April 9, 2020

Model and Process in Nursing Orientation, Part 2

Last week, in Part 1 of this series, I began to explore the idea of models of nursing orientation and various processes of orientation I have experienced. Specifically, I discussed my time as a newly-licensed orientee, as a preceptor, and as an orientee with prior nursing experience. This week, I’d like to connect these processes to the idea of induction in nursing orientation in order to catch a glimpse of the dynamics of community in nursing.

Last week, I referred to the processes of induction into community. By induction, I mean the incorporation of new elements into an existing system. In terms of nursing community, this would mean the incorporation of new members into an existing nursing unit. At its heart, the issue of induction approaches the age-old question of the nature and meaning of education. (Readers of this blog may quickly discern that I have many thoughts on education that will have to wait for future posts.)

In the meantime, I’d like to introduce some possible elements of the process of nursing orientation. These are gleaned from concrete experience with orientation, but are mentioned in abstract form to highlight their predictability based on their universal nature. This is not intended to be an exhaustive discussion, but I hope it will spark dialogue.

There are many states of familiarity with the existing nursing community, reflected in the idea of a continuum between the initiate (orientee or novice) and the experienced (preceptor or expert). Members of the community generally occupy positions along this continuum.

There are also numerous possible roles available for members of the community. In addition to reflecting low familiarity, orientee is a distinct role in the contemporary nursing organization, as is preceptor. There are many other roles available outside the preceptor-orientee dyad, such as charge nurse, supervisor, and unit manager. In addition, simply being another nurse on shift implies a role relative to the orientation process.

Early during orientation, the orientee is introduced to various people and processes that are important in the overall organization. The heads of departments and mechanisms for addressing certain job-related needs are addressed. While such information is often conveyed in one direction, from presenter to audience, there may be few time-efficient substitutes for simple acquisition of information.

Speaking of conveyance of information, there is actually a variety of educational formats. In addition to the classroom or conference room setting, there are web-based training modules, skills-validation sessions, group visits to specialized services, and unit immersion shifts. The sufficiency of time and array of experiences incorporated into nursing orientation and processes for evaluation of the overall effectiveness of orientation are means of quality assurance.

Overall, the nursing orientation process is subject to many changes in the organization. Formal restructuring may lead to changes in both the formal and informal apparatus of education. This vulnerability to change may be particularly great in cases of excessive “departmentalization” of education, when formal structures of the organization are emphasized to the neglect of informal, relational patterns.

Community composition is important in that continuity within the nursing community, or lack thereof, may be a function of changes in the population of people involved. Changes may involve obvious features such as the number of staff, acquisition of skills and/or degrees, the attainment or lapse of certifications, or the staff present during any given shift. However, at least as important are the intangible aspects of interpersonal relationships as well as the turnover and succession of staff.

One of the most memorable factors in my orientation experiences has been the number of preceptors offered to me as an orientee. Preceptors represent voices of influence. In a sense, preceptors are the nursing “parents” of orientees. It stands to reason that the longer the orientation and the fewer the preceptors included, the deeper the relationships between well-matched preceptors and orientees.

Another latent aspect of relationships within the complex community of a nursing unit is the phenomenon of mentoring. Whereas preceptors provide guidance during the formal induction of new staff to a nursing unit, the importance of ongoing guidance in the life of a nurse can be addressed by the formation of mentoring relationships. Through many conversations with young nurses in the early post-orientation phases of their careers, it has become clear to me that one of their greatest needs and most commonly felt deficiencies is the support of experienced nurses who can provide refinement that simply can’t occur during the limited-duration orientation period.

I know I’m not the only one thinking about these issues. What other aspects of model and process in nursing orientation can you think of?

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