Angela Campbell, RN, arrived at North Broward Medical Center in southern Florida fresh out of nursing school and full of excitement and enthusiasm. Within a few weeks, she found herself engulfed in a new nurse's worst nightmare.

A nurse on the night shift ridiculed her because she didn't know certain procedures, she said. Campbell felt afraid to ask questions. Other veteran nurses said she couldn't be trusted. Frightened and confused, she made a minor error.

Campbell was in her mid-30s. She'd worked as a teacher in her native Jamaica and earned a business degree in the United States. She'd gone to nursing school on a scholarship and graduated with a B average. But she began to think she was stupid. That she wasn't fit to be a nurse. That she'd chosen the wrong profession.

"I was miserable," Campbell said. "My self-confidence went down to the ground."

After Campbell's mistake, several nurses expressed concern about her to Marlene Roman, MSN, RN, medical/surgical clinical nurse specialist at North Broward and Coral Springs Medical Center and president of the Academy of Medical-Surgical Nurses. After hearing Campbell's side of the story, Roman had her switched to a day shift with a supportive preceptor.

Roman became Campbell's mentor, meeting with her regularly and reassuring her that she wasn't expected to know everything, that no question was too stupid, that she was a good nurse. Eventually, Campbell went back to the night shift under a new manager.

"Her manager told me she's a star on nights," Roman said. "Angela has told me she's so proud of herself."

If Campbell had had an experienced mentor to go to early on, Roman said, she might have been able to get help dealing with the other nurses' criticism instead of spending nights sitting alone in her car before her shift, praying she would not make a mistake.

Campbell's experience and similar horror stories from other new graduates have prompted Roman and other nurses from the Academy of Medical-Surgical Nurses to propose the creation of a new nurse mentoring program for hospitals. Although the program is still being fine-tuned, a number of hospitals already have started asking experienced nurses to help green ones.

In an effort to keep new nurses such as Campbell from becoming overwhelmed and leaving within their first year, hospitals around the country are implementing formal mentoring programs that pair first-year nurses and other new employees with hospital veterans.

The programs vary widely. Some use mentoring as part of an integrated new-nurse internship program. Some use carefully trained preceptors as mentors, others keep the roles purposely separate. The programs may last less than six months or as long as a year.

Some programs started by focusing on nurses fresh out of school, but many have expanded to include all new employees, including nurses who are returning after being away and nurses who have worked in other hospitals.

Although most hospital nurse mentoring programs focus on new graduates and new employees, nurse consultants and others who deal with nursing workplace issues say the profession needs to rethink the value of mentoring for nurses at all levels of their career: when they start a new job, when they enter a new department, when they go back to school. All of those situations may require a slightly different type of mentoring.

"The one thing about mentoring in nursing is that it is so complex," said Katherine Vestal, Ph.D., RN, president of Work Innovations Inc. a health care consulting group. "It's anything from politics to clinical details. It's not an easy job."

Formal mentoring programs are specifically tailored for new employees because many hospitals report that their greatest retention problems occur in the first year or two of the nurse's arrival and sometimes as early as within six months. The new nurses often have no time to find mentors on their own.

"In some places, 40 percent to 50 percent of all new grads leave within a year, and that's costly to management and disheartening for the new grad," said Cecelia Gatson Grindel, Ph.D., RN, associate director for the undergraduate program at Georgia State University in Atlanta and a founding member of the Academy of Medical-Surgical Nurses.

In days past, before patient stays became shorter and nurses had more time to spend with patients and colleagues, mentoring often occurred informally. Roman remembers working with other new nurses who banded together as a team. "We basically mentored each other," she said.

Now, hospital nurses, battling short staffing and mountains of paperwork, often have little time for anything but their work. "Nurses today often are stressed to get even basic patient care done and feel they can't devote the time needed for mentoring," Vestal said.

Little experience
At the same time, many new graduates come into the hospital with little patient care experience, said Carol Ann Cavouras, MS, RN, president and owner of Lawrenz Consulting, an Arizona-based company that works with acute care hospitals on staffing and scheduling. "They're just not as comfortable in the hospital as they were years ago," she said. Nurses returning after a few years may find increased patient loads and unfamiliar technologies. The pace is fast, the responsibility terrifying. After a few weeks of training they are expected to jump right in, said Charles Krozek, MN, RN, director of research, education and patient care services, and director of RN internship in pediatrics at Childrens Hospital Los Angeles.

Even experienced nurses from other hospitals may find themselves in need of someone to make them feel welcome and to help them navigate the system. Mentoring programs are "a retention effort, but they're really helping new people with the culture," Cavouras said.

Two-and-a-half years ago, Childrens Hospital Los Angeles decided to try reversing its 36 percent new-grad turnover rate by implementing a six-month nurse internship program for all new nurse employees. The program includes intensive preceptoring, debriefing and self-care, a classroom and skills lab and a mentoring program.

In the program at Childrens, mentors are nominated by their peers. They meet with new nurses over pizza. Based on that meeting and written profiles, each new nurse selects several prospective mentors. The internship office makes the final match.

For the six months of their internship, mentors and mentees must meet once a week. They talk about everything from career goals to problems with staff members to balancing their personal and professional lives, Krozek said.

At Albert Lea (Minn.) Medical Center-Mayo Health System, new graduates used to choose mentors from a bulletin board where their profiles and photographs were posted.

The hospital began its mentoring program in 1994 based on a similar one in a public school. Administrators found that some nurses ended up with too many mentees and some eager mentors didn't get any, said Jane Madson, RN, staff development coordinator at Albert Lea.

Administrators now match mentors with new grads, based on their personalities and interests, said Lori Routh, RN, hospital director of nursing at Albert Lea.

Many mentoring programs, including those at Albert Lea and Childrens Hospital Los Angeles, assign mentors who are not preceptors specifically so that new nurses can talk to their mentors without worrying about how it will affect job-performance reviews.

At Seton Healthcare Network, based in Austin, Texas, preceptors and specialty educators are trained to be mentors, to make sure all new nurses feel comfortable and welcome both during and after their orientation.

"When you leave nursing school, you leave the safety of your clinical instructor," said Joyce Batcheller, MSN, RN, senior vice president of operations and chief nursing executive for Seton. The preceptors and specialty educators understand they are filling that role until the new nurses gain confidence, she said.

Most programs include a training session for mentors, explaining how to be a good mentor, what mentors should and shouldn't do and even how to end a mentoring relationship when it is time for the mentee to move on. Mentors are not usually monetarily compensated, but many programs allow and even encourage the pairs to meet on company time. Some hospitals offer appreciation lunches or other rewards for mentors.

Administrators said they have quickly reassigned mentors if either member decides the relationship is not working out, but they added that this happens infrequently.

Rewarding work
Mentoring new nurses is rewarding, but sometimes a lot of work, said Jill Morstad, RN, an intensive care nurse at Albert Lea and a mentor since 1994. "It causes a little extra stress that some days you don't need," she said. But she feels a responsibility toward the new nurses at her hospital.

"You need to help those nurses grow up in the profession," she said. "If we're not going to nurture our own, who is going to nurture them?"

Because most programs are so new and because they vary so much, data on the value of mentoring are sparse. Childrens Hospital Los Angeles reported a drop from 36 percent to 16 percent in new-graduate turnover rates in the 2½ years since implementing its internship program.

Since starting its mentoring program two years ago, Botsford General Hospital, a 330-bed community facility near Detroit, has assembled 43 volunteer mentors from various units and specialties, said Connie Fleming, MSN, the hospital's director of nursing services. "It's starting to make a difference," Fleming said. Before the mentoring program, the hospital found it was losing nurses within the first two years of their hire dates. "We're not losing as many people during that time," she said.

Administrators of formal mentoring programs said they hope this introduction to mentoring will show new nurses the importance of finding their own mentors as they progress in their careers. Some said they would like to expand the formal programs to other areas, such as nurses entering new departments.

Because the role has changed so much in the last decade, nurse managers are especially in need of mentors, Vestal said. Vice presidents of nursing who used to help new managers adjust to their jobs are often too busy essentially running a small business, she said.

Without leadership development, management development and coaching-all areas traditionally developed through mentor relationships-many new nurse managers are left to wither on the vine, Vestal said. "They end up extremely frustrated, unable to meet the expectations of the day."

What the profession needs to do, she said, is to figure out a way to measure the benefits of mentoring at all levels. "What you can't measure, you can't reward," she said.

In addition to persuading hospitals to adopt its mentoring program, "Nurses Nurturing Nurses," the Academy of Medical-Surgical Nurses plans to collect and study data to provide more hard figures on the value of new-grad mentoring.

Many benefits of mentoring are difficult to measure. One of those is the number of mentoring relationships that develop into friendships between peers.

For Lisa Riedel, RN, and her mentor, Jennifer Lara, RN, both staff nurses in the intensive care unit at Botsford, the relationship has already become more of a friendship. Both are planning to go to graduate school in the same field and their conversations, mostly by phone and over the Internet, are about their school plans. They also have talked about staff members, "what number to you use to call in when you're sick, how long are breaks, really, and that kind of stuff," Riedel said.

Although Riedel was a six-year nursing veteran when she started at Botsford, she was still pleasantly surprised when Lara approached her, introduced herself as her mentor and showed her where the time clock was.

"It was nice to have somebody who was familiar with me and was there to greet me," she said.

Lara and Riedel work different shifts and haven't talked much face-to-face, Lara said. "But she knows I'll be here if she needs me. I know I've gone to her for things. Hopefully I'll know her for years to come if she stays around. I hope she likes it here."

Cathryn Domrose at kaguilar@well.com