In conjunction with the outcomes of the Healthy People 2020 initiatives, the majority of patient care is being done on an outpatient basis rather than at bedside. It is this shift in the healthcare system that demands nurses in the ambulatory setting have the support they need in order to meet the necessities of complex patients. The integration of quality and safety measurements in the outpatient practices requires registered nurses to have constant support and guidance from ambulatory nurse educators. Orientation programs can ensure nurses are properly trained, maintain competencies’ compliance, and ensure they are able to provide the highest quality patient care. The need for a formal orientation program in the ambulatory practices was recognized and the cardiothoracic ambulatory registered nurse orientation was created. Its purpose was to serve as the basis for the beginning of a formal outpatient new hire education program. The orientation included six online-based modules that educated the newly hired registered nurse about the most common cardiothoracic diseases, surgeries, and patient problems. The modules were designed to be completed over the course of the first two weeks of hire, followed by an additional four weeks of integration into practice before taking the final assessment. In addition to the final assessment, there was an evaluation of the orientation program and a preceptor evaluation that the new hire completed to ensure preceptors were properly trained. The use of an orientation tool, already in place at the organization, ensured all aspects of the job responsibilities were completed by the end of the six weeks. The program was presented to the clinical resource coordinators, director of outpatient practices, chief operating officer, as well as practice managers of the organization during the monthly outpatient nursing meeting. The program was presented to the chief nursing officer as well as inpatient nurse educators during a private meeting. The orientation program and its module-based format have been approved for immediate implementation.