Evidence Digest

The Latest Evidence on the Outcomesof Mentoring

Bernadette Mazurek Melnyk, RN, PhD, CPNP/NPP, FAAN, FNAP

The purpose of the Evidence Digest, a recurring columnin Worldviews, is to provide concise summaries of well-

designed and/or clinically important recent studies alongwith implications for practice, research, administration,and/or health policy. The articles highlighted in this col-umn may include quantitative and qualitative studies, sys-tematic and integrative reviews as well as consensus state-ments by expert panels. Along with relevant implications,the level of evidence generated by the studies or reportshighlighted in this column (see Figure 1) is included atthe end of each summary so that readers can integrate thestrength of evidence into their healthcare decisions.

Sambunjak D., Straus S.E. & Marusic A. (2006). Men-toring in academic medicine. A systematic review. JAMA,296(9), 1103–1115.

Purpose. The purpose of this study was to evaluate theevidence about the prevalence of mentorship and its impacton career development.

Design. Systematic review.Search Strategy/Methods. The following databases were

searched: (1) all evidence-based medicine reviews on Ovid-ACP Journal Club, from March 1991 to April 2006, theCochrane Database of Systematic Reviews, Database ofSystematic Reviews, Database of Reviews of Effects, andCochrane Central Register of Controlled Trials (1st Quarterof 2006), (2) Ovid Current Contents, all editions (1993–2006), (3) Ovid PsycINFO (1967–2006), (4) Ovid MED-LINE (1966–2006), and (5) Scopus (1996–2006). Keywords used in the search included mentor; mentoring;medicine; career mobility; leadership; teaching; preceptor-ship; interpersonal relations; students; research; schools,medical; academic medical centers; education, medical;and faculty, medical. Bibliographies of studies found alsowere searched and experts contacted for potential unpub-lished studies. Two authors independently reviewed thetitles and abstracts of all publications found to determineinclusion in the review. Inclusion criteria included a de-scription of the study population and availability of ex-tractable data.

Copyright ©2007 Sigma Theta Tau International1545-102X1/07

Findings. The search revealed a total of 3,640 citations.The review of abstracts led to the retrieval of 142 full-textarticles. Of these 142 articles, 42 met the inclusion criteriaand were included in this review. Most of the published re-search was cross-sectional descriptive studies, and 33 wereconducted in the United States. Fewer than 50% of medicalstudents and, in some fields, fewer than 20% of faculty hadmentors. Three studies were before- and after-case seriesdesigns, one was a case–control study, and one was a co-hort study. Four studies described the general importanceof mentorship. Of child and adolescent psychiatrists whowere surveyed in one study, 16% identified mentors as themost important aspect of their training experience. Amongadolescent medicine faculty in another study, 95% reportedthat their mentor was important to them.

Perceived importance of mentorship was related to ca-reer satisfaction. In a survey of faculty from 24 U.S. medicalschools, faculty members who had mentors had signifi-cantly higher career satisfaction scores than those withoutmentors.

Eight studies reported the positive influence that men-torship had on personal development and career guidance.One study conducted with Canadian obstetrics/gynecologyfellows found that those physicians who reported that theyhad a mentor were more likely to obtain a promotion. Inanother study that evaluated a structured mentoring pro-gram for junior faculty, findings indicated that the mentor-ship program increased self-confidence in academic rolesand skills. In yet another study, 38% of junior faculty whodid not form preceptor partnerships left the organizationcompared to 15% of those who did.

Twenty-one studies described the impact of mentoringon research development and productivity. Findings indi-cated that mentors increased mentees’ self-confidence andprovided resources and support for their activities. Menteeswere more productive in the number of publications andgrants. They also were more likely to complete their thesis.A lack of mentorship was reported as a barrier to com-pleting scholarly projects and publication. Mentors wereviewed as an important motivating factor in pursuing aresearch career. In one survey, more women than menbelieved that inadequate mentoring impeded their careergrowth.

170 Third Quarter 2007 �Worldviews on Evidence-Based Nursing

Evidence Digest

________________________________________________________________________

• Level I: Evidence from a systematic review or meta-analysis of all relevant randomized controlled trials (RCTs), or evidence-based clinical practice guidelines based on systematic reviews of RCTs

• Level II: Evidence obtained from at least one well-designed RCT • Level III: Evidence obtained from well-designed controlled trials without randomization • Level IV: Evidence from well-designed case-control and cohort studies • Level V: Evidence from systematic reviews of descriptive and qualitative

studies • Level VI: Evidence from a single descriptive or qualitative study • Level VII: Evidence from the opinion of authorities and/or reports of expert committees

Modified from Guyatt & Rennie, 2002; Harris et al., 2001

Figure 1. Rating System for the Hierarchy of Evidence (fromMelnyk & Fineout-Overholt, 2005).

Overall, in this body of research, mentorship was per-ceived to be important for career guidance, personal devel-opment, career choice, and productivity. However, therewas lack of experimental research to provide data regard-ing what mentorship strategies led to the best outcomes.

Commentary with Implications for Action in Clini-cal Practice, Administration, and Future Research. Theauthors of this systematic review concluded that thepoor quality of the studies did not allow them to (1)arrive at a conclusion regarding the effect size of men-toring, and (2) suggest specific strategies that should beimplemented at academic institutions. However, thereis substantial evidence from this review to suggest thatmentoring is related to positive outcomes in mentees.In making decisions about practice changes based onevidence, it should be remembered that: Level of Evi-dence + Quality of Evidence = Strength of Evidence→Confidence to Act. It must be remembered that someevidence is typically better than no evidence whenmaking decisions about clinical care. If this type ofapproach is not taken to practice, it might be decadesbefore research evidence is used to guide best prac-tices. Since there are a substantial number of descrip-tive/outcomes evaluation studies to indicate that men-toring is related to positive outcomes and there is cur-rently a nursing faculty shortage in some countriesacross the globe, it is likely to benefit academic in-stitutions to implement mentoring programs for newfaculty. More research in the form of clinical trials isneeded to determine exactly what type of mentoringstrategies lead to the best outcomes in mentees.

Level of Evidence: I

Beecroft P.C., Santner S., Lacy M.L., Kunzman L. &Dorey F. (2006). New graduate nurses’ perceptions of men-

toring: Six-year programme evaluation. Journal of AdvancedNursing, 55(6), 736–747.

Purpose. The purpose of this study was to determine theoutcomes of a mentoring program on whether new grad-uate nurses were: (1) satisfactorily matched with mentors,(2) received guidance and support, (3) attained socializa-tion into the nursing profession, (4) benefited from havinga role model for the acquisition of professional behaviors,(5) maintained contact with mentors, and (6) were satisfiedwith the mentorship.

Design. An outcomes evaluation.Sample. Six cohorts of new nurses who participated in

a mentorship program shortly after entering the nursingworkforce. Sixty percent of the mentees had bachelor’s de-grees, and more than half were 23 to 30 years of age. Themajority of the mentees had prior healthcare experience(e.g., as a patient care assistant, licensed practical nurse)and was assigned to the unit of choice.

Methods. A survey was administered to a total of 318new graduate nurses who had participated in a year-longresidency/mentoring program at one healthcare institutionin the United States over a 6-year period of time. Eight sur-vey items focused on the mentoring experience, including:(1) Were you able to meet with your mentor on a regularbasis, (2) Was having a mentor a stress reducer for you, (3)Did you “click” with your mentor, (4) Did your mentor pro-vide the guidance and feedback you would have liked, (5)What were the personal benefits to you from having a men-tor, (6) Would you recommend your mentor for a futurementor program, (7) If given the opportunity, what feed-back would you like to give your mentor, and (8) Wouldyou like to see changes in the mentor program?

Findings. Eighty-three percent of the mentees reportedthat they “clicked” with their mentors.

Twenty-eight percent of the mentees indicated that theyhad a strong connection with their mentor. Eighty to 90%of the nurses reported that their mentors provided the guid-ance and feedback that they would have liked. Slightly overhalf of the mentees indicated that their mentors moder-ated stress during the residency period. Slightly over halfof the mentees reported meeting with their mentors ona regular basis. Over half of the mentees were satisfiedwith their mentorship. Benefits of mentorship were greaterwhen mentors and mentees met regularly. Some mentorsand mentees reported that they were not knowledgeableabout what mentorship was and what to expect from therelationships.

Commentary with Implications for Action in Admin-istration and Future Research. This outcomes evalu-ation survey indicated that most of the new nurses

Worldviews on Evidence-Based Nursing �Third Quarter 2007 171

Evidence Digest

who participated in the mentorship/residency programreported beneficial outcomes. Findings would havebeen much stronger if an experimental design wouldhave been conducted with a comparison group, whichthen could have supported a causal relationship be-tween mentoring and positive outcomes. From the re-port of this outcomes evaluation, it also is not knownexactly what mentoring strategies were implementedand contributed to the self-reported benefits of the pro-gram. Therefore, it would be difficult for other hospitalsto implement the program and expect similar results.When healthcare institutions are considering the im-plementation of a mentoring program, the match be-tween mentor and mentee seems to be an important fac-tor for success of programs. In addition, clearly definingexpectations for both the mentors and mentees is im-portant before a mentorship program is implementedalong with the provision of mentor training.

Level of Evidence: VI

Zucker B., Coss C., Williams D., Bloodworth L., LynnM., Denker A. & Gibbs J.D. (2006). Nursing retention inthe era of a nursing shortage. Journal for Nurses in StaffDevelopment, 22(6), 302–306.

Purpose. The purpose of this study was to determine theoutcomes of an 18-month mentorship program on nurseretention in five hospitals in a healthcare system in thesouthern United States.

Design. An outcomes evaluation.Methods. A pool of nurse mentors was first developed.

Requirements for the mentors, who were called naviga-tors, included: (1) being a registered nurse, (2) 2 years ofnursing experience, (3) expertise in an area of practice,(4) recommendations from a direct supervisor and peer,(5) experience in preceptoring, coaching, teaching, and/orleadership, and (6) being passionate about nursing and astrong desire to help others develop their nursing careers.The navigators received monetary incentives for retaininga new graduate. Mentees were given the name of proteges.Both mentors and mentees completed personality profilesin order to match the right navigators to the right proteges.After mentors and proteges spent a day together for social-ization purposes, course work taken during the proteges’first year of employment included communication skills,conflict resolution, learning together, and time manage-ment.

Findings. Both navigators and proteges reported that theprogram increased their knowledge and allowed them tobecome better people and colleagues. Positive comments

from the proteges included that they felt a sense of impor-tance and worth, an increased sense of loyalty, and a familyatmosphere. The retention rate of new nurses in the health-care system increased by 16% and overall turnover rate fornew graduates was reduced to 10.6% with the program.

Commentary with Implications for Action in Admin-istration. The mentorship program implemented in thisoutcomes evaluation resulted in substantial improve-ments in nurse retention and turnover rates. Given thatthe average turnover rate for new graduates is 35% to60% across the United States, this yields a substan-tial cost savings for the healthcare system as cost sav-ings per retained nurse are estimated at approximately$40,000 (Zucker et al., 2006). Although this was nota randomized controlled trial with a placebo–controlgroup, which substantially weakens the internal valid-ity of the study, the outcomes clearly support the bene-fits of a mentorship program that focuses on topics thatare not typically covered in traditional hospital orienta-tion programs (e.g., communication, conflict and timemanagement). Given the high turnover rates in newgraduates, hospital administrators may want to giveserious consideration to implementing a mentorshipprogram for new graduates.

Level of Evidence: VI.

Craik J. & Rappolt S. (2006). Enhancing research uti-lization capacity through multifaceted professional devel-opment. American Journal of Occupational Therapy, 60,155–164.

Purpose. The purpose of this study was to answer thefollowing research question: How do occupational thera-pists develop the capacity to use research evidence in theirclinical practices?

Design. Qualitative study.Sample. Eleven occupational therapists (OTs) practic-

ing in adult stroke rehabilitation in four healthcare insti-tutions in Toronto, Canada, participated in this study andwere recruited through theoretical and snowball sampling.The OTs needed to be recognized by their peers as educa-tionally influential practitioners and practicing in research-intensive environments. The OTs were all female, and theiraverage age was 34 years. They had been in practice for anaverage of 9 years.

Methods. Grounded theory was used. Reports of partici-pants’ research utilization behaviors were gathered throughin-depth face-to-face interviews that lasted approximately1 hour, site visits, and post-interview clarification sessions.The interviews were translated verbatim and edited for

172 Third Quarter 2007 �Worldviews on Evidence-Based Nursing

Evidence Digest

accuracy by the interviewer. The data were analyzed us-ing a grounded theory approach.

Findings. The categories of codes related to the par-ticipants’ development of skills in research utilization re-lated to four primary activities, including (1) clinical prac-tice, (2) research production, (3) continuing education,and (4) mentoring students. The participants reportedthat their mentoring of students had an important influ-ence on their ability to integrate research into their prac-tices. Providing this type of mentoring to students served asa catalyst for updating their knowledge of current researchand its impact on practice. The more experience an OT de-veloped through clinical encounters, mentoring studentsand colleagues, and participating in continuing educationand research activities, the greater was her capacity to in-tegrate research into clinical practice.

Commentary with Implications for Action in Clin-ical Practice and Future Research. This study gener-ated evidence to support the fact that not only domentees benefit from mentorship, but the mentors ben-efit from the process as well. Teaching/mentoring oth-ers facilitated better integration of research and clinicalpractice in this sample of OTs. The mentors believedthat the mentorship of others assisted them in clinicaldecision-making processes and was a catalyst for re-search utilization. Although professionals often knowthat a higher quality of care is provided throughevidence-based practice, multiple barriers deter them

from consistently providing evidence-based care.Through mentorship, professional and personal growthcan occur, which could lead to a higher quality of clinicalpractice and better patient outcomes.

Findings from this study should not be generalizedbecause of the small, homogeneous sample used. Thereis a need to replicate this study within nursing and otherhealth professions to determine if findings would be sim-ilar.

Level of Evidence: VI.

ReferencesGuyatt G. & Rennie D. (2002). Users’ guides to the medical

literature. Washington, DC: American Medical Associa-tion Press.

Harris R.P., Hefland M., Woolf S.H., Lohr K.N., MulrowC.D., Teutsch S.M. & Atkins D. (2001). Current meth-ods of the U.S. Preventive Services Task Force: A reviewof the process. American Journal of Preventive Medicine,20 (3 Suppl.), S21–S35.

Melnyk B.M. & Fineout-Overholt E. (2005). Evidence-based practice in nursing & healthcare. A guide to bestpractice. Philadelphia: Lippincott, Williams & Wilkins.

Zucker B., Goss C., Williams D., Bloodworth L., Lynn M.,Denker A., & Gibbs J.D. (2006). Nursing retention inthe era of a nursing shortage. Norton navigators. Journalfor Nurses in Staff Development, 22 (6), 302–306.

Worldviews on Evidence-Based Nursing �Third Quarter 2007 173