Evaluation of a pilot mentoring programme for nurse managers

Mentoring in the clinical training of midwifery students - a focus study of the experiences and opinions of midwifery students at the Medical University of Warsaw participating in a mentoring program

BACKGROUND

The current system of clinical training for midwifery students in Poland is in need of considerable revision to adapt it to the global standards and the expectations of healthcare providers, healthcare users and student midwives themselves. Aim of this study was to report the experiences of midwifery students participating in a mentor-led clinical training program and their opinions of mentoring as a novel training method.

METHODS

A qualitative descriptive study that used a focus group was undertaken in the period from October 2017 to June 2019. The participants were 12 s- and third-year midwifery students at the Medical University of Warsaw who at various times during the study period had their clinical training in the Department of Obstetrics, Solec Hospital in Warsaw, Poland. All students had previous experience of clinical training other than clinical mentorship. At the end of the study, a focus group interview was conducted with all 12 participants. Five questions were selected to guide the focus group discussion: Did you get any valuable learning experience during your clinical training? How did this clinical training differ from your previous clinical training? What was your experience of one-on-one mentoring? Did the mentoring program meet your expectations? What do you think could be changed to make the proposed mentor-led clinical training more effective?

RESULTS

Four themes were identified. The study demonstrated that mentoring was perceived by the participants as an innovative and effective method of clinical training for midwifery students. All students positively evaluated the quality of the mentor-led clinical training which allowed improving their clinical skills and building new competencies. Students believed they could effectively use their clinical skills and make informed decisions in a safe and supportive clinical learning environment. They felt that their inclusion in the therapeutic team contributed to better patient care.

CONCLUSIONS

The use of innovative forms of clinical training at undergraduate level improves its effectiveness and in the future should be reflected in a high-quality maternity care. Mentoring has its advantages for both, mentor and mentee, but the main goal is to develop and improve professional competencies of the junior partner.

Mentoring the working nurse: a scoping review

BACKGROUND

Mentoring programs for nurses already in the health workforce are growing in importance. Yet, the settings, goals, scale, and key features of these programs are not widely known.

OBJECTIVE

To identify and synthesize research on in-service nurse mentoring programs.

METHODS

We reviewed nurse mentoring research from six databases. Studies either referred explicitly to in-service nurse mentoring programs, were reviews of such programs, or concerned nurse training/education in which mentoring was an essential component.

RESULTS

We included 69 articles from 11 countries, published from 1995 to 2019. Most articles were from high-income countries (n = 46) and in rural areas (n = 22). Programs were developed to strengthen clinical care (particularly maternal and neonatal care), promote evidence-based practice, promote retention, support new graduate nurses, and develop nurse leaders. Of the articles with sufficient data, they typically described small programs implemented in one facility (n = 23), with up to ten mentors (n = 13), with less than 50 mentees (n = 25), meeting at least once a month (n = 27), and lasting at least a year (n = 24). While over half of the studies (n = 36) described programs focused almost exclusively on clinical skills acquisition, many (n = 33) specified non-clinical professional development activities. Reflective practice featured to a varying extent in many articles (n = 29). Very few (n = 6) explicitly identified the theoretical basis of their programs.

CONCLUSIONS

Although the literature about in-service nurse mentoring comes mostly from small programs in high-income countries, the largest nurse mentoring programs in the world are in low- and middle-income countries. Much can be learned from studying these programs in greater detail. Future research should analyze key features of programs to make models of mentoring more transparent and translatable. If carefully designed and flexibly implemented, in-service nurse mentoring represents an exciting avenue for enhancing the role of nurses and midwives in people-centered health system strengthening. The contents in this article are those of the authors and do not necessarily reflect the view of the U.S. President's Emergency Plan for AIDS Relief, the U.S. Agency for International Development or the U.S. Government.

Nurse Managers' Experiences With Electronic Health Records in Quality Monitoring

Little is known about how hospital-based nurse managers use electronic health records (EHR) to monitor nurse-sensitive quality measures, or about how they learn to do so. This article describes the role of nurse managers in quality monitoring, their experience in using the EHR to monitor nurse-sensitive quality measures, and their related training. A convenience sample of nurse managers and directors (n = 28) was recruited to participate in semistructured interviews. The resulting data were analyzed, using content analysis. This study revealed 3 components of the nurse manager's quality-monitoring role: monitoring documentation, monitoring practice, and performing investigations. Facilitators for accessing EHR information included ease of navigation, timeliness and accessibility of reports, and usefulness of EHR tools. Participants described a range of formal and informal approaches to learning how to access information for quality monitoring in general and for the EHR specifically. The findings provide direction for further exploration of the EHR structures and processes needed to support nurse managers' information needs and quality-monitoring training.

Are healthcare middle management jobs extreme jobs?

PURPOSE

The purpose of this paper is to explore the incidence of "extreme jobs" among middle managers in acute hospitals, and to identify individual and organizational implications.

DESIGN/METHODOLOGY/APPROACH

The paper is based on interviews and focus groups with managers at six hospitals, a "proof of concept" pilot with an operations management team, and a survey administered at five hospitals.

FINDINGS

Six of the original dimensions of extreme jobs, identified in commercial settings, apply to hospital management: long hours, unpredictable work patterns, tight deadlines with fast pace, broad responsibility, "24/7 availability", mentoring and coaching. Six healthcare-specific dimensions were identified: making life or death decisions, conflicting priorities, being required to do more with fewer resources, responding to regulatory bodies, the need to involve many people before introducing improvements, fighting a negative climate. Around 75 per cent of hospital middle managers have extreme jobs.

RESEARCH LIMITATIONS/IMPLICATIONS

This extreme healthcare management job model was derived inductively from a qualitative study involving a small number of respondents. While the evidence suggests that extreme jobs are common, further research is required to assess the antecedents, incidence, and implications of these working practices.

PRACTICAL IMPLICATIONS

A varied, intense, fast-paced role with responsibility and long hours can be rewarding, for some. However, multi-tasking across complex roles can lead to fatigue, burnout, and mistakes, patient care may be compromised, and family life may be adversely affected.

ORIGINALITY/VALUE

As far as the authors can ascertain, there are no other studies exploring acute sector management roles through an extreme jobs lens.

Examining occupational stress, sources of stress and stress management strategies through the eyes of management consultants: a multiple correspondence analysis for latent constructs

To date, little research has yet focused in broad assessment for management consultancy professionals. This investigation aims to analyse management consultants' self-perceptions of occupational stress (SPoOS), sources of stress (SoS) and stress management strategies (SMS) and to find latent constructs that can work as major determinants in consultants' conceptualization of SPoOS, SoS and SMS. Measures were completed, including demographics and interviews. Complete data were available for 39 management consultants, 53.8% male and aged between 23 and 56 years (M = 38.0; SD = 9.2). The data were subjected to content analysis. Representation of the associations and latent constructs were analysed by a multiple correspondence analysis. Results indicated that 'intellectual disturber' (31.4%) was the most referred SPoOS, 'high workload' (15.1%) was identified as the most prevalent perceived SoS and 'coaching' (19.0%) was the most mentioned SMS. No significant differences between the two gender groups were found regarding the three total scores. SPoOS was explained by a two-factor model: 'organization-oriented' and 'person-oriented'. A three-dimension model formed by 'job concerns', 'organizational constraints' and 'career expectations' was indicated as a best-fit solution for SoS, and SMS was best explained in a three-dimension model by 'group dynamics strategies', 'organizational culture strategies' and 'individual support strategies'. This research makes a unique contribution for a better understanding of what defines SPoOS, SoS and SMS for management consultants.

How do they manage? A qualitative study of the realities of middle and front-line management work in health care

This project addressed three questions. First, how are middle management roles in acute care settings changing, and what are the implications of these developments? Second, how are changes managed following serious incidents, when recommendations from investigations are not always acted on? Third, how are clinical and organisational outcomes influenced by management practice, and what properties should an ‘enabling environment’ possess to support those contributions?

Data were gathered from around 1200 managers in six trusts through interviews, focus groups, management briefings, a survey with 600 responses, and serious incident case studies. For this project, ‘middle management’ meant any role below board level that included managerial responsibilities. Evidence provided by trust workforce information offices revealed that the management function is widely distributed, with > 30% of hospital staff holding either full-time management posts or ‘hybrid’ roles combining managerial with clinical or medical responsibilities. Hybrids outnumber full-time managers by four to one, but most have only limited management training, and some do not consider themselves to be managers. Management capabilities now at a premium include political skills, resilience, developing interprofessional collaboration, addressing ‘wicked problems’, performance management and financial skills.

Case study evidence reveals multiple barriers to the implementation of change following serious incidents. These barriers relate to the complex causes of most incidents, the difficulties in establishing and agreeing appropriate action plans and the subsequent problems of implementing ‘defensive’ change agendas. The conclusions from these case studies suggest that the management of serious incidents could potentially be strengthened by adding a change management perspective to the current organisational learning focus, by complementing root cause and timeline analysis methods with ‘mess mapping’ processes and by exploring opportunities to introduce systemic changes and high-reliability methods in addition to fixing the root causes of individual incidents.

Interview, focus group and survey evidence shows that middle managers are deeply committed but face increasing workloads with reduced resources, creating ‘extreme jobs’ with long hours, high intensity and fast pace. Such roles can be rewarding but carry implications for work–life balance and stress. Other pressures on middle management included rising patient and public expectations, financial challenges, burdensome regulation (external and internal), staffing problems, incompatible and dated information systems, resource and professional barriers to implementing change and problematic relationships with external agencies. Despite these pressures, management contributions included maintaining day-to-day performance, ‘firefighting’, ensuring a patient experience focus in decision-making, translating ideas into working initiatives, identifying and ‘selling’ new ideas, facilitating change, troubleshooting, leveraging targets to improve performance, process and pathway redesign, developing infrastructure (information technology, equipment, estate), developing others and managing external partnerships. Actions required to maintain an enabling environment to support those contributions would involve individual, divisional and organisational steps, most of which would be cost neutral.

Recommendations for future research concern the assessment of management capacity, the advantages and drawbacks of service-line organisation structures, the incidence and implications of extreme managerial jobs, evaluating alternative serious incident investigation methods, and the applicability of high-reliability organisation perspectives in acute care settings.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

A rapid matrix mentoring pilot

Purpose

This case study aims to report on the effectiveness of a matrix mentoring pilot project in a healthcare setting and its ability to build managerial competencies and enhance levels of employee engagement.

Design/methodology/approach

The study used a mixed‐method design with pre and post pilot evaluation phases. Focus groups were held with both mentee and mentor groups. Mentees also completed questionnaires that assessed their levels of managerial competency and engagement.

Findings

Mentees who engaged in a matrix mentoring pilot reported increased levels of managerial and leadership competencies, and employee engagement. Additionally, mentees realized greater exposure to managerial roles and responsibilities and experienced personal development and growth as a result of individual project assignments.

Research limitations/implications

The small sample size is the main limitation of this project. However, it was a pilot within a case study organization and one of the objectives was to learn from the experience.

Practical implications

Mentors and mentees reported positive feedback. Mentors were able to assess the capacity and interest of future potential leaders and mentees gained exposure to managerial competencies.

Originality/value

The originality of this research is found in the application of a matrix mentoring approach. Typically, mentoring programs match one mentor with one mentee. A team of mentors worked with each of the mentees and engaged in exposing the participants to a range of competencies. The literature suggests that managerial competencies in a complex setting, like healthcare, need to be diverse. This research presents one possibility for building such a range of abilities.

Enhancing Leadership Orientation Through Simulation

Many novice managers feel unprepared to handle some of the situations that occur as a daily part of their job. It is important to provide an environment through which novice managers can receive training and develop skills in effective communication in complex nursing environments. Simulation-based training can provide a safe, interactive way for new managers to develop their communication and leadership skills. This type of training allows novice managers to increase their confidence and improve their job satisfaction and their management skills.

Continuing connections: the experiences of retired and senior working nurse mentors

AIMS AND OBJECTIVES

This paper reports the benefits and challenges of a mentoring programme through which retired and senior nurses continued to support and nurture nurses and midwives currently working in the health system.

BACKGROUND

Nursing has an ageing workforce and faces significant loss of expertise because of retirements. Previously, mentoring programmes have been instituted in a range of nursing contexts and they have been a retention strategy for older nurses and midwives.

DESIGN

Mentors and their mentees worked together towards mutually agreed on professional and personal goals. They were asked to meet or speak together a minimum of twice per month for at least six months.

METHOD

As part of a collective case study, 15 mentoring dyads were established. Participants and mentors took part in qualitative, semi-structured interviews about their perceptions and experiences of the mentoring programme. Interviews were audio-taped, transcribed and analysed thematically.

RESULTS

Mentors reported the mentoring experience to be rewarding experience that enabled them to re-connect with nursing-related activities and brought new challenges in retirement. They perceived the mentees were visibly helped by their support and influence.

CONCLUSIONS

The mentors studied reinforced a positive self-concept as nurses and midwives in their mentees and assisted their development. Retired nurses and midwives in particular may have several characteristics that make them effective mentors.

RELEVANCE TO CLINICAL PRACTICE

Potential benefits are demonstrated for nurses and midwives vulnerable to workplace adversity, especially those new to Australia who may have limited professional and social networks. For health organisations, mentoring programmes may be an innovative method of retention that engages both mid-career nurses and midwives and those recently retired.

The continuing need for mentors in nursing

Peer-reviewed nursing research was surveyed to find progress or change in how nurses guide and nurture other nurses in their practice. Discussions on the characteristics required in an effective mentor, the selection process for a mentor, the role expectations of the partnership, the agreement between the mentor and the mentee, and the preparation for the roles are included. There is a continuing need for further study in this area of nursing to help build a strong, stable, and competent nursing workforce. Nurses involved in staff development may find the short survey a useful tool in planning and implementing a mentoring program.

Contributing to a culture of learning: a mentor development and support project for Australian rural nurses

Mentoring in rural and remote nursing receives little attention in the literature, even though it is emerging in Australia as a popular strategy to improve the retention of staff. The Association for Australian Rural Nurses established a 2-year Mentor Development and Support Project in 2003 with the aim of promoting mentoring among rural and remote nurses. During the life of the project, 101 such nurses attended Mentor Development Workshops. This project demonstrated that training is an important prerequisite for rural and remote nurses who are planning to enter a mentoring relationship. Participant evaluation showed an increase in mentoring knowledge and skills and a subsequent rise in confidence about undertaking the role. Participants also believed that their increased capacity to mentor was reflected in their workplaces, contributing to a positive culture of learning.

Evaluation of a research mentorship program in community care

This article describes the results of a qualitative case study evaluating a research mentorship program in community care settings in Ontario, Canada. The purpose of the program was to build evaluation and research capacity among staff of community care agencies through a mentorship program. Data were collected through in-depth, semi-structured interviews, focus group interviews, and written evaluations. Three themes were identified: taking hold, fostering hold, and holding on. Mentees took hold of new evaluation and research skills. Factors fostering hold included positive mentoring relationships and participation in relevant research projects. Mentees struggled to hold on to, and apply their skills within a community care context of challenges such as constrained resources and a mandate to provide client-centered care. The lessons learned include having trainees participate in relevant, time-limited evaluation and research projects, and early implementation of mechanisms to sustain integration of trainees' knowledge and skills within community care agencies.

Walking With another: rural nurses' experiences of mentoring

The aim of this constructivist grounded theory study was to explore rural nurses' experiences of mentoring. Mentoring is often proposed as a solution to the problem of nursing workforce shortages. The global problem of workforce for nurses can be defined using the parameters of recruitment and retention rates, `problems' with which result in staff shortages, particularly of experienced nurses. Constructivist grounded theory has its foundations in relativism and an appreciation of the multiple truths and realities of subjectivism. Seven Australian rural nurses were interviewed. To ensure data saturation of particular categories and the fit of tentative theoretical conceptualisations, two participants were interviewed twice with no new codes identified from the subsequent interviews. Cultivating and growing new or novice rural nurses was the core category which conceptualised a two-part process consisting of getting to know a stranger and walking with another. Supportive relationships such as mentoring were found to be an existing, integral part of experienced rural nurses' practice — initiated by living and working in the same community. In this grounded theory, cultivating and growing is conceptualised as the core category. A two-part process was identified — getting to know a stranger and walking with another. This paper examines one of these subcategories, walking with another, relating the ways in which experienced rural nurses walk with another by firstly keeping things in perspective for new or novice rural nurses, and secondly using a particular form of language called nurse chat. For experienced rural nurses, mentoring in this way delivers a number of different outcomes with various nurses. Because it is a part of the experienced rural nurse's practice on an ongoing basis, individual mentoring relationships do not provide an end in relation to this nurse's experiences of mentoring, rather they are part of an ongoing experience. Creating supportive environments that include developing relationships such as mentoring is a potential solution to local staffing needs that does not require intensive resources. Experienced nurses engaged in clinical practice have the potential to cultivate and grow new or novice nurses — many already do so. Recognising their role and providing support as well as development opportunities will bring about a cycle of mentoring within the workplace.

Live my work: rural nurses and their multiple perspectives of self

AIM

This paper is a report of a study to explore rural nurses' experiences of mentoring.

BACKGROUND

Mentoring has recently been proposed by governments, advocates and academics as a solution to the problem for retaining rural nurses in the Australian workforce. Action in the form of mentor development workshops has changed the way that some rural nurses now construct supportive relationships as mentoring.

METHOD

A grounded theory design was used with nine rural nurses. Eleven semi-structured interviews were conducted in various states of Australia during 2004-2005. Situational analysis mapping techniques and frame analysis were used in combination with concurrent data generation and analysis and theoretical sampling.

FINDINGS

Experienced rural nurses cultivate novices through supportive mentoring relationships. The impetus for such relationships comes from their own histories of living and working in the same community, and this was termed 'live my work'. Rural nurses use multiple perspectives of self in order to manage their interactions with others in their roles as community members, consumers of healthcare services and nurses. Personal strategies adapted to local context constitute the skills that experienced rural nurses pass-on to neophyte rural nurses through mentoring, while at the same time protecting them through troubleshooting and translating local cultural norms.

CONCLUSION

Living and working in the same community creates a set of complex challenges for novice rural nurses that are better faced with a mentor in place. Thus, mentoring has become an integral part of experienced rural nurses' practice to promote staff retention.

A model of caring mentorship for nursing

Mentoring is a multidimensional relationship that energizes personal and professional growth. This article explores the concept of mentoring in nursing and presents a mentorship model based on a caring philosophy. The RN-student nurse mentoring program cited is the result of a collaborative commitment between a community hospital and two colleges. Discussed are the experience, process, insights, and impact of the program as a retention and professional development tool.

The problem of workforce for the social world of Australian rural nurses: a collective action frame analysis

AIM AND BACKGROUND

Globally, nursing workforce shortages are a hot topic for discussion among politicians, academics and clinicians. This paper uses collective action framing to analyse the literature about the problem of workforce for Australian rural nurses.

EVALUATION

As part of a larger constructivist grounded theory study, we utilize collective action framing to bridge social world mapping and the literature. Data sources included journal databases, newspapers, newsletters and websites. We limited the years searched from 2000 to 2005. This analytical heuristic categorizes text into three main categories: diagnoses of a problem, postulations of solutions and actions to motivate change.

KEY ISSUES

Having mapped the social world of Australian rural nurses as comprising four groups of collective actors - community, advocates, academics and government - we trace the texts that they have produced with a focus on mentoring as a potential solution to the problem of workforce.

CONCLUSIONS

Mentoring entered the literature about the problem of workforce for Australian rural nurses because of a combination of political and academic will. These collective groups are now changing how they are framing the problem of workforce to focus instead on the globalization of nursing workforce shortages, which is resulting in diminished support for mentoring activities in clinical practice.

Getting to know a stranger--rural nurses' experiences of mentoring: a grounded theory

BACKGROUND

Mentoring is often proposed as a solution to the problem of successfully recruiting and retaining nursing staff. The aim of this constructivist grounded theory study was to explore Australian rural nurses' experiences of mentoring.

DESIGN

The research design used was reflexive in nature resulting in a substantive, constructivist grounded theory study.

PARTICIPANTS

A national advertising campaign and snowball sampling were used to recruit nine participants from across Australia. Participants were rural nurses who had experience in mentoring others.

METHODS

Standard grounded theory methods of theoretical sampling, concurrent data collection and analysis using open, axial and theoretical coding and a story line technique to develop the core category and category saturation were used. To cultivate the reflexivity required of a constructivist study, we also incorporated reflective memoing, situational analysis mapping techniques and frame analysis. Data was generated through eleven interviews, email dialogue and shared situational mapping.

RESULTS

Cultivating and growing new or novice rural nurses using supportive relationships such as mentoring was found to be an existing, integral part of experienced rural nurses' practice, motivated by living and working in the same communities. Getting to know a stranger is the first part of the process of cultivating and growing another. New or novice rural nurses gain the attention of experienced rural nurses through showing potential or experiencing a critical incidence.

CONCLUSIONS

The problem of retaining nurses is a global issue. Experienced nurses engaged in clinical practice have the potential to cultivate and grow new or novice nurses-many already do so. Recognising this role and providing opportunities for development will help grow a positive, supportive work environment that nurtures the experienced nurses of tomorrow.

Research and evaluation of clinical nurse mentoring: implications for the forensic context

The impact of mentoring programmes was examined in this extensive literature review. The effectiveness of such programs was considered for both the general clinical nursing and clinical forensic nursing environments. No literature discussing clinical nurse mentoring within forensic settings was discovered during the review, thus implications for this unique context are drawn from the current available literature.

A survey of e-mentoring among New Zealand midwives

Mentoring is a strategy that may assist the midwifery profession to support new graduates and midwives working in rural and remote areas. We conducted a survey of 1,577 New Zealand midwives about their opinions and experiences of mentoring. The questionnaire comprised 33 questions, nine of which were open questions. There was a 44% response rate. While the telephone was commonly utilized by mentors (37%) and mentored midwives (37%), the Internet and email played only a small part. Participants acknowledged the potential of these avenues for communication, but midwives felt that mentoring could be provided only by immediate, face-to-face contact. Nevertheless, e-mentoring could be a viable option and requires further investigation. About one-third of midwives identified geographical isolation as a barrier to being a mentor (38%) and being mentored (36%). The use of e-mentoring could remove the barrier of location and allow the midwife to chose a mentor who meets her needs, rather than because she is the only mentor available.