A competency-driven framework that meets every nurse where they are — and brings them all to the same destination.
Presented by Dana Mitchell, Critical Care Nurse Educator · FF Thompson Health · March 2026
1The phased model ties progress to demonstrated competence — so a new grad and a seasoned nurse can both use the same structure, move at their own pace, and finish fully prepared.
Some of this content is introduced during onboarding. The phased structure brings it back at the right moment — when the nurse has enough clinical experience for it to stick. Advancement is by demonstrated competence, not the calendar.
Unit systems, safety, communication standards, EMR, and general patient assessment. The non-negotiable baseline every nurse needs on day one.
Head-to-toe systems review. Skills performed with direct supervision. Dysrhythmia course completion required before Phase 3.
High-acuity specialty topics. Increasing independence. Advanced monitoring, vasoactive drips, vents, sepsis bundles, emergency response participation.
Full patient load. Preceptor as safety net only. Procedural mastery, high-alert medications, and independent sign-off.
Shadow your preceptor. Observe, ask questions, learn the unit flow. Focus on Chapters 1–3.
Begin performing skills with direct supervision. Your preceptor will be at the bedside with you. Chapters 4–12.
Increasing independence. Manage 1–2 patients with your preceptor available nearby. Chapters 13–18.
Near-independent practice. Full patient load with preceptor as a safety net. Chapters 19–21.
"Day 1–2: Focus on physical layout, emergency responses, call bell, clocking, and EHR login. Layer in event reporting, email, and intranet navigation as opportunities arise naturally during care."
"We just had a rapid response on the floor — let's debrief what you noticed about the activation process."
Phase 1 is the safety foundation. Do not advance until EHR and safety competencies are signed off.
Dysrhythmia course is a non-negotiable gate. Coordinate scheduling early — don't let it bottleneck the Phase 2/3 transition.
Confirm with the preceptor that the orientee shows clinical reasoning — not just task completion — before Phase 4.
Mr. Washington, 74M, admitted 2 days ago for left hip fracture repair. During your 1400 assessment: HR 104 (was 78), BP 106/62 (was 132/74), RR 24, Temp 38.2°C, SpO2 95% on RA. More lethargic than this morning. Wife says he's "not himself."
Multiple vital sign changes + new confusion post-op demands investigation. Do not assume fatigue.
📋 Teach Time: 8–10 min · Format: Read aloud, pause at decision points · Cascade: Teach your peer before your next shift
Phase 4 completion = orientation complete. Acknowledge it with the nurse and preceptor — it matters more than you think.
"There are three things I want you to always check: Mode (how it delivers breaths), Settings (what we set — TV, Rate, FiO₂, PEEP), and Measured Values (what the patient is actually doing)."
AC/VC — set tidal volume, every breath. Most common initial mode.
AC/PC — set pressure, volume varies. Used in poor lung compliance (ARDS).
PSV — patient-initiated, pressure-supported. Weaning.
"If the monitor looks abnormal — look at the patient first. Check leads, connections, assess the patient before treating the monitor."
📋 Teach Time: 10 min · Format: Hands-on at ventilator · Cascade: Teach your peer before your next shift
Everything lives on the Thompson ICU Hub — organized by type, print-ready, and editable. One link for preceptors, orientees, and managers.
"On a scale of 0–10, with 0 being no pain and 10 being the worst pain imaginable, what is your pain level right now?"
Use CPOT when patients cannot self-report. Total score: 0–8. Score ≥3 suggests significant pain.
The documents, teaching kits, and checklists in this library were developed using generalized, evidence-based clinical content as a foundation — drawn from the same body of 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.
The orientation checklist isn't two separate documents. It's one shared framework — the ICU version incorporates additional critical care items throughout. The core is identical.
The phased model isn't ICU-specific — it's a structure. Since the checklists already share a foundation, adapting it for med/surg is less work than building something new.
This isn't a mandate — it's an offer to collaborate. The ICU framework and resource library already exist. Adapting it for med/surg means customizing, not starting over.
For nurses who already have a solid med/surg foundation and are transitioning to the ICU — a focused pathway that validates what they know and builds what they need.
The Bridge Track makes cross-training a structured, visible process — not an informal arrangement. It gives med/surg managers confidence that their nurses are fully prepared before transitioning.
The structure, documents, teaching kits, and digital tools are in place. The next step is clinical review and alignment with Thompson policies and practice — and that's where your expertise comes in.
thompson.danamitchell.icu