Title : New graduate nurse competence and confidence on a high acuity intensive care unit
Abstract:
Research Question: What is the impact of a standardized, evidence-informed high-acuity ICU orientation on new graduate nurses' (NGN) competence and confidence compared to a standard orientation?
Background: Hospitals are increasingly onboarding NGNs into high-acuity ICUs amid a global nursing shortage. NGNs must manage critically ill patients without specialized orientation tailored to these environments, posing safety risks due to inexperience with high-risk procedures and medications. Despite existing studies on general ICU orientation, no research addresses NGN preparation specifically for high-acuity units.
Methods: A standardized, evidence-informed ICU orientation was developed. In Phase 1 (control), 7 NGNs were recruited from July–October 2024 in a 24-bed high-acuity ICU at a southeastern academic medical center. They received a standard 20-week orientation. Preceptors assessed competence biweekly using the Orientation Progression Tool (OPT; 1–5 scale). Confidence was self-assessed at baseline, 10, and 20 weeks using the Casey Fink Graduate Nurse Survey (CFGNS; 1–4 scale). For 17 high-risk skills using the Grundy Confidence Scale (5–25 scale) at the same intervals. Higher scores reflect greater competence/confidence. Phase 2 (intervention) began January 2024.
Results: The control group included 6 participants (4 female, 2 male), aged 22–28 (mean: 23.5), with varied education backgrounds. All had prior healthcare experience. Mean baseline CFGNS scores with range were: Role confidence 2.86 (.71), organize/prioritize care 2.88 (1.25), support 3.33 (1), role satisfaction 3.04 (.63), stress/burnout 2.44 (.83), resilience 2.83 (.67), organizational commitment 3.39 (1), preceptorship 3.45 (2), and skill confidence 1.96 (.72). Mean baseline of the mean Grundy Confidence Scale Score was 8.33 (4). OPT mean baseline was 1.5 (.87).
Conclusion: This is the first study to evaluate the impact of a standardized high-acuity ICU orientation on NGN competence and confidence—an essential step toward improving patient safety in these demanding care settings. Phase 2 data: available in Fall 2025.
