The RNAO Advanced Clinical Practice Fellowship was a comprehensive learning experience that took place part-time over 22 weeks at Holland Bloorview Kids Rehab under the capable leadership of my mentorship team. My overall goal was to increase my knowledge, skills, and expertise in program development through the development of an evidenced informal formal mentorship program while meeting an identified need for our organization. From this experience, a mentorship program was created for all recent in-patient graduate nurses that extend beyond orientation.

My first learning objective was to build skills in conducting literature reviews to gain a better understanding of the importance, needs, and effectiveness of various mentorship programs. The literature search provided me an opportunity to explore numerous databases or search engines and work with our librarian (see appendix A). The librarian provided me with strategies to retrieve relevant journals. Reviewing RNAO Best Practice Guidelines and CNO standards was very helpful for integrating recommendations and understanding expectations throughout the development of the project. The literature demonstrated the positive influence that mentorship has on nursing recruitment and retention, collegial relationships, and career transition (Block, Claffey, Korow, & McCaffrey, 2005; RNPDC, 2011). Mentorship is also a way of providing opportunities for nurses to share their expertise, increase learning, and provide leadership development, while at the same time, enhance quality, safety, and patient care satisfaction. The literature demonstrates how important organization support is to mentorship program success and sustainability. My primary mentor took the time to go through the articles and findings with me. Together we discussed the importance and relevance of mentorship at Holland Bloorview.

My second learning objective was to build my skills in conducting a stakeholder analysis through a needs assessment and external review. Conducting a needs assessment was a new experience for me. I developed a needs assessment survey for all recently hired nurses (within 12 months of hire) to hear about their experience transitioning into the organization and their thoughts of mentorship. It was very invigorating to hear what new hires had to say and how we were currently supporting them through their learning transition. From this survey, it was evident that a mentorship program would be of great value for recent hires in our organization. In addition, I attended several nursing meetings to hear the opinions and meaning of mentorship from nurses of all experiences. I met with several senior nurses to understand their thoughts and interests of mentorship. Through this, I was able to discover what is important to the front line nurses that will be involved in the mentorship program. The needs assessment took longer than anticipated as I had to ensure I got a significant sample size of respondents and capture the experiences of nursing staff. I created a presentation on these findings and used the data to inform and develop the mentorship program. Through data review of hiring practices and data on nursing experience, I was able to estimate needed numbers for a mentor pool for program implementation. Literature and the needs of the organization were used to inform and describe the characteristics of participants, and competencies and qualities required for the mentee and mentor role.

Identifying, who the external stakeholders were, meeting with the stakeholders, and generating the stakeholder analysis was a valuable exercise. I had the privilege of personally attending or conducting telephone interviews with experts in mentorship locally and across Canada. I mainly targeted institutions with pediatric populations and most had a rehab focus. I also met with experts from a local university and college, and regional mentorship experts from the east coast of Canada. Through these meetings, I was able to discover how local hospitals are incorporating mentorship. Many of these experts referred me to current research examples and toolkits in mentorship. We discussed successes, challenges, and lessons learned from mentorship programs in nursing. It was particularly interesting to hear the experiences of others as they implement mentorship programs in their organization, workplace or region.

My mentorship team was instrumental in assisting in reviewing my progress throughout the development of the program. This organization has high support in this initiative even with limited resources and competing priorities. Having an external mentor was very helpful for bringing in new thoughts and experiences from an external setting. I thank the mentorship team and organization for their valuable support. The positive experience with my strong mentorship team further highlights the value of mentorship.

Receiving feedback from staff and the mentorship team was instrumental for key decision points and program components. For final thoughts and feedback from frontline nursing staff, I will be seeking input from nurses during a poster presentation at our organization’s Nursing Summit Day. I was able to review additional feedback on the progress of the mentorship program. To develop evaluation strategies, I conducted self-directed learning activities and met with Kathryn Parker, the Senior Director from the Teaching and Learning Institute at Holland Bloorview to learn about a strategy to apply process evaluations. During the external scan, I reviewed several active mentorship programs to learn about their evaluation strategies. Through these interventions, a process and final evaluation were developed. The plan, do, study, act (PDSA) model has and will continue to be followed. Ongoing review of the effectiveness of the project will continue by obtaining feedback from mentors and mentees during implementation. I created a poster abstract and submitted it to an external nursing leadership conference and an internal nursing summit. From this, I created a poster presentation titled ‘Developing an Evidence-Informed Mentorship Program within a Pediatric Rehabilitation Setting’. Gratefully, both of these submissions were accepted.

With the foundational work completed, I felt prepared to develop a mentorship toolkit for mentors and mentees. The toolkit includes numerous topics including the rationale for the mentorship program, an overview of the program, resources for effective mentoring, giving feedback, developing a learning plan, a mentorship partnership agreement form, etc. Furthermore, a half-day mentorship workshop was created for mentors. I used materials from literature, recommendations from external partners and mentorship team, and mentorship toolkits to develop the content for the workshop. Materials from our current full day preceptorship course were considered, bringing the length down to a half day compared to a full day workshop. The workshop will cover important mentoring topics such as process and expectations, roles and responsibilities, transition theory, challenges, multigenerational workplace, adult learning theory, coaching, and giving feedback. Also, the workshop will provide opportunities for nurses to network and share their personal experiences through the integration of various activities. The activities developed aim to share experiences and keep the audience motivated and engaged. Participant binders were developed and include resources, slideshow, case studies, the mentorship toolkit, handouts, and an evaluation form. Lastly, to facilitate learning and competency building, a staff development workbook was created. This workbook includes competencies for the development for a new nurse in a pediatric rehabilitation setting, a learning plan, and other professional development guidelines. I believe that I have grown in my organizational, leadership and workshop facilitation skills through this experience.

Sustainability
I felt the mentorship program development was the culmination of my work, and yet, the work has just begun. The next phase will be implementation, in which is set tentatively for 2016. A debrief meeting will be scheduled with my mentorship team, senior director, operations managers, clinical educators and clinical resource leaders. During this meeting, I will share the fellowship process, activities, and results. This meeting will be a valuable time for feedback and discussion for implementation. Mentorship is a component of the nursing vision for Holland Bloorview. This alignment helps to highlight the significance of mentorship aiding in sustainability. During and after implementation, it is essential that mentors are recognized for their contributions and efforts in mentorship. This will add to sustainability and involvement from both mentees and mentors. Strategies for acknowledging mentors include a certificate of participation in mentorship workshop, recognition on performance appraisal, and broadcasting mentor relationships on an internal website. I will be working alongside the leadership team for continuous support of the mentorship program. Through evaluation and feedback from mentees and mentors during implementation, necessary adjustments to the program will be considered to best meet the needs of the mentee, mentor, organization, and clients and their families. Our clinical educators will introduce mentorship in orientation for all new hires. On-going evaluation and feedback of this new process from frontline nursing staff will continuously be collected to sustain this new process at Holland Bloorview.
My learning will be sustained through the ongoing activities listed above. I am very excited for the implementation of the mentorship program and to create a mentoring culture at Holland Bloorview.

Conclusion
The experience of this Advanced Clinical Practice Fellowship has been challenging and invigorating. I have grown personally and professionally with the support of my accomplished mentorship team. I have developed relationships both within and outside of Holland Bloorview that will continue to assist me in my professional growth. I can appreciate how the support from your senior management team is pivotal in the success of quality improvement initiatives. By setting learning objectives with clear deliverables, I was able to accomplish more than I thought possible. With the implementation of a mentorship program at Holland Bloorview, our nursing staff and organization will benefit and will truly impact the care of our clients and families.

I would like to thank RNAO for granting me this learning experience.