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1 PICOT Research Name Institution Course Date

2 Introduction Nurses' qualification positively impacts patients as it increases the likelihood of receiving high-quality care from competent nursing professionals. New nurses need critical skills to perform their duties, whether to the unit or new to nursing. Who better to show them than a more seasoned nurse in that department? As a new burse to practice or new nurse in the department, there are different preceptorship weeks of practice, which they are entitled to, to be more nurse ready for critical thinking, time management, and patient care. Due to nurse shortages, new nurses are pressured to end their orientation early, or preceptors are utilized for other purposes at the same time they are to be orienting. Does this ultimately hurt the nurse and patient care or aid the nurse in meeting the bar set on the floor due to the nursing shortage? Due to nurses and consistency of orientation and preceptorship, it should ultimately end at the targeted date because one never knows what could occur in those days. Encouragement should not occur to end the orientation quickly due to nurse shortage. There is great need for excellent, critical-thinking nurses with time management skills and outstanding patient care. Qualities that are established to come with time, support, and collaboration. PICOT Question Seasoned nurses being new to emergency department unit (P), what is the effect of preceptorship to a more structured program (I) compared to a less structured program (C) effect current practice needs which is adequate (O) with less safety events occurring (T)? Background New nurses face challenges when transitioning from nursing school to the hospital environment. Clinical settings can be overwhelming, and new nurses require guidance and support to provide high-quality patient care. Nursing orientation programs aim to provide new

3 nurses with the necessary knowledge and skills to perform their roles effectively. However, nurse shortages have forced hospitals to cut short nursing orientation programs, which may negatively impact clinical outcomes. There needs to be more nursing professionals within the healthcare industry. Consequently, healthcare institutions are experimenting with novel strategies to attract competent healthcare professionals (Spiva et al., 2020). Newly hired nurses can demonstrate a positive attitude and the capacity to deliver high-quality care by participating in a meticulously designed and implemented orientation program. Hospitals must establish orientation programs and consistently evaluate, revise, and restructure them to maintain patient satisfaction. Nurses with advanced skills and knowledge can provide significant advantages to patients and fellow nurses. Conversely, it was discovered that nurses possess a considerable amount of aptitude. Participation in an orientation program can enhance general education, professional development, interpersonal competence, clinical judgment, and practical application of knowledge for nurses. Competency-based nurse orientation programs are designed to cater to the needs of inexperienced and experienced nurses ( Watkins & Neubrander, 2020) . Working conditions can enhance the tolerability of the work environment and promote a stronger sense of camaraderie among nursing staff. Consequently, enhancing nurses' morale leads to improving the quality of care they deliver. It is imperative to establish a comprehensive training framework at all tiers of an organization to educate newly recruited personnel on current systems, methodologies, and regulations. Hospitals face a substantial financial obligation to recruit and educate nursing personnel (Anders, 2021). Consequently, it is recommended that organizations explore strategies

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4 to improve their orientation programs to retain nurses and reduce costs. Hospital orientation programs should include coverage of the fundamental principles of nursing autonomy. The implementation of structured orientation programs requires a dedicated team and department that can adjust to unforeseen obstacles. The optimal design of orientation programs for nurses in general and specialized clinical areas can be achieved through the expertise of staff educators within a healthcare environment ( Jeffries, 2022) . Organizations and nurse managers also create orientation programs. It was found that specific nurses exhibited deficiencies in knowledge and skills during the orientation program. The assessment facilitated the identification of specific domains that require enhancement within our orientation curriculum. Methodology The study used a quantitative research design. The population used was new nurses starting their roles in hospitals. The sample was randomly selected from hospitals with structured and unstructured nursing orientation programs. Data collection methods included surveys, chart audits, and interviews. Data analysis techniques included descriptive statistics, regression analysis, and ANOVA. Data Collection Survey. As an initial data collection method, newly hired nurses were administered questionnaires to self-assess their nursing competencies. The evaluation of the efficacy of the orientation program was conducted through the administration of a post-test, administered three months after the completion of the course by the nurses. The follow-up poll was completed by 70% of the invitees. Statistical Analysis. Given that gender, nationality, and level of education are categorical variables, it is possible to represent their frequencies and proportions through graphical means

5 visually. The term "continuous variable" is frequently employed to denote attributes such as age, years of experience, and dimension scores. An independent sample t-test was employed to ascertain the mean differences between dimension scores and study characteristics. Statistical significance was determined using two-tailed p-values set at 0.05. The statistical software SPSS 22 was utilized for data entry and analysis. Interviews. Both closed-ended and open-ended interviews were utilized to establish diverse and specific answers. Ensuring the time with each participant nurse was given a considerable time. The interview provided firsthand information that established a reliable source of data. Results New-to-practice nurses are given 14 weeks (about three months) of orientation in a high- paced Level II emergency department. In contrast, new-to-unit nurses are given 6 (and more once reevaluated). If a nurse feels as though they are comfortable with ending the orientation and the feedback from preceptors agrees, the orientation may be ended. The nurse, too, can be encouraged to end orientation early by leadership. The orientation program significantly impacted many facets, including the supportive role, diagnostic ability, therapeutic intervention, quality assurance, and occupational role. The program did not have a statistically significant impact on teaching, coaching, or situation management. Competence was unrelated to age, gender, or any other demographic factor. A brief overview of the hospital's departments and services was also decided upon after staff interviews. They anticipated learning about the hospital's policies and procedures and visiting the facilities. Participants noted a greater emphasis on sessions covering relevant policies, procedures, and skills. Attendees deemed the orientation credible, helpful, exhaustive, and instructive. They

6 expanded their knowledge and refined their skills, preparing them to provide high-quality care to patients. Many program alumni credit the training with boosting their confidence and providing a significant career boost. One respondent claimed it significantly improved their confidence and outlook on the job. Discussion Nursing education policymakers have recently mandated the General Nursing Orientation and Practice Preparation Program. The curriculum of this course provides novice nurses with the essential knowledge and skills necessary to perform their duties effectively ( Htay & Whitehead, 2021) . The course content encompasses nursing policies and procedures. The study aimed to assess the existing nurse orientation program and implement enhancements based on the findings. Research findings substantiate the objective, as mentioned earlier. The results indicated a significant influence of the orientation program on nurses' job performance. Based on previous research, it has been determined that the attendance of a nurse orientation program resulted in an enhancement of their performance. The findings of the focus group revealed that, overall, the participants exhibited elevated proficiency levels. This assertion is corroborated by empirical evidence. The study's findings indicated that upon completion of the orientation program, nurses exhibited a higher level of competence and professionalism in the execution of their duties. The research findings indicate that nurses could acquire more patient-related experience after orientation. Each nurse's competence level may differ based on their unique background and training. The results indicate that nurses possess the necessary skills to uphold professional norms, deliver ethical patient care, and fulfill various nursing duties. The application of theoretical knowledge to practical scenarios posed a challenge for them. A recent study has provided further

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7 evidence to support the assertion that nurses possess inadequate evidence-based knowledge. The study investigated the potential benefits of integrating evidence-based knowledge into educational interventions to enhance patient outcomes. When devising orientation programs, it is imperative to consider these various factors. Limitations . The study's outcomes are restricted in their generalizability due to the limited sample size and environmental constraints. The study's primary limitation pertains to the utilization of self-reported evaluations of participants' competence as the benchmark for gauging their proficiency. The effectiveness of content analysis may be hindered by the researcher's influence and interpretation, posing a challenge. The study outcomes could have been impacted by various factors, including but not limited to age, nationality, duration of time, level of expertise, and the researchers involved. The outcome was informed by the input of participants and other stakeholders, which was integrated through a discussion process. Conclusion In conclusion, orientation programs are essential for novice nurses to acquire the necessary competencies to deliver exceptional patient care. The study's results made a noteworthy contribution to the nursing field by demonstrating the efficacy of structured nursing orientation programs in improving clinical outcomes. Subsequent research endeavors should explore potential remedies for the nursing deficit and enhance the efficacy of nursing orientation programs.

8 Reference Anders, R. L. (2021, October). Patient safety time for federally mandated registered nurse-to- patient ratios. In Nursing Forum (Vol. 56, No. 4, pp. 1038–1043). Jeffries, P. (2022). Clinical simulations in nursing education: Advanced concepts, trends, and opportunities . Lippincott Williams & Wilkins. Monforto, K., Perkel, M., Rust, D., Wildes, R., King, K., & Lebet, R. (2020). Outcome-focused critical care orientation program: From unit based to centralized. Critical care nurse , 40 (4), 54-64. Spiva, L., Davis, S., Case-Wirth, J., Hedenstrom, L., Hogue, V., Box, M., ... & Ahlers, L. (2020). The effectiveness of charge nurse training on leadership style and resiliency. JONA: The Journal of Nursing Administration , 50 (2), 95-103. Watkins, S., & Neubrander, J. (2020, July). Registered nurse education in primary care: barriers and resolutions. In Nursing Forum (Vol. 55, No. 3, pp. 362-368).

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