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Review this presentation for a introduction to the Padlet

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New graduate nursing orientation is the introduction to a person’s new profession and start in the world of nursing; therefore, it has the potential to shape a nurses’ views and clinical practice.

The goals of nursing orientation programs have been to successfully transition nurses into their new roles and retain professionals in the nursing field.  Nursing orientation can be a time of culture shock, and if nurses experience a negative orientation experience, they many leave the field completely (Powers, Herron, & Pagel, 2019).

Since the late 1990s into the early 2000s, research has provided evidence that structured orientation programs with individualized attention provided by mentoring relationships with preceptors have increased retention of professional nurses and facilitated in increasing patient safety (Cooney, 1992; Klein, 2009; Riegel, 2013).

Nurse preceptor programs are continually evolving to reach new nurses, ensure nurses are supported in gaining skills, and work closely with qualified preceptors who offer direction and support needed to facilitate transitioning successfully into their new roles.  New graduate nursing orientation programs have transitioned from long “death by PowerPoint” presentations to hands-on interactive residency programs that fulfill the gap between nursing school and novice nurse.

References

Baldwin, K. M. , Black, D. L. , Normand, L. K. , Bonds, P. & Townley, M. (2016). Integrating Retired Registered Nurses Into a New Graduate Orientation Program. Clinical Nurse Specialist, 30(5), 277–283. doi: 10.1097/NUR.0000000000000235.

Ballard, J. , Mead, C. , Richardson, D. & Lotz, A. (2012). Impact of Disease-Specific Orientation on New Graduate Nurse Satisfaction and Knowledge Retention. Journal of Neuroscience Nursing, 44(3), 168–174. doi: 10.1097/JNN.0b013e3182527465.

Cooney, A.T. (1992). An orientation program for new graduate nurses: The basis of staff development and retention. The Journal of Continuing Education in Nursing, 23(5), 216-219. Retrieved from https://ju.idm.oclc.org/login?url=https://search-proquest-com.ju.idm.oclc.org/docview/915651966?accountid=28468

Klein, G. S. (2009). Beyond orientation. Nursing Management (Springhouse), 40(1), 10–13. doi: 10.1097/01.NUMA.0000343975.14096.75.

Powers, K., Herron, E. K., & Pagel, J. (2019). Nurse preceptor role in new graduate nursesʼ transition to practice. Dimensions of Critical Care Nursing, 38(3), 131–136. doi: 10.1097/dcc.0000000000000354

Riegel, E. M. (2013). Orienting a new generation of nurses: Expectations of the millennial new graduate. Open Journal of Nursing, 03(07), 461–466. doi: 10.4236/ojn.2013.37062

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Graduating from nursing school and passing your NCLEX boards is a great accomplishment and one to be very proud of, congratulations! Now you face the next step - applying and interviewing for a nursing job. This can be both exciting and stressful at the same time.

Choosing a job that has a good orientation program, however, can help lessen this stress for you. There are a few different types of orientation programs that a health care facility may offer. Understanding the different types can assist you when interviewing. Many of the terms used to describe orientation programs will vary depending on the health care facility. For instance, the health care facility may use the term preceptor program, mentor program, residency program, or nursing orientation. Most times the health care facility will include many of the same components necessary to orient you to your new role in the health care facility. It will be important for you, however, to find out what does the specific term mean to the institution you are applying to. Below, you will find the common meaning behind these terms in a typical acute care hospital setting.

Nursing Orientation
Most hospital-based nursing orientation programs will include a general orientation in the classroom followed by an orientation on the unit you were hired to work on. The classroom will include education from each department in the hospital, as well as education on the use of the electronic medical record (EMR). The classroom orientation can vary from a few days to a few weeks depending on the health care facility. Once the majority of classroom orientation is complete, you will orient with an assigned preceptor or mentor on the unit you were hired to work on. A or is a registered nurse, preferably with a BSN degree, who has been working at the institution for at least two years. The unit orientation can vary in length of time depending on the health care institution. You generally will be on orientation following your preceptor/mentor's schedule for about three to six months. If you were hired to work in a critical care area, your orientation will most likely be longer and even up to one year depending on the facility.

Many facilities are finding it challenging to recruit experienced competent nurses to work in critical care and specialty areas, such as the Emergency Department (ED) and Operating Room (OR). To meet this challenge, many hospitals started residency programs for new nursing graduates. The residency program generally requires the newly hired nurse to attend the general nursing orientation, as well education classes on specific skills you will need to work in your area. For example, if you are hired to work in the ED or the OR, you will need education and skill competency on ECGs and Advanced Cardiac Life Support (ACLS), as well as education on other skills needed for working in that specific area. Once the classroom training is completed and skill competency is verified you will orient in that area for a year, possibly longer depending on the facility and your learning needs.

Many new nurses ask what if I do not feel ready to come off orientation? This is a good question; most health care facilities will extend your orientation a month to a few months depending on your learning needs.

Interview questions
No matter what term the facility uses to describe their nursing orientation program there are some general questions you may want to ask when interviewing for the job. The questions include:

What type of nursing orientation program do you offer?

What type of education classes will I be taking?

How long will I be in orientation?

What support is available to me during and after my orientation?

Will there be one or many preceptors/mentors assigned to me during my orientation?

Can you provide a sample of what the orientation schedule may look like?

It is important to remember that the health care facility wants to make your orientation a successful one. A successful orientation program helps ensure your competency caring for patients and improves both nurse recruitment and retention at the facility. You are now ready to begin the interview process, and always keep in mind why you were called to the wonderful world of nursing. Blessings :)
Maureen Kroning RN MSN EdD
Nyack College School of Nursing

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Nursing Orientation: What to know for your job search

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Graduating from nursing school and passing your NCLEX boards is a great accomplishment and one to be very proud of, congratulations! Now you face the next step - applying and interviewing for a nursing job. This can be both exciting and stressful at the same time.

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Healthcare simulation is a method of teaching that uses trained individuals to recreate components of a clinical experience in a realistic simulated scenario.  It is a bridge between classroom learning and real-life clinical experience. Healthcare simulation reflects the various practice locations that learners will encounter (hospital and community settings).

There have been multiple research studies that prove the benefits of healthcare simulation.  The NCSBN (National Council of State Boards of Nursing) did a study that provided substantial evidence that up to 50% of high-quality simulation (scenarios involving Standardized Patients) can be effectively substituted for traditional clinical experience in all pre-licensure core nursing courses (Hayden, Smiley, Alexander, Kardong-Edgren, & Jefferies, 2014).

Healthcare simulation allows learners to practice clinical skills (physical assessment, prioritization of care and critical thinking) & to refine their interpersonal and communication skills (interview and history taking, patient education) in a safe, non-threatening environment.

References

Hayden, J.K., Smiley, R.A., Alexander, M., Kardong-Edgren, S. & Jeffries, P.R. (2014).  The NCSBN national simulation study: A longitudinal, randomized controlled study replacing clinical hours with simulation in prelicensure nursing education. Journal of Nursing Regulation, 5(2) Suppl., S1- S64.

Jeffries, P. R. (2015). Reflections on Clinical Simulation: The Past, Present, and Future. Nursing Education Perspectives (National League for Nursing), 36(5), 278–279. https://doi-org.ju.idm.oclc.org/10.1097/00024776-201509000-00002

Lindell, D., Poindexter, K., & Hagler, D. (2016). Consider a career as a healthcare simulation educator. American Nurse Today, 11(5), 58–59. Retrieved from https://search-ebscohost-com.ju.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=115590210&site=ehost-live

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4-Bringing Nursing Orientation Back To Life

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4-Bringing Nursing Orientation Back To Life

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March 2017 Vol. 12 No. 3

Author: Stephanie A. Walton, MSN, RN, and Deb Sitter, MA, BSN, BSM, RN-BC

Our hospital systems' journey to obtain Magnet® recognition led to an excellent opportunity: the chance to revamp and improve our nursing orientation program as part of the effort to achieve excellence in nursing practice. Our system consists of three hospitals that historically held separate nursing orientations-we combined them into a single, standardized orientation program.

But we didn't just standardize our practices. We took the leap from using a passive learning lecturestyle approach to implementing active, innovative learning strategies-giving our nurses a better chance to succeed at patient care.

We were two nurse educators responsible for three hospitals. Together, we identified challenges to combining resources and standardizing the orientation program, then brainstormed ways to address these challenges.

To coordinate multiple schedules at three different locations, we created a master orientation schedule and designated one educator as the main contact for scheduling. We selected the main campus as the location for orientation since the simulation lab, guest speakers, and majority of newly hired nursing staff were based there.

As the project progressed, we addressed scheduling glitches and the need for more instructors. We also enhanced coordination between departments. For example, based on feedback from new hires, we combined a half-day class in patient handling taught by the physical therapy department with a half-day class in electronic health records taught by the informatics department into a 1-day session. This helped decrease costs associated with travel and time spent in orientation.

We discovered that hospitals in our system didn't always schedule time for nursing staff to attend orientation. We worked with human resources and nursing leadership to help make orientation for new hires standard practice across the health system.

Once we completed plans for combining all three hospitals' orientation programs, we reviewed the curriculum for the 2-day nursing orientation. We wanted to change the orientation format from lecture-death by PowerPoint-to a learner-centered approach.

We reviewed all three hospitals' orientation programs to determine what content was shared in common. Our goal was to develop one or more active-learning strategies for each topic category identified. Research shows that active learning strategies can increase retention of information and satisfaction with the learning experience and strengthen learner engagement. (See Topics and activities for first day of orientation

For example, in keeping the millennial generation's love of technology, we incorporated a tabletbased game into the review at the end of the first day's session. We made use of three tablets allocated for nursing education. An app guided a charadestyle game in which learners had to describe a topic covered during orientation without saying the actual name in their description. If the app displayed the words "bedside report," the nurse could say, "informing the next shift about the patient in the room." Nurses responded positively to this active approach to learning.

For the second day of orientation, we used simulation techniques to teach key patient safety topics. Simulation-based education engages the learner in hands-on activities, providing a safe but effective learning environment and creating fresh opportunities to improve communication and build knowledge and skills.

Course content was based on National Patient Safety Goals established by The Joint Commission to help healthcare organizations address issues related to patient safety. A manikin was used to simulate unsafe situations. (See Simulation activities to teach safety

Instructors present nurses with a patient care scenario using the manikin. Nurses must observe and identify what they find unsafe, as if participating in a scavenger hunt for clinical insights. In the discussion that follows, nurses gain insight into the relationship between their observations and safety goals.

The next activity reinforces expectations for customer service, defined in our health system's standards for critical moments of service. Each nurse selects a card inscribed with a critical moment of service standard. He or she then has to demonstrate delivering care according to that standard as part of a simulation experience using a high-fidelity manikin operated by the instructor.

The group then takes a break. During the break, instructors use the manikin to set up a patient fall scenario. When nurses return from break, they must simulate the appropriate response to the fall. The instructor then leads a discussion on proper fall investigation procedures and interventions to prevent future falls.

Next, nurses practice donning and doffing basic personal protective equipment, included in the curriculum as part of heightened awareness of highly contagious infections. The instructor asks the nurses to peer review a partner and correct any mistakes to reinforce proper procedures.

Other topics are I.V. therapy, during which nurses complete hands-on practice with an I.V. pump, and code blue procedures, including a basic review of the crash cart monitor and how to activate a code.

We implemented evaluation procedures to ensure that our new orientation program meets nurses' needs and effectively prepares them to deliver safer care. We send a survey to nurses soon after they attend. Feedback indicates that most find learnercentered orientation effective and engaging.

Nursing orientation at our health system is now more streamlined, more efficient, and, most important, relies more heavily on active learning. We continue to monitor for barriers to effective learning to ensure continued success of the orientation program and make sure the learning experience remains optimal. Ongoing innovation in orientation is needed to give nurses new to our organization the best chance to succeed in practice.

Stephanie A. Walton is education coordinator lead at Mercy Hospital and Trauma Center in Janesville, Wisconsin. Deb Sitter is medical/surgical and ICU supervisor at Mercy Walworth Hospital and Medical Center in Lake Geneva, Wisconsin.

Selected references

Aldridge MD. How can nurse educators perform patient simulation efficiently? Teaching and Learning in Nursing. 2016;11(1):8-14.

American Nurses Credentialing Center. Pathway benefits.

Billings DM, Halstead JA. Teaching in Nursing: A Guide for Faculty. 5th ed. St. Louis, MO: Saunders; 2015.

Jeffery AD, Jarvis RL. Staff Educator's Guide to Clinical Orientation: Onboarding Solutions for Nurses. Indianapolis: Sigma Theta Tau International; 2014.

Joint Commission, The. 2017 Hospital National Patient Safety Goals. The Joint Commission website. 2016.

Kennedy JM, Nichols AA, Halamek LP, et al. Nursing department orientation: Are we missing the mark? J Nurses Staff Dev. 2012;28(1):24-26.

Related Articles:

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Bringing nursing orientation back to life - American Nurse Today

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March 2017 Vol. 12 No. 3 Author: Stephanie A. Walton, MSN, RN, and Deb Sitter, MA, BSN, BSM, RN-BC Our hospital systems' journey to obtain Magnet® recognition led to an excellent opportunity: the chance to revamp and improve our nursing orientation program as part of the effort to achieve excellence in nursing practice.

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5-Current State of New Graduate Nurses and Preceptors

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5-Current State of New Graduate Nurses and Preceptors

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For the past 10 years, the United States has been experiencing a critical shortage of registered nurses and data suggest this trend will continue through 2025 (Bong, 2019).  The current state of nurse residency is what some would call segregated.  New graduate nurses spend several weeks in a lecture setting then several weeks in a simulation setting.  Never truly combining the two until they are with their preceptor in the clinical setting.  This imbalance has led to an increase in new graduate turnovers as well as new nurses walking away from the profession altogether.

This article suggest that moral distress plays a key role as the new graduate nurse transitions from the learning setting to the professional clinical setting.  The author further suggests several unit-based interventions to reduce levels of moral distress in order to assist and make the transition more smoothly for the new graduate and the preceptor.

It is imperative that new graduates start with a firm foundation.  Otherwise, without prompting they can crumble under the pressures of learning a new unit, learning new systems and becoming a well-rounded nurse.  Not only are turnover and moral distress harmful to patients, but they are also harmful to hospitals and the healthcare system at large; nurse turnover costs can range from $90,000 to $145,000 per nurse depending on the localized salaries and specialty (Bong, 2019).  This study boost about the importance of new graduate nurses requiring support to effectively develop competency and promote retention.

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6-Future State of EHR Integration into Simulation

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6-Future State of EHR Integration into Simulation

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Kellie Bryant of NYU Rory Meyers College of Nursing discusses how she uses a simulation EHR to integrate real-time documentation into simulation experiences for nursing students.

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Wolters Kluwer: Lippincott Nursing Education

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Lippincott DocuCare: Academic EHR for Clinical and Sim Lab at NYU

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7-Current State of Real-time Documentation

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7-Current State of Real-time Documentation

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This study looks at the current nursing practice of real-time bedside documentation.  The author points out several challenges including the logistics of computer placement, as well as the electronic health record (EHR) turning the nurse-patient communication into a task-based “automatic” interaction.  A common theme is improving the workflow of documentation, as it is noted that the nurse tends to “play tag” with the patient and computer, going back and forth, reducing efficiency and patient satisfaction.

One could argue from this study there is a need to incorporate real-time documentation into nursing education and simulation experiences.  Currently, nurses are taught how to use the EHR separately from how to conduct clinical assessments.  To improve efficiency as well as enhance nurse-patient communication, these two skills need to be developed simultaneously.

Gaudet, C. (2016). Electronic documentation and nurse-patient interaction. Ans, 39(1), 3-3.

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8-Current State of Electronic Charting During Simulation, and Implications for Further Research

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8-Current State of Electronic Charting During Simulation, and Implications for Further Research

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This study sought to find out how prevalent simulation-based learning experiences (SBLEs) are in the classroom, skills laboratory, and simulation laboratory at nursing schools.  Currently only 56.2% of nursing schools use SBLE to provide students the opportunities to practice electronic charting during their education.  The authors agree that it is necessary for students to have opportunities to become competent using the EHR, and repetitive practice would be beneficial to their clinical readiness.

Further research is needed to support the use of the EHR in SBLEs not only in simulation laboratory settings, but in the classroom and skills laboratory as well.

Badowski, D., Horsley, T., Rossler, K., Mariani, B., & Gonzalez, L. (2018). Electronic charting during simulation: A descriptive study. Computers, Informatics, Nursing : Cin, 36(9), 430-437. doi:10.1097/CIN.0000000000000457

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9-Current State of the EHR: A Humorous Look

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9-Current State of the EHR: A Humorous Look

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ZDoggMD’s video EHR State of Mind is a look at how electronic charting has affected the workflow of clinicians.  In it he highlights the logistical challenges of computer placement versus patient bed location, as well as the time spent charting versus interacting with patients.

While the focus of the video is on doctors, nurses can use this video as a call to action to find solutions to integrating electronic charting into their daily workflow.  Electronic charting is not going away, so nursing students need to be taught how to integrate it the most efficiently and appropriately into their workflow, while still providing excellent patient care.

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EHR State of Mind | #LetDoctorsBeDoctors | ZDoggMD.com

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EHR's suck. Let's make 'em better. Go to http://LetDoctorsBeDoctors.com and tell the IT and government folks what's up. And check out http://zdoggmd.com for lyrics, behind-the-scenes dopeness, and all our other videos. Please SHARE...or the machines win. Credits: The legendary Devin Moore of Rabbit!

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10-Future of the New Graduate Nurse and the Preceptor

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10-Future of the New Graduate Nurse and the Preceptor

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This study looked at the turn-over rate for new graduate nurses and preceptor programs.  Based on employee satisfaction surveys and exit interview data, elements related to lack of critical thinking, poor communication and assessments were at the forefront.  A planning and development group was formed, which sought to create a program to provide a standardized orientation process, improve efficiencies related to on-boarding and orientation and increase retention of new nurses (Maryniak, Markantes & Murphy, 2017).

Dedicated preceptors and appropriate patient assignments were associated with increased comfort, confidence and retention.  Having a standardized practice allows both the preceptor and the new grad to know what’s expected of them.  The pressure of the preceptor being responsible for content and the pressure of the new grad trying to prove themselves is lifted.  Now they have a week by week model made available to them to ensure that they are on the same track.  This practice allowed for two measures of success.  The first measure of success focused on retention with a target of 2% improvement.  The second measure of success focused on patient satisfaction with a target of 0.5% increase.

This program is continually evolving, future research studies and evidence-based projects would be beneficial in the continuation of the program.  As the program is refined and fine-tuned it can be dispersed to other departments within different organizations in the hopes of increasing retention and patient satisfaction.

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11-Example of Hospital Room with Workstation for Real-time Documentation

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11-Example of Hospital Room with Workstation for Real-time Documentation

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(Image retrieved from https://www.medstarfranklinsquare.org/for-healthcare-professionals/nursing/nursing-education-and-career-development/)

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12-Implications for Advance Nursing Practice

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12-Implications for Advance Nursing Practice

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The future state of the new graduate nurse, the preceptor, and overall integration of EHR training into simulation relies greatly on advance nursing practice professionals.

Advance practice nurses, who specialize in education, need to integrate EHR training into nurse residency programs and orientation.

Advance practice nurses, nurse who specialize in informatics, need to design and implement EHR programs that are user-friendly and cost-effective. Also, informatic nurses can work to design limited-access versions of EHR for nursing students to obtain training prior to graduation and during clinical experiences.

Advance practice nurses are also called to conduct further research as technology continues to evolve and promote new graduate nurses' transition into clinical practice.

References

Bowling, A. M. (2016). Incorporating electronic documentation into beginning nursing courses facilitates safe nursing practice. Teaching and Learning in Nursing, 11(4), 204–208. doi: 10.1016/j.teln.2016.06.001

Chung, J., & Cho, I. (2017). The need for academic electronic health record systems in nurse education. Nurse Education Today, 54, 83–88. doi: 10.1016/j.nedt.2017.04.018

Hussein, R., Everett, B., Ramjan, L. M., Hu, W., & Salamonson, Y. (2017). New graduate nurses’ experiences in a clinical specialty: a follow up study of newcomer perceptions of transitional support. BMC Nursing, 16(1). doi: 10.1186/s12912-017-0236-0

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Incorporating Electronic Documentation into Beginning Nursing Courses Facilitates Safe Nursing Practice

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1) How does your organization prepare new graduate nurses for clinical practice?

2) After reviewing the padlet, what recommendations would you make for your organization’s new graduate nurse orientation program?