Nursing Orientation – Good One or Bad?

If you have ever taken a job in a hospital facility as a clinical staff nurse, then you most likely endured a clinical orientation. Did you love it?!! The really great orientations are imprinted on our psyches and embedded in our hearts. …The really bad ones are enough to make anyone quit the practice of nursing. Even non-nurses. I became a mentor to 2 wanna-be neonatal nurses, this post is dedicated to them.

Since those really are the only two choices – a Good O or a Bad O –
the Muse, RN is happy to start the following list in service to:

our future co-workers
…whose hearts deserve our warmest welcomes & best instruction
our Preceptors & Nurse Leaders
…who have always had the ability to make it so.


Good O: Your assigned Preceptor calls you at home within days of you accepting the job offer and introduces her/himself and chats you up a bit.
Bad O: You show up your first day of work at 0630 and the staff stands around looking at each other and shaking their heads. You overhear, “Ohhhh hell no. I’m not doing it.” and “Nu-uhh, don’t look at me…”

Good O: You have been assigned a Nurse Buddy – someone that was new within the last year like you! He/She keeps in touch with you, decorates your locker, eats lunch with you, shows you around and tells you stuff no one else even thinks to talk about…like where the Number 2 Bathroom is.
Bad O: You know no one and you eat lunch alone.

Good O: You have an assigned locker with space in it to put your bag.
Bad O: “Just look around and see if there’s an empty one or an open one and stick your stuff in.”

Good O: Your Preceptor sits with you that first day (or before!) and is interested in your nursing past and future, gives you time to complete a personal checklist of skills – known and to learn – and correctly articulates your goals and learning needs back to you.
Bad O: Your Preceptor announces “Follow me.” and you do …for the rest of the 6 weeks.

Good O: Your orientation begins with a day of touring the unit, observing some routine procedures, having lunch with the team, learning the phone and call bell systems, snooping through the supply room and being introduced to MDs, Charge Nurse(s), and support staff.
Bad O: Your orientation begins with “Follow me.”

Good O: Your clinical orientation begins with skill check-offs based on your self-eval. Everything that you checked as “Competent” is observed in practice and automatically cleared as a learning need.
Bad O: Your Preceptor never looks at your self-eval again after you complete it…and just ‘reminds’ you every so often that “we need to go through your checklist.”

Good O: Your Preceptor is assigned a group of patients that reflects a standard staff RN-assignment. You and Precept team-nurse them – with you assuming as much autonomously as you have indicated you know with Preceptor shadowing you; when faced with tasks or skills you have not learned, Precept steps in and you observe; when faced with learning opportunities, you demonstrate and Precept guides and cheers.
Bad O: Your Preceptor is assigned the hardest patients on the floor and sits at the desk all day. May even roll his/her eyes when you come to the desk and ask for help.

Good O: The length of time your clinical orientation lasts is fluid based on your mastery of the skills and time management needed to perform competently on your new Unit. Sticking points or hard-to-learn situations for you are noted and extra time/attention is devoted to these.
Bad O: The length of time your clinical orientation lasts is stated at the beginning and you are kicked from the nest on that date – ready or not. If performing above the standard New Grad level, you spend the length of the O insulted and bored to tears; if performing at the New Grad level, you spend the length of the O scared witless of The End Date.
Really Bad O: Your Precept ends the Orientation period with a snide, “Good luck.”

Good O: By the end of the clinical orientation, your skills list is completely checked-off, you are autonomously assuming the care of a standard RN-patient assignment and your Precept tells you daily – in some manner or another – what a great asset you are to the Unit.
Bad O: The end of your clinical orientation arrives and your Precept sits down and slaps initials and random dates in the Competent columns of your checklist and is glad to be done orienting.

More? Absolutely. But, you get the idea. Nursing Orientation is more than a perfunctory PIA to a Unit. It is your only chance, in both roles (New Nurse and Established Staff) to create a Culture of Fun & Caring. How we select our newest staff and how we treat each other before and during a Nursing Orientation is pretty damn reflective of how we are treating our patients….and of how our Leadership is treating us.

Nursing Orientation is all about establishing a relationship with a new employee. A new employee, mind you, that will make a decision to stay or go in the next 6 months. Make a decision to leave as difficult as possible for your new Mates by creating a bond of love, support, respect and friendship from the very beginning.