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Nursing U: a new concept for nursing orientation

Culley, Thomas MBA, BSN, RN, CVRN; Babbie, Andrea MSN, RN-BC; Clancey, Jeanne MSN, RN, CNRN; Clouse, Kathy MSN, RN-BC; Hines, Rosemerry MSN, RN, CMSRN; Kraynek, Monica MSN, RNC-LRN, RN-BC; Tutro, Josephine MSEd, BSN, RN-BC; Wittmann, Susanne MSHSA, BSN, RN

doi: 10.1097/01.NURSE.0000406194.73311.8f
Feature: PROFESSIONAL GROWTH
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Nursing orientation doesn't have to be dry and dull. Nurse educators can take this innovative approach, which resulted in giving new nurses a better learning experience. The bottom line? Fewer errors and a higher retention rate.

At Western Pennsylvania Hospital in Pittsburgh, Pa., Andrea Babbie, Jeanne Clancey, Rosemerry Hines, Monica Kraynek, Josephine Tutro, and Susanne Wittmann are education and development specialists, and Kathy Clouse is the director of nursing and housewide education. Thomas Culley, formerly an education and development specialist at Western Pennsylvania Hospital, is now an accreditation/ regulatory specialist at UPMC Presbyterian Shadyside, also in Pittsburgh, Pa.

The authors have disclosed that they have no financial relationships relating to this article.

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BOTH NEW GRADUATE and experienced nurses face significant challenges when starting a position in a hospital. The purpose of nursing university, a new approach to nursing orientation for newly hired nurses, is to enhance their experience, reduce errors, and improve retention at Western Pennsylvania Hospital, a 500-bed primary acute care facility in Pittsburgh, Pa.

Nursing university, which was developed by the authors, improves on existing programs and is outcome driven. It incorporates verbal instruction, visual cues, and tactile experiences. Nursing university was successfully incorporated without incurring additional costs or taking significantly longer than our traditional orientation. This article describes why this new approach was needed and the results of its implementation. First, consider traditional orientation and its pitfalls.

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Following tradition

In most acute care facilities, nurses attend nursing orientation before the clinical orientation. Nursing orientation introduces nurses to hospital policies and procedures, letting them customize their "toolkit of knowledge" to fit the mission, vision, and values statement and culture of their new organization. Nursing orientation should prepare new nurses for clinical orientation and decrease the learning curve, but many people have difficulty retaining massive amounts of new information.

Traditional nursing orientation typically consists of 3 to 5 days of "information overload" in an effort to comply with hospital policies and regulations from the state and regulatory organizations such as The Joint Commission. Nursing orientation also introduces newly hired nurses to the hospital's medical records and information systems. Educators typically include a review of common tasks or skills (such as using glucose meters) requiring proficiencies.

We decided to focus our efforts on reducing errors and improving retention by making orientation a better learning experience.

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Areas needing improvement

Understandably, new nurses often make mistakes that cost time and money and sometimes endanger patient safety. Although nurse educators try to turn errors into learning opportunities for new employees, mistakes may undermine new nurses' confidence. New nurses fear the consequences of errors. After making an error, nurses going through orientation have reported to us feelings of incompetence, embarrassment, and paranoia.

High nurse turnover is expensive, with most of the funds spent on the orientation and education of nurses needed to replace those who have left.1 Actual costs vary, but the generally accepted expense to replace one nurse on an inpatient unit is about $85,000.1

Nurses' perceptions of orientation vary due to personal preferences and learning styles. Generally, new employees' evaluations of the traditional nursing orientation program stressed dissatisfaction with spending many hours over several days watching videos and reviewing policies in a small classroom.

Comments we received about the nursing university orientation included:

  • "This part of nursing orientation was an eye-opener. It's good to bring up things that you don't think about happening."
  • "Awesome, awesome, awesome."
  • "This was the best mock presentation and demonstration I've ever had in my 20-year career!"

The staff educator responsible for orientation is usually aware of the difficulties that new nurses are experiencing but has few alternatives. Here's where the new program shows its colors.

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Why Nursing U?

The key to relief lies in how the information is delivered. Nursing university allows for some formal review of information and policies, but it also lets learners get out of the classroom to participate in a controlled learning opportunity to evaluate them. The tactile experience allows orientees to not only perform skills but also understand the rationale behind the policies governing the skills.

This learning opportunity addresses several topics one by one. (See Scheduling nursing university classes.)

Most lectures are followed by a hands-on opportunity in the simulation center to reinforce the education. Nursing university is conducted over 2 full days or "semesters," with each portion of the program lasting about 2 hours. Continuing-education credit is provided to nurses for participating in the program.

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Implementing the program

The main idea of the coursework is to address areas where orientees commonly struggle and are prone to making errors. By closely monitoring orientees during the first 6 months of employment, we identified trends in the types of errors made by orientees so we knew where to focus our efforts.

The lab portions are conducted in the Simulation, Teaching, and Academic Research (STAR) Center, where educators plan interactive learning experiences with high-fidelity manikins in a virtual-reality setting. Competencies are demonstrated by return demonstration in the STAR Center.

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Our methodology

We conducted a study using information provided by nurse managers about the performance of orientees in their first 6 months in a department. We analyzed the performance of 103 orientees in the study: 60 attended orientation before the new program was implemented, and 43 were oriented with the nursing university program. We compared data about medication errors, documentation errors, lab errors, and retention for the traditional orientation group and the nursing university group. Retention was defined as being employed on the same unit where the nurse was hired 6 months after orientation.

Retaining nurses on the units for which they've been hired affects quality outcomes as well as costs. Before implementing the nursing university concept, retention rates for newly hired nurses weren't satisfactory: only 69% of them remained on the same units 6 months after orientation.

Our data showed a 20% improvement in the turnover rate of new orientees who'd participated in the nursing university program. We found that 82% of nurses who participated in the nursing university program were still employed on the units for which they were hired 6 months after completing orientation.

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Future considerations

We need to continue to measure the long-term effectiveness of the university concept and compare it with a nurse residency model for orientation. (The nurse residency model is usually a 6-month to 1-year program where new nurses gain experience by working with a mentor and progress is measured incrementally over the year.)2–4 We need to continue to review the content areas to ensure the program's relevance to the needs of the orientees and the hospital's mission.

The university concept didn't decrease the average number of weeks for clinical orientation needed for nurses to feel competent to manage their own assignment.

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Better results

Nursing university is outcome driven and has reduced errors and increased retention. It accommodates diverse teaching and learning styles and has had a positive impact on the hospital's bottom line. In addition, nursing university lets nurses learn and earn CE credit for the time spent in nursing orientation—instead of simply enduring the process.

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Scheduling nursing university classes

First semester

  • NSG 101–I.V. Therapy Essentials/Central Line Care
  • NSG 201–Blue Alert (Cardiac Code)
  • NSG 301–Aspects of Documentation
  • NSG 401–Excellent Service

Second semester

  • NSG 501–Essentials of Pain Management
  • NSG 601–National Patient Safety Goals
  • NSG 701–Lab Interpretation/Blood Sampling
  • NSG 801–Competency Review
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REFERENCES

1. Jones CB. Revisiting nurse turnover costs: adjusting for inflation. J Nurs Adm. 2008;38(1):11–18.
2. Altier ME, Krsek CA. Effects of a 1-year residency program on job satisfaction and retention of new graduate nurses. J Nurses Staff Dev. 2006; 22(2):70–77.
3. Beyea, SC, von Reyn LK, Slatterly MJ. A nurse residency program for competency development using human patient simulation. J Nurses Staff Dev. 2007;23(2):77–82.
4. Reinsvold S. Nursing residency: reversing the cycle of new graduate RN turnover. Nurse Leader. 2008;6(6):46–49.
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RESOURCES

Meraviglia M, Grobe SJ, Tabone S, et al. Nurse-Friendly Hospital Project: enhancing nurse retention and quality of care. J Nurs Care Qual. 2008; 23(4):305–313.
Salera-Vieira J. The collegial clinical model for orientation of new graduate nurses: a strategy to improve the transition from student nurse to professional nurse. J Nurses Staff Dev. 2009;25(4): 174–181.
Strickland RJ, O'Leary-Kelley C. Clinical nurse educators' perceptions of research utilization: barriers and facilitators to change. J Nurses Staff Dev. 2009;25(4):164–171.
© 2011 Lippincott Williams & Wilkins, Inc.