A first-week checklist for new joiners in hospitals

A staff nurse joins on Monday. By Wednesday nobody has shown her the crash cart. She has no locker. She was told to ask any colleague about the infusion pump. The ward is short, the in-charge is busy, and the HR desk assumes the ward has done the orientation. By Friday she is looking at other advertisements.

The first week in a hospital is crowded. Badge, uniform, registration papers, ward orientation, equipment training, eight new names and the unspoken habits of the unit all arrive together. A sheet in the joiner's file stops items falling between the HR desk and the ward. A version to copy follows, then notes on running it.

Name:                    Role:                    Ward / department:
Joining date:            Ward in-charge:          Buddy:

DAY 1  (HR desk)
[ ] Identity, address and qualification documents seen and copied
[ ] Registration certificate seen, renewal date noted (clinical roles)
[ ] Offer terms, shift pattern and weekly off explained and signed
[ ] Badge, uniform, locker and punch or attendance method issued

DAY 1  (ward or department)
[ ] Walk of the unit: nurse station, crash cart, store, sluice, exits
[ ] Buddy introduced; ward in-charge's number saved
[ ] Roster for the first two weeks handed over

DAY 2 AND 3
[ ] Infection control: hand hygiene, PPE, sharps and waste segregation shown
[ ] Emergency codes and who to call; fire exit route walked
[ ] Equipment shown: monitors, infusion and syringe pumps, suction (as relevant)
[ ] Life-support training status checked; session booked if due

DAY 4 AND 5
[ ] Worked a shift alongside buddy with a signed observation note
[ ] Documentation shown: case sheets, medication chart, consent and handover forms
[ ] Competency list for the unit given, with the first three items to sign off
[ ] Five-minute conversation with ward in-charge: any concern?
[ ] Friday check by HR: all lines ticked or a date set for each blank

HR owns the Day 1 paperwork block. The ward in-charge owns the unit lines. The buddy writes the observation note after the shared shift. Everyone initials only what they did. The original goes in the personnel file, and the joiner keeps a copy.

Timing matters. Tick on the day, at the nurse station or the department desk, not from memory the next week. A tick made on Friday for Tuesday's session is a guess.

Support staff get a shorter version. It covers badge, locker, the route to the pantry and linen store, hand hygiene and waste segregation. It also says what to do if a patient falls and whom to tell. Doctors get the registration, the credential file, the on-call rule and the orientation to theatre or clinic that fits the role.

• A blank on the HR block means the office is late. Fix the process, not the person.
• A blank on emergency codes means the joiner should not work a night shift alone.
• A blank on life-support training means a date goes on the training calendar before Friday ends.
• Three or more blanks on one ward in a month suggests that ward needs help with orientation.
• A weak buddy note means choose a different buddy next time.

• Staff nurse: medication chart practice, blood transfusion check, restraint and fall rules, bed-side handover.
• Technician: calibration log, equipment fault reporting, radiation or sample safety as relevant to the department.
• Resident or junior doctor: case-sheet standards, consent forms, escalation to the consultant, on-call room and meals.
• Housekeeping and attendants: colour-coded bins, spill kit, patient transfer by trolley and wheelchair, lift etiquette.
• Front desk and billing counter: registration forms, estimate sheets, insurance desk contacts, how to calm an angry relative.

Most first-week lines can be done in minutes. Infection control cannot. Give it a proper half hour with the infection control nurse, in the ward and not a classroom. Show the hand-rub points, the PPE donning and doffing order, the sharps bin, the colour-coded waste bags and the isolation signage. Ask the joiner to demonstrate each back. Watch for gaps in glove removal, which are common even among experienced staff.

Add a line for needle-stick reporting. Every joiner should know, by day three, where the post-exposure kit is kept and whom to call at night. A joiner who has to ask this after an injury has already been let down.

The buddy is not a supervisor. She is the one who answers the small questions that a new nurse is too shy to ask the in-charge. Pick someone patient, two or three years in the unit, with a clean attendance and a good word from her colleagues. Give her a lighter patient load on the joiner's first two shifts if the ward can bear it. Thank her in writing.

The sheet covers week one. For the wider joining process, the employee onboarding process service sets out how to build a plan. The general hospitals onboarding page shows it in a broad hospital with many roles. For the reasons people leave if week one goes badly, read why employees leave hospitals. The hospital types hub puts this in context.