Onboarding Guide for Nurse Leaders 5 steps to Success

Nurse Onboarding, Training, Interview

When hiring, you are investing in a person. You spend time, money, and resources. In fact, according to Forbes.com, US companies spent an average of 72 billion dollars or $3,300 per hire. That’s a lot of money! Now factor in that many new hires don’t work out and you can see how hiring and retaining is one of, if not the, biggest factors of success. To build a strong house, you must have a stronger foundation. This all starts with the onboarding process.

 “Replacing talent runs as high as two times annual salary,” said Peterson. “And it’s not just about dollars. Culture and job satisfaction is hugely impacted, as well as morale, productivity, lost insider knowledge. It’s painful to lose people.” Ben Paterson CEO of BambooHR

5 Steps to Onboard Star Players

Before You Hire

Nurse Resume On-Boarding

Onboarding starts before you even hire the employee. It begins with the first contact with a potential candidate. Gone are the days of interviewing someone like an FBI interrogator where only the strongest survive. Instead, interviewing is about getting to know a person, their strengths, and weaknesses and deciding if they have the qualifications and personality for your company. Also carefully screening candidates and reading their resume before you even call them to come in respects their time and yours.

Set the tone

Nurse Interview, On-boarding
Copyright: petro / 123RF Stock Photo

I remember showing up to an interview right out of nursing school. I walked into the building where someone was sitting at a desk nearby, I walked over and stood patiently waiting for the person to look up as they were typing away on the keyboard. They just started to look up when the phone rang. I remember thinking ok they’re a little busy just be patient. Then as I was staring at the clock watching the time I was scheduled to interview slip away, she hung up the phone, and an employee walked by. She then proceeded to turn for a nice little chat with this employee who had a date this weekend with a girl he met last night at a club.

I had been standing there for some time and at this point was getting irritated thinking if this is any indication of how they treat their employees it’s not for me. I politely interrupted, “I am so sorry I just want to make sure I am in the right place, I am here to interview with _____.”

Now just to clarify, I did eventually get the job, but it did not work out. The too busy to acknowledge or work with people mentality was a theme throughout this company, and I ended up looking for employment elsewhere.

Compare this to a company I interviewed at where I walked in the door and was greeted with a smile and offered a cup a coffee while I waited for the manager to come get me. One left me questioning if this was right, even after getting the job. The other left me hoping they chose me so I could be a part of this dynamic team.

“About one-third of the new hires who had quit said they’d had barely any onboarding or none at all, and 15 percent of respondents noted that lack of an effective onboarding process contributed to their decision to quit.” Said Roy Mayor in his article Onboarding Key to Retaining, Engaging Talent

Keeping the tone

Nurse On-boarding, Training,

Setting the tone in the onboarding process begins with the interview, however, maintaining the tone is crucial.

“In today’s working world, employees want – and expect – more than just a brief introduction to the company they just joined, a few training sessions and a pay check. They want a personalized, interactive experience and a comprehensive understanding of the organization and how it can help grow them professionally. And, it does not take long for them to decide if they made the right choice.” First Impressions Count: Creating a Positive Onboarding Experience.

After a significant employee turnover rate within a 30-day period of time, I decided to do an exit interview with a candidate who left the company after only 2 weeks of employment. I was impressed with this candidate from day one and trying to find out why they left so soon. The candidate painted a pretty ugly picture for me. The interview was great, and they had been so excited to start. However, day one came, and no one remembered they were scheduled to start, they ended up walking around for almost 2 hours trying to find someone who would let them know what they were supposed to be doing. Ok mistakes happen they thought let’s give it an another chance. Day 2 they showed up and went to meet the person who was supposed to mentor them and found that person to be out sick. “Everyone looked at me like I had a disease, no one wanted to train me,” he said to me. This story went on and on, in fact, in the end, I questioned why he hadn’t left sooner.

Having a plan with contingencies is critical. It’s important to have the candidate feel like they are in the middle of a well thought out proven process designed solely for their success. These employees call off less and are much more stable because they see stability in the onboarding process.

Too much too soon

Overwhelmed on-boarding nurse

One of the biggest mistakes I see companies make in any industry is pushing new hires through the onboarding process too early. With staff shortages, and call offs, it’s tempting to grab the new hire and throw them on the floor to fill the spot. Not only is this dangerous in the medical field but it’s setting them up for failure. It is important to assess where they are and mold the process around them. Companies with a strict time limit for onboarding are not capturing the needs of their employees. Some of the greatest employees I have worked with took extra time in the onboarding process because they just weren’t ready to do it alone yet.

Create an Onboarding Experience

Nurse on-boarding eating alone

I remember my first day of high school. I didn’t know anyone. I walked onto campus with a map, books, and class list. Did I mention I didn’t know anyone? But you know what the one thing I dreaded from the time I woke up that fateful morning was? Lunch. You see, you can’t be too ambitious and sit with the popular kids but don’t want to jump into any group to early and get branded. At least until you get to know people. So instead you sit by yourself and hope no one notices you until you get the lay of the land.

What I didn’t know is that this dread followed me up through my career. Now I have grown much confident than the slightly nerdy kid I was back then. But it is always an uncomfortable social situation for me.

I then had an employer take control of this time. He took me to the cafeteria, showed me how to order, where to sit, and even sat with me during lunch. What an impression! I remember feeling very welcomed and relieved and built a great relationship from that day forward.

“It’s important for new hires to create meaningful connections with colleagues, management, and direct reports. Personally introduce new hires to the team during the first week (depending on the size of the team, you may want to spread this out over a few days). A team lunch is a great way for everyone to get to know each other on a personal and professional level.” The Staffing Stream.


Onboarding sets the pace for the rest of an employee’s career. Messing this up not only costs you time and money but potentially losing excellent candidates as well. One theory I have is that an excellent candidate is much less likely to stay in spite of a poor onboarding experience than a weak candidate. Those candidates that remain are often the ones who want to come to work scrape by and leave. While the people with higher standards move on to companies that meet their expectations.

To sum it up treat your candidates as people. Tailor your onboarding process to the individual and set the tone from day one.

“Clients do not come first. Employees come first. If you take care of your employees, they will take care of the clients.” Richard Branson


Author: Derek Di Camillo

I have been a nurse since 2010 and come from a variety of fields. CPR Instructor, Customer Service, IT/Technology to name a few. Through my travels I have learned many lessons that have prepared me for leadership roles in the Assisted Living industry. I am constantly seeking to better myself and share what I have learned and am learning along the way.