ATD Blog

Engagement in Nurse Onboarding: Is It Possible?

Wednesday, March 27, 2019

Nursing is a profession that’s been around since the beginning of time. Strong-minded healthcare providers have been treating the sick for centuries through war, famine, and epidemics. Nurses were the ones who had to deal with the real-life implications of living in a cruel, often unfair world. The industry of healthcare has come a long way since then.

Nursing Then and Now_UHS.jpg

©University Health System

Do you remember your first job? Both anxiety and excitement filled you as you walked in—Will they like me? Will I be able to do the job? Will my co-workers welcome me and help me learn about our company? Depending on the size of the company you joined, you more than likely participated in a new employee orientation. You were probably provided information on working hours, performance standards, benefits, and so forth, or had a “death by PowerPoint” experience. Do you remember it? Would you describe it as impactful or engaging?

In the early 2000s, the term “onboarding” was being used in many corporate industries. Healthcare was paying attention and knew it was important; but with so many regulatory agencies dictating what must be included in nursing orientation, the need for compliance training was paramount.

In today’s competitive healthcare market, nurses can work at any organization and in any city they choose. Couple that with the challenge to recruit, hire, and retain nurses, and you have your work cut out for you. In a report brief, Millennial Nurses Are Headed for the Exit. Here’s How to Stop Them, overall bedside RN turnover rose steadily from 2009 to 2015, landing at just under 12 percent in 2016. Of particular concern: One-quarter of nurses who left their facility in 2016 had less than a year of tenure. Many of those departing nurses are younger than 35, an age group that comprises nearly one-third of the nursing workforce.


In the Survey of Millennial Nurses: A Dynamic Influence on the Profession report, Millennials have distinct expectations about what constitutes a good working environment and how that can positively affect patient care. Among these expectations are professional development opportunities, transparent quality measures, a positive culture, and earnestly supportive leadership.

Knowing that our onboarding program was falling short of our new nurses’ expectations and was being reflected in post-course surveys, the talent development team went to work. They pulled together stakeholders over the course of a year to revamp the program to what it is today—an onboarding program that incorporates culture, connection, and commitment while meeting our compliance requirements. It is engaging and relevant.

Consider this:

  • O.C. Tanner reports 69 percent of employees with a great onboarding experience are likely to stay with their employer for at least three years.
  • Research indicates positive experiences in classroom nursing onboarding programs show a strong correlation to increased retention.

Unfortunately, most nursing orientation programs are presenter-centered, lecture-driven, and lack engagement and connection. As a talent development professional and nurse for 35 years, I have experienced this; and as much as I hate to admit it, have been the process owner and facilitator of a lackluster nursing orientation. Like most other technical trainers, I accepted the premise that this was the only way to deliver clinical content. It doesn’t have to be this way—we know more now!

There is a plethora of research to be found on the importance and impact of onboarding. As talent development professionals, it is our responsibility to challenge the status quo and look at nurse onboarding through a new lens to achieve our organization’s goals.

To discuss this challenge, join us at ATD 2019 for the session, Nursing Onboarding Redesign: Watch Your Program Evaluation Measures Skyrocket! Discover how a nationally recognized academic health system implemented a learner-centric nurse onboarding program by incorporating creative solutions and industry best practices. You will learn actionable strategies to implement immediately that will impact your nursing engagement, increase retention numbers, and improve your program evaluation measures!

About the Author

Pamela is a clinical learning consultant with the Center for Learning Excellence. For over 25 years, she has designed and delivered clinical and non-clinical training programs to employees. Pamela received a Bachelor of Science in Nursing from Niagara University and a Master of Science Degree in Psychiatric/Mental Health Nursing from the Medical College of Virginia/Virginia Commonwealth University. She is an ATD Certified Master Trainer and nationally certified by the American Nurses Credentialing Center in Nursing Professional Development. Pamela also serves as adjunct faculty to two schools of nursing and currently teaches a critical care clinical rotation.

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Very good article! Quick question and interested in your thoughts. Engagement in Nurse Onboarding is very important no doubt but what about ongoing engagement, post onboarding. Any thoughts on how effective is continuous and proactive engagement throughout their career
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Well done!
Thank you so much, Jacque!
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Such a fascinating article, by a very knowledgeable author!
Your positive feedback is so very much appreciated, Tracey!
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