LeadingAge Magazine · March/April 2014 • Volume 04 • Number 02

Orientation and On-Boarding: Mentors are Key to New Employees’ Success

March 04, 2014 | by Janet Lyons and Pat McBride

Inspired by poor retention rates and looking for a way to boost quality of care and employee satisfaction, this provider developed its own staff mentorship program that brings out the leadership in frontline staff.

Starting at a new organization, such as Christian Living Communities (CLC) in Greenwood Village, CO, can be compared to visiting a new country: Each company has its own rules, values, language (e.g., acronyms), dress, communication styles and acceptable behaviors. New employees need a safe way to learn and ask questions without accidently breaking unspoken norms and facing embarrassment or worse. Providing nursing mentors is one way an organization can help new employees be successful and build a positive connection. CLC did just that, implementing a nursing mentor program in each of our communities.

Our mentorship program started in October 2011 for certified nursing assistants (CNAs) and in January 2012 for nurses, and is still successful today. The retention rate for the nursing department has gone from 45% to 90%, and State Health Department citations have dropped from 122 to 14. Here is a closer look at our program.

Retaining nursing staff is daunting and difficult, especially within long-term care. The lack of well-defined on-boarding and mentorship programs for nurses in long-term care settings has contributed to high turnover, mediocre quality of care for residents, and poor satisfaction surveys from nursing staff, families and residents. The costs of nursing turnover, low retention rates and poor orientation programs create potential financial hardships for most health care organizations.

CLC, a relatively small organization serving about 1,200 residents with 600 staff, lacked an organized, well-defined orientation process. We also lacked nursing skill competency training and had no mentorship program to assist with retention of the nursing staff.

High costs and the impact of turnover within the nursing department were pressing problems. The CLC Human Resources Annual Report showed a trend of lowering employee-satisfaction scores over a four-year period. Residents were not happy with the care they were receiving and felt the staff was not trained appropriately to care for their needs.

Building on a paper she had written as part of her Masters of Science in Nursing coursework, Janet Lyons performed a literature search on mentoring processes. She found little related to long-term care; most examples were hospital-based. The on-boarding and mentoring process we developed was essentially built from scratch. The plan was designed to increase nurse retention rates within CLC, but also included ways to achieve cost savings within the nursing department. For instance, the financial impact of orientation for one nursing employee is at least $4,500. By reducing turnover the costs of orientation have dropped dramatically—from approximately $720,000 to $210,000 annually.

In Rosabeth Moss Kanter’s theory of organizational empowerment (in her 1993 book Men and Women of the Corporation), the organization should provide empowerment opportunities to increase employee attitudes, thus allowing the organization to become more effective in its goals. The managers of an organization need to provide employees with adequate information and resources to do the job, a good support system and the opportunity to learn and grow (Kane-Urrabazo, 2006). Employees who are empowered are thus more committed to the organization. Empowerment provides the caregiver with the confidence needed to advance in her career and increase her skill level.

Our mentorship program is based on three premises that tie to employee success and retention: (1) knowing the rules, including the values and mission of the organization and standards of practice; (2) having a best friend at work and development of a support system; and (3) empowering staff to train, educate and mentor their peers to do the right thing.

Editor's note: LeadingAge member EMA, based in Eldersburg, MD, uses a "pre-employment tool" to try to determine how well prospective employees fit into the organization. Applicants apply online and part of the process involves a survey assessing nine values. Learn more here.

CLC has three criteria for becoming a mentor: solid performance in job skills, behaviors supporting the mission and values of the organization, and enjoyment in training others. Mentors are nominated by their peers or supervisors. The mentor is then required to complete a written application. The application includes questions such as “Why do you want to become a mentor,” “What strengths do you have that would make you a good mentor,” and “How do you think you might benefit from being a mentor?” One mentor, for instance, answered the first question by saying, “I am ambitious and very driven. I can make a difference by training others to reach their full potential.”

Some of the strengths candidates identified that would make them good mentors included, “good relationships with co-workers,” “doing the job right the first time,” “I like to share what they know,” “I was a mentee,” “I am a positive person” and “I am responsible.” Mentors are compensated based on positive evaluations and retention of the mentee. The mentors are paid monthly, at the rate of $500 per mentee per year. The commitment includes giving the mentee individualized training and support in learning the core competencies of the job, developing a positive relationship with the mentee, and helping the mentee assimilate into the team.

Basically, once a mentor always a mentor! The mentor maintains her status permanently unless a job performance concern is established by their supervisor.

The mentors receive eight hours of training on topics such as communication, developing positive relationships, teamwork, giving respectful feedback, time management, how to deal with stress, what mentees need and when, and how to handle change. The second part of the mentor training includes a skills lab, where the mentors are tested on the same core competencies that the mentee is tested on, such as bathing, showering, ADL care, starting intravenous lines, admission procedures, etc. The mentors meet every month, led by the “champion” of the program (Pat McBride), to share best practices, new training opportunities, to provide input and feedback, and to learn new skills such as coaching and negative feedback. The mentors are also in constant communication with the champion to express ideas and discuss issues that may arise with the new mentee.

Mentors and mentees evaluate each other every month through written evaluations that are reviewed by the champion. This allows constant monitoring of the relationship and positive progression of training. Some examples of evaluation statements include: “She is a very hard worker and team player,” “She recognizes the need to help nursing assistants,” and “She needs occasional reminders to slow down.” Other statements have included, “He is an important asset to the organization” and “He can guide me and others in the right way to meet the standards of the organization.”

See this CLC video about the mentorship program:

When a mentee has completed the year-long program, CLC has a big graduation party and the mentor introduces the mentee as a new team member. Once they graduate, a new mentor is introduced during a management team meeting, given a mentor pin and ribbon to wear, and receives a standing ovation. Often the employee who was a mentee goes on to become a mentor. The mentors are also involved in training other team members. Mentors have presented an empathy experience in-service to all the CLC employees and to the board.

Our program has helped new hires learn the landscape of CLC and gain a sense of belonging and support that includes having a best friend: A win for CLC, for the employees and for our residents.