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Implementation of Self-Directed Clinic Orientation
Joan Randall, MS, RN, NEA-BC; Kim Vonhaden, BA, RN; Rose Garcia, BSN, RN
Background
New employees should be assured that they will be
supported and provided a complete and thorough
orientation to insure that they are successful in their new
role. The reality is with limited resources and no
standard clinic process or program for preparing current
staff to mentor new orientees, providing a
comprehensive orientation is challenging and incomplete
only to identify deficiencies later when errors occur or
incompetence is identified. Additionally, hiring of new
graduate LVNs was growing as the resource pool of
experienced staff was limited. This added to the
challenge of orienting to clinic policy/procedures and
daily routines, but also having to assess and train basic
clinical skills to new graduate nurses. EMC ambulatory
clinics have one nurse educator with 3 days of organized
group orientation to cover required regulatory training.
New employees are then sent to individual clinics for any
further orientation.
Purpose
The purpose of redesigning the clinic orientation was to
develop a standard process that flows well with a busy
ambulatory clinic and provide a more effective learning
environment. Strategies implemented were based on self-
directed learning and strengthening the new orientees self-
efficacy in optimizing this learning period and engaging them
in the process to enable them to quickly assimilate into the
clinic role with confidence, competence and be a productive
team member.
Triggering Issues
• Current ineffective and fragmented orientation process.
• No training for preceptors.
• Preceptor role undefined.
• Individual learning styles not considered.
• No accurate competency assessments.
• Multiple staff used to train with inconsistent feedback.
Do
• Standardize self-directed orientation workbook.
• Develop physician “preference” cards.
• Define preceptor role.
• Train preceptors.
• Consider individual learning styles.
• Identify key feedback time points.
• Standardize key benchmarks.
• Evaluation – preceptor and new hire.
Plan
New hires will receive a New Hire Handbook and be
introduced to their trained preceptor. Preceptors and
orientees will work closely together for 90 days following
expected competency measurements and documenting
completion. New orientees are given notebooks to take
notes and use for future reference. Regular scheduled
assessment and evaluation by clinical manager with new
hire and preceptor to provide feedback and guide in
adjusting the learning experience to reach expected
targets. Each clinic developed individual “physician”
preference cards outlining the unique rooming/
procedure setups for each of the primary care physicians
that a new employee might support on any given day.
New orientees complete a Learning Styles Inventory to
help guide preferred teaching method.
Eisenhower Medical Center
George & Julia Argyros Health Center
Clinic Division
Nursing Orientation & Competiencies
Check
• Pilot orientation process implemented in one clinic
December 2015-March 2016.
• Four employees completed new orientation process.
• RN Clinic Manager identified learning deficiencies
early in orientation with one new employee and
adjusted orientation process to address deficiencies.
• New hires rated “structured self-directed orientation”
favorably.
• Preceptors rated new process favorably with continuity
of interactions with new employee and ability to follow
up with them to reinforce learning.
Act
• Two additional clinics have developed physician
preference cards using standard template.
• Managers increased scheduled feedback time points
with preceptor and new orientee during pilot and will
adjust orientation plan.
• Utilize huddle to identify learning opportunities that day,
ex. procedures, injections, etc.
• Implement standard work flow (rooming patients,
nursing visits).
• Develop scenarios to learn in EMR training environment.

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