APNA's definition of primary health care nursing covers health, scope of practice, primary health care, roles and settings. We also explore general practice nursing and Phillips et al. six roles of the general practice nurse.
Improving job retention: The power of mentorship
Mentoring in the workplace delivers myriad benefits for the nursing workforce including job retention, promotion and advancement, higher satisfaction, morale and productivity. Now more than ever, it is considered an essential element in keeping nurses engaged and satisfied throughout their professional journey
Mentoring programs play a vital role in the career development of novice and experienced nurses to improve job satisfaction and the intent to stay in the nursing profession. Currently, mentoring programs are underutilised in addressing workforce strategies in the nursing sector. APNA’s ex-CEO David Malone has argued that, 'Better use of workforce strategies, such as mentoring, is imperative to address retention rates of nurses in primary health care.'
Carefully planned and executed programs such as APNA’s Transition to Practice Pilot Program (TPPP) focus on mentorship as one of the key elements to support both newly graduated and experienced Australian nurses transitioning into primary health care settings. Formal mentoring programs are important to both the mentor and the mentee as 'it supports the novice’s need to feel satisfaction and success as a professional nurse and offers the experienced nurse an opportunity to contribute to the profession.'2
As the National Approach to Mentor Preparation for Nurses and Midwives Framework suggests, 'Mentors are the gatekeepers for entry to the profession and we must not underestimate the responsibility and the privilege associated with the role.'2
Confronting job satisfaction and retention
While some turnover is to be expected for any role, no single reason can usually explain why employees decide to leave their positions. However, research has given us some insight into a few of the factors that may make or break employee retention. The more we learn and understand retention issues, the better they can be addressed and strategies can be implemented to minimise turnover and improve retention rates. A knowledgeable, skilled and stable nursing workforce will be pivotal in meeting the increased demand for healthcare services and better contribute to positive patient outcomes.
A study on employee retention conducted by TINYpulse revealed interesting findings on what impacts retention and overall job satisfaction in the workplace. Although the study did not focus on health care specifically, the research can be applied to the nursing workforce. Its major conclusions were that micromanagement and culture often determine if and when employees leave their roles.
The study found that freedom and retention have a large correlation: “Employees that have lots of freedom to make decisions on how to do their jobs are pretty satisfied and far less likely to think about finding a new employer.”3 This tells us that employees who are restricted by their managers and do not have any freedom or autonomy in their role are less likely to feel satisfied and valued at work, and result in them seeking new career opportunities. It seems reasonable to draw the conclusion that by enabling primary health care nurses to work to their fullest potential we can also positively impact nursing workforce retention rates and enhance productivity within the healthcare sector.
'A good mentoring program can boost retention at all levels'7
Culture was another major factor that played a part in retention, 'While not necessarily easy to define, the overall fabric of the environment one spends large amounts of time in naturally influences one’s perception of the work experience.'4 The study concludes that, 'Relationships of all kinds have a major impact on retention: relationships with managers, with co-workers, and with the broader company culture.'4 We can apply this knowledge to the nursing workforce quite well.
A nurse who has a clinical and professional nurse mentor, who feels supported and empowered at his or her workplace, may be more likely to find satisfaction in their role, feel fulfilled, and intend to stay in the nursing profession.
Mentoring and preceptorship: why we need both
Both mentoring and preceptorship are crucial to a nurse’s career and professional development.
A review of national and international literature reveals that the terms ‘mentor’ and ‘preceptor’ are often used interchangeably; however the two terms have different meanings and it is important to understand the difference in the context of primary health care nursing. Mentoring is important for succeeding professionally.
In the British Journal of Nursing, author James Vinales defines mentoring as a process by which one person (the mentor) encourages another individual (mentee) to manage his or her own learning so that the mentee becomes self-reliant in the acquisition of new knowledge, skills and abilities, and develops a continuous motivation to do so.5 Preceptorship (also known as clinical guidance, facilitation or supervision) is regarded as a shorter term relationship, focussed on clinical skills acquisition and socialisation to the work setting.6
Mentoring is more reactive and generally regarded as guidance.
Preceptorship is proactive and relates more to direct teaching and supervision.
Mentoring programs have proven to have positive effects on job satisfaction, which as we now know, has a positive implication on job retention. A 2004 study by Hegstad and Wentling revealed that the most prominent result of a formal mentoring program was retention6. This is supported by the 2012 integrated review to design a template for excellence in mentoring in the context of nursing education, which also cites that, 'Institutions providing mentoring programs experience increased retention and improved sense of community and professional identity.'11
'A mentor can challenge you, inform you, connect you and inspire you'1
Formal mentoring programs such as APNA’s Transition to Practice Pilot Program aims to contribute to the nursing workforce development and sustainability by supporting nurses new to primary health care to enhance the experience of the individual nurse, as well as assisting workforce retention in the area of primary health care nursing.
APNA has combined the two roles described earlier (mentoring and preceptorship) into a clinical and professional mentor role within the Transition to Practice Pilot Program and aims to evaluate this model at the end of the program in 2018.
In order for mentorship and preceptorship programs to be successful, APNA suggests that the following should be incorporated into mentorship programs where possible:
- Adequate training and support for mentors
- Adequate preparation for mentees
- Sufficient protected or designed time for mentors to undertake their role
- Consistency in application of mentorship programs Incorporation of peer support mechanisms in programs
- Clarification of role and purpose of participants at the start of the program
- Having measures in place to adderess potential crisis points for nurses undergoing transition programs.
Reflection-on-action: This involves reflecting on an event or situation after it has occurred to gain a deeper appreciation of what occurred, how you responded as a health professional, what the experience of others may have been in the situation, what was effective or valuable about your response, and what should or could change to improve professional capacity.
Reflection-in-action: This involves reflecting on an event or situation while it is occurring and being able to take action to address your observations in situations. This practice develops over time, and is a hallmark of highly skilled health professionals.
Critical reflection: This involves reflecting on our values and the assumptions we hold about ourselves, other people and the contexts in which we work and live. It requires an understanding of the social, cultural and political landscapes in which we operate. It is important to undertake critical reflection while practising both reflection-on-action and reflection-in-action
'The concept of mentoring is not new to nursing, as florence nightingale was Known to have mentored many nurses in her day'1
In order to develop a framework for nurse participants of the APNA Transition to Practice Pilot Program, a process was undertaken to identify current models of mentorship, preceptorship and transition to practice
A framework toolkit was developed to provide the clinical and professional mentors within the program with guidance in establishing a rewarding mentoring relationship with their transitioning nurse and to support them in their journey into primary health care. The mentoring framework also included templates for guiding mentoring conversations as well as information relating to education and resources around this aspect of the program.
The Transition to Practice Pilot Program mentoring framework incorporates the following elements:
- Reflective practice
- The role of a clinical and professional nurse mentor and transitioning nurse
- The benefits of being a clinical and professional nurse mentor
- How to achieve relationship success: principles and actions
- The desired characteristics and abilities of clinical and professional nurse mentors
- Mentoring toolkit to guide and assist in mentring conversations
Making the relationship work: achieving relationship success
There are characteristics and abilities that clinical and professional nurse mentors should embody to achieve relationship success with their mentee. A successful mentor–mentee relationship will be open, honest, caring and trusting, free from judgment where the nurses can explore their practice and reflect on their knowledge, skills and attitudes. Trust is essential in a mentoring relationship as it helps to ensure that the nurse feels safe, supported and respected.
As with any relationship, it takes work from both parties to engage, communicate and develop mutual trust for each other. As a mentor, promoting trust in the relationship includes expressing enthusiasm and reliability; active listening; open, productive and frequent communication; as well as listening to issues as they arise and offering constructive feedback.
On their part, mentees should be committed to their own development, frequently reflect on their practice and complete the requirements of their role. A strong mentor will assist the nurse to develop attributes that will help them broaden their own cultural and social potential beyond what they do every day and have a lasting impact on the individual and the profession.
The top-left table from APNA’s Transition to Practice Pilot Program Clinical and Professional Nurse Mentoring Framework and Toolkit highlights the key elements and actions for nurse-mentor relationship success.8
Reflective practice: Making sense of events
Put simply, mentoring helps guide reflective practice. It is 'the process of making sense of events, situations and actions that occur in the workplace'8 or 'the ability to examine one’s actions and experiences with the outcome of developing their practice and enhancing clinical knowledge9.'
Reflection is a powerful tool that promotes professional development for the mentor and the mentee. The three main forms of reflection are: reflection-on-action, reflection-inaction and critical reflection.
It is clear that mentoring programs for the nursing workforce are critical for career satisfaction and professional development. Looking at the bigger picture, lack of mentorship can lead to poor nurse retention, which has significant effects on the nursing workforce as a whole. It is important that mentoring programs be put in place to support newly graduated as well as experienced nurses, as this will contribute to the growth of this much needed and valued profession.
- Urban, E. Seven Proven Insights Into A Powerful Mentoring Relationship. (Forbes: 22 December 2017).
- Mariana, B. The Effect of Mentoring on Career Satisfaction of Registered Nurses and Intent to Stay in the Nursing Profession. (College of Nursing: 7 December 2011).
- NHS Education for Scotland, National Approach to Mentor Preparation for Nurses and Midwives, Core Curriculum Framework (Second Edition). NHS Education for Scotland, 2013.
- Troyani, L. Employee Retention: What’s Making Worker’s Quit (New Report). (TINYpulse: 28 September 2015). https://news.tinypulse.com/lt-employee-retention-report-82043/. Accessed 20180102.
- Lipman, V. Why Do Employees Leave Their Jobs? New Survey Offers Answers. (Forbes: 10 October 2015). https://www.forbes.com/sites/victorlipman/2015/10/10/why-do-employees-leave-their-jobs-newsurvey-offers-answers/#7a5852b27ea1. Accessed 20180102.
- Vinales, J. Mentorship part 1: the role in the learning environment.British Journal of Nursing. 01/2015: Volume 24, No 1.
- Art of Mentoring, Mentoring is Not Just for “Top Talent”. https://artofmentoring.net/mentoring-is-not-just-for-top-talent/. Accessed 20180109.
- Oelofsen, N 2012, Using reflective practice in frontline nursing, Nursing Times, vol. 108, no. 24, pp. 22-24, accessed 17 January 2017 https://www.nursingtimes.net/home/courses/using-reflectivepractice-in-frontlinenursing/5045779.
- Caldwell, L & Grobbel, C 2013, The importance of reflective practice in nursing, International Journal of Caring Sciences, vol. 6, no. 3, pp. 319-326, accessed 17 January 2017 http://internationaljournalofcaringsciences.org/docs/4.%20us%20La.Caldwell.pdf
- Nursing Research and Practice. 2012; 2012: 937906. Published online 23 May 2012.
- Jan M. Nick, Theresa M. Delahoyde, Darlene Del Prato, et al. Best Practices in Academic Mentoring: A Model for Excellence.
- The Association of Queensland Nurse Leaders (Inc),Mentoring Framework and Toolkit for Aspiring Nurse Leaders in Queensland, AQNL. Mentoring and Framework Toolkit. October 2013.[Internet accessed August 2016, December 2017].