Running head

Running head: MENTORING IN A LONG-TERM CARE FACILITY 1

Mentoring in a Long-Term Care Facility
Aisha Noah
NR660 Nurse Executive Capstone
7/28/18

About one in every seven person today is an older American. Over the past 10 years, the population age 65 and older has increased by 33 percent and is expected to double to 98 million by 2060. The population age 65 and older is growing at a fast rate. More people are living longer, we could attribute this to advance medicine and the longer people live requires more geriatric care. This translates to an increase in life expectancy leads to an increased need for caregiving. With age comes debilitating illnesses, and this requires seeking care in Long Term Care (LTC) facilities. Residents and their family rely on staff in these facilities to meet and care for their needs/needs of their loved ones. According to Kayyali (2014), the high level of turnover among LTC facility nurses especially newly hired ones is particularly troubling because these workers provide the essential daily care for nursing home residents and turnover negatively affects the quality of care. In South suburban LTC facilities, the high rate of turnover is becoming increasingly problematic as growing numbers of seniors depend on nursing homes for their care. This high rate of turnover has led to a low retention rate in LTC facilities and poor-quality outcome. The poor quality of care results in family dissatisfaction, increase in pressure ulcer amongst seniors, medication error reports to the State on neglect, law The purpose of this literature review is to answer the PICOT question; Among nurses in a South Suburban long-term care facility, will assigning mentors to newly hired nurses, compared to not assigning mentors, decrease turnover from a 34% to 9% rate in a six month period?
Nursing Turnover
Only a handful of detailed studies have been conducted that attempt to quantify the per worker costs of nurse turnover in different LTC facilities. According to Kirby (2018), nursing turnover can be very costly to LTC organizations. A recent study estimated the cost of turnover among newly hired nurses at $856 million industry-wide (Kirby, 2018). A study by the Nursing Solutions, Incorporated (NSI) (2015), noted a 17.2% turnover rate per year compared to a 13.5% rate per year four years earlier.
The impact of nursing turnover is complex and many associated costs are not immediately apparent, making it difficult to accurately assess total nursing turnover costs (Halter et al., 2017). For example, Kayyali (2014) noted that LTC facilities with high turnover rates of nurses usually experience a great increase in the number of deficiencies.
At a South Suburban LTC facility in a Suburban area, nurse turnover is so high that outside agency nurses were employed to provide care and constantly cajoled nurses to pick up overtime. On average this healthcare facility hires 3 new nurses each month. These issues affect the LTC facility profitability as a result of the significant costs of training replacement, overtime rates, and agency nurses. In the last year’s financial report, this LTC facility spent over $2,000,000.00 in staff development including hiring, training and contracting with agency nurses. This LTC facility and like many other LTC facilities are in need of strategies to reduce their turnover rate, retain an effective workforce and improve the employee motivation in the workplace (Rožman, Treven ; ?an?er, 2017).
Concept Analysis
Merriam Webster online dictionary simply defines mentor as “a trusted counselor or guide”. This definition is in line with teaching, training and guiding a newly hired nurse into a new role. Retention is simply defined in the same online dictionary as “the act of retaining : the state of being retained”. The concept of this literature review would look at how mentoring impacts retention of newly hired nurses into staying in LTC facilities for 6 months after they are hired. Literature articles that support mentoring and articles that necessarily did not support mentoring will be analyzed. Recommendations from the reviewed articles will be presented.
Literature Review
A literature search was conducted using the Chamberlain College of Nursing (CCN) super search engine. Multiple databases was searched beyond CINANHAL for best result. MEDLINE, Web science, Science Direct and PUB MED and Google Scholar were searched beyond CCN super searches provided variety of findings. The CCN search was limited to peer-review articles. Results were also limited to English journal articles published from 2013-2018. The following search terms were included: Nurse, turnover, retention, mentoring in the title or abstract. Search terms were connected and the Boolean operator AND was used. Initial super search yelled over 1,055 results. Abstract of 20 articles were reviewed and 10 articles appropriate to the topic of mentoring, retention and newly hired nurse turnover were selected. Among the 10 articles selected, 3 articles did not attribute retention of nurses to one particular intervention.
Retention in LTC facilities is likened to the nurses workload. Tummers, Groeneveld and Lankhaar (2013) asserted that the workload in most nursing homes is enough to scare any newly hired nurse even with a mentor. The mentor program could be effective if the mentor has a workload that would allow time to answer a mentee’s questions or explaining a new situation the mentee has not dealt with before. Tummers, Groeneveld and Lankhaar (2013) argued that mentoring in LTC facilities doesn’t necessarily lead to retention and did not support the idea that mentoring alone would produce a high retention rate. Edwards, Hawker, Carrier and Rees (2015) noted that a number of initiatives, such as internship programs, transition programs, preceptorship and mentorship have been introduced in LTC facilities to try and ease the newly hired nurse transition experiences. It was noted that no one single program was able to improve retention. A combination of these programs have been seen to be more effective in LTC facilities. A reason given why some of these models or programs do not work in LTC is the simple fact that all LTC facilities are not created or established the same and there is too many insufficient staffing levels (Black, 2015). The concept of LTC regardless of how it was established is to provide care. One size does not fit all for LTC facilities. For example, some homes or facilities are small with few staff and resources while some homes are big and belong to an organization with few resources. Regardless of the size of the LTC facility, mentoring is found to depend on the resources made available to nurses and how the workload affects how nurses perform their daily routine (Edwards, Hawker, Carrier ; Rees, 2015).
Even though mentoring alone would not improve retention rate in LTC facilities, nurse leaders still need to have strategies for low turnover and increased retention rate. According to the NSI (2015), many LTC facilities do not have comprehensive retention strategy despite noting such a strategy is crucial for retention. Mentoring as a strategy has well been documented in literature as an effective way healthcare facility could improve employee morale, job satisfaction, reduce turnover and improve on patient outcomes. When nurses are well prepared, retention rate tends to be low (Trossman, 2013). Trossman (2013) noted that mentoring newly hired nurses is an effective way to boost confidence of the nurse in his or her new role. As newly hired nurses shadow their mentors, they are integrally involved in gaining and learning new experiences. McGilton, Tourangeau, Kavcic and Wodchis (2013) found that nurses who intend to leave their job are LTC facility nurses and retention of these nursing staff in these facilities is essential. Given the right tools, like mentoring, nurses could stay longer in LTC. The limitation to the study conducted by McGilton, Tourangeau, Kavcic and Wodchis (2013) was that the sample of the study was limited in size and geographic location. Despite this limitation, they concluded that imploring mentorship is an effective strategy to keep nurses in LTC facilities.
In the context of LTC, mentors are expert or experience nurses that volunteer to coach, support, and educate newly hired nurses to develop confidence and skills (Marsh, 2015). Marsh (2015) noted that by supporting and mentoring newly hired nurses their clinical skills improve, and the mentorship programs may indirectly improve patient care outcomes by retaining both mentee and mentor nurses. Newly hired nurses exposed to the demanding nature of a LTC environment without proper training may become dissatisfied and leave the LTC setting. Current research supports the idea that mentoring offers a sense of belonging to a team that persuades newly hired nurses to stay in the profession (Marsh, 2015).
Transitioning to a new role can be very overwhelming and exhausting. According Schroyer, Zellers and Abraham (2016), newly hired nurses described feeling unsupported and overwhelmed when transitioning to their new role. In the literature review conducted by Schroyer, Zellers and Abraham (2016) they noted that the feelings of newly hired nurses being overwhelmed could be high in a stressful LTC environment. They found a mentoring program to be very beneficial as it provides new experiences for both the mentor and the mentee. The study limitation include not adding exit interview reasons why newly hired nurses left LTC despite the mentoring program and the study during period was not up to the 6 month periods initially set aside for the study. Schroyer, Zellers and Abraham (2016) suggested having a study that would extend past a 6-month period and they recommend combining mentoring programs with nurse residency programs and education classes for transitioning nurses.
In their literature review study, Chen and Lou (2014) noted that the implementation of mentorship programs is a crucial strategy adopted by LTC facilities to retain newly hired nurses. They found that newly hired nurses have limited experience and skills to provide quality care for LTC residents, therefore, newly hired nurses require the guidance of experienced nurses to assist them in understanding nursing and apply their theoretical knowledge to actual nursing situations. Chen and Lou (2014) found newly hired nurses heavily rely on the mentorship programs and guidance to accomplish the transitioning to a new role. The limitation of Chen and Lou (2014) study included an incomplete selection of studies and publications biases as the study was limited to electronic databases. They recommended one to one interpersonal relationships to could go beyond a year so that retention of nurses could be more sustained.

Conclusion
The aging population needs care and most of them need professional care and require stay in LTC facility. This translates to the need to provide care in LTC facilities. Newly hired nurses require assistance in developing relevant skills and staying on the job. Most literature reviewed concluded that the primary objective of mentorship programs is to reduce the high turnover rates and increase retention among newly hired nurses in LTC facilities. It is accurate to conclude that mentorship alone cannot increase retention rates without LTC facilities leadership providing the necessary resources for the nurses’ growth and development. It is also important to note that for a mentorship program to be productive the workload needs to be appropriate.

References
Black, P. (2015). Developing an Enhanced Perspective Of Turnover and Retention of Nurses and Health Care Aides in Long-Term Care Homes. Perspectives: The Journal of The Gerontological Nursing Association, 38(2), 25-30.
Chen, C., & Lou, M. (2014). The Effectiveness and Application of Mentorship Programs for Recently Registered Nurses: A Systematic Review. Journal of Nursing Management, 22(4), 433. doi:10.1111/jonm.12102
Edwards, D., Hawker, C., Carrier, J., & Rees, C. (2015). A Systematic Review of the Effectiveness of Strategies and Interventions to Improve the Transition from Student to Newly Qualified Nurse. International Journal Of Nursing Studies, 52(7), 1254-1268. doi:10.1016/j.ijnurstu.2015.03.007
Halter, M., Boiko, O., Pelone, F., Beighton, C., Harris, R., Gale, J., & … Drennan, V. (2017). The Determinants and Consequences of Adult Nursing Staff Turnover: A Systematic Review. BMC Health Services Research, 171-20. doi:10.1186/s12913-017-2707-0
Kayyali, A. (2014). The Impact of Turnover in Nursing Homes. The American Journal of Nursing, 114(9), 69-70. doi:10.1097/01.NAJ.0000453762.61882.82
Kirby, E. G. (2018). Patient Centered Care and Turnover in Hospice Care Organizations. Journal of Health & Human Services Administration, 41(1), 26-51. Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=a2h&AN=129349066&site=eds-live&scope=site
LeadingAge Minnesota, (2017). Surveys and Survey Results. Retrieved from
https://www.leadingagemn.org/knowledge-center/current-surveys-results/surveys-and-survey-results/
Marsh, V. (2015). Mentoring the Novice OR Nurse. AORN Journal, 102(2), P12-3. doi:10.1016/S0001-2092(15)00619-5
McGilton, K. S., Tourangeau, A., Kavcic, C., & Wodchis, W. P. (2013). Determinants of Regulated Nurses’ Intention to Stay in Long-Term Care Homes. Journal of Nursing Management, 21(5), 771-781. doi:10.1111/jonm.12130
Rožman, M., Treven, S., ; ?an?er, V. (2017). Motivation and Satisfaction of Employees in the Workplace. Business Systems Research, 8(2), 14-25. doi:10.1515/bsrj-2017-0013
Schroyer, C. C., Zellers, R., ; Abraham, S. (2016). Increasing Registered Nurse Retention Using Mentors in Critical Care Services. Health Care Manager, 35(3), 251. doi:10.1097/HCM.0000000000000118
Trossman, S. (2013). Better Prepared Workforce, Better Retention. American Nurse, 45(4), 1-12. Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true;db=ccm;AN=104233075;site=eds-live;scope=site
Tummers, L. G., Groeneveld, S. M., ; Lankhaar, M. (2013). Why do Nurses Intend to Leave their Organization? A Large-Scale Analysis in Long-Term Care. Journal of Advanced Nursing, 69(12), 2826-2838. doi:10.1111/jan.12249