RN Orientation Pathway
Pathway Tool For Orienting Nurses To Home-Based Care
In 2019 ElevatingHome & VNAA convened a series of leadership forums to discuss challenges to recruiting and retaining registered nurses to provide home health and hospice care. In the summary report, “New Graduates in Home-Based Care,“ ElevatingHome & VNAA noted a surging need for home-based care and increased demand for talented individuals to provide clinical care. Home care leaders identified orientation of home care nursing staff as a critical strategy for effective recruitment and retention of both experienced and new graduate registered nurses (RNs).
This module of the Blueprint for Excellence offers best practice tools to guide orientation of nurses new to homecare and hospice practice. Successful orientation programs correlate to greater satisfaction in practice and to nurse retention. The caliber of an agency’s orientation plan can heavily influence nurse candidates, particularly those making the transition to home care from inpatient services or as newly licensed professionals.
The ElevatingHome & VNAA RN Orientation Pathway draws from tools in use by high performing agencies. The tools were adapted by an expert work group to reflect best practices. Used together, the tools are part of a multi-modal orientation that takes place as a continuous process, with checkpoints and validation throughout the process. Four key components of orientation are Experiences, Skills, Standards and Coaching. The tools are aligned with home care nursing standards of practice and build on the premise that strong, versatile, competency-based orientation programs based on evidence and measured over time will reduce the risk of nurse vacancy and turnover. At completion, RNs are given responsibilities that align with their readiness.
The tools offered on this page are adapted from orientation programs developed by ElevatingHome & VNAA members. ElevatingHome & VNAA acknowledges the important contributions of these agencies, as well as the individuals to contributed to adapting the tools for industry-wide use.
VNAA Recommended Best Practices:
Best Practice: Develop a comprehensive orientation that includes self-learning, classroom time, skills demonstration and observations of the orientee in practice. VNAA has developed a tool to guide orientation of nurses new to home care that can be customized to fit specific agencies.
Best Practice: Establish expectations for engagement with the new nurse, for example, daily preceptor engagement, weekly supervisor meetings and regular checkpoint and coaching meetings.
Best Practice: Ensure that the preceptors / mentors providing training to new nurses also have training and support themselves.
Best Practice: Each agency should identify critical skills and other proficiencies that must be mastered before the nurse practices independently in the home, as well as other necessary skills that could be mastered after the initial orientation period.
Best Practice: Use checklists and other tools to document needs and proficiencies of new staff, ensuring competency before the nurse practices independently in the home.
Best Practice: Incorporate weekly collaborative ‘check-in’ meetings to ensure that orientees are making progress, identify barriers to independent practice and support new nurses with problem solving.
Best Practice: Supplement the direct preceptor relationship with coaching by agency leaders or supervisors designed to guide new nurses in developing critical thinking and skills needed to thrive in home care.
Best Practice: Demonstrate the engagement of the agency’s leadership by having leaders participate periodically in visits or check point meetings with the new nurse.
Best Practice: Incorporate a staff experience survey into the agency’s self assessment process to proactively identify factors that could impact recruitment and retention of new and seasoned staff.
The VNAA RN Orientation Pathway Tool is a set of downloadable, customizable checklists to guide and document orientation of RNs in home care. The Pathway Tool should be customized for the specific populations care for and skills needed by the agency.
Download the Combined Customizable RN Orientation Pathway Tool Here: The Pathway incorporates four elements of orientation:
- Orientation Experiences Checklist: Recommended elements of the 'orientation experience' the agency will set up for nurses new to the organization - the who, what and where of the organization
- Skills Checklist: A customizable checklist of critical clinical skills in home care nursing
- Standards of Care Checklist: A checklist of IHCNO standards of practice for home care RNs, with competencies underlying the standards. This tool is used by the preceptor/mentors and supervisors to verify that the nurse adheres to standards of care.
- Coaching Encounter Checkin tool: A guide for regular checkin meetings used to offer coaching and mentoring to support the nurse in mastering essential elements of home care
Download the Combined Customizable RN Orientation Pathway Tool Here
Standards of Practice
- International Home Care Nurses Organization and IHCNO International Guidelines for Home Health Nursing (free)
- American Nurses Association Home Health Nursing: Scope and Standards of Practice (2nd edition) (for purchase)
- ANCC Magnet Recognition Program® - guidelines to recognize organizations that value nursing talent
LeadingAge Workforce Resource Center - the LeadingAge Center for Workforce Solutions features workforce resources for older adult services.
Commercial Solutions (not endorsed by ElevatingHome& VNAA)
- Elsevier Mosby’s Orientation to Home Health Care
- National Leage for Nursing: Coaching for Excellence in Nursing (fee based course)
- Versant Healthcare Competency Solutions
- Tips for Coaching New Nurses (hospital based)
- Vanderbilt University Medical Center: Nurse Educator Resource Center (hospital based model may have elements relevant to home care)