Hispanic Health Care International, Vol. 11, No. 4, 2013
© 2013 Springer Publishing Company http://dx.doi.org/10.1891/1540-4153.11.4.173
Experiences of Mentoring Influences on the Personal and Professional Growth of Hispanic Registered Nurses Aida L. Egues, DNP, RN, APHN-BC, CNE New York City College of Technology (CUNY) Brooklyn, New York The purpose of this qualitative descriptive study was to explore the meaning of the experiences of mentoring influences on the personal and professional growth of Hispanic registered nurses (RNs). Focus group methodology was employed in the New York City metropolitan area with monolingual English or bilingual English/Spanish RNs (N 5 20) who perceived themselves to be at all levels of practice. The findings offer a summary of the experiences of mentoring for the 20 Hispanic RNs that includes little advancement support; hesitancy to being mentored; dependency on the self for personal and professional growth; and educational, practice, and socioeconomic barriers. This study suggests that mentoring of Hispanic nurses needs to be reexamined to improve and sustain a culture of mentoring that may enhance the education, recruitment, and retention of Hispanic RNs. El propósito de este estudio cualitativo descriptivo fue explorar la experencia y el significado de las tutorías sobre el crecimiento personal y profesional de enfermeras Hispanas (RNs). Grupos focales fueron utilizados para la recolección de los datos. El estudio se realizo en la Ciudad de Nueva York área metropolitana con enfermeras tituladas que hablaban Ingles, Español o los dos idiomas (N 5 20), no se considero el nivel de experencia clínica. Los resultados ofrecen un resumen de las experiencias de tutoría de las veinte enfermeras que participaron en el estudio tales como: escaso apoyo para progresar en el desempeño profesional; dependencia personal para lograr crecimiento personal y profesional; barreras socioeconómicas para la educación y práctica. Este estudio sugiere que las tutorías para enfermeras Hispanas deben ser re-examinadas con el propósito de mejorarlas manteniendo una cultura de tutoría que permita mejorar la educación, el reclutamiento y la retención de enfermeras Hispana. Keywords: Hispanic nurses; mentoring experiences; level of practice; advancement
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he current projected shortage of more than 1 million registered nurses (RNs) within the United States by the year 2020 (Health Resources and Services Administration [HRSA], 2010) continues to threaten the provision of quality health care for all citizens. Such a situation is particularly problematic given the burgeoning growth in the number of Hispanic individuals who will require care across all nursing settings (Egues, 2010). According to the U.S. Census Bureau (2012), the Hispanic population continues as the nation’s fastest growing and largest minority population,
with an estimated growth to approximately 66 million people, representing 19.4% of the total U.S. population by the year 2020. However, no such exponential growth is anticipated among Hispanic RNs. Hispanic RNs are not only the most underrepresented group of nurses in relation to their population numbers (Steiger, Bausch, Johnson, & Peterson, 2006; U.S. Department of Health and Human Services [USDHHS] Health Resources and Services Administration, 2010) but are also equally underrepresented among RNs possessing advanced practice and doctoral degrees (USDHHS Health
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Resources and Services Administration, 2008). Although there are close to 4 million RNs in the United States, only 3.6% of these nurses are Hispanic (HRSA, 2010) and only 10% have obtained additional nursing degrees (USDHHS Health Resources and Services Administration, 2008) required for advanced practice, education, and research. Fewer Hispanic RNs available diminishes the ability of the U.S. health care system to effectively prevent and treat diseases (National League for Nursing [NLN], 2007) as part of culturally sensitive, evidence-based care for Hispanics as for all minority individuals. Recruitment and retention of Hispanic RNs is of utmost importance if the United States is to educate and graduate a sufficient number of these nurses to fill the demands of health care. Mentoring has been shown to be the most influential way to successfully develop nurses while increasing their recruitment and retention (Dunham-Taylor, Lynn, Moore, McDaniel, & Walker, 2008). Mentoring is a progressive, mutually rewarding relationship where a more experienced individual (mentor) helps a less experienced individual (mentee) acquire knowledge and skills necessary for advancement (Shea & Gianotti, 2009). The literature shows an overwhelmingly positive result from mentoring as a type of support that helps another learn (Cottrell, 2006; Dangy, 2010; Maxwell, 2008; Zachary, 2009), while enhancing personal and professional life changes, with a change in self-confidence indicated most frequently (Madison, 2007). Therefore, in terms of benefits to both practice and society, the deficit in Hispanic RNs to serve as mentors and role models to Hispanic nursing students and nurses in the workplace may not only threaten the way in which evolving traditional practices and values of ethnic communities are communicated, integrated, and preserved within health care but may also endanger the personal and professional advancement of some Hispanic RNs (Egues, 2010). Such a dilemma may be addressed by attempting to understand how to improve and sustain a culture of mentoring that will help foster the recruitment and retention of these nurses (Egues, 2010).
faced these obstacles in their mentoring relationships also appeared to experience a stagnation in their overall advancement that included failure to attain both increased levels of education as well as increased levels of practice in nursing (Egues, 2010). As such, a deeper examination was warranted about Hispanic RNs’ access and barriers to mentoring, personal growth, professional growth, and attitudes toward nursing. Hence, the purpose of this qualitative descriptive study was to explore the meaning of the experiences of mentoring influences on the personal and professional growth of Hispanic RNs who perceived themselves to be at all levels of practice in nursing. The goals of the study were to add to the existing body of literature on mentoring and to provide greater insight regarding how Hispanic RNs experience advancement as individuals and as nurses, experience mentorship, and experience academic, personal, and workplace environments.
Review of the Literature Appropriately effective mentoring may be a strategy to increase the number of Hispanic nurses and provide encouragement for Hispanic RNs to pursue advanced degrees (Egues, 2010). The business, education, and health care literature have long supported that mentoring between persons of the same ethnic population leads to greater academic achievement (Shelton, 2003; Soroff, Rich, Rubin, Strickland, & Plotnick, 2002), personal satisfaction, and professional success (Cullen, 1991; Ragins, 1997). Early nursing literature in mentoring found that the support associated with mentoring relationships (Stewart & Krueger, 1996) may be used to guide nurses throughout the novice, advanced beginner, competent, proficient, and expert levels of nursing practice (Benner, 1984; Benner, 2001; Kanaskie, 2006). Advancement through the levels of practice was found to enhance an RN’s ability to provide more autonomous, effective, and efficient care (Benner, 1984). A mentor usually has advanced education and experience. However, in the workplace, few Hispanic RNs are found in executive areas of nursing (New York Academy of Medicine and the Jonas Center for Nursing Excellence, 2006) and in faculty positions. This may mean that novice Hispanic RNs have few or no mentors and positive role models (American Hospital Association [AHA], 2005) of the same ethnicity to provide advice, to teach, and to guide them from one level of nursing practice to another. An examination of the literature yielded negligible information about how Hispanic RNs experience mentoring or levels of practice. As such, a quantitative study by Egues (2010) more deeply investigated how mentoring influences the personal and professional advancement of Hispanic RNs through Benner’s (1984) levels of nursing practice (novice, advanced beginner,
Purpose A recent quantitative study provided new information about the quality of mentoring and the level of practice experienced by Hispanic RNs in light of a shortage of guiding mentors from a similar ethnic background (Egues, 2010). Study results indicated that although Hispanic RNs experienced some mentoring, there were perceived obstacles to personal and professional growth within their mentoring relationships. These obstacles included (a) a lack of desired friendship between mentor and mentee, (b) inadequate information about navigating workplace politics, (c) less than acceptable support from their mentors, and (d) a perceived lack of trust that mentees had in their mentors. Furthermore, Hispanic RNs who 174
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competent, proficient, and expert). Findings of that study revealed that Hispanic RNs do experience a quality of mentoring that differs from the mentoring experiences portrayed in the literature on mentoring and in the literature on Hispanic nurses. For example, Hispanic RNs experience only an average amount of mentoring behaviors or quality of mentoring. Hispanic RNs also experience a quality of mentoring focused on the mentor providing greater challenges and career counseling to the mentee, yet less focused on the mentor providing friendship and the teaching of professional and workplace politics. Furthermore, Hispanic RNs’ level of nursing practice is influenced by having a mentor; Hispanic RNs who are mentored experience not only increases in key mentoring activities where they learn how to negotiate through political landscapes, receive administrative support, and feel a demonstration of trust in the mentor– mentee relationship but also tend to attain increases in nursing practice expertise. Finally, as Hispanic RNs’ expertise in nursing practice increases, pursuit of higher education increases. The findings on mentoring among Hispanic RNs have various implications for nursing education, practice, and research (Egues, 2010). Although general research supports the notion of mentor activities, functions, and roles, it does not provide much in the way of details about when and where behaviors are most common if the mentoring process occurs, the perceptions of what individuals get from mentors, or how mentoring benefits minority populations, specifically Hispanics, within the nursing profession (Egues, 2010). The existence of an overall lack of mentoring, unclear personal and professional mentoring benefits, and unique challenges faced by Hispanic RNs suggest the need for additional study.
Methods Four focus groups were conducted in groups of four to eight participants (N 5 20) using a discussion guide based on a systematic review of the literature with specific, open-ended questions (see Appendix). Each focus group discussion lasted 1.5–2.0 hr, allowing sufficient opportunity for all participants to respond to the questions. A semistructured questioning format was used in the focus groups to encourage consistency of the questions asked across group participants. This format allowed for flexibility in accordance with the topics raised and level of participation within the groups (Krueger & Casey, 2000). All relevant printed materials were in English and all groups were conducted in English. Prior to beginning this grant-funded study, human subject approval was received through the college’s institutional review board (IRB) and informed consent was obtained from the participants. All participants were given a copy of the consent. Permission was obtained from the Department of Nursing where focus groups were conducted.
Setting and Sample Focus groups were held in the evening within private lecture rooms at a college within the New York City Metropolitan area. Healthy snacks and beverages were offered prior to the start of the focus groups. Participants were recruited following presentations at professional nursing organizations, schools of nursing, community and private health care organizations, and through referrals from Hispanic RNs in New York City and its boroughs. A flyer was distributed, which described the purpose of the study, researcher contact information, and study inclusion criteria. To enhance participation, the duration, extent, and frequency of participation were clearly communicated during recruitment. Potential participants approached the researcher or contacted the researcher if they met the following inclusion criteria: (a) adult, age 18 years or older, able to participate fully in providing consent for study participation; (b) male or female; (c) Hispanic registered nurse; and (d) either monolingual English or bilingual English/Spanish, able to read and write English. Participants received $10 transportation cards for travel from the focus group sessions.
Design and Methods Design A qualitative, descriptive inquiry explored the experiences of mentoring influences on the personal and professional growth of Hispanic RNs. The value of focus groups for the study was established by an extensive literature supporting methodology and issues of cultural/ethnic sensitivity. Focus group interviewing provides an optimal setting in which individuals can express, share, and compare their experiences in a nonjudgmental atmosphere so that all benefit from the information (Krueger & Casey, 2000) with minimal interpretation (Sandelowski, 2000). Focus group interviews are considered a culturally appropriate methodology for research with Hispanics because they draw on the group dynamics of use of oral traditions, norms of helping, and existing social networks that are unique and appropriate to this topic (Krueger & Casey, 2000).
Analysis Data analysis began and continued after each focus group session, which was recorded via two electronic instruments. Typed transcripts were used as a basis for data analysis. Qualitative content analysis was best suited to elicit meanings of experience from the data and allow themes to emerge from this descriptive study (Krueger & Casey, 2000). From the data, codes were consistently applied and generated by the experienced researcher via line-by-line coding of transcripts. Coding began during 175
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the initial read and transcription, with the researcher rereading, highlighting, and placing comments in the margins of original transcripts. Analysis continued with coding line-by-line and by section on hard copy of transcripts, with continued coding following computer entry of transcriptions. This iterative process allowed for constant comparison and consensus of themes (Hsieh & Shannon, 2005) that best represented the words of participants as their own. Themes emerged from the transcribed and coded interviews. These verification strategies, along with journaling by the researcher; participant checks before, during, and following focus group interviews (Spradley, 1979); and consultation with other qualitative researchers (Mayan, 2001) and Hispanic researchers helped assure the rigor of this study. Themes emerged from the first focus group interview, and saturation of data—that is, no new emergence of themes—was reached after the transcript of the fourth focus group was thoroughly reviewed.
and educational, practice, and socioeconomic barriers experienced.
Mentoring The focus group participants described experiences and feelings about mentoring. The themes that emerged about mentoring speak to experiences of hesitancy owed to (a) little support, (b) uncertainty, and (c) risk. Little Support. The participants noted that they experienced little support with regard to mentorship within nursing. Participants felt no one sought them out to be mentored, that there was neither discussion about mentoring nor interest in helping them succeed. One participant said, “I don’t think we have a backup system, where we go out of our way to take care of each other, like I see how other races, ethnicities, and groups do.” Another participant focused on nurse mentoring asked, “How can I help someone else when I have no one there for me? I’m expected to be there for all my Hispanic patients, families, students, and community. You want my help? It’s impossible!” One participant recalled the first time he experienced mentoring support:
Findings
I learned I had to ask for help, because no one offered to help me. But, it took a while to find out when and where to go for help. I tell everyone, you have to go find your own mentoring support system. It’s something you have to make up your mind to do.
Characteristics Demographic data collected from participants revealed that all of the focus group participants (100%) self-identified as of Hispanic ethnicity (N 5 20), whereas 70% (n 5 14) self-identified as White. Ninety-five percent of the participants were female (n 5 19). Participants ranged in age from 21 to 58 years, with from less than 1 year to 34 years of nursing practice. The mean age of study participants was 43 years (SD 5 3.8), and most had practiced as an RN for more than a decade (M 5 16 years, SD 5 2.2). All of the participants resided in the Northeast, whereas 80% (n 5 16) were born in the United States. Most participants spoke English at home (n 5 19) as well as in social circumstances (n 5 17). Few participants had advanced nursing degrees: only 5% (n 5 1) had a doctorate, whereas 10% (n 5 2) had a master’s degree. The remaining participants had either a baccalaureate degree (25%, n 5 5) or an associate degree (60%, n 5 12) as a terminal nursing degree. In terms of mentoring, 75% (n 5 15) of the participants experienced a mentoring relationship; 80% (n 5 12) had a Hispanic mentor whereas 20% (n 5 3) had a non-Hispanic mentor. Of those study participants who had mentors, only 1 had a nurse as a mentor in any capacity. The remaining participants who experienced mentorship had friends or family members as mentors. Data are arranged by the emerging themes as expressed by the focus groups. The themes offer a summary of the experiences of mentoring influences on the personal and professional growth of Hispanic RNs. The themes include perceptions of hesitancy toward the mentoring process itself, challenges to personal and professional growth,
Uncertainty. The participants noted that they experienced uncertainty with regard to mentoring. Participants felt that the entire concept of mentoring was difficult to understand given that they truly (a) did not know what mentoring was, (b) did not know how to seek out a mentor, and (c) feared the mentoring process. As one participant asked, “How would I know where to begin in asking someone to mentor me, when I’m not really sure what to ask for? What am I supposed to get out of it, and what would they [mentors] get out of it?” Therefore, participants felt unsure about what a mentoring relationship entailed, including its definition, expectations, and goals. Furthermore, participants felt that the mentors in their lives were informal and personal, such as a parent, a sibling, a relative, or a friend. Participants supported one another with “I agree with you. There’s no mentoring either where I work.” Lastly, participants somehow feared mentoring. One asked, “What if the mentor I choose doesn’t work out? Where will that leave me?” Risk. The participants noted that they experienced risk with regard to mentoring. They verbalized mentoring as a “risky” undertaking because of experiencing vulnerability. One participant asked, “Why should I put myself out there? So, I look desperate as if I need help or guidance?” Similarly, participants felt that seeking mentoring within nursing demonstrated a weakness that would position them at a workplace disadvantage. As one participant 176
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stated, “You can’t let other nurses know what you don’t know. Personally, I don’t want to take the chance of being set up to fail or of calling any attention to myself.” Finally, other participants felt that fear was holding them back; no positive outcomes could be experienced without taking a chance on working toward establishing a mentor–protégé experience. Participants felt there were “no safe mentoring” spaces for them.
through watching” was a necessary, culturally based protective mechanism against “the prejudice and professional jealousy of non-Hispanics.” As one participant stated, “For many of us, it’s best to fly under the radar.”
Barriers The focus group participants described experiences and feelings about barriers. The themes that emerged about barriers speak to experiences of (a) educational barriers, (b) practice barriers, and (c) socioeconomic barriers. Educational Barriers. When discussing barriers, participants responded by sharing their experiences about barriers to education that included lack of knowledge, few Hispanic professors, academic incivility, and program inflexibility. For example, many participants were the first in their families to pursue higher education, and so “. . . felt all alone in figuring out what to do about going to college.” Furthermore, participants noted that the lack of Hispanic professors was problematic. One participant stated, “I think that having a professor from my background, who understood my challenges, would have been a big help. But, there was no one.” This dilemma allowed incidences of relational aggression from professors as well as from peers. One participant said, “It was clear to me that professors, and other students had low expectations of my abilities. They were surprised that I did so well.” Others felt that gossip and isolation from study groups, as the “only one” in their nursing program, coupled with course and program inflexibility left participants to leave nursing programs or reconsider more nursing education. Practice Barriers. When discussing barriers, participants responded by sharing their experiences about practice barriers that included many forms of bullying as well as lack of encouragement to further professional attainment. For example, participants described times where favoritism, unfair evaluations, unfriendliness, and unkind remarks led to incidences of symptomatic illness and selfdoubt. One participant spoke of not wanting “. . . to go to work many, many times, because I knew that no one would support me that day. Again. Those times made me physically and emotionally sick.” Other participants felt that they were purposefully, or even innocently, excluded from learning about advancement opportunities as well as workplace politics. Socioeconomic Barriers. When discussing barriers, participants responded by sharing their experiences about socioeconomic barriers that included discouragement from becoming nurses, the need to work to support themselves or their families, and tuition cost and reimbursement. For example, participants shared that their families wanted them to enter other professions that were more financially lucrative, such as business or law. One shared, “No teacher or counselor ever supported my decision to become a nurse.” Many participants spoke about
Personal and Professional Growth The focus group participants described experiences and feelings about personal and professional growth. The themes that emerged about mentoring and personal and professional growth speak to experiences of (a) overcoming a hostile environment and (b) dependency on the self. Overcoming a Hostile Environment. The participants noted a need to overcome a hostile environment with regard to mentoring. Participants experienced nursing as “unfriendly” where bullying and insensitivity were expected as part of the fabric of the profession. One participant said, “I don’t know what it is about nursing, that we treat each other so badly . . . it doesn’t make me want to ask any other nurse to be my mentor.” In addition, participants felt a conflicted isolation because of their ethnic background. Although many participants felt their Hispanic ethnicity was an asset in terms of providing culturally competent care, others felt it created a skewed view of their abilities, that they were “. . . nothing more than translators.” The workload stress participants experienced from the increased responsibilities of assuring informed consent and patient satisfaction left them feeling marginalized with little advancement support. As one participant said, It hurts me that I feel that as a nurse, no other nurses want me to get ahead. It becomes worse to know that as a Hispanic nurse, I have to fight even harder to learn how to get ahead. It makes me feel excluded and alone.
Dependency on the Self. Participants depended on t hemselves to advance personally and professionally despite challenges. One participant expressed perseverance, “Don’t tell me ‘no,’ that I’m not good enough. Bring it on.” Another said, “It’s really up to me to determine my own paths. I prefer finding things out myself, by quietly watching who I think is successful.” This tendency to “quietly watch” or observe moments of success from the sidelines was echoed throughout this theme of dependency on the self. For example, although participants experienced personal and professional “struggle” that somehow made them “stronger” and “more determined to succeed,” they also shared the importance of “forcing” themselves to “secretly” network, overcome timidity, and try to seek out individuals who were not threatened by the success of others. Each focus group supported the notion that “jumping into” or forcing their way into advancement opportunities may be ill advised because of its seeming aggression. This stance further supported that “learning 177
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approach to mentoring Hispanic RNs may be purposefully planned and sustained outreach that is guided by the literature on mentoring as well as the cultural experiences of Hispanics in general and Hispanic RNs in particular. This is salient to note given participants experienced existing barriers to mentoring that are modifiable such as the creation of mentoring networks and outreach within civil, culturally competent, and safe spaces. The findings therefore support those of Gardner (2005), where barriers included cultural barriers, feelings of alienation, lack of understanding, and loneliness. This study’s results can be used to enhance recruitment and retention of future nurses. In community settings, young Hispanic individuals need to be exposed early in their schooling about the possibility of nursing as a profession. Given the cost of tuition and reimbursement, lack of mentoring, and nursing program inflexibility account for significant rates of attrition (Taxis, 2006), this study’s findings support encouragement of Hispanic nursing students to succeed in achieving goals once in nursing programs (Anders, Edmonds, Monreal, & Galván, 2007) and be armed with information before and during study. It would therefore be vital for nursing educators to investigate if mentoring is indeed occurring within their institutions and to consider what those factors are that enable success for student nurses of Hispanic ethnicity given the reports of their overall inability to be recruited into and graduate from nursing programs. Perhaps encouraging students to become members of professional nursing organizations would increase networking opportunities and confidence through mentoring and decrease feelings of loneliness. Also, such an approach may have positive recruitment and retention results, given Madison’s (2007) stance that mentoring increases self-confidence.
not having learned about financial aid or scholarships until after they had already applied to nursing programs, and of the “. . . need to work to make money, not just for myself, but to help my family.” This need was complicated by nursing program and workplace inflexibility as barriers that interfered with progression.
Conclusions and Recommendations The demographic makeup of the nation is changing so that nursing schools must strive to educate and produce Hispanic nurses qualified to meet the health care needs of a growing Hispanic citizenry as well as of an increasingly culturally diverse society. However, although the American Association of Colleges of Nursing reports a 2.1% increase of Hispanic nurses in baccalaureate programs from the years 2000–2009 (2010), such an increase has yet to significantly place the number of Hispanic nurses needed in the workforce. Hispanic students account for only 7.1% of nursing school graduates (HRSA, 2010), with attrition as high as 50% in nursing programs across the country (Newton, Smith, Moore, & Magnan, 2006). With the dire circumstances in the recruitment and retention of Hispanic nurses, the results of this study may be used to plan dedicated enhancement of Hispanic nursing student success as well as the personal and professional advancement of Hispanic nurses in the workplace through dedicated mentoring. The themes that emerged from these focus groups of Hispanic nurses are not generalizable to a larger population of Hispanic RNs. The demographics and their individual situations may have also led to the emerging themes. However, the findings provide implications for nursing education, nursing practice, and opportunities for further nursing research.
Implications for Nursing Practice The positive aspects of nursing professionalism in terms of personal and professional growth need to be implemented and recognized so that Hispanic nurses with experience are retained in the profession to help attract and retain individuals to choose nursing as a career choice. As such, nursing should capitalize on the use of Hispanic nurses as mentors to guide the next and present generation of RNs thorough personal and professional growth. However, mentors need not be of the same ethnic background to facilitate successful mentorship. Therefore, it would benefit the profession to take up the cause of mentoring for all nurses, regardless of level of practice, and to do so early in the profession. It is critical that nursing administrators understand the importance of mentoring and institute mentoring programs in their health care institutions. However, as in nursing education, mentoring as a process needs institutional support to succeed within a civil environment. Hence, workshops on mentoring and incivility would be places to start.
Implications for Nursing Education Regarding mentoring, this study’s results indicate that Hispanic RNs experience of a lack of mentoring support, an uncertainty of what mentoring is, a feeling that the mentoring process is risky throughout the educational and practice settings, and that Hispanic nursing students are not necessarily assertive in seeking mentorship. Hispanic nursing students need to learn that they must take on the responsibility of seeking out a mentor as opposed to expecting someone to seek them out as a mentee. For Hispanic nursing students, there exists the need for information regarding all facets of mentoring, including boundaries, contracting, goals, roles, outcomes setting, and their responsibility in the mentoring process. Hispanic nursing students must be counseled to be assertive in their search for mentors that will provide a mutually beneficial relationship focused on personal and professional growth. Perhaps the most successful 178
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Implications for Nursing Research
Improving faculty retention through more effective mentoring. Journal of Professional Nursing, 24(6), 337–346. Egues, A. (2010). The relationship between mentoring and level of practice among Hispanic RNs. The International Journal of Environmental, Cultural, Economic and Social Sustainability, 6(2), 293–304. Gardner, J. (2005). Barriers influencing the success of racial and ethnic minority students in nursing programs. Journal of Transcultural Nursing, 16(2), 155–162. Health Resources and Services Administration. (2010). The registered nurse population: Findings from the 2008 National Sample Survey of Registered Nurses. Retrieved from http://www.bhpr. hrsa.gov/healthworkforce/rnsurveys/rnsurveyfinal.pdf Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 11(15), 1277–1288. Jeffreys, M. R. (2004). Nursing student retention. Understanding the process and making a difference. New York, NY: Springer Publishing. Kanaskie, M. L. (2006). Mentoring—A staff retention tool. Critical Care Nursing Quarterly, 29(3), 248–252. Krueger, R. A., & Casey, M. A. (2000). Focus groups: A practical guide for applied research (3rd ed.). Thousand Oaks, CA: Sage. Madison, J. (2007). The value of mentoring in nursing leadership: A descriptive study. Nursing Forum: An Independent Voice for Nursing, 29(4), 16–23. http://dx.doi .org/10.1111/j.1744-6198.1994.tb00170.x Maxwell, J. C. (2008). Mentoring 101: What every leader needs to know. Nashville, TN: Thomas Nelson. Mayan, M. J. (2001). An introduction to qualitative methods: A training module for students and professionals. Edmonton, Canada: Qualitative Institute Press.National League for Nursing. (2007). The tri-council for Nursing policy statement: Strategies to reverse the new nursing shortage. Retrieved from http://www.nln.org/aboutnln/news_tricouncil2.htm New York Academy of Medicine and the Jonas Center for Nursing Excellence. (2006). Nurse retention and workforce diversity: Two key issues in New York City’s nursing crisis. Retrieved from http://www.nyam.org/initiatives/opd-pub.shtml Newton, S. E., Smith, L. H., Moore, G., & Magnan, M. (2006). Predicting early academic achievement in a baccalaureate nursing program. Journal of Professional Nursing, 23(3), 144–149. Ragins, B. R. (1997). Diversified mentoring relationships in organizations: A power perspective. Academy of Management Review, 22(2), 482–521. Sandelowski, M. (2000). Whatever happened to qualitative description? Research in Nursing and Health, 23(4), 334–340. Shea, G. F., & Gianotti, S. C. (2009). Mentoring: Make it a mutually rewarding experience. Menlo Park, CA: Crisp Learning. Shelton, E. (2003). Faculty support and student retention. Journal of Nursing Education, 42(2), 68–76. Soroff, L., Rich, E., Rubin, A., Strickland, R. D., & Plotnick, H. D. (2002). A transcultural nursing education environment: An imperative for multicultural students. Nurse Educator, 27(4), 151–154. Spradley, J. P. (1979). The ethnographic interview by James P. Spradley. London, United Kingdom: Wadsworth. Steiger, D. B., Bausch, S., Johnson, B., & Peterson, A. (2006). The registered nurse population: Findings from the March 2004 National Sample Survey of Registered Nurses. Washington, DC: United States Department of Health and Human Services,
Although this study supports other work about known barriers facing Hispanic RNs (Gardner, 2005; Taxis, 2006), it has findings that speak to mentoring challenges. To begin, quantitative and qualitative investigation should continue with larger and more varied populations to learn how Hispanic RNs experience mentoring by (a) other Hispanic RNs and (b) non-Hispanic RNs. How mentoring is occurring, what activities it entails, what makes mentoring successful, and what mentoring outcomes are measured all need to be further investigated. Given that the participants in this study relied mostly on themselves to maneuver through nursing, an examination of how those individuals without strong personal reserves manage is needed so that all individuals may thrive. In conclusion, this study provides an emic perspective on how experiences of mentoring influence the personal and professional growth of Hispanic RNs. Aside from common barriers still in existence (Jeffreys, 2004; Taxis, 2006), little support, uncertainty, and risk about mentoring promote a reliance on self within hostile educational and workplace environments. Mentoring has long been found to support individuals across professional disciplines, not just minority individuals, the weak, or the vulnerable. Furthermore, all nurses may benefit from revisiting a personal and professional responsibility to mentor each other. It is time for all of us to begin to ask ourselves what it takes to create safe spaces for Hispanic RNs to succeed. Mentoring may be the optimal way in which all RNs may begin to ascertain how our global world can be administered to with ethical nursing attention.
References American Association of Colleges of Nursing. (2010). Advancing higher education in nursing. Retrieved from http://www.aacn. nche/edu/research-data/EthnicityTbl.pdf American Hospital Association. (2005). White coats and many colors: Population diversity and its implications for healthcare. Chicago, IL: Author. Anders, R. L., Edmonds, V. M., Monreal, H., & Galván, M. R. (2007). Recruitment and retention of Hispanic nursing students. Hispanic Health Care International, 5(3), 128–135. Benner, P. (1984). From novice to expert. Excellence and power in clinical nursing practice. Menlo Park, CA: Addison-Wesley. Benner, P. (2001). From novice to expert. Excellence and power in clinical nursing practice. Commemorative edition. Upper Saddle River, NJ: Prentice-Hall. Cottrell, D. (2006). Monday morning mentoring: Ten lessons to guide you up the ladder. New York, NY: HarperCollins. Cullen, D. L. (1991). Mentoring and the new practitioner. AARC Times, 15(12), 38–39. Dangy, T. (2010). The mentor leader: Secrets to building people and teams that win consistently. Winter Park, FL: Legacy, LLC. Dunham-Taylor, J., Lynn, C. W., Moore, P., McDaniel, S., & Walker, J. K. (2008). What goes around comes around: 179
Egues Health Resources and Services Administration, Bureau of Health Professions, Division of Nursing. Stewart, B. M., & Krueger, L. E. (1996). An evolutionary concept analysis of mentoring in nursing. Journal of Professional Nursing, 12(5), 311–321. Taxis, C. J. (2006). Fostering academic success of Mexican Americans in a BSN program: An educational imperative. International Journal of Nursing Education Scholarship, 3, 1–15. U.S. Census Bureau. (2012). Who’s Hispanic in America? Retrieved from http://www.google.com/url?sa=t&rct=j&q=&esrc=s& source=web&cd=3&ved=0CEQQFjAC&url=http%3A%2F% 2Fwww.census.gov%2Fnewsroom%2Fcspan%2Fhispanic% 2F2012.06.22_cspan_hispanics.pdf&ei=aRwLUayaNZSw0Q H66IHQCw&usg=AFQjCNFN55ScYPXD9DfAkZczrVv7qnJ cyw&bvm=bv.41867550,d.dmQ U.S. Department of Health and Human Services Health Resources and Services Administration. (2008). Preliminary Findings: 2004 National Sample Survey of Registered Nurses. Retrieved
from http://bhpr.hrsa.gov/healthworkforce/reports/rn population/preliminaryfindings.htm#raceaandhep U.S. Department of Health and Human Services Health Resources and Services Administration. (2010). The registered nurse population: Initial findings from the 2008 National Sample Survey of Registered Nurses. Retrieved from http://bhpr.hrsa .gov/healthworkforce/rnsurveys/rnsurveyinitial2008.pdf Zachary, L. (2009). The mentee’s guide: Making mentoring work for you. San Francisco, CA: Jossey Bass. Acknowledgments. This manuscript addresses the findings of a study approved and funded through a Professional Staff Congress—City University of New York (PSC-CUNY) Award. Correspondence regarding this article should be directed to Aida L. Egues, DNP, RN, APHN-BC, CNE, New York City College of Technology, The City University of New York, 300 Jay Street, Brooklyn, NY 11201. E-mail: [email protected]
Appendix Sample Semistructured Starter Questions How do you experience mentoring? How do you experience personal growth? How do you experience professional growth? What methods or practices do you use to advance in your life? What access or barriers have you experienced with regard to mentoring, personal growth, and professional growth? What are your attitudes toward nursing at the academic and professional levels?
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Experiences of Mentoring Influences on the Personal and Professional Growth of Hispanic Registered Nurses Aida L. Egues, DNP, RN, APHN-BC, CNE New York City College of Technology (CUNY) Brooklyn, New York The purpose of this qualitative descriptive study was to explore the meaning of the experiences of mentoring influences on the personal and professional growth of Hispanic registered nurses (RNs). Focus group methodology was employed in the New York City metropolitan area with monolingual English or bilingual English/Spanish RNs (N 5 20) who perceived themselves to be at all levels of practice. The findings offer a summary of the experiences of mentoring for the 20 Hispanic RNs that includes little advancement support; hesitancy to being mentored; dependency on the self for personal and professional growth; and educational, practice, and socioeconomic barriers. This study suggests that mentoring of Hispanic nurses needs to be reexamined to improve and sustain a culture of mentoring that may enhance the education, recruitment, and retention of Hispanic RNs. El propósito de este estudio cualitativo descriptivo fue explorar la experencia y el significado de las tutorías sobre el crecimiento personal y profesional de enfermeras Hispanas (RNs). Grupos focales fueron utilizados para la recolección de los datos. El estudio se realizo en la Ciudad de Nueva York área metropolitana con enfermeras tituladas que hablaban Ingles, Español o los dos idiomas (N 5 20), no se considero el nivel de experencia clínica. Los resultados ofrecen un resumen de las experiencias de tutoría de las veinte enfermeras que participaron en el estudio tales como: escaso apoyo para progresar en el desempeño profesional; dependencia personal para lograr crecimiento personal y profesional; barreras socioeconómicas para la educación y práctica. Este estudio sugiere que las tutorías para enfermeras Hispanas deben ser re-examinadas con el propósito de mejorarlas manteniendo una cultura de tutoría que permita mejorar la educación, el reclutamiento y la retención de enfermeras Hispana. Keywords: Hispanic nurses; mentoring experiences; level of practice; advancement
T
he current projected shortage of more than 1 million registered nurses (RNs) within the United States by the year 2020 (Health Resources and Services Administration [HRSA], 2010) continues to threaten the provision of quality health care for all citizens. Such a situation is particularly problematic given the burgeoning growth in the number of Hispanic individuals who will require care across all nursing settings (Egues, 2010). According to the U.S. Census Bureau (2012), the Hispanic population continues as the nation’s fastest growing and largest minority population,
with an estimated growth to approximately 66 million people, representing 19.4% of the total U.S. population by the year 2020. However, no such exponential growth is anticipated among Hispanic RNs. Hispanic RNs are not only the most underrepresented group of nurses in relation to their population numbers (Steiger, Bausch, Johnson, & Peterson, 2006; U.S. Department of Health and Human Services [USDHHS] Health Resources and Services Administration, 2010) but are also equally underrepresented among RNs possessing advanced practice and doctoral degrees (USDHHS Health
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Resources and Services Administration, 2008). Although there are close to 4 million RNs in the United States, only 3.6% of these nurses are Hispanic (HRSA, 2010) and only 10% have obtained additional nursing degrees (USDHHS Health Resources and Services Administration, 2008) required for advanced practice, education, and research. Fewer Hispanic RNs available diminishes the ability of the U.S. health care system to effectively prevent and treat diseases (National League for Nursing [NLN], 2007) as part of culturally sensitive, evidence-based care for Hispanics as for all minority individuals. Recruitment and retention of Hispanic RNs is of utmost importance if the United States is to educate and graduate a sufficient number of these nurses to fill the demands of health care. Mentoring has been shown to be the most influential way to successfully develop nurses while increasing their recruitment and retention (Dunham-Taylor, Lynn, Moore, McDaniel, & Walker, 2008). Mentoring is a progressive, mutually rewarding relationship where a more experienced individual (mentor) helps a less experienced individual (mentee) acquire knowledge and skills necessary for advancement (Shea & Gianotti, 2009). The literature shows an overwhelmingly positive result from mentoring as a type of support that helps another learn (Cottrell, 2006; Dangy, 2010; Maxwell, 2008; Zachary, 2009), while enhancing personal and professional life changes, with a change in self-confidence indicated most frequently (Madison, 2007). Therefore, in terms of benefits to both practice and society, the deficit in Hispanic RNs to serve as mentors and role models to Hispanic nursing students and nurses in the workplace may not only threaten the way in which evolving traditional practices and values of ethnic communities are communicated, integrated, and preserved within health care but may also endanger the personal and professional advancement of some Hispanic RNs (Egues, 2010). Such a dilemma may be addressed by attempting to understand how to improve and sustain a culture of mentoring that will help foster the recruitment and retention of these nurses (Egues, 2010).
faced these obstacles in their mentoring relationships also appeared to experience a stagnation in their overall advancement that included failure to attain both increased levels of education as well as increased levels of practice in nursing (Egues, 2010). As such, a deeper examination was warranted about Hispanic RNs’ access and barriers to mentoring, personal growth, professional growth, and attitudes toward nursing. Hence, the purpose of this qualitative descriptive study was to explore the meaning of the experiences of mentoring influences on the personal and professional growth of Hispanic RNs who perceived themselves to be at all levels of practice in nursing. The goals of the study were to add to the existing body of literature on mentoring and to provide greater insight regarding how Hispanic RNs experience advancement as individuals and as nurses, experience mentorship, and experience academic, personal, and workplace environments.
Review of the Literature Appropriately effective mentoring may be a strategy to increase the number of Hispanic nurses and provide encouragement for Hispanic RNs to pursue advanced degrees (Egues, 2010). The business, education, and health care literature have long supported that mentoring between persons of the same ethnic population leads to greater academic achievement (Shelton, 2003; Soroff, Rich, Rubin, Strickland, & Plotnick, 2002), personal satisfaction, and professional success (Cullen, 1991; Ragins, 1997). Early nursing literature in mentoring found that the support associated with mentoring relationships (Stewart & Krueger, 1996) may be used to guide nurses throughout the novice, advanced beginner, competent, proficient, and expert levels of nursing practice (Benner, 1984; Benner, 2001; Kanaskie, 2006). Advancement through the levels of practice was found to enhance an RN’s ability to provide more autonomous, effective, and efficient care (Benner, 1984). A mentor usually has advanced education and experience. However, in the workplace, few Hispanic RNs are found in executive areas of nursing (New York Academy of Medicine and the Jonas Center for Nursing Excellence, 2006) and in faculty positions. This may mean that novice Hispanic RNs have few or no mentors and positive role models (American Hospital Association [AHA], 2005) of the same ethnicity to provide advice, to teach, and to guide them from one level of nursing practice to another. An examination of the literature yielded negligible information about how Hispanic RNs experience mentoring or levels of practice. As such, a quantitative study by Egues (2010) more deeply investigated how mentoring influences the personal and professional advancement of Hispanic RNs through Benner’s (1984) levels of nursing practice (novice, advanced beginner,
Purpose A recent quantitative study provided new information about the quality of mentoring and the level of practice experienced by Hispanic RNs in light of a shortage of guiding mentors from a similar ethnic background (Egues, 2010). Study results indicated that although Hispanic RNs experienced some mentoring, there were perceived obstacles to personal and professional growth within their mentoring relationships. These obstacles included (a) a lack of desired friendship between mentor and mentee, (b) inadequate information about navigating workplace politics, (c) less than acceptable support from their mentors, and (d) a perceived lack of trust that mentees had in their mentors. Furthermore, Hispanic RNs who 174
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competent, proficient, and expert). Findings of that study revealed that Hispanic RNs do experience a quality of mentoring that differs from the mentoring experiences portrayed in the literature on mentoring and in the literature on Hispanic nurses. For example, Hispanic RNs experience only an average amount of mentoring behaviors or quality of mentoring. Hispanic RNs also experience a quality of mentoring focused on the mentor providing greater challenges and career counseling to the mentee, yet less focused on the mentor providing friendship and the teaching of professional and workplace politics. Furthermore, Hispanic RNs’ level of nursing practice is influenced by having a mentor; Hispanic RNs who are mentored experience not only increases in key mentoring activities where they learn how to negotiate through political landscapes, receive administrative support, and feel a demonstration of trust in the mentor– mentee relationship but also tend to attain increases in nursing practice expertise. Finally, as Hispanic RNs’ expertise in nursing practice increases, pursuit of higher education increases. The findings on mentoring among Hispanic RNs have various implications for nursing education, practice, and research (Egues, 2010). Although general research supports the notion of mentor activities, functions, and roles, it does not provide much in the way of details about when and where behaviors are most common if the mentoring process occurs, the perceptions of what individuals get from mentors, or how mentoring benefits minority populations, specifically Hispanics, within the nursing profession (Egues, 2010). The existence of an overall lack of mentoring, unclear personal and professional mentoring benefits, and unique challenges faced by Hispanic RNs suggest the need for additional study.
Methods Four focus groups were conducted in groups of four to eight participants (N 5 20) using a discussion guide based on a systematic review of the literature with specific, open-ended questions (see Appendix). Each focus group discussion lasted 1.5–2.0 hr, allowing sufficient opportunity for all participants to respond to the questions. A semistructured questioning format was used in the focus groups to encourage consistency of the questions asked across group participants. This format allowed for flexibility in accordance with the topics raised and level of participation within the groups (Krueger & Casey, 2000). All relevant printed materials were in English and all groups were conducted in English. Prior to beginning this grant-funded study, human subject approval was received through the college’s institutional review board (IRB) and informed consent was obtained from the participants. All participants were given a copy of the consent. Permission was obtained from the Department of Nursing where focus groups were conducted.
Setting and Sample Focus groups were held in the evening within private lecture rooms at a college within the New York City Metropolitan area. Healthy snacks and beverages were offered prior to the start of the focus groups. Participants were recruited following presentations at professional nursing organizations, schools of nursing, community and private health care organizations, and through referrals from Hispanic RNs in New York City and its boroughs. A flyer was distributed, which described the purpose of the study, researcher contact information, and study inclusion criteria. To enhance participation, the duration, extent, and frequency of participation were clearly communicated during recruitment. Potential participants approached the researcher or contacted the researcher if they met the following inclusion criteria: (a) adult, age 18 years or older, able to participate fully in providing consent for study participation; (b) male or female; (c) Hispanic registered nurse; and (d) either monolingual English or bilingual English/Spanish, able to read and write English. Participants received $10 transportation cards for travel from the focus group sessions.
Design and Methods Design A qualitative, descriptive inquiry explored the experiences of mentoring influences on the personal and professional growth of Hispanic RNs. The value of focus groups for the study was established by an extensive literature supporting methodology and issues of cultural/ethnic sensitivity. Focus group interviewing provides an optimal setting in which individuals can express, share, and compare their experiences in a nonjudgmental atmosphere so that all benefit from the information (Krueger & Casey, 2000) with minimal interpretation (Sandelowski, 2000). Focus group interviews are considered a culturally appropriate methodology for research with Hispanics because they draw on the group dynamics of use of oral traditions, norms of helping, and existing social networks that are unique and appropriate to this topic (Krueger & Casey, 2000).
Analysis Data analysis began and continued after each focus group session, which was recorded via two electronic instruments. Typed transcripts were used as a basis for data analysis. Qualitative content analysis was best suited to elicit meanings of experience from the data and allow themes to emerge from this descriptive study (Krueger & Casey, 2000). From the data, codes were consistently applied and generated by the experienced researcher via line-by-line coding of transcripts. Coding began during 175
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the initial read and transcription, with the researcher rereading, highlighting, and placing comments in the margins of original transcripts. Analysis continued with coding line-by-line and by section on hard copy of transcripts, with continued coding following computer entry of transcriptions. This iterative process allowed for constant comparison and consensus of themes (Hsieh & Shannon, 2005) that best represented the words of participants as their own. Themes emerged from the transcribed and coded interviews. These verification strategies, along with journaling by the researcher; participant checks before, during, and following focus group interviews (Spradley, 1979); and consultation with other qualitative researchers (Mayan, 2001) and Hispanic researchers helped assure the rigor of this study. Themes emerged from the first focus group interview, and saturation of data—that is, no new emergence of themes—was reached after the transcript of the fourth focus group was thoroughly reviewed.
and educational, practice, and socioeconomic barriers experienced.
Mentoring The focus group participants described experiences and feelings about mentoring. The themes that emerged about mentoring speak to experiences of hesitancy owed to (a) little support, (b) uncertainty, and (c) risk. Little Support. The participants noted that they experienced little support with regard to mentorship within nursing. Participants felt no one sought them out to be mentored, that there was neither discussion about mentoring nor interest in helping them succeed. One participant said, “I don’t think we have a backup system, where we go out of our way to take care of each other, like I see how other races, ethnicities, and groups do.” Another participant focused on nurse mentoring asked, “How can I help someone else when I have no one there for me? I’m expected to be there for all my Hispanic patients, families, students, and community. You want my help? It’s impossible!” One participant recalled the first time he experienced mentoring support:
Findings
I learned I had to ask for help, because no one offered to help me. But, it took a while to find out when and where to go for help. I tell everyone, you have to go find your own mentoring support system. It’s something you have to make up your mind to do.
Characteristics Demographic data collected from participants revealed that all of the focus group participants (100%) self-identified as of Hispanic ethnicity (N 5 20), whereas 70% (n 5 14) self-identified as White. Ninety-five percent of the participants were female (n 5 19). Participants ranged in age from 21 to 58 years, with from less than 1 year to 34 years of nursing practice. The mean age of study participants was 43 years (SD 5 3.8), and most had practiced as an RN for more than a decade (M 5 16 years, SD 5 2.2). All of the participants resided in the Northeast, whereas 80% (n 5 16) were born in the United States. Most participants spoke English at home (n 5 19) as well as in social circumstances (n 5 17). Few participants had advanced nursing degrees: only 5% (n 5 1) had a doctorate, whereas 10% (n 5 2) had a master’s degree. The remaining participants had either a baccalaureate degree (25%, n 5 5) or an associate degree (60%, n 5 12) as a terminal nursing degree. In terms of mentoring, 75% (n 5 15) of the participants experienced a mentoring relationship; 80% (n 5 12) had a Hispanic mentor whereas 20% (n 5 3) had a non-Hispanic mentor. Of those study participants who had mentors, only 1 had a nurse as a mentor in any capacity. The remaining participants who experienced mentorship had friends or family members as mentors. Data are arranged by the emerging themes as expressed by the focus groups. The themes offer a summary of the experiences of mentoring influences on the personal and professional growth of Hispanic RNs. The themes include perceptions of hesitancy toward the mentoring process itself, challenges to personal and professional growth,
Uncertainty. The participants noted that they experienced uncertainty with regard to mentoring. Participants felt that the entire concept of mentoring was difficult to understand given that they truly (a) did not know what mentoring was, (b) did not know how to seek out a mentor, and (c) feared the mentoring process. As one participant asked, “How would I know where to begin in asking someone to mentor me, when I’m not really sure what to ask for? What am I supposed to get out of it, and what would they [mentors] get out of it?” Therefore, participants felt unsure about what a mentoring relationship entailed, including its definition, expectations, and goals. Furthermore, participants felt that the mentors in their lives were informal and personal, such as a parent, a sibling, a relative, or a friend. Participants supported one another with “I agree with you. There’s no mentoring either where I work.” Lastly, participants somehow feared mentoring. One asked, “What if the mentor I choose doesn’t work out? Where will that leave me?” Risk. The participants noted that they experienced risk with regard to mentoring. They verbalized mentoring as a “risky” undertaking because of experiencing vulnerability. One participant asked, “Why should I put myself out there? So, I look desperate as if I need help or guidance?” Similarly, participants felt that seeking mentoring within nursing demonstrated a weakness that would position them at a workplace disadvantage. As one participant 176
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stated, “You can’t let other nurses know what you don’t know. Personally, I don’t want to take the chance of being set up to fail or of calling any attention to myself.” Finally, other participants felt that fear was holding them back; no positive outcomes could be experienced without taking a chance on working toward establishing a mentor–protégé experience. Participants felt there were “no safe mentoring” spaces for them.
through watching” was a necessary, culturally based protective mechanism against “the prejudice and professional jealousy of non-Hispanics.” As one participant stated, “For many of us, it’s best to fly under the radar.”
Barriers The focus group participants described experiences and feelings about barriers. The themes that emerged about barriers speak to experiences of (a) educational barriers, (b) practice barriers, and (c) socioeconomic barriers. Educational Barriers. When discussing barriers, participants responded by sharing their experiences about barriers to education that included lack of knowledge, few Hispanic professors, academic incivility, and program inflexibility. For example, many participants were the first in their families to pursue higher education, and so “. . . felt all alone in figuring out what to do about going to college.” Furthermore, participants noted that the lack of Hispanic professors was problematic. One participant stated, “I think that having a professor from my background, who understood my challenges, would have been a big help. But, there was no one.” This dilemma allowed incidences of relational aggression from professors as well as from peers. One participant said, “It was clear to me that professors, and other students had low expectations of my abilities. They were surprised that I did so well.” Others felt that gossip and isolation from study groups, as the “only one” in their nursing program, coupled with course and program inflexibility left participants to leave nursing programs or reconsider more nursing education. Practice Barriers. When discussing barriers, participants responded by sharing their experiences about practice barriers that included many forms of bullying as well as lack of encouragement to further professional attainment. For example, participants described times where favoritism, unfair evaluations, unfriendliness, and unkind remarks led to incidences of symptomatic illness and selfdoubt. One participant spoke of not wanting “. . . to go to work many, many times, because I knew that no one would support me that day. Again. Those times made me physically and emotionally sick.” Other participants felt that they were purposefully, or even innocently, excluded from learning about advancement opportunities as well as workplace politics. Socioeconomic Barriers. When discussing barriers, participants responded by sharing their experiences about socioeconomic barriers that included discouragement from becoming nurses, the need to work to support themselves or their families, and tuition cost and reimbursement. For example, participants shared that their families wanted them to enter other professions that were more financially lucrative, such as business or law. One shared, “No teacher or counselor ever supported my decision to become a nurse.” Many participants spoke about
Personal and Professional Growth The focus group participants described experiences and feelings about personal and professional growth. The themes that emerged about mentoring and personal and professional growth speak to experiences of (a) overcoming a hostile environment and (b) dependency on the self. Overcoming a Hostile Environment. The participants noted a need to overcome a hostile environment with regard to mentoring. Participants experienced nursing as “unfriendly” where bullying and insensitivity were expected as part of the fabric of the profession. One participant said, “I don’t know what it is about nursing, that we treat each other so badly . . . it doesn’t make me want to ask any other nurse to be my mentor.” In addition, participants felt a conflicted isolation because of their ethnic background. Although many participants felt their Hispanic ethnicity was an asset in terms of providing culturally competent care, others felt it created a skewed view of their abilities, that they were “. . . nothing more than translators.” The workload stress participants experienced from the increased responsibilities of assuring informed consent and patient satisfaction left them feeling marginalized with little advancement support. As one participant said, It hurts me that I feel that as a nurse, no other nurses want me to get ahead. It becomes worse to know that as a Hispanic nurse, I have to fight even harder to learn how to get ahead. It makes me feel excluded and alone.
Dependency on the Self. Participants depended on t hemselves to advance personally and professionally despite challenges. One participant expressed perseverance, “Don’t tell me ‘no,’ that I’m not good enough. Bring it on.” Another said, “It’s really up to me to determine my own paths. I prefer finding things out myself, by quietly watching who I think is successful.” This tendency to “quietly watch” or observe moments of success from the sidelines was echoed throughout this theme of dependency on the self. For example, although participants experienced personal and professional “struggle” that somehow made them “stronger” and “more determined to succeed,” they also shared the importance of “forcing” themselves to “secretly” network, overcome timidity, and try to seek out individuals who were not threatened by the success of others. Each focus group supported the notion that “jumping into” or forcing their way into advancement opportunities may be ill advised because of its seeming aggression. This stance further supported that “learning 177
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approach to mentoring Hispanic RNs may be purposefully planned and sustained outreach that is guided by the literature on mentoring as well as the cultural experiences of Hispanics in general and Hispanic RNs in particular. This is salient to note given participants experienced existing barriers to mentoring that are modifiable such as the creation of mentoring networks and outreach within civil, culturally competent, and safe spaces. The findings therefore support those of Gardner (2005), where barriers included cultural barriers, feelings of alienation, lack of understanding, and loneliness. This study’s results can be used to enhance recruitment and retention of future nurses. In community settings, young Hispanic individuals need to be exposed early in their schooling about the possibility of nursing as a profession. Given the cost of tuition and reimbursement, lack of mentoring, and nursing program inflexibility account for significant rates of attrition (Taxis, 2006), this study’s findings support encouragement of Hispanic nursing students to succeed in achieving goals once in nursing programs (Anders, Edmonds, Monreal, & Galván, 2007) and be armed with information before and during study. It would therefore be vital for nursing educators to investigate if mentoring is indeed occurring within their institutions and to consider what those factors are that enable success for student nurses of Hispanic ethnicity given the reports of their overall inability to be recruited into and graduate from nursing programs. Perhaps encouraging students to become members of professional nursing organizations would increase networking opportunities and confidence through mentoring and decrease feelings of loneliness. Also, such an approach may have positive recruitment and retention results, given Madison’s (2007) stance that mentoring increases self-confidence.
not having learned about financial aid or scholarships until after they had already applied to nursing programs, and of the “. . . need to work to make money, not just for myself, but to help my family.” This need was complicated by nursing program and workplace inflexibility as barriers that interfered with progression.
Conclusions and Recommendations The demographic makeup of the nation is changing so that nursing schools must strive to educate and produce Hispanic nurses qualified to meet the health care needs of a growing Hispanic citizenry as well as of an increasingly culturally diverse society. However, although the American Association of Colleges of Nursing reports a 2.1% increase of Hispanic nurses in baccalaureate programs from the years 2000–2009 (2010), such an increase has yet to significantly place the number of Hispanic nurses needed in the workforce. Hispanic students account for only 7.1% of nursing school graduates (HRSA, 2010), with attrition as high as 50% in nursing programs across the country (Newton, Smith, Moore, & Magnan, 2006). With the dire circumstances in the recruitment and retention of Hispanic nurses, the results of this study may be used to plan dedicated enhancement of Hispanic nursing student success as well as the personal and professional advancement of Hispanic nurses in the workplace through dedicated mentoring. The themes that emerged from these focus groups of Hispanic nurses are not generalizable to a larger population of Hispanic RNs. The demographics and their individual situations may have also led to the emerging themes. However, the findings provide implications for nursing education, nursing practice, and opportunities for further nursing research.
Implications for Nursing Practice The positive aspects of nursing professionalism in terms of personal and professional growth need to be implemented and recognized so that Hispanic nurses with experience are retained in the profession to help attract and retain individuals to choose nursing as a career choice. As such, nursing should capitalize on the use of Hispanic nurses as mentors to guide the next and present generation of RNs thorough personal and professional growth. However, mentors need not be of the same ethnic background to facilitate successful mentorship. Therefore, it would benefit the profession to take up the cause of mentoring for all nurses, regardless of level of practice, and to do so early in the profession. It is critical that nursing administrators understand the importance of mentoring and institute mentoring programs in their health care institutions. However, as in nursing education, mentoring as a process needs institutional support to succeed within a civil environment. Hence, workshops on mentoring and incivility would be places to start.
Implications for Nursing Education Regarding mentoring, this study’s results indicate that Hispanic RNs experience of a lack of mentoring support, an uncertainty of what mentoring is, a feeling that the mentoring process is risky throughout the educational and practice settings, and that Hispanic nursing students are not necessarily assertive in seeking mentorship. Hispanic nursing students need to learn that they must take on the responsibility of seeking out a mentor as opposed to expecting someone to seek them out as a mentee. For Hispanic nursing students, there exists the need for information regarding all facets of mentoring, including boundaries, contracting, goals, roles, outcomes setting, and their responsibility in the mentoring process. Hispanic nursing students must be counseled to be assertive in their search for mentors that will provide a mutually beneficial relationship focused on personal and professional growth. Perhaps the most successful 178
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Implications for Nursing Research
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Although this study supports other work about known barriers facing Hispanic RNs (Gardner, 2005; Taxis, 2006), it has findings that speak to mentoring challenges. To begin, quantitative and qualitative investigation should continue with larger and more varied populations to learn how Hispanic RNs experience mentoring by (a) other Hispanic RNs and (b) non-Hispanic RNs. How mentoring is occurring, what activities it entails, what makes mentoring successful, and what mentoring outcomes are measured all need to be further investigated. Given that the participants in this study relied mostly on themselves to maneuver through nursing, an examination of how those individuals without strong personal reserves manage is needed so that all individuals may thrive. In conclusion, this study provides an emic perspective on how experiences of mentoring influence the personal and professional growth of Hispanic RNs. Aside from common barriers still in existence (Jeffreys, 2004; Taxis, 2006), little support, uncertainty, and risk about mentoring promote a reliance on self within hostile educational and workplace environments. Mentoring has long been found to support individuals across professional disciplines, not just minority individuals, the weak, or the vulnerable. Furthermore, all nurses may benefit from revisiting a personal and professional responsibility to mentor each other. It is time for all of us to begin to ask ourselves what it takes to create safe spaces for Hispanic RNs to succeed. Mentoring may be the optimal way in which all RNs may begin to ascertain how our global world can be administered to with ethical nursing attention.
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Egues Health Resources and Services Administration, Bureau of Health Professions, Division of Nursing. Stewart, B. M., & Krueger, L. E. (1996). An evolutionary concept analysis of mentoring in nursing. Journal of Professional Nursing, 12(5), 311–321. Taxis, C. J. (2006). Fostering academic success of Mexican Americans in a BSN program: An educational imperative. International Journal of Nursing Education Scholarship, 3, 1–15. U.S. Census Bureau. (2012). Who’s Hispanic in America? Retrieved from http://www.google.com/url?sa=t&rct=j&q=&esrc=s& source=web&cd=3&ved=0CEQQFjAC&url=http%3A%2F% 2Fwww.census.gov%2Fnewsroom%2Fcspan%2Fhispanic% 2F2012.06.22_cspan_hispanics.pdf&ei=aRwLUayaNZSw0Q H66IHQCw&usg=AFQjCNFN55ScYPXD9DfAkZczrVv7qnJ cyw&bvm=bv.41867550,d.dmQ U.S. Department of Health and Human Services Health Resources and Services Administration. (2008). Preliminary Findings: 2004 National Sample Survey of Registered Nurses. Retrieved
from http://bhpr.hrsa.gov/healthworkforce/reports/rn population/preliminaryfindings.htm#raceaandhep U.S. Department of Health and Human Services Health Resources and Services Administration. (2010). The registered nurse population: Initial findings from the 2008 National Sample Survey of Registered Nurses. Retrieved from http://bhpr.hrsa .gov/healthworkforce/rnsurveys/rnsurveyinitial2008.pdf Zachary, L. (2009). The mentee’s guide: Making mentoring work for you. San Francisco, CA: Jossey Bass. Acknowledgments. This manuscript addresses the findings of a study approved and funded through a Professional Staff Congress—City University of New York (PSC-CUNY) Award. Correspondence regarding this article should be directed to Aida L. Egues, DNP, RN, APHN-BC, CNE, New York City College of Technology, The City University of New York, 300 Jay Street, Brooklyn, NY 11201. E-mail: [email protected]
Appendix Sample Semistructured Starter Questions How do you experience mentoring? How do you experience personal growth? How do you experience professional growth? What methods or practices do you use to advance in your life? What access or barriers have you experienced with regard to mentoring, personal growth, and professional growth? What are your attitudes toward nursing at the academic and professional levels?
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