Take advantage of orientation to hone skills and build confidence.
Takeaways:
- Orientation aids nurses’ personal and professional growth, helps to reduce turnover rate, and improves overall patient outcomes.
- Preceptorship plays a critical role in orientation success.
- When nurses take full advantage of the preceptor experience, they enhance their professional enculturation.
Nurses have been discussing the factors affecting the ongoing nursing shortage for decades. Then came the COVID-19 pandemic. In response to the stress of this crisis, the International Council of Nurses (ICN) predicts an exodus of experienced bedside nurses. Confounding this projected shortfall is the assumed lack of clinical skills among new nurses whose hands-on clinical education in the past year was severely hampered by the pandemic. Orientation is crucial to a new nurse’s personal and professional growth. It also can help reduce a hospital’s turnover rate and improve overall patient outcomes.
Changing student demographics and curricular designs require additional preceptorship planning and support. For example, many nurses may be graduating from entry-level master of science in nursing programs, but that higher degree doesn’t necessarily mean more skills or an easy transition to practice. Similarly, precepting a new RN with nursing as a first degree may differ quite a bit from precepting a second-career new RN who has more life and professional experience.
Preceptorship—a short-term relationship between a novice nurse (preceptee) and an experienced nurse (preceptor)—plays a critical role in orientation success. Much has been written about preceptor best-practices, but less about how new RNs can optimize their professional acculturation. We offer some practical advice to accelerate a seamless transition to practice.
Find out what you don’t know
Nursing education encompasses a general curriculum. It doesn’t include many of the high-stakes, unit-specific tasks (such as initiating chemotherapy) that new RNs perform. During a job interview or on the first day of orientation, find out what hands-on skills are essential for working on the unit. If you’re offered an opportunity to shadow a staff member as part of the hiring process, take advantage of it. At the beginning of orientation, review the list of required competencies and honestly rank your comfort level with each.
Find out what types of diagnoses you’ll be managing, and review hospital protocols and professional organization guidelines. There’s no shame in hitting the pathophysiology and pharmacology books again after graduation. A firm grasp of these topics will aid your clinical decision-making.
When you don’t know what to do first
If you’re not sure where to start, review the nursing process (assessment, diagnosis, planning, implementation, and evaluation). Whether you’re administering a stool softener or admitting a patient after a craniotomy, keep the nursing process steps top of mind. For example, for the patient needing a stool softener, start by asking when they last had a bowel movement. For the patient who’s recovering from a craniotomy, obtain a baseline Glasgow Coma Scale score. Whether you’re encountering a routine or novel situation, ask the preceptor what they would typically do first.
Don’t be afraid to ask
Questions are your most powerful tool for unlocking knowledge and building a relationship with your preceptor. Although it’s true that there’s no such thing as a stupid question, take steps to hone your effective questioning skills. In How To Win Friends & Influence People, Dale Carnegie encouraged asking questions that the other person might enjoy answering. This doesn’t mean asking questions to get someone to like you. Rather, take a moment to phrase a question in a way that will prompt your preceptor to answer it with important details. Ask open-ended questions. Instead of, “Does propofol decrease blood pressure?” ask, “How does propofol affect the patient hemodynamically?” Pose questions any time—during handoff, huddle, or end-of-shift debriefing. Keep your tone conversational and focused, not like an interview or interrogation.
When learning a new skill, you may tend to perform it blindly without understanding the reason behind it. To maximize the learning experience, ask why a task is done before doing it. For example, you might excel in reviewing the five rights of medication administration (patient, drug, dose, route, and frequency) but overlook the right reason for giving the medication. Asking why can help improve your clinical judgment skills and promote patient safety (for instance, questioning the need for a medication if you don’t see a valid clinical indication).
Hands up for hands-on
Repetition enhances muscle learning and mental agility. If you think you can benefit from extra practice time, explore this option with the nurse educator. Some hospitals allow new grads and those in orientation to participate in supervised skills practice. Seek feedback from experienced colleagues after performing any procedure for the first time, and proactively request opportunities to practice. For example, if you struggle with I.V. insertion, do as many as possible. You might even ask co-workers if you can do their insertions.
Fortune favors the fully present
No one can argue that distraction is bad for patient safety. During your shift, unplug from social media and nonessential, nonwork-related connectivity. Rather than performing an internet search about everything that’s unfamiliar, give your preceptor your undivided attention and ask them for clarification. Mindful engagement with your preceptor will enhance collegiality and teamwork.
Thank your preceptor
Precepting is a skill. Doing it well requires energy, an understanding of adult learning principles, and a genuine desire to see new grads flourish into competent nurses. Be lavish and sincere with your gratitude and praise for your preceptor. Tell them how much you appreciate their teaching and support. Send a handwritten note or bring a small gift during and at the end of the preceptorship. You’ll continue to seek your preceptor’s guidance even after orientation is over. Maintaining goodwill will enhance collaboration.
Keep practicing
You may find transitioning to the RN role stressful. At times, you may worry that you’re harming the patient or feel overwhelmed with the amount of work and information coming at you. Keep your cool, and know that with practice, the job will get easier. A positive attitude and a growth mindset can help prevent burnout and provide you with emotional validation that practicing to the full extent of your education is worth it.
Kha Nguyen is a staff nurse in the cardiothoracic intensive care unit at Ronald Reagan UCLA Medical Center in Los Angeles, California. Fidelindo Lim is a clinical associate professor at New York University Meyers College of Nursing in New York City, and an American Nurse Journal Nurse Influencer.
References
Carnegie D. How to Win Friends & Influence People. New York, NY: Pocket Books; 1998.
International Council of Nurses. COVID-19 pandemic one year on: ICN warns of exodus of experienced nurses compounding current shortages. March 11, 2021.
