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.
While maternal outcomes have improved over the years, a considerable number of women in the United States die from or continue to experience a number of pregnancy-related complications. According to the National Center for Chronic Disease Prevention and Health Promotion [NCCDPHP], each year approximately 700 women die of pregnancy related causes while 50,000 women experience severe pregnancy complications. Women living with chronic conditions such as hypertension, diabetes, heart disease, and obesity are at a higher risk for complications during pregnancy, childbirth, and the postpartum period. In particular, African American women are more likely to die from pregnancy-related complications when compared to their white counterparts. Notably, maternal mortality is higher in the United States than in any other developed nation.
Severe maternal mortality is due to severe pregnancy complications. According to the NCCDPHP, these rates have doubled from 2000–2010 and have affected more than 50,000 women in the United States. Some contributing factors include: maternal age, persisting chronic conditions, complications during delivery, and pre-pregnancy obesity. Researchers note that approximately half of pregnancy-related deaths are preventable and point to implications for reducing maternal mortality.
Efforts to reverse these disturbing statistics will require a multifaceted and comprehensive approach. Interventions must include a focus on better data collection, quality improvement measures, provider and patient education, earlier identification and intervention targeting high-risk women, proactive preconception health approaches, and improved obstetrical and maternal care services. Many hospitals and health systems across the country are addressing the mortality death rates and have designed programs, which include some of the aforementioned strategies.
The rise in maternal morbidity and mortality has stimulated discussion and action among nongovernmental and governmental agencies, advocacy, and professional groups and the United States Congress. Groups such as the American College of Obstetricians and Gynecologists, Black Women’s Health Imperative, and the Alliance for Innovation on Maternal Health (AIM), to name a few, are speaking out for legislative action. The table below provides a brief snapshot of legislative proposals introduced at the federal level during 2018, the second half of the 115th Congressional Session. These and other initiatives are a critical first step to reversing the poor maternal health outcomes for women.
Nurses are encouraged to stay abreast of this issue by identifying the state of maternal health in their respective communities. Nurses wishing to improve maternal outcomes can do so by helping to identify high-risk populations and working with their respective institutions to develop educational programs, outreach initiatives, and quality standards for maternal care. As health care providers, nurses are well-suited to work with multidisciplinary teams to disseminate best practices as well as advocate for sound public policies focused on alleviating poor maternal outcomes.
Additionally, nurses can look to professional/specialty organizations to identify what organizations are doing to address maternal mortality. For example, the Association of Women’s Health, Obstetric and Neonatal Nurses, one of nursing’s leading organizations devoted to women’s health and newborns, has a number of resources on this issue and advocates for work that expands the work of state-based Maternal Mortality Review Committees. Maternal Mortality Review Committees are critical to collecting, reviewing, and monitoring data on pregnancy-related deaths.
RESOURCES
American Colleges of Obstetricians and Gynecologists
www.acog.org/Advocacy/ACOG-Legislative-Priorities
Association of Women’s Health, Obstetric and Neonatal Nurses
www.awhonn.org
Maternal Health Task Force
www.mhtf.org/topics/maternal-health-in-the-united-states
Severe Maternal Morbidity in the United States
www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html
Maternal Health: Proposed Legislation
Number Name Sponsor Provisions Comment
H.R. 5977Mothers and Offspring Mortality and Morbidity Awareness Act (MOMMA’s Act)Rep. Robin Kelly (D-IL)
· Establishes an expert federal review committee to help enforce national obstetric emergency protocol
· Establishes best practices between providers and hospital systems
· Improves access to culturally competent care training and workforce practices
· Standardizes data collection to collect uniform data
· Expands Medicaid coverage to cover the full postpartum period
Introduced 5/25/18
H.R. 5761 Ending Maternal Mortality Act of 2018 Rep. Raja Krishnamoorth (D-IL) Amends the Public Health Service Act to require Department of Health and Human Services to publish every two years a national plan to reduce maternal deaths occurring during or within 12 months of pregnancy Introduced 5/10/18
H.R. 5457 / S. 2637 Quality Care for Moms and Babies Act Rep. Eliot Engel (R-NY) / Sen. Debbie Stabenow (D-MI) Amends Title XI of the Social Security Act to improve the quality, health outcomes, and value of maternity care by developing maternity care quality measures and supporting maternity care quality collaboratives Introduced 4/16/18
H. Resolution. 818 / S. Resolution. 459 Black Maternal Health Week Rep. Alma Adams (D-NC) / Sen. Kamala Harris Creates awareness about the maternal health care crisis in the black community and the urgency to reduce maternal and morbidity among black women Introduced 4/11/18
Experts agree that mentoring is vital to your professional and personal development as a nurse. Good mentoring can lead to getting into—and through—nursing school, getting a great job, and getting into graduate school. However, as a minority nursing student or nurse, you may have little experience being a mentee and have many questions. Questions like: How do you approach a person you would like to have as a mentor? Do you only need one mentor? How do you know if you have a good mentor? Some minority nursing students and nurses have had mentors of the same culture or ethnicity as you and you may feel uncomfortable asking a nurse, instructor, or professor from an ethnicity or culture different from yours to be your mentor. The following tips may help you find a mentor and set the foundation for a rewarding mentee-mentor experience.
How do I know if I need a mentor?
All of us need a mentor. A mentor is an experienced person that advises you as you work to accomplish a goal or guides you through your education or career. As a nurse, there are many benefits to having a mentor. One benefit of having a nurse mentor is having someone who is impartial and can listen to you and give you direction. When your mentor shares their knowledge and experiences with you, you gain knowledge and insight. Thus, you can make choices, decide to gather more information, or even seek the advice of another mentor. Another benefit of having a mentor is often they will extend their network to you to help you. Many nurse mentors are willing to introduce you to other nurses that may be of assistance to you. For example, your mentor is a cardiology nurse and you are interested in going back to school to become an Adult-Gerontology Nurse Practitioner (AGNP). If your mentor knows one, they may often put you in touch with the AGNP because they cannot answer the types of questions you have about becoming one.
Many nursing students and nurses have more than one nurse mentor. You can have an all-round mentor, an education mentor, and one that is career specific, one that is research specific, and one that is a mentor in your practice specialty. You can have as many mentors as you need. It is better to find a mentor early in your nursing education or soon after you graduate because mentors are excellent recommendation writers for jobs or school because your mentor has listened to you talk about your aspirations and goals and can write about what they know about you.
The person I would like as my mentor is of an ethnicity or culture different from mine. Can that work?
Absolutely! In nursing, it can be very hard to find a mentor that is of your ethnicity or culture. It is perfectly fine to ask what has been their experience mentoring a person from a background different from theirs, what they learned, and what the challenges were. Keep in mind that you are deciding if this nurse will be a good mentor for you so ask what you need to know so you can make an informed decision.
How do I approach someone I would like to have as a mentor?
Before you approach your prospective mentor, think about or write down why you would like to have them as your mentor. It does not have to be elaborate. It could be that you aspire to be like them and you want to get their advice. It could be that you are interested in the type of nursing practice or research they do, and you want to shadow or work with them. Whatever your reason is, make sure you can concretely express it. Your potential mentor wants to know how they can help you. Remember, mentors are agreeing to share their time with you and they do not want to waste your time either.
Next, you should contact them by sending an email or calling them. When you contact them, you should let them know what you want and why. After an email response or call, you should ask to meet with them to begin the mentor-mentee relationship. This meeting can be over the phone if meeting face-to-face is not possible. This meeting is important for the two of you to get to know each other.
They have agreed to be my mentor! How do I prepare for our first meeting?
There are three goals for your first meeting. One is to have your mentor get to know you; the second is for you to get to know your mentor; and the third is to define your mentee-mentor relationship. In some cases, where a deadline or project is involved, a timeline may be necessary—and that is your fourth goal. There is no way for you to know everything about your mentor and for them to know you in one meeting. The important topics should include: where you are from, why you chose nursing, your goals and aspirations, and why you believe your mentor can help you. You should ask those same questions and add a question about why they choose their nursing career path, and their current goals and aspirations. Having this conversation is an excellent way for you and your mentor to connect and begin to build the foundation of a good mentee-mentor relationship.
Defining the mentee-mentor relationship should be the focal point of the first meeting because it establishes the foundation of your interactions. It defines what you want from the relationship and leads to the discussion on how to make your mentee-mentor relationship work for you both. There are three areas to cover in defining the relationship; the first is deciding whether the mentee-mentor relationship is formal or informal. An informal relationship does not require much work. Usually a verbal agreement to stay in touch with some regularity and the person agreeing to be your mentor is enough for an informal mentee-mentor relationship. A formal mentorship is usually in writing because it usually entails a project or deadline. Mentee-mentor relationships can go from being informal to formal and from formal to informal. Communication between the two of you is essential to navigating that part of the relationship.
Second, you need to decide how often you are going to meet. In informal relationships, this could be as needed or once a month. In a formal relationship, the frequency of meetings is often defined by what the project or deadline is.
Third, you must decide what type of meetings you are going to have and how long will they be. Again, in an informal relationship that may not be necessary as you will not be meeting frequently, and you can set the length of the meeting as it fits you and your mentor’s schedule. In the case of a formal relationship where regular meetings are necessary, the length of the meetings are important so that the appropriate amount of time can be set aside. In a formal mentoring relationship, an agenda or key discussion items are sent to your mentor in advance of the meeting. The agenda helps keeps you both on target.
In the case of most formal relationships, a documented timeline (i.e., a beginning and end) of the relationship or project is established. In establishing a timeline, you incorporate meeting dates, dates when you will send something to your mentor, and the timeframe when you should expect their feedback. When you do this step early in the relationship, it tends to keep everyone on task and on target. Of course, things happen, but it is important that each of you honor your formal agreement and renegotiate timelines as needed.
What do I do if my mentor is not a good fit for me?
Do not worry. Sometimes, the mentee-mentor match up does not work out as planned due to timing, different approaches, communication, and personality, among other things. Being an expert nurse, professor, or nurse researcher may not always mean that they will be a good mentor for you. If after your initial meeting or even after multiple meetings you find that you and your mentor are not a good fit, then the professional way to handle it is to end it. In the case of informal relationships, it is easier since there is no agreement for regular contact. However, it is best to thank your mentor for their time when you end the mentee-mentor relationship. In the case of a formal mentee-mentor relationship, a call, email, or letter is the most professional method to end it. Again, if you have spent time with your mentor, you should thank them for their time and what you state after that should be very professional, honest, and give at least one reason you no longer want to have a mentee-mentor relationship with that person. Keep in mind that if this is a person working in your career field that you do not want to “burn bridges,” so a scathing email or letter is not professional. When in doubt about what you have written, ask another trusted mentor or colleague.
How do I know I have found a good mentor?
Inc.com give us seven key qualities of an effective or good mentor. The seven key qualities are:
Ability and willingness to communicate what they know. A good mentor is able to make complex concepts and issues easy (or easier) to understand. A good mentor is open to sharing all the “secrets” of success with you in an effort to help you succeed. You just have to be open to listening and learning.
Preparedness. As a mentee, you should have an agenda or at least tell your mentor what you would like to discuss before you meet so that your mentor can be prepared. A prepared mentor has given thought to your questions or topic and is ready to have an efficient and directed conversation with you.
Approachability, availability, and the ability to listen. As part of the first meeting, you as the mentee have set up dates and times with your mentor and your mentor should keep those commitments and be ready to listen.
Honesty with diplomacy. A good mentor is going to be honest about whatever you are discussing. Being honest with you should be done in a professional and tactful manner, especially if your mentor is giving you feedback or critique.
Inquisitiveness. Your mentor may know a lot, but that does not mean they know everything. A good mentor is willing to learn new things about you and new topics. In essence, a good mentor is a lifelong learner.
Objectivity and fairness. A good mentor is looking forward to helping you succeed and that is it. There are no favors involved. Most often, your mentor may give you networking suggestions or offer to give you the name of a person who may be able to give additional support or a “foot in the door.” However, an expectation of a job or anything else because of the mentee-mentor relationship is not part of a mentee-mentor relationship. In the case where you and your mentor are working on a project, publication, or other work related items, the way your mentor will be acknowledged should be finalized before the project begins. For example, if you are a nursing student working on a research project you should know if you would be listed on a conference abstract or publication. If you are leading the project, you should ask your mentor how they would like to be recognized on the project.
Compassion and genuineness. Essentially, your mentor should be a good person. Being honest, fair, and objective does not equal mean and cold. A good mentor listens when you are having difficulties and is happy when you succeed. A mentee-mentor relationship is not a friendship; you may not be Facebook friends or follow each other on Instagram. However, a good mentee-mentorship relationship comes awful close to a good friendship and over time, who knows?
Taking the first step to establish a mentee-mentor relationship is usually on the mentee. Like any relationship, a good mentee-mentor relationship takes planning and having clear expectations and goals for the relationship. For minority nursing students and nurses, finding the right mentor and having a productive mentee-mentor relationship can be a daunting task when you have not had previous mentee experience and there are very few minority nurses to select as mentors. However, understanding how to establish the mentee-mentor relationship may make it less daunting and even more fruitful to enhancing your nursing career.
