Orientation, (sometimes called induction or "onboarding") introduces new, inexperienced, and transferred workers to the organization, their supervisors, co-workers, work areas, and job duties, especially to quality and safety. Orientation is extremely important. The information received is designed to help new staff acclimate to the healthcare team, learn acceptable tasks, and utilize key organizational processes to deliver high-quality, safe care. Both Federal and State regulations contain requirements for employee orientation.
Three key types of Orientation:
There are three main types of Orientation. House-wide or General Orientation, Department-specific Orientation, and Job-specific Orientation. Regardless of the type of orientation being provided, there must be documentation that the orientation was completed that resides within the Human Resource File for each employee.
Key Components of House-wide Orientation:
House-wide Orientation should be designed to cover broad topics related to facility operations. Typically, it should address:
- The mission, vision, and goals of the organization
- An overview of the facility’s organizational chart
- Key components of the CMS Conditions of Participation or Conditions for Coverage, such as the requirements related to Patient Rights, including ethical aspects of care, treatment, or services and the process used to address ethical issues based on their job duties and responsibilities. Topics such as the right to privacy, to be free from abuse, neglect and exploitation, confidentiality, and a safe, clean environment.
- Environmental Safety aspects such as Fire Prevention and Fire Safety, Workplace Violence, and Infection Prevention and Control and Emergency Management.
- Understanding of the organization's culture related to safety and information on the various cultures the organization's client base represents.
House-wide orientation must be completed prior to assuming any duties within the organization. It creates the foundation for a safe work environment and the provision of safe care.
We have seen many different ways of providing this foundational education. Whether provided in a classroom or provided through a learning management system, it is essential that organizations have the means to determine the effectiveness of this education.
Key components of Department Orientation:
Much opportunity exists for improvement in this area. Department Orientation involves the sharing of information that focuses on how the department operates. Key components of department orientation again focus on Fire Safety, Safety, and Emergency Preparedness. Showing new employees the location of their nearest fire extinguisher, fire exit and any important information that must be taken from the department in the event of a need to evacuate is essential content. This orientation should also address everyday functions such as the location of the time clock, work schedules, and work assignments. Sharing a clear vision of how the department participates in daily operations and the goal of providing the highest quality, safest care possible should be embedded in every orientation aspect.
Job-Specific Orientation:
Job-specific orientation typically contains the greatest amount of detail. It is within this component that the process of determining individual competency begins.
Job-specific orientation combines the mission, vision, values and goals of the organization with both the individual skills of the employee and expected department contributions to facility operations, to all come together.
Job-specific orientation is often referred to as the initial assessment of competency, as the assessment of competency must be completed before the individual performs clinical skills independently.
Five essential steps in designing your orientation programs:
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Preparation
Requires the development of a curriculum along with the training and preparation of preceptors. Some departments may choose to implement a didactic portion of the orientation program that focuses on common processes and procedures. The curriculum should, again, focus on how the department contributes to high-quality and safe care. Department orientation must include orientation to the department’s policies and procedures, inclusive of how and where these policies and procedures are located. Each conversation about each topic/each P&P must highlight how it contributes to safety. When choosing preceptors, they should be selected for their expertise and knowledge and their ability to teach and evaluate the new team member
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Incorporation
Welcome the new staff member to the team. Introduce new staff members to morning huddles, staff meetings, and the means of communication used in the department. Provide a tour of the environment and introduce them to the team members and their assigned responsibilities. Preceptors should be encouraged to have breaks/lunch with the new staff during the orientation period, and the managers should periodically check in with them as well. Ensure that new staff has access to all of the electronic systems as early as possible, including computer log-ins, parking garage, and door access, and medication dispensing system access, when applicable. Not having access to the department’s systems can be frustrating and alienating, and it creates a lag or barrier to learning.
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Goal-Directed Precepting
Weekly benchmarks to guide precepting activities should be established when using a preceptor model. Basic competencies should be performed, moving towards more complex procedures/tasks as time goes on. Successful completion of all competency skills must be individually documented. Evaluating performance weekly is an efficient way to track the progress and assist in making assignments for the new staff member. Preceptors need to be transparent and share their observations and experiences with the new staff members to ensure success. This will also help in identifying areas of strength and weakness. Team ownership of on-boarding new staff sends a powerful message about collaboration and teamwork.
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Direct and Timely Two-way Feedback
Managers should meet with new staff and their preceptors weekly or bi-weekly. Both the preceptor and the new staff should provide feedback on their progress. Ask new staff to be open and honest about their progress, confidence, and comfort level. Feedback should be honest and encouraging, with concrete recommendations for improvement. Preceptors are encouraged to provide feedback as close to the event in question. Timely and effective feedback will enhance the learning experience and increase the new staff members' confidence. It is important to note that there will be new team members who will require an extended orientation but will continue to succeed. Plan for this as you evaluate the completion of weekly benchmarks.
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Ongoing Support
After the departmental orientation period, the manager should make plans for the future support of the new staff member. The assignment of a mentor or “buddy” provides a resource and a sounding board for clinical questions and debriefing. The annual evaluation process, along with any forms or documents, should be reviewed. Involvement in shared governance councils and department projects will support the retention and longevity of new staff. Participation in department activities and continuous learning are key to engagement and prevention of burnout.
These elements provide structure for the initial onboarding, precepting, evaluation, and ongoing support of new team members. These practices are a worthwhile investment in promoting teamwork, employee satisfaction, employee and team performance, and high-quality patient care.
Summary
Not only is house-wide orientation an important part of introducing the new staff members to the organization, but so is departmental and job-specific orientation. By having a robust orientation process, you improve the likelihood of retaining new staff and building a highly functional team.
References
- 5 Essentials of Nursing Orientation by Susan Cline, MSN, MBA, RN, NEA-BC.
- Joint Commission Comprehensive Accreditation Manual for Hospitals 2024.
To learn more about Onboarding Procedures contact the Courtemanche and Associates Team at 704-573-4535 or email us at info@courtmanche-assocs.com.
