Mentorship Matters: Understanding the Impact of Mentorship for Advanced Practice Providers

Friday, 26 July 2019

Deb L. White, MSN(ed)/MHA, RN1
Diane Nuñez, DNP, RN, ANP-BC1
Amanda Dean Martin, DNP, CENP, ACNP-BC, RNFA2
(1)College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
(2)Banner MD Anderson Cancer Center, Gilbert, AZ, USA

Providing care for aging, chronically-ill, and underserved populations are challenging existing healthcare provider shortages. The use of nurse practitioners (NPs) and physician assistants (PAs) is an established means to help address provider shortages (Ewing & Hinkley, 2013; Harrington, 2011; Hooker & Everett, 2012; Swan, Ferguson, Change, Larson, & Smaldone, 2015). Advanced practice provider (APP) is an inclusive term to describe both NPs and PAs whom are increasingly employed by healthcare organizations, yet do not receive adequate professional on-boarding support. Healthcare organizations have established orientation programs for recently hired registered nurses, including time-period adaptations for newly graduated nurses. Being relatively recent solutions to the provider gaps in the healthcare industry, APPs experience role ambiguity and are often without support from colleagues or organizations during times of transition (Harrington, 2011; Hooker & Everett, 2012; Hill & Sawatzky, 2011). This lack of support can lead to job dissatisfaction, high organizational turn-over rates, professional attrition, and gaps in patient care, either due to unfilled APP positions or poorly integrated providers; creating additional cost burdens for the nation’s already financially strained healthcare system (DeMilt, Fitzpatrick, & McNulty, 2010; Faraz, 2017; Harrington, 2011; Hill & Sawatzky, 2011; MacLellan, Levett-Jones, & Higgins, 2017).

The APP workforce is projected to increase by 30% for PAs and 130% for NPs by 2025 (Hoff, Carabetta, & Collinson, 2017; National Commission on Certification of Physician Assistants (NCCPA), 2017; Poghosyan, Liu, Shang, & D'Aunno, 2017). With approximately 30,000 APP graduates entering the workforce annually it is imperative that these providers receive robust on-boarding and support if they are to meet expectations of providing high-quality care to patients with chronic and complex health care problems and remain in their professional role (American Association of Nurse Practitioners, 2017; NCCPA, 2017; MacLellan et al., 2013). The Institute for Healthcare Improvement’s (IHI) Triple Aim initiative is a global framework to help organizations decrease cost, improve quality, and increase access of healthcare services for all populations (IHI, 2018). Expanding the Triple Aim by including clinician satisfaction acknowledges the impact that provider needs have on overall patient outcomes (Bodenhemer & Sinsky, 2014). To be on target with the Quadruple Aim organizations must minimize the unnecessary costs associated with low retention rates, inadequate system integration, provider and patient dissatisfaction, and failure to meet quality outcome standards.

A time-honored, integral means of support and quality onboarding in many industries is mentorship. This is a dynamic, evolving relationship between an experienced professional and a novice professional that promotes knowledge application, systems navigation, organizational socialization and personal role integration. A Japanese proverb states “better than a thousand days of diligent study is one day with a great mentor” (Pillemer & Rheaume, 2013). While one day is certainly not equivalent to years of study, the value of a great mentor in the application of didactic knowledge is under-recognized in healthcare. Moving from the expert registered nurse to novice NP or entering into healthcare for the first time as a PA, while navigating the nuances of independent advanced practice in a healthcare system based on the medical-model is challenging; requiring strong professional self-identity, social skills, and organizational support. These are facets that cannot be taught in a didactic fashion but must be learned and practiced under the guidance of a more experienced peer, known as a mentor (Hill & Sawatzky, 2011; Hooker et al., 2015; Horner, 2017; Manzi et al., 2017). Providers who have a strong professional self-identity and feel supported by an organization are much less likely to leave (Faraz, 2016; Gerhart, 2012; Hooker et al., 2015). While mentorship alone does not solve other factors of job satisfaction, such as autonomy, workloads, benefits, and work environment, mentors can help novice APPs gain the self-confidence needed for autonomy, provide practical advice on managing workloads, and provide an avenue to the socialization needed in the work environment (Faraz, 2016; Race & Skees, 2010).

Healthcare, particularly nursing, lags behind other industries such as teaching and business management when it comes to supporting and growing the next generation; as evidenced by the paucity of literature addressing mentorship in healthcare professions. A preliminary search of PubMed, Cochrane, and CINHAL databases revealed a limited number of articles (approx. 40), few of which were primary research, on NP mentoring. Expanding the search parameters to include nurses and PAs revealed a few more results (approx. 80). However, in comparison to the amount of results returned when searching mentorship in the fields of education, engineering, and management (over 1,600; greater than 56,000 if thesis and dissertations are included) it is apparent there is a research gap in APP mentorship. This project will expand on the limited existing studies regarding the associations between mentorship, turnover rates, and job satisfaction, as well as explore the desired and beneficial characteristics of quality mentors. Information obtained during the project will be used to propose methods to increase the quality and quantity of experienced APPs serving as mentors. If APP mentorship mirrors the effects of mentorship in other industries, job satisfaction and retention will increase, as will the quality of care provided by APPs. Strengthening these professional foundations will likely allow for improved patient outcomes and reduced healthcare spending; as APPs will be better equipped to achieve the Quadruple Aim, experience improved transition to practice, and be more likely to remain in their professional roles over time.