ORIENTATION PROGRAM

for
NEW NURSES
in
EMERGENCY DEPARTMENT
 Outline
 Introduction
 Main Goal & Objectives
 Who Needs Orientation?
 The Importance of Orientation Program
 Preceptorship
 Orientation Program Development
 Orientation Program Schedule:
1. Scope of Service
2. Emergency Department Safety Orientation
3. Infection Control Policy
4. Professional/ Technical Skills
 Summary
 Introduction
Emergency Department (ED) is among those
professional arenas in the forefront of the nursing
Transition (Schriver J, et al 2003), it operates 24 hours a day, to
treat patients who are suffering from an acute illness, or
seriously injured; that may lead to severe complications if
not treated quickly (CSAHS, 2002).

Since Emergency Nursing is both fascinating and

challenging area in which to work, a comprehensive
orientation program for new nurses has to be accomplished
by a knowledgeable, well experienced nurse (Preceptor),
for a pre- designated period of time, according to the
characteristics of that new employee.
Orientation is a formal process to orient a new
employee about organization and the individual
place within the structure (Douglass L, 1997), Every
new nurse needs to be introduced to the work
environment and instructed in the performance
of specific tasks, the orientation is intended to
get the new employee off to a good start by
establishing a sense of belonging creating
welcoming work environment, supplying
necessary information that will answer his/ her
questions, and removing any uncertainties.
 Main Goal
To Provide New Nurses in the Emergency
Department with Orientation to Practice
Nursing in Keeping with The Hospital’s
Mission & Goals, Thus Increasing their
Awareness towards Work Safety & High
Standards of Care Provision in ED.
 Objectives
At the end of the orientation program the orientee
will be able to develop self-efficiency, & focused
continuous learning in order to function safely,
effectively and competently.
Moreover, throughout the orientation period the
orientee will be able to:
 Recognize the physical structure of the hospital & ED.
 Review goals, policies, & protocols of the hospital.
 Describe the organizational structure.
 Understand the communication process in the hospital.
 Identify functions of ED at the hospital.
 Objectives
 Be Competent with:
• Recognition, Recording and interpretation of signs and
symptoms of emergent and non- emergent adult and
pediatric patients.
• Initiation of BLS and ACLS for both adult and pediatric
patients
• Triage process in ED
• Parenteral administration of IV fluids, blood and blood
components, emergency drugs and substances.
• Safe and effective use of all electronic equipments.
• Recognition and intervention for life threatening
arrhythmias.
 Objectives
• Infection control, including aseptic technique.
• Management of wounds.
• Management of sepsis.
• Management of burns.
• Initial management of general trauma, spinal cord and head
injuries.
• Emergency delivery and initial care of the newborn.
• Initial management of overdose (drugs and alcohol), and
the withdrawal syndromes.
• Initial management of psychiatric emergencies including:
 The violent, homicidal, and suicidal patient.

 Management of grief reactions.

 Objectives
• Recognition and initial intervention of psychological
and social problems of patients & their families.
• Initial management of amputated parts.
• Knowledge of regional paramedic protocols.
• Recognition & management of the pediatric,
geriatric, & adult abuse/ neglect patient.
• Initial management of the sexually assaulted adult
and pediatric patient.
• Knowledge of emergency preparedness and disaster
plans
 Who Needs Orientation?
New graduates or experienced RN without ED
experience have not been exposed to any
emergency nursing content, nor have they had any
ED clinical experience in their nursing program
had been discovered, thus, nurses come to the
employer need preparation and education to
function at high level in busy emergency
departments (Emede K. 2003).
The Importance of Orientation Program
The Absence of Orientation Program will lead to:
 Increased Stress,
 Increased Disorientation
 Increased Self Missing
 Decreased Nurses’ Efficiency & Productivity
 Decreased Work Safety & Competency
 Increased Job Dissatisfaction,
 Diminished Retention
 Increased Turn Over
 Whose Responsibility?
It is the responsibility of the hospitals’
administrators, the director of nursing, the
supervisors, the preceptors & the nurse
managers, who must develop a strategy for
orientation in all hospitals’ departments;
including the emergency department, as it had
been proved it’s importance & necessity
 Preceptors’ Selection
The preceptors' group have to meet significant characteristics
and desirable qualities as follows:
a. Resilience and enthusiasm (Rudzik J. 1999),
b. Experience in emergency nursing at least for two years
(Alban A, et al 1999),
c. Demonstration of professionalism and knowledge (Rudzik J.
1999), (Ephron J, et al 1989),
d. Interest in precepting (Alban A, et al 1999) (Ephron J, et al 1989) (Meyer RM,
et al 2000),
e. Attendance at conferences on adult learning (Ephron J, et al 1989)
(Meyer RM, et al 2000) (Kidd P, et al 1999),
f. Attendance at classes or workshop for training preceptors,
including topics in effective communication, establishing
learning objectives, adult learning principles and
techniques for providing feedback for orientee.
Orientation Program Development
Since new nurses are expected to complete
an orientation program, that prepares them to
perform their assigned duties, the orientation
program should introduce this employee to
information, knowledge and skills essential to
effective performance, additionally; these
nurses should be checked for competency on
certain skills, knowledge, and equipments
needed for job performance.
 Orientation Program Schedule
The orientation program may be scheduled
for three months period (Probation period), in
order to allow new nurses to solidify their
emergency skills; including direct continuous
supervision and feedback from their
preceptors.
 Orientation Program Initiation
It's preferable that before initiation of
orientation program; the new nurse will fill the
emergency department training program
questionnaire (EDTP) (Zavotsky K. 2000) for assessment
and evaluation prior to commencing their duties:
as follows: (see next table)
Name: ______________________________________________
Unit currently working: ________________________________
Past RN experience: __________________________________

How would you describe your performance under stress?

___________________________________________________
How would you describe your ability to work with all members of
health care teams? ___________________________________
____________________________________________________
What type of patients do you most enjoy caring for? __________
____________________________________________________
What are some of your strengths as a nurse? _________________
_____________________________________________________
What are some of your weaknesses as a nurse? _______________
_____________________________________________________
 Orientation Program Schedule
Within four days (including training); the
preceptor and/or the director of nursing will explain
and review with the new nurse all the following:
A. Scope of Service
B. Emergency Department (ED) Safety Orientation
C. Infection Control Policy
D. Professional/ Technical Skills
 A. Scope of Service
1. Describe in details the services provided by the hospital
& its ED.
2. Introduce new nurse to other personnel:
 Identify and introduce co- workers.
 Identify/ introduce by name, title, and role other
personnel the new nurse will work with on a regular
basis.
 Identify other pertinent hospital personnel.

3. Familiarize new nurse with the hospital organizational

structure (use organizational chart):
 Identify new nurse’s immediate supervisor.
 Identify/explain other levels of supervision.
 A. Scope of Service
4. Review/ discuss/ explain performance management procedure and
plan:
 Discuss/ define new nurse’s role and responsibilities.
 Discuss performance evaluation process, to include competency
assessment.
 Discuss evaluation process.
 Discuss training requirements.
5. Review ED attendance procedures/ policy:
 Review work schedule, explain daily time schedule, reporting time,
breaks, meal breaks, signing in/ out procedures/ requirements.
 Discuss attendance expectations; calling in/ out notifying your
supervisor, requesting sick and annual leave time.
 Discuss overtime policies, procedures, and payments (if applicable).
 Discuss/explain and sign the work contract with new nurse. Form
should be signed by new nurse and supervisor on the 1st day and
returned to the Human Resources Manager at the same day.
 A. Scope of Service
6. Introduce new nurse to work environment:
 Familiarize new nurse with immediate work area.
 Familiarize new nurse with other areas where work may be
performed.
 Familiarize new nurse with extended work areas
 Identify emergency exits.
 Explain procedure/ responsibility for hospital security, looking up,
opening areas, lost keys… etc.

7. Discuss/ explain the importance of communication with clients:

 Greeting clients in a courteous, friendly manner.
 Providing clear, concise information and instructions
 Meeting the needs of the clients.
 Responding to customers concerns, complaints, and criticism timely.
 A. Scope of Service
8. Review/ explain hospital’s communication/ information
management systems:
 Review/demonstrate features of the telephone system
 Emphasize appropriate telephone etiquette and responsibility
 Review how telephone is expected to be answered e.g. - State

name, location…etc. “Ms. Linda, ED" Offer to be of

assistance, "May I help you?"
 Take/verify message (confirm/read back names).

 Emphasize responsibility for message being delivered

 Explain internal mail distribution system:

 Explain external mail distribution.
 Locate copy & fax machines for use (if applicable)
 Emphasize the use of phones, copy, personal computers, and fax
machines
 B. Emergency Department (ED) safety orientation
1. Review procedure for announcing an emergency;
(employee may demonstrate):
 Review/demonstrate how to call a code
(Blue/Red/Yellow)
 Demonstrate what to say when announcing an
emergency
 Demonstrate how to cancel an emergency
 Review emergency phone numbers as listed
 B. Emergency Department (ED) safety orientation
2. Identify/explain components of fire safety system:
 Locate fire alarm box; employee demonstrate use.
 Locate fire extinguishers (different types as necessary.)
 Locate sprinklers, smoke detectors.
 Locate/explain building evacuation plan.
 Review staff responsibilities during a fire emergency.
 Discuss evacuation procedures for fire drills.

3. Review Roles/ Responsibilities in Emergency Action (Disaster)

Plan:
 Location of emergency preparedness manual.
 Identify new nurse’s role in emergency actions plans.
 Locate environmental emergency plan, locate safe areas.
 Review responsibility during fire emergency.
B. Emergency Department (ED) safety orientation
4. Review information on Hazardous Material Management
 Locate/demonstrate use of Material Safety Data Sheets (MSDS)
 Review list and locate chemicals, stored/used in area
 Explain procedure for handling contaminated materials, if
applicable
5. Review reporting procedures for employee/ patient injuries:
 Discuss when to report.
 Discuss to whom to report.
 Identify location of Incident/ Accident report forms.
 Review worker’s compensation information and procedures.
6. Review emergency codes used in hospital:
 Code Blue, Medical Emergency.
 Code Red, Fire.
 Code Yellow, Assistance Needed, ASAP.
 Discuss employee's role/ responsibilities during codes.
 C. Infection Control Policy
Discuss/review Infection Control procedures, policies, techniques:
 Review the importance of Hand washing; focus attention on
posters located in bathrooms, kitchen areas.
 Review concept of Standard Precautions.
 Discuss when special precautions should be used.
 Discuss use of Personal Protective Equipment (Barrier Bag)
“PPE”.
 Discuss when to use PPE
 Identify location of PPE
 Discuss when and to whom Infections should be reported,
individual or employee infections, and Client infections.

Evaluation of the orientation program according to the evaluation

key: See Table 1
 D. Professional/ Technical Skills
(Adopted from Al- Makassed Islamic Hospital/ Jerusalem)

Skills Knowledge Item No.

Admission process: 1.
 Welcoming the pt. to
ER,
 Priority classification &
Triage,
 Does routine
investigation & Nursing
care
 D. Professional/ Technical Skills
Skills Knowledge Item No.
 Basic Nursing Procedures: 2.
e.g. Vital Signs
Others: …………………
 D. Professional/ Technical Skills
Skills Knowledge Item No.
General Nursing 3.
Procedures:
 Medications; oral,
IV.,IM...
 Specimen Collection;
urine, blood, swab…
 Doctors’ instructions
were carried out.
 Proper documentation.
 Proper communication.
 D. Professional/ Technical Skills
Skills Knowledge Item No.
Special Care: 4.
 Suctioning,
 N/G Tube Insertion,
 Bladder Catheterization
 IV. Insertion & Care,
 Blood Transfusion Care,
 Airway Application,
 Ambubagging,
 Dressing Care,
 Works properly with machines
 D. Professional/ Technical Skills
Skills Knowledge Item No.
Equipment Checking: 5.
 Emergency Bell,
 Defibrillators,
 Emergency Trolley,
 Suction Machines,
 O2 & Ambubags,
 Narcotics,
 Plaster Trolley,
 Ambulance,
 Others …………………
 D. Professional/ Technical Skills
Skills Knowledge Item No.
Certain Procedures: 6.
 Preparation of Pt. &
Equipments,
 Assisting Dr. with
Procedure/s
 Nursing Care post-
Procedure:
 Chest Tube,
 Lumbar Puncture,
 Cut Down,
 Suturing,
 CV line Insertion
 D. Professional/ Technical Skills
Skills Knowledge Item No.
Medication Protocol: 7.
 Knows the Medication,
 Prepares Medication &
Calculates the Dosage,
 Monitors the Pt. Post-
Medication (Side
Effects),
 Follow Special Nursing
Care for Medication
 D. Professional/ Technical Skills
Skills Knowledge Item No.
Emergency Protocols: 8.
 Recognizes Emergency
or Urgency,
 Knows How to Code or
Call for Help,
 Performs the Proper &
Needed Care Before
Emergency Team
Arrival,
 Works Efficiently & Fast
During Emergency.
 D. Professional/ Technical Skills
Skills Knowledge Item No.

Transfer or Discharge 9.
Process:
 Prepares Pt. Properly,
 Gives Proper Report,
 Teaches & Instruct Pt. &
Family,
 Communicate Properly
with Other Departments,
 Proper Documentation.
 Summary
At. the end, we can conclude that the
presence of orientation programs in ED will
increase staff efficiency, productivity &
creativity, in addition to work safety, increased
Job satisfaction, increased retention of nurses
& decreased turn over
 References
 Alban A, Coburn M, May C. (1999). Addressing the
emergency nursing staffing shortage: implementing an
internship using a nursing school instructor model. Journal of
Emergency Nursing 25: 509- 513.
 Central Sydney Area Health Services “CSAHS” (2002): The
Emergency Department. Available at: http://
www.cs.nsw.gov.au: Last updated: Jan 2002. (Accessed
06/10/2004).
 Douglass L, The Effective Nurse: Leader and Manager,
4th edition, Mosby, London, 1997.
 Emede K. (2003). A statewide ED nursing course for new
graduates or nurses without ED experience, Journal of
Emergency Nursing 29: No 5. Available at: http://
www.jenonline.org. (Accessed 19/10/2004).
 Ephron J, Andrea J. (1989). Collaborative university/
emergency student nurse preceptorship program. Journal
of Emergency Nursing 15: 116- 119.
 References
 Kidd P, Sturt P. (1999). Developing and evaluating an
emergency nursing orientation pathway. Journal of
Emergency Nursing 21: 521- 530.
 Meyer RM, Meyer MC. (2000). Utilization- focused
evaluation: evaluating the effectiveness of hospital nursing
orientation program. Journal of Nursing Staff Development
16: 202- 208.
 Rudzik J. (1999). Establishing and maintaining competency.
Journal of Intravenous Nursing 22:69- 73.
 Schriver J, Talmadge R, Chuoung R, Hedges J (2003).
Emergency Nursing; Historical, Current, and future roles.
Journal of Emergency Nursing 29: No 5. Available at: http://
www.jenonline.org. (Accessed 19/10/2004).
 Zavotsky K. (2000). Developing an ED training program;
How to “grow your own” ED nurses. Journal of Emergency
Nursing 26: No.5. Available at: http://www.jenonline.org.
(Accessed 19/10/2004).