The Journal of Continuing Education in Nursing

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Original Article 

Using a Mentorship Model to Prepare Newly Graduated Nurses for Competency

Sirima Komaratat, MNS, RN; Areewan Oumtanee, PhD, MS, RN

Abstract

This research was conducted to study the level of nursing competency of newly graduated nurses after using a mentor-ship model. Nineteen newly graduated nurses worked with a trained mentor. Before the experiment, newly graduated nurses were evaluated regarding their nursing competency by head nurses two times, with a 1-month interval between evaluations. Select experienced nurses were prepared in mentoring roles. The mentors and the newly graduated nurses worked together for 1 month. After that, newly graduated nurses were evaluated for nursing competency by head nurses again. All data were analyzed by median, quartile deviation, and Wilcoxon signed ranks test. The level of nursing competency of newly graduated nurses was higher using the mentor model. This finding showed that the mentor program increased the nursing competency of newly graduated nurses.

Abstract

This research was conducted to study the level of nursing competency of newly graduated nurses after using a mentor-ship model. Nineteen newly graduated nurses worked with a trained mentor. Before the experiment, newly graduated nurses were evaluated regarding their nursing competency by head nurses two times, with a 1-month interval between evaluations. Select experienced nurses were prepared in mentoring roles. The mentors and the newly graduated nurses worked together for 1 month. After that, newly graduated nurses were evaluated for nursing competency by head nurses again. All data were analyzed by median, quartile deviation, and Wilcoxon signed ranks test. The level of nursing competency of newly graduated nurses was higher using the mentor model. This finding showed that the mentor program increased the nursing competency of newly graduated nurses.

Mrs. Komaratat is Head Nurse, Chaiyaphum Hospital, Chaiaphum Province, Thailand. Dr. Oumtanee is Instructor, Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand.

The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity. They gratefully acknowledge the support of the graduate school, Chulalongkorn University, for partially funding this study.

Presented at the 39th Biennial Convention of the Sigma Theta Tau International Honor Society of Nursing, November 2–7, 2007, Baltimore, Maryland.

The authors would like to express their sincere thanks to Patricia Yoder-Wise for her encouragement and support until this article was accepted for publication.

Address correspondence to Areewan Oumtanee, PhD, MS, RN, Faculty of Nursing, Chulalongkorn University, Patumwan, Bangkok 10330, Thailand.

The practical capabilities of professional nurses are important to nurses’ duties. Efficiency and effectiveness of nursing services are analyzed against the practical ability of nursing staff, especially the professional nurses who take care of patients 24 hours a day, to make sure that the patients recover as soon as possible. Hanuchareankul (2000) noted that the responsibilities of hospital nurses are: (1) applying nursing procedures to reach a high standard of nursing care; (2) focusing on nursing management for patients or coordinating with other staff to arrive at the required standard of nursing care; (3) providing health knowledge to patients, clients, and even other nursing staff; and (4) working with multidisciplinary teams effectively.

Because professional nurses have to work in conjunction with other health care professionals, they have to have the ability to conduct their work in the best interests of their patients. Moreover, Schwirian (1978) has said that on-duty nurses have to effectively exhibit leadership, critical care, teaching and collaboration, planning and evaluation, interpersonal relations, and communication and professional development. These ideas have been employed extensively in developing questionnaires to evaluate the practical abilities of a professional nurse (Meretoja, Isoaho, & Leino-Kilpi, 2004). Most nursing scholars have concentrated their work on the practice of on-duty nurses. However, nurses certainly have differing experiences and backgrounds, and must have a variety of skills, especially new nurses. Benner (1984) called newly graduated nurses “novices,” which means that they have limited experience and have to develop their practice skills.

The authors conducted a pilot study of the abilities of novice nurses in one hospital in 2005. They found that novices cannot handle emergency situations properly, they lack the skills necessary to take care of complicated cases, they cannot inform and advise either patients or their relatives, they have no confidence and they are negligent at work, they lack understanding of nursing quality control, and they cannot work and coordinate with the rest of the health care team. The authors interviewed 10 novices about their experiences as newly graduated nurses. They said that at first they felt excited about the job, then scared, and then worried about their ability to deal with problems by themselves. These experiences of novices conform to the findings of Sanbudda (2003), who reported that the newly graduated nurses became anxious when faced with some situations at work, such as how to apply their knowledge in practice and when coordinating with other people as a health care team. In addition, Siraphongam (1997) found that the circumstances that made the newly graduated nurses anxious were communication with others (28.8% of subjects), caring for critically ill patients because they felt they lacked experience (19.7%), working with colleagues (18.2%), and nursing practice (13.6%). Such tension has a severe effect on the novice’s capability in the workplace (Chatchaisucha, Tonsiri, & In-krup, 2000; Songaiad, 2003).

The authors understood the problems as described and were aware of the importance of increasing their knowledge and ability to be most effective at work. DuBrin (2000) indicated in her work that to succeed or advance in their career, individuals needed to have at least one “coach” or mentor. In the study setting, a mentor was a nurse with more experience or a superior who worked closely with the newly graduated nurse. A review of the literature showed some important findings related to the effectiveness of a mentorship model for the newly graduated nurse. For example, Yordying, Suparasri, Yhangaen, and Chareansuk (2001) found that a mentorship program had helped novices to adjust to their role effectively. Moreover, the work of Songaiad (2003) found that the competence of newly graduated nurses to function in a team leader role in the first week after a mentorship experience was significantly better than prior to the mentorship program. The mentorship model has been found to be appropriate for nursing professionals because its main objective is quality development. Thus, the authors studied the effect of using the mentorship model on the competency of newly graduated nurses.

Hypothesis

The competency of newly graduated nurses will be significantly increased after implementation of the nurse mentorship model.

Conceptual Framework

The conceptual framework of this study was developed based on the nurse competency concepts of Taechaveerakorn and Oumtanee (2008) and the model of mentorship process of Morton-Cooper and Palmer (2000).

Nurse Competency Concept

The nurse competency concept originated from Benner’s 1984 study. She divided nurses into five levels: novice, advanced beginner, competent, proficient, and expert. Later, Taechaveerakorn and Oumtanee (2008) further studied nursing at each level based on the Thai nurse content. They found that the basic competency of novice nurses included four categories: (1) nursing care; (2) human relationship and communication; (3) decision-making and problem-solving; and (4) quality development and quality assurance. Those competency categories were not fulfilled when novices were nursing students. Thus, when they became newly graduated nurses, it was important for training to continue with a mentor.

Mentorship Model

The mentorship model in this study was based on a mentoring in practice concept described by Morton-Cooper and Palmer (2000). They proposed functional mentor roles, including advisor, coach, counselor, guide/networker, role model, sponsor, teacher, and resource facilitator. In addition, they suggested three mentoring phases: (1) initiation, which required a mentor to have effective communication skills to create an interpersonal relationship with a novice; (2) the working phase, when a mentor and a novice worked together; and (3) the termination phase, when a mentor gave the novice freedom to work.

Method

The study was conducted as quasi-experimental research. This one-group, time series design measured the competency of newly graduated nurses at three points: before the experiment (time 1); 1 month later (time 2); and after the mentorship experience was completed (time 3), after the mentor and novice had worked together for 1 month. Competency scores at time 1 and time 2 were baseline scores to document that there were no confounding variables affecting nurse competency before the experiment started.

Subjects

The authors used the population of novices as subjects in this study. There were 19 novices assigned to work in a selected hospital. After the institutional review board of Chulalongkorn University approved the proposal, the researchers asked permission from the director of nursing to allow all novices to participate.

Instruments

Three types of study instruments were used.

  1. Experimental instruments included a manual of mentorship, which was a booklet that the researchers had printed for the nurse mentors to review as a final part of their training to gain more understanding of their role in the nurse mentorship program. The Mentorship Knowledge Scale was a pre- and posttest form designed to test the knowledge of nurse mentors before and after their preparation course. The researchers developed the test from reviewing textbooks, documents, and research papers related to the mentorship model. The test was designed for easy objective responses and provided four answers to choose from. There were 15 questions, with Kuder-Richardson reliability of 1. Its index of difficulty was 0.43 to 0.83, and the discrimination value was 0.20 to 0.80.

  2. The control instrument for the experiment was the Mentor’s Activities Scale, which was used to evaluate the nurse mentors. The researchers designed the form for novices to evaluate their nurse mentors’ roles while they worked together for 4 weeks. The form evaluated four roles, including advisor and counselor, teacher, sponsor, and resource facilitator. It was a simple 25-item checklist using a “do/don’t” answer format. The form had a coefficient (calculated by the Cornell technique of Guttman) of .9, which is considered statistically significant.

  3. The evaluation instrument for the experiment was the Nursing Competence Scale, which built on the work of Taechaveerakorn and Oumtanee (2008). It was intended to evaluate four dimensions: nursing, human relationship and communication, decision-making and problem-solving, and quality development and assurance. It consisted of 20 questions with a five-point rating scale, reflecting highest to lowest competence. The reliability of this questionnaire with Cronbach’s alpha was .96.

The Experimental Process

The experimental process was separated into three steps:

Step 1: Preparation of Nurse Mentors. With assistance from the head of the inpatient department, the researchers selected some on-duty nurses using several criteria: at least 3 years of working experience, interest in the nurse mentorship program, good decision-making competency according to the situation, clinical skills, and communication skills. Nineteen qualified nurses worked “one on one” with newly graduated nurses. Before training, the researchers evaluated the knowledge of the nurse mentors and they earned an average score of 8.35 (of a total of 15 points). Then the nurse mentor was trained through lectures and participation in a workshop. The topics were nurse mentorship, adult learning, decision-making and resolving problems, and mentorship roles. The roles of the nurse mentor included acting as advisor, teacher, supporter, and facilitator. After training, the nurse mentors were evaluated again, and this time their average score was 11.76 (the average passing score was 11.25).

Step 2: Working Together. The researchers evaluated the competency of newly graduated nurses twice before the nurse mentorship program started. The first and second competency evaluations were 1 month apart. Then, using the competency scores as data to calculate statistical values, the researchers found that the competency of the newly graduated nurses was no different (Table 1). That meant that there were not other factors influencing any changes in novices’ competency. Later, the nurse mentor and the newly graduated nurse were assigned to work together for 1 month. Each week, they had to conduct activities as described.

Comparison of the Median Score of Nursing Competency Between Pre-Experiment at Time 1 and Pre-Experiment at Time 2

Table 1: Comparison of the Median Score of Nursing Competency Between Pre-Experiment at Time 1 and Pre-Experiment at Time 2

Starting in the first week (first day), the mentor and the novice got to know each other and built a relationship while the nurse mentor introduced the novice to the workplace and to the learning and training program that she had prepared for the novice.

From the second day of the first week until the third week, it was time to act as a real nurse mentor. The mentor had to perform four roles for the novice: (1) Advisor and counselor: The mentor taught the novice about decision-making and resolving problems at work. (2) Teacher: The mentor taught the novice about nursing skills, entering information in the nursing record, and working with patients. (3) Sponsor: The mentor worked with the novice to identify the patient’s symptoms and indications and performed a nursing evaluation, including taking responsibility for the assigned tasks. (4) Facilitator: The mentor taught the novice to work in cooperation with others, learning and developing educational aspects of the tasks, and described the rules of the department or hospital. During the session, the novices had a chance to evaluate their own mentor each week. This evaluation was intended for supervision of the mentors and was done to determine whether they performed their proper duties as qualified mentors.

Step 3: Mentoring Termination. At the end of the mentorship course, during the fourth week, the mentors allowed the novices to work independently on their mutual shifts while the nurse mentors looked on from a distance just in case the novices really needed advice or other assistance.

Data Analysis

The researchers analyzed data with the Wilcoxon signed ranks test, a nonparametric alternative to the paired t test for the case of two related samples or repeated measurements on a single sample that could not meet the assumption of the t test. It was used for paired data of competency of the newly graduated nurses before and after the experiment, where the researchers had two related samples they wished to compare. Values were reported as median, quartile deviation, and Z value. Researchers also set the significance level at .05.

Results

Nursing competency of newly graduated nurses pre-experiment at time 1 versus pre-experiment at time 2 was not significant at the .05 level. That meant that there was no difference in nursing competency between the two times (Table 1).

Nursing competency of the newly graduated nurses postexperiment was significantly higher than pre-experiment at time 1, at the .05 level (Table 2).

Comparison of the Median Score of Nursing Competency Between Pre-Experiment at Time 1 and Postexperiment

Table 2: Comparison of the Median Score of Nursing Competency Between Pre-Experiment at Time 1 and Postexperiment

Nursing competency of the newly graduated nurses postexperiment was significantly higher than pre-experiment at time 2, at the .05 level (Table 3).

Comparison of the Median Score of Nursing Competency Between Pre-Experiment at Time 2 and Postexperiment

Table 3: Comparison of the Median Score of Nursing Competency Between Pre-Experiment at Time 2 and Postexperiment

The results show that the nursing competency of newly graduated nurses after using the mentorship model produced significantly higher scores than before using the mentorship model, at the level of .05.

Discussion

From the study results, the level of competency of the newly graduated nurses increased after using the mentorship model, which supported the hypothesis. The results confirm the research of Siraphongam, Ratanareungwatana, and Kanogsuntorn (1995), who found that the mentorship model had a significant effect on developing the skills, knowledge, and self-confidence of the newly graduated nurse. The result also supports the work of Ronsten, Andersson, and Gustafsson (2005), who found that the mentorship model has played an important role in developing quality nursing. Chuemon (1997) and Pongprayun (2002) indicated that the work competency of the newly graduated nurses after the experimental mentorship process was higher than before the process. Moreover, O’Connor, Pearce, Smith, Voegeli, and Walton (2001) compared the expected competencies of the newly graduated nurses before conducting the mentoring program with the real competency of the newly graduated nurses after conducting the mentoring program. The study asked 139 senior nurses to evaluate expected competency, and nurse mentors evaluated the real competency of 36 newly graduated nurses. The results showed the novices’ competency to be higher than expected.

However, in conducting the model effectively for the novices, the manager had to help the nurse mentors develop their potential by preparing them to serve as mentors. The nurse mentor was required to attend the mentorship sessions. Boonyanurak (2003) said that anyone who wants to employ the nurse mentorship program must have a precise form and a system to operate the model. Morton-Cooper and Palmer (2000) suggested that effective communication was an important skill practiced by nurse mentors to build a good relationship between both parties.

The results also indicated that the competency of newly graduated nurses in taking care of patients was higher than before conducting the model because the mentor had trained and shown the novices how to work and coordinate with other staff. For complicated patient problems, the mentor had shown the new nurse practical ways to evaluate patients and how to understand and meet the patients’ needs. Thus, the module gave the novice the ability to take care of patients appropriately, based on nursing fundamentals, by diagnosing the patients’ symptoms, preparing a nursing plan thoroughly, promoting health, treating patients correctly, and rehabilitating them quickly. These findings match those of Barton, Gowdy, and Hawthorne (2005), who studied the development of the mentorship model at the Northeast Medical Center.

In terms of building a good relationship and communication, overall, the newly graduated nurses increased their competency from the level before mentorship because they got some advice and training from their nurse mentors (Meechusup, 1996). Moreover, the mentors had not only trained, demonstrated, and taught how to provide knowledge to patients, they had also taught the newly graduated nurses in the program to perform their on-duty work as a professional nurse. In the experiment, after the novices had been trained and had worked under the supervision of the nurse mentors, the novices had directly learned some hands-on experience, so they had built some skills, created effective relationships with colleagues and patients, and improved their communication abilities.

In addition, their competency in decision-making and resolution of problems was higher than before the experiment because the mentors had given them advice and supported them when they faced real problems while working. The novices had a chance to make their own decisions freely when they faced problems. Then their mentors would give advice if they saw mistakes on the part of the novices while caring for patients. The mentors were also assigned to evaluate the novices’ performance after the tasks had been assigned. The results would be reviewed by a manager to develop and improve the program for the next time. The competency in quality development and assurance had also increased after the mentoring. Nurse mentors taught novices to give safe, high-quality patient care.

According to the evaluation of the novices, both the novices and the mentors should have a chance to evaluate themselves. These self-evaluations will help them to continue to develop their skills. Moreover, the mentors in this study suggested that they should be assigned to work only as nurse mentors to increase their efficiency and allow them to concentrate on their coaching tasks. This in turn helps the novice to develop faster and more effectively.

The sample used in this study was small, although the researchers included all novices working at a selected hospital at that time (19) and assigned them to only one trial group without a control group. Thus, the results might show less confidence as a result of analysis with nonparametric statistics and the lack of a control group for results comparison.

Recommendations

The authors make the following recommendations:

  1. Research should be continued to study and evaluate the effectiveness of using the mentorship model to improve the performance of newly graduated nurses in nursing skills, decision-making, and problem resolution.

  2. The results indicated that the newly graduated nurses had improved their competency from a medium to a high level by using the mentorship model. Further research should study the results of implementing the model in conjunction with any factors that may increase the effectiveness of this training method.

References

  • Barton, D. S., Gowdy, M. & Hawthorne, B. W. (2005, August). Mentorship programs for novice nurses. Nurse Leader, 3(4), 41–44. doi:10.1016/j.mnl.2005.06.005 [CrossRef]
  • Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Boston: Addison Wesley.
  • Boonyanurak, P. (2003). Wisdom in nursing science. Bangkok: Prarham.
  • Chatchaisucha, S., Tonsiri, P. & In-krup, L. (2000). Anxiety and coping responses in new graduated nurses. Thai Journal of Nursing Council, 15(1), 14–23.
  • Chuemon, T. (1997). Effect of using nurse mentorship for newly graduated nurses model on job satisfaction and job performance. Unpublished master’s thesis, Chulalongkorn University, Bangkok, Thailand.
  • DuBrin, A. J. (2000). Applying psychology: Individual and organizational effectiveness. Upper Saddle River, NJ: Prentice Hall.
  • Hanuchareankul, S. (2000). Nursing: The science of practice. Bangkok: V. J. Printing.
  • Meechusup, S. (1996). Nursing administration (3rd ed.). Bangkok: Jiratkarnpim.
  • Meretoja, R., Isoaho, H. & Leino-Kilpi, H. (2004). Nurse competence scale: Development and psychometric testing. Journal of Advanced Nursing, 47(2), 124–133. doi:10.1111/j.1365-2648.2004.03071.x [CrossRef]
  • Morton-Cooper, A. & Palmer, A. (2000). Mentoring, preceptorship and clinical supervision: A guide to professional roles in clinical practice (2nd ed.). London: Blackwell Science.
  • O’Connor, S. E., Pearce, J., Smith, R. L., Voegeli, D. & Walton, P. (2001). An evaluation of the clinical performance of newly qualified nurses: A competency based assessment. Nurse Education Today, 21, 559–568. doi:10.1054/nedt.2001.0594 [CrossRef]
  • Pongprayun, Y. (2002). Effect of preceptor program on performance ability of newly graduated nurses. Unpublished master’s thesis, Burapha University, Bangsaen, Thailand.
  • Ronsten, B., Andersson, E. & Gustafsson, B. (2005). Confirming mentorship. Journal of Nursing Management, 13, 312–321. doi:10.1111/j.1365-2934.2005.00541.x [CrossRef]
  • Sanbudda, T. (2003). Working experience of newly graduated nurses in general hospital. Unpublished master’s thesis, Chulalongkorn University, Bangkok, Thailand.
  • Schwirian, P. M. (1978). Evaluating the performance of nurses: A multidimensional approach. Nursing Research, 27(6), 347–351.
  • Siraphongam, Y. (1997). Preceptorship: A bridge to role transition of graduated nurses. Ramathibodi Nursing Journal, 1(2), 85–91.
  • Siraphongam, Y., Ratanareungwatana, S. & Kanogsuntorn, N. (1995). Stress and coping of new graduated nurses during professional transition. Ramathibodi Nursing Journal, 10–11.
  • Songaiad, D. (2003). The effect of using nurse mentorship model on team leader’ role competency of newly graduated nurses, Thammasat University Hospital. Unpublished master’s thesis, Chulalongkorn University, Bangkok, Thailand.
  • Taechaveerakorn, N. & Oumtanee, A. (2008). Staff nurses’ competency based on career ladder, tertiary hospitals. Journal of Songklanakarintara Nursing, 28(1), 12–25.
  • Yordying, J., Suparasri, P., Yhangaen, R. & Chareansuk, K. (2001). A development of mentorship for newly graduated nurses, Chonburi hospital. Journal of Nursing College of Chonburi, 15(1), 21–29.

Comparison of the Median Score of Nursing Competency Between Pre-Experiment at Time 1 and Pre-Experiment at Time 2

Score of Nursing Competency Pre-experiment Time 1 Pre-experiment Time 2 Z

Median Quartile Deviation Median Quartile Deviation
Nursing care 3.00 0.10 3.00 0.10 −0.447
Human relationship and communication 3.00 0.13 3.00 0.13 −0.447
Decision-making and problem-solving 3.00 0.00 3.00 0.00 −1.000
Quality development and assurance 3.00 0.25 3.00 0.09 −0.412
Total 3.00 0.08 3.00 0.10 −1.155

Comparison of the Median Score of Nursing Competency Between Pre-Experiment at Time 1 and Postexperiment

Score of Nursing Competency Pre-experiment Time 1 Postexperiment Z

Median Quartile Deviation Median Quartile Deviation
Nursing care 3.00 0.10 4.00 0.20 −4.061*
Human relationship and communication 3.00 0.13 4.25 0.15 −3.885*
Decision-making and problem-solving 3.00 0.00 4.00 0.00 −3.947*
Quality development and assurance 3.00 0.25 4.16 0.16 −3.893*
Total 3.00 0.08 4.10 0.12 −3.831*

Comparison of the Median Score of Nursing Competency Between Pre-Experiment at Time 2 and Postexperiment

Score of Nursing Competency Pre-experiment Time 2 Postexperiment Z

Median Quartile Deviation Median Quartile Deviation
Nursing care 3.00 1.10 4.00 0.20 −4.031*
Human relationship and communication 3.00 0.13 4.25 0.15 −3.897*
Decision-making and problem-solving 3.00 0.00 4.00 0.00 −4.014*
Quality development and assurance 3.00 0.09 4.16 0.16 −3.878*
Total 3.00 0.10 4.10 0.12 −3.825*

Mentorship

Komaratat, S. & Oumtanee, A. (2009). Using a Mentorship Model to Prepare Newly Graduated Nurses for Competency. The Journal of Continuing Education in Nursing, 40(10), 475–480.

  1. New nurses or novices have limited experience and practice skills to provide quality care for patients.

  2. The mentorship model was introduced as a training program for increasing novices’ competency.

  3. Mentors should be assigned to work only as nurse mentors to increase their efficiency and concentration on their coaching tasks to help the novice to develop faster and more effectively.

Authors

Mrs. Komaratat is Head Nurse, Chaiyaphum Hospital, Chaiaphum Province, Thailand. Dr. Oumtanee is Instructor, Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand.

The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity. They gratefully acknowledge the support of the graduate school, Chulalongkorn University, for partially funding this study.

Presented at the 39th Biennial Convention of the Sigma Theta Tau International Honor Society of Nursing, November 2–7, 2007, Baltimore, Maryland.

The authors would like to express their sincere thanks to Patricia Yoder-Wise for her encouragement and support until this article was accepted for publication.

Address correspondence to Areewan Oumtanee, PhD, MS, RN, Faculty of Nursing, Chulalongkorn University, Patumwan, Bangkok 10330, Thailand.

10.3928/00220124-20090923-02

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