79 - Building Competence: A Tiered Orientation Model for Perioperative Nurse Success

Description: The Operating Room (OR) presents a uniquely complex environment for new Registered Nurses (RN), often marked by inconsistent onboarding and overwhelming educational demands. To address these challenges, the hospital organization Surgical Service line developed a system-wide team of OR Education Leaders, Educators, and Perioperative Operational Leaders who collaborated to design and implement a tiered, building block orientation model across 28 hospitals. Guided by a Curriculum Specialist in collaboration with a team of perioperative education leaders, this initiative aimed to streamline onboarding, enhance knowledge retention, and reduce less than one year turnover in perioperative nursing, fostering long-term retention.

The model was developed through a comprehensive review of existing orientation practices, including modular learning, hybrid instruction, and informal staff-led training. Drawing from diverse perioperative settings, ranging in specialty, trauma designation, and facility size, the team created a flexible framework that guides learners from foundational skills to independent practice. Specialty-specific training is introduced after core competencies are established, ensuring a balanced and manageable learning experience. By focusing on foundational onboarding first, the model ensures learners build core competencies before progressing to specialty-specific training, which may then be customized to reflect the unique workflows, case types, and operational needs of each individual site.

Implementation began with a phased rollout targeting new nurses, particularly those with less than one year of experience. The model standardized core OR orientation competencies including scrub orientation, introduced interactive virtual modules, and transitioned documentation from paper to electronic formats to promote learner engagement and consistency. Tiered skill labs offered progressive, hands-on training with OR technologies, enabling learners to build critical thinking and technical proficiency in a controlled environment before applying those skills in live surgical settings. These labs are integrated throughout each stage of the tiered orientation model, reinforcing key competencies as learners advance through successive levels of training.

An analysis of RN turnover among nurses with less than one year of experience was conducted at nine pilot sites that implemented the new orientation model in December 2024. To assess the impact, turnover data from 2025 Quarter 1 (post-implementation) was compared to the same period in 2024. Results showed a decrease in turnover, dropping from 4.72% in Quarter 1, 2024 to 2.19% in Quarter 1, 2025. Staff satisfaction and retention in the OR have improved, and orientation time and resource use have decreased. While these early results are encouraging, future turnover metrics will be evaluated as well as onboarding satisfaction feedback as the model continues to mature.

This ongoing initiative is centered on continuous improvement in perioperative nurse onboarding. Future goals aim to develop specialty-specific orientation tracks through evaluation of post-onboarding surveys assessing nurse satisfaction and preparedness, and retention data. These tracks are designed to meet the unique needs of individual sites, ensuring the onboarding process remains adaptable, scalable, and aligned with current best practices in perioperative education.