Culturally competent nursing mentorship for nursing students, nurses, or faculty often remains challenging when the mentor needs to reflect on the mentee. Understanding diversity in higher education and the strategies to improve culturally competent guidance is looked at through the lens of mentoring.
Brief History
The term ‘mentor’ was adopted from Mentor, a Greek mythological figure in Homer’s “Odyssey.” Mentor was placed in charge of Odyssey’s son, Telemachus. Their mythological relationship consisted of Mentor imparting wisdom, guiding, and sharing knowledge with Telemachus. In modern times the word mentor has come to mean a very experienced and trusted advisor. A mentee is the term for the person in the position of receiving the mentor’s training, guidance, advice, or wisdom (Grant & Hazel, 1993).
Nursing Mentorship
Becoming a nurse, advancing a nursing degree, or being a nursing professor all require skills and knowledge to be learned. A part of that learning comes from mentor-mentee relationships. Ideally, each nursing student or new faculty should have an available mentor sensitive to the mentee’s needs. Mentors that reflect or identify with their mentees would be optimal (Schuler, 2021). However, in the absence of availability, the mentor must practice culturally competent mentorship. The importance of the mentorship role becomes evident when the mentee does not reach their full potential or partake in opportunities within the profession.
U.S. Census Statistics and Nursing Numbers
According to the U.S. Census Bureau (2020), 57.8% of the American population is White, forming the majority; Hispanic and Latino Americans are the largest ethnic minority comprising 18.7%; Black or African Americans are the largest racial minority making up 12.1% of the population. Also noted on the census was an increase in multicultural populations. Additionally, according to the National Council of the Board of Nursing statistics (2021), ethnic/racial minorities represent 19.2% of the RN workforce. According to the numbers that represent the U.S. population and the population of the nursing workforce, there is a representation of minority nurses ranging from the bedside to academia.
However, the reality of these numbers is striking. Due to the lower numbers of minorities in the nursing field, mentors must commit themselves to cultivate culturally appropriate mentoring relationships. Working within the framework of who is represented then requires solutions to effective and appropriate mentoring. Employing creative and Evidence-Based Practice (EBP) mentoring styles is mandatory for successful mentor-mentee relationships.
Relevance
Mentoring advances the science of nursing; it helps develop and move forward the discipline along with its leaders and educators. However, cultural awareness and carefully suited mentoring styles to accommodate minoritized mentees are imperative for successful outcomes. Diversity is defined as different or varied. Whether the diversity is cultural, racial, religious, gender, class, or sexual orientation of a mentee, it must be acknowledged and understood by the mentor to help build a stronger mentoring relationship. This will add to the mentee’s development and foster meaningful results (Dirks, 2021).
Challenges
Some causes of the underrepresentation of minorities in nursing have been noted as lack of opportunity, educational finances, emotional and social support from the discipline, and lack of diversified mentors (Firth, 2021). However, when focusing on the need for diversified mentorship in the formation of nursing students, new nurses, RN to BSN students, and new nursing faculty, there are many obstacles for the mentor.
Some examples of challenges a mentor may face include assessing a mentee’s motivation, having the proper time to mentor, setting reasonable goals, and the mentor’s ability to properly assess the mentee’s knowledge, skills, or background. One prominent challenge in mentee assessment is correctly identifying diversity to incorporate appropriate mentoring into the relationship. Schuler (2021) states that nurse mentees recognize support and are thankful for shared insights from culturally competent mentors.
Recommendations
While acknowledging the low numbers of minority students, nurses, and faculty, how then will professors of any ethnic, racial, religious, or any diverse background be a mentor to their diverse minoritized students or new faculty? The answer is already in practice.
The very steps that the professors teach their nursing students to form nurse-patient relationships regarding cultural diversity. The movement to include culturally competent care in nursing is currently operational in practice and academia. Nursing professors teach their students to be culturally competent as it is woven throughout EBP curricula (Hung et al., 2019). Students are taught the values and how to incorporate, accommodate, and respect culture into their healthcare-providing practices. This level of teaching students culturally competent care must be transferred and utilized with mentor-mentee relationships between professors and students, nurse administrators and new nurses, and professors and new faculty.
First and foremost, the mentor must self-reflect on their thoughts and feelings. They must recognize any biases and explore how this will affect the mentoring relationship, therefore working to acknowledge and eliminate them honestly. Secondly, they must get to know their mentees through inquiry. Asking mentees to share their backgrounds and how they prefer to learn is an act of openness and accommodation.
Thirdly, the mentor must create an atmosphere of judgment-free mentoring to allow the mentee to receive the advice in their way.
Finally, and perhaps most importantly, the mentor and mentee must commit to being open, honest, and respectful in their roles. Without their commitment, the relationship is not built on a trusted foundation, and all that follows may be tainted. The lack of diverse nursing mentors may or may not be able to be wholly addressed by looking purely at the census numbers.
As nursing advances, there is a recommendation to include and support minoritized nurses in all roles of the profession. Regardless, whoever is in the role of mentor, must accept the current challenges and comply with the prerequisite to pledge to deliver EBP culturally competent guidance using the above-mentioned mentoring strategies.
Firth, S. (2021, August 12). Why are they so few people of color in nursing? Washington Correspondent, Medpage Today. https://www.medpagetoday.com/nursing/nursing/94025
Grant, M., & Hazel, J. (1993). Gods and Mortals in Classical Mythology. Springfield: Merriam-Webster.
Hung, H., Y., Wanf, Y., W., Feng, J., Y., Wang, C., J., Lin, E., C., L., & Chang, Y., J. (2019). Evidenced-based practice curriculum development for undergraduate nursing students:The preliminary results of an action research study in Taiwan. Journal of Nursing Research, 27(4), 30. doi: 10.1097/jnr.0000000000000298
Schuler, E. (2021). Evaluation of an evidence-based practice mentorship programme in a paediatric quaternary care setting. Journal of Research in Nursing, 26(1-2),149-165.
Before you officially become a nurse, you must graduate from nursing school, become licensed as a registered nurse (RN), and apply for your first job. Once you are hired, you will attend your first nursing orientation at your hospital or clinic. A nursing orientation is a course or set of courses designed to educate new employees about the facility’s procedures and policies. New nurses will also learn standards, codes of conduct, and the proper way to document patient information.
During orientation, employees will discover a wealth of information, including more about their work responsibilities. While these are some of the basics, your employer may also instruct you on other items that are specific to the hospital or clinic. Orientation topics may include how to stay safe and protect patients, as well as what color scrubs or what kind of nursing shoes to wear. You may also find out if you need to supply your own protective gear or stethoscope.
Since you must follow the facility’s policies at all times, it is important to pay close attention to the contents of your orientation session. The following tips will help you to ensure you retain everything you learn during your online sessions or in-person classes. Reading through these pointers before you attend your nursing orientation will help you to retain more information while you attend. A periodic review of the rules and standard operating procedures will help you to be successful at your career.
1. Arrive Early
As a new nursing employee, it is always important to be on time. Be sure to check the start time for your first day of orientation and then plan to arrive at least a few minutes early. It is especially important to be prompt if you are visiting a new building or entering a new facility. Consider that it may take longer than expected for you to find a place to park or walk to the meeting site. By arriving early, you will show your supervisor that you take your role seriously and that you are ready to get started.
If your instructor or supervisor arrives before orientation starts, introduce yourself. A formal introduction helps to make a good first impression, especially as a new professional in the nursing field. It is also helpful to make a connection just in case you have questions or need advice in the future. The relationship with your boss may also be the first one you make at your new clinic or hospital, which is why it is essential to begin promptly and positively.
2. Be Prepared with the Right Nursing Supplies
Check your orientation checklist as soon as you get it. You may need nursing supplies to get started. Sometimes, the best items and nursing gear are found online. A few days’ notice can help to ensure you get everything you need. In most cases, you will need to wear your scrub uniform and nursing shoes. You will also need a stethoscope, as well as a medical bag to carry your devices and documents.
Additional helpful items include a penlight and a storage clipboard. You may also benefit from a nursing watch with a second hand. Other popular nursing supplies that you should consider buying before orientation include a badge holder or lanyard, protective gear like eyewear and a few scrub caps.
3. Take Notes
As you go through orientation, you may have questions about the rules or policies the facility has for the nursing staff. You may also want to clarify reporting procedures or who to contact if you need something in the future. Take notes regarding each of your questions and then plan to follow up after the orientation session. Your notes may include contact information, like your orientation leader’s email or your supervisor’s office number.
Many hospitals will require nurses to take a test or quiz after the orientation session. This helps supervisors ensure that their employees understand how to do their job, document important information, and learn how to care for patients. Taking careful notes and highlighting sections of text will help you to remember key information before the exam.
4. Stay Organized
Being on time, taking notes and having the right office supplies will help you to stay organized. A folder, briefcase or storage bag can help you to keep your writing utensils, notebooks or orientation papers in the right spot. Keep these items away from your personal gear, such as your smartphone, wallet, or snacks. This will help you to locate the right items easier and faster.
If your sessions last for more than one day, double-check that you are to arrive the same time the next day. You should also find out if you will be in the same room for the rest of your sessions. Write down any changes on your smartphone or in your nurse’s notebook. If your orientation is at a different time than your typical nursing shift, be sure to let loved ones know about the changes as soon as you can.
Make the Most of Your Nursing Orientation
Nursing orientation will be full of information, but it is also an essential part of getting used to your new role. Since every hospital and practice is different, it is an excellent idea to pay close attention to your supervisor’s lectures or the facility’s learning videos. While you are sure to have a lot of questions, this is normal. It may take a little time to remember all of the rules and policies of the facility. If you arrive on time and stay focused throughout your orientation, your supervisor will be glad to help you through your first few weeks. Soon, you will be a pro at your workplace’s software and patient procedures.
Throughout my tenure for nearly 20 years as a nurse, nursing professor, and leader in higher education, I have learned a lot about the art of successful coaching. In both traditional, and non-traditional academic environments, no matter whether you connect physically in-person or virtually via video-conferencing, effective coaching can not only transform a nurse or student, but everyone they come in contact with, and ultimately an entire organization.
My proudest moments in leadership have been when I have helped my faculty have “light-bulb moments,” and deep moments of personal discovery. Discovering perceived versus actual obstacles in their teaching methodologies, and personal lives triggered powerful breakthroughs that left them forever changed. In a recent experience, it warmed my heart to have a team of faculty so passionate about student success and improved student outcomes, that they were willing to take a deep look at themselves and change anything that would hinder them from being the best professor that they could be. These faculty believed that transformed students started with transformed faculty. One particular cohort of nursing leaders I had the distinct pleasure of coaching were all geographically dispersed so we used a videoconferencing platform to meet as a group bi-weekly for 45-minutes, and one-on-one for 30 minutes for eight months.
During our meetings, I used evocative questioning and active listening to lead them on an individualized journey of discovery in personal and professional areas. The steps of the nursing process provided structure for our interactions. We started with the following:
Assessment: Defining where they are in their personal and professional lives, from a holistic perspective
Diagnosis: Identified area of opportunity for growth
Plan: Intentional action steps to achieve the goals
Implementation: Executing the plan
Evaluation: Reflecting on the journey, including personal and student outcomes
There were many lessons learned from this experience, but the greatest takeaway was that each faculty member personally experienced a fundamental internal shift and a personal transformation in their mindset and skillset and felt empowered to apply the lessons of their personal growth to student interactions and teaching methods. The application of the lessons they learned through my transformational coaching program not only enhanced their confidence in teaching, but also improved their coaching skills, student support, and student outcomes.
As an emerging nurse leader, I remember my mentor telling me that as I continued to teach nursing that my students would teach me more than I ever taught them. This was very true. The inspirational and empowering professional I desired to be for my students became an ever-evolving journey of self-discovery and becoming. I have been able to achieve extraordinary things throughout my nursing career because of mentors who allowed me to “borrow their belief” in me. Having someone to help you “unpack” personal and professional challenges, and change your perspective about adversity and obstacles has been priceless, totally life-changing, and essential for my growth. If nurse leaders seek to build more nurse leaders, mastering the art of effective coaching is critical.
From a student nurse deciding on a career path to a seasoned nurse looking to advance into administration, each step along a nurse’s career is filled with questions. Fortunately, mentors in the nursing industry are becoming a more visible presence.
The Nurse Mentorship Program at Stanford Health Care is one such valued and valuable mentoring program. Introduced in 2004 for graduate nurses, the program now encompasses a range of nurses in different areas of their careers.
Minority Nurse spoke with associate chief nursing officer for inpatient services and magnet program director at Stanford Health Care at Stanford University Anita Girard and with Stanford’s program manager of nursing excellence Kevin Tsui about the distinct benefits of this kind of program.
Girard and Tsui say many nurses seek mentoring for varied reasons. They might seek leadership advice or they might want guidance for switching specialties. Still others may be looking for assistance with specific tasks such as writing or giving a top-notch presentation at a conference.
Any nurse can gain from a mentoring relationship, says Girard, but a specific benefit is one that will help a nurse professionally and personally. “The biggest benefit is the networking nurses have being in a mentoring program,” she says. “Mentoring opens you up to a whole new world.”
Tsui agrees and notes the satisfaction nurses reap from establishing a firm footing in their careers and having someone who can help guide them. The resulting good feelings lead to happier nurses, and the benefits stretch far. “Those mentoring connections streamline goals, build positivity and retention, and nurses feel a sense of control,” he says.
Nurses, says Girard, can feel siloed. Despite being in the same profession, nurses have varying specialties and may not have opportunities to hear from nurses in different areas. Mentoring includes both the one-on-one discussions and the larger access to others in the industry that becomes available. “Mentoring gets you out of that box,” says Girard.
So how does a mentoring relationship benefit the nurses and their organizations? According to Tsui, “It’s crucial. By sharing an organization’s mission, vision, and values, it makes transparent the format for mentoring,” he says.
Nurses in a mentoring relationship within the same organization are working within the same culture, so are able to set clear goals and create objectives that are going to be important to the nurse’s career within that organization and in the larger industry. Often, says Girard, mentors will give guidance based on what they already know about the organization. They will be able to help a nurse put priorities in order for certification, advancement, skills development, and personal improvement.
Mentors are also able to be objective about a nurse’s path, so they can help nurses align their goals and use their own knowledge to help a nurse achieve those goals, says Tsui.
A mentoring relationship is definitely a give and take, says Girard. “You really need to make an effort to understand why you want to get into a mentoring relationship in the first place,” she says. And mentees need to make a solid commitment and understand that any mentoring activity needs to be given top priority, she says.
Mentees are responsible for reaching out, setting up clear timelines, and even using tools to streamline online tasks such as emails and calendar appointments. Any communication should have an agenda with clear and succinct ideas and questions. By doing this, the mentee shows the mentor clear goals and intentions mean they have a goal for mentoring and that it will be productive.
Tsui says that sometimes mentees are not clear about the process and expect the mentor to initiate or complete tasks for them. Instead they need to keep in mind they need to be committed to change and driven to use the guidance of the mentor to advance their goals.
At Stanford Health Care, the mentoring program satisfies a magnet hospital requirement, but the benefits have been extensive. “We are driven to excellence,” says Girard. “It is a journey of innovation and inquiry and what we can do to make things better.”
I waited five years for this day: my first day as a psychiatric-mental health nurse practitioner. Mental health is a specialty with the highest demand and lowest supply in the United States. I filled one of seven vacancies, so the staff welcome was warm and inviting to say the least. The outpatient setting was grandeur. It was a far cry from what I am accustomed to. The air was fresh, the bathrooms were clean, and I even scored a corner office! It is a shared space, but who cares? The office has a large window showcasing the mountains and orange trees. The desks are height-adjustable, giving the option to sit or stand. I was excited and prepared for whatever came my way. There was just one problem: It does not seem like they were prepared for me.
After a week and a half of hospital orientation, a nursing mental health supervisor invited me on a tour of my work area. It was my first day actually seeing the clinic and meeting my coworkers. After copious introductions, he invited me to his office. He began the conversation with an oh-so-familiar precursor in nursing: “I have to be honest with you.” I knew I was in for some hardcore truth. Here are the highlights of his honesty about orientation: (a) This is not the nursing you know; (b) there are no checklists or competency fairs for you; (c) you will shadow people who do not have your experience; (d) be a skeptical sponge; and (e) you will only get out of it what you put in to it.
I want to assure you everything the mental health supervisor said rings true. The following weeks were
an emotional rollercoaster. There were times I would feel challenged, confused, frustrated, bored, excited, and disappointed all before lunch hour. If you feel this way, this is normal. Experiencing a barrage of emotions is not unusual in your quest to function at the advanced practice level, learn the workflow and learn the system, all while maintaining your nurse identity. Work through it. Do not give up.
Here are some tips that will help you transition successfully from the RN to NP role.
Find a Mentor
Many new graduate nurse practitioners identify mentorship and structured orientations (i.e., residencies and fellowships) as most important in considering job prospects. If your employer is one-in-a-million and offers a nurse practitioner residency/fellowship program, I encourage you to apply. However, the truth is many employers do not offer nurse practitioner training programs. Do not be discouraged. Consider investing your time in a mentorship instead. Mentorship is a powerful tool to ease your transition. Mentors are reliable resources, safety nets, so to speak. They will assist in developing your knowledge base, clinical skills, and overall confidence. If you do not feel comfortable searching for a mentor. Do not worry. It is likely your supervisor will assign a mentor to you being that you are a new graduate. Be advised: Mentorship is a partnership in which both you and the mentor are responsible for your professional growth. Remember, you get out of it what you put into it.
Mentoring is a skill not everyone is able or willing to do. Poor mentorship is detrimental to your professional growth and work environment. It often results in disappointment, isolation, and poor job satisfaction. To avoid a bad experience, try to find a mentor whose experience resembles your own. If there is discord between you and an assigned mentor, or if you feel the mentorship hit a glass ceiling, request another mentor. There is no rule against it, and you do not want to stifle your growth.
Don’t Have a Plan? Develop One
If your employer does not have a program or plan for you, create your own. It is important to set deadlines and expectations for yourself and communicate those with your mentor and supervisor. If you fail to do so, you may find yourself practicing independently too soon. Orient yourself by reading standard operating procedures of your work area and shadowing different providers. Pay attention to the workflow, the workload, and interdisciplinary interactions. Once you are familiar with the system and feel comfortable, I recommend the sink or swim approach. It builds confidence from the start, and you will gradually become more independent.
Ease into first-time assessments and interviews by seeing patients with a clinician shadowing you. Invite constructive criticism and feedback. It can only benefit you. Invest in an updated prescriber’s guide, and search online for local and national organizations relative to your specialty. If you do not want to go bankrupt joining organizations, look at their event calendar. From there, you can attend meetings that would be most beneficial to you for a nominal fee.
Be Self-Aware
As the mental health supervisor mentioned, your training and experience may differ from that of your mentor. You will find a surprising number of nurse practitioners are oriented to their role by physicians. In addition, consider the variation of training and clinical experience within our own profession. There are nurse practitioner programs that require years of experience working as a registered nurse. Conversely, there are other programs that require little to no experience at all. You will see these variations in your workplace. Research suggests that RN experience neither promotes nor inhibits transitioning to the nurse practitioner role. Avoid the trap of drawing baseless conclusions. One graduate is not better than the other; however, experience shapes perspective. You will notice differences in perspective.
My background includes five years in a medical-stepdown unit and the emergency department as a registered nurse, so, naturally, not getting a set of vital signs because “they need to do that” is strange and disconcerting. I remember hearing a nurse practitioner say, “You are doing well. Do you see the difference? You are a nurse practitioner now. Nurses do not critically think. Nurses just take orders. Real thinking is not involved in that. Now, you have to think critically.”
Now, I have to be honest with you. You may hear similar comments in the office, the breakroom, or a meeting. Remember, some nurse practitioner programs are a fast-track to terminal degrees with little to no experience working as a registered nurse. Furthermore, physicians orient nurse practitioners to their role, not the other way around. These comments are not personal affronts. They are knowledge deficits. People do not know what they do not know, so know yourself. You critically think in your sleep. Be self-aware.
Know Your Place
Find your job description and read it thoroughly. Inquire about your role in your area. By role, I am not talking about the mechanics of advanced practice. I am talking about your position on your team. Nurse practitioners are utilized so many different ways. For instance, psychiatric mental-health nurse practitioners in my facility can admit and discharge patients, round on inpatient units, treat patients in the psych holding area of the emergency department, and see patients in an ambulatory care setting. It is important to know what role you play in your area.
Discuss performance measures and standards of care with your supervisor. “What are your expectations? How are you evaluating my performance? What is the standard of care?” Add their expectations to the list of expectation you should have for yourself. Use them to set your short and long term professional goals.
Knowing your place also has to do with knowing the culture. Every work environment has a culture. For me, transitioning from bedside nursing to an office setting was like waking up in the twilight zone. I went from sharing everything (i.e., computers, lunch, dreams, scrubs, pens) to boundaries and territories. Once, I was politely and abruptly escorted out of my office, a shared space, for taking a call while the other provider was charting on one patient. The first and only patient seen all day. This was yet another ride on the emotional roller coaster. Again, I am accustomed to sharing everything. I have seen three nurse practitioners share one office. I could not fathom the “No Talk While Typing” rule going over so well. Again, I did not consider it a personal affront. It was another opportunity for me to learn. Office culture is not at all like bedside culture. Read about office etiquette in shared spaces and be prepared. I most certainly was not.
I do not embarrass easily, so I am comfortable sharing my experiences. I hope my sharing will help make your transition smoother and less intimidating. The nurse practitioner role is indebted to the art of caring and compassion that is nursing. You are a member of the most ethical profession in the world, and nursing is at the heart of everything you accomplished. It is what distinguishes nurse practitioners from other clinicians. Remember, role change does not imply change of character or professional identity. You are a nurse, so this is not your first role transition. You have done this before, and you can do it again.
