KATHY DOERKSEN, RN, MN, CNN(C)

WHAT ARE THE PROFESSIONAL DEVELOPMENT AND MENTORSHIP NEEDS OF ADVANCED PRACTICE NURSES? KATHY DOERKSEN, RN, MN, CNN(C) This study investigated the professional development and mentorship needs of an existing group of advanced practice nurses. A prospective mixed-methods design included a survey followed by focus groups. The Strong Model (M. H. Ackerman, L. Norsen, B. Martin, J. Wiedrich, and H. Kitzman, 1996) recently provided a framework for the survey and discussions. It consists of five domains of practice: direct comprehensive care, education, research, support of systems, and publication and professional leadership. Fourteen advanced practice nurses participated, representing a variety of clinical areas in the clinical nurse specialist and nurse practitioner roles. Results demonstrate that advanced practice nurses identify various professional development and mentorship needs in all aspects of their roles. Although research was identified as a need that develops over time, it was consistently regarded as a primary focus for development and required mentorship. Respondents offered specific examples and the positions or roles that would be helpful in meeting their professional development and mentorship needs. Main themes that arose from the focus group were formal versus informal needs, needs change over time, and intellectual, administrative, and financial support. The advanced practice nurses' willingness to contribute to a mentorship program was explored. (Index words: Advanced practice nurses; Clinical nurse specialists; Nurse practitioners; Mentorship; Professional development) J Prof Nurs 26:141 151, 2010. 2010 Elsevier Inc. All rights reserved. Significance of the Problem ADVANCED PRACTICE NURSING roles are implemented with a variety of demands. Individuals in these roles are expected to be leaders in the professional practice of nursing (Ackerman, Norsen, Martin, Wiedrich, & Kitzman, 1996). Nurses begin as novices and work to become expert advanced practice nurses (Ackerman et al., 1996). The professional development and mentorship needs of advanced practice nurses as they move from novice to expert nursing leaders have not been explored. The relationship between improved professional development of advanced practice nurses and a positive influence on nursing practice and patient care has yet *Clinical Nurses Specialist, Neurosurgery, Winnipeg, Manitoba, Canada. Address correspondence to Kathy Doerksen: Clinical Nurses Specialist, Neurosurgery, 71 Inch Bay, Winnipeg, Manitoba, Canada R2Y 0X2. E-mail: skdoerksen@shaw.ca 8755-7223/09/$ - see front matter to be determined. This study takes the first step in understanding these issues by evaluating what the professional development needs are for advanced practice nurses and explores mentorship as a possible method of meeting those needs. Background and Literature Review Advanced practice nursing roles have been increasingly implemented throughout the country (Brown, 1998; Dunn & Knicklin, 1995). Nurses assuming advanced practice roles are expected to advance nursing through direct care, research, education, leadership, and various scholarly activities such as mentorship (Ackerman, Norsen, Martin, Wiedrich, & Kitzman, 1996; Sidani, Irvine, & DiCenso, 2000). A thorough review of the literature revealed little information addressing either the professional development or mentorship needs of advanced practice nurses. Five articles, using concept analysis, reference the need for advanced practice nurses to mentor staff nurses or nurse practitioner students but do not address the need of Journal of Professional Nursing, Vol 26, No. 3 (May June), 2010: pp 141 151 141 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.profnurs.2009.04.005

142 KATHY DOERKSEN advanced practice nurses (Beal, Steven, & Quinn, 1996; Fawcett, 2002; Hayes, 1994; Pelletier & Duffield, 1994; Price, 1998). Two sources described mentorship and its importance to the advanced practice nurse role, again through review and analysis of existing literature (Busen & Engebretson, 1999; Hockenberry-Eaton & Kline, 1995). Hockenberry-Eaton and Kline (1995) stated that, although nurse practitioners may be viewed as experts, they too require nurturing, learning, and support when learning the role. It is also stated that mentoring is used to help those who are less experienced in the role and may develop within an institution or in any setting where a group of the advanced practice nurses meets. Busen and Engebretson (1999) explored the concept of mentoring and commented that advanced practice nurses may select a mentor to assist in aspects of education, research, clinical practice, or professional activities. Hupcey (1993) conducted a survey to identify factors that improve or impact negatively on nurse practitioner practice. Twelve respondents stated that continuing education helped nurse practitioners in their role performance. More recently, research continues to emphasize role clarity and implementation (Cummings, Fraser, & Tarlier, 2003; Lindke, Canedey, & Kay, 1997). Van Soren and Micevski (2001) using a researchdeveloped questionnaire identified lack of support and lack of understanding of the role of nurse practitioners as a major barrier to role implementation. Purpose and Research Question The research question is, What are the professional development and mentorship needs of advanced practice nurses in a tertiary care hospital? A second purpose was to investigate the potential benefit of mentorship in assisting the advanced practice nurses to meet their identified professional development needs. Conceptual Framework The Strong Model by Ackerman et al. (1996) provides the framework for this investigation. Figure 1 depicts the patient being central to the model and consists of five Figure 1. domains of practice and three conceptual strands. This model was adopted at the study site to guide the nurse practitioners and the clinical nurse specialists practice. One key defining feature of the model is that advanced practice nurses function in each of the five domains of practice: direct comprehensive care, education, research, support of system, and publication and professional leadership. The domains are quite self-explanatory by title except for support of systems, which describes how the advanced practice nurse supports the system by development of standards, policies, procedures, or practice guidelines to improve patient care. Scholarship, collaboration, and empowerment are the conceptual strands that unify and influence each domain of practice. The model also identifies that individuals may come to the role as expert clinicians; however, they will advance in the role as experience is gained in the domains of practice. Ackerman, Norsen, Martin, Wiedrich, & Kitzman (1996) provided several examples of activities for each of the domains of practice. Study Design and Method A prospective descriptive design with mixed methods was conducted. Mixed methodology enables the researcher to stage the methods of data collection, converge the information, and provide a complete picture (Begley, 1996; Creswell, Fetters, & Ivankova, 2004). Initially, a survey was completed followed by focus group interviews to obtain detailed information and varying opinions (Morrison-Beady, Cote-Arsenault, & Fischbeck Feinstein, 2001). Setting and Sample The participants represent a convenience sample of advanced practice nurses at the Health Sciences Centre, a tertiary care hospital in Winnipeg, Manitoba, Canada. The advanced practice nurse role at the study site is defined as a clinical nurse specialist or nurse practitioner. The sample of advanced practice nurses represents roles in a variety of clinical areas from pediatrics to geriatrics and from acute care to palliative care, including both inpatient and outpatient settings. Individuals functioning in these roles do so utilizing the Strong Model to guide their practice. The number of nurses in these roles determined the sample size at the time of the study. Ethical approval was obtained through the appropriate facility. Data Collection Consent was obtained over the telephone, and surveys were distributed by mail. Surveys were coded, and the results provided the template for the interview guide for the focus groups (Cote-Arsenault & Morrison- Beedy, 1999). Two focus groups were offered at a convenient location. The focus groups were recorded using field notes including observed behaviors and nonverbal cues that may not be picked up by audiotape (Cote-Arsenault & Morrison-Beedy, 1999). The collated data from the

PROFESSIONAL DEVELOPMENT AND MENTORSHIP NEEDS OF APN 143 Table 1. Sample size Years as a registered nurse Years as an advanced practice nurse Age 14 23 (7 36) 5.5 (0.33 15.5) 44 (30 54) Note. Values are presented as M (range). focus groups were analyzed for themes by the investigators and the research assistant. Data were grouped under themes done separately by the three individuals and then compared. Participants received a small stipend. Survey Development and Testing Demographic data included age, years in advanced practice nurse position, years in nursing, and education level. Data regarding the participants' area of work were not obtained to protect the participants' anonymity. The survey consisted of structured and semistructured questions, using the Strong Model as a template for the content (Appendix A). The five domains of practice formulated the broad categories, and the questions were developed from the specific examples provided in the initial description of the Strong Model. The responses were based on a 5-point Likert scale ranging from 1 (no interest) to5(very interested). Participants were asked whether having a mentor would be helpful in meeting professional development needs for each domain of practice. They were also asked to choose from a list of positions or roles which would be helpful in providing mentorship in the particular category. The positions available to choose from were director of patient care services, advanced practice nurses located outside my hospital, university faculty staff, advanced practice nurses located within my hospital, physician, and health services researcher. Finally, in each of the domain of practice, the respondents were asked an open-ended question to identify any methods (other than having a mentor) that would meet their professional development needs. Content validity was determined by three advanced practice nurses in hospitals separate from the research site and one faculty member, all in the province of Manitoba, and a health service researcher with a nursing chair in advanced practice nursing in Canada. A pilot was used to determine test retest reliability involving three advanced practice nurses located at other hospitals on two separate occasions 2 weeks apart (Del Greco, Walop, & McCarthy 1987; Gomm, 2000). During the pilot, one of the three participants was delayed in responding to the second survey; therefore, those data were not included. The other two respondents demonstrated an acceptable range of a 1-point change for 40 of the 43 questions (93%). Decision-Maker Involvement The need to involve a decision maker in this study was based on the importance and ability to move the research recommendations forward. An initial meeting was held to determine the level of involvement, the process for involvement of the chief nursing officer, and the dissemination of the results. It was crucial to have the key stakeholder involved at the beginning to determine the research question's relevance and fit to the organization and at the end for formulation of the recommendations (Ross, Lavis, Rodriguex, Woodside, & Denis, 2003). Demographics All 14 eligible advanced practice nurses participated. Table 1 represents the demographic data of the participants. Survey Results The initial questions regarding the participants' need for further development were answered using a 5-point Likert scale. For the analysis of these questions, the Likert scale was collapsed into three categories: 1 2 = no interest, 3 = moderate interest, and 4 5 = very interested. Several items from each of the five domains were found to be important for the respondent's professional development. However, the research category was the only category in which every single item was identified as very important for professional development. Table 2 indicates how many items in each domain of practice were found to be very important for the participant's professional development. The next set of questions asked participants whether having a mentor would be helpful in meeting professional development needs in each of the domains of practice. Responses were graded as follows: 1 2 = strongly agree, 3 = uncertain, and 4 5 = strongly disagree. Table 3 demonstrates the responses, and once again, the research category was the only domain that had every participant strongly agree that a mentor would be helpful. The respondents were asked to choose from a list of positions or roles that would be helpful in providing mentorship for this category. Each position or role was chosen for at least one of the domains of practice. The most frequently chosen role varied depending on the category. For example, in direct comprehensive care, a physician role was indicated the most often, and university faculty staff was chosen for mentoring in the category of research. There were numerous responses from the participants when asked to identify any methods (other than having a mentor) that would meet their professional development needs. The responses varied depending on the domain of Table 2. Domain of practice Demonstrated interest in further developing, number of items/total items % Direct comprehensive care 6/16 38 Support of systems 5/9 56 Research 6/6 100 Education 4/6 67 Publication and professional leadership 1/6 16

144 KATHY DOERKSEN Table 3. Number of advanced practice nurses who strongly agree that mentorship Domain of practice is helpful (n = 14) Direct comprehensive care 10 Support of systems 11 Research 14 Education 8 Publication and 10 professional leadership practice; however, some of the suggestions were as follows: self-directed, literature review, seminars, journal club, courses, financial support, feedback from key people, broad perspective on health care delivery issues, small projects addressing clinical issues, be a mentor to a graduate student, have a mentor for guidance in research, educate nurses on the role of the advanced practice nurse, learn how to apply for grants, teach others, and observe advanced practice nurses in their roles. Some of the educational topics mentioned were evidenced-based research, research development, leadership roles, effective participation on committees, and use of technology for presentations. Several responses provided information when the participants were asked to identify any other professional development or mentorship needs they have. The participants identified the following: Bridge the gap from education to practice, conduct research, expand university program to include clinical nurse specialist stream, quality improvement, ethics, project management skills, roles and responsibilities of chairing a committee, clinical leadership skills, closer partnership with university faculty, and having an advanced practice nurse mentor through the first year. Focus Groups Following the survey, two focus groups were conducted using the results of the survey. The five questions that arose from the survey results, which formulated the focus groups, are in Table 4. The sixth and final question arose during both focus group discussions. Thematic Analysis of Focus Groups Formal Versus Informal Mentorship Needs Two main themes emerged from the content analysis regarding what form of a mentorship program is needed. Mentorship needs were determined to be formal and informal. Formal needs included individualized programs with a needs assessment, matching nurse practitioner with nurse practitioner and clinical nurse specialist with clinical nurse specialist, having a buddy system, developing a welcoming package with a directory of potential mentors, listing areas of interests and strengths, and having a directory with the university identifying their areas of interest. The informal needs stated by the participants were to offer support through meetings or over coffee, recognize the need for more than one mentor, and schedule their own time with a mentor. Mentorship Needs Change Over Time The respondents supported the reality of mentorship needs changing over time. The participants stated that initially they would need to focus on the day-to-day functions of the role. They also commented that at first their focus would be on clinical activities and later would emphasize the research component. The mentor would assist in broadening their perspective and foster growth in the role. It was also identified that annual retreats help to address the changes in needs over time. Supports Required for Mentorship The supports required for mentorship seem to fit into the broad categories of intellectual, administrative, and financial. Intellectual Support Intellectual support was identified particularly in the domain of research. There is a concern with a lack of connection with appropriate mentors to assist the advanced practice nurse in developing research projects. Participants stated that a directory of the university staff would be beneficial to allow the advanced practice nurses to match the faculty's knowledge and preferred research style with their own interests. When asked further about the mentorship with the university faculty staff, it was noted that a formal link for research and publication would be beneficial. There was a link identified which already exists between a regional advanced practice nurse group and the university; however, participants emphasized that an improved direct link between the practicing advanced practice nurses and the staff at the university needs to occur. There was expressed hope that a mentor may become available on-site for nursing research, which was being considered at the center. The intellectual support from having a nurse researcher on-site provided hope for those present in the focus groups. Physicians were identified as key mentors particularly for the nurse practitioners in the study. It was thought that Table 4. Questions formulated for focus groups How would you see a mentorship program working? What form would it take? How would you see your mentorship needs changing over time? What are your mentorship needs for conducting research? What systems supports are needed to implement a mentorship program? What specific supports are needed from potential mentors? What would you be willing to contribute to a mentorship program?

PROFESSIONAL DEVELOPMENT AND MENTORSHIP NEEDS OF APN 145 physicians would help to identify gaps in clinical knowledge and would become more familiar with the nurse practitioner role. It was believed that this would facilitate building a trusting relationship between the physician and nurse practitioner. It was thought that physicians could be mentors for research, with a special note that this would not replace the emphasis of nursing research. Administrative Support Administrative support became a thread throughout the discussions on mentorship. Protected time for mentorship, research, education, and professional development was deemed necessary. It was suggested that the protected time was important enough that it should be written into the job description. There were mixed opinions regarding the role of directors or nursing leaders as mentors for advanced practice nurses. Some felt the need to have their directors understand the role, however, at the same time allowing for independence in their practice. It was suggested that directors should support existing and the creation of new advanced nursing practice roles, facilitate connections to other resources, and support monetary demands. Financial Support Along with the intellectual and administrative support, financial support was identified as being key to meeting professional development and mentorship needs. Participants commented that funding is essential for research grants, educational opportunities, and the ability to protect time of the advanced practice nurses to pursue these endeavors. Willingness to Contribute to a Mentorship Program The participants provided several suggestions when asked what they were willing to contribute toward mentorship. First, they stated that informal mentorship already occurs; however, there is a need for a more formal program and a process to buddy new advanced practice nurses. The participants noted that readiness to mentor others and to be mentored should be based on a formal self-assessment. The need to be mentored may be more intense as they begin their role; however, the need never ends. It was also identified that the current advanced practice nurse committee meeting times should be increased to allow for more mentorship when the nurses in this particular group are together. The participants commented that they are currently providing and willing to provide mentorship to students at the university within their clinical specialty. When asked about the ability to provide mentorship outside the center of employment, the participants were willing to do this; however, they expressed concern regarding current workloads to accomplish this. They commented that their mandate as a group is as a formal committee with institutional goals and demands that require prioritization. The participants suggested that a directory of advanced practice nurses within the city would raise awareness of others in the role and what their clinical area of practices are and would provide a link for potential mentorship. It was thought that visiting advanced practice nurses in other hospitals or provinces would be beneficial to see varieties in the roles. With an increase in advanced practice nurse positions, it was commented that a satellite group of nurses in these roles in similar clinical areas but different facilities would be beneficial for mentorship. Limitations This study does have the limitations of a small sample size and a one-site setting of the participants. However, the results are strengthened by the mixed-method approach and the variability of the clinical settings in which each of the participants work. Discussion The literature tends to focus more on how advanced practice nurses can mentor other nurses (Ackerman, Norsen, Martin, Wiedrich, & Kitzman, 1996; Sidani, 2000); however, these results demonstrate that advanced practice nurses recognize the need for mentorship and professional development in each of the domains of practice. Hockenberry-Eaton and Kline (1995) identified that nurse practitioners will have learning needs, although they are considered to be in an advanced nursing role, and this was supported by these results. As mentioned previously, there is lack of evidence relating to the clinical nurse specialist's role and mentorship needs. Although the participants identified the need for further development in each domain of practice, it was the domain of research that was important with all indicators for every participant and showed that having a mentor would be beneficial. During the focus groups, research was identified as a professional development need that increases over time, which correlates with the novice to expert theme underlying the Strong Model. Research was the area where a lack of supports was identified. Specific suggestions for increased intellectual, administrative, and financial supports were provided to improve the advanced practice nurses' ability to conduct research. Another theme that emerged from the focus groups was the need for a mentorship program to be both formal and informal. Busen and Engebretson (1999) commented that the advanced practice nurses may wish to select a mentor. The participants provided further insight that both a formal and informal approach to mentorship, based on individual needs, would be helpful to the advanced practice nurses. It is also suggested that advanced practice nurses may require more than one mentor to fulfill the professional development needs in all the domains of practice, which is supported by Busen and Engebretson (1999). This insight is important particularly if the expectation is for the advanced practice nurse to function fully in the five domains of practice. The participants commented that informal mentorship occurs to some extent and identified several ideas how to formalize the mentorship of new nurses in these roles.

146 KATHY DOERKSEN Future Directions The results have been presented to the participants and in separate session to the chief nursing officer. There are plans to present the results to the partnering university plus at the director level at the study site. The focus groups sparked the interest of the advanced practice nurses to develop an orientation manual for new individuals in these roles. A working group from the advanced practice committee has been established to develop a template for mentorship based on these results. The participants utilized the results of this study to assist in the development of the goals for the upcoming year. The advanced practice nurses identified mentorship as being crucial in the professional development of research. The participants identified that administrative support would be crucial to fully enact the advanced practice nursing role. This has been supported previously in the literature and requires enactment in practice (Cummings, Fraser, & Tarlier, 2003; Irvine et al., 2000). Concurrently, the center was considering a scholar-inresidence position, and the participants plan to explore with the chief nursing officer the potential mentorship this role may provide for the advanced practice nurses. A future study including multiple sites across Canada to determine the mentorship and professional development needs should be considered. It would also be relevant to investigate these needs and how they differ between the clinical nurse specialist and the nurse practitioner. References Ackerman, M. H., Norsen, L., Martin, B., Wiedrich, J., & Kitzman, H. (1996). Development of a model of advanced practice. American Journal of Critical Care, 5, 68 73. Beal, J. A., Steven, K., & Quinn, M. (1996). Neonatal nurse practitioner role satisfaction. Journal Perinatal Neonatal Nursing, 11,65 76. Begley, C. (1996). Using triangulation in nursing research. Journal of Advanced Nursing, 24, 122 128. Brown, S. J. (1998). A framework for advanced practice nursing. Journal of Professional Nursing, 14, 157 164. Busen, N. H., & Engebretson, J. (1999). Mentoring in advanced practice nursing: the use of metaphor in concept exploration. Internet Journal of Advanced Nursing Practice, 1523-6064, 2. Cote-Arsenault, D., & Morrison-Beedy, D. (1999). Practical advice for planning and conducting focus groups. Nursing Research, 48, 280 283. Creswell, J. W., Fetters, M. D., & Ivankova, N. A. (2004). Designing a mixed methods study in primary care. Annals of Family Medicine, 2, 7 12. Cummings, G. G., Fraser, K., & Tarlier, D. (2003). Implementing advanced nurse practitioner roles in acute care: An evaluation of organizational change. Journal of Nursing Administration, 33, 39 45. Del Greco, L., Walop, W., & McCarthy, R. H. (1987). Questionnaire development: 2 Validity and reliability. Canadian Medical Association Journal, 136, 699 700. Dunn, K., & Knicklin, W. (1995). The status of advanced nursing roles in Canadian teaching hospitals. Canadian Journal of Nursing Administration, Jan-Feb, 111 135. Fawcett, D. L. (2002). Mentoring what is it and how to make it work. American Operating Room Journal, 75, 950 954. Gomm, R. (2000). Making sense of surveys. In R. Gomm & C. Davies (Eds.), Using evidence in health and social care. (pp. 26 45). UK: The Open University. Hayes, E. (1994). Helping preceptors mentor the next generation of NP's. Nurse Practitioner, 19, 62 66. Hockenberry-Eaton, M., & Kline, N. E. (1995). Professional insights. Who is mentoring the NP? Journal of Pediatric Health Care, 9, 74 75. Hupcey, J. E. (1993). Factors and work settings that may influence NP practice. Nursing Outlook, 41, 181 185. Irvine, D., Sidani, S., Porter, H., O'Brien-Pallas, L., Simpson, B., et al. (2000). Organizational factors influencing nurse practitioners' role implementation in acute care settings. Canadian Journal of Nursing Leadership, 13, 28 35. Lindke, L. L., Canedey, B. H., & Kay, M. M. (1997). A comparison of practice domains of clinical nurse specialists and nurse practitioners. Journal of Professional Nursing, 13, 281 287. Morrison-Beady, D., Cote-Arsenault, D., & Fischbeck Feinstein, N. (2001). Maximizing results with focus groups: Moderator and analysis issues. Applied Nursing Research, 14, 48 53. Pelletier, D., & Duffield, C. (1994). Is there enough mentoring in nursing? Australian Journal of Advanced Nursing, 11,6 11. Price, J. L. (1998). A reflective approach to career trajectory in advanced practice nursing. Advanced Practice Nursing Quarterly, 3, 35 39. Ross, S., Lavis, J., Rodriguex, C., Woodside, J., & Denis, J. L. (2003). Partnership experiences: Involving decision-makers in the research process. Journal of Health Services Research & Policy, 8, (Suppl 2), S226 S234. Sidani, S., Irvine, D., & DiCenso, A. (2000). Implementation of the primary care nurse practitioner role in Ontario. Canadian Journal of Nursing Leadership, 13, 13 19. Van Soren, M. H., & Micevski, V. (2001). Success indicators and barriers to acute nurse practitioner role implementation in four Ontario hospitals. AACN Clinical Issues, 12, 424 437.

PROFESSIONAL DEVELOPMENT AND MENTORSHIP NEEDS OF APN 147 Appendix A. Survey ADVANCED PRACTICE NURSES SURVEY Please answer each of the following questions: Please note that the information on this page will be coded and kept separate from the rest of the survey data. 1. How long have you been in an APN position in this Health Science Centre? years 2. Have you been an APN in other institutions prior to this one? No Yes, if yes, for how many years? 3. How long have you been a registered nurse? years 4. What is your age in years? years 5. What is the highest level of education you have obtained in nursing and if applicable, in other than nursing? Direct Comprehensive Care For each question, please indicate your level of interest in further developing your specific skill by checking ( ) one response for each question: 17. Having a mentor would be helpful in meeting my professional development needs for this category (Direct Comprehensive Care). Please check ( ) one.

148 KATHY DOERKSEN 18. If you have identified an interest in professional development in this area, please check off which positions/roles would be helpful in providing mentorship to you for this category (check all that apply). Director of Patient Care Services APN located outside my hospital Physician University faculty staff APN located within my hospital Health services researcher Other (please specify) 19. Please identify any methods (other than having a mentor) that would meet your professional development needs in this category. Please be as specific as you wish. Support of Systems For each question, please indicate your level of interest in further developing your specific skill by checking ( ) one response for each question: 29. Having a mentor would be helpful in meeting my professional development needs for this category (Support of Systems). Please check ( ) one. 30. If you have identified an interest in professional development in this area, please check off which positions/roles would be helpful in providing mentorship to you for this category (check all that apply). Director of Patient Care Services APN located outside my hospital Physician University faculty staff APN located within my hospital Health services researcher Other (please specify)

PROFESSIONAL DEVELOPMENT AND MENTORSHIP NEEDS OF APN 149 31. Please identify any methods (other than having a mentor) that would meet your professional development needs in this category. Please be as specific as you wish. _ Research For each question, please indicate your level of interest in further developing your specific skill by checking ( ) one response for each question: 38. Having a mentor would be helpful in meeting my professional development needs for this category (Research). Please check ( ) one. 39. If you have identified an interest in professional development in this area, please check off which positions/roles would be helpful in providing mentorship to you for this category (check all that apply). Director of Patient Care Services APN located outside my hospital Physician University faculty staff APN located within my hospital Health services researcher Other (please specify) 40. Please identify any methods (other than having a mentor) that would meet your professional development needs in this category. Please be as specific as you wish. _

150 KATHY DOERKSEN Education For each question, please indicate your level of interest in further developing your specific skill by checking ( ) one response for each question: 47. Having a mentor would be helpful in meeting my professional development needs for this category (Education). Please check ( )one. 48. If you have identified an interest in professional development in this area, please check off which positions/roles would be helpful in providing mentorship to you for this category (check all that apply). Director of Patient Care Services APN located outside my hospital Physician University faculty staff APN located within my hospital Health services researcher Other (please specify) 49. Please identify any methods (other than having a mentor) that would meet your professional development needs in this category. Please be as specific as you wish. _ Publication and Professional Leadership For each question, please indicate your level of interest in further developing your specific skill by checking ( ) one response for each question:

PROFESSIONAL DEVELOPMENT AND MENTORSHIP NEEDS OF APN 151 56. Having a mentor would be helpful in meeting my professional development needs for this category (Publication and Professional Leadership). Please check ( )one. 57. If you have identified an interest in professional development in this area, please check off which positions/roles would be helpful in providing mentorship to you for this category (check all that apply). Director of Patient Care Services APN located outside my hospital Physician University faculty staff APN located within my hospital Health services researcher Other (please specify) 58. Please identify any methods (other than having a mentor) that would meet your professional development needs in this category. Please be as specific as you wish. 59. Please identify any additional professional development and mentorship needs that you have. Thank-you very much for taking the time to complete this survey!