Implementation of a tiered, competency based orientation program

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Background and objective: Orientation programs for new graduate nurses in acute-care hospital settings aim to guide the transition from student to practicing nurse. Typically, these programs incrementally increase the workload of the new graduate nurse while providing clinical guidance. While effective, the model is time consuming and costly. The objective of this educational study was to ‘flip’ the model and determine the benefit of new graduate nurses initially providing specific care that aligned with their clinical skills and increased their clinical responsibilities as their skill set expanded. Clinical progression and orientation satisfaction scores were used to determine the program’s success.Methods: Guided by experiential learning theory and the skills acquisition model, competency was assessed by mastery. Thus, rather than exposing new graduate nurses to a single patient and moving toward providing care to an expected workload, orientation was holistic in nature and focused on the acquisition of clinical skills, from simple to complex.Results: Data from the seven participants reveal that none required additional orientation time or supplemental instruction. All seven new graduate nurses remained employed on the units of their orientation and successfully transitioned into professional nursing roles.Conclusions: Outcomes from this study included increased new graduate retention and a decrease in the time required to achieve clinical competency. Both outcomes resulted in a financial benefit to the acute-care facility. New graduate nurse and preceptor satisfaction with the study demonstrate the ability to mitigate the stress and anxiety associated with transiting to clinical practice.