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An Overview of Mentorship for New Graduate Nurses
The transition for a novice nurse should not be underestimated. Despite the hours of studying done in nursing school, new graduates tend to feel ill-prepared for the workforce. It is shown that new nurses benefit from continued mentorship beyond that of a typical orientation. In review of eleven articles exploring the impact of mentorship for new graduate nurses, the theme is overwhelmingly positive.
The studies conclusively report that mentorship is beneficial to the mentor, the mentee, and the profession at large. Mentees report that mentors increase their confidence as well as their career satisfaction (Ivey, 2012). Increased career satisfaction results in a cascade of benefits including a decrease in new graduate turnovers, improved quality care, and reduced hospital costs. These results support the need for continued education through mentorship as well as an alteration to the current orientation process.
Keywords: mentoring relationship, new graduate nurses, retention, job satisfaction, transition to practice, nursing shortage
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The concept of “mentorship” has been around for centuries. The original mention of “mentor” comes from the epic poem “The Odyssey” where a wise man named, Mentor takes on the task to educate Odysseus (Byington, 2010). This book dates back to 800 B.C. and yet, the current definition of a mentor has not changed. A mentor is merely an “experienced and trusted advisor” (Simpson, 1993).
In nursing, as in many other professions, professionalism is developed and is greatly influenced by mentors. This requires a host of resources including educators, finances, and a willing vessel. The goal of this research paper is to explore the role and power of mentorship in the process of developing well rounded and competent new graduate nurses. This paper will also take into account the impact of mentorship on the nursing profession as a whole.
For the new graduate nurse, there is a steep transition. The 1,080 classroom and clinical hours only take an individual so far. The patient load goes from two to six, the demands triple, and yet, the number of questions still remain. It is a common experience for new graduates to feel overwhelmed and inadequate as they overcome their theory-to-practice gaps. It is frequently reported that new nurses experience substantial self-doubt and insecurity in their new role (Gazaway, 2019). Many studies explore this time of transition and are finding orientation programs to lack individualization, consistency, and follow up with their new graduate nurses (Szalmasagi, 2018). This lack of continued mentorship or preceptorship is revealing detrimental effects for the nursing profession (Andersson, 2010).
Patricia Benner addresses the need for continued mentorship in the concept “From Novice to Expert.” This theory states that there are five levels of proficiency a nurse moves through as clinical experience is acquired. As experience is gained, the nurse gradually moves from practicing according to rules and guidelines to advancing to an instinctual form of nursing that Benner defines as expertise.
In the initial stages of an individual’s career, they are considered a novice who will then transition to an advanced beginner. Benner suggests that during these stages a nurse would most benefit from having a mentor (Ivey, 2012). A mentor will help challenge them to think critically as they gain experience through practice. It is estimated that it takes two to three years before a nurse is competent and has moved from the advanced beginner stage (Davis, 2016). Unfortunately, the nursing profession typically does not invest in their nursing graduates longer than six months.
The average orientation for a new graduate nurse is roughly three to six months depending on the hospital and location. Preceptorship is often terminated after the completion of this designated timeline leaving the new nurse to practice on his or her own. One study on this transition to practice revealed that graduate nurses do not feel comfortable, skilled, or confident until up to a year after being hired (Casey, 2004).
This leaves a gap in that transitionary time where new nurses begin to feel dissatisfied with their new role. Reported factors contributing to this dissatisfaction include a lack of support from experienced nurses, knowledge deficits, long hours, and stress (Szalmasagi, 2018). This has been leading to low job satisfaction and extremely high turnover rates within the first year of graduation (Byington, 2010).
A study performed in 2010 estimated 35-60% of new nurses leave their job within the first year, with 50% of new nurses leaving the profession within the first few years (Gray, 2018). Another study done in 2013 found that retention rates ranged from 25-64% for new graduate nurses hired in various hospitals (Friedman, 2013). These numbers are substantial, carrying a severe impact on the nursing profession and the healthcare system.
Hospitals have been looking to change these statistics and are finding that mentors play a crucial role in combating this vicious cycle. One hospital in the Midwest had a looming turnover rate of 31% for their new graduates. A pilot mentorship program was implemented for one year reducing their turnover rate to 0% (Gray, 2018). This has been attributed to a mentor’s ability to instill confidence, provide comfort, and promote competence (Gazaway, 2019).
The main goal of mentorship is to support new nurses in discovering their potential by giving them the confidence to grow (Rosser, 2017). A research article done by Teresa Byington discusses the keys to a successful mentor relationship which she lists are; trust, clear expectations, a common goal, and collaborative problem solving (Byington, 2010).
This structure allows for exploratory growth with the oversight and reflective feedback of someone more experienced. Several studies have revealed that this sort of mentorship model has a staggering impact. The participants of one study reported that the emotional support provided by the mentor made them feel accepted in the work environment and helped them navigate their negative feelings and uncertainty (Gazaway, 2019). This had a direct impact on the mentee’s desire to remain committed to the company and the profession (Gazaway, 2019).
Other benefits mentees have reported is the value of feedback and the gradual stretching they were provided through mentorship. The mentor’s feedback allowed them to see their deficits without feeling overburdened by their mistakes. This enabled the participants to change their approach, integrate the new knowledge gained, and move on (Gazaway, 2019). The benefits of this model provide professional growth for both the mentee and mentor resulting in a mutual increase in career satisfaction without an overburdening commitment (Gray, 2004).
According to the Institute of Medicine, the benefit of mentorship extends to the entire profession (Gray, 2004). Developing a partnership between novice and expert has been shown to improve patient safety, increase career advancement opportunities, increase productivity, and reduce hospital spending (Gray, 2004). A study done in a small community hospital in northern Indiana revealed a cost savings of $597,778 after the implementation of a mentorship program within the first year. The cost of mentorship in this rural hospital averaged $10,000, while the cost of a single turnover reached $42,000 to $64,000 (Szalmasagi, 2018). This study reveals that reducing new graduate turnovers not only impacts the nursing shortage but reduces hospital spending.
Mentorship is a great solution to help bolster the profession. The United States is currently in a nursing shortage that is only projected to increase as the Baby Boomers age and the need for health care increases (Nursing Shortage, 2019). It is even noted that nursing schools are having difficulty staffing hitting the profession at its roots (Gray, 2004). These barriers have only been heightened by the influx of new nurses leaving the profession. This has caused us to take a desperate look at the way we do things.
It seems the only way to counteract this nursing shortage crisis is by finding ways to invest in the next generation while maintaining the satisfaction of the current workforce. This will require increased creativity and incentives for preceptors. In a profession that is already short staffed, it would be important to provide rewards when asking for further involvement. Studies have already been exploring other forms of mentorship including peer to peer mentorship which has provided similar results. There are solutions, but it may require thinking outside the box.
There is a saying “nurses eat their young,” this cannot be the case anymore. A culture of nurturance and empowerment needs to take precedence. People are living longer and sicker lives. Nursing is not an individual sport, but a team effort. It is important to help spur each other to higher standards by being approachable and yet, teachable. This allows for mutual growth for not just the individual, but the profession. Those who have been in the practice have invaluable knowledge that is ready to be gleaned from. Maybe this next era will be marked by the saying “nurses teach their young.”
References
- Andersson, P.L. & Edberg, A.K. (2010). The transition from rookie to genuine nurse: Narratives from Swedish nurse 1 year after graduation. The Journal of Continuing Education in Nursing,41(4). doi: 10.3928/00220124-20100326-05.
- Byington, T. (2010). Keys to Successful Mentoring Relationships. Journal of Extension, 48(6): 1-4.
- Casey, K., Fink, R. R., Krugman, A. M., & Propst, F. J. (2004). The Graduate Nurse Experience. JONA: The Journal of Nursing Administration, 34(6), 303–311. doi: 10.1097/00005110-200406000-00010
- Davis, A., & Maisano, P. (2016). Patricia Benner: Novice to Expert – A Concept Whose Time Has Come (Again).
- Friedman, M.I., Delaney, M., Schmidt, K., Quinn, C., & Macyk, I. (2013). Specialized new graduate RN pediatric orientation: A strategy for nursing retention and its financial impact. Nursing Economics, 31(4). Retrieved from https://www.medscape.com/medline/abstract/24069715
- Gazaway, S., Gibson, R. W., Schumacher, A., & Anderson, L. (2019). Impact of mentoring relationships on nursing professional socialization. Journal of Nursing Management, 27(6), 1182–1189. doi: 10.1111/jonm.12790
- Gray, F. C. (2018). Mentoring and Advising to Reduce the Nursing Shortage. Austin Journal of Nursing & Health Care, 5(2), 1–2.
- Ivey, Jessica, ‘Transition from Student to Nurse: The Orientation Process’ (2012). Nursing Theses and Capstone Projects. 123. https://digitalcommons.gardner- webb.edu/nursing_etd/123
- Nursing Shortage. (2019). American Association of Colleges of Nursing (AACN). Retrieved from https://www.aacnnursing.org/news-information/fact-sheets/nursing-shortage
- Rosser, E. (2017). Developing our future leaders: the role of a global mentoring programme. British Journal of Nursing, 26(18), 1045–1045. doi: 10.12968/bjon.2017.26.18.1045
- Simpson, J. A. (1993). Oxford English dictionary. Oxford: Clarendon Press.
- Szalmasagi, J. D. (2018). Efficacy of a Mentoring Program on Nurse Retention and Transition Into Practice. International Journal of Studies in Nursing, 3(2), 31. doi: 10.20849/ijsn.v3i2.378
