Across the Continuum of Care: Mentoring
and Partnership in Progressive Care
By Madeleine Burke, RN, BSN, CCRN
Progressive Care Task Force
Mentoring and partnership play a vital role in
developing and molding future generations of nurses. Mature, expert
practitioners who mentor and partner with new nurses provide meaningful clinical
experiences that allow the beginning nurse to observe expert critical thinking
and problem solving.
Clinical judgement, advocacy, caring practices,
collaboration, systems thinking, response to diversity, clinical inquiry and
learning facilitator, which are described by the Synergy Model,1 are behaviors
that are integrated into clinical practice through observation and experience.
Because nurses working in progressive care units require the same level of
knowledge and clinical expertise as those working in critical care, newly hired
nurses can acquire the knowledge base and clinical competency they need by
integrating their orientation into already-established critical care internship
Mentoring and partnerships not only benefit the
newly hired nurse, but also provide an opportunity for experienced clinicians to
share expertise with their less experienced colleagues, which satisfies an
inherent professional responsibility. This helps the mentors to stay motivated
to keep current. They also benefit from the sharing of knowledge and
information. Their reward is in the growth and achievement of their prot�g�s and
in the development of a positive, long-term relationship.
In the mentoring role, these clinicians
demonstrate role expertise and promote socialization by role modeling and
sharing values and customs to provide a vision for the new nurse. Mentors also
provide support and structure to new nurses by listening, befriending and
expressing positive expectations; setting high standards; and empowering the
prot�g� to reach autonomy that comes from competency, self-confidence and
responsibility.2 Although structured models for mentoring and partnerships exist
in many organizations, many of the best mentoring relationships take place
through informal relationships.
Following are some practical suggestions for
influencing the career and professional development of new nurses:
� Get to know them as people.
� Invite them to lunch or to attend a conference
or workshop with you.
� Attend an AACN meeting together and introduce
them to other members.
� Offer positive feedback on a job well done.
� Remember how lonely and insecure you felt as a
new nurse on the unit, as well as how nurses who took an interest in you
impacted your career.
Three models can facilitate the relationship.
Three large internship programs for critical
care, medical-surgical and cardiovascular progressive care run concurrently at
Baylor University Medical Center, Dallas, Texas, where all newly hired
medical-surgical, cardiovascular and critical care nurse interns meet together
for one, eight-hour class. The purpose of combining this class time is to cover
core content that spans across all patient care areas, regardless of specialty.
Except when content specific to the ICU is covered, the ICU and cardiovascular
new hires remain together.
Newly hired nurse interns attend class two to
three days a week and obtain clinical experiences the other days. Progressing at
their own speed, they are matched with a primary and secondary preceptor, who
offer support and clinical expertise. The preceptors themselves are supported in
developing their role by attending an eight-hour class on the art of precepting.
At Baptist Hospital, Miami, Fla., a patient care
facilitator model was developed for the cardiac step-down unit. In this model,
leadership, patient advocacy, staff development and mentorship are combined into
Patient care facilitators are senior staff
members who oversee the care of between 12 and 14 patients and have 24-hour
accountability. They make daily rounds and have responsibility for their
patients from admission to discharge.
Because patient care facilitators do not assume
a patient care assignment, they are able to assist new graduates and experienced
nurses who are new to the unit. These facilitators serve as role models through
their expert handling of complex and emergency situations, dealing with
difficult patients and families and modeling relationships with physicians.
Because they know the patient�s �story,� they are able to relate vital
information to others.
This model was so successful on the cardiac
step-down unit that two other nursing units are in the process of adapting the
role for their patient populations. Patient and physician satisfaction has
improved significantly since the implementation of this role.
Mentoring New Nurses
Also at Baptist Hospital, a mentorship program
was implemented to help new employees learn about the culture and values of the
organization. The mentors are chosen by their managers because they are
exemplary role models and demonstrate a commitment to service excellence.
The mentor is responsible for regularly
communicating with the new employee and providing information about the
organization, as well as for discussing and exhibiting core values and service
excellence essentials. Being a mentor has a positive impact on performance
evaluations and is a step in climbing the clinical ladder.
Because of our changing healthcare environment
and the nursing crisis evidenced by an aging workforce and the ongoing nursing
shortage, sharing expertise becomes more important. Efforts to uphold AACN�s
vision for creating a healthcare system driven by the needs of patients and
families, in which critical care nurses make optimal contributions, require us,
individually and collectively, to commit to seeking out opportunities for
sharing our knowledge and experience.
1. Medina J (ed.) Standards for Acute and
Critical Care Nursing Practice. 2000. Aliso Viejo, Calif. American Association
of Critical-Care Nurses.
2. Busen N, Engebretson J. Mentoring in advanced
practice nursing: the use of metaphor in concept exploration. Internet Journal
of Advanced Nursing Practice. 1999. Volume 2, No. 2.
AACN offers a variety of small and large
research grants. Jan. 15 is the deadline for two of these grants:
Philips Medical Systems-AACN Outcomes for
Clinical Excellence Research Grant
This new grant, funded by Philips Medical
Systems, will award $100,000 every three years to support studies that center on
improved outcomes or system efficiencies in the care of acutely or critically
ill patients. Research conducted with this grant may apply to any age patient in
any clinical environment, but must relate directly to at least one of AACN�s
The grant will be awarded for the first time at
AACN�s 2003 National Teaching Institute and Critical Care Exposition, May 17
through 22 in San Antonio, Texas.
Clinical Inquiry Grant
This grant supports multiple awards of $500
each, up to $5,000 annually, for clinical research projects that directly
benefit patients or families. Interdisciplinary projects are especially invited.
AACN End-of-Life/Palliative Care Small
This grant awards $500 each to two projects
focusing on end-of-life or palliative care outcomes in critical care.
Due Feb. 1
Feb. 1 is the deadline for the following grants:
Datex-Ohmeda-AACN Research Grant
Sponsored by Datex-Ohmeda, this grant provides
up to $5,000 to support research by a critical care nurse addressing the issue
of nutritional assessment in the critically ill patient.
AACN Critical Care Grant
This grant awards up to $15,000 to support
research focused on one or more of AACN research priorities. The proposed
research may not be used to meet the requirements of an academic degree.
AACN Mentorship Grant
This grant awards up to $10,000 to support
research done by a novice researcher working under the direction of a mentor
with expertise in the area of proposed investigation. The novice researcher will
be the principal investigator and will receive the award. The novice researcher
may be conducting the research to meet requirements for an academic degree, but
the mentor may not. The mentor may not be a mentor on an AACN Mentorship Grant
in two consecutive years.
AACN Certification Corporation Research Grant
Sponsored by AACN Certification Corporation,
this grant awards up to four awards of $10,000 each for studies related to
Due March 1
March 1 is the deadline for the following
Evidence-Based Clinical Practice Grant
This grant awards $1,000 to cover direct project
expenses, such as printed materials, small equipment and supplies. Eligible
projects can include research utilization studies, CQI projects and outcome
evaluation studies. Collaborative projects are encouraged.
To find out more about AACN�s research
priorities and grant opportunities, visit the AACN Web site at
grants handbook is also available from AACN Fax-on-Demand at (800) 222-6329
(Canada call 949-448-7315), Request Document #1013.
The Power of One: Ethics Work Group
Examines Practice Dilemmas
Members of the Ethics Work Group for 2002-03
are (from left,
seated) Cynthia Janacek, Natalie Correll-Yoder and Suzanne
Burns and (from left, standing) Kate Sullivan-Collopy,
Elizabeth Rogan, Mary Hardy, Benny Bolin, Jacqueline Fowler
Byers, Katie Schatz and Kimberly Brown.
By Natalie Correll-Yoder, RN, CNS, MN, CCRN
Chair, Ethics Work Group
Informed consent, a patient�s decision-making
capacity, family decision making and suffering at the end of life are just some
of the issues that cause distress for critical care nurses as they try to
advocate for patients. Working with a shortage of staff or with colleagues who
are still learning critical care can aggravate this distress, as do the
ever-increasing workplace issues that result from stricter regulatory guidelines
and financial limitations.
How do we cope with situations where sick
patients outnumber the nurses available to provide them care? How do we support
colleagues who are new to critical care and still learning how to manage that
sick patient? What is it that we can do as critical care nurses?
Ethical dilemmas such as these that continue to
occur in the critical care environment were discussed by members of the AACN
Ethics Work Group when they met in August in Costa Mesa, Calif. As part of the
discussion, members were asked to identify not only the current clinical ethics
issues in critical care, but also what is needed related to end-of-life care.
Feedback from participants at the Ethics
Roundtable at AACN�s National Teaching Institute and Critical Care Exposition in
May provided some clarity to the issues faced by critical care nurses. The goal
of the Ethics Work Group is to identify and help develop resources to assist
critical care nurses in dealing with ethical issues or providing end-of-life
Joining me as members of the Ethics Work Group
for 2002-03 are Benny Bolin RN, ADN, MS, Kimberly Brown, RN, MSN, FNP, CS, CEN,
Jacqueline Fowler Byers RN, PhD, Mary Hardy, RN, BSN, Cynthia Janacek, RN, BSN,
AA, CCRN, Elizabeth Rogan, RN, BSN, MA, and Kate Sullivan-Collopy, RN, PhD, CCRN,
CCNS. Suzanne Burns, RN, MSN, CCRN, NP, is AACN board liaison, and Katie Schatz,
RN, MSN, NP, was staff liaison.
It is not always easy to speak out and advocate
for patients and their families. Having an understanding of ethical principles
and guidelines can assist the critical care nurse in this role.
Over the course of the next several months,
these members will provide support for AACN members by identifying helpful
resources and by writing articles on ethics and end-of-life cases for AACN News.
Each case study is designed to reflect common problems encountered in most
critical care areas and to provide the ethical principles and guidelines that
The �Power of One� will continue to be the theme
for this year�s Ethics Work Group. This story of �The Starfish� reminds us that
each critical care nurse can make a difference, one patient at a time. The
Ethics Work Group members hope the case studies provide tools that can help
critical care nurses make a difference with their patients.
The Star Thrower
As the old man walked the beach at dawn, he
noticed a young man picking up starfish and flinging them into the sea. Catching
up to the youth, he asked why he was doing this. The answer was that the
stranded starfish would die if left until the morning sun. �But the beach goes
on for miles and there are millions of starfish,� countered the other. �How can
your effort make any difference?� The young man looked at the starfish in his
hand and threw it to safety in the waves. �It makes a difference to this one,�
� Loren C. Eiseley
Nominations Are Due Dec. 1 for 2004 AACN
Distinguished Research Lecture Award
Dec. 1 is the deadline to apply for the 2004
AACN Distinguished Research Lecture Award. The recipient of this prestigious
award will present the Distinguished Research Lecture at AACN�s National
Teaching Institute and Critical Care Exposition, May 15 through 20, 2004, in
In addition, the distinguished research lecturer
receives a $1,000 honorarium and $1,000 toward NTI expenses.
The 2003 Distinguished Research Lecture will be
delivered by Kathleen Puntillo, RN, MS, DNSc, FAAN, a professor at the
University of California, San Francisco, on May 19, during AACN�s National
Teaching Institute and Critical Care Exposition in San Antonio, Texas. Her topic
will be �Pain Assessment and Management in the Critically Ill: Wizardry or
The lecture will again be sponsored by Philips
For more information, contact Research Associate
Dolores Curry at (800) 394-5995, ext. 377; e-mail,
Sepsis Education Program Is Now Available
in CD-ROM Format
Eli Lilly Grant Underwrites Purchase Fee
Identification and Management of the Patient
With Severe Sepsis,� AACN�s national sepsis education program for nurses, is now
available in a self-paced CD-ROM format. Funded by an unrestricted educational
grant from Eli Lilly and Company, this program is sponsored by AACN and is
accredited for 5.0 contact hours of CE credit for single users.
Narrated by clinical expert Barbara McLean, RN,
MN, CCRN, CCNS-NP, FCCM, the new program offers clinicians a comprehensive view
of the latest information on the diagnosis and care of patients with severe
The 170-page, audio/slide CD-ROM study guide
includes: pathophysiology of severe sepsis; identification of acute organ system
dysfunction; antibiotics, source control and monitoring in severe sepsis,
including investigational and new approved therapies; hemodynamic, ventilatory,
renal and other aspects of care; and nursing care of patients with severe
sepsis. Case studies are also included in the presentation.
To order this cutting-edge learning program for
only the $7.50 shipping and handling fee, call (800) 899-2226 and request Item
#004060. Quantities are limited.
Practice Resource Network
My fellow nurses and I have been frustrated
because of what we consider to be unsafe staffing ratios and patient assignments
in our critical care unit. Does AACN have written guidelines or recommendations
for staffing ratios and requirements for critical care units?
Because of the nurse�s critical role as a patient advocate, the responsibility
for ensuring safe, quality care for the patient is a valid concern. AACN
strongly advocates that the delivery of care be driven by the patient�s needs.
AACN does not advocate mandated nurse-to-patient
ratios. Instead, AACN believes that appropriate staffing of a patient care area
is dependent on the ability of the nurse to meet the needs of the patient.
According to the AACN Position Statement titled �Maintaining Patient-Focused
Care in an Environment of Nursing Staff Shortages and Financial Constraints,�
resolving staffing dilemmas requires a thorough understanding of the inter-
related factors that impact the quality of care
delivered, such as acuity, skill mix and available resources. (This position
statement can be accessed online at
http://www.aacn.org via AACN
Fax on Demand at  222-6329. Request Document #2001.)
When evaluating staffing issues, nurses should
be knowledgeable about federal and state regulations and their state�s Nurse
Practice Act, which defines the legal scope of nursing practice. In addition,
acute care hospitals that receive government funding for Medicare and Medicaid
patients are bound to conditions of participation, which include staffing and
quality-of-care guidelines. If you believe a violation has occurred, you are
responsible for notifying first your nursing supervisor, then the State Board of
To provide safe nursing care, the following
activities must be carried out:
� Accurate administration of medications and
implementation of critical medical treatment regimens
� Protection of patients at risk of harming
� Monitoring patients� responses to medical and
nursing interventions, consistent with each patient�s healthcare problem
� Notification of the physician of deteriorating
or unexpected change in a patient�s status
� Accurate documentation of the care delivered
to the patients
In today�s healthcare environment, the frequent
lack of nursing staff, as well as the fact that many units are being staffed by
mostly novice nurses is, unfortunately, common. If you feel that you have been
placed in an unsafe situation, you are ethically and legally obligated to
protect the patients. You are responsible for identifying the unsafe situation.
If you have concerns that a patient assignment or procedure that you have been
asked to do is unsafe or that you are not fully trained to accept, you should
report the situation immediately, preferably before you accept the assignment.
Begin by reporting your concerns to the charge
nurse, nursing supervisor or nurse manager. Document your concerns on a separate
sheet of paper, in an objective way, providing specifics to back up your
concerns. To protect yourself from legal liability, always keep copies of this
documentation. Some state nurses associations have �assignment despite
objection� forms that you may want to obtain. If the problem is a recurring one,
it is important for you to know if your state has a �whistle blower� protection
law, what it states and how you are protected if you decide to pursue the issue.
A useful tool for evaluating and strategizing
staffing needs is AACN�s Staffing Blueprint: Constructing Your Staffing
Solutions. Included in this comprehensive resource are references to sources
where you can find additional information. To order, call (800) 899-2226 and
request Item #300117 or visit the AACN Web site at
Do you have a practice-related question? Call
the Practice Resource Network at (800) 394-5995, ext. 217, or visit the AACN Web