Saturday August 30th 2014

Better prepared workforce, better retention

Programs illustrate the value of mentoring

Whether it is a brand new nurse taking on the challenges of full patient-loads or an experienced clinician moving into a managerial or academic role, having a mentor can make an RN’s professional life exponentially better than having to go it alone.

Nurses who are involved in mentoring say that every nurse deserves a trusted mentor. But historically, that’s not been the case, especially given the military and monastic roots of nursing.

“People didn’t think of mentoring before,” said Angela McBride, PhD, RN, FAAN, who wrote the book, The Growth and Development of Nurse Leaders, which speaks to the importance of mentoring. “Instead many of them had an attitude that if they went through hell, so should you.”

Although health care facilities are increasingly committed to having some formal structure for new nurses that’s “more than a good orientation,” McBride also agrees that, for other nurses, having the opportunity to be mentored is a matter of luck.

That lack of mentorship can lead to poor nurse retention, which in turn, hurts facilities’ bottom line.

Turnover for bedside RNs was ranging from 4.4 to 44.6 percent in 2013, according to the “2013 National Healthcare & RN Retention Report” published by Nursing Solutions, Inc., a nurse recruitment company. Further, the average cost of turnover for a bedside RN is between $36,000 to $48,000.

“New nurses get overwhelmed and can feel that nursing is not for them,” said McBride, an Indiana State Nurses Association (ISNA) member. “So they think they should go into some other career.”

Beyond new grads, McBride believes any nurse who is going through a career transition can benefit from a mentor.

“I see nurses moving along in their careers further faster, so a mentor can give them the tips they need to help them read between the lines and transition more smoothly into their new role,” McBride said.

Betty Dixon, DrPH, BSN, RN, knows firsthand the benefits of mentoring and being mentored.

“My first job was in the ER of a small hospital,” said Dixon, a Georgia Nurses Association (GNA) member and currently the director of Nursing and Clinical Services for the Coastal Health District. “I was very fortunate because I worked with a good group of nurses and had a mentor who showed me the ropes, helped me learn the culture of emergency nursing, and gave me the confidence to believe I could do the job. She also was very professional and a good listener.”

When Dixon moved from the bedside to an administrative position, she had another mentor who helped her navigate a new set of skills, such as budget planning and timesheet oversight. Now, she helps to ensure that new nurses are appropriately mentored in the complex role of public health nursing within her district, which encompasses eight counties in southeastern Georgia.

Dixon said that mentoring is an investment in the district’s nursing workforce that results in positive client outcomes.

“I believe that without mentoring, we might still have good nurses, but we might not have great nurses,” she said.

Proof that mentoring works

Franciscan St. Francis Hospital and Health Centers in Indianapolis has come up with a winning formula to help retain its nurses, including new grads. In addition to having a preceptor to help them hone their clinical skills, all new nurses are paired with a mentor over the course of a year to help them acclimate to their role and to the organization.

Experienced nurses who are either new to St. Francis or new to a specific unit also participate in the mentorship program, which was developed in 2006, rolled out house-wide in 2007 and has been tweaked over the years to better meet everyone’s needs, according to Kathy Fox, MSN, RN, a clinical nurse educator with Franciscan St. Francis’ Education Department and an ISNA member.

Fox and her colleagues created the program as a way to combat the nurse turnover rate of first-year RNs, who often left or transferred to a new unit because of poor working relationships. In 2004, that rate was 31 percent. But by 2009, two years into the program, the rate dropped to 10.3 percent. More than 350 nurse protégés have been matched with mentors — either of their own choosing or selected by their nurse managers — since its inception.

After a half-day training session early on in their orientation, nurse protégés, along with their mentors, sign a document agreeing to this relationship. They also must meet face-to-face a minimum of seven times a year, as well as report routinely on their progress. The end goal for all protégés is to become more confident, competent and autonomous in their practice.

Selecting nurses who can really be good mentors is key to the program’s success, Fox explained.

“Usually the mentors are great clinically,” she said. “But more than that, they are usually the ones who are known as “the glue” who hold their units together, who have great critical thinking skills, and who other nurses look to for help.”

In addition, mentors must possess qualities, such as being nurturing, kind, trustworthy, encouraging, and a good listener.

Protégés, in turn, must be willing to accept responsibility for their own professional development and growth; view mistakes as learning opportunities; and look at issues from other points of view, among other factors.

Beyond reducing nurse turnover, in post-mentorship surveys protégés reported that one of the biggest challenges their mentors helped them overcome was effectively interacting with physicians. Surveyed mentors expressed getting a better sense of the leadership role and staying more up-to-date on policies and procedures.

Fox added that the mentorship program has had other effects: More nurses are pursuing certification, advancing their education and participating on committees.

The program now is serving as a template for other departments at Franciscan St. Francis and other hospitals regionally.

Mentoring public health nurses

In a document revised in January 2006, the Georgia Department of Human Resources, Division of Public Health, now the Georgia Department of Public Health, Office of Nursing identified mentoring as a key strategy to address recruitment and retention within its public health nursing workforce.

Many health districts within the Georgia public health department have some type of mentoring program for their nurses, with a prescribed timeline in which new nurses must meet certain goals, according to Dixon.

In the eight counties within Dixon’s district, nurse managers generally serve as a new nurse’s preceptor and mentor, although nurses who run specific public health programs, such as immunizations, family planning and children’s preventive services, also act in this combined role.

New RNs shadow their mentors for some time and then gradually take on their own clients, with the seasoned nurses’ ongoing guidance and support. This formal mentorship usually lasts 12 to 18 months.

“It takes a while for a new nurse to get the courage to give a ‘little one’ five immunizations during one visit,” Dixon said. “For the mentor, it takes patience to explain how and why things are done. But by laying the groundwork, the new nurse will gain the knowledge and confidence she needs. And the health department benefits when everyone is working together.”

Cindy Hendry, RNC-MNN, the coordinator for Perinatal Children’s Health Services for the Coastal Health District and a GNA member, is currently mentoring two new nurses.

“They are integrally involved with whatever I do,” Hendry said. “They initially come with me on home visits, and I show them all aspects of direct patient care. I’ve been a nurse for a long time, and I don’t want anyone to do anything they don’t feel comfortable doing. ”

Hendry emphasized that one of the challenges for new public health nurses is understanding the breadth of clients’ needs.

“Public health nurses must have an understanding of clients’ lives to be able to help them set goals to become healthier,” Hendry said. “They have to find a way to make the prevention and health promotions activities they are offering click with people.”

Hendry can recall how her own mentor set a great example.

“I worked with premature infants on the 3-to-11 shift,” she said. “Anytime any of us had a problem, like with a blood draw, we would call our nursing supervisor. She wouldn’t do it for us. She would guide us through it, shoulder to shoulder, eyeball to eyeball. She was there for us to help us do our jobs.

“I could speak honestly to her, so she was like a friend, a mother, a teacher and a supervisor.”

Hendry also agrees that having a strong mentor helps with nurse retention.

“They don’t leave, because they’re happy,” Hendry said. “And, they’ve learned whatever they have to do the best way — pulling from themselves to solve a problem. And if they can’t, they know who to call.”

Supporting new faculty, looking toward the future

McBride currently is the chair of the National Advisory Committee of the Robert Wood Johnson Foundation’s Nurse Faculty Scholars Program. The program aims, in part, to strengthen the overall excellence of nursing schools by providing mentorship, leadership training, and salary and research support to beginning faculty.

These fledging faculty have four mentors, according to McBride. Their primary mentor is at their school of nursing and helps them understand what they need to do to get tenured and promoted.

The scholars program requires nurse faculty also to have a research mentor who is preferably not a nurse. That way they can get embedded into a larger, interprofessional world, such as within a center for aging. Faculty scholars also are assigned a national nurse mentor, who can help them see the bigger picture. And finally, their cohort within the faculty scholars program provides them with a network of peer mentors.

“Not all of these mentorships may be fully realized, but as a whole, these different mentors can give beginning faculty a lot of tips and advice that can help them in this demanding role,” McBride said.

And finally, McBride notes one of the major benefits of mentoring centers on ensuring the next generation of strong, competent nurses.

Said McBride, “It is our professional obligation to mentor — to help nurses to speak up, get along with difficult people and be strategic in their thinking. And when nurses are ready to retire, they want to make sure there are others prepared to take over.”

— Susan Trossman is the senior reporter for The American Nurse.


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