Improve the Retention of Public Health Nurses Through a Mentoring Program
A quality improvement mini-collaborative in North Carolina focused on developing a workforce development plan to increase public health nurse retention. After doing root cause analysis, the team developed a nurse-mentoring program and measured results after six months.
Nursing retention issues were pressing challenges that hindered the ability of health departments to meet population health services needs and to determine if a public health nurse mentoring program conducted over a 6-month period could be used to improve the competence, retention, and satisfaction of new public health nurses (defined as less than 2 years as a public health nurse or in a new public health nursing role). Health departments in the Central Partnership were invited to submit a proposal for a nurse mentor/mentee team to participate in the pilot project, and four health departments submitted applications that were approved. Nurse mentors received in-person training about population health service issues that should be covered in the pilot period and about how to serve as a mentor. Mentees received a phone orientation to the project. Over a 6-month period, nurse mentor/mentee teams met and implemented elements of the project manual, such as twice-monthly meetings. The Planning Committee sponsored monthly calls for team members (together and individually) to discuss team member progress and challenges they faced in achieving outlined goals.
Organization that conducted the QI initiative:
North Carolina Institute for Public Health
Davis, M. Public Health Quality Improvement Exchange. Improve the Retention of Public Health Nurses Through a Mentoring Program. Fri, 11/16/2018 - 11:27. Available at https://www.phqix.org/content/improve-retention-public-health-nurses-through-mentoring-program. Accessed March 26, 2023.
Background and Aim
To determine if a public health nurse mentoring program conducted over a 6-month period could be used to improve the competence, retention, and satisfaction of new public health nurses (defined as less than 2 years as a public health nurse or in a new public health nursing role).
Need For The QI Initiative:
In 2009, the NC Accreditation Learning Collaborative worked with the Central NC Partnership for Public Health on a QI mini-collaborative to assess the workforce to determine its abilities to deliver population-based services and to develop a specific workforce development plan. The NC Accreditation Learning Collaborative partners included the North Carolina (NC) Institute for Public Health, the NC Division of Public Health, and the NC Association of Local Health Directors. The Central Partnership was a collaboration of local health departments in the central part of the state. Partnership health directors determined that nursing retention issues were the most pressing challenges that hindered the ability of the health department to meet population health services needs. Partnership health directors identified staff in their organizations to serve as representatives on the Planning Committee for the project. Using available background data, the Planning Committee of nurse supervisors, nursing directors, and health educators shaped the QI approach by creating a nurse mentoring pilot project.
Area for Improvement:
Retention problems exist in all areas of nursing, but retention is particularly problematic in public health. An underlying cause of this retention problem is that nurses entering governmental public health positions have knowledge deficiencies in population focus, epidemiology, health education, advocacy, and case management. Turnover exacerbates the nursing shortage in public health agencies. The cost of turnover in one position is approximately 75% of the annual salary for that position.
The root cause of nurse retention problems in NC is that nurses entering governmental public health positions have knowledge deficiencies in population focus, epidemiology, health education, advocacy, and case management. This lack of knowledge results in job mismatch—that is, nurses are not trained to do their assigned roles in health departments—job dissatisfaction, and turnover.
Planning and Execution Details
Staff from the NC Institute for Public Health, the NC Division of Public Health, and the NC Center for Public Health Quality organized the work of the Planning Committee. The Planning Committee received basic training in collaborative quality improvement (QI) methods and created the Nurse Mentoring Pilot Project Manual. Health departments in the Central Partnership were invited to submit a proposal for a nurse mentor/mentee team to participate in the pilot project, and four health departments submitted applications that were approved. Nurse mentors received in-person training about population health service issues that should be covered in the pilot period and how to serve as a mentor. Mentees received a phone orientation to the project. Over a 6-month period, nurse mentor/mentee teams met and implemented elements of the project manual, such as twice-monthly meetings. The Planning Committee sponsored monthly calls for team members (together and individually) to discuss team member progress and challenges they faced in achieving outlined goals. Guest speakers also participated in the calls to further assist team members. A total of 10 nurse mentor/mentee team members were exposed (several teams had to have substitutions). At the end of the 6-month period, teams participated in a reunion meeting to discuss what they learned and receive certificates of completion.
3/1/10 to 11/1/10
Between 6-12 months
Methods of evaluation:
We conducted pre- and post-project surveys among nurse mentor and mentee participants. Participants were asked to complete the pre-project survey before attending training or project orientation and were asked to complete the post-project survey after the 6-month project period and before the reunion meeting. All participants completed the pre- and post-program surveys. Key measures are presented below with pre- and post-data.
|NC PH Nurse Mentoring Final Manual.docx||148.18 KB|
Measurable QI Outcomes:
Pilot Program Goals and Evaluation Results • Mentees planning to remain in public health will increase by 25%. At the beginning of the program, all mentees indicated that they intend to stay in public health at least 3–5 years, with three indicating they intend to stay 6 years or more. At the end of the program, there was no change in how long the mentees intended to stay in public health. During the end-of-program reunion, one mentee indicated that she would not have stayed in public health without the mentoring program. • Mentees who recommend working in a local health department to a colleague will increase by 25%. At the beginning of the program, three mentees stated they would recommend a local health administration job to a colleague, and one mentee stated that she was not sure. At the end of the program, two mentees stated they would recommend such a job, and two mentees stated they were not sure. • Mentee and mentor overall job satisfaction will improve by 15%. Mean pre-program job satisfaction was rated at 4.63 on a scale of 1 to 6 (with 6 being highest). Mean post-program job satisfaction was rated at 4.25. • Understanding of population-based services as well as mentee knowledge and understanding of their role will increase by 25%. Mean pre-program mentee confidence to perform their role was 4.75 on a scale of 1 to 6. Mean post-program mentee confidence to perform their role was 5.00. • One hundred percent of participating mentors and mentees will complete the 6-month program and all will be satisfied with the process. Due to a variety of circumstances, only one of the original mentor and mentee pairs completed the program as intended (Chatham). In one agency, the original mentee left the health department, and another was substituted (Orange). In a second agency, the mentor went on maternity leave, but a pre-identified mentor was substituted (Guilford). Wake County participated in the project but had extreme difficulty in identifying a mentor/mentee pair. The identified pair started about halfway through the program and participated in very few of the offered conference calls. Six of the eight respondents to the post-program survey indicated that the program was worth the time and effort and that the objectives for the mentor relationship were met. One respondent indicated that the lack of program structure was a barrier to participation. The other responded that barriers included issues with schedules and shifting job positions; therefore, she did not gain much from the experience. • More than 90% of mentees and mentors will be willing to serve as a mentor in the future. Seven of the eight (88%) mentors and mentees who responded to the post-program survey indicated they would be willing to serve as a mentor in the future. The mentor who was not willing to serve in the future indicated that she needed other responsibilities removed from her duties to serve as a mentor.
Other QI Outcomes:
Upon completion of the pilot project, the Nurse Mentoring Manual and training materials were revised and made available via the Web and disseminated to nurses throughout the state. The manual (attached) provides a how-to guide for a local health department to develop and implement a nurse mentoring policy and program.
Lessons Learned, Observations and Insights:
The following are tips from the final Nurse Mentoring Manual gleaned from the pilot: (1) Tailor goals and objectives in the contract to the mentee’s needs and the health department context. A mentee with little nursing experience may have different needs from a mentee who has nursing experience, but not in a health department. The size of a health department may also affect how goals and objectives are achieved. In a small health department, it may be very easy for a mentee to talk to others in different programs, but in a larger health department, these meetings may need more formal arrangement. (2) Options for the focus of the mentoring relationship could be: (a) public health nursing (understanding nursing in public health when new), (b) programmatic direction (could be for those nurses who are experienced in public health but in a new role), or (c) combination (could be for either new or experienced). (3) The mentor and mentee will need to determine the nature of the relationship—whether informal (e.g., hallway or cubical sessions), formal (e.g., as on a more set schedule at offsite locations), or some of both. The team will need to be flexible and ready to adjust to make the relationship productive. For example, in the pilot one team switched to breakfast meetings when lunch meetings could not be integrated into the work schedules. Thus, each team will develop the structure it will use for the mentoring relationship. This structure will include the elements (based on goals) that will be discussed and how meeting times will be scheduled. (4) There were several different mentor and mentee arrangements in the pilot. Some pairs worked in the same program but at different physical locations. Others worked in different programs and different locations. These arrangements can affect both the logistics of the pair meeting face to face and the content covered by the pair. As pairs are matched, these factors should be considered. (5) Part of public health nurse mentoring is to help the mentee learn more broadly about what public health is and what it does. To get beyond the typical program silos, the mentee could learn about other health department programs by meeting with staff from other programs or shadowing them in what they do. (6) To make every meeting as successful as possible, teams might want to identify a specific topic to address, and the mentor could identify and send materials on this topic to the mentee ahead of time. (7) Pitt County uses a meeting tracking log for informal and formal meetings; to make the most use of this log, this county sees how well each goal in the mentoring contract has been met. (8) Success factors noted by pilot participants are as follows: (a) Keep the relationship and meetings positive. (b) Have a clear understanding of the roles in the relationship. (c) Have an enthusiastic mentor (and the process can renew enthusiasm). (d) Provide guidance to the mentee through the orientation process. (e) Plan and provide, as appropriate, for the mentee nurse to learn other nursing areas and programs of the health department (cross-training). (f) Work together to select goals and be willing to change them, if necessary. (g) The development of goals for the mentee brings focus and purpose to the relationship. (h) The mentor should be open to evaluating the way “I do things as a mentor.” (9) To keep the momentum going throughout the local health department, Pitt County presented the program to its management team and at its supervisors meeting, reviewed the policies and procedures, and gained support from the managers and supervisors. Program updates are periodically provided at management team meetings to foster continued support.
Training and Preparation
QI Related Training Received:
The NC Center for Public Health Quality provided a half-day training to the Planning Committee on the Model for Improvement from the Institute of Healthcare Improvement (IHI).
Information about the Community
The NC Institute for Public Health and the North Carolina Division of Public Health serve the more than 9 million residents of the state.
Information about the Health Department
PHAB Accreditation Status:
QI Staff Information
Total number of Staff on QI Team:
QI team members:
NC Division of Public Health
NC Center for Public Health Quality
NC Association of Local Health Directors
Partner Organization Types:
Contact Information of the Submitter
NC Institute for Public Health, University of North Carolina at Chapel Hill Gillings School of Global Public Health
I've developed a nurse
I've developed a nurse mentorship program in my clinic as well. The nurses have verbalized a greater understanding regarding the scope of public health as opposed to acute care hospitals.