Building Confidence: 10 Orientation Learning Goals for Novice Nurses

One of the most important steps in the development of a novice nurse is to establish their learning goals. By choosing their own goals on the first day of orientation, they drive their own development. Establishing a learning goal early helps to foster the confidence and independence that will fuel their professional journey.

I like to facilitate this discussion by prompting them to ask key questions of themselves as they practice and set their own learning goals. Here are 10 examples of learning goals your novice nurses can set for themselves:

1. “Be a safe nurse so I don’t hurt anyone.” They can work on this goal every day by asking themselves two questions: “Why am I giving a medication, doing this procedure, providing this intervention?" and “What will each medication/procedure/intervention do to the patient, and what possible complications could result?”
2. “Know how to clearly and concisely talk to the APN or physician so I am truly advocating for the patient.” They should start by asking, “What key message am I trying to convey?” I suggest that the best way to get started is practice what they plan to say with their preceptor.
3. “Improve my knowledge and confidence, so I stop feeling sick when coming to work.” Most novice nurses tell me it took six to 18 months for the overwhelming anxiety to go away and to start feeling comfortable in their role. It’s important for them to know this early. An important question to ask themselves is, “Am I looking after myself, acknowledging my emotions and practicing self-care?” Another crucial element for them to consider: “Do I feel supported by my co-workers during this transition time?” At this phase, they are at high risk for burnout and leaving the unit.
4. “Know when to call the provider (APN or the physician).” Most nurses agree that if you even have the thought, “Maybe I should call the physician…” then you should probably go ahead and call the physician. I encourage the nurses to think, “Did I validate my concerns with the preceptor or charge nurse?” And I encourage them when validating to tell their colleague why they want to call the physician, and not just ask them if they should call the physician. There is a big difference between, “I’m noticing a change in my patient’s lung sounds, but the oxygen saturation hasn’t changed; do you think I should call the doc?” and “An hour ago my patient’s lung sounds were clear and now I hear crackles half up posterior, the respiratory rate is up to 24/minute but the oxygen saturation hasn’t changed; should I call the physician?” Trust your instincts but also validate them.
5. “Give report without forgetting any important details.” Keeping organized takes practice. I encourage my learners to talk to other nurses they admire for the way they give report, and to ask for tips. I also encourage them to use any tools that may be available in the EHR. New nurses should ask their colleagues, “What’s a key tip for giving report?” Or ask, “What’s your process for ensuring you don’t miss crucial points when you give report?”
6. “Learn how to handle a patient who is crashing.” Take your own pulse first! That is a lighthearted but very real motto for caring for the patient who codes or is crashing. I remind nurses to ask themselves, “Am I in control and ready to perform?” If you’re not in control of your emotions, you won’t be able to help your patient. Encourage your nurses to talk to the preceptors and ask, “Will you help guide me through this critical situation rather than take over?”
7. “Understand how to prioritize my time so my patients are well cared for.” Proper prioritization comes with time and practice. Getting feedback from the preceptor for decisions about patient care can help develop prioritization skills. For example, instead of asking the preceptor what to do, the new nurse should ask the preceptor, “What feedback do you have for me?” And, “Here’s what I think should be done next; do you agree?”
8. “Learn to think critically about my patients’ conditions and needs." Critical thinking comes with experience, but there are exercises nurses can practice to help develop this skill. Prompt your nurses: if they don’t know something, look it up and read about it. Invite them to participate in interdisciplinary rounds. This helps them listen to and learn how to participate in the critical decision-making discussions about patient care. Encourage them to ask questions of themselves and their peers, such as “Why was that treatment provided?” or “What effect do we expect that medicine to have on this patient?” Asking “why” isn’t just for 3-year-olds; it’s an important question for new nurses to ask, too, to build their knowledge base and grow their practice. Also, challenge nurses to study for certification. Have them review the AACN Synergy Model Competencies for Clinical Judgment and Clinical Inquiry. All of these will help develop the critical thinking skills necessary to provide optimal patient care.
9. “Remember to document everything.” Ensure that new nurses develop good habits from the beginning. Have them chart throughout the day. Push new nurses to ask for suggestions and tips. What works for their peers and preceptors can work well for them too – they don’t need to reinvent the wheel.
10. “Know how to care for my patients with sepsis.” All new nurses should learn their hospital’s protocols. They should look to their preceptors to help guide them in caring for these types of patients. Most importantly, they should know how to identify and guard against sepsis so treatment can start early. They should ask, “Is my patient’s temperature higher or lower than normal?” “Are there signs and symptoms of infection?” “Is my patient sleepy and confused?” Provide them with information and resources on sepsis management, as noted on AACN’s Clinical Resources Sepsis webpage.

Apply Knowledge to Practice

These suggested goals – and ideas for accomplishing them – show learners how they can apply new knowledge to their practice and connect their goal to their work every day.

Reflect Daily on Goals and Growth

I also advise them to keep a regular journal or simply reflect on their goal-related actions on their way home. This activity creates memories of positive experiences and provides proof of how they are growing daily in their practice.

Accentuate the Positive

Another exercise to help them stay positive and build confidence is to encourage them to reflect on one or two things they did well – no matter how small – every day as they leave work. Even learning where to find a supply is a win.

Finally, on the last orientation class day, ask them to revisit their goals and share with the class if they attained it, or what progress they have made toward achieving the goal. You’ll observe their awareness that they are connecting daily to their goal and continuing to grow in their practice.

Share your favorite facilitator tips

No matter how long you have been an educator, I know you have outstanding ideas for facilitating orientation and engaging learners. I want to hear your favorite tips for providing progressive and critical care nurse orientation.