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Article Review: Nurse Onboarding Can Improve Critical Thinking, Knowledge, and Satisfaction


Recently published in the Journal for Nurses in Professional Development, Onboarding New Graduate Nurses Using Assessment-Driven Personalized Learning to Improve Knowledge, Critical Thinking, and Nurse Satisfaction aimed to demonstrate how an evidence-based onboarding program can provide the most support possible to new graduate nurses as they transition from the classroom to practice.

The study compared two cohorts, one onboarded using an assessment-driven personalized learning plan, demonstrating:

  • 8% improvement in communication
  • 8% improvement in critical thinking
  • Increased scores in all 5 medical-surgical assessment domains
  • Improvement in 16 out of 24 nurse satisfaction scores (compared to only 7 out of 24 improved scores in traditional onboarding cohort)

Effective Nurse Onboarding

Healthcare leaders agree that effective onboarding is key to new nurse success, but often struggle to provide evidence-based support for specific onboarding programs.

However, healthcare organizations will benefit from measuring both the efficiency and effectiveness of an onboarding program. As leaders continue to focus on improving quality of care, improving the patient experience, and reducing readmissions, healthcare organizations find an even greater need for an effective onboarding process to ensure nurses are prepared to care for complex patient populations.

As noted in the study, traditional nursing onboarding programs have focused on technical skills and organization-specific policies and procedures. Although all of these are necessary for safe and effective care, they are not sufficient to meet the demands of today’s higher acuity, complex care environment. Higher acuity and more complex care require a higher level of critical thinking, knowledge, and clinical reasoning regarding disease process and evidence-based research and data to identify where opportunities for improvement exist or even the effectiveness of their process.

A Personalized Approach

It’s no surprise that new nurses will enter an organization with varied levels of knowledge and experiences. If nurse educators provide every nurse with the same information, some nurses may become bored and unengaged (if they’ve already mastered the information being taught), whereas other nurses who need more information may feel lost and left behind.

Nurse onboarding should be personalized to the new nurse in order to keep them engaged. As presented in the study, assessment driven, personalized learning is one important component to ensure knowledge gaps are identified and addressed. This lays the groundwork for a personalized learning approach that respects what the learner already knows.

Nurse Onboarding Study Overview

This study evaluated two cohorts, tracking their onboarding approaches. Compared to a traditional onboarding cohort, one cohort was onboarded using the Relias Onboarding assessment-driven personalized learning plan. The study compared critical thinking, knowledge, and nurse satisfaction between cohorts before and after personalized learning for onboarding.

As outlined in the article, this study showed that areas impacted by the personalized learning for onboarding, including relevant knowledge domains and critical thinking, were higher among nurses who participated in the personalized learning compared to nurses who were hired before the personalized learning was implemented.

For the measure of nurse satisfaction, the onboarding cohort showed improvement on 16 of 24 nurse experience questions between baseline and 12 months later, compared with the pre-onboarding cohort, which only showed improvement on 7 of the 24 nurse experience questions.

Research has demonstrated that effective onboarding programs show higher nurse satisfaction and higher competencies as well as lower turnover and lower stress levels. This suggests that this assessment-driven personalized learning is effective as it demonstrated higher nurse satisfaction and improvements in both knowledge and critical thinking compared to other cohorts.

Role of Relias

An efficient and effective onboarding program clearly demonstrates to new nurses that their healthcare organization is committed in their personal success and is willing to invest in them both personally and professionally.

Relias Onboarding was the assessment-driven personalized learning plan used to quantify the nurses’ clinical knowledge and judgment. This personalized learning component addresses ineffective orientation, by tailoring education to meet each individual nurse’s needs. An initial assessment identifies knowledge gaps for each nurse and then provides learning that addresses those gaps.

Additionally, preceptors can use the information from the assessment to identify which areas new nurses may need more or less support in order to help each nurse become safe, effective, and ready for independent practice.


Onboarding New Graduate Nurses Using Assessment-Driven Personalized Learning to Improve Knowledge, Critical Thinking, and Nurse Satisfaction

As published in the Journal for Nurses in Professional Development, this study demonstrated how effective onboarding improved knowledge, critical thinking, and nurse satisfaction.


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