Mentoring Program Susan Taylor, MA, RN

Objectives Identify the phases of acclimation for a new graduate nurse 11/9/2018 Objectives Identify the phases of acclimation for a new graduate nurse List reasons mentoring may help in retention of new graduate nurses Discuss the development of a nurse mentor program

11/9/2018 The greatest good you can do for another is not just to share your riches but to reveal to him his own. - Benjamin Disraeli

Background for mentoring programs Transition-to-practice programs (residencies) are emerging across the country They work to strengthen new graduate nurses’ acclimation to their units Strong national support for standardization Research links new nurses to patient safety issues and outcomes (NCSBN, 2011)

11/9/2018 What is a mentor? Defined as a trusted counselor, an experienced and trusted advisor, a guide, a wise teacher, a role model Some references maintain that mentoring is an intervention to improve the nurses confidence, promote professional development and encourage life long learning.

What is a mentee? Someone who is counseled, guided and advised 11/9/2018 What is a mentee? Someone who is counseled, guided and advised Seeks personal and professional development and growth through the assistance of an experienced and knowledgeable professional

Mentoring program goal 11/9/2018 Mentoring program goal To increase job satisfaction and retention while contributing to the personal and professional development of new nurses through relationships that provide nurturing and support

Objectives for a mentoring program 11/9/2018 Objectives for a mentoring program Establishment of a loosely structured and caring arrangement for sharing between two nurse colleagues Guide and counsel new nurses in their professional and interpersonal growth as they transition to the role of professional nurse Promote work behaviors that encourage growth and professionalism Communicate information concerning expectations, learning, stressors and patient safety Assist in the assimilation of new nurses into their new working environment

Why offer a mentoring program? 11/9/2018 Why offer a mentoring program? Promotes quality, patient–centered care and safety Improves retention of new nurses Improves skills, performance, confidence and comfort level for beginning nurses Provides support for nursing morale, communications and collegiality Builds a sense of professionalism, positive attitude Facilitates the transition into practice the first year of nursing Puts theory into practice Prevents new nurse isolation Builds self-reflection for both the new nurse and the mentor

New grad stress Linked to patient care errors (NCSBN, 2007) 11/9/2018 New grad stress Linked to patient care errors (NCSBN, 2007) Highest during the first 3-6 month period of practice Residency programs help to decrease stress with the addition of a mentor Increased stress of the new graduate nurse: those stressors could be the first time experiences, learning how to complete procedures on “real” people, having a job, living on their own, etc Stress levels of new nurses increase at the 3-6 month period of practice. This is the time when most new nurse’s orientation/transition programs end (NCSBN, 2007) In a year long residency program, stress was shown to decrease over time. Due to having the opportunity to continue to learn through clinical educational offerings that focuses on the New Grad’s area of expertise, i.e. Med Surg, ICU, Neonate, etc. Many residency programs have the additional opportunity for the New Grad to have a mentor to help the New Grad through the tough New Nurse situations

Major events in the first year of practice 11/9/2018 Major events in the first year of practice First code or death Physician to nurse communication Patient care situations that are confusing Communication events where responsibilities are unclear Patient safety events or near miss events Ethical dilemmas Assisting families in crisis 1. Physician to Nurse communication events where patient outcomes are at risk

Transition-to-practice & mentoring: return on investment 11/9/2018 Transition-to-practice & mentoring: return on investment Studies report significant ROI related to implementation of transition-to-practice programs Methodist Hospital in Houston reported a 13% turnover decrease and over $1 million savings (Pine and Tart, 2007) Children's Memorial Hospital, Chicago, reported a 17% turnover decrease and improved nurse recruitment (Halfer, 2007) 1. Methodist Hospital in Houston reported decrease in turnover of 13% after implementing UCH residency program with ~$1,098,000 cost savings & ROI of 884.7% (Pine & Tart, 2007). 2. Children’s Memorial Hospital Chicago reported a nurse turnover rate of 29.5% in 2002. Cost per new grad=$41,624. Following implementation of nurse internship program, average turnover rate decreased to 12.3%. The nurse residency and mentoring program is also attributed with improving nurse recruitment by 28%. Overall annually cost savings= $707,608.(Halfer, 2007).

The financial aspect It is estimated that 27% to 61% of new nurses leave jobs at 1 year or less Up to 57% of new nurses leave at 2 years Research indicates an improvement in new nurse retention rates for nurses participating in transition-to-practice programs New nurses participating in a nurse residency program had retention rates of 86-90% after one year of hire (Setter, Walker, Connelly & Peterman, 2011)

11/9/2018 The financial aspect The estimated cost of replacing a nurse is about 1.2 to 1.3 times the nurse’s salary (Kovner et al., 2009) Costs associated with replacing a nurse include Advertising and recruitment Vacancy costs (overtime, diversion, etc.) Interviews & hiring decision time Orientation and training New employee decreased productivity

Mentor qualifications 11/9/2018 Mentor qualifications Minimum one year of clinical experience Communicates in a clear manner while being a good listener Understands the scope of nursing practice Able to commit to program and mentee Displays a positive attitude and is a positive role model for nursing Provides moral support and guidance Agrees to evaluate the program These were criteria that we as the mentoring committee would look for in a mentor if we were seeking a mentor.

What mentors can do Coach Facilitate learning Encourage 11/9/2018 What mentors can do Coach Facilitate learning Encourage Frame the questions Ease work transitions Support Coach nurses through Dr. / Nurse relationship building or Nurse to Nurse relationship building Facilitate learning by helping nurses to recognize options for learning to do the right thing Framing the questions that need to be answered so that the new grad can find the answer in reflection, experiences, Ease work transitions by offering an outlet for emotions and concerns Support nurses through challenging events and promote growth

PRECEPTOR vs MENTOR A formerly assigned teacher with goal of showing the new nurse unit policies and procedures, and to assure competent skills/task practice Assists with socialization into the unit Typically a skilled clinician At least 1 year experience on the unit Approved to precept by manager Advisor Counselor Guide/networker Confidante Confidence builder Encourager Professional role model Sponsor Resource Facilitator Typically experienced professional

Phases of acclimation for the new graduate nurse 11/9/2018 Phases of acclimation for the new graduate nurse

Phase 1- orientation General hospital orientation Not a formal part of the Transition-to-Practice Residency Program or the Mentor Program Exposure to policy and procedures, basic nursing competencies and role expectations

Phase 2- transition Begin Transition-to-Practice classes or other specialty classes for nursing unit Complete unit-based competencies under the supervision of the preceptor Begin socialization into the unit

Phase 2- transition Guided by five concepts Communication and teamwork Patient-centered care Evidence-based practice Quality improvement Informatics

Phase 3- Integration Mentoring is the final step of the transition-to- practice and is part of the integration phase Two main categories of mentoring support Psycho-social Career

Mentoring support Psycho-social Career Professional role behaviors Counseling Friendship Acceptance Sponsorship Coaching Protection Support educational experiences

Planning and establishing a mentoring program Identification of potential mentors Provide information on mentor program with criteria to qualify, etc. Those interested apply. Set deadline for application Resource educators select mentors with input from managers/directors and the mentees Mentors and mentees sign an agreement to communicate with each other weekly or minimally bimonthly during the next 12 months Mentees are new graduate nurses or a nurse transferring to a new specialty

How the mentor and mentee are matched 11/9/2018 How the mentor and mentee are matched Interests Education degree or past educational experiences Mentor requests a specific mentee A mentee may also request a specific mentor Mentors and mentees will not come from the same unit (the caveat to this was if there was a specific request from a mentor) as noted by the mentor/mentee through the biographical sketch with assist with matching The mentor and mentee matching will also be based upon education degree or past educational experiences the Unit Manager or Director must approve again this must be approved by the Manager or Director The mentor is to not act as preceptor, but rather as a guide, or trusted counselor

Formal mentor/mentee relationship The mentor/mentee will have a face-to-face meeting at least once Weekly or bimonthly communication is an expectation but this can be electronic or phone communication Impromptu meetings can also be made upon the agreement of both the mentor/mentee The formal relationship will end upon the mentee’s one year anniversary Both mentor and mentee complete program evaluations

Education and support for mentors Develop an educational offering that Describes what the mentor role is and is not Offers tools to help a mentor start conversations and set goals with a mentee Have a core group of mentor support available for answering questions in the beginning of the program (usually the mentoring committee) Core group also can provide support through e-mail at the time of match-up to encourage the mentors during this sometimes awkward phase of getting to know someone new

Evaluations Survey mentor satisfaction through e-mail or paper 11/9/2018 Evaluations Survey mentor satisfaction through e-mail or paper Open house receptions for the mentors and the mentees as a thank you for participating in the program Utilize Survey Monkey questionnaire for the mentees

11/9/2018 Lessons learned Initial presentation to the new graduates needs to be more formal Do not make the program mandatory for all new graduates! Need to develop a more formal evaluation plan for the mentor and mentee to complete at the end of their formal time period together Try to keep the mentors and mentees on the same campus, even if not in the same unit

11/9/2018 More lessons learned Offer more structured ideas for starting a mentoring relationship for those who may be having a tough time Encourage first time mentors to complete the mentoring e-learning that is offered to them Encourage mentors to revisit the mentoring e-learning Gather more feedback from mentees Have a goal setting form or a structured first meeting form (suggested example handout) Ask new mentors if they would like to have the learning put on their plan so that they don’t have to search for it

References American Association of Colleges of Nursing and University Health System Consortium (AACN/UHC). ( 2009). Retrieved from: http://www.aacn.nche.edu/education-resources/nurse-residency-program Beecroft, P. C., Santner, S., Lacy, M. L., Kunzman, L., & Dorey, F. (2006). New graduate nurses’ perceptions of mentoring: six-year programme evaluation. Journal of Advanced Nursing 55(6), 736-747. Community Health Network. (2014, August 27). The value of mentoring for a new graduate nurse. Retrieved from: https://www.youtube.com/watch?v=fD-sGXNVKkg Halfer, D., Graf, E., and Sullivan, C. (2008). The organizational impact of a new graduate pediatric nurse mentoring program. Nursing Economics, 6(4), 243-249.  

References Indiana State Nurses Association (ISNA). (2011) Independent study: Visioning the future of nursing: Analysis of the IOM/RWJ Foundation report. (ISNA Bulletin, August, September, October). Indianapolis: ISNA Kovner, C.T., Brewer, C.S., Greene, W., & Fairchild, S. (2009). Understanding new registered nurses’ intent to stay at their jobs. Nursing Economics, 27(2), 81-89. National Council of State Boards of Nursing. Transition to practice: Promoting public safety. Retrieved from: https://www.ncsbn.org/2013_TransitiontoPractice_Modules.pdf Pine, R., Tart, K., (2007). Return on investment: benefits and challenges of baccalaureate nurse residency program. Nursing Economics. 2007 Jan-Feb; 25(1):13-8, 39. Setter, R., Walker, M., Connelly, L. M., & Peterman, T. (2011). Nurse residency graduates’ commitment to their first positions. Journal for Nurses in Staff Development 27(2), 58-64.