Reducing Nurse Aide Turnover: An Effective Onboarding Guide

Caregiver retention in today’s healthcare environment isn’t just a problem. It’s a crisis, with the current turnover rate being higher than ever before. The Long-Term Care Community Coalition reports that the average nursing home turns over 53.3% of its nursing staff yearly. Nurse aides are an integral part of the healthcare team in senior living and significantly impact resident well-being and facility reputation. 

While a high turnover rate can decrease resident satisfaction related to the poor outcomes a lack of continuity of care can bring, it also impacts your financial and operational efficiencies. Senior care leaders often revamp their caregiver retention strategies to stop the constant churn. However, many forget to dive into their onboarding processes, which is a key step in finding a crucial solution for caregiver retention. Not only will a robust orientation program reduce your turnover rate, but it will also help you stand out in a crowded market when hiring new nurse aides. 

This blog provides healthcare onboarding best practices for creating an effective nurse aide onboarding program to help you transition from turnover to fully-staffed and thriving. 

Rethinking Traditional Onboarding

Many long-term care leaders use onboarding and orientation as synonymous steps in the hiring process. If this describes your organization’s strategy, it might be time to rethink your onboarding experience to improve caregiver retention and engagement. Let’s take a look at the differences between onboarding and orientation. 

Understanding Onboarding and Orientation

Orientation is a short-term formal event that introduces a new employee to your organization. It focuses on general information and compliance, like educating on your mission and values, organizational structure, and HR policies. It doesn’t include regularly scheduled check-ins, feedback loops, or mentorship. You can think of onboarding as the tactical “need-to-know” information that helps the new nurse aide meet the basic legal and organizational requirements. 

In contrast, onboarding is a comprehensive, long-term, strategic process that fully integrates the new nurse aide into the organization's culture, operations, and processes. It goes beyond initial paperwork, general policies, and nursing unit assignment. Onboarding must focus on performance, productivity, culture and retention.   A few key pillars of a successful nurse aide onboarding program include: 

• Personalized Learning: Onboarding shouldn’t be a one-size-fits-all endeavor. You must create a personalized learning experience for every nurse aide. You can accomplish this by implementing assessment-driven personalized learning.
• Submersion into the Organization: Many organizations slowly integrate new nurse aides into their culture and values. However, early introduction to the facility’s culture, values, and expectations can significantly improve the nurse aide’s experience, engagement, and job satisfaction. 
• Integrating Foundational Skills with Critical Thinking: Everyone knows that onboarding must include procedural skills. However, critical thinking abilities and other essential traits are just as necessary. Without them, nurse aides may struggle with problem-solving, independent judgment within their scope of practice, and the inability to know when to escalate situations. 
• Mentorship and Peer Support: Connecting new hires with experienced colleagues helps to foster trusting working relationships. Knowing who to turn to for assistance can make the first few days at a new job much easier. 
• Expectations and Feedback Loops: Nurse aides who meet with their new supervisor often usually feel more prepared and engaged on the job. They understand the expectations and know who to go to when they need to provide feedback. 

Designing the Onboarding Experience

Investing in healthcare onboarding best practices means you’re making a long-term commitment to your staff. Now, that you know that nurse aide onboarding must be an experience, not just a one-time event on their calendar, let’s explore the three phases of onboarding and the activities that should happen in each one. 

Phase 1: Pre-boarding and Initial Integration

This phase of the onboarding experience begins just after offer acceptance and runs through the first week on the job. During this phase, you must begin to immerse the new employee into your organization through welcome activities. A few ideas for this phase include:

• Personalized Welcome Letter or Video: A warm message from the Director of Nursing or Administrator can go a long way in making the new nurse aide feel welcomed and included from day one. Have the healthcare leader express their excitement about the new staff member joining the team and share key aspects of the organization’s mission and values. 
• Meet Your Mentor Introduction: Assign a seasoned, high-performing nurse aide mentor they’ll work with for the first few weeks on the job. This person can offer information, support, answer practical questions, and help them navigate through daily routines and team dynamics. 
• Comprehensive Facility Tour: Your urge might be to take them directly to their assigned unit to meet the team. However, a guided tour that visits other key departments they’ll interact with, such as dining services, therapy, and administration, helps them understand the broader ecosystem of the organization. 
• One-on-One With Their Supervisor: A good working relationship with their supervisor must start on day one. A brief, dedicated meeting with their direct supervisor should happen on their first day. This meeting allows the supervisor to set clear expectations, discuss initial priorities, and simply welcome the new nurse aide, making them feel supported and heard. 

Phase 2: Structured Learning and Skill Development

Phase two begins during the second week on the job and runs through the end of the second month. This phase focuses on the nurse aide’s education and skill development. All required training must align with the organization, types of residents they’ll care for, and the unique characteristics of the senior living environment. Choose evidence-based training modules and educational materials specific to this environment. Be sure to consider the diverse needs of learners in the classroom. 

While staff on the same unit have similar educational needs, you can take your learning and development plan one step further by conducting assessment-driven personalized learning for each staff member. One study implemented evidence-based learning for onboarding with nurses and found that staff who completed an assessment-driven personalized learning plan demonstrated better knowledge, critical thinking, and job satisfaction compared to those who did not complete it. 

A few key activities during this phase include:

• Teaching clinical lab skills
• Conducting simulation exercises
• Completing all mandated  training and  testing
• Establishing skill competency

Phase 3: Ongoing Support and Competency Validation

The final phase runs from month three through the end of month six. The new nurse aide should start feeling confident about their daily job expectations by the time they begin this phase. Some organizations may struggle to keep up the momentum of checking in with the new nurse aide by this time in the onboarding experience. However, ongoing support during this phase can significantly impact caregiver retention. A few activities to prioritize include:

• Regular Check-Ins: Schedule 15 to 20 minute check-ins at least monthly with staff to ensure they feel engaged and have all of the tools and resources they need. 
• Continued Mentorship: It’s critical new nurse aides know who to turn to when they need support. Be sure they have a seasoned nurse aide or nurse mentor assigned. 
• Skill Refreshers: This phase is all about setting the nurse aide up for long-term success on the job. You must address any educational opportunities identified during phase two. This could include hands-on skills, critical thinking skills, and any other processes that need reinforcement.

The Power of Intentional Onboarding

Every decision maker in healthcare wonders how to invest in staff, reduce turnover, and improve patient outcomes. A well-structured onboarding program anchored in personalized learning and evidence-based practices is vital for nurse aide success. 

If you’re a leader in long-term care services, it’s time to invest in and prioritize your nurse aide onboarding as a strategic imperative for the long-term success and quality of care in your long-term care facility. Investing in nurse aides is inventing in the future of senior care.