The role of peer mentors in nursing

ABSTRACT: Mentors within an educational setting have traditionally been teachers and counsellors. Students mentors offer an alternative approach. Peer mentors have been shown to be superior to traditional mentors for reducing students’ levels of stress and anxiety, improving self-efficacy, and improving academic performance. Mentees have reported that student mentors are more accessible and relatable compared to formal instructors. Benefits have also been reported by the mentors themselves, including development of leadership and interpersonal skills. This review explores the feasibility and effectiveness of student mentors within nursing education. It will also look at the advantages and disadvantages of utilizing student tutors compared to traditional faculty. 

INTRODUCTION: Nursing is a profession that has heavily relied on mentors. Inexperienced nurses and nursing students rely on experienced nurses to help guide them through the complex health care system. McMaster’s School of Nursing (SON) has taken an innovative approach to mentoring by utilizing students or recent graduates for this process. For example, the simulation lab has a program called Peer Tutors, where students teach other student’s clinical skills outside the classroom. They also have a program called the Nursing Upper-Year Buddy (NUB), where a 3rd or 4th year nursing student is paired with a 1st year nursing student. The expectation is that the upper year student can provide academic and professional guidance and the program has been regarded as highly successful. Lastly, the SON offers 4th year nursing students the opportunity to pair with a recent graduate mentor that shares similar career interests and goals.   

STRESS AND ANXIETY: High levels of long-term stress and anxiety have been shown to negatively impact learning and memory (1). For example, stress is associated with inattentiveness, disorganized thinking, and reduced executive function, all of which are fundamental cognitive processes for learning (1). This is especially relevant to nursing education, as a recent literature review found that nursing school is consistently rated as one of the most rigorous and stressful programs (2). This review included 26 studies that focused on undergraduate baccalaureate nursing within America, Canada, and United Kingdom. Factors included were stressors and coping abilities. The studies summarized consisted of both qualitative and quantitative research.

One study explored the use of undergraduate students as clinical instructors rather than faculty members and found that 69% of mentees reported feeling less anxiety when taught by a student. They also reported having better experience with the nursing curriculum (3). A systematic review examined outcomes associated with peer mentoring and found that two prominent outcomes were stress reduction and improved resilience (4). Mentees reported a 43% reduction in stress and 32% reported developing resilience as a result of the mentoring program (4). 

SELF-EFFICACY:Self-efficacy is widely regarded as a necessary trait amongst health care professionals. In fact, the College of Nurses of Ontario (CNO), the regulatory body for nurses in Ontario, recognizes self-regulation as one of the 6 fundamental principles for maintaining professional competence (5). For nurses in Ontario to maintain their license, it is expected that they demonstrate a commitment to self-improvement and self-directed learning.

According to nursing students, self-efficacy can be defined as the ability to provide competent and safe patient care independently (6). However, studies have found that confidence levels in clinical settings are severely low (7). For example, a survey of fourth year nursing students found that 60-65% of the participants felt uncomfortable advocating for patients on their own (8). This trend extends to the recent graduate as well, where most report low confidence in crisis situations (9). Evidence suggests that students that receive peer mentoring show greater confidence and independence. For example, one study found that traits related to introversion decreased as mentors encouraged their mentees to talk about their fears. This finding was also associated with being able to communicate and advocate for patients more independently (10).

ACADEMIC PERFORMANCE:Academic performance is vital to becoming a competent nurse. In fact, a meta-analysis found that having a high-grade point average is significantly correlated with passing the nursing licensing exam (11-13). The evidence for the benefits of mentors on academic performance is mixed. One study investigated the effect of peer mentors on students who were at risk of failing. The group with the mentors increased their grades more than the group without the peer mentors, but this finding was not statistically significant (14). In contrast, a large qualitative study of over 400 participants found that both mentors and mentees self-reported improved grades (15-16).  

One benefit that does not appear to be mixed is the effect of peer mentors on attrition rates. Attrition rates in Canadian nursing schools range from 10-18% (17). One study found that on average, nursing schools with peer mentor programs have a 7.8% higher retention rate (18). Another study found that having access to peer mentors amongst first years reduced attrition rates from 6% to 2% (19).

MENTEE AND MENTOR EXPERIENCES: A commonly reported benefit of peer mentorship by mentees is the improved relatability of a peer mentor versus a professor. One study found that mentees felt like they could share anything with their peer mentor and that both parties enjoyed participating in meaningful discussion and reflection (20). A systematic review also revealed a common theme of personal and professional development in mentees. They found that 72.5% of mentees reported significant improvements in their teamwork skills and 58% felt they were more accountable and responsible towards their schoolwork (21).

The effects of peer mentoring have also been beneficial for the mentors themselves. After assuming the mentor role, peer mentors reported increased self-growth, self-efficacy, and leadership skills (22-24). This finding is particularly important considering nurses’ role as informal mentors and advocates for patients. 

Mentor-mentee relationships can be characterized as a mutual and reciprocal relationship wherein knowledge transfer is bidirectional because both sides are actively learning. Mentors have reported that this role has significantly expanded their knowledge and experience, and that this was one of the most rewarding aspect of their efforts (17).

PEER MENTORING VERSUS HIERARCHICAL MENTORING: Hierarchical mentoring for undergraduate students involves a mentorship between a student and a faculty member, adviser, or counselor. Both peer mentoring and hierarchical mentoring have been shown to positively impact traditional indicators of academic success such as GPA and retention (15-16). However, despite their similar effects, both styles have their benefits and weaknesses. 

Several barriers that make hierarchical mentoring unfeasible have been identified (19). For example, mentees frequently reported finding academic settings to be intimidating and fear that requesting mentorship could be perceived as a sign of weakness (19). Another barrier is the low faculty-to-student ratio, where students have complained about the lack of available mentors and lack of interest from faculty (19).

Use of peer mentoring in the literature has been shown to have many advantages in comparison to hierarchical mentoring. Advantages include lower costs, availability of more mentors, and improved relatability (24). One key element of a successful mentor-mentee relationship is sharing common experiences. It can be argued that peer mentors are more likely to have more in common with their mentees relative to faculty members (24). 

CONCLUSION: Despite its minimal use, there is evidence supporting the benefits of peer mentorship in undergraduate nursing. It represents a low-cost alternative to traditional mentoring and demonstrates bidirectional benefits for both mentees and mentors. However, it should be noted that studies investigating this tend to be underpowered. Replication of these studies with larger sample sizes is necessary to validate these claims. Nonetheless, the literature is very clear and supportive of the use of peer mentoring programs in undergraduate nursing. Students have the potential to fulfill this role and can be an invaluable resource for their peers requiring guidance and support. Should other undergraduate programs in the future attempt to implement a peer mentoring program, it would be beneficial to determine the specific areas in which students struggle by examining student feedback. Identifying common student needs can act as a basis to create targeted activities facilitated by peer mentors.

Written by Massod Nawa.

REFERENCES

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