Developing a Standardized Nursing Orientation for Clinical Employees in the Ambulatory Setting

In a large healthcare enterprise that features many different ambulatory clinic specialties and locations, it can be difficult to provide an orientation that is inclusive and applicable to such a wide range of staff members. However, it is imperative that the new employee receives the tools and information they need to be successful in their role and provide the best patient-centered care. In the absence of a standardized orientation and onboarding program, some clinical staff were not receiving this critical information. Confusion and chaos during the 90-day onboarding period can lead to stress, lack of motivation, and dissatisfaction with the role, the clinic environment, management, and the enterprise as a whole.

An ambulatory clinical orientation was developed specifically for the roles that fall into nursing services, including RNs, LPNs, and clinical services technicians (CSTs). Each new employee to these roles is invited to a four-hour orientation class. During this time, the participants receive a personalized folder that includes an orientation skills checklist, a list of required web-based trainings, and a list of all other courses that they are required to complete during the orientation period, along with helpful contacts and resources. During the lecture portion of the class, a wide range of important topics are covered: enterprise topics include parking, policies, and compliance; nursing services topics include the institution’s nursing professional practice model, Magnet designation, shared governance, and professional development opportunities; clinical topics include nursing sensitive indicators, ambulatory services protocols, emergency response procedures, specimen collection, and hand hygiene. Guest speakers and interactive quiz games keep participants attentive and engaged.

Key performance indicators were identified and a baseline metric was established prior to implementation of the orientation program. All participants received a survey based on the key performance indicators six months after implementation. The results showed a 40% increase in the number of new employees that were receiving and completing skills checklists, as well as a 10% increase in those that were receiving and completing the required web-based trainings for their role. In regards to knowledge, there was a 43% increase in exposure to nursing services topics, and a 47% increase in exposure to clinical topics.

Ambulatory clinical orientation continues to be successful almost one year after its conception. Evaluations remain positive, and improvements continue to be made. Attendees now participate in hands-on activities related to clinical responsibilities within their new role. Positive reactions from participants include comments regarding the hands-on opportunities, relevance to their new position, and a positive learning environment that invites participation and discussion. The goal is to promote best practice and patient-centered care through education, exposure, and support. With a standardized approach to orientation, new employees feel organized and prepared to deliver the best patient care in their new role. The success of this program has inspired a revamp of the onboarding process for all roles, including non-clinical, within ambulatory services.