Introduction:
Evidence based practice (EBP) involves the effective application of past research study findings with clinical expertise and patient’s preferences. It is a problem solving approach that results in individualized patient care and promotion of quality improvement. The EBP concept can be used to evaluate a nursing practice or change any policy or procedure in hospital settings too (Gray, Grove & Sutherland, 2016).
One major problem in nursing practice is the transition to actual practice and experiencing knowledge gap and job stress due to lack of exposure to the practical environment. Inability to cope up with the challenges often leads to job dissatisfaction, burnout and high intention to leave the job (Nantsupawat et al. 2017). Hofler and Thomas (2016) describes that current problem in health care setting is that new graduate nurse experience challenges during transition and there is lack of provision mentoring support for the group. Generational diversity in the workforce, performance anxiety and bullying further aggravates the issue. Novice RNs are often exhausted and overwhelmed by the challenges leading to attrition. Such issues eventually contributes to increased workloads, decrease in resources and lack of progress. Hence, it is time that focus on leveraging experiencing experienced staffs as mentors. This could be an appropriate strategy for mitigation of nursing retention issues and supporting successful transition to the workplace for nurses.
In the context of perioperative nursing, the issue of complex work environment is highly prevalent. Newly placed operating room nurse fail to cope up with the demands of the operative room and they often develop the intention to leave the job (Malley et al. 2015). Thus, the ultimate impact of these challenges is that nurses are likely to leave the job in large numbers and this is likely to affect return of investments for hospitals as they need to restart the recruitment process all over again. Mentorship program is one strategy to develop skill of staffs. Thus, this project aims to analyse the problem of nursing turnover and evaluate the impact of structured mentorship program compared to orientation on nursing retention process. The findings of the research will be used to develop evaluation plan and resource needed for the job.
Background:
The supply and demand of nurses is a major concern for all health care organizations. With the retirement of the baby boomers generation, it is estimated that nurse retirement and nursing shortage rate will further accelerate. According to the study by Dewanto and Wardhani (2018), nurse turnover is a human resource problem and addressing this is important as it can have an impact not only on quality patient care, but also the overall health care system performance (Dewanto and Wardhani 2018).These data from across the world provided the impetus for nursing leaders to develop strategies for nursing retention. The problem further aggravates in the specialty areas like operative room or surgical setting. This is said because operating room provides a unique retention challenge for newly placed nurse because of the complexities involved in surgical nursing (Vortman et al., 2019). The main cause behind this is the lack of exposure to surgical nursing in the nursing curricula. This is the reason behind skills gaps and unrealistic expectations. The operative room is an area of advanced technology and significant time constraints. To perform effectively in such environments, nurses need to be organized and prioritize responsibilities to meet surgical demands. However, novice peri-operative nurses are often underprepared for the reality of peri-operative nursing and this problem leads to a stressful job experience for them. In response to this change, it has been proposed to create a supportive environment for these nurse through mentoring. Mentor can help them model expected behaviour and develop the commitment to enhance patient care practice and outcomes (Beale 2016).
Preoperative area is the first hurdle that perioperative nurse need to cross during transition. The challenges increase because of the use of technology and it mainly relies on well information is transferred within the ward. However, information loss often occurs because newly placed nurses fail to relay important information. This contributes to increases workload and threats to patient safety too (Malley et al., 2015). Hence, mentors have a role in increasing their competence related to peri-operative assessment and assisting during transitions of care.
Evidence has revealed the benefits of structured mentoring program in increasing nursing retention, job satisfaction and engagement level among nurses (Szalmasagi, 2018). However, there is lack of evidence synthesis of the impact of such mentoring program for perioperative nurse. The study by Putra, Kusnanto and Yuwono (2020) gave idea about the benefits of mentoring functions on job satisfaction level of new staff nurses. The study indicated that mentoring on career development has positive impact on job satisfaction and job commitment. This study gave implications for nursing managers to work on this area. Similarly, the research by Mariani (2012) demonstrated that mentoring has immense impact of career perception of registered nurse and their intent to stay in the profession.
The above literature review indicates the challenges during the transition period and the significance of mentoring for perioperative nurses. As there is lack of data synthesis on impact of mentoring in surgical setting, finding out the impact of such mentoring program in perioperative setting is important. This would pave the way for bridging the skill gap for newly placed nurses and increasing their confidence in dealing with job challenges. Research in this area can promote implementation of initiative to maximize return on investment and retain more nurses on the job. The current practice in major surgical setting is that there is lack of focus on mentoring or on-the job supervisions. The results of the review is likely to increase attention of leaders towards the needs of mentoring during the initial period of transition.
Question:
While searching for any paper, the best step to find a paper is to draft a preliminary study question. Using PICO format is the best approach to frame a research question as it provides a framework for better clarity about the research population, intervention and outcome. PICO format is an important search strategy tool and it helps in framing questions related to prognosis or diagnosis. PICO question has been selected for this report as the aim is to evaluate an intervention and PICO format can give the best approach to develop proper research questions. It helps to focus on the single most important issue in the research (Eriksen & Frandsen, 2018). The PICO template that has been used to complete the research question has been attached in appendix 1.
In perioperative nursing (P), how does structured mentorship programs (I) compared to orientation (C) affect nursing retention(O) within two-year time frame(T)?
Search:
It is planned to conduct the research by searching for journal articles in PubMed and CINAHL. The main rationale for selecting these database is that they publish peer reviewed and full text papers from the field of bioscience, biomedical and health care. The search terms used for literature searching will be taken from PICO question. The key search terms that will be used are ‘Perioperative nursing’, ‘structured mentorship program’, ‘nursing retention’, ‘turnover’ and ‘orientation’. Other alternative search terms may include ‘intention to leave’ and ‘job satisfaction’. The alternative search term will mainly include terms related to the outcome and different types of mentoring program. It is planned to refine the search process by the use of filters. For example, only full text journal articles will be selected from the type of sources and the publication data will be set from 2010 to 2010.
According to Melnyk, single keywoards may result in large number of articles which may be mostly irrelevant. Hence, to save time and avoid getting relevant papers, combining the terms with booleane operators like ‘AND’ and ‘OR’ is needed. The use of ‘AND’ will ensure that papers with both the concepts are retrieved, whereas the use of ‘OR’ will ensure that papers with either of the two concept is retrieved. For example, the search terms will be combined like ‘mentoring program’ AND ‘nursing retention’ (Stillwell et al., 2010).
The inclusion criteria for article selection were as follows:
- Both primary and secondary research papers will be taken in the study
- All papers should have surgical patients as research participants
- The main outcome of interest in each of the studies should be patient satisfaction level
- Only papers published in English should be taken
- All the resources must be full-text and peer reviewed journal articles
- The articles must be published within 2010 to 2020
In addition, articles in language other than English and those without surgical patients will be excluded.
The title and abstracts of the articles were reviewed first. If it matched with the PICO question, it was included in the search process. Further screening of the article was done by comparing it with the above inclusion criteria. Based on this method of screening, total 6 articles were finally included in the review. It included studies by Szalmasagi (2018), Platt, Coventry and Monterosso (2019), Daniel, Ramnarine & Kathiravan (2017), Tonya Roth & Whitehead (2019) and Mirbagher Ajorpaz et al. (2016).
References:
Beale, K.L., (2016). Mentoring new nurses. AJN The American Journal of Nursing, 116(10), p.13.https://www.nursingcenter.com/journalarticle?Article_ID=3800142&Journal_ID=54030&Issue_ID=3800133
Biros, M., 2018. Capacity, vulnerability, and informed consent for research. the Journal of law, Medicine & ethics, 46(1), pp.72-78. https://doi.org/10.1177/1073110518766021
Daniel, E. S., Ramnarine, N., & Kathiravan, G. (2017). Effective Mentorship for Recruitment and Retention of Newly Registered Nurses at a Tertiary Care Hospital, Trinidad. Imp J Interdiscip Res, 3(2), 1161-71. http://www.onlinejournal.in/IJIRV3I2/198.pdf
Dewanto, A. & Wardhani, V., (2018). Nurse turnover and perceived causes and consequences: A preliminary study at private hospitals in Indonesia. BMC nursing, 17(2), p.52. https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-018-0317-8
Eriksen, M. B., & Frandsen, T. F. (2018). The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: a systematic review. Journal of the Medical Library Association: JMLA, 106(4), 420. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6148624/
Gray, J. R., Grove, S. K., & Sutherland, S. (2016). Burns and Grove’s The Practice of Nursing Research-E-Book: Appraisal, Synthesis, and Generation of Evidence. Elsevier Health Sciences. https://books.google.co.in/books?hl=en&lr=lang_en&id=oD_UDAAAQBAJ&oi=fnd&pg=PP1&dq=).+Burns+and+Grove%27s+The+Practice+of+Nursing+Research-E-Book:+Appraisal,+Synthesis,+and+Generation+of+Evidence&ots=ykSUN7mrjD&sig=-TOPq6yJZncxWpCyYZBHuAA4txI&redir_esc=y#v=onepage&q=).%20Burns%20and%20Grove’s%20The%20Practice%20of%20Nursing%20Research-E-Book%3A%20Appraisal%2C%20Synthesis%2C%20and%20Generation%20of%20Evidence&f=false
Hashemi, S.M.E.F., Asiabar, A.S., Rezapour, A., Azami-Aghdash, S., Amnab, H.H. and Mirabedini, S.A., 2017. Patient waiting time in hospital emergency departments of Iran: A systematic review and meta-analysis. Medical journal of the Islamic Republic of Iran, 31, p.79. https://pubmed.ncbi.nlm.nih.gov/29445707/
Hofler, L., & Thomas, K. (2016). Transition of new graduate nurses to the workforce: Challenges and solutions in the changing health care environment. North Carolina Medical Journal, 77(2), 133-136. https://www.ncmedicaljournal.com/content/77/2/133#:~:text=address%20those%20obstacles.-,Challenges,%2C%20performance%20anxiety%2C%20and%20bullying.
Malley, A., Kenner, C., Kim, T. & Blakeney, B., (2015). The role of the nurse and the preoperative assessment in patient transitions. AORN journal, 102(2), pp.181-e1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547842/
Mariani, B., (2012). The effect of mentoring on career satisfaction of registered nurses and intent to stay in the nursing profession. Nursing research and practice, 2012. https://www.hindawi.com/journals/nrp/2012/168278/
Mirbagher Ajorpaz, N., Zagheri Tafreshi, M., Mohtashami, J., Zayeri, F., & Rahemi, Z. (2016). The effect of mentoring on clinical perioperative competence in operating room nursing students. Journal of clinical nursing, 25(9-10), 1319-1325. https://pubmed.ncbi.nlm.nih.gov/26990142/#:~:text=Conclusion%3A%20Findings%20affirmed%20the%20positive,in%20nursing%20operating%20room%20students.&text=Health%20care%20systems%20may%20improve,the%20quality%20care%20for%20patients.
Nantsupawat, A., Kunaviktikul, W., Nantsupawat, R., Wichaikhum, O.A., Thienthong, H. & Poghosyan, L., (2017). Effects of nurse work environment on job dissatisfaction, burnout, intention to leave. International nursing review, 64(1), pp.91-98. https://pubmed.ncbi.nlm.nih.gov/27882573/
Platt, M. S., Coventry, T., & Monterosso, L. (2019). Perioperative nurses’ perceptions of cross-training: A qualitative descriptive study. Journal of Perioperative Nursing, 32(1), 19. https://www.journal.acorn.org.au/jpn/vol32/iss1/4/
Putra, A.P., Kusnanto, K. & Yuwono, S.R., (2020). Effects of Job Satisfaction and Organizational Commitment on Nurse Retention: A Systematic Review. INDONESIAN NURSING JOURNAL OF EDUCATION AND CLINIC (INJEC), 5(2), pp.197-205. https://injec.aipni-ainec.org/index.php/INJEC/article/view/319/pdf
Queirós, A., Faria, D. and Almeida, F., 2017. Strengths and limitations of qualitative and quantitative research methods. European Journal of Education Studies. https://oapub.org/edu/index.php/ejes/article/view/1017
Shen, Y. and Lee, L.H., 2018. Improving the wait time to consultation at the emergency department. BMJ open quality, 7(1). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5759711/
Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. Searching for the evidence strategies to help you conduct a successful search. AJN [Internet]. 2010 [cited 2016 July 10]; 110 (5): 41-7. http://download.lww.com/wolterskluwer_vitalstream_com/PermaLink/NCNJ/A/NCNJ_546_156_2010_08_23_SADFJO_165_SDC216.pdf
Suzan, Z. (2016). The relationships among job satisfaction, length of employment, and mentoring of nursing faculty. https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=3163&context=dissertations
Szalmasagi, J. D. (2018). Efficacy of a mentoring program on nurse retention and transition into practice. International Journal of Studies in Nursing, 3(2), 31. http://journal.julypress.com/index.php/ijsn/article/view/378
Tonya Roth, D. N. P., & Whitehead, D. (2019). Impact of a Nurse Manager Peer Mentorship Program on Job Satisfaction and Intent to Stay. Journal of Excellence in, 1(1), 4-14. https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=1001&context=jenhp#:~:text=A%20secondary%20purpose%20was%20to,satisfaction%20and%20intent%20to%20stay.&text=The%20results%20demonstrated%20a%20significant,stay%2C%20and%20transformational%20leadership%20behaviors.
Villanueva, C. A., Almadani, M., Mahnashi, F., Alyhya, S., and Alshreef, O. (2017). Waiting time in emergency department in Riyadh 2017. Journal of Biosciences and Medicines, 5(03), 55. https://www.researchgate.net/publication/315541073_Waiting_Time_in_Emergency_Department_in_Riyadh_2017
Vortman, R., Bergren, M. D., Baur, K., & Floyd, V. (2019). NURSE RETENTION IN THE OPERATING ROOM AFTER PERIOPERATIVE CORE CURRICULUM COMPLETION/LA RETENTION DES INFIRMIERES ET DES INFIRMIERS EN SALLE D’OPERATION APRES AVOIR TERMINE LEUR PROGRAMME DE BASE EN SOINS PERIOPERATOIRES. ORNAC Journal, 37(3), 13-28. https://go.gale.com/ps/anonymous?id=GALE%7CA600036471&sid=googleScholar&v=2.1&it=r&linkaccess=fulltext&issn=19276141&p=AONE&sw=w
