Journal of Nursing Education

Major Article 

The Value of Peer Mentorship as an Educational Strategy in Nursing

Tannis Andersen, MN, RN; Kathy Watkins, PhD, RN

Abstract

Background:

The emphasis of this article is to provide nursing instructors with a valuable educational strategy grounded in andragogical principles for reflection and implementation in their educational practice.

Method:

An expository review of the value of peer mentorship as an educational strategy that fits within the humanistic adult education philosophy and social constructivism theory was conducted.

Results:

The value in peer mentorship is greatest for nursing students as mentors and mentees, predominantly in encouraging self-directed learning, building relationships, providing emotional and educational support, and developing collaboration and leadership skills. In addition, peer mentorship provides value to instructors and educational institutions by supporting a positive student-centered learning environment that enhances student success.

Conclusion:

Peer mentorship as a valuable educational strategy can be recognized for future use within all levels of nursing education and can be applied universally to teaching and learning within other health care educational settings. [J Nurs Educ. 2018;57(4):217–224.]

Abstract

Background:

The emphasis of this article is to provide nursing instructors with a valuable educational strategy grounded in andragogical principles for reflection and implementation in their educational practice.

Method:

An expository review of the value of peer mentorship as an educational strategy that fits within the humanistic adult education philosophy and social constructivism theory was conducted.

Results:

The value in peer mentorship is greatest for nursing students as mentors and mentees, predominantly in encouraging self-directed learning, building relationships, providing emotional and educational support, and developing collaboration and leadership skills. In addition, peer mentorship provides value to instructors and educational institutions by supporting a positive student-centered learning environment that enhances student success.

Conclusion:

Peer mentorship as a valuable educational strategy can be recognized for future use within all levels of nursing education and can be applied universally to teaching and learning within other health care educational settings. [J Nurs Educ. 2018;57(4):217–224.]

Nursing education is focused on clinical and theoretical nursing content, critical thinking, skills acquisition, and evidence-based practice. When teaching, instructors are often knowledgeable and experts within their field of practice supporting their ability to provide educational content focus. However, it is important to understand that when teaching within the field of nursing, there is a need for instructors to exceed content matter expertise and engage in the scholarship of teaching through the utilization of andragogy principles supporting overall quality education for students (Aliakbari, Parvin, Heidari, & Haghani, 2015; Canadian Association of Schools of Nursing, 2013; Melrose, Park, & Perry, 2015b). In understanding this, teaching strategies within nursing program curricula need to be grounded in adult education philosophy principles and theories and support value in teaching and learning for students, instructors, and educational institutions. An educational strategy that corresponds with these concepts is peer mentorship. Specifically, peer mentorship can be related to the humanistic adult education philosophy and social constructivist theory. Accordingly, the purpose of this article is to analyze how peer mentorship relates to humanistic adult education philosophy and social constructivism theory and how it is a valuable educational strategy for nursing instructors to implement within their practice.

This article provides a review of the key concepts of peer mentorship, humanistic adult education philosophy, and social constructivism. The article discusses how peer mentorship relates to the humanistic adult education philosophy and social constructivism theory, including practical practice examples. In understanding the value of peer mentorship in nursing education, a comparison of benefits and challenges for students, instructors, and educational institutions was completed, and future recommendations and limitations are described.

Key Concepts

Peer Mentorship

At the heart of mentorship is the goal of helping, challenging, guiding, and supporting an individual (mentee) to grow and learn personally and professionally (Daloz, 2012; Grossman, 2012; McKimm, Jollie, & Hatter, 2007; “Mentorship,” n.d.). Further, mentorship is a collaborative, nonevaluative, reciprocal, and complex relationship and can comprise one to one or group structures and formal or informal processes (Daloz, 2012; Grossman, 2012; Okediji, Nnedum, & Enwongo, 2011). Traditionally, mentorship is a relationship between two individuals where one individual is more experienced and there is often a hierarchy between the mentor and mentee (Daloz, 2012; Grossman, 2012). Group mentorship is where the relationship consists of one experienced individual mentoring several novice individuals at the same time (Daloz, 2012; Grossman, 2012). Formal mentorship programs are generally well-defined, with a beginning and end date; have clear pre-determined written goals and processes; and the mentor and mentee are assigned to each other (Daloz, 2012; Grossman, 2012; Plamondon & Canadian Coalition for Global Health Research [CCGHR], 2007). In informal mentorship, the mentor and mentee often have a spontaneous, natural, long-term relationship; create their own direction; and are self-chosen (Daloz, 2012; Grossman, 2012, Plamondon & CCGHR, 2007). Regardless of the structure or process chosen, the goal of mentorship for the mentee remains the same in all situations.

Peer mentorship has the same goals, structures, and processes of mentorship but has one distinct variation. The variation lies within the mentee and mentor being equals with complementary knowledge, rather than the traditional unequal expert–novice knowledge (Grossman, 2012; Plamondon & CCGHR, 2007). This horizontal relationship eliminates hierarchal statuses; encourages sharing of ideas and learnings with peers; and enhances leadership for the mentor and mentee (Grossman, 2012; Plamondon & CCGHR, 2007). This distinct variation of equality provides value to the mentee–mentor relationship and can do the same within nursing educational programs when students are placed within those roles.

Humanistic Adult Education Philosophy

When teaching adults in the nursing field, there is an art and science (andragogy) behind employing educational strategies for learning (“Andragogy,” n.d.). By utilizing an adult education philosophy based on the andragogical principles of self-concept, experience, readiness to learn, orientation to learning, and motivation, instructors can engage in the scholarship of teaching and utilization of sound educational strategies (Aliakbari et al., 2015; Canadian Association of Schools of Nursing, 2013; Knowles, 1984; Melrose et al., 2015b). One philosophy is the humanistic adult education philosophy that focuses on the unlimited and unique potential of the individual learner; as a result, the student takes an active role in his or her learning to grow and develop through self-awareness and self-actualization (Elias & Merriam, 1980; Melrose, Park, & Perry, 2015c; Zinn, 1990). The teacher within this philosophy is a guide and facilitator, supporting the individual's cognitive and affective growth promoting well-being (Elias & Merriam, 1980; Zinn, 1990). Learning occurs with experience, exploration of self, interactions with others, openness to emotions and feelings, self-direction, discussion, and discovery (Elias & Merriam, 1980; Zinn, 1990). Team teaching, group work, and self-directed learning are all teaching strategies that fall within this philosophy (Elias & Merriam, 1980; Zinn, 1990). Overall, the humanistic philosophy is a student-centered approach encouraging individual growth, development, and self-actualization through goal setting and self-directed learning.

The student-centered approach supporting growth, goal setting, and self-actualization within the humanistic philosophy is in alignment with peer mentorship. With students engaging in the mentee and mentor roles, they are the sole focus of the relationship. The relationship is centered on their needs and taps into the students' unlimited potential for learning and leading each other. The students are able to support each other's growth within true reciprocity and collaboration by each setting their own goals for learning and self-actualization (Andrews & Rapp, 2015; Christiansen & Bell, 2010; Chojecki et al., 2010; Colvin & Ashman, 2010). With this in mind, they are able to guide, facilitate, and challenge each other to reach their end goals.

An example of peer mentorship highlighting the principles of the humanistic adult education philosophy would be when fourth-year nursing students are paired with first-year nursing students in a clinical placement. The first-year student is able to set learning goals in relation to skill sets that the fourth-year student has already acquired. The fourth-year student is able to set goals in solidifying current skill sets and in developing teaching and leading skills (Chojecki et al., 2010; Colvin & Ashman, 2010; Robinson & Niemer, 2010). The fourth-year student is able to facilitate the first-year student's learning through teaching, demonstrating, and practicing the skills. This enhances the learning of the first-year student and solidifies the fourth-year student's knowledge; at the same time, the fourth-year student can begin to develop teaching and leading skills (Robinson & Niemer, 2010). Within this example, each student is able to develop, work toward, and achieve his or her own goals.

Social Constructivism

The third key concept is social constructivism. Social constructivism is built on two premises. The first premise is that students' learnings are actively constructed by building on what they already know and understand through past experiences (Melrose, Park, & Perry, 2013a; Piaget, 1972). The second premise is that learning is social in nature. According to Vygotsky (1978/1997), one's experiences are influenced by those around them through words, interactions, collaborations, and relationships, resulting in increased learning beyond what one could have learned on one's own. This extension of learning is considered the zone of proximal development and is realized through intersubjectivity (finding common ground); scaffolding (building a base of support); and guided participation (sharing activities) (Melrose et al., 2013a; Vygotsky, 1978/1997). It is through the zone of proximal development where students can learn more together with the use of intersubjectivity, scaffolding, and guided participation that peer mentorship can succeed within nursing education.

Peer mentorship is a social experience and truly embodies the concepts of learning from each other, building a base of support, and sharing activities. Peer mentorship allows the mentor and mentee to take what they already know and build on their learnings by sharing with each other through interactions and collaborations. They can learn more on a subject when they can help each other with different aspects of the topic and see multiple perspectives. With setting goals and objectives within the mentorship relationship being a cornerstone for success, finding common ground through successful communication will be key in assisting the mentor and mentee in moving the relationship forward. The mentor and mentee can build their base of support from each other and as the relationship progresses the facilitation and support required from each other will decrease. As this occurs, it will aid in closure when the mentoring relationship comes to an end. Finally, peer mentorship is based on sharing of activities and learning from each other. Overall, peer mentorship is well supported by social constructivism as an educational theory.

An example of peer mentorship embodying social constructivism is when two students are taking the same course and they facilitate and challenge each other in their learnings by sharing notes, studying together, and questioning each other on the topic. They each take on the roles of mentee and mentor at the same time. They bring with them past experiences and can apply these experiences to their learning with each other. They share common ground in working towards learning the same subject matter. By sharing notes, they can see each other's perspective on the topic and have the chance to learn something they may not have understood on their own. By studying together and questioning each other they are sharing in a learning activity and have the chance to reinforce what they have learned. The students are truly building on what they know and advancing through the zone of proximal development.

In reviewing the key concepts of peer mentorship, humanistic adult education philosophy, and social constructivism, there is a good fit in understanding how peer mentorship as an educational strategy is grounded in philosophy and theory. This supports the use of peer mentorship being used within nursing education from an andragogical perspective.

Peer Mentorship in Nursing Education

As previously discussed, peer mentorship can have different structures (one-to-one or group) and processes (formal or informal). Two examples of peer mentorship have been given that concentrate on the one-to-one structure, but either situation could be formal or informal depending on what the educational institution has implemented. Other examples of peer mentorship within nursing education that are more formal are group projects such as student-led seminars and assignments requiring students to give each other critical feedback. The former would generally be classified as group and the latter as one-to-one. There are also formal peer mentorship programs with defined structure, design, and faculty and institutional support for the mentor and mentee. Regardless of the structure or process, benefits and challenges exist within peer mentorship for the students, instructors, and educational institutions.

Benefits and Challenges of Peer Mentorship

Benefits and challenges within peer mentorship in nursing education exist at all three levels—student, instructor, and institution. The benefits outweigh the challenges for all levels, with the largest support being for the students, followed by the institutions and ending with the instructors.

Nursing Students. Within a peer mentorship relationship, the student takes on the role of mentor or mentee. Each role has its own benefits and challenges, resulting in the need for the student to decide whether he or she wants to take on either role and determine what he or she wants from the relationship.

Mentee. The mentee is often the novice nursing student within the first year of the program. With this, the mentee often encounters trials that can include anxiety and isolation from being in an unfamiliar environment; not knowing what to do; experiencing clinical scenarios that are foreign to them; being unsure of expectations placed on them; and learning a new identity as a student and a nurse (Chojecki et al., 2010; Christiansen & Bell, 2010; Giordana & Wedin, 2010; Hamrin et al., 2006). Peer mentorship can benefit the mentee in overcoming these challenges, as shown in Table 1. However, it is important to keep in mind that peer mentorship creates its own challenges for the mentee, also shown in Table 1.

Peer Mentorship Mentee Benefits and Challenges

Table 1:

Peer Mentorship Mentee Benefits and Challenges

By reviewing the benefits and challenges, it is easy to identify the value of peer mentorship for the mentee, but there is a need for buy-in and engagement of the mentee to want to participate and take an active role in the relationship. This can be overcome through clear articulation and education of the benefits and anticipated outcomes for the mentee and supporting the mentee, with scheduled time for mentorship, provision of effective communication skills, assistance in goal development, facilitation of mutual respect between the mentee and mentor, and provision of tuition reduction incentives (Bryant et al., 2015; Chojecki et al., 2010; Robinson & Niemer, 2010).

Mentor. The mentor is often an experienced nursing student within the program and is past his or her first year of education. The mentor has overcome the trials the new nursing student experiences and is ready to share and solidify his or her learnings and experiences. The benefits and challenges the mentor experiences from peer mentorship are shown in Table 2.

Peer Mentorship Mentor Benefits and Challenges

Table 2:

Peer Mentorship Mentor Benefits and Challenges

As with the mentee, the benefits of the peer mentorship relationship prevail over the challenges and provide value to the mentor. The challenges with time, commitment, and effort required by the mentor and potential lack of knowledge on how to mentor can affect potential buy-in. This can be overcome by providing mentorship training on coaching, empowerment, motivation, constructive feedback, and caring; instructor support through regular engagement; well-defined structural processes; scheduled time within the curriculum for meeting; encouragement of participation for individuals who want leadership and teaching experience; tuition reduction; and education to the mentors on their valuable contributions of informing and addressing gaps they have identified in clinical processes, curriculum, and literature (Bryant et al., 2015; Chojecki et al., 2010; Colvin & Ashman, 2010; Daloz, 2012; Dennison, 2010; Grossman, 2012; Robinson & Niemer, 2010).

Instructors. Instructors take on an important role in facilitating the mentee–mentor relationship. Instructors support the relationship in ensuring it is moving forward smoothly and that learning is safe and appropriate. The instructor acts as an advisor to the relationship and is the evaluator of performance assisting in removing the hierarchal power in the relationship. The benefits and challenges of peer mentorship as an educational strategy are less for the instructors than for the nursing students; however, the benefits still provide value to the instructor. The benefits and challenges are shown in Table 3.

Peer Mentorship Instructor Benefits and Challenges

Table 3:

Peer Mentorship Instructor Benefits and Challenges

Although the benefits and challenges are nearly equivalent, the instructor can find value within the peer mentorship relationship through the knowledge that he or she is providing a caring student-centered learning environment and that he or she assisted the mentor and mentee to learn and grow beyond what they could have on their own. Overcoming the identified challenges affecting the buy-in for instructors can be addressed by using more experienced instructors to facilitate mentoring relationships, providing formal education on mentoring and facilitation skills, defining clear role definitions in the mentoring relationship, and reducing and building time into teaching workloads (Bryant et al., 2015; Chojecki et al., 2010; Colvin & Ashman, 2010; Hanover Research, 2014; McKimm et al., 2007).

Educational Institutions. Nursing educational institutions struggle with system-level issues, such as limited clinical placements and patients, increased number of students, budgetary constraints, and attrition rates (Chojecki et al., 2010; Christiansen & Bell, 2010; Dennison, 2010; Robinson & Niemer, 2010). Peer mentorship assists the educational institutions with these issues as shown in Table 4. Also shown in Table 4 are the challenges encountered by educational institutions when implementing peer mentorship.

Peer Mentorship Educational Institution Benefits and Challenges

Table 4:

Peer Mentorship Educational Institution Benefits and Challenges

If educational institutions incorporate peer mentorship into learning environments and the curriculum, there needs to be an understanding as to the extent, time, and effort that is required, particularly in relation to formal programming. Educational institutions will find value in investing this extra time and effort by knowing that peer mentorship relationship will enhance the student learning environment, provide a student-centered approach to learning, and support success and retention for the students (Chojecki et al., 2010; Christiansen & Bell, 2010; Robinson & Niemer, 2010).

Overall, the benefits for peer mentorship as an educational strategy are highly supportive of nursing students and provide instructors and educational institutions with an opportunity to create a positive and valuable learning environment. Nursing students are able to participate and direct their own learning, interact socially through collaboration, learn and grow with and beyond each other, and be leaders and role models. All these concepts fall within the humanistic adult education philosophy and social constructivism theory, supporting a grounded teaching and learning strategy.

Recommendations

By understanding that peer mentorship is an educational strategy that is supported by educational philosophy and theory and that there is value to nursing students, instructors, and educational institutions, several recommendations can be made to support successful implementation.

Mentee and Mentor

A recommendation for mentees and mentors is to take into consideration that although peer mentorship is meant to prevent hierarchical power and bring diverse opinions and viewpoints together, there is a possibility of conflict, with one student taking over the relationship, students not working together, holding onto narrow perspectives and preconceived ideas about others, and overall mistrust. By acknowledging this potential for conflict, working toward a relationship of trust, providing positive and critical feedback, and facilitating open and honest communication mentees, mentors, and instructors can work help to disinvite harmful behaviors and manage situations before they begin to cause irreparable damage (Andrews & Rapp, 2015; Bryant et al., 2015; Colvin & Ashman, 2010; Christiansen & Bell, 2010; Melrose, Park, & Perry, 2013c).

Another recommendation for mentees and mentors is to provide them with multiple avenues to enter into mentoring relationships (volunteering, self-pairing, faculty recruiting or pairing, or registering in formal mentorship or leadership curriculum courses). This allows for success, flexibility in recruitment for the mentoring relationships, and creation of thoughtful pairings of mentees and mentors based on the structure and process needs of the mentoring program implemented (Hanover Research, 2014; McKimm et al., 2007; Plamondon & CCGHR, 2007; Robinson & Niemer, 2010).

The last recommendation is being mindful that the mentee and mentor need to be fully invested in the peer–mentor relationship and outline their goals and learning needs. This can be accomplished by clearly communicating and understanding each other's roles and responsibilities and having preestablished contingency plans for when issues arise—for example, taking the time to find out why communication and understanding of roles and responsibilities did not happen, instructor-facilitated brainstorming with mentee and mentor on solutions for overcoming these causes, joint implementation and evaluation of solutions, and the ability to end the mentoring relationship (Grossman, 2012; McKimm et al., 2007; Melrose, Park, & Perry, 2013b).

Instructors

A recommendation for instructors is to provide them with education and support in their role as an advisor and facilitator by giving them tools and skills on mentorship, such as conflict resolution, communication, visioning, team learning, collaboration, systems thinking, generational and cultural diversity, and mentee–mentor pairing (Grossman, 2012; McKimm et al., 2007). Another recommendation for instructors is having processes in place for when students are struggling academically. With mentees struggling academically, the mentoring relationship can be beneficial if paired with a mentor who has strengths in the area in which the mentee is struggling; however, this does require a strong mentor and a relationship leaning toward tutoring (Robinson & Niemer, 2010). In addition, each situation of poor academics can be addressed with a student-centered approach through open and honest communication with the students involved, acknowledging the situation with the students, recognizing the stress for all involved, understanding the underlying causes, and building learning plans and structures to remedy the causes (Andrews & Rapp, 2015; Daft, 2015; Melrose, Park, & Perry, 2015a). In addition, instructors would need to follow their institutional processes for poor academic performance.

Educational Institutions

A recommendation for educational institutions is that they will need to incorporate mentorship processes into the curriculum and course programming. This will need to include education on mentoring; scheduled mentoring time; clear defined roles, responsibilities, and expectations; development of expected outcomes; and implementation of ground rules of respect, engagement, participation, and consequences if not followed (Bryant et al. 2010; McKimm et al., 2007; Melrose et al., 2013c). Another recommendation is to implement the structure and process that matches the curriculum need. For example, an online course is ideal to have peer mentorship implemented through critiquing each other's assignments. This is a less formal process and can be completed within pairs or groups, depending on the students' needs. In a clinical environment, a more formal process may be required when two students are collaborating together to ensure safe quality patient care. Finally, keeping in mind the need to balance tasks and overall broad learning course structure will require concepts of personalized learning and reflection—for instance, building on what one already knows, taking into consideration social and cultural beliefs, relating and goal setting on a personal level, and implementing reflection practices of journaling and dialogue (Melrose et al., 2013a).

Value in Health Care Education Overall

Beyond these recommendations and value within nursing education, peer mentorship can also be valuable within multilevels of nursing education and other health care education programs. Hamrin et al. (2006) evaluated the educational and experiential benefits of a peer-led support group for graduate students that included decreased anxiety, increased sense of belonging, improvement in transition into graduate studies, and gaining experience and competence in leading groups for participants. Mikkonen, Elo, Tuomikoski, and Kääriäinen (2016) completed a systematic review on peer mentor experiences with international health care students and found that peer mentorship provided significant value in being able to advocate cultural differences and decrease social isolation. Through their action research, Seenan, Shanmugam, and Stewart (2016) found value in peer mentorship for physical therapy students in building communication and teamwork skills. Finally, peer mentorship would be valuable to use within interprofessional education. Interprofessional education is “when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes” (World Health Organization, 2010, p. 7). Rather than requiring instructors from each health care profession, students who are peer mentoring each other from different professions can learn from each other and how they can work together to provide collaborative holistic patient care right within their educational program. The students become the experts within their profession, and the instructor can guide and facilitate the students' co-learning. In summary, peer mentorship can be used in many areas of health care education outside of nursing.

Limitations

There are two main limitations within this article. The first limitation is that it explores only peer mentorship as a valuable educational strategy within nursing. There are other forms of mentorship available to use within nursing education, and these options should also be explored when developing curriculum. The second limitation is that peer mentorship is related only to the humanistic adult education philosophy and social constructivism theory. Peer mentorship may fit well with other adult education philosophies and educational theories. Accordingly, instructors working from different adult education philosophies and theories presented in this article should not bypass peer mentorship. Instead, they should reflect on how peer mentorship may fit within their personal teaching and learning philosophy.

Conclusion

Peer mentorship as an educational strategy in nursing is supported by the humanistic adult education philosophy and social constructivism theory. When nursing instructors implement peer mentorship within their educational practice, students, instructors, and institutions acquire many benefits. Students as mentors and mentees receive the largest benefits, particularly in self-directed learning, self-actualization, support, collaboration, and leadership. Instructors and educational institutions benefit by being able to provide positive student-centered learning environments that enhance student success. Overall, peer mentorship provides a worthwhile educational strategy in nursing education that can also be expanded to other health care professions.

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Peer Mentorship Mentee Benefits and Challenges

BenefitChallenge
Having a comfortable relationship with the peer mentor, including development of a friendship and emotional supportBeing uncomfortable with sharing personal feelings with the mentor
Being able to bounce ideas off the mentorBeing concerned about relying on peer knowledge
Having the ability to share tasks with the mentorHaving a hierarchal relationship with the mentor being the expert and having power over the mentee being the novice
Being encouraged that all will be okay as the mentor can empathize having recently experienced the same situationNeeding a balance between support and autonomy
Having someone safe to ask questionsBecoming too dependent on the mentor
Becoming better students and increasing academic resultsBeing required to have strong communication skills
Learning cooperation and collaboration skill sets
Learning is individualized and student centered
Helping and teaching mentor through reciprocity
Sharing the work environment and feeling less intimidated

Peer Mentorship Mentor Benefits and Challenges

BenefitChallenge
Increasing critical thinking skillsAn overly dependent mentee
Increasing understanding of theory and clinical knowledgeNot having enough time to balance personal life, learning, and helping the mentee
Increasing cooperation and collaboration skillsDifficulty in providing constructive feedback without being an evaluator
Learning from the menteeA requirement for strong communication skills
Increasing facilitation, coaching, and leadership skills
Finding a passion for education
Feeling practice ready at graduation
Building confidence in professional practice
Recognizing how far they have come in their education and learning

Peer Mentorship Instructor Benefits and Challenges

BenefitChallenge
Being an advisor to the mentor and not always being an authoritarianBeing concerned with the impact to the student's learning if the mentor–mentee relationship encounters issues
Being able to nurture the mentor–mentee relationshipEnsuring the relationship is meaningful and productive
Having a reduced teaching load to support mentor–mentee relationship buildingEnsuring a hierarchal relationship is not created between the mentee, mentor, and instructor
Being able to facilitate communication and coordination of relationshipsHaving the mentees bypass or not keeping the instructor in the loop when required
Being able to support student self-learning

Peer Mentorship Educational Institution Benefits and Challenges

BenefitChallenge
Being able to place more than one clinical group (maintaining student–instructor ratios) within a clinical area when students are paired together caring for the same patientsThe time and planning it takes to implement a peer mentorship program
Providing team-based care to patientsThe need to support the nursing instructors who may be required to take a decreased workload to support the mentor–mentee relationship
Providing opportunities to develop clinical competencies outside the traditional modelThe cost of decreasing workload and building time into instructor scheduling
Providing a positive and supportive learning environment for student success
Increasing retention and decreasing attrition
Authors

Ms. Andersen is Director of Clinical Operations, Mosaic Primary Care Network, Calgary, Alberta, and Dr. Watkins is Director, Centre for Nursing Studies, Eastern Regional Health Authority, St. John's, Newfoundland and Labrador, Canada. Dr. Watkins is also Sessional Instructor, Faculty of Health Disciplines, Athabasca University, Edmonton, Alberta, Canada.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

The authors thank Dr. Sherri Melrose, Colleen Briggs, Elizabeth Pearson, and Susana Quezada for reviewing and editing the manuscript.

Address correspondence to Tannis Andersen, MN, RN, 67 Tipping Close SE, Airdrie, AB, Canada T4A 2A6; e-mail: tmavery@shaw.ca.

Received: July 20, 2017
Accepted: November 13, 2017

10.3928/01484834-20180322-05

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