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• W2113447792 abstract "Nursing orientation for acute or critical care nurses typically occurs in 3 stages: general hospital orientation (1 day), general nursing orientation (3–5 days), and a 6- to 12-week (or longer) precepted clinical experience whereby new nurses are paired with experienced nurses to learn directly on the unit of hire.1 Preceptors assist orientees to acquire basic nursing/unit-specific skills and become familiar with patients, protocols, care providers, and the unit’s culture. By the end of orientation, orientees are expected to demonstrate competence in basic unit-specific skills.Casey et al2 surveyed a cross-section of new graduate nurses (NGNs) from different hospital areas and found high stress and difficulty transitioning from student to professional roles. Root causes included lack of confidence in skill performance, deficits in critical thinking/clinical knowledge, relationships with peers and preceptors, struggles with dependence on others, frustrations related to the work environment (eg, nurse-to-patient ratios), organization/priority setting, and communication with physicians. As Casey et al2 acknowledged, preceptors are integral to role modeling of professional behaviors and facilitating nurses’ adjustments to their role. Thus, preceptors have immense responsibilities.This review was conducted to discover what impact preceptored orientation programs have on clinical knowledge and skills of nurse orientees as well as organizational and financial outcomes.CINAHL was the primary search engine. Key words included nurse orientees, preceptors, critical thinking, competency, socialization, retention, and job satisfaction. Only reports of educational programs in acute/critical care settings with a preceptor component from the past decade were reviewed. Reported outcomes focus exclusively on orientees. Thus, evaluations of preceptor education were not included.3–6 Various types of evidence were considered, but small investigations (N < 10) and qualitative analyses were excluded.Twelve research or program evaluation reports from the United States were retrieved (Table 1). Samples included NGNs and experienced nurses, and ranged in size from 18 to 197. Interventions included both classroom and preceptor-based learning.Program types included structured orientation (7 weeks-1 year), internship (8 weeks-1 year), and residency programs (1 year). Length of clinical preceptorships varied by specialty, experience, and learning needs. Some interventions incorporated structured cohort/roundtable sessions; regular meetings between orientees, preceptors, and managers; and professional role development sessions. Orientee outcomes that were evaluated included knowledge/skills (critical thinking, competency, autonomy), organizational (sense of belonging, job satisfation, organizational commitment, program satisfaction), and financial (retention/turnover, cost avoidance). Various measurement approaches were used.Critical thinking increased in the 1 program that evaluated this outcome.14 In 2 reports,15,17 self/peer ratings of competency trended toward improvement or improved significantly by program completion, with a continuous increase in confidence. Prioritization of outcomes was also enhanced by 6 and 12 months.13 Findings were mixed with regard to autonomy. Perceived fairly high at the beginning of 1 program, nurses’ autonomy dipped at 6 months but had recovered by year end.13 In another report,7 readiness to manage patient care at program completion was rated higher for experienced nurses than for NGNs. Autonomy was unaffected in another program.17In 1 evaluation, internship nurses at 6 months had a lower sense of belonging than at baseline or 12 months.10 Overall, satisfaction was high for choice of employment,16 as well as for praise, professional opportunities, and interactions at 12 months.11 Orientees also reported high satisfaction with their educational programs—even NGNs with high stress levels. Internship nurses maintained more realistic views of the professional nursing role.17 Nurses were satisfied with communication, coaching, and collaboration, as well as with spontaneous and simulation learning. Among all resources, preceptors were perceived to be most supportive during orientation.On the whole, evaluations were favorable for retention, vacancy, and turnover. Despite program overhead, good returns on investment were demonstrated, with cost avoidance associated with reduced turnover and employee replacement expenses.7–9,14,17Overall, studies reviewed represent class IIa evidence in support of preceptor-based orientation to increase program satisfaction and retention and to reduce turnover and cost (Table 2). Although institutions may initially look to education as a source for budget cuts, leaders should consider thorough, structured orientation programs with adequately prepared preceptors. Education to prepare preceptors for this critical role ranges from 1- to 3-day workshops. Further study is needed regarding appropriate ongoing education and support for preceptors. Preceptor-based orientation programs may ultimately lead to a return on investment at 1 year, as studies reported cost savings of $24 810 to $823 680 despite program costs.Although class IIa evidence also supported the effect of preceptors on orientees’ competency, this outcome has been less consistently and robustly measured. Other researchers could consider adding standardized competency rating scales. It is worth noting that no studies evaluated outcomes related to cultural competency, an expected competency from the Joint Commission.Critical thinking was measured in only 1 study.14 Other authors have documented interventions to improve critical thinking that rely on methods that are not based on preceptors. Studies reviewed showed that stress continued for new nurses, even with solid orientation programs. Additionally, increased autonomy did not occur until the first full year after orientation. Thus, plans must be in place for continued support of NGNs after initial orientation. NGNs perceive that it takes at least 12 months to feel comfortable and confident in their practice2,13 and to feel that they belong. This time frame extends far beyond the typical several week orientation provided by hospitals. Thus, resources such as orientation facilitators and mentors should be used to provide ongoing support for NGNs throughout their first year. Deliberate and evidence-based interventions that use preceptors are pivotal in orientation of nurses in the complex and dynamic world of acute health care. Consequently, preceptors are key to the orientation of both NGNs and experienced nurses, and the contribution of preceptors to successful outcomes of orientees and organizations should not be underestimated." @default.
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• W2113447792 date "2010-03-01" @default.
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• W2113447792 title "Preceptor-Based Orientation Programs: Effective for Nurses and Organizations?" @default.
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