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Chapter 17: Measuring evidence-based learning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87Level 2: Learning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87Measuring preexisting learning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87Chapter 18: Measuring application of knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91Level 3: Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91Chapter 19: Measuring results or impact . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .95Level 4: Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .95Chapter 20: Measuring return on investment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .97Level 5: Return on investment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .97Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .97Nursing education instructional guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .99Nursing education exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102Nursing education evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111Designing Nursing Orientation: Evidence-Based Strategies for Effective Programs 2006 HCPro, Inc.v

C HAPTER1The evolution of orientationOrientation is so much a part of staff development practice that it is difficult to believe that theprocess as we know it today has been in existence for only a few decades. How was the need for orientation first recognized? How do changes in healthcare provision influence the orientation process?Early daysFlorence Nightingale established training schools for nurses in the mid-1800s for the purpose ofimproving the efficiency of patient care delivery in hospitals. She advocated that nurses embark on ajourney of lifelong learning and use acquired knowledge and skills to improve patient care.(1)These early schools of nursing were affiliated with hospitals. Nurses learned the art and science ofnursing on patient units, and the hospitals were staffed primarily by students of nursing. Upon graduation, most nurses left the hospital setting and earned their living as private duty nurses in privatepractice.Because the majority of care was provided by nursing students and few professional nurses were hiredby the hospital, orientation was not a high priority.However, all of that changed with the Great Depression of the 1930s. The number of people able toafford the services of private duty nurses decreased dramatically, and, for the first time, large numbersof graduate nurses sought work in the hospital setting. This shift in practice setting triggered the needfor a variety of staff development services(1).Designing Nursing Orientation: Evidence-Based Strategies for Effective Programs 2006 HCPro, Inc.3

Chapter OneNewly hired nurses needed to be oriented to hospital routines, policies, procedures, and equipment.They also needed to learn to function as team members who were responsible for large numbers ofpatients, rather than as nurses in private practice, who seldom cared for more than one patient at atime. Orientation and inservice were generally provided by charge nurses, and on-the-job trainingwas the rule rather than the exception.Changes continued to take place rapidly in the healthcare arena. During both world wars, professional nurses left the hospital setting in large numbers to enter the armed forces, and the numbers ofnon-professional staff increased to ease the effect of the departing nurses. This increased the need fororientation, continuing education and training for all healthcare providers.Emergence of staff development departmentsHowever, it was not until 1953 that the Joint Commission for the Improvement of Care of thePatient proposed that a department devoted to the training and continuing education of nursingdepartment employees be established (1). Orientation was a top priority of training and educationdepartments, with members of such departments assuming the primary responsibility for the orientation of new employees, including precepting their clinical work.In 1978, the Joint Commission on Accreditation of Hospitals mandated that a position to overseeand coordinate staff development activities be established in its affiliated hospitals (1). Training andcontinuing education (staff development) were becoming legitimate nursing specialties.Throughout the final decades of the 20th century, rapid advances in technology and the prevention,recognition, and treatment of disease and injury made continuing education and training a vitalnecessity. Adequate orientation to an organization and job responsibilities assumed even greaterimportance, and accrediting bodies such as the Joint Commission on Accreditation of HealthcareOrganizations (JCAHO) established standards for the provision of new employee orientation.Eventually, these standards included mandates that employees assuming new roles also receive orientation, whether new to the organization or not. Further, the skills and knowledge required for various nursing specialties made it impossible for staff development specialists to provide all facets oforientation, and the preceptor role evolved.4 2006 HCPro, Inc.Designing Nursing Orientation: Evidence-Based Strategies for Effective Programs

The evolution of orientationChanging role of the staff development departmentAs the need for education and training expanded, so did the responsibilities of the staff developmentdepartment and its staff members. The “nursing staff development department” grew in scope andpractice in many organizations to include responsibilities for all employees, not just for those in thedepartment of nursing. These responsibilities included some facets of orientation, such as mandatorytraining and customer service education. The titles “nursing staff development department” or“nursing education department” changed to “professional development department,” “organizational development department,” or “education department,” thus reflecting the changes in authorityand responsibilities. Managers of such departments assumed titles such as Director of Education orVice-President for Education.Periodic shortages of qualified healthcare professionals, combined with the ever-changing knowledgeand skill base required of such professionals, triggered ongoing orientation concerns. The need forfaster and more efficient orientation programs surfaced and continues to plague staff developmentspecialists. “Orientation-on-demand” became the expectation of managers and administrators alike.Expectations of the orientees changed as well, and they continue to change.For the first time in history, four different generations are represented simultaneously in the workplace. Younger employees expect flexibility in their work schedules (including education offerings)and are comfortable using computer technology to meet their learning needs. Some employees preferto learn in solitude, while others need the camaraderie and team-building approach of face-to-facelearning. Compound these differences with basic variations in learning styles (e.g., visual, auditory,kinesthetic), and the staff development specialist faces a multitude of challenges that, at times, seeminsurmountable.However, despite these considerable challenges, it is an exciting time for staff development specialists. We are recognized by many as essential to the organization’s ability to hire and retain qualifiedprofessionals and as vital to the provision of quality patient care.Designing Nursing Orientation: Evidence-Based Strategies for Effective Programs 2006 HCPro, Inc.5

Chapter OneReference1. Avillion, A. E. (2004). A Practical Guide to Staff Development: Tools and Techniques forEffective Education. Marblehead, MA: HCPro, Inc.6 2006 HCPro, Inc.Designing Nursing Orientation: Evidence-Based Strategies for Effective Programs

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Chapter One 4 Designing Nursing Orientation: Evidence-Based Strategies for Effective Programs Newly hired nurses needed to be oriented to hospital routines, policies, procedures, and equipment. They also needed to learn to function