Nurse Practitioner Orientation and Mentorship: Perceived Competence
by
Melissa F. Coble
A scholarly project submitted to the faculty of
East Carolina University College of Nursing
in partial fulfillment of the requirements for the degree of
Doctorate of Nursing Practice
Greenville
2014
Abstract
Every year thousands of Nurse Practitioners (NPs) graduate and accept positions in
hospital based settings. Transitioning into these roles is typically perceived as stressful
for the novice Nurse Practitioner. NPs that complete an orientation program and are
supported by mentors are typically happier in their role, continue employment for a
longer time period, which then improves patient outcomes. Although developing and
maintaining such a program is a financial investment for the healthcare organization, the
positive impacts such as increased NP job satisfaction, decreased NP turnover will result
in cost savings for the institution. There are many studies regarding Registered Nurse
orientation, but little has been written about NP orientation programs and what is
currently being developed in this area. This paper will discuss the differences in Nurse
Practitioner perceived competence with and without an orientation and mentorship
program in critical care areas. Also addressed with be comparing the perceived
competence and longevity of NPs in various stages of their NP careers.
Keywords: Nurse Practitioner Orientation, Mentor, Mentorship
Acknowledgements
I would like to express my special appreciation and thanks to my chair Professor
Dr. Michelle Skipper, you have been a tremendous mentor for me. I would like to thank
you for encouraging me through the DNP project process. I would also like to thank my
committee members, Professor Dr. Connie Mullinix, Professor Dr. Cheryl Duke, Alisa L.
Starbuck, MSN, NNP-BC, NEA-BC for serving as my committee members. I also want
to thank you for your brilliant comments and suggestions. Thanks also to Dr. Sally Bulla
for your assistance during my scholarly project.
A special thanks goes to my family. Words cannot express how grateful I am to
my children, my mother and mother-in-law for all you have done to support me through
my doctoral program. A special thank you goes to my friend and colleague, Andrea
Sessoms MSN, CNM, I could not have made it through without your encouragement and
just being there for me when I needed someone to talk to. I would also like to say a
special thank you to my husband, Doug who has given me many pep talks and just made
me laugh when I felt like crying instead. Thanks so much!
Melissa F. Coble
©
Table of Contents
CHAPTER I: INTRODUCTION
Problem Statement
Justification of Project
Purpose
Project Hypothesis
Definition of Terms
Nature of the Problem
Summary
CHAPTER II: RESEARCH BASED EVIDENCE
Introduction
Review of Literature
Available Tools for Mentor Assessment
Available Tools for Nurse Competence
Theoretical Framework
Summary
CHAPTER III: PROJECT DESCRIPTION
Project Implementation
Protection of Human Subjects
Setting
Instrument
Project Design
Methods
Limitations
Timeline and Budget
Summary
CHAPTER IV: RESULTS
Introduction
Project Participants
Summary
CHAPTER V: DISCUSSION
Introduction
Implications of Findings
Application to Theoretical/Conceptual Framework
Limitations
Delimitations
Implications for Nursing
Recommendations
Conclusion
REFERENCES
APPENDICES
FIGURES
Appendices
Appendix A- Permission to use Mentor Role Instrument
Appendix B- Link to NP Survey
Appendix C- Permission to use Nurse Competence Scale
Appendix D - IRB Approval from Wake Forest Baptist Health
Appendix E – IRB Approval from East Carolina University
Appendix F- Email to Nurse Practitioners
List of Figures
Figure 1: Nurse Practitioners by Unit
Figure 2: Nurse Practitioners by Years of Service at the Academic Medical Center
Figure 3: Nurse Practitioners by Years Practicing as a NP
Figure 4: Utilizes Information Technology
Figure 5: Working in Multidisciplinary Groups
Figure 6: My Mentor Serves as a Sounding Board for Me
Figure 7: My Mentor is Someone I Can Trust
Figure 8: My Mentor is Someone I Can Confide In
Figure 9: My Mentor Shields Me
Figure 10: My Mentor Thinks Highly of Me
Chapter I: Introduction
According to Auerbach, (2012), the future Nurse Practitioner (NP) workforce is
projected to grow to 244,000 in 2025, an increase of 94% from 128,000 in 2008. Studies
have shown that mentors can help to ease transition into the NP role (Hayes, 1999;
Hayes, 2005; Gray & Smith, 2000; Myall et al, 2008). In 2010, the American Academy
of Nurse Practitioners worked with the Boards of Nursing to develop the Licensure,
Accreditation, Certification and Education (LACE) model that will serve to standardize
education, certification and training of Nurse Practitioners nationwide (APRN Consensus
Work Group & National Council of State Boards of Nursing APRN Advisory
Committee, 2008). Transitioning from NP student to practicing Nurse Practitioner often
is a time of stress and uncertainty for many new practitioners (Hill & Sawatzky, 2011).
As the demand for healthcare providers grow, so do opportunities for Advance Practice
Registered Nurses (APRNs) and large academic medical centers will be a major
employer of these needed providers (AACN, 2011). NPs that are transitioning into new
positions often state they feel isolated and unsure of organizational expectations.
Providing a standardized orientation and mentorship program can ease the transition to
the role and organization. Currently there is no standardization of orientation and mentor
process for Nurse Practitioners at the site of this project. The site of this project is a large
academic medical center in the southeastern United States. Few areas within the
academic medical center have an orientation process for transitioning these providers to
the workforce.
Problem Statement
According to the American Academy of Medical Colleges, the United States faces
a shortage of more than 90,000 physicians by 2020. Nurse Practitioners will serve to fill
many of these positions in the community and also within the hospital setting. Many
hospital settings will see triple digit growth in the number of nurse practitioners
employed. These providers often state that they do not fit into the models of nursing or
medicine, and are considered a hybrid. Development of standard orientation and mentor
programs for these NPs within hospitals will help to decrease stress and increase
compliance with governing agency requirements for ongoing competence documentation.
Providing a standardized orientation and mentorship program can help to ease the
transition to the role, the organization and possibly decrease turnover.
Justification of Project
Recognizing the importance of orienting/ training and maintaining Nurse
Practitioners within the Academic Medical Center is vital to meet the increasing demand
of providing excellent patient care and meeting the financial bottom line of the
institution. Ensuring that NPs are provided an orientation and mentorship program can
meet the Triple Aim that the Institutes of Healthcare Improvement developed, which
include: Improving the patient care experience, improving the health of populations and
reducing the per capita costs of health care (IHI, 2014). The current process for
orientation/ training nurse practitioners varies widely within the AMC system. There is
currently no standardization of orientation and mentor process. The goal of this project is
assess Nurse Practitioner transition to practice competence and perceptions of the mentor
process.
Purpose
The purpose of this project was to determine if orientation and mentorship of
Nurse Practitioners affects their perceived competence in the Nurse Practitioner role.
Patricia Benner’s theory of Clinical Competence was used as the theoretical framework
and was the basis of the Nurse Competence Scale used in this project.
Project Questions
The primary questions were:
1. Do Nurse Practitioners based in academic medical centers (AMC) that complete
an orientation and mentor process have a greater perceived competence than those
who do not complete an orientation and mentor process, as evidenced by
increased scores on the Nurse Competence Scale?
2. Do Nurse Practitioners that receive an orientation and mentor process stay
employed longer in their AMC based NP roles?
3. What are the differences in perceived competence between the NP that had recently
entered the NP role versus NPs that had been in the role for more than 5 years? 10
years?
The Nurse Competence Scale and the Ragins and McFarlin Mentor Role
Instrument (RMMRI) were administered over a six-week project timeline via an online
survey in an academic medical center setting. Medical staff services at the Academic
Medical Center were contacted to help identify two NP groups of similar size and work
function. The Neonatal group identified had an orientation and mentorship process in
place (Personal communication with Cynthia Thacker, September 30, 2013). The Adult
ICU NP group was identified to have similar size and work function but without a formal
orientation and mentor process. (Personal communication with Scott Bauer, MSN, NPBC, September 30, 2013). Once these groups were identified they were invited via to
participate in the online survey. Nurse practitioners that were employed in the Neonatal
Intensive Care Unit (NICU) and also in the Adult Intensive Care Unit (ICU) were used in
this convenience sample. These two groups were chosen due to their similar group sizes,
and nature of their work.
Definition of Terms
Orientation was defined as a set period of time that the new NP is paired with an
experienced NP to learn the NP role through collaborative patient care assignments. The
experienced NP helps to guide the practice and care decisions made by the novice NP.
Mentorship is a formal pairing of the new NP with an experienced NP throughout the
orientation and throughout the first year of employment. Nurse Practitioners are Masters
prepared Nurse Practitioners that have passed their certification examinations.
Nature of the Problem
Transitioning into an advanced practice role can be perceived as an overwhelming
time for most NPs. The literature is filled with articles about the benefits of orientation
and mentorship of new Registered Nurses into their role but there is little about
orientation and mentorship of NPs, especially in the hospital setting (Phillips et al., 2013;
Ivey, 2012). Many barriers exist in providing these programs to new NPs such as lack of
a centralized reporting structure to govern and oversee all NP activities, funds to support
orientation programs for each new NP entering the organization, resistance from
supervising physicians to a change in process of reporting and confusion about the NP
role from other members of the health care team as well as the public (Yeager, 2010).
Summary
Lack of organizational support and orientation of NPs can hinder their transition
into the hospital setting. Standardization of orientation and mentor processes may help to
easy this stressful transition and increase their perceived competence. Without these
processes in place the NP may feel isolated and confused about organizational
expectations and subsequently leave their jobs for other opportunities.
CHAPTER II: RESEARCH BASED EVIDENCE
Introduction
An interdisciplinary review of the literature was conducted using multiple
databases including CINAHL and Medline. This exploration of the literature was
completed to evaluate current knowledge regarding NP orientation and mentorship. The
search also included tools available to assess nurse competence and evaluation of
mentors. Keywords included nurse competence, mentors, mentorship, nurse practitioner
orientation and mentorship and nurse practitioner residency.
Review of Literature
According to Auerbach (2012), the future Nurse Practitioner (NP) workforce is
projected to grow to 244,000 by 2025, an increase of 94% from 128,000 in 2008. Studies
have shown that mentors can help to ease transition into the NP role (Hayes, 1999;
Hayes, 2005; Gray & Smith, 2000; Myall et al., 2008). Transitioning from NP student to
practicing NP is a time of stress and uncertainty for many new practitioners (Hill &
Sawatzky, 2011).
Large academic medical centers will be a major employer of these
needed providers (AACN, 2011). NPs that are transitioning into new positions often
state they feel isolated and unsure of organizational expectations. Providing a
standardized orientation and mentorship program can help to ease the transition to the
role and organization. Duke (2010) conducted a phenomenology study that explored the
perspectives of novice NPs. Novice NPs consistently described feeling overwhelmed
with their responsibilities (Duke, 2010). The new NPs also commented it took between
six to eighteen months to feel comfortable in their role. Participants in Duke’s study
were asked to give advice to other NPs that were entering into their new role. Their
advice was “to give it time and not to give up or judge their satisfaction with the role too
quickly” (Duke, 2010, p 49).
All nurse practitioners can experience dynamic changes as they move into a new
role, but the novice NP is subject to the most change. As the novice progresses through
the levels, they demonstrate changes using concrete experiences. They move from
analytic, rule based thinking to intuition (Benner, 2001). This can be a time of
uncertainty and stress. Balancing the demands of learning a new role, meeting team and
organizational demands, and filling in gaps in their knowledge base have been found to
be the cause of anxiety (Hill & Sawatzky, 2011). During these times of stress they look
to the organization and their peers to provide training and support to move them from
novice to knowledgeable NP. NPs are becoming a fixture in more and more hospital
units and Intensive Care Units (ICUs) as the resident work hours have decreased
(Nuckols & Escarce, 2005). Providing a standard orientation process for all NP entering
the hospital setting provides the basis for foundational knowledge that will guide their
practice. Orientation into the new role encompasses both building clinical expertise and
finding organizational fit within the institution. Kelly & Mathews (2001) looked at 21
NPs that had recently graduated as they made the transition into their first NP role. One
of the consistent barriers to practice was a lack of role clarity. These new NPs struggled
with learning how their organization runs, the roles of each team member, and where they
fit into the picture (Kelly & Mathews, 2001).
Nurse Practitioners that are establishing the role in a new department the stress of
transitioning may be magnified. The role comes with additional challenges such as
educating the public and coworkers about their role. Being the sole NP within a unit or
practice can increase the individual’s feelings of isolation. Yeager (2010) reported that
NPs that work in isolation can experience a lack of peer support and can be concerning
because the NP does not feel they have anyone to field questions or consult during times
of uncertainty.
Introduction to the Hospital Setting
There are several different variations of how new NPs are brought in to the AMC
settings. Some offer no formal orientation process and others have a mixed bag of formal
and informal processes in place for orienting new NPs, depending on which clinical area
they are hired (McKay, 2006). Orientation programs for new NPs should be aligned with
the mission and values of the organization. On boarding of the NP is a vital first step in
the process and may be a source of stress. Navigating through the requirements of a state
board of nursing, and/or medical board of the state as well as the credentialing process of
the organization can prove to be confusing to most new NPs. Supporting the NP through
this process should be considered an essential part of the on-boarding and orientation
process. Orientation programs that focus on helping the NP be successful in their new
role need to be well planned and should also utilize feedback from NPs that have been
through the process (Donner & Wheeler, 2009).
Nurse Practitioner Support
Hospitals that have a centralized NP reporting structure, including a director of
NP services may have a standard process in place for orienting NPs, but this is often the
exception due to the associated costs. Constructing an orientation process that meets the
needs of all NPs entering the facility is a challenge. Hospitals have limited resources and
have to be informed of the benefits / rewards they can be reaped by investing in novice
NPs. Healthcare organizations that provide a standard orientation can benefit from a
positive work environment/attitude of the NP, higher job satisfaction, and increased
longevity of these employees (Gerhart, 2012;, Bahouth & Esposito-Herr, 2009).
Orientation of the Nurse Practitioner is a process that starts prior to the first
clinical day. Most NP educational programs spend very little time, if any, discussing the
onboarding process that must occur from NP graduation to the time they start work. In
this transition time there are things the NP must do, such as register and pass a NP
certification exam. While these steps may be daunting for the new NP, this is merely the
first step in the onboarding to a new employer. NPs must also complete multiple paper
and online forms in order to have privileges to practice, credentialing forms must be
completed, as well as completion of required paperwork for nursing and medical boards
within their state.
The first step in the process should be to help the new NP navigate the sea of
paperwork in a streamlined and efficient manner. The next step is determining the
critical elements that need to be included in the orientation process. Bahouth & EspositoHerr, (2009) detailed the elements that were included in a 12 week NP orientation
program that was instituted at the University of Maryland Medical Center (UMMC). The
guiding principle of this process provided a structured goal based program that allowed
NPs to access essential resources within their organization.
Their program consisted of:
1. Streamlined the process for completion of “startup” activities, such as paperwork, etc.
2. Connecting the new NP with a mentor/ preceptor
3. Structured Clinical experiences to build knowledge and skill development
4. Provide time for peer support
5. Organizational resources available to them (Bahouth & Esposito, 2009).
Another such NP approach for orientation process involves using an interprofessional team simulation. Typically hospitals have a set process that is used to
onboard nurses. Woolforde (2012) discussed the process that was used at North ShoreLong Island Jewish (NSLIJ) Health System. By utilizing the existing RN orientation that
was standardized and centralized, they felt they would be able to incorporate NPs and
Physician Assistants (PAs) coming into the hospital setting. One of the main reasons for
this method was to conserve resources while adding these individuals to the orientation
process. Woolforde explained by using the existing structure they could be assured that
the NPs and PAs would enter the health system through a “clear and structured
mechanism, including a formal orientation program that would expose them to the
standards, policies, procedures, and team members with which they would be working”
(Woolforde, 2012, p. 1).
Evaluation of the process is also important. To retain these skilled NPs it is
necessary to build programs not solely on what administrators or experienced NPs
believe is important, but we should also include the opinions of NPs that have completed
the process. In order to provide the support that new NPs need we must elicit their input
on what their experience was during their orientation process, so that we may continue to
evolve and improve the program. In a NP job satisfaction survey by Pasaron (2013), five
areas were identified as important facets to include in an orientation program: NP
responsibilities/expectations, organizational culture, scope of NP practice, technical and
clinical competencies, and collaboration/communication and mentorship.
A successful orientation has also been stated to be an important part of a strong
collaborative practice between the NP and their physician colleagues (Donald et al.,
2009).
Bailey et al. (2006) found that NPs that had not been through a successful
orientation program had difficulty with the collaborative practice partnership and they
often were not working to the full extent of their scope. An effective collaborative is
imperative to provide the patients with the best care. NPs need to feel they have
receptive colleagues and are supported in their decisions concerning patient care. Some
have suggested that by providing a mentorship-guided orientation and clear role
expectations, such approaches have led to the most positive outcome from the process
(Bahouth & Esposito-Herr, 2009).
Transitioning
Transitioning from NP student to independent practitioner can be a time of intense
stress and anxiety. NPs feel that they are expected to function at a high level as soon as
they enter their role as NP, yet they lack the confidence and organizational knowledge to
meet these expectations they place on themselves. Kelly & Mathews, (2001) conducted a
qualitative study to explore the experiences of NPs that were transitioning to the NP role
in their first year of employment. The major themes that were discovered were that the
new NPs felt like they had a loss of privacy and control. NPs have also reported feeling a
sense of isolation, changes in relationship and role ambiguity (Kelly & Mathews, 2001).
One of the participants in the study by Kelly & Mathews (2001) stated, “lack of
organizational fit was correlated with less professional respect and lack of decisionmaking participation” (p. 158). Often times NPs feel that they are somewhere between
nursing and medicine and do not have a support system to help guide their practice. The
most frequent coping strategy that NPs identified in the transition to their position was to
develop a support system. Most met with other NPs or a peer that was also transitioning
into the role to find guidance and support (Kelly & Mathews, 2001).
Mentor Programs
Mentoring is a dynamic relationship between the mentor and the mentee. The
goal is for the mentor to pass along information, knowledge and skill to the new Nurse
Practitioner. The mentoring relationship can benefit both the mentee and mentor. A
successful relationship can also be a positive for the organization. Halfer et al., (2008)
reported a decrease in NP turnover rates, from 20% to 12%, one year after starting a
mentorship program. A mentor program can also be marketed by the hospital to attract
new NPs to the organization.
There are two types of mentor programs: Formal and informal. The
formal mentor program is typically set up by the institution and the mentor and mentee
matched without input from either party (Harrington, 2011). The formal mentor program
follows a preset agenda and objectives. The informal mentorship relationship does not
follow an agenda and develops naturally over time (Tourigny & Pulich) recommended a
formal program with trained mentors, organizational support, specific target goals, and a
plan for disengagement (2005). In a qualitative study in Australia of 45 general care
physicians and 47 NPs, “the expectation of the mentee included personal development
(such as increased self-confidence, sharing ideas, problem solving, or career
development), professional relationship development (such as politics and
interdisciplinary relationship), and role development” (Gibson & Heartfelt, 2005, pg 58).
Formal mentoring programs are highly valued in many disciplines. In some
organizations all new Advanced Practice Providers (APPs), (Nurse Practitioners,
Physician Assistants, Nurse Anesthetists and Nurse Midwives) can self-select or be
assigned a mentor in addition to their preceptor (Bahouth et al., 2013). The mentor
program at the Sovie Center at the University of Rochester Medical Center (URMC) uses
mentors outside of the APPs clinical area. URMC has a database approach, where any
APP with a particular need can be matched with a mentor through the system (Bahouth et
al, 2013). This is an interesting approach in mentoring; if an NP had an interest in
leadership, for example, they could pair with a nurse leader to get some real world advice
and experience in this area. According to a study by Cragg & Bailey (2010) NPs often
expressed a need for mentorship guidance in areas other than their clinical area.
Job satisfaction, expectation for advancement, career commitment, and intention
to stay at the current job were all greater for mentored individuals (Harrington, 2011). In
a study by Greene and Puetzer (2002) it was found that nurse recruits who participated in
the mentoring program at a Midwestern hospital had higher retention rates than for those
nurses without a program. Mentorship has been associated with retention.
The literature supports mentoring with an experienced NP will benefit the novice
NP in areas such as productivity, job satisfaction, longevity and increasing quality of
care. Brown and Olshansky (1997) noted that new NPs in their first year of practice that
worked in a supportive mentored environment had increased productivity in the primary
care setting. One aim of the scholarly project is to assess if these findings could be
extrapolated to a hospital setting. Mentors typically provide face-to-face feedback to the
mentee. The mentoring relationship can provide an avenue for NPs to work on quality of
care by examining process and outcome review results. Sheahan et al., (2001) reported
that of the NP participating in the study, 70 percent preferred verbal and not written
evaluations of their charting. Valuable feedback could be gained by incorporating a chart
audit during the mentor process (Harrington, 2011).
Organizational support for orientation and mentorship programs is an investment
in the providers that are direct care providers. The providers can enhance the patient care
experience and help to educate other staff in the facility. Effective health care
organizations must embrace a mentoring culture and set aside funding to provide this
resource for their employees. Besides the financial investment, the organization should
recognize and reward staff for successful mentorship (Myall et al., 2008).
Available Tools for Assessment of Nurse Perceived Competence and Mentor
Assessment
There are tools available for preceptors and instructors to assess nurse practitioner
students as they learn the NP role. The Nurse Competence Scale (Meretoja et al, 2004),
gives Registered Nurses the ability to assess their own competence in the RN role. Many
of the aspects of this tool can be applied to nurse practitioners transitioning into the NP
role. The Nurse Competence Scale is also based on Benner’s Novice to Expert theory.
There are several tools available to assess mentorship but no tools that are specific
to nurse practitioners. The Ragins and McFarlins Mentor Role Instrument (Ragins &
McFarlin, 1990), was chosen for this project due to its ease of used and its application to
the nurse practitioner role.
Gaps in Literature
There are not any specific tools designed for assessment of nurse practitioner
perceived competence or to nurse practitioner mentor instruments. There is also a gap in
knowledge regarding orientation and mentorship with nurse practitioner groups in
hospital settings, especially critical care area.
Theoretical Framework
The theoretical framework used to undergird the study of the concept mentor is
Benner’s theory of Novice to Expert. Benner’s Theory was based on Dreyfus model of
Skill Acquisition, which consists of five steps: Novice, Advanced Beginner, Competent,
Proficient, and Expert (Benner, 1982). Benner’s stages were developed to advance the
nursing profession through identifying levels of clinical knowledge to aid education and
clinical development. As Benner (1982) states, "The expert nurse, with her/his enormous
background of experience, has an intuitive grasp of the situation and zeros in on the
accurate region of the problem without wasteful consideration of a large range of
unfruitful possible situations" (p.405). This theory changed the profession's
understanding of what it means to be an expert, placing this designation not on the nurse
with the most highly paid or most prestigious position, but on care that they provide.
Summary
The literature search was conducted across several disciplines with multiple
search parameters. Orientation and mentorship are used in many disciplines such as
business, pharmacy, emergency services and of course nursing. In this search, it was
discovered that many studies have been conducted in each of these areas in regard to
orientation and mentorship, but little has been conducted with nurse practitioners that
practice within hospital settings. There are a few tools that can be used assess
competence, but for this project the Nurse Competence Scale (Meretoja et al., 2004), was
chosen because it was designed using the Novice to Expert Theory of Patricia Benner
(Benner, 1982). The Mentor Role Instrument by Ragins and McFarlin (Ragins &
McFarlin, 1990), was also chosen to assess the effectiveness of the mentor process.
CHAPTER III: PROJECT DESCRIPTION
Project Implementation
The purpose of this project was to examine the differences in perceived
competence between two nurse practitioner groups that work within the same large
academic medical center in the critical care area. One group had an established
orientation and mentor process while the other NP group did not have such a process in
place.
The two NP groups were identified based on the areas of practice (critical care),
group size and nature of their role. The sample size of the population was determined by
the number of NPs that had completed at least 90 days of employment in each of the two
groups and that voluntarily participated in the survey.
The NPs were invited to participate in the online survey through the email system
at the site of this project. Once the survey was completed, comparative statistics were
used to determine if the orientation and mentor process made a difference in the groups’
perceived competence in the NP role.
Correlations were made between the NP group that received an orientation and
mentor process to those NPs that did not receive any orientation and formal mentor
process.
Protection of Human Subjects
All nurse practitioners in the Neonatal Intensive Care and NP’s in the Adult
Intensive Care Unit were contacted by email to request their participation in the research
through the completion of the survey. There were no flyers or advertisement. No
protected health information (PHI) was accessed for recruitment and no PHI was
requested in the survey. All Nurse Practitioners in the fore mentioned groups were
invited by email to participate in an online anonymous survey. The link to the survey
was sent by email. Participation was voluntary with no penalty or loss of benefits for not
participating. The survey was anonymous and no identifying information will be
collected. Each survey included a letter to nurse practitioners that explained that their
participation in the survey was strictly voluntary. All nurse practitioners within the
Neonatal Intensive Care Unit and the Adult Intensive Care unit were included, ensuring
equal access to participation of women and minorities. The email also explained to the
potential participants that only information needed to study outcomes will be collected,
minimizing to the fullest extent possible the collection of any information that could
directly identify subjects, and all study information would be maintained in a secure
manner (See Appendix G)
Informed Consent
A waiver of the requirements for signed informed consent was requested and obtained
from academic medical center (IRB) and also the East Carolina University IRB. The
research presented no more than minimal risk of harm to subjects and involves no
procedures for which written consent is normally required outside of the research context.
An email containing the relevant information necessary to make an informed decision
about participation was part of the first section of the online survey for all participants to
read.
Confidentiality and Privacy
Confidentiality was protected by collecting only information needed to assess study
outcomes, minimizing to the fullest extent possible the collection of any information that
could directly identify subjects, and maintaining all study information in a secure manner.
All information from the survey was anonymous with no ability to link to a participant.
Data access was limited to study principle investigators. Data and records were kept
locked and secured, with any computer data password protected. No reference to any
individual participant appears in reports, presentations, or publications that may arise
from the study.
Data and Safety Monitoring
The principal investigator was responsible for the overall monitoring of the data and
safety of study participants. The principal investigator was assisted by other members of
the scholarly project committee. Collaborative Institutional Training Initiative (CITI)
modules for the protection of human subjects were completed by the project
administrator.
Setting
The project site is a not for profit academic medical center in southeastern North
Carolina. The survey was conducted in the Neonatal and Adult Intensive Care Unit with
the Nurse Practitioners practicing as Advanced Practice Providers within these units.
Instruments
The Nurse Competence Scale (NCS) is a 73 item distributed into seven
categories helping role (seven items), teaching –coaching (16 items), diagnostic functions
(seven items), managing situations (eight times), therapeutic interventions (10 items),
ensuring quality (six items), and work role (19 items) (Meretoja, 2003). Each item is
rated by using a VAS (0-100) with the ends labeled 0 for very low level and 100 for very
high level of competence. The frequency with which individual items are actually used
in clinical practice is indicated on a four point scale (0, not applicable in my work, 1 used
very seldom; 2 used occasionally and 3, used very often in my work) (Meretoja, 2003).
The RMMRI (Ragin & McFarlin, 1990), is a 33 item survey that uses a Likert-scale items
focused on perceptions of five mentoring roles in the career dimension (sponsor, coach,
protector, challenger, and promoter) and six mentoring roles in the psychosocial
dimension (friend, social associate, parent, role model, counselor, and acceptor).
Outcome items included overall perceptions of mentoring satisfaction and effectiveness.
Permission to use the Nurse Competence Scale and a copy of the tool are listed in the
Appendix C and D. Permission to use the Mentor Role and a copy of the tool are listed in
Appendix A and B.
Project Design
The first four questions were used to elicit demographic information. These
demographic questions addressed length of time NP had practiced as a NP, What unit
they worked on, Number of hours that were completed in the clinical component of their
education, length of time working in the NP role at the AMC. The remaining questions
consisted of 33 questions on the Mentor Role Instrument and 73 questions on the Nurse
Competence Scale (Appendix H).
Methodology
After completion of required CITI training and obtaining IRB approval, the online
survey was emailed to each NP in the NICU and Adult ICU. A list of NPs within these
two units was obtained through medical staff services. The survey was emailed initially
on March 10, 2014 with reminders sent on March 24th and April 14, 2014. The survey
was closed on April 21, 2014. The NPs had six weeks in which to participate in the
voluntary survey.
Data Collection
Nurse Practitioners received an invitation to participate in the online via email.
By participating in the survey the NPs gave implied consent. At the conclusion of the
survey the results were automatically collected on the online survey site database. The
survey was emailed to 23 NPs within both of the intensive care units. In the six-week
survey period 20 NPs participated in the survey.
Limitations
Several limitations of this project were noted. One limitation was the number of
participants within the two units. Offering the survey to all Nurse Practitioners within the
AMC would have potentially yielded greater participation. Repeating this study in other
academic medical centers with the entire nurse practitioner workforce could provide
additional support for implementation of orientation and mentorship programs for NPs
entering NP practice in hospital settings. The length of the tool was also seen as a
limitation. Many of the NPs started the survey but did not complete each question.
Questions at the end of the survey had fewer responses than those at the beginning of the
survey. If the NPs had protected time to complete the survey without possible
interruptions with patient responsibilities the completion rate may have been higher.
Another limitation was that each NP was not asked if they had someone they considered
a mentor. If they did not have someone they considered a mentor they may more likely
to answer neutral or negatively.
Timeline and Budget
Timeline
Objectives
Budget
Fall Semester 2013
1. Receive permission
for use of Nurse
Competence and
Mentor Role
Instrument tools
2. Committee approval
for the project.
3. WFBH IRB approval
1. No costs were
incurred from these
activities.
Spring 2014
1. ECU IRB Approval
2. Survey questionnaire
entered into online
line database forum.
3. NP list obtained from
medical staff
services.
4. Survey administered.
1. No costs were
incurred from these
activities.
Summer 2014
1. Analysis of findings.
2. Evaluate goals and
objectives.
3. Statistical assistance
with interpretation of
data. No costs were
incurred from these
activities.
Fall 2014
1. Evaluate goals &
objectives.
2. Complete final
written report for
submission.
1. Complete professional
poster and
PowerPoint for
presentation to
scholarly project
chair, committee and
University
community.
(unknown cost at this
time).
Summary
In summary, twenty of the twenty-three NPs voluntarily participated in the online
survey. No participants contacted the primary investigator, the committee chairperson, or
either of the IRBs with questions or concerns about the survey.
CHAPTER IV: RESULTS
Introduction
Data reported included results from both the Neonatal Nurse Practitioners and the
Adult Intensive Care Nurse Practitioners with the academic medical center. This data
includes demographic information about both groups, responses to both the Nurse
Competence Scale and Mentor Role Instrument.
Project Participants
The number of the participants partially or fully completing the study was twenty
(n=20). Of the participants, eleven were NPs from the Neonatal ICU and nine were from
the Adult ICU groups (See Figure 1).
Figure 1: Nurse Practitioners by unit
Twenty-three NPs in total were invited to participate in the online survey, of those
twenty chose to participant (87%). The NPs were further striated into years of service at
the AMC. The NICU group had 3 NNPs with zero to four years of service, three with
five to nine years of service, two with ten to fourteen years of service and three with more
than fifteen years of service at the AMC. The Adult ICU group has eight NPs with zero
to four years and only one NP with five to nine years of service. (See Figure 2).
Figure 2: Nurse Practitioners by years of service at the academic medical center
The total number of years of NPs experience was also assess within the
demographic information. The NNP group had four NPs that had zero in the 91days to
two years group, three NPs in the six to ten year ranges, and four in the ten years or more
of NP experience. The Adult ICU group had three each in the 91 days to two years and
two years to five year group, two NPs with six to ten years experience and one NP with
more than ten years of experience. (See Figure 3).
Figure 3: Total number of years of NP experience
The Nurse Competence Scale
Both of the NPs groups had equivalent scores for utilization of technology in the
workplace and developing patient care in multidisciplinary teams. (See Figure 4 & 5).
Figure 4: Utilizing information technology
Figure 5: Working in multidisciplinary teams
The NNP group scored higher in taking active steps to maintain and improve their
professional skills. The NNP group also scored higher than the adult ICU NPs in
critically evaluating their units care philosophy and systematically evaluating the
patient’s satisfaction with care. NPs that have been in their role for ninety one days to
two years scored higher in developing patient education and acting responsibly in terms
of limited financial resources than those NPs that had more than two years of NP
experience.
Ragins and McFarlin’s Mentor Role Instrument
The Adult ICU NPs scored higher than the NNPs overall on the mentor role
instrument. This increase in score may be due the Adult ICU having more novice NPs
that the Neonatal NP group. NPs that had less than five years of work experience, agreed
that their mentor served as a sounding board to develop and understand oneself, that their
mentor was someone they could trust and confide in as opposed to NP with more than
five years experience. (See Figure 6).
Figure 6: My mentor serves as a sounding board for me
NPs with less than five years of experience agreed that their mentor was someone
they could trust. (See Figure 7). The NPs with greater than five years were more likely
to answer neutral or disagree.
Figure 7: My mentor is someone I can trust
NPs that had less than five years of experience were more likely perceive that
their mentor is someone they can confide in. (See Figure 8).
Figure 8: My mentor is someone I can confide in
The more novice NPs also agreed that their mentor shielded them from damaging
contact with important people in the organization. (See Figure 9).
Figure 9: My mentor shields me
The novice NP group agreed that their mentor thinks highly of them. (See Figure
10).
Figure 10: My mentor thinks highly of me
Summary
There was not an observed statistically significant difference in the NPs that
completed an orientation and mentor process than those that did not complete this
process. The NNPs stayed longer in their roles than did the Adult ICU NPs. The Adult
ICU NPs had more favorable responses in regards to their mentor.
CHAPTER V: DISCUSSION
Introduction
For Nurse Practitioners transitioning to practice the first year is often perceived as
filled with anxiety and self doubt. Identifying ways to support and facilitate NP’s
transitions to practice within Academic Medical Centers will continue to be important as
the number of these providers grows. By providing an orientation and mentorship
program to NPs as they initiate practice will serve to lessen the feeling of isolation and
anxiety they face.
Implications of Findings
While there were positive correlations between the Neonatal NP group and the
Adult ICU group with use of technology in the workplace and developing patient care in
multidisciplinary teams, these findings were not found to be statistically significant.
Because of the nature of the NPs working in an intensive care unit use of technology and
working within many consulting services is a part of their-day to-day work. The fact that
both groups scored higher in this section is expected.
The demographic information gathered from the survey of both groups revealed
that the Neonatal NP group had greater longevity in their roles at the AMC. Of the eleven
Neonatal NPs that responded to the survey three had been in their roles five to nine years,
two NPs had been in their roles ten to fourteen years, and three NPs had been in their role
for at least fifteen years. This may due to the orientation and mentorship that the
Neonatal NPs receive. In the Adult ICU group of the nine that responded to the survey
only one had been with the group for more than four years, the remaining eight Adult
NPs had zero to four years of experience at the AMC.
The Neonatal NPs had higher perceived competence scores in relation to taking
active steps to maintain and improve their professional skills. The Neonatal NPs received
an orientation and mentor process when they begin their NP role at the AMC. The
Neonatal NPs have a twelve-week orientation and mentor process that provides one on
one support for the new NP. Mentorship of these NPs can lead to continuing to advance
their careers. These NPs also have a person to provide guidance in regards to
professional organizations and organizational resources within the AMC. The Neonatal
NPs scored higher than the Adult ICU NP group in critically evaluating their units care
philosophy and systematically evaluating the patient’s satisfaction with care.
When comparing all of the NPs regardless of their designated work area, some
similarities exist between the NPs with less than two years experience as compared to
NPs with more than two years of experience:
1. Scored higher in developing patient education
2. Scored higher in acting responsibly in terms of limited financial resources than
those NPs that had more than two years of NP experience
Developing patient education is an essential function of the Registered Nurse
(RN), when transitioning to the NP role some of the areas of strength as a RN bleed into
the role of the NP. The more experience the NP has they may not be as involved with the
development of patient education materials as the bedside RNs.
Financial awareness has not always been a part of the medical decision making
process but in the last few years the use of resources has become a primary focus. NPs
with less than two years of experience may not be as set in their prescribing patterns than
those with more experience.
The Adult ICU NP group had higher scores on the mentor role instrument than the
Neonatal NP group. This result may be attributed to the NPs not having an orientation
process and relaying more on an informal mentoring to learn the job role and
expectations.
When comparing the NP groups regardless of designated work unit, some
similarities exist between the NPs with less than two years experience as compared to
NPs with more than two years of experience. The novice NPs depend on their mentor
whether they are formally assigned or are an informal mentor. As the NP gains more
experience they are not as tied to their mentor as they would be in those first years of role
transition.
Application to Theoretical/Conceptual Framework
Patricia Benner’s Novice to Expert theory was offered as the theoretical model for
Nurse Practitioner’s transitions to practice in five steps: Novice, Advanced Beginner,
Competent, Proficient, and Expert (Benner, 1982). The Nurse Competence Scale was based on
Benner’s theory (Meretoja et al., 2004).
Limitations
The generalizability of these findings are extemely limited due to the sample size
of twenty-three particpants. The twenty-three participants did not answer all the
questions in the survey which further limits the findings. A larger sample size would
have improved the generalizability. Structuring the survey in such a manner that does not
allow for questions to be omitted would have also lead to stronger results. Thirty percent
of surveys (N = 6) were completed fully and 70 percent were not completed (N = 14).
Delimitations
The major delimitation to the project was the length of the survey. The total
survey was more than one hundred questions which limited the full completion of the
survey by each participant. There were no tool identified that measure Nurse
Pracititioner perceived competence. Several limitations of this project were noted. One
limitation was the number of participants within the two units. Offering the survey to all
Nurse Practitioners within the AMC would have potentially yielded greater participation.
Repeating this study in other academic medical centers with the entire nurse practitioner
workforce could provide additional support for implementation of orientation and
mentorship programs for NPs entering NP practice in hospital settings. The length of the
tool was also seen as a limitation. Many of the NPs started the survey but did not
complete each question. Questions at the end of the survey had fewer responses than
those at the beginning of the survey. If the NPs had protected time to complete the
survey without possible interruptions with patient responsibilities the completion rate
may have been higher. Nurse Practitioners could potentially not have the technical
computer skills that are needed to complete an online survey. A paper survey could be
offered to these individuals. Another limitation was that each NP was not asked if they
had someone they considered a mentor. If they did not have someone they considered a
mentor they may more likely to answer neutral or negatively.
Implications for Nursing
Understanding the impact of transitioning to practice on novice NPs is important
so that we may adequately meet their needs. Frequently novice NPs are struggling to
meet the demands of their new role, meet organizational requirements and learn their role
within the medical team.
As medical residency time continues to decrease the number of Nurse
Practitioners that will be coming into the Academic Medical Center environment will
continue to increase (Nuckol & Escarce, 2005). Nurse Practitioners are identified as
“substitutes” to complete the work that the resident hour restriction would leave (Nuckol
& Escarce, 2005). Nurse Practitioners are a “cost effective and quality solution to a
variety of health care delivery needs” (Bahouth &Espositio, 2009, pg 82).
Replication of this study with a larger sample size including all Nurse
Practitioners within the Academic Medical Center would serve to strengthen future
research in this area. Investigation of newly developed tools to evaluate perceived
competence for Nurse Practitioners would provide greater insight.
Nurse Practitioners should not only advocate for their patients but also feel
empowered to lobby for their orientation needs. Awareness of health policy from the
organizational level to the national level is the responsibility of all nursing professionals.
Advocacy knowledge will help novice NPs and experienced NPs set an agenda and share
their insights about the process with the executive level of administration and solutions to
ensure longevity of the Nurse Practitioner workforce. Increasing the length of NP
employment would offset the costs of the orientation and mentorship program, not to
mention the increase in NP productivity and decrease the cost of patient care. This type
of program would ensure that NPs are meeting the Triple Aim set forth by the IHI. A NP
that has an orientation and mentorship program would be comfortable in their role and in
turn be better advocates for their patients that would increase the patient care experience.
Learning the organizational protocols and goals would ensure that the NP is improving
the health of populations while decreasing the per capita cost of patients within the
system. Moving the NP along the Novice to Expert continuum through orientation and
mentorship will ensure that they are able to build valuable clinically based experience
that will ensure that the NP is ordering tests and treatments based on actual needs of each
patient instead of historical trends.
Development of a standardized orientation and mentorship program for all Nurse
Practitioners entering the Academic Medical Center must take into consideration meeting
the ethical and cultural needs of this group as well.
Recommendations
Future implications for nursing practice include analysis of barriers to transitions
to NP practice at the Academic Medical Center and start of a formalized mentoring
program. The numbers of Nurse Practitioners practicing with AMC continue to increase,
yet most are not offered a structured orientation and mentorship experience.
Although twenty of the twenty-three NPs invited participated in the study, in
future studies, the project administrator would decrease the number of questions
presented to the participants and also structure the survey that forces a response to each
question. This would ensure that each participant would answer each question to allow
for more accurate data for analysis.
Conclusion
In this study the data does not show any statistical significance, but this author
would recommend standardization of this program. The transition to independent NP
practice can be challenging. Mentor NPs must be dedicated to the mentoring process and
be patient with the novice NPs as they navigate the process. Guiding hospital
administration to support and fund orientation and mentorship programs for NP entering
practice is key to providing a quality and competent workforce in Academic Medical
Centers.
References
American Association of Colleges of Nursing. (2004) AACN position statement on the
practice doctorate in nursing. Available at
http://www.aacn.nche.edu/dnp/dnppositionstatement.htm.
APRN Consensus Work Group & National Council of State Boards of Nursing APRN
Advisory Committee. (2008). Consensus model for APRN regulation: Licensure,
accreditation, certification & education. Retrieved from
http://www.ncsbn.org/Consensus_Model_for_APRN_Regulation_July_2008.pdf
Auerbach, D. (2012). Will the NP workforce grow in the future?: New forecasts and
implications for healthcare delivery. Medical Care, 50(7), 606.
Bahouth, M. N., Ackerman, M., Ellis, E. F., Fuchs, J., McComiskey, C., Stewart, E. S.,
& Thomson-Smith, C. (2013). Centralized resources for nurse practitioners:
Common early experiences among leaders of six large health systems. Journal of
the American Academy of Nurse Practitioners, 25(4), 203-212.
doi:10.1111/j.1745-7599.2012.00793.x
Bahouth, M. N., Bahouth, M. N., & Esposito-Herr, M. B. (2009). Orientation program for
hospital-based nurse practitioners. AACN Advanced Critical Care, 20(1), 82; 82-90;
90.
Bailey, P., Jones, L. & Way, D. (2006). Family physician/nurse practitioners: stories of
collaboration. Journal of Advanced Nursing. 53, 381-391.
Benner, P. E. (2001). From novice to expert: Excellence and power in clinical nursing
practice. Upper Saddle River, N.J: Prentice Hall.
Brown, A., Christie, L. M., Higgerson, R. A., Mikhailov, T. A., Stojadinovic, B. J., &
Forbes, M. L. (2012). A national survey of PICU nurse practitioners - opportunities
to standardize practices and optimize service delivery.Pediatric Nursing, 38(5), 249250,277. Retrieved from
http://search.proquest.com.jproxy.lib.ecu.edu/docview/1173239306?accountid=1063
9
Brown, M., & Olshansky, E. (1997). From limbo to legitimacy: A theoretical model of
the transition to the primary care nurse practitioner role. Nursing Research, 46,
46-51.
Dilmore, T. C., Rubio, D. M., Cohen, E., Seltzer, D., Switzer, G. E., Bryce, C., &
Kapoor, W. N. (2010). Psychometric properties of the mentor role instrument when
used in an academic medicine setting. Clinical and Translational Science, 3(3), 104108. doi:10.1111/j.1752-8062.2010.00196.x
Donald, F., Mohide, E.A., DiCenso, A., Brazil, K., Stephenson, M., & Akhtar-Danesh, N.
(2009). Nurse practitioner and physician collaboration in long-term care homes:
Survey results. Canadian Journal of Aging, 28, 77-87.
Donner, G. & Wheeler, M. (2009). Innovative approaches are needed to support
practitioners. The Canadian Nurse, 105, 2, 8-9. Retrieved from
http://search.proquest.com.jproxy.lib.ecu.edu/docview/232037009?accountid=10639
Duke, C. (2010). The lived experience of nurse practitioner graduates’ transition to
hospital-based practice. ProQuest (UMI Dissertation Publishing No. 34119121).
.
Gehart, L. (2012). A new strategy to invest in the capital of novice nurse practitioners.
Nurse Leader, 10, 3, 51-53.
Gibson, T., & Heartfield, M. (2005). Mentoring for nurses in general practice: An
Australian study. Journal of Interprofessional Care, 19, 50-62.
Gray, M., & Smith, L. (2000). The qualities of an effective mentor from the student
nurse’s perspective: Finding from a longitudinal qualitative study. Journal of
Advanced Nursing, 32, 1542- 1549.
Greene, M., & Puetzer, M. (2002). The value of mentoring: A strategic approach to
retention and recruitment. Journal of Nursing Care Quality, 17, 67-74.
Halfer, D., Graf, E., & Sullivan, C. (2008). The organizational impact of a new graduate
pediatric nurse mentoring program. Nursing Economics. 26, 243- 249.
Harrington, S.(2011). Mentoring new nurse practitioners to accelerate their development
as primary care providers: A literature review. Journal of the American Academy
of Nurse Practitioner, 23, 168-174.
Hill, L. A., & Sawatzky, J. V. (2011). Transitioning into the nurse practitioner role
through mentorship. Journal of Professional Nursing, 27(3), 161-167.
Hayes, E. (1999). Athena found or lost: The precepting experiences of mentored and
non-mentored nurse practitioner students. Journal of the American Academy of
Nurse Practitioners, 11, 335-342.
Hayes, E. (2005). Approaches to mentoring: How to mentor and be mentored. Journal of
the American Academy of Nurse Practitioners. 17, 442-445.
Hittle, K., & Tilford, A. K. (2010). Pediatric nurse practitioners as hospitalists. Journal of
Pediatric Health Care, 24(5), 347-350.
doi:http://dx.doi.org.jproxy.lib.ecu.edu/10.1016/j.pedhc.2010.06.009
Institutes of Healthcare Improvement. (n.d.) Retrieved October 13, 2014 from
http://www.ihi.org/Engage/Initiatives/TripleAim/pages/default.aspx
Ivey, J. (2012). Transition from student to nurse: The orientation process. (Order No.
1520129, Gardner-Webb University). ProQuest Dissertations and Theses., 50.
Retrieved from
http://search.proquest.com.jproxy.lib.ecu.edu/docview/1114560375?accountid=10
639. (1114560375).
Kelly, N. & Mathews, M. (2001). The transition to first position as nurse practitioner.
Journal of Nursing Education, 40(4), 156-62. Retrieved from
http://search.proquest.com.jproxy.lib.ecu.edu/docview/203975982?accountid=106
39 doi:http://dx.doi.org.jproxy.lib.ecu.edu/10.1016/j.profnurs.2011.02.004
Meretoja, R., Isoaho, H., & Leino-Kilpi, H. (2004). Nurse competence scale:
Development and psychometric testing. Journal of Advanced Nursing, 47(2), 124133. doi:10.1111/j.1365-2648.2004.03071.x
Mckay, H. (2006). Trauma nurse practitioners-baptism by fire! variations in role
orientation. Journal of Trauma Nursing, 13(3), 102-4. Retrieved from
http://search.proquest.com.jproxy.lib.ecu.edu/docview/194451627?accountid=10639
Myall, M., Levett-Jones, T., & Lathlean, J. (2008). Mentorship in contemporary practice:
The experiences of nursing students and practice mentors. Journal of Clinical
Nursing, 17, 1834- 1842.
Nuckols, T. K,. & Escarce, J. J. (2005). Residency work-hours reform. Journal of
General Internal Medicine, 20(10), 873-878. doi:http://dx.doi.org/10.1111/j.15251497.2005.0133.x
Pasaron, R. (2013). Nurse practitioner job satisfaction: looking for successful outcomes.
Journal of Clinical Nursing. 22, 2293 – 2604. http://doi: 10.1111/j.13652702.2012.04331.x
Phillips C., Esterman A., Smith C. & Kenny A. (2013) Predictors of successful transition
to Registered Nurse. Journal of Advanced Nursing 69(6), 1314–1322. doi:
10.1111/j.1365-2648.2012.06123.x
Ragins, B., & McFarlin, D. (1990). Perceptions of mentor roles in cross-gender
mentoring relationships. Journal of Vocational Behavior, 37, 321–339.
Sheahan, S., Simpson, C., & Rayens, M. (2001). Nurse practitioner peer review: Process
and evaluation. Journal of the American Academy of Nurse Practitioners, 13,
140-145.
Tourigny, L., & Pulich, M. (2005). A critical examination of formal and informal
mentoring among nurses. Health Care Manager, 24, 68-76.
Woolforde, L. (2012). Onboarding nurse practitioners: A healthcare system approach to
interprofessional education. Nurse Leader, 10, (5), 1-3.
Yeager, S. (2010). Detraumatizing nurse practitioner orientation. Journal of Trauma
Nursing, 17(2), 85-101. Retrieved from
http://search.proquest.com.jproxy.lib.ecu.edu/docview/595206620?accountid=10639
Appendix A
Permission for Use of Mentor Role Instrument
Dear Dr. Ragins,
Greetings! I am a nurse practitioner in rural North Carolina, and in the preparation stages
of my doctoral project at East Carolina University. I am writing to ask permission to use
your Mentor Role Instrument in my capstone work. The tool would be administered to
nurse practitioners within a large academic medical center in North Carolina. This tool
would be used to evaluate nurse practitioner mentoring following orientation to the
neonatal and critical care intensive care units.
I am so grateful that you have dedicated your career to better understanding mentoring
and its importance to business and health care. My work will also focus on application of
Patricia Benner’s Novice to Expert Nursing theory to the orientation and mentor
process. In my literature review, I have struggled to find useful tools that would help
bring some objective data to such a subjective issue.
Could you please provide a complete copy of the Mentor Role Instrument?
Of course, if permission is granted, I would be most willing to share results with you
from the work.
Sincerely,
Melissa Coble MSN, NNP-BC
November 12, 2013 @ 10:47 am
East Carolina DNP student
Dear Melissa
Thanks so much for your interest in our work! I've attached two articles which have the
items, likert scales, instructions etc for the mentor role instrument and also the mentor
satisfaction scale (see appendix). I've also attached a book chapter that has another scale
which may be of interest to you - it captures high quality mentoring (see table in
chapter). Of course you can use all of these measures. I published them so that people
can use them for their research.
Good luck with your research!
Belle
November 12, 2013 @ 11:31 am
Dr. Belle Rose Ragins
Associate Editor, Academy of Management Review
Professor of Human Resource Management
Sheldon B. Lubar School of Business
University of Wisconsin-Milwaukee
3202 N. Maryland Avenue
Milwaukee, Wisconsin 53211
e-mail:
Home Office:
Work Office:
Work Fax:
Ragins@uwm.edu
(414) 332-5134
(414) 229-6823
(414) 229-5999
http://www4.uwm.edu/business/faculty/busfaculty/ragins.cfm
Appendix B
Link to NP Survey
https://www.surveymonkey.com/s/7DG3FDX
Appendix C
Permission to Use Nurse Competence Scale
Dear Dr. Meretoja,
Greetings! I am a nurse practitioner in rural North Carolina, and in the preparation stages
of my doctoral project at East Carolina University. I am writing to ask permission to use
your Nurse Competence Scale in my capstone work. The tool would be administered to
nurse practitioners within a large academic medical center in North Carolina. This tool
would be used to evaluate nurse practitioner competence following orientation to the
neonatal and critical care intensive care units.
I am so grateful that you have dedicated your career to better understanding nursing
competence and its importance to patient care. My work will also focus on application of
Patricia Benner’s Novice to Expert Nursing theory to the orientation process. In my
literature review, I have struggled to find useful tools that would help bring some
objective data to such a subjective issue. Could you also provide a full copy of the tool to
use in my capstone work?
Of course, if permission is granted, I would be most willing to share results with you
from the work.
Sincerely,
Melissa Coble MSN, NNP-BC
East Carolina DNP student
November 12, 2013 @ 10:32 am
Dear Melissa, thank you for your interest in the Nurse Competence Scale.
I am pleased if you find the Nurse Competence Scale useful for your study. You must
ask the official permission to use the NCS from Wiley - Blackwell who holds the
copyright for the English version. There are no costs associated to the use.
The NCS should only be used in its original form. The whole instrument, the 73-item
Nurse Competence Scale as well as the scoring methodology is published in that article
(Meretoja et al. Nurse Competence Scale: development and psychometric testing. JAN
47(2), 124-133). The validity and reliability of NCS is reported in that publication as well
the assessment scales for evaluation of competence levels and frequency of using
competencies in actual clinical practice.
Do not hesitate to contact me again if you have some questions to discuss.
Good luck for your very important study and keep me posted !
Riitta Meretoja, Adjunct Professor, PhD, RN
November 18, 2013 @ 5:25 am
Appendix D
Appendix E
Appendix F
Email to Nurse Practitioners