ENTRAR            

INSTRUMENTS

The mentorship program in the competency development of Nursing professionals: the perspective from the United Kingdom

Rafaela Camacho Bejarano,¹ Yuneysa García Flores, ² Germán Calvo González,³ Antonio Luis Carrasco Gómez,⁴ Juan Gómez Salgado^5
1Departamento de Enfermería. Universidad de Huelva, España. ²Unidad de Neurología. Hospital Insular. Las Palmas de Gran Canaria, España. ³Unidad de Traumatología, Hospital Juan Ramón Jiménez, Huelva, España. ⁴Unidad de Ginecología. Hospital Infanta Elena, Huelva, España. ⁵Distrito Sanitario Condado-Campiña. Universidad de Huelva, España

Manuscript received by 18.3.2010
Manuscript accepted by 15.6.2010

Index de Enfermería [Index Enferm] 2011; 20(1-2): 101-105

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Abstract

Training is one of the keystones in which professional satisfaction and healthcare quality are sustained. The European Space for Higher Education has emphasized the imperious need for guaranteeing an adequate training for professionals focused on competency acquisition, integrating academic and practical education. The mentorship program is an initial training system promoted by the NHS (National Health Service) in the United Kingdom for newly qualified staff nurses. These programs offer the possibility for novice nurse to have an adaptation period to their new professional role, having an expert nurse as reference, who will be responsible for providing orientation, training and feed back to these new professionals within their specific work environment. This program will enhance their motivation and professional satisfaction at the same time than guaranteeing the delivery of a high quality care based on an excellence and patient safety model.
Key-words: Mentor/ Nursing Continuing Education/ Competency- Based Education/ Staff development.

Introduction

    In the past few years, as part of the European Convergence Process, the importance of the competency acquisition at academic and professional level has been emphasized. Now, more than ever, there is an existing consciousness about the need for new qualified professionals to have an academic education focused on their future professional profile.
    Within the healthcare settings, new competencies have been included to guide the basic training of future healthcare professionals, adjusting their profile to the current healthcare system and society demands. These competencies acquisition is based on a basic academic education complemented with a practical training, where aims and follow up are set in order to assume the specific professional responsibility.
    In this complex way for competency acquisition, it is necessary to consider an initial training period where basic aspects of the healthcare organization are included, facilitating the adaptation of newly qualified and new staff to their new jobs, optimizing resources use and guaranteeing a high quality care based on excellence achievement and on an appropriate professional training.¹

What is a mentorship program?

    The mentorship program (induction or training program) consists in an accompaniment process to support the role development, and to facilitate the integration within a professional group or the reference institution. The mentor/ tutor is a professional with a wide training and experience that assumes the responsibility of guiding and assessing the mentee on the professional development.^2,3
    There are different types of trainers within the clinical setting which have been developed and strengthened from their original role. The preceptor figure was implemented in the United Kingdom around 1960.They were initially Nursing professionals with a wide clinical experience although other qualities such as the motivation for teaching and communication skills were considered.³ Furthermore, the coach represents a figure which provides the novice nurse a critical and objective perspective about their role, being a professional guide. Is the person in charge of providing support in the professional development.^4,5
    The mentor role, on the other hand, seems to reflect the progress of the two figures mentioned above. According to Stolovitch and Keeps (1999) mentor is an individual who attends the novice growing and learning needs though their professional experience and qualification.⁶ This training process, mentorship or training program has to be flexible and individualized, and followed up by qualified professionals. Mentors help mentees to get confidence and to perform their role on a safe and responsible manner throughout an adequate knowledge and skills and a reflective practice, which will provide them the keys for an optimum organization as well as solving problems strategies to assess their professional decision making process. The mentor should not set any prejudices on the mentee but has to facilitate his role to help the mentee feeling comfortable facing complicated situations. The novice nurse will be able to analyse and reflect upon the complexity of the organization of the healthcare system and establish the orientation of his/her career.¹ Megginson and Clutterbuck (1996) described mentorship as a support provided by one person to another regarding knowledge, work or thoughts transmission.⁵ In this case, the mentor covers the personal and professional assessment as well as a teaching role from teaching and future professional development perspective. The mentor assumes the responsibility of helping the mentee getting confidence and motivation through new knowledge and reflection, facilitating them the clues for an optimal organization and the required strategies from problem- solving and decision making capacity, applicable to their working environment. The mentor should not set prejudices on the mentee but support him/her facing complex situations. Within the main objectives it is agreed that the novice has to be able to deep in the healthcare organization and establish the criteria for the consequent development on their professional career.^4,5
    Through the mentorship program, the mentee gradually acquires the competencies required and escalates on the professional career, reflecting on a higher working satisfaction and self-fulfillment. The novice will reach the competent level and, in the near future, to develop his/her capacity to manage new and potentially stressful situations.
    Overall, this mentorship program consists on an adaptation period and initial training where novice professionals have the opportunity of get an overview of general and specific characteristics of the system. The training process, mentorship or training program should be flexible and individualized, and well organized by the well-trained and motivated professionals. This system ensures and enhances some relevant aspects within the healthcare organization: a higher staff motivation and implication, an integration of the continued education in the competency development and a significant reduction of the clinical variability linked with an increment of safety in care delivery as the key tools to improve the quality of the healthcare system.^7,8
    This model is widely extended within the United Kingdom, where it is included on the continuing training system of each unit or healthcare organization. Basically, the mentorship program is based on an accompaniment of the novice professionals, where the more experienced, more highly motivated and better trained ones organise and develop a follow-up procedure through a regulated training program.⁸ The mentor figure constitutes a role model for the mentee, providing the required assessment to assist their integration on the system.^9,10
    The training program is included in the formative plan of each unit, complemented by the teaching sessions of each clinical areas organized by the continuing training group. The assistance to these sessions is recorded in a learning portfolio which will be used as the evidence of the achieved competencies. This portfolio can also be used to be promoted to a higher competency level, accrediting the received training and the participation on the different seminars.
    Undoubtedly, this approach about the initial training of novice professionals requires a previous investment in human and material resources, although in most of the cases, is enough with a good organization of the available resources and an optimization of the dedicated training time. This change requires a reorientation of the current organizational culture, being essential to have an important support from managers and directives to facilitate its implementation. This is only an attempt to enhance healthcare quality, patient safety and professional satisfaction through a valuable support on their professional development. The teaching duty, inherent to nurses' role, is recognized and made explicit, and fully integrated in this system. Each unit has the responsibility of assuming the initial and continuing professional training and providing the time and tools needed for its development. The mentor profile can be compared, for guidance, with the figure of the practice tutor existing in Spain, although with important nuances regarding role, responsibility, approach and level of recognition.¹³
    The program has demonstrated to have very positive repercussion in Nursing professionals as well as in the quality of the services. There are many studies where this issue is raised and the effectiveness of this measure is proven.^14-16 Sometimes, this training program could be designed by a reorganization and restructuration of the already existing welcome programs, which are present in some Spanish hospital environments. This system could also be extensive to other healthcare levels and services, as is shown by the implementation experience in the United Kingdom.

Aims

    The mentorship program is focused on providing orientation and guidance to newly qualified and recently incorporated nurses, facilitating the adaptation to their new professional role, integrating them within the healthcare institution. It is understood under the denomination of newly incorporated staff all those nurses who start working on a new service, therefore including newly qualified nurses as well as nurses with experience in other clinical areas. Besides, ensures a standardized basic training within the specific clinical settings, including a deeper knowledge on the most common health problems, treatments and protocols, patient demands and organizational principles of the clinical organization.^17,18
    -Specifically, a mentorship program is focused on the achievement of the following objectives:
    -Providing support and information in transitional periods between basic training and the job development in a specific working environment.
    -Facilitate the needed orientation, assessment and reinforcement for basic competencies' development for the professional development.
    -Constitute a support for the current professional demands within a context.
    -Promote personal, professional and social development: increase self-esteem and self-confidence, interpersonal relationships and the participation/ integration of the new team members.
    -Develop a higher implication, commitment and collaboration within the organization members.

Methodology

Mentorship program development

    The total duration of the program can vary according to the mentee needs, although the average is between 4-8 weeks. The logical sequence goes from the more general aspects of hospital dynamic, organization and orientation of the different services towards more concrete issues related to the specific unit and the job development. The mentor is in charge of continuously evaluate the formative requirements of the mentee as well as exploring together common areas of interest and, if required, to contact with another professional involved on that specific issue to provide orientation. In relation to the clinical activity, once the main objectives are covered, the mentee works closely with the mentee, who will gradually assume a higher level of responsibility until reaching the pertinent competency level to develop the professional role in an autonomous manner. In this gradual process, the novice professional can still rely on the mentor support and assessment and other expert professionals working in the same area. At the end of the process, the mentor will certify by a written report the competencies reached as evidence to be included in the portfolio. This is the way of guaranteeing that the mentee is able to develop the basic tasks related to his/her job description in relation to the training received, approaching patients´ care response and consequently. This is the first step on the professional career, where newly incorporated members of the staff initiate their training on a specific area. Once this initial period is completed and, as long as a supplementary training is demonstrated with courses, seminars and scientific work, a higher competency level can be achieved, implying a professional and retributive recognition according to the level of responsibilities assumed.
    This is a cyclic process as previous mentees will become mentors when they reach required training and experience, offering their knowledge for the institution benefit. The implementation of the mentorship program is built upon an evidence based practice and requires a specific training for mentors regarding teaching strategies and an expert knowledge of the clinical settings.⁹ For their teaching profile requirements there are specific courses known as: Facilitating Learning in Clinical Practice, which aims to provide the necessary tools to facilitate the integration and learning of the new staff. According to the literature search, the institutions and organizations which invest more time, effort and resources in professional education and support to mentors and trainers, observe a higher satisfaction and lower professional mobility.^5,17,19
    A study performed by Hall et al. (2009) highlights the benefits of the team work developed by a group of health care students and professionals with experience in the clinical in relation to quality improvement.¹² The main finding of this study is the innovative idea of introducing students as agents of change on the service dynamic. On the other hand, more experienced professionals benefit from students on training, updating their knowledge on new learning tools and the implementation of new protocols and guidelines.²⁰ These results can be applied to a working environment where new and experienced professionals could develop a joined training centered on an evidence based practice and the excellence of care, resulting highly beneficial for the professionals involved and for the organization itself.
    The development of a mentorship program includes an agreement and a compromise between mentor and mentee by a written learning contract, which will be developed with the elaboration a portfolio where all the evidence will be collected and the progress on the new competency levels acquisition will be recorded.
    The design and implementation of these mentorship programs is extensive to other contexts such as University environments, where the mentorship programs have been approached from a double perspective: as guidance for novice teachers, who receive support from more experience ones; and for new students, where an increasing number of universities are introducing a welcome program, being experienced students the responsible for providing information to the new ones.^21,22

Learning contract

    The learning contract is an agreement between mentor and mentee where an analysis of the learning needs and areas of interest is performed in order to determine an individualized training plan. This document will be a guide to orientate the formative program, which assessment will be performed jointly between mentor and mentee, considering the initially set objectives by the institution and the clinical area. This document will be signed by both involved parts and will be the credential for the commitment acquired and the proposed objectives.

Portfolio of evidence

    All this documentation previously described will be reflected on the evidence portfolio. As stated by Barberá, the portfolio is a tool for the collection of written evidence of the personal and professional achieved objectives, ordered and presented following specific guidelines, with the purpose of enhancing a reflective practice (educative, professional or civil).²³ The portfolio is understood as an evaluation system integrated in the learning/ teaching process; it consists on a selection of evidence (on a dossier or folder format) collected by the mentee during the mentorship period according to a specific goal. These evidences (certificates, interviews, academic activities, subject assignments, etc.) allow the mentee demonstrate his/her achievements and, at the same time, the mentor follow-up. The evidence has to be accompanied by a justification and a reflection of the mentee, where the relation between the evidence showed and the learning acquired. These contributions help raising consciousness about what learning and how it is managed, at the time that regulates the learning process. The quality of constant reflection about the own learning makes the portfolio a valuable evaluation system within the continuing training and evaluation framework, strengthening the significant learning. The use of the portfolio has become one of the cornerstones on the competency acquisition; it is considered a methodological tool with two main objectives: the reflection upon the competency development, with the intention of improving it, and the competency accreditation purpose.²⁴ In this sense, it has a formative value (reflection for improving) and other as supporting document (proof of achievement). For this reason the portfolio is an increasingly used tool, being an important contribution for the self-directed learning based on a reflective practice.

Results

Competency levels (Figure 1)

    Professional qualification is reflected on the competency levels system, which is directly related to different levels of responsibility. These competency levels are currently in process of implementation within the Spanish National Health System, being a fact in some regions as Andalucía. The professional organization by competency levels responds to a combination between experience and training, being an essential requirement to assume certain professional responsibilities inherent to specific posts. As described by Benner (2001), there are 5 professional levels o grades of competency acquisition: novice, advanced beginner, competent, proficient and expert. Benner's theory defends that Nursing as profession is under continuous development, mainly influenced by the changing socio-sanitary contexts, the population ageing, the growing prevalence of chronic processes, the higher patient's expectations and demands, the use of new diagnostic and therapeutic technologies, etc., being especially important to maintain a balance between users' and system demands and the training offered to healthcare professionals.²⁵

Conclusions

    A high quality healthcare services and patient safety are two of the keystones in the policy design over the last few years, where the patient/ user is placed as the heart of the system, being a responsibility for healthcare professionals in general, and for nurses specifically. Adequate training is an essential tool to guarantee the best possible health care within an evidence-based context. This mentorship program offers a valuable support for newly qualified and recently incorporated nurses, being also a recognition for experienced and trained nurses who develop the mentor roles. This is perfectly articulated within the nurses´ continuing training system.
    The mentorship program is a basic tool to ensure novice nurses´ adaptation process and basic training, enhancing the quality of the care provided and the integration of theory and practice. Through this training system, the risk of errors and professional stress is significantly reduced. It could be integrated on the different regions accreditation system, such as Andalucía, and create the initial stage for novice nurses.
    Simultaneously, this program becomes the credential evidence of their teaching role of the most expert and better trained professionals, improving novice nurses and their own level of motivation and implication, facilitating a high quality care delivery based on the excellence, reducing the clinical variability associated risks.

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