Background: In December 2017, a needs assessment survey was conducted with all RNs and LPNs across 25 practice sites. The results indicated a need to focus on the foundations of care and infrastructure to support nursing practice. One intervention identified was the need for a standardized orientation program for onboarding nurses.

Purpose: To engage nurses in the design of an orientation program to meet the needs of newly hired RN and LPN staff and ensure excellence in patient care.

Theoretical framework: The Donna Wright model for competency assessment, adult learning theory, and structural empowerment theory.

Methods
Design: A work group was recruited with a clearly defined scope and timeline for orientation implementation.

Participants: Fourteen members included RN/LPN staff and clinical nurse managers representing all specialties.

Process: The work group met every two weeks from January to May 2018. During the initial meeting the theoretical framework was discussed. The team analyzed survey data from nurses and reviewed AAACN Scope and Standards of Practice to prioritize content for orientation. Program objectives were written to guide the curriculum development. Once the outline for the two-day orientation was drafted, members engaged experts throughout the organization to develop content. The team refined this content to ensure cohesiveness across the curriculum. Additionally, the group gathered orientation checklists from the practices and synthesized these into one core orientation checklist. Nurses in specialty areas were engaged to create a supplement to the core checklist that addressed specific competency needs. Finally, a best practice guideline articulated a shared vision for duration of precepted experiences and expectations of stakeholders during onboarding to the practice.

Measures: PES-NWI and CWEQ-II surveys for the nurse needs assessment. A program evaluation tool was created with Likert scale and open-ended items for participants to complete. Nurse turnover rate was tracked monthly pre- and post-implementation.

Analysis: The evaluations were analyzed each month with rapid improvements to the content and flow of orientation throughout the first six months.

Results: Nurse orientation was implemented in May of 2018 as a monthly offering. Over 78% of nurse participants rated orientation as very good or excellent, with 73% indicating it was about the right duration. Examples of open ended comments are: "I was overall very impressed by the nursing orientation. It left me with the impression that nursing is valued and well supported…It made me feel excited to begin my career here in nursing," and "I would like to know more about protocols, standards of practice, and ensuring that we are following evidence-based practice." Turnover rates for nurses have remained stable. The impact of the orientation intervention is anticipated in turnover data 12-18 months post implementation. Nurses will be resurveyed (PES-NWI and CWEQ-II) in May 2019.

Conclusions and implications: The work group reported engagement in a project that made a significant impact to professional nursing practice. The work group informed a curriculum design that resonated with practice and yielded positive program evaluations. Nurse orientation is a consistent learning and competency validation opportunity as nurses are onboarded to the organization.

Joanne S. Charles MSN, MPH, MSW

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