The needs of healthcare facilities are ever-changing. Depending on patient census, staff shortages, seasonal viruses, and, as we’ve learned, potential pandemics, the demand for temporary staff to cover gaps and shortages is constant. Healthcare organizations fill those needs by using contract nurses, travel nurses, and agency staff. That means the nurse or support staff who are there for Monday’s shifts may not be there the following week.
Because healthcare staff can change so rapidly, the traditional orientation doesn’t really work. Moreover, it seems like a lot of wasted time, effort, and budget to expect short-term staff to spend days in orientation sessions, shadowing experienced staff, and going over paperwork, only to leave a few days or weeks later.
However, onboarding is a necessary task. Without it, you risk errors in patient care, like medication or equipment misuse, and failure to follow facility protocol. If your temporary staff is unfamiliar with how your facility operates, there could be a lapse in infection control, especially during busy seasonal virus times.
Rebuilding a System That Works When Staff Changes Weekly
So, how can you run an effective orientation when your staff changes frequently? The answer is to rethink orientation for your temporary staff. Streamline your system and build it around the information your temporary staff must know to work their first shift safely and efficiently. Everything that isn’t immediate can be learned through the experience of the workday. Here, we offer a guide for you to use to streamline your current orientation system and rebuild it for your temporary staff.
Separating the Critical “Must-Know” Information
The most important information you need to share with staff that changes weekly can be broken into three parts. They are:
- Safety Practices Before Patient Contact: This part of your orientation for short-term staff covers anything that could cause patient harm or that which could threaten compliance and regulatory requirements. For example:
- Identifying patients
- Patient allergies
- Medication information and safety
- Code response activation
- Evacuation routes in case of fire or other threat
- Hygiene practices
- Isolation precautions
- Fall prevention
- Restraint
- Protocol for escalating concerns
- Include any specific hazards of your unit or facility, such as behavioral health or handling of hazardous medication, such as oncology meds.
- Guidance For the First Shift: This part of orientation covers practical needs for the first shift. Your nurses will need to know:
- Where to obtain necessary supplies
- How to reach a nurse manager
- How to reach the pharmacy or order lab work
- How to request help
- Shift handoff protocols
- Documenting
- A Brief Introduction to Organization’s Culture: This is optional for short-term staff, but can be offered as a handout. You may include:
- History
- Administration structure
- Career development
- Any other information that you feel your short-term staff should know.
The first part of the “Must-Know” information is critical. You may be tempted to add to it, and if it is something that could impact patient care, then certainly add it to the list. If not, move it down a tier or two.
Build Orientation Accordingly
Cohort-based orientation works best when applied to a group of incoming staff, who all begin at the same time. But when you have short-term staff that changes weekly, or even daily, you can’t constantly assemble a cohort. But you can build a workable orientation as an on-demand system. Here’s how that looks.
Begin With a Core Orientation Program: Design a 60-minute to 90-minute session, recorded or live, that you can make available as often as possible. Center your session around the most critical safety protocols and break the session into short micro-modules that retain attention. Don’t hold short-term staff for any longer than necessary. A lot of what you go over in your session may be practices they know inside and out. However, for the safety of your patients and your facility, this session is crucial.
Build Content That’s Particular to Your Unit or Facility: Short-term staff tends to float to different specialties and environments. That’s why the most effective orientation when staff changes weekly is focused on your patient population and their specific needs. A skilled nursing facility will be different from a med-sug unit. Memory care requires protocols that cardiac rehab does not. A summary and perhaps a video that covers the basics such as common emergencies, protocols, and use of equipment, as well as key contact information, works much more effectively than a time-consuming orientation.
Standardize the Delivery: You’ll want to ensure every new weekly staff member shares the same knowledge. When you have different nurses onboarding your short-term staff, you end up with varying degrees of quality orientation. But when you design a script, along with a checklist, consistency won’t be lost. The same is true for orienting your weekly staff with equipment. When you operate from a source of clear and critical information, in a consistent and standardized manner, everyone will be on the same page.
Complete Paperwork Before the First Shift for Effective Orientation
Paperwork costs your healthcare organization time and budget. Streamline that process by making sure your short-term staff has access to their paperwork before that first shift. Of course, if you are working with BOS Medical Staffing, we make sure your temporary staff members are prepared and ready to start working on day one.
- Begin with a Pre-Arrival Packet: Send information about dress code, parking, badge instructions, and a bit about what to expect on their first day to your staff ahead of time. Any credentialing or health screening that hasn’t been completed can be sent along in the packet. BOS Medical Staffing makes sure you have all you need before our agency nurses arrive.
- Provide Access: If possible, provide access to the health records system and medication dispensing process before the first shift. Login information and badge permissions should be granted whenever possible.
When documents are gathered in advance, and permissions are given for access to medications and health records, your weekly staff nurses can hit the ground running. This makes the best use of everyone’s time.
Enact a Buddy System
For every new staff member, you should use the buddy system for effective orientation. This works for short-term staff as well as when you need to onboard permanent staff. Alert the orientation partner that this is part of their job, not an added burden. Offer bonus pay if that helps.
Here’s how your healthcare organization can make the most of the Buddy System.
- Adjust the Buddy’s workload so they have time to orient the new staff member. If you don’t, either their work will suffer, and mistakes may be made, or the orientation won’t be fulfilled.
- Provide the Buddy with a short script and checklist. As mentioned above, that keeps everything consistent. The Buddy can judge if they want to provide more information beyond the basics. Include things like staff introductions, where to go to find things, who and how to call for help, and any other information that makes their shifts go more smoothly.
- Train the Buddy in the most effective way to orient someone who may only be on staff for a week.
- Offer the Buddy guidance as needed. Be available. Your organization may decide the Buddy System is an opportunity to observe and promote from within.
- Gather feedback from the Buddy. What do they feel works, and what are their thoughts on how to make the orientation for short-term staff more effective?
Quick-Reference Tools and Guides Make Orientation More Effective
When you’re in a new environment, learning new information, it can all be a little overwhelming. And you can’t count on retaining some of the new info you’ve learned. That’s when a quick-reference guide comes in handy.
Some of the tools and guides you can design are:
- Laminated information cards at each workstation with essential phone numbers or extension numbers, code procedures, where to find supplies, and chain of escalation.
- QR codes that link to informational and instructional videos for equipment.
- First-shift survival information, such as a top-ten list of things that confuse newcomers.
- Clear signage and identification of supply closets, etc.
Phone numbers and extensions, equipment instructions, supply locations, and procedures change and evolve. Make sure your reference tools and guides stay up to date.
Returning Staff is an Asset
When you have staff gaps and need weekly and short-term nurses to complement your permanent staff, you may find some temporary hires return over time, no matter how long. If this pattern develops, that’s good news for your healthcare organization. The returning temporary nursing staff will likely only need a refresher orientation, or just an update on policies that may have changed. Don’t discount the long-term potential of a short-term hire.
Indicators to Track If Your Orientation is Effective for Short-Term Staff
No orientation is effective if it doesn’t work. Assess your orientation for staff that changes weekly by measuring the following:
- What is the turnaround time from the nurse’s arrival to independent assignment?
- How confident is the Buddy that the new staff member can handle the job?
- Are new staff members completing the most critical part of your streamlined orientation (Safety Practices Before Facing Patients) before facing patients?
- Is the new staff member confident and satisfied with their orientation?
Use the feedback to tweak your orientation so that it becomes more effective and benefits your organization, your staff, and, most importantly, your patients.
Customize Your Orientation
To create an effective orientation when staff changes weekly, you need to change the design, tailoring your efforts to make the most of your time and theirs. Success depends on how carefully you prioritize. Safety and patient care are obviously your number one concern, so build orientation around that.
Use the “buddy system,” so your agency staff has someone to go to for information when necessary. Design “quick reference” guides, and be proactive in providing informational packets before your agency healthcare staff schedules their first shift.
Keep in mind that the goal of your orientation isn’t to onboard your one-week employee as you would integrate your full-time nursing staff. Your primary objective is ensuring that those short-term healthcare staff members have a solid grasp of what they need to safely provide patient care, feel welcome in their new, albeit temporary, workplace, and that they know who to comfortably go to when they have questions. When you accomplish this, you protect your patients, support your permanent staff, and create a relationship with temporary staff that they will jump to return the next time.
You Have Needs, We Have Answers
At BOS Medical Staffing, we work to provide healthcare organizations with the right staff at the right time. We work with full-time, part-time, temporary, and travel nurses who possess the clinical skills and knowledge, as well as the soft skills that you need for your facility. All of our nurses and healthcare professionals are fully vetted, with background checks and confirmed certifications and licensure. For more information on how BOS Medical Staffing can help you, please contact us.
