The nursing profession has seen several challenges in recent years associated with high levels of stress, burnout and turnover. The COVID-19 pandemic exacerbated these issues, making it more critical than ever to find sustainable solutions that support and retain nursing staff. At University Health Network’s (UHN’s) Peter Munk Cardiac Centre (PMCC), in Toronto, Canada, an innovative coaching and mentorship program was created to address these challenges, providing structured professional development opportunities for nurses.
A New Approach to Nurse Development
The initiative, spearheaded by Dr. Barry Rubin, PMCC medical director, Pam Hubley, vice president & chief nursing executive at UHN, and Sarah McDermid-Flabbi, nurse lead, aims to improve nurses' work experience by implementing an 80/20 model, dedicating 80% of their time to patient care and 20% to professional development. The program is based on two key components: coaching and mentorship.
In the coaching stream, experienced nurses have the opportunity to support novice nurses, internationally educated nurses, and those transitioning between care areas. These coaches are relieved of their patient assignments for 12 hours each week over 16 weeks, allowing them to focus entirely on guiding and coaching their colleagues at the bedside.
The mentorship stream enables nurses to self-select a mentor based on a specific work project or their professional aspirations. Whether they are exploring career transitions, considering advanced practice nursing roles, or seeking help on a project of interest, this protected time offers one-on-one mentorship every week.
“This program aims to assess whether providing nurses with a structured, 16-week professional development opportunity on a weekly basis positively impacts their well-being and retention,” McDermid-Flabbi explained.
The Drive Behind the Initiative
The program is part of a study about nurse well-being that Rubin and team are conducting at PMCC. The driver was a 2024 study (co-authored by Rubin), which found high levels of distress among nurses using the Well-Being Index Tool developed by the Mayo Clinic. It found that 75% of nurses were experiencing high distress, with 55% classified as severely distressed. Severe distress was linked to an eight-fold increased risk of burnout and a three-fold increase in the likelihood of leaving the profession within two years.
“With this in mind, we went to our nurse colleagues and said, ‘We know there are high levels of burnout. It's your work-life balance; it's the perception of not being listened to. It's a variety of things that are commonplace unfortunately in nursing’,” Rubin said. “We then went one step further and said, ‘Let’s use a co-design process and ask the nurses, ‘How do you want to solve this? What would be best for you?’”
The key takeaways from the co-design discussions with nurses emphasized the need for structured support systems, mentorship and career planning opportunities, which led to development of the PMCC Nursing Clinical Coaching and Mentorship Program.
“The nurses have said to me, ‘I can’t believe program leadership is paying attention to us,’” Rubin said. “There’s this machinery of healthcare and constant churn and the expectation that nurses are just going to be there. We took a different approach and asked nurses ‘Hold on a second. How are you doing? What are the drivers of the real problems that you’re having, and how could we work with you to affect solutions?’ It was their responses that motivated our desire to improve the work environment for nurses, and our passion for this project.”
Funding and Implementation
One challenge in implementing the program was securing funding, as participating nurses needed protected time to be relieved of clinical duties during their development sessions. Thanks to a generous donation from the Peter and Melanie Munk Foundation, the hospital was able to cover the costs of backfilling the units, so that interested staff could participate in this professional development program, ensuring that patient care was not compromised while supporting staff development.
“Nurses for many years have talked about the importance of having opportunities to engage in quality improvement and engage in projects and initiatives that relate to improving their work life and their workflow,” Hubley said.
Registered Nurse (RN) Tigist Abraham participated in the program and received mentorship to implement a process improvement project with her multidisciplinary team in their procedure area. She noted that inefficiencies in patient flow led to frequent demands for overtime, which impacted her time with her family.
“I found a mentor who had experience working with similar issues. So, even though he wasn’t directly my manager, he was very familiar with what we were going through,” Abraham said. “We met once a week to discuss updates on my progress, and he really took me under his wing.”
As a result of the mentorship, Abraham developed a successful solution that was supported by all the stakeholders. The project outcomes are still being measured, but she notes that the need for overtime has already declined.
Measuring Success
While the program is still being evaluated, early qualitative feedback has been overwhelmingly positive. Nurses have reported:
- Reduced anxiety among younger and internationally educated nurses.
- Increased confidence in navigating hospital policies and procedures.
- A greater sense of support and belonging in the workplace.
- Renewed engagement in professional activities after experiencing pandemic-related burnout.
A formal statistical analysis is currently being conducted with key metrics, including changes in Wellbeing Index scores, job satisfaction, organizational commitment and self-efficacy. Additionally, the study will compare retention of participating nurses with a propensity-matched cohort to assess whether the program contributes to long-term nurse retention.
“Across the board, we are hearing things like decreased anxiety for the younger nurses that are on the unit or the internationally educated nurses, relearning a new culture, a new way of providing care, really understanding our policies and procedures, and having someone in a role that is dedicated to answering your questions with respect and non judgment,” McDermid-Flabbi said.
A Model for Other Institutions
For hospitals looking to implement a similar program, the key takeaways from PMCC’s experience include:
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Engagement with nursing leadership and executive teams to align the initiative with institutional goals. - Seeking donor or administrative funding to support staffing adjustments.
- Using a collaborative approach that involves nurses at all levels of program design and execution.
- Leveraging word-of-mouth and peer recommendations to drive participation.
- Prospective evaluation of the impact of the Clinical Coaching and Mentorship Program on nurse well-being and retention.
“This is such an important program, because I think we need to redesign and reimagine how we think about nursing care and the nursing shift work,” Hubley said. “We have found it increasingly difficult to build in time for learning, time for reflection, time for projects, as the system has continued to be under constraint.
“I think we have to really reimagine what we expect, what we create, and how we enable point-of-care nurses to continue to deliver care. It’s essential,” she added. “Keep that knowledge that’s developed at the point of care, but enable other opportunities that are meaningful and productive for professionals.”
As the final results emerge, the program has the potential to demonstrate that investing in nurses not only enhances their well-being but also has a profound effect on patient care and overall hospital sustainability.
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