Building Nurse Mentoring Programs focused on Quality Improvement
In Rwanda, as in many resource-limited settings, the majority of primary care is delivered at health centers staffed by nurses. Delivering quality care is often limited by both facility challenges and the performance of health providers. Implementing nurse mentoring and quality improvement initiatives is an important strategy to improve care, particularly in sub-Saharan Africa where patient care is being shifted from physicians to nurses, especially in HIV care and treatment (Kanchanachitra et al. 2011).
Partners In Health, in collaboration with the Rwandan Ministry of Health, launched the Mentorship and Enhanced Supervision at Health centers (MESH) Program in Kirehe and Southern Kayonza districts in 2010. While early results show promising benefits of this intervention, we have faced many challenges in implementing and growing this program. During this five day online discussion, experts in the domains of clinical mentoring and quality improvementhave shared their experiencesand reflections on mentoring activities, M&E data utilization for effective mentoring, mentor selection and training, and ongoing support for mentors.
Highlights:
Mentoring contributes to nurses’ professional development by teaching skills in new areas and encouraging growth. Mentoring has the potential to sustainably contribute to high-quality clinical care (WHO 2005).
A mentoring approach that leads to improved quality of care must focus on both individuals through side-by-side teaching and on systems through supportive supervision.
In addition to the tailored clinical training, mentors need to receive hands-on training in supportive supervision techniques, approaches to adult learning, and implementing Continuous Quality Improvement models.
Mentors need to be trained how to use existing data sources/reports to inform their mentoring interventions. They can then teach their nurse mentees how to effectively utilize data to improve patient care.
Mentors should provide regular feedback to their mentees, supervisors and stakeholders. Similarly, mentors should receive regular feedback from these parties.
Local and national government bodies should be involved early in the process of designing and implementing a mentoring program
There is a need to improve support health center management skills since the lack of management skills affects mentoring and training outcomes. Training health center managers could sustain improvements brought about through clinical mentoring(Rowe et al. 2010).
Nurse attrition rates and lack of motivation have been identified as challenges to implementing mentoring programs at health centres. The WHO proposes the following measures to address this challenge: recognition schemes, performance management, training and professional development, leadership, participation mechanisms, intra-organizational communication processes
References
Kanchanachitra, C. et al., 2011. Human resources for health in Southeast Asia: shortages, distributional challenges, and international trade in health services. Lancet, 377(9767), pp.769-81. Available at:
Rowe, L. a et al., 2010. Building capacity in health facility management: guiding principles for skills transfer in Liberia. Human resources for health, 8, p.5. Available at:
WHO, 2005. WHO recommendations for clinical mentoring to support scale-up of HIV care , antiretroviral therapy and prevention in resource-constrained settings. Therapy, (March), pp.16-18.