a unit of analysis,
which was one combination of words or the meaning of a
sentence or phrases. After this, the data were reduced.
Similarities and dissimilarities were sought from the
reduced impressions. Impressions with the same meaning
Rejected publications based on title, which did not
conform to inclusion criteria 3 or 4 (n = 631)
Literature based on search strategy and
inclusion criteria 1, 2 and 3 (n = 2649)
Rejected publications based on abstract, which did
not conform to inclusion criteria 3 or 4 and 5
(n = 1529)
Publications based on title (n = 2018)
Publications/research articles based on
abstract (n = 489)
Available and single publications/ research
articles (n = 311)
Rejected whole original research based on the text of
invalid content, which did not conform to inclusion
criteria 4 and 5 (n = 224)
Rejected non-scientific publications, which did not

conform to inclusion criterion 6 (n = 5)
Research articles in valid scientific journals
with a referee system (n = 306)
Research articles based on the valid content
(n = 82)
Rejected research based on the evaluation of quality,
which did not conform to the specific evaluation
criteria (n = 25)
Rejected ‘not available’ publications (inclusion
criterion 7) (n = 69) and ‘duplicate’ publications
(n = 109)
Research articles based on the evaluation
criteria (n = 57)
Accepted nursing research articles on
mentoring of nursing students for this
review (n = 23)
Rejected research articles which are not from the
field of nursing (n = 11)
Research articles in nursing science
(n = 46)
Rejected nursing research articles which do not use
the concept of mentoring (n = 23)
Figure 1 Systematic review process.
M Jokelainen et al.

Nursing, 20, 2854–2867
Table 3 Evaluation form with evaluation sections and criteria
for research articles
Evaluation sections Evaluation criteria with levels of value and
points
I Background of the research 3 The background is inclusive,
relevant and presented systematically
2 There is a moderate background with some main points
presented
1 There is hardly any background and it is superficial and/or its
context is insufficient
0 The background/context does not meet the aim of the research
or it is entirely lacking
II Aim of the research and
research questions
3 The aim of the research is described precisely and clearly, the
research questions are accurate and
realistic
2 The aim of the research is described briefly; the research
questions are discussed with minor inaccuracies
1 The aim of the research is described inadequately. Research

questions are presented inaccurately or
implicitly
0 The aim of the research is unclear or is lacking completely.
The research questions are lacking or it is
hard to recognise them
III Design and method of
research
3 The design and method of the research are well suited with
respect to the aim of the research, and they
are described clearly
2 The design and method are applicable but their description
could be more accurate
1 The design of the method is only briefly covered or it is
unclear. The method is described inaccurately
and/or its applicability is questionable
0 There is no design and method of research, or they are
inappropriate
IV Study group/sample 3 The study group is described
accurately as is the reason why the group concerned was
chosen. Those
who did or did not answer have been accounted for and
explained. The size of the sample is

appropriate, clearly described and justified as suited for the
research
2 The data/selection of the study group is mainly described with
some inaccuracies. The size of the sample
is sufficient, it is described and justified
1 There is hardly enough information about the study group.
The size of the sample is mentioned but
there are no other details
0 There is no mention about either the study group or the size of
the sample
V Material and data
collection
3 The material applies well to the research, and it is described
in detail. The data collection method is
appropriate and fits the research questions. Data collection is
described accurately
2 The material is appropriate, and it is described sufficiently.
The data collection methods are appropriate
with respect to the research questions. Data collection is
described briefly with the main points included
1 Reasonable material with scarce description. The data
collection method is questionable with respect to
the research questions. Data collection is described inaccurately

0 The material is scarce, and there is no description of the data
collection. The method of data collection
is inappropriate
VI Data analysis 3 The choice of the data analysis method and
the data analysis are justified and clearly described
Qualitative: The data analysis process is described accurately
and carried out correctly
Quantitative: Analysis and justifications for the statistical
analysis methods are accurately described and
carried out correctly
2 The choice of qualitative and quantitative analysis is briefly
told, the main points of the data analysis
process can be found but examples are lacking
1 There is a brief mention about the material analyses with
minor/inaccurate data analysis
0 There is no mention about data analyses, or they are
performed incorrectly
VII Results 3 The results with respect to the research questions
are clearly told, consistent and proceed logically. The
results are interpreted appropriately, and they are compared
with previous research. The tables/charts
(if they exist) are explained in the text

2 The results are mentioned briefly, and there could be more
information. The interpretation of the results
is fair, and they are partly compared with previous research.
The charts/tables (if they exist) partly
support the text
1 The results are described inaccurately, there are no
explanations and they do not follow logically. The
results repeat data (analysis unfinished) and their interpretation
is inaccurate, and comparison with
previous researches is scarce
0 The results are not mentioned, or they do not relate to the
research question. The interpretation of the
results is incorrect, and no comparison with previous research is
made
20, 2854–2867 2859
were gathered first into one class by doing a classification.
Next, after undergoing categorisation, classes with similar
content were combined into subcategories and these were
labelled. In the next phase, subcategories with similar

contents were combined into upper categories. Finally, by
further abstraction, two themes were formulated based on the
four upper categories. An example of the content analysis
process of one upper category, which is a part of one theme,
is presented in Fig. 2.
Results
Mentoring of nursing students in clinical placements is
presented in two themes labelled ‘Facilitating students’
learning in clinical placements’ and ‘Strengthening students’
professionalism’. These include issues of mentoring expressed
as actions that promote students’ learning and professional
development. These two themes are presented in detail in the
following, based on the content of the four upper categories
and ten subcategories (Fig. 3).
Facilitating students’ learning in clinical placements
This theme was based on two upper categories. The one of
them was creating a supportive clinical learning environment,
which included all the arrangements in placements that

prepare students’ practice and organise their support system.
‘Preparing clinical placement fitness for learning’ consisted of
advance planning of training and placement learning, which
included, for example, ensuring the applicability of place-
ment, planning and organising learning opportunities and
being aware of details of students and their training docu-
ments, like the nursing curriculum. The other arrangements
were ensuring fluent implementation of training and place-
ment learning, for example, naming personal and substitute
mentors and organising the student’s first day in placement,
relevant or same shifts with the mentor and enabling an
interpersonal relationship with the mentor. Assuring stu-
dents’ individual support opportunities in placement learning
was another preparation issue. This included practices of
organising student guidance needed during training, for
example, availability of a mentor, enough time and regular
meetings with the mentor. All these issues concerning the
learning environment helped students learn nursing. The

‘Organising training in an interpersonal learning environ-
ment’ subcategory presented actions that supported students
in learning nursing issues in placements. One of these actions
was familiarising the student with placement as a working
environment, including adjusting to the hospital, different
units and the student’s own ward and the culture of care and
the climate in the ward. In addition, one action was enabling
students’ equal participation in teamwork in placement. This
included familiarising the student with all the staff in the
ward, making it possible for the student to become commit-
ted to placement and the working society and for the staff to
accept the student as a member of the care team. Moreover,
co-operating with other stakeholders in placement who are
participants in students’ clinical training was another issue.
Table 3 (Continued)
Evaluation sections Evaluation criteria with levels of value and
points
VIII Ethical issues 3 The ethical issues of the research are
widely told (incl. acquisition of anonymity, research approval

and
contraction of informed consent). (The use of an existing
questionnaire). The weaknesses of the
research are considered
2 The ethical issues of the research are considered but they have
minor deficiencies or inaccuracies
1 There is scarce or unessential mention about ethical issues or
weaknesses
0 There is no mention about ethical issues or weaknesses
IX Reliability 3 The reliability of the implementation of the
research (concepts, study group, questionnaire, material,
data collection and analysis) is widely considered (e.g. internal
and external validity). The results are
realistic and credible
2 The implementation of the research and the reliability of the
results are described moderately with
minor deficiencies
1 There is a scarce description about the reliability of the
research and the results
0 There is no description about the reliability of the research or
the results
X Usefulness of the results 3 Conclusions are presented; they
are clear, based on results and bring in something new/different.

The
effects of the results have been considered from practical and
developmental point of view. Issues of
further research are considered and proposed
2 Two issues from the aforementioned section are mentioned
(the lacking issues are mentioned)
1 Only one issue from the first section is mentioned
0 There are no issues mentioned from the first section
M Jokelainen et al.
Nursing, 20, 2854–2867
- Providing the relevance of placement for training
- Informing the student on placement and its prerequisites
- Assuring learning possibilities despite a narrow specialty
- Clearing the contextual learning possibilities in the ward
- Planning applicable patients for training in placement
- Planning learning situations and visits to different units
- Arranging suitable practices to gain nursing experiences
- Organising hands-on possibilities in placement
- Observing limitations of activities in placement for training
- Knowing details of the student and the nursing curriculum
- Reading up on instructions on training beforehand
- Orientation to learning tasks and evaluation of training

- Naming a personal mentor and a substitute mentor
- Organising a 1:1 relationship between student and mentor
- Having a continuous relationship with the mentor
- Giving information on the first day of training
- Arranging the student’s arrival to placement
- Working in the same shift with the student on the first day
- Ensuring a substitute mentor during absence
- Committing all the staff to support the student with the mentor
- Making it possible to work in all shifts
- Organising varying shifts
- Working in the same shifts with the mentor
- Working near the student as a present hostess
- Being available to the student
- Spending particular time only with the student
- Organising time for the student every day
- Giving quality time to the student
- Having appointments with the mentor frequently
- Sharing events with the mentor regularly
- Helping the student adjust to the new environment
- Integrating the student with the work organisation
- Familiarising the student with the training hospital and ward
- Helping the student adapt to the atmosphere in the ward
- Helping the student understand practices, routines and
protocol in the ward
- Connecting the student to the new culture, staff and
community

- Participation of the student as a part of a nursing team
- Taking care of the student’s entry into the working team
- Having a feeling as being an equal partner in the working
group
- Adapting the student to the nursing profession
- Involving the student with the nursing staff and other
personnel
- Integrating the student as a part of the workers in the ward
- Creating feelings of belonging to the personnel
- Awakening feelings of being welcome to placement
- Helping in settling down and accepting the standards of
placement
- Giving the student equal staff rights
- Accepting the student as a legal worker in the working society
- Participating in holistic patient care with other professionals
- Working in close and open relationships with co-workers
- Working as an advocate of the student
- Organising trusted collaboration between the student and
patients
- Discussing training and problems with other colleagues
- Sharing support of the student with other staff
- Having support from the school/educational unit
- Having regular meetings with the teacher/other educators
- Linking school and clinical placement work together
- Working with teachers by sharing knowledge and feedback
Planning
training and
placement
learning in

advance
Ensuring
fluent
implementation
of training
and
placement
learning
Assuring
individual
support
opportunities
for placement
learning
Familiarising
with
placement
as a working
environment
Co-operating
with other
stakeholders
participating
in training
Enabling
equal
participation
in teamwork
in placement
Preparing

clinical
placement
fitness for
learning
Organising
training
in an inter-
personal
learning
environment
Creating a
supportive
learning
environment
Reduced impressions Class Subcategory Upper
category
Figure 2 Example of the content analysis process in one upper
category.
20, 2854–2867 2861
This included, for example, the mentor’s regular meetings

with the lecturer or other educators from the university and
the mentor’s working in a collaborative relationship with
colleagues and patients.
‘Enabling an individual learning process’ was the other
upper category, and it described mentoring as ensuring the
possibility for nursing students to study based on personal
learning plans and to develop by evaluating learning. The
‘Making possible a personal, goal-oriented learning path’
subcategory was formulated from actions that help nursing
students advance, based on current personal skills and
learning goals. Additionally, clarifying the basic level of
students’ skills, observing students’ personal learning needs
and goals, taking into account students’ individual zones of
development and advancements according to the phases and
demands of studies were actions in mentoring of nursing
students. Mentoring was focused on increasing students’
responsibility to work independently by steps and helping
students to grow from observers to independent workers,

which increased students’ skills in coping with nursing
actions independently. Providing learning possibilities, taking
care of students’ learning situations and helping students with
career planning were essential in mentoring. The ‘Assessing
personal development and achievement of learning outcomes’
subcategory concerned evaluation of students’ learning and
performance during the clinical learning period. These
mentoring actions included sharing feedback on learning
between mentor and student, which involved giving real-
time, regular and constructive feedback on performance,
mistakes and nursing skills. The other actions were making
objective judgements of students’ development in learning
and performance, which included knowing the evaluation
criteria and assessing students’ learning outcomes.
Strengthening students’ professionalism
This other theme included two upper categories of mentoring
nursing students’ professional responses and behaviour. First
mentoring was shown as ‘Empowering development of

professional attributes and identity’ of students, which
presented treating students as persons and nursing profes-
sionals. This was achieved by working with students in a
professional relationship and implementing actions that
promote students’ growth in the nursing profession. The first
subcategory, ‘Treating as an equal individual and a nursing
colleague’, included aspects of positive attitudes towards the
student as a human being, including respecting and honour-
ing the student as person and a learner of nursing. In
addition, taking care of students and showing empathy
towards them during the clinical practice period were other
Facilitating
students’
Learning
Strengthening
students’
Professionalism
Creating a

supportive
Learning
environment
Enabling an
individual
Learning
process
Empowering
development of
Professional
attributes and
identity
Enhancing
attainment of
Professional
competence
Preparing
clinical
placement
fitness
for learning
Organising
training in an
interpersonal
learning
environment
Making

possible a
personal
goal-oriented
learning path
Assessing
personal
development
and
achievement
of learning
outcomes
Treating as
an equal
individual
and a nursing
colleague
Interacting as
professional
partners in a
co-operative
relationship
Promoting
growth and
commitment
to the
nursing
profession
Facilitating
attainment of
stipulated
clinical

skills
Enabling
improvement
of
theoretical
skills
Deepening
the
development
of critical and
reflective
thinking
Mentoring nursing students in clinical placements
Figure 3 Mentoring of nursing students in clinical placements
based on the systematic review.
M Jokelainen et al.
Nursing, 20, 2854–2867
issues. These included showing interest in, caring for and
understanding students and also trusting them, which con-
firms students’ capability in nursing. ‘Interacting as profes-
sional partners in a co-operative relationship’ was the second
subcategory, which presented mentoring as co-work between

mentors and students in patient care situations and close
interactive relationships. Working together as nursing pro-
fessionals meant students were taken into different kinds of
nursing activities in every shift to work with the mentor like
nurses side-by-side. In addition, working in a close interactive
relationship included acting as equal pairs in co-operation,
having mutual, trusted communication and interaction and
working together as collegial friends. The ‘Promoting growth
and commitment to the nursing profession’ subcategory,
based on the nursing profession and mentoring, was
expressed as motivating students to study nursing with
psychological support and encouragement. Furthermore,
familiarising students with nursing as work and an occupa-
tion, acting as a role model for students, showing different
aspects and functions in the work of nurses and also imaging
demands of the nursing profession were included in this
subcategory. Moreover, mentoring is an action that facilitates
students’ emotional development and helps students to

understand their own feelings and emotions and those of
the patients they care for and supports students in dealing
with emotions in difficult nursing situations.
Second, the ‘Enhancing attainment of professional compe-
tence’ upper category contained three subcategories focusing
on nursing students’ clinical, theoretical and critical thinking
skills. In the first subcategory, ‘Facilitating attainment of
stipulated clinical skills’, mentoring was presented as training
the student to improve hands-on clinical nursing and com-
munication skills in interaction with patients. This included
teaching and advising on how to use different nursing
methods in real care situations and also guiding students in
meeting patients, communicating and co-operating with
them. Second, mentoring was also described as ‘Enabling
improvement of theoretical skills’ by enhancing students’
understanding and knowledge of relevant care processes,
linking theory into nursing practice, supporting the search for
and application of knowledge. Other mentoring elements

consisted of direct teaching, guidance, advising and counsel-
ling. The third subcategory, ‘Deepening the development of
critical and reflective thinking’, included mentoring actions
that create opportunities for students to develop their critical
thinking skills. One action was to facilitate students to learn
from experiences using active listening, discussions and
sharing of nursing experiences. Mentoring also involved
encouraging students to consciously reflect on nursing pro-
cedures and their own learning. The development of critical
reflections encouraged students to ask questions and present
arguments about nursing practice and to debate the key
issues. Mentoring also facilitated the development of prob-
lem-solving and decision-making skills by helping to clear up
difficult nursing situations. Furthermore, supporting students
in expressing their personal opinions, alternatives and ideas
and helping students understand reasons and evaluating
nursing systematically were also included in this subcategory.
Discussion

This systematic review described mentoring of nursing
students in clinical placements. The results showed that
student mentoring integrates individual and organisational
aspects and environmental, collegial, pedagogical and clinical
attributes in nursing placements. This kind of integration of
learning and practice, professional and personal develop-
ment, bridges the gap between theory and practice in working
life. All these aspects have unified importance in student
mentoring, by supporting students’ learning and professional
growth, as is also highlighted in nursing authors’ guidelines
(e.g. MSHA 2004, NMC 2008). Furthermore, this review
showed aspects similar to those presented by Yoder (1990)
and Andrews and Wallis (1999) in their description of
mentoring as personal and career development in teaching
and learning. The long duration of a mentoring relationship,
as Andrews and Wallis (1999) expressed, was not visible in
the results of this review.
The mutual relationship between an individual nurse and

the student is an important aspect, but it is increasingly
essential for the managerial level to provide opportunities for
student mentoring with enough resources and education.
First, a very notable aspect is the creation of a supportive
learning environment, because it does not exist self-evidently.
Likewise, early studies (e.g. Saarikoski & Leino-Kilpi 2002,
Pearcey & Elliott 2004) argued that a positive ward atmo-
sphere in the learning environment is very significant for
nursing students. Therefore, advance preparation and orga-
nisation of placements for students’ clinical learning are very
important, because students feel safe and are assured of the
quality of the placement learning opportunity, provision and
support. This is crucial if we wish to retain nursing students
and reduce attrition. Second, facilitating students’ individual
learning processes is also essential; this requires pedagogical
competence from the nursing professionals in placements.
First of all, this influences their ability to provide a goal-
oriented assessment of students’ performance, which requires,

among other things, a deep understanding of the goals of
education. Assessment is said to be challenging in student
mentoring (Bray & Nettleton 2007) and, for example, in the
20, 2854–2867 2863
UK, this aspect is becoming increasingly demanding, partic-
ularly with the implementation of the NMC (2008) sign-off
of mentors’ policy and guidelines. Therefore, there is a need
to organise formal education in student assessment for nurses,
as Pellatt (2006) suggests, which should be fair, constructive,
objective and not influenced by other factors, such as
friendship, emphasise Bray and Nettleton (2007) as well as
Webb and Shakespeare (2008).
Strengthening the student’s professionalism and the devel-
opment of a professional identity were other important
aspects of mentoring. Students want to be treated as

individuals and colleagues during placement learning. There-
fore, enthusiasm and positive attitudes in placements are
important, as Webb and Shakespeare (2008) highlight and
they influence students’ learning significantly. Furthermore,
in a mentoring relationship, it is possible to achieve a level of
collegiality with students. Friendship was also included in
mentoring, but it seldom happened in practice (Bray &
Nettleton 2007). On the other hand, current nursing educa-
tion values the student’s independence and self-direction in
learning, which puts the responsibility on students to be
active in the mentoring relationship (Andrews & Chilton
2000). However, it is significant that mentors motivate
students to learn nursing in placements and act as role models
of nurses. Surprisingly, a clear expression of being proud of
the nursing profession was not brought out in the review.
Nevertheless, Pearcey and Elliott (2004) presented that a
positive image of the profession strengthened students’ view
of their own career as nurses and a negative image discour-

aged students’ career planning in the future. In addition, the
wellness and job satisfaction of nurses are enhanced by taking
on mentoring (Dyer 2008).
Student mentoring included facilitation of achievement of
professional competence and professional growth of the
students. Reflective learning and critical thinking are crucial
for students to learn to be able to develop new thinking and
practices in clinical nursing when working as professional
nurses in the future. However, it was surprising to note that
the influence and use of technology in nursing practice was
not considered in mentoring of students. However, the
growth of technology is increasing in health care, for
example, in the use of electronic documentation.
Student mentoring was seen in this review mostly from
the perspectives of a mutual 1:1 relationship between the
student and a mentor, who is considered a very significant
person for students in clinical placement (Elcigil & Sari
2008, Hyatt et al. 2008) and this working relationship has

been said to be a requirement for effective mentoring.
However, the role of ward managers or head nurses in
student mentoring did not emerge explicitly in this review,
as expressed in the study by Saarikoski and Leino-Kilpi
(2002). Nevertheless, leadership and management are
essential baselines in organising, coordinating and develop-
ing student mentoring in placements (e.g. MSHA 2009).
Surprisingly, in this review, student mentoring did not
include group or peer mentoring, whereas co-operation with
lecturers and other stakeholders in placement was a part of
student mentoring. The relationship between education and
practice has also been presented as inadequate (Myall et al.
2008), which needs enhancing. Moreover, the roles of
stakeholders in supporting nursing students in clinical
practice vary internationally and need to be reviewed
closely (Carnwell et al. 2007).
Validity of the review
The validity of this systematic review process has been taken

into account through careful planning, working and evalu-
ation in every phase of the process. The use of a peer reviewer
increases the validity of the content (Whittemore 2005), as
two scholars from the research group independently reviewed
the articles based on specific pre-formulated inclusion and
evaluation criteria (Magarey 2001). Moreover, the inclusion
criteria were pretested before the search with a couple of
random literature publications, as was the evaluation form,
to select only relevant research articles of good quality
(Whittemore 2005).
The review question was quite broad but clear, and there
were enough data to answer the question sufficiently.
Therefore, it was not necessary to widen or renew the search
strategy, which was exactly defined. Saturation of data was
achieved; so, there was no manual search made in addition to
the electronic search. Furthermore, the validity of the data
analysis was ensured by formulating the categories using the
process of content analysis (see Cavanagh 1997).

Limitations of the review
The limitation of unrepresentative search results was mini-
mised by planning the keywords of the databases carefully
together with library professionals. For this review, only the
term mentoring in the field of nursing was accepted from the
search. Other related terms were excluded because of the
large amount of material and the intent to obtain a clear
description within one concept. Furthermore, only published
research articles, excluding academic theses, review publica-
tions and other prescriptive literature, authors’ guidelines,
non-research-based reports or discussions, unpublished
manuscripts, books and articles published outside the desig-
nated time, were included in this review.
M Jokelainen et al.
Nursing, 20, 2854–2867
In addition, some research articles had to be rejected
because of availability or translation problems from the

native language to English (Slovenian, Norwegian, Korean,
Chinese, Portuguese, French and Danish); the search strategy
did not limit the language of the articles. Moreover, it was
surprising that no nursing research articles from the USA
emerged in this review. Nevertheless, according to the ISI
Web of Science database, over half of the nursing mentoring
publications in 2000–2004 were from the USA. It might be
possible that American publications emphasise mentoring
mostly in the context of nursing professionals or peers. These
aforementioned issues might limit the search results and
cause selection bias.
Conclusion
This systematic review provides a unified description of
mentoring of nursing students in clinical placements. It needs
to be systematically and regularly reviewed to reflect changes
in nursing practice, education and the health care context.
Especially, we have to carry out comparative research of
student mentoring approaches in clinical practice contexts at

the national and European level. Moreover, further research
needs to be carried out because of limitations owing to the
variability of terminology used in clinical practice and
education. However, related concepts of mentoring, as used
and applied in different health care contexts and disciplines,
must also be considered and compared to achieve and
maintain a workable description.
Inevitably, a clear and systematic strategy for mentoring
nursing students, achieved through adequate resources,
formal preparation and education of mentors, will prove
challenging for management in nursing organisations. The
provision of effective student mentoring in nursing organisa-
tions could be one of the issues with which the nursing
organisation can promote recruitment and retention of
nursing students as a workforce in the future. This is crucial
to take into account in nursing organisations at the present,
when a shortage of nurses is an increasing problem in most
EU countries.

Relevance to clinical practice
A clear description of student mentoring is essential in clinical
nursing placements to ensure parity in the approach to
mentoring. The clarity of the description will facilitate
effective mentoring of students, also international and
exchange students, by acquiring positive clinical experiences
and increasing confidence in clinical placement learning. The
development of systematic provisions and structure for
student mentoring in the health care context will help
improve the quality of placement learning opportunities,
provision and support for students. A unified understanding
of student mentoring also makes it possible to develop and
evaluate an appropriate mentor preparation programme for
nurses and create a basis for a multi-professional mentor
preparation programme in health care organisations.
Acknowledgements
We thank the Finnish Foundation of Nursing Education for
giving a grant to the research project and the University of

Eastern Finland (formerly University of Kuopio) for giving
a PhD grant to the corresponding researcher, which made
this systematic review possible.
Contributions
Study design: MJ, HT, KT; data collection and analysis: MJ,
HT, KT, DJ, KC and manuscript preparation: MJ, HT, KT, DJ.
Conflict of interest statement
None declared.
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Advanced accounting
Final assignment
1) (10 points)
Indigo Company is offered a contract whereby it will be paid
$10,000 every six months for the next five years. The first
payment will be received six months from today. What will the
company be willing to pay for this contract if it expects a 16%
annual return on the investment?
$ 49,114.50
$ 72,498.00
$ 67,101,00
$ 98,229.00
$ 59,890.50
2)(10 points)
3)(10 points)

4)(20 points)
On June 30, 1993, the DEF Corporation sold bonds with a face
value of $100,000. The contract rate of bond interest was 9%
with interest payments on December 31 and June 30. the bonds
mature in 10 years. When the bonds were sold, the market rate
of bond interest was 12%. How much money did the DEF
Corporation receive when it sold the bonds?
$119,252
$110,042
$100,000
$ 82,795
prepare the accounting entry for the interest payments on both
December 31 1993 and June 30 1994
5)(25 points)
The Kitchener Company issued bonds with a par value of $150
000 on their initial issue date. The bonds mature in 15 years and
pay 8% annual interest in two semi-annual payments. On the
issue date, the annual market rate of interest for the bonds was
10%.
a) What is the size of the semi-annual interet payment for these
bonds?
b) How many semi-annual interest payments will be paid on
these bonds over their life?

c) Were the bonds issued at par, at a discount, or at a premium?
d) Estimate the market value of the bonds as of the date they
were issued?
e) Present the journal entry that would be made to record the
bonds issuance and the first monthly interest payment.
6) (25 points)

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