Retention Begins with Effective Onboarding

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

The successful hiring of great candidates is only the first step. Staff retention begins with a good onboarding experience. Unfortunately, some nurse managers delegate these responsibilities to preceptors or unit educators sometimes without good follow-up. This happened to a manager I recently spoke with. He thought things were going smoothly with orientation on the unit he managed but then received feedback that there were issues with onboarding. New graduates received a thorough orientation as part of their residency, but the transition for more experienced nurses was hit and miss depending on the unit workload. He interviewed several recent new nurse hires and received important feedback about key elements that seemed to be missing from orientation. Dissatisfaction with employment often starts when new staff members feel like they have been given a poor orientation to the unit.

You should have regular check-ins scheduled at the end of the first week. Examples of questions to ask on check-in include the following:

Has our team made you feel welcome?
Did you receive what you needed to begin work? (ex. new employee benefits information, ID badge, keys, email, and EMR access)
Do you have questions that have not been answered?
What challenges do you see in your new role?
Is there anything we should change to help new staff better adjust to the unit?

Other steps to improve onboarding included the following:

Become more intentional about how new staff is welcomed as an important addition to the unit.

When new staff joins your community, they have no history and may not be aware of important cultural norms, values, and behaviors. It is important for the nurse leader coach to make sure they are welcomed and introduced to others as a valued team member. Preceptors play a key role in the onboarding of new staff and should be carefully selected to make sure they are positive role models. New staff should be encouraged to ask questions and contact you directly with any concerns that they may have.

Ensure new staff is given a thorough orientation even if they are experienced.

New staff should receive orientation at both the hospital and unit level. Key policies and procedures should be reviewed. A thorough orientation checklist provided by either the manager or unit educator should be used to ensure that all new staff receives the same information. Don’t skip steps even when you are short staffed. Always remember, you are setting the stage during orientation for a smooth transition.

Do regular check-ins on the progress of new staff members.

Nurse managers should schedule a meeting with new staff at the end of the first week, at the 30-day point, at 60 days and mid-year to see how things are progressing and to assess satisfaction with employment. This is a good time to assess whether expectations are being met, answer questions, clarify policies, assess challenges and use the information to refine the onboarding process.

Begin the professional development coaching.

The late Dr. Stephen Covey in his work, The 7 Habits of Highly Effective People, advised that we should begin with the end in mind. This is good advice in coaching new staff. Much of the first six months of employment is usually spent on performance coaching, but long-term commitment will be built if you include professional development coaching. Learn about each new staff member’s personal goals for their career and begin the individual development plan. Help staff to establish at least 2-3 personal development goals. The goals should include actions and a timeline. Every manager should have a list of professional growth opportunities available to staff on their unit such as:

Certification preparation classes
Cross-departmental committee participation
New graduate mentor
Charge nurse classes
Unit practice council participation
Community leadership activities (heart walk, United Way drive, mission trips)

Preventing staff turnover is an ongoing challenge for many nurse leaders. Many decisions made about whether the organization is a good fit happen in the first few months of employment. Make great onboarding a key signature strength for your unit.