Mentorship of Novice Nurses 1

Running Head: MENTORSHIP OF NOVICE NURSES

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(9, 12, 2010)

 Mentorship of Novice Nurses 2

Outline

Abstract

Introduction

The Need for Orientation

New Orientation Model

Preceptor-Based Orientation

Possible Barriers to Better Mentorship

Conclusion

Reference List
 Mentorship of Novice Nurses 3

Mentorship of Novice Nurses

Abstract
Evidence based practise is the meticulous, explicit and sensible use of available best
facts and evidence in making decision in clinical service provision for individual
patients. The practise of evidence based mentorship means integration of the
professional clinical expertise with the best job orientation programs to offer better
adaptation for both experienced and novice nurses. Evidence based practise is one
of the most sensible advances reached in the nursing profession to help the
professionals in making decisions. This is because the evidence in this case hold out
the trust and optimism that the practitioners will succeed in providing the patients
with the best currently available information regarding the issue. This is why this
paper addresses evidence based mentorship program for learner nurses. Studies
have shown that both experienced and novice nurses experience anxiety when they
are recruited to a new job, new department or new position. However, the
experienced nurses have an advantage of adopting very fast having experienced or
worked under different clinical situation. However the novice nurse come in with a
mindset, which often present a major obstacle during orientation and adapting to the
new working environment. This paper highlights the effectiveness of a meaningful,
critical evidence-based mentorship program for novice nurses. Evidence based
meaning researching what it entails and then implementing it. It’s therefore shows
practitioners dedication to use all approaches available to identify the most efficient
means for any problem in all areas of organisation including novice nurses.
 Mentorship of Novice Nurses 4

Introduction

Mentoring in nursing profession is a fundamental undertaking that need to be

supported. Traditionally, the process of transformation of workers was met by

obstacles of anxiety and fear of what will happen when a certain situation emerged.

Nurses, especially fresh graduates had a difficult time adapting to the practise.

However, placement teaching was introduced to assist them to quickly adopt and

alleviate fears and anxiety. This way, the nurses had to be allocated mentors to

guide them through the organisational expectation and the requirement of the

nursing profession. The relationship between a mentor and the novice nurse or

protégé should never be underrated. The nurses who accept the responsibility of

mentorship and help to orient the new graduate nurse should be appreciated and

rewarded for devoting their time, sharing knowledge and professional experiences

with novice and future colleagues. Though it’s a professional responsibility of the

licensed nurses to assist new nurse graduates to increase in skills and expertise up

to their maximum potential, some organisation fail to do this and later experience

dire consequences when novice nurse are not properly oriented and did not develop

enough confidence to practise without fear.

The Need For Orientation

The orientation period offers a context of interaction between experts or

professional nurses and the student nurses or novice nurses. This at times can result

in inadequate attrition. Even though there are several studies that have addressed

the orientation need of novice nurses, there is little that has been done to analyse

how experienced nurses can be helped (Dellasega et al, 2009, p. 311). Therefore a

study by Dellasega et al sought to assess whether the needs of the novice nurses

were similar to those of experienced nurses.

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The moment a nurse is hired into a health facility, the work environment being

to shape their attitude, perceptions, functionality and satisfaction (Dellasega et al,

2009, p. 311). Some experts have indicated that proper orientation sets the proper

track for the novice nurse to progress on while on the job. The first 30 days nurses

get to the job are very crucial for possible satisfaction and retention in future.

Improper orientation can result in what is termed as ‘burnout’ whereby the new

nurses shift from a certain working station to the next even before they have adapted

to the change in that unit (Dellasega et al, 2009, p. 312). This is likely to affect their

confidence in the next unit and generally they will feel inadequately prepared to do

their job. Orientation period is usually described by many nurses as exciting and

threatening because the nurses are usually thrilled to get the job and at the same

time they are anxious of what is expected of them and they strife to be perfect. This

is when the conflict begins because they have less experience but they think that too

much is expected of them.

Novice nurses could feel that the new job is complex due the fears of

inadequacy. However experienced nurses moving to another department have better

ability of adaptation because they can realistically assess the situation and

comprehend faster what the new position entails hence they adjustment to that

position in individual and professional perspective is efficient (Dellasega et al, 2009,

p. 314).

Novice nurses need to be focused, ready to learn, suppress their personal

super ego and try to overcome their fears. The fear of uncertainty exist in almost

everyone but with time that fades away as the novice nurse do more of the routine

practises under supervision and then on their own. When asked how, the felt on their

initial days at work, nurses stated that they experienced feeling so conflict and
 Mentorship of Novice Nurses 6

uncertainty (Dellasega et al, 2009, p. 314). At times they even questioned their

decision to venture into nursing and whether the expectations were realistic. Most of

the nurses claimed to have experienced nervousness, stress, anxiety and even

somatic reaction to the work duties. These reactions were mixed feeling of

excitement of the new daring career.

New Orientation Model

Because of the problems of job turnover in nursing, preparedness to carry out

patient care, job satisfaction and vacancy, the Midwestern University through its

affiliate medical centre established a new model for orientation. The model was

informed by approaches from essential if critical care orientation and the learning

and training needs were assessed by use of a Basic Knowledge Assessment Test

for over 173 individuals (Klienpell, 2009, p. 261).

Linda, the lead researcher stated that she had become frustrated as a clinical

expert and an instructor while trying to provide a momentous care orientation model.

Linda Morris also states that she had observed dissatisfaction of the orientation

programs by managers, the mentor nurses were frazzled, novice nurse were

extremely anxious, orientees were irritated by sitting in classroom throughout,

something that they probably did not need and job turnover was very high (Klienpell,

2009, p. 261).

She adopted simulation techniques to be used during orientation. She was

amazed to realise that there was so much information for administrators and staff

educators who also assisted in writing the program. The participants indicated that

the simulation experiences and guides were the most efficient approaches of

educating the new nurses (Klienpell, 2009, p. 261). According to Linda, the new

orientation model is not just a mere program but presents an opportunity to research.
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Basically the goal of the project was to offer meaningful orientation model that would

see competent nurses develop their ability to think critically and produce more

secondary results (Klienpell, 2009, p. 262). The new model of simulation is better

than tradition classroom orientation. This was very unproductive having nurses with

varied practical experience teach a class about practical things. The new model has

addressed four critical components; online learning to provide standard knowledge;

cases studies for facilitate critical thinking among novice nurses; practical clinic time

with preceptor (mentor) to offer the novice nurses an opportunity of practical

application of their skills and application of high-fidelity simulation to enhance real-

time critical thoughts (Klienpell, 2009, p. 262).

The implication of the new model has been seen in improved job satisfaction

rates, the turnover is greatly reduced and there number of vacancies consequently

dropped. A number of teaching strategies have also been integrated in the new

model including classroom time and simulation sessions, supervised clinic sessions

by preceptors, return demonstration and video studying (Klienpell, 2009, p. 262). The

concluding remarks were that critical thinking even when pressurized by

overwhelming job duties or anxiety was a key factor to nursing care and it is

achievable to train the nurses on critical thinking by use of case studies and

simulation.

Preceptor-Based Orientation

In the cases of critical care nursing, there are usually three stages of

orientation involved to ensure that novice nurse advance and adapt into the nursing

profession. The first stage is usually a day long and entails general orientation of the

hospital of healthcare facilities and departments. the second is usually about three to

five days where the new nurse is familiarized with general nursing practises (Sandau
 Mentorship of Novice Nurses 8

& Halm, 2009, p. 184). The third one is much longer, lasting about six to twelve

weeks and it entails protected clinical practises. This is where the new nurse is

paired to a mentor who in most cases is a professional registered nurse so that the

new nurse can learn practical from the expert and sometime do the roles on his/her

own but supervised by the RN nurse mentor. The role of the preceptors or mentors is

to ensure that the new nurse adequately learn both basic and specific nursing skills,

become better acquainted with dealing with patients, the facility’s protocol and the

organisation culture (Sandau & Halm, 2009, p. 184).

A cross-sectional study of newly recruited nurses from various hospitals by

Casey revealed that the nurses experienced high levels of stress and trouble in

transitioning from novice to professional duties. The major cause of all these types of

reaction was attributed to lack of confidence in their skills and knowledge, weak

relationship with peers and mentors, overdependence on the colleagues, work

related frustrations, poor communication with doctors and poor critical thinking skills

(Sandau & Halm, 2009, p. 184). Preceptors play a crucial duty of modelling the

professionalism that nurses attain later and help in facilitating their adjustment to the

new responsibilities and expectations.

The outcomes of the study where the mentorship program was preceptor-

novice show several achievements. Good preceptorship lead to improved ability of

critical thinking among the novice nurses (Sandau & Halm, 2009, p. 184). This was

obtained from a study by Sandau on preceptor-based orientation. The nurses

showed growing confidence levels with time, after a period of 6 months, the new

nurses showed readiness to handle patient care process independently without

direction of preceptor. This showed that they were more confident (Sandau & Halm,

2009, p. 187).
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Regarding organisational outcomes, the new nurses showed signs of lack of

dedication or a sense of belonging. They felt that they were not being appreciated.

However, after a period of 12 months the level of job satisfaction increased

considerably and they got attached to the health facility meaning that their sense of

belonging had grown (Sandau & Halm, 2009, p. 187). They appreciated the

education programs of the organisation more and they also adopted more realistic

perception of the nurses’ roles as professionals. They became satisfied with the way

training was being done; they accepted the communication styles and were more

collaborative. Among all the available set to assist the novice nurses to adapt to the

organisation, supportive preceptors score very highly (Sandau & Halm, 2009, p.

187). It’s pertinent to note the preceptors also need education and some training to

be prepared for the role of mentoring new nurses. This call for future studies

regarding the appropriateness of ongoing education programs for nurses on job

which could eventually offer better mentorship outcomes (Sandau & Halm, 2009, p.

188).

Besides the evidence given as to why preceptor oriented mentorship it’s also

important to consider the type of relationship that exists between the professional

nurse and the novice. As cited, poor relationship will not achieve the intended goals.

The professional nurses must be willing to share their knowledge with novice nurses

(Hallin & Danielson, 2009, p. 161). They should act as role models to educate new

nurses on the new job roles and also be guides in socializing. The relationship is

usually time-limited yet the nurses are required to have obtained maximum skills and

competencies. By the time the period of preceptorship lapses, the nurses are

expected to be more confident when performing clinical procedures, they are

expected to be rational in decision making so that they reach informed decisions and
 Mentorship of Novice Nurses 10

finally they are expected to be able to apply the acquired knowledge to specific

medical conditions independently (Hallin & Danielson, 2009, p. 163).

Possible Barriers to Better Mentorship

There are some obstacles that have been identified as being potential

impediment to achieving the goals mentorship in nursing. Communication is a major

barrier. The preceptor and the novice may fail to communicate effectively meaning

that the learning needs of the novice nurses will not be met. Therefore, the preceptor

is required to be a socialiser whereby he/she can be able to identify and discuss the

needs of the novice nurse. On the other hand the novice nurse should be open to

discuss with the professional nurse. This way, the learning will be learner directed

and more exploratory (Hallin & Danielson, 2009, p. 164). There is likely that conflict

may arise because of differences of expectations. It’s important that the two parties

assume non-judgemental attitude or criticism or unwarranted complaints concerning

the program. They can dialogue and reach rational consensus or invite a third party

to offer direction. Fear and anxiety can be overcome by discussing them with

professional nurses since these reactions are normative.

Recommendation

This paper strongly supports orientation where mentors give their protégé or

novice nurse maximum direction. In order to improve chances of workers retention

and job satisfaction, then this study recommends implementation of preceptor-based

orientation so that the novice nurses learn practically and they do so from the best.

Some institution may think that avoiding apprenticeship like program would cut their

cost but the impact could be devastating (Sandau & Halm, 2009, p. 187). Leaders

need to put in place a strong structured program for orientating novice nurses by use

of sufficiently prepared preceptors. In order to prepare the mentors for their job,
 Mentorship of Novice Nurses 11

further education or some form of training should be conducted probably for 1 to 3

day workshops. Still there needs to be further studies for the best way to ensure

mentors are prepared for their role (Sandau & Halm, 2009, p. 187).

Standard competency skills rating need to be designed to direct the evaluation

of the progress of the novice nurses during the program. There is a little concern on

this because currently there is no research that has produced conclusive results on

the cultural and expected competencies (Sandau & Halm, 2009, p. 187).

Implementing preceptor mentorship program is a feasible project considering

that many health facilities have some form of orientation program in place. Therefore

introducing one that will be like placements study for student nurse will be very easy

to achieve. Few steps will guide the implementation. The first step to ensure the

mentorship program is needs driven where the novice nurses directs the process.

This way, the new nurses reorganize themselves and their internal processes

are adjusted to meet the critical skills and create new standards that commit to

continuous improvement. The more complex the needs of patients are, the more

pertinent it becomes to be more skilled so that the expectations of patients are

matched by the services offered.

Second is to establish a transactional quality management strategy that

addresses patient needs. This means that there will be continuous improvement in

nurses’ skills rather than short-term meeting the daily expectations. The process of

ensuring better orientation will also assure continuing assessment. The process of

mentoring should be designed to satisfy the needs of patients in nursing practice.

A strong leadership that focuses on improvement of the patient results is

essential. Removing representatives enable the organization to support the

administrative needs of patients directly. Educating novice nurses on technical and

 Mentorship of Novice Nurses 12

application skills to contribute to the firm’s service productivity; this means that

novice nurses have to be trained so that they can be able to analyze a problem, to

integrate it and to be able to conceptualize the solution and aid in the process of

implementation.

Conclusion

Being familiarised with the job expectations by a professional nurse had a

positive impact on new nurses as studies show. Working under the watch of a

registered nurse ensured that they focus on the needs of the job and try to master so

that in future they can do the tasks on their own. From the study of the needs of

professional nurse when they move from one position to another or another

department brought about very important insight to the needs of novice nurses. This

is because the recommendations wanted the professional nurses to assume the role

of novice nurse for them to learn much better.

There is always mixed expectation when joining a new position. Anxiety to do

the job is the commonest symptom for many nurses both experienced and novice.

However, experienced nurses had better chances of adapting and gaining

confidence to function because of their prior experiences. While Novice nurses were

likely to identify issue like lack of proper leadership or lack of appreciation or lack of

respect from colleagues, experienced ones have more realistic expectation and

focused on their abilities to work together with colleagues. More research has to be

carried out to find more generalizeable conclusion. However, using the current

statistics and information, orientation to a new job needs to be designed to address

the emotional needs of the novice nurses as well as professionals. Sometimes

assuming new roles from scratching can be very challenging and that’s why

sometimes nurses have to learn totally new skills hence need more support from the
 Mentorship of Novice Nurses 13

experienced ones as their mentors. Such specific consideration of individual can

result in effective and successful transition from inexperienced to a professional with

time.

Finally it’s important to appreciate that nursing is a practise venture where

practical experience together with theoretical knowledge are very important.

Therefore the best ways of learning would be through hands on experience. This will

offer direct experience in the clinical setting as well as allow integration of knowledge

concepts. Thinking processes are often triggered when unfamiliar situations are

encountered in practise. A preceptor should hence target to inspire critical thinking,

clinical preparation and the individual learning needs of the novice nurse. Since

many researchers have shown that preceptor based oriented is effective in

supporting novice nurses as they venture into clinical practise, future studies should

target on the experiences that the novice nurses go through in order to come out

successfully. This could solve the barriers of communication, fear or anxiety.

Furthermore there should be more studies on first-time preceptor or mentor to

assess whether they offer same efficiency as nurses who has mentored several

others before.
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Reference List

Dellasega, C. Gabbay, R., Durdock, K., & Martinez-King, N. (2009). “An Exploratory

Study Of The Orientation Needs Of Experienced Nurses,” The Journal Of

Continuing Education In Nursing, Vol. 40, No. 7, pp. 311-317

Hallin, K., Danielson, E. (2009). “Being A Personal Preceptor For Nursing Students:

Registered Nurses’ Experiences Before And After Introduction Of A Preceptor

Model,” Journal Of Advanced Nursing, 65(1), 161-174.

Klienpell, R., (2009). “Evidence-Based Review And Discussion Points,” American

Journal Of Critical Care, Vol. 18, No. 3, Pp. 261-262

Sandau, K.E., & Halm, M., (2009). “Programs: Effective For Nurses And

Organisation? American Journal Of Critical Care,” Vol. 19, No. 2, Pp. 184-189