By Steven Clark
As Dr. Jacqueline Witter explained in her paper on mentoring nurses published in the Journal of Business and Economics, “Mentoring is a two-way circular dance that provides opportunities for experience, giving and receiving each other’s gifts without limitations and fear. Mentors guide, support, advise and apply relevant examples from their experiences to facilitate the learning process of their mentees…a more knowledgeable and experienced person takes on a supportive role of overseeing and encouraging reflection and learning.”
Dr. Witter, vice president, nursing quality and informatics at SBH, knows about mentoring having written her doctoral dissertation on the subject and having mentored scores of nurses throughout her career. She strongly believes in its importance in supporting the growth of nurses at all levels of their career. The process, she adds, can be informal or formal.
There can also be some confusion over terms.
“The terms ‘precepting’ and ‘mentoring’ are used interchangeably and they’re not the same,” she says. “Preceptorship is very task oriented and typically runs for four to six weeks, and then you’re left on your own when you are expected to fly.”
Mentoring, when compared to preceptorship, she says, “is more nurturing. It’s about relationships, where you can discuss anything or can call at any time to say, ‘I just need to share what it is I have to say.’ It can be personal, or it can be work related.”
Dr. Janine Adjo, chair of the Department of Pediatrics at SBH, has long been a strong advocate of mentorship. This means teaching both the “x’s” and “o’s,” as well as helping others become leaders.
For years, in addition to members of her staff, she has mentored young patients who have hopes of going into medicine, as well as girls and recently young women in organizations like My Sisters Keeper and Bottom Line. Mentorship, she says, is about helping people succeed, something she does by modeling behaviors and letting people know about her own journey.
“It’s also about sponsorship, where I hope to bring people, including women and underrepresented people, into leadership roles,” she says. “I’m always looking to get others prepared for these opportunities.”
A leader, she says, must be a strong communicator and networker. Over the years, she says she took pieces of what she witnessed as a resident and a young attending. “I saw what people did great and what they didn’t do so well and modeled my behavior accordingly.”
She refers to a cartoon that illustrates to her the difference between an effective leader and a mediocre one. In half of the cartoon, the bad leader sits on a chair ordering his subordinates to pull the rope. In the other half, the good leader stands in front, working hand-in-hand with his team. She compares this to her actions during the past year. “During the height of Covid, I could have worked from home as department chair, but that would not have shown leadership. I was here seeing patients, directing the residency program and leading the department. I thought it was important to do that.”
Language is particularly powerful, she stresses to her staff, as is volunteering to do things that might be outside their comfort zone.
“I tell them to make sure to do stuff that makes you feel uncomfortable. Otherwise, growth won’t happen. Don’t worry about knowing all the ins and outs. Just go for it.”
Dr. Ed Telzak, chair of the Department of Medicine at SBH, is passionate about mentorship. He sees teaching the next generation of physicians what it takes to be capable and compassionate as his most important mission next to patient care.
“It’s one of your major responsibilities in being a physician, particularly in an institution like SBH, where we have a large number of residents relative to number of beds and full-time faculty.”
His department has just short of 100 residents, which is more than some major medical centers around the country. They also teach scores of medical school students from the CUNY School of Medicine and the Albert Einstein School of Medicine.
Future doctors must be taught how to make “the patient experience a good one, given their vulnerability and stress, especially in a population like the one SBH serves. There is a certain amount of distrust with medicine, doctors and hospitals,” he says. “Patients need to know that you’re concerned about them and that includes being able to express your level of concern. Patients know when you know what you’re talking about and when you don’t know what you’re talking about. You need to explain in a language they understand, at a level they understand, why you’re putting them through a test that may be uncomfortable. You don’t want to be going into a patient’s room and not know what you’re going to say.”
It comes down, he says, to preparation. “What I teach residents and medical students is that before you go into a patient’s room you need to take a timeout for 10 – 15 seconds as you’re washing your hands with hand sanitizer. Make sure you know the patient’s name, so that you are not calling Mr. Rodriguez, Mr. Gonzalez. Make sure you know what their issues are, how they will react so you can adjust your tone accordingly, know what their concerns are, and what the day and the next couple of days will be like for them to the best of your ability. You need to know how to gear the conversation to make them feel comfortable. That means letting them know about their medication, what the test results show. You need to make them feel that you really know what’s going on with them. You don’t want to go in and have the patient say, “I had a catscan yesterday, what does it show?’ and you say, ‘I don’t know. I haven’t looked at or read the report.’ That’s all part of mentoring.”
He teaches them to be as prepared for seeing the patient as they would for taking a final exam. Before the advent of COVID-19, Dr. Telzak says he would meet every week with medical students and then, in groups of six or seven, take them to interview the patient. “I would often spend a certain amount of time discussing whether the patient had shortness of breath, chest pain, visual issues, alcohol abuse, if they were homeless. And, if so, I would explore why they were homeless, when they became homeless, and what kind of environment they grew up in. What is it like to live on the street or in a shelter? If they have a tattoo, and some tattoos are characteristic of being done in prison, I would say, ‘How long were you in for? When did you get out? And what was it like being out?’ You want to explore things that give a full range of depth to the patient encounter.
“It’s very easy to medicalize a patient, but part of the joy in medicine is realizing that people lead remarkably complicated lives and you as a medical student, intern, resident, doctor have unique access. People will talk to you about parts of their lives they wouldn’t talk to a close friend or sibling about. Once you’ve had that conversation with a patient and you walk in the next day it’s a different appreciation that person feels. They may think to themselves, ‘I haven’t been asked these questions by a doctor ever’ and it makes a difference in relationships, in how they trust you, the likelihood they will return to your hospital. I believe these types of interactions have real beneficial outcomes that unfortunately are very difficult to quantify.”
Mentoring is about the ability to put yourself in the patient’s shoes, he adds. “I’ve been on the other side and one of the things I often speak to the residents and students about is, ‘Have you ever had someone you really care about – a parent, a sibling, a cousin, a child – in the hospital? If so, you know what it feels like when someone gives you the time of day and does that one extra thing for you and you feel confident in them.’ Put yourself in that mindset.”
Dr. Witter agrees with this. “I always say to nurses, ‘Envision what it would be like to be that patient in that bed. Always think about what that patient is going through and don’t take things personally.
“You have to learn how to detach. You have to learn to be empathetic, and not sympathetic, because you want to envision what the patient is going through and be able to detach. And never be judgmental.”
CHANGES BROUGHT BY THE PANDEMIC
COVID-19 has revised certain principles Dr. Telzak and other physicians hold dear.
“Covid has altered some of the principles that I’ve tried to emphasize in mentoring,” says Dr. Telzak. “Covid has decreased contact with the patient, time spent next to a patient, sitting down and holding their hand.”
Patient/doctor contact, he believes, is particularly important when it comes to delivering bad news. “We’re re-thinking how we do this. You sit down, look into their eyes and try to connect with them. You may hold their hand. You may ask for them to have a family member present. All of that doesn’t happen, or at least happens much less frequently, during Covid. From a mentoring perspective, we don’t have a good answer for that. It doesn’t mean it’s gone. But it has been modified.”
Dr. Witter believes more nurses asked to be mentored during the height of the pandemic. “The emphasis shifted somewhat to, ‘I need to be mentored because I’m not sure I want to stay in the profession.’ It’s involved mentoring them about ‘what’s my next step?’ It’s more nurturing, more about offering the support and guidance to help them get through the daily routines – to praise, sing, listen to someone. The focus was different than before. I had a nursing educator who walked out last April. I said, ‘What do you mean you’re out?’ She said, ‘I’m leaving. I’m retiring. I’m afraid to die.’ Did I allow her to do it? Of course. I would have had regrets if I didn’t let her do what she wanted to do.”
Dr. Adjo believes that young doctors need to actively search for their mentors. “You just don’t wait. You need to actively seek out people who can mentor you. And it doesn’t have to be in your field.” She was impressed after hearing about two older doctors at other institutions. So she emailed them, asking if they would mentor her. “Both have taken the time to answer my questions and have given me thought-provoking advice,” she says. Conversely, she encourages younger doctors at SBH, women in particular, to reach out to her for advice that she willingly dispenses.
Dr. Witter frequently gets requests from nurses, including some in senior leadership roles, asking her to mentor them. “Getting a mentor can happen at any point in one’s career,” she says. “I have mentees who have reached out to me who are more experienced than I am in the nursing field. They know I’ve done a lot of work and writing on mentoring, so they seek me out. Mentoring happens regardless of one’s level, regardless of one’s status.”
She mentions a senior vice president of nursing getting her doctorate in nurse practice who approached her recently with this request. “I nurtured and advised her. And if something is not right, I’m going to tell it, but I’ll do it softly.”
Dr. Telzak points to two physicians who mentored him early in his career. One, Dr. Sheldon Wolff, was physician-in-chief at New England Medical Center, where Dr. Telzak was a resident, and clinical director of the National Institute of Allergy and Infectious Diseases, where he also mentored a recognizable name – Dr. Anthony Fauci.
“Shelly Wolff was a guy with enormous generosity,” says Dr. Telzak. “He had real feelings for people and he was very interested in people’s lives. He didn’t treat that many patients, but those he saw he knew and they were all very thankful he was their doctor. They felt like they had hit the lottery.”
His other mentor was Dr. Donald Armstrong, head of infectious diseases at \ Memorial Sloan Kettering, where Dr. Telzak worked as an infectious disease physician early in his career. “He was among the first leaders of HIV care and policy. He was very early in recognizing and pushing the government to do HIV testing on blood, and very aggressive in getting Memorial to take care of HIV-infected patients. The thinking at the time was ‘We are a cancer hospital. What are we doing with young gay men and drug users and people of color?’ He helped de-stigmatize the disease and had enormous compassion and I felt I was very open to learning that approach and being that type of physician.”
MAKING A DIFFERENCE
But does mentoring work? In Dr. Witter’s study on mentoring, her conclusions found that those newly hired nurses who had mentors reported significant improvements in their clinical decision making, commitment to professional nursing standards, positive feelings about nursing at the hospital, and their willingness to remain in the nursing profession.
The lack of mentoring can have an immediate impact as well. Dr. Adjo tells the story of her husband, who 30 years ago was a young Black man with a freshly minted degree in business administration heading out for his first post-graduate job interview. It was at a large company owned by the father of a friend who had encouraged him to apply for the position.
His father, a graduate of John Jay College, was a cop and his mother a lab technician in a blood bank and they were not well versed in the world of business,” she says. “Uninformed, he went to the interview wearing cowboy boots, a sports jacket and an open collar. When he looked around and saw everyone else in suits and ties, he instantly realized he was inappropriately dressed. But, no one had advised him how to play in this unlevel playing field. If no one told him, how would he know?”