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1 Spring 2013 Volume 85 No. 1 FEATURE NEWS MNA Champions the Standards of Care Act Page 2 Also in this Issue Sleepy Eye Nurses Vote for MNA Representation page 6 North Memorial Nurses Avoid Major Layoff Fiasco page 7 Scope of Practice Issues Addressed page 10 Self Study Continuing Education: Mentoring Relationships page Honors & Awards Nominations page 24 Official Convention Call MNA s 108th Annual Convention October 13 16, 2013 St. Paul, MN The Minnesota Nursing Accent Spring

2 FEATURE NEWS Nurses Push for Patient Safety at the Capitol Minnesota s legislators are getting a dose of reality this session, as nurses converge on the Capitol to push for measures to reduce patient risk in hospitals. House File 588 and Senate File 471 were introduced at a February 15 press conference hosted by MNA and featuring authors, Rep. Joe Atkins and Sen. Jeff Hayden, respectively. MNA President Linda Hamilton introduced the legislators, saying They share our concern that patients are needlessly at risk in our hospitals because not enough skilled registered nurses are on duty to adequately handle the needs of vulnerable people in the acute care setting. MNA members Sandie Anderson and Susan Kreitz underscored the need for legislative action. Anderson echoed thousands of nurse voices, stating Beyond the closed doors, behind the curtains, below the shining brass awards for safety, nurses witness too much suffering and too many errors. We witness way too many near-misses because we are stretched dangerously thin. It is all so unnecessary. Kreitz exposed a truth born out in recent research that shows a systemic pattern of failure of hospital management to respond adequately when nurses notify supervisors that patient care is at risk because of poor staffing. A survey conducted of MNA nurses revealed that when bedside nurses notified supervisors of unsafe staffing, 17 percent of the time nurses received no response from On February 15, MNA members Sandie Anderson and Susan Kreitz were joined by Rep. Joe Atkins to announce the introduction the Standards of Care bill. managers and nearly one-third of the time were told to make do. Our frustration mounts when we warn our managers that, in our professional judgment, patients are at risk as a result of not enough time to provide adequate care for the amount of patients at the level of acuity we are assigned, said Kreitz. The legislative process is a grueling one. As of this writing, the bill has been considered and passed in no less than five different committees in the House and Senate. Each time, MNA members have stepped up to deliver incisive and compelling testimonies, or were prepared to speak on behalf of colleagues and patients throughout the state. Other members packed the rooms in support. Patients Will Gain The bill lays the foundation to empow- On January 4, nurses from Bemidji, Hibbing and the Twin Cities gathered with colleagues from Thief River Falls to kick off the Standards of Care Campaign to shed light on the crisis of patients at risk in hospitals throughout the state. On the Cover Nurses testified in several hearings regarding the Standards of Care Act. Pictured center is President Linda Hamilton. Surrounding her, clockwise is Joe Howard, Juli Uzlik, Eric Tronnes and Courtney Lucht. Minnesota Nursing Accent Minnesota Nurses Association 345 Randolph Avenue, Ste. 200 Saint Paul, MN / Spring, 2013 PUBLISHER Walter Frederickson, RN MANAGING EDITORS Jan Rabbers Chris Reinke BOARD OF DIRECTORS President: Linda Hamilton, RN, BSN 1st Vice President: Bernadine Engeldorf, RN, BS 2nd Vice President: Barb Martin, RN, RNC Secretary: Cindy Prout, RN Treasurer: Pam Scott, RN, BSN, BSE Directors: Lori Christian, RN, BS, CEN Pat Dwyer, RN, BSN, CRRN Deb Haugen, RN, BSN Eric Tronnes, RN Mary Turner, RN Pat Webster, RNC Office Hours: Monday-Friday 8:15 a.m. - 4:30 p.m. Subscriptions Published: March, June, September, December Opinions All opinions submitted are subject to the approval of the publisher, who reserves the right to refuse any advertising content which does not meet standards of acceptance of the Minnesota Nurses Association. Minnesota Nurses Association Accent (ISSN ) is published four times annually by the Minnesota Nurses Association, 345 Randolph Avenue, Ste. 200, Saint Paul, MN Periodicals Postage paid at Saint Paul, MN and additional mailing offices. Postmaster, please send address changes to: Minnesota Nurses Association 345 Randolph Avenue, Suite 200 Saint Paul, MN The Minnesota Nursing Accent Spring 2013 Nurses Push for Patient Safety cont. on page 7

3 FEATURE NEWS Twin Cities Nurses Ratify Three-Year Contract Twin Cities nurses represented by the Minnesota Nurses Association ratified their contracts in December with health care systems in the Twin Cities. The three-year agreement is effective June 1, 2013 May 31, 2016 and impacts 12,000 nurses working in 13 different facilities in the metro area. Nurses agreed to contracts that will increase wages by 4.5% over three years. When they approached us, we saw a great opportunity for an efficient process that would be good for our communities and our patients, said MNA President Linda Hamilton. Both parties agreed prior to entering the negotiations to bargain over wages only. Doing so ensured, for both sides, all current language, including clauses related to important nursing practice standards, remain intact. This is a fair contract that will play one part in helping nurses direct our attention to our most important work of keeping patients safe, said MNA President Linda Hamilton, RN, BSN. The systems and hospitals involved in the contract are: Allina (Abbott Northwestern/Phillips Eye Institute, United, Unity, Mercy) Fairview (Southdale, Riverside) Children s Hospitals and Clinics (Minneapolis, St. Paul) HealthEast (Bethesda, St. John s, St. Joseph s) North Memorial Medical Center Park Nicollet Methodist Hospital Preventable Adverse Events are a System Failure After nine years, hospitals are still reporting 314 adverse events that could have been prevented. The Adverse Health Event report, released in January by the Minnesota Department of Health, portrays a bleak picture of patients at risk in Minnesota s hospitals, and a troubling pattern of lack of improvement over the years. Patients are suffering; families are grieving because systems did not adequately protect them from preventable mistakes, such as falls and the development of pressure ulcers. Beyond the sobering revelations of the Adverse Health Event report, nurses at the bedside are deeply concerned that other troubling instances are not reported. We catch our breath with every near miss, every late medication, every discharge with hasty instruction. We provide a safety net through our continual monitoring, but we see the foundation of that net eroding more each day. Our frustration mounts when we warn our managers that in our professional judgment patients are at risk as a result of not enough time to provide adequate care for the amount of patients at the level of acuity we are assigned. Many Years; Much Money; Little Improvement A 5-year record of Minnesota Department of Health s report on Adverse Health Events in Minnesota hospitals From the summary we learn there were: 14 deaths in 2012 compared to five in serious injuries compared to 84 in Nearly 90 percent of the cases of harm or death were a result of falls. Though there was a decrease in pressure ulcers from 141 to 130, not being able to re-position tubes accounted for more bed sores last year than the prior year. Year Total Events Serious Injury or Death Falls Pressure Ulcers The Minnesota Nursing Accent Spring

4 PRESIDENT S COLUMN Legislative Lessons I love learning, even if it feels chaotic and unsettling at times. The bulk of what I ve learned about policy-making and nurse advocacy, however, is affirming. First, let me share some practical insights that may give you the tools you need to better advocate beyond the bedside. 1. During session CALL the legislator-it is more effective than or letters. Talk or leave a message for a legislative assistant who frequently relays the messages on to the legislator. An or letter may not get opened for some time. 2. Make the message short. I live in your district and I support staffing legislation for nurses because (give a patient-centered reason). Leave your contact information and address. 3. Attend the town hall meetings occurring in your district. They are opportunities to publically ask their support. 4. All elected officials are normal folk just like you and I they want to hear from their own constituents. You are important to them. They serve the public and we elected them. 5. Patient safety is a non-partisan issue. By that same token, we must always assume that every legislator needs persuading. I do believe all legislators want to do what is in the best interest of their constituents, and the best way to make that happen is for constituents not paid lobbyists to personally connect with our elected officials. We need to push the legislators to cast the right vote. Now, here s what I ve learned that has affirmed why I m proud to be your elected leader of this great organization. I hope you will be as inspired as I am to use the above tools and your own resources to take your advocacy to the next level. Nurse Practice Act / Scope of Practice Affirmed: Nurses across Minnesota are passionate about the Nurse Practice Act and your actions have protected and improved it. Fact: Hundreds of you attended and spoke at hearings held by the Board of Nursing to develop changes to this statute that governs the practice of nursing. You commented and participated in surveys over a four-year time-frame. You wrote letters to your legislators. Result: You were heard. The resulting agreement better reflects the practice of the LPN and the RN. What s more, I believe we forged a stronger alliance with our LPN colleagues that will benefit our practice and our patients Standards of Care Affirmed: Nurses are unconditionally dedicated to reducing the risk to patients exposed to inadequate staffing. Affirmed: You are ready to take on this fight, even if it means facing seemingly infinite resources in opposition. Affirmed: You have the power to influence decision-makers who may be sitting on the fence. Fact: Since the 2013 legislative session began, 400+ members have personally meet with their or contacted your representatives. Fact: 15 nurses testified at Committee hearings (visit mnablog.com to view videos of testimonies) Fact: 3,300 Unsafe Staffing Forms made a visible impression on one Senate Committee hearing Fact: Hospitals and the Minnesota Hospital Association employ 78 lobbyists nearly one lobbyist for every legislative district in Minnesota. Fact: Real stories about real patients in real hospital beds made a difference in key votes during committee hearings. Result: The Standards of Care Act is still on track to be considered by both chambers of the Legislature. If passed, Governor Dayton has indicated he will sign it. 4 The Minnesota Nursing Accent Spring 2013 Legislative Lessons cont. on page 21

5 Nurses Are Exposing the Reality: Patients Are At Risk By Walter Frederickson, RN, MNA Executive Director One thing I know is to listen to nurses: If my family member was admitted I wouldn t go home because I d be too afraid of something bad happening. We were five nurses short, and eight new patients came in. We ve got several confused patients hitting their call buttons, but we can t get to them to help re-orient them. We re so understaffed we can t even spare the time to update family members, so now they re upset too. If you pay attention to those who are at the bedside, patients are at risk. Somewhere, somebody is waiting for medication; somewhere, a family is getting hurried discharge instructions with their loved one; and somewhere, a patient is developing a bedsore or infection because their nurse is too busy to move them or just change their dressing. That somewhere is here in Minnesota, where we pride ourselves on excellent health care. It can t continue. Every Minnesotan who s admitted into any hospital or medical facility must feel that there will be someone to take care of them. In 2010, after the Minnesota Nurses Association started tracking unsafe staffing situations online, nurses reported more than 1,000 incidents in just six months. When MNA asked members if staffing was a major issue at their facility, almost half said yes. Clearly, the issue of nurse staffing has moved beyond just good working conditions for MNA members it s affecting patient safety. The Minnesota Department of Health recently released its annual Adverse Event report. Suffice it to say, the number of events stayed fairly constant. Safety in hospitals isn t improving and it bears mentioning that this study is based on the self-reporting of hospitals on their own events. MNA is fighting for minimum standards for all patients, regardless of facility or union representation. The issue is so critical, MNA is launching a major campaign to pass patient safety standards. The Standards of Care Act sets nurse staffing to the national standards incorporating acuity and census grids and holds facilities accountable if they fail to meet those standards. Patient staffing in Minnesota hospitals would be tracked and reported to ensure compliance. These standards aren t MNA s, or California s, or Massachusetts. They were developed by nationally-recognized nursing organizations, which have determined the optimal number of nurses to assure patient safety. In one case, the Med/Surg units, where no standard exists, the Standards of Care Act establishes a professional committee with the state department of health that would establish reasonable and attainable standards. The knee-jerk reaction is: that sounds like an expensive solution, or isn t there an easier way? Logic, however, says the Standards of Care Act is an easy solution MNA Purpose The purpose of the Minnesota Nurses Association, a union of professional nurses with unrestricted RN membership, shall be to advance the professional, economic, and general well-being of nurses and to promote the health and well-being of the public. These purposes shall be unrestricted by considerations of age, color, creed, disability, gender, health status, lifestyle, nationality, race, religion, or sexual orientation. MNA Strategic Goals 1. MNA empowers registered nurses to use their collective strength, knowledge, and experience to advance and enhance safe and professional nursing practice, nursing leadership, and the community health and well-being. 2. MNA exemplifies a positive, powerful union of professional nurses that advances nursing and patient interests in the Upper Midwest. 3. MNA promotes effective RN staffing and safe working conditions for both patients and registered nurses in direct patient care, in policy and political arenas, and in our communities in the Upper Midwest. 4. MNA increases membership and participation as a union of professional nurses through effective internal and external organizing, member activism, education, and mobilization. 5. MNA actively promotes social justice, cultural diversity, and the health, security, and well-being of all in the Upper Midwest in its organizational programs and in collaboration with partner organizations. 6. MNA, in solidarity with the National Nurses United and the AFL-CIO, will promote the rights of patients, nurses, and workers across the United States Organizational Priorities A. Position MNA for negotiations from strength across Minnesota. B. Transform MNA to capitalize on grassroots member collective power and activism to achieve MNA goals. C. Organize to increase MNA membership, participation, and solidarity to promote the MNA mission and strategic goals through political activism, collective action, organizing of new bargaining units, and development of local and regional activity. D. Educate and mobilize members around health care reform and pursue short- and long-term strategies to achieve a single payer health care system with guaranteed health care for all. E. Continue MNA s campaign for patient safety to ensure the integrity of nursing practice, nursing practice environments, and advance safe patient staffing standards and principles through worksite collective action, collective bargaining, legislative initiative, grassroots organizing, political action, public visibility, and education consistent with the MNA Strategic Plan and the objectives of National Nurses United (NNU). F. Involve the labor community in advancing labor, nursing, and patient issues. G. Play an integral role in building the National Nurses United. Frederickson cont. on page 7 The Minnesota Nursing Accent Spring

6 E & GW MNA Wins Job and Back Pay for St. Peter Nurse Jodi Jones, a state psychiatric nurse with 25 years of experience, has won her arbitration case with the Minnesota Security Hospital in St. Peter, Minnesota, including re-instatement of former rank, position, and back pay. In addition, disciplinary proceedings will also be removed from her personnel record. Jones was terminated for an alleged error in therapeutic judgment. Later, her employer changed the reason to a different reason. For her judgment and care, Jones was disciplined and let go, but the arbitrator sustained the grievance in every particular on all points and particulars. He even took issue with the state s case and noted it had failed its burden by a wide margin. If we didn t have a (nurses) union, Jones said, I would have no chance of getting my job back. We re just so lucky to have an opportunity to present a case. The arbitrator noted that Jones was in a tough situation with little counsel on what to do and that the state s investigation was conducted after she was fired, not before. Jones will be returning to work in the near future and collect approximately a year s worth of pay and benefits she would have received if still on the job. Jones is the second state nurse in two years that MNA has won a job back with back pay and the fourth nurse to win re-instatement this year. I m so grateful for all the work and time. They really believed in me. You can t imagine the stress on you in that situation, Jones said. The resource (of the union) is unbelievably important. Until it happens to you, you just never know that. Sleepy Eye Nurses Vote For Union Representation with Minnesota Nurses Association Twenty-four registered and licensed practical nurses at Sleepy Eye Medical Center have the power of 20,000 additional voices at their workplace with a Feb. 20 decision to join the Minnesota Nurses Association. Leaders are confident the move will lead to better and safer care for patients of the critical access hospital located in south central Minnesota. With a contract behind us, we can better advocate for our patients, said Naomi Freyholtz, RN. Nurses were stirred to organize in part because skilled colleagues have been exiting the facility due to frustration with management practices regarding scheduling and staffing. We ve lost 33 nurses in three years, said Freyholtz. We stood to lose more if things didn t change. Katie Grams, LPN, sees the benefit of connection in joining a community of nurses. It s such an advantage to be represented by people who deal with facilities similar to ours and who share our concerns, she said. She sees the power to bargain as a strong tool to help her profession. As we are the voice of our patients, we are the voice for each other in our union, Grams added. Recipe For a Young Activist By Jenifer Dahl My husband Dave and I hired our 12.5 year-old to do the suppers every night. We both hate to cook them so we would rather pay her to do it. Mackenzie wanted us all to meet 6 The Minnesota Nursing Accent Spring 2013 around the table and discuss her contract. Dave and I were too tired on the night she wanted to do it so we just signed her paperwork to pacify her somewhat, and were heading to bed when she told us she wanted $20 a day for making supper. I told her she wasn t getting that much but I would pay her $5 a day and we would take turns doing the dishes. She mentioned getting a mediator and wanted her 20 year-old brother Logan s help in case she needed to protest/strike. He could help her with the signs and chants. Whoa! Watch what you tell your children about the day s events I guess We settled on $5 per meal but she wants absolutely no help and no advice (written in her contract) and we all take turns with the dishes. She makes delicious lasagna. Jenifer Dahl, RN, is a member of the Sanford Bagley MNA bargaining unit.

7 North Memorial Nurses Avoid Major Layoff Fiasco Management at North Memorial Hospital in Robbinsdale started the year on a cheery note by abruptly announcing a restructuring of nursing staff during a Labor/Management meeting. MNA leaders and staff Joe McMahon were informed the hospital intended to reduce the RN staff by approximately eight FTEs. Specifically, management s plan was to reduce North s IV team by 6.8 FTEs and restructure the Mom/Baby and the Women s & Children s units, which would result in a layoff/rebid process. The resizing efforts, as the hospital agenda labeled the exercise, targeted five different areas in total. We pulled out our contract books, said MNA Bargaining Unit Chair Mary Turner. Amid pressure from management to agree to a layoff timeline, the MNA committee responded calmly and with authority. We pointed out the negotiated language that clearly outlines the process required prior to issuing layoff notices, said Turner. Steps, like offering early retirement to eligible RNs and allowing RNs to reduce hours or take voluntary leaves of absence, have long been successfully used to moderate devastating facility-wide cuts. MNA leaders also demanded documentation from management regarding the need for the layoff, but received no evidence-based justification during that meeting or the subsequent meeting the next day. We d been very busy over the holidays and the census was staying high, said Turner. The numbers just didn t add up. In fact, MNA was able to produce contrasting information. Labor Specialist Joe McMahon highlighted to management the hospital had paid more than $3.4 million in RN overtime in 2012; and used 18,000 hours of casual part-time in just the past six months. Some units couldn t even meet core needs, said McMahon. Casting these facts aside, hospital management announced its intention to proceed with layoffs. MNA objected to the time frame and submitted a detailed data request for justification. A next meeting was scheduled for January 25. Equipped with contract language, steadfast leaders and binders full of weak data presented by the employer, the MNA committee negotiated new terms of the next steps during the 10-hour meeting. They agreed to move off the 8 10 FTEs down to 5 8; they added 2 IV team positions to the grid; rescinded a layoff for one entire unit, and promised to provide extended orientation for those choosing to bump into the ER, said Turner. Plus, the early retirement option kicked in. Nurses Push Safety from page 2 er patients and to document the level of crisis in patient safety in Minnesota hospitals. It requires hospitals to post key information about their staffing levels on a public website. In addition, it sets up a research study to help determine the correlation between nurse staffing and patient outcomes, using Minnesota-specific data. MNA is confident that combining the behavior of reporting staffing information, along with capturing authentic data will confirm the need for improved staffing and, more importantly, to hold hospitals accountable for appropriate staffing levels. Our Work is Not Done - More Nurse Input Needed NOW The legislation is likely to be heard on the floor of both chambers sometime in April or May. Please contact your representative and senator and urge them to support this bill. To Do before April 26: Call your Representative regarding House File 588 Call your Senator regarding Senate File your legislator using MNA s Frederickson from page 5 that saves money and lives. We know, for example, that nurses are being called by their staffing offices on a daily basis to report early or work an extra day or stay late. This costs money. As any manager will tell you, proper planning saves time and money. We also know that patients are taking longer to recover thanks to complications from hospital stays, even after they return home. We know that patients can t return to work. We know that patients are being readmitted within 30 days of discharge. These consequences also cost money, but the real cost is the loss of a family member who suffered or fell or coded because of a lack of staffing. That family doesn t want to hear what proper staffing would ve cost the hospital. Nurses care about patients. Always have. Always will. When they can t do their jobs properly, then nurses advocate for better solutions that ensure patient safety. Nurses have told their supervisors and employers that patients are at risk. Today we need to tell lawmakers that Minnesota deserves better. Minnesotans deserve the Standards of Care Act. Grassroots Action Center at Talking points: You are a nurse living in the district. You have seen the consequences of unsafe staffing on patients There is a crisis in patient care in Minnesota (and my hospital) We need public disclosure and reporting of staffing levels I believe research will document the crisis I witness now, and will help keep patients safe in the future. The Minnesota Nursing Accent Spring

8 LEGISLATIVE UPDATE Standards of Care The Standards of Care Act is focusing on collecting Minnesota-specific data on issues of nurse staffing transparency as it relates to patient outcomes. We continue to strongly believe every patient in the state deserves a minimum number of Registered Nurses and that any data collected will validate the thousands of nurses in Minnesota who experience unsafe staffing on a daily basis. We ve learned that legislators have many questions about staffing and not enough hard data specific to Minnesota hospitals. The bill s framework would improve transparency by requiring hospitals to report their staffing on a quarterly basis, and tie it to data on nursing-sensitive health outcomes like falls, infections and pressure ulcers. MNA believes we have an opportunity to create a robust reporting system reflecting real nursing hours per patient day. In addition, the bill s language now includes a study, developed by the Minnesota Department of Health that will evaluate the correlation between nurse staffing and patient outcomes, to be completed by The bill has passed through five different committees so far. The House and Senate versions differ, and we will continue to pursue language that creates reporting requirements that provide the most transparency for patients and a true picture of nurse staffing in Minnesota. It continues to be very important for nurses to contact our legislators to ask them to support the most robust reporting language possible. Contact your state legislators to ask them to support strong consumer transparency language, nurse staffing reporting and a comprehensive study that gathers real data about the correlation between staffing and health outcomes? Let them know that unsafe staffing is still a problem for Minnesota patients and we need meaningful data collection to protect patients. Health Insurance Exchange signed into law Governor Dayton has signed the Minnesota Health Insurance Exchange into law. The new program, now called MNSure, will allow Minnesotans to access affordable health care, including the uninsured and employees of small businesses. The exchange will be consumer friendly, transparent and will encourage competition among insurance companies. The exchange is estimated to save Minnesotans and businesses $1 billion by Governor s Revised Budget The Governor released a revised budget proposal, which dropped sales tax changes but continues the Governor s commitment to tax fairness. Under his proposal, income taxes will go up on the top 2% of earners (average income of $617,000), leaving the other 98% with no tax increase. MNA continues to support the Governor s commitment to progressive taxation and investment into key state priorities including health care and education. Employer Reporting of Drug Diversion Legislation MNA representatives testified about a bill that would require hospitals to report employees who divert drugs to their professional licensing board. While MNA does not condone drug diversion, chemical dependency is an illness that is best treated through early intervention and ongoing monitoring. We are concerned that this legislation would discourage health professionals from self-reporting and seeking help from the confidential Health Professionals Services Program. Legislators on the committee agreed that it is important to add protection for self-reporters that would allow them to seek confidential help for their chemical dependency. An MNA Family Benefit Medicare Supplemental Insurance for MNA Members and Relatives 65+ (Yep, this does mean aunts, uncles, moms, dads, brothers, sisters, cousins, grandparents who are Medicare-eligible!) MNA has made available to its Medicare-eligible retirees and their Medicare-eligible relatives a voluntary Group Medicare Retiree plan offered through Medica Insurance Company and marketed by Holden Insurance Agency. 8 The Minnesota Nursing Accent Spring 2013 Group Prime Solution SM offers two benefit options: Option 1 Comprehensive benefits with 100% coverage for covered medical services. Four-tier Part D benefit with NO coverage gap or donut hole Includes coverage for Medicare Part D excluded drugs; e.g., benzodiazepines, barbiturates, and ED drugs. Option 2 Comprehensive benefits with affordable copays for covered medical services. Four-tier standard Part D plan. Includes coverage for Medicare Part D excluded drugs. Group Prime Solution plans deliver all the benefits of Medicare Parts A, B and D, plus additional benefits, such as a basic health club membership through SilverSneakers Fitness Program and a Nurse Line to assist you with non-emergency medical questions. You, your spouse and any eligible dependents must be enrolled in Medicare Parts A and Part B or Part B only to enroll in the Medica Group Prime Solution Plans. Contact Al Winters (Phone) / (Cell)

9 MNA Day on the Hill 2013 MNA nurses flooded the Capitol on Tuesday, bringing the message that patients are at risk in Minnesota hospitals, and we must have a statewide standard of care to ensure patients get the nursing care they deserve. Nurses from all over the state gathered in St. Paul on Feb. 5 to meet with their legislators and call for patient safety legislation, as well as to support Governor Dayton s budget and increased access to affordable health care for all Minnesotans. At an evening event prior to MNA Day on the Hill, members also took part in education sessions and heard from speakers including Governor Mark Dayton and Commissioner of Management and Budget, Jim Schowalter. Student Nurse Day on the Hill MNA welcomed over 300 nursing students from every corner of Minnesota to St. Paul on Thursday, Feb. 28 for MNA s annual Student Nurse Day on the Hill. Students heard from MNA nurses about the importance of advocating for patients at the Capitol, and listened to capitol veteran Representative Jim Abeler (R-35A, Anoka) describe the characteristics of effective citizen lobbyists. After the program, they visited the Capitol, beginning what we hope is a long career of nurse activism. The Minnesota Nursing Accent Spring

10 PRACTICE UPDATE Scope of Practice Issues Addressed with Changes to Nurse Practice Act MNA, the Minnesota Board of Nursing and organizations representing LPNs assessment delineated. 1. Definitions of focused (LPN) and comprehensive (RN) have agreed to changes to the Minnesota Focused nursing assessment (LPN) is of the health status of individuals Nurse Practice Act clarifying the scope of through the collection and comparison of data to normal findings and the individual s current health status and reporting changes and responses to interven- LPN practice, and the relationship between LPNs and RNs. tions in an ongoing manner to a registered nurse or the appropriate The decades-long process has not been licensed health care provider for delegated or assigned functions. without controversy and the input of hundreds of MNA members was critical to the collection, analysis and synthesis of data used to establish a health status Comprehensive assessment (RN) of the health status of patients through achieving a resolution that improves the baseline, plan care, and address changes in a patient s condition. practice of all parties involved. Note: Difference between individual (LPN) and patient (RN) Overall, more than 800 individuals participated in providing feedback on the lan- collected by an LPN requires reporting to the appropriate provider so is not an which is defined as an individual, group, or community. The information guage. MNA members attended listening independent function. sessions last summer and/or submitted 2. Delegation is within the scope of only the RN. Assigning and monitoring written comments. Thanks to all of you nursing tasks to unlicensed assistive personnel is within the scope of an who spoke up on behalf of your profession. LPN. Delegation means transferring to a competent individual the authority The Minnesota Nurse Practice Act language has not been updated in over forty Assignment means designating nursing activities or tasks to be performed to perform a selected nursing task in a selected situation. years, so this agreement reflects decades of by another nurse or unlicensed assistive person. advances in nursing care. 3. Supervision is within the scope of only the RN and means the guidance Thanks to chief authors Rep. Patti Fritz, by a registered nurse for the accomplishment of a function or activity. a retired LPN, and Sen. Chris Eaton, RN, The guidance consists of the activities included in monitoring as well as and a former MNA member, who expertly establishing the initial direction, delegating, setting expectations, directing moved this legislation through the process. activities and courses of action, critical watching, overseeing, evaluating, At this writing, both versions of the bill are and changing a course of action. awaiting votes in the respective chambers 4. Teaching, health promotion, and care coordination within the scope and are expected to pass. Governor Dayton has indicated he would sign the legis- 5. New language regarding accountability for the quality of care delivered of only an RN. lation into law. by both the RN and LPN is recognizing the limits of knowledge and experience; addressing situations beyond the nurse s competence; and evidencing that level of education, knowledge, and skill ordinarily expected of an individual who has completed an approved professional (practical) nursing education program. Note: This language could be utilized to provide protection for reporting unsafe staffing. 10 The Minnesota Nursing Accent Spring 2013

11 Ethics Committee Book Club for Nurses Provocative discussion on ethical issues posed in today s literature Feature Book Walk of the Centipede by Jay Clark and Aura Sanchez-Garfunkel A revealing tale of loneliness and camaraderie, dissonance and intimacy with hospital staff, and pain and triumph as one man struggles to reclaim body and spirit after a devastating accident. April 16, :00-7:00 pm MNA Office 345 Randolph Ave., Suite 200 St. Paul, MN No cost to MNA members - $10 for non-mna members - light dinner provided REGISTER BY APRIL 12, 2013 Login to the Member Portal at Click on Event Registration tab Once registered you will recieve an communication acknowledging your registration Questions or to register by phone Contact MNA Education Department , ext. 122 or Nursing Contact Hours This program for 1.8 contact hours has been designed to meet the Minnesota Board of Nursing continuing education requirements. However, the nurse is responsible for determining whether this activity meets the requirements for acceptable continuing education. Minnesota Nurses Association 345 Randolph Avenue, Suite 200 St. Paul, MN , Fax: /1/13 The Minnesota Nursing Accent Spring

12 Mentoring Relationships AUTHORS: MNA Commissions on Nursing Practice and Education Purpose: To provide nurses with information and resources needed to develop formal mentor relationships. Learning Objectives Upon completion of this independent study article the nurse participant will be able to: 1. Clarify the definition and attributes of a mentor relationship. 2. Explain the stages of the mentor relationship. 3. Identify the responsibilities and benefits inherent of a mentor relationship. 4. Describe the activities of a mentor relationship. 5. Demonstrate completion of a written contract. 6. Identify responses for evaluating the mentor relationship. Nursing Contact Hours - This program for 2.0 contact hours has been designed to meet the Minnesota Board of Nursing continuing education requirements. However, the nurse is responsible for determining whether this activity meets the requirements for acceptable continuing education. Directions to receive a Certificate of Completion Login to MNA Member Portal at Click on Event Registration, then on Mentoring Relationships Test and Evaluation Questions. Questions? Contact MNA Education Department at , ext. 122, or Key Words MENTORING Mentoring is a process in which a more experienced nurse shares expertise with a mentee. Alleman (1982) defined mentoring as a relationship between two people in which one person with greater rank, experience, and/or expertise teaches, counsels, guides and helps the other to develop both professionally and personally. MENTORING RELATIONSHIP A dynamic relationship that develops from the needs of the mentee and the abilities of the mentor. MENTOR A mentor helps the mentee adapt and grow by sharing knowledge, assisting with role identity and being a supportive listener. MENTEE The mentee is in a new role, whether they have practiced for a long time or are new to the profession. Many authors prefer to use the term protégé instead of mentee. 12 The Minnesota Nursing Accent Spring 2013

13 A Parable A farmer rescues a baby eagle that had fallen from his nest. The farmer nurses the bird back to health and puts it in with his chickens. The eagle grew up living as a chicken; happy to peck grain in the yard, roost in the coop and never fly higher than a few inches off the group. One day a friend of the farmer saw this and asked why the eagle acted like a chicken. The farmer simply explained that the eagle was too lazy to fly away. That he had learned that the coop was warm and the food plentiful. The friend bet the farmer $50 that he could teach the eagle to fly. You re on said the farmer. The friend took the eagle to the top of the barn, where it looked like it was going to naturally take to the air until it looked down and saw all the chickens in the yard. The eagle gently glided down and started to peck grain and strut around the yard. The next day the friend took the eagle to the mountains, where he patiently taught the bird to spread its wings and fly. The farmer s friend left the eagle gracefully circling the treetops, but by the time he had returned to the farm to collect his bet, the eagle had returned to the chicken yard and was contentedly pecking grain again in the yard. The friend paid up, but came back the next day and took the eagle again to the mountains. This time, in addition to the patient teachings of yesterday, he told the bird You are an eagle, not a chicken. Eagles soar through the air, hunt for rodents, and live in nests high in the trees. They don t peck grain, live on the ground or sleep in the coop. The friend spent all day with the eagle and at the end of the day the eagle flew off, confident in his new knowledge that he was an eagle not a chicken. And was never seen at the farm again. (The committee would like to thank Leah Curtin, ScD(h), EdD, RN for the concept of this parable) Introduction In a nursing practice setting that is faced with generational differences, short-staffing, rising patient acuity and new technology, nurses now more than ever need to support one another. Nurses are at risk for confidence loss, horizontal and lateral violence, fear of retaliation, loss of job and perceived professional isolation. A nurse who is new to a role or specialty practice setting will find it rewarding to learn from an experienced nurse. A professional relationship known as mentoring can be developed so that the person seeking help (mentee) can freely learn from a seasoned colleague. A mentor relationship can help the mentee to handle a variety of settings with renewed confidence. In addition, a mentor can gain a sense of personal satisfaction by sharing one s wisdom and experience. For both the Mentor and mentee professional development is enhanced and improves the quality of patient care. According to the ANA Code of Ethics (2001 p.9) Provision 1.5, there is a statement that guides the nurse to care for their colleagues, The nurse maintains compassionate and caring relationships with colleagues and others with a commitment to the fair treatment of individuals to integrity-preserving compromise, and to resolving conflict. A Mentor relationship is one way to support colleagues when there is a new role transition within the practice setting. A relationship that nurtures, caring, trust, learning and open communication will promote a smooth transition with quality and safety in the new role. (Marcani, 2002 p.5) The nurse contributes to the professional development of peers, colleagues and others. According to the Nursing Scope and Standards of Practice (2004, p. 37 & 89), there are standards and criteria that outlines the professional nursing role regarding mentoring Standard 10. Collegiality: The registered nurse interacts with and contributes to the professional development of peers and colleagues. Mentoring motivates the individual who may have lost sight of why they entered this very honorable profession and encourages them to renew and share these reasons and values with the nurses they mentor. Connie Vance, EdD, RN, FAAN As a whole, the profession of nursing and professional organizations of nursing can benefit from mentoring as nurses validate themselves and what they do. Individuals frequently enter nursing with strong humanistic and altruistic values. One major advantage of being a mentor is to see the difference nurses can make within the nursing profession, and not just with the clients they serve. Nurses need advocates and supporters within the profession as much as the profession needs the support of the people served. The goal of mentoring in nursing is to retain nurses in active practice, facilitate recruitment, increase professional skills, help structure the profession and increase client satisfaction. In accomplishing these tasks the profession is strengthened and the community as a whole benefits. When nurses support other nurses, the profession enhances its power to control its own practice and destiny. Mentoring is valuable as it enhances professionalism in practice, regenerates nursing from within, and facilitates uniting nursing as a profession. When a nurse is mentored, the mentee is more likely to mentor another nurse, thus strengthening the profession of nursing. Encouraging the mentee s growth in a non-judgmental environment and explicating appropriate risk taking are essential components of mentoring. For the purpose of this Mentoring Relationships cont. on page 14 The Minnesota Nursing Accent Spring

14 Mentoring Relationships from page The Minnesota Nursing Accent Spring 2013 article, the term mentee is used to denote a person that is new to a role whether they have practiced nursing for a long time or are new to the profession. Self-governance that involves decision-making and taking responsibility for those decisions is a priority in today s health care environment. Mentoring is a mechanism to facilitate the development of this skill. The mentor helps the mentee by: supporting validating empowering building confidence strengthening the practice of the mentee Mentor relationships offer a safe harbor in which to build these skills. The mentoring relationship can be initiated by the mentor, by the mentee, by a professional association or by the employer. The relationship can be formal or informal. The formal relationship is for a specific time period. Nurse researcher and educator Connie Vance (2000) views the mentoring relationship as global, encompassing most relationships and most contacts. As professional nurses, we should always be eager to mentor whenever a nurse needs our assistance, or to receive beneficial mentoring when needed. Vance (2000) named this global mentoring the mentoring mentality. She encourages collaborating in contrast to competing. It is right for the profession of nursing. Stories from the Field: Nurses share stories about mentoring At age 11, I lost one of my best friends to a brain tumor. Ginny was fun and active and when she was diagnosed, I don t think I fully understood what her disease would mean to me for the rest of my life. After her first surgery, I would go to her house and read to her because it had affected her vision. Her mom would let me go with her whenever they did special things so Ginny would have someone she felt comfortable with. I remember that we went to Twenty Thousand Leagues Under the Sea at a big theater in another town. She always laughed and I never wanted her to know how strange I thought she looked with only half a head of hair. When she was able to go back to school, one of us was always assigned to be with her if she was sent to the bathroom, went on errands for the teacher or did assigned tasks (like getting milk for the snack break). When her sister developed an allergy to her cat, she gave it to me and then would come and visit it. Before she died, I would go to her house and at the end she didn t respond to me. When she died, the whole 5th grade class went to the funeral and acted as an honor guard as the casket was carried from the church. Ginny was the mentor who directed me into nursing. Jan was my big sister in nursing school. She was always there when I thought things were going down the tube. She never hesitated to talk when I needed to talk, to encourage me to do more, when I wasn t sure I could do it, to let me cry when things got out of hand. She even included me in upper class outings when it was appropriate. Although I have lost track of her, I still feel that strength and support when I look closely at my career. Joan was a nursing instructor. We were some of her first students and she was only about 5 years older than we were. I have looked up to her throughout my career as a nurse, instructor, supervisor, colleague and friend. She participated in the nursing care with her students. She was bright and thoughtful, not overpowering but a gentle giant when it came to mentoring. I know that I am not the only student she taught who continues to feel the impact of her strength and support. Her critical thinking and problem-solving behaviors were especially supportive as a supervisor. She taught leadership by example, without ever raising her voice or criticizing those nurses she was supervising or working with. She was and is my mentor as a nurse and a person. One of the most important things we can do in our profession is to find our own replacement. There were nurses within MNA who asked and encouraged me to become active. People like Carol, who was moving and asked me to take over her role on the District Board of Directors; Ruby, who appointed me to the membership committee when that meant being sure there was 85% membership in MNA in your facility or you didn t stay a contract facility; Judy who helped me better understand the negotiating process but more importantly helped me understand how important it was to be professionally active and not just a union member, Vonnie, who replaced herself with me to try to carry on the profession as a professional with all the dignity only she had; and Linda, who taught me that we can continue to impact our profession through adversity and illness and that what we leave behind is a lasting memory. To all these very professional mentors who taught me the value of who I am professionally, I have the greatest gratitude, for without them my professional life would be empty and I wouldn t know that I needed to replace myself. My big sister in nurses training was probably my first true mentor. I remember several times that she was there for me. I still vividly remember every time I m cleaning a patient, either alone or with another caregiver. I can still hear Kay saying, You ll never get him clean doing it like that, as she wrapped t-paper generously around her hand and wiped repeating the process as needed. Then she put lotion on fresh t-paper and wiped again, lubricating the skin. It is, as I said before, something I ve used many times in my 40+ years as a nurse and have shared this how to with several co-workers as well. Kay was there for me in the years in training and after graduation as well, asking how are you doing? And how s work going? I always felt cared for by this teacher, friend and mentor in nursing.

15 The Development of a Mentor Relationship The mentoring relationship is a dynamic relationship that develops from the needs of the mentee and the abilities of the mentor. A healthy mentor relationship is a Win-Win situation for both the mentee and the mentor. The purpose of the relationship is to help the mentee adapt to the new role. Through the relationship, the needs of the mentor/ mentee must be identified. A mentor is not a friend nor a boss, but a colleague with the expertise that the mentee desires to attain. There are distinct stages of the mentoring relationship, but like the grieving process, these are not always linear in progression. The relationship may take two steps forward and one step back to previous stages. Whether we look at the farmer or the friend in the parable of the eagle, this story illustrates the power one person can have on the goals and self-perception of another being. Misconceptions, compliance and apathy can limit the abilities of a mentee, while support, knowledge and empowerment can help them achieve their full potential and grow into their position. Stages STAGE ONE Finding Someone to Help STAGE TWO Working Together STAGE THREE Self-Confidence is Evolving STAGE FOUR Secure with the knowledge and ready to fly STAGE ONE: Finding Someone to Help The mentee may or may not realize they need a mentor. The relationship can be initiated by either party, but the need must be recognized by both for a healthy relationship to occur. Santiago (2012) has a few tips for choosing the right mentor: Choose an experienced, senior level-nurse in the specific role area of interest. This nurse will be able to assist you with more knowledge and expertise. Choose a nurse who is local or nearby and if possible someone in your organization. Close proximity enables your mentor to guide you through situations that are be specific to your area such as economic, political, or legal issues that may affect your role. Choose a nurse who has a good balance of similarities and differences to your strengths and weaknesses. If you choose a mentor who is too much of an opposite, then it will be too difficult to follow their lead. If you choose a mentor who is too much the same, then you may find the skill sets between the two of you too similar. Choose a nurse who is willing to answer questions, give advice and lend a helping hand from time to time. A mentor can be someone who is a friend or co-worker, who happens to be in a role position that you are developing. (Santiago, 2012) A new transition can be very overwhelming if a nurse has a good experience he or she tends to develop into the new role with more confidence. The mentee and mentor meet. Mentors and mentees may enter into a mentor relationship in a number of different ways, including: Luck: The mentee just happens upon someone willing to help them become acclimated to the environment or position. Mentee actively searches for a mentor: Mentee recognizes the need for help and seeks out another with the desired expertise. Will you help me? Experienced registered nurse reaches out to a novice nurse: Recognizing the novice needing assistance. May I help you? Organized mentor program: Mentees and mentors are routinely assigned to one another through an established process. You re elected to serve. Of the above four, the most successful and reliable is the organized mentor program that has an established process of introduction, goal setting, troubleshooting and evaluation. In this process, mentees are identified and paired with experts that have volunteered to mentor. They follow guidelines that direct the relationship and its duration. The success of these programs is based on the willingness of the mentee and the mentor to enter into this relationship with well-defined expectations of both parties and the availability of resources for problems and questions. Goals and objectives are set for the relationship Goals reflect the reason for the relationship, e.g. upon completion of this relationship, the mentee will function competently as a Charge Nurse. A mentor relationship may have more than one goal and should include a reasonable time frame for completion. Criteria for the relationship should be set at the beginning. Objectives are the tasks that need to be completed to meet the goals. They should be written in behavioral terms, e.g. what is the mentee able to demonstrate, discuss, identify or explain. A reasonable time frame for completion should be established. Discuss the limits and boundaries of the relationship The process of clearly defining the mentor relationship is called setting boundaries. Setting boundaries means all parties agree on the goals and means of implementing the relationship. A commitment of time and availability is expected of the mentor and mentee. Areas to consider Mentoring Relationships cont. on page 16 The Minnesota Nursing Accent Spring

16 Mentoring Relationships from page mentoring relationships influence the shape, quality and outcome of professionals career paths. Connie Vance, 1994 when setting boundaries for the relationship are: 1) the goals; 2) the nature and frequency of contact; 3) the duration; 4) termination provision; 5) availability on and off the job; 6) means of communication; 7) resources available; 8) expectations of each other; and 9) No fault. Any party to the relationship may terminate it without penalty through a simple notice. STAGE TWO: Working Together During the early part of the mentor relationship, the mentor and mentee share a mutual exhilaration for the process. Goals and objectives are clear and each is committed to the process. They spend time getting to know each other s strengths and abilities and they work together to resolve conflict as it occurs. Mentor s role includes teacher, adviser, supporter and sounding board The mentor s ability and willingness to help the mentee grow contributes to a healthy relationship. The mentor actively seeks ways to help a mentee adapt without exceeding the limits and boundaries of the relationship. These may include: 1) sharing of pertinent articles; 2) telephoning/ to check on how things are going; 3) reviewing individual needs; 4) offering insight on situations; 5) listening to the mentee s ideas; 6) directing the mentee to other resources; 7) attend a forum that relates to your common professional interests; and 8) the mentor can also help the mentee make connections with other professionals and professional organizations. The rewards are in the success of the mentee and the mentor/mentee relationship. According to Dragoo (1998), the mentor/mentee relationship is likened to that of master craftsman and apprentice. This is a journey whereby knowledge is transferred from theory to practice. The journey is guided by those with experience (p.12) A mentor relationship will be successful if the mentee and mentor take responsibility for their roles in the relationship. Specifically a mentee needs to be able to: Identify needs and expectations, Have a positive attitude to work and career, Willingness to try new opportunities and to learn, Be open to receiving advice, feedback and constructive criticism, Give time to and effort to the mentoring process, Respect the time and commitments of the mentor, Network with other people so as not to become dependent on the mentor, and Be trustworthy and respect confidentiality. A mentor needs to be able to have knowledge and/or experience related to: 16 The Minnesota Nursing Accent Spring 2013 Contemporary health care delivery in community/ clinic/public health, hospital, state/long-term and acute care facilities, Global, national and statewide healthcare issues, and be skilled in Relationship building while maintaining confidentiality. STAGE THREE: Self-Confidence is Evolving Mentee seeks the independence and opportunities to demonstrate what has been learned in the relationship The mentee is no longer a mentee and seeks to demonstrate new-found abilities. The mentee may resent being as closely monitored as they were in the beginning of the relationship. Mentor s role progresses to consultant The mentor now gives advice only when asked and works towards the dissolution of this successful relationship. As the mentor relationship comes to an end, the mentee may encounter unexpected opportunities and challenges that changed the goal of the relationship. This may require the support of the mentor or the development of another mentoring relationship better suited to meeting maturing needs. This is similar to when an adult child leaves their parents and enters a relationship with a significant other. STAGE FOUR: Secure with the Knowledge and Ready to Move On Adult child leaves their parents and enters a relationship with a significant other Goals and objectives are met or completed Celebrate! The success of this relationship is meeting the agreed-upon goals and objectives. The mentee has enhanced skills to function independently in their new role. Mentor relationship is dissolved It s over and the participants are free of the responsibilities and commitments of this relationship. Mentee and Mentor become colleagues with mutual respect for one another The end of the mentoring relationship does not mean the end of the relationship between its participants. The participants may grow to respect the strengths and abilities of each other. Responsibilities A successful mentor/mentee relationship will include the following responsibilities: A. Expectations: The expectations of a mentor and mentee relationship need to be made clear early in the relationship. They may need to be clarified and revisited as the relationship matures. There are individual expectations as well as facility expectations. Each need to be identified and discussed. B. Time: A willingness on the part of both individuals to invest time will create a solid relationship and will lend a sense of importance to its development. Some meet weekly, others may choose to meet monthly. Respecting each other s time commitment is important. Return all telephone calls or s and keep scheduled meetings.

17 C. Ground Rules: The ground rules/parameters will determine the scope of the relationship. These ground rules need to be developed within the expectations of the relationship. This will keep the mentor/mentee relationship focused. D. Insight: Both individuals need to be somewhat visionary, or at least willing to invest in positive change. Professional growth occurs with positive change. E. Communication: The communication within the mentoring relationship needs to be on-going, confidential, informative, and constructive. Both mentor and mentee must employ active listening and give continued feedback on the expectations and goals of the relationship. F. Networking: The mentor refers the mentee to available support systems and connections. Networking with other professionals eases the transition of the mentee into a new role by providing support and acceptance. G. Cultural Awareness: The mentor is sensitive to the mentee s cultural needs and potential cultural conflicts. H. Closure. When the expectations and goals have been completed, it is time for the relationship to end; the end should be at a time that is agreeable to both parties. The mentor-mentee relationship is that of a master craftsman and apprentice. This is a journey whereby knowledge is transferred from theory to practice. The journey is guided by those with experience. Jossie Dragoo, 1998 Relationship Wheel The mentor and mentee have a fluid relationship where responsibilities flow from one to the other. Benefits Mentors produce leaders... empower and inspire us to take risks, to reach our full potential, to make substantial contributions to our workplaces and our profession. (Vance 1994) Mutual rewards and benefits exist for the mentee, the mentor, the workplace and the profession of nursing. When the parties involved fulfill the previously mentioned responsibilities, the benefits will happen mutually for all. Mentoring allows the mentee to learn coping mechanisms and acquire positive learning experiences for future change. The mentor assists the mentee to appropriately engage in risk-taking and to develop the necessary mechanisms for strengthening her professional identity as the farmer s friend taught the eagle. Benefits to the Mentee A mentor may assist the mentee in networking with individuals, both internally and externally to the organization. The mentor provides guidance through formal and informal power structures. Benefits to the mentee: 1) Non-judgmental support and special interest; 2) Guidance through formal and informal power structures; 3) Enhanced self-confidence and self-esteem; 4) Career development assistance; and 5) Nursing skills will be recognized and erroneous information will be corrected before it is a problem for the mentee. In a study of 126 registered nurses in clinical practice the traits learned from the mentor included: independence, dedication to the job, frankness, discipline and neatness. (Shields 1986) In addition, the mentee will learn the skills to be a future mentor and will be socialized into the nursing profession. Benefits to the Mentor The mentor s own abilities and leadership skills will be enhanced through the mentoring relationship. The mentor can share her own experiences and help the mentee avoid the hurdles and roadblocks that the mentor experienced in the past. A mentor is likely to feel empowered and be more committed to the organization. The mentee will benefit from non-judgmental support and special interest from the mentor. The mentee will experience the enhanced self-esteem and self-confidence. Nursing skills will be recognized and erroneous information will be corrected before it is problem for the mentee. (Lafleur 2012). Connie Vance (1994) describes mentoring relationships as influencing the shape, quality and outcome of the professional s career paths. According to Funderburk (2008) and Lafluer (2008), job and career satisfaction are also increased for the mentor. At some career point, the mentor may wish to become a mentee in a new mentor/ mentee relationship. A good mentor can make the difference between success and failure in your career. Joan M. Lakoski, 1999 Mentoring Relationships cont. on page 18 The Minnesota Nursing Accent Spring

18 Mentoring Relationships from page 17 Benefits to the Mentee Lafluer (2010) surveyed research studies (between 1979 to 2009) related to the positive impact of mentoring. Benefits to the mentee included personal satisfaction within the practice setting, professional success, organizational and professional contributions. In addition Daley, et. al. (2008) a research study paired senior students in a leadership course with instructor-led groups of first year students in the clinical and laboratory settings. They found that the first-year students who were mentees of the senior student mentors gained confidence with their knowledge and skills and were able to refine communications with patients, families, and staff members and think more critically about patient care issues. Unanticipated benefits included patient, family and staff appreciation and recognition for quality patient care. Benefits to the Workplace/Profession The nursing profession benefits as a whole when individual nurses abilities and leadership skills are enhanced, thus increasing career and job satisfaction. It is easier to recruit people into the nursing profession when nursing has satisfied mentors. Recruitment and retention strategies will be strengthened by a strong mentoring programs, thus promoting a stable work force. The professional organization benefits when members are motivated and socialized into the organization. Members who are mentored are more likely to be: 1) active in their professional organizations; 2) motivated to address future changes in the health care field; and 3) enhance leadership abilities for self and others. How To Do It Once the decision is made to create the relationship, initial contact must be made. This can be done by face-to-face contact, by telephone, or by . Distance and time factors should be considered in coordinating communication. Select a place to meet that provides an opportunity for a private conversation. If the individuals in the mentor relationship are of different genders, meetings should be held in public areas to prevent any problems related to significant others or peers. During this initial contact, an open honest conversation should include: expectations of the relationship boundaries and limits anticipated length of relationship number and frequency of contacts and the final expected outcome A commitment to the relationship should also be established. Discussion about each other s value systems and beliefs may be beneficial to clear up any misunderstandings in the beginning. Both parties should agree that if the relationship does not appear to be successful or if life circumstances change, the 18 The Minnesota Nursing Accent Spring 2013 option to terminate the relationship exists. Once the relationship has been established, activities a mentor can provide include regularly scheduled meetings, phone calls or s. The mentor assesses the learning needs and learning style of the mentee. The mentor may assign projects that provide information or promote growth while the mentee makes the commitment to follow through (Dragoo 1998). The mentor also introduces the mentee to other key members of the organization who can provide information or support. It is also important for the mentee to understand where these key people fit in the organizational structure and what information can be gained by establishing relationships. The mentor may also facilitate entry into meetings and activities usually attended by high-level people and act as a source of information on the missions and goals of the organization. The mentor may also invite the mentee to a professional organization meeting where the mentee can meet additional professional nurses. These members can be external or internal to the organization (Dragoo, 1998). Eddison (1999) states that at any stage of the relationship, activities may include counseling, providing guidance and listening. Lakoski (1999) adds that the role of mentor includes being a sounding board and giving that extra boost of confidence. As a sounding board, the mentor helps the mentee analyze a problem, set priorities and decide a course of action. Mentors are future focused. The mentee will want to identify problems and ask for help when it is needed. Another important activity performed by the mentor is evaluation and constructive feedback. For first-time mentors, providing feedback may be uncomfortable. Keep in mind that no favors are done by remaining silent if the mentee is not meeting expectations. When giving feedback, be objective, but sensitive to feelings. Some refer to the Oreo cookie method. Start with something positive, then discuss areas that have opportunities for improvement and then end with something positive. Never let the mentee leave hearing negative feedback last. Remember, the goal is to increase the mentee s confidence. Effective mentoring relationships will have the following characteristics of the mentor: (a) be a seasoned professional who is willing to share experience and expertise to promote career development; (b) support mentee career goals by suggesting projects and exploring positions in the organization that will support skill development; (c) suggest education workshops, programs, etc.; (d) share personal stories, provide case studies for the mentee to reflect and discuss, (e) serve as a role model and help the mentee to avoid mistakes that the mentor has experienced; and (f) guides the nurse to reflect on current and past situations and to assess the positive and negative impact of the experiences. (Thompson, 2012, p ) As the mentor/mentee relationship closes, final activities include deciding how, or if the relationship will continue. If it seems appropriate, the mentor encourages the mentee

19 to become a mentor in the future. The mentor may make recommendations for advancement and publicly praise the accomplishments and abilities of the mentee (Murray 1991). And finally, the mentor and mentee should celebrate the successes of the relationship. As long as the participants recognize the process for terminating the relationship early and discuss this - neither will feel stuck in an unpleasant experience. No fault means any party to the relationship may terminate without penalty through simple notice. Stachura and Hoff (1990) have several recommendations for mentoring relationships: 1) Participation be strictly voluntary; 2) There be an orientation to mentoring with clear expectations; 3) Ongoing administrative support of the relationship and structured guidance for the relationship; 4) The mentoring program should have a clear beginning and ending event with about six months in between. Nurses who have reported that mentors are a strong influence on their careers believe that the most significant contributions mentors make are: 1) Offering feedback on performance; 2) Sharing expertise with the mentee; 3) Serving as a role model; and 4) Demonstrating a belief in the mentee. The beauty of giving away knowledge is that it costs nothing. Jay Mazurowski, 1998 Evaluating the mentor relationship How does the mentor evaluate whether their contribution and guidance to the mentee has been helpful? What does the mentor use as tools to evaluate the mentee and their response? Does the mentee evaluate the mentor and the process that was used in the mentor/mentee relationship? Are care-giving skills of the mentored individual improved? Is there a significant benefit/loss to the mentor/ mentee? Evaluating the effects on the organization Is the care received by mentors or mentees different from that of those who are not involved in this process? Does it contribute to the welfare of the receiving individuals or organizations? Does mentoring help to retain employees in an organization or facility? Is there a personal incentive to be a mentor, or are people being required to mentor new employees and thus see it as a burden to an already overworked nurse? What growth has occurred on a professional basis? Evaluating Self What growth has occurred on a professional basis? Are caregiving skills of the mentored individual improved? Is there a significant benefit/loss to the mentor/ mentee? Conclusion In conclusion, as the healthcare environment becomes more complex and staffing levels are compromised, support for preparing and developing nurses in their new roles is necessary for the future of the RN workforce. A new transition can be overwhelming if a nurse has a good experience he/she will develop into the new role with confidence. Although mentoring carries many responsibilities it also delivers many benefits to the mentee, the mentor, the workplace and the profession of nursing. The mentor may feel rejuvenated and have increased job satisfaction as a result of the relationship. Surely the organization will benefit from motivated employees and less turnover and the professional organization may benefit by retention of nurses within the profession. The relationship can be a process of renewal, reaffirmation, and validation of the individual - thus the individual will be able to judge. When a nurse is mentored the mentee is more likely to mentor another nurse thus strengthening the profession of nursing. This will lead to a retention of nurses in active practice, facilitating recruitment, increasing professional skills, helping to structure the profession and increasing client satisfaction. When nurses support other nurses, the profession enhances its power. This power can enhance our nursing practice and destiny. Mentoring can be formal or informal, whichever you choose! It can be a personal achievement or part of an organizational plan. The success of the relationship depends upon the commitment the mentor and mentee are willing to make to meet the challenges and capitalize on the strengths. The rewards are great. Hopefully, you will start a mentoring relationship soon! Final Thoughts The Mentee says: Florence, I do need a mentor. I m so glad you sent her/him. Life is so much easier. My stomach s definitely less queasy. The Mentor says: Florence, I wonder if I m called to be a mentor, I can t understand why you sent her/him. I trust that she/he will see with great clarity. My strength is my basic humanity. To help others succeed requires not just telling them what to do, but also showing them. Thompson, 2012 Mentoring Relationships cont. on page 20 The Minnesota Nursing Accent Spring

20 Mentoring Relationships Learning Exercise: Matching Mentors with Mentees (Match the mentee scenario with the best suited mentor. Answers at the bottom of the page). Matching mentors with mentees needs to be well thought out. Below are a few scenarios that describe nurses who are seeking mentoring. Mentee One Sally, RN, is detailed oriented, likes to ask questions and to debrief with someone after an event or situation. Mentee Two Sonja, RN wants to advance her role in women s health. She is concerned about her skill performance and ability to communicate with other healthcare professionals in her specialty area. Mentee Three Ken is a nurse who prefers to discuss how to handle conflict in the workplace, wants to improve interpersonal skills in order to develop relationships with other staff. Also, he wants to become more active in union/political activities. Mentor A Mary is highly experienced in a specialty area with in-depth knowledge in its content and research focus. She is willing to give career advice and guidance. Mentor B Gloria is a nurse who prefers listening and giving feedback with a therapeutic listening style. She is highly organized when it comes to setting up her patient care assignment. Mentor C Anna likes to work through work related problems and give advice and feedback. She is a Board member of her professional union. Self Assessment Tool: Mentee (Complete Questions 1 thru 8) 1. You decide you need a mentor to help you learn your new job. Identify one person you know personally who could be your mentor (person named is your personal choice). 2. List what qualifications this person has that makes them a good candidate to be your mentor. 3. Your selected person has agreed to be your mentor. What goals did you agree upon? 4. What objectives will you use to meet your goals? 5. Your mentor has suggested that you attend a meeting between the CEO and physicians despite the fact that you were not invited. What do you do? 6. It s been a month since your appointment and you will be heading to your second Nursing Leadership Meeting. You ask your mentor not to attend. During the meeting two nurse managers demand you make a decision about the space allotted to storage for their unit. You make a decision to share the space, which infuriates the nurse manager that used to have exclusive use of the space for a lounge. Once the meeting is over, what do you do? 7. It s been six months since your appointment and you re feeling you have a handle on your job. What do you do now about your mentor? 8. Now that you have mastered your job, what skills could you provide as a mentor? Answers: Mentor A = Mentee 2; Mentor B = Mentee 1; Mentor C = Mentee 3 20 The Minnesota Nursing Accent Spring 2013

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