Mentorship in Advanced Practice Nursing

“I work with children too, but I have not encountered anyone approaching them and their families as you do.” My mentee told me on her first day shadowing at the clinical site. She was a nurse practitioner (NP) student whom I was assigned to be a mentor for her clinical rotation. I was unsure which area of my interaction with the patient caught her attention. In this blog post, I will describe my narrative on mentoring, theoretical underpinnings, and mentoring strategies and conclude with the reward of mentorship.

Personal narrative on mentoring

My foundation in the nursing program, Bachelor of Science in Nursing (BSN), comes from Nepal. My undergraduate nursing college incorporated American nursing education standards with a problem-based learning approach. However, my education system was rooted in British until high school. The BSN curriculum was highly structured, and all students strictly followed the same curriculum. The mentor was considered a perfect role model in every aspect, and mentees were meant to follow them. Pursuing a Master of Science in Nursing (MSN) at the University of Texas Health Science Center Houston, I discovered that the educational system differed. I was surprised when the admission committee asked me to make my course plan for the degree and how long I wanted the program to be or, in other words, when I would like to graduate. I was given an academic advisor who was a mentor throughout my graduate school. Very soon, I was able to build a good relationship with my mentor, who helped me navigate through any educational barriers and made me familiar with the educational system. I have the notion of education thickly embedded in me, which could be from my upbringing. My parents were intensely focused on education. I remember walking down the graduation aisle after MSN and asking my friends, “So when are we coming back for Ph.D.?” my friends looked at me and laughed, saying, “I have not thought about that yet!”. When I started practicing, I knew I would teach and mentor students.

Theoretical Underpinning

The mentoring strategy I have developed throughout my practice expands the theoretical concept in Falk-Rafael’s “Critical Caring” health-promoting process of engaging in transpersonal teaching-learning. Dr. Rafael explains this process as “engaging in a genuine teaching-learning experience that attends to the unity of being and meaning attempting to stay within other’s frame of reference” (Falk-Rafael, 2005, p. 42). The graphic representation of the model is a metaphor for a tree. The roots are derived from Watson’s Caring Science. The trunk of the tree describes the critical caring theory as a way of being, knowing, and choosing. The five branches of the tree reflect different practices guided by the theory. These practices are: (a) using a systematic reflexive approach, (b) engaging in transpersonal teaching-learning, (c) providing, creating, and maintaining supportive and sustainable environments, (d) meeting needs and building capacity, (e ) being open and attending to any spiritual perspective.

TG was a nurse practitioner student whom I had an opportunity to mentor in a hospital-based urgent outpatient care pediatric clinic. I adopted the following teaching and learning steps in attempting to stay within my mentee’s frame of reference:

Step 1: Mentor & mentee orientation. Review the course requirements, learning objectives, policies, and protocols of the clinical setting where mentoring is performed. This helps the mentor and mentee be on the same page throughout the learning process. For example, TG learned the clinic policies, and I reviewed her educational objectives. In this way, we used a systematic reflexive approach to critical care theory by setting goals and preparing ourselves for teaching and learning.

Step 2: Encourage the mentee to develop what they are more passionate about learning out of the school curriculum during the mentorship. Example: TG was enthusiastic about learning suturing skills, so I kept that information in mind. I facilitated her to perform the skill whenever there was an opportunity. This process helped the mentor and mentee engage actively in teaching and learning.

Step 3: Create a worksheet that works for you and your mentee. I start my day collaborating with the mentee while taking patients. We select one topic for educational purposes when we see any compelling case. For example, if TG saw a patient with a head injury, I encouraged her to study the head injury and relate the history and physical findings with the patient she encountered. This way, the mentee can understand the physiological changes related to head injury and see how it applies to her advanced nursing practice. Utilizing knowledge and practice simultaneously promoted transpersonal teaching and learning, as described in critical care theory.

Step 4: Once the mentee has mastered the first half of the learning curve, I review the progress and add short-term goals on communication skills, bedside manners, prioritizing patient needs, and navigating complex family dynamics and working situations. TG helped me identify difficult family situations and facilitated reporting to child protective services when needed. In this process, both mentor and mentee provided, created and maintained supportive and sustainable environments.

Step 5: Becoming more independent and putting it all together. I encourage the mentee to perform clinical skills confidently and discuss the management plan with me. I involved TG in making a clinical decision and encouraged her to provide me with her recommendations. It helps the mentee to provide their input. We should always remember that there is always another way of doing things. Consult and participation between mentor and mentee can create better patient management. This step describes meeting the needs of the mentee and building the capacity of competency as a team.

Rewards

The reward in mentoring guided by Critical Caring theory is the feedback from the mentee- such as this feedback shared by Taisia Gates (with her permission):

“Before I met Kunta, I was working as a family nurse practitioner in pediatric urgent care for about four years at a small private urgent care. I decided to go back to school and get my pediatric acute care certification. Toward the end of my program, I was forced to do clinical in urgent care due to Covid restrictions. I felt that I would not learn anything as it was the job I had done for years. To my surprise, while working with Kunta, I learned numerous practices and patient care tactics that I continue to use to this day. Kunta was an amazing mentor who taught me compassion, patient advocacy, and impeccable bedside manner that I did not experience with other preceptors. She is very down-to-earth and approachable, which makes being in the student role much more enjoyable and fosters an environment for learning. I encourage Kunta to continue being a blessing to other students by being a mentor, preceptor, or teaching role. I feel that she was destined to be in that position. I personally believe that with her encouragement and positivity, I’ve become a better person and provider to the kids that I take care of every day. ”
Taesia Gates, MSN, FNP-C, CPNP-AC

Recently, I met Taesia in hospital scrubs at my regular work. She approached me and asked, “Ms. Kunta, do you remember me? You mentored me two years ago. I now work as an acute care Nurse Practitioner at the Emergency Department here at this hospital.” I was surprised to see her. She said, “You were very inspiring, and I was motivated to come back and work here.” This was a feeling that I could not measure in words. I am very proud of her accomplishment. My mentorship journey continues, and I take this as pride and honor to contribute to the profession in building the next generation of competent nurse practitioners. My rewards are my autonomous, substantial, and independent mentees, and my outcome is providing quality health care to patients by abiding by our core values in nursing.