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Manage with care

Clinical Mentorship in Nursing

While the nursing shortage reaches an all-time high and nurse retention reaches an all-time low, our neuroscience nursing department at Johns Hopkins Hospital, Baltimore, has launched an innovative mentoring program in an effort to keep nurses in their clinical settings. This program draws from the expertise of the most experienced nurses and has created a unique position that allows the expert nurse to guide, teach and encourage the newer nurse in the immediate clinical setting.

The mentoring program evolved during a time when it seemed as though we could do nothing to retain nurses. Some describe the lack of clinical nurses as a problem so severe that hospitals are beginning to "bleed at the seams." As administrators face bed closures due to the lack of available nurses, new nurses come into the hospital setting and before we know it, they pack their bags and leave for less stressful work environments.

Judith "Ski" Lower, nurse manager of the neuroscience critical care and progressive care units at Johns Hopkins, knows new nurses experience very high levels of anxiety -- especially after clinical orientation has ended. This intense anxiety persists for at least the first 6 months of employment. We discovered that we needed to bridge this gap of time in the post-orientation phase to help the new nurse survive. Specifically, a guide or mentor was needed to assist the new nurse toward refinement of clinical skills, critical thinking skills and time management skills.

Guiding New Nurses
Clinical mentoring was a term that emerged as Lower began consulting with me as a colleague and former clinical nurse in the neuroscience nursing department. We determined that the daily routine in each of our nursing units had become so complex that new nurses had to battle overwhelming odds in order to serve as competent clinicians and excellent patient care providers. Increasingly complex health problems in patients have forced acuity levels to skyrocket. Survival for everyone on a busy clinical unit meant that no one was available to guide and mentor even the newest nurses.

Since the program's inception, we have retained nurses at impressive rates. We are fully staffed and are preparing to expand our bed capacity. It's fair to say the clinical mentoring role is one of several programs that has helped recruitment and retention. Developing the mentorship role has been a 2-year process, and the role is still evolving. These are some of the methods we have found that have worked for us:

1. A mentor needs to possess particular characteristics and qualities that are essential for success. Mentors are experienced, expert-level nurses who desire to guide, nurture and teach less experienced nurses. Mentors are motivated by their love for nursing and the desire to guide the next generation of nurses toward positive and successful experiences. Good role modeling skills are also essential; an effective mentor is one who can influence and inspire others, a person who recognizes the concept of caring as the core of the mentoring relationship.

2. Our mentors begin the mentoring relationship by teaching some of the introductory core curriculum classes to new nurses. We stay involved during the orientation process so we are aware of the orientee's progress, and we assist the preceptor as needs are identified.

3. When orientation is over, the mentor designs a schedule to work alongside the new nurse as much as possible. Mentors don't take over any assignments, but they are able to recognize when the new nurse is beginning to feel overwhelmed and help them identify why. The goal is to assist the nurse toward completion of the shift so that care is delivered safely and competently.

On-the-Job Training
Skills and concepts are taught as experiences arise and hands-on assistance is available from the mentor. As the program proceeds, the nurses experience a sense of accomplishment through the achievement of predetermined goals.

4. Mentors teach a series of classes that are designed to help the new nurse understand and cope with surviving in the real world of nursing practice. These classes are held at the 3-month and 6-month interval and include detailed instruction on topics such as improving communication skills, self-scheduling for survival, and ways to identify useful resources when one faces the worst shift imaginable.

The mentor teaches skills on how to handle a level 1 code situation, how to manage unit operational problems, and an introduction to the upcoming role of primary nurse. The mentor's involvement in teaching these classes allows for further evaluation of the nurses' progress and clearer identification of continued interventions needed throughout the following months.

Clinical mentorship has spread throughout the neuroscience nursing department. Each unit has designed the role based on their unique perspective. The common purpose of each clinical mentor is to guide, inspire and teach nurses in an effort to sustain the highest level of excellence in clinical nursing practice.

Gail Biba is a nurse clinician and clinical mentor in the Neuroscience Critical Care and Progressive Care units at Johns Hopkins Hospital, Baltimore.


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