This is the second part of a special two-part article on the importance of nurse preceptorship and mentoring. Click here to read Part One.
Ethical Standards, Just Culture, and the Faculty/Mentor/Preceptor – Student Relationship
Ethics and standards in nursing are principles associated with values, human conduct, and consideration for others. Nursing ethics, in particular, are ethical principles that guide practice. The principles related to nursing ethics and bioethics overall are beneficence, nonmaleficence, autonomy, justice, and fidelity. Each of these principles contributes to the foundation of nursing education and practice principles, and standards of practice devised by organizations, such as the American Nurses Association (ANA), the International Council of Nurses (ICN), and the American Association of University Professors (AAUP).
According to the ANA Code of Ethics 6.3, the nurse has a responsibility to contribute to an environment that encourages transparency, support, effective interpersonal communication, and respect.11 The National League for Nursing (NLN) indicated that another component of the guiding principles for nursing education is integrity. To exhibit integrity, it requires one to treat others respectfully while communicating courteously and positively.11 Additionally, the NLN identified diversity as an important guiding principle. The NLN position on diversity maintained that the faculty/mentor/preceptor member supports open communication, fosters uniqueness, utilizes innovative teaching strategies regardless of race, gender, religion, age, financial status, physical abilities, or other belief systems.11 The NLN indicated that to create an environment that supports diversity, inclusion, and just culture. All persons should provide open and respectful exchanges.11 This is not limited to the faculty/mentor/preceptor member.
Some of the ways that faculty/mentor/preceptor can achieve creating a just culture is to encourage the students to engage in self-reflection, promote professional practice standards within the curriculum, and be effective role models for collegial.1 Intimidation and disruptive behaviors foster medical error and create poor patient satisfaction, increase the cost of care, and cause knowledgeable clinicians to leave the workforce in search of new professions, thus increasing turnover and shortage rates. Therefore, the faculty/mentor/preceptor can engage and empower the student by creating a culture that is free from intimidation and punitive sanctions.11
Ten best practices to be used to incorporate standards into nursing practice and nursing education, which are: 1) support the nursing code of ethics; 2) offer ongoing education; 3) create an environment where nurses can vocalize concerns; 4) employ interdisciplinary and interprofessional learning; 5) enlist nurse ethicists to speak to nurses; 6) provide unit-based ethics mentors (for practice); 7) hold a family conference (in the practice setting); 8) sponsor an ethics journal or club; 9) reach out to other professional associations for resources; and, 10) offer employee or student counseling services.12 The ANA Code of Ethics, for instance, is a framework for nursing practice.11 Therefore, nurses should be familiar with this code and utilize it as a personal framework for practice.11, 12
The Impact of Negative Role Models
Negative role-modeling, horizontal violence, and aggression on the part of faculty or nurses in the clinical setting each serve to promote barriers in effective precepting and mentoring for the student or trainee. A study performed identified that barriers related to negative role modeling, such as passive-aggressive and threatening behavior and negative faculty and clinical staff attitudes, impede learning and threaten student progression and retention in nursing programs.13 Low retention rates of nursing students directly impact the matriculation of more nurses into the nursing profession, where a shortage already. Students who cannot identify with the nursing profession or fail to become socialized within the profession would eventually leave.13
Negative role models infringe upon the students’ ability to learn and contribute to a negative psychosocial learning environment.13 As the need for new nurses grows concerning an encroaching nursing shortage, effective management of the clinical setting related to students’ ability to think and effectively learn critically is vital. Negative role modeling and horizontal violence occur in both the clinical and classroom settings and have a deleterious impact on the nursing student’s ability to learn and critically think.
The Continuous Need
There is a driving need to develop the knowledge and skills necessary to meet the demands and interpersonal issues evident in today’s patient populations.14 Today’s faculty members, mentors, and preceptors will need to address the needs of a changing society, act as change agents for progress, and be skilled and knowledgeable of technological advances. Further, today’s students need creative learning environments that encourage ethical standards, promote effective interpersonal behaviors, and educate students in rendering multidisciplinary care. The future of health care delivery systems will rely on a multidisciplinary approach to rendering safe and effective care. With the management of care serving to emerge as a critical component in health care delivery, nurses must exhibit leadership and skill in interdisciplinary and collaborative practice to improve health care delivery and quality.
Thus, the faculty mentor and clinical preceptor must incorporate methods to increase interdisciplinary collaboration, education, practice, and exchanges. Furthermore, both are charged with preparing current and future nurses for growth in their respective roles as members of the interdisciplinary health care team. Nurses are being called upon to fill expanding roles and to master technological tools, information management systems while collaborating and coordinating care across teams of health professionals. Therefore, they must work diligently to prepare future nurses for the challenging clinical environment that awaits them.
11American Nurses Association (ANA). (2001). Code of ethics with interpretive statements. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf
12Wood, D. (2014). 10 best practices for addressing ethical issues and moral distress. Retrieved from http://www.amnhealthcare.com/latest-healthcare-news/10-best-practices-addressing-ethical-issues-moral-distress/
13Hawthorn, D., Machtmes, K., & Tillman, K. (2009). The lived experience of nurses working with student nurses in the clinical environment. The Qualitative Report, 14(2), 227-244. Retrieved from https://nsuworks.nova.edu/tqr/vol14/iss2/2
14Wilcock, P. M., Janes, G., & Chambers, A. (2009). Health care improvement and continuing interprofessional education: Continuing interprofessional development to improve patient outcomes. Journal of Continuing Education in the Health Professions, 29(2), 84-90. doi:10.1002/chp.20016
Teaching, precepting, mentoring, guiding, or instructing are all used interchangeably when describing the role that one takes to teach another in any setting. Effective and passionate role models, who are willing to guide another to learn in the work or school environment, are pivotal to the success of an organization.
Mentoring or teaching in the academic nursing setting serves to promote the advancement of nurses in both clinical and academic work environments. Precepting in nursing, which most often occurs in the clinical setting, promotes the use of role modeling and shadowing to build specific skill-sets required for the specialized field of nursing. Guiding and instructing in the nursing academic and work settings consist of mentoring, precepting, role modeling, and input from staff in administrative positions.
Nurses Teaching Nurses
As an operating room nurse, I was blessed to have a wonderful nurse preceptor. She was extremely generous with the knowledge that she had gained over a very long nursing career. Her willingness to spell out each procedure using visual diagrams and thorough explanations helped me to excel. She taught me the surgical procedures, the instruments to be used, the technique to follow, the descriptions of the temperaments of the surgeons for whom I would work, and the way to deal with difficult personalities of the environment. She approached each surgical case with a tenacity of spirit and a drive to provide the very best possible care for each patient…every time. To this day, she embodies the truly compassionate art associated with nurses teaching nurses.
I have been blessed with learning the challenging and unique aspects of nursing from some incredible nurses. I have also learned valuable lessons from those who gave credence to the adage that nurses eat their young. Despite the challenges of navigating the stress associated with those lessons, I have continually modeled the positive behavior of strong nursing preceptors to contribute to the profession. Part of being a strong nursing preceptor or educator is having the ability to recognize the talent around us. When I was working as a clinical educator, I knew that there was a plethora of talent around me. There was a proverbial treasure trove of experience and untapped potential everywhere I went. It was my job to provide education and guidance while ensuring that competencies were met. However, I also felt that it was my responsibility to tap into the potential around me. I encouraged nurses to develop short presentations to share with the staff on topics that impacted their work environments and patient populations. The unofficial program was called simply, “Nurses Teaching Nurses.” Who better to speak to the department about significant issues and patient concerns, than the nurses who had to deal with it every day?
We have so very much to learn from one another. It is so important that we are open to sharing our experiences and to be willing to teach others. Not only does the simple act of sharing what we know serve to help the patients that we serve; it improves the work environment.
When Should We Seek Guidance?
Asking for help and guidance is an important component of learning. The relationship between the student and the faculty member or clinical preceptor should find its foundation in open communication and mutual respect. The faculty member, academic administration, clinical preceptors, and leaders are required to facilitate a learning environment that promotes a just culture, is conducive to learning, and aids students achieve desired didactic and clinical outcomes.1 Likewise, the nursing profession is required to abide by professional standards and a code of ethics. These standards and codes of ethics serve as a guiding force throughout the nursing career. In all of the interactions, nurses have while caring for patients and representing an institution.
What About Mentoring?
Students require strong mentoring to understand his or her potential role as a nurse. Further, faculty members, mentors, and preceptors also require mentoring to be effective leaders in the classroom and clinical areas. Providing active mentorship during the novice educator’s transitioning phase is a helpful strategy that is useful for enhancing effective transitioning for the new educator.2 Therefore, effective mentoring programs provide a strategy for improving retention in nursing.2 Further, equal importance is placed upon the facilitation of positive mentor/preceptor-to-student relationships while they transition into the role.
The National League for Nursing (NLN) created an excellence model to identify eight core elements necessary to attain and maintain excellence in the nursing profession. Additionally, the NLN stressed that the nurses need to understand the principles that are fundamental to their profession, use technology to manage and find information, and be leaders and agents for change.3
The American Association for the Colleges of Nursing (AACN) indicated that the United States faces a major nursing shortage and increased workforce opportunities in the next eight years.4 In 2011, the National Academy of Medicine (NAM) (formerly the Institute of Medicine (IOM)) recommended that all nurses have a Bachelor’s of Science in Nursing (BSN) by the year 2020.5 The NAM’s recommendations create an emergent need to increase the nursing faculty and staff nursing workforce. Nursing is one of the many vocations in which a growing need for improvement of workforce retention exists.
In the wake of a nursing faculty shortage, there is a need to retain current faculty and recruit new faculty. Academic institutions and health care facilities are responsible for the retention of nursing faculty. An important component of maintaining work environments conducive to retention of the nursing faculty workforce is associated with the provision of adequate mentorship. The Health Resources and Services Administration (HRSA) indicated that the primary problems facing healthcare are: financial constraints, healthcare workforce shortages, the changing needs of an aging population, which have prompted a national dialogue on the need for new healthcare models to meet the healthcare demands of the 21st century, facilitation of working nurses’ abilities to participate in continuing education programs and increasing healthcare information technology demands. Medical schools, institutions, practitioners, and students will be required to create strategies for coping with the increased volume of new information and changing patient demographics.6
Improving the Student-Faculty/Mentor/Preceptor Member Relationship through Mentoring
Mentoring is a critical component to the success of a program and the nurse. Mentoring is a relationship between a seasoned and novice professional that aids in developing the novice individual to be a productive component of the team. The goals of mentoring are to assist the novice faculty member in overcoming obstacles encountered in daily work, improving individual productivity, and increase employee satisfaction.7 Mentoring is effective for the faculty member and contributes to the increased awareness on the part of the student via interaction, sharing of enthusiasm, and formulation of new insights that contribute to the advancement of teaching styles.
There are many issues to consider when mentoring or receiving mentorship. The nursing profession has a responsibility to remain vigilant regarding influences that change the direction of not only the profession but in nursing education. Further, nursing educators must work to adapt the changes in a curriculum to model the changes that occur in society, political climate, demographics, economics, workforce trends, and any external or internal issues that may influence change in the way nurses deliver care.8 For change to occur in a curriculum and to build meaningful learning experiences for students, nursing educators need to prepare the nursing student by continually analyzing those forces that impose change and encouraging interpersonal dialogue between students and in the student-faculty/mentor/preceptor relationship.8 Therefore, there is a need for academic administration to construct methods for assessment and to provide the tools to monitor changes as they relate to curriculum design and redesign. Imposing change without assessment and communication will create an ineffective learning environment.
Types of Mentoring Processes and Strategies
Other researchers contend that mentoring effectively enhances cultural diversity in the profession of nursing and academia. Four effective mentoring strategies to encourage academic success consist of communication, professional leadership, confidence-building activities, and students. Further, successful mentoring programs are dependent upon a strong organizational infrastructure.9 Shadowing is another method of mentoring. The literature indicated that shadowing is now a tool for medical residents. The assignment of medical residents to nursing staff, as each makes patient rounds, serves to educate the resident about the role of the nurse.10 Sternszus et al. ‘s 2012 study served to identify the importance of residents as role models, and the impact role modeling had on undergraduate medical students.10
1National League for Nursing (NLN). (2021). Core values. http://www.nln.org/about/core-values
2Culleiton, A. L., & Shellenbarger, T. (2007). Transition of a bedside clinician to a nurse educator. MEDSURG Nursing, 16(4), 253-257.
3National League For Nursing (NLN). (2006). Excellence in nursing education model. http://www.nln.org/newsroom/news-releases/news-release/2006/11/03/excellence-in-nursing-education-model-unveiled-at-2006-nln-education-summit-230
4American Association of the Colleges of Nursing (AACN). (2014). Nursing shortage fact sheet. Retrieved from http://www.aacn.nche.edu/media-relations/NrsgShortageFS.pdf
5Institute of Medicine (IOM). (2011). The future of nursing: Leading change, advancing health. (pp. 221-254). Washington, DC: The National Academies Press. Retrieved from http://books.nap.edu/openbook.php?record_id=12956&page=221
6Health Resources and Services Administration (HRSA). (2010). Addressing new challenges facing nursing education: Solutions for a transforming healthcare environment. Retrieved from: http://www.hrsa.gov/advisorycommittees/bhpradvisory/nacnep/Reports/eighthreport.pdf
7Kapustin, J.F. & Murphy, L.S. (2008). Faculty mentoring in nursing. Topics in Advanced Practice Nursing 8(4).
8Veltri, L. M., & Warner, J. R. (2012). Forces and issues influencing curriculum development. In In D.M. Billings & J.A. Halstead (Eds.), Teaching in nursing: A guide for faculty (4th Ed., pp. 92-104). St. Louis, MO: Elsevier Saunders.
9Wilson, V., Andrews, M., & Leners, D. (2006). Mentoring as a strategy for retaining racial and ethnically diverse students in nursing programs. Journal of Multicultural Nursing & Health (JMCNH), 12(3), 17-23.
10Sternszus, R., Cruess, S., Cruess, R., Young, M., & Steinert, Y. (2012). Residents as role models: Impact on undergraduate trainees. Academic Medicine, 87(9), p 1282–1287. doi: 10.1097/ACM.0b013e3182624c53
Part Two of this article will publish tomorrow.
The image of nursing has changed since the days of its founder, Florence Nightingale; however, the devotion is the same. Nursing as a profession, coupled with the men and women who make up its numbers, function as the first line of defense for their patients. Therefore, stewardship, governance, and advocacy for the profession must be employed by nursing leaders for its protection and progression.
Importance of Stewardship
The nursing profession is a vital component in functioning society, and nurses fill the roles of an educator, facilitator of care, administrator, counselor, and advocate. Nursing leaders have a pivotal role in the process of progress and change for the profession. They are the representatives and the face of their departments. They must exercise stewardship at the point of service while working to advocate for respectful interactions with patients and promote a just culture (Murphy, 2009). Stewardship is a concept that includes the philosophy of practical analysis and practice of serving others in such a way as to provide leadership while observing the shared values of the staff for which they are in charge. The staff is the intrinsic force in a department; therefore, its steward’s goal is to serve, protect, and perpetuate its growth and function (Murphy, 2009).
The steward at the point of service must be aware of challenges and differences while cultivating these aspects into objective and impartial practices. Nurse leaders and staff members can promote their practice while creating change by the effective communication of ideas and observations made on patient care. Further, the transformation of current practice into a more efficient delivery of care can be facilitated by open collaboration with nursing leaders and physicians. A realization that we are all in this together would serve to impact nursing in such a positive way.
Improving Nursing Through Shared Governance
Shared governance is a term that was introduced over twenty years ago and was used to provide actionable strategies to provide nurses with power over their practice. Shared governance is a collaborative strategy used by organizations to encourage nursing staff to manage their practice with a high level of commitment to practice (Green & Jordan, 2004). Further, the process of shared governance works to stimulate workplace advocacy, which operates at the local, state, and national levels of government. Without nurse leaders, staff participation, and the use of collective knowledge of patient care implications related to poor staffing ratios, policies will not change. Simply put, shared governance provides nursing with a vehicle to promote their collective voice.
The Leader and Advocacy
Nurses and nursing leaders are already aware that health care reform is needed. They are the first to see a breakdown in the efficiency and efficacy of patient care; therefore, it is the nursing profession’s collective responsibility to promote change (Abood, 2007). Further, to be an effective advocate for change, one must possess the desire, will, time, and energy required to engage in reform at the legislative level. There are a growing number of uninsured patients, a rise in the costs associated with providing quality care, and a continual decrease in the healthcare workforce. These problems impose a great strain on the nurses currently in practice. The strain further imposes the numbers of those who choose to be involved in reform. The current workforce is under excessive stress, which directly corresponds to a lack of interest in representing themselves or sharing their collective voice. Work stress aside, Abood asserts that nurses find it difficult to leave the comfort of their practice to engage in the battle to be heard by their legislators (Abood, 2007). However, without representation from the nursing leadership in practice, policies cannot be changed. It is the combined knowledge and field experience held by the nursing profession that is needed to influence those who make policies for change to occur.
Nursing leadership will encounter greater challenges in the near future. The management of human capital, digital technology advancement, and cost control are three of the major challenges and opportunities that nursing leaders will face in the 21st Century (Lee, Daugherty, and Hamelin, 2017). Nursing leaders will play a critical role in transforming healthcare through active participation on the nursing units and in executive boardrooms. Critical issues, such as an aging population and the nursing shortage, continue to be prevalent in the United States and globally. Therefore, nursing leaders will need to address issues that affect retention and create new ways to promote the profession.
Nursing leaders need to expand upon the foundation created by nursing pioneers such as Florence Nightingale. The integration of shared governance into the workplace begins with the nursing leader. There also needs to be a collective effort to revise and reform policies at all levels of administration within an institution and our state and national governing bodies. There is a legacy to uphold. By joining state nursing associations and showing solidarity, the profession can serve the public in a much larger capacity. The nurse leader has many challenges ahead. In taking pride at the bedside, the nurse has the power to impact not just those that he or she serves, but to the families, administrators, and peers alike. Our presence can be our voice, as well.
Abood, S. (2007). Influencing health care in the legislative arena. The online journal of issues in nursing, 12(1).Retrieved September 14, 2020 from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No1Jan07/tpc32_216091.aspx
Alexander, K. L. (2019). Florence Nightingale. Retrieved September 14, 2020 from https://www.womenshistory.org/education-resources/biographies/florence-nightingale
Green, A. & Jordan, C. (2004). Common denominators: Shared governance and workplace advocacy – strategies for nurses to gain control over their practice. The online journal of issues in nursing, 9(1). Retrieved September 14, 2020 from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No1Jan04/SharedGovernanceandWorkPlaceAdvocacy.html
Lee, E., Daugherty, J., & Hamelin, T. (2019). Reimagine health care leadership, challenges and opportunities in the 21st Century. Journal of PeriAnesthesia Nursing, 34(1), 27–38. https://doi-org.ezproxy.umgc.edu/10.1016/j.jopan.2017.11.007
Murphy N. S. (2009). Nurse leaders as stewards: the beginning of change. The open nursing journal, 3, 39–44. https://doi.org/10.2174/1874434600903010039. Retrieved September 14, 2020 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2737121/
Nightingale, F. (1946). Notes on nursing: What it is, and what it is not. Philadelphia: J.B. Lippincott.
Summers, S. J. & Summers, H. J. (2004). Media ‘nursing’: Retiring the handmaiden. Retrieved from https://www.nursingcenter.com/pdfjournal?AID=483200&an=00000446-200402000-00002&Journal_ID=54030&Issue_ID=483197
Healthcare is rapidly changing before our eyes. In the age of COVID-19, we have seen the rise in the use of technology to render primary care visits, participate in physician consults, perform basic patient intake assessments, and schedule surgical procedures. According to the US Bureau of Labor Statistics (BLS), healthcare occupations are “…expected to grow 15% from 2019 until 2029”. Additionally, the BLS (2020) identified that the growth in the healthcare workforce is associated with the aging population and the increased need for healthcare services. The future of nursing and the rise in the use of technology at the point of care is at the forefront in the profession.
The Current Job Market for Healthcare Professionals
The healthcare industry has experienced considerable growth over the years. Most prominently, the healthcare job market witnessed its largest amount of growth in 2018 and 2019. In 2018, 346,000 new healthcare jobs were created in 2018, which outpaced other business sectors, such as food services, construction, retail sales, and manufacturing. Although healthcare has seen significant growth in job creation, the World Health Organization (WHO) maintains that there is still a worldwide shortage. More than 18 million healthcare workers will be needed in 2030 to address the needs of the underserved and in underdeveloped nations. The US Government Accountability Office (GAO) issued a report on the healthcare workforce, which stresses the importance of directing federal funding to the education of physician residency programs, nurse practitioners, and physician assistants in order to meet the impending demand.
The Future of the Job Market for Healthcare Professionals
The healthcare job market and requisite educational programs are poised for expansion in the coming years. The BLS projected that there is and will be a need for 45 different healthcare-related positions from now until 2029. The growing need for physicians, nurse practitioners, physician assistants, nursing, lab, and pharmacy support, and other support staff poses an immediate and future labor demand, as well as a need for funding for and creation of educational programs. Additionally, the BLS noted that the rise in the use of technology will create a need for trained personnel in the areas of IT security, software development, and new products associated with the Internet of Things (IoT). Therefore, there will be a need for educators to facilitate the educational needs of a growing healthcare workforce.
Rise of the Machine and Technology
The use of healthcare technology and the advancement of technological applications has grown over the last ten years. Healthcare quality has been enhanced through the use of health information technology, such as the adoption of the electronic health record, integration of technology in bedside care, and the rise in use of telehealth. Some of the main technology jobs that will be in demand in the near future such as artificial intelligence development, telemedicine, nanomedicine, virtual reality for physical and mental health care, 3D printing designers for skeletal bones and prosthetic devices, and advanced robotic surgeries. The rise in the use of technology will continue to create additional jobs in the healthcare sector and revolutionize healthcare.
A Lifelong Educational Process
There is a profound need for healthcare providers from all sectors of the industry. Technology and the jobs it creates adds to this need. In the next five to ten years, it is likely that some positions will be replaced with artificial intelligence and that telemedicine will be commonplace. That said, the healthcare providers and their collective experience and expertise will always be in need. Therefore, the education and development of healthcare providers will be essential and ongoing. Accordingly, healthcare professionals will need to continuously engage in lifelong learning to meet the impending demands associated with the ever-changing healthcare landscape.