Future of Nursing

D ow

nloaded from

http://journals.lw w .com

/ajnonline by

B hD

M f5eP

H K av1zE

oum 1tQ

fN 4a+kJLhE

ZgbsIH o4X

M i0hC

yw C X 1A

W nY

Q p/IlQ

rH D 3i3D

0O dR

yi7TvS Fl4C

f3V C 4/O

A V pD

D a8K

K G K V 0Y

m y+78=

on 03/08/2022

Downloadedfromhttp://journals.lww.com/ajnonlinebyBhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78=on03/08/2022

58 AJN ▼ August 2020 ▼ Vol. 120, No. 8 ajnonline.com

PROFESSIONAL DEVELOPMENT

The challenge of an aging workforce, one that will see increasingly heavy retirement numbers within the next several years, is an ongoing reality, and when large numbers of older nurses leave the workplace, they take with them a wealth of experience, knowledge, and wisdom.1-5

In 2010, a landmark report released by the Insti- tute of Medicine (IOM), The Future of Nursing: Leading Change, Advancing Health, recommended increasing the number of RNs educated at the BSN level or higher to prepare them for leadership roles and ensure that career-long professional develop- ment is embraced at the institutional and individ- ual levels.6 Despite these recommendations, the need for highly educated and experienced nurses has not abated.3, 7

High turnover rates among “professionally younger” nurses in acute care settings are a serious matter and contribute to concerns about current and future workforce capacity. Across the literature, newly licensed RNs have reported being overwhelmed in their workplaces by such variables as heavy work- loads, increased stressors, and the growing complex-

ABSTRACT: Nursing leaders continue to struggle with capacity issues in both clinical and academic settings— particularly those related to aging patient and nurse populations and the increasing com- plexity of health care in general. Programs and resources for formal mentoring have primarily focused on mid- and advanced-career RNs, but there is an imperative to develop methods of expertly mentor- ing “professionally younger” RNs across all settings and roles. In 2017, the American Nurses Association (ANA) conducted an extensive member needs assessment with more than 15,000 respondents. Three distinct career-stage categories were identified: early-career nurses, up-and-comers, and nursing leaders. The early-career nurses and up-and-comers listed “being mentored” among their top two member benefit requests. In response, the ANA launched a national virtual mentorship program in September 2018. The program aligned with criteria, recommendations, and charges from the Ameri- can Nurses Credentialing Center’s 2019 Magnet Recognition Program; the landmark 2010 report from the Institute of Medicine (IOM), The Future of Nursing: Leading Change, Advancing Health; and a 2019 IOM consensus study, The Future of Nursing 2020–2030. This article provides a general overview of the program, including evaluation and modifications, and discusses implications of using the ANA’s career-stage categories in virtual mentoring.

Keywords: career development, leadership development, mentoring, nursing, professional development, virtual mentoring

ity of patient care.2, 8, 9 These concerns can lead to diminished self-confidence.9

In addition to onboarding, orienting, and precept- ing new nurses, developing readily and more widely available mentoring curricula has become para- mount. As health care leaders continue to struggle with capacity issues in both clinical and academic settings—particularly those related to aging client and nurse populations, alongside the growing com- plexity of baby boomer health care—we are faced with the necessity of providing expert mentorship to the next generation of RNs across all settings and roles.2, 10, 11

Mentoring is not a new strategy for helping younger learners or workers increase their knowl- edge and skills; however, professionally younger colleagues may not have been routinely or formally advised during their educational preparation as to the importance of seeking and accepting mentor- ship from the onset of their careers or of learning on the job how to pursue this aspect of professional development. Nurses are typically paired with pre- ceptors in their workplaces, but they may not have

Investing in Nursing’s Future Mentoring across the profession.

[email protected] AJN ▼ August 2020 ▼ Vol. 120, No. 8 59

a clear understanding of how mentoring differs from precepting.12

WHAT MAKES MENTORING DIFFERENT Mentors are usually not based in the same work- place as their mentees, or are at least not in a direct line of authority. Mentors are seen as professionally older and more experienced colleagues who give their time and expertise for a specified period of time, which can be short or long. It is a confidential relationship and is viewed, for the most part, as a formal one with designated goals, objectives, a timetable, and outcomes agreed upon between the mentee and mentor and often involves face-to-face communication.12-15

Traditional mentoring programs often provide interactions in person, but the number of qualified mentors who are available in any one geographic area may be insufficient to meet the demands of a significantly larger mentee population. These con- straints may also steer mentoring resources and opportunities toward more seasoned professionals who are moving up the career ladder instead of younger and more vulnerable nurses.

Virtual (online) mentoring, on the other hand, allows a professional relationship to be established and maintained in different milieus: synchronous or asynchronous, without geographical boundaries, and independent of a participant’s workplace. Means and modes of communication are limited only by one’s imagination in this age of social media, cell phones, computers, and other readily available technologies.13, 16-18 There are multiple references in the literature citing ways in which professional orga- nizations, businesses, and academic and clinical institutions offer mentoring programs, using models that involve traditional or virtual methods—or a blend of both.13, 14, 16, 17, 19-22

The American Nurses Association (ANA) has designed and implemented a formal virtual men- toring program using a unique three-tiered approach for the matching of large cohorts of mentees and mentors at all levels of practice across the country. The purpose of this article is to provide a general program overview, including evaluation and modifications, and to discuss ben- efits of using the ANA’s “career-stage categories” in virtual mentoring.

By Peggy O’Neill Hewlett, PhD, RN, FNAP, FAAN, Jan Santolla, MS, BSN, RN, and Sabita Devi Persaud, PhD, RN, PHNA-BC

P h

o to

© S

h u

tt er

st o

ck .

60 AJN ▼ August 2020 ▼ Vol. 120, No. 8 ajnonline.com

PROFESSIONAL DEVELOPMENT

THE ANA’S VIRTUAL MENTORSHIP PROGRAM As the premier organization representing the inter- ests of the nation’s 4 million nurses, the ANA has long been involved in advancing nursing leadership standards for the profession and has a demonstrated commitment to career development through the mentoring process.23-25 In 2015, the association contracted a software company to assist with the design of an online mentoring program. This was not the first ANA mentoring initiative but was developed in response to an expressed need from members at the time. Those opting to join were able to register, enter personal and demographic infor- mation, describe what they envisioned in a mentor, and then self-select a mentee–mentor match. The program was planned simply for the purposes of helping nurses find a mentor or mentee with mini- mal organizational interaction thereafter. This approach appealed to some—but at the two-year evaluation point (in 2017), participants identified a need for a more formalized program.

Although it is not primarily focused on the devel- opment of a mentorship program, the ANA conducted an extensive membership assessment in 2017 with multiple objectives. One was to establish identifiable needs within cohorts of RNs representing specific demographic and psychographic characteristics. Input from both in-person and virtual focus groups, as well as individual interviews, was gathered from a representative cross-section of more than 15,000 RN participants. These were primarily ANA members, although some nonmembers were included.

Based on this information, the ANA determined that the RNs fell into three career-stage categories, each with distinct characteristics.

Early-career nurses. With zero to four years of experience (an average of 2.9 years) working as RNs, these nurses are new to the profession and striving to survive and thrive. They report being under great stress and are fighting disillusionment. This group demonstrates the need for positive and effective mentoring and creates an incentive for the profession to ensure them a positive entry into their careers so that they can be long-term, productive members of the workforce.

Up-and-comers. These nurses have been work- ing in the profession for five to 14 years (an average of nine years) and in general report being hopeful about nursing and their careers. As a group, up- and-comers are midcareer nurses who tend to be in a period of transition to the area (or areas) of the profession in which they wish to lead. These emerg- ing leaders demonstrate a clear need for cultivation by mature and successful colleagues.

Nursing leaders. Includes dedicated colleagues with 15 or more years of experience who wish to advance the profession—they are tenured (not nec- essarily in an academic sense but rather through

years of experience and advanced education) in senior nursing roles and represent a rich source of potential mentors at the local, state, regional, and national levels.

When asked to name their top desires for ANA member benefits, the vast majority of both early- career nurses and up-and-comers ranked “mentorship program” as number one or two. An overwhelming response to the same question from the participating nursing leaders was a “desire to give back.” These particular findings revealed an excellent opportunity to help many of their professionally younger nurse colleagues in a meaningful way. In September 2018, the ANA Mentorship Program was launched as a national initiative for active members. The 2018– 2019 Mentorship Program class, or “cohort,” enrolled more than 1,800 members (resulting in more than 900 mentee–mentor pairs), and October 2019 enroll- ments for 2019–2020 topped 2,600 (more than 1,300 mentorship pairs).

THE MATCHING PROCESS The program’s matching process enables individu- alized mentoring for hundreds of professionally younger colleagues without limitations created by location, area of practice, or specialty. The virtual aspect of the program and the career-stage catego- ries allow for a unique type of matching for men- tees and mentors.

For the 2018–2019 inaugural cohort, all match- ing was conducted manually by ANA staff using a specified set of data provided electronically by the enrollees as general guidelines—primarily years of experience, highest level of education, primary role, and geographic location. No guarantees were made that mentors would be in the same area of practice; therefore, in order to make matches for all mentees, it was assumed that those enrolled as mentors had transferrable leadership skill sets that would be help- ful to mentees in practice areas other than their own.

Although the manual matching process in the first year worked reasonably well, it was extremely time intensive for the ANA staff and therefore lim- ited the size of the cohort. With an eye toward increasing participation in the second year of the initiative, the ANA contracted an experienced Web-based–platform vendor with a record of suc- cess using this type of technology and, having already run a best-in-class mentorship program, sub- ject matter expertise. Matching for the 2019–2020 mentee–mentor pairs was done using this new prod- uct based on information provided by participants (primarily the number of years of nursing experience and highest educational level) and using a tested algorithm. Although matching remains a work in progress, the overall goal is to match less experi- enced nurses with those more experienced—and for the most part, this is being accomplished.

[email protected] AJN ▼ August 2020 ▼ Vol. 120, No. 8 61

The three career-stage categories were used in matching both the 2018–2019 and 2019–2020 cohorts. All of the early-career members were enrolled as mentees. The up-and-comers were pri- marily assigned as mentees, with some qualifying as mentors for less experienced nurses by virtue of the number of years they had been in the profession and the descriptions of their professional experience in leadership roles. Almost exclusively, the nursing leaders were designated as mentors because they had at least 15 years of experience and advanced education.

HOW THE PROGRAM WORKED—AND WORKS A program of this size and scope requires substan- tial organizational resources and support. The ANA provides staff support for a program administrator, who oversees the Web-based platform; marketing services; and online leaders for the mentor and mentee communities. The online community leaders are charged with following the community post- ings, responding frequently to concerns and issues that arise, and providing updates on mentoring skills and related topics.

Once the matches were made for the first cohort, the ANA hosted a mentor webinar outlining the program blueprint and the pairs began their own negotiations to structure the mentoring relationship. Although the ANA provided resources on how to go about these initial communications, cohorts were generally not provided with formal instructions or rules regarding how these activities were set up— with the exception of an expectation that there would be some type of virtual communication at least every two weeks.

The ANA provides all resources for the new Web-based platform, which offers sophisticated features to assist the mentees and mentors in con- necting, planning, communicating, and, ultimately, succeeding. This is a reflection of the ANA’s commit- ment to the development of a broad and inclusive virtual mentoring initiative. The ANA Mentorship Program is included as an association benefit, so there is no additional cost for members to partici- pate; the program is closed to nonmembers.

In the first year, the ANA did not have formal guidelines on how the mentee–mentor agreement would be formed, how progress toward the mentee goals and objectives would be determined, or what “completion” of the program would look like, nor did the association institute any requirements regarding documentation. Mentors used a variety of ways to handle these issues, from allowing the relationship to develop and progress organically to structured documentation of all events throughout the six months. Many participants recommended that “more structure” be provided in subsequent years, and the new online platform meets this need.

Throughout the program, mentors found mul- tiple opportunities to assist their mentees with career development. Examples of these activities included publications, grant submissions, curricu- lum vitae and resume development, career coun- seling, effective formal and informal evaluation strategies, conflict management, networking, and work–life balance. From the outset, formal and informal evaluation information received from the 2018–2019 participants drove program improve- ments. The two online community leaders moni- tored the postings of mentees and mentors several times a week and used informal real-time feedback to address immediate concerns. Online computer surveys administered by ANA staff were used for more formal program changes. For the final pro- gram evaluation survey, there was a 32% response rate among mentors and a 25% response rate among mentees, with an overwhelming majority of responders indicating satisfaction with the program and their matches.

Included in the new Web-based platform for the second cohort are mechanisms for participants to provide immediate and ongoing feedback, as well as formalized surveys scheduled during the eight- month program. This allows for regular collection and analysis of information shared among mentees, mentors, and the ANA program staff.

It became evident that some of the mentees likely joined the program without a full understanding of their role in the relationship. There were mentors who had active interactions on the front end with their mentees, but over time some of the mentees slowed down their communications and “dropped out” without notification—leaving their mentors to wonder how or why this had occurred. This sug- gests that younger nurse colleagues may not be well schooled in and have limited appreciation for how their active role in this type of relationship will assist them with a focused and fast-tracked career path. The new program software allows staff to track mentee–mentor pairs throughout the process and sends timed reminders of tasks, meetings, and goal and objective updates—all of which enhance the tracking and measurement of individual partici- pant and program outcomes.

Upon conclusion of the first formal program (March 31, 2019), mentors were charged with over- sight of a timely transition in the relationship with their mentees. Guidelines and suggestions on how to end a mentee–mentor relationship were shared with this group of nurse leaders, and they were advised that an informal relationship could be maintained with their mentee if that was mutually desired and agreeable. Many mentors responded through the online community that they planned to continue their relationships in some form after the program ended. Additionally, many expressed their apprecia-

62 AJN ▼ August 2020 ▼ Vol. 120, No. 8 ajnonline.com

PROFESSIONAL DEVELOPMENT

tion for the opportunity to participate in this unique project and intended to do so again when the 2019– 2020 program opened for enrollment.

With more than 900 pairs of mentees and men- tors participating in the first year, many cited the program as one of the “best opportunities” they had been given in their careers.

Many of the inaugural-cohort mentors reported that they had experienced reciprocal learning from their mentees in the form of “seeing the workplace through younger eyes.” Contributors offered a host of suggestions—many of which were incorporated for 2019–2020—to help make the program stron- ger and have an even greater impact on the profes- sional development of our RN members.

LESSONS LEARNED Based on the success of the first year of the program, the ANA expanded the second year from six to eight months (October 2019 to June 2020). The new time frame was determined on the basis of participants’ feedback regarding the need for more time to develop an effective mentoring relationship with measurable outcomes. With a 43% increase in the number of participants across the three career-stage categories, the ANA made a list of important “les- sons learned” from members of the first mentee– mentor cohort, the online community leaders, and the ANA staff and leadership team and made addi- tional changes. • Bringing in the Web-based–platform vendor to

support and improve the enrollment and match- ing process for the expanded program; it pro- vided new avenues for communication, schedul- ing capabilities, and resource tools to facilitate the mentee–mentor relationships. The new plat- form also provided a more formal template for setting goals and objectives, along with technol- ogy for enhanced engagement between the men- toring pairs.

• Hosting weekly discussions in both online com- munities, guided by the community leaders; this improved communications between the two groups at the program level.

• Creating a private, members-only online commu- nity for mentees (one had already been established for the mentor community), in order to provide direct support and learning.

• Providing webinars designed specifically for each of the two groups—mentors and mentees— before matching took place. In the first year of the program, there was only a webinar for mentors, and that was provided at the time of matching. The new format provides both groups with an overview of the program and crucial information on how to get the most out of the Web-based platform’s connection capabilities and the online communities.

BENEFITS OF USING THE CAREER-STAGE CATEGORIES IN VIRTUAL MENTORING There are several potential benefits to the ANA’s virtual mentoring initiative and the career-stage cat- egories to identify and match mentees and qualified mentors across all levels of the profession.

First, with an ever increasing demand for leader- ship skills across the nursing workforce, mentoring of professionally younger colleagues needs to occur much earlier along their career trajectories.26, 27 The ANA’s all-virtual program eliminates geographical limitations to who can serve as mentors. Traditional models of mentoring have required mentors “on the ground,” working face-to-face with mentees, even if there is an online component of the work.

Second, professional development is required to maintain and expand competency—but as a profes- sion, we have to question whether there has been sufficient emphasis on the fact that early mentoring would assist younger colleagues in establishing and building a successful career trajectory.6 In order to clearly understand the role mentoring might play in professional development, there must also be an investment of time and resources toward teaching younger nurses the differences between mentoring, coaching, and precepting.12, 28 This type of virtual mentoring model helps mentees and mentors learn together and provides new access to a wide variety of networking opportunities.

Third, one important benefit of this program is that it offers a new mentoring option for those agen- cies seeking or renewing Magnet status—especially in light of the requirements for mentoring across all levels by the American Nurses Credentialing Cen- ter’s Magnet Recognition Program.24 Although no specific mentoring models have been specified for obtaining or maintaining Magnet status, the ANA’s three career-stage categories represent a new and unique path toward meeting the increasing need for large numbers of qualified mentors in all settings and roles.

Finally, the IOM’s Committee on the Future of Nursing 2020–2030 has established the need for dynamic leaders across all levels of nursing to assist in creating a new “culture of health.”29 Virtual men- toring programs such as the one discussed in this article offer new options for targeted leadership development, both now and into the next decade.

Nurses must assume responsibility earlier in their education and careers to devise a professional- development trajectory, and they should be provided with education and strategies on how to accomplish this.30 Traditionally, professional development has been fairly informal and focused on guiding col- leagues toward additional learning (seeking higher degrees or attending continuing education sessions). Formal leadership training has been the primary entry point for structured mentoring programs. The

[email protected] AJN ▼ August 2020 ▼ Vol. 120, No. 8 63

next generation of nurses must become more nimble in their drive toward professional development, remaining cognizant of the need to seek out mentors who are in alignment with their career goals. They must have a clear understanding of the mentee and mentor roles and responsibilities and be encouraged in their efforts by their educators and employers. Willing and qualified mentors need to be identified and then given the opportunity and training to take on these virtual relationships. Current health care leaders should immediately coordinate efforts to develop a forward-thinking, comprehensive action plan on a national scale for new and innovative vir- tual models such as the one implemented by the ANA. This prototype provides a road map for the timely and ongoing investment in future generations of emerging nurse leaders. ▼

Peggy O’Neill Hewlett is dean emerita at the University of South Carolina College of Nursing in Columbia, and serves as the ANA Mentorship Program Leader. Jan Santolla is a membership consul- tant with the American Nurses Association in Silver Spring, MD. Sabita Devi Persaud is an associate professor at Notre Dame of Maryland University in Beltsville, and serves as the ANA mentee online community leader. Contact author: Peggy O’Neill Hewlett, [email protected]. The authors have disclosed no potential conflicts of interest, financial or otherwise.

REFERENCES 1. American Association of Colleges of Nursing. Nursing short-

age. Washington, DC; 2019 Apr. Fact sheet; https://www. aacnnursing.org/Portals/42/News/Factsheets/Nursing-Shortage- Factsheet.pdf.

2. AMN Healthcare; The Center for the Advancement of Healthcare Professionals. 2017 survey of registered nurses: viewpoints on leadership, nursing shortages, and their profes- sion. San Diego; 2017. https://www.amnhealthcare.com/ uploadedFiles/MainSite/Content/Campaigns/AMN%20 Healthcare%202017%20RN%20Survey%20-%20Full%20 Report.pdf.

3. Buerhaus P, et al. Four challenges facing the nursing work- force in the United States. J Nurs Regul 2017;8(2):40-6.

4. Health Resources and Services Administration. Supply and demand projections of the nursing workforce: 2014-2030. Rockville, MD: U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis; 2017 Jul 21. https://bhw.hrsa.gov/sites/default/files/bhw/nchwa/projections/ NCHWA_HRSA_Nursing_Report.pdf.

5. The Lewin Group. Wisdom at work: retaining experienced RNs and their knowledge—case studies of top performing organizations. Falls Church, VA; 2009 Mar 25. https://www. rwjf.org/en/library/research/2009/03/wisdom-at-work.html.

6. Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing at the Institute of Medicine. The future of nursing: leading change, advancing health. Washington, DC: National Academies of Medicine; 2011. Consensus study report; https://www.nap.edu/catalog/12956/the-future-of- nursing-leading-change-advancing-health.

7. AARP Foundation; AARP; and the Robert Wood Johnson Foundation. Future of nursing campaign for action: campaign successes. Washington, DC; 2019. https://campaignforaction. org/wp-content/uploads/2019/03/campaign_successes_ 3.29.19.pdf.

For more information about the ANA 2020–2021 Mentorship Program, visit https://anamentorship. chronus.com.

8. Kovner CT, et al. Newly licensed RNs’ characteristics, work attitudes, and intentions to work. Am J Nurs 2007;107(9): 58-70.

9. Zimmerman C, Ward-Smith P. Attrition of new graduate RN: why nurses are leaving the profession. Mo Nurse 2012(Spring).

10. American Hospital Association; First Consulting Group. When I’m 64: how boomers will change health care. Washington, DC; 2007 May. https://www.aha.org/system/ files/content/00-10/070508-boomerreport.pdf.

11. Juraschek SP, et al. United States registered nurse workforce report card and shortage forecast. Am J Med Qual 2012; 27(3):241-9.

12. Petrin RD. Coaching vs. mentoring: 25 ways they are different. Boston: Management Mentors, Inc.; 2013 Dec 10. https://cdn2. hubspot.net/hub/41809/file-14055515-pdf/docs/coaching__vs_ mentoring_-_detailed_insights_from_management_mentors.pdf.

13. Kirk J, Olinger J. From traditional to virtual mentoring. Cullowee, NC: Western Carolina University; 2003 Jan 6. ED 475 467 CE 084 824. Informational analyses; https://files.eric. ed.gov/fulltext/ED475467.pdf.

14. Lewis TD, Flannery AH. Advancing professional development through virtual mentoring. Hosp Pharm 2016;51(4):277-8.

15. Robert Wood Johnson Foundation. Mentoring in nursing: a boon to nurses and patients. Princeton, NJ; 2013 Jan 10. https:// www.rwjf.org/en/library/articles-and-news/2013/01/mentoring-- a-boon-to-nurses--the-nursing-profession--and-patient.html.

16. Clement S. The use of virtual mentoring in nursing educa- tion. Online J Issues Nurs 2014;18(2).

17. Dietz J. How to create a great mentoring program in your online community [blog post]. 2017. https://blog.higherlogic. com/how-to-create-a-great-mentoring-program-in-your- online-community.

18. Hussain Z. The technology in practice. In: Clutterbuck D, Hussain Z, editors. Virtual coach, virtual mentor. Charlotte, NC: Information Age Publishing; 2010. p. 53-76.

19. American Association of Colleges of Nursing. MentorLink: connecting for success. 2020. https://www.aacnnursing.org/ Academic-Nursing/Professional-Development/Leadership- Development/MentorLINK.

20. Morin K, et al. Preparing leaders in maternal-child health nursing. J Obstet Gynecol Neonatal Nurs 2015;44(5):633-43.

21. Rick C, et al. The reality of virtual learning for nurses in the largest integrated health care system in the nation. Nurs Adm Q 2003;27(1):41-57.

22. Tsui K, Girard A. Driving an intentional cultural change through an enterprise-wide mentoring program. Nurse Lead 2019;17(3):197-200.

23. American Nurses Association. ANA leadership competency model. Silver Spring, MD; 2018 Jul. https://www.nursingworld. org/~4a0a2e/globalassets/docs/ce/177626-ana-leadership-booklet- new-final.pdf.

24. American Nurses Association. 2019 Magnet application man- ual. 2019. https://www.nursingworld.org/nurses-books/2019- magnet-application-manual.

25. Trossman S. Better prepared workforce, better retention: pro- grams illustrate the value of mentoring. Am Nurse 2013;45(4): 1, 12.

26. Jacobs S. An analysis of the evolution of mentorship in nursing. International Journal of Mentoring and Coaching in Education 2018;7(2):155-76.

27. Mariani B. The effect of mentoring on career satisfaction of reg- istered nurses and intent to stay in the nursing profession. Nurs Res Pract 2012;2012:168278.

28. Clutterbuck D. Welcome to the world of virtual coaching and mentoring. In: Clutterbuck D, Hussain Z, editors. Virtual coach, virtual mentor. Charlotte, NC: Information Age Publishing; 2010. p. 3-29.

29. Board on Health Care Services, Health and Medicine Division, National Academies of Sciences, Engineering, and Medicine. The future of nursing 2020-2030. Washington, DC: National Academies Press; 2020. Consensus study report; https://www.nationalacademies.org/our-work/the-future-of- nursing-2020-2030.

30. Hinds PS, et al. Creating a career legacy map to help assure meaningful work in nursing. Nurs Outlook 2015;63(2):211-8.