sophisticated care. And in a national, stratified, representative sample survey of nursing administrators from acute care hospitals and long-term care facilities conducted in 2001 by the National Council of State Boards of Nursing, fewer than half of nursing administrators evaluated newly licensed nurses as possessing the overall educational preparation to provide safe, effective care. RNs were viewed as particularly lacking skills in recognizing abnormal physical and diagnostic findings and responding to emergencies (Smith and Crawford, 2002a). These findings were quite similar to the responses of a nationally representative survey of newly graduated nurses conducted by the same organization in 2001. These nurses also reported needing better educational preparation or work orientation in recognizing abnormal laboratory findings and responding to emergency situations (Smith and Crawford, 2002b).

This lack of knowledge is not just a result of the inability of prelicensure programs to provide education on all therapies needed for all clinical conditions. At present, a number of state boards of nursing have no mechanisms in place to promote ongoing acquisition of knowledge and skills to maintain clinical competency. As of March 2001, 24 of the 56 U.S. states and jurisdictions required RNs to engage in continuing education, and 4 required competency examinations (National Council of State Boards of Nursing, 2001). Moreover, both AHA and JCAHO have stated that many hospitals have scaled back their orientation programs for newly hired nurses and ongoing in-service training and continuing education programs for nurses as a result of financial pressures (Berens, 2000; JCAHO, 2002). Inadequate training of hospital nurses has been cited as a key contributor to medical errors (Berens, 2000). Table 5-7 shows the types of orientation programs

TABLE 5-7 Types and Average Length of Orientation Programs for Newly Licensed RNs

Type of Program


Average Length (in weeks)

No formal orientation


Classroom instruction/skills lab only



Classroom instruction and/or skills lab plus supervised work with patients



Work with an assigned preceptor with or without additional classroom instruction or skills lab work



Formal internship with or without additional classroom instruction or skills lab work







SOURCE: Smith and Crawford (2003).

The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement