WILLMAR -- Once a month Elaine Miller sits down with the novice nurse whom she mentors.
They talk informally. How are things going? Are there any questions? Does the new nurse need advice or feedback about the patient situations she's encountering?
Miller has been impressed with how quickly the nurse is increasing her hands-on and critical-thinking skills.
"I just feel like soon she won't need me," she said.
Miller, a registered nurse in Rice Memorial Hospital's recovery room and ambulatory care service, is among a handful of experienced nurses who are mentoring rookie nurses in a pilot program started this year by the city-owned hospital.
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The mentor program is one of the ways in which the hospital is trying to help smooth the transition for nurses newly graduated from training.
These nurses enter the work place with all the right knowledge and skills, said Jessica Vagle, clinical nurse specialist with the adult health unit at Rice Hospital.
What they often find, though, is a completely different world from the classroom, she said. "It's much faster-paced than their school experience. They're taking care of more patients. Patients are sicker. They're here for shorter stays. Nurses are more on their own."
They're still learning how to prioritize and see the big picture -- and doing so in a setting that's often highly stressful, Vagle said.
On top of that, they're adjusting to rotating shifts, working weekends and holidays, and in many cases trying to settle into a new and unfamiliar community.
The first year out of training is one of the most vulnerable times for a new nurse, said Ann Rossell, a nursing float pool supervisor and head of Rice Hospital's mentorship program.
Without support, rookie nurses can be at risk of floundering, losing their enthusiasm, and possibly burning out or leaving nursing altogether, Rossell said.
"It's a major casualty if they leave the profession," she said.
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Creating a good first experience is important, agreed Miller, the mentor.
"I think it's really important for the retention of nurses," she said. "To be an information resource is important to help that novice. ... Nursing is changing so much. It's impossible to prepare for all the potentials and all the skills you need."
For this reason, Rice has joined a growing number of hospitals that are taking formal steps to coach and support new nurses during that critical first year on the job.
"It's the right thing to do for our staff," Vagle said.
About nine or 10 newly graduated nurses are hired at Rice each year.
Three years ago the hospital launched an orientation program designed specifically for them.
"We felt we needed to do something to help support those nurses coming out of school and give them some extra tools," Vagle said.
The orientation program -- which comes on top of a standard orientation that's offered to all new hospital employees -- gives rookie nurses an additional day of training one day a month for up to six months.
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This is a chance to dig deeper into issues such as theory, care guidelines and the conceptual thinking that underpin patient care.
"It's very clinically focused," Vagle said. "It enhances their nursing process and their skills."
It's a chance to talk about support and resources that are available to help novice nurses through the rough patches.
The program's organizers hope they can help foster a sense of meaning as well.
It's easy for nurses to feel overwhelmed and self-critical, Rossell said. "Nurses tend to be perfectionists. They are very hard on themselves and I think that really contributes to burnout. They have a hard time letting go. This is about teaching them to look at what they've accomplished, to not feel bad about asking questions."
Vagle said she's hearing from many of the rookie nurses that the importance of their relationship with their patients often hits home once they enter the work force.
"They didn't anticipate it to be so rewarding," she said. "It's a special profession, to have people's lives in your hands and interact with them in high-stress situations."
The orientation program has been growing. It was expanded this year from once to twice a year.
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The mentorship program -- a relatively new concept in Minnesota hospitals -- also was launched this year on a pilot basis. To start with, it's for newly graduated nurses, but Rossell hopes to some day offer it for all recently hired nurses and eventually for all Rice employees.
Hospitals across the United States are looking for whatever they can do to retain their nurses, Rossell said.
When a nurse leaves, one of the single biggest reasons is a lack of employer support, she said. Some of the most recent studies are finding that mentors are a key strategy to retaining nurses.
Rice's new mentorship program formally matches rookie nurses with experienced nurses for one year.
"It's something that provides what we call a safe harbor," Rossell said. "They're paired with someone who can listen, who is confidential, someone who they can go to with their deepest fears."
Mentors can be particularly effective at helping new nurses navigate the unwritten rules of hospital culture, at helping them develop a network of friends and fit into the care team.
Integration into the overall community -- finding out where to meet people, where to go to church, where to shop for groceries -- is something Rossell wants to tackle as well.
"In a small community it's often really hard to get into that," she said. "That's been identified as a big reason for people leaving. It's not work-related -- it's lifestyle-related and not being able to find friends."
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Feedback suggests that the extra support and coaching for new nurses is helping to make a difference.
"It's been very positive. The evaluations have been very good," Vagle said. "They're saying it enhances their nursing process and their skills."
Hospital officials are tracking the nurse turnover rate to measure the impact of coaching and mentorship initiatives, she said.
"The hospital is paying very close attention to this. It is used as a recruitment tool and a retention tool," she said. "This is what the cutting edge is -- new graduate programs."
Rossell said an evaluation component is in the process of being developed for the mentorship program, so that Rice can continue to improve and refine it.
"We do want to continue to evaluate what worked for them and what didn't work for them," she said. "While we're not able to provide the ongoing courses that a large hospital can, I do think we offer something on a much more personal level and adapt to the person's needs. They don't feel as lost in a crowd.
"If we can show we can improve retention and competence and happiness, it's going to be worth it."
