How to Help a Struggling Nurse Succeed During Orientation

Have you, an educator, ever been the preceptor for a nurse who's struggling to "get it" during orientation? Maybe you've done everything you can think of, and they still aren't succeeding in their role.

Have your peers considered them a problem learner? The novice nurse who makes ICU or PCU staff say, "They don't pick up material quickly enough. I've been trying to teach them, but they aren't learning. I have to keep telling them how to do things." We strive to find ideal ways to approach and support the nurse who's struggling. Ultimately, we want everyone to help the orientee succeed. If they can't make it through orientation and develop competency, they become a burden on unit resources and a risk to patient health and safety.

But what if the nurse who is struggling in their transition to practice isn't the problem? Their failure to learn or use their knowledge could be a symptom of a larger issue, one that's burning out nurses and preventing them from succeeding at the bedside.

Before assuming that your struggling nurse isn't fit for the ICU or PCU, let's explore what the problem could be — and how to solve it. In my experience, the majority of nurses who struggle during orientation are misunderstood. These nurses can learn complex critical care material and apply it successfully, but they don't get the opportunity. Here are some common reasons and suggestions for improvement.

Why New Nurses Struggle During Orientation

Silence Kills

In 2025's "Silence Kills 2.0: How Communication Failures Stifle Innovation and Harm Patients," healthcare workers were least likely to fully confront a team member for the following behaviors: incompetence, 36%; lack of support, 31%; disrespect, 30%; poor teamwork, 27%; crucial moments bias, 20%. Bullying is a form of disrespect and kills teamwork, and it continues to occur in critical care and progressive care units. Examples of bullying and disrespect by experienced healthcare team members that lead the novice nurse to be silent include:

• Assuming the novice nurse doesn't fit in and then badmouthing them to others
• Disliking the new nurse and then gossiping about them and their nursing care throughout the unit
• Not giving the new nurse the benefit of the doubt or lending emotional support during their transition into the unit
• Voicing only negative criticism instead of constructive feedback and then expecting the nurse to magically improve

Novice nurses are often treated unfairly. They aren't given the time and tools to succeed and then, to add insult to injury, they're blamed for not thriving in an unfair environment. In these instances, the novice nurse won't seek help or speak up, and then they're considered problem learners when they're actually being bullied and haven't had a chance to learn, prove themselves or show they fit in.

Impact of Bullying on New Nurse Retention

How common is it?

According to the 2025-2026 Trends Survey, 56% of nurses have witnessed or experienced bullying in the past year. This exact thing happened to me when I started as a nurse in my first ICU. I was considered a problem learner. My preceptor was too busy with her patients to answer my questions or provide feedback, so I didn't learn things I should have learned. Before I knew it, there were rumors around the unit that I was stupid and shouldn't be an ICU nurse.

Fortunately, that lit a fire under me to pursue certification rather than leave, but that's not always the case. According to the "2026 NSI National Health Care Retention & RN Staffing Report," 22.9% of all new RNs leave within their first year. After many years as a nurse educator, I'm not surprised. When nurses leave, it's usually because an unsupportive environment pushes them out the door rather than any lack of skills or knowledge. "AACN Position Statement: Bullying, Incivility and Verbal Abuse" states bullying, incivility and verbal abuse in the workplace are unacceptable. It also outlines recommended actions for nurses and organizations. In "Confronting Bullying and Incivility in Nursing," an AACN Voices in Nursing podcast, Dr. Renee Thompson shares practical strategies for nurses and leaders to address harmful behaviors, strengthen accountability, and build cultures grounded in respect, professionalism and psychological safety.

Ideas to Help Nurses Succeed During Orientation

Individualize Novice Nurse Orientation

Sometimes the novice nurse struggles because preceptors or other experienced nurses don't understand how nurses who are new to the profession learn or how to assess entry-level knowledge and competence. Everyone is a little different. Some people are visual learners; others are hands-on learners. Some prefer e-learning modules they can complete at their own pace. Some succeed in classroom environments, and others do better with one-on-one mentoring where they can ask specific questions. AACN sets the standard for assessing entry-level nurse competence and knowledge with the AACN Competence Framework and Toolkit and AACN Knowledge Assessment Tool. Both of these resources help individualize orientation and provide guidance for preceptors to help them teach and assess novice nurses' competency. For more ideas to help you create learning environments for different learning styles, read my blogs on the flipped classroom and goal creation for novice nurses.

Provide Actionable Feedback Using Validated Assessment Tools

As I mentioned in my personal story, constructive feedback is essential. Think of it as food for novice nurses! They need it to survive and thrive. How are they supposed to learn and improve without feedback? Well, I should say without actionable feedback. Generic feedback for the nurse that doesn't provide specific next steps isn't very helpful. Here are examples of feedback that is too broad:

• You need to develop critical thinking.
• You need to learn to advocate.
• You need to learn to communicate.

These comments have no specific, actionable points. When the new nurse hears a comment like one of those, it probably goes in one ear and out the other, and then they'll make the same mistakes again. Frustrating for them and frustrating for the unit; not to mention an easy way for the nurse to be called unfit for the unit. The competence framework and toolkit consist of content-validated performance outcomes based on the AACN Synergy Nurse Competencies that provide objective, actionable feedback to help your preceptor team overcome giving vague feedback.

Schedule Regular Check-ins During Nurse Orientation

Check-ins between new nurses and their preceptors achieve many of the same things as effective feedback: They reinforce good behavior and accurate knowledge, stop incorrect knowledge and clinical care practices, provide some time to discuss how the nurse is adjusting, and offer an opportunity to ask questions. These meetings can be as short as five to 10 minutes every week. The point is to set aside some time for preceptors to ask specific questions, share suggestions and identify strengths and areas for improvement. Preceptors will also understand how the new nurse learns best, which can be very helpful. Consider questions such as:

• What is going well? (Start with a positive comment, because the orientee will default to what they aren't doing well.)
• What have you learned during this shift?
• What do you need to do to improve in a specific area or skill?
• What goals should we set to achieve the improvement you seek?

When preceptors get really busy, though, the first thing to fall by the wayside is check-ins. The nurse doesn't get the attention they need, so they flounder and think "maybe I'm just not cut out for this unit." Hello turnover. I recommend a check-in every two weeks, for consistency.

If you get pushback from nurses and other staff along the lines of, "I don't have time," remind them that feedback is one of the best and fastest ways to get a new nurse up to speed so they need less help later. Plus, if a five- or 10-minute check-in session could make a big difference in the quality of patient care in the ICU or PCU, wouldn't they want to do it?

Nurse educators: Remember that you're also part of this check-in chain. Try to meet with new nurses every two weeks, whether in a meeting or rounding in the unit. Noticing how well new nurses are applying their knowledge will help gauge their progress and also improve your program. Creating a recurring appointment on the calendar ensures the time is set aside.

Create a Healthy Work Environment for New Nurses

Much of the time, an unsupportive environment pushes new nurses out the door. On the other hand, a healthy work environment (HWE) helps nurses and other staff be at their best for each other and their patients. There are six AACN HWE standards:

• Skilled communication
• True collaboration
• Effective decision-making
• Appropriate staffing
• Meaningful recognition
• Authentic leadership

Use the free HWE assessment tool to see where your unit stands, and access resources to help you solve identified problems.

Build a Positive Learning Environment During Orientation

Speaking of tools, I've had great experiences using a commitment tool I created to promote buy-in from both the preceptor and the new nurse. The tool is basically a one-page sheet that outlines some HWE behaviors, such as avoiding gossip and promoting positive communication. When I was a nurse educator, I sat down with preceptor and nurse pairs, and I asked them to commit to creating a positive learning experience for the nurse. They signed the commitment tool, and it became a mission statement that guided their interactions. It's so simple, but I was surprised how well this tool worked to get everyone on board right from the beginning.

I outlined a commitment process in Chapter 22, Application of the Synergy Model to Orientation, Page 182, in the book "Synergy for Clinical Excellence: The AACN Synergy Model for Patient Care," 2nd ed. (2017)

Support New Nurses With Professional Communities

AACN offers online communities for nurses to share best practices and seek guidance on their challenges.

• Nurses new to practice can join a safe space for connection, guidance and support from peers in similar situations. AACN offers the Future and New Nurse Community for student nurses and nurses with less than three years of experience.
• The Nurses in Professional Development Community offers discussions on best practices for transition to practice and onboarding nurses new to progressive and critical care.
• The Clinical Practice Community offers discussions and sharing best practices on a variety of topics, including precepting.

Give Preceptors the Resources to Succeed

Like you, preceptors are busy people. If it takes too much time, they probably won't do it. Be sure to give them all the tools and resources they'll need in one easy packet that includes:

• HWE information
• The commitment process in "Synergy for Clinical Excellence: The AACN Synergy Model for Patient Care," 2nd ed. (2017)
• Information to join the online Nurses in Professional Development Community to connect with and share best practices with preceptors and educators
• Resources from the AACN Orientation Pathway
• Explanations of specific, actionable feedback
• Your time and attention

Preceptors also need to learn how to give actionable feedback. AACN's "Fundamental Skills for Preceptors" course has excellent information on providing feedback, including feedback in a crisis. If preceptors succeed, the new nurse will succeed. And if the nurses succeed, you succeed.

Key Takeaways to Help Struggling New Nurses Succeed

We became professional development nurses (educators) to help make the system better - better for nurses and better for patients. By doing these simple things, we can prevent people from describing new nurses as struggling or problem learners, create an HWE and build teams of knowledgeable and passionate nurses.

I want to know: What are some of your tried-and-true solutions for helping nurses during their transition to practice?