For too long, onboarding in healthcare has been a whirlwind of paperwork, an impersonal orientation and a bit of a sink-or-swim mentality on the floor. It’s a lost opportunity in a pivotal moment that can lead people to disengage, or worse, leave the organization.
We must do better in the U.S. when 1 in 5 early-career nurses leaves their organization, even as overall nurse engagement begins to stabilize. And the earliest days carry outsized weight: roughly 20% of voluntary nursing turnover occurs within the first 45 days — before most new hires have found their footing or their place on the team.
The financial implications alone are staggering. Estimates of what it costs to replace a single bedside nurse range widely by experience and specialty, from roughly $61,000 to $88,000. But the true cost is far greater. High turnover rates lead to stressed managers, increased costs, disruptions in care continuity and decreased team morale.
At Hackensack Meridian Health, we have made it a one-year strategic priority to improve retention rates among new team members. We developed a multi-pronged strategy to help nurses, physicians and others feel a sense of belonging immediately and to know they have support, all of which continues to strengthen our culture.
Hands-on support before day one
A cornerstone of this new approach is making sure new team members feel welcome before their first day, and providing better mentoring and support so they can see a clear path to growth and success in the early, challenging days of their career.
Starting next month, when a person is hired at Hackensack Meridian Health, they will receive a welcome video from me, and within 48 hours, a call from their leader. A week prior to their start, they will hear from their leader again. On day one, it’s a team huddle to welcome the new colleague to create an immediate sense of belonging. There’s also a monthly gathering for new hires. I am also continuing a tradition that’s been very successful: I regularly meet with our newest teams at a local golf entertainment facility and driving range — we call it Tee Off with the CEO — a great opportunity to connect in a relaxed and fun environment.
We will also routinely send “high fives” to new team members from the Culture and Team Member Well-being team. This will amplify the reach of our dedicated recognition platform, which already provides an opportunity for real-time, peer-to-peer recognition and leaders giving a shout-out for great work, all of which helps us foster a culture of mutual gratitude.
Stronger together: ‘buddies,’ feedback and listening
Another key component to our new onboarding approach is enhanced mentoring and a more robust buddy system. For our new nurses, we are focused on a residency program that supports new professionals clinically and holistically. A preceptor provides one-on-one, on-the-job training, supervision and mentorship to new graduates who are facing “transition shock” between nursing school and the fast-paced, high-tech clinical units they are staffing. In fact, we believe in it so strongly that we are extending it to the second year of a nurse’s career. Most importantly, we integrate self-care and overall well-being initiatives from the start to help develop healthy habits early on, in order to decrease compassion fatigue and burnout.
We are also creating a buddy pilot — an extension of the nurses’ buddy system — and will recommend that leaders assign new team members a buddy in their team. Ultimately, we will reach many new team members and pair them with an experienced mentor who can provide guidance, support and a safe space to ask questions. This is not an informal arrangement but a structured program with clear expectations and dedicated time for mentor-mentee interactions. For example, my chief of staff is a “buddy” to five people and meets with them monthly.
Additionally, we’re improving our 30- and 90-day surveys of new team members, making them shorter and more open-ended to elicit better feedback. We want people to know their voice matters from day one.
A key feature to this is a program known as Stand Out, which includes weekly check-ins between our teams and their leaders. It’s a great way to stay on track and remind our teams that we greatly value their opinions. For example, one of the questions is, “What did you loathe this week?” At first, I thought this was too extreme a question, but I have grown to appreciate the candor it elicits from people. It really helps us track specific drains on their time and morale to improve future work satisfaction.
How the work pays off
Ultimately, this is about building a strong, resilient and inclusive culture, which is at the heart of team member recruitment and retention. We have worked hard to strengthen our culture and are now ranked No. 39 on Fortune’s “100 Best Companies to Work For” in the U.S., among all sectors. This marks the second consecutive year we have made the list, and we are the highest-ranked health system in New Jersey.
Investing in a comprehensive and compassionate onboarding process is not a luxury; it is a necessity. It is an investment in our people, our patients and the long-term health of our organization.
Robert C. Garrett is CEO of Hackensack Meridian Health, New Jersey’s largest and most integrated health network with 18 hospitals, more than 500 patient care locations, 40,000 team members and the Hackensack Meridian School of Medicine.
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