NSG/547 Week 4: Coaching, Mentoring and Development, sample paper

The First Year in the Operating Room: A Coaching, Mentoring and Development Plan to Keep Perioperative Nurse Residents Past Their Anniversary

[Student Name]

University of Phoenix

NSG/547: Human Resources Management

Week 4 Assignment

[Instructor Name]

[Date]

The hospital, its department and the plan are a composite written for a model paper.

The recruitment plan from Week 1 leans on a residency that turns new graduates and transfers into operating room nurses. Their training is a large investment, and last year almost one new hire in four left within twelve months, worse than the national figure of about 17.5% for new nurses leaving a first job within a year (Kovner et al., 2014). Recruitment will not close the staffing gap unless more of those hired stay. This paper designs a plan to develop and keep them.

Why Nurses Left

The departing nurses gave three reasons in their exit interviews: orientation that was too thin for newcomers to the operating room, call, which Week 3 addressed, and a feeling that experienced staff did not welcome newcomers. Two residents who left described being corrected sharply in front of surgeons and "never being asked how I was doing." Research on transition to practice associates structured programs with preceptors and a curriculum with better outcomes for new nurses (Spector et al., 2015), and the department's residency provides that structure; the plan below adds the relational support that exit interviews showed was missing.

Coaching and Mentoring Defined

Coaching is performance-focused: a preceptor or manager helps a resident master specific skills and behaviors, gives feedback and tracks progress. Mentoring is relationship-focused: an experienced nurse outside the resident's reporting line offers guidance, perspective and a sense of belonging over a longer period. Residents need both, because a nurse can become technically competent and still leave because no one made them feel they belonged.

Element 1: Preceptor Coaching With Structure

Each resident works with one main preceptor through the first three months and a second preceptor through the next three. Preceptors complete a preceptor workshop that teaches coaching with questions, specific feedback and a weekly progress record. The preceptor and resident meet for 15 minutes each week to review the competency checklist and set the next week's goals. Feedback is given privately; correction in front of the surgical team is limited to immediate safety issues, followed by a private conversation.

Element 2: A Mentor From Outside the Reporting Line

Each resident is paired with a mentor, an experienced nurse from another perioperative area, such as the recovery unit or the endoscopy suite, for the first year. Mentors meet with residents at least monthly, in person or by phone, to talk about how the resident is doing, not only what they are learning. Mentors are volunteers, receive a two-hour orientation and are recognized with a mentor designation on their badge and in their annual evaluation.

Element 3: Manager Check-Ins

The nurse manager meets each resident at 30, 90, 180 and 365 days. The meetings use four standard questions: What is going well? What is harder than you expected? Is there anything that might make you think about leaving? What can I do to help? These stay interviews let the manager hear concerns while there is still time to act.

Element 4: A Development Path With Milestones

Residents follow a defined path: by three months, independent circulating in general surgery; by six months, independent in two additional specialties and completion of the residency; by nine months, first call shifts with a buddy; by twelve months, independent call. Beyond the first year, the path continues toward specialty team membership, charge nurse development and certification in perioperative nursing, with the hospital paying the examination fee. A visible path gives residents a reason to stay beyond the first anniversary.

Element 5: Changing the Culture

The complaint about an unwelcoming culture cannot be solved by residents' programs alone. The director will set expectations at staff meetings that incivility is not acceptable, include welcoming behavior in all staff evaluations, ask surgeons' leadership to address public criticism of nurses and recognize staff who precept and mentor well. The staff council will run a brief civility survey twice a year.

Element 6: Peer Support

Residents from each cohort meet monthly for an hour with the perioperative educator to share experiences. Peer groups reduce isolation and let residents see that their struggles are shared.

Selection and Retention Are Linked

Retention starts before hire. Residents selected through the structured process in Week 2, with a shadow shift that shows them the real job, are more likely to be suited to the work; research on selection methods finds that structured, job-related selection predicts later performance better than informal interviews (Schmidt & Hunter, 1998). The plan therefore tracks retention by selection cohort, so that selection questions can be revised if some predict departures.

When a Resident Struggles

Some residents will struggle. When progress falls behind the path, the preceptor, educator and manager meet with the resident to identify the reason, such as a skill gap, anxiety or a mismatch with the specialty, and agree on a plan with extra practice or a change of pace. If the specialty is not a fit, the manager helps the resident transfer elsewhere in the hospital rather than lose them entirely.

The Preceptors Need Support Too

Preceptors carry most of the coaching load. The plan limits each preceptor to one resident at a time, reduces the preceptor's room assignments during the first six weeks of a resident's orientation where the schedule allows and pays a precepting differential. Preceptors meet monthly with the educator to discuss difficult situations, which also keeps coaching consistent across the department.

Recognition

Residents who reach each milestone are recognized at the department's monthly meeting, and completion of the residency is marked with a small ceremony attended by surgeons and anesthesia leaders. Recognition signals to residents and staff that the department values the newcomers it is training.

Costs

The plan's added costs are preceptor workshop time, mentor orientation, manager meeting time and the certification fee, about $42,000 a year. Losing one resident after training costs the department roughly the residency investment of $38,000 plus months of traveler coverage, so preventing two departures a year more than pays for the plan.

Timeline

The plan starts with the next residency cohort: preceptor workshops and mentor orientation in the month before the cohort begins, pairing on the first day and the first manager check-in at 30 days.

Measures

The plan will be measured by first-year turnover of residents, with a target of under 12%; residents' ratings of preceptor feedback and belonging on a survey at three, six and twelve months; completion of manager check-ins, target 100%; mentor meeting frequency; certification rates at three years; and the civility survey results.

Conclusion

Keeping residents past their first anniversary requires coaching that builds skill, mentoring that builds belonging, manager check-ins that catch problems early, a visible development path and a culture that welcomes newcomers. Each element responds to a reason residents gave for leaving, and the plan's cost is less than the cost of the departures it aims to prevent.

References

Kovner, C. T., Brewer, C. S., Fatehi, F., & Jun, J. (2014). What does nurse turnover rate mean and what is the rate? Policy, Politics, & Nursing Practice, 15(3-4), 64-71. https://doi.org/10.1177/1527154414547953

Schmidt, F. L., & Hunter, J. E. (1998). The validity and utility of selection methods in personnel psychology: Practical and theoretical implications of 85 years of research findings. Psychological Bulletin, 124(2), 262-274. https://doi.org/10.1037/0033-2909.124.2.262

Spector, N., Blegen, M. A., Silvestre, J., Barnsteiner, J., Lynn, M. R., Ulrich, B., Fogg, L., & Alexander, M. (2015). Transition to practice study in hospital settings. Journal of Nursing Regulation, 5(4), 24-38. https://doi.org/10.1016/S2155-8256(15)30031-4