Journal of Pediatric Nursing (2014) xx, xxx–xxx

Mentoring Practices Benefiting Pediatric Nurses1,2,3 Meghan M. Weese MSN, RN, CPN a,⁎, Louise D. Jakubik PhD, RN-BC, CSP b , Aris B. Eliades PhD, RN, CNS a , Jennifer J. Huth BSN, RN, CPN a a

Akron Children's Hospital, One Perkins Square, Akron, OH Nurse Builders, Suite #350, Philadelphia, PA

b

Received 2 December 2013; revised 11 July 2014; accepted 23 July 2014

Keywords: Mentoring; Nursing; Research

Previous studies examining predictors of pediatric nurse protégé mentoring benefits demonstrated that protégé perception of quality was the single best predictor of mentoring benefits. The ability to identify the mentoring practices that predict specific benefits for individual nurses provides a better understanding of how mentoring relationships can be leveraged within health care organizations promoting mutual mentoring benefits. This descriptive correlational, non-experimental study of nurses at a northeast Ohio, Magnet® recognized, free-standing pediatric hospital advances nursing science by demonstrating how mentoring practices benefit pediatric nurse protégés. © 2014 Elsevier Inc. All rights reserved.

MENTORING HAS EMERGED as an essential element of nursing satisfaction, workforce recruitment and retention efforts, and identified as a key element of the work environment in Magnet® recognized organizations (American Nurses Credentialing Center, 2013; Buffington, Zwink, Fink, DeVine, & Sanders, 2012; Halfer, 2007; Halfer, Graf, & Sullivan, 2007; Lartey, Cummings, & Profetto‐McGrath, 2013; Latham, Ringl, & Hogan, 2011; Long, McGee, Kinstler, & Huth, 2011). The value of mentoring for individuals and their organizations is evident in the healthcare literature (Latham, Ringl, & Hogan, 2011; Trossman, 2013). Further, the literature quantifies the specific individual and organizational benefits of mentoring among staff nurse protégés (Jakubik, 2007; Jakubik, 2008; Jakubik, Eliades, Gavriloff & Weese, 2011). Although the value of mentoring and its evidence-based outcomes are well known, there is limited evidence regarding how to mentor 1

The authors have no conflict of interest. Extramural funding: Delta Omega Chapter of Sigma Theta Tau International. 3 Presentations: Akron Children's Hospital Pediatric Nursing Conference, October 10, 2013, Akron, OH and Sigma Theta Tau Biennial Convention, November 16–17, 2013, Indianapolis, IN; and Society of Pediatric Nurses Convention, April 10–13, 2014, Phoenix, AZ. ⁎ Corresponding author: Meghan M. Weese, MSN, RN, CPN. E-mail address: [email protected]. 2

http://dx.doi.org/10.1016/j.pedn.2014.07.011 0882-5963/© 2014 Elsevier Inc. All rights reserved.

(Jakubik, 2012). The identification of specific mentoring practices which would elicit mentoring benefits for individual nurses and their organizations is needed (Jakubik, 2012). This article presents the results of a nurse mentoring study which identified six specific mentoring practices and their relationship to six previously defined nurse mentoring benefits among pediatric staff nurse protégés. This study, therefore, contributes to a contemporary understanding of how mentoring practices can be used to elicit the benefits of mentoring among pediatric staff nurse protégés.

Literature Review PubMed and CINAHL were searched for nursing literature published in English from the last 10 years. Key words included: mentoring, retention, Magnet®, satisfaction, job enjoyment, pediatrics.

Mentoring in Nursing Mentoring is an intentional, long-term relationship focusing on professional development and career advancement (Fawcett, 2002). Mentoring is a triad relationship between an experienced

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M.M. Weese et al.

nurse, a less experienced nurse, and the organization in which they work (Jakubik, 2007; Jakubik, 2008; Jakubik et al., 2011; Zey, 1991). A mentor shares professional knowledge, skills, and experience through a long-term relationship to promote the protégé's professional development (Jakubik, 2008). A mentor is different from a preceptor. Precepting focuses on orientation of the new nurse to develop clinical skills, become oriented to the unit, and acclimated to the work environment (Funderburk, 2008). A preceptor fulfills a structured, time-limited, job training role. In contrast, mentoring is a long-term, sharing relationship that benefits both participants and the organization. The literature supports mentoring in clinical practice, leadership, and for specific professional development, such as research or evidence-based practice mentors, and to promote a healthy work environment, etc. (Kelly, Turner, Speroni, McLaughlin, & Guzzetta, 2013; Krause-Parello, Sarcone, Samms, & Boyd, 2012; Latham, Ringl, & Hogan, 2011; Leung, Widger, Howell, Nelson, & Molassiotis, 2012; Long, McGee, Kinstler, & Huth, 2011; Wilson, Kelly, Reifsnider, Pipe, & Brumfield, 2013).

perspective (protégé, mentor, and organization) to capture both individual (protégé and mentor) and organizational benefits of mentoring (Jakubik, 2007; Jakubik, 2008; Jakubik et al., 2011; Zey, 1991). Zey's mentoring model is consistent with the classic business paradigm of mentoring as a triad (mentor, protégé, and organization) so prevalent in the business literature (Scandura, 1992; Zey, 1991), as compared to the dyad (mentor and protégé) paradigm which is typical of the service professions (Harriss & Harriss, 2012). Zey's study incorporated organizational outcomes such as retention, succession planning, and promotion in the model's higher level mentoring activities, which are not typically included in the assumptions of a dyad approach to mentoring which focuses on protégé outcomes of learning and feeling supported by the mentor. Jakubik's research applied Zey's mentoring model to nursing practice in the development of a research agenda and associated research instruments to study mentoring in nursing from a triad perspective that would incorporate organizational outcomes.

Mentoring Research

Mentoring Benefits

Most mentoring research is descriptive and focuses on the role aspects of mentors (Cameron-Jones & O'Hara, 1996; Chow & Suen, 2001; Darling, 1984; Fagan & Fagan, 1983; Harvey, 2012; Hayden, 2006; Neary, 2000; Walsh & Clements, 1995). There has been tremendous interest in mentoring of novice and advanced beginner staff nurses in Magnet® recognized hospitals, however, mentoring past the first year of practice has not been well addressed (Beecroft, Kunzman, & Krozek, 2001; Benner, 1984; Clarke-Gallagher & Coleman, 2004; Hom, 2003; Pinkerton, 2003; Rush, Adamack, Gordon, Lilly, & Janke, 2012). Mentoring has been proposed as an important method to recruit and retain nurses and to promote knowledge and skill development (Allen, 2002; Chen & Lou, 2013; Chenoweth, Merlyn, Jeon, Tait, & Duffield, 2013; Fawcett, 2002; Greene & Puetzer, 2002; Hom, 2003; Latham, Ringl, & Hogan, 2011; Oermann & Garvin, 2002; Pinkerton, 2003). Beginning with Vance in the 1980s to the present time, mentoring is a clear tool for leadership development in nursing (Galuska, 2012; Jakubik et al., 2011; Vance, 1982). Mentoring beyond orientation was a key recommendation suggested by novice nurses to enhance quality of work life (Maddalena, Kearney, & Adams, 2012). Experienced practitioners may benefit from mentoring to improve leadership skills and facilitate career progression (Harriss & Harriss, 2012; Lartey, Cummings, & Profetto‐McGrath, 2013; Latham, Ringl, & Hogan, 2011; Owens & Patton, 2003).

Research demonstrates the benefits of mentoring in nursing practice. However, replicable predictors of mentoring benefits have been limited. Prior to this study, Jakubik's studies among pediatric staff nurse protégés representing multiple healthcare organizations across 26 states demonstrated that quality was the single best predictor of mentoring benefits overshadowing other predictors including: length of employment/retention, mentoring type (formal versus informal), and mentoring quantity (Jakubik, 2007; Jakubik, 2008; Jakubik et al., 2011). Although there is strong evidence in the literature to support the benefits of mentoring, evidence on how to elicit those benefits through mentoring (i.e. mentoring practices) is lacking. It is, therefore, the purpose of this research to elicit the mentoring practices that will predict mentoring benefits. Health care organizations and the nursing profession are in need of a clear and consistent body of knowledge related to mentoring that identifies specific mentoring practices and benefits in nursing practice. Without solid evidence of specific mentoring practices and their associated benefits, it will be increasingly difficult to develop and gain support for effective mentoring initiatives that support nurses in their practice.

Mentoring Perspectives The argument is emerging in the literature for a mentoring paradigm shift in nursing from dyad to triad perspective. Studies demonstrate the value of a triad mentoring

Theoretical Framework The theoretical framework guiding this study was Zey's Mutual Benefits Model applied to nursing practice (Zey, 1991). Zey's model views mentoring as a triad relationship among the mentor, protégé, and the organization in which they work. According to this model, there are mentoring activities and benefits which occur for each member of the triad mentoring relationship. In Zey's model, the mentoring activities and related mentoring benefits include: teaching

Mentoring practices benefiting (mentoring benefit = knowledge), supporting (mentoring benefit = personal growth), providing organizational intervention (mentoring benefit = protection), and sponsoring (mentoring benefit = career advancement). Jakubik applied Zey's model to nursing practice, adding two additional subscales, changing the term ‘activities’ to ‘practices’ and renamed Zey's original mentoring activities and benefits subscales using terminology that better reflects nursing practice (Jakubik, 2012; Jakubik et al., 2011; Zey, 1991). Jakubik's mentoring practices and associated benefits subscales include: welcoming (mentoring benefit = belonging), mapping the future (mentoring benefit = career optimism), teaching the job (mentoring benefit = competence), supporting the transition (mentoring benefit = professional growth), providing protection (mentoring benefit = security), and equipping for leadership (mentoring benefit = leadership readiness) (Figure 1). These six mentoring practices and benefits subscales were reflected in and measured by valid and reliable research instruments, the Mentoring Practices Inventory (MPI) and the Mentoring Benefits Inventory (MBI), each described in the instrumentation section of this article.

Operational Definitions ‘Mentoring in nursing’ is a career developmental relationship among an experienced nurse, a less experienced nurse, and the organization in which they work. It is intentional, long-term, and involves an experience differen-

Figure 1

3 tial (Jakubik, 2007; Jakubik, 2008; Jakubik et al., 2011). Mentoring in nursing involves specific mentoring practices (facilitated by the mentor) which are associated with six mentoring benefits for the protégé. A ‘nurse protégé’ is the hospital staff nurse who is the less experienced member of the mentoring relationship and whose professional development is the focus of the relationship (Jakubik, 2007). A ‘nurse mentor’ is an experienced nurse with professional knowledge, skills, and experience, who engages in a long-term relationship with a protégé aimed at the protégé's professional development through specific mentoring practices (Jakubik, 2008). ‘Mentoring practices’ are specific career developmental phenomena that are facilitated by the individual mentor. These practices, defined in Table 1, include: welcoming, mapping the future, teaching the job, supporting the transition, providing protection, and equipping for leadership. Mentoring practices are measured using the total score on the MPI (α = 0.97). ‘Mentoring benefits’ are positive outcomes of the mentoring relationship experienced by the protégé, the mentor, and/or the organization (Zey, 1991). For the purposes of this study, mentoring benefits were limited to those protégé and organizational benefits that are perceived by the protégé. These benefits, defined in Table 1, include: belonging, career optimism, competence, professional growth, security, and leadership readiness. Mentoring benefits are measured by the total score on the MBI (α = 0.98).

Hypothesized predictive and statistically confirmed relationships of mentoring practices on mentoring benefits.

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M.M. Weese et al. Table 1

Definitions of mentoring practices and benefits.

Mentoring Practices Welcoming: The mentor and unit/organization serve as hosts for the protégé in order for the protégé to learn about the unit/ organization and become incorporated into the unit/ organizational culture. Mapping the future: The mentor leads by example and shows the protégé the way for the future. The organization provides career paths to unlock the protégé's potential for career development. Teaching the job: The mentor teaches the protégé skills and information regarding his/her job, profession, career and organization. The unit/organization provides the context for a learning environment. Supporting the transition: The mentor supports the protégé in the development of confidence, communication skills, problem-solving skills, decision-making skills and an improved perception of the image of nursing. Providing protection: The mentor creates a favorable environment for the protégé's career development by working on behalf of the protégé to provide a supportive practice environment and conveying to the protégé that the mentor really cares about the protégé's success. Equipping for leadership: The mentor promotes opportunities for the protégé to lead others and to develop leadership abilities. Mentoring benefits Belonging: The protégé learns about unit/organization and becomes incorporated into the unit/organizational culture. Career optimism: This benefit is future-oriented. The protégé becomes engaged in and optimistic about plans for his/her career path. Competence: The protégé receives accurate information regarding his/her job, profession, career and the organization. The protégé demonstrates the ability to perform assigned functions. Professional growth: This benefit is focused on a positive perception of the image of nursing. The protégé develops confidence in taking on new challenges and demonstrates improved communication, problem-solving and decision-making skills. Security: Creating a favorable and supportive organizational environment for career development results in the protégé perceiving that someone works on his/her behalf to provide a supportive practice environment and that someone at work really cares about his/her success. Leadership readiness: Achievement of this benefit is demonstrated by the protégé's improved confidence in leadership abilities and actively seeking out opportunities to lead others.

staff nurse. In addition to the primary and secondary aims of this study, the researchers were interested in exploring the relationship between the subscales of mentoring practices and benefits. The hypothesized relationships of mentoring practices to mentoring benefits are shown in Figure 1.

Methods Study Design This is a descriptive, correlational, non-experimental research study using survey methodology.

Sample The sample for this study was a convenience sample of registered nurses at a Magnet® recognized, free-standing, pediatric hospital in northeast Ohio. The sample size required for this study was a minimum of 100 subjects who met the inclusion criteria. This sample size was determined using the Cohen power analysis table (Munro, 2005) and the identified p value of ≤ 0.05, a moderate effect size of 0.50, and a power of 0.80. A total of 1,477 nurses were invited to participate in the study. The total respondents were 329 (22% of the population sample) with a total sample of 186 (57% of respondents) nurses who met the inclusion criteria. Demographic characteristics of the respondents are displayed in Table 2.

Protection of Human Subjects The study was reviewed by the Institutional Review Board (IRB) at the study site prior to conducting the study. A waiver of consent was approved, as adult nurse participants were informed that completion and submission of the electronic survey implied consent for the responses to be included in the study data analysis. This study was an anonymous electronic survey with no identifying information to link respondents to the data being collected. Confidentiality was maintained as study data was reported in the aggregate with no personal identifiers. Participant incentives included the opportunity to enter a raffle to win one of ten $25.00 gift cards, and the opportunity to include participation in the study to meet the requirements of the study site's nursing career ladder.

Inclusion and Exclusion Criteria

Study Purpose The primary aim of the study was to determine if mentoring practices predict mentoring benefits. The secondary aim of the study was to determine if there is a higher frequency of mentoring by nurses who were mentored as a staff nurse compared to nurses who were not mentored as a

Criteria for inclusion in the study were: current employment at the study site, a minimum of one year experience as a registered nurse, and self-identified experience as a pediatric staff nurse protégé in a mentoring relationship occurring at the study site. Exclusion criteria were: nurses engaged in mentoring relationships in which the protégé and mentor work for different organizations, nurses engaged in

Mentoring practices benefiting Table 2

5

Demographic characteristics.

Characteristic Current licensure RN CRNP or CRNA Missing data Age in years b 30 years 30–39 years 40–49 years 50–59 years N 60 years Gender Female Male Work setting Outpatient Inpatient Combination of outpatient and inpatient Position Staff nurse Nurse supervisor, charge nurse or administrator Nursing development or education Other

n

%

168 90.3 15 8.1 3 1.6 31 39 55 48 13

16.6 21.0 29.6 25.8 7.0

email reminded potential subjects to print their survey completion certificate with their name on it in order to enroll in a raffle drawing for one of ten $25.00 gift cards and the opportunity to include participation in the study to meet the requirements of the study site's nursing career ladder. The third electronic mailing, thank you/reminder, was intended to remind the participants to complete the research instruments and was emailed between five business days after the second contact, or two weeks after the initial contact. The fourth and final electronic mailing was sent four weeks after the initial contact. It contained the electronic link to the research instruments and informed the respondents that this was the final contact.

179 96.0 7 4.0 38 20.0 123 66.0 25 14.0 112 60.2 37 19.9 12 6.5 25 13.4

Instrumentation The online survey contained demographic items, items on mentoring experiences, and two valid and reliable instruments, the MPI and MBI. The MPI measured the independent variable, mentoring practices, and the MBI measured the dependent variable, mentoring benefits.

MPI mentoring relationships as a mentor rather than a protégé, and protégés in roles other than pediatric staff nurse during the time of the mentoring relationship. Nurses were encouraged to participate in the mentoring study whether or not they had been mentored in a mentoring relationship as a pediatric staff nurse protégé. Nurses were asked a series of items at the start of the survey that determined their eligibility to participate, and provided data on the number of nurses who had and had not been mentors and the number of nurses who were and were not mentored as a staff nurse.

Data Collection Methods The researchers recruited subjects during one month, using electronic distribution of the data collection instrument to invite registered nurses on the hospital's email address list to participate in the study. In accordance with the Dillman “Tailored Design Method” for distribution of the electronic survey, the study included a series of four emails with follow up supporting survey completion and return. (Dillman, Smyth & Christian, 2009). The first contact, the pre-notice email, highlighted the importance of participation. Respondents who did not meet the study criteria were identified by their responses to select items and routed to a disqualification page thanking them for their willingness to participate. The second contact, a letter of invitation email, was sent five business days after the pre-notice letter and included the study aim, importance of participation and a link to the electronic survey (Dillman, Smyth, & Christian, 2009). This

The MPI is a 36-item instrument developed in 2011. It was validated using panels of seven expert judges representing the nursing academic community, hospital nursing administration, and nursing practice in two separate rounds of validation judging to reduce the instrument from 200 items to 72 items (36 individual items and 36 organizational items). The instrument was later tested for reliability in a pilot test (N = 72) in 2011 with a Cronbach's alpha of 0.97 for the individual MPI items and 0.98 for the organizational MPI items. In 2012, the MPI was reduced to 36 individual items in order to focus the instrument solely on individual mentoring practices. In the current study (n = 186) the MPI had a Cronbach's alpha of 0.98.

MBI The MBI was originally called the Jakubik Mentoring Benefits Questionnaire (MBQ). The MBQ was a 57-item instrument developed in 2006 that was used in previous studies where it was deemed overly lengthy (Jakubik, 2007; Jakubik et al., 2011). Validation of the tool was conducted by a panel of six expert judges representing the nursing academic community, hospital nursing administration, and nursing practice. The content validity index for the 57-item tool was 0.96. A major academic children's hospital in the northeastern United States served as the site for a reliability testing pilot study (N = 11) with a Cronbach's alpha internal consistency reliability of 0.99. Following initial content validation and reliability testing in the pilot study,

6 (representing 10% of the subjects required to conduct the first of three research studies using the MBI) the instrument was then used in national studies of pediatric nurses (Jakubik, 2007) with N = 93 and N = 214, respectively, and one study of pediatric nurses at a single children's hospital (Jakubik et al., 2011) with N = 139. The instrument demonstrated good psychometric properties with a Cronbach's alpha internal consistency reliability of greater than 0.96 in previous studies (Jakubik, 2007; Jakubik et al., 2011). In each of the aforementioned studies, all item-to-total correlations were positive and greater than 0.20. After factor analysis was performed, the original MBQ instrument was reduced to 36 items with each factor containing 6 items and a final Cronbach's alpha of 0.97 (Jakubik, 2012) and was renamed the MBI. In the current study, the MBI had a Cronbach's alpha of 0.98 (N = 186).

Data Analysis The Statistical Package for the Social Sciences (SPSS) IBM Statistics, Version 19 and SAS, Version 9.3 were used to input and analyze the data using descriptive and inferential statistics, Pearson correlation analysis and multiple regression analyses. A biostatistician provided statistical consultation for data analysis.

Results Mentoring Experiences The mean number of years spent in a mentoring relationship was 4.3, while the median number of years was 1.0. Eleven survey items providing data on mentoring experiences of the participants are summarized in Table 3. Ninety-six percent (n = 171) of the participants reported having been mentored by a nurse as a pediatric staff nurse protégé. Eighty-one percent (n = 151) of those meeting inclusion criteria who reported being mentored in this study became a mentor to a pediatric staff nurse protégé. With regard to the timing of the mentoring relationship, 20% (n = 37) reported that their mentoring relationship was still ongoing, while 33% (n = 62) reported that their mentoring relationship ended 10 or more years ago. For the remaining 47% (n = 70), their mentoring relationship ended sometime between one and nine years ago. The type of mentoring was fairly evenly divided between formal and informal mentoring. Thirty-four percent (n = 64) indicated that their relationship was formally established through the workplace, while 28% (n = 52) indicated that their relationship was informally established. Thirty-five percent (n = 69) indicated that they had both formal and informal mentoring relationships. Sixty-eight percent of nurses (n = 126) were assigned to their mentor, while 26% of nurses (n = 49) self-selected their mentor.

M.M. Weese et al. Table 3

Mentoring experiences of respondents.

Mentoring experiences

n

%

Reported being mentored by another nurse Reported an ongoing mentoring relationship Mentoring relationship ended 1 to 9 years ago Mentoring relationship ended 10 years or more ago Formal workplace established mentorship Informally established mentorship Experienced both formal and informal mentorship Reported an assigned mentor Self-selected a mentor Became a mentor to another nurse Reported mentoring another nurse regardless of if they were mentored

171 37 70 62 64 52 69 126 49 151 166

96.0 20.0 47.0 33.0 34.0 28.0 35.0 68.0 26.0 81.0 89.0

Study Aim One The research hypothesis that mentoring practices predict mentoring benefits was supported. There was a strong positive relationship between mentoring practices and mentoring benefits. The correlation between total mentoring practices and total mentoring benefits was 0.89 (p b 0.01). Furthermore the coefficient of determination was r2 = 0.79, which means that 79% of the variation in mentoring benefits can be explained by the variation in mentoring practices. The study hypothesis was analyzed using stepwise linear regression analysis, which revealed an overall R = 0.889 with 79% of the variance in mentoring benefits explained by mentoring practices (p b 0.0001). Mentoring practices were positively and significantly associated with mentoring benefits (unstandardized beta = 0.81, p b 0.001). For every unit increase in practices, a 0.81 unit increase in benefits is expected.

Study Aim Two To determine whether or not there was a higher frequency of mentoring by nurses who were mentored as a staff nurse compared to nurses who were not mentored as a staff nurse, respondents were first asked if they had been a mentor previously to a staff nurse prior to being asked the study's main inclusion question regarding whether or not they had been mentored as a pediatric staff nurse. A crosstab/ chi-square statistic was not significantly different for the two groups. This may be explained by the skewed cell sizes between the two groups, as most study respondents reported being mentored (94%; n = 221), and therefore, the non-mentored group for comparison (6%; n = 15) was small. While the comparison of mentored versus non-mentored groups of nurses did not yield data useful for understanding the influence of being mentored on becoming a mentor, there was an additional study item which asked the extent to which being a staff nurse protégé influenced one's decision to become a mentor. The mean score for this item was 3.71 (range 1–5), indicating that being a staff nurse protégé had a

Mentoring practices benefiting positive influence on becoming a mentor. A majority of this study's sample of mentored nurses reported becoming a mentor themselves [81% (n = 151)] and, 66% of nurses (n = 121) indicated that mentoring had a somewhat or very strong influence on their decision to become a mentor.

Relationship Between Subscales of Mentoring Practices and Mentoring Benefits In addition to the primary and secondary aims of this study, the researchers were interested in exploring the relationship between the subscales of mentoring practices and benefits. Multiple regression analyses were conducted to further examine the relationship between the mentoring practices and mentoring benefits. All six mentoring practices were entered using the stepwise method with inclusion criteria of 0.05 and exclusion of 0.10. For the benefit competence, two practices were significant predictors; teaching the job and providing protection, F(2,183) = 224.04, p = 0 .000. Four of the six practices were predictive of a sense of career optimism: equipping for leadership, mapping the future, teaching the job, and welcoming, F(4,181), = 137.7, p = 0.000. There were two significant predictors for security, providing protection and equipping for leadership, F(2,183) = 311.98, p = 0.000. Professional growth had three significant predictors: supporting the transition, teaching the job, and equipping for leadership, F(3,182) = 173.38, p = 0.000. There were also three predictive practices for belonging: teaching the job, equipping for leadership, and welcoming, F(3,182) = 89.99, p = 0.000. Finally, there was only one practice predictive of leadership readiness, that of equipping for leadership, F(1,184), 243.47, p = 0.000. Regression results are summarized in Table 4.

7 Table 4 Regression analysis summary for mentoring practices effect on mentoring benefits. Variable Benefit: belonging Teaching the job Equipping for leadership Welcoming Note: Adjusted R2 = .591 (N = 185, p = .049) Benefit: career optimism Equipping for leadership Mapping the future Teaching the job Welcoming Note: Adjusted R2 = .747 (N = 185, p = .003) Benefit: competence Teaching the job Providing protection Note: Adjusted R2 = .707 (N = 185, p = .000) Benefit: professional growth Supporting the transition Teaching the job Equipping for leadership Note: Adjusted R2 = .737 (N = 185, p = .000) Benefit: security Providing protection Equipping for leadership Note: Adjusted R2 = .771 (N = 185, p = .000) Benefit: leadership readiness Equipping for leadership Note: Adjusted R2 = .567 (N = 185, p = .000)

B

SEB

Β

.308 .217 .201

.110 .054 .102

.315 .298 .217

.401 .291 .411 .276

.081 .071 .109 .092

.561 .305 .366 .260

.535 .257

.081 .071

.561 .305

.197 .394 .232

.094 .082 .053

.211 .393 .311

.617 .285

.059 .050

.598 .327

.621

.040

.755

Discussion This study is the first of its kind to operationalize mentoring practices and demonstrate that specific mentoring practices predict specific mentoring benefits using valid and reliable research instruments. This research illuminated and quantified the specific mentoring practices, which predict specific mentoring benefits in nursing practice. This study has contributed to nursing science evidence of how mentoring benefits can be elicited in nursing practice.

Practices and Benefits The six mentoring practices were statistically shown to predict the hypothesized associated mentoring benefits. Figure 1 provides the statistically confirmed relationships. Five mentoring benefits (belonging, career optimism, professional growth, competence, and security) were statistically

predicted by more than one mentoring practice. Interestingly, the mentoring practice ‘equipping for leadership’ predicted five mentoring benefits (Figure 2). These findings suggest a need to further explore and modify the beginnings of Jakubik's theory of nurse mentoring benefits, moving from theoretical to statistically confirmed relationships among mentoring practices and benefits. Additionally, these findings suggest that mentoring initiatives should consider the strong role of the mentoring practice ‘equipping for leadership’ in predicting overall mentoring benefits. During a time in healthcare when nursing leaders are needed to transform care and care delivery, it is interesting and practically significant that this research study demonstrated that ‘equipping for leadership’ was the most prevalent mentoring practice promoting the benefits of mentoring. This finding suggests that there is a connection between the science of developing people through mentoring and the science of leadership development. Further research is needed to explore this finding.

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M.M. Weese et al.

Figure 2

Mentoring benefits predicted by equipping for leadership mentoring practice.

Mentoring Perspectives

Research Context and Future Research

This study reinforced Jakubik's application of Zey's mentoring model to nursing practice (Jakubik, 2007). These study findings support the two traditional roles in a dyad mentoring relationship, ‘teaching’ and ‘supporting’. The ‘teaching’ mentoring practice predicted the mentoring benefits of competence, career optimism, professional growth, and belonging. The ‘supporting’ mentoring practice was statistically confirmed as a significant predictor for professional growth. These findings uphold the traditional dyad (protégé and mentor) paradigm of mentoring in nursing, which focuses almost exclusively on the teaching and supporting roles of nurse mentors. Additionally, the study supports the organizational mentoring benefits (security and leadership readiness) consistent with the triad (protégé, mentor, and organization) rather than dyad perspective of mentoring. These findings support a paradigm shift in nurse mentoring from dyad to triad perspective (Jakubik, 2007; Jakubik, 2008). The advantage of a triad perspective of mentoring is that it moves beyond individual benefits of mentoring (competence and professional growth) to include the organizational benefits of mentoring (security and leadership readiness) (Jakubik, 2007; Jakubik, 2008).

The overall findings of this study were also reflected in the preliminary results of two concurrent studies: 1) a children's hospital in the southwest (n = 126); and 2) pediatric nurse journal subscribers and professional organization members (n = 100). These three studies were conducted concurrently to gather data for factor analysis of the MPI and to assess whether different samples would have similar results. Mentoring practices significantly predicted mentoring benefits in all studies (Jakubik & Weese, 2014). Furthermore, the statistically confirmed relationships between specific mentoring practices (teaching, protecting, and equipping) and mentoring benefits (competence, security, and leadership readiness) were the same in the three studies. This study serves as the basis for evidence-based mentoring initiatives that can be implemented and studied using an action research approach. The findings of this study should be extended to include mentoring intervention research studies based on application of these study results and use of the MPI and MBI instruments. For example, use of the MPI and MBI to conduct a unit or organization gap analysis to identify the area(s) of focus to meet unit or organizational goals. This next step is crucial to providing mentoring for nurse protégés that is based on scientific evidence. Future research must include replication studies in other populations to determine if these findings are replicable outside of pediatric nursing. Populations of non-pediatric nurses for future study could include medical-surgical, critical care, ambulatory, and surgical services. Focused studies could be conducted looking at sub-specialties within pediatric nursing associated with high turn-over rates particularly pediatric critical care, pediatric emergency, and pediatric surgical services. Comparing pediatric and non-pediatric nurses and facilities with and without Magnet® recognition status is also warranted. Additionally, further examination of the psychometric properties of the MPI should include factor analysis to determine its statistically confirmed subscales. The development of an evidence-based model for nurse mentoring could be developed through the examination of the relationships between the practices and benefits subscales in the newly refined MPI and MBI instruments.

Mentoring Begets Mentoring This study demonstrated that those who are mentored become mentors. In the current study, 66% of nurses (n = 121) indicated that mentoring had a somewhat or very strong influence on their decision to become a mentor. Furthermore, 81% of the study respondents actually went on to become mentors to pediatric staff nurses. These findings are consistent with previous studies which demonstrated the high rate of mentoring among those nurses who were previously mentored (Jakubik, 2008; Jakubik et al., 2011). Unfortunately, the researchers in this study were unable to make comparisons about the mentored versus non-mentored nurses due to the high overall rate of mentoring at the study site. This finding alone suggests that the mentoring acts as an intensifying force to produce more mentoring.

Mentoring practices benefiting Lastly, future research is needed to further explore the impact of being mentored on becoming a mentor. The relatively low rates of non-mentored respondents in this study prevented exploration of the differences in rates of becoming a nurse mentor between the mentored and non-mentored groups of nurses.

Limitations This study was conducted in a single Magnet® recognized, free-standing, pediatric hospital in northeast Ohio, and responses indicated a high frequency of mentored (n = 171) versus non-mentored (n = 12) pediatric nurses. The high rate of mentoring in this particular organization precluded the researchers from identifying a group of non-mentored nurses to provide data to address study aim #2 regarding whether there is a difference in the rates of becoming mentors between mentored nurses and non-mentored nurses. A higher response rate may have increased the imbalance between mentored and non-mentored groups. Although the minimum sample size of 100 subjects was surpassed, the response rate of 22% fell below the investigators' target of 30% and is below the 58% and 48% response rates of previous surveys (Jakubik, 2008; Jakubik, et al., 2011). While the high rate of mentoring might suggest a biased sample, the findings in these studies were replicated in two concurrent national studies (Jakubik & Weese, 2014).

Implications for Practice This study extends nursing science by operationalizing measures of specific mentoring practices that predict mentoring benefits with the use of valid and reliable instruments. The findings provide mentoring practices that can be intentionally applied and measures to determine if specific, desired benefits are achieved. Application of these research findings in the workplace provides tools for evaluating the presence of mentoring practices and benefits. While this study was not an intervention study, it suggests specific practices and benefits that could be taught and replicated in clinical practice to promote the benefits of mentoring for individual nurses and the organizations in which they work.

Conclusion As a result of this study, specific practices on how to mentor are now known. This evidence supports the value of mentoring and associated outcomes. Provision of concrete, teachable and measurable mentoring practices, and resulting mentoring benefits reinforces the paradigm shift from the dyad to triad perspective of mentoring. Outcomes of this

9 study lay the groundwork for creating a mentoring culture in nursing practice that demonstrates a structurally empowering work environment of a Magnet® organization.

Acknowledgments This study was supported in part by a research grant from the Delta Omega Chapter of Sigma Theta Tau International. The authors would like to thank Jean Frisone, BSN, RN, and Denise Page, BSN, RN for serving as members of the study team; Lillian Prince, MS, Biostatistician, Rebecca D. Considine Research Center, Amy E. Leader, DrPH, MPH and Dr. Deb Shelestak, PhD, RN for assistance with data analysis; and the Nursing Research Center, Rebecca D. Considine Research Institute, Akron Children's Hospital for study support.

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