• Case Study
  • March 3, 2015

Tiered PICU Orientation Gets New Nurses to Patient Bedside Faster

This case study outlines how educators at Children's Mercy Hospital in Kansas City, Missouri, improved the quality and effectiveness of their Pediatric Intensive Care Unit (PICU) orientation program.

In 2013, driven by the expansion from a 27- to a 41-bed PICU and the need to hire more nurses, Children’s Mercy Hospital revamped its onboarding program to get new hires ready for direct patient care more quickly and effectively.

Challenged with no longer having the luxury of providing 20 weeks of upfront training, the unit’s education coordinators had to create a program that ensured new nurses gained both competence and confidence in patient care skills.


  • New nurses receive the right clinical education at the right time via the most effective method.
  • New nurses transition to performing safe, quality patient care more quickly than in traditional models of orientation programming.


Children’s Mercy Hospital & Clinics set a goal of promoting and accelerating clinical readiness to provide safe, quality care to critically-ill patients. Recognizing that critical thinking and expert performance develops over time, the education team created a three-tier phased program, presented over an 18-month period, that focuses on basic skills and safe care of lower-acuity patients in Tier 1, progressing to care of higher-acuity patients and learning the “why’s behind the how’s” in Tiers 2 and 3.

Additionally, the team chose to use a blended learning model consisting of the Children’s Hospital Association's (CHA) Pediatric Learning Solutions courseware, classroom and at-the-bedside precepted experiences. While the phased approach allows learners to apply new skills and build confidence as they progress from caring for lower- to higher acuity patients, the blended approach allows educators and preceptors to focus their time on application of foundational learning (imparted in CHA’s online courses) and further enhancement of clinical judgment.


  • One teaching method can’t do it all! The sequenced combination of CHA’s e-learning courses, classroom and clinical experiences provide an effective and learner-centric onboarding program.
  • Account and plan for communication gaps between preceptors and new nurses.
  • Use newer nurses to teach the time management skills of Tier 1 and seasoned staff to teach pathophysiology concepts for Tiers 2 and 3.


Bootcamp - 7 days
Intro to PICU

Tier 1 - 10 weeks
Focus on lower acuity patients
33 CHA and classroom courses
Work in unit with preceptor

Work - 3-6 months

Tier 2 - 12 clinical shifts
Higher acuity patient training
20+ CHA modules
Work in unit with preceptor

Work - 1 year

Tier 3 - At 1.5 years
Advanced training for three patient diagnoses
Most acute patients
Six weeks with preceptor


Sally Fagan (Children’s Mercy)
PICU Eduction Coordinator
(816) 234-3539

Amy Nelson (CHA)
Senior Director, Product Management
(913) 981-4185