Training New Nurses When You Are New Yourself

Training new nurses when you are new yourself is one of the most common scenarios that nurses face in the workforce. After all, with the current rates of turnover and the number of new grads most departments are taking on, you may very well be one of the most senior nurses in the department. So, how are you supposed to train a new nurse when you are still learning yourself? Although it is not an ideal scenario, there are some tips that can help you set a strong foundation for your orientees. Showing your orientees how to find the answer and troubleshoot, assert themselves, and interact effectively with a team is 90% of the battle of being successful in the OR.

Roleplaying, Resources, and Education

No matter your experience level in the OR, you will always be learning. No surgery is routine, and this is one of the best lessons for your new hires. You will need to teach them how to be comfortable with being uncomfortable. After each orientee experiences a few cases that follow the anticipated course, you should talk through their mental checklist of tasks they need to accomplish for each procedure. The orientee should begin to establish a flow and independently go through the basic process of things like transferring the patient over to the OR table, placing sequential compression devices, and hooking up the equipment. As they master each skill, you should provide feedback in the moment, including what they are doing well and how to improve their practice. Then, you can continue to slowly add on new, more complex skills and have them practice the new skills with your support and direction, both of which will help them continue to build independence. 

It will be critical to go over how to page specialty teams, where the phone list is kept in the room, and the mental process when prioritizing tasks. (Of note: verbalizing these things also helps to improve your own practice by bringing to light any gaps in knowledge.) To help solidify your teachings, you should go over possible scenarios related to your cases, discuss what your orientee would do, and physically walk through the processes. After the resources are laid out, it will be essential to role-model expected behavior. This is true even when you don’t know the answer. When this occurs, you should remain calm and walk them through the process of finding the answer.

You should set aside an hour each week to provide education to your orientee (this is in addition to any weekly departmental in-service meetings). These education sessions provide time to solicit their feedback and simulate high-risk, low-volume events. You can start roleplaying scenarios when cases don’t go as planned; abdominal hemorrhages, airway emergencies, and malignant hyperthermia crises are a few examples of situations to simulate or roleplay. You also can share personal anecdotes to help relate to their experience and leave a lasting imprint on their practice. 

You will need to show your orientee how to assert themself and interact effectively with a team. Much of this is achieved through effective communication techniques. To confirm accuracy, you should instruct your orientee to repeat back any verbal orders they receive using closed-loop communication (ie, acknowledging that they received the information and verbally clarifying with the sender that the information received is what they intended). To help to build a strong rapport with the team, they also should be instructed to debrief with the team about what went well and aspects of the case that could use improvement.

Teaching in Action

One personal example of my teaching in action occurred during a debrief about my orientees' day. One orientee began to talk about a laparoscopic case that had not gone as planned and had to be converted to an open procedure. I began a discussion and prompted the team with questions, such as

• What are some indications that the team may have difficulty entering the abdominal cavity?
• When is it a good time to step away from the field and begin charting?
• What are some things you may hear that could indicate the team may need to convert to an open procedure?
• What additional items do you need to open to the field? How should you prioritize these items?
• Who do you call if you need help? Where do you find their numbers?

After having an open discussion, we simulated this in the lab. Everyone was assigned a role as a member of the surgical team, and we worked through this scenario with each team member taking a turn as the RN circulator. We physically moved through the motions of a conversion of a laparoscopic procedure to open. The following day, one of the orientees involved in this training had a laparoscopic case emergently convert to open and was able to recognize the early signs and preemptively acquire the appropriate supplies and instrumentation needed.

AORN Resources

Open access:

• AORN Position Statement on Orientation of the Registered Nurse and Surgical Technologist to the Perioperative Setting
• 6 Precepting Pearls for Onboarding Success - AORN Article
• 3 Precepting Tips for Priority Onboarding - AORN Article
• Your Practice: 12 Tips for New Preceptors - AORN Periop Today Article
• 5 Ways to Create Connections for New Periop Hires – AORN Article

AORN members can access:

• Tips for Being an Effective Nurse Preceptor - AORN Journal