Newly graduated nurse practitioners (NPs) often face challenges transitioning into practice due to increased responsibility, limited support and unclear role expectations. This quality improvement study examined the implementation of a mentorship program for new NPs in Nova Scotia, supported by the Nursing Innovation Fund and developed in collaboration with Nova Scotia Health, the IWK Health Center, and the Department of Health and Wellness. Ten NPs engaged in virtual or hybrid mentoring relationships. Findings highlighted six months as a critical period for role identity, with ongoing workload and support challenges noted at 12 months. Results suggest mentorship must be flexible and tailored to evolving needs.

Introduction

The inclusion of nurse practitioners (NPs) in acute and primary care settings is known to improve clinical and service-related outcomes, address rising complexity and respond to increasing healthcare demands (Htay and Whitehead 2021). In Canada, there has been an increased demand for healthcare services due to an aging population (Statistics Canada 2022). Although one of the smallest provinces, Nova Scotia (NS) has one of the highest rates of chronic disease, with over 50% of patients over the age of 65 living with at least two chronic conditions (Health Infobase 2024).

In 2022, the number of NPs licensed to practise in Canada grew by 11.0%, the largest growth of all nursing designations (CIHI 2022). Despite this, turnover rates among NPs from the US are estimated to be as high as 15% (Strobehn et al. 2024). At NS Health, NPs are categorized as a subset of nursing within local data systems, making transfer and recruitment data difficult to track. Local teams are currently working to improve data acquisition. Similarly, data on Canadian NP retention and turnover are limited; however, there is ample evidence that NP retention in Canada is an emerging concern (Splane et al. 2023).

Universally, high turnover of newly graduated NPs is thought to be due to increased responsibility, less defined role guidance and limited support systems (Barnes 2015; Barnes et al. 2021; Faraz 2017; Mannix and Jones 2020). To address this, comprehensive professional development for new graduate NPs is recommended (Barnes et al. 2021). Without these supports, NPs may be more susceptible to poor role transition, low job satisfaction and increased turnover intention (Brown and Olshansky 1997; Cappiello and Boardman 2022; Dillon et al. 2016; El Hussein and Ha 2023; Faraz 2019; Gonzales et al. 2022; Hart and Bowen 2016; Klein et al. 2020; Ortiz Pate et al. 2023; Owens 2018, 2021; Pleshkan and Hussey 2020; Sullivan-Bentz et al. 2010; Zapatka et al. 2014).

Mentorship is a vital component of the nursing profession, benefiting both mentees and mentors (Perumal and Singh 2022). Advantages include fostering a positive workforce, promoting high-quality, patient-centred care and improving staff retention (Coventry and Hays 2021; Perumal and Singh 2022). Traditionally, mentorship has taken place in person; however, with the rise of virtual platforms – accelerated by the COVID-19 pandemic – it is now more accessible. Despite the increasing availability, research on virtual mentorship is now more accessible. Existing programs are often small-scale, scarce and typically confined to a single site (Bradshaw et al. 2021; Cappiello and Boardman 2022). As a result, the potential impact of virtual and hybrid NP mentorship remains unclear.

With support from the NS Nursing Innovation Fund, a quality improvement project was undertaken to explore the impact of a provincial virtual mentorship program on newly graduated NPs. The pilot project was a collaboration between the NS Department of Health and Wellness and two primary health organizations: the IWK Health Centre (IWK) and NS Health. This pilot project included an organization-based literature review completed by library services, an abbreviated environmental scan and pilot program for development and evaluation.

Background

A rapid literature review was conducted by the library services at the authors' healthcare organization, analyzing 22 articles on virtual mentorship and NP or advanced practice nursing mentorship. Of these, two focused on initiatives for nursing students. While nursing students were not the primary focus of this quality improvement study, these articles provided valuable insights into the impact of mentorship on professional development and recruitment. For example, Dahlman (2022) highlighted the significant role of virtual mentorship in recruiting and retaining undergraduate nursing students from underrepresented minority groups, though research in this area remains limited. In addition, Wang et al. (2022) found that virtual peer mentorship contributed to enhanced personal and professional growth for both nursing student mentees and mentors.

Virtual mentorship also offers opportunities for nurses to develop leadership and educational skills. Shermont et al. (2023) explored the role of virtual nursing mentorship as an educational tool, specifically using virtual education sessions. Their study used pre-intervention, post-intervention and six-month follow-up surveys to assess stress levels, task competence, barriers to mentorship and the effectiveness of mentorship tools. Findings suggested that virtual learning environments serve as effective platforms for delivering educational content.

Similarly, Rossiter et al. (2024) examined a mentorship training program designed to prepare mentors to provide structured mentorship support to primary healthcare nurses. Structured mentorship was defined as a program with clear guidelines, formal agreements and alignment with best practices and research within the discipline and context. Pre- and post-training surveys indicated that primary healthcare mentoring programs should be developed in a structured and context-specific manner and that online mentorship can enhance access to mentorship opportunities, particularly in rural areas.

Congruently, Faiman (2011) found that varied learning preferences and tailored virtual mentorship delivery methods were necessary to offset barriers to virtual mentorship, such as time constraints and technological barriers. Faiman notes that while virtual mentorship offered flexibility, it was often deprioritized compared with in-person sessions, with nurses sometimes being expected to complete modules during unpaid time.

Although research on virtual NP mentorship is limited, evidence suggests that traditional NP mentorship improves job satisfaction, retention and role transition, especially when mentors have dedicated time and resources (Li et al. 2023; Lloy et al. 2023; Moss and Jackson 2019). Further supporting the value of structured mentorship, Durand et al. (2023) reported significant improvements in NP job satisfaction and knowledge assessment following a one-year fellowship program that incorporated structured clinical training, scheduled didactic sessions and structured mentorship.

Finally, the release of the “Nursing Retention Toolkit: Improving the Working Lives of Nurses in Canada” in 2024 emphasized the importance of structured mentorship for new graduates, transitioning and internationally educated nurses and underrepresented populations in nursing to improve retention rates of the Canadian nursing workforce (Health Canada 2024).

Collectively, the findings underscore the importance of structured mentorship programs with clear guidelines and suggest that virtual mentorship may enhance NP professional development, role satisfaction and retention (Durand et al. 2023; Rossiter et al. 2024).

Methodology

The NP virtual mentorship program received support through the Nursing Innovation Fund, a provincial initiative that aims to transform nurse clinician ideas into practical innovations. Supported by the NS Health interprofessional practice and learning teams at NS Health and the IWK, the program was developed in the fall of 2023 and piloted from January 2024 to January 2025.

An abbreviated environmental scan highlighting the pre-existing NP mentorship programs in Canada was conducted in November 2023. Of these, the NS NP virtual mentorship program was modelled after programs in Saskatchewan and Ontario (RNAO Nurse Practitioner 2019; Saskatchewan Association of Nurse Practitioners 2023). Virtual mentorship was defined as mentorship that facilitated the exchange of information through the utilization of one or more digital platforms, including audio and video applications, messaging applications and/or telephone communication (McReynolds et al. 2020).

Consistent with Rossiter et al. (2024), the pilot project followed a structured, context-specific approach. Monthly meetings facilitated mentor–mentee pairings and provided a platform for discussing challenges and growth opportunities. Mentees had the option to participate in strictly virtual-based mentorship or a hybrid model incorporating both virtual and in-person mentorship. Of the eight respondents, two selected this hybrid approach. Notably, the two NPs who chose the hybrid mentorship model worked in the same facility as their mentors, whereas the other participants were based elsewhere in the province. Microsoft Teams, licensed through the NS Health and the IWK, served as the primary communication platform required for all virtual mentorship activities at these institutions.

Each NP mentee, in collaboration with their mentor, completed a letter of agreement outlining shared goals, meeting schedules and behavioural expectations. These agreements, along with learning needs plans, were adapted with permission from the Saskatchewan Association of Nurse Practitioners (2023) mentorship program. Formalized professional support through the healthcare organization was available in cases where a significant learning deficit was identified or if the mentorship relationship became problematic or non-functional.

Mentor and mentee meetings were scheduled according to the mentees' preferences, with most opting for weekly check-ins lasting between 30 and 60 minutes. By the end of the 12-month pilot evaluation, only two of the NP mentees expressed a need to continue with the program. Notably, both individuals experienced a change in position – either transitioning to a different NP role or adapting to their role within the clinic's care delivery model during the mentorship period. While each mentee was offered various mentor resources, including scheduling advice, clinical case reviews and relevant guidelines or system navigation recommendations, the most frequently provided support was counselling related to role transitions.

Participants

In collaboration with two healthcare organizations, 10 newly hired or transitioning NPs were offered the opportunity to participate in the provincial NP Virtual Mentorship Program. Of these, five were primary care NPs, one was a pediatric NP and four were adult specialty practice NPs. Of the 10 potential respondents, eight surveys were returned. The two unreturned surveys were sent to two adult specialty practice NPs.

Instrumentation and Data Collection Plan

Mentee tracking data, including number and duration of visits, virtual versus in-person and length of program engagement, were logged at weekly planning meetings. Rooted in applicable themes from the Novice Nurse Practitioner Role Transition Scale (Barnes et al. 2021), site-specific surveys were developed. Mentee surveys were administered before the virtual NP mentorship program in January 2024 and again at six and 12 months.

The program was designed to run over a period of 18 months; a timeline selected based on the evidence that customized nursing mentorship lasting between 12 and 24 months positively impacts nursing retention, self-confidence, problem-solving skills, professional communication and the transition from new graduate to practising nurse (Gularte-Rinaldo 2023). Furthermore, based on Benner's (1984) Novice to Expert Transition Theory and Brown and Olshansky's (1997) NP Transition Theory, it is expected that a new NP will transition out of the novice stage by 18–24 months.

Data Analysis

Surveys were distributed through the provincial survey program named Select Survey. A descriptive analysis was completed using the software program SPSS Version 29 (IBM Corp 2022). Additional comments pulled from the open text boxes were included and analyzed by two researchers for common themes. As there were few open-text responses, a formal software program was not used. Mentee retention was measured through survey completion at each of the designated time points. Initial feasibility was assessed by analyzing trends in the frequency of mentor–mentee interactions, the duration of each interaction and the required mentor-to-mentee ratio.

Ethics

A quality improvement exception status form was approved by the healthcare organization's research ethics board. All virtual encounters occurred via the organization-supported Microsoft Teams program and the meetings were not filmed. Datasets were de-identified and results were presented as pooled, and not individual, results.

Results

Both mentees and mentors had similar demographics and did not represent a heterogeneous group (see Table 1). Mentees typically engaged in 30–60 minutes of mentorship per week and each mentor supported between four to eight mentees, depending on the mentor's employment status.

Among the five original mentors, the roles varied: one part-time and one casual professional practice leader, one full-time NP educator, one pediatric NP and one neonatal NP with protected mentorship time. In fall 2024, permanent funding allowed the hiring of three casual provincial practice leaders – recent retirees with extensive experience in adult specialty and primary healthcare – to support program expansion. In addition, funding was secured for a provincial practice leader at the pediatric centre to further develop the program.

Mentors

Five mentors responded to the survey, with over half indicating that they did not have access to their own mentor when starting practice. All reported that they had a good understanding of the role of the NP and felt that they had a voice in the organization. Similarly, all five indicated that they belonged in the NP role, enjoyed working with their population (clinical NP responses) and could meet the demands of their NP role (clinical NP responses).

Mentees

The results from the pre-, six- and 12-month mentee surveys are presented in Table 2, while quotes retrieved from open text boxes are included in Table 3.

Discussion

At the conclusion of the 12-month survey, findings showed that five NPs remained in their roles, two transitioned to new positions within the same organization and one relocated to another Canadian province. Qualitative statements highlighted the added value of mentorship beyond the typical confidence-building during the first year. Specifically, mentorship provided opportunities to review complex cases in a judgement-free environment, protected time to problem-solve case management and a space to explore feelings of inadequacy with an experienced peer. Similarly, as the NP mentors were professional practice leaders, they were able to further support mentees by helping them navigate system challenges and address site issues before they escalated. Overall, NP mentees regarded their mentors as strong role models. Both virtual and in-person mentorship were found to be valuable, with the recommendation that the mentorship format be tailored to the needs of each NP mentee. While encouraging, the small sample size, limited time frame and restricted geographical area (NS) of this quality improvement project preclude interpreting the findings as evidence of improved retention. Future research is needed to more objectively evaluate the impact of virtual mentorship programs on NP retention.

The six-month mark was identified as a pivotal point in NP transition and retention. At this stage, 86% of the NP mentees felt they did not have a voice in the organization, and only 43% felt a sense of belonging in their NP role. By the 12-month mark, these figures improved to 67% and 92%, respectively.

These findings align with the NP transition model proposed by Brown and Olshansky (1997), which describes the first six months of practice as a “launching” period – the most challenging phase of the first year. This phase is further divided into four subcategories: (1) feeling like an imposter, (2) confronting anxiety, (3) getting through the day and (4) battling time. The subcategory “feeling like an imposter” reflects the experience of NPs struggling with a sense of belonging in their role. Brown and Olshansky (1997) reported that several participants in their study felt like imposter, noting that they “struggled to deal with the dissonance between their internal sense of being impostors, fueled by their lack of experience and the external expectations that they function as competent, legitimate NPs” (p. 48).

In addition, findings from the NP virtual mentorship pilot program are consistent with research by Misener and Cox (2001), highlighting several key factors that contribute to both a sense of belonging in the role and having a voice in the organization, which are critical to job satisfaction. These factors include: (1) input into organizational policy, (2) freedom to question decisions and practices, (3) consideration of opinions and suggestions for workplace change, (4) respect for professional input and (5) opportunities to develop and implement ideas.

At the conclusion of the 12-month survey, mentees reported greater difficulty in keeping up with work demands, with 41% agreeing or strongly agreeing with the statement “I can meet the demands of the NP role”. At the six-month mark, this figure was 57%, unchanged from the pre-survey response. This finding is consistent with evidence suggesting that programs aimed at fostering a positive NP transition to practice should extend to 18–24 months, allowing balance between access to mentors or preceptors – particularly for managing complex patients – and being granted the autonomy to develop and expand one's scope of practice (Faraz 2019). Future work should investigate the types of mentorship supports that are the most beneficial during months 12–18 of practice, compared to those needed in the first 12 months. Based on these findings, incorporating caseload management around the 12-month mark may be especially valuable. In addition, future research should explore the mentorship needs of NPs from equity-deserving populations and internationally educated NPs. As discussions around NP residency programs, certifications and portfolio-based learning evolve, studies could also examine how virtual or in-person mentorship can be formally integrated.

Limitations

This quality improvement project had several limitations, including a lack of diversity, a small sample size, use of a site-specific survey and implementation within a single Canadian province. Mentees consistently demonstrated a strong understanding of the NP role across all three testing points. This may suggest a sampling bias, where individuals with a solid knowledge of the NP role are more likely to participate in programs aimed at optimizing NP practice. Future studies should compare retention rates among individuals with varying levels of understanding of the NP role. Finally, as the program evolved, multiple adaptations were made during plan-do-study-act (PDSA) cycles to address emerging needs.

Implications for Nursing Leadership

This study highlights the importance of structured mentorship in enhancing NP transition, promoting NP retention and fostering NP confidence. Nursing leaders can use these data to advocate for the integration of formal, virtual mentorship programs, particularly in regions facing NP shortages or high turnover rates. By supporting tailored mentorship initiatives, leadership can foster stronger professional identities, reduce feelings of imposter syndrome and improve role clarity, especially in the transition from registered nurse to NP. In addition, leadership can shape organizational policies to allocate time and resources for mentorship during the critical period between six and 18 months (Schoessler and Waldo 2006). Earlier in the learning journey, mechanisms could help reduce the risk of NPs feeling a diminished voice within the organization or a weakened attachment to their professional identity. These strategies may include knowledge translation about the normalcy of feelings of disengagement and challenges in role solidification around the six-month mark. Such information can be integrated into academic curricula, targeted onboarding programs and education for healthcare leaders to help them recognize and address early signs of disengagement among new practitioners (Duchscher 2008; Labrague and McEnroe-Petitte 2018; Rush et al. 2013).

Conclusion

As the NP profession continues to expand, it is essential to provide structured support for NPs as they transition into their professional role. Mentorship – whether delivered virtually, through a hybrid model or in person – has been shown to enhance role integration and foster a sense of belonging when mentors are actively engaged in their mentees' professional growth. In NS, the NP mentorship program has expanded beyond novice or newly transitioning NPs to include those with identified needs at any stage of their career. Mentorship is now integrated into the NP onboarding tool, and the program currently supports 40 NPs across the province.

Although further evaluation is required to determine the long-term impact and feasibility of such programs, early findings are promising, most notably in improving accessibility for NPs in rural and remote settings, mitigating geographical barriers and fostering a more equitable and inclusive professional support system. While targeted mentorship initiatives in areas experiencing nursing shortages and rural and remote areas are important, mentorship should also be considered as a broader retention strategy applicable across all practice settings.

Correspondence may be directed to Melanie Dunlop by e-mail at melanie.dunlop@nshealth.ca.

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