Onboarding: Getting to "I Do" with Your New Employees

Jon Brummond

Jon Brummond , PA-C, MS

Published July 17, 2015

My wife and I met on the first day of physician assistant (PA) school. I saw her across the room during orientation and knew right away that I wanted to marry her.

I then spent the next few years getting her on board with that plan.

These days, I often think back to our courtship when I welcome new PAs and nurse practitioners (NPs) to our practice. We want good clinicians to fall in love with our organization, but we also know that in the current job market, they have more "suitors" competing for their attention than Scarlett O'Hara. If we're going to convince them to stick around, we've got to bring our A game from day one.

In this post, I'll discuss the crucial importance of good employee onboarding process, what's at stake, and some lessons learned from my own experience as a long-time site lead (and now regional lead) for our partnership.

Great Relationships Take Work

Simply put, onboarding is the process of introducing a new employee to the culture, structure and systems of your workplace. When done well, it builds the new hires sense of belonging, confidence and allegiance. In many ways, it's synonymous with employee retention — keeping good people around and avoiding the dreaded revolving door.

As we'll see, onboarding has many parallels to a long-term relationship. It's not enough to land a first date. It takes thousands of conversations, glances, romantic gestures, gifts and shared experience to discover that you are right for one another. And while the actions may change, this "courting" process continues in some form for as long as the relationship lasts.

Many managers (myself-included) tend to focus on recruiting new employees at the expense of onboarding. Bringing new hires in the door is something concrete that we can point to as a success. Unfortunately, it won't do your organization any good if you can't convince them to stick around.

While all employees (and their organizations) benefit from onboarding, PAs and NPs are a particularly timely example. These professionals play an essential role in meeting the healthcare needs of the newly insured and growing elderly populations. Our practice literally can't recruit them fast enough.

The rub is that it takes about two years for a newly hired PA/NP to become fully productive within the organization. During this time, we pour considerable resources into their development. (Many of these professionals are new to the specialty when they come to us.) However, our data shows that this is also a potentially fragile time in the employer-employee relationship, with significantly higher attrition rates.

The good news: if we can nurture these clinicians past the two-year mark, the chances of forging a fruitful long-term relationship increase dramatically.

Winning Their Hearts

How exactly do you get your employees to fall in love with your organization so they stick around? There are two things you need to accomplish:
  • Clarify Expectations. A big part of dating is figuring out whether your wants and needs are compatible with the other person's. That's what our PA and NPs are exploring in their first two years with us. Is this truly the place I can see myself building a career? And even if I can, is there another place that might be even better for me?
  • Acculturation. Every organization has unique attitudes and values. (For example, at Vituity, we try to nurture a "culture of caring" that encompasses everyone from clinicians to consultants to our practice support staff.) Successful onboarding supports employees as they explore ways to "fit" within this culture.
So how do you accomplish these things? I sure don't have all the answers, but here are a few lessons from my experience:

Make a positive first impression. Just as romance often begins before the first date, onboarding starts long before the first shift. Always strive for a positive first impression with potential employees, whether that first interaction is a handshake, a casual conversation at a conference or a nurturing email. Think about how you can you make yourself and your organization attractive so that candidates want to take the next step.

Perfect your formal orientation process. Congratulations, that awesome candidate has just accepted your offer. Now that you've got a commitment, show them they made the right choice. Some ideas for easing them into the organization:
  • Tours and staff and introductions
  • Schedule their first few shifts with a clinical lead/manager for extra support
  • Welcome calls or letters from human resources and organizational leaders
  • Compile written materials into an orientation binder
  • Hold regular welcome events for new hire events across the organization
Show them the ropes. To thrive, new hires need to learn the "streetwise" stuff that isn't in the employee handbook. They need to know which physician orders which tests, which tech specialist is a whiz with Macs and which manager should be avoided until they've had their morning coffee. One of the best ways to accomplish this is to pair them with an experienced mentor who can help them navigate their new environment. Formal training and recognition programs for mentors can enrich the experience for both participants.

Foster early effectiveness. Almost all new hires want to do a good job, but they often aren't sure how to go about it. One of the most important things we can do as leaders is to help them align their goals with the organization's. For PA/NPs, we focus on boosting their operational efficiency, productivity, documentation and EHR training as well as a patient safety technique called the cognitive pause.

Offer opportunities to grow. When we survey our PAs and NPs about what they want in a practice, they invariably show an interest in educational opportunities — and I think that's fairly universal among high performing workers in all fields. For this reason, we start early when it comes to steering them toward webinars, symposia, online CME modules, committee work and learning opportunities in their hospitals and communities.

Engage the team. Your team is one of the most powerful resources you have. When you're taking someone special home to meet your family, you tell mom to be on her best behavior and dad to tone down the political rhetoric. Onboarding is no different. If you can instill a sense of collective responsibility for the new hires' positive experiences, your job as a manager will be much easier.

Continued maintenance. Thousands of books have been written on the topic of "Keeping Your Romance Alive," and much of this advice translates to the workplace. Onboarding and retention efforts should continue as employees grow and mature in their careers. Be attentive to their changing needs and offer opportunities for leadership and education. Sometimes a slight adjustment in job duties helps keep mature employees fresh and engaged.

Like I said, I don't have all the answers. And as in the romantic world, not all employee relationships work out for the long term. But when they do, it's rarely an accident. It's the product of thousands of interactions that demonstrate all the ways we genuinely care for our people and their careers.

Having said all that, I've realized I better take my wife on a date tonight. Happy onboarding and best of luck.

Partnering to improve patient lives

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