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The Importance of Onboarding

Taking time to properly acclimate a new employee to her new role is critical to retention.

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A recent study by Accountemps suggests one out of three employers lacks an orientation program for new hires. In response to the question: "Does your company conduct a formal orientation for new hires?" 34 percent responded "no."

Perhaps surprisingly, the study showed smaller organizations were more likely to have orientation programs than large organizations (67 compared to 52 percent).

While preceptorship programs are common in healthcare, there are other best practice efforts that can improve onboarding from the standpoint of enculturation and alignment with mission.

In fact, getting new employees quickly on board and aligned with the organization's mission, vision and values is a key benefit of orientation programs say those who offer them.

Whether referred to as orientation or onboarding, two terms that have become fairly synonymous, and taking time to properly acclimate new employees to their roles and the organization is critical, said Josh Warborg, district president at Robert Half International in the Seattle area (Accountemps is one of Robert Half's professional staffing divisions). 

"It is very expensive to bring a new hire on," Warborg noted. Organizations that don't bring those new employees on effectively face the "high likelihood that a person won't make it and will end up looking for another opportunity, or just won't succeed."

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'All About the Mission' 

Onboarding programs must leave nothing for granted and, importantly, must consider the perspective of the new hire and the issues and concerns that she may have.

At Huntington Hospital in Pasadena, CA, Lynette Dahlman, MSN, RN-BC, director of clinical education and academic partnerships, stressed the importance of being attuned to the inputs of those being oriented.

The hospital's orientation program has been in place for a number of years, she said, but it is modified continually based on voice of the customer inputs from both participants and staff.

"Over the years, as we've gotten feedback from our managers and new grads, we've changed the program to meet the changing healthcare needs," she noted. "You can't be static - you have to really be dynamic and you have to listen to the voice of your customers."

A focus on mission is a core part of the orientation process at Huntington and Dahlman was recently pleased to learn the mission resonates not only from a training standpoint but through actual experience.

One new grad, Frances "Francie" Bakar, BSN, RN, said "everybody is all about the mission." Dahlman was gratified to hear that and noted, "I hadn't really heard anybody talk about it that way, but it is true."

In addition to orienting new hires to mission, vision and values, effective onboarding plays a critical role in helping ensure strong relationships and internal networks that are so important to long-term success.

"I believe there is great value to starting each employee off with a consistent message that makes them feel welcomed and valued as a new member of the team," said Melonie Boone, president and co-founder of Complete Concepts Consulting Inc. in Chicago.

Customized Orientation Programs

The overarching goals of the onboarding program, said Boone, should be to tell the new hire:

  • the company story;
  • the company mission and vision;
  • the company expectations, including policies and procedures; and
  • how the employee plays a role in helping the organization meet its goals.

George Bradt is managing director of the executive onboarding consulting firm PrimeGenesis, based in the New York city area, and the author of Onboarding: How to Get Your New Employees Up to Speed in Half the Time (Wiley, 2009). He points to five steps toward building a successful onboarding program:

1. Align your organization around the need for your hires and around the details of each role.
2. Acquire the right team members in the right way.
3. Accommodate by preparing your new hires to do real work right away.
4. Assimilate by managing announcements and proactively helping with engagement.
5. Accelerate results by supporting your new hires with resources and purpose-driven leadership.

At Huntington, much emphasis is placed on the orientation program with a special focus on new nursing graduates who are exposed to the nursing shared governance structure as well as quality and Six Sigma projects from the outset of their time with the organization, said Dahlman.

Orientation is customized based on the individual competency of the new graduate nurse.

After an initial 2-week training session, the manager, preceptor and new grad meet periodically to discuss competency goals and how well the new grad has progressed toward independent practice. Weekly meetings are held to provide additional training on specific topics and areas of practice.

A key area of training and education is around regulatory issues that many school programs don't cover. A practical focus, along with ample opportunity to connect with others and build relationships, is a key part of the process.

"We give them an opportunity to help each other in a forum where they can give each other tips on best practices - it's very safe for them," Dahlman said.

Effective Acclimation

Based on their research, Accountemps offers five tips for helping new hires acclimate effectively:

  1. Roll out the red carpet. New employees want to make a great impression right away and it's important for the organization to do the same. Try to personally greet the new hire on the first day to make her feel welcome. Go out of your way to reiterate how happy you are that the individual has joined the team.

  2. Aim to ease anxieties. Starting a new job is nerve-racking. Encourage questions and offer introductions. Schedule a departmental lunch to give the newcomer a chance to get to know co-workers in a less formal setting and help establish rapport.

  3. Arrange day-in-the-life tours. During the initial weeks on the job, ask the new employee to meet with and observe key colleagues she will be working with across the organization. These training sessions will allow the new employee to learn who does what while gaining a broader understanding of various departments, job functions and the inner workings of the organization.

  4. Provide a road map. Paint a detailed picture of what the employee can expect in the first few months on the new job. Address topics the new hire needs to learn, review core job responsibilities, explain top priorities and highlight performance goals. Maintain an open-door policy and schedule regular touch-base meetings.

  5. Make use of mentors. Consider assigning a mentor who can provide guidance and share institutional knowledge. A mentor can shorten the learning curve, allowing the new employee to make more substantive contributions early on.

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Onboarding is a critical part of welcoming new employees, particularly new nurses, to healthcare organizations.

While the Accountemps survey indicates that fully one-third of organizations in general do not have formal orientation programs for new hires, it is unlikely this situation exists in healthcare environments.

Still, simply having a program doesn't make it an effective program. Seeking and following best practices, listening to the voice of the customer feedback, and ensuring mission and messaging align are all vitally important to ensure effective onboarding for nursing staff.

Lin Grensing-Pophal is a frequent contributor to ADVANCE.


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This article only addresses "new graduate nurses." There are many nurses changing jobs and facilities, many of them experienced nurses. Orientation programs need to have a core component but also evaluate and meet the new nurse at her level of experience and tailor the goals and length of orientation accordingly.

I began a nursing position several years apart at 2 different hospitals. I had 20+ years acute care and other experience, including critical care. I was hired for MS/telemetry. I was followed around by a nurse with 1 year experience, so much younger than me, who breathed down my neck as I took blood pressures on my patients. The other "preceptor" was just a few years younger than me but also assumed I was green, and began showing me how to take temperatures and make beds. Frankly, even a new graduate nurse (and nursing assistant) should know these things and orientation is wasted on these "skills."

Because the nurse manager who hired me did not "orient" my preceptor(s) to ME - who I was, where I came from, what my background and experience was, both orientations failed not long after they began. I didn't get up and running as fast as I would have liked because I had to waste time on basic skills and try not to offend preceptors when I asked them to orient me to the real nuts and bolts of the job clinically etc. The nurse manager hired me and was not seen again, leaving me to hammer out my own path and needs with nurses who became offended and defensive when I asserted myself, no matter how diplomatic I was.

Not all "orientees" are new graduates. Orientation is what every nurse "new" to an institution receives. But "new" to the institution does not mean "new" graduate or inexperienced. Managers need to keep that in mind.

Amy Williams,  RN Coder,  Mercy HealthSeptember 06, 2012
Philadelphia, PA



Lin Grensing-Pophal
The Importance of Onboarding
Taking time to properly acclimate a new employee to (her) new role is critical to retention.
No HIM? Wow! how inclusive. And u want to make strides in nursing???


tony ,  clinical nurse IISeptember 02, 2012
Atlanta, GA




     

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