How do you transform a graduate nurse who's never set foot in an operating room into a great surgical nurse? We solved this staffing challenge by developing a hands-on, in-house training program that gives nurses who had limited exposure to the perioperative setting in nursing school a chance to see up close and personal how our surgical unit runs.

Our Perioperative Nurse Intern (PONI) Program seems to be working quite nicely. Since its inception, we've trained 21 nurses to become staff circulators, many of whom might not have considered OR nursing as a career choice without the specialty training we provided. Nine (nearly half!) have stayed in our department for at least 12 months. Some have continued their path of professional growth to assume management and other leadership positions in the OR.

I'm a proud product of our internship program. When I was hired as a new graduate nurse into the internal float pool at SCL Health Lutheran Medical Center in Fall 2014, I expressed a strong desire to transition into the surgical services department. I was accepted into the internship program in Fall 2015. I completed 61???2 months of training and have been working as a full-time OR nurse since April 2016.

A paid internship

AORN's Periop 101 program inspired our internship program. Ours is designed as a 6- to 7-month long didactic and hands-on competency program. Here's how it works.

Once we hire a nurse through the regular interview process, she goes straight to the internship program. The first 4 weeks are didactic, followed by combined didactic and hands-on training. For the remainder of the program, interns rotate through our multiple surgical specialties, guided by staff RNs who serve as preceptors.

The first couple of weeks, we keep it simple. We introduce the intern to the surgical services department: its rooms, teams and services. We outline policies and procedures, and build on basic concepts of the perioperative environment. We start the rotation with easier services, like GYN, and slowly move to more complex services, like neuro. Our interns don't get stuck with one service the entire time — they get a taste of all the services we offer, except for cardio.

Throughout the program, a preceptor is there every step of the way to encourage the intern and answer any questions she might have. Interns receive feedback from preceptors on a daily basis as they rotate through the various specialties. After a month or two of being in the OR, the intern gains more responsibility by getting more involved in services and gains hands-on experience.

On their own

The program is based off of individual progress, so the intern ultimately decides what she wants to handle throughout the process. The last few weeks are when the nurse decides if she's ready to be on her own. If she's ready, she'll branch off from her preceptor — who will be less involved, but still nearby as a resource. The program also weeds out the nurses who find out the OR is not the place for them. Because it gives nurses a real-life dose of how our facility runs, they're able to know early on if surgery is the right choice for them.

Not only does this gradual training build essential skills like opening sterile supplies and counting instruments, but it also helps nurses get used to our unique way of doing things. Nurses learn each surgeon's preferences firsthand, the running of the room and what it's like to work with each member of the team. This is beneficial, especially when working with new nurses. It's like filling a blank slate. Because the nurse has never worked in another surgical facility, she's more likely to accept and adapt to our way of doing things.

Retention tool

There may be no better way to build a talented and dedicated team than to train your new hires yourself. It's also a great retention tool. Nurses who graduate from the internship program feel confident and content, which creates a strong sense of loyalty and attachment to our facility. It also creates camaraderie as the interns bond with each other, their preceptors and our veteran staff members who are ready to help and teach. In the end, the energy and expense we expend on our internship program pays us back with experienced, confident nurses who stick with us. When you factor in how difficult it is to recruit and hold onto good OR nurses nowadays, that's a pretty sound investment. OSM