1. Gallo, Susan BSN, MBA
  2. Siedow, Jeanne RN

Article Content

In May 2001, our medical-surgical unit began preceptoring novice nurses differently, using a method that emphasizes one-on-one mentoring with tailored assignments. The new system nurtures the pace of learning by focusing specifically on the orientee's needs, not the nursing unit's staffing needs. The net result is increased staff retention, which we've measured by significantly decreasing our unit's nurse vacancy rate.


Tailored delivery

As we focused on the novice nurses' needs, two thoughts kept surfacing, which later became our guiding principles:


[white diamond suit] create a nurturing environment to allow bonding with us, the unit staff


[white diamond suit] tailor orientation to the novice nurses' needs, not the nursing unit's staffing needs.



We exercised these two principles successfully. What worked particularly well was how we started orienting them differently. The novice nurse worked the preceptor's work schedule, allowing us to pair an orientee with a preceptor on a daily basis. This constancy helped us focus on continued skill development and learning and assisted our preceptors with remaining integral to the new person's role on our unit.


Specialized approach

We call each day of unit orientation a "patient orientation" (PO) day. The initial PO day in our unit doesn't include patient care and is called PO-0 day (0 patients are cared for); PO-1 signifies one patient is cared for, and so forth. Each orientee initially is scheduled for one PO-0 day, with two PO-1 days to follow. This is our assessment phase, during which we learn about the new nurse's knowledge base and comfort level with our patients.


We specify PO day designations to the learning abilities of each orientee, as well as the learning experiences available on the nursing unit. Our orientations expose new nurses to the various types of patients seen on the unit, and usually include observation of procedures in surgical and diagnostic areas and time with therapists, specialists, and intravenous-start staff. Orientees learn patient care routines, develop prioritization, and become familiar with policies and paperwork to round out the learning experience. Eventually, the new nurse cares for 3 patients, then 4, continuing up to 7.


We found that seasoned preceptors are able to orient two nurses simultaneously; this 2:1 relationship works best once the initial assessment week has passed.


Unique results

Our new orientation model yields positive rewards for our unit. Consider our results:


[white diamond suit]New orientees feel they receive a rich, thorough orientation. They cite success factors as having the time to learn without stress and feeling truly bonded with staff during their training.


[white diamond suit]Our preceptors feel they have adequate time to assess and guide novice nurses. They feel better able to monitor orientee progress and plan for next-day experiences. They complete orientation paperwork in a timely fashion to meet Joint Commission on Accreditation of Healthcare Organizations standards.


[white diamond suit]Our costs of orientation haven't increased. In fact, our orientation costs decrease when we train more than one orientee simultaneously. By using a 2:1 orientee/preceptor relationship for 30% to 40% of orientation, we reduce our staffing costs of orientation by approximately 20% per orientee.


[white diamond suit]Our vacancy rates are down. Our fiscal year 2000 average nurse vacancy rate was 35%; the 2001 average nurse vacancy rate dropped to 26%. In May 2002, we hired only one new nurse and averaged a 5% vacancy rate. The rate was 0% at the beginning of fiscal year 2003.


[white diamond suit]Our nonproductive costs are lower. It costs $40,000 to bring a new medical-surgical nurse into our organization; this includes hiring and orientation expenses. Our annual savings translate into continued savings year after year as our vacancy rate remains near zero.


[white diamond suit]We're retaining nurses. At present, our nursing unit is fully staffed, with no open nursing positions.



Our solid team effort represents the focused effort and gentle nurturing of those who care about other nurses enough to initiate change. And what a difference it makes working together to guide novice nurses into this new era.