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  1. Bumgarner, Susan D MSN, RN,C, CPAN
  2. Biggerstaff, Ginger H MSN, RN,C


An orientation pathway was developed using a patient centered approach. The pathway provides a guide or "road map" for the preceptor and new nurse to care for high-volume patient populations in medical and surgical units. Benefits include application of the nursing process, promotion of critical thinking skills, reduction of reality shock, and improvement in job satisfaction and retention. This article describes the rationale behind the approach and its application to nurse orientation. Steps in the process are described. Staff development educators can use the steps to develop orientation pathways for other practice settings.


Nurse educators' and managers' experiences in dealing with new nurse anxiety reminds one of how critical orientation is to the success of the new nurse's employment. Orientation directly influences retention, job satisfaction, productivity, and quality patient care (Biley & Smith, 1998). This article presents the adaptation of a clinical pathway used in a preceptor program to provide patient-centered approaches to nurse orientation.


Providing effective and quality orientation is challenging for staff development educators. Creativity, innovation, and organization of expected outcomes during orientation are a must. Typically, new nurse orientation involves lengthy skills checklists that often become scavenger hunts. The new nurse and preceptor spend much time looking for equipment, supplies, forms, and manuals in order to validate the nurse's understanding. This method is ineffective in preparing the new nurse to care for the population of patients in a particular clinical arena. Checklists fail to promote links between psychomotor skill performance and critical thinking or quality nursing care of patients (Storti et al., 1999).


Effective orientation programs should enhance competent patient care by promoting critical thinking skills. New nurses and preceptors need well-organized orientation plans to serve as guides in preparing the nurse to provide quality patient care and teaching plans for preceptors.