Pilot Project: Transforming Nursing Orientation in an Intensive Care Unit Using the Training Within Industry Concept
CCCF ePoster library. Orlicki C. Oct 31, 2016; 150904; 26
Cynthia Orlicki
Cynthia Orlicki
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Topic: Education

Pilot Project: Transforming Nursing Orientation in an Intensive Care Unit Using the Training Within Industry Concept

Orlicki, C. Intensive Care Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada


Integrating registered nurses hired into a Level 3 Intensive Care Unit (ICU) who lack a background in critical care can be challenging. Presently at St. Joseph’s Healthcare Hamilton, an eight week orientation is organized to give new hires the required theory and practical clinical components. However, after several years of assessing the orientation process the clinical educator identified the following issues: the use of multiple mentors for one new hire, a lack of ongoing evaluation between the mentors and each new hire’s progress, inconsistent evaluation of the quality of the skills performed, and the inability of mentors to provide objective feedback regarding the new staff member’s clinical performance to the clinical educator.
The objective of this pilot project was to create a tool that could be used by the learner (new staff hire), multiple mentors, and the clinical educator that would have nursing skills clearly defined and objectively evaluated in order to provide continuity.
This pilot project employed concepts from the Training Within Industry program with regards to hands-on learning and practice. Using the Job Instruction Training Sequence, each skill required for entry into practice in the ICU was broken down into its major steps, key points, and rationale. Each skill also incorporated hospital approved policy and procedure references, best practice guidelines, and references to nursing procedure manuals. The tool created was called the Skill Development Timetable (SDT). The quality of skill performance was evaluated using the Bondy Nursing Scale.
Education was provided to mentors individually by the educator to ensure comfort with the new orientation program. 
New staff appreciated the tool since it provided clear information on the skills they needed to master during the orientation period, the level of performance they needed to achieve and the objective criteria they would be evaluated on. In turn, mentors were happy to be able to review the tool before mentoring and be able to plan their days and ongoing education with each learner.
The clinical educator was able to review the SDT at any time to follow the progress of the learner and mentors, offer suggestions for identified learning gaps, and discuss the need for exposure of skills in simulation or practice to ensure all required skills were experienced at some level. 
During orientation the quality of skill performance and obtaining objective feedback from multiple mentors can be problematic. The Skill Development Timetable was introduced to establish clear performance criteria for new staff and mentors in order to enhance skill mastery. The Bondy Nursing Scale has proven to be an excellent tool to evaluate skill performance in a consistent manner. Future use of the SDT could be expanded to assist in the evaluation of ICU nurses no longer on orientation requiring additional education around skill mastery.   


Bondy, K. (1983). Criterion – referenced definitions for rating scales in clinical evaluation [Electronic version]. Journal of Nursing Education, 22, 376-38.

Narusawa, T. & Shook, J. (2009). Kaizen Express: Fundamentals for your lean journey. Cambridge, Massachusetts: Lean Enterprise Institute, Inc.

NSW Health, Nursing and Midwifery Office – Transition to Intensive Care Steering Group Report December 2007 (2008). Retrieved October 19, 2015, from http://www.health.nsw.gov.au/nursing/projects/Documents/trans-icu-jan08.pdf.

Quick Guide 'Bondy Assessment'. (2007). Retrieved October 19, 2015, from http://federation.edu.au/__data/assets/pdf_file/0010/52489/Bondy_Assessment_2007.pdf.

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