Academic leaders are increasingly concerned about the retention rate of nursing students. They have identified three major reasons for student attrition: (a) vague educational goals, (b) dissatisfaction with the educational program, and (c) unclear career objectives. Mentoring has been suggested as an effective strategy to increase retention of nursing students because it addresses these issues (Dorsey & Baker, 2004). The creation and promotion of peer mentorship opportunities may also be a practical solution to lessen the burden on faculty, provide peer-to-peer learning opportunities, and promote the leadership and teaching skills of senior nursing students (Dennison, 2010). Studies have documented the benefits of mentoring to retain nurses and nursing students in the work force and clinical settings (Baldwin, Mills, Birks, & Budden, 2014; Del Prato, Bankert, Grust, & Joseph, 2011; Dennison, 2010; Dorsey & Baker, 2004; Elliott, 2016; Gilmore, Kopeikin, & Douché, 2007; Shaffer, Tallarica, & Walsh, 2000; Wagner & Seymour, 2007).
Owens and Patton (2003) stated that “mentorship creates a shared learning environment and fosters a professional caring relationship…. Mentorship…allows each student/nurse to be a recipient and a provider, a leader and a follower, a teacher and a learner, a mentor and a mentee, often concurrently. The mentorship process…advances…not only…individual success but…the future of nursing as a profession” (p. 203).
The importance of mentoring in nursing has been recognized as a strategy for developing a culture of caring, support, and shared learning in nurses only since the 1970s (Ketola, 2009). In the first 100 years, nursing was seen as an apprenticeship and there was little mentoring as we know it currently (Ketola, 2009). Nurses were trained in the skills and procedures they needed by physicians, hospital administrators, or more experienced nurses (Ketola, 2009). Nursing was viewed as a temporary occupation before marriage and children (Ketola, 2009). Not until women received the right to vote were they able to have access to science laboratories and patients (Rossiter, 1982).
The majority of current nurses are educated in colleges and universities; they spend fewer hours in hospital clinical rotations due to limited sites (Kline & Hodges, 2006; Rodriguez, 2013). Because of this transition, exposure to expert nurse mentoring has markedly diminished (Larue, Pepin, & Allard, 2015). In addition, high-fidelity technical simulation is being increasingly used in student learning laboratories to provide procedural skill experience.
What is Mentoring?
Mentoring is a peer learning strategy that builds on the development of a humanistic caring relationship between two people in the same setting (Blowers, Ramsey, Merriman, & Grooms, 2003; Stone, Cooper, & Cant, 2013), in which knowledge, support, and skills are exchanged with a holistic focus on nurturing the novice (Dennison, 2010; Wagner & Seymour, 2007). Mentoring includes an emotional component by providing empathy, support, counseling, and guidance to the mentee. What takes place when mentor and mentee are together enables positive outcomes from the mentoring relationship. It provides the environment that motivates the mentee to prepare for the reality of their expectations. The mentor also benefits from the mentoring experience, often receiving a boost in self-esteem, knowledge, and confidence (Penman & White, 2006; Watson, 1999). The mentoring process creates a connective and safe environment that “allows healing, truth and wisdom to be discovered” (Swanson, 2000, p. 32). Through the use of caring intention and actions, mentee and mentor participate in “a special way to transfer knowledge” (Byrne & Keefe, 2002, p. 391) that can be called “a learning relationship” (Dingman, 2002, p. 8) and “a critical companionship” (Titchen, 2003, p. 33). The social networking that occurs during the mentor–mentee relationship also enhances communication among peers (Radford, 2014).
Mentors provide an encouraging relationship for another's growth and development. Tobin (2004) identified seven roles that relate specifically to mentoring: (a) teacher, (b) sponsor, (c) advisor, (d) agent, (e) role model, (f) coach, and (g) confidante. According to Kendall-Raynor (2013) “If we want to have caring nurses, we must ensure time for good mentoring (p. 12).” This means setting aside time in the daily schedule to create the culture of mentorship (Kendall-Raynor, 2013). Essential characteristics of a mentor include: (a) friendliness, (b) good sense of humor, (c) patience, (d) effective interpersonal relationship skills, (e) approachability, and (f) professional development abilities” (Ali & Panther, 2008, p. 37).
The mentoring relationship goes beyond helping students meet their academic needs; it helps them to learn to be caring individuals by “helping another grow” (Mayeroff, 1971). Through that relationship, the participants have greater order, meaning, and stability to their lives; this occurs for both the cared for and the carer (Mayeroff, 1971). The caring relationship promotes higher self-awareness, knowledge, and understanding of others, patience, and honesty; it also facilitates trust, humility, hopefulness, and courage (Mayeroff, 1971; Wagner, 2000, 2002). Caring for another person helps one develop their therapeutic-self (Wagner, 2000, 2002). By participating in the mentoring relationship, the mentor intentionally cares for another person. This includes concern for the other person, a sense of responsibility to assist the other person, and a feeling of attachment (Gaut, 1983). Nursing theorists identify seven attributes of caring that nurses' practice (Roach, 2002):
- Compassion (empathy and sensitivity).
- Competence (use of evidence-based knowledge).
- Conscience (moral and ethical decision making).
- Confidence (trust in one's ability to care for another).
- Commitment (upholding standards of care).
- Comportment (professional presentation).
- Creativity (envisioning innovative care practices and healing environments.
Just as in Watson's (1999) theory of human caring, the care provider and the patient have a “caring moment,” which the nurse and the patient are in a place where they are learning from each other. Also in the caring relationship that takes place during mentoring, the mentor and the mentee share that caring moment (Watson, 1999). In that instance, they are learning from each other. Wagner's (2000) caring mentorship model describes the mentorship experience as transformative in terms of the ability to care for others, create an environment of mutual awareness and openness, nurture respect, and envision new possibilities (Wagner, 2000). This relationship goes beyond the tasks of acquiring learning and skills. It is a developmental growth process that will impact the future ability of the participants to care for others (Wagner & Seymour, 2007; Johnson, 2003).
Benefits of Mentoring Are Mutual
Studies indicate that students mentored early in the nursing program demonstrate reduced anxiety, greater self-confidence, and satisfaction in the learning environment; they overcame learning difficulties and were helped to learn how to do specific nursing skills such as drug calculations and time management, as well as strategies to master the sciences (Giordana & Wedin, 2010). They also had improved retention rates (Giordana & Wedin, 2010; Penman & White, 2006). Mentors reflecting on the experience speak about increased awareness of their leadership styles and more confidence in their teaching abilities (Giordana & Wedin, 2010). The experience helped them develop their professional skills and nurture a professional attitude and awareness about the field of nursing (Watson, 1999). Mentoring also helps level the playing field for students coming from diverse backgrounds (Penman & White, 2006).
Several studies examine mentorship in the nursing student clinical rotation and how it ameliorated student stress. For example, Daley, Menke, Kirkpatrick, and Sheets (2008) implemented a Partners in Practice program in a baccalaureate program. It matched senior-level nursing students with first-year students. The first-year students reported being able to critically think about administering health care to their assigned patients. The senior-level students stated that they gained time management skills, delegation skills, and better communication skills. An unexpected outcome was that faculty were able to assign patients with higher acuity to the first-year students in the mentorship program (Daley et al., 2008).
Ness, Duffy, McCallum, and Price (2010) examined using mentoring to assist the students to improve their “decision making skills” to provide competent patient care in Glasgow, Scotland. Ness et al. (2010) built on the work developed by Carlson et al. (2009) to assist mentors to teach the questioning technique to elicit critical thinking in the mentees, although they were in their clinical rotation to prepare them as midwives (Carlson et al., 2009; Ness et al., 2010).
In a program based in a clinical setting, senior nursing students were paired with beginning nursing students (Giordana & Wedin, 2010). The mentors modeled care for the mentees and enjoyed the opportunity to look at new models of teaching in the clinical setting. The beginning-level students reported their experiences as satisfying, reducing their anxiety, and increasing their confidence level. From the mentors' perspective, the experience was “empowering” for the mentees, and the mentors appreciated experiencing the leadership role and exploring teaching opportunities in the clinical environment (Giordana & Wedin, 2010).
Bensfield, Solari-Twadell, and Sommer (2008) initiated an elective voluntary peer leadership course for undergraduate junior and senior nursing students who would serve as peer leaders for second-year students (sophomores) in a Fundamentals of Nursing laboratory course (Bensfield et al., 2008). The training course taught skills for professional socialization, communication, collaboration, organization, and leadership. Course participants were encouraged to develop their own personal teaching style and consider nursing education. The participants who became peer leaders reported decreased anxiety and reaffirmed their motivation to be a nurse. The mentoring process reminded them of their own growth and learning, stimulated self-reflection on the desire to give of oneself to help someone else succeed, and nurtured the desire to be a teacher (Johnson, Hastings, Purser, & Whitson, 2011; Lewellen-Williams et al., 2006). The sophomore mentees reported improvement in performance of skills, greater confidence, motivation, and encouragement. Other benefits for the sophomore students included (Bensfield et al., 2008):
- Increased sense of responsibility.
- Decreased stress levels.
- Better organization skills.
- Development of intrapersonal skills.
- Increased collaboration skills.
- Socialization into the profession.
- Being with positive role models.
- Increased collegiality among students in the nursing school.
Jokelainen, Turunen, Tossavainen, Jamookeeah, and Coco (2011) suggested universal standards for student mentoring. They recommend that nursing organizations mentor nursing students to stimulate recruitment and retention and encourage them to become professionally competent (Jokelainen et al., 2011). They concluded that nursing organizations need to support the mentors (Morton-Cooper & Palmer, 2000; Wilkes, 2006).
A 2-year mentoring program in an Australian university starts with first-year students at the beginning of orientation and maintains the mentoring relationship for 2 years. The program was initiated after a study found low retention rates due to students' inadequate preparation and lack of persistence when confronting difficulties in the educational program. The study also showed that students who do not have peer support networks or time management skills were not able to successfully cope with the stress and challenges of their educational program. The mentors were voluntary third- and fourth-year students (upper-classmen) that started as second-year students (sophomores) to help first-year students (freshmen) who signed up via e-mail for the program (Zeegers & Martin, 2001).
With the development of the Internet and e-mail capabilities, mentoring programs no longer are limited to face-to-face meetings or one geographic location (Coxon, 2014). An Internet chat-room provides new educational opportunities for Internet-based mentorship programs. In the chat room or via e-mail, mentees can have a mentor from different facilities and establish an on-going relationship beyond the time of a specific program. Clear guidelines should be established to guard personal information and maintain focus on professional topics (Shaffer et al., 2000).
Peer Mentorship in an Urban College Setting
A voluntary peer mentoring program in an undergraduate baccalaureate nursing curriculum was operated between 2004 and 2012. The program was started in response to six nursing students in a senior-year independent study course who thought they would have benefited from such a program during their college years. Working with two faculty in the department, the students developed a peer mentoring program after studying existing models. The initial focus of the program was on the improvement of student retention rates and on studying innovative techniques to foster success in student learning. These techniques were applied to improve student performance at the college; the resulting strategies were implemented across the Department of Nursing. The mentoring program included ongoing collaboration with the Academic Resource Center (ARC) of the college that is run by individuals with expertise in special education. The ARC also coordinated paying the mentors who received the hourly minimum wage. The mentoring program itself was coordinated by its own director, who also trained the mentors.
Content of Mentorship Program
By spring 2016, the mentorship program included peer tutoring, supportive guidance, and suggestions not only about particular subject matter, but also about how to succeed in life as a nursing student. The program complemented the ARC and counseling center services. Sophomore and junior students in clinical nursing courses were the mentees and had to request participation. Student mentors were identified and selected by the director of the mentoring program based on course grades, a minimum of a B+ average, and faculty recommendations. Mentors received reimbursement for their participation through the ARC. The ARC also managed mentor time sheets and received session summaries. Each year, participation ranged 10 to 20 mentors and from 15 to 40 mentees.
Role of Program Director
The program director selected student mentors in consultation with faculty, organized training sessions, paired mentors with mentees, monitored progress of each mentee and mentor, and held weekly meetings with mentors. At the weekly meetings, the director shared information on different teaching methods and approaches the mentors could take with their mentees. The program ran from September through May, with the intention that the same mentor would continue to work with their mentee for the school year.
Role and Training of Mentors
Mentors received three training sessions lasting between 1.5 to 2 hours each on approaches to tutoring, as well as management and organization of the sessions (See Table 1 for content of training sessions). Experts from the counseling center and the ARC were invited to present information on teaching and learning styles, time management, and anxiety and stress reduction. Three trainings were given before the mentors began tutoring.
Training Program for Peer Mentors, Department of Nursing
Mentors were assigned one or more students depending on the number of mentee requests and met twice per week for 2 hours each with their mentees. The students kept a journal to log in their hours and to record their feelings and activities around the mentorship process. Mentors had to fill out a “Mentoring Session report” (see Table 2 with sample entry), describing how they prepared, what they accomplished, student input and activity, what went well, what they would do differently, and what they plan for the next session. The form contained questions and comments to consider in writing about the mentoring session that were formulated by the staff of the ARC. Mentors taught their mentees good study habits, test-taking skills, and mnemonics and reviewed content in preparation for examinations. They also reviewed class and clinical assignments, offered sample test questions with rationale for the answers, and prepared students for new content. At the end of the school year, the mentors were asked to prepare a PowerPoint® presentation for faculty and students at the Sigma Theta Tau Scholarship Day at the college on how they viewed the program.
Mentoring Strategies for Mentees
Mentees signed a contract that they would do their readings and answer reading guide questions prior to coming to the study sessions. In the contract, they agreed to attend all scheduled sessions to show respect and appreciation for the mentor's time and preparation, as well as professional behavior. Mentors helped from one to six students at a time—sometimes meeting together, sometimes individually. Hundreds of mentees and mentors have used the program since its founding (see Table 1 for forms used in the mentorship program).
Over the years, outcomes from student feedback surveys at the end of the school year were positive. Mentored students reported being more successful in their coursework, gained test-taking skills and tips, and did better on final examinations. The mentors gained confidence about their knowledge and skills and believed it would be helpful in preparing for the NCLEX. All mentors passed their NCLEX on the first try. Students who were being mentored from the beginning of the semester were successful in their courses. Mentors valued the training they received and incorporated the information into their mentee plans. Mentors reported using a variety of strategies to help their mentees succeed (Table 2).
Mentors and mentees questioned at the end of the semester were positive in their feelings about the program and the benefits they received in helping them study and take examinations.
Student comments included:
- I liked that it was a set 2 hours of studying with another helpful source.
- [The program] really helped in my studying.
- My exam grades improved significantly.
- It's good to get another interpretation and explanation of the material from another perspective.
Students liked the “ability to ask questions,” and “found the sample test questions helpful.” They appreciated how the program taught them “how to study and what to look for when taking nursing tests.”
My mentors taught me acronyms to remember certain things in different chapters such as fluids and electrolytes. It was also helpful to get an older nursing major's perspective on how difficult they thought the course was and how they passed.
Another wrote of her mentor:
She gave us tips on how to take the test and ways to memorize information and how to apply it, so I can understand.
One student reported:
Because of this program I passed Kaplan with a 100 and I also passed my final course examination, because my tutor went over difficult topics with me.
Another mentee said:
We can compare notes from students from different classes and this just gives us extra study time during the week.
Mentees also commented. One mentee suggested that everyone should be in a mentor program and recommended it for students preparing to take medical and surgical, especially for “specific tips on how to do well:”
It was also helpful to get an older nursing major's perspective on how difficult they thought the course was and how they passed.
Mentees noted that when their mentor said something:
We know we really need to do it, even though the faculty [said] the same thing.
The mentees became a natural support group. They were able to share their anxieties about test taking and this “made learning easier.” One mentee said:
Being in a group was effective for the students as they were able to help each other and answer each other's questions.
The program was especially effective when “students came prepared with their reading done and with questions.”
Mentors also reported benefitting from the program in developing leadership skills and self-confidence. A mentee said:
Being able to guide these students not only helped me grow as a peer student but also as a leader in nursing.
Being a mentor “helped me realize that I do have the patience and knowledge to help someone else succeed.” It was a “great opportunity to help fellow students succeed in their classes.” A mentor wrote that she was inspired because she “was able to focus all of my time on two nursing students and make sure that they understood everything possible for their upcoming test and Kaplan [the preparation for NCLEX].” “Helping the students succeed,” wrote one mentor, “was a humbling experience.” She added:
Nursing is extremely hard, and the mentorship program emphasizes that support is always here.
The mentors helped mentees understand that “most often, [the] reason for choosing the wrong answer was because they misread the question.” During the process of mentoring, mentors were able to review the content and test-taking skills for their NCLEX, including medical and surgical concepts. They became “more confident in the course material, as well as learning.” They discovered “many different ways of teaching and how to approach content.” The mentors were able to empathize with the students about the anxieties of test taking. Mentors shared personal experiences and stories about their undergraduate career. This helped motivate students and lowered their anxiety around test taking.
Mentors especially appreciated the diverse learning techniques they were trained in for the program. They found effective the approach of teaching the material to the mentee on the first day and on the second day having the mentee teach back the material to the mentor. This technique also benefited those students who learn by listening or taking notes and those who learn by talking about the subject matter.
Over the years, several challenges were prevalent. Mentors stressed the need to start the program within the first 2 weeks of the upcoming semester to succeed. Another challenge was arranging the meeting between mentor and their mentees, especially when three or more mentees were involved. One mentee wrote:
One negative is that we all had different clinical schedules, so we couldn't meet at a certain time every week, so we had to go on a week-by-week basis.
Mentors commented that they were frustrated when they went out of their way to reach out to students requesting help but then the students did not show up or called to cancel at the last minute. Another challenge is recruiting enough mentors to be assigned to all the students who request help.
Another issue recognized by the mentors was student mentee load. Some senior mentors had groups ranging up to seven mentees and had difficulty meeting with the whole group because of their own preceptorship schedule in the hospital. The ideal load would be two to three students at the most per mentor; students recommended no more than four mentees at a time. Some mentees “who were shy and didn't work well with groups” also would benefit from one-to-one sessions. Mentees wanted more emphasis on study skills and help with identifying what kind of learner they are and appropriate study tips.
This article has described a peer mentoring program for nursing student through the eyes of the mentors and mentees participating. In general, the mentors in this program expressed concern about their students' success and wanted them to continue getting support after the mentor graduated. Many mentors told the students to contact them in the following year if they needed any help. Mentees appreciated their mentors and the program, and both benefited. Both groups recommended its continuation by the college. Some mentees suggested that all students should participate.
This program generated a culture of caring and support to the students, with the understanding that they would give back to others what they had received. One year you were the mentee, and the next year you gave back as the mentor; however, the mentors described having received more as a mentor in their own education and their own understanding of themselves as a potential teacher or leader. They expressed pride in being able to help another person. In subsequent years, many of the mentors became clinical preceptors and faculty in the college's nursing program and in other programs.
This program is continuing in a modified format. It may benefit from a full evaluation to promote similar programs to develop a culture of caring among nursing students, as well as academic and professional success.
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Training Program for Peer Mentors, Department of Nursinga
|Description of mentees and recruitment||Voluntary participation|
|Reading guide questions|
|Attendance, class, and mentor sessions|
|Mentorship techniques||Stress-reduction techniques|
|Using VARK tool to assess learning styles|
|Think, pair, share activity|
|Planning the mentoring session||Journal sample|
|Sample test review checklist|
|Mind mapping sample|
|Concept mapping example|
|The VARK questionnaire|
|Checklist for handling overstress|
|Study aid books|
|NCLEX review books|
|Counseling center test anxiety workshops|
|Demographic survey||Mentee and mentor|
|Feedback survey||Mentee and mentor|
Mentoring Strategies for Mentees
|Navigating the Kaplan site|
|Exchanging personal contact information to facilitate asking questions|
|Having a general outline before meeting with students|
|Gathering discussion questions from the students|
|Formulating new questions|
|Going over sample test questions and their rationale|
|Teaching test-taking skills|
|Having mentees teach each other a particular topic to give confidence in their mastery of the topic|