NIC: An Orientation Program for Long-Term Care

BACKGROUND

An organized, comprehensive orientation program enables new nurses to adjust to their new work environment and feel a part of the organization. The orientation program at the Alverno Health Care Facility, a 135-bed long-term care facility in Clinton, IA, was based on state and federal requirements and job descriptions. The familiarity of having included NANDA, NIC, and NOC in resident care plans for years prompted the integration of standardized nursing language into the existing orientation.

MAIN CONTENT POINTS

Successful implementation of NIC requires organizational commitment. The revamping of the orientation began with meetings of the nursing management team consisting of the chief executive officer, nursing supervisors, infection control nurse, continuous quality improvement nurse, and inservice director.

During the initial phase of development, the NIC interventions most applicable to long-term care were identified. From this list, each team member selected 25 interventions based on regulations, frequency, and high risk. These interventions were compared to the topics in the existing orientation program. Job descriptions were reviewed for key roles to identify topics that correlated to the interventions. Data were queried from the care plans to determine the frequency of nursing diagnoses, interventions, and outcomes. In addition, federal requirements were itemized with the corresponding intervention identified for each area.

The team collated the data from the existing orientation, job descriptions, care plans, and federal regulations to select 25 care competencies to include in the nursing orientation program. The team agreed to designate seven activities most applicable to long-term care for each intervention. Staff nurses were included in the selection process. Some activities listed in the third edition of NIC were altered to be more specific to long-term care. The results were compiled and used as the foundation for the nurses' orientation and performance evaluation.

The orientation program was designed to be completed within 4 weeks, with week 1 addressing federal and OSHA requirements. A preceptor was assigned to each new nurse to enhance the learning opportunities. Various methods of presentation were constructed using the principles of adult learning to foster interest and retention of information. Classes were interspersed with clinical orientation.

CONCLUSIONS

Including NIC interventions in the nursing orientation program provided an opportunity to support standardized nursing language, conveyed a sense of teamwork and commitment to the organization, and defined expectations in the standards of care. The general orientation for all departments was enhanced by incorporating NIC into required topics of safety, infection control, abuse prevention, body mechanics, resident rights, and dementia management. Further, the NIC-based orientation was used as a basis for the hiring process.