Running head: NURSE MENTORSHIP AND NURSE RETENTION

Research Proposal: Nurse Mentorship and Nurse Retention

Corinne Bradley, Theresa Connors, Amy Herrington, Jessica McClusky, Jennifer McDermitt, &
Sarah Rousseau
Ferris State University

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CHAPTER 2: LITERATURE REVIEW

Research Proposal: Nurse Mentorship and Nursing Retention
New nurses entering practice face a challenging transition characterized by anxiety,
uncertainty, and lack of confidence (Ferguson, 2010). One factor mediating some of these
challenges in the workplace is mentorship. Mentorship is a critical component of success in the
healthcare field. During their career, mentored nurses are more likely to have higher retention at
their institution, report greater self-efficacy, and improved career satisfaction (Cho, Ramanan, &
Feldman, 2011). 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.
Chapter 2 will discuss support for the Modeling and Role Modeling Theory. Showing the
relevance and applicability to nursing mentorship programs and the effect on new graduate nurse
retention. A literature review will outline 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. The systematic review of the literature helps
to frame a general discussion about mentoring, but reveals a limited amount of literature related
to the correlation between mentorship programs and new graduate nurse retention, the qualities
of an effective mentor as reported by the mentee, and the appropriate structure of nursing
mentorship programs for the new graduate nurse. It is the aim of this study to explore the
relationship between nurse mentorship programs and nursing retention of new graduate nurses.

Theoretical Foundations in Literature

The Modeling and Role Modeling Theory of Erickson, Tomlin and Swain is used to
support the proposed study of the effect of nurse mentorship programs on nursing retention. This
theory is based around the client being the central focus of the study, and for the purpose of the

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proposed research the client is the new graduate nurse (GN). The major concepts of this theory
that support the proposed study include modeling, role modeling, nursing, nurturance,
unconditional acceptance, person, how people are alike, and how people are different (Erickson,
2010, pp. 541-543). It is essential that GNs are accepted for their personal aspirations and are
taught in a holistic non-judgmental manner to facilitate the transition into nursing practice. This
requires a safe environment with a mentor who is unconditionally accepting of the mentee and
encourages growth and development. The theory concepts not only demonstrate the behaviors
necessary of the mentor but also the basic needs of the GN. Chapter one gives a more detailed
outline of the mentioned concepts and their importance to nurse mentor programs increasing
nursing retention. In this chapter supporting literature will be reviewed to demonstrate the
validity of the theory to the proposed study.
Alligood (2011) utilized the Modeling and Role Modeling Theory in an action research
study evaluating the theories impact on improving patient quality of care and nursing retention
and satisfaction. The study was based in a large medical center in the southern United States that
occurred over one years time (Alligood, 2011). The sample consisted of the action researcher
and the facilities pertinent staff. The study had three cycles in which the theory was introduced
to floor nursing staff as well as nursing leaders and administrators (Alligood, 2011). During the
three cycles not only did staff nurses learn to utilize the theory in patient care, but administrators
learned to utilize the theory when considering the treatment of staff. The study showed that with
the introduction of this theory nursing retention increased, as well as job satisfaction and the
desire of nurses to continue their education further (Alligood, 2011). The limitations of this
qualitiative study include the absence of quantifiable measurement tools. Another limitation to
the validity of the study is that personal subject approval was not obtained all though the Chief
Nursing Officer gave permission and ensured that ethical standards of the facility were met

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(Alligood, 2012). When reviewing this literature in correlation to the proposed study it does
support the Modeling and Role Modeling Theory as being a proven theory in improving practice.
Modeling and Role Modeling Theory has demonstrated positive theory-based practice
outcomes (Alligood, 2011, p. 982).
Arruda (2005) utilized the Modeling Role Modeling Theory in relation to nursing
retention specifically. The drive for this study was based on the nursing shortage and the need
for nurse leaders to ensure the retention of staff especially, with the increasing numbers of GNs
leaving their positions or the profession in general. This study looked at the importance of
understanding the nursing staff needs utilizing Maslows Hierarchy of Needs (Arruda, 2005).
When staff needs are not met and they feel as though their concerns are not heard it increases
turn over and detrimental effects to the nursing profession and healthcare as a whole. The
limitations of this study included that it is a proposal but no formal testing was performed
(Arruda, 2005). The article is also eight years old, however the authors of the proposed research
see the information presented as verification that the Modeling and Role Modeling Theory has
positive influence over nursing retention and the necessity for GNs needs to be met.
Olaer (2012) performed a descriptive correlational research study focusing on mentoring
activities of experienced nurses and the improved performance of nurse trainees. The study was
conducted at St. Vincent General Hospital in Cebu City with 30 experienced nurses and 30 nurse
trainees making up the testing sample (Olaer, 2012). Olaer (2012) put great emphasis on the
need of mentor activities on the success of GNs entering the healthcare field. Effective
mentoring is critical in delivering high quality care, ensuring patient safety, and facilitating
positive development of health care workers (Olaer, 2012, p. 41). Olaer (2012) utilized
multiple theories for the purpose of this study including the Modeling and Role Modeling
Theory. The main concepts of this theory emphasized in the study were the desire of individuals

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to be accepted, respected, and viewed as being unique and appreciated ensuring his or her
success (Olaer, 2012). The results showed a positive correlation to mentoring activities and the
performance and development of GNs (Olaer, 2012). The limitations to this study were the fact
that only one facility and one location were utilized. The study does provide support that the
Modeling Role Modeling Theory is valid in the correlation between nurse mentor supports
needed for the success of GNs.
Koren and Papamiditrious (2013) utilized the Modeling and Role Modeling Theory in
their study of staff nurse spirituality. The descriptive qualitative study took place in a 400 bed
suburban hospital with 11 nurse participants (Koren & Papamiditrious, 2013). The study proved
that nurses need collegial support to discuss experiences and brainstorm improvement processes
(Koren & Papamiditrious, 2013). It was also discussed the need for a social support arena
accessible just to nurses where they may speak freely of their concerns and experiences (Koren
& Papamiditrious, 2013). The limitations to the study were the small sample size as well as the
utilization of convenience sampling (Koren & Papamiditrious, 2013). This study showed a
positive impact of the Modeling and Role Modeling Theory concepts in discovering the needs of
staff nurses including the holism of the individual and the importance of staff needs being met
(Koren & Papamiditrious, 2013).
Schultz (1998) looked at the use of the Modeling and Role Modeling Theory in advising
nursing students and the success it promotes. The study took place at the Metropolitan State
University of Nursing, with a focus on the impact of positive influence on student success
(Schultz, 1998). The study broke down the key concepts of the theory and the importance of
support needed by nursing students from advisors (Schultz, 1998). The study is 15 years old
providing some limitation, however the use of the theory supports the validity and reliability for
further studies.

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Lamb (2005) in writing her masters thesis looked at the impact of the Modeling and Role
Modeling Theory in nurse mentoring. The qualitative study took place at Montana State
University College of Nursing with nine experienced nursing faculty and seven junior level
nursing students (Lamb, 2005). The concepts of the Modeling and Role Modeling Theory were
broken down into mentor and mentee categories supported by a conceptual map (Lamb, 2005).
There was vast discussion on the theory and the support that mentorship provides improving
relationship building and professional development. The limitations to the study were the
sample size and the fact that the entire sample of people were at the same level in their
educational careers as well as their only being one male participant (Lamb, 2005). This study
supports the strength of the Modeling and Role Modeling Theory as the theories applicability in
the development of mentorship programs.
The articles reviewed support the testability of the Modeling and Role Modeling Theory
as well as its replicated use in nursing literature. In order for a theory to be useful in guiding
practice, education, or research, evidence is needed that the theory is valid (Lamb, 2005, p. 16).
The literature reviewed demonstrates that the Modeling and Role Modeling Theory is valid for
the proposed study. The literature validates that the concepts support the effect of nurse mentor
programs on nursing retention.
Literature Review
Challenges
Transitioning from the role of a student to a professional nurse can be very difficult. As a
GN makes this transition, he or she will face many challenges as well as have many
opportunities. 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

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performance anxiety, fear of making mistakes, time constraints, lack of support and difficulty
with delegation, prioritization and time management.
A qualitative study involving 37 new GNs employed in a hospital in a Northwestern state
found that new GNs experienced stress from not knowing what to expect and from experiencing
daily operational conflicts (Clark & Springer, 2011). This study also concluded that other
challenges included lack of time to conduct a thorough assessment and utilize critical thinking
(Clark & Springer, 2011). The GNs had stress related to fear of making a mistake that might
harm a patient, not feeling prepared for their job as a nurse and having unsupportive preceptors
(Clark & Springer, 2011). This study utilized a convenience sample which while not a preferred
sampling approach is often the easiest (Polit & Beck, 2012). This study had an adequate sample
size and provided rich data. It is important to note that there are no required sample sizes for
qualitative research but the sample size is based on what information is needed (Polit & Beck,
2012). This study provided insight into challenges that new GNs face. One limitation of this
study was that it was conducted at only one hospital (Clark & Spinger, 2011). Additional studies
should be conducted to replicate this study in additional hospitals in other areas of the country to
see if similar themes arise.
Pinchera (2012) conducted a phenomenological research study describing experiences of
new GNs. The results included that new GNs experience fear, lack of confidence in their
abilities, feeling overwhelmed and powerless (Pinchera, 2012). From this study, it was found
that GNs have trouble with prioritization, time management, and delegation (Pinchera, 2012).
GNs had an increased need for time in order to complete all of their tasks and reduce their stress
(Pinchera, 2012). This study had a purposive sample of five newly licensed nurses who were
interviewed utilizing unstructured interviews (Pinchera, 2012). The data was analyzed using
Colazzis seven procedural steps which are explained in detail in this article (Pinchera, 2012).

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When using Colaizzis methodology the researcher only utilized five of the seven steps, which is
a limitation of this study (Pinchera, 2012). Pinchera (2012) did relate her findings to previous
literature which validates the credibility of her findings even though she had a small sample size
(Steubert & Carpenter, 2011). Pinchera (2012) did not discuss that data saturation was achieved
so this demonstrates the need for further research on this topic with the recommendation of a
larger sample size (Streubert & Carpenter, 2011).
Another challenge discussed in the literature is performance anxiety. Washington (2012)
conducted a quantitative research study with 24 new graduates enrolled in a six month residency
program working in a 15-facilty health care organization including multiple types of units. This
study concluded that performance anxiety is present in new GNs but at a manageable level
(Washington, 2012). After the nurse residency program, these study participants had decreased
anxiety (Washington, 2012). This study measured performance anxiety utilizing the Clinical
Experience Assessment form that had been developed by Kleehammer and utilized in previous
nursing research (Washington, 2012). The tool had a reliability coefficient of .82. The high
coefficient demonstrates the internal consistency of these results (Polit & Beck, 2012). The
results which demonstrated a decreased anxiety level had a reliability coefficient of .896.
Reliability coefficients above .8 are considered good (Polit & Beck, 2012). Therefore, the
results of this study can be considered reliable.
Wu, Fox, Stokes & Adam (2011) conducted a research study measuring work-related
stressors and intention to quit employment among graduate nurses within the first three years
after graduation. The Job Stress Scale of Newly-graduated Nurses tool was utilized and had a
reliability of .93 demonstrating high reliability. This study which included 154 registered nurses
reported nurses in this study experienced moderate stress caused by demanding care, equipment
issues, nursing skills, interpersonal relationships and hospital responsibilities (Wu et al., 2011).

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Overall, nurses who reported the highest level of stress had worked less than two years (Wu et
al., 2011). Wu et al. (2011) stated that the results of this study were similar to the results of other
earlier studies which demonstrate the reliability of this studys results. The limitations of this
study included a small convenience sample which does not allow the results to be generalized to
other areas of the country (Wu et al., 2011) Additional studies need to be conducted to replicate
this study.
The literature supports that new GNs face many challenges as they transition from
students to professional nurses. As hospitals develop transition plans for new GNs, it is
important to implement strategies to help them manage the many challenges that they face.
Nurse mentorship programs are one strategy that hospitals may consider to help new GNs in
their role transition. If mentorship programs help to support nurses during this transition, it
should help to increase nursing retention.
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. However, there is
limited research on actual mentorship programs as they relate to the new GNs retention rates.
Rush, Adamack, Gordon, Lilly, and Janke (2012) conducted an integrative review of the
literature related to formal new GN transition programs. They utilized 47 articles to discuss and
identify the most integral parts of transition programs. Formal programs were found to be related
to increased nurse retention when mentors had formal training, mentees were given support for at
least six to nine months, healthy work environments were cultivated, and a focus was provided
on skill development (Rush et al., 2012). While this did not add additional data to the data pool,
this research was helpful in summarizing vital components to successful transition programs. The
literature review discussed various types of transition programs, highlighting the need for a
specific review of mentorship programs to be completed.

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Fox (2010) described the use of a mentorship program in a large health system in an
attempt to decrease turnover rates. Initial turnover rates in 2006 were as high as 31% among new
GNs in their first year. The program paired mentors with protgs who were provided with
support and coaching through structured training sessions. The initial number of pairs included
12 mentors and 12 mentees, however that number increased each year over the three years
discussed to include 125 mentors and 200 protgs. By the end of the evaluation period in 2009,
the turnover rate had decreased to11% (Fox, 2011). Though these numbers show great
improvements in retention, nurse managers chose the mentors and mentees involved. This
sampling technique does not allow for appropriate random sampling. Additionally, it was not
stated if these mentees included were all new GNs. Length of time as a nurse was not included as
a criteria for choosing the mentees. Because of this, it is difficult to compare the provided
turnover rates, as the 31% relates to GNs only, and the 11% stated from 2009 does not
distinguish GN versus established nurse.
Faron and Poeltler (2007) conducted a similar study where mentor and mentee pairs were
assigned together for the GNs first year of employment. These mentors were available for
support both during structured monthly meeting times as well as impromptu needs that arise
during shifts. The first year of the program included 87 mentor-mentee pairs; however, only 57
of these mentees were new GNs. The initial GN turnover rates at the hospital were 20% in the
first year. Data from this research showed a decrease in the turnover rate to 7% (Faron &
Poeltler, 2007). Since only 57 of the 87 mentees were GNs, it is not differentiated clearly
whether this 7% turnover was related to just new nurses, making it difficult to draw definite
conclusions related to the effectiveness of the mentorship program.
Pine and Tart (2007) discussed a new GN residency program at a large metropolitan
hospital. The program focused on leadership, patient outcomes, role development, and critical

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thinking. Prior to implementation of the program, the hospital system saw a GN turnover rate of
50%. One year after program implementation, the turnover rate for this population of GNs
dropped all the way to 13% (Pine & Tart, 2007). The improvement in turnover rates is
impressive, however, this program was internally developed at one institution, and results are
only depicted for a one-year follow-up. It would be necessary to continue providing results
through subsequent years to demonstrate continued program success. Additionally the use of a
residency program does support the idea that organization and structure improve the new GNs
orientation experience. This article does not discuss a mentorship program, showing that the
outcomes of a mentorship program for GNs is an area that needs to be addressed.
Kramer, Halfer, Maguire, and Schmalenber (2012) completed a longitudinal study of
5,316 new GNs at 28 Magnet hospitals over three years. After the implementation of residency
programs at these institutions, data showed that multi-stage nurse residency programs increased
the retention rates of new GNs. This increased retention was attributed to the structured
residency program, as well as the healthy work environment the GNs were placed (Kramer et al.,
2012). This study provides an excellent sample size in number of nurses, as well as multiple
different hospital settings, increasing reliability and validity. The research is centered on
residency programs and not specifically mentorship; however a correlation can be seen between
the necessity of a structured environment for the GN and retention. This idea can be used when
discussing mentorship. Further research is needed in this scope to determine the wide-spread
effectiveness of mentorship programs on GN retention.
Research completed by Cottingham, DiBartolo, Battistoni, and Brown (2011) discusses a
mentorship program developed at a rural community hospital. The program known as the
Partners in Nursing (PIN) program was evaluated over an 18-month period with a capacity of 20
mentor-mentee pairs. The mentees were new GNs within their first year of employment. The

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PIN program included weekly meetings between mentor and mentee, as well as monthly
development meetings with the entire group together. The mentors provided support and teaching
for clinical skills and emotional questions. After 18-months there was 100% retention with the
new GNs involved with the PIN program, as well as 100% intention to stay with the profession
(Cottingham et al., 2011). While these results are promising for the use of a mentorship program
as it relates to retention, there are issues to be addressed. There was no data regarding the
original retention rates for the area; this comparison would have increased the validity of the
study. Additionally, continued evaluations and expansion of this program is necessary to show
success. While the program was successful in the short term, the long term benefits have yet to
be shown.
Overall, structured orientation programs have been shown to be an effective method to
increase GN retention. However, more research is needed to solidify the effectiveness and
determine the appropriate structure of nursing mentorship programs for this population of nurses.
Additionally, the qualities of an effective mentor play an important part in the nurse mentorship
process and should be examined closely.
Qualities
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.
Cho, Ramanan, and Feldman (2011) set out to define the ideal qualities of mentorship by
conducting a qualitative analysis of the characteristics of outstanding mentors. The objectives of
the study were to better understand and to identify the important qualities of outstanding mentors

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as described by their mentees letters of nomination for a prestigious lifetime achievement award
in mentorship at the University of California, San Francisco (UCSF). 53 individuals responded;
62% who submitted letters were female and 75% of mentees were currently at UCSF. The
faculty mentors nominated for the award ranged in age from 53 to 78 years and 30% were
women. When asked about the main characteristics of their most effective mentoring
relationship five themes emerged: admirable characteristics, how mentors guide their mentees
careers, strength of time commitment, support for personal/professional balance, and legacy of
mentoring. Admirable personal qualities included compassionate, enthusiastic, generous, honest,
insightful, selfless, and wise. The most common descriptions that described their professional
skills included intellectual, skilled clinician, and teacher. Mentors were able to identify their
mentees potential, set high standards, and provide a vision. There were four aspects that
measured the strength of time commitment: the frequency, availability, duration, and quality.
The final theme was the legacy of mentoring. The mentor must act as a guide to help the mentee
when it was their turn to become a mentor. Cho, Ramanan, & Feldman (2011) argued that there
are few studies that identify the qualities of an effective mentor and there is a gap in integrating
these key qualities into a mentor training programs. By identifying these key characteristics, it
may help to decrease the gap. A limitation of the study is that it is focused on only one
institution and it is not possible to correlate the findings to other institutions or the impact that it
had on the mentees careers. Also, the letters only focused on the positive mentoring experiences
and did not analyze poor mentoring experiences. This study clearly demonstrates the ideal
qualities of a mentor; however these qualities need to be integrated into practice.
Ferguson (2011) also discussed the characteristics of outstanding mentors and the
integration into work and professional socialization. Ferguson (2010) used Grounded Theory as

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the qualitative method of data collection, analysis, and theory development. In the study,
participants were invited to discuss factors in their workplace that supported or inhibited clinical
judgment, including the characteristics of effective mentors. The participants were recruited
through letters of invitation from a professional nursing association in two provinces in Canada.
A total of 25 Registered Nurses consented to the study; 24 female and one male, with an average
age of 28 and range from 24-39 years. Data was collected by audio-recorded guided interviews
lasting 90 minutes over a 16 month period. This ensures that the same general areas of
information are collected from each participant, while still allowing a degree of freedom and
flexibility in getting the information from the participant (Polit & Beck 2012). Each participant
was interviewed three times. By interviewing a person multiple times, it will increase the
credibility and validity (statistics) of a qualitative study (Wood & Ross-Kerr, 2011). The
audiotapes were then transcribed verbatim. The core variable that emerged was that of Seeking
Learning, the intent of new nurses to continue to learn in practice (Ferguson, 2011, p.120).
The findings of the study indicated that from the perspectives of the participants, they did not
find a connection with their assigned preceptors so they sought other nurses as their role model
and mentors. GNs picked those experienced nurses in the workplace who were friendly,
welcoming, supportive, and encouraging to them (Ferguson, 2011). All of the GNs indicated that
they wanted a mentor whose nursing practice they admired and respected. Most GNs sought
after mentors who were knowledgeable, supported new nurses in their decision making, and
assisted new nurses to think critically about their patient situations. GNs also valued the holistic
practice of their mentors (Ferguson, 2011). GNs felt that they gained status in the work group
because the mentor helped them to integrate and relieved stress related to this. They sought out
nurses who were supportive as well as the fact that they enjoyed nursing. Nurses who answered

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their questions, provided additional information to ensure that they were aware of possible
pitfalls or tips and suggestions, or offered supportive feedback that helped new nurses improve
their nursing care were the most sought out nurses (Ferguson, 2011). They also valued nurses
who were non-judgmental. The author found that GNs chose mentors who assisted them to
develop their clinical judgment and practice knowledge, were strong role models, and who
demonstrated the kind of nursing care to which they aspired (Ferguson, 2011). The study did a
good job on defining the key characteristics of an effective mentor; however the study chose an
informal process of selecting a mentor. GNs were left on their own to seek out their own mentor.
A formal process for pairing the GN with a mentor might be beneficial when developing a
mentorship program.
LaFleur & White (2010) discussed the mentor/mentee relationship and the benefits from
the perspective of the mentor rather than that of the mentee using an integrative review. The
theoretical framework for this review was Benners from Novice to Expert Theory. There were
33 articles total that were reviewed for contents specific to the benefits of being a mentor. Three
primary themes emerged associated with the qualities of mentors: personal attributes,
professional skills, and abilities. The personal attributes associated with the mentor include
honesty, openness, friendliness, enthusiasm, compassion, flexibility, and consistency. Mentors
and mentees identified teaching ability, competence, knowledge, and assessment skills associated
with the professional skills of the mentor. Other characteristics associated with an effective
mentor were sharing responsibility, role-modeling, interpersonal relationships, and
communication skills, including openness to communication, active listening, and providing
constructive feedback. Confidentiality, openness, and honesty were rated as the most important
qualities of a mentor in several studies. Additional qualities included sharing information, active

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listening, motivating, empathy, showing respect, and encouraging the students to ask questions
and request help. The study also addressed barriers to mentoring and mentor benefits. The study
focused on implications for case management, but the findings can be applied throughout the
healthcare spectrum. Much of the information reviewed involved studies conducted outside the
United States. Therefore, further research is needed to investigate the qualities of effective
mentors in nursing and the integration of these qualities into mentorship programs in the United
States.
Perry (2009) investigated the connection between attitude and relationships between
mentors and students and the motivation to learn. To study these outstanding nurses, the study
used a phenomenology approach. In total, 15 nurses were nominated by their colleagues as
being exceptionally competent. Eight nurses were chosen to participate in the study. The nurses
were interviewed twice and observed in a private location over a 40 week period or until content
saturation occurred (Perry, 2009). According to Polit & Beck (2012) sub-samples require at least
30 observations when applicable. The interviews were taped and transcribed. The observations
were made on the nursing unit and the observations were recorded in a field journal daily. The
data was analyzed into a narrative analysis and a poetic interpretation (Perry, 2009). The major
findings of the study were that exemplary clinical nurses are also outstanding role models. They
were described as lighthearted; all-encompassing disposition, an ability to see the lighter side of
situations as they occur (Perry, 2009, p. 244). The nurses positive attitude helped to establish
relationships and aided in creating rapport with colleagues. The role models who had an
optimistic attitude were the individuals who should be selected to act as mentors for GNs.
Positive attitudes were contagious and could uplift the morale of the whole team potentially
influence both the quality of care provided, as well as the quality of the work environment. Due

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to the research approach used, the researcher may have influenced the observed participants
behaviors (Perry, 2009). Also, the complexities of human interactions made it difficult to convey
the correct message at times. This study spoke to the importance of an optimistic attitude and its
importance in being an effective mentor.
Latham, Ringl, & Hogan (2011) used a quasi-experimental, non-control group design
utilizing pre and posttests over a three year period with 198 Registered Nurses (RN) (including
89 RN Mentors and 109 RN mentees) in two southwestern U.S. hospitals. The goal of this study
was to evaluate the effects of mentoring on nurse perceptions on the supportive culture of the
workplace environment, professional skill development, decisional involvement, and retention
and vacancy rates. Among other key variables, they looked at qualities of an effective mentor
which included using effective communication, collaboration, and shared decision making skills
to support a healthy work environment. Mentors provided personal and emotional guidance,
coaching, advocacy, career development, role modeling, strategies and systems advice, learning
facilitation, and friendship. Mentors can be arranged to assist in clear lines of communication
between management about work needs of the nursing staff (Latham, Ringle, & Hogan, 2011).
The findings of the study indicated that there are valuable resources that can be shared between
universities and hospitals to improve the health care workforce environment by creating a formal
mentor program that includes education and follow up support.
The literature reviewed share the same themes about the qualities that make an effective
mentor. In general, mentors should be good listeners, willing to provide honest information and
feedback to their mentees. They should be empathetic and non-judgmental. A mentor is
encouraging and provides proper guidance for their mentee on the proper way to handle difficult
issues by providing encouragement. A mentor is a good role model. An effective mentor

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demonstrates the proper way to behave and has excellent social skills and is supportive. Mentors
should have admirable time management skills. Communication is fundamental to mentoring
and the mentor needs to have the time to have regular meetings with the mentee and be available
to answer questions or provide insightful feedback. All of these qualities start with the desire of
the mentor to help.
Further research needs to be conducted on the characteristics of effective mentors in
nursing because it is explored only minimally in literature (Ferguson, 2011). Also, much of the
literature involved research studies conducted outside of the United States such as Australia,
Philippines, and the United Kingdom. There is minimal research on the correlation of effective
mentoring relationships or the qualities of outstanding mentors (Cho, Ramanan, & Feldman,
2011).
Benefits to the Mentor
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 mentors company and the nursing profession, decreased workplace stress,
increased professional success, increased professional confidence, and increased personal/career
satisfaction.
The study by Latham et al. (2011) found that team building and conflict resolution skills
were improved among both the mentors and mentees. The study also revealed that mentors felt

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less burned out and felt reinvigorated (Latham et al., 2011, p. 351). In addition, the study
found that mentors were more engaged and more likely to support others, including coworkers
not involved in the mentorship program (Latham et al., 2011).
Workplace stress is not an issue experienced only by GNs. All nurses can be affected by
workplace stress regardless of their status of novice, competent, or expert. A qualitative study of
Australian rural nurses with seven participants found that mentors benefit from the trusting and
supportive relationship formed through mentorship (Mills, Francis & Bonner, 2007). The study
found that workplace stress is decreased when individuals have more supportive relationships in
the workplace (Mills, Francis & Bonner, 2007). The importance of healthy workplace
relationships is highlighted in this study. This study had a relatively small sample size and could
benefit from further research with a larger sample.
An integrative review performed by LaFleur and White (2010) exploring mentor-mentee
relationships, as well as the benefits of the mentor revealed four categories of benefits including
positive impact on practice, personal satisfaction, professional success, and organizational and
professional contributions. The review showed that many mentors found a positive impact on
practice because as the mentor educates the mentee, the mentor is also learning or refamiliarizing with forgotten information (LaFleur & White, 2010). The joy of giving back
through educating others produced personal satisfaction for mentors as well (LeFleur & White,
2010). Mentors also benefit by increased professional success, including increased job
satisfaction, increased earnings and more opportunity for advancement (LaFleur & White, 2010).
Last, mentors feel more engaged in the nursing profession and their organization (LaFleur &
White, 2010). This integrative review was completed through a search of the CINAHL and the
OVID databases for articles from 1979 to 2009, including non-research articles. The integrative
review provided rich data in regards to the benefits to the mentor.

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The California Nurse Mentor Project was developed and employed in four hospitals, two
in Southern California and two in Northern California, over three years (Mills & Mullins, 2008).
The aim of the project was to improve quality patient care through improved retention of nurses
(Mills & Mullins, 2008). The project involved 450 registered nurses that participated in the
program as a mentor or mentee (Mills & Mullins, 2008). Through surveys and focus groups,
significant data was produced showing how a mentorship program is not only a benefit to the
mentee, but also the mentor. The California Nurse Project found that mentors involved in the
project had increased job satisfaction and their professional confidence improved (Mills &
Mullins, 2008). Two indicators increased significantly for mentors in relation to professional
confidence including increase in their knowledge base and further development of their job skills
(Mills & Mullins, 2008). Mentors also reported feeling more engaged in their job and nursing as
a career (Mills & Mullins, 2008). Last, the mentors involved in the California Nurse Mentor
Project benefitted from an increasing sense of achievement, sense of fulfillment, improved
relationships with colleagues and managers, and perceived appreciation and respect from others
(Mills & Mullins, 2008). Utilizing the mentorship model employed by the California Nurse
Project in other areas of the country could further strengthen the evidence produced by the
project.
The research identified shows that mentors also benefit from involvement in a
mentor/mentee relationship. However, there were very few studies that focus solely on the
benefits to the mentor and it would be beneficial for research to be completed in this area. As
hospitals seek ways to manage the transition of GNs and utilize mentorship program, the
hospitals will likely experience other benefits including the benefits to the mentors discussed, as
well as the potential for improved cost effectiveness.
Cost Benefit Analysis

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21

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.
Cottingham et al. (2011) examined the implementation and cost of a mentorship program,
Partners in Nursing (PIN) (p. 250). The PIN was developed by the Community Foundation of
the Eastern Shore which is located in Salisbury, Maryland. The program was developed to
combat the nursing shortage. The project was meant to address three concerns previously
identified: GN turnover, diminished support of nursing leadership, and nursing shortage in the
area (Cottingham, 2011). The estimated cost of nursing turnover was $10,000 per position. After
18 months of the program the organization found the cost of supporting one mentor/protg pair
was estimated to be $8,552 (Cottingham, 2011, p.254). The return on the initial investment was
significant. The study was limited by the participant sample size and the use of only one location
for research. Further research should be conducted to validate the associated costs and results.
Faron and Pelter (2007) wrote a qualitative review on increasing retention rates through
mentoring. The program included 57 new graduates hired in one year and 85 mentor/mentee
relationships at Sharp Mary Birch Hospital for Women in San Diego, California. Before the
implementation of the mentor program the hospital had a new graduate turnover rate of 20%.
After implementation the turnover rate dropped to seven percent (Faron & Poeltler, 2007). They
found that at a 20% turnover rate cost $660,600 to replace 11 GNs; however the cost for a seven
percent turnover rate of four GNs was $242,400 (Faron & Pelter, 2007). The cost of the program

NURSE MENTORSHIP AND NURSE RETENTION

22

for one year totaled $95, 400, less than a quarter of what the hospital was saving in training costs
in one year. The studies reliability is limited by the inclusion of only one location and a small
participation pool. Further research should be conducted to build upon the results found.
Foster and Hillman (2011) conducted a qualitative/quantitative study to evaluate the
effectiveness of a GN residency program over a four year period at the Childrens Hospital of
Michigan in Detroit, Michigan. Retention rates two years prior to the implementation of the
residency program were 49%, since implementation the retention rate rose to 73% (Foster &
Hillman, 2011). The study found that the cost savings could be estimated at 4 million dollars
over the 4 years if using an approximate monetary value of $50,000 per nurse, a cost used by the
hospital system office or nurse recruitment (Foster & Hillman, 2011, p. 55). The researchers are
currently still gathering qualitative support for the study. The research was only conducted at the
one hospital in Michigan, thereby making the results potentially limited.
Another study which examined the cost of nursing mentorship is by Latham, Hogan and
Ringl (2008). In this qualitative/quantitative study which lasted three years and included 171
registered nurses. The program was initiated in 2 hospitals: a 450 bed non-profit community
hospital and a 400 bed teaching medical center (Latham et al., 2008). The program measured
different concepts including teaching and learning styles, personality, occupational stress,
professional practice environment, assessment of Magnet elements of nursing services,
organizational cultural competency, self-perceptions of cultural competency, and mentor
evaluation (Latham et al., 2008). The study paired mentors with willing mentees to improve
work environments and patient outcomes. Preceptor and mentor roles were clearly defined in
order to differentiate and demonstrate that this was a mentorship program not a preceptorship.
Review of the program found that the mentors had prevented more than 24 RNs from leaving

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23

the two hospitals, with a cost savings of almost $2.5 million using a $100,000 per RN
replacement charge(Latham et al., 2008, p. 38). The study does identify that nurse-to-nurse
support is only one piece to the puzzle. Limitations to the research include the sample size and
the use of only 2 hospital locations. New research needs to include a larger sample pool and
multiple locations in order to substantiate the results.
In 2007 a review was done of the nurse residency program at The Methodist Hospital in
Houston, TX. The article stated that there is documented stress related to a GNs preparedness,
their role performance, and retention. The hospital was facing a 50% turnover rate in 2003 and
chose to face this problem head on with the development of a nurse residency program (Pine &
Tart, 2009). The design of the program was meant to address a range of issues including clinical
practice and professional growth (Pine & Tart, 2009). At the end of the first year of the program
a cost benefit analysis was completed. The analysis found that the program was cost effective
with a cost savings of $823,680. After program implementation the retention rate improved from
50 % to 89% (Pine & Tart, 2009). The review includes only on nurse residency program, which
limits the results and requires further review to corroborate the previous findings.
Studies have shown that GNs are unprepared for the transition from student to
professional. GNs expressed a desire to gain long term development in clinical judgement and
debriefing skills (Trepanier, Early, Ulrich, & Cherry, 2012). This study included 15 hospitals,
finding that before implementing a residency program the estimated cost of nurse turnover was
estimated to be $17,977,500 and after the institution of the residency program that number
plummeted to $2,749,500 (Trepanier et al., 2012). A cost comparison between a traditional
orientation program and a residency program was conducted, which yielded a potential savings
of $13,460 per participant. The study did include some secondary information that may be

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24

potentially unreliable. The inclusion of such information requires further research to confirm the
results.
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. A gap remains in the literature
demonstrating a need for further research.
Summary
The literature reviewed demonstrates use of Ericksons 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

NURSE MENTORSHIP AND NURSE RETENTION

25

mentorship programs of GN retention, the proposed study will further research this issue. The
proposed study will focus on the effects of a nurse mentorship program on the retention of new
GNs at multiple hospitals in the Detroit area. The design, method, sample, and analysis of this
study will be discussed in chapter three.

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26

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