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5 Essentials of Nursing Orientation

By Susan Cline, MSN, MBA, RN, NEA-BC, Consultant and Creative Health Care Management

Nursing orientation plays a pivotal role in the competency and retention of newly hired registered nurses. Effective orientation and precepting programs produce nurses who provide competent, quality patient care and are enculturated as productive members of the healthcare team. With the replacement cost of one registered nurse estimated to be as high as $64,000, retention of staff continues to be an important objective for nurse managers and directors. Additionally, collaborative relationships and teamwork have been identified as key indicators of nurse satisfaction.

Effective nursing orientation programs should include these five essential components:

  • Preparation
  • Incorporation
  • Goal-Directed Precepting
  • Direct and Timely Two-way Feedback
  • Ongoing Support 

1.       Preparation 

Successful nursing orientation requires the development of a curriculum and the training and preparation of preceptors. Specialty units should consider implementing a didactic portion of orientation that focuses on common diagnoses and procedures, along with high risk/low incidence competencies. It is important to understand that an expert clinical nurse may not make for an effective preceptor. Preceptors should be selected both for their clinical expertise and for their ability to teach and evaluate new staff members. A preceptor workshop with modules on adult learning and providing feedback can be very helpful in preparing preceptors to orient newly hired registered nurses. 

2.       Incorporation 

New staff members should be welcomed and incorporated into the team as early as possible. Introduce new staff members in morning huddles, staff meetings, and by e-mail communication. Provide a thorough tour of the environment, introducing team members by name and role. Encourage preceptors to take rest periods and lunch breaks with new staff members during the orientation period. Nurse managers should check in with new staff members on a daily basis, even if it is just a quick “Hello” and “Is there anything that you need?” Ensure that new staff nurses have access to all of the electronic systems as early as possible, including computer log-ins, parking garage and door access, and medication dispensing system access. Not having access to the department’s systems is frustrating and alienating, and it creates a barrier to learning. 

3.       Goal-Directed Precepting 

Nurse managers should establish weekly benchmarks to guide precepting activities. Benner’s From Novice to Expert model is an effective approach; new staff nurses start with basic competencies and move toward more complex procedures as the weeks go by. Evaluation forms with the suggested behaviors for each week are an efficient way to track progress and guide patient selection. Preceptors are encouraged to share the new staff member’s learning goals and objectives with the charge nurse and staff nurses on a daily basis so that they can identify patient care and procedural opportunities. Team ownership of onboarding new staff sends a powerful message about collaboration and teamwork. 

4.       Direct and Timely Two-way Feedback

Nurse managers should meet with new staff nurses and their preceptors weekly or bi-weekly. Both the preceptor and the new staff nurse should provide feedback on their progress. Ask new staff nurses to be open and honest about their confidence and comfort level.  It is frustrating for everyone to discover that the new staff nurse is behind in achieving orientation benchmarks. Feedback should be honest but encouraging, with concrete suggestions for improvement. Preceptors are encouraged to provide feedback as close as possible to patient care events or procedures. Timely and effective feedback will enhance the learning experience and increase the new nurse’s confidence. It is important to note that there will be new team nurses that will required an extended orientation but will continue on to success. Plan ahead for this as you evaluate completion of weekly benchmarks.

5.       Ongoing Support 

At the conclusion of the nursing orientation period, the nurse manager should make plans for the future support of the new staff nurse. The assignment of a mentor or “buddy” provides a resource and a sounding board for clinical questions and debriefing. Any routine documentation audits should be explained throughout orientation so that expectations are clear. The annual evaluation process, along with any forms or documents, should be reviewed. Involvement in shared governance councils and unit projects will support retention and longevity of new staff nurses. Participation in unit activities and continuous learning are key to engagement and prevention of burnout.

Incorporation of these elements as part of nursing orientation provides structure for the initial onboarding, precepting, evaluation, and ongoing support of new staff nurses.  These practices are a worthwhile investment in teamwork, nurse satisfaction, and high quality patient care.

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Susan’s experiences as a Magnet® Program Director and front line manager have re-ignited her passion for her profession. As a consultant at Creative Health Care Management, her greatest joy is mentoring individuals, teams, and hospitals to develop their gifts in pursuit of a culture of excellence. Susan’s professional interests include mission and vision development, project management, and transformational leadership through effective communication in addition to the development of structures and processes to support a Magnet® journey. Susan can be contacted at scline@chcm.com.

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