Introduction.
There are many challenges which are facing hospitals in the recent past and especially in the new millennium, one of the major problem is the issue of nurse retention in the hospitals. Most of the people in the medical field and especially bedside nurses are abandoning their careers due to lack of job satisfaction.
There is a projected shortage of nurses in the next twenty years, these projections were made by the United States department of health and human services in 2002 and by use of the population reports which have been given, the deficit of the nurses is expected to be 29% an equivalent of one million nurses by the year 2020. This therefore means that there is a great need for trained and qualified nurses in the medical field since data shows that there was a 28% increase in the number of registered nurses (Rns) who chose non-nursing careers between the years 1992 and 2000 due to lack of satisfaction in their work.
This therefore means that there has to be a development of mentorship programs whose major project will be to enhance job satisfaction of nurses and this will definitely lead to improvement of nurse retention and the patient outcomes will also improve as the nurses will be more dedicated in their profession.
The concept of mentorship originate from Greek mythology and it was practiced in the muddle ages through the apprenticeships and it is defined as the relationship between nurses which is on the basis of mutual respect and compatible personalities with the main aim of guiding nurses towards profession as well as personal growth. In involves guidance, support, well-being, socialization, empowerment, education and career progression of individuals and it creates a supportive environment where the nurses will have the morale of coming to work.
Background and significance
The nursing field has been experiencing shortage problems and the current reasons for the shortage are quite different from the past reasons. In the past, the shortage was basically caused by lack of nurses for filling the positions available and the problem was easily solved through increase in enrollment and graduations in the nursing schools. However, the current problems are as a result of the nurses leaving the bedsides of the patients so that they can engage themselves in other roles associated with nursing and due to this, there has been a shortage of bedside nurses.
Studies shows that a great percentage of nurses plan to leave direct patient care in 5 years time and the reasons given are poor interdisciplinary communications, lack of autonomy and stress, others are frustrations, burnt out, workload and lack of support and respect. The costs associated with turnover are said to be twice the salaries of nurses and the cost of replacement is also great and unless the issue is addressed, the cycle will grow and create acute shortages of nurses. Data show that the mortality and mobility of patients are directly related to nurses patient load and showed that the mortality rate of additional surgical patient assigned to a nurse increased significantly due to inadequate orientation and training.
Staffing levels have also contributed to this, patient outcomes influence physician and patient satisfaction and also affects the bottom line of the hospital and since physicians and patients have the ability to choose the hospitals to be in, dissatisfaction of either of them impacts negatively on the revenues generated and as a result financial inability of the hospital to hire additional nursing staff and therefore the cycle is once again perpetuated. As the current shortage are expected to worsen, the nurse to patient ratio affects the safety and outcomes of patients, satisfaction of physicians as well as the fiscal status of the hospital. If nurses reasons for leaving are clearly known, the organizations should therefore respond by formulating strategies which will lead to increased retention (Block, Claffey, Korow & McCaffrey, 2005).
Statement of the problem.
From the literatures conducted, there is a positive relationship which exists between the nurse mentorship programs and the nurse retention rates where the increased retention is associated with adequate staffing which affects issues of patient safety such as mortality, medical errors and the length of stay in the hospitals. Increased retention of nurses also affects the expenditures of the hospital inversely since it leads to elimination of the costs which are associated to the hiring and the training processes which are conducted every time new nurses are recruited in the hospital. However, mentorship is not often regarded as an integral component of the nursing organizations but if it affects the retention rates and the retention affects issues such as patient satisfaction as well as a financial bottom line for the hospital, it should therefore be made an integral part of the organizations (Block, Claffey, Korow & McCaffrey, 2005).
The purpose of this study therefore is to review the impact that the mentorship programs has on the retention of nurses and the health organizations and the essential components of the program will be identified as well as suggestions for the implementations which should be made.
Literature review.
Most of the hospitals around the world consider nurses as a very valuable resource and as the nurse workforce age creating a shortage for the nurses, the newly graduated nurses who come into the facilities feel exited, nervous and ambitious. They experience stress during their transformation from students to nurses and this transformation calls for a mentoring program in the hospitals (Smith, n.d).
Mentor can be said to be a wise counselor and a trusted teacher with a mythological character, it is an intense relationship between a novice and a knowledgeable person or can also be defined as a long term relationship which promotes the well being of a novice. Roles of precepting, supervising, teaching and facilitating are equated but mentorship has a much broader role which involves both formal and informal supporting, coaching, guiding, role modeling, counseling and sharing. The process is a longitudinal relationship which in the long run develops in four stages and can take months and even years, these stages are initiation, cultivation, separation and redefinition.
Initiation involves the meeting of the mentor and the mentees, they get to know each other and set goals so that they can ensure the best success in building the relationship. The process of mentoring and being mentored are said to be voluntary and they should select for themselves the persons whom they want to be with and as the relationship between the two people matures, they then move to the second stage of mentorship development.
Cultivation which is the second stage involves information sharing, the joint problems are solved and this promotes a respectful confrontation of decisions as well as exploration of expected alternatives which are available. A successful mentorship process empowers the ability of the mentees to move forward in the career and the personal life which he/she has chosen and this process is the one that leads to the third stage.
The separation stage is the third stage and is where the mentees are separated from the original novice-expert roles and therefore the fourth stage which is redefinition comes along where the mentoring relationship is mutually redefined towards going separate ways or else towards an everlasting friendship (Benner, 1984).
Building of this relationship requires time together although there are others who view that the initial relationships build an everlasting partnership, more so, some personal attributes make the mentoring experience more successful.
There are various roles which are associated with mentoring, among then are to look for the values and skills of the mentees which can be developed and reinforced, to give a career advice which is honest and is important in a trusting relationship and the current skills should be reinforced so that they can be used for the current as well as in a future job. A mentor should be fully committed to mentoring relationship and should devote time for it, input and feedbacks should not be taken in an offensive manner and should help the mentees to develop an independent and creative thinking with an open and clear two way communication.
His goals as well should be to assist in the succession planning of the institution with a keen interest in creation and diverse roles of leadership, he/should assist the mentees to develop their career so as to become individuals with high potential, skill building, broadening of perspectives the creating an awareness of the objectives of the organization should be promoted and should also ensure self awareness so that it can enhance development of professional aspects of an individual (Bally, 2007). The mentor should also be an approachable person and empathetic and should not be judgmental because if they judge the mentees then it will be difficult to deliver full results (Blauvelt & Spath, 2008).
The mentees should follow through the decisions, have a passion for goal and career, personal and professional ethics and respectful thinking for one self. The key traits however are honesty, commitment of time and self, respect and communication skills and are very essential and they correlate highly with the caring attitudes of a person.
Mentoring and caring.
Caring involving helping of another person to grow and the major aspects of it are knowing one self and the other person, honesty, patience, hope of the possible and courage among others. Caring brings meaning, order, and stability to life which changes to both the care giver and the person being cared for. It is an international act to care for another person and the act involves concern, responsibility, a feeling of attachment towards each other. The theory of human caring describes the caring actions which are driven by moral intention to preserve human dignity as an interactive and metaphysical process which leads to personal relationships between the two persons.
The therapeutic nurse acknowledges another nurse’s subjective experience and needs to know self and therefore this determines the ability of the inability of the nurse to respond, this is similar to the mentoring moment where they both have a mutual opportunity and also a personal level of friendship where they can share with each other.
The informal mentoring process is not new in the field of nursing and so as to major more on the benefits, the formal programs started in the 1970s and today the mentoring program is has been made available in most of the settings such as clinical, leadership, educational and academia. There are many benefits which are accrued from formal mentoring programs; there are improved cultural exchange in the health facilities, personal; development of individuals is realized, there is a maximization of intellectual worth as well as an increased productivity from the people. There is an increased transfer of skills from one person to another and through this, there is an environment of continuous learning, there is efficient sharing of knowledge and the individuals are integrated with the organization as the image of the organization is enhanced (Campbell, 2007).
There are mentorship models which have been in use today, these are traditional, inclusion, team, vertical /horizontal mentoring forward model and horizontal peer-to-peer mentorship which help the nurses to to adopt the mentoring mentality of respect, openness, presence, sharing and learning in every relationship that they have. The models are very helpful during the organization of mentoring strategies although a more universal transformative model is needed for the growth of both the local and global partnerships in the educational and health care settings (Wagner & Seymour, 2007).
Improving retention rates in Newly graduated nurses.
The future of nursing is based on the newly graduated nurses, however, what should be asked is how the already experienced nurses welcome them and how they make them stay in the facilities. These graduates use a lot of the facilities resources in recruitments and orientation and they later leave thinking they can be more prosperous in another area, this attitude is because they are hired in the off-shit positions and they have less support systems in case of insecurities, they are also put in charge of the night shifts even before they are ready for the responsibility and this makes them unsatisfied. There are various studies which are done in regard on how to increase confidence, competence and retention of the NGNs (CNA, 2004).
The concept of preceptor is a positive force in the accomplishment of these elements although there is no enough data which shows how the programs which are used meet the needs and the expectations of the NGNs. The orientation for the NGNs can be very grueling, increased patient levels have added to their stress when making the transition from being a student to being a staff, this however can either be a motivating factor and can at the same time be a negative factor and can also create a barrier to learning if the stress levels are too high. NGNs say that their first months are very stressful and the greatest challenge is in putting the learnt theory into practice, the strategies which are given to them to address their needs are only the length of the orientation process, the personal approach of the NGNs through the preceptors and socialization aspect.
The NGNs complain that the preceptor programs are usually not long enough and the quality of nursing leadership can be greatly affected by quality nursing in relation to development of collegial relationships between the leaders and the staff and although most of the orientation process take place on the staff to staff basis, connections which are well established between the nurse managers and the NGNs are likely to lead to better and also long term relationships in the workplace.
The nurses hired into the float pools experience increased stress and due to this, many of the health institutions are hesitant in hiring the NGNs into the float pool, the current nursing shortage however will override the precedent and the graduates will be hired in to the float pools as well as the flounder in case there are no changes to be made in the process of orientation. It is very important to accept others into groups and should not make the NGNs life miserable and ‘eat their young’, therefore since they take care of patients, so they should also take care of they NGNs who are joining them and therefore orientation program should be adjusted so that they can meet the individual needs of the students.
Program development.
In a 150 bed community hospital nursing department, there was a strategic plan which was implemented in addressing the safety, satisfaction, skills and staffing and included the revamping of the orientation process for the newly graduated nurses. The hospitals orientation program classroom section was very much structured but they became less formalized from the time the newly graduated nurses moved in them. The was a review of the preceptor programs which are currently used and together with the the feedback which was derived from the nurses who had undergone the former or the old orientation process when they were NGNs, the information was presented to the leaders of the nurse.
The review which was conducted included Vermont Nurse Intern Project (VNIP) which the leaders of the nurses had seen in its detail in 2001 at the American Organization of Nurse Executives national conference. The portions which were used to develop the VNIP model were believed to help in meeting the NGNs needs and the leaders of the nurses agreed that confidence, competence and the satisfaction of the newly graduated nurses are very vital and are needed in the quest if increasing the retention of the bedside nurses and therefore there were funds which were released so that the new receptor program can be implemented so that the goals of the NGNs can be met.
Vermont Nurse Intern Project.
The Vermont Nurse Intern Project (VNIP) was due to a collaboration between colleges and hospitals in the entire state of Vermont and the model made was a match of a preceptor and preceptee who worked together in what was referred to as a ‘married state’ during the entire period of orientation. There was also an idea of working together in the complete shift during the entire period of eight weeks which was a contradiction of the normal NGN method where the patients are gradually taken at a time progressed instead of a nurse who already has the experience acting as a resource when he/she is required. The pair worked side by side in the entire process and there was a receptor who was always present so that the NGNs can be well guided and so that the receptor can demonstrate the organizational skills since there were unexpected changes which took place within the assessment. At the end of the program, the leaders and the organizations believed that the newly graduated nurses will be much better and will therefore be able to assume the full assignments for the shifts without any problems.
Designing a new preceptor program.
So as to revamp the orientation process, the professional development (PD)staff were the ones who took up the work. They were increased to 44 which was equivalent to full time so that they can be available in all the shifts and the class room week followed, there was a two week rotation which was allowed where each of the NGN was to spend a full day in areas such as the operating room, the recovery room, in the endoscopy, the invasive radiology, in the areas of stress testing and also in the department of emergency. This experience was so that they can understand the preparations, procedures and the aftercares which are required in a better manner. The ‘married state’ of VNIP was for achieving the necessary continuity and it was incorporated in the program, there was a requirement of 24 hours each week for the NGNs or even more and therefore the program had an 11 week minimum and there were extensions where it was seen necessary. The PD staff still observed the NGNs are they met on quarterly basis and also in other informal ways so as to monitor their progress and this also kept them alert on issues which may arise (Almada, Carafoli, Flattery, French & McNamara, 2004).
The feedbacks from the nurses in regard to the old orientation process showed that the hiring NGNs into the float pool was an issue that surfaced and those hired as floats in the past saw a lack of support after orientation and others had left the organization. Although it was decide to avoid hiring NGNs in the positions, it was not possible and therefore so as to fill the positions it was decided that NGNs will have additional orientation after the 8-week preceptorship where they would spend a month on other areas with a resource person.
In preparing the preceptor, they are to attend a full day program to increase styles of communication, learning and personality traits, and they were required to have a successful paring and the program was implemented with positive feedback. The study purpose was to provide NGNs with programs to increase retention rates and be better prepared in assuming roles.
Theoretical framework.
The leaders in the hospital believed ‘married state’ of NVIP will be well as new preceptor program and fit in novice to expert used in theoretical framework for PD’s and it was successful from the advanced beginner stage and it provides continuous feedback with positive results to the goal. The receptor program was developed on these considerations, preceptor presence will be one teacher and then to a resource person, according to (Benner, 1984), Novice to expert shows that NGNs have book knowledge but no experience to bridge gap from class to real patient care and therefore the program is to help them grow into staff nurse and not be hidden by it.
Research question.
Will a newly designed receptor program provide education, support, and help NGNs to accept their staff nurses role and as a result increase their retention rates?
Design.
There was both qualitative and quantitative technique with sample of 40 NGNs practicing in 150-bed non teaching community hospital at Massachusetts, 48 NGNs started the program but two did not complete and therefore not counted but included in the overall retention rate. Satisfaction data was based on 40 surveys and NGN retention on 46 nurses , demographics included 4 males, 42 females where 44 were Caucasians and 2 African Americans, ages were between 21 to 55 with 2 diplomas, 42 associate degrees and 2 baccalaureates.
Method of data collection.
Survey method of data collection was used and were given to each NGN after the receptor program completion, it addressed satisfaction, reasons why the NGNs are considering as basis for leaving, any possible improvements as a result of the program. The coded survey tool had closed and open ended questions and visual analogue scales (VAS) which maintained data validity. Advantages of using survey is that they are relatively inexpensive, can be used to collect large samples, they can be used in remote locations and are standardized therefore more precise and is highly reliable.
The rate of return from the survey was 89% from the sample of 40 and one survey was not used as the nurse did not use the VAS correctly, data on retention and vacancies were provided by the nursing resources director . The data showed nurses hired in a 14 month period before implementation and 14 month period for nurses hired after implementation.
Findings
For quantitative results, NGNs were asked if they have ever heard of the receptor program before coming to the organization and if it was of any influence to their decisions; 35 said they had heard of he program and influenced their decisions. 35 answered that the program was what they expected while 5 answered no, when asked to rank the aspects of the program, the aspects ranked as most important were duration of orientation, matching of preceptee and preceptor and availability of PD staff. When asked of the reasons which would make them to go elsewhere, sift availability, money and located were rated as most frequently.
VAS answered the question of overall satisfaction with program experience where high satisfaction rate was showed as the average of the VAS mean for the area was 93.7%, overall retention rate had increased from 60% to 89% therefore 29% increase and the hospital vacancy rate was 3% which was a decrease by 9.5%, the vacancy rate compare favorably to 10.2% which is a national rate and 9.3% for north east according to (American Organization of Nurse Executives, 2000). Due to uncontrollable situations and feeling of lack of acceptance and support, three nurses had left in a year and the retention rates for NGNs was 93%compared to the baseline of 25%.
From the qualitative research which was used in the second section , it had open ended questions which were of help to PD staff as they were to help them make any changes which would improve the program and of the 5 who answered that the program was not to their expectation, the issue of how it differed varied and nothing was noted among three of them, one said it was better than expected and no explanation for the other. When asked what they thought PD would do to support and prepare NGNs, there were three themes received which addressed hand-ons learning, education support from PD and instructions on systems and paper work, review of the statements by three nurses showed a 100% agreement on the themes and the issue on PD was more common. Issues on education were negative and positive and negative though majority were positive.
Discussion
Although there were many cases of NGNs leaving after one year, it was due to uncontrollable situations , there was increase in retention rates and the program feedback was positive, this was due to the increased duration for the orientation. The NGNs were more comfortable after orientation and there were few problems reported as the level of confidence and satisfaction was high. Although the study was aimed at increasing retention rates, there was an anticipated cost saving and it was realized since there were no traveling nurses and the costs for recruitments were spent to hire more staff and in orientation, intradepartmental relationships were also improved due to rotations between different departments.
Limitations.
Some of the limitations faced from the process is that it was difficult to monitor the new style which was used for precepting so as to get a 100% compliance, some of the persons acting as preceptors needed guidance in the area as much as the NGNs needed in their new roles therefore extra attention was needed for both. The sample size which was used for the study was small and the study was conducted for a single setting therefore the results were limited, The NGNs were only able to compare the program to their personal needs and expectations and they were taken to be the judges of the programs and they gave it a high mark.
Conclusion
When nurses mentor other nurses, they together help each other to grow. Some of the mentoring characteristics are such as compassion, respect, conscience, confidence, and overall caring attributes and so that the desired of creation of a transformative relationship can be realized, there is need for empowerment, mutual healing and personal growth and the mentoring needs should be reflective and have a meaning for both the mentor and the mentees and the mentoring needs should also go beyond the affective and the cognitive levels of understanding. The mentoring process is complex and multidimensional process which can be learned overtime as the work goes on, it requires aspects such as reflections, the knowledge of the mentoring process and the skills required, one should have reflection of of profession and self and there should have communication as well as social skills which will provide support the mentoring process. It can therefore be said to be a professional obligation and a strategy which is needed so that recruitment can go on well and increase the retention rates for bedside nurses and NGNs. All health facilities need to recognize and support the programs so that there can be a strong foundation for mentoring and so that the nurses can be satisfied with their work and therefore be more dedicated. As a result, the retention rates are increased and the financial use inf the facility is minimized which allows the facilities to improve the orientation programs and hire more nurses.
Reference:
Almada, P., Carafoli, C., Flattery, J. B., French, D. A. & McNamara, M., (2004), improving the retention rate of newly graduated nurses, journal of nurses in staff development, vol 20(6).
American Organization of Nurse Executives, (2000), acute hospital survey of RN vacancy and turnover rates.
Bally, J. M. G., 2007), The role of nursing leadership in creating a mentoring culture in acute care environments, Nursing economics, Vol 25(3).
Blauvelt, M. J. & Spath, M. L., (2008), passing the torch: a faculty program at one school of nursing, Vol 29 (1)
Benner, P., (1984), Novice to expert excellence and power in clinical nursing practice,
Menlo park, CA.
Block, L. M; Claffey, C.; Korow, M. K. & McCaffrey, R., ( 2005), The value of mentorship within nursing organizations, nursing forum, Vol 40 (4).
Campbell, C., (2007), mentoring in nursing:commitment with results, AAAGN viewpoint
Canadian Nursing organization (CAN), (2004), achieving excellence in professional practice a guide to preceptorship and mentoring, Ottawa Ontario.
Smith, L., (n.d), mentoring program increased retention, Danbury hospital, Danbury, CT.
Wagner & Seymour, (2007), a model of caring mentorship for nursing, journal for nurses in staff development, vol 23(5).
Appendix. 1
Survey sample
Section A.
Have you ever heard of the receptor program before coming to the facility?
YES. NO.
Did the program influence your decision making ?
YES. 35 NO. 5
Was the program what you had anticipated?
YES. 35 NO. 5
Rank the various aspects of the program in the below grid.
Not important Important Most important
Length or orientation
Matching of preceptor with preceptee
Availability of the PD staff
Which factors would make you go else where?
Not frequent Frequently Most frequently
Money
shift availability
location
7. overall satisfaction with the experience in the program.
Mean
8. What satisfaction do you have with the decision to work here?
9. Was the PD staff in tune with your needs?
10. What would be your overall rate for the preceptor program?
11. How many NGN left the facility in the first year of the receptor program and why?
Reason Number who left
High cost of housing
relocating due to work and family issues
total
Section 2
12. Was the program as you expected? ……………………………………………………………
13. What can PD do to prepare and support the NGNs?
Hands on learning,……………………………………………………………………………………
Instructions on the systems and………………………………………………………………….
Education and moral support……………………………………………………………………..
Appendix 2
Survey sample
Section A.
Have you ever heard of the receptor program before coming to the facility?
YES. 35 NO. 5
Did the program influence your decision making ?
YES. 35 NO. 5
Was the program what you had anticipated?
YES. 35 NO. 5
Rank the various aspects of the program in the below grid.
Not important Important Most important
Length or orientation 22 (55%)
Matching of preceptor with preceptee 14 (35%)
Availability of the PD staff 4 (10%)
Which factors would make you go else where?
Not frequent Frequently Most frequently
Money 0 4 18 (45%) shift availability 0 4 8 (20%)
location 1 1 4 (10%)
overall satisfaction with the experience in the program.
Mean
What satisfaction do you have with the decision to work here? 92.3%
Was the PD staff in tune with your needs? 96.7%
What would be your overall rate for the preceptor program? 92.2%
How many NGN left the facility in the first year of the receptor program and why?
Reason Number who left
High cost of housing 1
relocating due to work and family issues 2
total 3
Section 2
Was the program as you expected? ……………………………………………………………
What can PD do to prepare and support the NGNs?
Hands on learning,……………………………………………………………………………………
Instructions on the systems and………………………………………………………………….
Education and moral support……………………………………………………………………..