New Environment of Care Guidelines for 2024

At the foundation of any clinical relationship is trust: trust between clinicians and patients, trust among the interprofessional team members, and trust between a new hire and the preceptor. Building a trusting relationship between the new hire and preceptor takes time, but there are some things that a preceptor can do to develop the trusting relationship.

Be Explicit About Expectations
Expectations within nursing practice are often divided into two buckets: the written competency-based activities and the unwritten rules of practice. Quite different from nursing school curriculum, where grades are generated on very specific evaluation criteria, the OR requires new hires to integrate into the culture of daily practice that varies among services and surgeons. The idea that the same procedure can differ due to a surgeon’s preference for instruments is a concept with which new hires struggle.

Create Opportunities for Clinical Experiences
One of the most challenging aspects of precepting is entrusting clinical care to the new hire. Preceptors often find themselves in close proximity of the new hire because they cannot relinquish control of patient care, which presents challenges when the new hire is nearing the completion of the orientation period. Additionally, preceptors question whether or not the new hire is competent to practice independently and, therefore, can be entrusted with patient care.

Form an Environment of Feedback
New hires require feedback from their preceptors to correct behaviors and grow professionally. The preceptor should establish the frequency and format of feedback delivery, such as by summarizing feedback at the end of each shift, taking time to emphasize what went well and what needs improvement.

Create a Psychologically Safe Environment
Psychological safety, according to Edmundson and Lei, is the “perceptions of consequences of taking interpersonal risks in a particular context such as a workplace.”3 Psychological safety occurs when the orientee can anticipate how the preceptor gives feedback, responds to questions, and acts as a backup when the team asks specific questions regarding the procedure or care of the patient. Providing a structure for how feedback will be given and inviting the orientee to give feedback about the preceptor’s style of teaching can help create a psychologically safe environment, as can encouraging the orientee to ask questions in a place where others will not overhear the questions and make judgments about the orientee’s knowledge level. Another way for the preceptor to foster psychological safety is to stay close by the orientee, especially early in the orientation period, to help answer questions that team members may ask.

Take a look at written rules versus unwritten rules, action steps to develop clinical experiences, and download a feedback form at: https://www.aorn.org/the-stitch/article/building-trust-with-your-new-hire

There's more Periop Talk at: https://www.aorn.org/about-aorn/aorn-newsroom/periop-talk

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What are the three biggest changes to the Guideline for Medication Safety? It all depends on your facility, but labeling, hazardous medication and antibiotic oversight were three issues that really stood out to guideline author Julie Cahn, sr. perioperative practice specialist at AORN. Medication errors are preventable but continue to occur despite regulations, governmental resources and oversight, recommendations from professional organizations, and accreditation body standards. Elimination of medication errors is important because these errors can cause patient harm, reduced patient confidence in the health care system, and increased costs. 

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AORN leaders, like perioperative nurses everywhere, agree food can be the highlight for celebrating Perioperative Nurses Week. Listen in as Board President Vangie Dennis, Vice President Darlene Murdock, and Board Director Megan Nolan share some additional ways to have fun, bond with colleagues, and connect with the community. Spoiler alert: they love the food, too!

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