At a time when nursing shortages are straining health care systems, St. Joseph’s Healthcare Hamilton (SJHH) is driving meaningful change with a redesigned orientation program that’s boosting new nurses’ confidence and reducing vacancy and turnover rates. 

The impact of the redesigned orientation model is already evident. In areas of St. Joe’s that are using the new orientation model, such as general internal medicine, turnover rates fell to just 17 in 2024/25, compared to 33 in 2023/24.  Similar success has been noted in other departments, including critical care and acute mental health. 

“We recognized that the nursing workforce was changing,” explains Andrea McKnight, director of interprofessional practice. “We were seeing a lot of internationally educated nurses coming in and applying for positions… we were also seeing nurses who went through schooling during the pandemic where the shift to virtual really was prominent.” 

Building competence with the layered learning model 

Launched in March 2024, after nearly a year of development, the new orientation program takes what is called a layered learning approach — which focuses on building knowledge, skill, judgement and confidence in the nurses. The orientation’s curriculum has been optimized into a three-week program using multiple learning models and weekly goals designed to strengthen the relationship between new nurses and mentors.  

To date, 137 learners have participated in the new program which includes new pre- and post-surveys to assess self-efficacy and readiness to practice, the integration of self-care and wellness principles especially in high-stress areas like critical care. 

“We really wanted to move away from people having to extend orientation and feeling like they were failing,” says Brooke Cowell, executive vice president of clinical operations and chief nursing executive. “Instead, we now develop individualized plans in collaboration with the orientees that meet them where they’re at—so they are set up to be successful from the beginning.”  

Regular scheduled meetings with the orientee, mentor, educator and manager ensures continuous practice improvement as informed by the learning plan and feedback loops. 

In the Intensive Care Unit for example, Andrea adds, “we drastically decreased our vacancy rates… We brought in a large cohort of new grad and internationally educated nurses, and I want to say maybe only one person out of that group wasn’t successful in their orientation. That was pretty reassuring to us that what we’re doing is working.” 

Future growth 

St. Joe’s is now exploring opportunities to expand the layered orientation model to other health professions. “There’s been a lot of discussion about how a similar approach could support other health professionals in terms of their onboarding and orientation,” Brooke says. 

While other hospitals are just beginning to look at similar changes, St. Joe’s is proud to be setting a new standard. “We were kind of leading the way—one of the first to start and push this forward. Now other hospitals are following. Some have asked us to share our approach, our theories, our evidence,” says Andrea. 

At its core, the redeveloped nursing orientation program has seen success due to the nurse educators that have put this together and are still rolling it out. Brooke adds, "It’s really important to celebrate how instrumental the educators and advanced practice nurses were. We had the vision, but they were the ones who built and continue to roll this out." 

The program has also led to the introduction of a new mentorship program with many senior nurses participating. The mentorship program touches on topics of feedback, cultural humility, and in particular, recognizing how to support internationally educated nurses. 

As the orientation program continues to evolve, the focus remains clear: equipping nurses not just to survive, but to thrive—and in doing so, reinforcing St. Joe’s commitment to safe, confident, and compassionate care.