ABSTRACT: This second article focuses on the management of the struggling or failing student in practice. Most students perform well in practice and require relatively little support in achieving their learning objectives whilst in clinical placement. Some students, however, may be challenged by a range of issues whilst in the practice setting. This article focuses on the identification and management of veterinary nursing students who are struggling in practice.

Managing the failing or struggling student can be challenging. Students identified as not performing well or struggling need to be identified and managed effectively, as failing to fail a student is detrimental to the student, mentor and ultimately the veterinary nurse profession.

Students can struggle with a range of issues, including personal and home life difficulties. These can often be complex and demanding, with some students away from home for the first time, particularly on full-time undergraduate programmes. Lacking their usual coping framework can exacerbate problems on the programme or in the learning environment. Clearly the latter source of problems will require specific and sometimes tailored approaches, often dealt with by a personal tutor.

The Royal College of Nursing (RCN) offers a Toolkit for Mentors that provides some useful suggestions for managing a struggling or failing student.1 The vast majority of students, however, perform very well and have no issues; but a failing or struggling student can be stressful for mentor and student alike. Table 1 outlines some suggested coping strategies for managing failing students.

Recognising the struggling student

Recognising a struggling or failing student in a placement can be difficult, particularly if you are not working with them on a daily basis. Maloney & Carmody et al„ (1997) identified some early signs that may be manifested themselves in a range of behaviours that can be indicative of a failing student.2 These are outlined in Table 2.

Other more specific – and perhaps more explicit – problematic behaviour includes attending placement inappropriately dressed, perhaps with facial piercings or having body odour. Being consistently late for work or not contacting the placement in event of sickness/delay, insensitivity to patients and/or their owners either in person or on the telephone, and being abrupt or rude to other members of staff are examples of other behaviours that need challenging as soon as possible.

Managing the struggling student

Price (2006) identified some of the anxieties that mentors may have in terms of managing struggling students and subsequently identified a three-step approach to managing them.3 Prices’ suggested approach included the following: clarification, exploration and implementation. Table 3 outlines Price’s three-step approach with some suggested management techniques.

Failing to fail

Several research studies relating to human nursing have highlighted the phenomenon of qualified nurses ‘failing to fail’ students who demonstrate a lack of clinical competence in the placement.4' 5,6&7 A seminal report on student nurses by Duffy (2003) for the Nursing and Midwifery Council (NMC) – nursing’s regulatory body – explored this issue by researching mentors and lecturers’ experiences regarding this ‘failing to fail’ phenomenon and about why some student nurses were being allowed to ‘pass’ clinical assessments without having demonstrated sufficient competence.6

Whilst Duffys study relates to nursing practice, these issues appear generic and, therefore, equally applicable to veterinary nurse students. Duffy (2003) identified three key factors that influenced student assessment – these were existing problems, failing theory rather than practice, and differing agendas.6 Whereas clinical practice staff were often aware that students were not performing for some considerable time, they were reluctant to put ‘pen to paper’, subsequently creating significant frustration, even anger, in other mentors who were then placed in the position of having to fail the student, often at an advanced stage of their study.

In a study by Lankshear (1990), staff expressed concern about failing students, with their anxiety being that this would be viewed as a personal failing, or that they had is some way failed the student.8

Duffy also discovered that a greater number of students failed their theoretical assessments, such as assignments, than failed a practical or clinical assessment. A possible reason for such a discrepancy was the tool used to assess the clinical skills. It was potentially faulty, being too subjective with no one validated tool used for clinical practice.

A Scottish study on the validity and reliability of the tools used to assess competence concluded that there was often ‘little or no relationship’ between most of the clinical competence assessment methods that were utilised in practice.9 Duffys team recommended that a multi-method approach to the assessment of clinical competence was a preferred method of assessment.

Aiding the struggling student

Action Plans have been more commonplace in veterinary nursing practice in recent years. However, to be used effectively and successfully the role of the mentor is extremely important to ensure that the students remain ‘on track’ and are able to fulfil and meet their identified learning needs. Action plans can also be useful in managing and assisting the struggling or failing student. Developing and implementing an action plan is actually useful for all students, not just those who are struggling.

However, owing to time constraints, action plans are usually only used for students who, as a mentor, you feel are having issues in practice. Action plans do not have to be complicated or difficult – the best ones are those that are probably just on one side of A4 and cover the five suggested main points outlined in Table 4.

Any action plan should be formulated and written in conjunction with the student and both must sign it. It can be created at any time during the placement, when the mentor or the student identify that specific learning needs are not being met.

The earlier an action plan is started in a placement the better and it should set out how any gaps in learning can be addressed.

The GROW model

The GROW Model is one that is, maybe, more familiar in veterinary nursing practice and is used to identify and develop the learning objectives for students (Figure 1
). The GROW model can be used by the clinical coach to define and identify any particular learning needs that the student may have throughout the placement or period of training. This model can be used as a template for a one-to-one session with either one or a group of students.

Figure 1: The GROW Model

The four elements of the GROW model are listed below and Figure 1 outlines the GROW model diagrammatically.

G – Goal

This is to establish and agree the long¬term aims and objectives for the clinical placement and agree any particular topics for discussion. For example, a specific clinical skill or communication skills.

R – Reality

The reality element focuses on assessment of the student and encourages student self-assessment. The clinical coach can offer feedback, ensuring that the student remains objective and challenge any assumptions and discarding any irrelevant or erroneous information.

O – Options

Options refer to the full range of options available to the student, in terms of the specific learning objective that has been identified. During the Options element, the clinical coach can be inviting the student to make suggestions about how they may improve their practice, and to ensure that they have selected the correct care package/pathway for the patient and their owner.

W – Wrap-up

Wrap -up refers to the range of action that is available to the student in practice and to encourage them to commit to their chosen action. The clinical coach can encourage the student to identify any potential obstacles to delivering care and make suggestions as to how these may be overcome. Specific support may need to be identified – perhaps some additional learning or other resources – and agreed specific steps and timing will be agreed, so that the student is clear as to when the learning objectives need to be completed.


This article has addressed the issue of clinical coaching for supporting veterinary nursing students in practice. Although much of the literature is drawn from nursing in the human world, many of these concepts and frameworks are generic and can apply, in fact, to any health professional, whether their patients are human or otherwise!

The use of Action Plans and the GROW model as frameworks for managing students who may be struggling or failing in practice have been discussed. The article has reviewed the practical issues of managing the struggling or failing student, including how they are identified, and some suggested management strategies have been highlighted.

The task of clinical coaching is usually an additional role that many veterinary nurses adopt, sometimes with little negotiation, support or preparation and often in addition to an already busy clinical role. Clinical coaching for students requires a professional, experienced individual who understands the key elements to successfully developing a beneficial, supportive relationship with their student. 


Lynda Sibson MSc RGN RSCN

Lynda began her nursing career in Surrey, later training at Great Ormond Street Hospital and working as a paediatric nurse.

She then became a practice nurse in a GP surgery and after qualifying as a nurse practitioner, worked in a nurse-led minor treatment centre in central London before joining a telemedicine organisation and completing her Masters Degree in Advanced Healthcare Practice. More recently, Lynda was a principal Lecturer at the University of Hertfordshire, developing and running some advanced practitioner and paramedic programmes, and is now a nurse consultant with her own consulting company, Sibson Consulting Ltd, www.sibsonconsulting.com

To cite this article use either

DOI: 10.1111/j.2045-0648 2011.00089.x or Veterinary Nursing Journal Vol 26 pp 285-288


1.   Royal College of Nursing [2007] Guidance for mentors of nursing students and midwives An RCN toolkit. London, RCN.


2.   MALONEY. D., CARMODY, D. and NEMETH. E. 11997) Students experiencing problems learning in the clinical setting. In McAllister. L.. Lincoln, M„ McLeod. S. & Maloney. D. (editors) Facilitating learning in clinical settings. Cheltenham: Stanley Thornes. 185-213.

3.   PRICE. B. 12006) Addressing problematic behaviour in learners. Nursing Standard. 20140): 47-48.

4.   DUFFY. K. and SCOTT. P. A. 11998) Viewing an old issue through a new lens: a critical theory insight into the education-practice gap. Nurse Education Today, 1813): 183-189.

5.   RUTKOWSKI. K. 12007) Failure to fail: assessing nursing students' competence during practice. Nursing Standard. 22(13): 35-40.

6.   Duffy. K. 12003) Failing students: a qualitative study of factors that influence the decisions regarding assessment of students' competence in practice. Glasgow Caledonian University,

7.   SHARPLES. K. and KELLY. D. 120071 Supporting mentors in practice. Nursing Standard. 21(39): 44-47.

8.   LANKSHEAR 119901 Failure to fail: the teacher's dilemma. Nursing Standard. 4(20): 35-37.

9.   NORMAN. I. J.. WATSON, R.. MURRELLS, T, CALMAN. L. and REDFERN, S. (2002) The validity and reliability of methods to assess the competence to practise of pre-registration nursing and midwifery students. International Journal of Nursing Studies. 39(2): 133-145.

Further reading

Royal College of Veterinary Surgeons (20061 Veterinary Nursing National Occupational Standards and Qualification Structures for NVQ Levels 2 and 3. London. RCVS.

Royal College of Veterinary Surgeons 12008) Guide to Professional Conduct for Veterinary Nurses. London. RCVS.


• VOL 26 • August 2011 • Veterinary Nursing Journal