Nurse Mentor Initiative
Summary
Nursing shortage throughout Canada has been a progressive issue according to the report published by the Canadian Association of Schools of Nursing 2021. This report identified that the number of registered nursing graduates from entry-to-practice programs decreased 6% in 2020 as compared to 2018, and a decrease in admission rate of 1.9% 2019-2020 compared to 2017-2018.
With the advent of COVID-19, nursing staff attrition and early retirement rate increased further gaps throughout all health care sectors (Murphy 2022, Buchan 2022). For the hospital sector, the shortage of nurses caused an increase in patient to staff ratios. This impacted patients by decreasing quality of care and increased safety incidences; increased nursing stress and burnout; and increased health care costs to replace and onboard new hires due to nursing staff leaving the profession or organizations (Haddad 2023, Buchan 2022, RNAO 2022).
COVID-19 also impacted the quality of training to nursing students, in which education transitioned from a clinical hands on focus, to an on-line virtual platform. The result of removing clinical training and skill development within the hospital environment caused the student nurse to lack the skill in viewing the patient’s care from a nursing holistic perspective, and an opportunity to advance clinical skill development. This has created gaps in knowledge with our current generation of graduate nurses employed within the hospital environment (Agu 2021; Leaver 2022).
Lakeridge Health (LH), a five site community hospital in the Region of Durham, has identified a need to reorganize and develop an internal initiative to grow and sustain our nursing staff. By highlighting the corporate goal of “Transforming the experience of our people and teams”, Lakeridge Health is aligning this key priority to address the current nursing shortage by endorsing projects that decrease burnout and support staff retention.
As a result, the focus of this fellowship was developing and piloting a Nurse Mentor Initiative that enabled the expertise of select clinical nurses to enhance nursing practice with clinical skill development, time management, and safe patient practices at the bedside. The patient care departments selected to participate in this initiative were identified due to high staff turn over rates.
My overall learning goals was to acquire an understanding of the functions of management and administration within a health care organization focusing on developing strategies to sustain staff health and well-being, which is part of the ACPF Wellness Stream.
The first learning objective focused on creating a team of nursing staff to mentor and strengthen clinical skills at the bedside. This required an understanding of the union and non-union expectations in order to develop a job description and interview tools. During this process, the title of Clinical Practice Leader II (CPL II) for this team was established. The original focus for this team was to have recently retired, or close to retiring, nursing staff participate in this initiative. Due to a lack of interest from this sector, the positions were opened for all nursing staff throughout LH. Interviews were conducted and candidates selected. Due to the internal process of transitioning nursing staff from the bedside, the CPL II team required a staggered educational and onboarding process.
My second objective was to develop surveys and forums for the CPL II team to share feedback of their perception of the CPL II initiative. In researching survey development and discussing with the LH research lead, a survey was developed using a format supporting quantitative and qualitative feedback. The forum of Biweekly meetings with the team in which evaluating data, ‘Share the Wealth’, and discussions on challenges and opportunities were brought forward. Another forum established were monthly 1:1 discussions.
The final objective was strategizing with the CPL II team the tools, resources and activities to be put in place to assist with educational and clinical support to the bedside nursing staff. By utilizing the RNAO Best Practice Champion Toolkit, CPL IIs were able to identify gaps, perform Plan, Due, Study, Act (PDSA) process, and develop strategies and tools to enhance clinical skill development at the bedside.
Through this process I gained knowledge in understanding corporate compliance with human resources and regulatory disciplines, collaborating and obtaining stakeholders’ endorsement, developing and analyzing related data, and strategizing how to enhance shared governance with the CPL II team.
Outcomes
For the patients at Lakeridge health, CPL IIs endorsed patient safety by addressing educational and hands on safe practice to our front line staff. This was identified by reviewing a skills log that the CPL IIs participated in completing. In reviewing the monthly data, the team supported evidence based safe practice by enhancing knowledge and expertise in utilizing LH policies and procedures, as well as providing hands on in-services, was captured. An overview of the some policies and procedures endorsed at the bedside include chest tube care and maintenance, peripherally inserted central catheter (PICC) and central line accessing/deaccessing, and nasogastric tube insertion, care and maintenance.
Highlighting how the patient experienced nursing care couldn’t be emphasized more than when a patient came to thank the nursing staff for the care received. This patient was being looked after by a new graduate nurse when his condition began to deteriorate. With the mentoring and support from the CPL II, the patient was able to get the required interventions in a timely manner. The Manager of this unit informed our Communications department, and this story was highlighted during Nurses Week.
As part of the CPL II requirement, it was decided that the CPL IIs would be available for all nursing staff skill development on their assigned patient care unit(s). The assumption by the CPL II team was that their time would be focused on supporting newly hired nurses (less than one year) within the patient care unit. In reviewing the skills log, the team was surprised that experienced nurses also utilized this team for clinical skill and expertise.
As the tenure of the CPL IIs was coming to a close, this team shared that several nursing staff commented to them that their role was valuable to them and their nursing practice. Some of the comments shared by the nursing staff from the survey was supported by following comments:
- I really like the cpl 2 role. I’ve utilized them a lot and I find them very helpful
- I feel the CPL II role has been a great initiative. I am thankful for all the extra education. I feel it has enhanced my nursing practice. I hope this initiative continues.
- I enjoy this new role. Especially the hours they work.
- The addition of the CPL IIs have been really integral in my growth as nurse.
In follow up with the leaders, the patient care managers and clinical practice leaders, identified how valuable this team was to the development of their staff. One of the leaders wrote ‘I am so thankful for having had the opportunity to have … to support our team. As mentioned before, we have had several new staff join our ISU team, most of them brand new RPNs. I sincerely believe we could not have on boarded/supported our staff as successfully without the amazing support’.
As for the CPL IIs, the survey sent to the CPL II identified that this group enjoyed the role, felt it was valuable, and contributed to their professional development. Some of the comments shared were:
-It was a great opportunity and allowed me to further explore the educator role
-Enhancing patient care and teaching staff new skills was a huge reward
Overall experience
The original plan was to have the CPL IIs have orientation together and start at the same time. Unfortunately, this didn’t happen due to several different factors. As a result, there was a need to realign this initiative, and this could only have happened with the assistance from my mentor. Having my mentor support and help navigate some of the challenges was important in order for this initiative to continue. Drawing on my mentor’s expertise and connections was a huge asset.
What was also required was a need to ensure to be flexible. Being flexible was important in realigning time lines to meet required outcomes, enabled the capability to meet the CPL IIs needs and assistance with any mentoring required, prioritizing the feedback supplied through the PDSA cycles, and evaluating and sharing the data obtained from the surveys. As to the timelines identified in my learning plan, I was grateful that RNAO was also flexible in allowing me to submit an extension due to the CPL II team requiring staggered start dates.
A surprising finding was that not all of the leaders on the patient care units adopted the CPL IIs to their full potential. This left some of the CPL IIs unsure as to the direction or amount of support staff members required. These CPL IIs needed more assistance from me to tailor their role and set up resources so this team could progress to meet staff learning needs.
This initiative was a vision that I have had for several years, and it was amazing to see the theory come to fruition. This could not have happened without the members of the CPL IIs rising to the challenge of being apart of a new model of care. I cannot say enough about the dedication and energy that this group of CPL IIs brought to this position, to the staff, and the patients on their perspective units. They were able to make this role be identified as valuable to the organization, and incorporate best practice that supported safe patient care.
