167 - Elevating OR Orientation to Onboarding: Strengthening Engagement and Safety

Description: Description of team
A nursing team was formed with leadership, surgical team, and nursing educator to elevate the current intraoperative orientation program to a comprehensive onboarding program.

Preparation and planning
Following the pandemic, staffing challenges revealed a decline in intraoperative nurse retention and a rise in new graduate hires. The objective of this project was to elevate the existing orientation program into a comprehensive onboarding experience to improve nurse retention, team engagement, and quality. This initiative emphasized a bi-directional support model, ensuring that new hires receive both guidance and opportunities to provide feedback, thereby strengthening team cohesion and patient safety.

Assessment
The previous program consisted of a fixed schedule per surgical service specialty, daily preceptor feedback forms, online Association of periOperative Registered Nurses (AORN) Periop 101 curriculum, and an 8-week scrub school at a local college. Identified gaps included the lack of a flexible schedule, real-time competency tracking, observation days, and routine bi-directional feedback meetings.

Implementation
The new onboarding program introduced a standardized, feedback-driven approach to help new nurses build clinical knowledge, gain hands-on experience, and enhanced interdisciplinary collaboration. It retained core components such as the AORN Periop 101 curriculum, organization standardized education, and an 8-week nursing scrub school. The surgical specialty resource (SSR) nurses from each service line were responsible for the daily preceptor feedback, completing the standardized competency-based checklist, and offering recommendations for progress to the new hires. Additionally, new hires met with intraoperative leadership and gave their feedback into their own orientation. This removed a fixed orientation schedule and allowed for nurses to progress when it was safe to move forward in the program. It also allowed leadership to intervene sooner if a nurse was not progressing to determine next steps. The program encouraged open communication, tailored orientation schedule based on progress, and supported better performance through the onboarding program.

Outcome
After implementation, team engagement in Culture of Safety survey increased by 33% from 2024 to 2025. Teammate survey scores improved in professional development (51.67% to 60.42%), adequacy of resources and staffing (34.44% to 40.28%), and overall safe care assessment (58.3% to 60.7%). Retention also improved from 85.54% in 2024 (with 3 new nurse hires leaving within 1 year) to 94.10% in 2025 (with no new nurses leaving within 1 year).

Implications for perioperative nursing
A structured perioperative onboarding program enhances clinical readiness, professional growth, and patient safety by supporting early integration into the surgical team. This initiative aligns with the AORN Guidelines for Perioperative Practice, specifically those addressing Team Communication, Orientation and Competency Assessment, and Safe Patient Handling and Movement. Standardized education, competency checklists, and bi-directional feedback promotes consistency, collaboration, retention, and fosters a culture of safety. Additionally, reducing turnover, the program also lowers the high cost of perioperative nurse recruitment and onboarding, which can go as high as $120,000 per nurse.