1. Nurse Mentorship and Nurse Retention
Corinne Bradley, Theresa Connors, Amy Herrington, Jennifer McDermitt, Jessica McClusky, and Sarah Rousseau
Ferris State University

2. Chapter 1 Support for research proposal Problem & Purpose Statement
Theoretical Framework
Research Questions
In Chapter 1, our research proposal is developed including background information that supports our question of interest and a condensed literature review to support the need for further research. The problem/purpose statement and the research question are also developed. Last, the theory that will frame the proposal is identified.

3. Introductory Background
Nurse Mentorship programs
Effect on new graduates
New graduate retention
Improved job satisfaction
It is well known that the United States is experiencing a nursing shortage. Due to the nursing shortage, nursing programs have begun to implement ways to increase the number of graduating nurses each year. However, the turnover rate among new graduate nurses within the first year is 30% or higher and by the second year it can reach greater than 50% (Hillman & Foster, 2011). It is important to explore any opportunities to improve retention rates among new graduate nurses. Transitioning into the nursing profession is often very stressful and it has been shown that mentors can be a valuable tool in creating a positive work environment. Therefore, nurse mentorship programs and the effect on new graduate nurse retention rates must be researched as a possible tool to increase job satisfaction and improve retention rates among new graduate nurses.

4. Literature Review Positive effects of mentorship
Qualities of effective mentor
Effect of mentorship on new grad
Further research needed
The nursing literature shows that mentorship is related to positive effects in the nursing profession. However, there are few studies on the qualities of a good mentor and few studies on the effect of mentorship on new graduates. The outcomes of a mentorship program for new graduate nurses is an area that needs to be addressed. More research is needed to solidify the effectiveness and determine the appropriate structure of nursing mentorship programs for the new graduate nurse.

5. Problem/Purpose Statement
The purpose of this study is to explore the relationship between nurse mentorship programs and nursing retention of new graduate nurses.
The creation of a nurse mentorship program could be one focus for nursing employers to help improve nursing retention. Very few studies have been published on the impact of nurse mentorships programs and the effects on nursing retention of new graduate nurses. The purpose of this study is to explore the relationship between nurse mentorship programs and nursing retention of new graduate nurses.

6. Theoretical Framework
Modeling & Role Modeling Theory
The theory identified for our framework is the Modeling and Role Modeling Theory. This theory relates to the problem statement in relation to the effectiveness of the mentorship program to the retention of new graduate nurses with effective mentor and role modeling behaviors to demonstrate acceptable, evidence-based practices, ensuring the success of new graduates. The modeling and role modeling concepts also reiterate the importance of an open, non-biased, and supportive relationship between the mentor and mentee to assist in the challenging transition from nursing student to professional nurse.

7. Research Questions
What is the relationship between nurse mentorship programs and nursing retention among new graduate nurses?
The research question proposed is: What is the relationship between nurse mentorship programs and nursing retention among new graduate nurses?

8. Chapter 1 Summary Introductory Background
Abbreviated Literature Review
Problem & Purpose Statement
Modeling & Role Modeling Theory
Research Questions
The purpose of this study is to examine the effects of mentorship programs on retention rates of newly graduated nurses. The high turnover rates of new graduate nurses substantiates the importance of identifying tools to improve retention, including development of a mentorship program. The study will utilize Erickson’s Modeling and Role Modeling Theory. A review of the literature showed that there is a lack of information regarding the effect of mentorship programs on the retention of newly graduated nurses. From this, it is evident that this relationship needs to be further explored.
In Chapter 2 the gap in research will be examined including further research to help substantiate findings from earlier studies as well as adding to existing knowledge.

9. Chapter 2 Theoretical Foundation
Effects of Nursing Mentorship Programs on new Graduate Nursing Retention Rates
In Chapter 2, literature was reviewed to support use of Erickson’s Modeling and Role Modeling Theory for this study. Also, literature was reviewed showing the relevance and applicability to nursing mentorship programs and the effect on new graduate nursing retention rates.

10. Modeling and Role Modeling Theory
Several studies demonstrated the use of the Modeling and Role Modeling theory. In 2011, Alligood utilized this theory in an action research study to demonstrate the positive effect it had on improving nursing practice. Also, in 2012, Olaer performed a study that provided support that this theory is valid in the correlation between nurse mentor supports needed for the success of graduate nurses.

11. Literature Review of Nursing Mentorship
Challenges
Effects of Mentorship on Nursing Retention
Qualities of an Effective Mentor
Benefits to the Mentor
Cost Benefit Analysis
Literature reviewed outlined the major concepts of the study including challenges for graduate nurses, effects of mentorship on nursing retention, qualities of an effective mentor, benefits to the mentor, and a cost benefit analysis.

12. Challenges Performance Anxiety Fear of Making Mistakes
Time Constraints
Lack of Support
Difficulty with Delegation, Prioritization and Time Management
A search utilizing PubMed in relation to challenges of new GNs yielded 40 research studies published within the last five years. These studies involved both qualitative and quantitative research. These studies listed various challenges that new graduates face such as performance anxiety, fear of making mistakes, time constraints, lack of support and difficulty with delegation, prioritization and time management.

13. Effects on Nursing Retention
Using structured orientation programs as a means to provide overall staff satisfaction, development, and retention has been well discussed in the nursing research. Studies by Fox (2011), Faron & Poelter (2007), and Pine & Tart (2007) demonstrated that structured orientation programs such as residency programs and nursing mentorship programs increased nursing retention rates. However, there is limited research on actual mentorship programs as they relate to new graduate nurse retention rates.

14. Qualities of an Effective Mentor
Tim Commitment
Feedback
Supportive
Role Model
In the literature reviewed, effective mentors possessed certain qualities that allowed the mentor/mentee relationship to be successful. Some of these qualities included an unselfish commitment of time, straightforward and concise feedback, being supportive, and being a role model. When nurses did not possess these qualities the mentor/mentee relationship was found to be less effective.

15. Benefits to the Mentor Improved interpersonal skills Decreased stress
Personal Satisfaction
Professional Success
Though nurse mentorship programs are developed for the purpose of benefitting the mentee, the program can be equally beneficial for both parties. The mentor may experience different challenges but the overall benefits to both the mentor and mentee cannot be overlooked. A search on PubMed and CINAHL to discover the benefits to the mentor in a mentorship program produced limited results. However, both quantitative and qualitative studies were identified, as well as integrative reviews. The literature revealed that mentors in a mentorship program benefitted by improving team building and conflict resolution skills, increased engagement in the mentor’s company and the nursing profession, decreased workplace stress, increased professional success, increased professional confidence, and increased personal/career satisfaction.

16. Cost Benefit Analysis
The training of a new employee can be a costly venture. The cost to assist a new GN to transition from student to professional can be even more expensive. GNs not only need the orientation time to their new surroundings, but to their new profession as well. It is becoming increasingly important that new graduates receive not only quantity but quality in training, and mentorship programs have begun to play a key role in this transition. There are both quantitative and qualitative studies examining the cost of mentorship programs to facilities. The literature reviewed supports the idea that a nurse mentorship program is not only cost effective but beneficial to the GN. The literature shows a positive correlation between cost and return on investment of a nurse mentorship program.

17. Chapter 2 Summary MRM Theory Effects Qualities Benefits
Cost Benefit Analysis
Gap in the Literature
The literature reviewed demonstrates use of Erickson’s Modeling and Role Modeling Theory as an effective framework for the proposed study. The literature demonstrated this theory is valid and has been tested in prior nursing research. This theory has been utilized in relationship to nursing retention as well as mentorship.
The literature review focused on challenges faced by GNs, effects of nurse mentorships on nursing retention, qualities of an effective mentor, benefits to the mentor, and a cost benefit analysis. Findings revealed that GNs face many challenges as they transition from students to professional nurses. The literature also revealed that nurses who are supported through this transition via structured programs such as mentorship and residency programs are more likely to have higher retention rates at their institutions. The literature also stated that effective mentors demonstrate specific qualities and personally experience benefits from being a mentor. Finally, the literature showed that structured transition programs have a positive correlation between the cost and return on investment.
The systematic review of the literature revealed that there is a limited amount of research on the correlation between mentorship programs and GN retention. A gap also exists in the literature about the qualities of an effective mentor and the appropriate structure of mentorship programs for GNs. Due to the limited amount of research available regarding the effects of nurse mentorship programs of GN retention, the proposed study will further research this issue.

18. Chapter 3 Research Design Setting and Sample Methods Data Analysis
Reliability and Validity
Limitations/Delimitations
Ethical Concerns
Chapter III will provide the design and methodology for the proposed study. Data analysis, reliability, validity, limitations, delimitations, and ethical concerns will also be discussed.

19. Research Design Quasi-experimental design Non-equivalent control group
For the purpose of the proposed study the research design to be utilized will be a non-equivalent control group quasi-experimental design. The study will occur over a one year time period. To increase the reliability and validity of the study a pre and post-test will be performed prior to implementation of the mentorship program. The literature supports the use of such design in evaluating how mentorship affects retention.

20. Setting and Sample
The target population for this study will include a sample of GNs commencing their first registered nursing position. This will include all GNs regardless of graduation date. GNs with various demographics (age, sex, race) will be recruited, as well as both associate-prepared and bachelors-prepared GNs. The GNs will be recruited at four Detroit area hospitals. The study will utilize a convenience sample at each of the four hospitals. Three hospitals will adopt an identical mentorship program design, while one hospital will maintain the current preceptor orientation program. All of the four hospitals are general medical and surgical hospitals and are all teaching hospitals: Saint John Hospital and Medical Center, Henry Ford Hospital, Sinai-Grace Hospital, and Oakwood Hospital and Medical Center

21. Methods Expanded Nursing Stress Scale
Index of Work Satisfaction Questionnaire
Demographic Information Sheet
Mentorship Program Evaluation
After core orientation classes have been completed and prior to beginning the mentorship program, graduate nurses will be mailed, the Expanded Nursing Stress Scale, the Index of Work Satisfaction Questionnaire and the Demographic Information Sheet. Nurse Mentees will be allowed to view videos of their mentors describing their strengths, weaknesses, and why they want to be a mentor. After viewing these videos, mentees will be allowed to choose their top 3 mentors. The mentee will work the same schedule as the mentor for three months.
The mentor will complete 2-8 hour training sessions regarding how to be a mentor. The mentor and mentee will continue to work the same schedule for the next 9 months. At this time the mentor will serve as the mentees primary resource. At the end of one year, the graduate nurse will be mailed the Expanded Nursing Stress Scale, the Index of Work Satisfaction Questionnaire, the Mentorship Program Evaluation and the Demographic Information Sheet. Participation in the mentorship program is mandatory but completion of the questionnaires is voluntary. In order to maintain the integrity of Erickson assertations and avoid internal validity threats, the nurse mentee will self-evaluate their attainment of the assertations. The mentoring relationship can also be a confounding variable and will be evaluated by the mentee in the mentorship evaluation tool.

22. Data Analysis ANCOVA ANOVA t-test chi-square Y = β0 ± β1X1 ± ε
Y = β0 ± β1X1 ± β2X2 ... ± βkXk ± ε
For the purpose of this proposed study the data will be analyzed using a statistical software system called Statistical Package for the Social Sciences (SPSS). Measures of central tendency and other descriptive statistics will be used to summarize demographic and work environment data using frequency distribution tables. Descriptive and multivariate statistics will also be used to analyze data. The relationships among the data will be examined using t-tests and ANOVA analyses to test for differences between groups.
ANOVA
chi-square
t-test

23. Summary of Methods for Computing Reliability*
Test-retest
Equivalent-forms
Internal consistency
Inter-scorer
Test and retest will be completed for this research when the Expanded Nursing Stress Scale is given to the participants of the study at different times and results will be compared.
Equivalence is important to the reliability of the instruments used in this proposed research. The Index of Work Satisfaction Questionnaire is an important measurement tool for the proposed research, and coders need to have a “high level of agreement” (Polit & Beck, 2012). If the coders are in agreement to the extent of relevance of each question then the belief is that errors in measurement are decreased (Polit & Beck, 2012).
*Reference
Polit, D. E., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia, PA: Lippincott, Williams, & Wilkins.

24. Validity* Face Validity Content Validity
Validity for this study will identified through face validity and content validity. Face validity simply refers to whether the instrument appears to measure what it is intended to measure (Polit & Beck, 2012). The Index of Work Satisfaction Questionnaire fits this example; it appears to those participating in the study to be directly related to the study. The questions address the topic of study and allow the participants to provide their feedback. Content validity looks at how relative the questions are to the topic of study. The Index of Work Satisfaction Questionnaire is very relative to the topic of study. This questionnaire measures the satisfaction of the nurses’ position. The questionnaire will be given before the subjects participate in the study and then again when the program is completed. This will also contribute to the testing and retesting of the instruments.
*Reference
Polit, D. E., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia, PA: Lippincott, Williams, & Wilkins.

25. Limitations/Delimitations
Financial Commitment
Participants
Hospital Settings
Time Constraints
The mentorship program will come is an unspecified financial commitment that becomes the responsibility of the hospital. The chosen hospitals may not be able to absorb such a cost for the duration of the research.
Participants
Mentors and mentees that choose to participate may not complete the program. There are also personality differences amongst the participants, resulting in mid-research changes in participants that need to be considered as a limitation to the research. The participants will be both associate-prepared and bachelors-prepared GN’s; this may have an effect on the results of their experiences as both are prepared for the profession in different ways.
Hospital settings
The four hospitals chosen are from only the city of Detroit, and may potentially yield results that may differ from hospitals in small cities, or rural areas.
Time Constraints
Due to the time constraints of the research the participant pool may also be limited based on the number of new GN’s hired at the selected hospitals.

26. Ethical Concerns* Informed consent Right to privacy Beneficence
Debriefing
Institutional Review Board (IRB)
Collaborative Institutional Training Initiative (CITI)
Informed consent
In order to show informed consent, the study participants will be provided all of the above information, and will be asked to sign a consent form stating they understand and are voluntary participants in the research.
Right to privacy
all survey data tool responses will be completed anonymously, meaning the researchers will not be able to link the responses to the exact study participant
Beneficence
the control and experimental groups with appropriate and safe hospital orientations to allow them to be successful nurses. Furthermore, care will be taken to be sensitive to the timing of the research in the participants’ careers.
Debriefing
The researchers will provide a thorough debrief for all study subjects, and will refer them to the appropriate resources if discomfort or anxiety still exists following the session.
Institutional Review Board (IRB)
By submitting and gaining IRB approval, the researchers will show the plan for appropriate treatment of their participants.
Collaborative Institutional Training Initiative (CITI)
all members of the research team will complete ethics education training and certification. The completion of CITI training will demonstrate ethical awareness and knowledge in all those interacting with the study participants
*References
Polit & Beck (2012)
Fouka, G. & Mantzorou, M. (2011). What are the major ethical issues in conducting research? Is there a conflict between research ethics and the nature of nursing? Health Science Journal, 5(1), Retrieved from
Polit, D. E., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia, PA: Lippincott, Williams, & Wilkins.

27. Expectations
Success of mentorship programs vs traditional orientation programs
Effect of mentorship programs on the mentee
Qualities that define a successful mentor
After putting together this research proposal, we would expect to find a few things. First, we expect that those hospitals participating in the mentorship program will have a higher retention of nurses than our control hospital that is using a traditional orientation program. We also expect to find that the mentorship program will have a positive effect on the new graduate nurses, including increased job satisfaction. Finally, we expect to find which qualities in the mentor are most beneficial and successful when working with a mentee

28. Contributions Finances Successful orientation Staff satisfaction
The results from this study could contribute greatly to the nurse educator and nurse administrator roles. In a time when hospitals are striving to be more financially responsible, the success of a program that retains new nurses and decreases turnover would be especially beneficial. Additionally, the mentorship program will provide a more successful orientation, as we expect new nurses to complete the program with higher job satisfaction and less intent to leave their job. This reduces the orientation workload for nurse educators, as they will not be seeing the same amount of turnover on the unit.

29. Sharing the Findings Publication Poster Presentations Conferences
Workgroups
There are many ways to disseminate the knowledge we would gain to the nursing community. First, we would hope to publish in a scholarly journal, especially one that is read frequently by nursing educators or administrators who would benefit from knowing about the outcomes of a mentorship program. Poster or conference presentations are another way to hit a wide range of nurses, from bedside to administrators. Utilizing these would allow for the group to ask questions directly to the researchers, enhancing the learning opportunity for both parties. Finally, the researchers are able to bring the information found back to their own institutions where they work, and can share their findings with orientation workgroups, educators, or manager groups.

30. References
Alligood, M. (2011). Theory-based practice in a major medical centre. Journal of Nursing Management, 19(8), doi:
Faron, S., & Poeltler, D. (2007). Growing our own: inspiring growth and increasing retention through mentoring. Nursing for Women’s Health, 11(2),
Fouka, G. & Mantzorou, M. (2011). What are the major ethical issues in conducting research? Is there a conflict between research ethics and the nature of nursing? Health Science Journal, 5(1), Retrieved from
Hillman, L., & Foster, R. (2011). The impact of a nursing transitions programme on retention and cost savings. Journal of Nursing Management, 19(1), doi:
Olaer, Jr., D. C. (2012, July). Mentoring activities of senior nurses and performance of nurse trainees. International Journal of Education, 3,
Pine, R., & Tart, K. (2007). Return on investment: benefits and challenges of a baccalaureate nurse residency program. Nursing Economic$, 25(1), 13.
Polit, D. E., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia, PA: Lippincott, Williams, & Wilkins.