Pioneering an Innovative Approach for New Graduate Emergency Department Orientation

Purpose:
With an Emergency Department (ED) turnover rate for RNs at 69%, this urban, level 1 trauma center developed and implemented a unique custom designed orientation program that focused on retention for 30 new ED graduate hires.

Significance:
It's predicted that the current nursing shortage will continue, resulting in a shortage projection of ~340,00 RNs by 2020. Therefore, it remains critically important to recruit new nurses and retain experienced RNs, particularly in workplaces with high turnover rates, such as hospitals.

Strategy and Implementation:
Our creative 6 months orientation was designed to expand the knowledge & skill sets of new nurses so they may be successful working in an ED. The orientation has 4 components: attendance at weekly ED physician Grand Rounds; special class sessions geared towards types of patients & situations they may encounter in the ED; hands-on pieces encompassing growth & development, nursing skills, & critical thinking; and ends with a new program called Home Stretch. Home Stretch allows the orienting new grads to provide nursing care in a team setting, work independently (with preceptor supervision), initiate bedside rounds, gain experience in trauma care, & ensure goals of orientation are completed. Other components include orientation time in ICUs & Pediatric ED, helicopter ride-along, hospital-wide shadowing, & participation in hospital RN Residency program. Post-orientation interviews and surveys were conducted to all graduates of the program immediately following their orientation program.

Evaluation:
Turnover has decreased from 69% to 16% for 2010 due to our new graduate orientation program. 84% of RNs who did the survey feel their success as an ED RN was directly r/t orientation. 100% of the RNs continue to work in the ED setting. 22 of 30 new grad RNs remain employed within this particular ED.

Implications for Practice:
This successful, innovative new grad ED orientation program may be replicated at other same setting organizations. There were no additional costs involved in this orientation program to the ED or the organization.