August 8, 2020

Model and Process in Nursing Orientation, Part 1

Last week, I mentioned my transition from night shift on a medical unit to day shift with a wound care unit. Thus far, I’ve survived the first week and believe I’m well on my way to being integrated into my new unit. During this week, I’ve learned a few things about the orientation processes I’ve either gone through, am going through, or have participated in as a preceptor. These processes suggest different models of community and induction into community, and I’d like to explore some aspects of model and process in nursing orientation in this series.

My first nursing orientation experience lasted approximately two months. It began with a week of day shift “nursing fundamentals” classes. These were not intended to recapitulate what I had learned in nursing school. Instead, they were designed to introduce to me various structures and processes in place within my organization and specific individuals in leadership positions.

Following that first week was a blend of day shifts along with some additional class time and web-based training modules. Then came the awkward transition to night shift, interspersed with day shift classes. When it was all said and done, my orientation involved close to 20 shifts on the unit, most of which were spent on night shift.

Between my original orientation and now, there have been significant changes in my nursing life. Most of the individuals I worked with originally have moved on, including all but one of my preceptors, although I still see a few of them occasionally around the hospital. In fact, most of my preceptors have gone through multiple job changes themselves since my orientation. The structure and process of staff development and education has changed remarkably as well.

During my final few weeks of life on the medical unit, I was asked to serve as a preceptor, and I was happy to do so. I initially expected the process to be very similar to the one I had gone through. However, I was surprised to hear that the orientation process for newly licensed nurses involved only a dozen shifts on the unit. For nurses with any amount of experience, orientation involved only nine shifts on the unit. The paperwork involved has also been altered dramatically.

Had I entered nursing with such an orientation, I wouldn’t have had any experience for comparison, so I can’t really know how I would’ve adapted. However, during my 18 shifts of orientation, I worked with no fewer than eight preceptors. I’ve been told that’s highly unusual, and I believe it. I went through orientation at the end of a calendar year and just weeks before a unit restructuring that made way for the formation of a new progressive care unit.

I know I had to work through a great deal of mixed messaging, but I now see that I had the “luxury” of 18 shifts to do so. Were I to go through orientation now, with four or five preceptors, let alone eight, all within 12 shifts on the unit, I suspect I would’ve had some second thoughts concerning my career choice. Mercifully, orientation typically involves only one or two preceptors, limiting the possibility of mixed messaging and allowing for deeper relationships between orientees and preceptors.

The orientation I’m currently experiencing will last approximately ten weeks. Because my transition constitutes a lateral transfer within my organization, I will not be working through classes in addition to my orientation shifts, although I will be expected to obtain relevant certification. The unit is small in terms of personnel, and I will have two main preceptors.

As far as I can tell, my unit works so well together that I anticipate very consistent messaging from my preceptors. I’ve never before held a nursing position with a specialist unit, but all things considered my current orientation seems very thoughtfully and appropriately organized.

I know there are many nurses who have been forced to endure very difficult orientation experiences that have left them burdened with mixed messaging and inconsistent modeling on the part of preceptors, lack of support following orientation, and worse. The feeling of “being had” by hiring personnel, of investing in a “sure thing” that turns out to be a bait-and-switch scheme, can be tragically similar to becoming a nurse and going through orientation. This is especially the case when the model and process of orientation accounts more thoroughly for the aims and needs of the organization than of the human beings involved. I’d like to continue to discuss some of the issues involved in upcoming posts.

What was your nursing orientation experience like? Let’s compare notes.

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