1. Mentoring In the Neonatal intensive care unit- A project for Nursing
Courtney Noel
Ferris State University
This presentation will outline a mentoring project in the Neonatal Intensive Care Unit (NICU) at Helen DeVos Children’s Hospital in Grand Rapids, Michigan. It is brought to you by Courtney Noel.

2. Overview What? When? Where? Why?
Provide a mentorship program for new nurses
When?
Beginning the nurses first week on the unit and continuing for one year following orientation completion
Where?
In the Neonatal Intensive Care Unit (NICU) at Helen DeVos Children’s Hospital in Grand Rapids, MI
Why?
To address the turnover rate and dissatisfaction being experienced in the NICU and to further career development leading to higher quality care and a decrease in complications for the nurse, patient, and the institution.
The focus of this project was to create a mentoring program for new nurses employed in the neonatal intensive care unit (NICU) at Helen DeVos Children’s Hospital in Grand Rapids, Michigan. The mentorship begins during a nurses first week on the unit and continues for one year following the completion of orientation. The reason this mentorship program was established is to address the high turnover rate and dissatisfaction being experienced in the NICU currently. The current NICU employs over 300 staff members with 250 of those being registered nurses caring for critically ill newborns at the bedside (Spectrum Health,2015). Many of these nurses have been in the NICU for two years or less; this is also the timeframe most voluntary resignations originate from (J. Snyder, personal communication, Sept 3,2015). Currently, the NICU turnover rate sits at approximately 12% (J. Snyder, personal communication, Sept 3, 2015). But, why do most nurses leave their jobs? According, to a study performed by Peter D. Hart Research Associates (as cited by the Joint Commission, 2012) the top reasons nurses leave their jobs are for a decrease in stress and physical requirements (56%), working hours more conducive to work/home balance (22%), greater pay (18%), and further opportunities for growth (14%).  Job satisfaction also plays a role in when people seek alternative employment. “In a recent study, 41percent of nurses working were dissatisfied with their jobs; 43 percent scored high in a range of burn-out measures; and 22 percent planned to leave their jobs in the next year” (Joint Commission, 2001, p.10).  However, despite these overwhelming statistics 74% of nurses surveyed stated they would continue in their current position if change was instituted (Joint Commission, 2001). High turnover rates and job dissatisfaction pose a risk to nurses, patients, families and the institution. For example, nurses are at risk for “chronic fatigue, job-related injuries, and even physical assaults” (Joint Commission, 2001). The institution spends large amounts of money training new nurses. In a critical care unit the average cost to orient a new nurse is 64,000 dollars (Joint Commission, 2001). Patients are at higher risk for poor health outcomes related to poorly provided care or a lack of care and dissatisfaction as well. In a survey of nurses reflecting on their last shifts 31% did not perform skin care, 20% did not provide oral care, 28% of nurses did not provide important education, and 40% did not comfort or speak to their patients or families (Joint Commission, 2001). Mentoring programs have been shown to increase job retention, improve job satisfaction, and provide continuing career development (Race & Skees, 2010). By positively impacting nurses greater care is achieved for patients and families and the institution benefits as well.

3. Goal
To create a mentor program by Dec 2, 2015 in which new staff (mentees) feel supported and appropriately matched with mentors (seasoned staff) at 21 days following program enrollment.
A S.M.A.R.T. goal is defined “as one that is specific, measurable, achievable, results-focused, and time-bound” (University of Virginia,n.d.). The S.M.A.R.T. goal identified as important in the success of the mentorship program is to create a mentor program by Dec 2,2015 in which new staff (mentees) feel supported and appropriately matched with mentors (seasoned staff) at 21 days following program enrollment.

4. OBJECTIVES Identify goals of mentorship program.
Draft proposal for mentorship program.
Identify requirements for mentor and mentee.
Send with mentor expectations and letter of interest request.
interested mentors biography blog and picture request.
Create mentor blog book.
Send request for biography questions from mentee.
Pair mentor/mentee by Nov 2, 2015 (1st group), subsequent groups to be paired by the conclusion of the mentees first week on the unit (mentees choose from 3 choices of mentors).
Host mentor/mentee lunch mixer: Date to be determined.
Send follow-up surveys to mentor/mentee by Nov 21, 2015.
Follow-up on surveys and make changes if needs arise by Dec 2, 2015.
In order to reach the S.M.A.R.T goal identified a number of objectives were necessary to complete. Short and long-term goals of the mentor program and requirements for the mentor/mentee needed to be identified. A proposal needed to be drafted and approved by NICU manager, Julie Snyder and the NICU shared leadership council. Once approval was granted an was drafted and sent to the neonatal unit requesting individuals to submit a letter of interest in regards to being a mentor. A biography blog and picture request was sent to those who submitted letters of interest. A mentor blog book was created containing pictures and blogs of interested mentors. A questionnaire was sent to mentees in order to allow the mentors to be narrowed down to three individuals who based on blogs and questionnaires would be good matches. During the mentees first week on the unit they are provided the three blogs and pictures and asked to make a decision about who they would like to be paired with. Allowing the mentee to pick their own mentor has been shown to create a more successful mentor/mentee relationship (Nobscot Corporation, 2015). A mentor/mentee lunch mixer will be included for mentors and mentees to get to know one another. A follow-up survey will be sent to both mentor/mentee to evaluate the relationship. Changes to the pairings will occur if needs arise allowing for a more successful partnership.

5. Project process & completion
Meet with manager to discuss mentoring in NICU
Draft proposal
Literature review of mentor programs
Meet with educator to discuss program
Write Proposal
Get proposal approved by NICU manager
Recruit interested individuals to join project team
Draft and send to current RNs in NICU
Follow-up on responses with meeting
Identify goals of mentorship program (with team)
Goals and concerns
Mentorship in the NICU
Examine previous successful mentor programs & literature
On the next few slides you will see the steps my team and I went through in order to complete this project. Currently, the lunch mixer is on hold due to professional constraints I encountered during this process (available on professional and ethical issues slide). This portion of the project will be reevaluated at a later date and initiated if approved and if a proper time can be achieved to include all individuals. At completion of this project time frame seven new employees (mentees) were paired with mentors. Only four of the seven returned the follow-up questionnaire or were paired long enough to meet time constraints determined in the goal statement. This was also a professional concern related to lack of mentee engagement. Of these four all felt supported and appropriately paired with their mentor based on returned questionnaires. While this does meet the goal defined at the beginning of this process I feel more progress needs to be made, changes identified on the professional and ethical issues slide instituted and further evaluation of outcomes followed to determine if this program is going to be successful in the NICU.

6. Identify requirements and expectations for mentor and mentee (with team)
Discuss requirements and expectations of mentor/mentee
Write up document containing expectations/requirements
Send to unit RNs with mentor expectations and letter of interest request
Draft with team
Send to current staff
interested mentors biography blog and picture request
Gather list of interested members
Draft biography blog questions
Draft mentor acceptance letter
Send containing blog questions and acceptance to the mentor team letter to accepted RN

7. Create mentor blog book Gather mentor biographies and pictures
Edit for grammar and professionalism
Place in laminated pockets in mentor binder
Send request for biography questions for mentee
Draft biography questions for mentee
Meet with orientation coordinator to discuss mentees start date
questions to mentee and compile responses
Present mentor program to Shared Leadership Council
Create PowerPoint detailing mentor program
Present to shared leadership council
Revamp according to shared leadership recommendations
Send recruiting day staff members
Assess s for membership desire
Send blog request and acceptance letter to dayshift willing staff members
Edit for grammar and professionalism add pictures
Add to mentor book

8. Pair mentor/mentee
Owner of process to pick three mentors determined based on blog question responses to be compatible with mentee
Mentee to choose one of the three preselected mentors
Mentor sheet to be moved to chosen tab in mentor binder and mentee blog to be stapled and dated to mentor sheet to allow for surveys to be sent and program to be discontinued at appropriate time
Host mentor/mentee lunch mixer: (ON HOLD)
Create plan
Draft invitation
Invite and plan activities/speakers
Send follow-up surveys to mentor/mentee 21 days (Nov 23, 2015) days post program enrollment.
Draft follow-up surveys for both mentor and mentee
Evaluate responses against goals
Respond to follow-up surveys
Change program and repair mentor/mentee if needed

9. Quality & safety
Problem: Poor communication related to -new unexperienced staff (high turnover) -nurse dissatisfaction -lack of trust between providers (high turnover) Service Analyzed: Nurse Orientation Solution: NICU Mentorship program (Quality improvement project) Quality Improvement Project: Analyzes a service over and over again to stop errors or improve satisfaction (Yoder-Wise, 2015). Results: Positive relationships, increased self confidence, more favorable patient care environment, increased communication between providers, satisfy patient safety goals outlined by the Joint Commission
Prior to proposing the idea of a nurse mentorship program areas of growth had been identified in the NICU at Helen DeVos Children’s Hospital. With the increased rate of turnover and the largely dissatisfied remaining staff it was determined multiple episodes of poor communication or a lack of communication between peers and other disciplines had potentially placed patients at risk for complications. This proved something needed to be done to encourage positive relationships and trust to facilitate these crucial conversations. Many of the issues seemed to stem from fear or a lack of self-confidence on the part of new staff. This caused analysis of the nurse orientation process or the beginning of a quality improvement project, mentoring in the NICU. A quality improvement process analyzes a service to stop errors or improve satisfaction (Yoder-Wise, 2015). By undergoing this quality improvement process nurses will be provided a trusted individual on the unit to ask questions and create a positive relationship with. This and other positive relationships born out of the mentoring process will provide the nurse more self confidence and comfort leading to a more positive patient care environment and increased communication between peers and other disciplines. According to Yoder-Wise (2015) “a more favorable patient care environment is associated with a lower rate of serious complications or adverse events” (p.376).  This quality improvement project also aims to satisfy the patient safety goal identified by the Joint Commission in 2014 of “improving communication between providers” (Yoder-Wise, 2015).

10. Professional/ethical issues
Confidentiality
Professional
Lack of continued engagement by team members
Lack of engagement by mentees
Difficulty with budget approval for mentor/mentee lunch mixer and time constraints
Most of the time as nurses we think about the ethical considerations concerning patients and families. But, ethical practice can touch nurses as well. In the quality improvement project, a mentoring program in the NICU, new nurses (mentees) are being taught and provided care by seasoned nurse (mentors). As individuals being cared for, the mentee has a right to expect a form of confidentiality. Their mentor should provide information about conversations had between the two parties only to the individuals deemed necessary to provide a positive care experience to the mentee. In this case those individuals have been identified as the nurse educators, the mentees clinical preceptor, and the nursing supervisors. Throughout this process it has come to my attention mentors have been speaking about some conversations in inappropriate areas or to inappropriate individuals regarding their mentees. In order to, combat this problem moving forward this expectation will be defined on the mentor/mentee expectations provided prior to acceptance into the program and matching. If a breech in confidentiality occurs the mentor will be asked to step out of the role.
Professional issues arise everyday in nursing. One of the professional issues identified during this process was a lack of continued engagement by staff identified as team members crucial to building a successful mentor program in the NICU. Members were aware of the commitment (meetings and collaborative efforts) expected prior to the initiation of this project. However, it was difficult to get members to be consistently present at meetings to provide feedback and assist in creating documents and the expectations outlining the program. As the project manager, I originally may have contributed to this situation by not actively listening and beginning the project with my own agenda and expectations. I needed to look at myself and be willing to change my approach. I then needed to be transparent with the team about my original behavior apologize and let them know I needed their expertise. I then needed to follow through as an active listener and respect others opinions to create the best mentor program possible. Another, professional issue experienced during this project is a lack of engagement by mentees. Some mentees did not return the original questionnaire provided them to allow for timely pairing with a mentee. Once paired this did not provide ample time to accurately assess the mentor/mentee relationship in order to measure success against the identified goal of this project. Going forward as a team and project manager I feel it will be necessary to explain the what, when, and why of the mentorship program to new mentees allowing them to understand the importance this program holds for them and the unit as a whole. My plan moving forward will be to meet with my team members and collaborate to create an overview document containing this information and provide it to the mentee prior to initiation of the program. I am hopeful that by understanding the rationale behind the program and the benefits it provides to them as professionals they will desire to be more engaged and timely. The third professional issue I encountered is the NICU manager left on maternity leave during implementation of this process. One of the nurse supervisors stepped in as interim manager in her absence. I had discussed the mentor/mentee lunch mixer with the NICU manager prior to her leave however, approval had not be passed on in her absence. The interim manager did not wish to commit to this process at the time and felt this issue could be reevaluated upon the managers return to the unit and a plan put in place for continuing lunch mixers strategically throughout the pairing process. Currently, the lunch mixer is on hold until approval and a further plan can be put into place.

11. Lessons Learned How to practice active listening
Importance of active listening in teamwork and collaboration
How to practice active listening
How to navigate the change process and help staff through the changes
The importance of a well developed project management plan (with flexibility) prior to beginning a project
By working through this process I learned many lessons which have had an effect on me both personally and professionally. I hope to continue to grow in not only my project management skills, communication style, and career development but as a person as well. One of these lessons is the importance of active listening in project management and any type of collaboration we as nurses embark on. According to Yoder-Wise (2015) all individuals desire to have some control of their environment and a belief their skills are being used to make a difference. By not actively listening individuals do not feel this is true. This can lead to disengaged staff, negativity, and poorly functioning teams (Yoder-Wise,2015). At the beginning of this project I believe as stated previously I managed a poorly functioning and disengaged team due to my lack of active listening skills. Sensing this problem with my team I did some research on how to effectively actively listen. This is the second thing I learned and will continue to progress at throughout my professional career. According to Heldman (2011) active listening is more than just listening it is observation and total engagement in the conversation. In order to do this effectively an individual must show interest, allow others to provide their thoughts and opinions without interruptions, eliminate distractions, ask questions or repeat what you believe you heard the individual say, and provide eye contact if possible (Heldman, 2011). I used the above techniques after researching active listening during meetings and collaborative efforts leading to much improved staff engagement and productivity. A third lesson I learned is what a change process entails and how to help an individual move through the process. Yoder-Wise (2015) explains there are three steps to a planned change including unfreezing, moving, and refreezing. In the unfreezing stage, an organization or person realizes a change is needed (Yoder-Wise, 2015). By sending out the literature I found during my literature review and what I am proposing to the unit and asking for individuals who want to work on the project and for unit feedback I am assessing if individuals are ready for a change and providing literature as to why this will be a positive change. “If more people understand and are in favor of the change it is more likely to occur and be successful” (Yoder- Wise, 2015, p.308). The second stage of change is the moving phase (Yoder-Wise, 2015). During this phase feedback and staff involvement are necessary in creating and planning how the change will occur (Yoder –Wise, 2015). Staff involvement gives staff a feeling of owning the change and makes them positive change agents (Yoder-Wise, 2015). These staff members will be proud and excited about the change and will spread the positive message to others allowing for a more effective successful change. The third step is refreezing (Yoder-Wise, 2015). During this phase it is important to reinforce positivity about the change to keep motivation and excitement at the forefront (Yoder-Wise, 2015). I will plan to do this by keeping staff apprised of how many people are being mentored and how those in the mentor and mentee phase feel the program is going based off of follow-up questionnaires. I will also keep the unit apprised of any changes made to the program based on feedback and continue to recruit interested individuals. The fourth lesson I learned is a well developed project plan is necessary to determine risks, impacts, constraints, time lines, and responsibilities (Heldman, 2011). By identifying these components early flexibility can be built into the original plan and the project has a higher rate of success.

12. References
Heldman, K. (2011). Project management jumpstart (3rd ed).Indianopolis, IN: Wiley Publishing Inc. Joint Commission. (2001). Health care at the crossroads: strategies for addressing the evolving nursing crisis. Retrieved from: _crossroads.pdf Nobscot Corporation. (2015).Mentoring tips. Retrieved from: frequently-asked-qu Race, T.K., & Skees, J. (2010). Changing tides: improving outcomes through mentorship on all levels of nursing. Critical Care Nursing Quarterly, 33(2), Retrieved from: Spectrum Health. (2015). Meet the neonatal center team. Retrieved from: University of Virginia. (n.d.).Writing S.M.A.R.T. goals. Retrieved from: ting_SMART_Goals.pdf Yoder-Wise, P.S. (6th ed.). (2015). Leading and managing in nursing. St Louis, MO:Mosby