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Fostering Excellence in Professional Practice With Mentorship

Howard, Elisabeth D. PhD, CNM, FACNM

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The Journal of Perinatal & Neonatal Nursing: April/June 2020 - Volume 34 - Issue 2 - p 104-105
doi: 10.1097/JPN.0000000000000477
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Mentors and apprentices are partners in an ancient human dance, and one of teachings great rewards is the daily chance it gives us to get back on the dance floor.

Parker Palmer,1The Courage to Teach

Formal mentorship is of proven value in the business, academic, and medical arenas. It is considered essential to the future vitality of a profession.2 While it is intuitive that informal mentorship occurs within nursing, formal workplace mentoring programs are not standard, yet are essential for a healthy work environment and professional development and to achieve Magnet designation.3 This column reviews the literature on mentoring in nursing practice, the history, theoretical background, and key resources on implementation to promote both professional and personal development.3

Mentoring is recognized as a popular tool for career advancement in all types of organizations. Mentoring relationships are, in fact, a key to success.3 Properly defined, mentoring is a collaborative relationship between 2 or more individuals that supports the career and/or personal development throughout one's career.3 Ideally, true mentoring is a relationship that inspires growth and development.4 Nurses often provide informal mentoring for students and new graduates without formal recognition or defined outcomes of those relationships. Mentoring functions are implicit to professional practice and include sponsorship, coaching, protection, exposure, acceptance, and, ultimately, social and emotional support.3 While mentoring is a popular approach for developing knowledge and skills across a number of disciplines, there is limited literature in professional practice, acknowledging how it may be utilized and implemented.

HISTORY

The story of mentor comes from Homer's Odyssey. Odysseus, King of Ithaca, who fights in the Trojan War and entrusts the care of his household to Mentor, who serves as teacher and overseer of Odysseus' son, Telemachus.5 The word “mentor” evolved to mean trusted advisor, friend, teacher, and wise person.5 History offers many examples of mentoring relationships: Socrates and Plato, Hayden and Beethoven, Freud and Jung.5 Mentoring is a fundamental form of human development where one person invests time, energy, and personal know-how in assisting the growth and ability of another person.4,5 Mentors are wise guides who lead the mentee to self-actualization.4 A more recent example of this coaching relationship is captured in movie The King's Speech, the story of Prince Albert and his speech therapist. Prince Albert struggled with a stutter most of his life, with much attention and work done with speech therapists over time. His newfound speech therapist's positive reassurances contrasted the Prince's experience with past speech therapy failures, enabling him to ultimately ascend and reign as King George and to broadcast inspiring, calming, and much loved speeches to the country during wartime. Hence, the mentor relationship fosters both personal and professional growth.

ADVANCEMENT IN NURSING PRACTICE

It is well recognized that clinical expertise is necessary for the advancement of nursing practice and that this occurs along a continuum of 5 stages of novice to expert.6 Benner's model of nursing expertise is adapted from the Dreyfus model of skill acquisition.7 The Dreyfus model describes how individuals progress through various levels in their acquisition of skills.6 Benner's theory is an explanatory model of the way in which practical and theoretical knowledge is integrated into and generated by nursing practice. There are 5 stages. The first is novice, beginners who have no experience clinically and are learning the objective and context-free rules that govern their behavior. The second stage is advanced beginner, those who have acquired some global concepts and can demonstrate acceptable performance. Stage 3 is the competent nurse. This is typified by the nurse who has been on the job in the same or similar situation for 2 or 3 years. Stage 4 is the proficient nurse who has attained a grasp of the whole picture and is guided by maxims rather than rules. Finally, the expert nurse who no longer adheres to or is guided by rules but by extensive clinical experience.6 For each of these stages, a clinical mentor is needed. It is recommended that new graduates be oriented by competent, but not expert, nurses and that nurses with experience but new to the clinical setting be oriented by experts.6

Formal workplace mentoring programs in hospitals improve nurse and patient satisfaction, as well as organizational costs.7 Mentoring not only facilitates best clinical practices and professional growth for the mentee but also the mentor must remain current with clinical policies and practices to best guide the mentee, making it a mutually beneficial relationship. A model program in Pennsylvania uses the 6 healthy work environment best practices as put forth by the American Association of Critical-Care Nurses (AACN) in addition to the novice to expert model to build and sustain a mentorship program in their professional development department.7

The 6 essential standards provide evidence-based guidelines for success in implementing a mentorship program. These include skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership.7 A formal mentorship program not only expands on each of these standards with regular check-ins, dialogue, and growth opportunities but also supports each and multiplies the compounded benefits to its participants, their organization, and patients.7 When every relationship is approached as an opportunity to learn the potential for mentoring, moments are created. These short, uplifting interactions can sustain and enhance a healthy workplace environment. Every conversation has the potential to be a mentoring moment, and people at all levels are encouraged to seek the support from one another.

CONCLUSION

New graduate nurses need more than an orientation, they need mentoring. This mentoring ideally continues throughout their advancement toward excellence and is reciprocated throughout a professional practice career. Combining theoretical knowledge of the advancement of clinical judgment using the novice to expert framework with the 6 healthy work environment best practices establishes a foundation for a formal mentorship program. There are excellent tool kits available for implementation.8

It is the dance of the spiraling generations in which the old empower the young with their experience, and the young empower the old with new life, reweaving the fabric of human community.

Parker Palmer,1The Courage to Teach

—Elisabeth D. Howard, PhD, CNM, FACNM
Director of Midwifery
Women and Infants Hospital
Associate Professor
Obstetrics and Gynecology (Clinical)
Alpert Medical School of Brown University
Providence, Rhode Island

References

1. Palmer P. The Courage to Teach: Exploring the Inner Landscape of a Teacher's Life. Hoboken, NJ: John Wiley & Sons; 1998.
2. American Association of Colleges of Nursing. Fact sheet: nursing shortage. https://www.aacnnuring.org. Published 2018. Accessed January 30, 2020.
3. Chen C, Lou M. The effectiveness and application of mentorship programmes for recently registered nurses: a systematic review. J Nurs Manag. 2014;22:433–443.
4. Kram KE. Mentoring at Work: Developmental Relationships in Organizational Life. Glenview, IL: Scott, Foresman; 1984.
5. Brown University. Overview of the GELT Program. http://www.brown.edu/about/administration/global-engagement/global-experiential-learning-and-teaching-gelt-program. Accessed January 30, 2020.
6. Benner P. From Novice to Expert: Excellent and Power in Clinical Nursing Practice. Menlo Park, CA: Addison-Wesley Publishing Co; 1984.
7. Peña A. The Dreyfus model of clinical problem-solving skills acquisition: a critical perspective. Med Educ Online. 2010;15. doi:10.3402/meo.v15i0.4846. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2887319. Accessed January 30, 2020.
8. AACN, Robert Wood Johnson Foundation. The mentoring toolkit and handbook. http://www.newcareersinnursing.org/resources/mentoring-toolkit-and-handbook.html. Accessed January 30, 2020.
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