Faced with high turnover, persistent staffing shortages and budget constraints, hospitals can’t afford to hire, lose and re-fill the same position every year.
But many providers are facing this exact challenge: According to the 2025 NSI Nursing Solutions, Inc. National Healthcare Retention & RN Staffing Report:
- Close to thirty percent (29.9%) of all new hires at hospitals left within a year. This same group accounted for over a third (37.5%) of all turnovers. As consistent with previous surveys, a majority (61.4%) of exiting employees had less than two years of service.
- Over twenty-two percent (22.3%) of all newly hired RNs left their organizations within a year, with first year turnover accounting for a third (31.9%) of all RN separations.
To build more sustainable staffing pools, hospitals should take action to keep the talent they already have from deserting the onboarding process.
A structured, formal and long-term onboarding process can make the difference: Research from the Association for Advancing Physician and Provider Recruitment (AAPPR) shows a significant correlation between onboarding quality and job satisfaction: Among physicians and other health professionals who had had a positive onboarding experience, 56% reported they were highly satisfied with their jobs, compared with just 19% of those who had had a negative onboarding experience.
Just 2% of those who had had a positive onboarding experience said they were dissatisfied with their jobs, compared with 12% of those who had had a negative one.
Despite the importance of strong onboarding, the study suggests many hospitals may have gaps in their onboarding programs: In the AAPPR report, only 57% of physicians and clinicians reported having received “formal” onboarding at their current job.
In this post, learn how hospitals and healthcare organizations can improve satisfaction and retention by creating more robust onboarding programs.
1. Nail your first impression: The “preboarding” advantage
The period between an offer acceptance and the first day is often a “black hole” where candidate engagement can wither. Unexpected delays at this stage – like a delayed background check – can cause new hires to get cold feet and potentially take another offer.
Consider outsourcing pre-hire tasks to accelerate onboarding
Choosing vendors that can accelerate pre-hire tasks is critical because delays in background screening, license verification, etc. can cause top-tier candidates to accept competing offers. Specialized vendors leverage advanced technology and extensive databases which can provide faster, more accurate results than in-house teams, significantly reducing your overall time-to-hire. Furthermore, outsourcing these tasks allows your HR team to focus on strategic priorities like interviewing and onboarding, rather than getting bogged down in manual administrative workflows.
Eliminate first-day friction
Use a digital onboarding platform to allow new hires to complete e-forms and policy acknowledgments from home, to make the onboarding process more candidate-friendly and speed up time-to-care.
Create a complete pre-orientation checklist
No hospital would forget to order a lab coat or setting up equipment and billing systems for a new hire. But there are other items that hospitals overlook in the rush to onboard new physicians.
One of them is setting up a welcome sign for each new physician. “I think the welcome sign, as basic as that sounds, was something that I think we take for granted — that you’ve been hired and people want you to be here. And making those small gestures goes a very long way,” Balchunas said in the same AMA webinar. “Sending an email ahead of time just to say, ‘We’ll see you on Monday. We’re going to meet you here, here’s what your first week will look like.’ Those are things that go a long way to helping people feel welcome.”
She also recommends securing Electronic Health Record (EHR) elbow support — real-time, hands-on assistance provided to clinicians by IT experts during the implementation or “go-live” of a new Electronic Health Record system — for new hires.
“The other piece I would say that was a typical miss was getting that EHR elbow support,” she adds. “Our onboarding team provides that EHR support. Our schedules are incredibly busy, you can imagine how many people we onboard, so we had a notice period that we would say, ‘Can you please request this within 21 to 30 days?’ That wasn’t happening. And, it makes a huge difference to provide this at the elbow onboarding support, and I think that was probably a routine miss.”
Logistics first
Provide a mobile-friendly portal with “day-one” essentials: where to park, what to wear, and where to find coffee. Providing these resources early demonstrates that the organization values their growth and well-being.
2. High-tech foundations for high-touch care
Digital health technologies (DHTs) and automation aren’t just for patient care; they can improve efficiency throughout the hiring and onboarding lifecycle.
- Simulation-based training: Consider using Virtual Reality (VR) or digital simulation tools for high-risk protocols like infection control. This allows new staff to build confidence in a zero-risk environment and has been shown to reduce clinical errors.
- EHR Readiness: Navigating the Electronic Health Record (EHR) is a primary stressor for new clinicians. Providing specialized training on EHR software systems before their first live shift can drastically reduce early-on-the-job stress and improve patient safety.
3. The 90-day roadmap: moving beyond orientation
Orientation is an event. Onboarding is a process that should span at least three months, according to industry standards. In a hospital setting, a 30-60-90 day plan might look something like this:
- The 30-60-90 Day Plan: Establish clear, attainable milestones.
- Pre-boarding: Create a streamlined process for performing pre-hire tasks, such as completing a background check, verifying credentials, and filling out paperwork.
- 30 days: Complete EHR training and shadow key roles.
- 60 days: Begin independent patient care with weekly mentor check-ins to bridge potential gaps in ongoing support.
- 90 days: Conduct a formal performance review and collect feedback on the onboarding experience.
- After 90 days: Keep new hires engaged through ongoing mentorship and periodic check-ins to reinforce key points and ensure role proficiency.
- Gradual workload integration: Gradually increasing responsibilities prevents the burnout that fuels early turnover. The American Medical Association suggests taking anywhere from 12 to 24+ weeks to ramp up a new physician’s patient loads, depending on their level of experience.
4. Mentorship as a burnout shield
In a high-stress hospital environment, human connection is the “glue” that promotes retention. Successful provider onboarding programs are essential for improving retention and productivity.
- Peer navigators: Assigning an onboarding “buddy” from day one is one of the most effective ways to support a new hire. It reduces anxiety and provides a safe space for questions.
- Structured preceptorships: Programs like HealthStream’s Preceptor Development ensure that the guidance new nurses receive is consistent and high-quality.
- Foster belonging: Invite new hires to Employee Resource Groups (ERGs) early. This helps integrate them into the organizational culture and sets clear expectations.
5. Measure, listen and iterate
You cannot manage what you do not measure. HR teams should track key performance indicators (KPIs) to refine the process continually.
- Key metrics: Monitor time-to-productivity, 90- and 360-day retention rates, and onboarding satisfaction scores.
- Pulse surveys: If you only collect feedback during exit interviews, you’re missing out on data points that can help you make immediate improvements to employee experience and reduce turnover. Instead, conduct short surveys at the 30, 60, and 90-day marks to identify friction points and respond more quickly..
- Stay interviews: Conduct “stay interviews” at 45 days to ask what is working.
How Accurate can help simplify healthcare onboarding
Healthcare onboarding is complex, but hospitals can’t afford to cut corners when it comes to vetting and screening new physicians. The right background screening partners can help hospitals simplify their screening and verification without slowing down their hiring goals.
Accurate helps hospitals streamline background screening and meet their onboarding goals with healthcare-specific checks, powerful technology, and the personal support you expect from a true partner.
Accurate background checks for healthcare may include the following components:
- Criminal background checks (county, state, federal, national)
- License verification
- FACIS Level 1 and 3M searches
- OIG and SAM exclusion list checks
- Sex offender and abuse registry checks
- Drug and health test scheduling integrated into the same portal as background screenings
- Occupational health management
- Employment and education verification in 195 countries
We help organizations like yours simplify their background screening challenges with the following features:
- Centralized platform with near real-time tracking
- 40+ ATS and HRIS integrations including Workday, Greenhouse, iCIMS and more
- Mobile-first candidate experience
- Global compliance support
- Same-day drug testing scheduling
- Progressive screening by role
- Dedicated healthcare support teams
- 24/7/363 global client and candidate support
