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The GN orientees expressed their perceptions that they often were left alone or on their own during their orientation. The GNs spoke of this as an aspect of the orientation that they had not expected. From the perspectives of GN1, GN2, and GN4, there were days when they were assigned patients with some, albeit minimal, oversight from their designated preceptors. During these times, GN1, GN2, and GN4 claimed that they were left alone to make independent decisions related to the care of their assigned patients because their preceptors had patient assignments of their own and were too busy to help them. GN5 and GN6 recalled being pulled to other nursing units, being given patient assignments, and having preceptors to guide them.

GN6 stated:

When I was pulled to CCU, I felt like the preceptor and nurses there did their best to help me; I felt guided, and everything was explained. I felt that the preceptor there cared about me doing things the right way, but after I went back downstairs to med-surg, I felt as if I was on my own. I was left alone to figure out a lot of things by myself.

M1, M2, and P3 reported that in their view as experienced nurses, putting inexperienced GNs into clinical situations for which they were not prepared and for which they did not have the guidance of preceptors left their clinical judgments up to subjectivity. P1 added that allowing GNs to work on their own before they were ready to assume those responsibilities as advanced beginner nurses without the knowledge base or experiential learning needed put all stakeholders (i.e., other nursing personnel, medical personnel, and patients) at risk. The preceptors explained this from their general

perspective as something that had been happening for a great deal of time. P1, P2, and P4 claimed that this situation was a usual occurrence when nursing units were understaffed.

GN6 told of a time when her preceptor was pulled and she was on her own: I was scared and nervous because I was left alone many times during orientation because my preceptor was pulled, or she had a set of patients she had to worry about. I had to try to figure things out by myself a lot during the orientation. The reviewed documents did not support letting GNs practice without the supervision of preceptors during the orientation. Researchers have asserted that paying attention to the safety issues surrounding patient care outcomes and the safe practice of

GNs during the orientation period should be fundamental when training nurses to care for patients with acute and chronic illnesses (Haleem et al., 2011; Harrison-White & Simons, 2013; Mariani, 2012; Romyn et al., 2009).

Summary. The preceptor and GN participants agreed that not having the

supervision of experienced nurses during the orientation when critical decisions had to be made was not clinically safe. In addition, transferring GNs from one unit to another did not provide the GNs with a structured orientation; instead, they found themselves constantly transitioning between new preceptors and new nursing units, and lacking the understanding and confidence to practice at a level for which they were not yet prepared. Practicing independently as RNs requires a background and an understanding of the different categories, classifications, and subdivisions of nursing within the acute care setting.

M1 and M2 discussed the GNs being on their own during orientation from a managerial perspective. They argued that according to the orientation policy, the GNs should never be left on their own for one major reason: patient safety. When assigning preceptors to GNs, it was the organization’s responsibility to ensure no deviation from the safety measures that were in place during the orientation, even if there were a lack of nursing personnel in the hospital. It was important to adhere to the orientation policy to ensure that no inexperienced orientees were substituted for expert staff RNs.

The provision of expert nursing support by qualified RNs was the responsibility of the organization. In addition, the facility had to ensure the safe practice of GNs by upholding the practice as established by policy that the orientees had to remain with the

preceptors during the orientation period. Using GNs as staff nurses and putting them in positions to make decisions for which they were not ready did not ensure the best possible outcomes for patients, the community, the hospital, and the orienting GNs, as expressed by all participants.

All of the participants also agreed that it was the responsibility of SHMC to ensure that the GNs were not alone to provide care to acutely and critically ill patients without the benefit of having more experienced nurses with them to guide, train, monitor, and confidently ensure that the inexperienced GNs were working within their scope of practice. Moving preceptors to other units and leaving GNs without preceptors or with RNs who might or might not have had precepting experience or who lacked confidence in this area did not safeguard or support the policies of SHMC and the patients.