Document Type
DNP Project
Department
School of Nursing
Date of Degree
Spring 2025
Degree
Doctor of Nursing Practice (DNP)
Primary Advisor
Dr. Laurie Posey, Ed.D
Keywords
Tiered skills acquisition; Married state preceptorship; Skills-layered orientation; Staged orientation; New graduate nurse
Abstract
Background: Challenges to transition to practice highlighted the need to improve orientation for new nurses. Research supports a tiered skills acquisition method to increase confidence, improve clinical judgement, and better prepare new graduate nurses for Emergency Department (ED) challenges.
Objectives: The purpose of this quality improvement project was to implement and evaluate a new orientation program in the ED at two hospitals by introducing tiered skills acquisition orientation for new nurse graduates to optimize their confidence and clinical judgment in caring for a full assignment of patients, and to increase the efficiency of the orientation process.
Methods: A quasi-experimental design with parallel comparison groups was used to compare program outcomes (i.e., orientee’s self-assessed confidence, preceptor assessments of clinical judgement, orientation duration, and orientee and preceptor perceptions of the programs) from the tiered and traditional methods of orientation.
Results: Descriptive statistics were used to analyze all variables. Tiered skills acquisition method participants had improved clinical judgement and confidence as compared to the traditional participants. A two-tailed t-test used to compare the duration of the orientation of the control and intervention groups found there was a statistically significant decrease (t=2.18, p<0.01) in orientation duration with the tiered skills acquisition method. Most preceptors preferred the tiered skills acquisition method over the traditional method.
Conclusions: The use of the tiered skills acquisition method for orienting new graduate nurses can help increase confidence and improve clinical judgement in caring for a full assignment of patients while increasing the efficiency of the orientation process.
Implications: Changing the orientation method may reduce attrition among new nurses by better equipping them to care for a full assignment of ED patients, while decreasing funding needed for orientation.
Copyright Notice
©2025 Claire Gonder. All rights reserved.
Recommended Citation
Gonder, C. (2025). Improving Emergency Department Orientation with Implementation of the Tiered Skills Acquisition Method. , (). Retrieved from https://hsrc.himmelfarb.gwu.edu/son_dnp/171
Open Access
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