DiversityNursing Blog

By Debra Wood via NurseZone.com

July 12, 2012 - Who says that mentorships are only useful for new, fresh-out-of-school nurses?  Health care facilities, schools of nursing and professional associations are trying new approaches to reach out and support nurses throughout their careers, resulting in benefits for all parties involved.

Mentors can guide a nurse’s career and help the mentee weigh alternatives and avoid pitfalls; at the same time, mentors enhance their own skills and the profession as they pass along knowledge and intangibles necessary for success. And employers can realize a double bonus--by improving retention rates at both levels within their workforce.

“Mentors are critical to our profession,” said Lois L. Salmeron, Ed.D, RN, MS, CNE, ANEF, associate dean for academic affairs and professor at the Kramer School of Nursing at Oklahoma City University in Oklahoma. “This is one way to nurture our own and retain nurses.”

The Kramer School offers a formal mentoring program, assigning a seasoned faculty member to someone new to the program, ideally team teaching. Most remain close after the one-year formal program ends.

“We view [mentoring] as key to a positive transition,” said Salmeron, who adds that mentors also are important when a nurse wants to change specialties.

Cynthia Nowicki Hnatiuk, EdD, RN, CAE, executive director of the Academy of Medical-Surgical Nurses, called mentors the single most effective way to help nurses learn a new role and increase their confidence.

“It provides a one-on-one opportunity for two individuals to teach and learn together,” Hnatiuk said.

“Mentorship is something that never really stops, and something each person has to take responsibility for themselves,” added Ora Strickland, Ph.D., RN, FAAN, dean of the Florida International University (FIU) College of Nursing and Health Sciences in Miami. “You will have many mentors through your career, and more than one mentor at one time, depending on what you are trying to gain skills in.”

Strickland has found most mentors enjoy the experience.

FIU offers a research mentorship program to increase the research productivity of its faculty and help them learn how to network, seek funding, conduct studies and publish their findings. The mentorships cross disciplines to encourage collaboration.

Formal mentoring programs

Many nursing employers provide formal mentoring programs.

UnitedHealth Group Center for Nursing Advancement built its own nurse mentoring initiative, leveraging best practices. It facilitates monthly in-person and virtual mentor/mentee interactions. Mentees submit profiles about development needs and potential mentors’ strengths, and the center electronically matches them. After the one-year mentorship ends, mentees can continue attending special events.

Dawn Bazarko, DNP, MPH, RN, senior vice president of the Center for Nursing Advancement, reports 100 percent of the first cohort of nurse mentees has continued working at UnitedHealth and 21 percent have received a promotion. The center is now building a new mentoring program for more seasoned nurses within the organization to take on broader leadership roles.

“We’re taking our experience to inspire and evolving that to address the needs of our senior nurses,” Bazarko said. “Nurses are critical to the people we serve, modernized health care and our business success. It’s a deliberate investment in their personal and professional enrichment.”

MedStar Good Samaritan Hospital in Baltimore also offers a formal mentoring program and has found it reduces turnover and increases productivity, reported Joy Burke, RN, MSN, CCRN, a clinical specialist at Good Samaritan. The hospital offers mentoring classes to prospective mentors, who must have at least two years of experience. Approximately 130 nurses have taken the course and are currently mentoring 67 novice nurses.

“The nurse has a friend, a buddy, someone they can call on,” Burke said. “They get critical feedback from the mentor.”

Huntington Hospital in Pasadena, Calif., pairs new hires with a mentor, said Lynette Dahlman, MSN, RN-BC, director of clinical education and academic partnerships. Serving as a mentor earns credit toward a nurse’s career ladder.

Nurses do everything they can to help a nurse grow, so they are proud to work alongside [of them],” Dahlman said.

Texas Children’s Hospital in Houston also offers a formal mentoring program. The hospital matches mentors and mentees with like backgrounds and with the skills the mentee needs. Formalized classes provide resources and an objective look at internal resources.

Kara Boakye, RN, BSN, CPN, nurse manager of the progressive care unit at Texas Children’s, said she has gotten to know herself better and become a better leader after being mentored by Emily Weber, RN, NEA-BC, nursing director for newborns at the hospital.

“I feel I gain just as much from the relationship, because it makes me pause and think about why I would make that decision,” Weber said. “Both parties gain a lot from it.”

South Nassau Community Hospital in Oceanside, N.Y., takes a slightly different approach with its mentoring program, designed to help nurses advance to the expert level. It matches nurses with potential to move up with outstanding stars who can mentor and coach them in communication skills, working within the organization and understanding the health care industry.

“Mentoring isn’t about clinical skills,” said Sue Penque, Ph.D, RN, CNP, chief nursing officer at South Nassau. “A mentor is above and beyond what you get in didactic training.”

South Nassau conducts annual assessments of nurses’ strengths and performance to evaluate the effectiveness of the program. It also identifies experiences where people can grow and take on new responsibilities while the mentor is present and able to coach.

Finding a mentor

While a formal program might make it easier to connect with a mentor, nurses often can find one independently. Nurses should observe others who practice as they aspire to and approach that person, advises Hnatiuk.

Penque has asked a nursing leader in academia whom she admired to mentor her.

Strickland has approached subject-matter experts whose abilities and skills she respected and asked them for mentoring and has never been turned down.

Finding the right mentor “can be just as hard as finding a good husband or wife--and well worth the search,” said author and relationship expert April Masini of Naples, Fla. She recommended being persistent and trying until you connect with the right person; when you succeed, be careful not to seek more time than agreed upon and to respect professional boundaries.

The Academy of Medical-Surgical Nurses recently launched a free, self-directed mentoring program with online validated tools, including mentor and mentee guides, for nurses new to the specialty and those who are changing settings.

“We would love for people to use the resources,” Hnatiuk said.

Mentoring across the profession

In addition to mentors in clinical and academic settings, nurses also mentor each other in professional associations.

The Association of Pediatric Hematology/Oncology Nurses recently introduced a members-only, two-year mentoring program, which matches experienced mentors with mentees. The goal is to facilitate member’s career growth and leadership development.

Ramón Lavandero, RN, MA, MSN, FAAN, senior director of communications and strategic alliances for the American Association of Critical-Care Nurses and a clinical associate professor at Yale University School of Nursing in New Haven, Conn., said mentoring is embedded in the fabric of the association’s community of nurses. The organization has a formal process for newly elected board members, and chapter advisors offer mentorship to local leaders.

“Mentorship ranges from coaching on leadership development and succession planning to problem solving challenging situations,” Lavandero said. “A newer chapter known for its innovative activities may mentor an experienced chapter that wants to explore new direction.”

From Nurse.com

Alisa Glaister, RN, credits her opportunity to ascend from new grad to nurse manager to a few key colleagues, including a director from a different unit who advised her as she led a project to treat angioplasty patients on the telemetry floor. “He helped me get my foot in the door for this project, which I believe has led to my current management position,” said Glaister, a nurse manager at St. Mary’s Medical Center in San Francisco.

Glaister met with her mentor weekly to discuss techniques of effective leadership. “He was a tremendous help and guide,” she said. 

Mentoring has gained considerable respect as an essential element for training new nurses, whether they’re fresh out of school or recently transferred from another unit. “The first year [out of school] you have those vulnerable moments all the time, and you forget what you have accomplished,” said Hazel Curtis, RN, BSN, MPH, an education specialist for staff development at Loma Linda (Calif.) University Medical Center. “A great mentor picks you up, dusts you off, gives you a pat on the back and says, ‘You can do it.’” 

Going one on one

Formal mentoring programs hatched in professional associations and hospitals are popping up around the country as researchers and managers find the practice boosts a nurse’s job satisfaction and confidence. 

Cecelia Gatson Grindel, RN, PhD, CMSRN, FAAN, studied the outcomes of Nurses Nurturing Nurses (N3), a mentoring program designed by the Academy of Medical-Surgical Nurses. The year-long program was rolled out to 40 medical institutions across the country in 2002. Grindel, a professor and interim dean at Georgia State University in Atlanta, said data she could gather indicated more than 90% of mentored nurses stayed on the job, compared to attrition rates as high as 30%. Feedback collected throughout the pilot year of the program suggested mentored nurses had more job satisfaction and confidence. 

Yvonne Brookes, RN, director of clinical learning at Baptist Health South Florida in Miami, found similar results after implementing a residency program that included a mentorship component. Previously, turnover among the system’s 4,000 nurses averaged 22%, often because new graduates left the profession or pursued an advanced degree after their first year. Since implementing the program in 2007, the new graduate turnover rate dropped to 6%, she said.

“We realized it wasn’t about the science, it was all that other stuff that goes to the head of a new grad,” she said. 

“Other stuff” can range from implementing unit procedure to dealing with difficult managers or unhelpful preceptors. It can be conflict with patients or their families dealing with the shock of witnessing a death for the first time. “Sometimes you just need to vent,” Brookes said.

A mentor also can help a nurse recover from making a medical error — a potentially traumatic experience — by offering emotional support and emphasizing that one mistake doesn’t make a bad nurse. 

Choosing teams

Matching the mentor who responds to help with complaints, concerns, self-doubts and errors with the nurse who needs to share them is somewhat hit and miss in formal mentorship programs. Both parties have to accept the relationship takes time — not an easy pill to swallow in today’s intense work environment.

N3 guidelines advised managers to look for someone with three- to five-years of experience in the same field who worked outside the nurse’s unit. In a new mentoring program at St. Mary’s, nurse managers help match personalities and proximity, among other factors, Glaister said. “We really take into consideration who we’re matching with whom,” she said.

At Baptist Health, the process was more intuitive, Brookes said. Mentors and mentees gathered in one room to talk one on one and then rotated until every mentee had met every mentor. “It’s sort of a speed-dating situation to find a mentor that will work for you,” she said. 

Programs across institutions vary, but the time commitment can range from trading a text message or two per month to having biweekly meetings for one year. Since many new nurses are assigned to the night shift, a good deal of these conversations happen in the evening. But meetings also can be irregular or precipitated by emergent situations, said Abigail Mitchell, RN, DHEd, MSN, a professor at D’Youville College, Buffalo, N.Y., and a nursing supervisor at Kaleida Health, Buffalo, N.Y. “If they’re in crisis, you have to handle it,” said Mitchell, who runs a private mentoring firm. “You can’t just say, ‘It’s not our date to meet.’”

Generation gaps can present challenges in mentor-mentee relationships. For instance, younger nurses are often more comfortable communicating through texting and email. Nurses from the baby-boomer generation are sometimes reluctant to mentor the next generation. “The work ethic is different,” Mitchell said. Boomers will pick up extra time or stay over their shift to help coworkers, while some younger-generation nurses rather go home and pick up extra hours when it works for them, around holidays, for example, she said.

Sometimes the mentor-mentee relationship just doesn’t work out, but that doesn’t necessarily mean mentoring didn’t work. Anecdotal evidence from the N3 program indicated nurses who’d been assigned a mentor were likely to seek out another if the first relationship wasn’t helpful. Managers also have noticed that mentored nurses go on to mentor their junior colleagues. “The process has fed on itself,” Brookes said. “The more professional their approach, the more they want to contribute to the next group coming in.”

The program’s success has inspired Brookes to extend the model to other levels of the profession. A med/surg nurse with 15 years experience still needs guidance when transferring to a different unit, like critical care, she said. She is mentoring four managers to help them ease into their new roles. “They’re degreed up to the caboozle, but that doesn’t mean they know whom to reach out to,” Brookes said.

At this level, mentoring is more about handling people and situations than about patients and skills. Healthcare management involves evaluating staffing ratios, managing human and fiscal resources and strategic planning. Sometimes advice is just practical: a nurse manager would do well to keep a pressed blazer in the office closet, for example. 

Recently, Curtis convened a small mentor circle for managers. The new managers come together about once a week to ask questions and hear presentations on broad topics of interest, such as the hospital culture. The program has boosted their confidence, she said. 

Educating educators

Academia, too, reaps benefits from mentoring. Shellie Bumgarner, RN, MSN, CEN, EMT, a clinical educator at Lenoir-Rhyne University School of Nursing in Hickory, N.C., sought help to implement an education day for nurses at a small rural hospital. 

She found a mentor at the 2010 national convention of the Emergency Nurses Association, which had started EMINENCE (Establishing Mentors InterNationally for Emergency Nurses Creating Excellence) in 2008. The pair worked together for one year, talking about once a month and trading emails frequently. 

Her mentor helped her with the substance of her topic, which focused on pediatric care in smaller, rural facilities. She also contributed creative ideas to help Bumgarner find a way to cover the shifts of nurses who attended her training. “She advised how to tweak my ideas to better fit the smaller hospital,” she said. 

Retention of nursing faculty is as urgent as the need for unit staff, as professors leave academia for higher paying jobs. The National League for Nursing, which focuses on nursing education, released “The Mentoring of Nursing Faculty Tool Kit” to promote recruitment and retention of nurse faculty (available online at NLN.org/facultydevelopment/mentoringToolkit/index.htm). 

Beyond orientation, mentoring faculty includes the development of teaching and research skills. 

Mitchell has started her own mentoring program targeting faculty. Managing workload and outlining governance procedures are primary topics, she said.

The idea may be slow to grow, but more nurses at all levels are realizing the importance of mentoring, said Brookes. Is it a widespread practice? “No,” she said. “But it should be.”