As baby boomers retire and new perioperative nurses are hired, successful onboarding will be essential for the orientee's success. The American Association of Colleges of Nursing reports an expected 19% growth in nursing between 2012 and 2022-approximately 526,800 new positions. In addition, the college has also projected a need for approximately 525,000 replacement nursing positions, totaling 1.05 million nursing positions by 2022.1
Successful orientation/onboarding is a major financial commitment for the organization. The approximate cost of orientating/onboarding a novice perioperative nurse is between $30,000 to $50,000 and $10,000 to $15,000 dollars to orient/onboard an experienced perioperative nurse.2
Orientation vs. onboarding
Although the terms orientation and onboarding are often used interchangeably, there is a distinct difference. Orientation refers to an exchange of information (for example, policies and procedures, organization mission statements, and organizational structure) and is part of the onboarding process.3 Onboarding is the process of "building engagement from the first contact until the employee becomes established within the organization."3 Onboarding happens over a period of time, typically months, and must be part of a strategic plan aimed at employee retention. The average time for orientation/onboarding an experienced and inexperienced nurse is 3 and 6 months, respectively.2
Hiring the right person is essential. A common recommendation is to hire for attitude, not for skills. As a perioperative nurse with over 30 years of experience, I have seen employees succeed and flourish in their roles, and I have seen those who found the OR environment too challenging and went on to explore other opportunities. A new perioperative nurse's success is dependent on several factors, including a welcoming learning environment, developing clinical competence, the ability to apply critical thinking in new situations, and developing collegial relationships. Good preceptors and leadership can help with this, but it really depends on the new employee to develop these relationships.
Making the effort
Every department in the organization has its own miniculture, and the OR is no exception. One of the unique characteristics of the OR is the necessity to work within teams. When new nurses come on board, setting clear expectations (being engaged, showing initiative, and having good time utilization) will help to develop a base for cultivating those relationships. New RNs benefit from taking the extra effort to go to breaks with their colleagues and getting to know them on a personal level. Those who make the extra effort, in my opinion, have a higher rate of success. The OR is a busy and sometimes stressful environment. Existing staff are more likely to take the time to share information with someone who demonstrates that they "want to be there." Understanding that orientation/onboarding is a partnership between leadership, peers, and the new employee will help ensure the process is successful.
Elizabeth M. Thompson, MSN, RN, CNOR
Editor-in-Chief Nursing Education Specialist Mayo Clinic, Rochester, Minn. [email protected]
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