Small Group Mentoring 1
Small Group Mentoring:
A Method for Improving Outcomes in Foundations of
Nursing Practice
4/14/2013
El Paso Community College Teachership Academy
Jose Luis Lopez MSN, RN
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ABSTRACT
The purpose of this study is to determine the effectiveness of small group mentoring in first
semester nursing students, aimed at improving outcomes in the Foundations of Nursing
Practice course. The conceptual framework is derived from Florence Nightingale’s
Environmental Theory in which the main focus was the control of the environment of
individuals and families. Through the manipulation of the environment of both negative and
positive outcomes, a balance can be maintained. The research design is a descriptive
longitudinal study using a convenience sample of first semester nursing students over the span
of four semesters (Spring 2010, Fall 2010, Spring 2011, and Fall 2012). The control group for this
study is the first semester nursing students during Spring 2010 where no mentoring took place.
Findings in the review of literature suggest that faculty mentoring and support of students have
a positive impact on the retention of students. Supportive social networks, community
involvement, as well as family and home involvement play a significant role in the success of
first semester nursing students. In conclusion, mentoring of first semester nursing students has
been effective in their performance of unit exams. If we are to improve the outcomes of first
semester nursing students, a more formal approach to mentoring must be established. Our
Nursing Program is bound to face major challenges if we do not continue to provide a network
of support to our nursing students.
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INTRODUCTION:
More than four decades ago, John E. Roueche highlighted calls for increased attention to
student progress and success in his first book Accountability and The Community College;
Directions For The 70’s. Since then numerous reports have been published which suggest that
we have seen too little improvement in our public schools and community colleges. In an
article published by the Center for Community College Student Engagement in 2010, “The Heart
of Student Success”, Mr. Roueche (Director of Community College Leadership Program at The
University of Texas at Austin), stated, “It is well known that the great majority of students
enrolling in community colleges require remediation in one or more of the basic academic skills
and that most community colleges function as ‘emergency rooms’ for many of their entering
students. Not only are many students still alarmingly underprepared for college, but they too
often have developed an active aversion to mathematics, English, and the educational process
more generally.”
Students enrolled in the El Paso Community College (EPCC) Nursing Program are no
exception to the many obstacles faced by students at other community colleges throughout the
country. Most of the nursing students at EPCC are of Hispanic origin, with English as their
second language. Many come from low income families and must maintain employment in
order to pay for school and support their families. Single mothers are not uncommon, and
neither is being the first person in their immediate family to attend college. Many lack a solid
support system at home to assist them with the rigors of nursing school. Some face social
isolation from their friends and family since most of their time is spent playing catch-up with
their studies in order to achieve success.
Many nursing students have a difficult time adjusting to the enormous amount of
information presented during their first semester of study, as well as to the question format
used in unit and standardized exams. Entering students continue to demonstrate a deficiency in
study and test taking skills. The process of critical thinking is an essential
component/requirement in the student’s ability to correctly answer assessment and application
type questions.
In her book “Notes on Nursing” Florence Nightingale emphasizes the roles of environmental
management and manipulating the environment to prevent diseases. She focuses on a
relationship of cooperation and collaboration. The conceptual framework for this study is
derived from Florence Nightingale’s theory. The design of this model, in which the major
components are student, environment, and faculty, illustrates how the manipulation of the
environment can play a significant role in student success and provides the structure for
understanding those external factors which affect the students during their course of study.
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Mentoring students during their first semester of study may very well be the key in improving
overall test scores and success rates of first semester nursing students.
PROBLEM STATEMENT:
The vast majority of students admitted into the nursing program are only used to
memorizing information and answering knowledge-based questions. They do not realize that
nursing school requires that they understand concepts and apply them to various situations.
The unit exam questions and the standardized examination from Assessment/Technologies
Institute, LLC (ATI), are of similar format utilized by the NCLEX-RN examination, required by the
Texas Board of Nursing for licensure in the State of Texas. Some students are not academically
prepared for the rigors of the nursing program while others may lack the discipline, enthusiasm,
commitment and motivation to succeed. Their first encounter with reality seems to be when
they take their first unit exam, and for some disbelief in their performance is not uncommon.
Nursing exams not only test the acquired knowledge of the assigned material, but also the
student’s ability to apply that knowledge in real situations.
PURPOSE OF STUDY:
The purpose of this study is to determine the efficacy of a small group mentoring
intervention program aimed at improving test scores of first semester students in Foundations
of Nursing Practice.
RESEARCH QUESTIONS:
This research is guided by the following research questions:
1) Will small group mentoring improve test scores of first semester nursing students?
2) Is there a correlation between early mentoring intervention and the performance of
first semester nursing students’ unit exams and standardized test scores?
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REVIEW OF LITERATURE:
Mentoring
Dorsey and Baker (2004) reviewed 16 studies which support the premise that faculty mentoring
and support of students have a positive impact in the retention of students.
Academic Performance
Potolsky (2003) revealed in her study that prerequisite science courses grades have a
relationship to the academic performance of first semester nursing students. Students who had
higher prerequisite course grades generally performed better in their first year of nursing
school than their counterparts with lower prerequisite course grades. The study also found that
students performed better in the prerequisite courses than in the first semester nursing
courses, perhaps due to their lack of understanding and ability to apply complex concepts to a
hypothetical patient situation.
Part-Time Employment, Age, Ethnicity
The study conducted by Salamonson and Andrew (2006) found that working more than 16
hours per week during the semester had a detrimental effect on students’ academic
performance. Perhaps the most obvious argument for decreased academic performance in this
scenario is less time available for studying. The study also revealed that those students who
worked in nursing-related employment did not hold an advantage in academic performance,
even for a nursing practice-based subject. Older students achieved better grades than younger
students entering college soon after graduating from high school. Non-native English speakers
of English are also are more likely to underperform academically, and have disproportionately
higher failure rates in their first year of nursing school than native English speakers.
Retention
Baker (2010) found that the highest rated strategies for retention of minority students were
those that involved direct interaction of nurse faculty and students. Baker also noted that the
most effective strategies used were: timely feedback on test performance, timely feedback on
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clinical performance, and faculty availability. Faculty-student interaction is a vital component in
the retention of students, and students view faculty as a key factor in their continued success in
nursing programs (Shelton, 2003). Financial support affects access to and continuation of
nursing school. Major factors stated by students that influenced graduation from nursing
programs included supportive faculty, individual motivation, peer support, and belonging to
nursing associations (Amaro, 2005).
CONCEPTUAL FRAMEWORK:
Mentoring Environmental Model
MANIPULATION OF
ENVIRONMENT (Mission, Family,
Cultural Diversity, Community)
MENTOR
FACULTY
FAMILY
Communication
Knowledge
Critical Thinking
Accountability
Evaluation
MANIPULATION OF
ENVIRONMENT (Mission, Family,
Cultural Diversity, Community)
Positive
Outcomes
Student-success
MENTEE
STUDENT
Negative
Outcomes
Poor Performance
on Exams
The conceptual framework is based on the mentoring design of a model in which the major
components of Mentee/Student, Environment, and Mentor/Faculty form the foundation. The
sub-concepts elucidate the major concepts as they relate to the successful outcomes of the
student. The threads serve to guide both the student and mentor by ensuring that the common
subjects necessary for success are addressed throughout the semester. Foundations of Nursing
Practice introduces the role of the professional nurse as a provider of care, coordinator of care,
and member of a profession, and emphasizes knowledge, judgment, skills, and professional
values within a legal/ethical framework (El Paso County Community College District 2012-2013
Catalog).
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The integration of positive and negative outcomes is essential in the concept of student
success. The development of these outcomes guides the student in developing a framework in
which he/she can master the subject matter.
The concept of Environment provides the structure for understanding those external factors
which affect the students during their course of study. The mission of the institution and
student, individual and family relationships, cultural values and beliefs, and the resources
available within the home and community bind both mentor and student.
Communication is an active process entailing verbal and nonverbal skills for the purpose of
sharing information. This two-way street provides mentor and student the avenue to establish
a trusting relationship, allows for greater sharing of knowledge and expertise, and increases
interaction and enhanced mentoring, leading to decreased attrition.
Knowledge is the expertise, and skills acquired by a person through experience or education,
the theoretical or practical understanding of a subject, what is known in a particular field or in
total, facts, and information. The term knowledge is also used to mean the confident
understanding of a subject with the ability to use it for a specific purpose if appropriate (Oxford
English Dictionary, 2011).
Critical thinking is a framework for problem solving and a way in which an individual can
identify and analyze the actions, decisions, values, and judgment of him and others. Critical
thinking skills are developed in time through one’s progress in education and experience.
Accountability is the responsibility of both the mentor and student, and a concept in ethical
and legal boundaries. It is the obligation that mentor and student share, and is essential in
setting the standard of responsibility and sustainable development.
Evaluation of self and objectives is an essential component to measure progress. It is the
determinant factor that allows one to proceed with or formulate a new approach. Honesty
plays a major role in the evaluation of self.
METODOLOGY/ RESEARCH DESIGN:
The purpose of this research design is to determine if an early education intervention
program is effective in improving outcomes in the course Foundations of Nursing Practice
course. The design is a descriptive longitudinal study using a convenience sample of first
semester nursing students over the span of four semesters (Spring 2010, Fall 2010, Spring 2011,
and Fall 2012). The control group for the study is the first semester nursing students during
Spring 2010 where no formal mentoring was provided. Information for the study was obtained
using test scores on unit exams in Foundations of Nursing Practice and National Council
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Licensure Examination (NCLEX) Pass Rates for El Paso Community College. The intervention site
was school based. Students were mentored in small groups of no more than ten students and
on an individual basis. Mentoring was provided to all students who performed poorly on unit
exams and to those who sought improvement in their performance.
INTERVENTIONS:
The focus of early intervention is to identify those students at risk of not achieving academic
success. Initially students were identified as being at risk if they failed any of the unit exams. An
Action Counseling Plan was initiated to address the student’s deficiencies and students were
required to review their exams with their mentor and attend tutoring sessions for test taking
skills, drug dosage calculations, open lab, and clinical sessions before their next scheduled unit
exam.
A more formalized process of identifying students at risk was established in the last two
years of this study which focused on “Jeffry’s Cultural Competence and Confidence Model”
(Jefferys, 2010) which includes academic, environmental, and background variables. Such
variables include reading comprehension and math scores, work, family and peer support, first
in family to go to college, and English as a second language. This process enabled the
identification of student’s at risk at a much earlier stage. Effective intervention efforts begin
early by reaching out to students. Early intervention programs provide students with
information about program requirements and expectations, and serve to widen their options in
achieving academic success. Successful retention strategies to improve student outcomes
include workshops in the Nursing Process, test taking skills, study techniques, note taking, and
educational websites to improve reading comprehension.
Non-cognitive variables appear to be more reliable measures of minority students' ability to
succeed in college (Sedlacek, 1996). These non-cognitive variables include positive self-concept,
realistic self-appraisal, long-range goal setting and planning, presence of a strong support
person, successful leadership experience, demonstrated community service, and the ability to
demonstrate experiential knowledge or the application of learning to real-life experience.
An institution with comprehensive retention services provides counseling, tutoring, academic
support, career planning and placement services, as well as work to improve the social climate
on campus and the cultural competency skills of academic advisors and faculty members
(Dumas-Hines, 2001).
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RESULTS:
Examination scores for all Foundation of Nursing Practice students were tabulated to obtain
unit exam averages. Formal mentoring began during the Fall 2010 semester and continued
through the Fall 2012 semester. During the Fall 2011 and Spring 2012 semesters no data was
obtained, (see Figure 1). The exclusion of data during the Fall 2011 and Spring 2012 limits the
findings during this mentoring period. One can only deduce from the data provided that
students during this period benefited in the same way in improving their examination scores.
Averages For Unit Exams
Spring '10
68 72 70
83
74
Exam 1
85
75
Fall '10
Spring '11
86
76 76 82
83
Exam 2
72 77 72
Exam 3
Fall '12
86
78 82 77 81
84
75 78 77
Exam 5
Final Course
Grade
Exam 4
Figure 1
The percentage of students passing the Foundations of Nursing Practice unit exams and
passing the course was obtained by tabulating the number of students taking the exam and
completing the course, (see Figure 2). No data was obtained for the Fall 2011 and Spring 2012
semesters. Formalized mentoring, however, was provided during these two semesters.
Percentage of Students Passing
Spring '10
94 84 84
71
32 42 40
Exam 1
Fall '10
58 60
45
Exam 2
77
Exam 3
Spring '11
Fall '12
94
91
65 66
70
87
72
85
100
66 75 69
39
Exam 4
Figure 2
Exam 5
Final Course
Grade
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The NCLEX pass rate results were obtained from the Texas State Board of Nursing web site
www.bne.state.tx.us/nursingeducation/edudocs/RN-5yr-passrate.pdf ,(see Figure 3). Mentoring
of all students at El Paso Community College was formalized beginning with the Fall semester of
2010. The majority of the students who graduate in the Spring of 2012 received four semesters
of formalized mentoring. Graduates from each year included those students that were off track
due to personal or academic circumstances.
NCLEX PASS RATE
Year of NCLEX
Exam
2010
2011
2012
2013* (First
Quarter Results)
Percent Pass Rate
78.38%
88.51%
92.37%
97.87%
Ratio of Students
Passing NCLEX
Examination
116/148
134/148
121/131
46/47
Texas Board Of
Nursing 2013
Figure 3
SUMMARY:
Small Group Mentoring of first year nursing students is an effective method for improving
outcomes in Foundations of Nursing Practice. There appears to be a direct correlation between
early intervention and the success of students. The formal mentoring of students, for the most
part, did not take place until after the administration of the first unit exam. Mentoring was also
interrupted by the start of clinical rotations during the administration of exams 4 and 5. Review
of literature reveals that faculty mentoring and support of students has a significant positive
impact on the students’ success. Further, direct interactions are the highest rated strategies to
decrease student attrition rates. The most effective strategies were: timely feedback on test
performance, timely feedback on clinical performance, and faculty availability. Faculty-student
interaction is a critical element in the retention of students, and students view faculty as a key
Small Group Mentoring 11
factor in their persistence of nursing programs. The vast majority of students admitted into the
nursing program use rote learning, verbatim memorization techniques, when answering
knowledge-based questions. This is in contrast to the understanding of concepts, critical
thinking and application of nursing principles essential to nursing. The unit exam questions and
the NCLEX –RN examination (required by the Board of Nursing for licensure in the State of
Texas) are of similar format. Some students are less academically prepared for the rigors of the
nursing program, while others may lack discipline and motivation to study and persevere. Still
others are lacking the economic or familial support to help them achieve and maintain
academic success.
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REFERENCE:
Amaro, D., Abriam-Yago, K., Yoder,M. (2006). Perceived barriers of ethnically diverse students
in nursing programs. Journal of Nursing Education,45(7). 247-254.
Baker, B., (2010). Faculty ratings of retention strategies for minority nursing students. Nursing
Education Perspectives, 11(4).216-220.
Dorsey, L., & Baker, C. (2004, July/August). Mentoring undergraduate nursing students:
assessing the state of the science. Nurse Educator, 29(6), 260-265.
Dumas-Hines, F. A. (2001) Promoting diversity: Recommendations for recruitment and
retention of minorities in higher education. College Student Journal, 33 , 190-96
El Paso County Community College District (2012) 2011-2012 catalog, 41, pg261.
Jeffreys, M.R., (2010). Teaching Cultural Competence in Nursing and Healthcare second edition.
New York: Springer Publishing Company, LLC
Nightingale, F., (1992). Notes on Nursing. Philadelphia: J.B Lippincott Company.
Oxford English Dictionary, (2011) Oxford University Press
Potolsky, A., Cohen, J., Salor, C., (2003, September/October). Academic performance of nursing
students: do prerequisite grades and tutoring make a difference. Nursing Education
Perspectives, 24(5), 246-250.
Salamonson, Y., Andrew, S., (2006) Academic performance in nursing students: influence of
part-time employment, age and ethnicity. Issues and Innovations in Nursing Education,
342-349.
Sedlacek, W.E. (1996) Employing non-cognitive variables in admitting students of color. New
Directions for Student Services, 74, 79-91.
Shelton, E. (2003). Faculty support and student retention. Journal of Nursing Education, 42(2),
68-76.
Texas Board of Nursing (2013) Texas Board of Nursing NCLEX-RN Pass Rate for Last 5 Years.
Retrieved April 12, 2013 from Texas.gov:
www.bne.state.tx.us/nursingeducation/edudocs/RN-5yr-passrate.pdf
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