create a power point presentation using guidelines attached use information in milestone 4 paper to complete
DESIGN FOF CHANGE 1 2 DESIGN FOR CHANGE Introduction
Health care organizations are currently facing the challenge of developing competent
and confident new graduate nurses who remain in their hospitals (Ulrich, Krozek, Early,
Ashlock, Africa & Carmen, 2010). Recruitment and retention of new nurses has become a
major concern. It has become paramount to facilitate the transition of new graduate nurses to
professional RNs in order to increase their commitment and retention. Does the use of a
formal mentoring program for new graduate nurses have a positive effect on retention?
Evidence has shown that new graduates and their organizations can benefit from a structured
mentoring program. According to Cottingham, DiBartolo, Battistonio & Brown (2011),
?Enhancing nurse retention via mentoring programs is just one creative approach to address
the nursing shortage and reduce the significant costs associated with turnover.? The nursing
focused plan is to implement a mentorship program using a model for evidenced- based
Contribution to the Future of Healthcare
A mentoring program can be a major contribution to healthcare and can benefit all
stakeholders including administrators, employees, physicians and patients. More change can
happen in a work environment if one is in a mentoring culture atmosphere where there is a
dynamic exchange of ideas (Grossman, 175). Including all stakeholders in the planning of the
mentoring program will instill the understanding of the need for change as well as a sense of
ownership. A mentoring program facilitates employees to be tied to the organization and be
loyal for the good of the organization. Evidence has shown it can also reduce the problem of
turnover which has a negative effect on patient outcomes as well as negative financial costs to
the organization. After a mentoring program, turnover rates dropped; the increase in the
retention of RNs resulted in documented cost savings including less expenditure on 3 DESIGN FOR CHANGE
recruitment, employing travel nurses, and employing adjunct faculty (Grossman, 155). Every
nurse could benefit from being in a mentoring culture. This culture should permeate the nursing
workforce for broader impact, not only with individual nurses who desire mentoring but also
within the organization and the profession (Grossman, 28). Mentoring that takes place between
an experienced nurse leader and a mentee will generate success for both parties, plus the
organization that employs each and the profession of nursing (Grossman, 33).
Change Model Overview
Rosswurm & Larrabee, (1999) provide a change model as a guide to facilitate change
which includes six steps; assess the need for change, link the problem, interventions and
outcomes, synthesize the best evidence, design practice change, implement and evaluate the
change in practice, and integrate and maintain practice change. Nurses should use this guide
to facilitate change as a tried and proven model that has been developed and tested by
Rosswurm & Larrabee (1999).
Step 1: Assess the Need for Change
PICOT question: Does the use of a formal mentoring program for new graduate nurses
have a positive effect on retention? Current practice at many facilities consists of a standard
orientation period of approximately 8 weeks in which a new graduate RN is passed on from
preceptor to preceptor without any accountability of their training or experiences. As a result,
many new graduate RNs make it through the required skills necessary during orientation, but
they lack confidence due to not having the opportunity to assimilate and grasp the new skills.
They also do not have the opportunity to develop trusting relationships with the other staff
nurses. Many become overwhelmed due to lack of support and sense of belonging and
consequently leave there positions within their first year. In contrast, a mentorship program
provides mentoring and precepting by the same individual. A mentoring culture welcomes and 4 DESIGN FOR CHANGE
supports the new graduate RN while cultivating confidence, competence, and a sense of
belonging, which results in improved recruitment, retention and reduced turnover rates
(Edwards, Kawker, Carrier & Rees, 2011). The problem of retention of new graduate RNs is to
be discussed with the nurse managers and nurses. Next, practitioners can review the evidence
using internal data produced from the human resources department of the turnover rates of
new graduate nurses over the past year and compare with previous years. The result of the
internal data can be compared with external data from similar facilities.
Step 2: Link the problem, interventions, and outcomes
New graduates job satisfaction and turnover intentions have been linked to the use
of a formal mentoring program. Current practice consists of a standard orientation period of
approximately 8 weeks. During this process, the new graduate RN is paired with a
preceptor(s) and is required to complete a series of competencies within an 8 week
orientation period. They generally make it through the required skills, but lack confidence
and the opportunity to develop trusting relationships with the other staff nurses and become
overwhelmed due to lack of support, sense of belonging and consequently leave there
positions within their first year. Potential intervention is the use of a formal mentorship
program in which a new RN graduate is paired with one mentor who ensures the schedule
has them paired on each shift. This relationship has no time limit and promotes a mentoring
spirit in work groups. The outcome is a positive work environment where nurses want to
work and patients want to receive care with the ultimate goal of the retention of professional
nurses. The identified outcomes can be measured by retention rates obtained from the
human resources department and satisfaction surveys such as the New Nurse Confidence
Scale (NNCS) and Intent to Stay/Job Diagnostic Survey (JDS) (Grindel & Hagerstrom,
2009). 5 DESIGN FOR CHANGE
Step 3: Synthesize the Best Evidence
Literature review includes contributions from Ulrich, Krozek, Early, Ashlock, Africa
& Carmen, 2010 who introduces a qualitative and quantitative, longitudinal 10-year study
which addresses the problem of developing competent and confident new graduate RNs
who remain in their hospital. The study discusses evidence that new RNs and their
organizations can benefit from structured mentoring. Fox, 2010, discusses a qualitative
mentor pilot program conducted over a 1-year period which addresses the concern of
retention of new nurses for all health care organizations. The study provides evidences of its
success and expansion with a documented turnover rate of 31% in 2004 to 10.3% in 2009.
Edwards, Kawker, Carrier & Rees, 2011 provide a systematic review which includes
quantitative studies, quasi-experimental studies, observational studies, surveys and
descriptive studies which provides several strategies to ease the transition process of new
graduate nurses by increasing confidence, sense of belonging, competence and retention.
The review discusses a variety of formal approaches including mentoring programs.
Cottingham, Dibartolo & Brown, 2011, provide a 2-year nationally funded pilot program
which describes a mentoring program called Partner in Nursing (PINS) which was
developed to address the problems with the workforce shortage, retention, lack of support
and job satisfaction of new graduate nurses. The PINS initiative aims to provide mentoring
beyond the typical orientation period of newly graduated nurses. Dyess & Parker, 2012
introduce quantitative research in which data was collected over a 10-month program using
survey instruments which addresses the difficulty new graduate nurses experience during
the professional transition stage such as lack of support and retention. This research
highlights the importance of transition support through the Novice Nurse Leadership
Institute which strengthens competency and supports coping skills through mentoring.
Spence, 2012 introduces a descriptive correlation design with cross-sectional analysis of 6 DESIGN FOR CHANGE
data from a mail survey of new graduate nurses which describes new graduate nurses work
experiences, career satisfaction and the problem of retention. The analysis recommends that
new graduate nurses have support structures including a strong orientation and mentoring.
Outcomes reported lower turnover and increased job satisfaction. A critique worksheet will
be used to organize the information and provide an evidence rating scale to assess the
quality of the evidence.
Step 4: Design Practice Change
After careful review of the best evidence, weighing cost and benefits, and
considering the consequences and stakeholders (administrators, employees, physicians and
patients), the implementation of a mentorship program will be tested using a pilot study on
one of the nursing units. Upon agency approval and administrative support, a unit will be
selected to conduct a pilot study of volunteer mentors. All nursing staff and volunteer
mentors in the pilot study will be educated on evidenced based protocol. (Rossurm &
Larrabee, 1999) The pilot study will be evaluated from the nursing staff and volunteer
mentors including all their input. Stakeholder input and feedback is critical to gaining buyin. Tools to be used to measure outcomes will be satisfaction surveys such as the New Nurse
Confidence Scale (NNCS), and Intent to Stay/Job Diagnostic Survey (JDS) (Grindel &
Hagerstrom, 2009). Additionally, retention rates will be obtained from the human resources
department after a one year implementation period.
Step 5: Implement and Evaluate the Change in Practice
The pilot mentorship program will be implemented on the selected unit with the unit
educator as the designated coordinator responsible to closely monitor the process. The pilot
program will be conducted over a one-year period. After the designated time has elapsed, the data
will be collected and interpreted to identify the differences before and after the study. A
determination will be made if the mentoring program should be adopted or rejected based on the 7 DESIGN FOR CHANGE
pilot unit, managers, pilot coordinator, QI and survey data, cost data, and recommendations from
stakeholders (Rosswurm & Larrabee, 1999). Evaluation of the mentoring program will be
measured using various assessment tools including evaluation forms to measure the progression
of the relationship between mentor and mentee, satisfaction scales, and retention rates.
Step 6: Integrate and Maintain the Change in Practice
Active participation of all stakeholders throughout the 6-step model has proven to
significantly increase a positive acceptance of the mentorship program. The practice change
will be successfully implemented after reviewing the revisions and recommendations from
the stakeholders with the volunteer mentors and staff nurses. Finally, the evidence based
protocol will be presented to the standards and practice council for approval. All information
will be communicated to administration and practitioners and in-service education will be
conducted hospital wide to introduce the new mentorship program (Rosswurm & Larrabee,
Evaluation of the mentoring program will take place after completion of the 1 year pilot
program. It will be measured using various assessment tools including evaluation forms to
measure the progression of the relationship between mentor and mentee, satisfaction scales,
and retention rates. More specifically, an evaluation questionnaire will be used for mentee
students to assess the mentors. Additionally, satisfaction surveys such as the New Nurse
Confidence Scale (NNCS) and Intent to Stay/Job Diagnostic Survey (JDS) (Grindel &
Hagerstrom, 2009) will be used to measure the satisfaction level of the mentor and mentees.
Finally, internal data of turnover rates can be produced from the human resources department
and will be compared to previous years. 8 DESIGN FOR CHANGE
Next Steps to Maintain the Change
Maintaining the change will be supported by active participation of all stakeholders.
The mentorship program will be closely monitored by a designated coordinator and will be
maintained in practice by continued in-service education and reinforcement from administrators,
employees, physicians and patient outcomes. Data will be collected, interpreted and
evaluated quarterly to ensure success of the program. Further, the new program will be
institutionalized through official policy to ensure the program will be maintained.
Recruitment and retention of new graduate nurses has become a major concern in health
care organizations. Facilitating the transition of new graduate nurses to professional RNs is
essential to increasing their commitment and retention. Evidence has shown that new graduates
and their organizations can benefit from a structured mentoring program. A Model for Change
to Evidence-Based Practice, Rosswurn & Larrabee?s (1999), provides a six-step guide to be
used to successfully implement a mentorship program; The need for change is supported by
the number of new graduate nurses who leave their positions within the first year. New
graduates job satisfaction and turnover intentions have been successfully linked to the use
of a formal mentoring program. Literature review on mentorship programs has provided
solid evidence and after careful review of best evidence, the implementation of a
mentorship program pilot study is initiated. The pilot mentorship program is implemented
and closely monitored by a designated coordinator over a one-year period at which data is
collected, interpreted and evaluated. The mentorship program is then revised based on
recommendations and is presented to the standards of practice council for approval. Finally,
it is communicated to all stakeholders including in-service education to staff and is
maintained in practice. DESIGN FOR CHANGE 8 References
Cottingham, S., DiBartolo, M.C., Battistoni, S., & Brown, T. (2011). Partners in nursing. A
mentoring initiative to enhance nurse retention. Nursing Education Perspectives,
Dyess, S., & Parker, C. G. (2012). Transition support for the newly licensed nurse: A programme
that made a difference. Journal of Nursing Management, 20(5), 615-623.
Edwards, D., Kawker, C., Carrier, J., & Rees, C. (2011). The effectiveness of strategies and
interventions that aim to assist the transition from student to newly qualified nurse.
The JBI Library of Systematic Reviews. 9(53):2215-2323.
Fox, K. (2010). Mentor program boosts new nurses? satisfaction and lowers turnover rate.
Journal Of Continuing Education In Nursing, 41(7), 311-316. Doi: 10.3928/0022012420100401-04
Grindel, C., & Hagerstrom, G. (2009). Nurses nurturing nurses: outcomes and lessons learned.
MEDSURG Nursing, 18(3), 183.
Grossman, S.C. (2013). Mentoring in nursing. A dynamic and collaborative process. New York:
Springer Publishing Company.
Rosswurm, M.A., & Larrabee, J.H. (1999). A model for change to evidence-based practice.
Image, 31, 317-322.
Spence, H.K. (2012). Job and career satisfaction and turnover intentions of newly graduated
nurses. Journal of Nursing Management, 20(4), 472-484. Doi:10.1111/j.13652834.2011.01293.x DESIGN FOR CHANGE
Ulrich, B., Krozek, C., Early, S., Ashlock, C., Africa, L., & Carman, M. (2010). Improving
retention, confidence, and competence of new graduate nurses: results from a 10-year
longitudinal database, Nursing Economic$, 28(6), 363-375. 8