The first 45 days are crucial for new nurse retention

When it comes to staffing, healthcare is experiencing something of a perfect storm. The pandemic left everyone exhausted and on the edge of burnout. Stemming the tide of healthcare professionals streaming through hospital doors requires some creative thinking and careful planning—beginning with onboarding new employees.

Registered nurses are one group of healthcare workers most likely to leave their positions. Press Ganey surveys reveal that, nationally, nearly 30% of RNs are at risk of leaving their organizations. Nurses younger than 35 who don’t feel connected to their team, managers, or organization are the most likely to leave. Approximately one in five nurses who fit this profile ultimately leave their job.

Turnover is costly—in terms of both time and money. The average cost of turnover for a bedside nurse is $40,038. Plus, the recruitment process must begin again. Those first weeks of employment for nurses are incredibly important, as 20% of voluntary turnover happens in the first 45 days. It’s during those first weeks that new employees form attachments to the organization and to their teams—and find where they fit. When healthcare organizations get the drivers of staying right—and employ effective nurse retention strategies—new hires are 20% more likely to remain.

Top nurse retention strategies for healthcare organizations

Nurse retention strategies are critical to an organization’s ongoing success. The question then becomes: What drives nurses to stay? What are the nonnegotiables for dedicated nurses? We call them the “healthcare must-haves,” and they include things like teamwork, inclusion, liking their work, and feeling like their work makes a real difference in the world.  

Some of the more specific contributors to inclusion and belonging include: 

• Psychological safety. Nurses need to feel safe in bringing up problems.
• Civility. Respect is important, and nurses need to know that conversations with leadership will be civil.
• Input. Nurses need to know that their ideas will be heard and seriously considered.
• Recognition. Everyone wants to be recognized for their contribution to the success of the team and organization. 
• Growth and development. Having a plan to continue to grow and work at the top of their license is an important element of wanting to stay with an organization.
• Leadership. The relationship between leadership and workers must be one of mutual respect and teamwork.
• Work/life balance. Press Ganey’s data reveals that nurses who work nights and weekends are often less engaged than those who work other shifts. Having a healthy work/life balance and being comfortable with the shifts they work is crucial to the retention of nurses.
• Inclusion. Nurses should feel that they can be authentically themselves at work without fear or worry.

Onboarding newly hired nurses and travel nurses together 

Many health systems currently have a significant number of new hires and travel nurses working together. Oftentimes, travel nurses don’t get the same onboarding experience that new hires do. It may be time to rethink that process and integrate the workforce so travelers and permanent staff are given the same onboarding treatment to increase the likelihood of nursing staff retention.

Although there are costs associated with onboarding travel nurses, the tactic can provide long-term benefits. Everyone learns the same processes and systems as well as the approaches required for equitable care delivery across the continuum.

Specific tips to improve the feeling of belonging include:

• Weekly check-ins
• Assign a mentor
• Onboarding surveys for 30 and 90 days
• Ask for feedback from coworkers
• Set goals for progress (30, 60, 90, 180 days)
• Schedule meetings for progress feedback (30, 60, 90, 180 days)
• Provide coaching and guidance throughout onboarding

Improving nursing staff onboarding and retention over time

An onboarding and retention plan that worked smoothly in 2015 may not provide the same results in 2023. By asking new hires the following questions at least once a week—for a month or more—it’s possible to continually refine and improve the nursing staff retention strategy.

• How do you feel about your new job?
• What do you enjoy most in your new role?
• Is the job (or team or organization) what you expected?
• Has anything surprised you, and, if so, what?
• What would you add or change in your training?
• Do you have the tools and resources you need to do your job?
• Do you feel you’re building relationships with your coworkers?
• How can your manager improve?
• Is there anything you think we should offer new employees that wasn’t offered to you?
• What is working or not working in your new role?
• Is there anything about your position or the organization that is still unclear?

When trends emerge, the answers to these questions may point to areas for improvement in nursing staff retention. Creating an action plan based on the information new employees provide is one of the best ways to continue improving the onboarding process. Understanding the new hire processes, and fixing broken parts of it, is one of the keys to improving retention of nurses, both in that critical first six weeks and in the long term.

For more information about improving nurse onboarding, nurse retntion strategies, and the employee experience, reach out to an employee experience expert.