Digital Repository Masters Theses Spring 2026 Bridging the Gap: Mentorship to Enhance Labor and Delivery Nurse Competence in Rural Hospitals Jill Nelson Bogue Weber State University Follow this and additional works at: https://dc.weber.edu/collection/wsudoctoral Nelson Bogue, J. 2026. Bridging the Gap: Mentorship to Enhance Labor and Delivery Nurse Competence in Rural Hospitals. Weber State University Doctoral Projects. https://cdm.weber.edu/digital/collection/WSUDoctoral This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact archives@weber.edu. WSU REPOSITORY MSN/DNP Bridging the Gap: Mentorship to Enhance Labor and Delivery Nurse Competence in Rural Hospitals Project Title by Jill Nelson Bogue Student’s Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY Ogden, UT 4/16/2026 Date Jill Nelson Bogue 4/16/2026 Student Name, Credentials (electronic signature) Date Angela Page, DNP, APRN, PPNP-BC MSN Project Faculty (electronic signature) 4/25/26 Date Anne Kendrick, DNP, RN, CNE 4/25/26 Anne Kendrick Date (electronic signature) DNP, RN, CNE MSN Program Director Note: The program director must submit this form and paper. 1 Bridging the Gap: Mentorship to Enhance Labor and Delivery Nurse Competence in Rural Hospitals Jill Nelson Bogue Annie Taylor Dee School of Nursing Weber State University Angela Page, DNP, APRN, PPCNP-BC MSN Project 4/16/2026 2 Abstract Purposes/Aims: The purpose of this project is to implement a structured mentorship program to enhance confidence, competence, and proficiency among second-year nurses cross-training into Labor and Delivery within a rural hospital. Rationale/Background: Rural hospitals face challenges such as low patient volume, limited clinical exposure, and inconsistent mentorship, which hinder nurses’ progression from novice to competent in the labor and delivery settings. The literature demonstrates that structured mentorship, peer support, and simulation improve clinical confidence, skill acquisition, retention, and readiness for specialty practice in low-volume units. Methods: Guided by the Stetler Model of Evidence-Based Practice, this quality improvement project uses a five-phase approach: needs assessment, literature validation, feasibility evaluation, program development, and outcome evaluation. Project interventions include structured mentor selection, a labor and delivery competency checklist, monthly mentor-mentee check-ins, simulation-based learning, and pre- and post-program surveys. Ethical considerations include confidentiality, fairness, and psychological safety throughout mentorship and simulation. Results: It is anticipated that the structured mentorship program will improve nurse confidence, competence, and readiness to care for L&D patients, while also reducing delays in completing required certifications such as Certified-Electronic Fetal Monitoring. Improvement in training consistency and competency validation is also expected. Conclusions: This project has the potential to strengthen Labor and Delivery nurse development in rural settings, enhance patient safety, support workforce retention, and provide a replicable 3 framework for other low-volume or rural hospitals. Results may be disseminated through organization leadership, interdisciplinary teams, and future scholarly or conference presentations. Keywords: mentorship, rural nursing, labor and delivery, clinical competence, nurse confidence Bridging the Gap: Mentorship to Enhance Labor and Delivery Nurse Competence in Rural Hospitals Second-year nurses in rural hospitals often face unique challenges when cross-training into a specialized Labor and Delivery Unit. Due to low patient volumes and limited mentorship, these nurses frequently report feeling underprepared and lacking confidence (Lewallen & Van Horn, 2024). Structured mentorship programs support nurse development, which is crucial for nurses in rural hospitals (Compton & Rich, 2023). This project aims to demonstrate how a formal mentorship program can cultivate greater competence, boost confidence, and increase proficiency of second-year nurses transitioning to labor and delivery care in rural settings. Statement of Problem Limited resources and high demands characterize rural nursing. Consequently, these nurses receive cross-training and must manage a broad range of responsibilities, making their work environment uniquely challenging (Cawthorn, 2025). Although cross-training produces operational flexibility, this strategy poses difficulties in specialized units with frequently low patient volumes, such as labor and delivery. As a result, second-year nurses in labor and delivery training report struggling to gain sufficient hands-on experience to progress from novice to competent, especially in rural hospitals, where they often face greater responsibility and less support (Mitchell et al., 2018). At a rural hospital in central Utah, nurses are taking several years to complete their Certified Electronic Fetal Monitoring (C-EFM) certification. According to the 4 newly harmonized Intermountain Health procedure, new graduates and RNs without fetal monitoring experience have 24 months from the beginning of their orientation to Labor and Delivery to achieve certification (Intermountain Health, 2025). To address this issue, a targeted intervention is needed. This Quality Improvement (QI) project recommends a structured mentorship program for second-year nurses working in a rural hospital's labor and delivery unit in Central Utah to improve patient outcomes, nurse skill development, and self-confidence. The intended outcomes are improved nurse competency, a support system for nursing education, and quicker certification completion. Second-year nurses training in this rural hospital are the primary beneficiaries. In contrast, labor and delivery patients, newborns, and their families are secondary beneficiaries of improved nurse training. Significance of the Project Nurses in a rural hospital report limited confidence and under-preparedness, and are not ready to start caring for labor and delivery patients independently. This could be due to limited mentorship and low patient volumes (Lewallen & Van Horn, 2024). At a rural hospital in Central Utah, second-year nurses are sent to an urban facility for 12 shifts to orient to labor and delivery; however, once they return, there is no formal mentorship in place to continue supporting their development (K. Credile, personal communication, September 2025). These transitions are especially critical for these nurses, who often face steep learning curves and limited hands-on experience in low-volume rural labor and delivery units. Mentorship programs in rural healthcare settings foster strong relationships, enhance communication, and support nurses through key transitions such as adapting to rural practice, integrating into specialized roles like labor and 5 delivery, and progressing from novice to competent nurse (Rohatinsky et al., 2020). This gap contributes to delays in certification, reduced confidence, and inconsistent patient care. This project addresses the lack of structured support following initial labor and delivery orientation. Implementing a formal mentorship program will provide second-year nurses with ongoing guidance to build confidence and clinical competence. This will not only support nurse development and retention but also enhance patient safety and satisfaction, ultimately benefiting the hospital and the families it serves. Review of the Literature Due to low patient volumes, a lack of structured mentorship, and inadequate hands-on experience, second-year nurses in rural hospitals cross-training into labor and delivery units frequently face considerable obstacles (Lewallen & VanHorn, 2025). To better understand how to support these nurses, this literature review examines current evidence on structured mentorship programs tailored to rural healthcare settings. The following PICOT question guides the review: In rural nurses in their second year of employment who are training in Labor and Delivery, does a structured mentorship program, compared to no structured mentorship program, improve confidence, competence, and proficiency within their second year of employment? The Stetler Model of evidence-based practice was selected to guide the development and implementation of this project, based on the findings of the literature review. Framework The Stetler Model of evidence-based practice will guide the implementation of a structured mentorship program for second-year nurses in labor and delivery training in rural hospital settings. The Stetler Model consists of five phases. The first phase is preparation, where 6 a problem or needed change is identified. Validation is the next step, which involves gathering evidence and assessing its credibility and relevance to the project. Comparative evaluation and decision-making: In this third phase, the evidence is weighed to determine whether it is appropriate for a specific setting. The fourth phase is translation/application, where a plan is developed to put the evidence into practice. The fifth phase is evaluation, during which outcomes are assessed to determine whether the implemented change has had a positive impact and whether any adjustments are needed (National Collaborating Centre for Methods and Tools [NCCMT], n.d.). This framework will work well in a rural setting, where resources may be limited and clinical decisions must be evidence-informed and responsive to the realities of rural care. According to Agnel et al. (2025), evidence-based practice mentorship programs enhance nursing practice by promoting standardized care and best practices. Additionally, it ensures that all nurses are trained using the same evidence-based guidelines, thereby reducing the likelihood of errors or inconsistent care (Panneerselvam & Ramasamy, 2024). This Stetler Model's structured framework aligns with the mentorship program's stages for second-year rural nurses training in labor and delivery. A needs assessment is conducted at the start of the preparation phase to find areas where nurses lack clinical proficiency and confidence. Examining a broad range of research that demonstrates the efficacy of mentorship in enhancing nurses' competence and confidence in rural environments is part of the validation phase. The beneficial effects of structured mentorship on the development and retention of clinical skills have been repeatedly demonstrated across multiple studies (Mitchell et al., 2018; Rohatinsky et al., 2020). During the comparative evaluation and decision-making phase, input from educators and managers will help determine the feasibility and relevance of implementing 7 the mentorship program in the specific rural context. The translation/application phase involves launching a pilot program with obstetrics-trained mentors, utilizing simulation-based training, and conducting structured monthly check-ins. Finally, the evaluation phase will involve a presurvey, a post-program survey, and skills assessments to measure growth in clinical confidence and proficiency. This approach ensures that each step of the project is grounded in evidence and tailored to the unique challenges of rural nursing practice. Strengths and Limitations The Stetler Model is a valuable, well-organized framework that helps nurses integrate evidence into clinical practice. One of its strengths is its flexibility, which allows it to be used by individuals or small teams, making it a good fit for rural hospitals where staffing and resources may be limited (Stetler, 2001). The model leads users through five stages: preparation, validation, comparative evaluation/decision making, translation/application, and evaluation. It strongly emphasizes critical thinking and reflective decision-making (National Collaborating Centre for Methods and Tools [NCCMT], n.d.). This step-by-step process helps ensure thoughtful decisions are based on credible evidence. It also allows for formal and informal research, which is helpful when applying evidence in settings with limited access to large-scale studies. For this MSN project, the Stetler Model supports the development of a mentorship program by providing a straightforward process to assess needs, apply evidence, and evaluate outcomes, tailored to the realities of rural nursing practice. While the Stetler Model is useful for guiding evidence-based practice, it does have limitations. It does not explicitly address system-level elements that affect a project's adoption and sustainability, such as organizational culture, leadership support, or interdisciplinary 8 collaboration (Stetler, 2001; NCCMT, n.d.). This may present challenges when implementing changes across departments or when administrative buy-in is needed. The model also assumes that users possess the skills to critically appraise evidence and make informed decisions, which may not always be the case in settings with limited training or support (Ominyi et al., 2025). In this MSN project, these limitations can be addressed by involving nurse educators and managers early to help guide decision-making and ensure the mentorship program is feasible and supported within the rural hospital environment. Search Strategies A literature review found evidence to support the use of structured mentorship and orientation programs for second-year nurses training in labor and delivery units in rural hospitals. The search was conducted using Weber State University's Stewart Library system OneSearch and Advanced Search (which span multiple databases), as well as CINAHL, Google Scholar, and PubMed. These databases were selected due to their significance in evidence-based practice, nursing, and healthcare education. Only articles published between 2018 and 2025 were included in this review to ensure current literature. Search terms used included various Boolean combinations of the following keywords: "nurse" OR "RN" AND "orientation" OR "training" AND "structured" OR "cross-training" AND "rural hospital" OR "community hospital" AND "mentorship" OR "peer support" AND "confidence" OR "competence" OR "preparedness" AND "rural mentorship" OR "rural labor and delivery training" AND "Benner's Theory" OR "novice to competent." These terms were selected to reflect the PICO framework's components and to capture literature on nurse development, training strategies, and support systems in rural healthcare environments. Since there were few results specifically on training labor and delivery 9 nurses in rural hospitals, the search was expanded to include general rural nurse mentorship programs in hospital settings. This adjustment enabled the inclusion of relevant studies that address the development and support of nurses in rural practice settings. Synthesis of the Literature Three themes were identified from the literature: (a) the importance of structured mentorship programs in building nurse competence (Crook, n.d.; Lalithabai et al., 2021), (b) the role of peer support in enhancing nurse confidence (Varghese & Schkrabak, 2024; Alsalamah et al., 2022), and (c) orientation barriers in rural labor and delivery settings: implications for structured mentorship programs (Lewallen & VanHorn, 2025; Rauta et al., 2025). These recurring patterns across the literature will inform the development of a quality improvement project to strengthen second-year nurses' preparedness and improve patient outcomes during cross-training in rural labor and delivery units. Importance of Structured Mentorship Programs in Building Nurse Competence Building nursing competency requires structured mentorship programs, particularly in the early stages of clinical practice. A nursing orientation program in a multicultural acute care context was assessed by Lalithabai et al. in 2021. A 15% average rise in post-orientation scores demonstrated a statistically significant improvement in nursing competency. Compton and Rich (2020) and Gularte-Rinaldo et al. (2022) claim that structured mentorship programs enhance the skills of recently hired nurses by fostering confidence, collaboration, and integration into clinical practice. Crook (n.d.) states that a structured orientation program improved newly employed nurses' self-assessed talents and confidence. Mentors have reported feeling better prepared for 10 their roles and noted improvements in patient care outcomes. This feedback reinforces the idea that structured mentorship programs play a vital role in developing nurses' clinical competence. Benner's Novice to Expert theory offers a conceptual framework for understanding how nurses develop competence through structured support and repeated clinical experiences (NursingTheories.org, 2025). Multiple peer-reviewed journal articles report that structured orientation and mentorship programs improved nurse clinical performance and confidence, underscoring the importance of targeted support in fostering professional competence. Specifically, Sterner et al. (2021) found that work experience and controlled exposure to acute situations significantly affected novice nurses' confidence and clinical judgment. This highlights the value of supervised, real-world learning in developing professional competence. Similarly, Mehri et al. (2025) and Lewallen and Van Horn (2025) corroborated these findings, showing that supportive settings and mentorship helped novice nurses develop essential clinical skills through hands-on experience and reflection, thus closing the gaps in areas such as decision-making and communication (Alsalamah et al., 2022; Rauta et al., 2025; Sterner et al., 2021; Varghese & Shkrabak, 2024). Role of Peer Support in Enhancing Nurse Confidence Improved confidence among second-year nurses, particularly those training in rural labor and delivery settings, is often linked to peer support during orientation and transitional periods (Rohatinsky et al., 2020; Mehri et al., 2025; Rauta et al., 2025). Mentorship and consistent feedback helped new nurses overcome self-doubt and anxiety, thereby enhancing their clinical abilities, time management, and professional development, according to Mitchell et al. (2018) and Alsalamah et al. (2022). This kind of guidance is especially valuable in rural hospitals, 11 where staffing and support may be limited (Mitchell et al., 2018; Rohatinsky et al., 2020). Having access to preceptors and opportunities for peer involvement during orientation boosted nurses' self-confidence, highlighting the importance of teamwork, practical experience, and mentoring in assisting nurses in feeling more competent and self-assured in clinical practice (Lewallen & Van Horn, 2025; Mehri et al., 2025; Rauta et al., 2025). Orientation Barriers in Rural Labor and Delivery Settings: Implications for Structured Mentorship Programs Nurses undergoing training in rural labor and delivery units often face significant orientation challenges, which can hinder their ability to achieve clinical competence. Limited staffing, low patient volumes, and irregular mentorship lead to less practical experience and slower skill development (Lewallen & Van Horn, 2025; Mehri et al., 2025). Without sufficient assistance, second-year nurses in rural hospitals would be expected to take on more complex duties, which could lead to feelings of unpreparedness and delays in obtaining their National Electronic Fetal Monitoring Certification (Rauta et al., 2025; Rohatinsky et al., 2020). Research indicates that orientation programs in these environments often lack continuity and structure, which hinders nurses' ability to confidently transition into specialized roles, such as labor and delivery (Alsalamah et al., 2022; Mitchell et al., 2018). These obstacles underscore the need for structured mentorship programs that provide ongoing coaching, peer support, and targeted skill development to facilitate rural nurses' transition from novice to proficient practice in their second year of work. Summary of Literature Review Findings and Application to the Project 12 Three recurring themes emerged from the literature review: the role of peer support in enhancing nurses' confidence, the importance of structured mentorship programs in developing nursing competence, and the challenges second-year nurses face in rural labor and delivery settings during orientation. Numerous studies have shown that directed learning, practical experience, and regular feedback are key components of structured mentorship programs that enhance clinical competence (Crook, n.d.; Lalithabai et al., 2021; Compton & Rich, 2020; Mehri et al., 2025). In rural settings with limited staffing and assistance, peer support, especially during orientation, helped novice nurses feel less anxious and more confident (Mitchell et al., 2018; Alsalamah et al., 2022; Rohatinsky et al., 2020). Research has also revealed that rural nurses often face unique orientation challenges, such as low patient volumes and limited mentorship, which can delay skill development and preparedness for specialized units, including labor and delivery (Lewallen & Van Horn, 2025; Rauta et al., 2025). These results support the development of a structured mentorship program for second-year nurses in rural labor and delivery units, adapted for cross-training. In these high-acuity settings, the proposed program aims to bridge gaps in competence, confidence, and proficiency, thereby enhancing nurse readiness and improving patient outcomes. Project Plan and Implementation This section describes the strategy for implementing a structured mentorship and crosstraining program for second-year nurses, focusing on cross-training in labor and delivery units within a rural hospital setting. In the project, preceptors are responsible for shift-based clinical supervision and competency validation, while mentors provide longitudinal guidance, reflective support, and professional development across the duration of the cross-training program. The 13 goal of this project is to improve nurse competence, confidence, and retention by addressing gaps identified in the literature review. These gaps include limited patient exposure, lack of structured mentorship, and an inconsistent orientation process (Lewallen & Van Horn, 2025; Compton & Rich, 2020). This project will be implemented at a rural hospital in Central Utah, with the primary recipients being these nurses, and the secondary beneficiaries including patients, newborns, and their families. Stakeholders, including nurse educators, unit managers, and clinical mentors, will play a critical role in supporting implementation and ensuring alignment with organizational goals (Ominyi et al., 2025). The plan moves through five stages, guided by the Stetler Model of evidence-based practice: (1) preparation, which included conducting a gap analysis and needs assessment; (2) validation, this phase was completed through the literature review conducted for this project; (3) comparative evaluation, which determined whether implementing a mentorship program is realistic in the rural hospital setting; (4) translation/application, where the mentorship program will be developed and launched using the completed competency checklist, mentor qualifications and incentives, simulation-based learning, and monthly check-ins; and (5) evaluation, which will include pre- and post-surveys and feedback to gauge program efficacy (NCCMT, n.d). Plan and Implementation Process Preparation During the preparation phase, the master's student, who was also the Nursing Professional Development Practitioner (NPDP), met with the department nurse managers and the Chief Nursing Officer to discuss gaps in labor and delivery training and review current onboarding and competency processes (C. Jacobson, T. Carter, E. Ashby & N. Anderson, 14 personal communication, January 2026). These conversations helped guide the gap analysis. The needs assessment was conducted by speaking with nurses who have already completed labor and delivery cross-training, as well as those preparing to begin the process (S. Rowley, B. Holt, L. Finlinson & J. Dutson; January 2026). Their feedback highlighted challenges, including limited clinical exposure, inconsistent support, and uncertainty about required competencies. These findings confirmed the need for a structured mentorship program tailored to the unique demands of the rural labor and delivery setting. Validation The validation phase was completed through the literature review conducted for this project. The evidence consistently supported structured mentorship as a credible and effective approach for improving confidence, competence, and overall preparedness among second-year nurses training in rural labor and delivery. These findings confirmed that a mentorship program is an appropriate evidence-based strategy to address the training gaps identified in this rural setting. Comparative Evaluation Phase During the comparative evaluation phase, the master's student project lead worked with stakeholders to determine whether the proposed mentorship program would realistically improve nurses' competence, proficiency, and confidence in the rural hospital setting (C. Jacobson, personal communication, January 2026). This process included comparing current orientation practices with the training elements proposed in the mentorship model. One area of focus was the 12 orientation shifts completed at the urban hospital, and stakeholders discussed whether this level of clinical exposure is sufficient or whether 15 adjustments are needed to better support second-year nurses. Stakeholders also evaluated how orientation should continue once nurses return to the rural facility, including whether the urban preceptor should maintain contact and whether a rural-based preceptor should follow the nurse throughout the remainder of the process. Another topic of discussion was the frequency of simulation training, since holding only one annual obstetric simulation may not provide adequate hands-on experience for new labor and delivery nurses. Increasing the number of simulations and determining an appropriate schedule were possible ways to strengthen skill development and nurse confidence. The information gathered from these conversations will guide decisions on resource use, scheduling, and program design to ensure the mentorship program is practical and sustainable in this rural setting. Translation/Application During the translation and application phase, the focus will shift to developing and launching the structured mentorship program, informed by data and stakeholder recommendations. This will include selecting experienced labor and delivery nurses to serve as mentors using the mentor selection criteria and expectations created for this project (see Appendix A). Mentors will receive training to ensure consistency in guidance and competency validation. The competency checklist designed for the rural setting will also be implemented to help identify areas where nurses need additional exposure and practice (see Appendix B). Simulation will be incorporated to address low patient volumes and offer hands-on experience with high-risk obstetric situations. A monthly check-in form will be used to guide structured follow-up between mentors, educators, and nurses and to support progress reviews, address challenges, and reinforce learning (see Appendix C). These steps will help ensure the mentorship 16 program is implemented systematically and realistically, aligning with the needs of the rural labor and delivery unit. Evaluation The evaluation phase will focus on determining whether the mentorship program improves confidence, competence, and overall readiness among second-year nurses training in labor and delivery. Pre- and post-surveys developed for this project will be used to measure changes in these areas and to gather feedback on the training experience (see Appendix D). Additional input from mentors, educators, and unit managers will help identify the program's strengths and areas that may need adjustment. The information collected during this phase will guide future improvements to ensure the mentorship program remains effective and supportive in the rural labor and delivery setting. Interdisciplinary Team Nursing Professional Development Practitioner (NPDP) The NPDP will oversee the design and implementation of the mentorship program. This role includes training mentors, ensuring competency validation aligns with organizational standards, and monitoring progress throughout the program. The educator will also facilitate simulation sessions and provide ongoing support to both mentors and nurses, which is essential for maintaining consistency and quality in training (Agnel et al., 2025). Labor and Delivery Mentors Experienced labor and delivery nurses will serve in a formal mentor role that is distinct from the preceptor role and extends beyond shift-based clinical supervision. While preceptors focus on real-time bedside teaching and competency validation during scheduled shifts, mentors 17 provide longitudinal guidance throughout the cross-training period to support professional development, confidence building, and progression toward independent practice. Mentors will maintain an ongoing relationship with second-year nurses to facilitate reflective discussion of clinical and simulation experiences, assist with individualized goal-setting using structured monthly check-ins, and help synthesize learning when patient volume is limited. This sustained mentorship approach supports role transition, reinforces clinical reasoning and escalation decision-making, and promotes readiness for independent labor and delivery practice in a low-volume rural setting (Mitchell et al., 2018; Rohatinsky et al., 2020). Unit Managers Unit managers will play a critical role in scheduling and resource allocation. They will ensure that nurses have time for mentorship activities without compromising patient care. Managers will also collaborate with educators and mentors to address workflow challenges and maintain staffing coverage during training sessions (Ominyi et al., 2025). Preceptors Preceptors will provide shift-based bedside supervision during scheduled clinical shifts and are responsible for real-time teaching, skill demonstration, and validation of labor and delivery competencies using the standardized competency checklist. The preceptor role focuses on supporting safe patient care, reinforcing unit workflows, documentation standards, and effective communication during routine and emergent clinical situations. Preceptors provide immediate feedback, validate skills as they are demonstrated in practice, and identify areas requiring additional exposure or reinforcement. Observed strengths, progress, and learning needs will be communicated to the mentor and Nursing Professional Development Practitioner (NPDP) 18 to support continuity between shift-based clinical performance and the nurse’s ongoing development (Alsalamah et al., 2022). Quality and Safety Team The quality and safety team will monitor patient outcomes and safety indicators to evaluate the impact of the mentorship program. Their role ensures that improvements in nurse competence translate into better patient care and reduced risk of adverse events (Sterner et al., 2021). Collaboration among these professionals will create a supportive learning environment that enhances nurses' confidence and competence. By working together, the team will ensure that training is consistent, evidence-based, and aligned with organizational goals. This interdisciplinary approach promotes safer care for mothers and newborns, reduces delays in certification, and improves overall patient satisfaction (Compton & Rich, 2020; Rohatinsky et al., 2020). Description and Development of Project Deliverables This project required the development of several deliverables designed to support a structured mentorship program for second-year nurses training in labor and delivery at a rural hospital. These materials provide clear expectations, promote consistent skill development, and help evaluate the program's overall effectiveness. Each deliverable was informed by findings from the literature review, which emphasized the value of structured mentorship, consistent feedback, and standardized training tools in rural healthcare settings. Mentor Selection Criteria and Expectations 19 Mentor selection criteria were created to ensure that experienced labor and delivery nurses serving as mentors are prepared to support second-year nurses throughout their training (see Appendix A). This deliverable outlines the qualifications, responsibilities, and expectations for mentors, including providing guidance, offering constructive feedback, and assisting with competency validation. The literature consistently shows that high-quality mentorship improves confidence, competence, and role transition—particularly in rural environments where nurses often have limited support (Compton & Rich, 2020; Rohatinsky et al., 2020). Establishing clear mentor expectations helps create a consistent experience for all nurses entering the labor and delivery cross-training process. Labor and Delivery Competency Checklist A structured competency checklist was developed to guide training and ensure that essential skills are consistently taught and evaluated (see Appendix B). The checklist includes key labor and delivery competencies such as fetal monitoring, labor support, obstetric emergencies, newborn assessment, and communication requirements for the unit. Research demonstrates that structured competency tools help standardize orientation and improve clinical preparedness, especially when patient volumes are low (Lalithabai et al., 2021; Sterner et al., 2021). This checklist also supports the timeline required for completing C-EFM certification (Intermountain Health, 2025). Using this tool throughout the mentorship period will help identify areas where nurses need additional practice and ensure progress toward independent practice. Monthly Mentor–Mentee Check-In Form 20 The monthly check-in form was developed to provide structure for ongoing communication between the nurse, mentor, and educator (see Appendix C). The form includes space to document completed competencies, identify challenges, and outline goals for the upcoming month. The literature highlights that regular, structured feedback improves confidence and reduces the stress associated with transitioning into specialty roles (Mitchell et al., 2018; Alsalamah et al., 2022). In rural hospitals, where nurses often feel isolated, scheduled check-ins help ensure steady support and consistent progress (Rohatinsky et al., 2020). This tool keeps everyone aligned and helps ensure the mentorship experience remains meaningful and effective. Pre- and Post-Program Surveys Pre- and post-program surveys were developed to measure changes in nurse confidence, perceived competence, and overall readiness to care for labor and delivery patients (see Appendix D). The surveys use Likert-scale items and open-ended questions to gather both quantitative and qualitative feedback. Survey data will help evaluate whether the mentorship program meets its intended outcomes. Evidence supports the use of structured survey tools to assess mentorship effectiveness and guide program improvement (Agnel et al., 2025; Gularte-Rinaldo et al., 2023). Comparing pre- and post-survey results will help determine where additional support or adjustments may be needed in future program iterations. Timeline Once the literature review and project deliverables were completed, a proposed timeline for implementing the structured mentorship program was developed (see Appendix E). First, the 21 NPDP and unit manager will review the project plan, including the mentor selection criteria, competency checklist, monthly check-in form, and survey tools. Any recommended revisions based on their feedback will be completed within one month. Next, mentors will be identified and invited to participate in the program. Mentor preparation and training will occur over the second month, allowing time to review program expectations, clarify responsibilities, and ensure consistency in competency validation. During this period, second-year nurses entering labor and delivery training will also receive an orientation to the mentorship program, outlining the expectations and timeline for participation. The mentorship program will run for three to five months. During this time, nurses will begin working with their assigned mentors and use the competency checklist throughout their clinical shifts. Monthly mentor–mentee check-ins will be conducted to assess progress, address challenges, and ensure that sufficient support is in place. Simulation-based learning experiences will be incorporated as needed to reinforce skills that may be difficult to achieve due to low patient volumes. At the end of the five-month mentorship period, the post-program survey will be distributed to participating nurses. Mentors, preceptors, and unit leaders will also provide feedback on program effectiveness and feasibility. The NPDP will then evaluate the survey results and qualitative feedback, identifying trends, areas for improvement, and recommendations for future program cycles. The timeline was intentionally designed to provide adequate preparation, structured support, and meaningful evaluation. Allowing time for mentor training, consistent check-ins, and simulation reinforcement helps ensure a smooth implementation. The use of pre- and post- 22 program surveys will offer valuable insight into the program's impact on confidence, competence, and readiness for labor and delivery practice in the rural setting. Project Evaluation The evaluation of this structured mentorship program will use both formative and summative methods to determine its impact on nurses' confidence, competence, and clinical readiness in the rural labor and delivery setting. Multiple data points will be collected to assess progress throughout implementation and to measure overall program outcomes. Formative Evaluation Formative evaluation will provide ongoing feedback during implementation to identify areas needing adjustment and to ensure that nurses receive the support they need as they progress through the mentorship experience. Completion of monthly mentor–mentee check-ins using the Monthly Check-In Form (Appendix C) will assess competency development, clinical exposure, and confidence levels. This process allows mentors, the NPDP, and the unit manager to identify, monitor progress, and intervene early when skill gaps, low patient exposure, or confidence concerns arise. The Labor and Delivery Competency Checklist (Appendix B) will be reviewed regularly by the mentor and NPDP to track skill completion, identify areas requiring remediation, and ensure consistent competency validation across mentors. The checklist functions as a formative tool by highlighting skills that require additional practice, simulation reinforcement, or targeted instruction. Incorporation of simulation performance feedback throughout the mentorship period addresses challenges related to low patient volume. Simulation facilitators will promote 23 psychological safety throughout the simulation experience and provide structured guidance during both the scenario and the debrief. Simulation activities will emphasize crisis resource management (CRM) principles, including communication, role clarity, situational awareness, teamwork, and effective use of available resources. Time-outs will also be incorporated when appropriate to allow participants to pause, reassess, and apply CRM strategies. During structured debriefs, facilitators will guide reflective discussions to strengthen clinical judgement, coordination, and confidence in managing obstetric patients. Summative Evaluation The summative evaluation will measure the mentorship program's overall effectiveness upon completion by comparing end-of-program outcomes with baseline data. Pre- and postprogram surveys (Appendix D) will assess specific changes in nurse confidence, perceived competence, and readiness to care for labor and delivery patients independently. Survey items will include Likert-scale questions and open-ended responses to gather both quantitative and qualitative data. These surveys will serve as the primary summative measurement tool to evaluate program impact. Summative evaluation will also include the percentage of competencies validated by the end of the mentorship period. The final competency checklist will be reviewed to determine whether participants met established skill benchmarks, including fetal monitoring interpretation, obstetric emergency management, and documentation requirements. 24 Completion of required training courses, such as AWHONN and C-EFM, will be tracked. A reduction in time to completion, compared with historical data at the rural hospital, will be used as an indicator of program effectiveness. A collection of feedback from mentors, NPDPs, and managers at the end of the program will evaluate the feasibility, sustainability, and perceived value of the mentorship program. This input will help determine whether the program aligns with staffing realities and supports longterm improvements in nurse preparedness. Findings will inform future program modifications and strategies for sustaining the mentorship initiative within the rural hospital setting. Using both formative and summative methods provides a comprehensive approach to evaluating the mentorship program. Ongoing formative assessments will guide real-time adjustments and ensure meaningful support during training. At the same time, summative measures will determine whether the program achieved its intended outcomes of improving confidence, competence, and readiness among second-year nurses cross-training in labor and delivery. Findings from this evaluation will guide future program refinements and support sustainability within the rural hospital setting. Ethical Considerations This quality improvement project involves second-year nurses participating in a structured mentorship program that supports the required cross-training process in the labor and delivery unit at a rural hospital. Because caring for labor and delivery patients and obtaining CEFM certification are established job expectations, participation in the program's educational and competency components is required as part of their role. However, participation in project 25 surveys and voluntary feedback activities will not affect employment status, scheduling, or future training opportunities. Ethical principles, including fairness, respect, confidentiality, and psychological safety, guide all aspects of the project. All nurses training for labor and delivery will receive equal access to mentorship, simulation experiences, and competency support to ensure an inclusive and nondiscriminatory learning environment. Psychological safety is emphasized throughout mentorship and simulation. Before participating in the simulation, all nurses sign a confidentiality agreement requiring them to protect the privacy of other participants, maintain professionalism, and keep all scenario details and performance observations confidential. The agreement reinforces that simulation is a safe learning environment in which open reflection occurs only during the debriefing session. Any breach in professionalism is addressed with the nurse's manager. These expectations support honest discussion, collaborative learning, and skill development in a low-volume rural setting. Simulation sessions will not be recorded, and debriefing conversations will remain confidential among facilitators, mentors, and the participating nurse. This protects privacy and fosters trust during skills practice and review. All project documents, including competency checklists, check-in forms, and surveys, will be stored securely and reviewed anonymously to protect privacy. This process ensures participants feel their honest feedback is valued and contributes to program improvement. The NPDP acknowledges the potential for personal bias when evaluating progress or interpreting feedback. To minimize this risk, evaluation processes will involve multiple stakeholders, and standardized tools will be used to ensure consistency, fairness, and objectivity. 26 These measures help ensure the project supports ethical professional development and aligns with organizational expectations and accepted standards in nursing practice. Discussion Second-year nurses transitioning into labor and delivery in rural hospitals often face significant challenges, including low patient volume, limited exposure to high-acuity scenarios, and limited access to structured mentorship. Research demonstrates that mentorship and targeted support improve nurse confidence, competence, and clinical judgment (Compton & Rich, 2020; Rohatinsky et al., 2020). Likewise, inadequate preparation and limited clinical exposure contribute to increased anxiety, delays in skill acquisition, and inconsistent care (Lewallen & Van Horn, 2025; Mitchell et al., 2018). This project seeks to address these gaps by implementing a structured mentorship program designed to enhance readiness, strengthen clinical skills, and support safe patient care in a rural labor and delivery unit. The following sections discuss evidence-based methods for disseminating project findings, the significance of this project to nursing practice, the project's implications, and recommendations for sustaining and expanding the mentorship model. Evidence-Based Solutions for Dissemination As required in NRSG 6802, the project’s anticipated results, key observations, and preliminary recommendations will be presented to faculty and peers during the course’s final scholarly poster session. This presentation occurs prior to project implementation and provides an opportunity to receive feedback, engage in scholarly discussion, and refine the implementation plan based on insights gathered during the poster session. 27 Upon completion of the mentorship program and the evaluation period, project findings will be disseminated through several venues to support organizational learning and future implementation efforts. Within the rural hospital, findings will be shared with key leaders, including the Chief Nursing Officer, the Labor and Delivery manager, other nursing department managers, and the Labor and Delivery medical director. Disseminating results to this group supports transparency, highlights the program's impact on nurse competence and confidence, and strengthens leadership support for future training initiatives. In addition, findings will be shared with the Labor and Delivery clinical specialists for the organization, who oversee obstetric standards and provide expertise across facilities. Because second-year nurses complete 12 shifts of orientation at an affiliated urban hospital, dissemination will also include presenting outcomes to key stakeholders at the partner site. Sharing results with the nursing professional development team, preceptors, and nursing leaders at the urban facility will help align expectations, improve continuity between off-site and on-site orientations, and support recommendations to enhance the collaborative orientation model. Additional internal dissemination strategies may include presenting the project during education meetings, highlighting results in staff meetings, or sharing the outcomes with interdisciplinary committees and the Rural Hospital Nursing Professional Development Cohort. If project outcomes demonstrate meaningful improvements in nurse confidence, competence, and progression toward C-EFM certification, further dissemination could occur at regional maternal health or rural healthcare conferences or through publication in nursing professional development or quality improvement journals. Broader dissemination would support 28 replication of this mentorship model in other low-volume labor and delivery settings facing similar training challenges. Significance to the Advancement of Nursing Practice This project advances nursing practice by addressing a critical challenge faced by rural hospitals: developing and maintaining competent labor and delivery nurses despite low patient volumes, limited specialty exposure, and inconsistent access to experienced mentors. Research shows that new and transitioning nurses often struggle with confidence, clinical judgment, and the acquisition of specialty skills without structured support, especially in high-risk areas such as obstetrics (Lewallen & Van Horn, 2025; Mitchell et al., 2018). These gaps can delay progression to competency, increase stress, and potentially compromise patient safety. By implementing a structured mentorship program, this project directly supports the professional growth of rural nurses and enhances the quality and safety of maternal care. Structured mentorship has repeatedly been shown to improve nurses' confidence, communication, competence, and readiness for independent practice (Compton & Rich, 2020; Rohatinsky et al., 2020). In rural settings, where opportunities for hands-on obstetric experience are often limited, mentorship becomes even more essential. The mentorship model used in this project provides ongoing guidance, simulation-based reinforcement, and consistent expectations through a standardized competency checklist. These strategies help nurses bridge experience gaps in low-volume environments and support steady progression toward required specialty certification, including C-EFM. This project also advances nursing practice by reinforcing the importance of evidencebased training methods. Simulation and crisis resource management principles help replicate 29 high-risk obstetric events that nurses may rarely encounter, enabling them to build critical thinking, teamwork, and emergency response skills in a safe, controlled environment. Evidence supports simulation as a highly effective method for improving clinical readiness, communication, and decision-making among nurses across practice settings (Alsalamah et al., 2022; Sterner et al., 2021). Integrating simulation into the mentorship program ensures that skill development continues even when clinical opportunities are limited. Furthermore, this project supports broader professional goals related to nurse retention, workforce stability, and patient safety. Providing structured mentorship and clear pathways to competency can improve job satisfaction, reduce burnout, and strengthen organizational commitment, all of which contribute to a more stable and prepared workforce (Rohatinsky et al., 2020). Improving nurse readiness and confidence also has downstream effects on maternal and neonatal outcomes, particularly in rural communities where access to high-risk obstetric support is limited. Overall, this project advances nursing practice by strengthening clinical competence, fostering supportive professional relationships, integrating evidence-based education strategies, and enhancing patient safety in rural labor and delivery settings. The mentorship model established through this project provides a replicable framework that other rural or low-volume hospitals may adopt to support specialty development and improve maternal care outcomes. Implications This project has several important strengths. The structured mentorship model provides clear expectations for skill development, supports consistent competency validation, and enhances communication among mentors, nurses, and NPDPs. The incorporation of simulation is 30 a significant strength in a low-volume rural setting, as it allows nurses to practice high-risk obstetric emergencies they may not frequently encounter clinically. Monthly check-ins and standardized competency tools create accountability and enable early identification of learning needs, promoting steady progression toward competency. Despite these strengths, the project has several limitations. Low patient volume may continue to restrict hands-on learning opportunities, even with simulation reinforcement. Staffing challenges in a rural facility may limit the number of available mentors or strain the small pool of experienced labor-and-delivery nurses. The program also relies on self-reported confidence surveys, which may be influenced by individual perception or response bias. Additionally, turnover among second-year nurses or mentors could disrupt the continuity of the mentorship process. Several strategies may reduce or eliminate these obstacles. Increasing simulation frequency during periods of low patient volume can help ensure that essential skills continue to be practiced. Training multiple mentors and distributing mentorship responsibilities can prevent burnout and improve program sustainability. Strengthening communication and collaboration with the affiliated urban hospital, where nurses complete their initial 12 shifts of orientation, may also support continuity between off-site and on-site learning. Ongoing involvement from the NPDP, unit manager, and clinical specialists will be important to maintaining program consistency and responding to barriers as they arise. By proactively addressing these challenges, the mentorship program can continue to support the growth and preparedness of nurses transitioning into labor and delivery practice in a rural environment. Recommendations 31 Based on the outcomes and anticipated challenges of implementing the structured mentorship program, several recommendations can guide future improvements and ongoing development of the project. Continued refinement of the competency checklist is recommended to ensure it remains aligned with evolving organizational standards, updated evidence-based practices, and changes in unit workflow. Expanding simulation to include additional obstetric emergencies, rare clinical events, and interdisciplinary communication scenarios may help further strengthen nurse readiness in a low-volume setting. Future program cycles may benefit from developing a formal mentor support process, such as mentor debriefings or peer forums, to reduce burnout and enhance mentor satisfaction. Tracking long-term outcomes, such as retention rates, time to independent practice, and time to C-EFM certification, would provide additional insight into the program's broader impact on workforce stability and professional growth. Gathering follow-up feedback from nurses several months after completing the mentorship program may help determine the sustainability of confidence and competence gains over time. Another recommendation is to expand the mentorship model to other specialty areas within the hospital, such as emergency nursing or postpartum care, to address workforce needs across departments. Collaboration with other rural hospitals may also provide valuable opportunities to compare outcomes, share best practices, and develop regional mentorship networks for nurses transitioning into specialty practice. Additional research could examine whether structured mentorship influences patient outcomes, reduces adverse events, or improves interdisciplinary communication within rural labor and delivery units. 32 These recommendations can strengthen the mentorship model, support long-term sustainability, and help develop safe, confident, and competent labor and delivery nurses in rural settings. Conclusions Second-year nurses transitioning into labor and delivery in rural hospitals face unique challenges that stem from low patient volume, limited exposure to obstetric emergencies, and inconsistent access to structured mentorship. The literature review highlighted the significance of these barriers. It provided strong evidence supporting structured mentorship, competency-based learning, and simulation as effective strategies for improving confidence, clinical judgment, and readiness for independent practice. These findings directly informed the development of a structured mentorship program designed to meet the needs of nurses cross-training into labor and delivery within a rural environment. The project implementation plan used the Stetler Model to guide development of the mentorship program, incorporating evidence-based strategies such as standardized competency checklists, monthly mentor–mentee check-ins, simulation reinforcement, and collaboration with both rural and urban training sites. These components were selected to create consistency, support skill acquisition, and bridge learning gaps created by infrequent clinical opportunities. Evaluation methods, including pre- and post-surveys, competency validation, and stakeholder feedback, will determine the program's effectiveness in improving nurses' confidence and competence, and in advancing their progression toward required certification. Overall, this project has the potential to strengthen the preparation of rural labor and delivery nurses, support safer maternal care, and improve workforce stability in an essential 33 specialty area. By providing a structured, evidence-based approach to training, the mentorship model offers a replicable framework that may benefit other low-volume or rural hospitals facing similar challenges. The outcomes of this project can help guide future improvements in orientation, mentorship, and specialty development, ultimately advancing nursing practice and promoting high-quality care for mothers, newborns, and families in rural communities. 34 References Agnel, J., Molle, J., Colson, S., & Chays-Amania, A. (2025). The Impact of the Evidence-Based Practice Mentor on Nurses: A Scoping Review. Worldviews on evidence-based nursing, 22(2), e70016. https://doi.org/10.1111/wvn.70016 Alsalamah, Y. S., Hosis, K. A., Harbi, A. A., Itani, M. S., Tassi, A. E., & Fawaz, M. (2022). Student to nurse transition and the nurse residency program: A qualitative study of new graduate perceptions. Journal of Professional Nursing, 42, 195–200. https://doi.org/10.1016/j.profnurs.2022.07.007 Cawthorn, A. (September 11, 2025). Rural Nursing Challenges and Opportunities. Healthcare. https://www.indwes.edu/articles/2025/09/rural-nursing-challenges-opportunities Compton, L., & Rich, D. (2020). Development of a Nurse Mentorship Program. JOGNN. https://doi.org/10.1016/j.jogn.2020.09.003 Crook, J. (n.d.). Structured orientation program for newly hired nurses. Annie Taylor Dee School of Nursing Gularte-Rinaldo, J., Baumgardner, R., Tilton, T., & Brailoff, V. (2023). Mentorship ReSPeCT Study: A Nurse Mentorship Program's Impact on Transition to Practice and Decision to Remain in Nursing for Newly Graduated Nurses. Nurse leader, 21(2), 262–267. https://doi.org/10.1016/j.mnl.2022.07.003 Intermountain Health. (2025). Electronic fetal monitoring certification procedure. https://www.intermountainhealth.org/policies/efm-certification 35 Lalithabai, D.S., Ammar, W.M., Alghamdi, K.S., & Aboshaiqah, A.E. (2021). Using action research to evaluate the nursing orientation program in a multicultural acute healthcare setting. International Journal of Nursing Sciences, 8(2), 181–189. https://doi.org/10.1016/j.ijnss.2021.01.002 Lewallen, L. P., & Van Horn, E. (2025). Exploration of competence and incompetence in new graduate nurses: Orientation leaders’ and preceptors’ perspectives. Nurse Education in Practice, 104361. https://doi.org/10.1016/j.nepr.2025.104361 Mehri, Z., Zarshenas, L., Rakhshan, M., Khademian, Z., Mehrabi, M., & Jamshidi, Z. (2025). Novice nurses’ professional competence: A qualitative content analysis. Journal of Education and Health Promotion, 14(1). https://doi.org/10.4103/jehp.jehp_1819_23 Mitchell, A., Lucas, C., Cisar, P., Wilson, K., & Bowe, J. (2018). Mentoring Novice Nurses in Healthcare Organizations. International Journal of Medical Science and Health Research, 2(1). https://doi.org/https://ijmshr.com/uploads/pdf/archivepdf/2020/IJMSHR_02_24 Ominyi, J., Nwedu, A., Agom, D., & Eze, U. (March 6, 2025). Leading evidence-based practice: Nurse Managers’ strategies for knowledge utilisation in acute care settings - BMC Nursing. BioMed Central. https://bmcnurs.biomedcentral.com/articles/10.1186/s12912025-02912-5 Panneerselvam, S., & Ramasamy, S. (2024). Strategies to improve evidence-based practice competencies in nursing education: Addressing the need of the hour. Journal of family 36 medicine and primary care, 13(8), 3441–3442. https://doi.org/10.4103/jfmpc.jfmpc_237_24 Patricia Benner’s from novice to expert theory: Case studies and practical insights. NursingTheories. (February 7, 2025). https://nursingtheories.org/benners-novice-toexpert-theory Rauta, S., Junttila, K., Strandell-Laine, C., Peltokoski, J., & Haapa, T. (2025). The quality of orientation for newly hired nurses in acute care settings in a university hospital: A crosssectional study. Applied Nursing Research, 81, 151903. https://doi.org/10.1016/j.apnr.2025.151903 Rohatinsky, N., Cave, J., & Krauter, C. (2020). Establishing a mentorship program in rural workplaces: connection, communication, and support required. Rural and remote health, 20(1), 5640. https://doi.org/10.22605/RRH5640 Sterner, A., Ramstrand, N., Palmér, L., & Hagiwara, M. A. (2021). A study of factors that predict novice nurses' perceived ability to provide care in acute situations. Nursing open, 8(4), 1958–1969. https://doi.org/10.1002/nop2.871 Stetler model of evidence-based practice. NCCMT. (n.d.). https://www.nccmt.ca/knowledgerepositories/search/83 Varghese, L., & Shkrabak, S. (2024). Seamless Transition: Strategies for effective new nurse orientation and practice integration. Nurse Leader, 23(1), 58-61. https://doi.org/10.1016/j.mnl.2024.09.024 37 Appendix A Mentor Selection Criteria and Expectations Labor and Delivery Mentor Qualifications and Role Expectations Purpose The purpose of this document is to outline the required qualifications, responsibilities, and training expectations for mentors participating in the structured mentorship program for second-year nurses cross-training in Labor and Delivery within a rural hospital setting. These criteria ensure consistency, safety, and high-quality educational support aligned with project goals. This mentor role is intentionally distinct from the preceptor role and focuses on longitudinal professional development, reflective learning, and confidence-building rather than shift-based competency validation. Required Mentor Qualifications • • • • • • • • Minimum of two years of clinical experience in Labor and Delivery. Current Certified Electronic Fetal Monitoring (C-EFM) credential. Completion of the facility’s Preceptor Workshop, qualifying the nurse as a trainedpreceptor. No active or recent disciplinary action on record. All annual education, competencies, and organizational training requirements fully met. Demonstrated adherence to all unit policies, safety standards, and professional practice expectations. Strong communication and interpersonal skills, including the ability to provide clear, supportive feedback. Willingness to fulfill all mentor responsibilities and complete required mentor training. Mentor Responsibilities • • • • • Provide longitudinal professional guidance and support throughout the mentorship period, focusing on confidence development, clinical reasoning, and role transition. Use the standardized competency checklist to identify gaps, guide goal setting, and support professional development, rather than to perform shift-based competency validation. Support learning in a low-volume rural environment through simulation debriefing, reflective discussion, and case-based review. Offer constructive, timely feedback using evidence-based strategies. Documentation expectations include weekly documentation completed by the mentor and monthly check-ins completed by the nurse manager with input from the NPDP. 38 • • • Escalate concerns regarding clinical performance, patient safety, or training barriers to the NPDP or unit manager promptly. Model professional behavior, teamwork, and safe clinical practice consistent with organizational standards. Assist nurses in reflecting on clinical experiences and simulation performance to strengthen clinical judgement and readiness for independent practice. Scheduling and Time Commitment • • • • • • • Mentors will be paired with a mentee for the duration of the program (typically 3–6 months) Althoug formal mentor-mentee check-ins are scheduled 1-2 times per month, mentoring is intended to be a continuous, longitudinal relationship that provides ongoing guidance, reflection, and support throughout the cross-training period. May assist with simulation sessions or targeted skills reinforcement as needed. Serve as the designated mentor during the mentee’s 12 required shifts at the partnering urban hospital, providing follow-up support, coaching, and continuity throughout the off-site portion of training. Coordinate and communicate opportunities for additional clinical exposure when Labor & Delivery patient volume is low at the rural facility. This may include inviting the mentee to come in when not scheduled, as appropriate, to observe or participate in active L&D cases. Maintain proactive communication regarding scheduled inductions and cesarean births, ensuring mentees are aware of upcoming learning opportunities and can arrange to attend when feasible. Collaborate with the NPDP and unit manager to balance mentorship needs with staffing and operational requirements. Mentor Training Requirements • • • • • Program structure and expectations. Use of the competency checklist for consistent evaluation. Coaching and communication strategies applicable to adult learners. Simulation support and strategies for low-volume learning environments. Documentation expectations include weekly documentation completed by the mentor and monthly check-ins completed by the nurse manager with input from the NPDP. 39 Appendix B Labor and Delivery Competency Checklist Labor and Delivery Competency Checklist Nurse Name: Mentor Name: Start Date: Target Completion: Clinical Competencies Competency Fetal monitoring: baseline, variability, accelerations, decelerations Fetal monitoring: Category I-III interpretation Vaginal exams: dilation, station, effacement, and membrane status Induction/augmentation medications: Pitocin, Cervidil, Cytotec) Obstetric medications & safety parameters EFM strip documentation Managing precipitous delivery Shoulder dystocia maneuvers Postpartum care PPH hemorrhage protocol Neonatal resuscitation workflow and algorithm Magnesium protocol Delivery set-up and care Bed set-up Pre-eclampsia assessment & interventions Patient education and teaching Validated Mentor Initials Notes 40 Management of diabetic mom during labor C-section prep Competency C-section recovery Assisting with fetal scalp electrode insertion (FSE) Assisting with intrauterine pressure catheter insertion (IUPC) and maintenance OB monitors Assisting with epidurals Open infant warmer Setting up delivery Specimen labeling (placenta, cord gases) Validated Mentor Initials Notes Emergency Scenarios Scenario Prolapsed cord Uterine rupture recognition Pre-eclampsia/eclampsia Placental Abruption Shoulder dystocia PPH (blood loss, medications, interventions) Neonatal resuscitation (dry, stimulate, PPV) Validated Mentor Initials Notes Documentation Competencies Documentation Use of L&D Navigator main workflow (Overview → Labor → Delivery → Postpartum) Accurate navigation between tabs (Rounding, Care Plans, Notes, Flowsheets) Labor flowsheet documentation (VS, pain, progress, interventions) Validated Mentor Initials Notes 41 Cervical exam documentation (dilation, effacement, station, presentation, membranes) Contraction pattern documentation (frequency, duration, intensity) Validated Documentation Mentor Initials Notes Fetal monitoring flowsheet entries (baseline, variability, accelerations, decelerations) Documentation of position changes and interventions Medication flowsheet documentation (Pitocin, MgSO4, epidurals, etc.) OB rounding flowsheet completion Third stage labor documentation (QBL, placenta assessment) Time of birth & Apgar scoring Documentation of provider bedside evaluation Professional Behaviors Behavior Demonstrates respectful, patient-centered communication at all times Maintains situational awareness during labor, delivery, and emergencies Uses SBAR and closed-loop communication with all team members Escalates clinical concerns promptly following chain of command Collaborates effectively with providers, anesthesia, and support staff Maintains privacy, dignity, and cultural sensitivity for all patients Responds calmly and professionally in high-stress or emergent situations Mentor Initials Notes 42 Accepts feedback constructively and seeks clarification when needed Follows safety protocols consistently (time-outs, double checks, PPE) 43 Appendix C Monthly Mentor- Mentee Check-In Form Monthly Mentorship Check-In Form This form is intended for use in the organization’s electronic system (SharePoint). Please complete the final version electronically so it can be accessed by all required team members. Check-In Information Month Number: ___________________ Date: ___________________ Mentee: ______________________________________ Mentor: ______________________________________ Educator: ______________________________________ Manager: ______________________________________ Mentor/Mentee Meeting Frequency: ☐ Weekly ☐ Biweekly ☐ Monthly ☐ As needed Clinical Exposure This Month Number of L&D Shifts Worked: ______________ Key Experiences / Patient Encounters: High-Risk Exposures: ☐ Shoulder dystocia ☐ PPH ☐ PEC/Eclampsia ☐ STAT C-section ☐ Cord prolapse ☐ Neonatal resuscitation ☐ Other: ___________________________________________________________________ Competency Progress Competencies validated this month: 44 Competencies pending due to low volume: Courses Completed (check all that apply): ☐ STABLE ☐ MOMS ☐ NCC Prep Review ☐ AWHONN Fetal Heart Monitoring ☐ Basic Fetal Heart Monitoring ☐ C-EFM Exam Completed ☐ Other: _________________________________________ Simulation / Skills Practice Simulation/Skills completed this month: ☐ Yes ☐ No If yes, scenarios/skills: Key takeaways: Confidence / Readiness (0–10: 0 = least confident, 10 = most confident) EFM Interpretation: 0☐1☐ 2☐ 3☐ 4☐ 5☐ 6☐ 7☐ 8☐ 9☐ 10☐ Normal Labor Workflow: 0☐ 1☐ 2☐ 3☐ 4☐ 5☐ 6 ☐7☐ 8☐ 9☐ 10☐ OB Emergencies: 0☐ 1☐ 2☐ 3☐ 4☐ 5☐ 6☐ 7☐ 8☐ 9☐ 10☐ Communication/Escalation: 0☐1☐ 2☐ 3☐ 4☐ 5☐ 6☐ 7☐ 8☐ 9☐ 10☐ 45 What Is Going Well Barriers / Support Needed ☐ Low patient volume: _____________________________________________________________________________ ☐ Limited high-risk exposure: ______________________________________________________________________ ☐ Scheduling/staffing limitations: ________________________________________________________ ☐ Knowledge gaps: ________________________________________________________________________ ☐ Skill gaps: ______________________________________________________________________________ ______ ☐ Confidence concerns: ________________________________________________________________________ ☐ Other: ______________________________________________________________________________ _________________ Action Plan (SMART Goals= Specific, Measurable, Achievable, Relevant, Time-Bound) Progress on Last Month’s Goals: ☐ Met ☐ Partially Met ☐ Not Met Progress Notes: Goal 1: ____________________________________________________________ Plan: 46 Target date: ______________ Validation (D/S/V/R) (D = Demonstration, S = Simulation, V = Validated, R = Return Demonstration): __________________________________________ Goal 1 Status: ☐ Not Started ☐ In Progress ☐ Validated Goal 2: ____________________________________________________________ Plan: Target date: ________________ Validation (D/S/V/R): ______________________________________________ Goal 2 Status: ☐ Not Started ☐ In Progress ☐ Validated Comments Mentor Comments: Nursing Professional Development Practitioner Comments: Manager Comments: Mentee Comments: Acknowledgements Mentee Acknowledged: ☐ Yes Date: ___________________ Mentor Acknowledged: ☐ Yes Date: ___________________ 47 NPDP Acknowledged: ☐ Yes Date: ___________________ Manager Acknowledged: ☐ Yes Date: ___________________ Next Check-In Date: ______________________________ 48 Appendix D Pre- and Post- Program Survey https://forms.office.com/r/4P6Hfwi7UW?origin=lprLink 49 Appendix E Structured Mentorship Timeline 1st Month Review and Revise Plan 2nd Month Mentor Training and Orientation 3rd-5th Month 6th Month Mentorship Implementation Survey Data Evaluation