After practicing in an advanced nursing role for nearly 20 years, I have witnessed the evolution of this role in healthcare. Once thought of as glorified nursing staff with limited to no autonomy depending on the State of employment, advanced practicing nurses are expanding their roles in patient care. However, registered nurses have been accused in the past of “eating their young” by protecting their turf and making it harder for the unseasoned nurse to learn real world experiences. This process may have past along to those RNs that became APRNs. The autonomy that was strived for by advanced nurses may have led to gaps in mentoring and interprofessional collaboration.
From a mentoring perspective, I wanted to give back for the time my preceptor gave me during course work. I have offered my time as a preceptor for students and witnessed several colleagues do the same. However, this is rarely seen once students graduate. Mentoring in larger organizations, if seen at all, is synonymous with orientation most of the time. Real mentoring takes time, and the schedules of most advanced practice nurses is limited. Newer nurses are looking to the medical staff for guidance and not their colleagues. In smaller practices where nurses have more autonomy and more time, mentoring does exist. I have seen this mostly when one nurse has experience in one area of practice and each can exchange their unique expertise, particularly in a primary care setting, or performing procedural work. The adage of see one, do one, teach (mentor) one should be practiced more. From an advanced practice nursing view, I believe mentoring will happen more as the hierarchical structures of providers change.
From an interprofessional collaboration perspective, at a large practice, I witnessed a staff of surgeon meeting on a weekly basis to discuss new research. I attempted to have the advanced practice nursing staff meeting monthly. It was met with much resistance, not from the surgeons, but from the APRNs. Part of this resistance comes from time commitments, as well as, APRNs seeing themselves and their colleagues as salaried employees many times. I have seen a lack of ownership of the patient in larger organizations. In small organizations, I hear the term “my patient” frequently used and this leads to more interprofessional collaboration within the smaller organization and when discussing care of the patient with other APRNs outside the organization. No matter the setting or the nursing role, nurses should take ownership of patients. I think this would help nurses naturally look for the best solutions and in turn begin to help each other more. I have been on my own in an office several times and I can remember how welcoming it was to have another APRN in the office to discuss care of patients and learn from their experiences. What can the larger organizations do to be more welcoming?
In closing, it seems the comparative factors for both mentoring and interprofessional collaboration stem from the size of the organization from my perspective. I have been out of the larger hospital systems for a few years and would be interested to hear about the status of how experienced nurses are treating new graduates.
Bob Hobbs, APRN, MSN, MBA, DipACLM