Summary nurses is currently a serious problem

Summary of relevanceProblemNegative mentoring experiences (NMEs) would result in the mentee’s disappointment and decision to leave nursing job. Little attention has been given to provide the tools to evaluate NMEs such as questionnaire in nursing workplace.What is already knownPast research has found that many new nurses confronted NMEs in the mentorship and NMEs was composed of five dimensions. What this paper addsThis study can provide a negative mentoring experience questionnaire (NMEQ) with theoretical base for hospital nurses. NMEQ also can be used as an important management tool in the process of monitoring and managing mentoring programs.. 1. IntroductionThe shortage of hospital nurses is currently a serious problem for clinical nursing care, and it is one that lacks an effective solution. The high turnover rate of nurses is a main contributor to this problem, with new staff nurses being the group with the highest outflow rate (Currie & Hill, 2012). Kovner and Brewer (2010) found that within the first two years of work, new staff nurses have a turnover rate of 26.2%. The high turnover rate of new staff nurses is ususally caused by difficulty adapting to a new environment, a low sense of professional accomplishment, the difference between expectations and reality, and a high level of work-related stress (Lea J. & Cruickshank, 2005; Tastan, Unver, & Hatipoglu, 2013). In order to solve the problem of adapting new nurses to the new work environment, mentoring programs that aim to shorten the acclimation period of new nurses have been implemented in many hospitals. The programs involve establishing positive work attitudes and career outlooks, as well as strengthening the competence to adjust to the workplace and their work efficiency, therefore lowering turnover rates (Kajander-Unkuri, Leino-Kilpi, Katajisto, Meretoja, Räisänen, Saarikoski, Salminen, & Suhonen, 2016; Li, Wang, Lin, & Lee, 2011; Nelsey & Brownie, 2012). Sufficient past research has found that conflicts do exist in the interactions between mentors and mentees occasionally. When accumulated over a long period of time, the resulting negative experiences not only have the possibility to reduce the efficacy of mentoring programs,but also help to undermine the effects of knowledge transfering in mentorship. Evantually, it would result in mentoring dysfunction and deminishing  relationship effectiveness(Harrington, 2011; Huang, Weng, & Wu, 2013).  Eby(2000) pointed out that there are both positive and negative experiences coexisting within the course of interactions. The study showed that more than 50% of new nurses confronted negative mentoring experiences (NMEs), and even the mentees with the same mentor could also encounter positive and negative experiences at the same time. Particularly, these mixed experiences constantly outweigh the benefit of positive experiences that should not be underestimated (Eby, Butts, Durley, & Ragins, 2010). The NMEs usually caused mentees multiple effects like lower psychological and career support, poor learning experience, lower work satisfaction, greater work-related pressure, a higher level of workplace frustration and high turnover tendency etc.(Eby, Butts, Lockwood, & Simon, 2004; Omansky, 2010). When there’s more negative accumulation than positive one in the nature of mentorship, one or both parties may possibly decide to withdraw from the relationship and strengthen the intention to quit(Huang et al., 2013).At the stage of first learner, the new staff nurses have to deal with the pressures from all sides and the effect of NMEs on the mentee could range from a slight impact on work performance to resulting in severe disappointment and decision to leave the job. We’ve been able to observe this phenomenon through the most superficial sign such as high turnover rates, however, it’s been already the unchangeable and irreversible result. Thus, if a proper scale can be developed to help nurse managers aware and analyse negative experience in the early stage, it’s possible to find appropriate methods to manage the sources of potential serious problems, thereby reducing NMEs and the turnover rate of new staff nurses. Consequently, to assess mentees’ NMEs is important theoretically and practically. Little attention has been given to provide the tools to evaluate NMEs such as NME questionnaires or scales since the previous research mainly focused on the positive aspects of mentorships, e.g. mentoring function, in nursing workplaces (Hu, Wang, Yang, & Wu, 2014; Chen & Lou, 2014; Huang, Weng, & Chen, 2016). The purpose of this present study is to develop a negative mentoring experience questionnaire (NMEQ) with theoretical base for hospital nurses as an important tool for nurse managers and test its validity and reliability.2. Literature reviewThe Mentoring Program, also known as the Clinical Preceptor Program, has been in operation in the nursing field for many years(Nowell, Norris, Mrklas, & White, 2017). Huang et al. (2016) and Omansky (2010) indicated that mentoring programs can provide psychological and career support for new staff nurses. Despite of providing benefits for the mentee, it must be noted that mentors may also create NMEs for the mentees. Dysfunctional mentoring outcomes could happen after the implementation of mentoring programs, and have effects on both the mentor and mentee(Harrington, 2011, Huang et al., 2013). Eby et al.(2000) indicated that NMEs, arising between mentor and mentee, would inhibit the ability and the willingness of the mentors to teach their mentees. Eby et al.(2000) specifically indicated that NMEs should be composed of the five elements of distancing behavior, lack of mentor experience, manipulative behavior, mismatch within the dyad, and general dysfunctionality. Huang et al. (2013) used an qualitative method with new nurses in Taiwanese hospitals, which led to the conclusion that NMEs include the following five important dimensions. First, an institutional dimension encompassing negative experiences caused by the mentoring program. Second, a mentor dimension in which the mentor initiates negative experience. Third, a nursing manager dimension, where nursing managers cause negative experience. Fourth, an other medical staff dimension, in which other medical staff (physicians, physician assistants, administrative staff, etc.) instigate negative experience. Finally, a mentee dimension in which the mentee instigates negative experience within their relationship with their mentor. Huang et al.’s (2013) research conducted rigorous grounded theory analysis and also applied a theoretical basis in line with the current state of nurse mentoring programs in Taiwannese context. Therefore, the present paper used the findings of Huang et al. (2013) to developed NMEQ.3. Material and Methods 3.1. Design and sample A cross-sectional study was employed to collect data. The subjects were new staff nurses who have been in mentorship programs and had been working for less than two years in two regional Taiwanese hospitals. After obtaining from the ethical approval of the Institutional Review Board of Show Chwan Memorial Hospital (reference number: 1021205), questionnaires were employed to collect the study data. The collection of data was divided into two stages. First, this study do the drafting of preliminary items, expert validity and reliability analysis in the pilot study. Expert validity analysis was used to secure content validity and was conducted by 5 representative nursing managers with plenty of mentoring experiences. After that, 30 valid participants were collected from these two hospitals and the survey was administered in February 2014. The aim of the stage was to review and revise the draft of NMEQ according to the results of expert validity and reliability analysis. In the main study, this study sent 290 samples with self-report questionnaires in total. 255 valid participants were collected, with 87.93% valid response rate. The participants responded to the questionnaires at the hospital and returned it to the research assistants. The survey was administered between 1 March 2014 and 30 June 2014.3.2. Questionnaire designThis study defined NMEs as the sum of dysfunctional mentoring outcomes would occur during the processs of imlpementing mentoring programs, which have effects on both the mentor and mentee and adopted the assertions of Huang et al. (2013) to develop the draft of NMEQ. Two scholars and two nurse managers who majored in mentoring programs were involved in constructing the preliminary draft items. A 5-point Likert scale was employed to measure the extent to which the participants agreed with the items on the NMEQ (5 = strongly agree ; 1 = strongly disagree).3.3. Data analysisIn addition of descriptive statistics, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to examine the construct validity of the NMEQ while Cronbach’s alpha valueswas measured to evaluate the reliability. Child (2006) indicated that  EFA could be adopted to identify the factor structure of a set of observed variables but CFA could be used to confirm the factor structure of a set of observed variables. In our study, we employed EFA to explore the fundamental factor structure of all NMEQ items and used CFA to confirm the factor structure of all NMEQ items and allowed us to test a relationship between PCIQ items and PCIQ dimensions. Finally, this study used the scale of Weng and Huang’s(2012) mentoring function scale as a criterion and used Pearson’s correlation coefficient to test criterion-related validity. The analyses were conducted using IBM SPSS 17.0 and AMOS 18.0. 4. Results4.1. First stageThe study proposed 48 preliminary items first and then invited 5 senior nursing managers with multi-year mentoring experience to perform the expert validity test. The relevance of each item was rated by the experts. A score of 0 denoted “not relevant or somewhat relevant” and a score of 1 denoted “quite or highly relevant”. We obtained the content validity index (CVI)) by calculating the number of experts giving a rating of 1 divided by the number of experts, the one which was less than 0.8 would be removed. An average score of 0.92 was computed from 33 items and the remaining 33 items were included into a reliability test. All samples in the pilot study were female, 35 respondents were unmarried, with 40% between 26 and 30 years old, 93.33% had worked for the hospital for between 1 year-and-7 months and 2 years, and 35 respondents with a Bachelor of Science degree. According ot the results of reliability analysis, three items were deleted because the values of item-to-total correlation of these items were less than 0.5. The remaining 30 items were included in the second stage (Cronbach’s ? = 0.92).4.2. Second stageIn the main study, Of the 255 new staff nurses, 248 participants were female, 85.5% were unmarried, with 60.39% between 20 and 25 years old and 67.84% held a BSc degree or higher. All of sample had been working in hospitals for less than 2 years and 45.9% had been working in hospitals for less than 1 year. 52.16% said that they usually interacted with their mentors. 59.6% were instructed by the mentors with Level III and 71.4% had experience of mentoring other nurses (See Table 1).Insert Table 1 about here4.2.1. Exploratory factor analysis  The present study used the Kaiser-Meyer-Olkin (KMO) test and Bartlett’s test of sphericity to evaluate sampling adequacy. The value of KMO was 0.924 and the signifcance of Bartlett’s test was less than 0.01, showing that EFA could be applied to our data. A principal component analysis with the varimax method was then used to perform a principal axis factoring. The number of extracted factors were the factors with eigenvalues greater than 1 and the selected factors were the groups with factor loading greater than 0.5. Accordingly, the results showed that a total of five factors were extracted and these factors accounted for 70.05% of the total variance. Finally, 29 items were kept after deleting G1 item that have factors loadings on two factors reached 0.5. The details are listed in Table 2.Insert Table 2 about here.The first factor was included in twelve items, explaining for 43.51% of the variance, and was named the “mentor dimension” (Cronbach’s ? = 0.96) due to these items imply a negative experience caused by the mentor.  The second factor consisted of  six items, accounting for 10.47% of the variance, and was named the “mentee dimension” (Cronbach’s ? = 0.84) because the items deal with negative experiences caused by the mentee. The third factor was included in four items, explaining for 6.84% of the variance, and was referred to as the “nursing manager dimension” (Cronbach’s ? = 0.92) owing to the items relate to negative experience caused by nursing managers. The forth factor consisted of three related items, accounting for 5.13% of the variance, and was named the “other medical staff dimension” (Cronbach’s ? = 0.88) because these items indicate negative experiences caused by staff other than nurses. The fifth factor was included in three items, explaining for 4.04% of the variance, and was referred to as the “institutional dimension” (Cronbach’s ? = 0.72) due to the items indicate instituational problems leading to negative experience. 4.2.2. Confirmatory factor analysis Aluja et al. (2006) indicated that in order to avoid the subjective character of decision-making when different exploratory factor solutions are compared, CFA should be continuously used to test the structure of psychological questionnaires. They conducted EFA and CFA with the same sample. Therefore, we further conducted CFA and obtained a good fit between the measurement model of NMEQ and the questionnaire data ( =2.36; GFI=0.82; AGFI=0.78; RMR=0.05; RMSEA=0.07; NFI=0.87; IFI=0.92; TLI=0.91; CFI=0.92). The value of composite reliability for each dimension ranged from 0.72 to 0.96, and the significances of the factor loadings of all items were less than 0.01. The average variance extracted (AVE) values for all dimensions were higher than 0.5 except institutional dimension, which means the NMEQ has acceptable internal consistency and convergent validity (See Table 3) Besides, the CFA results also revealed that the square roots of all the AVE values of every research dimension were higher than each pairwise correlation coefficient. In short, the measurement models of NMEQ all displayed satisfactory discriminate validity. Finally, target coefficient was employed to assess the relationship between the first-order model and the second-order model. The target coefficient of the measurement model is 0.96 (848.379/884.275) (p<0.01). Therefore, the first-order factors of the measurement model could be well accounted for the second-order model.(Marsh & Hocevar, 1985)Insert Table 3 about here.4.2.3. Criterion-related validityIn order to test criterion-related validity, Weng and Huang's(2012) mentoring function scale (including the) was employed as positive mentoring experience and an inverse criterion for NMEQ. Weng and Huang's(2012) scale was composed of three elements of role modeling function, career development function, and psychosocial support function. In Table 4, NMEQ has reported sufficient criterion-related validity because the Pearson's r correlation results showed that NME and all dimensions of NMEQ had significantly negative correlation with all dimensions of mentoring function.Insert Table 4 about here.5. DiscussionThe empirical results of this study show that using the arguments of Huang et al. (2013) as a basis, NMEQ has sufficient reliability and validity, as will be explained below for each dimension. The institutional dimension refers to negative experience caused by institutional elements, which includes hospital institutions, human factors, and education institution factors. Huang et al. (2013) found that new nurses did not see their schools' methods for providing clinical care as practical in the nursing care. Lee and Chung (2012) found that new nurses in hospitals often have difficulty applying their knowledge to a clinical nursing environment; a problem manifesting itself in poorer care. The mentor dimension indicates negative experiences inflicted on the mentee by the mentor, and includes questions about workplace bullying, verbal communication, instruction methods, and mentor personality. Previous studies have shown that workplace bullying is common in the nursing field, and when new nurses encounter such behavior in the workplace, they often choose to leave (Hutchinson, Jackson, Wilkes, & Vickers, 2008). The mentee dimension refers to negative experiences caused by the mentee themselves. Eby and McManus(2003) noted that NMEs are not necessarily caused by mentors; mentees can also cause NMEs. Eby et al.(2008) indicated that NMEs caused by the mentee can be divided into three categories: interpersonal problems, destructive relational patterns, and performance problems. NMEs caused by the demeanor of nursing managers or their poor interaction with mentees are classified under the nursing manager dimension. Wright et al.(2014) also found that low-quality communication and poor interaction between new nurses and nursing managers accounts for 65% of problems between them and they were often unable to find effective ways of handling these conflicts. Finally, the other medical staff dimension indicates that negative experiences can be caused by poor communication between other medical staff and the mentee. Nursing often requires interaction and collaboration with other medical staffs other than mentors. Lin et al.(2011) pointed out that some medical staffs may have a poor attitude toward new nurse and then it would cause negative experiences for mentees.  6. Limitations and recommendations This research only chose the new staff nurses as samples from the Taiwanese hospitals. To further clarify the impacts arising from different kinds of nursing program, we suggested that a large-scale dataset from different national nursing contexts would be feasible for future researchers. In addition, we explored NME from the points of view of mentees; therefore, only single-side mentoring experience was explored. It is suggested that future researchers could keep on investigating NME from other stakeholders' views, for exmaple, mentors and clinical nurse managers.7. ConclusionNMEQ of this study for hospital nurses is reliable and valid. This scale contained five dimensions and 29 items. The results of CFA showed NMEQ had good convergent validity and discriminant validity. Correlation analysis also indicated that NMEQ have good criterion-related validity.NMEQ can be used as an important tool for nurse managers in hospitals. It allows nurse managers to pay more attention to the new staff nurses' negative experiences in the mentorship. NMEQ also can be used as an important management tool in the process of monitoring and managing mentoring programs. Upon using NMEQ, the nurse managers could clearly measure the effectiveness of mentoring program, knowing which aspect the negative experiences of new staff nurses come from, and keep abreast of the right directions to improve mentoring program in the future. In addition, the both positive and negative experiences of mentoring programs could be assessed and analyzed at the same time. Thus, the empirical results of this study provides abundant important evidence for nursing human resource theory and a practical reference for those in the field.NMEQ also can help clinical nurses understand and evaluate the categories and the level of negative experiences that new nurses are would confront during the process of mentoring programs. Thus, it can help new nurses strengthen their adaptability in nursing workplaces. Finally, what the study has found was a significant contributor to negative experiences that there is an apparent phenomenon of workplace bullying and poor interaction between mentors, mentees, nursing managers, and other medical staff. Accordingly, the present research suggested that nurse managers could develop mentorship training programs in order to improve interaction between mentees and others. Funding This study was supported by a grant from the Ministry of Science and Technology in Taiwan (NSC102-2410-H366-015).

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