Talk to me about orientation

[KateRN1]

I am investigating a complete revamp of the orientation process for our field staff. Tell me what elements you think are critical to orientation for a home care nurse (Medicare intermittent visits), whether you're an old pro or a greenhorn. I have my own ideas, but I can't come up with it all on my own. I need fresh ideas from people in other situations who can think outside the box--or simply within a different box. Forget the usual how to operate the computer system and tell me what kind of training/education is needed in the field. Give me your "orientation wishlist," both from the point of view of the new hire and the preceptor, please.

[HealthyNurse]

This is not technically "in the field" orientation, but what I found from working in the role of a home health educator is that having a course that includes an overview of home health services, Medicare regulations, and PPS is very important. Even nurses who had been working in home care for years can benefit from getting this information in one place rather than having to piece it together. In the field, a good overview of case management and what it entails is very helpful. Also, a good explanation and demonstration of the OASIS walk and how to collect and answer OASIS items is key.

[annaedRN, RN]

I've been precepting for awhile now. For the most part I enjoy it and have a fair amt of support from my supervisors. I've found that the first 2 days are mostly shadowing, then it works well to start with visits and the day to day stuff, then move on to the OASIS training and then lastly case management. Trying to see where the strength and weaknesses of each new employee lies - compiling a list of skills that need to be checked off on (IV, vacs, ostomies, etc). I usually have them about 3 weeks before they start doing visits independently, still meeting up for OASIS stuff. Biggest obstacle is that I am a case mgr too, and often my schedule cannot be lightened up sufficiently to allow me time to go over all of that HH specific stuff - like the forms, how Medicare works/requirements, etc. That leaves the new employee having to call with each new situation...which is ok, but not ideal. I realize there is no way that you can cover all of the different scenarios during orientation, but more time and education sets them up for success rather than failure.

I would like to see some extra time for new employees to do OASIS training, spend time with other disciplines, have a day with intake to learn how the how whole thing starts, etc. I do have a lot of handouts to give them as references but seeing how things happen and learning the regs from the office point of view is helpful - makes it easier to do if you know WHY it needs done. Normally though, once someone is ready to start seeing patients, it is hard to make time for them to orient in the office because they are needed in the field. Anyway, could probably think of a bunch more...but I am on call and have to head out here shortly. Let us know what all you come up with

[caliotter3]

For a person new to hh, no less than one week going with a seasoned visit nurse. By day 5, the orientee should be doing the work with critique from the precepting nurse.

[Susan317]

I think everyone should be given a mentor and follow them for at least a week.

[4evernrs]

One thing that I insist on with our orientees, is that their training be initiated on PAPER, rather than the computer. They have to understand all the necessary elements on paper before they know what to look for in the electronic chart. NOT that our orientation "program" is by any means a good one - we essentially just try to tailor it to each individual.

[Tender HH RN]

I completely agree 4evernrs. We actually are still dealing with paper forms because we are fairly new but we had a separate training to focus on paperwork. It took time, but we created documents that explained key areas to ensure the nurses fill out their paperwork correctly. We also gave general examples on common patients. We have only trained a few employees but they found it helpful.