Recently, the Medical University of South Carolina (MUSC) Perioperative Services realized they had a problem: their newly hired nurses were not happy with the orientation process, and didn’t feel well-prepared to function on their own afterward. In order to re-orient OR orientation to meet their staff’s needs, perioperative leadership formed a Performance Improvement (PI) team, led by Tim Brendle and Stephanie O’Driscoll and made up of team members Monica Sallis-Nelson, Christy McEachern, Sonya Spruill, Danielle Hostler, and Monica Dunn.
The team began by surveying newly hired OR nurses, experienced OR nurses, and nurse preceptors to find out what they liked about orientation, and what they thought could be improved. The team used a number of brainstorming tools, including a “5 Whys” analysis and vertical Affinity Diagram to help enumerate their main root causes for the orientation problems:
· The current orientation format (computer-based learning modules) was not hands-on
· Many new nurses had no experience in the OR, and the module content did not make sense without a real-world reference point
· The orientation rotations were too short to give new hires experience in all of the surgical service lines at MUSC
· The final orientation exam occurred in the middle of orientation, rather than at the end, and did not include a practical (hands-on) component.
Based on these root causes, the team drafted corresponding solutions, including more hands-on practice to go with all didactic education content, starting clinical rotations and shadowing earlier in the orientation timeline, and adding a hands-on component to the final exam, which now takes place at the end of orientation.