EDUCATION AND PROFESSIONAL DEVELOPMENT

Wise women: mentoring as relational learning in perinatal nursing practice

Annette Ryan, Lisa Goldberg and Joan Evans

Aims and objectives. The focus of this paper is on one of four themes from a study exploring mentoring relationships between nurses in the intrapartum setting. The theme, relational learning, highlights how perinatal nurses engage with each other and engage with birthing women on a journey of learning in perinatal nursing practice. Background. Few studies have explored the contextual, lived experiences of informal mentoring relationships within nursing, particularly within perinatal nursing. Design. A qualitative feminist phenomenological study that considered a gender-centred, embodied exploration of human lived experiences was conducted. Method. Five registered nurses practicing on a tertiary level labour and delivery unit in eastern Canada were purposefully recruited. Data were collected by phenomenological interviews, practice observations in the clinical setting and reective journaling. Results. Four themes emerged through thematic analysis and researcher interpretation: the meaning of nurse-to-nurse mentoring, mentoring as relational learning, mentoring as embodied learning and a contextual understanding of nurse-to-nurse mentoring. Relational learning came to be understood through feminist phenomenological analysis, which revealed that expert perinatal nursing knowledge develops within positive mentoring relationships between perinatal nurses practicing with birthing women. This learning extends beyond tasks to a holistic understanding of clinical situations within specic health and social contexts. The mentor models positive perinatal nursing practices and creates a sense of enthusiasm that harnesses the raw passion new nurses often have for practice. Conclusion. The ndings in this study aim to promote the understanding of the importance of relational, experiential learning for perinatal nurses professional development. Relevance to clinical practice. The results from this study will encourage nurses and nurse leaders to support mentoring by providing adequate resources and positive feedback for mentoring relationships. This will foster and sustain expert nurses to support novice nurses in perinatal practice. The ndings also offer insight for perinatal practices beyond nursing, including midwifery. Key words: learning, mentoring, nursing, perinatal care, phenomenology, qualitative
Accepted for publication: 31 March 2009

Introduction
Nurses in practice often use informal, unit-based and relational sources of new knowledge selection, transfer and
Authors: Annette Ryan, RN, MN, Perinatal Nurse Consultant, Reproductive Care Program of Nova Scotia, Halifax Professional Centre, Halifax, Nova Scotia, Canada; Lisa Goldberg, PhD, RN, Assistant Professor, Dalhousie University, School of Nursing, 5869 University Avenue Halifax, Nova Scotia, Canada; Joan Evans, PhD, RN, Associate Professor, Director, Communications Skills Program, Division of Medical Education, Dalhousie University Halifax, Nova Scotia, Canada

use (Asselin 2001). In the last few decades, nurse researchers have begun to use feminist and sociological theories to highlight the unique knowledge base of nurses that is grounded in the caring relationships and lived experiences
Correspondence: Annette Ryan, Perinatal Nurse Consultant, Reproductive Care Program of Nova Scotia, Halifax Professional Centre, 5991 Spring Garden Road, Suite 700, Halifax, N.S. B3H 1Y6, Cananda. Telephone: (902) 470-6619. E-mail: annette.ryan@iwk.nshealth.ca

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of nurses as women as opposed to knowledge that is purely objective and analytical (Hagell 1989, DeMarco et al. 1993, Perry 1994, Im 2002, Goldberg 2005, Routledge 2007). Therefore, it is important to consider the unique daily interactions between nurses that build meaningful relationships and thus inuence uptake of clinical knowledge. This discussion, then, focuses on mentoring relationships between nurses in the intrapartum setting and how perinatal nurses engage with each other and engage with birthing women and their families, on a journey of learning in perinatal nursing practice.

Background: exploring the mentoring literature

Mentoring is a broad concept that may include aspects of preceptoring, role modelling and coaching. However, typically preceptoring, role modelling and coaching do not involve long-term, established relationships and are thus, only components of the mentoring relationship (Fox et al. 1992, Haynor 1994, Smith et al. 2001, Faron & Poeltler 2007). According to Parse (2002, p. 97), mentoring arises when two or more presences engage in a dialogue about a scholarly opportunity. This mentormentee relationship is one of complex, non-linear human interactions involving collaboration and transformation, which are key to professional nursing growth. Benner (1984) describes professional nursing growth as a transition and evolution of nursing knowledge from novice to expert within specic nursing practice contexts. The ve levels of transition include: novice, advanced beginner, competent, procient and expert. There have been several models and frameworks created to outline the processes of mentoring. At present, no singular model of mentorship is deemed superior to another. Thus, although the literature suggests that nurses value mentoring and mentorship, there is considerable confusion regarding the mentoring role (Andrews & Wallis 1999). Researchers cited several benets of mentoring for mentors, mentees, the nursing profession and health care organisations. Benets include pride in facilitating the professional growth of another nurse (Groah 1996), the creation of nurses who will become mentors (Scott 1990, Smith et al. 2001, MoererUrdahl & Creswell 2004), reduced costs for recruitment and retention of nurses, improved patient outcomes and enhanced patient satisfaction (Smith et al. 2001, Greene & Puetzer 2002, Scott 2005). Therefore, it is imperative for health care organisations to explore processes of mentoring in an effort to create and modify organisational policies that reect value for nursing and nursing professional development (Almada et al. 2004, Boswell et al. 2004, McKinley 2004, Murphy et al. 2004, Santucci 2004, Tourigny & Pulich 2005).
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Mentoring that occurs in the practice environment and which is initiated and developed between nursing colleagues without formal organisational supports is termed informal mentoring (Tourigny & Pulich 2005). Informal mentoring refers to a relationship based on mutual identication and personal development needs (Tourigny & Pulich, p. 71) where knowledge is transferred between peers and is based on personal experience, intuition, judgement, know-how, expertise and individual insight (Tourigny & Pulich, p. 68). Understanding mentoring relations and the transfer of knowledge from nurse to nurse is key to providing positive, supportive practice environments for nurses and an integral component of recruiting and retaining nurses in practice (Neuhauser 2002, Hom 2003, Hurst & Koplin-Baucum 2003, Mills et al. 2007). Although structured mentoring programs have been studied in several professional settings, few studies have explored the contextual, lived experiences of informal mentoring relationships within nursing or perinatal nursing. Thus a phenomenological study with a feminist perspective was warranted to explore the meaning of informal nurse-to-nurse mentoring relationships within current historical, intra and interprofessional, social, economic and gendered health care contexts.

Method
Methodology: for embodied practices
The methodology for this study was feminist phenomenology, which considers a gender-centred, embodied exploration of human experiences. The nurse researcher who works with Merleau-Pontys existential phenomenology seeks to discover [study] participants/patients perception of their lived experience (Thomas 2005, p. 69). Perceptions are based on intentionality (situated perspective) with the environment, placed against dynamic, contextualised cultural and sociopolitical backgrounds and involve interconnectedness between humans and the life world (Thomas 2005). As well as individual interactions with the world, Merleau-Ponty supported interactions with others as fellow travellers in lifes journey (Pollio et al. 1997). This offers opportunity for dialogue involving reciprocal intersubjective relatedness and coexistence within a common world (Merleau-Ponty 1945). Although aspects of existential phenomenology (focus on everyday lived experiences, embodiment, perception and contextualisation) are shared by feminist theory (Code 1991), the work of Merleau-Ponty was implicitly framed by a male perspective (Grosz 1994). This renders invisible the effects of oppressive and androcentric forces within society. Feminist phenomenology, however, focuses on the lived,

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Education and professional development

Mentoring and relational learning in nursing Table 1 Interview question guide 1 I am interested in nurse-to-nurse mentoring on the unit. Please tell me about your experience of nurse-to-nurse mentoring on the labour and delivery unit. 2 What is your understanding of mentoring? 3 Please tell me about your experiences as: A. a mentor B. b mentee C. both 4 What factors supported the mentoring experience? 5 What factors inhibited the mentoring experience? 6 How is the mentoring experience different for you now compared to when you rst began practicing?

diverse experiences of women situated in broader sociopolitical, historical and economic contexts and thus explores the complex social relations that shape the lived realities of women. These realities are often shaped by a male-centred world (Goldberg et al. 2009). In keeping with the tenets of feminism, this inquiry was mutual, informative, subjective and aimed at, not only gathering valuable participant information, but also in sharing research ndings with nurses. From a feminist perspective, this offered participants valuable insights into the mentoring experience and potentially aimed to improve perinatal nursing care, patient outcomes and inuence health care policy development.

Participants
Through purposeful sampling, ve registered nurses were recruited from a labour and delivery unit in a tertiary level hospital in eastern Canada. This provided a sample of participants who had experiences relating to the phenomenon being researched (Kruger 1988, p. 150). This form of sampling is congruent with a qualitative design (Sandelowski 1995, Coyne 1997, Barbour 2001, Byrne 2001). Inclusion criteria included participants being a registered nurse practicing on the labour and delivery unit at the tertiary care centre, who completed orientation and worked on the unit for at least two years and who stated she has been a mentor and/or mentee. The participant sample included a diverse sample of nurses all with a variety of experiential, educational and professional backgrounds. This enabled the capture of multiple perspectives to contribute to the rich interpretive descriptions of storied data. Recruitment occurred through presentations to nursing staff, information posted on the bulletin board in the staff lounge and education room and via an in-hospital email system.

participants referred to colleagues or birthing women. Two practice observations of approximately 612 hours were completed on the labour and delivery unit of the tertiary centre where the study participants practiced. The observation periods did not always include nurses who participated in the interviews. The researcher looked for and listened to the stories of how nurses engaged with each other and with birthing women and their families and how these engagements inuenced nurses learning. Further, the practice observations provided an opportunity for purposeful focused observation aimed at providing a deeper understanding of contextual factors (Maggs-Rapport 2000) that inuenced mentoring relationships. During practice observations, the role as researcher was clearly articulated to all staff, women and families and written notes were completed after each practice observation. In addition to the interviews and practice observations, a reective journal was maintained to reveal the researchers locatedness and to link theoretical, professional and personal knowledge with the data and the research experience (Benner 1984, Fakude & Bruce 2003).

Data collection
On approval from the required health ethics review board, data were collected using one-on-one interviewing, practice observations and reective journaling. Written informed consent was obtained from each participant prior to commencing the study and to maintain condentiality, all study materials were kept in a locked le cabinet. Five unstructured, conversational interviews ranging from 6090 minutes in duration were completed. Six questions guided the informal discussions (Table 1). All interviews were audiotaped and transcribed verbatim and took place at a time and in a location convenient for the participants. In the phenomenological analysis process, pseudonyms were used for participant direct quotes or when

Data analysis
Through thematic analysis of interview data in a feminist phenomenological framework, the commonalties were explored between nurse narrative responses to highlight the meaning of the lived experiences of the mentoring relation. Reexive notes taken after each interview and after the observation periods were used to facilitate interpretation of data. The existential themes of body, time, space and relation (van Manen 1997) were discussed in a feminist interpretation that was attentive to the impact of gender, power and oppression in the perinatal nursing practice environment. The result of the analysis was textual data of the feminist phenomenological account of the perinatal nurse-to-nurse mentoring relation.
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A Ryan et al. The centre of it all, of all the learning happens in the room with the labouring woman. We talked about the care and read through the policies but the real learning was with the woman in labour and watching the nurse [mentor] be with her and do for her and know herknow her as a unique person experiencing birththat showed me who I needed to be.

Results and discussion

Four themes emerged from the participants stories and through researcher interpretation and analysis: the meaning of nurse-to-nurse mentoring, mentoring as relational learning, mentoring as embodied learning and a contextual understanding of nurse-to-nurse mentoring. In what follows, the theme of mentoring as relational learning is discussed as a way of understanding how the relationships perinatal nurses have with each other and with birthing women are central to the learning and mentoring relationships that support the evolution of perinatal nursing expertise.

Mentoring as relational learning

In that moment I saw her [the nurse mentee] connecting with the labouring woman and I knew we did it, we got her thereit took some time and encouragement but we did itwe got her to the point where she is a labour and delivery nurse. (Margie, nurse participant)

Further, such learning also transpires between and among nurses themselves. Bergum (2003) suggests that there is a relational space between intersubjective objects in the world. For perinatal nurse-to-nurse mentoring, the relational space is the space of learning that supports birthing women and that transpires between nurse mentors and mentees in complex health, social and gendered contexts. It occurs in a hegemonic, hierarchical and biomedical birthing space. Young (1990, p. 59) recognises the challenges of professionals who perform caring functions for birthing and pregnant women in the current medical realm. She says:
They are usually women, usually poorly paid and their activities are usually seen as complementing and subordinate to the direction of activities like diagnostic tests, drug and surgical therapies by the physicians, usually men. The alienation experienced by the pregnant and birthing woman would probably be lessened if caring were distinguished from curing and took on a practical value that did not subordinate it to curing.

The elation of Margies words show in her broad smile as she proudly recalls the moment when she knew that the young and inexperienced nurse she mentored had become a perinatal nurse. This becoming was demonstrated by the nurse mentees interactions with the birthing woman, not only in her ability to start an intravenous or titrate an oxytocin infusion, but more importantly, in the integration of those skills as she engaged with the birthing woman. It is in the relationships between perinatal nurses and birthing women that perinatal nurses engage with each other and engage with birthing women and their families on a journey of learning and nursing professional development. Through conversational interviews and participant observations, Goldberg (2005) explored the relationships between perinatal nurses and birthing women in the context of hierarchical health care practices. She found that the relationship between birthing women and perinatal nurses is unique. In a short period of time an engagement occurs that unites the two together in an embodied experience that ends with a remarkable journey: the birth of a baby (Goldberg, p. 401). Similarly, there is considerable research about the midwifewoman relationship (Kirkham 2000). Lundgren and Berg (2007) highlight concepts such as meaning, trust, mutuality and availability in building a positive relationship between the midwife and the birthing woman. Thus engagement points to a key nding in both perinatal nursing and midwifery care. Julie, a novice nurse from the study describes the learning relationship as one built on the relational learning that transpires between and among nurses and birthing women. She says:

Doane (2002, p. 401) describes relational practice as a humanely involved process of respectful, compassionate and authentically interested inquiry into anothers (and ones own) experiences. Nurses who are able to understand their own life contexts and the life contexts of others are engaged in this relational learning space and thus, are able to fully engage in nursing practice. Merleau-Ponty (1962, p. 119) describes this intersubjective nature of the lived body as never purely individual. It is constituted in relation to the Other and is therefore uniquely specic to my social, environmental and familial situation.

Modelling perinatal nursing practice

Although each relationship with a birthing woman and each mentoring relationship between nurses occurs in a complex situatedness, there are some noted similarities realised in the stories of the participants in the study. Sara, an experienced nurse from the study, suggests that learning occurs when nurses observe each other interacting with birthing women. Cate, also an experienced perinatal nurse, agrees that as a kinaesthetic learner herself, she often models nursing practice to nurse learners. Modelling occurs when the nurse mentee observes and imitates the relationship between the nurse

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mentor and birthing woman. Role modelling and demonstration by expert nurses have been found to facilitate student nurse learning and to improve the uptake of best practices (Eaton et al. 2007). Cate describes herself as a nurse who:
learns by watching and doing. Im not very good at just reading something and thinking well, thats how it has to be done. So I teach in the same way. Ill show, Ill explain, Ill show and as much as possible, Ill tell people why Im performing that task.

Sara also shares how she models the intimacy of the relationship between the nurse and the birthing woman through presence, conversation and touch. She tells of how she has been with several new nurses who stand far away from the birthing woman and attempt to engage with her. Sara says:
They stand at the door, far from the bed or set the table up in the corner to do their charting but I tell them and show them, you need to get closer, to interact with her [the birthing woman].

women with unique birth experiences. This woman-centred view of women as individuals in their unique, embodied, birth experiences is in keeping with perinatal nursings holistic view of the patient where all parts of being human make up the greater whole (Newman 1997) and in keeping with the philosophical tenets of phenomenology which espouses an integrated body-subject view of the self (Wilde 1999, Goldberg 2002). Cate, for example, tells how the unique stories of birthing women are central to her mentoring relationships. She describes the importance of obtaining the counsel of her nursing colleagues when caring for birthing women. She says:
to me, thats very much the mentoring. Its daily, its ongoing, its subtle, you know. Somebody will come out and say, well, you know, Ive done this and Ive tried that. Well, your counsels there and its a group of people at the desk saying, well have you done this, or, I always try and do this and if that doesnt work, then you know, maybe youre going to have to call them back and say, its not working and the trial and so I mean, its not one person you mentor, its the group.

Through her own engagement with the birthing woman, Sara encourages the mentee to get closer, to be physically engaged and to talk with the birthing woman and her family. This enables the nurse to begin to build the relationship with the birthing woman, to develop a connection that is genuine, unique and meaningful. Goldberg (2005, p. 405) describes the initial moments between a nurse and birthing woman as introductory engagement. She considers this an interaction [which] is crucial to establishing a relationship with birthing women. The gazing, touching and listening qualities of a perinatal nurse are not forgotten by the women who have been in their presence. This authentic connection (Bergum & Dossetor 2003) is modelled by the mentor as she interacts with birthing women, and thus provides the mentee with an example of how to begin the nurse and birthing woman relation. A genuine relationship between the nurse and the birthing woman creates respect and trust. Trust between the birthing woman and the nurse is described by Goldberg (2008) as key to fostering the birthing womans trust in her own bodys power to birth. Trust and respect are not only key to creating positive relationships between nurses and birthing women but are also important for mentoring relationships (Bergum & Dossetor 2003). During the practice observation periods conducted on the unit, it became clear that the birthing space is also the learning space without the physical bodily presence of the birthing woman. In other words, when nurse mentees and mentors talk to each other about the experiences of birthing women, as a means to seek advice and/or validation for nursing practice from their colleagues, they typically do not speak of women in general terms but they tell stories of

However, nurses woman-centred philosophy is challenged in current institutionalised birth environments. Although perinatal nurses attempt to regard birthing women as embodied beings, encapsulating intentionality and capable of determining their own birthing trajectories, the Cartesian ghost is forever resurfacing in an attempt to objectify the body of the Other (birthing woman) (Goldberg 2002, p. 447). When the birthing woman is the topic of learning, she becomes a relational subject in the learning. The birthing woman is the central text on which nurse mentees and nurse mentors share their relational learning space. What this means is that the caring relation between the birthing woman and the nurse mentor becomes the model for the nurse mentees understanding of how to be a perinatal nurse. The nurse mentee is able to connect her theoretical learning to experiential nursing practice. Benner (1984) asserts that nurses must identify patterns of development and knowledge acquisition to connect theory to practice and to explore transitions from novice to expert. This sense of being a perinatal nurse reaches far beyond the tasks of nursing, to a place where engagement and conversation with the birthing woman is modelled by the mentor and mirrored by the mentee. This mirroring is key to authenticating the success of the mentor/mentee relationship and it is key in providing positive feedback to the mentee that she has performed well and to the mentor that her efforts have created learning in the relational space (Smith et al. 2001, Mangone et al. 2005). Modelling not only occurs when perinatal nurses show each other how to practice with birthing women, but also
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happens when nurses model how to engage with each other. Cate shared her most memorable stories of being a mentee. She was relatively new to the nursing profession and she was in a new and unfamiliar practice setting where she was marginalised due to cultural differences. Fortunately, the charge nurse, who was a highly regarded, knowledgeable and experienced nurse, took Cate under her wing. In fact, Cate said she did not see in herself what this nurse saw and:
she was just this incredible womanand when you rst met her, youd think, ohhh, god, she looks so sharp and stern. Then shed smile and I mean, her whole personality was in that smile it was her example of how she treated me and peoples attitude towards me [changed] and it took a lot of hard work on my part to be accepted. And in the end I was and I have to say, I was.and respected, on my own merit. Without her, it would never have happened.

I am thus socially constituted and my identity is built on the interpenetration of self and Other and Others are already socially constructed beings also. The modes of being - and their social signicance - are incorporated into myself and therefore the limits to my potential modes of being will vary depending on whom I associate with and under what social/environmental contexts.

The above discussion not only demonstrates how the charge nurse mentored Cate as an individual nurse but also further demonstrates how she mentored the other nurses, by example, through the way she treated and interacted with Cate. It also shows how collegiality, respect, openness to ideas and believing in others are key to supporting nurses in practice. Farrell (2001) suggests that to obtain widespread collegiality in nursing, nurses need to consider a multi-level approach to battling conict in and beyond the nursing profession. This approach considers identifying and challenging broader, misogynistic structures, organisational structures and workplace practices and nally, nurse-to-nurse relationships that perpetuate conict in nursing.

Beyond the tasks: creating the learning space

Well, you know, its not automatic. You have to it comes over time and I dont know if thats really something you can teach versus its just youre teaching all the individual things and you just get faster. It just, eventually, like I cant fathom coming in and thinking, my god, I can talk to a patient, ask them everybodys names, their life story, start their IV and doing theyre screaming and you know, if theyre really distressed, waiting for an epidural and theyre seven centimetres and like, doing all that and just talking to them calmly and remaining calm [myself].

To create a positive learning space, mentors focused rst on the task-oriented skills of nursing and then transcended beyond to a point where relations with others, primarily the birthing women, become the learning space. According to Bergum (2003), the tasks need to become an extension of the body of the nurse so that the needle being inserted in the vein is used in an embodied way and is not the focus of the interaction with the patient. As Goldberg (2002) suggests, nurses need to reexamine nursing care beyond the tasks, to celebrate birthing women as embodied, subjective beings. Although, many of the study participants acknowledged the importance of learning new skills as mentees, they focused more so on how mentors enabled them to build relationships with labouring women. This emphasises the importance of human-to-human interactions and relationships in nursing care (Gadow 1988, Benner & Wrubel 1989). Hartrick (1997) suggests that models for care in nursing need to move beyond objective mechanistic/ behavioural models to models of interpersonal practice that recognise the complexity of human relating. Learning through human relating involves sharing of narratives with the birthing woman and sharing between nurses. Gadow (1999, p. 65) describes this sharing between nurses and patients as ethical narratives created by patient and nurse from the homeland of their engagement [which] are thus more than individual accounts: they are relational narratives. When the life stories become the focus of nursing care, the nursing tasks eventually become habitual acts that supplement the nucleus of the learning space, which is the space shared between mentor and mentee with the birthing woman.

Perinatal passion and meaning

I can weep just as easily today over a delivery, than I can when I rst startedand a lot of it has to do with the people that youre with and what you put into it, how much youre putting into it and yes, you connect better with some than others, but theres always, always, a lurch in my stomach or in my heart, that says, wow.

Kayla, a nurse participant, reects on her learning over time and how she is able to integrate all her knowledge of being a perinatal nurse and put that knowledge into action to support birthing women. Her embodied actions with nursing peers and birthing women have inuenced the evolution of Kayla as a perinatal nurse. Merleau Ponty (1962, p. 148) describes how our embodied interactions in the world create our world. He says:
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Cates eyes glazed with tears as she reected on what being a perinatal nurse means to her and as she remembered the shared moments with women during the miracle of birth. It is this connection to the heart that provides meaning and purpose for perinatal nursing practice. Nurses who nd nursing practice meaningful discover a sense of intrinsic

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value, which provides them with self-afrmation (Pask 2003). When a perinatal nurse has passion, it is an infectious force that acts as a motivator for those in practice and a recruiter for those seeking perinatal practice (Borchardt 2005). Julie, a nurse participant describes comments she received from a nursing student. She says:
I dont get as much opportunity to be a preceptor, but recently I had a student nurse for a day. And she just sent me this long card the next day, saying, thank you so much. You wouldnt believe how much your passion is contagious and its so great to hear you talk about how much you love this.

Nurses, both in practice and student nurses coming into practice, need to hear about the positive stories in nursing and how perinatal nurses love for being with birthing women and sharing the life-altering experience of birth, keeps them practicing. Staden (1998) concluded that, although the emotional work nurses do to develop relationships with patients often lacks social value, nurses nd the relationships they develop with patients bring them great joy and meaning. The nurse participants in the study all cited a mentee and a mentors passion for and commitment to perinatal nursing practice as integral to supporting a positive mentoring relation and for supporting positive relations with birthing women. Cate shares her love for perinatal nursing in the reverence she has for women and their ability to birth:
But I mean, its that incredible, incredible feeling of, wow, when people say, oh, thank you for all the work youve done and you think, really, really, if you only knew what your own body has just done. Thats the phenomenal work, you know. You have done it. I was just here. I was a guider, I was a councillor, I was a coach, I was but the work you have doneAnd yes, all the committees and all the rest of it to make things better, theres still nothing as happy, or theres nothing as satisfying as doing the hands-on care. And if I give back something, then I give it back maybe in teaching others and being there for others.

perinatal nursing practice. At a time when the nursing shortage is escalating, the average age of a registered nurse in Canada is 45 years (Villeneuve & MacDonald 2006) and professional development opportunities are few, novice nurses depend more and more on their expert colleagues for support and mentoring. This research clearly demonstrates how informal nurse-to-nurse mentoring is a daily part of nursing professional development. Nurses become expert perinatal nurses through learning that occurs in the relationships between nurses and between nurses and birthing women. Although structured orientation, theoretical knowledge and foundational nursing education provide a framework for becoming a perinatal nurse, experiential learning is embodied in the mentoring relational space between nurses and birthing women. This relational learning happens through engagement with the birthing woman and the modelling of perinatal nursing practices by the mentor with the birthing woman. Concurrently, the nurse-to-nurse mentoring relationship sparks passion and meaning for perinatal practice and not only motivates the novice nurse to become an expert perinatal nurse but also inspires nursing students to engage in perinatal practice. It is important to note that there are several gendered, historical, political, professional, social and economic factors that also inuence nurse mentoring. These are explored further in the fourth theme of this work. As van Manen (1997) suggests, phenomenological work has the potential to elicit diverse responses from those who read the work and for those who were participants in the work. The feelings elicited from readers engagement with the work may range from feelings of discomfort, anxiety and guilt, to hope and increased awareness and liberation, depending on where readers see themselves in the work. These feelings can advance awareness and thus effect change in clinical policy and practice.

Similar to Cate, Goldberg (2004) describes the notion of reverence enacted in perinatal practice when a nurse elicits deep respect for the birthing woman and her family through her ability to individualise care to meet the unique needs of the birthing woman in her own life context. For Cate, teaching and supporting other nurses to revere the birthing woman and her family, creates a sense of excitement, enthusiasm and philosophical direction that harnesses the raw passion new nurses often have for practice.

Relevance to clinical practice

The ndings from this research are intended to encourage nurse leaders, nurse administrators and nurses themselves, to support mentoring relations by providing adequate time, human resources and positive feedback for mentoring relationships. It is anticipated that information from the study could stimulate changes to mentoring practices that will improve the perinatal nursing practice environment and increase recruitment and retention of nurses in perinatal care, which will have a positive impact on birthing womens wellbeing. This inquiry has implications not only for informal nurse-to-nurse mentoring in perinatal care but in other nursing and midwifery practice settings as well. It may also inuence the development of policies to support formal
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Conclusion
The ndings from the study aim to promote an understanding of the importance of mentoring and experiential learning in

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mentoring programs such as mentor match programs and preceptoring.

Future research
Future research related to nurse-to-nurse mentoring illuminated by the study include: the importance of exploring gender and power in nurses subversive communication with other health care professionals (e.g. physicians), a more in-depth exploration of bullying or horizontal violence in nursing and an exploration of nurse-to-nurse mentoring in other perinatal practice settings such as antepartum or postpartum and more generally, in other nursing and midwifery practice settings.

Acknowledgements
The authors thank Research Services at the IWK Health Centre for providing funding for this project through an IWK Category A Research Grant, thesis supervisors, Dr Lisa Goldberg and Dr Joan Evans and thesis committee members, Professor Denise Sommerfeld, Dr Sue Campbell and Glenda Carson. A special thanks to the exceptional nurses who participated in the study, the richness of your stories and your honesty and raw passion for perinatal practice and nurse-tonurse mentoring made this work possible.

Contributions
Study design: AR, LG, JE; data collection and analysis: AR, LG and manuscript preparation: AR.

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