1. Fleming, Kathryn PhD, RN, CPHQ, NEA-BC

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Evidence shows that the implementation of an effective nurse mentorship program impacts the course of our profession by empowering nurses to make confident, well-informed decisions regarding patient care; improving their overall job satisfaction; and creating a long-term commitment to high-level professional development.1,2 Healthcare organizations also benefit from cost savings related to the hiring and training of new nurses. And, ultimately, strong, effective mentorship leads to higher-quality patient care and better patient outcomes.3

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Nurse leaders are acutely aware that the success of any initiative requires staff engagement at all levels. Organizational goals are never achieved by attempting, in various ways, to force staff into adherence or "buy" staff loyalty. Nurses need to come to the heartfelt realization that change is needed and that they're the clear, primary drivers of improved patient care. Change doesn't, exclusively, occur in the boardroom by developing evidence-based policies. Effective change more likely occurs at the bedside by using an organic, grass roots approach: qualified RNs who've been identified to mentor other nurses. Mentors exemplify a passion for quality improvement and patient safety, demonstrating the desire to share their knowledge, experience, and the challenges of their professional journey to shine a light on the importance of excellent patient outcomes.


The specialty scholar peer mentor program was developed after identifying the successes of one clinical nurse initiating change on just one unit. The goal was to develop clinical nurses into effective peer mentors to help facilitate hospital-wide patient safety and quality improvement.


If at first you don't succeed...

Our peer mentors weren't randomly selected. They were a small group of nurses who participated in, and successfully completed, the highest level of clinical advancement. Identified as "specialty scholars," they were responsible for the completion of critical quality improvement projects. The specialty scholars were guided by campus liaisons-nurse leaders who were experienced in the area of quality improvement. The campus liaisons scheduled monthly meeting time to work on the projects with the specialty scholars. However, projects progressed slowly because the specialty scholars only sought assistance during these meetings.


Identification of these factors was vital in the decision to assess the overall program. What could be done to revitalize the specialty scholars and motivate more nurses to work on achieving the highest level of clinical advancement? In 2014, a program assessment was completed. Each campus was visited and the specialty scholars were given the opportunity to provide feedback and discuss the program. Lack of communication was a consistent concern shared by all participants. Specific examples of failed communication included uncertainty about due dates, confusing documentation requirements, and lack of knowledge about what resources were available for project assistance.


During visits to each of the campuses for monthly meetings, it was interesting to note that there were always one or two nurses who were extremely motivating, which helped boost the morale of the other specialty scholars. They were the forward thinkers, the ones who were determined to breathe new life into a program that faced many challenges. Excitement mounted as these nurses were presented with the opportunity to become peer mentors. There was a unanimous response: 100% of the invited nurses agreed to take on this role. Because the program was brand new, the peer mentors wouldn't only be mentoring their nurse colleagues on specific projects, but also working on the development of documents, tools, and training curricula for new and existing specialty scholars. There was no additional reimbursement for this new role and the added responsibilities. But, still, the peer mentors were eager to get started.


...Redesign and shine

The specialty scholar peer mentor program was created from a need to have additional support for individual quality improvement projects. However, with the limitations of the campus liaisons who were only able to offer feedback once a month to the specialty scholars, this was no longer a practical response to the program's growing needs. With thoughtful consideration given to past challenges and how to pull interested, qualified participants into an updated creative process, the program has evolved into a robust opportunity to bring on more scholars, offering an environment for peer mentors to collaborate, learn together, and develop the skills they need to take ownership of their program.


Phase 1 of the program was implemented at the beginning of 2015, with five peer mentors representing three of the five hospital campuses. The objective was to clarify and set the framework for their role. This included identification of role expectations, as well as the standardization of tools and forms for use in their mentorship practice. Development of formal training was an important step in assisting the peer mentors to gain the essential skills needed for successful mentorship relationships: building rapport and trust; listening; providing feedback; employing plan, do, check, act (PDCA) principles; and understanding project management.4


All five facilities were targeted to identify peer mentors. Selection criteria included feedback from campus leaders and current participation in the specialty scholar program. A meeting schedule outlined a set agenda, with learning activities to address evidence-based strategies, mentorship skill development, and the Magnet(R) framework. Time for networking between colleagues was also built in because the peer mentors from different campuses often didn't know each other, despite working for the same hospital system.


The monthly peer mentor meetings are attended at almost a 100% rate, often at the end of a 12-hour shift or on the mentors' day off. Many sign on to the video conference from vacation destinations so as not to miss the next learning activity or to help fellow mentors with ideas on how to move a project forward. There's sharing and camaraderie among the group, creating an invaluable opportunity to grow stronger as professionals with a clear mission. They're proud of their program, their outcomes, and their joint efforts with fellow clinical nurses. The peer mentors developed improved strategies to manage unexpected data results and assist their nurse colleagues in applying the updated information. They're also learning to modify the plans moving forward by consistently utilizing the PDCA cycle.


Demonstrable success

Our metrics include peer mentor engagement, program growth, and multidisciplinary collaboration. Engagement is defined as attendance at the monthly peer mentor meetings. Growth is identified by the increase in the number of peer mentors. These metrics were rolled out before the end of 2015. Engagement improved 66% and growth increased 125%. In addition, all five campuses are now represented.


A well-defined measurement of multidisciplinary collaboration is proving to be one of the challenges for the peer mentor program. Beginning in the fourth quarter of 2016, we're measuring staff retention and job satisfaction. Both measurements are currently tracked by human resources at the system and campus level. Select components of the employee satisfaction tool serve as part of the peer mentor survey methodology. In addition, monthly meetings at two of the five hospital campuses are led by peer mentors, with the campus liaison taking on a consulting role. To date, feedback from the campus liaison and peer mentors is positive, which has sparked plans to roll out this meeting structure to the other campuses.


It's inspiring to witness the enthusiasm and persistence of these dedicated nurses who started working together as strangers, with no financial incentive to take on the role and the labor-intensive responsibilities of a peer mentor, and no formalized program in which to work. They truly represent what continues to be the fabric of the nursing profession: hard work; laser sharp focus on quality improvement of patient care; creative solutions; and partnership with each other, hospital administration, and the nursing community at large. In 2017, our focus will be on measurement and how to successfully link the work of the peer mentors to patient safety and improvement.




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