NURSE RESIDENCY: MENTORING AND

RETENTION OF THE NEW GRADUATE

NURSE

Allison PetersUniversity of Central Florida

Nursing shortage is an age old challenge spanning the course of over 50 years (Fox & Abrahamson, 2009)

Retirement of ‘baby boomers’ who are not being replaced by an adequate amount of younger RN’s (Fox & Abrahamson, 2009)

Estimated 400,000 nurses needed to replace & keep up with demand; influx of 703,000 jobs for registered nurses between 2004 and 2014 (Zangaro, Soeken, 2007)

Significance & Background

Issues Years ago career choices for females were

secretary, teacher or nurse; many chose nursing

Current ageing workforce is retiring, and putting a large demand on the healthcare system

Economic downturn saw the return of retired nurses to the workforce which caused a false sense of fulfillment and a laxness on recruitment and retention (Ulrich, Krozek, Early, Ashlock, Africa, & Carman, 2010).

Specific Problem• 42% of the nurses hired in acute care hospitals are new graduate

nurses (Goode, Lynn, Krsek, & Bednash, 2009)

• New graduates face many dilemmas such as lack of support mechanisms, communication issues with other staff and physicians, unrealistic workloads and inability to transition from a student to a nurse (Pellico, Brewer & Kovner, 2009)

• New nurses are leaving healthcare (36% within the 1st year & 56% in the 2nd year) (Ulrich, Krozek, Early, Ashlock, Africa, & Carman, 2010).

• Cost of hiring a new nurse is $300,000 per percentage point of staff turnover (PriceWaterhouseCoopers, 2008)

Role of the Nursing Leader

• Promotes within others open communication, enthusiasm, vision, shared governance, quality practice and a genuine caring and support for nurses (American Nurses Association, 2009)

• Provides a climate of learning in an environment that is psychologically safe & enhances a climate of trust and mutual respect (Billings & Halstead, 2009)

• Fosters creating a confident nurse who is able to tackle daily issues that involve use of expertly honed critical thinking skills that will assure quality patient care delivery.

Leaders Defined

Mentors- Establishment of relationship with mentee, helps novice nurse develop as a professional & assists with social culture offering constructive feedback

Preceptors- Orient nurses to responsibilities, rules, practice goals & teach hands on learning experiences

Both are experienced clinicians who are teachers and resources for the mentees

(Persaud, 2008)

Informal MentoringAn Alternative

No formalized plan of action

Relies on past experience of mentor and how they were taught as a nurse

May be ineffective in retention (Tourigny, & Pulich, 2005)

Mentor may lack skills needed to teach such as assessing learning styles or changing their own teaching style to match the students need (Billings & Halstead, 2009)

Evidence To Support The Nurse Residency Program

• Nursing shortages have increased the need to hire new graduate nurses in specialty areas such as the ER, ICU & OR--Now the rule not the exception (Persaud, 2008)

• Critical time of employment for new nurses is between 12 & 24 months (Fox, 2010)

• Organizations can support the transition of novice nurse to expert nurse through nursing residency or mentoring program (Berezuik, 2010).

Retention Of Resident Nurse Residency prepares the new graduate nurse

with the education which enables them to practice competently and effectively within their environment

They will be confident in their own mental and physical skills and remain educationally engaged in their specific practice

Implementation Plans

• Discover programs that have a proven success rate within specific unit

• Designate a preceptor and a mentor

• Mentor training and objectives

• Protégé and mentor sign a contract stating commitment to follow program (Fox, 2010)

Mentoring & Residency Plans Available

Peri-Op 101- AORN for operating room nurses (Persaud, 2008)

SSFHS (St. Francis Hospital and Health Centers – nurses of inpatient, OR and ER units (Fox, 2010)

Versant RN Residency Program-based on novice to expert framework then expanded to include CC, ER, OR, L&D, NICU, PICU (Ulrich, Krozek, Early, Ashlock, Africa, & Carman, 2010)

• GENERAL CRITERIA FOR SELECTION: PROTÉGÉ

1. SEEKS CHALLENGES OR NEW RESPONSIBILITIES

2. LOOKS FOR FEEDBACK

3. ACCEPTS RESPONSIBILITY FOR PROFESSIONAL DEVELOPMENT AND GROWTH

4. SEEKS TO IMPROVE

5. REFLECTS INTEREST IN INVESTMENT FOR THE FUTURE

6. IS COMMITTED TO THE PROGRAM AND THE MENTOR

7. IS WILLING TO LOOK AT ISSUES FROM DIFFERENT VIEWPOINTS8. TRIES NEW APPROACHES9. VIEWS MISTAKES AS A LEARNING PROCESS10. COMMUNICATES NEEDS11. IS EXCITED ABOUT NURSING12. IS COACHABLE“THE PRIMARY CONSIDERATION FOR SELECTION OF MENTEES SHOULD BE THATTHEY ARE MOTIVATED TO DEVELOP DIFFERENT OR GREATER COMPETENCIESTHROUGH AN INTENSIVE RELATIONSHIP WITH THEIR MENTOR.” (LACEY, 2008,

General Criteria for Selection: Mentor 1. Keeps current on practice standards2. Is considered an expert on the unit3. Is a good listener4. Is able to provide advice appropriately and in a

timely manner5. Is able to teach new nurses6. Is able and willing to share knowledge and

experiences7. Promotes a positive environment and is optimistic8. Promotes learning and professional advancement9. Serves as an advocate to promote the nursing

profession10. Encourages ideas11. Is nurturing, kind, considerate, and trustworthy12. Is not threatened by others13. Works with the hospital’s mission and values14. Is committed15. Works well under stress16. Demonstrates all of these characteristics by

example “Mentors will be expected to motivate, support, teach,

counsel, promote, and protect.” (Lacey, 2008, p. 24)

(Fox,2010 Mentor-Protégé Selection Criteria p. 313)

Evaluation/Reflection

• Daily rounding• Meeting with mentor &

protégé on monthly basis• Luncheon at 6 & 9 months• Preceptor/Mentoring bonus

pay• Self- evaluation survey

SAMPLE SURVEY There is good coordination and communication of effort in my work

group. 2. My work group works together when a problem needs to be solved. 3. Departments work well together to get the job done. 4. Our unit personnel treat one another with respect and dignity. 5. Employees are treated with respect by the physicians. 6. Employees go out of their way to help and support patients. 7. I am encouraged to come up with better ways to meet customers’

needs. 8. The values of the organization are evident in our everyday

practices. 9. I would recommend this organization to a friend as a good place to

work. 10. My work makes good use of my skills and abilities. 11. Overall, I feel confident that my job will be satisfying 1 year from

now.

(Fox, 2010, Pre & Post Evaluation Survey, pg. 314)

Conclusion Having a nurse residency program will decrease

the amount of turnover by ensuring transition from novice to expert nurse is a positive one

Mentoring the new graduate nurse is empowering thus building self confidence through optimism & support

A positive experience as a novice nurse will help to develop the nurse as a future mentor

Mentoring/Residency programs assure there is a plan that includes quality,safe care for our patients (Goode, Lynn, Krsek, &

Bednash, 2009)

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and Standards of Practice. Silver Spring, MD: Nursebooks.org Berezuik, S. (2010). MENTORING IN EMERGENCY CARE: 'GROWING OUT

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