In September 2003, Manager Julie Lewis, RN, CCRN, asked me to help organize a better system for orienting new staff nurses. Our interchangeable units at Tenet’s Atlanta Medical Center, Atlanta, Ga, consist of an 18-bed surgical intensive care unit (ICU), a 10-bed cardiac ICU, and a 9-bed vascular ICU.

At the time, we had 15 nurses undergoing orientation and 28 preceptors. As a result, the new nurses were constantly faced with being assigned to 5 to 6 different preceptors, frequent schedule changes, and difficulty in keeping up with their progress. The care coordinators were frustrated when 3 or 4 new nurses would show up during shift change and ask with whom they should orient.

Needing to change the orientation process, I scheduled a meeting with the current preceptors to brainstorm how we could improve it. After our first meeting,...

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