Hit the Jackpot: Creating High Rollers in Your Ambulatory Care New Employee Orientation

As part of our organization’s Magnet journey to achieve nursing excellence, our ambulatory care education department had an opportunity to centralize and standardize new employee orientation (NEO) for clinical staff. Aligning with our professional practice model which embraces caring relationships as a central focus, our ambulatory care education team re-designed the NEO curriculum with the following goals in mind:
• Provide the new hire with an overview of the organization’s mission, vision and values and integration of these into ambulatory care services.
•    Provide the new hire with the resources, skills, and support necessary to be successful in their new job or role with an emphasis on standard work to improve quality metrics.
•    Connect with the new hire to foster a supportive and caring relationship and welcome them into the organization.

Previously, new clinical staff received 1-5 days of NEO depending on role. Ambulatory care practice managers, some non-clinical, were required to oversee orientation and training of new hires. This resulted in variances and inconsistencies in the new-hire orientation process and reported decreased satisfaction by staff and leaders. Also, the needs assessment showed that only 40% of the assigned inpatient-focused learning management system (LMS) modules were relevant to the ambulatory care new hire.

To address the areas for improvement, principles of adult learning theory including a learner-centered approach were applied to the curriculum re-design. This approach incorporated a blended-learning model involving didactic lecture, facilitated case studies, hands-on skills, and interactive self-directed learning modules. The self-directed LMS modules were revised to include specific content relevant to ambulatory care.

During the onboarding process, the new hire is automatically assigned the ambulatory care LMS curriculum appropriate for their role (RN/LVN or MA). In addition, the new hire is registered in the LMS for an 8-hour instructor-led training (ILT) that is offered bi-weekly. Course content is based on the clinical education matrix from the Association for Nursing Professional Development (ANPD) as well as additional education needs identified in collaboration with ambulatory care stakeholders.

Learner engagement methods include case studies with facilitated group discussion, gamification, simulated patient care activities using the electronic medical record (EMR), videos with group debriefing, hands-on skill practice (ex., manual blood pressure measurement), and interactive, self-directed learning modules.

Utilizing Kirkpatrick’s levels of evaluation, the post-activity evaluation process includes a questionnaire to evaluate the learner’s satisfaction with the program (level 1: reaction). A formative assessment is conducted by providing feedback following the return demonstration of hands-on skills as well as asking the learner to identify one takeaway from the program to apply to their clinical practice (level 2: learning). Each new hire is provided a standardized core competency-based orientation (CBO) tool to have validated in the clinical practice area (level 3: behavior). Anticipated outcome measures include a decrease in first-year turnover, decrease in average length of orientation, decrease incidence of errors, improved quality metrics, and improved perceived patient safety culture (level 4: results).