Orientation Program Overview · 2026

A Phased Approach
to Nurse Orientation

A competency-driven framework that meets every nurse where they are — and brings them all to the same destination.

ICU Med/Surg

Presented by Dana Mitchell, Critical Care Nurse Educator · FF Thompson Health · March 2026

The Core Principle
Anyone. Any level. Any starting point.
Same comprehensive outcome.
New Grad
Starts Phase 1 · Moves at full learning pace
Experienced Med/Surg RN-New to Thompson or Cross-train to ICU
Starts Phase 1 · Validates quickly, review phase 2, focuses time in Phase 3–4
Experienced ICU RN, new to unit
Starts Phase 1 · Moves through Phases 1–2-3-4 rapidly
Everyone starts at Phase 1→ Variable pace→ Consistent, comprehensive outcome

Where We Are — and What This Adds

📋 How Orientation Works Today
  • A dedicated preceptor works through the skills checklist with the orientee
  • Coming off orientation is a qualitative call — made individually by preceptor and manager
  • Preceptors are already doing their best to provide this structure
  • Some content is introduced in onboarding week; repeat teaching at the right time cements it into practice
✨ What the Phased Model Adds
  • Named phases give the checklist a shared language everyone can use
  • Defined milestones make advancement decisions transparent and consistent
  • Progress is documented — a different preceptor can step in seamlessly
  • Experienced nurses move quickly through what they know, focus time where they need it
  • Supports what preceptors are already doing — doesn't replace their judgment

The Four-Phase Framework

Some content is introduced during onboarding. The phased structure brings it back when the nurse has the clinical experience for it to stick. Advancement is by competence — not the calendar.

1
🏗️
Phase 1

Foundations

Unit systems, safety, EMR, communication standards, and general assessment.

Chapters 1–3
→
2
🩺
Phase 2

Core Practice

Head-to-toe systems review with direct supervision. Dysrhythmia course required before advancing.

Chapters 4–12
→
🔄 Nurse Residency / Cross-Train
3
🫀
Phase 3 — ICU

ICU Transition

High-acuity specialty topics. Vents, drips, hemodynamics, sepsis bundles, emergency response, ect.

Chapters 13–18
3
🏥
Phase 3 — Med/Surg

Med/Surg Specialty

Post-op care, wound management, telemetry, deteriorating patient response, sepsis bundles, ect.

Med/Surg Track
→
4
🎯
Phase 4

Unit Integration

Full patient load. Preceptor as safety net only. Procedural mastery and independent sign-off.

Chapters 19–21
1
Foundations
Orientation & Safety · Chapters 1–3
🖥️EHR Navigation — documentation, MAR, assessments, results review
🚒Safety Systems — fire plan (RACE/PASS), HIPAA, event reporting
🛏️Safe Patient Handling — mobility protocols, lift equipment, fall prevention
📋General Assessment — admission assessment, falls risk, alarm management
✓EHR documentation completed independently
✓RACE/PASS verbalized; emergency equipment located
✓Chapters 1–3 checklist signed off

From the Preceptor Guidebook — Ch. 1

ICU Preceptor Guidebook · Chapter 01
Preceptor Talk Track
Suggested Language

"Day 1–2: Focus on layout, emergency responses, clocking, and EHR login. Layer in event reporting and intranet navigation as they arise naturally during care."

Real-Time Teaching

"We just had a rapid response — let's debrief what you noticed about the activation process."

Competency Progression
ObservedPreceptor demonstrates while narrating. Orientee identifies key steps.
PerformedOrientee performs at bedside. Coach through steps; intervene only if patient safety at risk.
CompetentOrientee performs independently. Debrief at end of shift.
Preceptor Guidebook · Page 14Version 1.0
2
Core Practice
Review of Systems · Chapters 4–12
🫁Respiratory — oxygen delivery, NIV, ventilators, ABGs, chest tubes
❤️Cardiovascular — hemodynamics, rhythms, vasoactive meds, EKG, pressure lines
🧠Neurological — GCS, pupils, stroke, seizure management
⚕️All 9 body systems — GI, GU, Musculoskeletal, Integumentary, Psychosocial

🔒 Hard Gate Before Phase 3

Dysrhythmia course completion must be verified before any nurse advances. Coordinate scheduling early — don't let this be the bottleneck.

From the Orientee Handbook — Ch. 5 Cardiovascular

ICU Orientee Handbook · Ch. 05 — Cardiovascular
Key Knowledge
  • Heart Sounds: Auscultate at 4 landmarks — Aortic, Pulmonic, Tricuspid, Mitral. Identify S1, S2, murmurs, gallops.
  • Telemetry: 5-lead placement: White-right, Black-left, Green-right leg, Red-left leg, Brown-V1.
  • Vasoactive Meds: Norepinephrine (first-line septic shock), vasopressin, epinephrine. Central line, dedicated lumen, titrate to MAP goal.
Skills Checklist
Auscultate heart sounds at all 4 landmarks and document
Apply telemetry leads correctly and set alarm parameters
Zero and level an arterial line at the phlebostatic axis
Identify sinus bradycardia, A-fib, and VT on the monitor
Safely initiate and titrate a vasoactive infusion per protocol
Orientee Handbook · Page 38Chapter 05 of 21
3
ICU Transition
Specialty & Critical Care · Chapters 13–18
🦠Sepsis — SIRS criteria, NEWS scoring, Hour-1 bundle, ongoing management
💊Pain Management — PCA, drip titration, 0–10 scale & non-verbal pain scale
🚨Emergency Response — provider communication, Stroke Alert, MI Alert, mock codes
🏅ACLS required for nurses without a current card
🍺Alcohol Withdrawal — CIWA-Ar, delirium tremens, seizure protocol
✓Manages vasoactive drips with minimal prompting
✓Demonstrates clinical reasoning — not just task completion
✓ACLS current · Chapters 13–18 signed off

From the Scenario Library — Sepsis Recognition

Cascade Scenario · Sepsis Recognition & Response
Clinical Scenario

Mr. Washington, 74M, post hip repair Day 2. During your 1400 assessment: HR 104 (was 78), BP 106/62 (was 132/74), RR 24, Temp 38.2°C, new lethargy. Wife says "he's not himself."

⚡ Decision Point

Multiple vital sign changes + new confusion post-op. What do you do?

✅Calculate NEWS + screen for sepsis — Score = 10. HIGH. Emergent response.
❌"He's probably just tired from surgery" — dangerous assumption.
❌Give Tylenol and recheck — masking a potential emergency.

📋 8–10 min · Read aloud · Pause at decision points · Cascade to peers

Cascade Education · Scenario ModuleSepsis Recognition
4
Unit Integration
Procedural Mastery · Chapters 19–21
💉IV Access — peripheral, central venous, line maintenance & troubleshooting
🩸Blood Products — administration, verification, transfusion reaction management
💊Medication Administration — high-alert meds, drip management, ISMP standards
🎯Full independent practice — nurse of record, charge communication, full patient load
✓All 21 chapters signed off on orientation checklist
✓Preceptor attestation of independent practice
✓Manager sign-off for independent assignment

From the Teaching Kit Library — Ventilator Management

Cascade Teaching Kit · Ventilator Management
Teaching Script — At the Ventilator
1
The Basics (2 min)

"Three things to always check: Mode (how it delivers breaths), Settings (what we set), Measured Values (what the patient is actually doing)."

2
Modes (3 min)

AC/VC — set volume, most common. AC/PC — set pressure, ARDS. PSV — patient-initiated, weaning.

3
Alarm Rule

"Monitor looks abnormal? Look at the patient first."

📋 10 min · Hands-on at ventilator · Cascade to peers

Teaching Kit · Ventilator MgmtStation-Style

The Resource Library

Everything on the Thompson ICU Hub — one link, organized by type, print-ready and editable.

📋

Core Documents

  • ICU Preceptor Guidebook (21 chapters)
  • Orientee Handbook & Workbook
  • RN Orientation Checklist
🛠️

Teaching Kits

  • Arterial Line & CVP Monitoring
  • Ventilator Management
  • Central Line Maintenance
  • Chest Tube Management
  • + 7 more kits
🧠

Scenario Modules

  • Sepsis Recognition & Response
  • Cardiac Arrhythmia Response
  • Respiratory Failure Escalation
  • Deteriorating Patient SBAR
  • + 6 more scenarios
🃏

Pocket Cards

  • ABG Interpretation
  • Pain Assessment (NRS + CPOT)
  • GCS & Neuro Checks
  • NEWS / Sepsis Screening
  • + 8 more cards
💻

Digital Tools

  • ECG / Dysrhythmia Webapp LIVE
  • ABG Practice Game LIVE
  • Power Minutes (IV, A-Line, Chest Tube)
  • Med-Surg → ICU Cross-Train Hub
📊

Tracking

  • Cascade Education Tracker
  • Phase progress (Orientee Workbook)
  • Preceptor competency sign-off pages

A Note on These Resources

⚠️

Content Status

These resources were developed using generalized, evidence-based clinical content as a foundation — drawn from work being prepared for a future ICU nursing reference.

They have not yet been reviewed or aligned with Thompson-specific policies, protocols, or practice standards.

What That Means for Next Steps

  • The framework and structure are solid — the content needs your clinical expertise to finalize
  • Each chapter and checklist item should be reviewed against Thompson policy before active use
  • This is an invitation to collaborate — not a finished product being handed down

Who Should Be Involved

  • Unit managers & charge nurses
  • Experienced preceptors — ICU & med/surg
  • Pharmacy (medication chapters)
  • Risk management / compliance

A Shared Foundation — Built for Both Units

One checklist. The ICU version adds a critical care layer throughout. The core is identical.

🏥 Med/Surg Orientation

  • Phases 1–2 (shared): EHR, safety systems, head-to-toe assessment, all body systems, sepsis, pain management, IV access, medications, blood products
  • Phase 3 — Med/Surg specialty: Post-op care, wound management, chest tube management, telemetry & dysrhythmia (tele context), deteriorating patient response, mock codes (med/surg scenarios), ACLS optional
  • Phase 4 — Unit Integration: Full independent assignment, preceptor attestation, manager sign-off
Phases 1–2 sharedPhase 3 — Med/Surg specialtyPhase 4 — Unit integration
Same topics,
unit context

🫀 ICU Orientation

  • Phases 1–2 (shared): EHR, safety systems, head-to-toe assessment, all body systems, sepsis, pain management, IV access, medications, blood products
  • Phase 3 — ICU specialty: Advanced hemodynamics, vasoactive drips, mechanical ventilation, arterial lines & CVP, Ceribell & advanced neuro, dysrhythmia (ICU context), hemodialysis, mock codes (ICU/arrest scenarios), ACLS required
  • Phase 4 — Unit Integration: Full patient load, preceptor as safety net, procedural mastery, manager sign-off
Phases 1–2 sharedPhase 3 — ICU specialtyPhase 4 — Unit integration

A Proposal for Med/Surg

The same framework, your context. The checklist foundation already exists — adapting it means customizing, not starting over.

What a Med/Surg Version Looks Like

Phase 1

Foundations — identical to ICU

Phase 2

Body systems with med/surg patient context

Phase 3

Specialty med/surg: post-op, wound care, telemetry basics

Phase 4

Full independent assignment + preceptor attestation

Why It's Worth Considering

  • Replaces informal orientation with a consistent, documented framework
  • New grads and experienced hires follow the same structure
  • Cross-training nurses share language and recognized competencies
  • One framework simplifies onboarding travelers and agency staff

What This Is Not

  • Not a mandate — an offer to collaborate
  • Not starting from scratch — the framework exists
  • Not adding work — adding structure to what's already happening

Bridge Track

For nurse residents and med/surg nurses transitioning to the ICU — validates what they know, builds what they need.

Phase 1/2 — Validated Quickly

  • Everyone starts at Phase 1 at Thompson
  • Experienced nurses move through it rapidly
  • EHR documentation ✓
  • Safety systems ✓
  • Head-to-toe assessment ✓
  • All body systems ✓
  • IV access & medication admin ✓
✓ Phase 1–2 Completed Rapidly
→
Accelerate
to ICU

Phase 3–4 Focus

  • Advanced hemodynamic monitoring & pressure lines
  • Vasoactive & sedation drip management
  • Mechanical ventilation
  • Dysrhythmia interpretation — ACLS certification
  • Chest tube management
  • Mock codes & emergency response
  • Hemodialysis patient care
  • Cerebellar & advanced neuro assessment
  • ICU-specific provider communication

The Manager's Role

🚀 At Orientation Start

  • Assign a primary preceptor — phased checklist ensures continuity if someone steps in
  • Ensure preceptor has Guidebook and Hub access
  • Establish expected phase pacing based on experience
  • Schedule check-in at the end of each phase

🤝 Supporting Your Preceptors

  • Protect preceptor/orientee pairs on the same shifts
  • Don't pull the preceptor to charge or float during orientation
  • Check in — shared with educator
  • Surface concerns early; don't wait for a late-phase crisis
  • Recognize the extra effort — publicly when you can

✅ Phase Transitions

  • Preceptor recommends advancement; manager approves
  • Checklist sign-offs must be complete before advancing
  • Dysrhythmia course = hard gate for Phase 3
  • Phase 4 completion requires manager final sign-off
  • Acknowledge each milestone — it matters to them

🚩 Red Flags to Watch For

  • Checklist not progressing by end of Phase 2
  • Preceptor/orientee interpersonal conflict
  • Dysrhythmia course not scheduled by mid-Phase 2
  • Orientee avoiding procedures rather than attempting them
  • Preceptor burnout — consider a co-preceptor, this model enhances shared precepting
🏥
One Framework. Both Units. One Hub.

The Framework Is Built —
Now We Refine It Together

The structure, documents, teaching kits, and digital tools are in place. The next step is clinical review and alignment with Thompson policies — and that's where your expertise comes in.

thompson.danamitchell.icu 📋 Full Program Overview

Dana Mitchell · Critical Care Nurse Educator · FF Thompson Health · March 2026

1 / 15