Critique of Evidence Based Practice: Section 3 - Collection and Analysis Evidence

Critique of Evidence Based Practice: Collection and Analysis Evidence – The purpose of this EBP was to develop, deliver, implement and evaluate a staff education program geared towards senior staff nurses regarding awareness and comfort level in effective mentorship…

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Critique of Evidence Based Practice: Collection and Analysis Evidence

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Introduction

The clinical site had no mentorship program, which had led to a large nursing turnover creating a challenge for this and all LTC facilities to appropriately staff their nursing units. This Doctor of Nursing Practice (DNP) project led to the development of staff education that served to help senior nurses in this LTC facility to improve their awareness and comfort level on mentoring nurses.

Evidence-based literature was used to develop a mentorship program that was to be adopted at the project site. This educational project was focused on staff education of an experienced nurse’s potential to enhance their awareness and comfort level in mentoring new and novice nurses employed at this project site. This EBP targeted experienced nurses already employed within the organization and utilized the mentorship skills they had acquired as mentors.

The purpose of this EBP was to develop, deliver, implement and evaluate a staff education program geared towards senior staff nurses regarding awareness and comfort level in effective mentorship. Section two summarized how the retention of experienced nurses as mentors was important to the transition and improvement their awareness in mentorship in LTC facilities. A mentorship program that improved nursing awareness, measuring comfort level towards mentorship and increased job satisfaction of both new and experienced nurses could be a cost-effective option.

Section 3 outlines the literature that substantiated the importance of a mentorship program on nursing retention in an LTC facility. This section also provides an overview of how the evidence was collected and analyzed for the doctoral project. Topics such as the practice-focused question, operational definitions, sources of evidence, and relationships to the practice-focused question are discussed. Additionally, this section covers the methodology used for the literature search in terms of the specific databases, key terms, scope of the review, and analysis of the literature and synthesis of the evidence.

Practice Focused Question

This project addressed the problem of how to effectively improve the awareness of a mentor by using seasoned professional nurses, who were already employed at the LTC facility. There were critical nursing shortages that were affecting the staffing of nurses in LTC facilities. Long-term care facilities were using temporary nursing services to meet their nursing workforce needs. At the time this project began, there were no education programs on mentorship at this project site.

Educating senior professional nurses on effective mentorship aimed to improve nursing awareness, enhance their comfort level in the mentorship and the training of new nurses as well as, in the long term, increase nursing retention rates in this LTC facility. The practice-focused question is: Will an evidence-based educational program for senior nurses in long-term care improve their awareness and enhance their comfort level in mentorship?

The purpose of conducting an evidence-based educational module for the identified gap in practice that this project addresses was to provide evidence on nursing mentorship to increase awareness related to how to effectively mentor new graduate nurses in long-term care. There were critical nursing shortages that were affecting staffing in long-term care facilities.

Long-term care facilities were using temporary nursing services to meet the nursing workforce needs. Information within the literature, Jones (2013) and Lavoie-Tremblay et al., (2014) identified the benefits of experienced nurses as mentors as being able to retain them in the nursing workforce and improve their job satisfaction while renewing their organizational commitment.

This project served to narrow the gap in practice by developing a formal program that capitalized on the experience in nursing awareness, measuring comfort level in mentorship, with the potential to increase the retention of experienced nurses and produce a favorable nursing skill mix in the LTC facility setting.

Sources of Evidence

The long-term care facility had no nurse mentorship program that lead to an increase in nursing turn over during the previous year (St. Paul’s House, 2016). The interdisciplinary team was motivated to address the gap in nursing awareness and mentorship through education, and to evaluate the effectiveness of the education through participant learning.

The project sources of evidence were drawn from the existing literature on mentorship, adoption of education from the AMC A source of evidence was drawn from evaluation data that I collected through demographic, pre, and post surveys questionnaires during the development and evaluation process. The source of evidence drawn from the extant literature will be discussed next followed by a discussion of the data drawn during implementation and evaluation of the educational program.

Literature Review

Retention and Turnover

Turnover among nurses in the long term care facilities has become more prevalent as the need for competent, experienced nurses in a long term care has increased and the supply of new graduate nurses establishing and sustaining employment in long term care facilities has decreased. Turnover had caused chaos in the health care workforce because of its cyclic nature.

Nurses create a void when they leave employment in long term care facilities, particularly in large numbers, that must be filled by the nurses and assistive personnel who remain employed (Grossman & Valiga, 2016). The void continued until replacement nurses were hired, which creates difficult working conditions for the remaining nurses who then find comfort in leaving employment with the long-term care facility as well (Grossman & Valiga, 2016).

The economic impact of turnover lies not just with the exiting nurses, but with nonproductive time the job vacancy exists, followed by the training of the replacement (O’Brien-Pallas et al. 2016). The professional impact was that when a nurse leaves, they take with them their learned experiences and expertise’s gained from the organization that will take time to replenish in long term care units with. new nurses Consequentially, nursing turnover is proportionate to the amount of experience the nurse leaving possessed.

Benefits of Mentorship on Turnover and Retention

Turnover not only takes its toll on the workforce, but it affects the care delivered to patients and the outcomes of that care. Patients are more likely to be discharged and readmitted within more recent literature due to the expectation of this nursing subgroup replacing an aging workforce in the last ten years, organizations have recorded new graduate turnover rates within their first year to be as high as 70% (Al-Dossary et al., 2014).

Formal orientation programs began in 2002. Known as Nurse Residency Programs they relied on experienced nurse mentors to facilitate the process that resulted in an improvement of new graduate attrition rates (Goode et al., 2013; Rush et al., 2013; Ulrich et al., 2013).

These experienced nurse mentors were enlisted to provide guidance and feedback to help the new graduate learn skills such as (a) communication with others to address/avoid horizontal violence, (b) facilitating interaction with supervisors, and (c) developing coping mechanisms to deal with impending reality shock and subsequent isolation (Barnett et al., 2014; D’Ambra et al., 2010; Kramer et al., 2011).

More specifically, both new graduate nurses and experienced nurses reported more intention to stay with an organization when given the opportunity to attend educational sessions to build their autonomy, when presented with a career ladder to advance professionally, and when afforded frequent interactions and support from their direct supervisors (Brunetto et al., 2013; Murrells, Robinson, & Griffiths, 2008).

Support from peers was found to be as crucial as support from managers with the formality of a mentorship experience being responsible for not only retaining nurses but improving the work environment (Latham et al., 2008; Weng et al., 2010). Mentoring relationships that were facilitated by the sustained employment of experienced nurses are found to be a strong contributing factor to decreasing new graduate nursing turnover and increasing job satisfaction and retention of the experienced nurse mentor according to Grindel & Hagerstron, (2009).

Nursing mentorship programs at LTC facilities reduced nursing turnover rates by improving the quality of the work environment and satisfaction of new nurses through the guidance and support of senior nurses (Canadian Health Care Association, 2012).

Benefits of Mentorship

Several researchers had stated that an influencing factor in nurse retention in a long-term care facility was the characteristics of a multigenerational workforce that can be an overarching contributor to nursing turnover rates. In research by Weick et al. (2010), millennial/generation nurses were independent contractors who will leave an organization in search of better opportunities if the demands of the job do not align with their expectations and career goals.

Also noted was that people thrived on work-life balance and a career that was fast-tracked. (Weick et al, 2010). According to Keepnews et al., (2010) identified schedule flexibility, financial rewards, and recognition as key factors influencing the retention of Generation X? nurses.

Mentoring was an invaluable tool in the professional development of new and seasoned nurses in several different areas of nursing that included clinical, education, research, and administration (Frost and Nickolai, 2013). It allowed novice nurses to feel nurtured and helped by their co-workers and increased the likelihood of contentment and success in their nursing profession (Frost and Nickolai, 2013).

A qualitative, hermetic study published by Kvande et al., (2015), emphasized situational awareness as an asset that come with experience. This study references experienced nurses in Intensive Care Units (ICUs) as crucial health care providers. Experienced ICU nurses recognized incipient changes in patients, and reduced time to intervention, which contributed to positive patient outcomes. These nurses also recognized the broader safety concerns of a stressed nursing department. The nurse’s ability to recognize critical situations evolves with lived nursing experiences.

Seasoned nurses considered experts in their fields were the ideal candidates for mentors of all generations. The benefits of tapping into them as an underutilized resource included the transfer of mentorship based on years of experience within the organization.

More important was that a program designed to reinvest in seasoned and experienced nurses increased their job satisfaction, enhanced their productivity, re-engage them in their profession, and delayed their retirement from clinical nursing. A qualitative study on seasoned nurses described the nurse’s feelings of a renewed commitment to the profession and their perceived contribution to the next generation of nursing by sharing their lived nursing experiences (McDonald et al., 2012).

Concepts that emerged from the literature were nurses’ sense of empowerment and belonging in the work environment as key elements in retaining nurses. A nurse’s psychological capital was the ability to endure a stressful working environment with a positive, resilient, and optimistic outlook.

The premise of a collegial and collaborative culture where nurses achieved a sense of belonging became engaged, and empowered members of the organization were a fundamental element in nurse retention. Boamah & Laschinger, (2014) validated this concept in a study with a 38% nurse turnover, the highest percent, occurring in nurses with less one year of clinical experience who cited lack of belonging as a reason for leaving an organization.

Mentorship in Long Term Care Facilities

There were several examples found in the literature that correlated mentorship programs with reduced turnover rates and costs associated with nursing turnover in a long-term care facility. The concept of a mentorship program was not new. Healthcare providers in the United States implemented the Partner in Nursing program targeted at reducing nursing turnover with a mentorship program post receiving a grant in 2006 (Cottingham et al., 2011).

Post-implementation data revealed that the investment in the 18-month program can realize final cost savings for organizations of between $34,000 and $56,000 per retained nurse. According to studies by Mills & Mullins (2008) and Burr et al., (2011), there was a significant difference in the retention of nurses who participated in formal mentor programs for their initial year of employment compared to those that did not. Each study had nurse turnover rates of more than 20% during the first year of hire. When participating in a mentorship program during the first year of hire, a reduction in nurse turnover rates was reported to be as low as 8% and 7% respectively.

While the mentorship program cost was approximately $58,000 annually, each study was able to translate the financial benefits of their respective programs with a return on investment through turnover cost savings of more than $300,000 in the first year. Mills and Mullins (2008) and Burr, Stichler & Poeitier, (2011). According to Breau & Rheaume, (2014), a cross-sectional study of 133 nurses reported that only 3% of the participants were likely to leave their position in the following year.

When examining this low rate, it is apparent that there is a strong collaborative mentoring environment that exemplified teamwork amongst all nurses which contributed to the nurses reporting their intent to stay. A reoccurring theme of empowerment and a personal state of control and competence were strong indicators for high nurse retention rates in the long-term care facility, Mills and Mullins (2008) and Burr, Stichler & Poeitier (2011).

Reasons for voluntary nurse resignation from their organization continued to follow common themes. Participants from 136 health care organizations across the United States participated in the 2016 Nursing Solutions Incorporated (NSI) survey that reported reasons for resignation. Personal reasons were the top theme for separation (NSI, 2017). These results were vague and could be open to interpretation by an organization’s leader.

However, analyzing two of the top five reasons–retirement and workload/staffing ratios–the demands on the current nursing workforce that contributes to a vicious cycle of nurse turnover. The 2017 NSI report was the first time that retirement had been reported as one of the top five reasons for nurses resigning. These statistics bring attention to the need to develop a plan that will focus on prolonging the retirement of seasoned and experienced nurses so that their expertise can be instilled in the next generation of nurses.

Publications over the past ten (10) was included in the search due to the breadth and depth of the project. Articles pre this time were eliminated because of the vast changes and trends that have occurred in healthcare over the past 10 years such as retention, nursing turnovers, reimbursement, practice models, and a shift to outpatient care with the enactment of National Health Reform in 2010 (Kaiser Family Foundation, 2011).

As Mentoring is voluntary; it is based on mutual respect with agreed expectations, and valuable to both the mentor and the mentee. The benefits of successful mentoring relationship are appreciated in the form of increase job satisfaction, improves teaching skills, promotion of collegiality, team building, and improves academic and clinical performances (Breit 2015).

Johnson (2016) came to a conclusion that mentoring helped cultivate nurse leaders, retain nurses, and diversify the nursing workforce. By strengthening the nursing workforce. nursing mentorship improved the quality of patient care and outcomes. Mentoring could foster the leadership skills that nurses needed to secure larger roles in developing, designing, and delivering health care (Johnson, 2016). Mentoring relationships inside healthcare organizations and academic institutions could help these organizations retain nurses and nurse educators, reducing the cost of turnover (Breit, 2015). These are positive benefits for social change.

The qualitative need for nurses should not supersede the quality needed in an individual providing nursing care. The quality of nursing care increases with the development of experience, and expertise and must be fostered (source?). Therefore, improving awareness of senior nurses to be mentors to new nurses was an important problem to address and was the focus of this EBP.

This educational program addressed how to build trust with the mentee nurse, foster mentoring and leadership skills, gain skill in effective communication techniques, and foster increased awareness of the benefits of mentorship. A review of the sources of evidence generated during the project will be discussed next.

Archival and Operational Data

A human resource representative at the project site organization-maintained data on nurse mentorship programs to improve nursing awareness and comfort level to long-term care mentors by collecting facts from a variety of sources. The first source of data was gathered from the project site.

These data were obtained from the collection of demographic surveys completed by senior nurses and the feedback from those experienced nurses or employees choosing to stay at the organization and those that were continuing their employment in the LTC facility. In addition to requesting information from the senior nurse’s mentorship styles, two to three peers in the department where the nurse was employed were also asked to complete a survey on how they would improve their skills in mentorship.

The human resource department filtered and sorted data, providing a detailed composite report specific to the organization. Demographic information was presented in categories such as length of employment, years of service, and ranks of the top reasons for separation from the organization. This DNP project used a paper form survey with an assigned number (for the confidentiality of participants).

The exit surveys provided the de-identified demographic data and the reason for leaving among nurses. These data were used to develop the educational program by developing an additional draft of the education based on the literature and incorporate the exit questionnaire tests. Evaluation data were collected during the 30-day periods pre and post the nurse mentorship educational program. The pre- and post-survey results were used to determine whether the educational intervention was effective as the mentors improved their nursing awareness and measure their comfort level post the mentorship program.

Evidence Generated for the Doctoral Project

The effectiveness of this evidence-based practice project was evaluated with the use of pre/post survey tests and demographic data collected using a paper form survey with an assigned nonidentifiable number (for the confidentiality of participants). The mentorship program pre-survey and post-survey tests were used to evaluate the improvement of the nurse mentor’s awareness.

The DNP student developed a mentorship program that was specific to the needs of the organization. The problem aligned with the practice-focused question regarding implementing an evidence-based educational program on mentorship for long-term care nurses at the practicum site (ANCC, 2014; Stevens, 2013). This evidence-based educational program on mentorship for senior nurse mentors was an effort to increase their mentoring awareness and comfort level at this long-term care facility, and therefore aligned to the gap in practice of mentoring awareness skills. (ANCC, 2014; Stevens, 2013).

Participants

The target population for this evidence-based education DNP project included senior nurses who work in long-term care. The targeted number was between 18 and 30 nurse-participants from this Long-term care DNP site. For nurses to meet the inclusion criteria, they are being nurses for at least 4 years and above of experience in different health care settings pre they employed in long term care.

Nurses were excluded from the survey if they are new nurses who are currently employed by LTC and does have a 4 years and above experiences in different healthcare settings. The participants of the DNP project were seasoned nurses from this long term care facility who had a clinical experience for a total of more than five to ten years overall.

Procedures

Each senior nurse who had been nurses for at least 4 years and above of experience who was employed in the organization was asked to complete a demographic pre and post-test survey questionnaire. The collection of data commenced (Demographic, pre, and post-survey). The supervisors and director of nursing provided de-identified ongoing nurses information for the staff education DNP project.

Demographic information was presented in categories such as nurse length of employment, years of service, and educational level. DNP project leadership facilitated the completion of the pre- and post-surveys prior to the implementation of the mentorship program and following the program to assess expert nurses regarding their improvement nursing awareness in mentors.

Protections

The writer submitted the necessary paperwork to obtain approval from Walden University and the sponsoring health system’s Internal Review Board (IRB) prior to developing the mentorship program. No risk or discomfort to the learner was involved in the collection of the data. Common ethical considerations were anticipated in this project such as voluntary participation, anonymity, confidentiality, and references.

All data, information and survey results were kept anonymous, treated with confidentiality, and only shared for the project so that this student could implement this educational program. Meetings and correspondence were documented on a standard form, which did not have any identifiers. Pre and post-tests were de-identified by using only numbers to identify participants. Data will be kept in a human resource department in a secure area for 5 years.

Analysis and Synthesis

Trends and themes from nurse exit interviews were used to develop a program specific to the needs of the project site. Discovering those trends helped guide me when establishing the foundation of the program. The design and content of the program was formatively and summative evaluated by key stakeholders to assure that each component of the mentorship program addressed organization specific needs.

The program was implemented and evaluated using pre/ post-survey questionnaires on nursing awareness on mentorship and comfort levels on mentorship to serve as baseline data and as a method to compare pre- and post-implementation data regarding the nurse’s intent to leave the organization. That comparison data may determine if the nursing awareness on mentorship and comfort levels on mentorship.

Summary

The purpose of program evaluation was to determine if the educational project was effective to increase nursing awareness and measure the comfort level of long-term care mentors. IRB approval for the project was obtained from Walden University’s IRB prior to the implementation of this project (IRB# __).

At the time the DNP, there were no education programs on mentorship at this project site. Educating senior professional nurses on effective mentorship aimed to improve nursing awareness, enhance their comfort level in the mentorship and the training of new nurses as well as, in the long term, increase nursing retention rates in this LTC facility. Hence, the project focused on improving awareness and enhancing comfort levels in mentorship of senior nurses in long-term care.

Demographic and pre/post-survey was collected by DNP project leaders with consent from senior nurses to evaluate the improvement of their awareness and measure their comfort level post the implementation of the mentorship program. These data were analyzed to determine if the educational mentorship program helped to improve the nursing awareness and enhance their comfort level of long-term care mentors by comparing measures pre and post implementation, analyzing for differences, and considering the insights gained from observation. The findings, recommendations, implications and conclusions of the educational project are presented in section 4.

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Critique of Evidence Based Practice: Section 3 – Collection and Analysis Evidence

Critique of Evidence Based Practice: Collection and Analysis Evidence

Paper details

Solution

Introduction

Practice Focused Question

Sources of Evidence

Literature Review

Retention and Turnover

Benefits of Mentorship on Turnover and Retention

Benefits of Mentorship

Mentorship in Long Term Care Facilities

Archival and Operational Data

Evidence Generated for the Doctoral Project

Participants

Procedures

Protections

Analysis and Synthesis

Summary

Related Key Searches

SOAP NOTES

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Frequently Asked Questions

Hector Johnson

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Critique of Evidence Based Practice: Collection and Analysis Evidence

Paper details

Solution

Introduction

Practice Focused Question

Sources of Evidence

Literature Review

Retention and Turnover

Benefits of Mentorship on Turnover and Retention

Benefits of Mentorship

Mentorship in Long Term Care Facilities

Archival and Operational Data

Evidence Generated for the Doctoral Project

Participants

Procedures

Protections

Analysis and Synthesis

Summary

Related Key Searches

SOAP NOTES

Read More:

Frequently Asked Questions

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Hector Johnson

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Episodic/Focused SOAP Note: Focused Nose Exam

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