Making Experienced RN Orientation Worthwhile, Meaningful, and Appropriate

By: Cindy Burke, MSN, RN, CMSRN, clinical educator

In October, I had the opportunity to represent Premier Health and give a podium presentation at the 2019 Professional Nurse Educator Group Conference at the Cleveland Clinic. It was an amazing experience, and gave me the opportunity to share the new, interactive orientation format we use at Premier Health for experienced RNs. Below is an abstract from the presentation:

Putting the Spark In Orientation Problem

Recent evidence from an integrative review of the literature suggests that lack of an evidence base for comprehensive experienced registered nurse (RN) orientation may impact learning outcomes as well as nurse retention and job satisfaction. (Peltokoski J, Vehvilainen-Julkunen K, Miettinen M. Nurses’ hospital orientation and future research challenges: an integrative review. Int Nurs Rev. 2016; 63(1): 92-103). Nursing orientation must support the nurses’ ability to retain crucial information when orientation is completed as well as support nurse retention and satisfaction.

What is Known

When facilitating learning for nurses, adult learning theory must be considered to develop knowledge and skills required for successful completion of nursing orientation. Additionally, Malcolm Knowles’ theory describes adult learners as practical, and education should help the learner convert educational content into real-life situations. Finally, the past experiences of the learner bring value to the educational process. These three core constructs were the basis for development of innovative teaching strategies for an experienced registered nursing orientation program.

Description of Innovation/Best Practice

Based on participant feedback using anonymous web-based surveys from 2017 through June 2018, the approximately 16 hours of lecture-based content delivered by subject matter experts was modified. Using adult learning principles and integration of the learner’s past experience with real-life scenarios, the program was modified with a 12-hour interactive seminar, utilizing simulation, audience response devices, case studies, learning boards, games, and skits with immediate critique and evaluation by the learners. Following research ethics approval, data analysis compared the RN responses of strongly agree to the four elements of program evaluation before and after orientation restructuring. Analysis revealed the following results:

  • Scope of Orientation was appropriate for my needs improved 34 percent (p=0.004)
  • Case Studies, examples and skills helped me learned the content improved 38 percent (p=0.0001)
  • Content helped me understand the expectations of my role improved 36.89 percent (p=0.0002)
  • The program was a worthwhile investment of my time improved 37.1 percent (p=0.0001)


Design nursing orientation so that experienced nurses find the program worthwhile, appropriate, and meaningful for practice. Use of evidence and “thinking outside the box” with continuous evaluation help guarantee success.

The session was well-attended, and many participants reached out to me throughout and after the conference stating they wanted to implement some of these ideas at their organization. I also had the opportunity to network with educators from across the country and attend presentations from which I was able to bring back ideas to improve our practices. This experience made clear to me that we are doing truly amazing things here at Premier Health. I am proud to be part of an organization where we are supported to create and implement innovative ideas to help improve all areas of nursing practice.

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