New grad orientation program boosts growing ICU

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By Mary Thacker, RN, Reba McVay, MSN, RN, and Kerry Sue Mueller, MBA, BSN, RN, CCRN

Since opening a new 29-bed medical ICU in April 2006 at the University of Maryland Medical Center in Baltimore, MD, the nurse management team has interviewed, hired, and oriented 34 new graduate nurses, 36 nurses without intensive care experience, and three experienced ICU nurses. The opening meant the unit needed to hire more than 50 new nurses as it expanded from 10 to 29 beds.

Orienting so many new nurses at one time posed a challenge, so the organization created a new system to closely monitor the nurses while they completed orientation, which proved so successful that they have retained almost all of them in the MICU today.
A color-coded schedule was developed that made a visible impact on the way orientees were paired with their preceptors. The charge nurse could review the schedule and quickly identify orientees, which assisted in making appropriate educational assignments. The system worked so well that it continues to be used by MICU.
A chart was created containing information such as orientees' experience levels, hire date, preceptors, and potential dates of completion of their orientation. Classes pertaining to subjects specific to the MICU patient population were added into the schedule prior to completion of the orientation period. This allowed the management team to assess the progress of each orientee on a weekly basis and to update the schedule with consideration to the abilities of each orientee. Both the preceptor and the orientee were able to plan experiences around class topics and request appropriate assignments to complete the learning experience.
Weekly meetings with the preceptor, orientee, and the management team were held to review each orientee's progress. The management team then met to discuss issues and plan for interventions to keep the orientation process on track. The average orientation period was 8-16 weeks, with allowances made to meet the needs of the orientee in achieving the best orientation experience.
Classes planned for the orientee gave them the chance to build relationships and form camaraderie with individuals from outside the MICU, which ultimately improved communication between units.
Nursing management and preceptors used Benner's novice to expert theory to evaluate each orientee's progress. As the new ICU nurses moved through Benner's stages of clinical competence, they were added into the orientation process as secondary preceptors-allowing for a special bonding experience between even newer nurses and those further along in the process.

The unit has seen benefits from the practice of shared experiences and support systems that developed between staff members during orientation. This system has proven to be effective in meeting the immediate needs of this rapidly growing unit, and has lead to long-term benefits in retention. The MICU has hired 73 nurses since 2006 and retained 65 of them. Six of the nurses who left the MICU are still employed in other areas within the hospital.

Benner, P. (2000). "The wisdom of practice." American Journal of Nursing 100 (10): 99-102.

Editor's note: Thacker is a Senior Partner, MICU; McVay is a Clinical Nurse Specialist, MICU; and Mueller is Patient Care Services Manager, MICU. All three are from the University of Maryland Medical Center, Baltimore, MD.