Clinical mentoring of nurse practitioners: the doctors' experience

Abstract

The clinical development of nurse practitioners (NPs) has historically been dependent on mentorship from medical practitioners, yet their experience of this mentorship is generally unexplored. NPs have an ambiguous relationship with medicine as they have been dependent on medical mentorship to develop clinical skills, and they substitute into roles traditionally associated with medical practice. Consequently, NPs challenge professional boundaries and present particular concerns to their medical mentors. Practitioner ethnography examined the experiences of medical mentors, nurse practitioner students and academic staff during a clinical degree programme. This paper reports specifically on the medical mentors, focusing primarily on their professional authority relationship with their students and on their experience of imparting and sharing clinical knowledge. These experiences fell into three perspective stages, the provisional perspective, transitional perspective, and final perspective. Medical mentors were instrumental to the advanced clinical role of the student NP. This resulted in a conflicting experience of promoting a clinical role that challenged traditional medical authority. The effect of this was a cautious re-negotiation of professional boundaries. In future NP students (and their academic teachers) need to acknowledge this if they are to mutually gain the most from their relationship with their medical mentors.

Mentoring Nurse Practitioners in a Hospital Setting

“…Nurse practitioners provide healthcare services similar to those of a physician, with a unique approach that combines philosophical approaches from both nursing and medicine. The blended approach to patient care focuses on both cure and care (AANP, 2010;Barton, 2006;Geier, 2000;Spinks, 2009). …”

“…Common barriers such as role confusion, lack of support, and feelings of isolation, insecurity, vulnerability, doubt, inadequacy, and anxiety are found across multiple studies (Barton, 2006;Brown & Olshansky, 1997;Forbes & Jessup, 2004;Heitz et al, 2004;Nichols et al, 2005;van Soeren & Micevski, 2001). The process of becoming a competent NP involves a process of learning and practicing that is different for each individual.…”

“…The process of becoming a competent NP involves a process of learning and practicing that is different for each individual. Called "from limbo to legitimacy" or "a rite of passage", transition to the NP role involves social, cultural, and professional changes and require negotiations within NPs own values and within their professional circles (Barton, 2006;Brown & Olshansky, 1997).…”

“…Mentoring during internship is aimed at helping new NPs understand the advanced practice role and facilitate transition. Role transition is a staged process that takes time and requires professional relationships renegotiation and socialization into new professional groups (Barton, 2006;Barton, 2007).…”

“…Mentoring has been found to improve role transition, job satisfaction, and retention while facilitating socialization, emotional well being, and the acquisition of skills and knowledge for nurses and nurse practitioner students (Barton, 2006;Barton, 2007;Cashin & Potter, 2006;Faron & Poeltler, 2007;Halfer, Graf, & Sullivan, 2008;Persaud, 2008). Mentoring is a main component of orientation and internship programs for NPs, but there is little empirical evidence that mentoring can effectively improve transition to the advanced practice role (Bahout & Esposito-Herr, 2009;Cusson & Viggiano, 2002;Sorce, Simone, & Madden, 2010).…”