Alternative Approaches to Mentoring

In response to the increased turnover of new graduate nurses, numerous mentoring programs have been developed to support nurses during their first year of practice.^17–20  These programs are often timed to begin at the end of the precepted clinical experience and continue through the first 1 or 2 years of practice. In a recent review of the literature describing mentoring programs for new graduates, the authors revealed improved retention in various clinical settings, but comparisons were difficult because of wide variation in program design.¹⁹  The authors suggested that successful programs should include rigorous selection and training of mentors and organizational support that would reduce barriers such as time constraints and scheduling conflicts.

Other mentoring programs have found benefit in including as mentees experienced staff who are moving into a new specialty area.^5,21,22  For example, Schroyer et al²¹  provided mentors to all new hires without previous critical care experience—whether those staff were new graduates, staff transitioning from another specialty area, or nurses reentering practice. They reported a 25% reduction in 6-month turnover after the implementation of a mentorship program in their critical care units.²¹ 

Mentoring can also be implemented to enhance the professional development and engagement of experienced critical care nurses. Training and education have been linked to retention across all career stages, and mentoring for experienced staff can help them map their career and identify new opportunities within a unit or organization.^7,23  Informal mentoring can occur spontaneously as staff seek advice from an identified expert, but programs with more structure promote intentional connections to accelerate professional development.^10,17  These programs generally focus on helping nurses acquire additional clinical expertise in a specific area or encouraging staff to transition to a new role in leadership, education, or advanced practice. Rather than assigning participants, the programs may recruit interested staff to work with mentors who have recognized expertise as managers, educators, or researchers.^8,24–26 

Mentoring was endorsed as a method to help nurses prepare for leadership roles in the Institute of Medicine’s 2010 report entitled The Future of Nursing.²⁷  Organizational support is needed to connect critical care staff with skilled leaders who can highlight the importance of their role.²⁸  Canadian research involving nurses who provide direct care suggested that guided opportunities to develop leader ship skills could encourage staff to consider a management role.²⁹  This type of mentorship has been linked to increased confidence and leadership self-efficacy, which in turn could support manager succession planning for critical care units.³⁰  Mentorship is also an important component of development as new leaders assume their roles.³¹ 

Another application for mentoring experienced critical care nurses is to expand their use of evidence to improve clinical practice. Spiva et al³²  recruited nurse leaders, clinical nurse specialists, and educators to serve as mentors for evidence-based practice projects. These staff received training to enable them to better support staff engaged in implementing clinical improvement plans. The American Association of Critical-Care Nurses’ Clinical Scene Investigator program uses a similar model, providing a roadmap to assist organizations in implementing and sustaining staff-led practice changes.³³  The Clinical Scene Investigator program’s national faculty mentor nursing teams as they conduct projects to improve outcomes among critical care patients, such as reducing the incidence of hospital-acquired infections, pressure ulcers, or delirium.³⁴  Mentoring by research scholars who are employed by the hospital or an affiliated university has facilitated the implementation of research projects by critical care staff within their units.^24,25 

Mentoring has also been recognized as a strategy to help experienced staff increase competency in advanced practice roles such as clinical nurse specialist or nurse practitioner.^26,35  Staff transitioning into these roles may feel isolated, especially in facilities where they have limited access to other practitioners in a similar role or specialty area. In these situations, a mentoring program could facilitate the development of a mentor network that connects new staff with regional or national practitioners who have expertise in their clinical area.³⁶ 

Mentoring programs designed for novice nurses may look different than those developed for experienced staff, but both benefit from intentional planning, organized implementation, and periodic evaluation to ensure success.^5,10,11  Logistics may vary on the basis of the objectives of the program, the target audience, and available resources. Various resources to support program development are available in the literature and through national organizations. For example, the American Association of Medical-Surgical Nurses provides online access to their mentoring program, and the materials can be customized to meet organizational needs.³⁷  The Society of Critical Care Medicine also offers an online toolkit to support mentoring.³⁸  The essential tasks for each phase of developing a mentorship program are listed in Table 3.

The literature on mentoring provides guidance regarding both features that are considered critical for a program’s success and barriers that may impede the mentoring relationship. Successful mentoring programs include a matching process that ensures a good fit between the mentor and mentee, criteria for establishing clear goals and timelines, communication options to support the relationship, and adequate time for assessing progress and providing feedback.^5,9,17  Participants and program administrators identified time constraints and access to qualified mentors as common barriers^8,19,36,39  (Table 4).

In general, mentors should have the necessary skills to perform the role, including general characteristics such as good communication skills, accountability, and a desire to help others grow and develop, as well as expertise in the desired area.^2,4  Mentoring is about developing an intentional long-term relationship with a mentee, so it requires the mentor to commit both time and energy to the process.⁷  Self-assessment tools are available to help staff who are interested in mentoring, allowing them to evaluate whether they have the skills they would need to perform in the role of mentor.³⁷  Ideally, the mentor should not be the mentee’s supervisor, as this could create conflicts in the relationship. For example, concerns might arise about performance appraisals or the supervisor’s need to support the unit’s goals rather than those of the mentee.⁴⁰ 

For programs designed to support career development or succession planning, a pool of mentors could be recruited on the basis of an identified area of expertise. For example, successful leaders or advanced practice nurses may be asked to participate as mentors for new leaders or to guide staff in implementing a practice project.^32,41  In some roles, such as that of nurse educator, mentoring may be a required component of the job description.

Lack of access to a mentor is often cited as a significant obstacle to a mentoring relationship.^3,42  In some situations, a lack of local mentors with the desired skill set may present a barrier. This issue may occur more frequently in small facilities that employ staff with limited expertise in a particular specialty or that lack staff in a certain professional role.³⁹  For example, nurses working in critical access hospitals may struggle to find mentors with expertise in caring for high-acuity patients. One option to address this is distance mentoring, whereby the mentor and mentee are in different institutions or geographic locations.⁴³  In larger health care systems, multiple institutions could share a mentor pool that supports both the system’s larger urban facilities and its rural critical access sites. Another option for finding an external mentor is connecting with local chapters of organizations such as the American Association of Critical-Care Nurses or Sigma Theta Tau. These organizations might be willing to recruit volunteer mentors from among their members. To be successful, an organization needs to develop a structured process to connect mentees with potential mentors—a process based on their specific needs, goals, and expectations.^44,45 

A good fit between mentor and mentee is critical and has been recognized as one of the most important factors in a program’s success.^19,37,45  Mentoring is a relationship, and as such it requires a certain amount of compatibility and commitment. To be successful, the mentor’s communication style, professional skills, and expectations for the role must align with the mentee’s goals and expectations.³  Some programs suggest using personality assessments such as the Myers Briggs Type Indicator or learning style inventories to identify compatible styles.^2,17,22 

Programs can use various processes to match mentees with mentors; these processes may be influenced by the degree of structure, the number of available mentors, and the goals of the program.^3,4,9  Mentors and mentees can be paired through assignment by a third party such as a mentor program coordinator or a unit manager, or through an individual request initiated by the mentor or mentee on the basis of an identified need or desire. Assignment may be more common in programs that have been developed to meet organizational goals such as recruitment or retention.^20,22  In those situations, considerations might include pairing staff who work similar shifts or in the same clinical unit.²² 

When feasible, it is preferable to allow mentees an opportunity to have some input in the selection process.⁴⁰  Programs have used several creative strategies to introduce mentees to possible mentors. For example, some programs have mentors create a written biography describing their interests and area(s) of expertise, which is then shared with potential mentees.^22,42,45  Another program offered mentees an opportunity to review video-recorded vignettes of potential mentors before meeting with them.¹¹  Face-to-face selection could be achieved by hosting an open house where mentees and mentors spend a short time together, meeting each other in a “speed dating”–type process, before the mentee selects a mentor.⁴⁵  Software programs similar to match. com are also available in some industries, but their use has not been widely reported in the literature on mentoring in health care.

In many cases, mentoring will be a one-on-one relationship, but triad or group mentoring can also be productive.^42,43  It may be helpful to have more than 1 mentor so each can address different aspects of development. For example, in rural settings, a local mentor could help support socialization to the facility and community while a distant mentor could address questions regarding specialized skills.⁴² 

Both the mentor and mentee need to understand the expectations for their respective roles and what resources are available to support their work. This information may be provided through in-person classes, online modules, or written materials so participants understand and are willing to commit to working together. Content usually addresses the objectives of the program, suggested goals and activities, an anticipated time frame, and organizational resources such as funding or a program coordinator.^17,19 

During their initial meeting, mentors and mentees should identify specific goals for the relationship and a time frame for completion.¹⁰  Goals might focus on increasing knowledge or acquiring skills in a clinical setting, or they may be more personal, such as maintaining a work-life balance. For experienced staff, goals may expand beyond their clinical setting to trying out a new role, developing a professional network, participating on a project team, presenting at a conference, or cowriting an article for publication.⁴¹  The discussion should also address general expectations for the relationship, including confidentially, accountability, and how potential conflicts will be addressed.⁵ 

Although mentoring is meant to be a positive experience for both the mentor and mentee, the literature does describe potential pitfalls. For example, toxic mentoring may occur if goals or expectations are unrealistic, if confidentiality is violated, or if there exists a conflict of interest that places the mentor’s needs over the mentee’s.^2,5,42  Other negative experiences could arise if the mentee becomes too dependent on the mentor or the mentor exerts too much control over the mentee.⁴  Not every mentoring relationship will be successful, so both the mentor and mentee should agree at the start to an option to terminate the partnership if it does not work.⁶ 

Another important part of the planning process is to decide on a feasible plan to ensure regular communication.^3,45  This element can be challenging, especially when mentors and mentees have different schedules or work in different locations. Communication strategies can include face-to-face interactions (in-person or virtual meetings), phone calls, emails, or text messages.^19,36  Email communication provides 1 option for sharing information, but discussions via phone or an online communication platform such as Skype offer enhanced opportunities for robust discussion. Relationship building also benefits from in-person meetings, which can occur both formally and informally (eg, over lunch or coffee), but in either case they should be scheduled to provide some consistency.

Although the frequency of connections may vary, a regular schedule is important to maintain the relationship and ensure progress toward goals.^18,22,43  Goals may need to be revised over time as the mentee acquires experience or as their perspective changes. Mentors may need to reframe expectations for mentees to help them realize that success (“productivity”) also comes from lessons learned from setbacks or by overcoming barriers.⁴¹  Having a coordinator or liaison who periodically meets with the mentor-mentee pair can also help facilitate communication and the accomplishment of goals.⁴⁶ 

Both mentors and mentees frequently cite as a barrier a lack of time for mentoring activities.^8,19,39  Mentoring may be perceived as valuable, but finding time for it while at work can be burdensome. Structured time for mentoring activities can help increase opportunities for mentors to connect with their mentees. Such time could include monthly lunch meetings, social networking nights, classes or continuing education sessions, or attendance together at a local or regional conference. Organizational funding for meeting time has been noted as a significant benefit.³¹ 

Periodic evaluation is required to sustain a successful mentoring program. Such evaluation includes an assessment both of outcomes for the individual goals of both the mentor and the mentee, and of the organizational objectives for the program.^2,3,10  Metrics may include completion of the program, number of meetings, goals accomplished, and mentor-mentee satisfaction.²¹  Feedback from participants can identify barriers to success and opportunities to improve the program. Positive individual outcomes provide an opportunity to celebrate a mentee’s successes and recognize the mentor’s contributions. These experiences can be shared with others to sustain momentum for the program. Research and anecdotal reports support the concept that having a good mentor creates in a mentee a desire to mentor others.^47,48 

Mentoring is important to critical care nursing in that it helps to recruit and retain staff, promotes continued professional growth, and preserves the precious commodity of expertise in caring for critically ill patients. Various programs should be developed to support mentoring opportunities that align with a critical care nurse’s career trajectory. Novice nurses feel supported and valued through mentoring, and experienced clinicians can be renewed and energized by the experience. Organizations and patients benefit from an engaged workforce and improved quality of care.