Nurses Experience of Mentorship: The experiences of mentorship to newly qualified nurses in the first year of clinical practice in university hospital, south wales

Introduction

The profession of nursing shows a great variance in perception between how it is viewed by laymen and how nursing care is delivered. This may be contributory to the education of nurses in general (Tichelaar et al., 2013). However one of the most important aspects remains how existing qualified nurses supervise the newly qualified ones. This educational relationship is what constitutes nursing mentorship (Jokelainen, 2013). The importance is that nursing mentors enable for the identification of nurse leaders and also for them to develop long term in an organisation. Besides this, it also constitutes to lowered turnover rates of nurses. . The implication thus remains, whether nursing mentorship does add value along with the rest of the curriculum in nursing practice for these novice nurses.

Even though there are many studies that have been conducted on mentorship in nursing, there persists a generalised misperception about what mentorship is for the students or newly qualified nurses in clinical practice (Bray & Nettleton, 2007). The main misperception they have relates to the extent of the role that mentors play in their development. Where most studies have been focused on the perspectives of the mentors, management and educators, little focus has been given to perceptions of the mentees where the perceptions between the two have been deemed to be existent (Mckinley, 2004). The study here thereby focuses on the lived experiences of mentorship of newly qualified nurses in the first year of clinical practice in university hospital, south wales- so as to explore the opinions of the mentees further and also to explore the mentor-mentee relationship to constitute to the existing body of literature.

Literature review

This section will discuss the findings of previous literature that explore the experiences of newly qualified nurses in clinical practice. The study by Maitland (2012) explores the importance of preceptorship. This refers to the support that is to be provided to newly qualified nurses in clinical practice. The study findings here revealed that the transition from a student to a practicing nurse in the clinical setting was in fact stressful. The study also further identified factors that constituted to this including mentors who were unsupportive, lack of time to spend with mentors, inadequate learning experience in the clinical setting and basic lack of knowledge of the work in clinical practice. The main weakness of this study is the small sample size and the lack of transferability. The strengths however remaining more insight offered on the impact of mentors on the new clinical nurses. This is in turn bears implication to the present study in that the same experience noted here cannot be transferred to the said population which warrants further research on the same.

The study by Maitland (2012) however, bears implication beyond the scope of preceptorship (which relates to the orientation of the new nurse after which they are passed on to the mentors) wherein it has been deemed that adequate mentorship is needed to overcome the issues faced by newly qualified nurses in clinical practice. In line with the above, Harper (2005) also attempted to explore the experiences of newly qualified nurses in a clinical setting. The study adopted a phenomenological qualitative design with the use of directional questions for the conduct of an interview. The study recruited eight registered nurses of which seven responses were analysed. The study in its findings has identified eight stressors that constitute to a difficult experience. These include high nurse patient ratios, inadequate time to spend with patients, brief periods of orientation, time management and lack of time to spend with their preceptors. Additionally, the study also identifies lack of support as the main factor with preceptors being considered valuable in the transition but advocating the need for better mentorship thereafter. The implication of these findings again are consistent in that the present study needs to explore the same in their setting, but however offers insight on mentorship as a whole. Another study by O’Shea and Kelly (2007) was conducted in Ireland that explores the lived experiences of newly qualified nurses in clinical practice. The study used a phenomenological, hermeneutic and Heideggerian approach. Of the ten responses that were analysed the analysis demonstrated that the nurses felt anxiety and reported many organisational and managerial defects warranting the need for better mentorship.

As evidenced above, while much of the studies indicate the need for better mentorship and some others the need for better learning and teaching in the education process, some others have reported the experiences of newly qualified nurses. However, the number of studies that have explored such an experience does not pertain to region of South Wales. . All of these factors indicate paucity in the literature in the context of South Wales and thereby warrants further exploration for the same region. To bridge such a gap of dearth in knowledge of mentorship in this region, the main reasoning would remain that much of the studies conducted in other regions pertained to phenomenological drawings and showed no transferability to other similar population suggesting that there may be a variance in perception. The present study is hence undertaken so as to contribute to the existing body of literature for the region of South Wales and make recommendation for both practice as well as further research. With this view, the methodology of the study has been detailed below.

Aim

The aim of the study is to explore the lived experiences of mentorship of newly qualified nurses in the first year of clinical practice in university hospital, south wales and to also identify the preferred mentorship style –that can optimise the efficiency in supervising the newly qualified nurses’ specific to the region of South Wales.

Research objectives

• To identify the challenges faced by the newly qualified nurses during their first year in clinical practice in the university hospital at South Wales, UK
• To describe the positive and negative experiences of the newly qualified nurses during their first year in clinical practice in the university hospital at South Wales, UK
• To analyse a preferred mentorship practice by the newly qualified nurses

Research questions

• What are the challenges faced by the newly qualified nurses during their first year in clinical practice?
• What are the experiences of the newly qualified nurses during their first year in clinical practice?

Research methodology

6.1 Research design

In the arena of social science on of the most common concepts is that of phenomenology, which basically deals with philosophy and in the context of research, is based on the experiences of an individual within a particular setting (Finlay, 2009). The study here adopts a descriptive qualitative approach with the view of interpretivism that can enable for better understanding (Miles and Huberman, 1994; Easterby-Smith, Lewis and Thornhill, 2012). Hence, a descriptive-interpretive approach is employed here. Descriptive phenomenon merely describes the poorly understood aspects of an experience while the interpretive approach derives from such explanation with due regard given to other influencing features such as geographical region (and culture), and employment. This is thus apt, as the study aims to explore the lived experiences of the newly qualified nurses specific to South Wales (Matua and Van Der Wal, 2015).

One of the main reasons as to why a quantitative study design is not suitable for this research study is that the study seeks in depth understanding of the experience. Thereby, the interest lies neither in the quantification nor the generalising of the findings (Lincoln and guba, 1985). Other types such as ethnography which deals with the observance of a culture to make sense or grounded theory that involves conceptualising on the basis of exhaustive data does not fall within the purview of lived experiences of an individual pertaining to the context required. Hence the phenomenological type of qualitative method is chosen here (Moriarty, 2011).

6.2 Sampling

In the case of qualitative methodology, only a small sample size is necessary and even considered optimum. This is so as the researcher deems to understand in depth the core feelings behind a phenomenon based on a lived experience of chosen respondents (Silverman, 2011). An important aspect of any qualitative research is to choose participants that are best suited to the study albeit with the appropriate characteristics. This further justifies the aspects of purposive sampling (which is a judgment sampling based on the requirements of the research) as the researcher is required to choose newly qualified nurses in their first year which is contributory to the topic of interest for this study (Palinkas et al., 2013). The sampling can also intentionally forge an understanding of the phenomenon that forms the basis of a study (Creswell, 2007). Furthermore, this sampling technique also enables the researcher with a set idea of the needed sample for the conduct of the study. Within purposive sampling, there exists many types (Maximum variation, typical case, total population, criterion and so on); however for the purpose of this research criterion purposive sampling will be used which is based on willingness to participate and availability (Easterby-Smith, Lewis and Thornhill, 2012) the criterion aspect of the sample refers to the criteria based on role, education or knowledge in this context. The main drawback of purposive sampling is that the findings here cannot be generalised. This is so as the findings are subjective with respect to the chosen population only and hence adopts (Comptrollers Handbook, 2015) and hence adopts the same.

6.3 Sample size

The sample size chosen for this qualitative study that employs the use of face to face interviews is dependent on factors such as research question, study duration and study setting. As this study aims to explore the lived experiences of newly qualified nurses in their first year of clinical practice, a purposive sample size of 15 will hence be considered. The participants will be recruited from the South Wales, University hospital. They will be recruited via sharing criteria for choosing (such as employment and role; newly qualified nurses) on notice boards to maintain confidentiality.

6.4 Data collection methods

The study will employ a semi-structured interview pattern that will be conducted face to face mainly as the study aims to discern the experienced of newly qualified nurses. It contains a set of directional questions that later allows for a development in the conversation (Easterby-Smith, Lewis and Thornhill, 2012) that in turn allows for the researcher to further analyse the experiences of the newly qualified nurses in their first year of clinical practice with respect to their mentors and mentorship as a whole. A structured interview on the other hand is one that involves use a set questionnaire that does allow for further development in the conversation, this type is more suitable where generalising the results are sought (Gill et al., 2008). Therefore, a semi structured interview is most suited in this context so that the experiences, opinions and challenges face by these nurses in clinical practice in relation to mentorship practices may be elucidated and from them, an adequate mentorship style may be identified.

6.5 Validation and credibility of the questionnaire

The evaluation criteria as set forth by Guba and Lincolan (2005) will be used here. This is so as to assess how trustworthy a qualitative study is based on factors such as credibility, conformability, transferability and dependability. A pilot study will also be conducted on 2 participants to further validate the present research and also for any issues that may arise as result of the questionnaire to be used (Quinlan, 2011; Jankowicz 2005).The questionnaire to be used for the interview will be developed based literature review as well as the personal experience of the researcher. The questionnaire will further be assessed by the supervisor as well a professor for the purpose of enhancing the credibility of the questions.

6.6 Conducting the study

McNamara (2009) states that the most important step in the data collection process in the preparation for the interview. He further states that emphasis is to be given to unambiguous focus on the research questions so as to improve the interview process and reduce the bias. It has been further suggested that the conduct of the interview must take place in an area or space of least distraction as this not only constitutes to the quality of interview as taken by the researcher but also of the respondents (Yin, 1989; Krueger, 1994). This has been instanced through a study conducted by McDowell (1998), wherein the respondents were reluctant to answer the questions that were posed to them in their work environment (a bank) as they felt uncomfortable and were cautious of other issues as well. In view of this, the study will hence be conducted in a private hall/room that is placed away from the clinical departments so that these nurses can feel more comfortable. The interview will be conducted after the set working hours of each of these nurses as per their availability. An orientation will take place that informs all the participants of the confidential nature of the interviews and also state that study participation is voluntary and based in willingness. This is an important aspect as it builds trust and a suitable rapport with which to move forward into the interview. In this aspect, rapport has been described as free and open discussions (for lesser structured interviews) and has also been deemed the most important aspect of research interview. This is so due to the fact that most respondents show reluctance to come forth with their experience fearing consequences of such revelation. Thus building a rapport is of utmost importance to elicit honest, clear and detailed responses as to their lived experience (Dundon & Ryan, 2010). Additionally, permission from the university will also be obtained.

As for the proceedings of the data collection, the interviewer will jot down information such as the duration of employment, behaviours, expectations, reactions, and observations of the participants (Marshall and Rossman, 1999). The interview will be conducted face to face by using a data recorder. As the study is a qualitative one, the interview as well as the synthesis will occur as a simultaneous process (Merriam 1988; Marshall and Rossman, 1989; Schatzman and Strauss, 1973). The interviewer will then transcribe the responses verbatim for the purpose of analysis.

Data analysis

A qualitative thematic analysis based on interpretative derivations will be the main analysis of the data in this study. The entire data collection process is divided into stages elaborated as follows. The very first stage involves the transcribing of the collected data along with the organisation of the same based on sources it has been received from. The transcribing is done after the data is collected. The researcher will then prepare transcripts that are based on the recordings of the responses. This further provides the researcher with a feel of the participants for better understanding of their experience (Colaizzi, 1978). A transcript thus forms a written format of the interview. The accuracy of the data is directly related to the accuracy of the transcription. It also offers the degree of dependability of the data.

The next stage entails the reading of the prepared transcripts so that the information may be understood generally by further also evaluating the credibility (by adopting a systematic in depth approach to the interview) The third stage involves categorising the information into themes and further sub themes so that the logical structure and meaning of this information is presented more clearly to the researcher. For the purpose of increasing the reliability of the responses, a software tool such as the QSR Nvivo will also be used for textual analysis. The tool codes the words frequently used throughout the responses for each question thereby basing the interpretation on the same (Rossman and Rallis, 1998).

This software will further make themes through the use of codes and also discerns the association between such codes so that the data may be presented graphically for better clarity.

For the sake of enhancing the reliability of the data obtained further the researcher will also undertake other analytical strategies. One such strategy is presenting the recordings to the supervisor while discussing the challenges faced in data collection if any and cross checking the conduct of the study. The supervisor may also cross check the recordings with the transcripts for discrepancies if any (Lincoln and Guba, 1985).

Ethical considerations

An ethics committee approval will be obtained from the faculty of research at the University of South Wales, UK. An ethical approval is required so as to uphold dignity, respect and beneficence. In this study, ethical issues can arise in the interview process. This can be in the form of conflict of interest or reveal issues of confidentiality. The main stay reason for confidentiality would be to ensure that no student is implicated in their discussion of the senior staff. The ethical factor (or the lack thereof) in this scenario pertains to revealing information regarding the senior staffs, which if were to be revealed will negatively impact the existing relationship between the newly qualified nurses and the staff. The researcher however has to be fully aware of such ethical issues and also undertake a non-disclosure for the same. To mitigate such circumstances, firstly the identity of the interviewer must be confidential. To ensure the same, the participants will be recruited into the study via website, notice boards and word of mouth. In this case, the criteria (of the criteria purposive sampling method) will be used in the advert for the population. People who fit into this category will approach the researcher and thereby selected if matching the said criteria. The information thus passed on will entail the purpose of participation with explicit mention that participation is voluntary, contact number and timings of the interview. Further to this, all the participants will be required to sign an informed consent document which contains an information leaflet as well as all the terms of participation such as that the identity of the participant and whatever the respondent may share is confidential information. The document will also state that the respondent can withdraw from the study at any time without consequence (Munhall, 1988; Field and Morse 1992; Kvale, 1996). The participants will also be informed that all the procedures including the interview are documented recorded and will be subject to review by one other person. Lastly, any and all information contain identity of the individual will be deleted while the data will be stored in password protection to align with the data information act. Furthermore, all the data will be organised in codes or pseudonyms for further ethical considerations.

Dissemination of the findings

The study will bear suggestions for how the experiences of mentorship in clinical practice are perceived by newly qualified nurses in their first year. Since not many studies have been conducted from this perspective and in the region of South Wales, the findings of the study can bear implication in the adoption of better mentorship practices to increase the efficiency of learning in clinical practice. The findings of the study will thus be disseminated by improving the communication between the mentor and the mentees and also enhancing their relations. The target audience will be the newly qualified nurses as well as the nursing mentors in South Wales with the findings of the study channelized through technical reports, scientific study and scientific publication.

Time scale

Main Activities/ Stages	Month 1	Month 2-4	Month 5-6	Month 7-8	Month 9-10	Month 11-12
Topic selection	*
Identification of secondary data sources	*
Preparation of research proposal	*
Ethics Approval		*
Preparation of literature review		*
Description of research methodology			*
Preparation for interview and ethics form			*
Primary data collection			*
Analysing data				*
Comparing findings with present literature-discussion				*
Conclusion and recommendations					*	*
Approval and submission					*	*

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