mentoring and job satisfaction: perceptions of certified nurse-midwives

EDUCATION EXCHANGE—Lauren Hunter, CNM, MS

MENTORING AND JOB SATISFACTIONPerceptions of Certified Nurse-Midwives

Christina Wiegert Cuesta, CNM, MN and Kathaleen C. Bloom, CNM, PhD

ABSTRACT

The purpose of this study was to investigate the relationshipbetween mentoring and job satisfaction among recently certi-fied nurse-midwives. The Demographic Data Questionnaire,Job Satisfaction Survey, and Quality of Mentoring Tool weremailed to all first-year eligible members (N 5 466) of theAmerican College of Nurse-Midwives (ACNM). A total of 317surveys (68%) were included in the analysis. Sixty-five percent(n 5 208) have had a mentor. Twenty-six (8%) had participatedin the ACNM Mentoring Program and 33 (10%) had partici-pated in a student mentoring program other than the ACNMMentoring Program. The most frequently identified qualities ofthe mentoring relationship were model, supporter, envisioner,and investor. Eighty-one percent (n 5 249) reported that theywere satisfied with their current job. There was no significantrelationship between stated job satisfaction and participation ina mentoring relationship. A significant, but low, correlationwas found between stated job satisfaction and the quality of thementoring relationship (r 5 .16, P 5 .03) and between scoreson the Job Satisfaction Survey and Quality of Mentoring Tool(r 5 .14, P 5 .04). q 1998 by the American College ofNurse-Midwives.

Mentoring is a dynamic, noncompetitive, nurturing rela-tionship in which an older, more experienced personteaches, guides, advises, sponsors, role models, andbefriends a younger, less experienced person (1–4). Theage difference between mentor and protege may notapply in highly technological fields where a youngerperson may have more knowledge and experience thanan older person or when the protege has changedcareers (5,6). Mentoring is important for the personaland professional development of clinicians, such ascertified nurse-midwives, nurse practitioners, and clinicalnurse specialists (7,8) and may play a role in the transi-tion to the professional role and in subsequent jobsatisfaction.

The most common type of mentoring is the step-ahead mentor. The step-ahead mentor, usually a person

with more experience than the protege, can give guid-ance to the protege who is starting out on the same path(9). The overall goal of mentoring is to promote theprotege’s personal and professional development (1–4,10). A mentor can clarify and nurture the role andstrengthen the skills of the beginning clinician (8), de-crease role conflict, confusion, frustration, and anxiety(7), and teach the protege the informal rules of theorganization (11). Mentoring also serves to socializemembers to the values and standards of the profession,maintain the standards of the profession, and ensure thequality and continuity of the profession’s leaders(1,7,12). The benefits of a mentoring relationship arenot limited to the initiation of one’s career, but they canalso rejuvenate careers that have become stagnant aswell as assist with the retention of competent profession-als (5,11,13).

There are also potential advantages for mentors whomay feel delight and pride with the professional advance-ment of their proteges (1). Mentors also go throughperiods of self-discovery during the relationship as theyrealize the amount of knowledge and expertise theypossess as they share it with their protege (12). As theprotege develops into an independent professional, thementor’s career could be enhanced through the contin-ued collaboration and professional networking with theprotege (1,11).

Characteristically, both parties in a mentoring rela-tionship are active participants, such that the mentor ismore than a passive role model or a preceptor. Mentorsassist the neophyte to learn about the reality of theworkplace, political scene, and professional socializa-tion, thereby facilitating career advancement (6,14). Therelationship has the potential to increase self-confidence,self-awareness, and self-actualization, and it may bemanifested in greater job satisfaction and careerprogress, greater productivity, greater personal and pro-fessional success, a clearly articulated career plan, andempowerment. Mentoring relationships are thought tobe particularly important during the transitional period ofstudent to professional, assisting with role transition andteaching the realities of the workplace. Difficulties in

Address correspondence to Kathaleen C. Bloom, CNM, PhD, AssistantProfessor, University of Florida College of Nursing, 653-1 West 8thStreet, Jacksonville, FL 32209.

Journal of Nurse-Midwifery • Vol. 43, No. 2, March/April 1998 111

q 1998 by the American College of Nurse-Midwives 0091-2182/98/$19.00 • PII S0091-2182(97)00156-0Issued by Elsevier Science Inc.

making this transition can lead to dissatisfaction anddecreased performance (1,15,16).

Nursing leaders, nurse executives, and teachers haveidentified mentoring roles and behaviors that are similar.Mentors act as confidants, teachers, sponsors, intellec-tual guides, confidence builders, encouragers, inspirers,visionaries, role models, coaches, door openers, andgate keepers (1,13,15,17). Frequently, the mentor col-laborates, strategizes, and supervises as well as providescareer advice, intellectual stimulation, financial support,and emotional support (13,18).

In the classic study by Roche (19), 75% of the top1,250 executives in the United States stated that theyhad been mentored. Those who had been involved in amentoring relationship earned on average 28% moremoney, were more likely to have advanced degrees,were happier with their career progress and their work,had a clearly articulated career plan, and were morelikely to mentor others. Mentoring also has been shownto have a positive effect on personal development,increasing self-confidence (17,20–22), self-awareness,and self-actualization (17,22), and empowerment (23).

Currently, there are two well-known formal mentoringprograms for midwifery* students: the American Collegeof Nurse-Midwives Mentoring Program sponsored by theACNM and Mi Amiga, the mentoring program used bythe Community-Based Nurse-Midwifery Education Pro-gram (CNEP). To date, there has been no formal evalu-ation of either program. The ACNM began the ACNMMentoring Program in March 1993 as a direct result ofthe student report submitted at the 1990 national con-vention. The goal of the ACNM Mentoring Program is tonurture the certified nurse-midwives (CNMs) and certifiedmidwives (CMs)* of the future by supporting them intheir personal and professional growth. In 1994, 80% ofthe student nurse-midwives enrolled in the University ofCalifornia, San Diego’s nurse-midwifery program partic-ipated in the ACNM mentoring program and viewed itfavorably; most participants reported telephone relation-ships with their mentors. However, minimal evaluationfeedback was received by the ACNM from any nurse-midwifery program; furthermore, many students at theACNM’s 1995 national convention were unaware of theprogram’s existence and continued to request the for-mation of a mentoring program (E. Fairchild; personalcommunication, May 1996).

Nurse-midwifery students enrolled in CNEP have theopportunity to participate in the Mi Amiga MentoringProgram, a system of peer support, but not a truementoring relationship as previously defined. The pro-gram is completely student run and matches studentswith other CNEP students and not with practicing nurse-midwives. The purpose of the program is to providestudents with a supportive network in which to give andreceive advice as well as share joy and frustrations, andto decrease the social isolation associated with distancelearning. The incidence of participation in this programis not known (S. Cook; personal communication, July1996).

JOB SATISFACTION

Interest in job satisfaction began in the 20th century as aresult of the industrial revolution (24). Job satisfaction isthe degree to which one’s work meets personal needs,desires, wishes, and goals (25). Characteristics of the jobhave been found to be good indicators of job satisfaction,especially the importance of low levels of role ambiguity(26,27). Job complexity positively affects job satisfac-tion, whereas job stress has a negative affect (28). Thecharacteristics of the organization also have been foundto be important. These characteristics include feedback,communication, affiliation, and autonomy (27–29).

The impact of mentoring on job satisfaction hasreceived substantial attention in the literature. Staffnurses, female attorneys, and teachers who had beenmentored are more satisfied with their work than thosewho had not been mentored (20,21,30). Caine (25)investigated the relationship between job satisfaction andmentoring in a sample of 519 clinical nurse specialists.Almost 68% of the participants reported involvement ina mentoring relationship, and those who participated ina mentoring relationship had greater job satisfaction.There have been no reports in the literature regardingmentoring among CNMs. The purpose of this study,therefore, was to investigate mentoring and job satisfac-tion among recently certified nurse-midwives. Specificresearch questions were 1) What is the incidence ofmentoring relationships?; 2) What is the quality of thementoring relationship?; 3) What is the level of jobsatisfaction?; and 4) What is relationship between men-toring and job satisfaction?

Christina W. Cuesta is a graduate of the nurse-midwiferyprogram at the University of Florida, where she received her MSN.She completed her BS at SUNY-Binghamton in 1989.

Kathaleen C. Bloom is assistant professor at the University ofFlorida College of Nursing.

* CNMs/CMs and midwives as used herein refer to those midwiferypractitioners who are certified by the American College of Nurse-Midwives (ACNM) or the ACNM Certification Council, Inc.; midwiferyrefers to the profession as practiced in accordance with the standardspromulgated by the ACNM.

112 Journal of Nurse-Midwifery • Vol. 43, No. 2, March/April 1998

Methodology

In this direct replication of Caine’s (25) survey of clinicalnurse specialists, a comparative survey design was usedto explore the relationship between mentoring and jobsatisfaction among recently certified nurse-midwives.The research proposal was approved by the InstitutionalReview Board at the university and was reviewed by theResearch Committee of the ACNM, who approved theuse of the ACNM membership list for the survey.

The survey was mailed to all first-year eligible mem-bers of ACNM (N 5 466) with a postage-paid returnenvelope. Ten days after the initial mailing, a reminderpostcard was mailed to all 466 members. After a second10-day period, all nonrespondents were mailed an addi-tional questionnaire. A returned survey was interpretedas consent to participate. Data collection lasted for aperiod of 6 weeks.

Measures

Incidence of mentoring was measured by asking if theparticipant had 1) participated as a student in the ACNMMentoring Program; 2) participated as a student in amentoring program other than the ACNM MentoringProgram; 3) been mentored as a student, but not as partof a formal mentoring program; 4) been mentored as anew nurse-midwife; and/or 5) not had a nurse-midwifementor. The incidence of mentoring was determined byan answer of ‘‘yes’’ to any of the 5 questions. Theincidence of job satisfaction was measured by asking theparticipant ‘‘Are you satisfied with your current job?’’

The Quality of Mentoring Tool (QMT) consists of 14items scored on a five-point Likert scale. Participantsrank the mentor on 14 specific qualities: model,envisioner, energizer, investor, supporter, standardprodder, teacher-coach, feedback-giver, eye-opener,door-opener, idea bouncer, problem-solver, careercounselor, and challenger (25,31). The total score onthe QMT is obtained by calculating the sum of thevalues for each quality. The possible range of scores is14 to 70, the higher the score, the greater the qualityof mentoring. The QMT was developed by Caine (25)as part of her research, and the author reportsestablishment of validity and reliability in her sampleof clinical nurse specialists. Validity was established byliterature review as well as review of the tool by anexpert panel for appropriateness, clarity, and suc-cinctness with a Content Validity Index of .94. Test-retest reliability (.93) and internal consistency (Cron-bach’s alpha 5 .91; Spearman-Brown split-halfreliability coefficient 5 .88) also were established.Cronbach’s alpha in the current research was .95.

The Job Satisfaction Survey (JSS) consists of 20 itemsscored on a five-point Likert scale. Participants indicate

the degree of agreement with statements that describetheir job and employing institution (25). The final ques-tion on the JSS requires participants to indicate on ahorizontal line (visual analogue scale with descriptiveendpoints) the degree to which they are satisfied withtheir jobs. The total score on the JSS is obtained bycalculating the sum of the values for each of the first 20statements. The possible range of scores is 20 to 100,the higher the score, the greater the job satisfaction. TheJSS was developed by Caine (25) as part of her research,and the author reports establishment of validity in thesame manner described for the QMT, with a ContentValidity Index of .93. Internal consistency also wasdetermined (Cronbach’s alpha 5 .88; Spearman-Brownsplit-half reliability coefficient 5 .83). Cronbach’s alphain the current research was .91.

RESULTS

Three hundred fifty (75%) surveys were returned. Ofthese, 20 were returned after the return deadline andwere not included in the analysis. Three surveys werereturned to the researcher as undeliverable, six surveyswere not completed correctly, and four blank surveyswere returned. The sample size for analysis, therefore,was 317 (68%). The mean age of the participants was39.34 years (range 23–58, SD 5 6.72). The mean grossannual income for full-time CNMs was $52,740 (SD 513,963). Other characteristics of the sample are pre-sented in Table 1.

The incidence of mentoring in this population was65% (N 5 208). Of these, 26 had participated asstudents in the ACNM Mentoring Program, 33 hadparticipated as students in a mentoring program otherthan the ACNM Mentoring Program, and 91 indicatedthat they had a nurse-midwife mentor as students, butnot as part of a formal mentoring program. One hun-dred nine (35%) did not have a nurse-midwife mentoreither as a student or since graduation.

The mean score on the QMT was 51.75 (SD 511.82), with a range of 14–70, and a median of 53. Thequality of the nurse-midwife that received the highestrating was model. This was followed by supporter,envisioner, and investor. Other qualities received moremoderate ratings (Table 2).

A total of 249 (81%) reported they were satisfied withtheir current jobs, 57 (18%) were not satisfied, and 11(3%) did not respond. The mean score on the JSS was74.19 (SD 5 12.96). There was a range of 34–99, andthe median was 76. A significant correlation (r 5 .60,P , .001) was found between stated job satisfaction andthe score on the JSS.

Spearman correlation analysis revealed no relation-ship between stated job satisfaction and participation ina mentoring relationship (r 5 .02, P 5 .76). There were


low, but significant, correlations between the score onthe QMT, stated job satisfaction (r 5 .16, P 5 .03), andthe score on the JSS (r 5 .14, P 5 .04). Chi-square

analysis revealed no differences between mentored andnonmentored groups and stated job satisfaction (x2 50.097, P 5 .755). Wilcoxon rank sum analysis revealedno differences between mentored and nonmentoredgroups and the score of the JSS (SD 5 14,204.5, z 51.85, P 5 .07).

Among those mentored as students, there was nodifference in stated job satisfaction based on the type ofstudent mentoring (x2 5 12.71, P 5 .35) or the score onthe JSS (SD 5 3261.5, z 5 0.47, P 5 .64). Wilcoxonrank sum analysis revealed a significant difference be-tween those participating in the ACNM Mentoring Pro-gram and others mentored as students on the score ofthe QMT (SD 5 13337, z 5 2.81, P 5 .005). Partici-pants in the ACNM Mentoring Program generallyranked their mentors lower on the QMT.

There was no relationship between age, educationalpreparation, or characteristics of the primary employerand either the quality of the mentoring relationship orjob satisfaction. There was a small but significant rela-tionship between work status and the score on the QMT(r 5 .16, P 5 .025), stated job satisfaction (r 5 .20, P 5.0005), and the score on the JSS (r 5 .21, P 5 .0002).Those working full time as a CNM tended to be moresatisfied and have more positive mentoring. There wasalso a relationship between income and stated job satis-faction (r 5 .12, P 5 .04) and score on the JSS (r 5 .25,P 5 .0001). Those with higher incomes tended to bemore satisfied. Finally, there was a relationship betweenthe nurse-midwife’s primary responsibility and bothstated job satisfaction (r 5 .17, P 5 .003) and score onthe JSS (r 5 .27, P 5 .003). Those whose primaryresponsibilities are as clinical nurse-midwives tended tobe more satisfied.

DISCUSSION

Participants in this study were all members of theACNM. The sample, therefore, may not represent newlycertified midwives who are not ACNM members. In aneffort to control for years of experience in midwifery, thesample only represents first-year eligible members.

The incidence of mentoring relationships amongthe newly certified nurse-midwives in this sample wasmoderate: a little less than two thirds of the respon-dents experienced mentoring by a CNM. However,this means that more than one third of newly certifiednurse-midwives lack a nurse-midwife mentor. This islower than other reports, indicating a 75% incidenceof mentoring among top executives (20), a 71–86%incidence among nursing leaders and executives(1,13,17), an 84% incidence among nurses (20), andan 83% incidence among clinical nurse specialists(25). This is a disturbing finding and warrants furtherinvestigation.

TABLE 1Sample Characteristics

Characteristic N %

Marital statusMarried 254 70Single 49 15Divorced 35 11Widowed 3 1Other 4 1.2

Midwifery preparationMaster’s degree 229 72Certificate 75 24Both 13 4

Primary responsibilityClinical nurse-midwifery with births 267 84Clinical nurse-midwifery withoutbirths 21 21More than one primaryresponsibility 19 6Other 15 5No response 9 3

Employment sitePrivate physician office 107 35Hospital 84 26Government or military 27 9Private nurse-midwifery practice 26 8Health department 23 7Educational institution 12 4Freestanding birth center 12 4Health maintenance organization 8 3Hospital-based birth center 1 ,1Employed outside of nurse-midwifery 7 2Other 11 3

TABLE 2Qualities of the Nurse-Midwife Mentor

Quality MeanStandardDeviation

Model 4.29 0.86Supporter 4.27 1.02Envisioner 4.07 1.07Investor 4.04 1.07Feedback giver 3.91 1.09Idea bouncer 3.91 1.12Energizer 3.84 1.06Teacher-coach 3.78 1.09Standard prodder 3.76 1.09Problem solver 3.72 1.13Challenger 3.43 1.10Eye opener 3.10 1.18Door opener 3.03 1.28Career counselor 2.88 1.25


There is, overall, poor participation in the ACNMMentoring Program. The reason for this is unclear.Students and practicing midwives may be unaware of thepresence or purpose of the mentoring program. Thelack of participation also may be a function of the busyand hectic lives of students in midwifery educationprograms and midwives in clinical practice. Studentsmay perceive their faculty members and preceptors asfulfilling the function of a mentor and therefore not valueparticipation in a formal mentoring program during theireducational years. Because the first year of practice is socrucial for the development of the professional role ofthe nurse-midwife, the ACNM might consider a mentor-ing program for first-year eligible members.

The quality of the mentoring relationship generallywas moderate to high, with a median of 53 of a possible70. Newly certified nurse-midwives indicated they werefrequently impressed by, had respect for, and admiredtheir mentor (model) and appreciated the mentor’s will-ingness to listen, help, and provide encouragement(supporter). Interest in the profession and practice ofnurse-midwifery was sparked by the nurse-midwife men-tor (envisioner), and the mentors were appreciated fortheir contribution of time and effort in the relationship(investor). The identification of these qualities is similar tothose identified by nursing leaders (1,13), nurse execu-tives (17), and clinical nurse specialists (25), as well asteachers (18) and student teachers (15). Mentored nurse-midwives who worked full time tended to have had amore positive mentoring relationship. This makes sensebecause there is probably greater availability and accessto the mentor when one is working full time. There is aneed to formally evaluate the content, process, andquality of the current mentoring programs of nurse-midwives, with emphasis on well-defined outcomes.

The implications for the neophyte as well as theseasoned midwife are many. Neophytes should capital-ize on the benefits of mentoring relationships by askingfor assistance and seeking opportunities to learn frommore experienced professionals (31). They should fur-ther position themselves as someone worth the invest-ment of time and effort on the part of the mentor.Experienced practitioners, administrators, and educatorsshould influence, guide, and teach those less-experi-enced professionals with whom they have contact(1,32). The ACNM includes collaboration as one of thehallmarks of midwifery in the core competencies (33)and identifies participation in midwifery education as oneof the professional responsibilities of the CNM/CM.Mentoring is one way of fulfilling these commitments.The finding that participants in the ACNM MentoringProgram rated their mentors lower on the QMT is anarea of concern. The ACNM Program Committee mightconsider including mentoring workshops or educationalsessions at conventions to facilitate increasing both

overall participation in mentoring and increasing thequality of the mentoring relationship.

The incidence of job satisfaction among newly certi-fied nurse-midwives was high: 81% of the respondentswho answered this question were satisfied with their jobs.This is consistent with the Caine (25), who found 83% ofthe clinical nurse specialists were satisfied with their jobs.The level of job satisfaction was moderately high: themedian was 76 of a possible 100 on the JSS. Consistentwith previous research findings (25), nurse-midwiveswho were working full time, those working primarily asclinical nurse-midwives, and those with higher salariestended to be more satisfied with their jobs.

The low level of the relationship between mentoringand job satisfaction found in this study is contrary tofindings of a relationship between mentoring and jobsatisfaction among female attorneys (34), teachers (21),health care workers (30), staff nurses (20), and clinicalnurse specialists (25). This may be a function of theminimal variation in job satisfaction reported by therespondents. The lack of a relationship also may beexplained by the quality of the mentoring relationship. Ifthe quality of the mentoring relationship is not high, itmay fail to influence job satisfaction.

Despite the overwhelming evidence in the literature ofthe positive results of a mentoring relationship, a causeand effect relationship between mentoring and out-comes has never been clearly established. Hagerty (35)states that increases in self-actualization, self-confidence,and self-awareness may be the result of someone ex-pressing interest in the protege and not the result of therelationship itself. Hagerty also wondered about thepossibility of a halo effect: are ambitious people morelikely to seek the guidance of a mentor?

Although many potential advantages for the mentorhave been cited (1,11,12,36), little attention has beenpaid in the research literature to the effect of thementoring relationship on the mentor (6,10). Past re-search, including the current study, focused solely on thementoring relationship from the perspective of the pro-tege. It would be interesting to construct a study com-paring the perceptions of paired mentor and protegecouples about the advantages, disadvantages, perceivedbarriers, and outcomes of the mentoring relationship.This might better identify reasons for the lack of men-toring received by 35% of the newly certified nurse-midwives in the current study.

Three areas were not addressed in this study but mighthave provided more clarification of mentoring relation-ships. The study only addressed nurse-midwife mentors.It would be beneficial to know if the respondent had amentor who was not a CNM. It would also be helpful toknow the role that the mentor had in the protege’s life,eg, a colleague in the workplace, a faculty member, or aclinical preceptor. Finally, a knowledge of the mentored


respondent’s satisfaction with the mentoring relation-ship and the nonmentored respondent’s desire for amentoring relationship would be helpful.

CONCLUSIONS

Mentoring is an important relationship in the growth,development, and maturation of nurse-midwives. It is adynamic, noncompetitive, and nurturing relationship inwhich an experienced nurse-midwife provides guidance,role modeling, and friendship to a less experiencednurse-midwife. The protege has the potential to experi-ence increased self-confidence and self-actualization asthe result of the relationship. Although few significantrelationships were found in the current study, it doesappear that newly certified nurse-midwives, in general,tend to be mentored less than other professionals ineither nursing or other professions. This is an area thatdeserves attention by members of the profession so thatthe knowledge and skills of new graduates are maximizedand their potential contributions to the profession andpractice of midwifery are facilitated.

A very special thank you to Barbara Dembeck, CNM for all her time andpatience as she coded and entered all the data gathered for this study.The authors also acknowledge and thank the nurse-midwives who tooktime out of their busy schedules to complete and return the survey.

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mentoring and job satisfaction: perceptions of certified nurse-midwives

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