Mentoring is one of the broadest methods of encouraging human growth and potential.
After completing this chapter, you should be able to:
• Describe the difference between mentoring, coaching, and precepting.
• Identify characteristics of effective mentors, mentees, and preceptors.
• Implement strategies for finding a mentor.
• Discuss the types of mentoring relationships.
• Examine components of a nurse residency program.
Ashley
It was my first day as a nurse extern in a busy medical intensive care unit. As I walked into my new place of work, I observed nurses on the phones, talking with doctors, and running in and out of patients’ rooms with stern looks on their faces. So many questions were going through my head. Which one of these nurses was my preceptor? What would my preceptor expect from me? Would he or she be receptive to helping me develop into my role as a professional nurse? I entered the room where the nurses receive hand-off report from the night staff. It was there that I had my first encounter with Julie, who would become my preceptor, nursing role model, and mentor in the months ahead.
Historical Background
Did you ever wonder where the word mentor originated? It originated from Greek mythology. Mentor was the name of a wise and faithful advisor to Odysseus. When Odysseus (or Ulysses, as the Romans called him) left for his long voyage during the Trojan War, he entrusted the direction and teaching of his son, Telemachus, to Mentor. According to mythology, through Mentor’s guidance, Telemachus became an effective and beloved ruler (Shea, 1999). Mentor’s job was not merely to raise Telemachus but to develop him for the responsibilities he was to assume in his lifetime. Mentoring is one of the broadest methods for encouraging human growth and potential.
What Mentoring is and is Not
A definition of mentoring in nursing is captured by Meier (2013) as “a nurturing process in which a more skilled or more experienced person, serving as a role model, teaches, sponsors, encourages, counsels and befriends a less-skilled or less-experienced person for the purpose of promoting the latter’s professional and/or personal development” (p.343). Oftentimes, the term mentoring is confused with coaching or precepting. Coaching is an approach to assisting an individual’s growth through partnership with a colleague or other individual who is an equal. In coaching, one person focuses on the unique and internal qualities observed within the other person that may not be recognized or appreciated (MindTools, 2016). In the business world, executives often refer to themselves as coaches rather than managers, thus fostering a collaborative team-oriented approach. The International Coach Federation (2016) defines coaching as a partnership that enables and motivates the individual receiving coaching to attain his or her highest achievement in all areas of life. From a nursing perspective, the term health coaching describes the partnership between the nurse and patient, where the nurse assists the patient in identifying and engaging in healthy lifestyle choices. Olsen (2014) offers an operational definition of health coaching as “a goal-oriented, client-centered partnership that is health-focused and occurs through a process of client enlightenment and empowerment” (p. 24). From these definitions, it is clear that coaches help individuals find new ways to solve problems, reach goals, and design plans of action to motivate people to participate in activities that will advance and fulfill all aspects of their lives. According to Guest, “The strength of mentoring lies in the mentor’s specific knowledge and wisdom, in coaching it lies in the facilitation and development of personal qualities. The coach brings different skills and experience and offers a fresh perspective, a different viewpoint. In both cases one-to-one attention is the key” (1999, p.7). An effective coach does not need to have experience in the activities or context of what he or she is teaching. Rather, an effective coach has a unique set of qualities for coaching individuals in achieving knowledge and skills in a particular area.
Based on these definitions, coaches possess characteristics of mentors, and mentors share attributes of coaching. Considering this, mentoring and coaching complement one another and are often used concurrently in assisting individuals to grow both professionally and personally.
What about preceptors? The term preceptor simply means “tutor” and generally refers to a more formal arrangement that pairs a novice with an experienced person for a set time period, with a focus on policies, procedures, and skill development. Preceptors serve as role models and precept during their regularly scheduled work hours, which is part of their work assignment, in contrast with mentors, who are chosen, not assigned, and focus on fostering the mentee’s individual growth and development during an extended period. Mentors develop a professionally based, nurturing relationship, which generally occurs during personal time (Fig. 3.1).
What Is Preceptorship?
A preceptorship is a clinical teaching model in which a student is partnered with a preceptor and a faculty member, usually during the student’s last semester of nursing school (Billings & Halstead, 2016; Bott, Mohide, & Lawlor, 2011). Nursing schools sometimes use the term capstone course synonymously with the term preceptorship. In a capstone course, the senior-level student works one-on-one with a preceptor who is a competent and experienced registered nurse (Fig. 3.2). The preceptor guides, observes, and evaluates the student’s ability to perform clinical skills with competency and to begin applying critical thinking and organization skills in managing a group of patients in a specific setting. The preceptor and the nursing student identify goals and work in a collaborative fashion toward meeting the goals. During a traditional preceptorship, the nursing student identifies an area of interest that he or she anticipates working in following nursing school, because it provides an opportunity for the student to acquire and master nursing skills common to the specialization area and to begin practicing clinical decision making and prioritization (Emerson, 2007). The preceptorship experience promotes role transition and socialization for the nursing student while fostering professional leadership skills in the preceptor. For example, a student may begin to role-model characteristics of prioritizing patient care based on observations of how the preceptor plans and prioritizes patient-care activities. In turn, the preceptor gains leadership traits by communicating and role-modeling professional behaviors. Preceptors have been referenced in the literature as clinical coaches where they foster critical thinking, safe practice, and socialization during the first year of practice for the new nurse (Bratt, 2009).
What Happens If I Experience a Challenge During My Preceptorship?
When the time arrives for you to complete your preceptorship at the end of your nursing education program, rest assured that those feelings of uncertainty and anxiety that you experienced on your first day of nursing school are normal and will subside with time. As you establish a professional relationship with your preceptor, it is important to understand your role and responsibilities as preceptee as well as the preceptor’s role and responsibilities. But what happens when you are placed with a preceptor who doesn’t share the same excitement and interest as you do in participating in the preceptorship? Or what happens when your personalities do not blend well? What do you do?
First, it is important to identify the issues you are having with your preceptor. It may be helpful to write down what is concerning you and share this information with your clinical site supervisor before communicating your concerns to the preceptor. A word of advice: Never approach an issue with anyone (this includes your preceptor) when your emotions are running high. Give yourself a little time to cool off.
After you have discussed your concerns with the clinical supervisor, arrange a time to meet with your preceptor to communicate your concerns in a professional manner, while also providing suggestions for a possible solution to the issue(s) you are having with your preceptor. Oftentimes, expressing your concerns to your preceptor will help the preceptor recognize and see your perspective on an issue. Equally important is for you to provide an opportunity for the preceptor to provide you feedback and offer suggestions on any concerns or issues related to the preceptorship experience. If neither you nor the preceptor is able to resolve the issue(s), then reach out to your clinical faculty for guidance and support. For additional conflict resolution strategies, refer to Chapter 13, Conflict Management.
A preceptorship has also been identified as a nurse residency program, where a new graduate nurse completes a formalized residency at his or her first place of employment as a professional nurse. Nurse residency programs are now being implemented across many practice settings to ensure that new graduates deliver safe patient care.
What is a Nurse Residency Program?
The moment has finally arrived; you have passed the NCLEX-RN® and obtained your RN license. Now the next step in your professional career path as a nurse begins as you land your first position as a professional nurse. Making this step (what might feel like a big leap!) in your nursing career is like a moment of passage. Gone are the days of nursing school; you are no longer a student but a competent professional nurse. To that end, it is no surprise that you might be feeling a little bit scared or anxious as you start your first day working on the unit at your new place of employment. Remember your first day of nursing school? Similar feelings are sure to surface again as you begin working as a new graduate nurse.
In an effort to ease the transition into the clinical practice setting and reduce job-turnover rates of new graduate nurses, nurse residency programs are now being employed by many health care organizations as a requirement for all newly hired graduate nurses. You might be asking yourself, what exactly is a nurse residency program? A nurse residency program is a formalized orientation that varies in length (anywhere between 6 and 18 months, but usually for about 1 year), where a new graduate nurse works full-time on the unit where he or she will be working following completion of the residency program. Nurse residency programs vary at each institution but essentially serve the same purposes, which are to assist the new graduate nurse with transitioning into the nursing role by providing orientation to the unit to which the new graduate nurse is hired and working with a dedicated and experienced nurse throughout the residency who serves as both a mentor and a coach. In addition, residency programs provide additional specialty training, certification, and courses that may be a unit-specific requirement for the newly hired graduate nurse. Twibell et al. (2012) added that nurse residency programs include a focus on curriculum and specific clinical experiences grounded in evidence-based practice as well as offer new graduate nurses an opportunity for professional growth and socialization as members of the health care team (see the end of the chapter for a list of relevant websites and online resources). Following completion of a nurse residency program, the nurses will work on the unit where they completed the residency. The American Association of Colleges of Nursing offers a listing of nationally accredited nurse residency programs.
Further support for requiring all new graduate nurses to complete a nurse residency program following completion from a prelicensure degree program has been proposed by the Institute of Medicine (IOM). The IOM in collaboration with the Robert Wood Johnson Foundation conducted a 2-year initiative examining how nursing practice and education will transform the delivery of health care. In the 2010 IOM report, The Future of Nursing: Leading Change, Advancing Health, the IOM recommended that the following actions should be taken to implement and support nurse residency programs:
▪ State boards of nursing, in collaboration with accrediting bodies such as The Joint Commission and the Community Health Accreditation Program, should support nurses’ completion of a residency program after they have completed a prelicensure or advanced practice degree program or when they are transitioning into new clinical practice areas.
▪ The Secretary of Health and Human Services should redirect all graduate medical education funding from diploma nursing programs to support the implementation of nurse residency programs in rural and critical access areas.
Practice Issue
The clinical environment presents an engaging and rewarding experience for nursing students to begin applying nursing concepts and skills learned in the classroom setting to the practice setting. However, changes impacting health care, decreased clinical site availability, increased student enrollment, and faculty shortages have required key stakeholders in both academia and practice to develop alternative models of clinical education that will prepare tomorrow’s professional nurse to practice competently and safely. Nurse residency programs are a move in that direction, where a graduate nurse participates in a 1-year program that fosters role transition and clinical decision-making skills grounded in evidence-based practice. Providing a smooth transition into practice has also contributed to increased retention of new graduate nurses and decreased job burnout following completion of the nurse residency program (UHC/AACN, 2016a).
Implications for Nursing Practice
• Health care organizations consider adopting a nurse residency program new graduate nurses are required to complete at the beginning of their employment.
• Implement an evidence-based curriculum under the nurse residency program that focuses on development of critical thinking behaviors and aligns to established core competencies implemented by the health care institution.
• Collaborate with academic institutions to align nurse residency program objectives with nursing educational program outcomes.
• New graduate nurses who have completed the 1-year nurse residency program reported an increase in confidence, competence, organization and prioritization, communication, leadership, and a reduction in stress levels (UHC/AACN, 2008, pp. 5–6).
• Since its inception, UHC/AACN’s nurse residency programs have an average retention rate of 95% for first-year employed nurses (UHC/AACN, 2016b).
Considering This Information
What are your thoughts on completing a nurse residency program as a requirement of your employer following graduation from nursing school?
▪ Health care organizations that offer nurse residency programs and foundations should evaluate the effectiveness of the residency programs in improving the retention of nurses, expanding competencies, and improving patient outcomes (IOM, 2010, p.12).
In 2008, the American Association of Colleges of Nursing (AACN), in collaboration with the University HealthSystem Consortium (UHC), developed a nurse residency program for postbaccalaureate nurses following completion of their educational programs. The UHC/AACN nurse residency program is 1 year long and uses an evidence-based curricular framework for preparing new graduate nurses to transition from their role of novice to competent practitioner. At the time of this publication, 187 practice sites in 32 states currently offer the UHC/AACN nurse residency program (UHC/AACN, 2016a) (Research for Best Practice Box 3.1). The benefits of a nurse residency program have also been extensively studied by the National Council State Boards of Nursing (NCSBN).
The NCSBN implemented a transition to practice study for new graduate nurses employed in their first nursing position (NCSBN, 2016). The aim of the study was to examine the effectiveness of a transition to practice program on new graduate outcomes with regard to safety, competence, stress, job satisfaction, and retention as compared to current onboarding programs used by hospitals participating in the study (Spector et al., 2015, p.26). The NCSBN Transition to Practice Model (TTP) employed in the study consisted of an extensive institution-based orientation program, trained preceptors who assisted the new graduate with onboarding processes specific to the unit he or she was working in, and Quality and Safety Education for Nurses (QSEN) online educational models that the new graduate nurses completed during the study. Findings from this study support the utilization of transition to practice programs to improve new graduate readiness for practice and increase retention. Based on findings from the study, researchers (Spector et al. 2015) suggest that nurse transition programs have essential elements that are evidence based (Box 3.1). As you begin your career as a professional nurse, here are additional questions you may want to ask your employing institution or agency:
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