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Stemming the tide of nursing attrition: developing resilience via a peer mentorship program

  
https://infirmiere-canadienne.com/blogs/ic-contenu/2021/10/18/endiguer-la-vague-dattrition-en-soins-infirmiers-d
Oct 18, 2021, By: Lia Sanzone , Vanessa D’Aquila , Sae Fukamizu
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Participants in McGill University’s Nursing Peer Mentorship Program felt empowered by helping others, a qualitative research project found. The participants’ motivation to support one another, and their collective willingness to demonstrate to others that they are not alone, fostered their sense of belonging to a tightly knit community of nursing students.

Takeaway messages

  • Fostering resilience in nursing students is an excellent strategy to reduce attrition rates when they enter the profession.
  • McGill University’s Nursing Peer Mentorship Program improved students’ resiliency by creating peer support networks, teaching coping mechanisms, and boosting feelings of commitment to the nursing profession.
  • All nursing education institutions should invest in peer mentorship programs.

The current nursing shortage and issue of nursing attrition from the profession continues to contribute to the challenge of attaining a stable and adequate nursing workforce. According to the Canadian Nurses Association (CNA), there will be an estimated shortage of 60,000 full-time equivalent registered nurses in Canada by 2022 (CNA, 2009), with an increasing number of regulated nurses reportedly choosing not to practise nursing. Between 37 and 57 per cent of new graduate nurses will leave their employment in their second year of practice (Chandler, 2012; Laschinger, Grau, Finegan, & Wilk, 2012), the highest attrition rates in the nursing profession.

According to O’Brien-Pallas, Murphy, Shamian, Li, & Hayes (2010), each nurse who leaves their employer costs an average of $25,000 a year. Factors such as anxiety, lack of confidence and competence, heavy workload, and difficult interpersonal relationships increases attrition among new nurses. These stressors can affect one’s sense of resilience (Sandler, 2015). The attrition of students from entry-to-practice nursing programs is an issue that must also be addressed (CNA, 2009).

Currently, the majority of interventions to improve the retention of new nurses target the transition between graduation from nursing school and the first 6-12 months of employment (Edwards, Hawker, Carrier, & Rees, 2015). There is no clear consensus on the best approach for transitioning to the workplace, but the strategies include internship or orientation programs, mentorship and preceptorship, and simulation-based learning (Edwards et al., 2015).

There will be an estimated shortage of 60,000 full-time equivalent registered nurses in Canada by 2022.

Resilience has been well established in the literature. It has been defined as “an individualized process of development that occurs through the use of personal protective factors to successfully navigate perceived stress and adversities” (Stephens, 2013, p. 130). As resilience can be strengthened with cumulative successes, it is an essential developmental process that should be enhanced among all our future nurses, starting with nursing students. Ultimately, a stronger, more resilient cohort of nursing students can contribute to decreased attrition rates from entry-to-practice programs and from the profession altogether.

Studies have demonstrated that peer mentorship programs promote nursing student resilience through the development of communication, problem solving, and interpersonal and leadership skills (Rohatinsky, Harding, & Carriere, 2017). Peer mentorship programs also promote collegial relationships among students and foster socialized learning where the non-hierarchical relationship between a mentor and a mentee serves as a safe space where vulnerabilities can be discussed (Jacobs, 2017). Furthermore, mentorship is an established strategy for promoting employee recruitment and retention, increasing socialization, and enhancing personal fulfilment (Rohatinsky, Harding, & Carriere, 2017).

In 2014, nursing students and a faculty member at McGill University founded the Nursing Peer Mentorship Program (NPMP) to help nursing students transition to university life and subsequently to their future workplaces. An additional goal of the program was to respond to the psychosocial and academic needs of nursing students to maximize their ability to cope with the stress associated with nursing school (Vandal et al., 2018).

Method

A qualitative research project using an optional online survey was developed to collect data from university nursing students and alumni who were participating in the NPMP at the time, or who had participated in the NPMP during their studies.

A convenience sampling strategy (i.e., via snowball sampling) was used to disseminate the survey (see Appendix for survey questions) and to encourage participants to share the survey with others. The Facebook pages of the NPMP and the undergraduate, graduate, and nursing alumni student associations were used to reach past participants.

The participants had two months to complete the survey. Definitions of each aspect of resilience — health, well-being, optimism, sense of humour, flexibility, and self-efficacy — were provided (see Appendix [PDF, 242.4 KB]) in the survey with the goal of assessing participants’ perceived benefit of resiliency obtained from the program.

The participants individually provided qualitative feedback about the program’s strengths and areas for improvement in the comments section of each question. The qualitative data that was generated from the feedback was processed using a method of thematic content analysis (i.e., by identifying categories from the data and then refining those categories into broader themes) (Simons et al., 2008).

Results

A total of 35 participants responded to the survey (28 female, 7 male), of which 21 were active participants of the NPMP and 14 were alumni recounting their experiences with the program. There were no modifications made to the survey, nor were there unintended consequences resulting from the project.

The following themes were generated from the qualitative data.

Theme 1: Not alone through these feelings

Many participants wrote about the unique ability of the mentoring relationship to foster support, as the “program gives you a link to a student who has been through the same or similar experiences as you are facing but who has come out the other side and is still successful” (Participant 2). Overall, mentees felt that they had someone to turn to. Mentors who had similar experiences in the past were able to lead by example and provide hope for their mentee’s future within the nursing profession. Participant 22 identified the peer mentorship program as “a great support, both mentally and in adaptation to university student life.”

Theme 2: Building personal and professional skills and coping mechanisms

Participant 8 emphasized their role as a mentor: “the program helped me realize [that] I like to teach others,” while Participant 4 stated that they “developed skills in relation to time management, but especially how to organize gatherings with a large group of people”; these leadership skills would encourage them “to also get involved in the future in [their] workplace.” An added perceived benefit was that some of the skills acquired from the program were transferable to their future employment.

Participants identified unique ways to foster resilience, oftentimes by consulting their mentors, then by reframing, problem solving, and goal setting. These aforementioned coping techniques were taught during some of the NPMP workshops, as Participant 32 recounts: “I remember a stress management course offered through this program, and it helped me organize my time and be aware of other ways to improve in my time management.” They then reflected on how this influenced their coping mechanism: “This was an asset because by better managing my time I had more time to adapt and be flexible if an adverse event did take place.”

Participant 9, an alumnus, confirmed that “learning the importance of teamwork and building strong bonds in the workplace is the best way to cope through adversities.”

Theme 3: Commitment to the profession and promotion of sustainable resilience

When participants were given the opportunity to strengthen and motivate their nursing community, they felt the drive to continue to pay it forward: “This experience will stay with me forever and it has (in a low-stress environment) allowed me to experience the role of a mentor, which is why I would like to be a mentor eventually […] or preceptor wherever I work” (Participant 32). Participant 14, another alumnus, expressed their desire to provide new nurses with a warm greeting to the community: “I love helping nursing students and new nurses on the unit. I want them to feel welcomed and comfortable seeking guidance.”

Another alumnus (Participant 3) was exhilarated by their mentee’s enthusiasm: “My mentee’s optimism in becoming a new nurse was motivating to me!” Participant 32 provided an inspiring summary of their cultivation of empowerment: “This program has allowed me to be more aware of all the resources available and that everything is achievable either by yourself or with the help of others.”

Many participants demonstrated an ability to reflect on their experiences with the NPMP. A mentor provided a reflection: “Sharing my experiences with my mentee, I was able to also reflect […] and analyze how I could have handled some [situations] better” (Participant 35).

Discussion

This research project found that peer-to-peer mentorship programs develop resilience in nursing students.

The qualitative data validates the recognized benefit of mentorship relationships in attaining and developing interpersonal, leadership, and coping skills, as well as its positive effect on the perception of social support (Jacobs, 2017; Rohatinsky et al., 2017; Wong, Stake-Doucet, Lombardo, Sanzone, & Tsimicalis, 2016). The sooner these valued skills can be developed, the sooner nursing students can use them when facing new challenges.

The mentors were able to give back to the nursing community by empowering their mentees.

A key finding from this project was that helping others empowered the NPMP’s participants. The participants’ motivation to support one another, and their collective willingness to demonstrate to others that they are not alone, fostered their sense of belonging to a tightly knit community of nursing students.

With the coping skills they learned and nurturing support they received, NPMP participants were better able to face adversities. These essential leadership skills are what the nursing profession must continue to foster in future nurses, as optimism, self-efficacy, and a sense of hope are commonly found in resilient nurses (McAllister, 2013).

To develop and maintain resilience, nurses must engage in reflection to acknowledge their personal growth (Reyes, Andrusyszyn, Iwasiw, Forchuk, & Babenko-Mould, 2015). Reflective practice helps nurses “identify their own risk and protective factors; share experiences of resilience and vulnerability so that others may learn from and perhaps emulate the strengths and avoid pitfalls” (McAllister, 2013, p. 59). Furthermore, reflection can help nurses develop problem-solving skills through their ability to recognize a challenge and use cognitive reframing to generate strategies to overcome it. As well, sharing and praising the outcomes identified from the process of reflection with peers can foster a sense of pride (McAllister, 2013).

A distinctive feature of the NPMP is that students enrol in it voluntarily and take responsibility for getting the most out of their experience (e.g., by getting involved as either a mentor, mentee, and/or a member of the NPMP organizing team). Many mentees go on to become mentors in the program and express a sense of empowerment and hope of becoming a mentor at their future workplace.

The development of nurses’ resilience is crucial in promoting nursing retention. When resilient nurses view workplace stress as a challenge that they can overcome and learn from, they can achieve a greater sense of professional fulfilment and satisfaction. This contributes to increased job retention (Hudgins, 2016).

Peer mentorship can engender such resilience by building positive working relationships with peers, developing coping mechanisms, and engaging in reflective practice. Within the nursing workforce, “promoting a culture of resilience for leaders and staff members is a catalyst for organizational resilience” (Cline, 2015, p. 121). Furthermore, encouraging the use of practices that build resilience can unify organizations in becoming stronger.

Limitations

The generalizability of this project’s findings is limited by the small sample size and the nature of convenience sampling. The students and alumni who responded to the informal survey might have been, by nature, more actively involved within their mentor-mentee dyad, increasing the risk of in-group bias. Future research can aim to increase the sample size and thus carry out interviews with more participants to add depth to the data provided.

Implications for nursing education

This research project has demonstrated that nurse-peer mentorship programs cultivate resilient individuals who are confident about their nursing careers and who want to give back by becoming mentors themselves, either at school or future workplaces. While resilience is a process of personal development, nurses need the support that schools can offer to develop knowledge and skills in dealing with challenging work environments (Sanderson & Brewer, 2017).

Cohorts of new nurses who value helping one another can contribute to an enhanced level of commitment to the profession. The development of such nurses creates a fresh generation of leaders who will not only rise above adversity, but also inspire others who are struggling. As we have seen, programs such as the NPMP have the powerful potential to propagate inspiration, confidence, and the intrinsic willingness to support the greater good.

Conclusion

This informal research project enabled active and past participants to share their experiences of resilience gained from the NPMP. Participants reported that they had someone to turn to for support and encouragement and that they were not alone with their feelings. They also had opportunities to work on improving their personal and professional skills by attending NPMP workshops tailored to their interests and were able to develop coping mechanisms to foster resilience during stressful times.

The mentors were able to give back to the nursing community by empowering their mentees in similar situations. In addition, when participants reflected on their personal growth, they were able to acknowledge their strengthened resilience and willingness to influence their workforce.

While attrition rates from the profession are increasing and nursing shortages are prevalent, there appears to be an added benefit to fostering resilience in nursing students during their studies. Educational institutions are encouraged to invest in their own peer mentorship programs. Compared with the incorporation of resilience training into an already full nursing curriculum, a peer mentorship program such as the NPMP can be relatively easy to implement. Investing in these collaborative programs ensures a low-cost initiative that can potentially provide sustainable and empowering ways to foster resilient nurse leaders.

References

Canadian Nurses Association (CNA). (2009). Tested solutions for eliminating Canada’s registered nurse shortage. Retrieved from https://www.cna-aiic.ca/-/media/cna/page-content/pdf-en/rn_highlights_e.pdf?la=en&hash=22B42E6B470963D8EDEAC3DCCBD026EDA1F6468D

Chandler, G. E. (2012). Succeeding in the first year of practice: Heed the wisdom of novice nurses. Journal for Nurses in Staff Development, 28(3), 103–107.

Cline, S. (2015). Nurse leader resilience. Nursing Administration Quarterly, 39(2), 117–122.

Edwards, D., Hawker, C., Carrier, J., & Rees, C. (2015). A systematic review of the effectiveness of strategies and interventions to improve the transition from student to newly qualified nurse. International Journal of Nursing Studies, 52(7), 1254–1268.

Hudgins, T. A. (2016). Resilience, job satisfaction and anticipated turnover in nurse leaders. Journal of Nursing Management, 24(1), E62–E69.

Jacobs, S. (2017). A scoping review examining nursing student peer mentorship. Journal of Professional Nursing, 33(3), 212–223. doi:https://doi.org/10.1016/j.profnurs.2016.09.004

Laschinger, H. K. S., Grau, A. L., Finegan, J., & Wilk, P. (2012). Predictors of new graduate nurses’ workplace well-being: Testing the job demands—resources model.Health Care Management Review, 37 (2), 175–186.

McAllister, M. (2013). Resilience: A personal attribute, social process and key professional resource for the enhancement of the nursing role. Colegio de Profesionales de la Enfermeria de Puerto Rico, 66(1), 55–62. doi:10.7429/pi.2013.661055

O’Brien-Pallas, L., Murphy, G. T., Shamian, J., Li, X., & Hayes, L. J. (2010). Impact and determinants of nurse turnover: A pan-Canadian study. Journal of Nursing Management, 18(8), 1073–1086. doi:10.1111/j.1365-2834.2010.01167.x

Reyes, A. T., Andrusyszyn, M. A., Iwasiw, C., Forchuk, C., & Babenko-Mould, Y. (2015). Nursing students’ understanding and enactment of resilience: A grounded theory study. Journal of Advanced Nursing, 71(11), 2622–2633. doi:10.1111/jan.12730

Rohatinsky, N., Harding, K., & Carriere, T. (2017). Nursing student peer mentorship: A review of the literature. Mentoring & Tutoring: Partnership in Learning, 25(1), 61–77. doi:10.1080/13611267.2017.1308098

Sanderson, B., & Brewer, M. (2017). What do we know about student resilience in health professional education? A scoping review of the literature. Nurse Education Today, 58, 65–71. doi:10.1016/j.nedt.2017.07.018

Sandler, M. (2015). Why are new graduate nurses leaving the profession in the first year of practice? A rapid review of current literature. Unpublished. University of British Columbia, Okanagan, B.C.

Simons, L., Lathlean, J., & Squire, C. (2008). Shifting the focus: Sequential methods of analysis with qualitative data. Qualitative Health Research, 18(1), 120–132. doi:10.1177/1049732307310264

Stephens, T. M. (2013). Nursing student resilience: A concept clarification. Nursing Forum, 48(2), 125–133. doi:10.1111/nuf.12015

Vandal, N., Leung, K., Sanzone, L., Filion, F., Tsimicalis, A., & Lang, A. (2018). Exploring the student peer mentor’s experience in a nursing peer mentorship program. Journal of Nursing Education, 57(7), 422–425.

Wong, C., Stake-Doucet, N., Lombardo, C., Sanzone, L., & Tsimicalis, A. (2016). An integrative review of peer mentorship programs for undergraduate nursing students. Journal of Nursing Education, 55(3), 141–149. doi:10.3928/01484834-20160216


Lia Sanzone, RN, BScN, MSc(A), MScAdm (Cert), is an associate professor, director of the BSc(N) program, and director of the Nursing Peer Mentorship Program (NPMP) at the Ingram School of Nursing, McGill University.
Vanessa D'Aquila, RN, BScN, is an MSc (A) nursing service administration third-year student at McGill University, Ingram School of Nursing. She has been a member of McGill's NPMP organizing team since 2014, and is a pediatric intensive care unit registered nurse.
Sae Fukamizu is a graduate student at the Lawrence S. Bloomberg Faculty of Nursing at the University of Toronto and is completing her studies in the nurse practitioner program. During her undergraduate nursing studies at McGill, she worked with Lia Sanzone and fellow nursing students to create the Nursing Peer Mentorship Program. She is passionate about peer mentorship because she believes it fosters greater social connection, knowledge exchange, resilience, and leadership in the nursing community.

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