Introduction
Over the next five years, the nationwide shortage of nurses is predicted to increase as the aging nurse workforce begins to retire while baby boomers will, simultaneously, require considerable health care resources and thus nursing care (U.S. Department of Health and Human Services, 2007). The demand for nurses is rising, while increases in supply lag behind (Saver, 2006). The education of nurses to meet the workforce demands makes it imperative that we examine methods to support retention and progression of nursing students enrolled in our programs. Considerable resources are expended to recruit qualified students into nursing programs and later into healthcare organizations. Retention of these valuable members to the nursing profession should be a priority. With attrition rates in most nursing programs nationwide ranging from 30-50%, nursing faculty and institutions of higher education are faced with a growing need to develop effective programs and strategies that promote student success until graduation and beyond (Colalillo, 2007). These measures are necessary to mitigate the adverse psychological effects on students as well as financial costs to students, institutions of higher learning and society (Jeffreys, 2004). Additionally, measures to support new nurse graduates are needed as they transition to the professional nurse workforce where statistics indicate that turnover rates can reach 35-60% (Beecroft, Kunzman & Krozek, 2001).
Background
Undergraduate nursing student retention is a complex multidimensional, dynamic process that is influenced by many factors (Jeffreys, 2004). Students enter nursing programs with varying academic, personal and environmental factors that impact on their ability to succeed (Jeffreys, 2004). The community college has long been viewed as a doorway of opportunity for nontraditional students including those from immigrant populations, older students and those seeking a second career (Colalillo, 2007). The nontraditional student is quickly replacing the traditional student in nursing, most evident in community colleges (Shelton, 2000). This has resulted in a more diverse pool of nursing program applicants including those from underrepresented groups where Limited English Proficiency (LEP) is prevalent. Typically, the retention rates of nontraditional students are substantially lower than those of traditional students (Jeffreys, 2004). Moreover, nursing is dependent on accurate verbal and written skills for exchanging vital data. Attrition of nursing students from underrepresented groups especially with LEP remains problematically high due to becoming discouraged from academic problems directly related to language issues (Klisch, 2000; Guhde, 2003).
The challenge of graduating qualified students and boosting the nursing workforce emphasizes the need to continually assess, monitor and evaluate factors that influence student retention and progression and utilize the information to inform policy, pedagogy and practice to promote student success. Successful, qualified graduates must be nurtured to remain in nursing. One practice that has received considerable attention over the past few years is the role of mentoring in fostering success and retention in nursing. The creation of a comprehensive mentoring program in the department of nursing at a diverse, multicultural, urban community college grew out of an effort to provide a resource for nursing students and new nursing graduates to promote perceptions of confidence as well as provide a social support network to foster retention in a demanding and stressful academic program. The outcomes of the mentoring effort will be discussed along with the challenges and rewards of recruiting peer mentors and sustaining an ongoing mentoring assistance program.
Review of the literature
Retention in higher education has been widely reviewed and studied and the literature contains numerous proposed models that reflect the complexities of student persistence and success (Alvarez & Abriam-Yago, 1993; Bean & Eaton, 2001; Cameron-Buccheri & Trygstad, 1989; Pascarella, Smart & Ethington, 1986). Tinto (1975) found that both academic and social integration were important in increasing the likelihood of retention. The findings, supported the premise that the stronger the academic and social integration, the less likely the student will voluntarily withdraw (Tinto, 1975).
Bean and Metzner (1985) first identified and defined the older, part-time, commuter student citing differences in the attrition process between these nontraditional students and their traditional counterparts. The interaction of three variables including student characteristics, academic and environmental variables determines academic and psychological outcomes which in turn influence persistence in college and retention (Bean & Metzner, 1985, p. 493). Nontraditional students tend to interact less with the collegiate environment and more with the environment external to the institution than do traditional students (Bean & Metzner, 1985; Napoli & Wortman, 1993, 1998). Financial disposition and family responsibilities create role conflict resulting in psychological stress (Jeffreys, 1998, 2001). Family responsibilities and family crisis was most often cited as severely or moderately restricting both academic achievement and retention (Jeffreys, 2001). Therefore, many nursing programs, particularly at the community college level whose student body consists predominantly of nontraditional students, must anticipate their needs and develop early interventions that support students academically and psychologically (Brown, 1987; Colalillo, 2007).
Undergraduate nursing student retention was specifically addressed by Jeffreys (2004) with the development of a model that addresses both traditional and nontraditional nursing students. This model regards nursing as set apart from other disciplines such as liberal arts and sciences in that a high level of accuracy and high standards in performance are required in the profession. Contemporary nontraditional nursing students are identified as meeting one or more of the following criteria: age 25 years or older, enrolled part-time, male, speaks English as a second language, member of an ethnic or racial minority group, has dependent children, holds a general equivalency diploma and require remedial classes (Jeffreys, 2004 p.7). The rigors and demands of the nursing curriculum tend to raise anxiety and stress levels of most students even those with good academic standing (Colalillo, 2007). An added dimension to nursing is the expectation of nursing students to develop an understanding of their evolving professional identity. This is vitally important in retaining nursing students and keeping graduates in the profession. However, assuming and maintaining this professional identity can be difficult for students with little exposure to and inaccurate perception of the role of the professional nurse (Harvey & McMurray, 1997).
Jeffreys (2004) identifies the interaction within the context of the profession (nursing) and career development as holding as much importance as the interaction within the social system of the college environment. For students to maintain the desire to persist and fulfill their goals, professional integration factors need to be nurtured. Early conceptualization of an identity in nursing may contribute to student success and persistence in nursing (Cook, Gilmer & Bess, 2003). “As proposed by Bean and Metzner (1985), nonacademic factors may compensate for low levels of academic success, yet high levels of academic success result in persistence and continued enrollment only when accompanied by positive psychological outcomes” (Jeffreys, 2004, p. 124). Therefore, successful academic performance accompanied by positive psychological outcomes (perceived attitudes about college, utility of the program to career goals and satisfaction) fosters the ability to persist, whereas poor integration into the profession along with poor psychological outcomes may lead to early departure (Jeffreys, 2001 p.143). The extent to which students are involved in their own educational process is a good predictor of graduation and academic achievement (Astin, 1977, 1984; Jacobi, 1991). Student participation in programs designed to promote involvement in learning, such as freshman workshops and senior seminar series, create a path for academic success. Based on these concepts, the key elements to facilitating student retention are student integration into the educational program and the reciprocal commitment of faculty to students and student to program (Jeffreys, 2002).
Strategies for promoting retention and success include culturally congruent nursing faculty advisement and assistance, enhancing student opportunities for participation in professional events and membership, promoting positive and productive peer partnerships, enrichment programs and student resource centers (Jeffreys, 2004). Mentoring is one such enrichment strategy that is gaining popularity in many practice-based professions including medicine, law, business, psychology, education and nursing (Jacobi, 1991; Andrews & Wallis, 1999).
Much of the literature in regard to mentoring is concerned with definitions of the concept and determinants of the nature of the mentoring role but there is lack of agreement on both the definition of the role and the function of the mentor (Andrews & Wallis, 1999). In addition, the literature reveals disagreement about the congruency of the characteristics of the mentor in relation to the protégé (Jacobi, 1991). Some of the characteristics in question are the age of the mentor to the protégé, duration of the mentoring relationship and the importance of gender or ethnic similarity between mentors and protégés (Jacobi, 1991). Rice & Brown (1990) points to a “growing interest in higher education in using undergraduate students as peer mentors which discounts the importance of age differences between mentors and protégés” (Jacobi, 1991 p.511). Recommendations for the length of the mentoring relationship vary widely in the literature from as short as a brief encounter to as long as 10 years (Jacobi, 1991). The literature has been noted to describe mentoring programs that serve students during their first year in college (Johnson, 1989). Much of the descriptive and theoretical literature points to the effectiveness of cross-race or cross gender relationships (Jacobi, 1991). While higher education literature is divided about this issue, many programs in practice strive to pair students with a mentor from their own gender or ethnic background (Meznek, McGrath & Garcia, 1989; Johnson, 1989; Jacobi, 1991). However, there is no evidence suggesting cross-sex or cross-race pairs to be completely unworkable (Jacobi, 1991)
The literature predominantly reflects mentoring in a positive light despite empirical evidence that mentoring actually improves academic outcomes (Andrews & Wallis, 1999). Faculty have the ability to influence student success by demonstrating psychologically supportive behaviors such as caring, encouraging, demonstrating interest, and listening, or functionally supportive behaviors such as problem solving, planning, providing feedback and role modeling (Shelton, 2000). Earnshaw (1995) examined mentoring from the student’s perspective who viewed mentors as having a significant role in their clinical learning. Many of the students highlighted the importance and influence of role modeling in their interactions (Andrews & Wallis, 1999). Students progressing from the pre-nursing sequence of courses to the more intense clinical courses need transitional interventions to assist in adaptation to the course load and rotation schedules and to begin the process of socialization into the profession. Colalillo (2007) found that students who participated in a formal, structured mentoring program during their first clinical nursing course showed improvement in pass rate and progression rate by 6-11% overall when the intervention was applied (p. 32). In addition, participation in mentoring resulted in improved psychological outcomes (increased confidence, goal achievement and stress reduction) (Colalillo, 2007). The study, which involved first semester nursing students in an associate degree program where the nontraditional student predominates, illuminates the need for a more comprehensive and multifaceted approach for promoting student success at all levels of academic, social and professional development.
Method
In an effort to improve graduation rates of students enrolled in the nursing program at Queensborough Community College and provide a bridge for transition into the role of the profession, the faculty saw a need to sustain mentoring strategies across the entire curriculum and tailor each strategy appropriately to the level of student development and need.
The various phases of the comprehensive mentoring program include: Level I - The Introduction to Nursing Program Student Orientation and a six session faculty led mentoring program for all first semester nursing students, to foster the development of critical learning skills required at the college level. Level II – Peer mentor assistance program, which is available to all intermediate level students. Level III – Peer mentor leadership and graduate seminar series which is available for all senior level students.
As reported earlier, outcomes of the Level I intervention included a 6-11% improvement in attrition rates in those first semester nursing students who participated as compared to a similar demographic group of those at the institution who did not (Colalillo, 2007). The Level II intervention of peer mentor assistance was a response to the continured poor attrition rates of near 50% in the second semester nursing student at the institution (Colalillo, 2007; QCC Nursing Faculty, 2004). In 2006, second semester nursing students were first recruited for participation in a peer mentoring assistance program to help them navigate the intensity of the second semester nursing course. The purpose of the Peer Mentor Assistance Program was to provide a “helping hand” in which mentees could benefit from contact with a nursing student (mentor) who had successfully passed the second semester and was familiar with the requirements needed to be successful. Due to the nature of the community college student lifestyle, peer mentor relationships were envisioned as flexible. Contact was done through “in person” meetings, telephone or email. Feedback from early program participants led to the development of an introductory “Meet-and-Greet” early in the semester between interested mentees and mentors to provide an opportunity for an initial face- to-face meeting. This was coordinated with the Student Nurse Association to be held during one Club Hour Session. While attrition rates did improve for the second semester student, several other factors, such as consistent tutoring sessions and faculty led review sessions, may have contributed to this improvement. However, 98% of surveyed second semester nursing student mentees reported positive responses to the value of a senior peer mentor (Reilly, 2007).
The Level III Intervention was a Peer Mentor Leadership Program and Senior Seminar Series. Senior level nursing students were recruited to become Peer Mentors by asking them to “Dare to Care” about their junior colleagues. An information flyer was distributed and a talk was given by the Faculty Facilitator to all senior level classes. Interested students were invited to attend an information and training workshop where prepared materials about mentorship were provided and discussed. Emphasis was placed on the mentoring relationship as one who provides support and assistance and not tutoring. Faculty facilitators believed that tutoring could be provided through other resources and that mentors could be recruited more easily if they understood that enormous amounts of time, such as might be needed with tutoring, would not be required. Students were invited to a Meet-and-Greet session where mentor-mentee partnerships often self-selected. Remaining students were partnered by faculty facilitators. Mentors were asked to update the faculty facilitators periodically throughout the semester or immediately if problems developed and a “Wrap-up” session was conducted at the end of the semester to discuss the positive as well as the negative factors of the program. Mentors reported positive psychological outcomes of the experience. Some of the comments that attested to this were, “I realized I had gained some knowledge after all”, “I was respected and looked up to”, and “Nursing school is tough, so it is very easy to take care of only myself; however, through being a mentor, I could overcome myself and realized even in the most difficult time, I still could help others” (Reilly, 2007). As a reward for volunteering their time, these senior level peer mentors were invited to attend a “Meet the Graduates” forum at which, as the newest graduates, they could interact with nursing program graduates of the institution who were invited “home” to share their experiences and advice to the newest graduates. This forum was held after the semester was formally concluded and exams were over but prior to the sitting for the NCLEX licensing exam by the newest graduates. These sessions were often poignant and inspiring as working graduates shared their struggles and adjustments to the reality of the “Real World of Nursing” with the graduating senior students, 100% of whom found this to be a valuable experience (Reilly, 2007).
Another component of the Level III intervention was a series of Senior Seminars for the senior level students at which various speakers from the community were invited to address the students on pertinent topics that the faculty deemed important for senior level graduating students and necessary for professional development. Some of these topics included preparation for a job search, managing stress, transitioning to a new role, and integrative examinations of patient care situations. Ninety-seven percent of the 78 nursing students that participated agreed or strongly agreed that the presentations were useful (Reilly, 2007). Future expansion of the Peer Mentoring Program includes the development of a Blog for graduates to remain in contact and provide resources regarding employment and possible solutions for resolution of problems in the work environment. If successful, establishment of a nursing student Blog is envisioned as another form of peer mentor assistance with appropriate oversight.
Conclusion
Persistence to graduation from a nursing program can be difficult even for accomplished students. Nontraditional students, the hallmark of community college enrollment can find the challenges daunting. In this period of nursing shortages, faculty must implement interventions that can assist students to successful achievement of their goals. Faceted mentoring programs can be one strategy by which students can receive valuable support from peers in similar settings and offer opportunities for development of leadership and a lifelong affinity for caring and sharing.
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