Nurse Onboarding Tips For Success in the OR and Beyond

Nurse onboarding matters. Everyone knows it. Yet, looking at surgical services  departments across the country, you might get a different impression. In today’s fierce talent market, retention is a core concern for hospitals and ORs. Despite that, the first play for retention — onboarding — gets little love. As a result, ORs and hospitals are paying for it.

According to the Society for Human Resource Management, the cost of hiring a new employee can be 3-4 times the position’s annual salary. According to the Bureau for Labor Statistics, the median salary for an RN is approximately $86,000. Therefore, an OR annually losing ten nurses could represent over $1 million in recruitment costs alone. In short, turnover is unsustainable, even for the most profitable healthcare organizations.

Here, the Sullivan Healthcare Consulting Team will explore three vital tips for improving nurse onboarding with insights from our senior consultant, Shawn Craddock, DNP, RN, CNOR, NE-BC. Let’s get right to it.

Tip 1: Don’t Forget Nurse Preboarding

Preboarding is an essential part of the onboarding process. In fact, the onboarding program’s success is hampered from the start if your hospital doesn’t develop a preboarding program. Approximately a third of new employees decide to leave within the first 90 days at an organization. Preboarding helps prevent that by engaging new nursing hires, preparing them for their upcoming role, and making them feel like they’re a part of your OR community— not apart from your OR community.

Unfortunately, many ORs do not have new hire nurse preboarding processes. “From the moment a nurse is hired to their first day, they typically get next to no communication outside of being told to take their pre-employment physical and complete their paperwork,” Craddock said. These ORs are missing a golden opportunity to connect and engage with that nurse, bring them into the organization, make them feel wanted, and give them that warm fuzzy feeling.

Some great things to do during your nurse preboarding process include:

  • Setting expectations
  • Engaging new nurses with your OR’s reward and recognition tools and programs
  • Showing them that you will recognize them in the ways they like to be recognized.

Ultimately, nurse preboarding ensures that new OR nurses show up on the first day with excitement, not anxiety.

Tip 2: Get Serious About Education During Nurse Onboarding

When people leave within the first year, their onboarding and training experience consistently ranks as one of the top drivers behind their decision. For hospitals and ASCs, a one-year nurse turnover is unsustainable. Organizations can’t afford to continually invest time, resources, and energy into recruitment, only for nurses to leave several months later.

Unfortunately, many hospitals see significant attrition levels in the first year because they haven’t committed to quality nurse education. The increasingly common practice of using unit-based educators (UBE) isn’t enough. When hospitals use unit-based educators, “it becomes harder to control the program quality because multiple people are trying to teach the same thing,” Craddock explained. This disjointed training program leaves new nurses with inconsistent training practices and messaging.

For your nurse onboarding program to be effective and meet the needs of new nurses, you need a dedicated education program. That means it has a consistent leader, transparent processes and competencies, and follows verified AORN standards.

Why You Should Implement a Periop 101 Program for New Nurses

New nurses need significant training, repetition, and consistency, each new day adding on a new skill or competency to be performed. For example, one day, they might be focused on nothing but counting. The next day, they might be responsible for plugging in equipment and counting. Then, they might do the pre-operative interview, plug the equipment in, and count.

A step-wise approach significantly improves retention and increases confidence compared with the laissez-faire training model used in many ORs. More importantly, it ensures that nurses reach a state of minimal competence, which isn’t guaranteed in hospitals using UBEs or shadowing methods.

Finally, a dedicated nurse training program represents an investment in your hospital’s future leadership and succession planning. Serving in the educator role is a natural career stepping stone for many nurses, and by eliminating it, hospitals cut the number of pathways a nurse’s career can take.

Dedicated training programs during onboarding build confidence and guarantee competence. 

Tip 3: Help Hospital Leadership Understand the Value of Onboarding

Effective nurse onboarding is vital to an OR’s success. And with the OR being the revenue engine of the hospital, staffing challenges can significantly hinder what’s possible for your organization. Helping senior hospital leadership understand what that means for the bottom line can help drive investments in dedicated training roles.

For example, patient volume and throughput will stagnate or fall — bringing revenue with them — if an OR is a revolving door for staff. The financial risk doesn’t stop there. Unstable staffing and inconsistent onboarding programs for OR nurses can put patient safety at risk, threatening the hospital’s accreditation status, eligibility for receiving reimbursement from CMS, and creating malpractice liabilities.

Still, many hospital leaders won’t take action until they see the evidence. OR directors can make a compelling case by running a simple cost-benefit analysis of implementing a dedicated Periop 101 program with a trainer. Take the number of nurses who have turned over in the last year and multiply it by the potential 3-4 times their annual salaries. Compare that cost to the salary of a single nurse educator whose role would significantly reduce turnover, and you get a picture of a rapid ROI.

Investments in nurse onboarding have a fast ROI. Helping executive leadership see that can help ORs secure the training budgets they need. 

Nurse Onboarding is Like Construction

Everything rests on a solid foundation. If you cut corners, you might still be able to erect the building. Still, each void weakens the structure’s ability to withstand stress, just like a haphazard onboarding program weakens your OR’s ability to retain nursing talent. As Craddock said, “Onboarding isn’t part and parcel. You need to recruit well, preboard well, and onboard well for turnover issues to subside.”

Each organization’s needs are different, so onboarding will often look different between them, as it will between different nurse specialties. Shortcuts might work temporarily, but the stresses it puts on an organization will lead to the same problems over time.

Is your OR struggling to onboard nursing talent? You’re not alone. More importantly, you don’t have to accept that OR nurse turnover is a part of modern healthcare. Shawn Craddock and Sullivan’s team of perioperative consultants can help your organization identify retention challenges and implement realistic, proven strategies to reduce them.

To start saving hundreds of thousands in recruitment costs, contact Sullivan’s team today.

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