Why an Effective Onboarding Program Improves Newly Licensed Registered Nurse Retention

First impressions matter! In any organization, you want to make positive impressions last. When newly licensed registered nurses (NLRN) enter an organization, they are excited and eager to begin their journey as a healthcare professional. NLRNs work hard, dedicating countless hours to study and pass the NCLEX, and they are excited to take on the real world of patient care. Understanding important characteristics of a good nurse are just as important as prioritizing qualities of a good nurse leader to truly impact nurse retention.

We know that nurse retention efforts begin on day one. A nurse’s experience in his/her first year have an impact on whether he/she chooses to stay or leave.

However, did you know?

• 17.5% of NLRNs leave their first nursing job within their first year of employment, according to a study funded by the Robert Wood Johnson Foundation.
• The average cost of turnover for a bedside RN is $44,400, according to the 2020 NSI National Health Care Retention & RN Staffing Report.

With onboarding an NLRN, healthcare organizations are charged with taking the NLRN under their wing and growing them to their full potential. Organizations must simultaneously recognize and develop leadership potential. Therefore, effectively onboarding a new hire is vital to the success of both the employee and to the organization.

Three Key Components for a Successful Nurse Onboarding Program

1. Engage the Newly Licensed Registered Nurse 

Onboarding an NLRN should be engaging and meaningful with structure and content relevant to the new hire and to his/her unique learning needs. One way to demonstrate an organization’s commitment to nurse success is to include the NLRN as an active member in the onboarding process. Be sure to set aside time for setting goals, assess individual needs, and understand his/her thoughts and expectations around onboarding. Align the organizations goals with the goals of the NLRN to establish a successful onboarding process.

The key to a successful onboarding experience includes having a strong structure with the right content to support the NLRN, even well past the onboarding phase. Relevant education that places a focus on patient-centered care, quality improvement principles, communication, teamwork, technology, professional practice, and applying evidenced-based practice (EBP) principles are necessary components for the onboarding process. Blended learning models that adapt to the unique learning needs of an NLRN can further strengthen engagement and ongoing retention efforts.

We know that variations exist in exactly how much past exposure to actual clinical situations an NLRN may have had.  Limitations may also exist in his/her ability to apply the actual knowledge he/she has acquired to complex patient situations. Therefore, it is essential to provide opportunities for the NLRN to apply his/her new knowledge and skills, whether in classroom discussion, preceptor time, or in a simulation environment. Offering personalized learning opportunities for application and reflection, further enhances the NLRN to participate in ways that foster both critical thinking and clinical reasoning. This will not only facilitate the engagement process, but also bridge gaps between clinical knowledge and clinical application.

2. Efficiently Onboard Your Newly Licensed Registered Nurse

Process efficiency is another key component to successful onboarding. It is important to identify process steps that need to be streamlined to promote efficiency and avoid unnecessary duplication.  Additional consideration involves identifying what resources and steps are yielding efficient and effective outcomes. In evaluating an onboarding program, each process step should be able to demonstrate value to the organization and to the newly hired nurse.

Efficiency in process and structure are foundational to an effective onboarding process. According to the American Society for Healthcare Human Resources Administration, onboarding is the process of assimilating a new employee into the healthcare organization with structured engagement. The experience of structured engagement and assimilating a new employee into the organization has a long-lasting impact.

According to the Society for Human Resource Management (SHRM):

• Organizations with a standard onboarding process experience 50% greater new hire productivity.
• 69% of employees are more likely to stay with a company for three years if they had a positive onboarding experience.

The onboarding process needs to strongly connect the NLRN to the organization. The NLRNs must feel confident in the support of their nurse manager, nurse educator, and with a strong preceptor/clinical coach or mentor, as they continue with the organization. This level of organizational commitment to the NLRN will yield tremendous benefits to an organization.

3. Effectively Onboard in Measurable Ways

Healthcare organizations will benefit from measuring both the efficiency and effectiveness of an onboarding program. As we continue to focus on improving quality of care, improving the patient experience, and reducing readmissions, healthcare organizations find an even greater need for an effective onboarding process to ensure the NLRN is prepared to care for complex patient populations.

According to SHRM, an ineffective onboarding process can contribute to early turnover with nearly one-third of all new hires quitting their jobs within the first six months. But how can we determine the ineffectiveness and where there are opportunities for improvement? 

Aligning metrics to desired outcomes is a key step to begin measuring effectiveness. There are many ways to measure effectiveness such as engagement/feedback surveys, job performance, evaluation, clinical outcome alignment, and process efficiency metrics, to name a few. Measuring the efficacy of an onboarding process should be a continual process improvement effort.

How Relias Can Help

While there may be variation in how health systems onboard an NLRN, it is imperative to ensure that NLRNs are equipped with the knowledge, attitudes, and skillset to be successful within an organization. An efficient and effective onboarding program clearly demonstrates to the NLRN that their healthcare organization is committed in their personal success and is willing to invest in them both personally and professionally.

Relias Onboarding assesses a nurse’s proficiency and personalizes a learning plan to ensure quality and safe practice in the top four hospital specialties: medical/surgical, labor & delivery, intensive care, and the emergency room. Relias Onboarding is perfect for blended learning, and the content is ANCC accredited, so nurses earn continuing education credit as they learn. A personalized learning plan approach reduces the time and cost of onboarding, while ensuring readiness to practice and improving nurse satisfaction.

Editor’s Note: This post was originally published in October 2017 and has been updated with new information.