Nursing Needs a Reality Check: Mentorship, Onboarding, and Beyond

Carter explained that the first step is to support the nurse leaders who will be managing new graduate nurses and facilitating their introduction into the organization.

“Mentoring includes ongoing communication, engaging with their staff and having that presence as a leader to establish and maintain a rapport with the new graduates is critical to their success,” Carter said, “so that you have awareness what is contributing to them staying in the organization or leaving] …and hopefully you can help support them through the latter to avoid them exiting the organization.”

Heuston recommended implementing preceptors and training to support new nurses, while also focusing on making sure that the tenured nurses doing the training are recognized.

“You’ve got to focus on the retention of your senior staff,” Heuston said. “The very first thing I did was talk to senior nurses to see what was difficult for them, and they felt really unrecognized for the work of training new nurses.”

Heuston said the solution was building the training into the clinical ladder, in a program called CAPE, which stands for clinical advancement for professional excellence. Within the program, nurses can move up a level and get extra compensation added to their base salary for preceptoring and mentoring. The nurses also receive training on how to function in a training role.

“I felt like really acknowledging the senior staff who are putting that time and energy into training, and training, and training new people and new nurses,” Heuston said, “and really being attuned to the newer nurse.”

At St. Mary Medical Center, they have students who use the hospitals as part of their clinical rotation, which provides a first impression of the organization and work environment.

According to Carter, leaders also have a role in creating a first impression by being visible and approachable for students who are seeking guidance.

“Being visible is extended outside of the hospital with our academic partnerships and community events,” Carter said. “Our facility also precepts graduate and doctoral students to ensure we provide opportunities for all future healthcare careers.

At WVU Medicine, Heuston said they piloted an Aspiring Nurse program, in partnership with academic institutions throughout West Virginia and the surrounding states. The goal of the program is to take into consideration the social determinants of health and to give nurses the support they need to continue their education.

“We selected really good partners and developed a contractual agreement with them, where we gave five thousand dollars a semester with absolutely no strings to how they spend it,” Heuston said. “What we needed in exchange [was] we developed a role where we had mentoring for them on a monthly basis to the organization.”

The CNOs at WVU Medicine will interview each candidate to develop relationships with them early on. Once the students are in the program and go through a signing ceremony, they become integrated into the health system’s culture, Heuston explained, and leadership follows up with them on a monthly basis and students can receive support tailored to their needs.

Onboarding

Another key strategy for CNOs is placing nurses within the right departments and making sure that the onboarding process is smooth and efficient.

At St. Mary Medical Center, Carter said the nurses join the workforce in one of the following ways, experienced nurses, new graduate nurses or transition to new specialty. Carter explained the transition program option affords nurses the opportunity to train in a different specialty.

The most common pathways for transition nurses are telemetry to the intensive care unit or telemetry to the emergency department.

“Transitional nurses are highly motivated to make this change,” Carter said. “It’s the same onboarding process that is provided to the new grads, with less precepting time based upon their previous clinical experience.”

“Similar to our nurse residency program, the transition program includes class time and clinical experience in the patient care area,” Carter continued. “Training is supported by a preceptor, residency coordinator, department staff and leaders. There are learning modules and additional class time to support their learning.”

Carter said the outcomes of this program have been positive, and that the transitional tracks support nurse retention by allowing the nurses to train in new specialties and transfer to another department within the facility.

“It’s more important that they stay within the hospital as a whole,” Carter said. “It’s fine if they want to move from department to department, but as long as they stay at the organization that’s the greatest benefit to the facility and the community.”

At WVU Medicine, Heuston recommends switching focus to making nurses excited about joining the med-surg units.

“Med-surg nursing is really where we need the nurses, where we need to recruit to, and make the better work environment,” Heuston said. “We’re really focusing this graduation class on in-depth clinical experiences in med-surge environments that are welcoming and excited to have them.”

Heuston said it’s the CNO’s job to then give nurses a great clinical ladder to climb so that they want to stay in the field.

“The new generation [wants] to continue to develop and see themselves advance in their career and not have to wait 20 years,” Heuston said. “[Not] every nurse [has] to go to CRNA school or nurse practitioner school to advance their career, because all of us need good med-surg bedside nurses that are going to take care of us when we’re sick.”

This is part two of a two-part series. Read part one here.