A medical intensive care unit implements mentorship to ease the transition from novice to practicing nurse.
- After orientation is complete, newly hired nurses seek additional support from their peers.
- Mentorship programs can effectively support the emotional and professional health of novice nurses.
- Learn how to build a mentor program that meets the unique needs of new hires, supports a healthy work environment, and helps retain staff.
When adjusting to the fast-paced, frequently stressful atmosphere of a critical care unit, even the most knowledgeable nurses experience insecurity, uncertainty, and fear of failure. Patricia Benner’s novice-to-expert model describes a ladder of nursing skill acquisition (which can be aided by preceptors during orientation), but it doesn’t address the emotional journey involved. Mentor programs can positively influence new hires by supporting their emotional and professional health after formal training. Mentorship also is associated with increased career advancement and improved job satisfaction, which may increase nurse recruitment and retention.
The medical intensive care unit (MICU) at the University of Vermont Medical Center in Burlington developed and implemented an informal mentorship program to help support novice nurses as they transition into their staff roles.
Mentorship in action
In 2014, as a member of the practice council, I was tasked with conducting a survey of newly hired MICU nurses to assess challenges they face after orientation. In response to the survey, 33% of new nurses said they didn’t feel supported. Of those who did feel supported, many identified challenges and offered suggestions for improving the unit’s treatment of new hires; 100% of respondents felt that having a mentor might ease the transition from orientation to practice. The practice council reviewed the survey results and chose to move forward with creating a mentor program for new hires. I volunteered to research and build the program objectives, goals, and resource content. The council voted on the concepts and named me mentor coordinator. I formalized the materials and began recruiting mentors from among unit staff.
Newly hired MICU nurses complete a 14-week orientation called the Critical Care Nurse Internship, which includes class time, online exams, and a preceptorship. I designed the program to begin after orientation ends, when most new nurses reported a lack of support. The program’s objectives and goals were compiled in a reference guide that encourages mentors to share their expertise and experience, promote self-awareness, provide helpful feedback, and motivate their mentees. (See Guide for success.) As the mentor coordinator, I organized meetings and collected data about the program. I stepped down as mentor coordinator; that role still exists and is shared by two staff nurses. As full-time bedside nurses, they must complete their coordinator responsibilities in addition to regularly scheduled shifts (not to exceed 40 hours a week).
Formal mentorships typically have a defined end date and the mentor and mentee are matched by a third party. The MICU mentor program follows an informal model, which allows for a more natural, long-term relationship.
Research among mentored nursing students shows that mentees value the absence of strict guidelines to allow for maximum autonomy and flexibility according to individual needs and priorities. In the MICU program, new nurses select their mentors and together they determine the duration of the mentorship. In addition, the program doesn’t require the mentor to share the same schedule as the mentee, and in-person meetings are recommended but not required; instead, mentors and mentees can communicate via phone or email.
When new nurses near the end of orientation, the mentor coordinators introduce them to the program. They’re given a workbook that outlines the program’s objectives and goals and offers suggestions about how to find the right mentor, including examining learning styles (for example, verbal vs. hands-on), knowledge gaps, and professional goals. Identifying their needs helps mentees recognize mentors who will suit them. Some new nurses choose mentors they’ve already developed a rapport with and look up to professionally, or the coordinator may make suggestions based on the mentee’s learning preferences, professional goals, and schedules. For example, if a new nurse wants guidance on end-of-life care, the coordinator might pair him or her with a mentor who has experience with palliative care. For mentees who want to regularly work with their mentors, the coordinator compares schedules and makes suggestions based on how often shifts overlap.
After a mentor is selected, the pair meets with the coordinator to outline expectations, confirm contact information, and establish a meeting schedule. These mentor-mentee meetings (check-ins) provide an opportunity for the new nurse to discuss personal challenges, ask for advice, or simply chat with the mentor. Check-ins occur at least once a week for the first month after orientation.
The mentor program has provided an added structure to new nurses’ transition into the MICU and helped to establish a mentoring culture among the unit staff. The mentor coordinators continue to gain valuable feedback via surveys aimed at assessing how well the program is meeting its objectives. Since the program began in 2014, all new nurses who responded to the surveys indicated that it has met its chief objective: Providing support to new nurses and easing them through the transition from orientation to staff nurse. Over 87% of survey respondents described their mentorship experience as positive. The remaining respondents indicated that they received support from other staff members and felt the program was unnecessary. These responses were categorized as neutral because they didn’t indicate a negative outcome but suggest that the unit is developing a mentoring culture. (See Positive outcomes.)
Staff retention was another objective of the program as turnover can affect the cohesiveness of the work environment, burden remaining staff, and negatively impact patient care. After new nurses are hired in the MICU, they’re asked to remain employed in the unit for at least 2 years. Since the program began, 70% of participating new nurses remain employed on the unit; only 10% left it before their 2-year contract was complete.
Tips for success
Mentor program success depends on continuing assessment and leadership support.
As part of the mentee survey, new nurses were asked how long they feel mentorship should continue to provide support: 50% of respondents recommended 2 to 3 months of support after orientation, 33% recommended up to 6 months, 8.3% recommended 1 month, and the remaining had different durations. Based on this new information, the mentor coordinators now ask mentors to support their mentees for a minimum of 2 to 3 months after orientation.
The mentor coordinator role has proven essential to the ongoing success of the program. And management support has been crucial to ensure the coordinator is allocated time and resources to meet with new nurse participants, update materials, and assess best practice solutions. Evidence shows that mentorship can be effective only if the unit and its leaders make a firm commitment to support it. According to Race and Skees, 84.8% of healthcare organizations view nursing staff retention as an imperative, but little evidence suggests that this attitude translates into operational practice. By dedicating hours to the coordinator role and developing a mentor program, leaders will reap long-term benefits of increased job satisfaction and retention.
The success of this program reflects directly on the practice council’s original commitment to support the mentor coordinator role and the veteran staff nurses who continue to volunteer as mentors, diligently working to provide support to new nurses and building a healthier work environment one mentorship at a time.
Emily Glassman is an RN III mentor coordinator in the medical intensive care unit at the University of Vermont Medical Center in Burlington.
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