Implementing an ICU Nurse Mentorship Program to Bridge the Gaps Before and After Becoming an ICU Nurse

Most nurses who start in the ICU cannot imagine what being an ICU nurse entails. Complex medical and social situations compounded by the emotional roller coaster that accompanies critical care nursing are not adequately captured in a school lecture, clinical rotation or orientation module. The physical and emotional toll of the work environment is difficult to imagine until you are an ICU nurse. The question becomes, "How do we not only retain new nurses but also give them the tools that no classroom can teach?"

Our Medical Intensive Care Unit (MICU) Mentorship Program's goal is to have the new nurse succeed and flourish in the MICU environment. This goal is accomplished by bridging the mentee's past, present and future with nursing in the MICU. By closing the gap between life before the MICU and becoming an ICU nurse, the mentorship program helps the mentee develop in their new role by providing tools, support and guidance, building their confidence to create and advance their career ambitions and goals. By implementing this program, we intend to help retain mentees as nurses during the nursing shortage and incorporate elements of AACN's standards for a healthy work environment, while also developing leadership skills, a sense of purpose and the confidence of nurses who serve as mentors.

Why We Needed Mentors

The MICU served as the COVID-19 ICU for the hospital during the pandemic. Our hospital, University Hospitals Cleveland Medical Center, is a major academic center for both nursing schools and medical programs. The schools followed the 2020 American Association of Colleges of Nursing's recommendations advising schools to reduce student interaction with known or suspected patients with COVID-19. Nursing schools changed their model of education, decreasing exposure for students in the hospital setting.

Coinciding with the change in nursing schools, new nurses experienced minimal in-person interactions with visitors at the bedside. In talking with new staff who were hired during the pandemic, they were struggling with making the transition from student to nurse, clinically and socially. They shared that the decrease in clinical time and experiences affected their clinical skills. As COVID-19 restrictions were lifted and visitors returned to the bedside, new nurses stated they struggled having face-to-face conversations with visitors and families as most of their training had been virtual, either on a video conference platform or on the phone. At the same time new staff nurses were struggling at the bedside, travel nursing requirements changed, lowering the required years of experience to only one year of working experience before being able to travel, resulting in newer nurses leaving their original units sooner.

We developed the mentorship program to strengthen the clinical skills of new nurses while improving their relationships with unit staff and visitors. We recognized that more than ever, nurses are in higher demand and in limited quantities. Providing the tools and training to make them successful is a key component of retention. This mentorship program takes a multifaceted approach to nurturing new hires, and the more experienced nurse mentors gain a sense of purpose and individual recognition in the organization. The program engages both new and experienced nurses in their environments.

Choosing Mentors

The mentors in the program are experienced nurses from the MICU who have chosen to advance their positions by becoming level 2 or 3 RNs through the hospital's clinical ladder promotional process. Through this process, these RNs have committed to quality and processes at the hospital and unit levels. They are also engaged in leadership roles at the hospital and unit levels. To enter the clinical ladder a RN must have at least two years of clinical experience and be certified in a nursing specialty. The mentor's commitment level is evaluated every year as part of their reapplication to maintain their level 2 or 3 RN role. Having MICU nurses as mentors means they are able to relate to their mentees' challenges, since they have had similar circumstances during their careers. Having the mentors from the same unit as the mentees also provides familiar faces and resources for the mentees during their shifts.

Using the Healthy Work Environment (HWE) Standards

After evaluating the struggles of new nurses, the mentorship program was designed to incorporate the components of the American Association of Critical-Care Nurses HWE standards; skilled communication, true collaboration, effective decision making, meaningful recognition, authentic leadership and appropriate staffing. The mentorship program officially runs for the first two years of a nurse's career in the MICU. The timeline for the program is as follows:

0 - 3 Months

• Orientation
• Assign a mentor

3 Months - 2 Years

• Monthly meetings wiht mentor
• Quarterly mentorship group meetings

3 Months

• MICU Education Day

6 - 9 Months

• Code Blue Class

9 Months - 1 Year

• MICU Communication Class

Meetings

Incorporated AACN HWE Standards: True Collaboration, Skilled Communication, Authentic Leadership

Formal and informal nurse leaders are able to use these meetings as platforms to mentor and break down relationship barriers through presentations and open-dialogue discussions, demonstrating their Authentic Leadership in the unit. The leaders can relate to the participants since they had the experiences and emotions the mentees are having during their nursing journey.

• Monthly meetings are informal touch bases between the mentor and mentee. Questions during this meeting are framed to give the mentee an opportunity to discuss any situation they have experienced.
• Quarterly meetings are formal and involve all nurses with less than 2 years on the MICU, mentors, an assistant nurse manager and a nurse manager.
• Quarterly meetings involve team-building activities, speakers and open forums.
  • Examples of topics that have previously been presented are receiving feedback, coping with COVID and moral distress.
  • Guest speakers, such as the MICU medical director, chief nursing officer, nursing director and MICU attendings, have been invited to speak.

MICU Education Day

Incorporated AACN HWE Standards: Effective Decision Making, Authentic Leadership, True Collaboration, Meaningful Recognition

• The class is taught by senior MICU nurses, nursing educators and respiratory therapy. These key stakeholders help direct the standard of care provided in the unit. It also allows a form of recognition for the vast knowledge and experience these stakeholders bring to our unit.
• This class is an eight-hour day with both hands-on and classroom-style learning.
• Topics: respiratory (ventilators, ARDS, COVID), GI/GU (GI bleed, rapid transfuser), endocrine (hypoglycemia protocols, insulin drips), Code Blue scenarios, hemodynamics/cardiac review, back to basics, neuro (Arctic Sun and ICP monitoring)

Code Blue Class

Incorporated AACN HWE Standards: Skilled Communication, True Collaboration, Effective Decision Making.

• The Code Blue class takes what is learned in ACLS and how a scenario at CMC Code Blue operates.
• Topics: code team roles, crash cart and med box, defibrillator, algorithms (PEA, pulseless VTACH/Vfib), communication (constructive interventions and closed loop communication) and mock code situations.
• An in-depth look at the "why" behind a Code Blue scenario builds the nurses Effective Decision Making skills to collaborate with the interprofessional Code Blue team and provide the highest care for our patients.

Communication Class

Incorporated AACN HWE: Effective Communication, True Collaboration.

• This class is led by three mentors and me, an educator. The class is a back-and-forth conversation applying communication techniques and what we have found to work and not work through our personal stories.
• Topics we cover:
  • Precipitating Factors
    • What did you bring back to work with you today?
      • Examples: Do you have in the back of your mind that you need to pick up your kids after work, or maybe you and your spouse had a fight before work this morning?
    • What does the patient (or family member) have on their plate?
  • Types of Patients
    • Alert &+oriented X4
    • Confused
    • Unconscious/sedated
  • Family Members
    • Introductions and relationship-based nursing
    • Presenting expectations
    • Fielding tough questions
    • Discussing end of life
  • Combative or Escalating Individuals
    • Verbally abusive
    • Threatening
    • Physically abusive or violent
  • Interprofessional communication (physicians, respiratory, etc.)
  • Peers
    • Day-to-day interactions
    • Real time feedback
    • Crucial conversations

Feedback

The mentorship relationship is symbiotic. I receive feedback from both our mentors and mentees on the positive impact it makes for them personally.

"My experience with mentorship within the MICU started as a very informal relationship with an ACN (Advanced Clinical Nurse, Level 2). He and I quickly connected over similar interests and had many conversations during night shifts. Starting as an exploration of my goals and what I wanted to get out of the career of nursing, quickly became a long-lasting relationship. I believe he recognized potential within me and started guiding me to improve upon skills and increase involvement.

"At some point in my career, probably two or three years into being a MICU RN, he invited me to attend a meeting he was co-chairing. Looking back, I feel this was his way of getting me more involved and advancing my career. This ended up being the UH CMC Resuscitation Committee, which we are both still involved in. Involvement with this group sparked my dedication to process improvement and eventually led to me obtaining my CCRN." - Mentee

"What is great about the mentorship program is that it has provided me with an experienced nurse to support me as I gain experience as a nurse. My mentor and one of my preceptors have been my "go-to" since early in my orientation. When I have a bad day, I always look at the staffing sheet to see if she is on the next shift. My mentor has given me someone to look up to and someone to make proud as I continue to gain experience. The large group meetings have given me the chance to see my co-workers off the unit and to realize that most of the nurses with my level of experience share the same emotions and difficulties as I do." - Mentee

"Empowering each other through the mentorship program maintains the MICU's history of producing a family of excellent nurses. As a senior nurse, my actions are influential and my experiences can help guide others with self-care and care of patients. These are issues the mentee face that I would not have thought about until this program started. It is beneficial for both the mentor and mentee when time is taken to just listen. My MICU family has guided me for years and I am proud to be able to use my experiences to uplift spirits, answer questions and help provide guidance." - Mentor

"Mentoring is what the MICU is all about. Without it we have nothing. It's impossible to do this job alone so when you mentor you create that team that is necessary to provide the quality of care we demand from each other." - Mentor

"Mentorship both formally and informally can be extremely rewarding in that many times you see a young person enter their first career role with a tremendous amount of potential yet lack the professionalism and sometimes life experiences. With the right balance of encouragement and constructive feedback you can watch them grow right in front of you." - Mentor

Improved Retention

In addition to the positive psychosocial feedback, there have been positive results of the MICU mentorship program with 45 potential nurse participants over a two-year span of hiring.

• 40 candidates chose to participate.
• Of the five who did not participate four left the MICU within 14 months.
• Of the 40 who did participate, 100% had a one-year or more retention rate, and 68% had a two year or more retention rate in the MICU.
• 20% of participants received advanced certification during the program.

The MICU's mentorship program stands as a beacon of excellence emulating our nursing vision statement: UH Nurses Empower, Advocate, Innovate to achieve excellence in human caring. By bridging the gap between their past experiences and their future goals, the program provides essential tools, guidance and encouragement to promote success, foster belonging and improve retention. This initiative addresses the nursing shortage by enhancing retention rates and integrating the standards of AACN's Healthy Work Environments. Many of us have often said that some days it seems like we spend more time with our co-workers than we do with our families. Just as the relationships and cultures we cultivate outside of work do not happen overnight or come without effort, neither does our working relationship and culture. We all spend a lot of time at work (sometimes too much time, but that's another topic), we help make the workplace somewhere we not only enjoy being also a healthy work environment.

When we commit to fostering our fellow nurses at the unit-based level, we have the opportunity to positively impact not only our practice but the profession as a whole on many levels. What does mentoring look like in your unit?