1. Mentoring Early Career Registered Nurses to Increase Intent to Stay
Kendall Young, DNP-C, MSN, RN-BC, CCM
September 20, 2019

2. Special Acknowledgements
Most Importantly - Jesus Family - Bert Sandlin, Kenneth Young, Judy Young, Melanie Young, Jamie Hillman Project Chair – Loyola University New Orleans Janet DuBois, DNP, APRN, FNP-BC, FAANP, FNAP, Professor Ochsner Project Mentor Deborah Ford, MSN, Nurse Fellow RWJF, Ochsner CNO Ochsner Health System Jessica Peterson, PhD, RN – Senior Nurse Researcher LeeAnn Dooley, BSN, RN, CPAN, Mentor Academy Coordinator Jeffrey Hamilton, MSN, MBA, Nurse Residency Coordinator Bruce Weinberg, AVP, Nursing Workforce Management Jeffrey Burton, PhD, Senior Biostatistician Jennie Miele, CNE Coordinator Southeast Louisiana Staff Development Organization Members
Thank you Jesus! Thanks to my wonderful family. Thanks to Dr. DuBois. I had so much support on this project from both Loyola and Ochsner.

3. Problem: Bedside RN Turnover
~ 17.5% of new nurses quit within the first year10
43% leave the hospital before their third year10
↑ turnover of RNs from 0 to 5 years experience10,15, 20, 22
Nationwide
Nursing Turnover
Almost 17.5% of new nurses quit within one year of starting first job10
Causes staff shortages, negative work environments, and decreased quality of care to patients4, 9, 12
Turnover of Early Career Nurses
43% leave hospital-based employment before their third year10
RN’s with less than one year and RN’s with 1-3 years have a higher probability of turnover 10, 20
10Kovner et al., 2014; 15Nursing Solutions, Inc., 2018; Ulrich et al., 2010; 22 Mills et al., 2016

4. 15Nursing Solutions, Inc., 2018

5. Problem: Turnover Turnover - Large Louisiana Hospital System
Turnover Bedside RNs in %
Of those - >85% left before their 5th anniversary

6. Background/Significance
The hospital system has:
RN’s leaving the organization
Early Career RN’s > First Year Flight
↑RN vacancies
↑costs
292 full-time/part-time bedside RN’s left the organization between January 2017 and August 2017
Career Link showed 238 RN vacancies - October 2017
Turnover rate is 19.4% for the system
First year flight RN turnover was 21% for the first eight months of 2017
RN’s with 1-3 years of service made up 64% of all RN turnovers from January 2017 to August 2017.
Their average turnover cost is $30,000
Mentoring was found to be a solution to nurse retention 1, 2, 4, 5, 8, 14, 16, 17, 18, 19, 21
Mentoring had a significant decrease in turnover
reduced turnover costs and negligence rates
improved nursing competence, job satisfaction, along with improved communication and interpersonal relationships5
A mentoring program had positive effects on the mentor, mentee, and the organization. 21
A mentoring program reduced turnover in one hospital from 31% to 10.3% over a five year time period. 17

7. Precursors to Turnover
4Buffinton et al, 2012; 7Hofler & Thomas, 2016; 9Koppel et al., 2017; 11Lambrou et al., 2014; 12Martin, 2015; 15Nursing Solutions, Inc., 2018; 18Twigg & McCullough, 2013; 23De Simone, S., Planta, A., & Cicotto, G., 2018

8. Consequences to Turnover
*Decreased Satisfaction23
*Decreased Engagement23
hospital where I work, Lack of access to mentoring can lead to job dissatisfaction, intent to leave, and turnover of registered nurses7, nurse residency program is a convenience sample of early career RN’s (1-5 years)
Precursors to Turnover – if nurses are unhappy with their jobs and are not engaged in unit or organizational activities
Decrease job satisfaction
decreased engagement
work environment – gossiping, short staffed, management not involved
Lack of mentoring
Consequences to Turnover Turnover leads to staff shortages, negative work environments, and decreased quality of care to patients4, 9, 12
Decrease patient outcomes18
Costs to the hospital 4, 9, 15
Negative work environment11
Relevant supporting literature
Beginning lit review
4Buffinton et al, 2012; 7Hofler & Thomas, 2016; 9Koppel et al., 2017; 11Lambrou et al., 2014; 12Martin, 2015; 15Nursing Solutions, Inc., 2017; 18Twigg & McCullough, 2013, 23De Simone, S., Planta, A., & Cicotto, G., 2018

9. Purpose of Project
To determine if pairing mentors with ECRNs in a large hospital system in south Louisiana would improve intent to stay and to assess the feasibility of continuing the practice.
PURPOSE: Succinctly describe your purpose in doing this project (and it’s not to finish your DNP!). Should be in one statement, 1-3 bullet points, or one root component and a couple of bullet points.
[ONE SLIDE]

10. Clinical/Systems Question
Will pairing mentors with ECRNs in a large hospital system in south Louisiana improve their intent to stay?
Will it be feasible to continue this practice?
Much of the research on nurse retention is in first year.
Pair with mentors- Mentoring improves intent to stay and retention14

11. Current State - Mentoring
CNO Council
New Hires/New Grads
Preceptor
Mentor

12. Retention Strategies in the Literature
Literature Review
Systematic Reviews
Zhang et. al. (9 studies)
Chen & Lou (5 studies)
Nei, Snyder, & Litwiller (106 studies)
Retention Strategies
Mentoring
Praise and recognition
Meaningful peer relationships
Decision-making involvement
Educational/professional development opportunities
Staffing
Positive leadership/work environment
292 full-time/part-time bedside RN’s left the organization between January 2017 and August 2017
Career Link showed 238 RN vacancies - October 2017
Turnover rate is 19.4% for the system
First year flight RN turnover was 21% for the first eight months of 2017
RN’s with 1-3 years of service made up 64% of all RN turnovers from January 2017 to August 2017.
Their average turnover cost is $30,000
Mentoring was found to be a solution to nurse retention 1, 2, 4, 5, 8, 14, 16, 17, 18, 19, 21
Mentoring had a significant decrease in turnover
reduced turnover costs and negligence rates
improved nursing competence, job satisfaction, along with improved communication and interpersonal relationships5
A mentoring program had positive effects on the mentor, mentee, and the organization. 21
A mentoring program reduced turnover in one hospital from 31% to 10.3% over a five year time period. 17
BACKGROUND/SIGNIFICANCE EVIDENCE: Provide a synopsis (in bullet format) related to the importance and significance of your project. Make a convincing argument for your project, based on what is known, as well as identifying gaps in our knowledge regarding the topic.
[ONE SLIDE – TWO at absolute MAXIMUM. Can use GRAPHICAL DISPLAY IF NEEDED. A picture is always worth 1,000 words or more!]
1 Advisory Board Company, 2017; 2AACN, 2016; 4 Buffington et. al, 2012; 5 Chen & Lou, 2014; 8IOM, 2009; 14 Nei, Snyder, & Litwiller, 2015; 16 Ramboo, Abdullah, & Piaw, 2013; 17 Trossman, 2017; 18 Twigg & McCullough, 2013; 19Verrett & Lin, 2016; 21 Zhang, Qian,Wen, & Zhang, 2016

13. Project Solution to Turnover
Mentoring 1, 2, 4, 5, 8, 14, 16, 17, 18, 19, 21
↓ turnover costs and negligence rates
↑ competence, job satisfaction, communication, and relationships5
positive effects on all involved21
proven turnover reduction 5, 17
Improves nurse retention1, 17
Improves Intent to stay14
1 Advisory Board Company, 2017; 2AACN, 2016; 4 Buffington et. al, 2012; 5 Chen & Lou, 2014; 8IOM, 2009; 14 Nei, Snyder, & Litwiller, 2015; 16 Ramboo, Abdullah, & Piaw, 2013; 17 Trossman, 2017; 18 Twigg & McCullough, 2013; 19Verrett & Lin, 2016; 21 Zhang, Qian,Wen, & Zhang, 2016

14. Sample Population of Interest/Setting
Southeast Louisiana’s largest nonprofit, academic, multispecialty healthcare system
Multiple hospitals represented
Project participants
Convenience sample (Mentees)
Participants in the 2018 System Nurse Residency
Program (N = 21)
RN’s working in inpatient acute care settings
Mentors
Completed mentor academy
works at their facility
At least 6 months more experience

15. Demographics of Participants (Mentees)
Sample – Convenience (N=21)
RNs in an ANCC Nurse Fellowship program
Years RN Experience: <1 (N=1); 1-3 (N=15); 3-5 (N=4); 5-10 (N=1)
Age Range: (N=1); (N=9); 30-4 (N=6); >35 (N=5)
Education: ADN (N=9); BSN (N=12)

16. Framework for Project
Benner's Application to Nursing of the Dreyfus Model of Skill Acquisition3, 6:
3Benner, 1982

17. Ethical Considerations
Protection of human subjects is forefront to this project.
No expected risks.
Internal Review Boards (IRB)
Ochsner and Loyola IRBs – approved
Informed consent
All participants signed informed consents
Human Subjects training
2018 National Institute of Health Human Research
CITI
Confidentiality
Self-generated unique identifier
Paper shredded
Password protected computer
The unique identifier will allow the pre and post-surveys to be matched without anyone knowing who filled out which survey.

18. Intervention- Mentors
Increases
Decreases
Retention 1, 2, 4, 5, 8, 14, 16, 17, 18, 19, 21
Job satisfaction5
Competence5
Communication5
Turnover/ turnover intent5
Costs5
Negligence rates5
1 Advisory Board Company, 2017; 2AACN, 2016; 4 Buffington et. al, 5 Chen & Lou, 2014; 8IOM, 2009; 10Kovner et al., 2014; 14 Nei, Snyder, & Litwiller, 2015; 16 Ramboo, Abdullah, & Piaw, 2013; 17 Trossman, 2017; 18 Twigg & McCullough, 2013; 19Verrett & Lin, 2016; 20Ulrich et al., 2010; 21 Zhang, Qian,Wen, & Zhang, 2016

19. Project Design Quality Improvement Feasibility Pre and Post
Dependent variable
intent to stay
Independent variable
mentoring

20. Project Action Plan/ Processes
Approval from Professor April 2018
Council for Approval to go to IRB
April 2018
Ochsner IRB Approval
August 2018
Loyola IRB August 2018
Pre-TIS and Demographics Survey Completed by ECRN Participants
August 2018
Mentor who Completed Mentor Academy/ECRN Mentee Pairing
September 2018
Mentoring
September – December 2018
Evaluation and modification of survey with nurse residency program coordinator in December 2017
Pre and post intervention survey to nurse residents
Assign mentors to the nurse residents will begin in If not enough RN’s meet the
criteria, recruitment of previous nurse residents will be attempted. Additional mentor classes will
begin in Evidence shows mentoring as an intervention for retention (Advisory Board Company,
2017; AACN, 2016; Chen & Lou, 2014). Mentor programs increase job satisfaction and decrease
turnover and intent of turnover (Chen & Lou, 2014).
Post-TIS and Feasibility Survey Completed by ECRN Participants
December 2018
Project evaluation and Data analysis
Survey results
Statistical Analysis
January 2019

21. Mentors and mentees paired
Procedures/Steps
Informed consents
Pre-intervention surveys
Demographic
Turnover Intention Scale (TIS) survey
Mentoring site sign-up; Pairing mentors/ECRNs
Pre-Intervention
Meet face-to-face monthly
, text, call, and/or meet in person once a week
Mentors and mentees paired
Post-intervention surveys
TIS survey
Feasibility questionnaire
Data analysis
Post-Intervention
feasibility pilot to determine benefits of implementing a mentoring program for ECRNs and its potential benefits.
TIS – Roodt permission granted, 15-item scale to determine intent to stay , reliable

22. Evaluation/Statistical Analysis
Data Analysis
Statistical Analysis System SAS/STAT® software, Version 9.4
Significance level α=0.05
Analysis of completed surveys (N=21)
Paired t-tests for pre/post-TIS mean changes
Means, standard deviations (SD), 95% confidence intervals (CI), and p-values
Qualitative data analyzed for themes
The TIS is a 15-item scale. Turnover Intention Scale, a valid and reliable tool, is used to determine pre- and post-intervention results (Bothma & Roodt, 2013). Demographic information will be collected pre-intervention; while the feasibility questionnaire will be collected post-intervention. The Turnover Intention Scale (TIS) data collection comes from the pre- and post-intervention surveys. To ensure statistical data will be paired correctly, participants will be given a unique identifier to place on the pre- and post-tests. The unique identifier is the answer to a list of questions from self-generated identification codes (SGICs) and will be used to form unique identifiers pre- and post-surveys (Kristjansson, Sigfusdottir, Sigfusdottir, and Allegrante, 2014). There are questions, in which, the answers will go on both the pre and post surveys to match them for data collection (Appendix H). The participant and their unique identifier will be kept confidential by the researcher and will be destroyed by placing in shredder box at the end of the study in December Turnover Intention Scale, a valid and reliable tool, will be utilized to determine pre- and post-intervention results (Bothma & Roodt, 2013).
vnt to which a person intends to stay in the organization.

23. Discussion and Results
The participants found mentoring
Beneficial
May improve intent to stay
Small sample size (N = 21)
Recommendation
Offer mentoring to others in this career stage
Organizational implications
Continue pairing ECRNs/mentors
↑system-wide need for mentors
↓ECRN turnover
Sample – Convenience (N=21)
RNs in an ANCC Nurse Fellowship program
Years RN Experience: <1 (N=1); 1-3 (N=15); 3-5 (N=4); 5-10 (N=1)
Age Range: (N=1); (N=9); 30-4 (N=6); >35 (N=5)
Education: ADN (N=9); BSN (N=12)
Intent to Stay
Intent to turnover was statistically significantly less post intervention (M=-4.43; p=0.006)
100% feel pairing mentors with ECRNs can increase intent to stay
>95% found mentoring was beneficial for them
Feasibility
Majority interacted weekly (85.7%), met face-to-face monthly (81%)
>90% rated program Excellent or Very Good
100% felt program should be offered to all Early Career RNs
> 95% felt mentoring will benefit other ECRNs
>85% recognized a difference between mentor and preceptor

24. TIS Survey What does all of this mean?
Some items were not significantly different after the intervention
small sample size (N = 21)
short relationship (12 weeks)
Intent to turnover was statistically significantly less post intervention (M=-4.43; p=0.006)
What does all of this mean?
Less likely to look for another job
Improved well-being
Intent to Stay
Intent to turnover was statistically significantly less post intervention (M=-4.43; p=0.006)
100% feel pairing mentors with ECRNs can increase intent to stay
>95% found mentoring was beneficial for them
Feasibility
Majority interacted weekly (85.7%), met face-to-face monthly (81%)
>90% rated program Excellent or Very Good
100% felt program should be offered to all Early Career RNs
> 95% felt mentoring will benefit other ECRNs
>85% recognized a difference between mentor and preceptor

25. Feasibility Questions (N=21)

26. Feasibility Questions (N=21)

27. Themes from Feasibility Questionnaire
Moved out of comfort zone
Increased Communication Skills
Someone to talk to
Connection
Increase Confidence to ask for help
Accountability
Trust
Peer Compassion
Reflection
Set and obtained goals
Therapist
Decrease stress

28. Barriers & Supports Barriers Supports Not enough mentors in some
hospitals
Difficulty pairing on time due to
shift work or unanswered s
Supports
Mentor Academy offered monthly; encouraged
System leadership supports retention efforts
Nurse Residency program will continue to pair all
ECRN participants with mentors due to positive feedback

29. Sustainability Support, Lots and Lots of Support
Nurse Residency Program Coordinators
Mentor Academy Program Coordinators
stated they want this to continue going forward
System Executive Leadership
support and encourage mentoring
SUSTAINABILITY: How will you manage to develop sustainability for your project (e.g., how can you get integrated into the institution)?
[ONE SLIDE MAXIMUM]

30. References
Advisory Board Company. (2017, July 5). First year nurse retention toolkit. Retrieved from
American Association of Critical Care Nurses’ (AACN). (2016). AACN standards for establishing and sustaining healthy work environments: A journey to excellence, 2nd ed. Retrieved from
Benner, P. (1982, March). From novice to expert. The American Journal of Nursing, 82(3), doi: /
Buffington, A., Zwink, J., Fink, R., Devine, D., & Sanders, C. (2012). Factors affecting nurse retention at an academic Magnet® hospital. Journal of Nursing Administration, 42(5): doi: /NNA.0b013e
Chen, C., & Lou, M. (2014). The effectiveness and application of mentorship programmes for recently registered nurses: A systematic review. Journal of Nursing Management, 22(4), doi: /jonm.12102
Coble, R. (2017). Pedagogy for professional schools and students. Vanderbilt University Center for Teaching. Retrieved from
REFERENCES: Add your references here (can use smaller font, e.g., size 18 to accommodate) and do not double space. You can do in APA formatand simply add the superscripted numbers you used in slide set, or NOT use APA format… whatever format you use, be consistent.
[PROBABLY NEED SEVERAL SLIDES]

31. References
Hofler, L., & Thomas, K. (2016). Transition of new graduate nurses to the workforce: Challenges and solutions in the changing health care environment. North Carolina Medical Journal, (77)2,
Institute of Medicine (IOM). (2011). The future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press. Retrieved from
Koppel, J., Deline, M., & Virkstis, K. (2017). The case for focusing on millennial retention...1st article in a 2-part series. Journal of Nursing Administration, 47(7/8), doi: /NNA
Kovner, C. T., Brewer, C. S., Fatehi, F., & Jun, J. (2014). What does nurse turnover rate mean and what is the rate? Policy, Politics, & Nursing Practice, 15(3-4), doi: /
Lambrou, P., Merkouris, A., Middleton, N., & Papastavrou, E. (2014). Nurses’ perceptions of their professional practice environment in relation to job satisfaction: a review of quantitative studies. Health Science Journal, 8(3),
Martin, C. J. (2015). The effects of nurse staffing on quality of care. MEDSURG Nursing, 24(2), 4-6. Retrieved from

32. References
Naim, M. F., & Lenka, U. (2017). How does mentoring contribute to Gen Y employees' intention to stay? An Indian perspective. Europe's Journal of Psychology, 13(2), doi: /ejop.v13i2.1304
Nei, D., Snyder, L. A., & Litwiller, B. J. (2015). Promoting retention of nurses: A meta-analytic examination of causes of nurse turnover. Health Care Management Review, 403(3), doi: /HMR
Nursing Solutions Inc. (2018) national health care retention & RN staffing report. NSI Nursing Solutions, Inc. Retrieved from Ochsner Health System
Ramoo, V., Abdullah, K. L., & Piaw, C. Y. (2013). The relationship between job satisfaction and intention to leave current employment among registered nurses in a teaching hospital. Journal of Clinical Nursing, 22(21-22): doi: /jocn
Trossman, S. (2017). Better prepared workforce, better retention. The American Nurse, October 7, Retrieved from

33. References
18. Twigg, D., & McCullough, K. (2013). Nurse retention: A review of strategies to create and enhance positive practice environments in clinical settings. International Journal of Nursing Studies, 51(1): doi:
Verret, G., & Lin, V. (2016). Easing the transition: An innovative generational approach to peer mentoring for new graduate nurses. Journal of Pediatric Nursing, 31(6), doi: 
Ulrich, B., Ashlock, C. H. Krozek, C., Africa, L. M., Early, S., & Carman, M. L. (2010). Improving retention, confidence, and competence of new graduate nurses: Results from a 10-year longitudinal database. Nursing Economics, 28(6),
Zhang, Y., Qian, Y., Wen, F., & Zhang, Y. (2016). The effectiveness and implementation of mentoring program for newly graduated nurses: A systematic review. Nurse Education Today, 37, doi:
Mills, J., Chamberlain-Salaun, J., Harrison, H., Yates, K., and O’Shea, A. (2016). Retaining early career registered nurses: A case study. BMC Nursing, 15(57). Doi: /s z. Retrieved from
De Simone, S., Planta, A., & Cicotto, G. (2018). The role of job satisfaction, work engagement, self-efficacy and agentic capacities on nurses' turnover intention and patient satisfaction. Applied Nursing Research, 39,  Retrieved from