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Angela Campbell, RN, arrived at North Broward Medical
Center in southern Florida fresh out of nursing school
and full of excitement and enthusiasm. Within a few
weeks, she found herself engulfed in a new nurse's worst
nightmare.
A nurse on the night shift ridiculed her because she
didn't know certain procedures, she said. Campbell felt
afraid to ask questions. Other veteran nurses said she
couldn't be trusted. Frightened and confused, she made
a minor error.
Campbell was in her mid-30s. She'd worked as a teacher
in her native Jamaica and earned a business degree in
the United States. She'd gone to nursing school on a
scholarship and graduated with a B average. But she
began to think she was stupid. That she wasn't fit to
be a nurse. That she'd chosen the wrong profession.
"I was miserable," Campbell said. "My
self-confidence went down to the ground."
After Campbell's mistake, several nurses expressed
concern about her to Marlene Roman, MSN, RN, medical/surgical
clinical nurse specialist at North Broward and Coral
Springs Medical Center and president of the Academy
of Medical-Surgical Nurses. After hearing Campbell's
side of the story, Roman had her switched to a day shift
with a supportive preceptor.
Roman became Campbell's mentor, meeting with her regularly
and reassuring her that she wasn't expected to know
everything, that no question was too stupid, that she
was a good nurse. Eventually, Campbell went back to
the night shift under a new manager.
"Her manager told me she's a star on nights,"
Roman said. "Angela has told me she's so proud
of herself."
If Campbell had had an experienced mentor to go to
early on, Roman said, she might have been able to get
help dealing with the other nurses' criticism instead
of spending nights sitting alone in her car before her
shift, praying she would not make a mistake.
Campbell's experience and similar horror stories from
other new graduates have prompted Roman and other nurses
from the Academy of Medical-Surgical Nurses to propose
the creation of a new nurse mentoring program for hospitals.
Although the program is still being fine-tuned, a number
of hospitals already have started asking experienced
nurses to help green ones.
In an effort to keep new nurses such as Campbell from
becoming overwhelmed and leaving within their first
year, hospitals around the country are implementing
formal mentoring programs that pair first-year nurses
and other new employees with hospital veterans.
The programs vary widely. Some use mentoring as part
of an integrated new-nurse internship program. Some
use carefully trained preceptors as mentors, others
keep the roles purposely separate. The programs may
last less than six months or as long as a year.
Some programs started by focusing on nurses fresh out
of school, but many have expanded to include all new
employees, including nurses who are returning after
being away and nurses who have worked in other hospitals.
Although most hospital nurse mentoring programs focus
on new graduates and new employees, nurse consultants
and others who deal with nursing workplace issues say
the profession needs to rethink the value of mentoring
for nurses at all levels of their career: when they
start a new job, when they enter a new department, when
they go back to school. All of those situations may
require a slightly different type of mentoring.
"The one thing about mentoring in nursing is that
it is so complex," said Katherine Vestal, Ph.D.,
RN, president of Work Innovations Inc. a health care
consulting group. "It's anything from politics
to clinical details. It's not an easy job."
Formal mentoring programs are specifically tailored
for new employees because many hospitals report that
their greatest retention problems occur in the first
year or two of the nurse's arrival and sometimes as
early as within six months. The new nurses often have
no time to find mentors on their own.
"In some places, 40 percent to 50 percent of all
new grads leave within a year, and that's costly to
management and disheartening for the new grad,"
said Cecelia Gatson Grindel, Ph.D., RN, associate director
for the undergraduate program at Georgia State University
in Atlanta and a founding member of the Academy of Medical-Surgical
Nurses.
In days past, before patient stays became shorter and
nurses had more time to spend with patients and colleagues,
mentoring often occurred informally. Roman remembers
working with other new nurses who banded together as
a team. "We basically mentored each other,"
she said.
Now, hospital nurses, battling short staffing and mountains
of paperwork, often have little time for anything but
their work. "Nurses today often are stressed to
get even basic patient care done and feel they can't
devote the time needed for mentoring," Vestal said.
Little experience
At the same time, many new graduates come into the hospital
with little patient care experience, said Carol Ann
Cavouras, MS, RN, president and owner of Lawrenz Consulting,
an Arizona-based company that works with acute care
hospitals on staffing and scheduling. "They're
just not as comfortable in the hospital as they were
years ago," she said. Nurses returning after a
few years may find increased patient loads and unfamiliar
technologies. The pace is fast, the responsibility terrifying.
After a few weeks of training they are expected to jump
right in, said Charles Krozek, MN, RN, director of research,
education and patient care services, and director of
RN internship in pediatrics at Childrens Hospital Los
Angeles.
Even experienced nurses from other hospitals may find
themselves in need of someone to make them feel welcome
and to help them navigate the system. Mentoring programs
are "a retention effort, but they're really helping
new people with the culture," Cavouras said.
Two-and-a-half years ago, Childrens Hospital Los Angeles
decided to try reversing its 36 percent new-grad turnover
rate by implementing a six-month nurse internship program
for all new nurse employees. The program includes intensive
preceptoring, debriefing and self-care, a classroom
and skills lab and a mentoring program.
In the program at Childrens, mentors are nominated
by their peers. They meet with new nurses over pizza.
Based on that meeting and written profiles, each new
nurse selects several prospective mentors. The internship
office makes the final match.
For the six months of their internship, mentors and
mentees must meet once a week. They talk about everything
from career goals to problems with staff members to
balancing their personal and professional lives, Krozek
said.
At Albert Lea (Minn.) Medical Center-Mayo Health System,
new graduates used to choose mentors from a bulletin
board where their profiles and photographs were posted.
The hospital began its mentoring program in 1994 based
on a similar one in a public school. Administrators
found that some nurses ended up with too many mentees
and some eager mentors didn't get any, said Jane Madson,
RN, staff development coordinator at Albert Lea.
Administrators now match mentors with new grads, based
on their personalities and interests, said Lori Routh,
RN, hospital director of nursing at Albert Lea.
Many mentoring programs, including those at Albert
Lea and Childrens Hospital Los Angeles, assign mentors
who are not preceptors specifically so that new nurses
can talk to their mentors without worrying about how
it will affect job-performance reviews.
At Seton Healthcare Network, based in Austin, Texas,
preceptors and specialty educators are trained to be
mentors, to make sure all new nurses feel comfortable
and welcome both during and after their orientation.
"When you leave nursing school, you leave the
safety of your clinical instructor," said Joyce
Batcheller, MSN, RN, senior vice president of operations
and chief nursing executive for Seton. The preceptors
and specialty educators understand they are filling
that role until the new nurses gain confidence, she
said.
Most programs include a training session for mentors,
explaining how to be a good mentor, what mentors should
and shouldn't do and even how to end a mentoring relationship
when it is time for the mentee to move on. Mentors are
not usually monetarily compensated, but many programs
allow and even encourage the pairs to meet on company
time. Some hospitals offer appreciation lunches or other
rewards for mentors.
Administrators said they have quickly reassigned mentors
if either member decides the relationship is not working
out, but they added that this happens infrequently.
Rewarding work
Mentoring new nurses is rewarding, but sometimes a lot
of work, said Jill Morstad, RN, an intensive care nurse
at Albert Lea and a mentor since 1994. "It causes
a little extra stress that some days you don't need,"
she said. But she feels a responsibility toward the
new nurses at her hospital.
"You need to help those nurses grow up in the
profession," she said. "If we're not going
to nurture our own, who is going to nurture them?"
Because most programs are so new and because they vary
so much, data on the value of mentoring are sparse.
Childrens Hospital Los Angeles reported a drop from
36 percent to 16 percent in new-graduate turnover rates
in the 2½ years since implementing its internship
program.
Since starting its mentoring program two years ago,
Botsford General Hospital, a 330-bed community facility
near Detroit, has assembled 43 volunteer mentors from
various units and specialties, said Connie Fleming,
MSN, the hospital's director of nursing services. "It's
starting to make a difference," Fleming said. Before
the mentoring program, the hospital found it was losing
nurses within the first two years of their hire dates.
"We're not losing as many people during that time,"
she said.
Administrators of formal mentoring programs said they
hope this introduction to mentoring will show new nurses
the importance of finding their own mentors as they
progress in their careers. Some said they would like
to expand the formal programs to other areas, such as
nurses entering new departments.
Because the role has changed so much in the last decade,
nurse managers are especially in need of mentors, Vestal
said. Vice presidents of nursing who used to help new
managers adjust to their jobs are often too busy essentially
running a small business, she said.
Without leadership development, management development
and coaching-all areas traditionally developed through
mentor relationships-many new nurse managers are left
to wither on the vine, Vestal said. "They end up
extremely frustrated, unable to meet the expectations
of the day."
What the profession needs to do, she said, is to figure
out a way to measure the benefits of mentoring at all
levels. "What you can't measure, you can't reward,"
she said.
In addition to persuading hospitals to adopt its mentoring
program, "Nurses Nurturing Nurses," the Academy
of Medical-Surgical Nurses plans to collect and study
data to provide more hard figures on the value of new-grad
mentoring.
Many benefits of mentoring are difficult to measure.
One of those is the number of mentoring relationships
that develop into friendships between peers.
For Lisa Riedel, RN, and her mentor, Jennifer Lara,
RN, both staff nurses in the intensive care unit at
Botsford, the relationship has already become more of
a friendship. Both are planning to go to graduate school
in the same field and their conversations, mostly by
phone and over the Internet, are about their school
plans. They also have talked about staff members, "what
number to you use to call in when you're sick, how long
are breaks, really, and that kind of stuff," Riedel
said.
Although Riedel was a six-year nursing veteran when
she started at Botsford, she was still pleasantly surprised
when Lara approached her, introduced herself as her
mentor and showed her where the time clock was.
"It was nice to have somebody who was familiar
with me and was there to greet me," she said.
Lara and Riedel work different shifts and haven't talked
much face-to-face, Lara said. "But she knows I'll
be here if she needs me. I know I've gone to her for
things. Hopefully I'll know her for years to come if
she stays around. I hope she likes it here."
Cathryn Domrose at kaguilar@well.com
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