Mentoring is an opportunity to impart experiences, skills, perspectives, and ideas to accelerate the success of another person. Historically, nurses have been bred from the “nurses eat their young” mentality where experienced nurses pride themselves on an almost hazing ritual with new staff in the misconceived idea that this will toughen the novice nurse. Not only is this a dangerous culture for patients, it is a practice that has caused numerous nurses to leave the profession early in their career paths. By developing a formal mentoring program for nurses, organizations can recruit and retain quality nurses and positively impact the overall culture of the nursing departments.
According to an article by Eleanor Barbera, PhD, turnover rates in long-term care is alarmingly high, 55%-70% for nurses and up to 100% from CNAs. The cost of replacing a nurse who leaves ranges from $38,000 to $61,000 – which translates to nearly $7M in annual cost to an organization. During exit interviews, nurses’ site “personal reasons” as the number one reason to voluntarily resign and an alarming 23.8% of all new hires leave within the first year. Multiple studies show that formal mentoring programs can reduce the overall turnover rate for businesses, and healthcare is certainly a business.
Mentoring is different than preceptorship, but when these two crucial methods are brought together under the same umbrella, nurses in new clinical areas are set up for success. Precepting is the process where an experienced nurse is tasked with overseeing the skill development of an inexperienced nurse. This isn’t always a new nurse, as seasoned nurses often take on new roles during their careers. An example might be a nurse with 10 years of experience in the Intensive Care Unit who has taken a position and change of pace as an MDS coordinator. An experienced MDS coordinator or ADON is assigned to precept the new nurse with a list of skills that the precepting nurse must teach the novice nurse. However, organizations must choose experienced nurses who can teach new skills as well as provide mentoring to the new staff (mentee). Unfortunately, most departments choose the most clinically-skilled nurses or most senior nurses as preceptors, but these nurses may not be the most effective at teaching or mentoring.
According to Ann Tardy at LifeMoxie Mentoring & Leadership, in conjunction with the Association of California Nurse Leaders, there are nine stages of mentoring to consider when developing a formal mentoring program. When these stages and expectations are built into a dual Preceptor/Mentor program, this will not only teach and enhance skills, but will impart the experience, perspectives, and sponsorship that should occur for new staff. Sponsoring is where the mentor seeks out additional experiences for the mentee, speaks up for or defends the new nurse or promotes the qualities of the nurse to physicians or other interdisciplinary team members. In contrast to the “eat their young” behaviors, the concept of “sponsor and praise in public, criticize in private” will eventually create a positive change in cultural norms of how new staff members are received and perceived in the department. This is not only reserved for the direct care nursing units; this model also applies to nursing leadership.
These nine stages are designed to promote a formal process which the mentor and mentee can rely upon during the assigned relationship. Each stage can easily translate into a Precepting/Mentoring program:
- Prepare: Nursing Education, in collaboration with departmental leaders, develop a unit-specific formal program to address the principles of sponsorship, mentoring, and precepting.
- Connect: Seasoned nurses with strong clinical skills and proficiency in developing relationships are matched with new nurses.
- Establish Trust: Part of the formal program should include written exercises in how to develop trust, such as identifying common interests or providing free lunch tickets for the mentor and mentee to spend time together out of the department.
- Clarify the Goal and Measure of Success: The formal program will define overall goals (to foster an inclusive relationship between staff and improve competency) and will include checklists of skills to define the success of the preceptorship. The list could also include the expectation for the mentor to provide introductions with overlapping departments, such as physical therapy and the dietitian.
- Agree on the Structure and Expectation: The program will define the time frame of the formal relationship. Ideally, the formal mentoring evolves to an informal mentoring relationship which will foster inclusion and belonging, thus reducing turnover in the organization.
- Engage in Mentoring Activities: Part of precepting and mentoring is allowing time for feedback. For example, having the new nurse present to the physician directly during interdisciplinary care plan meetings. Any feedback or criticism is done in private.
- Engage in Conversation: This could include a book for the new nurse such as Stephen Covey’s The Speed of Trust or a book related to the nursing department. The mentor and mentee could read these together and have scheduled time to review the takeaways.
- Seek and Share Advice: It is imperative to the success of a mentoring and precepting program to allow time in the partnership’s schedule to review key incidents or ask questions. Ideally a nurse who is assigned as a preceptor/mentor will have a slight reduction in their daily assignments to allow for this crucial interaction.
- End and Debrief: At the end of the formal program, both the mentor and the mentee should have the opportunity to rate one another in strict confidence. The organization must be confident in the new nurse’s ability to safely perform their role independently. Likewise, the department must ensure that those participating in a preceptor/mentor role are competent to provide all of the essential elements required in a reputable and sustainable program.
Healthcare organizations who are seeking methods to reduce nursing turnover rates and create a culture of inclusion must consider the value that formal mentoring brings to the business of healthcare. As more nurses retire from the workforce in the next 10 years, it is wise to invest in programs to attract, train, and retain newer nurses to establish a positive and sustainable workforce.
Additional resources: Nurses who thrive in mentoring and leadership positions could benefit from looking into earning a dual MSN/MBA degree.