The range and breadth of ED nursing also is such that true proficiency is not usually achieved without at least one-to-two years of clinical experience. Thus, what can be more important than teaching the “content” is teaching the “process” of critical thinking, recognizing that there are different ways to describe how we come to useful clinical decision making.

Having developed a way to teach process more than content using clinical mapping, case studies, in situ decision making exercises, and using the educator as primary preceptor, ED orientation programs as well as orientations in other areas of nursing can be made more efficient and successful. Most orientation programs are not as successful as they could be because the staff is overwhelmed, the atmosphere in most units is not conducive to learning, and the staff is not trained to teach what the orientee needs to know. When the educator is precepting, the staff is not overwhelmed with the task of teaching from scratch, the orientee feels freer to ask questions, and learning, not just surviving, is the objective. Critical thinking can be better developed in this atmosphere, and the incorporation of new nurses into the culture of the ED or floor is more welcoming than the traditional “survival of the fittest” model.