Evaluating SANE Programs

Evaluating SANE Programs

Sexual Assault Nurse Examiner (SANE) programs were created by nursing professionals to address the under-reporting and under-prosecution of adult sexual assaults by providing comprehensive medical care to survivors and expert forensic evidence to the legal community.

To date, there are more than 600 SANE programs in every state in the country, addressing the unique and often complex needs of sexual assault victims, according to the International Association of Forensic Nurses (IAFN). And while SANE programs are held up as the model for best practice in the case of sexual assault victims, only a handful of programs have been evaluated rigorously.

Rebecca Campbell, PhD, professor of community psychology and program evaluation at Michigan State University, says SANE programs caught on and spread quickly throughout the United States and internationally, but they did so with little evaluative data to guide implementation.

Studying SANE

Campbell’s research focuses on sexual assault and how the legal, medical, and mental systems respond to the needs of rape survivors. She and her team conducted a series of research studies on how SANE programs impact adult sexual assault prosecution, including the following:

• By analyzing criminal case outcomes five years prior to the launch of a SANE program and during the first seven years of SANE programs, one study found that more sexual assault cases moved through the legal system and raised guilty pleas or trial convictions from 24% to 29% after the implementation of a SANE program.

• An examination of SANE program goals and philosophies and how they influenced patient care practices for sexual assault victims found that programs with a primary goal of case prosecutions lacked comprehensive victim services, including education that impacts a victim’s long-term well-being.

• A national random sampling of 110 SANE programs found consistency in forensic evidence collection, sexually transmitted infection prophylaxis, information on HIV and pregnancy risk, and referrals to community resources.

Several SANE studies have confirmed that the criminal justice system benefits from SANE programs through quality evidence collection, expert testimony, and improved communication with law enforcement. The common thread in these studies is that SANE programs lead to increased arrest rates, charges, convictions, and sentences in sexual assault cases.

These studies also noted the impact of SANE nurses is felt on many levels:

• SANE nurses attend to the medical, forensic, and psychological needs of sexual assault victims;

• SANE nurses have extensive training and experience in forensic evidence collection;

• SANE programs may increase prosecution rates in their communities by collecting forensic evidence that increases the likelihood of case referral by police;

• SANE programs contribute to the recovery gains made by victims.

But a number of studies, including a 2007 study from the University of Kentucky, pointed out that only a small number of programs had a formal reporting system in place that communicates case outcomes, including arrests, prosecutions, and convictions. Knowledge of case outcomes, study authors noted, provides a learning experience by identifying strengths and weaknesses at both the law enforcement and medical community levels.

At the first national SANE Coordinator Symposium in 2009, the group called for additional research in several areas, including developing best practice for SANE programs and compiling SANE models used nationally.

SANE Toolkit

Campbell and her team used a competitive grant from the National Institute of Justice to develop a practitioner toolkit for evaluating the work of SANE programs. The toolkit offers three evaluation designs:

• Pre-SANE/post-SANE evaluation—compares how far cases progress through the criminal justice system before and after the implementation of the SANE program;

• Post-SANE-only evaluation—compares how far cases progress through the system after launching a SANE program;

• Ongoing evaluation—charts prosecution outcomes from this point forward.

The toolkit walks users through a six-step evaluative process and offers ideas for using those findings to improve best practices, as well as reporting, investigation, and prosecution of sexual assault cases. The goal of the toolkit is to assist SANE program staff in evaluating how their program affects the progression of sexual assault cases through the criminal justice system.

The four main sections of the toolkit include a basic overview for conducting a program evaluation, an introduction of how SANE programs create change in communities, a step-by-step explanation of the three types of evaluations a program can use, and an illustration of how to create community action by determining what works and what needs to be improved in a particular SANE program.

The pilot program evaluated six SANE sites—two rural, two mid-sized, and two urban programs. The pilot found that most sexual assaults reported to law enforcement (80% to 89%) were never referred by police to prosecutors, or there were no charges filed by the prosecutor’s office. None of the programs had a statistically significant increase in prosecution rates pre-SANE to post-SANE, but cases processed post-SANE were 80% more likely to achieve convictions or guilty pleas.

Campbell said the evaluative results of the six programs are representative of SANE programs nationwide. “Nationally, this is very typical,” she says. “We’ve seen a lot of studies where most sexual assaults reported with forensic exam do not end up in successful prosecution. That’s what the six programs in this study highlights.

“This continues to be an issue, a problem.”

Campbell says the toolkit did what her team hoped it would do—it got people talking and looking at data to see what’s really happening in their communities, in regard to sexual assault cases. She says the toolkit resulted in communities applying for new grants to form new programs or to revitalize existing sexual assault response teams.

The toolkit and materials are available for public distribution through the National Criminal Justice Reference Service, and other SANE programs are starting to use it, according to Campbell. She says she hopes to secure additional grant funding to create a more interactive, web-based version of the toolkit.

“There is only so much one organization—one discipline—can do in terms of trying to address the problem of under-prosecution of sexual assault,” Campbell says. “Nursing programs focused on patient care and forensic work should continue to focus on good patient health outcomes, because it’s a crapshoot on what happens in the legal system.”

Creating a SANE Program

Diane Daiber, RN, SANE-A, a forensic nursing services coordinator at the Cleveland Clinic in Ohio, was working as a staff RN and case manager in the emergency department setting for 19 years when she realized there was a disconnect between health care and patients touched by violence.

“Many nurses will describe taking care of a patient who has experienced sexual assault and not having the understanding or knowledge about sexual violence to provide optimal care,” says Daiber, adding that most nurses have no training in assessment of sexual assault or in the collection of evidence. “I cannot think of any other diagnosis that is handled that way. I knew there must be a better way of caring for patients who have experienced violence, and took the SANE training.”

She took her initial SANE class in 2001 with two other nurses and was granted the opportunity by her employer to develop a SANE program at Hillcrest Hospital in the Cleveland Clinic system. Today, the SANE program employs four SANE-A (adolescent/adult), two of whom have dual certification in SANE-P (pediatric).

Daiber says once the program was developed, the benefits became clear. The Cleveland Clinic SANE practice evolved to forensic nursing, with SANEs responding to domestic violence and other forms of maltreatment and trauma, as well as sexual assaults.

“As nurses, our priority is the health and welfare of our patient. We provide one-on-one, holistic, patient-centered care,” says Daiber. “Sexual assault has short- and long-term health consequences. We understand the neurobiological effects of trauma.

“Our goal is to decrease the effects of that trauma and begin the healing process from the moment we meet this patient and their family or significant others.”

The Cleveland Clinic’s SANE practice is hospital-based, with most patients seen in the emergency department. But SANEs will travel to other nursing floors for consultation, and forensic teams travel to other hospitals in the Cleveland Clinic system if the patient’s medical condition prohibits her or his transport to a SANE.

Daiber says there is great interest in the field, but the on-call structure of most departments makes it challenging for nurses to maintain a commitment. She explains that expanding the patient population to include domestic and teen dating violence, child and elder maltreatment, liability-related issues, and trauma patients will ensure the most comprehensive use of the clinical skills of the forensic nurse.

“The key is that forensic nurses have trauma-informed care skills to provide care to patients that have experienced all forms of trauma and abuse,” says Daiber.

Preparing Tomorrow’s Forensic Nurses

More and more schools of nursing are adding forensic nursing certificate and degree programs to address the increased interest.

“There is no specific path to getting into the field,” says IAFN President Polly Campbell, RN, BS, BA. “Some nurses seek out the forensic nursing role through their workplace; others discover the role through reading, webinars/educational sessions, or colleagues; others pursue it through higher education.”

Educational opportunities in forensic nursing have increased significantly in the last 10 years, says Jennifer R. Campbell, program coordinator and assistant director of the University of California, Riverside Extension, which offers a Forensic Nursing Certificate through an online degree program that focuses on victim advocacy and investigative sciences.

Mary Kozub, PhD, RN, assistant professor and forensics advisor at Xavier University School of Nursing in Cincinnati, Ohio, says television and media are driving a societal and cultural fascination with forensic sciences. She jokes about writing a letter to the crime drama CSI to suggest adding a forensic nurse to the team to educate the public about their work.

Xavier offers an MSN forensic nursing concentration, in addition to a dual degree option with the Criminal Justice Department. As a nurse at Cincinnati Children’s Hospital Medical Center for six years, Holly Shively saw everything from trauma to gunshot wounds in the operating room. When she was looking for advanced educational opportunities, she found the forensic nursing program at Xavier University and refocused her career goal on working in homicide and, potentially, a coroner’s office.

“I would like to do evidence collection and expert witness testimony in the court system,” says Shively, adding that she worked with the local police homicide unit and the coroner’s office through the Xavier program. “I was able to do anything they were doing at any of the crime scenes, including collecting evidence, taking pictures, interviewing suspects and witnesses. I actually went into the crime lab and learned to do fingerprinting. They taught me their skills.”

Susan M. Schmidt, PhD, BSN, MSN, CNS, COHN-S, CNL, director and professor/epidemiologist in the Xavier University School of Nursing, says she worked with the Criminal Justice Department at the university on the dual degree option because health care workers do not understand crime scenes and the importance of protecting evidence, as well as how to treat a criminal and a victim with respect and dignity.

“A nurse could bring a lot to that crime scene,” says Schmidt. “We’re moving as a nation into a whole new area of the Affordable Care Act. With that, we’re moving into population health and away from taking care of sick people, trying to take care of well people and keep them from getting sick.

“Forensic nursing will help one of the leading causes of ill health in our nation turn around.”

Job Outlook

While SANE programs—and the forensic nurses behind them—are making an impact and interest in the field is growing among nursing professionals, finding a job in this relatively new and still evolving field can be a challenge.

In the United States, most forensic nurses practice in hospitals, but they can also work in child advocacy centers, universities, community anti-violence programs, coroners’ and medical examiners’ offices, corrections institutions, and psychiatric hospitals. They also may be called in on mass disasters or to help out during community crisis situations.

According to the US Bureau of Labor Statistics, there were 2.7 million registered nurses in the United States in 2010. Job growth for RNs is expected to grow by 26% through 2020.

The IAFN’s goal is to have a forensic nurse in every hospital and venue where her or his skills are needed. But because it is a relatively new specialty in nursing, there aren’t many jobs out there. Typically, a forensic nurse creates a job that is then recognized in the work setting. But Polly Campbell says there is a growing value and recognition of the skills forensic nurses bring to the table, and she is confident opportunities will grow with time.

“As is often the case, a forensic nurse must often pioneer her first position in a hospital or community since there is so little awareness of the role and what the specialty has to offer,” says Polly Campbell. “Changes in attitudes and beliefs, federal and state laws, and caring health care providers have all contributed to an improved standard of care for victims and perpetrators of violence. Forensic nurses are change agents, leading the way for all practitioners.”

Kimberly Bonvissuto is a freelance writer based in Cleveland, Ohio.


How Mentoring Programs Influence Workforce Diversity

How Mentoring Programs Influence Workforce Diversity

Karen Bankston, PhD, MSN, FACHE, didn’t have management in her career sights when she started as a fledgling emergency room nurse in 1976 at then-Southside Hospital in Youngtown, Ohio. She wasn’t thinking much beyond giving the best care possible to patients with traumatic injuries and acute health issues.

Yet Bankston’s chief nursing officer, Ruth Eldridge, MSN, RN, had a different idea. She saw enough leadership potential in her young nurse to offer herself as a mentor. Bankston admits that she didn’t even know what the term meant back then. But with Eldridge’s counseling persistence, her career took a rewarding trajectory, eventually leading to her present position as associate dean for clinical practice, partnership, and community engagement at the University of Cincinnati’s College of Nursing.

It’s from that perch that Bankston now offers similar counsel to nurses-in-training. As faculty advisor for AMBITION—Advising Minorities By Inspiring and Transforming Them Into Outstanding Nurses—she wants to impart the same wisdom that her now retired mentor did to her years ago. “I’ve always been grateful to Ruth. If she hadn’t taken that step and said to me, ‘I’m going to help guide you because I see that you can do some great things,’ I might have had a totally different career than the one I’m enjoying today.”

A Place at the Table

Perhaps you’ve had a similar experience. Someone spotted you as a diamond in the rough, a professional gem ready to be mined and polished. Or maybe you were the one searching for a seasoned colleague to help you buff your skills, build your portfolio, or strategize your next move. In either case, you’ve likely reaped the benefits in forging relationships with people who have your back and your best interests at heart.

But in the bigger universe, how does mentoring actually help diversify the nursing workforce? What role does it play in answering the calls of the National Academies’ Institute of Medicine (IOM) and other nursing organizations for increasing diversity and giving an ever-changing patient population culturally competent care?

Mentoring can have widespread implications beyond boosting individual careers. By giving minority nurses and nurse practitioners a necessary leg-up in broadening their options and fine-tuning their skills, mentoring changes the face of one organization and the makeup of the entire field. By encouraging persons of color to join, grow, succeed, and stay in the profession, it expands diversity, one person at a time.

More specifically, developing a mentoring relationship exposes you to jobs you’ve never heard of—and to people who’ve never heard of you. It shows you that others have done what you’ve only thought of doing in passing. Now that you know their path, however, you can accomplish those goals too! Finally, by tapping people you respect for their wisdom, you ready yourself as an effective participant at any leadership table. In doing so, you’ll bring diversity to the highest decision-making levels of the profession’s ladder, not just those lower rungs.

As Commander James Dickens, DNP, NP, FAANP, US Public Health Services, Office of Minority Health, Dallas-based Region VI, observes: “Nurses always talk about having a place at the table, but I think it’s more important than just that. You also need to have a fundamental understanding of what occurs…of what roles you and your colleagues bring to the team. Sometimes you may be the only nurse or nurse practitioner sitting there, so it’s important to understand the expectations.”

An Invitation into the Fold

Yet you can’t diversify the leadership table if you’re not in the profession in the first place. Although mentoring is an essential technique for helping nurses and nurse practitioners of color enter the job market and capitalize on their skills, it’s also an effective tool in attracting promising young men and women into the field initially.

By encouraging ethnically and racially diverse students to take the academic plunge, mentors play a critical role in expanding the nursing universe at the earliest possible juncture. They’re key for steering mentees as they navigate the rigors of training programs that are both new and challenging. They’re a sounding board when the educational waters get murky or rough. But their primary role, beyond helping fledgling nurses graduate with flying colors, is to make sure persons of diversity understand that they have a place in the profession and are capable of the work.

“People sometimes have the perception that they can’t succeed at nursing, especially if they’re part of a racial minority or from a different culture or lower socio-economic background,” says Willa Hill Fuller, RN, executive director of the Orlando-based Florida Nurses Association and a veteran mentor and mentee. “They didn’t have a mom like my mother who just never let me think that I couldn’t do something. Mentors can help eliminate those kinds of attitudes, so their mentees can realize their potential.”

Growing up disadvantaged, Gordon Gillespie, PhD, RN, a Robert Wood Johnson Foundation Nurse Faculty Scholar and assistant professor at the University of Cincinnati’s College of Nursing, had no aspirations to be a nurse. Like many men, he initially bought into the gender biases surrounding the profession, stereotypes that can stifle that initial interest and prevent retention. But Gillespie had a major supporter in his mother-in-law, herself an RN. She not only saw his potential, but eventually, with the help of other nurses, convinced him that nursing fit him to a “T.”

“As I look back, it’s almost a miracle that I graduated from college, let alone became a PhD,” he says. “But someone looked at me and said, ‘I have faith in you. I believe in you. I will challenge you.’ That’s where mentorship is really essential. It can keep students in a program until graduation so we have that diverse workforce.”

Today, Gillespie is both a mentor and mentee. As part of a scholarship program designed to single out the next generation of academic leaders, he’s put together a team of role models to facilitate his own growth beyond the doctorate and the experience he’s already amassed. For Gillespie, that includes two campus colleagues—one a nurse and the other from a different discipline—to help him deal specifically with being a good researcher, teacher, and fellow professional within his program. A third mentor, separate from both nursing and Cincinnati, serves as his external “safeguard.” She offers a broader perspective on a given situation from her spot in Baltimore. “I used to believe that having a one-on-one relationship with a single mentor was the perfect situation,” he says. “But now I realize that a package of mentors is excellent. It’s going from good to great.”

The model has worked so well for Gillespie that he uses it as a guide in mentoring his own students, particularly the young men he meets as the faculty advisor for the College of Nursing’s MENtorship program. With the ultimate goals of enrollment and retention to graduation and beyond, MENtorship was initiated to help male nursing students not only recognize the possibilities of a career in a caring profession, but also to deal with the real-life issues of choosing one dominated by women. In doing so, the discussion between mentors and mentees—upper classmen for lower classmen, and licensed nurses for seniors—often centers on dispelling gender myths and dealing with the challenges of caring for the opposite sex.

Gillespie’s mission is to turn out male nurses who are not only potential leaders, but also content enough in their own skin to stick with the profession. “Our goal is to give these young men the support they need so they’re very comfortable with who they are as men in nursing,” Gillespie says. “We want them to be able to go out and broadcast to the world, ‘Here I am. I’m proud of what I do.’”

Formalizing Tasks

To be effective, should mentoring occur vis-à-vis a formal structure or can you connect successfully in other “organic” ways? Truth is, whether you come together in the framework of a program or by linking with people whose substance and style you admire, you can have a very successful relationship. That is, as long as you’re on the same page in terms of goals, expectations, and even practicalities. There are times, however, when a formal construct not only cements mentoring as an important part of a nurse’s professional life and training, but also serves as a significant tool for bringing and keeping more persons of color into the fold.

For instance, in 2008, the Robert Wood Johnson Foundation (RWJF) joined with the American Association of Colleges of Nursing (AACN) to launch the RWJF Careers in Nursing Scholarship Program, an effort to alleviate the nation’s nursing shortage by dramatically expanding the pipeline of students from minority backgrounds via accelerated nursing programs. Since its inception, RWJF has awarded some 2,700 $10,000 scholarships, through grantee schools of nursing, to entry-level nursing students coming into the field from other careers. Preference is given to awardees from underrepresented groups or disadvantaged backgrounds.

To achieve that success, however, program officials knew early on that they had to establish consistency in how their grantees—nursing programs throughout the country—not only defined mentoring, but how they would be implementing it. Out of the concerns that people don’t confuse mentoring with academic counseling came a toolkit (www.NewCareersinNursing.org) to guide grantees in setting up a program.

“If organizations can formalize their mentoring efforts, I think the odds are much better that they’ll see success,” says Vernell P. DeWitty, PhD, RN, program deputy director. “But even if they don’t have the resources we provide our grantees, as long as they have a good understanding of what mentoring should look like and how it should be approached, I think it can work.”

Likewise, for the past six years Marquette University’s College of Nursing has used Project BEYOND (Building Ethnic Youth Opportunities for Nursing Diversity), an effort funded by the Federal Health Resources and Services Administration, to increase the number of minority BSN students admitted to and graduating from its nursing program. Mentoring is one aspect of an agenda that also includes tutoring, structured leadership programming, and peer-to-peer support.

In terms of connecting, both mentors and mentees come together in what’s called the “World Café,” a meet-and-greet event conducted much like speed dating. Mentees spend five minutes with each licensed RN to share information and measure the chemistry. Before formalizing any relationship, however, they spell out their three top choices from which program directors make the final match. From there, it’s a matter of meeting initially to firm up the details, which must include at least two face-to-face meetings per semester. Most mentoring pairs, however, are regularly in touch throughout their collaboration.

Since the goal is academic success, Project BEYOND features a separate specialist who also oversees a small cadre of upper grads or graduate assistants who peer tutor younger students. “We find that peer mentoring can be very effective because the relationship with another student is often easier to establish than with a faculty member or nurse,” says Juanita Terrie Garcia, MEd, RN, Project BEYOND coordinator. “Mentees have a level of confidence that they’ll benefit from their mentors because they’ve just gone through something similar. It’s fresh.”

Since the inception of Project BEYOND, Marquette nursing officials have witnessed an increase in minority enrollment from 12% to 18% with retention rates of 96% to 100%. That’s translated into more than 30 underrepresented minority students successfully graduating, with seven enrolling in graduate programs. Project staff members believe they’re making progress because they’ve taken a “holistic” approach to raise not only academic skills, but self-confidence as well.

“One of the most significant factors affecting the success of minority students is their level of confidence,” says Gloria Rhone, MSN, RN, Project BEYOND’s academic support coordinator. “They have to deal with all sorts of stereotypes about their ability to perform whether they’re applicable or not. So having somebody there to motivate them, encourage them, and just be a good listener can help build that self-esteem.”

Opening Doors, Expanding Opportunities

By connecting with supportive and insightful individuals, minority students can indeed bolster their initial skills so they’re ready to be successful, working members of the profession. Yet establishing mentoring relationships after you’ve finally entered the workplace as a licensed practitioner can be just as fruitful as connecting with role models in training. Mentoring throughout your working years not only secures your personal long-term success, but also introduces your talent, perspective, and vision to the organization.

By assisting new (or seasoned) nurses in plotting their career paths and fine-tuning their skills, mentors help mentees take their ambitions to the next fulfilling level. Whether you connect formally or informally, working with a mentor is a way to network with colleagues, demonstrate your abilities, and grow into jobs that fit your ambitions and long-term plans. From promotions to PhDs, mentoring brings a bevy of people into the job force, priming them for the next move. But for starters, it bridges the inevitable gap between education and practice so there can be no doubt that a new face on the block will be a valuable asset.

Once they come on board at Minneapolis-based Fairview Health Services, for instance, new graduates, along with nurses new to an acute care setting, undergo a variety of steps to ensure their initial success and long-term tenure. Beyond orientation and a preceptor to help them navigate the hospital and their unit, they’re also part of a year-long nursing residency program, an added layer of training and support. It’s then that they buddy with a mentor—usually a nurse manager or other nurse leader—to master the nuances of Fairview’s unique workplace.

They may also join the system’s diversity circle, a separate mentoring effort that brings minority professionals together to broaden their networking reach in meeting leaders of color. Although diversity is part and parcel of every endeavor, the circle puts real faces to the concept that you can grow within the organization.

Indeed, later on when they’re ready to take on more responsibilities, they’ll have access to developmental programs available to every promising nurse. But initially, the focus is on grappling with the challenges of picking up the pace and seeing greater numbers of patients than they did in training. It’s about learning how to be in command of their new environment—and comfortable enough to commit for the long haul.

“It’s important to connect people with people,” says Laura D. Beeth, Fairview’s systems director, talent acquisition. “It shows that you care about them…that you’re not just throwing them out there. Instead, you’re giving them a safe place to ask questions, especially when they’re overwhelmed and need to reach out.”

In terms of diversity, Fairview’s residency program is far from the organization’s only attempt to broaden its nursing corps. Officials have established a veritable roadmap of pipeline programs to lure minority persons into the medical field, whatever their ultimate career choice. From support for two Minneapolis health career-focused high schools to individual scholarships and summer internships, Fairview has instituted opportunities at every step of the training continuum to find, attract, and fund potential nurses of color.

Much of the activity begins with the hospital’s award-winning SCRUBS Camps, an annual opportunity for minority teens, among other high schoolers, to live and breathe what it’s like to work in medical careers. So named for the attire of the attendees, SCRUBS is an intense three- to five-day college campus tutorial involving a largely hands-on agenda. Participants network with faculty members who, if only for a short time, mentor them on their choices.

Although her introduction to Fairview didn’t involve summer camp, Marion Lee, RN, BA, MSN, has benefited in other ways from her relationship with the health system and her colleagues. Besides a $10,000 sponsorship to finish her nursing education (via an accelerated master’s degree), Lee has reaped many rewards from the preceptors and mentors she’s encountered as both a student and newly minted professional. The people surrounding her have been instrumental, for instance, in helping her sharpen her skill sets, especially in approaching patients, interacting with their families, and managing her time doing both.

But the biggest advice she’s received may involve just being sensitive to other cultures. Even though Lee is Mexican by birth, she has to keep in mind that patients from other areas of the world don’t always appreciate her Latino warmth. “We’re very touchy, feely people,” Lee says. “We love to hug and touch. Sometimes patients look so lonely that I just want to hold their hands. But I have to step back and realize that I can’t do that. I have to remember that there are boundaries.”

Testing New Waters

Like Lee, you may have discovered your niche at the bedside. But not every nurse will find caring for patients his or her forte. Fortunately, in today’s market there are other ways to use your skills and unique background. Whether filling a for-profit or not-for-profit position, nurses and nurse practitioners are sought-after commodities in all sorts of places that need their clinical expertise and patient perspectives.

So how can mentoring ensure that minority nursing professionals have options beyond traditional health care jobs? By helping mentees fine-tune their business savvy and sharpen their political senses, mentors are critical assets in broadening choices beyond direct patient care. They facilitate diversity not only by helping nurses boost their competencies in areas never addressed in nursing school, but also by steering them to new options for their expertise.

As Elizabeth Allee, BSN, clinical trial project manager for Indianapolis-based Eli Lilly and Company, observes: “Mentoring in a corporate environment is extremely, extremely important. In a hospital, a nurse is a nurse, even though every area is different. But when you come into a company, your knowledge and training can be used across multiple departments. You need a mentor to help you leverage your expertise so someone will look at you and say, ‘This person would be a great fit for our team!’”

Allee credits the right people for giving her the right advice at the right time as she’s transitioned from her first Lilly job in global patient safety to her current role overseeing global clinical trials for various therapeutic teams. Ten mentors along the way have helped her navigate the politics of the organization and readied her for the next step. Today, she’s returning the favor by marshaling advice for 12 fellow employees, many of whom are nurses of color.

She’s also a founding leader of the Lilly Nursing Forum, a ground zero effort for promoting both patient-centered community initiatives and nursing professionals. Even though there’s no formalized mentoring structure within the forum, the networking that occurs exposes nurses to opportunities not always obvious in a behemoth corporation. Allee, for instance, just returned from a six-month assignment in China, a stint that wasn’t on her career radar until she learned of it through her forum contacts.

Among their activities this year, forum participants are keying into Lilly’s corporate initiative, “Fit for Life,” by focusing on career as one of several wellness areas. As part of that agenda, Allee predicts an increased emphasis on mentoring, not only as a strategy to help individual nurses realize their potential within the company, but also to help the company retain its nursing talent.

When Dorothy Jackson, RN, MS, came to Lilly in 2006, she brought along 20 years of diverse experience in surgical, coronary care, ICU, and community health nursing. As a former clinical research coordinator for an outside cardiology group, her past experience fit nicely into her first job, a contract employee on Lilly’s cardiovascular research team. Today, Jackson serves as a global lead for case management, meaning she provides safety collection oversight for Lilly’s endocrine clinical drug trials.

She’s also a Lilly Nursing Forum leader, a position suggested initially by her friend and current mentor, Liz Allee. Jackson had worked with two previous mentoring colleagues before tapping her former department co-worker to help her identify her next professional steps. Together, the two are focused on fine-tuning her career development plan so the path she chooses fits her strengths and skills.

Besides offering advice and networking contacts, Allee has encouraged her mentee at every turn to chase new pursuits in broadening herself and upping her profile. When the nursing forum started, for instance, she urged Jackson to join, even though her mentee was hesitant of the time commitment. Allee persevered, however. Today, they’re collaborating not just on Jackson’s future, but also in creating educational outreach projects using a variety of forum nurses. It’s a natural fit for Jackson, who does health training and diabetes education in her community.

“Liz made me take a second look at something I probably would have passed on,” says Jackson. “She kept saying, ‘You’d be good at this. You do community service all the time. You have a good outlook on nursing. Let’s do this together.’ I think an important part of being a good mentor is simply looking at a person and saying, ‘You’d be a great fit.’”

Good Mentors Worth Gold

What makes for good mentoring? There’s no one-size-fits-all formula in selecting people to emulate or tap for their advice. But here are some factors that you may want to think about as you make your choices.

Numbers and variety count. Mentoring doesn’t have to be one-stop shopping. Putting together a team of people who can work with you on a variety of fronts can help you address issues beyond even nursing. One of the best mentors DeWitty had as a young unit head nurse, for instance, was her hospital director. He gave her the opportunity to sit in on meetings and afterwards ask any questions about the deliberations. By delving into the details of such conversations, she had a better understanding of how things worked. To broaden her perspective, DeWitty has tapped people from fields other than nursing throughout her career. The variety, she says, “not only gives you a different perspective but also helps you become a much more rounded professional.”

Think culture and beyond. Don’t limit yourself to nurses who share your race or ethnicity. Even though it’s important to find examples of people within your own community who’ve excelled at what you want to do, it’s just as important to match your needs with the best resources available. The first mentor who made such a difference in Bankston’s life, for instance, was Caucasian. Likewise, it was expected that DeWitty would pair with African American nurse mentors during her PhD program. But she had lived and worked most of her life in a culturally diverse environment, so she looked for a role model mix. “Similarities in ethnicities are important,” she says. “But you should go deeper to see if two people are operating on the same wavelength and are really the best match.”

Reach beyond your environment. Nowhere is it written that you have to limit your choices to those directly surrounding you. A good mentor can be as close as the next office or as far away as a distant land. Just as long as you have a structure in place for connecting with someone efficiently, you can make those long distance collaborations work nicely. For instance, Dickens, who usually confines his advice as a mentor to masters-degree hospital administration nurses stateside, also mentors a chief nursing officer at an American hospital in Saipan. He’s helping her traverse the concerns of being isolated geographically in a hospital that needs help with its CMS (Centers for Medicare and Medicaid Services) status when she’s not necessarily being prepared for the job.

Be flexible. If you’re the mentee, don’t be afraid to ask for a referral or to end the relationship when you’ve gone beyond what this person can offer you. If you’re the mentor, be ready to suggest another nurse or professional who has the right contacts and advice if that’s not you. Dickens, for instance, doesn’t hesitate to push people along or connect them with new sources. “It’s extremely fluid,” he says. “Some of my mentees have outgrown me because their career trajectory has set them in another direction. I understand that. I say, ‘Look, I want to keep you in my back pocket. I’ll never go away. I’ll always be available to you.’”

A Final Note

Whether you’re starting your career or just moving into the next phase, seeking the counsel of wise and diverse colleagues can make the difference between success and failure. Mentoring is critical at every step in a minority nurse’s professional journey—to soar academically as a student, to transition into the workplace as a novice, and to plot the best career path as an experienced pro. It can provide nurses of color the kind of insight and edge that helps them succeed personally as they bring needed diversity to their patients, colleagues, and the profession at large.

Bankston, for instance, has benefited immensely from her mentor’s early and frequent message: To be taken seriously, especially in a world fraught with biases, she’d need to be at the top of her game. Whether that meant polishing her skills, dusting off her professional demeanor, or adding another credential to a growing resume, Bankston responded by listening, learning, and doing. When Eldridge pointed out, for instance, that Bankston’s hand movements were a distraction when she presented, she practiced diligently in front of the mirror to employ them effectively. Likewise, when her mentor suggested that an advanced degree would be paramount in the roles she envisioned for her young charge, she started thinking PhD.

Today, Bankston counts stints as both a hospital chief nursing officer and chief executive officer among the titles she’s earned since her mentor first spotted those leadership qualities. As the faculty advisor for AMBITION, a peer-to-peer tutoring group, she wants young minority nursing students not just to have the right skills to behave admirably in the workplace, but to master the rigors of nursing school so they can get their foot in the door. By pairing upper classmen with freshmen who need to overcome any hurdles, AMBITION alleviates the isolation that Bankston herself felt in nursing school 40 years ago. It also keeps a new generation of minority nurses committed to a profession they, in turn, will diversify.

“As minority nurses, we need people in our lives who’ve already navigated the waters,” says Bankston. “Finding mentors who are both trustworthy and honest can help us recognize the potential missteps and even push us when we think that we just can’t do anymore. They’re very important in our career journey.”