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The Staff Educator September 2009

Orientation

Designing individualized nursing orientation

Interviewing prospective nursing employees is only Diana Swihart, PhD, DMin, MSN, CS, APN, RN-BC,
the first step in the successful integration of newly hired ANCC Magnet Recognition Program® Director at Bay
nurses. After hiring, it is up to educators, nurse manag- Pines (FL) VA Healthcare System. “It’s then up to us to
ers, and preceptors to design individualized orientation focus on the service-specific orientation and get them re-
programs that facilitate the transition from new nurse to energized and excited about their service orientation.”
confident practitioner.
Most orientation programs begin with need-to-know Focusing on individual needs
tasks, such as the review of general policies and pro- “It’s important to individualize orientation based on
cedures, attending mandatory classes (e.g., safety and the background, education, and experiences of each
infection control), and completing paperwork. After cov- nurse,” says Swihart. “Some are experienced nurses,
ering these basics, the specific departmental orientation some have recently graduated, some are making transi-
usually begins. tions from a geriatric or mental health setting to acute
“By the time new employees come to us, some care. Generally, you can’t do a scripted orientation.”
have begun to lose interest in the process,” according to Swihart recommends assessing all orientees during
the first meeting. “I will spend maybe the entire first
Save the date! morning [of departmental orientation] digging in, asking
The Nursing Leadership Summit where they’ve worked or gone to school, what kinds of
The Premier Nursing Training Event experiences they have, and what they think they need as
Hyatt Harborside | Boston, MA | September 20–23, 2009 part of orientation to be successful,” she says.
During orientation, some nurses move quickly into
Don’t get lost in a crowd of thousands—join HCPro in
the clinical setting, whereas others need more time in
Boston at the Hyatt Harborside Hotel for the industry’s
the classroom before moving ahead with a preceptor.
most intimate, hands-on nursing programs.
Pushing people into the clinical setting too rapidly with-
September 20—Shared Governance Symposium: out assessing what they need sets them up to fail. It is
­Listen while Tim Porter-O’Grady, DM, EdD, APRN, important to provide individualized orientation rather
FAAN, and Kim Hitchings, MSN, RN, NEA-BC, share
than a cookie cutter approach where all nurses progress
practical strategies on building a shared governance
through the same orientation at the same speed, regard-
culture.
less of educational preparation and experience.
September 21–22—Excellence in Leadership: Hear
from renowned industry experts on topics such as reten- Competency-based progress
tion, communication, and quality improvement. Competency-based orientation is the basis for success-
September 23—Nursing Peer Review: Experts share ful clinical orientation, Swihart says. Orientation com-
how to design a nursing peer review committee charter petencies ground new employees and are part of the
and establish a formal, unbiased process for evaluation of ongoing, unit-specific competencies. Orientees work
nursing care. with their preceptors to demonstrate ability in necessary
skills, some of which vary from unit to unit.
To register or for more information, call 800/801-6661
Experienced nurses may be able to demonstrate com-
or visit www.greeley.com/seminars.
petency quickly, whereas newly licensed nurses may

© 2009 HCPro, Inc. For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at www.copyright.com or 978/750-8400.
September 2009 The Staff Educator Page 7
need more time. This is where the flexibility and indi-
viduality of orientation comes in: Well-prepared, expe-
rienced preceptors are key to identifying competencies
and helping to facilitate individualized orientation based
on the unique needs of each new employee.
Swihart advocates that all nurses meet with their
managers periodically to discuss how they’re doing,
identify professional goals and objectives, and determine
a course of action for their individualized profession-
al development. These meetings should be separate and
distinct from performance evaluations. Nurses and man-
agers can have productive, respectful discussions without
the stress of a performance evaluation setting. Ultimate-
ly, ownership of professional growth and development is
the responsibility of the individual employees.
“We are fortunate in that we have many resources,
including links to colleges and universities, that nurses
can access,” says Swihart. “For example, suppose critical
care nurses feel they need more education in the criti-
cal care arena. They might attend a critical care course at
a university, attain the education they have identified as
important, and apply for tuition reimbursement.”
Protecting preceptors
When asked what is the most important issue for suc-
cessful orientation, Swihart immediately states: “Protect
the preceptor!” Too often, preceptors are still asked to
take a full patient load while precepting a new employee
and may be floated to another area or assigned to differ-
ent shifts than their preceptees. Managers and educators
must look at the long-term outcomes rather than short-
term inconveniences. Preceptors must be allowed the
time and proximity to successfully guide their orientees
into clinical practice. If not, they risk losing the precep-
tors or having to address the problems that arise when
orientees are not adequately integrated into their new
work setting.
To have a truly successful orientation, managers, pre-
ceptors, and all nursing staff members must make a com-
mitment to participate in an individualized, flexible,
competency-based orientation program.
© 2009 HCPro, Inc. For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at www.copyright.com or 978/750-8400.
Some organizations may not realize the time and ef-
fort necessary to help newly licensed nurses achieve suc-
cessful transition into practice, Swihart says. Some new
graduate nurses come from universities or colleges that
do not provide enough clinical experience to build con-
fidence. “We must remember that most of these new
graduate nurses are really basically advanced beginners.
They are not, nor should they be expected to be, profi-
cient nurses,” says Swihart.
She recommends partnering with academic institu-
tions, such as by having an educator become a part-time
faculty member at a local college of nursing, to help pre-
pare new nurses. Such employees recognize what is
needed in the clinical setting for point-of-care nursing
and engaging hospital staff members and have the abil-
ity to navigate and influence the academic environments
from which some of our new nurses come.
It’s also vital to have a strong nursing education de-
partment with clinical experts who work with managers,
preceptors, staff members and new employees to help
new nurses build confidence.
A well-designed orientation is a small investment with
potentially unlimited returns. As we provide the big pic-
ture and clinical goals, introductions, and support dur-
ing new employees’ transition into service, we can build
professional relationships to benefit the organization and
our communities of practice for years to come. n
Editor’s note: Nursing orientation is of special interest to
Swihart, who has designed numerous programs. On October 27,
she will be speaking on the HCPro Webcast “Nursing Orienta-
tion: Best Practices for Effective New Hires.”
Upcoming events
October 27—Designing Nursing Orientation: Evidence-
based Tools for Effective Programs (SKU102709)
For more information, call HCPro’s customer service
representatives at 800/650-6787 or visit www.
hcmarketplace.com.
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