As the nursing profession continues to grow and develop, mentoring of our new nurses is essential to developing the nurse leaders of the future. Hear what Mary Terhaar, DNSc, CNS, RN, Director of the Doctor of Nursing Practice Program and Associate Professor at Johns Hopkins University School of Nursing in Baltimore, Maryland, and Angela Barron McBride, Ph.D., RN, FAAN, and Chair of the National Advisory Committee of the Robert Wood Johnson Foundation Nurse Faculty Scholars program have to say about nurse mentoring.

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Jamie Davis:         Angela and Mary, welcome to Nursing Notes Live and I guess I’ll start with you, Angela. Would you like to share with us a little bit about your background in nursing, why you became a nurse and what led you to where you are today?

Angela McBride: I am someone who became a nurse in part because all through high school, I worked as a nurse’s aide. I had a great-uncle who was good friends – he was a priest – he was good friends with a nun who was the head of a hospital and he actually was instrumental in getting me to do nurse’s aide work. But this was at a time in the ‘50s when you wound up doing really quite a large range of things even though you were not educated. And I was just intrigued with the range of what kind of things you could be doing as a nurse. I wound up eventually specializing in psychiatric mental health nursing. I wound up after that then getting into university teaching. So, for me, it’s been a route from liking to work with people and their families, liking the idea that every day is different, there’s so many things that you can do, and then being increasingly interested in preparing nurses for tomorrow. I’m old enough that my whole career has been spent with a lot of what was the development of nursing, the development of advanced practice programs, the development of doctoral programs, the development of post-doc research training. I continue to really be loving nursing for the range of what you can wind up doing so the – I think when I was growing up, it was the notion of a nurse is a nurse is a nurse. So one thing I know is whatever your talent, there’s a spot for you in nursing.

Jamie:                   I love the way you say that, whatever your talent is, there’s a spot for you. I’d certainly never thought I’d become a nurse journalist when I got started and yet I really love what I do now. So that’s very interesting you say that. Mary, what about you? What was your background in nursing? Why did you decide to become a nurse?

Mary Terhaar:     Well, it was fun to listen to Angela describe hers. My grandmother was a nurse at the end of the war and at that time the training wasn’t the same but I always admired her work and so that got me started. Much like Angela, I worked as a candy striper in a hospital. So I guess I think I’ve always been a nurse as far back as I can remember. So that gave me this appetite for nursing all across the house. So I was the person who always volunteer to go wherever there was help needed and that always gave me the chance to see nurses working in different settings, solving different kinds of problems and meeting different kinds of needs. I’ve always been attracted to that. So when I was in nursing school, and I’m a three-year grad, when I was in nursing school I worked in labor and delivery and NICU and I loved it and I still went wherever was needed. But my heart really was in the NICU. So all throughout my career, I’ve been in NICU and labor and delivery. I’ve been somebody who could solve problems when I finished my doctorate, I became someone who could solve problems using evidence in practice and so that was the work that I did on the practice side. And I came to teaching later on. It’s been just about a decade now that I’ve been teaching. So I’m at Hopkins and I have great privilege of running the DNP program here where I help nurses learn to use evidence to solve problems. So that’s kind of how I’ve come where I am. And like Angela says, there’s so many opportunities for nurses and so many different practices or practice settings in which to be a nurse. I’m very excited by all the potential and the amazing folks that are coming into the profession which I think is what brings us to the interest in mentoring.

Jamie:                   Well, we all as nurses know the importance of mentors in helping to bring us to where we are today and influence our paths. But it’s been defined by the Institute of Medicine report back in 2010 that mentoring in nursing was an important part of a process of increasing our nursing workforce. Angela, what are your thoughts on that? Why is it that the IOM report recognized that as such an important aspect?

Angela:                You know, I think you have to go to school and get degrees to read the lines. But you need socialization and mentoring experiences to learn how to read between the lines. There’s so many things that you have to learn as you go into, say, a new setting where to have somebody who helps you negotiate getting to know the organization, helping you network, helping you connect to resources, helping you realize the range of opportunities perhaps even at that institution that forged you. One of the things I do right now is I chair the National Advisory Committee for what is the Robert Wood Johnson Foundation’s nurse faculty scholars program. This is a program for junior faculty who are in the process of establishing their program of scholarship and getting used to the experience of being a faculty member. And we actually, in that program, have four different kinds of mentoring. When you apply, you have to say who you’re primary mentor will be. This is someone in your school of nursing who is more senior, who will help you negotiate being a faculty member in that school. You also have to apply with a research mentor and, in fact, we encourage that you get someone not in nursing, on your university campus who will help you develop your program of scholarship. Once you’re in the program, we then assign a national mentor to you to help you not just be limited by the advice you’re getting in your home institution but connecting you to a nurse scholar nationally who will help you with big-picture thinking. And then when you are in the program, you’re in it for three years and the people who are part of your cohort is in enormous amount of peer mentoring with support of individuals. I believe that that program has been successful as it is. Because it understands that for you to in fact grow and develop as faculty member, you actually need these various kinds of supports to help you understand and – in class, sometimes you’re embarrassed with asking certain questions. The thing about mentoring is you have somebody more senior who actually is committed to helping you be successful and negotiate the range of things that you are going to have to confront in a relatively beginning position.

Jamie:                   Mary, I love how Angela said that you need more than one mentor and sometimes mentors outside of the nursing field, you are involved in the – you are the director of the DNP program at Hopkins and you’re essentially training mentors to be mentors in effect?

Mary:                    You know, that’s interesting. In the practice environment, yes. We are training – we are preparing nurses who will be in clinical practice and will be scholarly in their work and we’ll be able to help to develop other nurses who will be scholarly and serious in their work. And it is fabulous. I get excited by the outcome that our students are able to accomplish by approaching discipline problem-solving and in work. And I get excited because some day will be able to role model that for other nurses. It’s interesting because as you make that reflection that we’re preparing mentors. Perhaps that’s a piece of a curriculum that we should amp up. I think that we prepare our graduates to teach by example, to lead by example. But we also teach them to go – Angela, do you remember the piece that Marie Manthey wrote? I think it was in the ‘80s about the different relationships that you should have for your career development, do you remember that piece?

Angela:                I do. I do. In fact, I, over time, have come to believe that mentoring isn’t just for beginnings. I think every time you go through a transition, you need some mentoring or what I like to say when they make you Secretary of Health and Human Services, you’re going to have to  get in touch with people who were previously in that position and get tips from them. Informal tips on how to be successful in that kind of a role.

Mary:                    Right. So it’s interesting because I think folks have to think of mentoring and think of looking up for mentorship. So even our students, even our undergrads, we’ll tell the undergrads, you need to have this set of relationships and you need to have someone who is far enough, ahead of you in career that you can be inspired and awed by them and you can look at their trajectory and say, “This is how I will achieve my goals” and to ask them for perspective on your progress. We encourage them to have someone who is, like Angela said, not in their organization and perhaps not in their – not even a nurse. So it’s a great idea to track along with a colleague of yours who’s in finance and say, “Well, what kind of career moves are you making and what kind of risks are you taking and how hard are you pushing and am I doing the same within my profession?” And then for our undergrads, we encourage them to mentor someone who’s just a little behind them because they make fabulous coaches to other students who are quite new in the program because they have a really fresh memory of what it was like at the entry and what that struggle was like.

Angela:                Exactly. I think one of the best sort of coaching things I ever heard was one of our senior students got up as part of a panel for beginning nursing students. And it was a woman who was about seven months pregnant and she commented on having two other children under the age of three. And she began by saying, “Let me tell you how I study because I don’t have time enough to go back. I have to get it the first time.” And she proceeded to list a series of tips of how she studied to retain material. And I have to tell you, everyone in the audience from the beginning nursing students to the most senior faculty members were taking notes because she spoke with an authority about her subject that somebody else could not have mastered.

Mary:                    And that’s one of the things that we need from our mentors, right, that we need from our mentors, that we need when mentoring, is we all need help with this balance thing which is probably a fallacy, isn’t it? It’s probably more carving than balance that we’re all about but how are you faithful to all your commitments and that would be professional and personal and, Angela, in our RWJ, you did a great job of saying and how you’re faithful to yourself. I love the piece that you do in RWJ talking about – and what is it that you’re doing for your own health and for your own mental health and to refresh because we can get so programmed toward the professional accomplishment that we lose the whole being which is the thing that we need to be good nurses.

Angela:                You’ve raised several of the big areas that I think mentoring deals with. I think in a mentoring relationship, you can ask about issues of time management, how you balance different responsibilities and interests with people frequently being – giving on the one hand tips but also talking about, you know, I think in a career to dance. You talked about – do you achieve balance? I think it’s a U-curve. I think if you’re not engaged enough in work, you could be stressed but if, in fact, you have too much you’re over stressed. So working family can be a really good combination unless you’re getting into sliding some of the responsibilities and feeling badly about it. But I think it’s something about everybody sharing how they try to combine being a partner, being a daughter, being a mother, being a parent, being a worker. How do you find time to both teach but also to find time for writing, finding time for perhaps your own involvement in professional organizations? And you’re right, there’s no big answer to this. It’s a dance that you do but there’s something about understanding that the constraints you’re feeling are commonplace once sort of normalizes things. But often people do give you tips about how they handle things that gives you a better way of dealing with things and maybe what you’ve been doing all along.

Mary:                    Right. It gives you some perspective. I think the opportunity to speak with mentor or to speak with someone to whom you’re serving as a mentor is the opportunity to just push the pause button and to do some reflecting on personal and valuable and professional content and progress. That’s a pretty delicious thing. So mentoring someone else gives back to us as much as being mentored…

Angela:                I think the important thing to note is since we’ve talked, mentoring can be a longer term one-to-one relationship, but it can be a whole series of relationships that are of different periods of time. And I would argue for universities and clinical agencies, we’re now at a point where sometimes it’s a mentoring structure that you put in place rather than as a mentoring relationship per se. What do I mean by that? I found, for example, in having a writing group in a university. We do have faculty members at different stages, maybe some graduate students. We are all either trying to work on spreading an article or writing a grant proposal. But it’s a writing group that meets regularly where we take each other’s work seriously. Trying to give help so that if somebody is struggling with the piece trying to give them good feedback knowing that when you present your own work, they’re going to take your work seriously and try to give you good feedback too. To me, that kind of a writing group, various support groups, a brown bag exchanges of teaching tips. Those structures for me are sort of like mentoring structures where it isn’t so much a one-to-one relationship but the organization is trying to facilitate getting tips from each other in a sort of collegial way and I think those are very important too.

Mary:                    So, Angela, I think that’s such a great segue. We must put in place these mentoring structures and you’ve spoken about several – the RWJ, the writing groups – and we look at the transition that’s happening in nursing now. That we’re all getting grayer and that the average age of a nurse is much higher. In my state I think the average is in the 50s. So we need to bring in the next generation. We need to bring in the next generation not only to the bedside in a context of a shortage where they’re struggling to get positions but we need to bring them into leadership positions and have them ready, prepped, to fill the leadership positions that will be vacated and that’s true in practice and as it’s true in academe. So we’ve just put in place a new structure where what we’ve recognized is the DNP’s, as might it is, we’re preparing them and as capable as they are they still struggle on re-entry into practice once they’re done with their degree. Much the same way the PhDs did, when the PhD degree was new. And so we put in place a mentoring structure for them as they re-enter practice. So we can say, “So what do you need to do in order to continue translating? What problems are you tackling? What are the barriers?” A nice peer group so that they can help each other manage the obstacles to translating evidence into practice and obstacles into meaningful contribution back to the institutions.

Angela:                All of this represents a big paradigm shift because I’m old enough that I was part of a world where the attitude that prevailed seemed to be – “I went through hell to get those educations so should you.” And I think what we see now is really a whole different viewing of our own profession. I think that you see the mentoring structures because people really are in – I think there’s never been a better time to go into nursing. The demand for nursing leadership is so great. The Institute of Medicine, there’s a number of reports talking about the need for transformational leadership from nurses. And I think all of us, no matter what generation we are, I think on a whole, in some ways, we are more energized not to see ourselves as just caregivers where the focus is on what we do for other people but that it’s an exciting – and that’s important – but that it’s such an exciting field that we all feel, I think, even more invested in helping people come into the field, be as excited about the field as we are. But also to move on and try different positions of leadership knowing that when you go in, you’re not – nobody goes into a new position where they know everything about that new position. No matter whatever transition it is, you can profit from some kind of informal support, however, it is provided. And that has become such a staple of what I think is a more energized nurturing professional stance on the part of nursing.

Mary:                    It’s more energized and nurturing. And I think another paradigm that’s different is early in our careers it was important to figure out nurse and nursing and to mentor within nursing. So we were kind of getting a good replication of the DNA. “This is a good nurse. Let’s all be – let’s make sure that we’re strong good nurses.” And now, the inter-professional focus of nursing is, I think, changing the models for mentorship and our exposure so that I think nurses are more likely to look to others for mentoring while still having a strong core as a nurse and conversely to offer mentorship to others from a nursing perspective that helps them to develop professionally as providers as well.

Angela:                It’s interesting because I have had physicians come to me for mentoring. Because I think they saw that the school of nursing was taking seriously I think mentoring in a way that so many other health schools were not in terms of we were more advanced in that direction. But also now that nurses have what I considered to be full careers. Meaning, that even if you work for the same organization for 40 or 50 years, the notion that you would do the same thing year in and year out is a very dated notion of nursing. The expectation now is that with additional skills and with additional opportunities, additional responsibilities and things open up for you, more and more nurses are assuming inter-professional leadership within whatever agency they’re working. And so I think that nurses are seen as good mentoring models not just for people in their own profession.

Mary:                    Good mentoring models and nurturing, I think, sometimes our colleagues practice in the context of more competitive in a less helpful way and perhaps less of the philosophy that all both can rise at the same time. I do think we can offer that perspective to other disciplines. One helps many.

Jamie:                   This has been an amazing discussion and I don’t want to – I would love to sit back here and let it go on for eternity because I’ve really enjoyed listening to both of you talk about mentoring. We have to wrap-up though. There’s a finite amount of time here and I just wanted to let each of you have a final word on mentoring. Maybe, Mary, if you would speak to perhaps what someone seeking a mentor should look for in their mentor as we wrap up.

Mary:                    So I think in looking for a mentor, it’s wise to look for someone whose career you would wish to emulate. Someone who you think has integrity, who shares the value that you share. Someone who is accomplished. But as you’ve spoken of in this conversation, maybe accomplished in the domains of their life where you also would aspire to accomplish. Yes, so I would look to someone who you would wish to emulate and someone who will speak truth, someone who will tell you the difficult things that you need to hear because it isn’t all a cheerleading process. It needs to be sometimes an honest, thoughtful look in the mirror with support from someone who’s been there to help you to choose good path and not choose just easy or familiar. Sometimes you have to move outside your comfort. If you’re the smartest person in the room, the saying is, I think, you might need to find another room and I think that a mentor can help you to do those things.

Angela:                That’s a great line.

Jamie:                   Angela, how about you from the other side? What should a mentor, as wrap up, seek to be to their mentee?

Angela:                   Well, I think you want someone who understands the struggle, understands that in a practice profession, there’s, in addition to the book learning, there’s how things apply in real-life conditions. And someone who understands of the context and can help you with the context. I think you also want to mentor who is going to – you see, I believe at the beginning, you need to do some talking about whether it’s a good fit. Building on what Mary said, you might go to somebody who’s like you. But I think you also then need in the first session to talk about how you’re going to handle the relationship, what are the expectations, what are – I always say that you set up the relationship so that if it’s not a good fit, nobody loses face by saying, “This isn’t working out.” So that you can make additional choices. But I think to talk about your style. I think the big danger with mentors is they often do want someone who is like them and then that becomes problematic when you begin to get people who are different from you historically. And I say this as there are more minorities in nursing, as there are more men in nursing. I think if you are a Caucasian woman mentor, you need to be very sensitive to – also that it may not be a common experience. One of the things I’m finding, by the way, that mentors are talking about, is often when they themselves got degrees when they were more senior and experienced, they came to value a relationship with a mentee who’s a self-starter. The more we have programs for talented individuals at the undergraduate level to go through to the doctorate, the more those individuals are not quite the same self-starters as perhaps their mentors were in the way they negotiated that trajectory. And sometimes there are difficulties because you’re expecting the person to be more of a self-starter and they actually need more structure, more tips, more concrete advice than a more senior experienced person. So I think that a good mentor is also savvy about – “This individual may be like me in some respects but then they were like quite different and I need to help them with the pieces of their own background to realize their fullest potential.”

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Make sure you check out the entire May 2013 issue of Nursing Notes, examining mentoring in nursing. You can read the entire issue online at www.discovernursing.com and don’t miss the other Nursing Notes Live episode this month where I interview nursing graduate and TYLENOL Future Care Scholarship recipient Kayla Hanson about her experiences with nursing mentors. You’ll find this and other podcast episodes at the Nursing Notes by Johnson & Johnson Facebook page, and in the podcast area in iTunes.

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