Mentors can mend the gap: solving the underemployment dilemma

A workforce shortage looms even as unemployment plagues the sector; greater commitment to teaching nurses at all levels new skills can address both problems.

Mentoring is underused in addressing nursing workforce challenges.

Australia’s healthcare system is facing an impending crisis, as increasing levels of chronic and complex disease combined with a rapidly ageing population. With nurses driving care and management of these types of diseases outside the acute setting, there is an urgent need to address recruitment and retention issues in the Australian primary healthcare nursing workforce.

There is expected to be an acute shortage in this workforce. Analysis conducted by (now defunct) Health Workforce Australia projected a significant shortfall of 27,000 nurses in the primary healthcare sector by 2025. Two of the reasons for this projected shortfall are high exit rates and low numbers of workforce entrants.

At the same time, there is an increasing rate of unemployment within the nursing profession overall. The Australian Institute of Health and Welfare states that 9100 RNs and midwives in Australia are unemployed – a 102 per cent increase since 2011. Many of these unemployed nurses are recent graduates.

The solution could be staring us in the face. Australian Primary Health Care Nurses Association (APNA) chief executive David Malone says better use of innovative strategies, such as mentoring, is imperative to address nursing care for an ageing Australia.

One of these strategies involves development of a mentorship program to support newly graduated and experienced Australian nurses transitioning into primary healthcare. Traditionally, transition-to-practice programs have focused on acute care, but there is considerable scope to extend this to primary healthcare.

In the British Journal of Nursing, author James Vinales defines mentoring as, “A process by which one person (the mentor) encourages another individual (mentee) to manage his or her own learning so that the mentee becomes self-reliant in the acquisition of new knowledge, skills and abilities, and develops a continuous motivation to do so.”

Involvement in mentorship and preceptorship is embedded in the competency standards for Australian RNs. Under part 4.3 of the Nursing and Midwifery Board of Australia’s National Competency Standards for the Registered Nurse, a nurse “participates where possible in preceptorship, coaching and mentoring to assist and develop colleagues”.

Review of national and international literature reveals that the terms ‘mentor’ and ‘preceptor’ are often used interchangeably; however, the terms have different meanings. Mentoring is generally regarded as guidance, while preceptorship is more about direct teaching and supervision. In a December 2012 review undertaken for the Victorian Government Department of Health, it was acknowledged that mentors are a key element of most early graduate programs for nurses, and that mentors should provide support that encourages and facilitates independent practice, development of decision-making skills, and clinical judgement.

What we need then, are appropriate resources and infrastructure to support the mentoring experience.

While most mentorship programs have focused on acute care, a program for graduate nurses to transition to primary healthcare has been described as a potential nursing workforce development and sustainability strategy. A 2014 study by Peter Mellor and Jennene Greenhill looked at three South Australian rural transition-to-practice programs in the 2008–09 year and concluded that graduate nurse transition programs need to have the physical and human resources necessary to deliver clinical support and ensure patient safety. It also highlighted the need for three essential core elements – leadership support, clinical supervision, and effective inter-professional relationships – to be incorporated in all transition-to-professional-practice programs.

In order for mentorship and preceptorship programs to be successful, APNA suggests a number of factors that should be incorporated into mentorship programs where possible:

• Adequate training and support for mentors
• Adequate preparation for mentees
• Sufficient protected/designed time for mentors to undertake their role
• Consistency in application of mentorship programs
• Incorporation of peer support mechanisms in programs
• Clarification of role and purpose of participants starting the program
• Having measures in place to address potential crisis points for nurses undergoing transition programs.

APNA is offering a transition-to-practice pilot program as part of the Nursing in Primary Health Care Program funded by the Australian Government Department of Health. The program is supporting up to 25 nurses who are transitioning to a variety of primary healthcare settings (e.g., correctional health, aged care, community, general practice), and their workplaces. These nurses, who may be either recently graduated or established nurses transitioning from acute-care settings, will be offered a range of support over 12 months, including self-directed learning modules and specified contact hours with their mentor. Workplaces will receive funding to ensure they can adequately invest in supporting the mentor-mentee connection. Tranche 1 of the program is underway. Tranche 2 commences in early 2017.

Elizabeth Stewart is project manager of chronic disease management and healthy ageing at APNA.

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