An Essay on Mentorship

Mentorship: Collaboration for Competency

The success of any nursing student in any program in any clinical setting is multi-faceted enhancing the complicated nature of education and the perception of competencies whether student or educator. This is an important concept to be sensitive to as the process of moving forward with the knowledge and skill-sets needs to be supported and nurtured in order to facilitate the standard of care that is safe, accountable, and competent. The expectations of students within academia and within the staff mix on units can vary giving students a sense of role ambiguity diminishing the sense of belonging and taking away from the clinical learning experience. According to Higgins, Lathlean, Levett-Jones, & McMillan (2009),Nursing students’ motivation and capacity to learn, self-concept, confidence, the extent to which they are willing to question or conform to poor practice and their future career decisions are influenced by the extent to which they experience belongingness (p.316).Acceptance by senior and experienced nurses plays a pivotal role in the development of self-concept and application of theoretical perspectives into practice. Negative experiences with staff are detrimental to the learning process by creating environments of stress, anxiety, and an overall feeling of un-acceptance by staff, and at times, instructors. This can be attributed to the many factors that are influencing the profession of nursing including increased workloads, decreased staffing, scope of practice issues, safe work environments, and violence in the workplace (Lofmark et al, 2008). These issues influence nurses perceptions of their jobs and can negatively affect their attitudes towards themselves, colleagues, patients, and students (Ali & Panther, 2008). Addressing these issues is difficult as resources such as funding are scarce. This is creating environments that are not conducive for learning amongst degree bound nurses, and in fact, is contributing to attrition in nursing programs as well as changes in career paths as a nursing degree is achieved (Bray & Nettleton, 2008). Acceptance through effective mentorship beginning once the clinical experience has begun is critical to fostering the minds of tomorrow today. This can be achieved through the implementation of a framework that would act as a guideline for staff nurses who may be paired with students to follow ensuring continuity of the mentoring process. Communication amongst unit staff and nursing schools who place the students is crucial for outlining expectations from the staff and students. This clarification aids in debunking assumptions and provides a better understanding of students scope of practice and expectations from potential staff mentors on the floor (Andrews et al, 2006). In the current health care environment, mentorship continues to be a challenge for nurses as finding the balance for the education of a student and completing assigned duties in an already high stressed, high paced nursing environment is diminishing the mentorship process, and in the larger picture, compromising the values and principles of the profession and the quality care we provide.

            Historically, mentorship of nursing students was not the method of choice for education, and in fact, was not widely accepted as the model of choice for student integration in the clinical setting until the early eighties (Ali & Panther, 2008). The working model of acquiring skills and knowledge by self-direction under indirect supervision was the model of choice as the scope of practice in nursing was limited and un-regulated. Many nurses and nursing students in the past found themselves to be autonomous practitioners, learning their skills within the situations they found themselves in without adequate guidance or support (Bray & Nettleton, 2008). As the profession has been radically evolving with the expanding nature of health care in all its multi-faceted discoveries, and the resulting increased demand for nursing services, the fundamental approach to education needed to change (Ali & Panther, 2008). Providing competent, comprehensive, accountable, and safe care founded upon evidence has become the driving force behind fostering the future nurses of tomorrow. According to Ali & Panther (2008), Mentoring is an important role that every nurse has to assume, formally or informally, sooner or later in their professional life (p.35).This is a powerful concept as it exposes the fact that we as a nursing collective have an obligation to foster the growth, both academically and clinically, the novice nurses of tomorrow. Utilizing nurse leadership to be pro-active in creating positive and safe work environments through empowerment and support of nursing staff is an effective strategy in addressing barriers to the mentorship perception and process. Pragmatic approaches and follow through with nursing concerns and issues, specific or broad in scope, will bring about better learning environments for both mentor and mentee.

            According to the Practice Standards of College of Nurses of Ontario, A nurse in an educator role demonstrates sound practice standards by, planning and implementing creative learning opportunities for students, critically analyzing and evaluating nursing practice including education, and creating an environment where learning is encouraged (p.8). Legally and ethically, nurses are bound to the codes of ethics set forth by our governing bodies. As a collective, advocating for quality work environments which support the opportunities for mentorship and education is sound ethical practice and must be encouraged for successful student outcomes (CNA, 2008). This addresses the dynamic nature of nursing as a self-regulating profession. Nurses eat their own was a common expression used to describe the staff-student relationship during the educational process and the acceptance as a novice RN into the profession.  As our profession evolves, and issues are clarified through analysis and subsequent practice standards, this phrase is becoming more uncommon amongst new nurses as the dynamics of nursing is shifting in an accelerated evolution. Mentoring is not a legally binding term but viewing from a professional standpoint, it is an ethically binding term because it is the responsibility of all nurses to represent their profession through attitude, knowledge, accountability, ethical practice, and continuing competence within the scope of education and patient care (CNO, 2002). It is important for all nurses who interact with students to be cognizant of the fact that their knowledge, attitude, and communication skills play a direct role in the educational process no matter how small the interaction. One negative experience can influence a students perspective on the profession and affect their practice with patients and colleagues. Providing mentorship within the ethical and legal framework improves student performance and boosts self-confidence leading to successful outcomes (Ali & Panther, 2008).

            Providing culturally appropriate care within a professional relationship within the context of mentorship is crucial in attaining mutual respect and trust. Identifying cultural characteristics and working within the parameters of that particular individuals defining concept of belief and approach provides opportunities for beneficial educational experiences for both mentor and mentee (Belgrave & Cecilia, 2009). Taking into consideration and being respectful of the differences of ethnicity, culture, and belief structures provides a strong basis for mentorship and enhances the learning experience as both nurse and student are comfortable and confident with the established relationship. Cultural competency is an integral part to nursing practice and nurses and nursing students must be sensitive to their own values and assumptions about patients and colleagues to be able to create health care environments conducive to learning and healing. Nurse attitudes and nursing mentorship towards students within the construct of society is a relatively unknown issue. Professions have a tendency to be non-transparent unless exposed creating greater awareness. Since the framework for education is in place, it is difficult to expose instances where negative student experiences have compromised patient care. Society is generally unconcerned with interactions and attitudes within the profession unless in directly affects the delivery and quality of patient care (Hurley & Snowden, 2008). Since mentorship does take place in a variety of health care settings with a variety of nurses from diverse backgrounds, patients and their families may accept the approach of teaching by nursing staff as the standard even if in a less than desirable learning environment (Doherty & Mendenhall, 2006). As long as the quality and continuity of care is present the awareness of potential educational shortfalls with students will be masked and will remain an issue solely within the context of nursing without the important prevailing opinions of an informed public.

            From a political standpoint, mentorship and nurse relationships with students is an investment in health care. Having confident, educated, and competent nurses working within health care in all its aspects improves the health outcomes of patients and their families and subsequently reduces fiscal spending on redundant or repetitive re-admissions or treatments. Investment in nursing students and effective education and mentorship allows for greater critical thinking skills, health education competencies, and furthering of education increasing scope of practice (Shakespeare & Webb, 2008). Lack of mentorship and one on one teaching benefits nothing as students may develop autonomous strategies for self education that may not be founded in evidence. This decreases the viability of the profession as a whole and contributes to dangerous work environments for staff and patients. Recently in Ontario, the government instituted the nursing graduate guarantee initiative. This ensured guaranteed full time employment for all nursing graduates that signed up for the program in an area of their choice. For six months, new graduates are to receive mentored employment by senior nurses enhancing and nurturing the integration of new graduates into the professional workforce. This investment has proven to be a success, so much so, that problems have arisen from it. Staffs from various hospital units across the province are reporting a lack of senior nurses to mentor new graduates as they at times outnumber the qualified staff. This initiative mandates participating hospitals to pair new graduates with mentors as written in the policy manual. This is causing a backlash as new graduates are forced to look beyond their areas of interest or to relocate to work and gain the invaluable experience with paired mentors (Nursing Graduate Steering Committee, 2009). As these issues have been identified, ideas must be generated for recommendations in how to solve this issue. As the logical shift to evidence-based practice and approached becomes the norm in professional practice, mentorship is becoming the standard of clinical educators. The Ontario government and other health care stakeholders are aware of this hence the mandatory criteria of mentorship are to be met. The benefactors of mentorship are everyone. Government benefits with improved patient care with better outcomes. The profession of nursing benefits as continuity and quality care is ensured through sound practice founded through supportive and evidence-based learning. This promotes a better image and greater emphasis on trust, the building block of the nurse-client relationship. Also, the professions that interact with nursing also benefit as mentees are shown the value of collaboration broadening the inter-professional relationship with a patient-centered focus (Lockyer, Moule, Sales, & Wilford, 2008). Patients and their families benefit as the mentored nurse provides the best possible care and treatment ensuring the best possible outcomes within the framework of evidence-based practice. Safe, accountable, comprehensive and competent care is just a few of the many reliable benefits patients and their families will receive as smart, motivated, and inspired degree nurses bring improved practice and thinking to the bedside or wherever they may be.

            Taking in to consideration that the profession of nursing is female dominated, focusing on the distinctly unique female approach to leadership and education plays a major role in the acceptance and attitude towards the education of nursing students. Women have a unique understanding of women and this reflected in the nature of mentorship styles and adjustment to learning needs. This draws upon the fundamental basis of nursing which is caring and expression, traits traditionally not associated in the mainstream with males (Philips, 2008). Mentorship is not associated with either men or women but for students entering a complicated and challenging workforce. Sex does not determine competency or skill-set learned through mentorship but rather influences the perception of nursing by patients and their families. As the profession evolves, so does opinion and thought towards competent mentored nurses by the very people we treat and care for. Nursing is not a female profession; it is a female dominated profession that has provided a great foundation by many great persons. It is important to be cognizant of this fact as the dynamics of the profession slowly change as the image of nursing improves with modern thinking.

            The economic benefits of applying a mentorship program within an academic and health care setting are enormous. Fostering growth in skills and confidence ensures mentees are comfortable with their identities and competencies contributing to retention of smart nurses who place great emphasis on maintaining nursing excellence in practice (Godfrey, Nelson, & Purdy, 2004). With low turnover of mentored nurse’s, health care settings save money on hiring incentives, training costs, resources, and patient lengths of stay. Mentored nurses strive for nursing excellence in practice and this is reflected in patient outcomes which in turn are reflected in fiscal patterns. It just makes economical sense to mentor nurses.

            Mentorship has reflected well with me, my learning style, and I am appreciative to the nurses who became attuned to my learning style early on. On the other hand, I have had some less than desirable experiences within the clinical setting, and this did have an effect on my attitude towards staff on units and my opinions of their competencies as compassionate caregivers. As a student who has felt the cold hand of un-acceptance in the midst of trying hard to fit in and prove myself to be a competent professional, the feeling of discouragement is enormous and without the proper supports such as intuitive clinical instructors and nursing faculty, it is difficult to sway my opinion and the negative views I have towards individuals in the profession. Having these proper support systems, or, mentors of a different kind, helps guide me through the problems that arise within my practice wherever it may take me. It is important for me to stay patient-centered and focused on my nursing excellence. Being the best that I can be is the only way to gain the respect of future colleagues, and this does involve mentorship. Also, making my clinical instructor aware of the kind of education I benefit from helps ensure the proper pairing to a nurse willing to mentor, allowing me the freedom to practice without stress or anxiety. In summary, the importance of mentorship with students and new grads is paramount in providing the surety of confidence in practice. It makes sense to invest in programs designed around the concept of mentorship in learning, as it fosters and nurtures the bright minds of nurses for tomorrow’s world. Without change and evolution, stagnation becomes the norm, decreasing the stability and viability of the people involved in any organization, professional or not. Continually moving forward and developing new strategies for education, such as mentorship, strengthens professions and empowers individuals to make just and ethical decisions based on the best available evidence.





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