A template-based standardized ambulatory oncology nurse orientation process substantially reduced turnover rates at a large academic comprehensive cancer center, ONS member Christina M. Matousek, MSN, RN, OCN®reported in an article in the June 2024 issue of the Clinical Journal of Oncology Nursing. Additionally, the standardized training ensured new nurses built consistent, disease-specific experience across 17 different interprofessional disease teams.

Nurse Orientation Template

Matousek began her development process by evaluating the cancer center’s new ambulatory oncology nurses’ competencies and onboarding needs. Through a gap analysis, job shadowing, and direct feedback from nurses about the education and training new hires needed, Matousek identified the following challenges:

  • New hires were assigned to teams without any formal training, causing them to learn their roles independently. 
  • Managerial or educational meetings were not embedded into the orientation plan. 
  • Specific areas for improvements and education were unique to each disease-specific team, such as disease processes, procedures, patient education, and antineoplastic treatment modalities.

To address those challenges, Matousek created an orientation template outlining standardized onboarding experiences, contact information to facilitate communication, and directions to different site locations. 

Onboarding Process

Over 8–12 weeks, new ambulatory oncology nurses followed an onboarding plan that included: 

  • One-on-one preceptorship and shadow experiences in infusion, medical, surgical, and radiation oncology counterparts; advanced practice providers; clinical trials team; and unlicensed assistive personnel
  • Didactic education in three oncology fundamentals classes that reviewed basic oncology and ambulatory education tailored to the nurses’ experience in oncology or ambulatory settings
  • Weekly progress evaluations in which the new nurse, nurse educator, and management team reviewed progress, answered questions, discussed concerns, and established plans for the following week

Impact on Nurse Satisfaction and Retention

On postimplementation surveys distributed to all staff, respondents said that they felt supported throughout the onboarding process but identified opportunities to refine the training, such as:

  • Offering more specific and frequent shadow experiences
  • Allowing more time for shadowing surgical or medical oncology counterparts 
  • Evaluating the orientation plan structure 

After implementing the orientation, turnover rates decreased by 13.22%, from 17.39% in May 2020, to 4.17% in July 2022, Matousek said.

“Since 2020, studies have shown that 24% of newly hired nurses leave their positions within one year,” Matousek said. “The U.S. Department of Labor projected that more than 275,000 additional nurses will be needed between 2020 and 2030; therefore, retention of staff is key to maintaining a stable workforce. This project and similar studies continue to support the need for a standardized orientation to enhance nursing practice in the ambulatory care setting to improve turnover and vacancy rates.”