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Pao Yue-kong Library, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong http://www.lib.polyu.edu.hk UNDERSTANDING THE MEANING OF MENTORING OF NEWLY GRADUATED REGISTERED NURSES FOR GOOD WORK IN HONG KONG LAW YEE SHUI Ph.D The Hong Kong Polytechnic University 2016 THE HONG KONG POLYTECHNIC UNIVERSITY SCHOOL OF NURSING UNDERSTANDING THE MEANING OF MENTORING OF NEWLY GRADUATED REGISTERED NURSES FOR GOOD WORK IN HONG KONG LAW YEE SHUI A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY AUGUST 2015 CERTIFICATE OF ORIGINALITY I hereby declare that this thesis entitles ‘Understanding the meaning of mentoring of newly graduated registered nurses for good work in Hong Kong’ is my own work and that, to the best of my knowledge and belief, it reproduces no material previously published or written, nor material that has been accepted for the award of any other degree or diploma, except where due acknowledgement has been made in the text. __________________________________ (Signed) Law Yee Shui (Name of student) i ABSTRACT OF DISSERTATION ENTITLED ‘Understanding the meaning of mentoring of newly graduated registered nurses for good work in Hong Kong’ Submitted by Law Yee Shui for the degree of Doctor of Philosophy at the Hong Kong Polytechnic University in August 2015 Background Nursing in a complex and dynamic health care landscape resembles sailing in stormy seas and rainy weather, while good work is akin to a distant beacon that seems beyond reach, yet must not be ignored. Mentoring has been one of the most frequently suggested strategies for facilitating both the transition of new graduates and good work, as if it were a panacea. Nevertheless, the concept of mentoring in nursing practice remains ambiguous and confused, and the term is often used interchangeably with preceptoring, a related concept in the literature. Mentoring as a way of promoting good work among newly graduated nurses has to date been underexplored. Aim The aim of this study is to understand the meaning of mentoring newly graduated registered nurses (NGRNs) in the transition and in the pursuit of good work through different stories of experiences that are lived, told, relived, and retold in a complex health care landscape. Design The research methodology that was adopted was based on Clandinin and Connelly’s narrative inquiry. Four methods were employed to collect field texts from four sources of data in eight participating public hospitals in Hong Kong. Eighteen NGRN participants were recruited to participate in the one-year enquiry process through repeated interviews and email conversations. Focus group interviews were also ii conducted with 11 preceptors and 10 stakeholders (senior nurses, ward managers, and doctors). Relevant hospital documents relating to the participants’ stories of their experiences were also reviewed. The research texts were composed from the field texts through the iterative process of narrative and paradigmatic analyses. Findings Thinking narratively of the participants’ stories of their experiences along the three dimensions – temporal, personal-social interactions, and the place of the narrative inquiry space – revealed the complexity of mentoring NGRNs for the transition and the pursuit of good work. NGRNs are in need of ongoing mentoring throughout their first two years of clinical practice in their transition and in the effort to sustain good work in the midst of educative and miseducative experiences. Four interrelated narrative threads are discerned from the NGRN, preceptor, and stakeholder participants’ stories of their experiences, hospital documents, and the integration of the findings with the relevant literature. They are: 1) Contrasting stories of the preceptorship programme, 2) Knotmentoring for good work with self, opportunistic, and peer mentoring, 3) Understanding not-mentoring through assumptions about practice readiness and scolding, and 4) Disempowering by sacred hospital or unit stories. Conclusion This narrative inquiry has served as a springboard to generate insights into how NGRNs are mentored by themselves and others in the midst of ongoing experiences, to sustain their stories of good work in nursing. New possibilities are imagined in the narrative inquiry space to support NGRNs in persisting to sail towards the beacon in stormy seas and rainy weather. Mentoring them to perform good work will benefit patients and their families now and in the future by helping to retain nurses who are committed patient advocates to mentor future generations. iii PUBLICATIONS ARISING FROM THE THESIS Publications and Conference Presentations Pang, M. C. S., & Law, B. Y. S. (2010, February 9). Good work in nursing and mentorship scheme. Paper presented at the Hospital Authority General Manager of Nursing Meeting, Kowloon Hospital, Hong Kong. Chan, E. A., & Law, B. Y. S. (2011, July 29). Narrative inquiry. Invited paper presented at the 2011 National Nursing Research Conference Jointly Organized by the Pi Iota Chapter, Honor Society of Nursing, Sigma Theta Tau International and the School of Nursing Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China. Law, B. Y. S., & Chan, E. A. (2012, February 23). Making good: Understanding the meaning of mentoring newly graduated registered nurses in Hong Kong. Paper presented at the 15th East Asian Forum of Nursing Scholars, Singapore. Law, B. Y. S., & Chan, E. A. (2013, May 18). Telling and retelling of stories of good work by newly-graduated registered nurses in Hong Kong. Paper presented at the 9th International Congress of Qualitative Inquiry (QI2013), University of Illinois, Urbana-Champaign, USA. Law, B. Y. S., & Chan, E. A. (2014, June 27). Learning and sustaining to be a patient advocate as a newly graduated registered nurse: Speaking up and being heard. Paper presented at the panel presentation of the Conference on Communication, Medicine and Ethics, The Universita della Svizzera Italiana, Lugano, Switzerland. Law, B. Y. S., & Chan, E. A. (2015). The experience of learning to speak up: A narrative inquiry on newly graduated registered nurses. Journal of Clinical Nursing, 24(13-14), 1837-1848. Law, B. Y. S., & Chan, E. A. (2015). Taken-for-grantedness of the externship experience in shaping the post-registration experience of newly-graduated registered nurses: a narrative inquiry. Manuscript submitted for publication. Law, B. Y. S., & Chan, E. A. (2015, June 29). Communicating for compassionate mentoring for newly graduated nurses’ identify formation and patient safety. Paper presented at the 3rd International Symposium on Healthcare Communication, International Research Centre for Communication in Healthcare (IRCCH), The Hong Kong Polytechnic University, Hong Kong. iv ACKNOWLEDGEMENTS Writing and rewriting this dissertation resembles the trek I made in Nepal in the middle of my study, which would not have been possible without the contribution and support of different important parties. I would like to take this opportunity to acknowledge the support that I received throughout my journey of narrative inquiry. I would like to express my deepest gratitude to my chief supervisor, Dr E. Angela Chan, who devoted valuable time, energy, and patience in mentoring me to become a narrative inquirer. There were countless times during the process when I felt so frustrated, under stress, and uncertain that I burst into tears in her office, where I obtained important support, reassurance, and empowerment. There were also times when I received her phone calls and emails sharing new insights and giving me advice throughout the busy academic semesters, as well as on weekends and during vacations. She was my constant source of encouragement and inspiration, and my role model. I am also indebted to my co-supervisors, Prof. Samantha Pang and Prof. Chien for their intellectual inspiration and advice. I wish to express my sincerest thanks to Samantha for offering me the valuable opportunity to pursue a doctoral degree and for her support and understanding when my family experienced repeated crises in the first two years of my part-time study under her supervision. Thousands of flowers to my NGRN, preceptor, and stakeholder participants to whom I can never express enough gratitude for their trust in me and contribution to my dissertation and growth. I deeply appreciate friends who provided assistance in making this dissertation possible, by helping me apply for ethical approval from the different hospitals and/or recommending and recruiting participants. I want to thank my editors, Charlene, Josephine, and Hannah for their expeditious and quality work. v I would like to express my sincere thanks to my friends for their ongoing support and encouragement. They are: Ms Lai XiaoBin, Ms Pin Pin Choi, Ms Daphne Cheung, Mr Ken Ho, Ms Alina Ng, Ms Maggie Chan, Ms BB Law, Ms Cathy Yue, Ms Kapo Tse, Ms Nicola Lung, Ms Jennie Chan, Ms Carrie Wong, Ms Amy Wu, Mr Pong Chiu, Mr Aro Tong, Ms Shara Lee, Mr Maurice Cheng, Ms Anna Laszlo, Ms. Amanda Wong, Ms Clara Leung, Mr Bjorn Tam and Ms. Jennifer Kan.