Graduate nurses (GN) coming into health care may lack confidence in skills contributing to a challenging and lengthy orientation. Tenured nurses leaving health care led to an “experience complexity gap” noted by the advisory board. GNs are required to take care of higher acuity patients with little experience and lack confidence in basic skills. A literature search was completed, and many low-level, high-quality articles were found.
Many of the articles noted institutions completing a quality improvement for the orientation. The recommendations of the evidence were to provide GNs time to practice skills including daily tasks, medication pass, assessments, computer systems, and high-risk/low-volume scenarios (blood, falls, codes). Ideally the learning environment would be a safe place outside of an assignment, led by an intensive leader, and cohorts of four or less.
An intensive period (IP) curriculum was created with an intensive leader overseeing a cohort of GNs. Each IP was 10 eight-hour days. Curriculum was based upon the literature, quality indicators, and system orientation checklist for competencies. GNs completed “task objectives” as listed in the curriculum and received a binder with policies, standard work, or handouts that complimented the tasks. Both didactic and clinical methods were utilized during the IP. Skills that required hands-on would be completed on the clinical unit by utilizing a “pop-up skills” list where the staff could identify opportunities for the GNs. Debriefing was completed at the end of each day and homework was assigned to prepare for the next day.
Seven GNs over three months participated in this skills-based intensive orientation and reported satisfaction with the program. Further evaluation of their confidence and competence will be collected throughout the first year. Preceptor perception was evaluated using new graduate nurse performance survey with additional encouragement of the GN’s overall preparedness.
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