Building a Skilled Healthcare Workforce

During the onset of the COVID-19 pandemic, my colleagues and I, as healthcare professionals, continuously navigated between unknown roles, responsibilities, and settings. I understood what onboarding in this everchanging transitional landscape should encompass. However, my reality was far from this previously established ideal process. Furthermore, I questioned my abilities to provide this structure for other inexperienced staff as they arrived in the new and uncharted settings we all found ourselves navigating. A couple of years ago, I began researching this phenomenon, driven by curiosity about the experiences of other novice healthcare workers. How did they perceive their education, training, and support during their professional onboarding?

Education and training are concepts entwined by practical skills and theoretical knowledge requirements. These considerations extend beyond each individual's needs to construct a proficient, qualified healthcare workforce (Doughty et al., 2018). Formal support and mentorship are multifaceted concepts renowned for increasing motivation and resilience and enhancing patient care quality (Ulupinar & Aydogan, 2021).

What is Best-Practice Onboarding?

Through my research and personal experiences, I have found that healthcare environments that promote excellence often provide strong foundations for new healthcare workers. Referred to as onboarding, this introductory process revolves around organisational expectations, ethical values, operations, and benefits required for employment success. Providing these structures can lead to positive learning outcomes, increased time management and flexibility (Hall et al., 2019). Novice healthcare workers rely on and expect onboarding processes that provide encouraging feedback and supportive learning opportunities. Well-orchestrated, supportive, and repetitive skill and knowledge practice enables them to flourish within new roles and build their professional identities (Sessions et al., 2021).

Challenges to Effective Onboarding

Recent studies have outlined how unhealthy workplace environments that lack support and learning opportunities force novice healthcare workers into unknown role acceleration. A pressurised, fast-paced transition to practice increases the risks of adverse patient outcomes, staff conflict, stress, and burnout (Hall et al., 2019; Naylor et al., 2021). Disappointing substandard onboarding programs prolong learning curves and increase healthcare worker maladaptation and vulnerability. Conversely, transitional education, training and support are proven to improve professional development and confidence (Crismon et al., 2021; Kurnat-Thoma et al., 2017).

Efficient onboarding programs can be utilised as a recruitment and retention tool, especially considering current healthcare workforce shortages (Young-Brice et al., 2022). Employee retention is the primary measure of overall and fiscal healthcare organisational success. Therefore, the dynamics, including onboarding programs, which drive these outcomes, should also be considered a measure of success (Crismon et al., 2021; Kurnat-Thoma et al., 2017).

Education teams will support programs that exude excellence and are ready to fulfil personalised assessment, competency, and learning needs and preferences. We can measure successful onboarding outcomes by how supported novice staff feel towards providing safe, quality patient care, and then quality data that measures how well they actually do this. Furthermore, by comprehension, they gain and express organisational expectations and career-long critical thinking and decision-making abilities (Valdes et al., 2023).

Maximising the Onboarding Phase

Personalised, evidence-based onboarding provides organisational opportunities to leave an inviting first impression on new staff. Effective training and education create staff feelings of value and encouragement for optimal performance, which increases job satisfaction and engagement. Contrarily, when organisations implement lacklustre programs with minimal support, staff may feel undervalued and underprepared for their stressful realities (Valdes et al., 2023).

All healthcare workers must meet the exorbitant demands of complex, high-acuity environments. Understandably, they yearn for onboarding aspects that use evidence-based practice to identify and optimise opportunities to ensure that their knowledge and skills gaps can be well-supported and approached with a higher level of clinical judgment (Valdes et al., 2023). Organisations can gauge new staff's genuine performance and productivity abilities when they provide adequate support, training and education for optimal role fulfilment (Kurnat-Thoma et al., 2017; Valdes et al., 2023).

Investing in Staff Retention

Turnover rates amongst novice healthcare workers are notoriously high, creating logistical challenges for organisations. Robust onboarding infrastructure can be born from education and training programs, easing the transition to practice (Valdes et al., 2023; Young-Brice et al., 2022). Strengthened by mentorship, these nurturing workplace programs encourage cultivating their sense of belonging to match their utmost potential (Hall et al., 2019). Although these comprehensive elements are costly for organisations, hiring and training a revolving door of new staff is also exorbitant and can be mitigated through investing in satisfactory onboarding processes, which are rewarded by increased staff retention (Hall et al., 2019; Young-Brice et al., 2022).

Experiences and Perceptions of Novices

The COVID-19 pandemic accelerated onboarding and induction training as it necessitated the fast-tracking of many new starters, including clinicians temporarily returning to practice or staff quickly transitioning to new areas. Ongoing persistent workforce challenges in the wake of the pandemic exacerbate the already disconcerting novice phase for many new starters. Our research has uncovered that many newly hired healthcare workers are dissatisfied and concerned with how they will perform their roles and provide adequate patient care. Unavailable educators and reduced prioritisation of onboarding support, education and training increased staff turnover rates and adverse medical events. Our recent findings included many occurrences of needing more educational teams or facilitated onboarding. Potentially disastrous effects remain as healthcare organisations scramble to fill unprecedented staff shortages. Establishing the best available evidence for support, education, and training requirements is crucial in protecting healthcare systems and the future leaders who will be relied upon (Crismon et al., 2021).

Enhancing Onboarding Experiences

Our healthcare climate continuously evolves and should match onboarding experiences that evoke innovation, feedback, and ad-hoc learning opportunities. New healthcare workers can build resilience and agility within dynamic roles requiring effective communication and performance. Our research outlined the requirements for significant organisational support, which promotes meaningful workplace social connections and self-care development to avoid adverse emotional outcomes from stress or anxiety (Doughty et al., 2018). Burnout was a theme continuously highlighted whilst researching the onboarding experiences of new healthcare workers. The most commonly reported aspects affected by poor onboarding were role satisfaction and retention. Although pandemic conditions are easing, the experiences of support, training, and education are not necessarily improving. Ensuring adequate educational teams, debriefing, extended orientation periods and supported competencies could go a long way in future program development and implementation (Sessions et al., 2021).

Successful onboarding lays the foundation for healthcare staff to thrive and provide quality patient care. Prioritising effective induction training and robust support for new starters’ transition to practice improves job satisfaction, staff retention, and the ability to provide optimal care.

References

Crismon, D., Mansfield, K., Hiatt, S., Christensen, S., & Cloyes, K. (2021). COVID-19 pandemic impact on experiences and perceptions of nurse graduates. Journal of Professional Nursing, 37(5), 857–865. Link to Article

Doughty, L., McKillop, A., Dixon, R., & Sinnema, C. (2018). Educating new graduate nurses in their first year of practice: The perspective and experiences of the new graduate nurses and the director of nursing. Nurse Education in Practice, 30, 101–105. Link to Article

Hall, S., Taylor, S., & Altobar, C. (2019). Transition to practice: Onboarding components for establishing and sustaining healthy work environments. AACN Advanced Critical Care, 30(4), 416-420. Link to Article

Kurnat-Thoma, E., Ganger, M., Peterson, K., & Channell, L. (2017). Reducing annual hospital and registered nurse staff turnover—A 10-element onboarding program intervention. SAGE Open Nursing, 3, 2377960817697712. Link to Article

Sessions, L.C., Ogle, K.T., Lashley, M., & Austin, E.N. (2021). Coming of Age During Coronavirus: New Nurses' Perceptions of Transitioning to Practice During a Pandemic. The Journal of Continuing Education in Nursing, 52(6), 294–300. Link to Article

Ulupinar, S., & Aydogan, Y. (2021). New graduate nurses' satisfaction, adaptation, and intention to leave in their first year: A descriptive study. Journal of Nursing Management, 29(6), 1830–1840. Link to Article

Valdes, E. G., Sembar, M. C., & Sadler, F. (2023). Onboarding New Graduate Nurses Using Assessment-Driven Personalized Learning to Improve Knowledge, Critical Thinking, and Nurse Satisfaction. Journal for nurses in professional development, 39(1), 18–23. Link to Article

Young-Brice, A., Farrar-Stern, K., & Malin, M. (2022). Comprehensive Onboarding and Orientation to Support Newly Hired Faculty in a Nursing Program. Nurse educator, 47(6), 347–351. Link to Article

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