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June 19, 2019

By: Julie Mason Jubb, DNP, RN, CNE

Mentorship through positive relationships

Mentorship is an important concept for new nurses, as they work to navigate the profession and learn needed skills for success in their new role. The nurse role can be a challenge to learn without a compass, road map, or guide. Nurses learn most about what being a nurse is and the “how” of nursing when they begin nursing practice. Nursing leadership has an important responsibility to guide the next generation of nurses toward positive outcomes. Whether a novice or seasoned nurse, you can be part of positive change within the profession. The concept of “nurses eating their young” can no longer have a place in the profession.

Mentorship can be defined in many ways. This concept can range in definition from a seasoned nurse sharing knowledge with a new nurse to an “intense relationship” between a new nurse and an expert to create an environment of success for both the individual and the organization. The nurse and mentor can both learn and grow together.

The Robert Wood Johnson Foundation (2014) states that in a survey of newly licensed RNs, nearly one in five new nurses will leave their job in the first year. In the National Healthcare Retention and RN Staffing Report (2016) suggests that hospitals can lose up to 8.1 million yearly due to staff turnover. The American Association of Colleges of Nursing (2019) suggests that the nursing shortage will continue to increase due to the rising age of the baby boomers, with an estimate of 1 million nurses retiring by 2030. The U.S. Bureau of Labor Statistics (2019) projects that the employment of registered nurses will grow 15% from 2016 to 2026, much faster than the average for all occupations. An Institute of Medicine report (2010) confirms the goal that all nurses should be mentors.

Nursing literature has a body of knowledge about the difficulties of the transition from nursing school to clinical practice. This shift can be a daunting task, and the new nurse may not have all the tools needed to practice at the required higher level. Nursing leaders and mentors are needed to bridge this gap in knowledge. Qualified and competent nursing staff can use their expertise to benefit their unit and the care that is given on the unit by mentoring new staff.

A stronger workforce benefits everyone. Think of these goal concepts that the new nurse or the nurse transitioning to a new role should have: confidence, retaining staff, competence, critical thinking, improved clinical judgement, job satisfaction and high performance. No matter whether we are the frontline nurse or the leader, each of us wants to have these valuable skills in clinical practice and within the organization.

Much has been said on the relationship between the nurse and patient, and this is certainly a valuable relationship. However, there are many other relationships that the new nurse needs to build, including the relationship with a mentor or leader. Leaders can actively support the future of the profession modeling appropriate conduct in practice. New nurses or a nurse experiencing a new role can feel overwhelmed and frustrated, and may see the role as a daunting experience. Role change can be fraught with spoken and unspoken rules. Consider two case scenarios.

Case scenario 1

You’re a new nurse who is working with a preceptor on a medical-surgical unit. It’s been a daunting experience leaving nursing school and beginning to practice in the “real world.” Everything is so different than what you saw working in clinical or the lab for check-offs in nursing school. You’re happy to be a nurse and worked so hard to get your nursing license.

You have found in your first few weeks of nursing that you don’t really know what you are doing. The medication pass is overwhelming and daunting. It feels like you get further and further behind each day. The last day you worked, it took you an hour longer to complete your morning med pass, and you didn’t get your assessments charted until the afternoon. You try so hard but continue to fall behind. It’s so hard to know what you should do first and why. You really want to do a good job.

You are supposed to push medications through a G-tube. You haven’t done this since quarter two in school. You discuss what you remember with your mentor and ask for guidance to make sure that you do this skill correctly, since this is the first time you have completed this on your own. You leave the nursing station to go gather needed supplies and then come back to get your preceptor. When you return, you hear your preceptor making fun of you to the other seasoned nurses. You hear the nurses talking about how you don’t know anything and how stupid you must be to not be able to complete a simple med pass. You’re embarrassed and are determined to never feel like this again. You see that asking questions or clarifying points only makes you look weak to these experienced nurses.

Case scenario 2

You have been a nurse for almost a decade and have a background in long-term care and medical-surgical nursing. You have always wanted to be a critical care nurse, so you’re excited that you were approved for the transfer to a new ICU. You have a wealth of knowledge and believe that you will be a strong asset for this organization.

In your few weeks in the new role, you can’t believe how horrible you feel at work. You thought that with your many years of experience, you would be an extremely knowledgeable nurse on this unit. Each day, you’re seeing new things and levels of acuity, and you currently don’t have the high-level skills to meet these needs. You’re frustrated and have left work several times in tears. You have also had the nurse preceptor on your new unit question your skills on several occasions in front of other nurses. You want to be successful and just need help accomplishing this professional goal.

Mentors as leaders

Having a leader guide the process in either scenario can be the difference between a nurse staying in the new role or leaving the organization or even the profession. Think back to Maslow’s hierarchy of needs. Everyone wants to feel loved and a sense of belonging. Mentors and leaders can show the value of new nursing staff by helping shape a healthy workforce. Organizations depend on new nursing staff in building the healthcare team.

Transformational leadership is all about leading through inspiration and encouraging in positive ways for exceptional outcomes. Leaders aren’t only chief officers or managers within an organization. Many nurses work as informal or formal leaders as preceptors, mentors, and charge nurses. Caring and compassionate leadership is vital to these roles. Every nurse was once a novice nurse. Each nurse starts their profession by coming out of nursing school.

Taking action

Mentoring new nurses is everyone’s responsibility. Build relationships. Establish a rapport and trust with another nurse. Be willing to help and care for others. Nursing is more than just having confidence in a list of skills.

Mentors need both strong communication and listening skills. Empower others to speak freely and safely. This is a key in this mentorship relationship. Empathy for others and the ability to express this knowledge can guide the mentor/mentee relationship. Nurse leaders can support and promote positive relationships through social group outings, activities, encouraging communication via phone/text/social media, and meetings with meals. Communication and activities build relationships with staff on a unit.

In nursing today, there is a lot of information and research about caring. The terminology of caring for self is certainly important. Without self-care, some nurses become burnt-out in their roles and can become angry and hateful people. No one wants this. We hear about care for our patients. Certainly this is the reason that nurses do what they do. Nurses are all about patient satisfaction and outcomes.

One additional concept is to care for others in our profession. Are we the nurse who helps build up those on the unit or tear others down? Caring for others is a vital piece of the positive change needed in this profession. Remember to have fun and build relationships in your clinical practice. If it is only hard work and responsibility, it is difficult to have positive relationships. Nurses continue to do more with less in higher acuity patient loads. New nurses need to connect inside and outside the organization. Think creatively to build the rapport needed for success.

Do nurses eat their young? This is a sad fact that is heard in healthcare and in the literature. Each of us can play a part in this needed change. What if seasoned nurses began to stand with the new nurses and were determined to be an example and to protect the new nurses and colleagues? Each of us matters and has the ability to be a part of positive change. So, yes, nurses might eat their young—but not on my watch.

Takeaway tips

Key points for the new nurse or the nurse in a new role:

  • You are not alone. You can do this.
  • You matter. You are helping bridge the gap of the nursing shortage and will make a difference in the lives of your patients.
  • Remember your “why.” Why did you go to nursing school? Think about the hard work and what you have accomplished. Let this guide you in your new role.
  • Remember that it won’t be like this forever. 12-hour shifts do end … Even if they end at 13 hours.
  • Reach out to positive staff members on your unit.
  • Learning and knowledge building take time. This will get better.
  • Find someone who is exceptional at time management or prioritization. Ask if you could learn more from them.

Key points for the preceptor:

  • You are so important!
  • You are shaping nursing.
  • How receptive are you to questions? It is so important to be a safe sounding board for the new nurse in your care. Think about how to communicate more clearly and in a positive way.
  • Remember that everyone has to start. Each of us has started with almost zero experience in the profession. Add safety to your conversations. How can you encourage and support the needs of the novice or new nurse to their role?
  • How can you build the relationship between you and your mentee?
  • Think about how you address questions. What is your verbal and nonverbal communication saying? Is it positive? Congruent?
  • What are ways to address important or critical conversations? Think about how to challenge and guide appropriately.
  • What are ways to address the “why” of the profession? Think about how to guide the new nurse in concepts like prioritization, delegation, and time management.

Julie Mason Jubb is an associate professor or nursing for the Chamberlain College of Nursing in Downers Grove, Illinois.

 

Selected references

American Association of Colleges of Nursing. Nursing shortage. 2019. aacnnursing.org/News-Information/Fact-Sheets/Nursing-Shortage

Chun-Mei K, Chiu HS, Lin YK, Chang WY. Development of a situational initiation training program for preceptors to retain new graduate nurses: Process and initial outcomes. Nurse Educ Today. 2016;37:75-82.

Clavelle JT, Prado-Inzerillo M. Inspire others through transformational leadership. Amer Nurse Today. 2018;13(11):39-41.

Edwards D, Hawker C, Carrier J, Rees C.  A systematic review of the effectiveness of strategies and interventions to improve the transition from student to newly qualified nurse. Int J Nurs Stud. 2015;52(7):1254-1268.

Gross Forneris S, Fey M. Critical conversations: The NLN guide for teaching thinking. 2018. Washington, DC: National League for Nursing.

Killian S M. Examining mentoring relationships for nurses: A pilot study. JOCEPS: J Chi Eta Phi Sorority. 2015;59(1):17-21.

Robert Wood Johnson Foundation. Nearly one in five nurses leaves first job within a year, according to survey of newly-licensed registered nurses. 2014. rwjf.org/en/library/articles-and-news/2014/09/nearly-one-in-five-new-nurses-leave-first-job-within-a-year–acc.html

Stone R. A good mentor will never make you feel like a burden. Br J Nurs. 2018;27(1):32.

University of New Mexico. The high cost of nurse turnover. 2016. rnbsnonline.unm.edu/articles/high-cost-of-nurse-turnover.aspx

Verret G, Lin V. Easing the transition: An innovative generational approach to peer mentoring for new graduate nurses. J Pediatr Nurses. 2016;745-56.

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