Four Planning Tips for Successful Novice Nurse Orientation

As educators, we’ve all struggled with planning orientation for acute, progressive and critical care nurses. In this post, I’ll share some of my tips for planning a successful novice nurse orientation — based on years of experience and plenty of trial and error.

Tip #1: Be like a Boy Scout

My husband volunteers with the Boy Scouts of America, which teaches their members to always “Be Prepared.” As educators, we may not wear their uniform, but that motto applies to us as well.

We must anticipate what is needed and have it purchased, available and scheduled in advance of the first day of orientation. Preparation is everything. Here are a few ideas to consider while you’re planning:

• Textbooks and E-Learning access
  • Consider what and how far in advance any purchases need to be made. For example, textbooks, supplies and online courses
  • Find out who will sign off on the purchase, and determine if you’ll need an invoice
• Classroom and simulation preparation
  • Have rooms been reserved?
  • Confirm that your supplemental instructors are prepared and scheduled
  • Ensure the teaching material is evidence-based, consistent and applicable to your facility
• Preceptors
  • Ensure the preceptors are oriented and prepared with the tools they need to guide and evaluate their learners’ progress

Lesson in Action

I was an experienced educator with numerous orientation classes tallied on my clipboard, when I discovered the day before my critical care residency class that I had forgotten to order 20 E-Learning seats. Thankfully, the E-Learning vendor devised a plan to deliver the seats the next day.

The moral of the story for veteran and new educators alike? Orientations inevitably go better when you use a checklist.

Remember: Prepare yourself and your new nurses for a great experience.

Tip #2: Assess your novice nurses’ needs

Nurses new to acute, progressive and critical care come with different experiences, knowledge, skills and attitudes. When large numbers of novice nurses need to be oriented, assessing their unique needs can be a challenge. Some questions I’ve used as part of the assessment include the following:

• Which units are they going to be working in?
• Which skills and competencies do they need immediately?
  • Think about what is necessary to ensure safe patient care. Someone recently asked me, “What do they need immediately so they don’t seriously harm someone?”
• Which skills and competencies aren’t as critical and could be taught later in the orientation?
• What tools are needed to conduct this assessment?
  • What tools are available with your E-Learning course?
  • What tools can you create?
  • What tools do you need to purchase?

Lesson in Action

In my hospital, nurses from all ICUs (cardiac surgery, neuro, trauma, general surgery, medical, long-term acute care), the emergency department, cardiac cath lab and post-anesthesia care unit attended the critical care residency. Each unit’s immediate competency needs were different.

But they all needed to be able to identify when a patient was failing and to prioritize the next steps in the care plan. This awareness helped us craft an orientation that met the diverse needs of each unit while avoiding a chaotic education plan.

We’ll address scheduling ideas in an upcoming blog post.

Tip #3: Connect with the manager or leader of each unit to collaborate and agree on the schedule, goals and outcome measures

I find collaborating with unit leaders and mutually agreeing on orientation plans is the most efficient way to orchestrate a successful experience. During planning, be sure to discuss the following:

• Who is scheduling the novice nurse?
  • To whom do you need to deliver the classroom and simulation schedule to ensure it appears on the master schedule for each nurse?
• How are patient assignments identified? Is current skill level and potential skill development with more complex patients considered?
  • This step might not be as easy since all patients seem to be complex. Consider that we all care for patients who are more stable, more resilient and need less intensive monitoring than those who require constant attention, leaving little time for us to take a break.
  • Patient assignments for a novice nurse need to consider their skill level, their learning needs and where are they on their progression to advanced beginner.
  • Also consider the knowledge, skills and attitudes of the preceptor. Are they flexible and able to guide the novice nurse through simple and complex patient encounters?
• How are preceptors identified? Who selects and matches preceptors to each novice nurse? How are preceptors oriented? How are preceptors evaluated?

Lesson in Action

Early in my career as an educator, I would get to the unit early to assess patient complexity and assign nurses based on the needs of the novice nurse and the E-Learning topic assigned. Other managers and I came to realize that this procedure created an issue with inconsistency in preceptors, and that a consistent preceptor is more important than the day-to-day patient assignment. Any capable preceptor can provide teaching and learning opportunities no matter the complexity of the patient.

Just remember that even the most experienced preceptors can’t do it alone. Collaboration throughout the process is key.

Tip #4: Determine how, when and by whom evaluation will be done

To do more of what works (and less of what doesn’t), first you have to find out what does work. I find that asking myself questions helps me identify what will work!

Start on your orientation evaluation process by answering the following questions.

• How often should evaluations be conducted?
  • Daily, weekly, biweekly or monthly?
• Who is conducting the evaluations?
  • Educator? Manager? Preceptor? All three?
• Should the evaluations be formal, informal or both?
  • Use open-ended questions such as: What are you doing well? What could you do better? What goals do you want to achieve this week?
• What outcome measures are you using to evaluate progress?
  • E-Learning completion? Competency skills checklist? Preceptor evaluation tools?
• How can you ensure that documentation is simple, not cumbersome?
  • For instance, implementing the Likert scale vs open-ended feedback, and considering what is valuable and actionable for the learner.

Lesson in Action

One of my favorite activities during orientation for nurses new to ICU and PCU is to round with them in the units. I love hearing what they are doing to take care of the patient, allowing them to share their successes and struggles.

I love asking them why their patient is receiving norepinephrine or dexmedetomidine, or what ventilator settings mean or any number of other concerns to focus on. Most importantly, rounding gives me a chance to understand how the novice nurse is applying the knowledge gained through the E-Learning and blended-learning activities. It also inspires case study ideas for the next in-person class, so the new nurses can benefit from their classmates’ experiences.

In addition to rounding on the units, at my former hospital we created an evaluation tool using the AACN Synergy Model for Patient Care. The eight nursing characteristics and levels of attainment provided a framework for evaluating progress toward competency. It also gave the preceptors and novice nurses a common tool to discuss difficult-to-define skills such as what it means to:

• Develop critical thinking
• Advocate for the patient
• Use skilled communication to talk to a provider about a patient’s declining condition

The tool and information about its development are in the book: “Synergy for Clinical Excellence. 2nd ed.”

Last, I consider other educators and resources such as AACN to be valuable. Here are some of my favorite resources for connecting with other educators and helping to plan orientations:

• Professional Development Community: Chat with educators who are orienting acute, progressive and critical care nurses using a blended format
• Fundamental Skills for Preceptors: 6.75-hour E-learning course to get your preceptors started with the tools for orienting novice nurses.
• Synergy for Clinical Excellence: The AACN Synergy Model for Patient Care: Chapter 22 “Application of the Synergy Model to Orientation

What are your favorite resources that help you plan your orientations?

Share with me and our community of exceptional nurses!!