Reducing Annual Hospital and Registered Nurse Staff Turnover—A 10-Element Onboarding Program Intervention

Employee turnover is a key metric and performance indicator when evaluating the fiscal and operational effectiveness of any health-care facility. This article outlines a turnover analysis and onboarding program performance improvement initiative used by a 187-bed community hospital in the Washington DC metropolitan area to reduce staff turnover. Using an evidence-based approach, we evaluated facility staffing statistics, exit survey data, research literature, and industry exemplars. We identified presence of severe turnover for hospital and nursing staff employed less than one year (new hires), with 2009–2012 annual new-hire losses ranging from 28.8% to 49.6%. Exit survey data identified only 50% to 62% of new employees who felt that: hospital orientation provided necessary information for successful employment; they had people to go to with concerns; and they had a realistic understanding of their job. Therefore, a 10-element program intervention was designed to strengthen and standardize the new employee onboarding process. Program elements focused heavily on retooled onboarding communications, including frequent new-hire interactions with managers and regular support from assigned high-performing colleagues. Post program implementation, overall annual hospital turnover decreased from 18.2% to 11.9% and new-hire turnover losses decreased from 39.1% to 18.4.%, which was statistically significant between measurement periods (Wilcoxon signed ranks test, Z = −2.06, p = .04). Implementing a standardized onboarding format that was specifically tailored to support new-hire employees allowed our hospital to rapidly reverse unsustainable turnover increases. The successful reduction in hospital and nurse turnover we achieved was rooted in multidisciplinary engagement of institutional stakeholders, managerial collaboration across departments, and strong support from executive hospital leadership.