1. Gasparini, Robin ADN, RN, PCCN
  2. Apter, Janet MSN, RN

Article Content


Improve clinical practice by providing education and tools to more effectively orient staff into a challenging cardiothoracic unit.



Evidence supports that a strong unit orientation improves quality of care delivery, safety in practice, and retention of proficient nurses.



Orientation on a high turnover unit was in need of structure and process. Inexperienced staff with less than six months of experience were precepting new graduate nurses. New nurses were taught tasks with little critical thinking application. Orientation was often extended and problems with the orientation process were identified too late to retain the orientee.



End of orientation surveys were completed to evaluate the orientees perception of current orientation. In collaboration with unit leadership, staff core competencies were identified. A series of four classes, four hours in length, were developed using expert coaches. The leadership team supported that classes would be held on the same day each week and would be a scheduled 12-hour shift for the orientee, making classes budget neutral. A pathway was designed to guide learning experiences and identify learning objectives for each week. Biweekly evaluations were scheduled to evaluate both preceptor and orientee and encourage feedback and goal development. After the four-hour class, the orientees work with a designated educator to see in practice the objectives of that class in accordance to the pathway. A blueprint of the orientation process was created to consistently guide staff.



Surveys indicated orientees felt comfortable in providing care to the cardiothoracic patient population, comfortable in the identification of resources, and positively supported and encouraged with appropriate feedback at appropriate times. No orientations have been extended since new on-boarding process and staff and patient satisfaction have improved.



Through leadership, collaboration, and expert coaching, the CNS student was able to design, implement, and evaluate a program to reduce overall costs associated with training and improve satisfaction of staff and patients.


Implications for Practice:

Improved orientations are instrumental in the integration of staff into the practice of nursing. Growing and retaining competent nurses to care for patients are imperative to quality care.


Section Description

The journal is proud to share the student abstracts accepted for poster presentation at the 2009 National Association of Clinical Nurse Specialists Conference. These abstracts are submitted under a separate later deadline and therefore did not appear in the journal with the general abstracts. Congratulations to these CNS students and their faculty mentors.