• Case Study
  • July 26, 2016

Creating a Staged Approach to Critical and Acute Care Orientation

This case study outlines how Ann & Robert H. Lurie Children's Hospital of Chicago is simplifying learning pathways to improve competencies and retention of new nurses caring for complex patients.


New nurses hired to work in the critical and acute care units at Lurie Children’s Hospital were consistently overwhelmed by the training required. The graduates, with varying levels of pediatric, clinical and academic experience, became frustrated early in their employment. This translated into costly retention problems.

Hospital educators also experienced challenges with the process including

  • Limited time to orient nurses to the complexities of their patient populations
  • Undefined timelines and competencies for each orientation stage
  • No method to identify and address individual learning gaps
  • Less than optimal communication between educators, managers, preceptors and new hires

Overall, the education team needed to enhance the learning experience, reduce training time, and improve retention to ensure safe and quality care to patients with varying acuity levels.


To resolve the issues with the existing orientation process, staff members developed a staged onboarding model that
  • Standardized learning across units
  • Defined unit-specific pathways
  • Provided a timeline and guide for skill mastery and defined competencies

The model incorporated the Children's Hospital Association's (CHA) Pediatric Learning Solutions online modules, simulation, classroom instruction, one-on-one preceptors, transition sessions, clinical exchange, and evidence-based practice projects.

New nurses are oriented to the hospital, general pediatrics and their units in different stages. The standardized process helps new hires, managers, and preceptors know what competencies should be achieved at each stage. The new approach has enhanced communication among all stakeholders and saved the organization both time and money.

Lessons learned

  • Educators and preceptors can now gauge orientee progress as a result of the staged approach and intervene sooner if an individual is having difficulty.
  • The team identified the clinical experiences needed for new hire success.
  • Don’t underestimate the time needed for educators to embrace and utilize the new concept.


  • Individualized preceptor orientation
  • Pediatric nursing classes
  • Pediatric Learning Solutions online modules
  • Transition sessions
  • Clinical exchange
  • Evidence-based practice mentorship

Course examples

  • Fluids and Electrolytes
  • Arterial Blood Gas Analysis
  • Mechanical Ventilation
  • Medication Calculation


Barbara Keating, MS, RN-BC (Lurie Children’s)
Director of Clinical Learning & Innovation
(312) 227-0081

Patty Kohn (CHA)
Director, Client Relations
(913) 981-4187