An Orientation Experience: Introducing Newly Licensed Nurses to Ambulatory Care Settings

Abstract

This project aimed to evaluate the impact of an orientation program on retention and clinical confidence of newly licensed nurses hired in ambulatory care settings. Twenty-three percent of newly licensed nurses leave their first employment within one year, based on inpatient hiring data, causing a financial strain on health care organizations and a profound effect on quality outcomes and patient experiences. Newly licensed nurses are not typically hired into ambulatory care settings and orientation programs are not geared towards this population; therefore, the negative impact on retention, finances, patient experiences, and quality outcomes can be substantially greater than in other practice areas. This quality improvement project focused on implementing an ambulatory-specific orientation program using a prospective longitudinal design across multiple sites within one healthcare entity. A 12-week orientation program was implemented and provided 17 newly licensed nurses the opportunity to rotate every two weeks through 22 clinic settings; part of a larger health system. An evidence-based survey tracked clinical confidence over 12 months. Engagement sessions were incorporated into the project to provide additional support to the newly licensed nurses. At the end of one year, 12 newly licensed nurses remained employed in the ambulatory care setting, and overall turnover was one percent less in this setting for newly licensed nurses (18%) when compared to turnover for newly licensed nurses in the health system (19%). The survey data recorded a steady increase in clinical confidence during the newly licensed nurses’ first year of practice. Designing a 12-week orientation experience in an ambulatory care setting can improve newly licensed nurse retention and clinical confidence. Incorporating engagement sessions provides insight into what is essential to newly licensed nurses.