This chapter focuses upon guiding nurses to choose the right career opportunity in an environment that works for the individual. It further explains the process and components of what should be expected in a nursing orientation. Performance feedback is reviewed, while comparing and contrasting different organizational responses to performance.

It is important to understand the work environment and patient population that a nurse chooses to work with because of the experience one will receive. For example, nurses choosing to work in a general medicine and/or surgery setting will be exposed to a variety of diagnoses, medications, treatments and teaching situations. Nurses working in specialty areas gain experience as described above with select patients with specific diseases and disorders. Community health nursing may expose a nurse to a broad spectrum of a specialized patient populations depending upon the focus of the agency such as, OB and hospice. Different skills will develop with different settings. For example, nurses working in critical care develop the ability to plan for specialized and technical care to a limited number of patients, whereas a nurse on a general floor may need to prepare and organize for a more diverse group of patients.

In any case, orientation is essential to the transition from a student to a nurse managing patients. Orientation often involves a general orientation, which includes information and skills that are required of all nurses such as, policies and procedures, CPR training, and departmental roles. Unit-specific orientation focuses upon specific competencies that nurses need to possess in order to provide care. Often nurses will be asked to identify their own learning needs along with what the department requires. This information is tracked over time through check lists and templates. Performance feedback is typically provided through preceptor assessment, feedback from peers and patient interviews, and is objectively based upon the job description. Sometimes employees will require corrective action due to the need to improve performance, if there is lack of understanding the rules, difficulty with organizing patient assignments, or an inability to complete shift work on time. Mutual goals are typically established and steps are outlined to bring performance to an acceptable level.