Final OIP

Building an Approach to

RCT Onboarding

Creating a Standardized Onboarding Process

Lauren Brischke

The 2014 MHR Summer Internship Program

MHR 365: Professional Development in MHR

August 7, 2014

2014

Central Wisconsin Center Organizational Impact Project

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Table of Contents Executive Summary……………………………………………………………………………………………………2

Objective…………………………………………………………………………………………………………2

Methodology……………………………………………………………………………………………………2

Key Results………………………………………………………………………………………………………2

Recommendations……………………………………………………………………………………………2

Statement of Project Objective………………………………………………………...…………………………3

Organizational Profile of CWC……………………………………………………………………………………4

Organizational Environment ………………………………………………………………..………4

Organizational Relationships……………………...…………………………………………………7

Competitive Environment ……………………………………………………………….……………8

Strategic Context …………………….…………………………………………………………..…………8

Current Onboarding process for RCTs……….………………...…………………………………….9

Literature Review……………………………………………………………………………..………………………10

Methodology……………………………………………………………………………………………………………...28

Key Results……………………………………………………………………………………...………………………...29

Recommendations …………………………………………………………………………………………………….37

Summary Table of Key Results and Recommendations…………………………………………..43

Appendices……………………………………………………………………………………………………………......44


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Executive Summary

Objective:

The objective of this project is to provide the Central Wisconsin Center with recommendations for developing a process for consistent, standardized employee onboarding for new Resident Care Technicians that can be applied across all living units. Improving the onboarding process for new RCTs will help increase retention and reduce turnover in the long-term. Ultimately, an evaluation of the current onboarding process combined with best practices research will lead to specific recommendations for creating a systematic onboarding process for RCTs onto their assigned Living Units. Best practices both within the organization and in other best-in class organizations will provide support for the provision of recommendations for building a systematic approach to onboarding.

Methodology: The main focus of this project is the transition stage between Certified Instructional Program training and RCT assignments to the Living Units. The current process used by different Living Units was investigated through informational interviews with each of the roles involved in the process, including UDs, RCS’s, RCT’s and Job Coaches. Triangulation was utilized between focus Groups, interviews, and a survey to gather data and analyze perspectives from a variety of sources and include involvement from all levels of the workforce.

Key Results:

Some living units currently apply some very positive onboarding practices There is no sound, systematic, structured approach to onboarding across living units New RCTs experience an information overload during the transition from CIP training to their

assigned living unit

There is no consistent approach to personal welcoming from key people

There is an opportunity to improve the understanding of the preceptor role and responsibilities

for both the new RCT and the RCT preceptor

There is no consistent process owner(s) for the onboarding program that integrates the activities

of stakeholders or holds them accountable.

There is an opportunity for better preparing new RCTs for working with individuals at CWC.

There is not a performance evaluation system for the onboarding process

Recommendations:

Apply the best practices used by some units at the center to other units.

Develop a comprehensive new employee toolkit that includes checklists and a written

onboarding timeline.

Modify the time period RCTs have to learn unit-based information so it is longer and more

participatory.

Create a more structured preceptor program.

Speed the development of important working relationships for new RCTs

Increase accountability for the onboarding process by establishing owner of the process as a

whole and defining who controls various steps

Expand Unit-Based training to better prepare new RCTs for working with individuals at CWC

Seek further feedback on onboarding program from new employees


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Statement of Project objective(s)

Project Objective

The objective of this project is to provide the Central Wisconsin Center with recommendations for

improving the employee onboarding process. Ultimately, an evaluation of the current onboarding

process provides a baseline for making specific recommendations for creating a more systematic,

standardized onboarding process for Resident Care Technicians onto their assigned Living Units

after CIP training. The current employee onboarding process involves a three day New Employee

Orientation, CIP training followed by a test, and unit-based training/orientation. As employees are

oriented in a variety of ways to their assigned living unit, recommendations for building a more

consistent approach to onboarding will contribute to reducing variation and improving the

onboarding experience for new RCTs.

Project Overview

Due to the inconsistency in the onboarding processes between living units, RCTs may not be getting

a complete onboarding experience that allows them to feel welcomed and confident with their new

responsibilities. Re-evaluating this process will help the Central Wisconsin Center build a

structured approach to new employee onboarding that will allow new RTCs to feel more confident

and knowledgeable as they begin working on their assigned Living Units. Onboarding has grown to

be an integral component of the overall retention strategy for employees and includes activities

designed to help them make a smooth transition into organizations. As RCTs are the largest sector

of the workforce at CWC and essential to the services CWC provides, it is not just advantageous but

also necessary to improve RCT engagement during a critical phase of their employment. By

creating a standardized approach to meet individual needs, CWC will be able to develop an effective

onboarding process that engages and educates employees during their transition. As the center is a

learning community devoted to increasing knowledge of best practices, onboarding best practices

both from within the center and other leading organizations are included in this report. Applying

best practices to develop an approach to onboarding will allow the center to better integrate

employees and reduce growing new-hire turnover rates, and recommendations will be based off

research on best practices, as well as key results from interviews, focus groups, and a survey.


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Organizational Profile

Organizational Environment Description of products/services Located in Madison, WI on a campus near Lake Mendota, the Central Wisconsin Center is a

residential care and treatment facility that provides support for over 200 individuals with

intellectual disabilities. CWC is one of three facilities in Wisconsin licensed by the state to provide

support for individuals with Intellectual Disabilities in 1953. The Center provides assessment,

treatment planning, outreach, education, medical services, and rehabilitation technology services.

CWC has three short-term care programs including the Medical Short-Term Care Unit (MSTCU),

Short-Term Assessment Program (STAP), and Developmental Evaluation Clinic (DEC). The MSTCU

supports children and adults with medical and physical disabilities, DEC supports children and

adults with regression in skills or memory or mild behavior concerns, and STAP supports children

and adolescents with significant behavioral challenges and/or psychiatric needs. In addition to the

short-term programs, the CWC also provides Nursing Services to ensure comprehensive, safe

nursing care and Rehabilitation services comprised of five departments including Occupational

Therapy (OT), Physical Therapy (PT), Rehabilitation Technology Laboratory, Respiratory Therapy

(RT), and Speech/Language Pathology (SLP). Each department provides evaluations of the

individuals’ level of functioning, including recommendations for apartment staff, community staff,

active treatment, and equipment.

Culture

The Centers culture is reflected in its Vision, Mission, and Core Values, which are present

throughout all living and work areas at the center. The center fosters a culture that supports open,

two-way communication, high-performance work, and interdisciplinary teamwork. The center

creates a supportive environment of dedicated employees in a team-

based culture that respect the expertise of each member. Emphasis is put

on a comprehensive Active Treatment and person-centered philosophy

that guides the center’s approach to treatment and support services, and

is reflected in the center’s logo: People caring for People. The Center’s

focus is on human development, health, environment, and quality of life

in all of the services provided to individuals with intellectual disabilities.


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Mission, Vision, and Values

Mission: We support people with developmental disabilities to achieve their full potential by

enhancing human development, health, environment and quality of life.

Vision: Central Wisconsin Center, as a resource center of excellence for citizens with developmental

disabilities, provides state-of-the-art services in outreach, education, assessment, short-term

admissions, and residential services.

Table 1: Core Values

Person-Centered

A person-centered philosophy guides our approach to treatment and support strategies. We maximize individual potential by our focus on human development, health, environment, and quality of life.

Respect & Dignity

We believe that all people are of equal human value. We believe that each person is unique in talents and abilities. We believe that everyone deserves quality service. We celebrate the diversity of the people who live and work at CWC

Dedication

We are responsive to our customers, passionate in our advocacy, principled in our approach, and responsible in our actions.

Excellence We strive for excellence and seek continuing improvement in all we do.

Collaboration & Partnership

We promote inclusion and participation in a team-focused environment. Together, we seek creative approaches to common issues.

Community

We are a learning community devoted to increasing knowledge of best practices. We achieve success when sharing and integrating this knowledge into the broader community.

Safety We are committed to the safety of the people who live and work at CWC.

Key Assets

The center’s interdisciplinary approach embraces a variety of skilled professionals and many

different levels of expertise. The ability to leverage collaborative disciplines in the centralized

location allows for diversity in ideas and experiences of the staff. As other providers require

individuals to receive care through multiple organizations in different locations, the team-approach

at CWC allows them to provide comprehensive evaluations for individuals with efficiency and

timeliness. Other assets include state-of-the-art equipment, access to innovative resources and

leading educational programs through research partners such as UW, UW Hospital, WFA, and the

city of Madison offers the center a diverse workforce.


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38%

16%

15%

11%

8%

5% 4%

3%

Percentage of Employees

RCT

LPN/Other Nursing

Medical

Other

Building/Maintenance

Office/Administrative

Food Services

RCS

Classification

Core Competencies

The Center’s core competencies are excellence in providing “Active Treatment” services through

Person Centered processes and therapeutic evaluation of complex medical/behavioral conditions

through Short-Term Care services. Active Treatment is a regulatory term defined as an active and

continuous treatment program to achieve a planned set of coordinated goals for each individual. By

providing the active treatment necessary for the individual to function with as much self-

determination and independence as possible, the center embraces an Active Treatment philosophy

that allows the center to provide high quality support.

Workforce Profile

CWC has over 800 employees in disciplines including Administrative Staff, Nursing Services,

Medical Services, social workers, pharmacist, recreation therapy, speech therapy, teacher or

educational specialist, and others. RCTs are the largest sector of the workforce, followed by nursing

and medical positions. The educational range of Center employees is broad and extends from high

school, technical colleges and universities, medical schools, certified training programs, graduate

schools, and post doctorate work. The center also currently has over 65 volunteers involved as

“Foster Grandparents” and other volunteers in a variety of programs that directly and indirectly

support resident services.

Figure 1. Employee Classification by Count/Percentage

Key regulatory agencies

CWC has a variety of regulatory agencies that oversee and regulate the services provided to

individuals that reside there. The Center for Medicare and Medicaid Services (CMS) and the DHS,

Division and Quality Assurance (DQA), are the primary agencies regulating the center. The Health

Information Portability and Accountability Act (HIPAA) and the Occupational Safety and Health

Classification Number of Employees

RCT 334

LPN/Other Nursing 139

Medical 129

Other 96

Building/Maintenance 66

Office/Administrative 46

Food Services 39

RCS 25


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Administration (OSHA) set regulator standards. HIPAA and other privacy laws require employees

to share information only as needed to meet resident’s needs. The Wisconsin Department of

Regulation and Licensing regulates standards of practice for health care professionals and the

center complies with all laws and regulations governing transparency such as Wisconsin Public

Records laws and Online Survey and Certification Reporting System (OSCAR). Business functions

are audited by the Wisconsin Legislative Audit Bureau and the DHS Office of Policy Initiative and

Budget. Compliance with ICF/MR certification is monitored by unannounced, annual federal and

state program reviews and surveyors. Also, senior leaders establish internal policies and

committees to monitor and review standards of practice.

Organizational Relationships Structure

CWC resides under the administration of Wisconsin Department of Health Services (DHS) and the

Division of Long-Term Care (DLTC). The Center’s senior leadership is organized as the

Administrative Staff and reports to the Center Director, who reports to the Bureau Director of

Center Operations, who reports to the administrator of the Division of Long-Term Care. By

implementing a cross-functional structure that parallels the quality improvement work of the

System Management Teams (SMTs) with the entire Administrative component, the integrated

structure aligns all members of the organization. SMTs include environment, planning, safety,

health, customer service, workforce development and human development & quality of life.

The Center has 12 buildings interconnected by a basement tunnel system, including seven buildings

for residential and short-term care, a food services building, an administration building, and two

houses. The centers other major facilities include two parks, one restored prairie, two heated

swimming pools, walk paths, and outside patios.

Please see Appendix A for an Organizational Chart.

Key Customers, Stakeholders The key customer group is the individuals that receive the services at the center. Other customers

and stakeholders include the family and guardians, county agencies, Managed Care Organizations

(MCO) and employees. The key requirements and expectations for stakeholder groups are outlined

in figure 2.

Figure 2. Customer, Stakeholder

Key requirements, expectations

Long- Term Residents Comprehensive, coordinated Active Treatment plan, specialized medical care Short-Term Residents Assessment/ Evaluation, goals for return to community, Safe environment

Family/Guardians Special medical/behavioral needs met, Safe environment, and kept informed

Counties/MCO Ease of access and services, Results on service goals, Transition/training


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Strenths

-Centralized services

- State-of-the-art equipment

- highly skilled experts

-SMT structure

-interdisciplinary teams

Weaknesses

-Ensuring a safe environment in an aging infrastructure

-high turnover rate for RCTs

Opportunities

- Partnerships with leading edge research /treatment organizations

-Madison offers a diverse, highly educated workforce

Threats

-Aging population with complex needs

-State budget reductions

-Aging workforce

-reduction in number of LT residents

Competitive Environment Current Competitive Position

Because of the uniqueness of the mission, the center does not directly compete with other

organizations. With a strong reputation as a unique provider of services for individuals with

complex medical/behavioral needs in combination with profound Intellectual Disabilities, the

center maintains a competitive advantage in the healthcare industry through highly specialized

services.

Changes in Competitive Position

The changing role of the state government from a direct service provider to a coordinator of health

care services is impacting the centers direction and the market trend is shifting towards short-term

services. As the model for long-term care for people with Intellectual Disabilities transitions to a

Managed Care Organization system, the CWC is currently not admitting anymore long-term

residents and is expanding short-term services.

Strategic context Key Strategic Challenges and Competitive Advantages The center’s key strategy is to optimize and coordinate services to achieve the mission “support

people with developmental disabilities to achieve their full potential” and the current strategic plan

is focused on expanding outreach and short-term services. Factors influencing the centers strategic

position are centralization of services, leading edge research partners, and a skilled workforce.

With continued reduction of long-term residents at the center and expansion of short-term care

services, the center will experience workforce challenges as employees capabilities will need to

adjust.

Figure 3. SWOT Analysis


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Current Onboarding process for RCTs

Overall, the center views the orientation process as a key approach to understanding the MVV,

culture, core competencies, and current strategic initiatives. New Employee Orientation (NEO) sets

standards and expectations for employment at CWC, gives an overview of the Mission, Vision, and

Core Values, and introduces new employees to their role in the Active Treatment process.

Following NEO, all new RCT’s attend a formal certification program for becoming a Certified

Nursing Assistant (CNA). The Staff Education and Training department provides classes and 6-weeks of

hands-on training, coaching, and mentoring as part of the CNA program at no cost or long-term

commitment by employees. Beginning in NEO, competency assessments are used to evaluate workforce

learning and development needs. Reinforcement of knowledge and skills on the job is assessed through

pre-and post-testing, competency demonstration, precepting, and formal orientation. Workshops

conducted on living units follow up on training provided in classrooms and check that skills are being

properly applied through the completion of skill check lists, etc. The competency training has

transitioned from traditional classroom based education to hands-on with minimal lecture time. Staff is

assigned to specific units when they complete orientation training based on their preference and

experience, and the center conducts a 3 month conference with all new care staff. Unit and department

directors facilitate the team process, set and evaluate established performance expectations, and support

departmental SMART goals linked to strategic actions.


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Literature Review: Best Practices for New Employee Onboarding

This literature review provides a comprehensive summary of current onboarding research and

includes a description of what onboarding involves, why it is important, and the current best

practices used in effective onboarding programs. Other sections describe how to avoid common

mistakes in the onboarding process, create a strategic onboarding process, a case example of a best-

in-class onboarding program, and some additional research on role transition for nurse

practitioners. Guiding principles, practical strategies, and best practices will provide a stimulus for

creating a customized approach to onboarding that addresses the particularities of an organization

including its unique personality, culture, and constellation of operational needs and challengesi.

Onboarding Overview

Onboarding, also known as organizational socialization, encompasses the complex process

through which new hires learn attitudes, knowledge, skills, and behaviors required to function

effectively in their organizationii. It refers to a series of practices designed to help new employees

acclimate to their new role and assimilate the culture of the organization, reaching from the initial

orientation through the following months. Onboarding is “the process of acquiring,

accommodating, assimilating, and accelerating new team members to the organization”, and it

begins when a new employee is offered a position and ends when the employee is considered fully

functional. As it covers an employee’s first year, it incorporates various offices and functions,

addresses the whole range of employee needs, and is strategic in focus with active participation

from key employeesiii. Onboarding programs get new workers up to speed and facilitate

socialization, which is the process in which an in individual acquires the attitudes, behaviors, and

knowledge needed to successfully participate as a new organizational memberiv.

Why Onboarding is Important

As half of all hourly workers leave new jobs within the first 120 days, onboarding is

essential to help new employees adjust to their jobs by establishing better relationships to increase

satisfaction, clarify expectations and objectives to improve performance, and provide support to

help reduce unwanted turnoverv. Outcomes of an effective onboarding process include higher job

satisfaction, organizational commitment, lower turnover, higher performance levels, career

effectiveness, and lowered stress. Effective onboarding and induction reduces anxiety and stress

about a new position and assists in fostering commitment to the companyvi. Research has revealed

that employees who attend a structured orientation program were 69% more likely to remain with

the company after three years than those who did not go through the same programvii. Also, by


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upgrading their onboarding process, organizations have been able to reduce turnover and improve

attendance. With a thorough onboarding process, “the probability of achieving the goals of the

business and employee are greatly increased; without it, the probabilities of disappointment,

employee turnover, re-work, and dissatisfied clients all grow unnecessarily”viii.

Large amounts of time and money are invested in searching for and recruiting new

employees and onboarding assists in ensuring productivity as soon as possible, enhancing new

hires transitions into the organization and helping them to be more engaged. A comprehensive

onboarding program, including communicating performance indicators, an assessment of strengths

and weaknesses, and providing feedback, training, and networking opportunities can increase

employee performanceix. As the economy continues to impact budgets, recruiting, and staffing, a

robust onboarding process embedded in the socialization process will assist organizations in

successfully improving retention and performance measuresx. Research reports that 90 percent of

new employees make their decision whether to stay with the organization within the first six

monthsxi . Next to productivity gains, retention of talent is one of the key incentives for enterprises

to ensure smooth new hire integration and several research efforts have elaborated on how

attitudes and beliefs that newcomers develop in the first weeks of their employment remain

relatively stable, emphasizing the importance of instilling positive attitudes toward learning and

collaboration early onxii.

Despite widespread acknowledgement of the importance and return on investment of

onboarding, research shows that most respondents report inconsistent and unsatisfactory

onboarding in their organizations, more than one-third are without a formal process to monitor

and coordinate completion of activities, and a majority reported lack of consistency across their

organization for onboardingxiii. These findings show that organizations still have far to go in

implementing practices consistently.

Formal Onboarding

Organizations considered “best in class” for onboarding have more formal onboarding

programs that provide a carefully timed, fixed sequence of activities for new employees as well as

help from organizational role modelsxiv. Research shows that organizations that engage in formal

onboarding by implementing step-by-step programs to teach new employees their roles, the norms

of the company, and appropriate behaviors are more effective. Formal onboarding refers to a

written set of coordinated policies and procedures that assist an employee in adjusting to his or her

new job in terms of both tasks and socializationxv. According to Bauer, onboarding has four distinct


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levels called the “Four C’s”xvi that are the building blocks of successful onboarding and are outlined

in figure 4.

Figure 4: The Four C’s of Successful Onboarding

Organizations should leverage all four of these building blocks to achieve proactive onboarding,

which is when your firm systematically organizes onboarding with a strategic human resource

management approachxvii. IBM’s “Assimilation Process” is an example of proactive onboarding,

consisting of three steps including affirming, beginning and connectingxviii. Not only are there clear

timelines for each step, but there are specific tasks that should be completed during each step such

as welcoming the new employee and assigning a coach during the Affirming step.

Components of Onboarding

Harmon offers employee’s perspectives of what is important when bringing new employees

into an organization and provides an understanding on how the onboarding process impacts

employee engagement through socialization and contribution. Harmon identified 11 common

components of onboarding and categorized them into 3 groups included in figure 5xix.

Figure 5: Categories Components of onboarding Socialization & Integration Organization/departmental orientation

Mentors or buddies Networking opportunities

Understanding Job/ Organization New hire checklist Performance management Line of sight goals Organizational leadership, culture, history, values Compliance training

Learning Styles & Knowledge Transfer Online training Classroom training On-the-job training

Some of the most important onboarding components identified by Harmon include

sufficient procedures and training, employees perceive their opinions count and are comfortable

Co

mp

lian

ce

Lowest Level

Teaching basic legal, policy-related rules and regulations C

lari

fica

tio

n

Ensuring employees understand new jobs and all related expectations

Cu

ltu

re

Broad category that includes providing a sense of organizational norms--both formal and informal

Co

nn

ecti

on

Vital interpersonal relationships and informational networks that new employees must establish


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sharing ideas, clear job expectations with timely communication and realistic requirements.

Additionally, understanding the organization structure, facilities, services, customers, tours, and

social networking available for relationship building, welcoming activities focused on building

relationships, introduction to key organizational personnel are other important onboarding

activities. Others include higher level and key working relationships, receiving prompt set-up

services, general processes and guidance for employee benefits, new employee manual,

performance review process, and camaraderie.

How to Avoid Common Onboarding Mistakes

There are many common onboarding mistakes that organizations make that decrease the

effectiveness of their process for supporting new employees throughout this transition. By

avoiding these mistakes, organizations can more effectively integrate new employees into their

organization.

Providing too much information

A common onboarding mistake organizations make is providing too much information in

too short of a time for employees to absorb and retain the information. The large amount of

information communicated to employees in the first year should be given in small doses that allow

for the employee to internalize and apply to their work assignmentsxx. Smart organizations break

the information into sections and select the most effective medium for the particular type of

information, offloading information that is best accessed on one’s own onto the corporate

intranetxxi. As electronic onboarding tools will play an increasingly more important role in

successful onboarding, organizations will be able to keep their employee manual online, including

information such as welcome messages, information on mentoring program, checklists, parking

instructions, and performance review follow upsxxii.

Disorganized and Dull Orientations

As new employees may perceive an onboarding program as a representation of the entire

organization, having a disorganized onboarding program is another common mistake and can

impact both the short term perceptions of employees and long term reputation of the organization.

The onboarding process is especially vulnerable to interpretation during onboarding because

people feel vulnerable in ambiguous, unfamiliar situations and are more likely to take first

impressions as indicators of the company as a wholexxiii. Also, organizations can avoid dull

orientations by creating an inspiring experience that reassures new hires they made the right

choice and lays the foundation for high employee engagement. Using creative training techniques,


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interactive exercises, and games to provide information throughout the onboarding experience will

help organizations avoid making this mistake.

Not providing support or following-up

Using the “sink or swim” approach to onboarding without the appropriate support and

coaching is one of the most common and damaging mistakes organizations make—not only does it

increase the probability the new employee will leave, it communicates to all employees morale

damaging messages that the organization doesn’t care about or value employeesxxiv. The level of

support provided to employees after leaving orientation communicates an important message, and

providing new hires with a mentor and periodic check-ins sends the kind of message that leads to

engagement. Additionally, not following up or keeping in touch with new hires as they integrate

into the organization is another common mistake. Effective onboarding means actively seeking out

new hires and checking in, as well as making it easy for them to provide feedback. The safer

employees feel sharing their opinions, the more likely you are to prevent employees from waiting

until their exit interview to tell you what went wrongxxv.

Everything Matters and the Emotional Experience

A useful guiding principle for avoiding common onboarding mistakes is that “everything

matters” in the onboarding program; every choice, every action, and every communication has

potential consequences. A well-organized, professionally delivered program will communicate a

message that reflects and supports the organizations culture of excellencexxvi. Also, when creating

an onboarding process an organization should think about the experience as they make decisions

about how to structure it, how to welcome new hires, and how to introduce them to team members.

Providing measured doses of only the most essential information in digestible chunks creates a

very different experience than overloading new hires with information. Many organizations create

onboarding experiences evoke emotions such as confusion, frustration, overwhelmingness,

boredom, anxiety, insecurity, and regret. Onboarding processes should provide a new hire

experience that allows new employees to feel welcome, comfortable, secure, valued, important, and

confident. Considering all aspects that impact the new hire experience and the emotions and

perceptions they evoke will help to create a more inspired, engaged, and committed workforcexxvii.

Role Transition (for Nurse Practitioners)

Research indicates that novice Nurse Practitioners (NPs) experience a substantial transition

as they move into their new practice role and frequently struggle with balancing multiple

demandsxxviii. Newly graduated NPs describe feelings of being ill-prepared for the expectations of

their new role and a lack of support to assume responsibilities. New nurses often find themselves


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concerned about their lack of experience and training, and inability to make serious decisions and

provide a safe, skilled patient care and new graduate nurses do not feel confident that they can

meet the performance expectations of their healthcare employersxxix. However, they can achieve

success with the guidance of a well-developed orientation plan and peer support. Understanding

the transition experience is important for not only NPs but also for their mentors, as “knowledge of

the transition process is the basis for guiding the development of structured education and support

strategies to meet the needs of the NPs during and beyond the orientation period”xxx.

Although historically there has been little evidence of pre-developed orientation planning

for many providers, beginning NPs require a well-developed orientation plan to improve their

transition into their role, ensure excellence in patient care delivery, and assure job satisfaction. Not

only will they need time to become fully socialized, but also to identify with and develop the

professional behaviors expected of the NP role. It typically takes several months to successfully

transit from RN to NP role, including working through a period of uncertainty, identify with the

values and norms of role, and incorporating these into their daily practices in a supportive learning

environment. Successful transition is critical for complete actualization of the NP role and it is

imperative that strategies are developed to support the NP through this process. Critical

components of orientation include (1) a structured onboarding process; (2) system orientation to

achieve knowledge and skills with processes and tools used in the work environment; (3) training

program with identified goals, time frame for achievement, and learning methods; (4) evaluation

and goal-setting process which identifies frequency of review for meaningful feedback; and (5)

socializing opportunities with other NPs for networking and ongoing supportxxxi.

Other research describes the transition from limbo to legitimacy including negotiating the

new position, confronting job anxiety, confidence building and increasing competence, and

affirmation of the abilitiesxxxii. Successful onboarding programs have standardized orientation

plans for unit- and specialty-based NP roles, based on a multidimensional approach to improve the

transition of new NPs. Programs include features such as assignment of NP preceptor and

opportunities for socialization, as well as the development of standardized position descriptions for

the NP role that summarize common behaviors and practices of NP and which can be modified to

give a clear understanding of expectations in practice.

Successful attainment of clinical knowledge and skill is supported by the preceptor-NP

relationship and each new NP is assigned a single preceptor who will guide and monitor progress

and degree of independence. Support for the precepting NP is provided by the institution's

program manager as well as the unit-based managerxxxiii. The preceptor supports the creation of a


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Figure 6: Aberdeen Competitive Framework Key (defines enterprises as one of 3 levels of practices and performance)

Laggards (30%)--practices that are

significantly behind the industry average

Industry average (50%)--practices that represent the average or norm

Best in class (20%)--practices that are the best currently being employed and significantly superior

to industry norm

welcoming and supportive environment and a consistent approach to orientation across the

institution allows for successful transition into practice for new NPs.

Identification of best practices Techniques and practices that are widely used by practitioners should be used by

organizations to develop their own approaches to onboarding. Best practices are defined as

“processes that represent the most effective way of achieving a specific objective” and the essence

of identifying best practices is “transferring knowledge from those who know how to do something

well to those who are keen to learn more” xxxiv Understanding best practices and how these

practices assist managerial leaders in providing paramount onboarding experiences for new

employees is key to staff engagement and retentionxxxv. The Aberdeen competitive framework is

described in figure 6. Lee describes that “best practices are perhaps most useful as a stimulus for

creating one’s own approach”xxxvi, and by applying some of the best practices currently being used

in the industry, the center can create a more structured, formalized onboarding process. The

following section of this literature review outlines best practices used by leading organizations.

Assimilation and the Support Community

If onboarding is used as a tool for recruiting and retaining staff, the respective onboarding

processes, such as mentoring and/or a buddy, can help with the acclimation processxxxvii. Speeding

up development of important working relationships provides support for getting new employees

up to speed and many people define onboarding as “assimilation coaching”xxxviii. Assimilation

encompasses both helping your new employee adjust to the new culture (culturalization) and

helping them build mutually beneficial relationships with the most important stakeholders

(socialization). While onboarding encompasses more than assimilation, it is a practice that best- in-

class organizations utilize to smooth the onboarding process.

Also, assigning and preparing a preceptor is essential for providing a more welcoming and

supportive learning environment. It is important to make sure you prepare your mentors to

succeed and make it a positive experience by making sure they have the guidance, training, and

time allocation required to do this important job well. If they see it as a burden they well convey


17

that message to new hires, so organizations should provide a mentor checklist that maps out

specific tasks for the mentor at key intervals to help them cover all basesxxxix. The preceptor should

serve four main roles including (1)educator –develops critical thinking, teaches technical skills, and

fosters the application of theoretical knowledge into practice; (2) Role model—models professional

and effective behaviors related to prioritization, time management, and communication; (3)

socializer—introduces the trainee to essential collaborators and team members; (4) evaluator—

maps progress, provides feedback, measures/documents competency xl.

Organizations have varying names for the preceptor role including buddy and mentor, but

essentially they have a similar objective and overlapping responsibilities. Graybill defines a buddy

as someone whom a new hire can ask questions that he or she may not want to ask of a new

supervisor, form the trivial, such as where the bathroom is or where to eat lunch, to more politically

sensitive questionsxli. Others distinguish a buddy from a mentor, defining mentor as a relatively

senior person to help new employees learn the big picture and a buddy as someone at the same

level who can ask trivial questions without fear of repercussionsxlii. Mentors help ease the stress

and anxiety experienced the first year of practice and facilitate socialization and promote self-

efficacy. However an organization defines the role, mentoring, preceptoring, and proctoring are

required to support the needs of individuals that vary regarding competence and confidence, and

training guidelines need to be defined to establish robust mentoring arrangementsxliii. Mentorship is

critical to the novice NP’s successful transition and positively influences feelings of

interconnectedness and role socializationxliv. Agenda items for meetings can help support a

meaningful dialogue that allows for continual assessment, evaluation, and refinement of the role.

As many of the most anxiety creating issues for a new hire are issues related to “learning the ropes”

about company politics, unwritten rules, who the “go to” people are, and informal channels for

getting things done, mentors play a critical role in new hires sense of securityxlv. A mentorship

program also provides a method for employee recognition and professional development, allowing

them to demonstrate leadership skills that will help prepare them to be supervisors.

Socialization and Networking Opportunities

Providing socialization and networking opportunities that allow new employees to develop

relationships and assimilate to the culture. New NPs should be encouraged to participate in

hospital-wide NP activities to moderate socialization and reduce feelings of isolation, allowing them

a feeling of belonging within the organizationxlvi. A strategy for gaining confidence is being actively

involved with an NP peer group or network to help NPs gain confidence through meetings that

provide opportunities to develop relationships with other novice NPs going through similar


18

transitions and obtaining guidance from other experienced NPsxlvii. The development of a new NP

peer group would allow for the exploration of challenges during the early years of NP practice and

provide support via group mentorship, and peer group activities assist with confidence

development and foster relationship buildingxlviii. A new trend in networking circles is occurring in

some universities across the country which involves networking circles of employees of like jobs

meeting to discuss best practices, challenges, and continuous improvement ideasxlix

. Some argue

that relational onboarding is more important than informational onboarding, suggesting that

socialization tactics directly affect how newcomers develop perceptions of support and

embeddedness in new work environment. As early experiences of socialization are important for

creating relationship ties that help make them more committed to the organization, the quantity of

interactions is less important than the quality of the relationships.

Culture of Inclusion and Welcoming Environment

Creating a culture of inclusion and finding mechanisms to provide new employees with

social support is essential for successful onboarding. For institutions hiring larger groups of NPs to

a variety of services, creating an additional meeting focused on issues of the new NP that has a safe

and confidential environment for open discussions about the transition processl. Managers should

encourage new NPs to attend these meetings and activities for new hires to learn team-building

skills and partnerships should be included in meetings to make employees feel more welcomed. By

making new employees feel welcome, it will be easier for them to connect with and integrate into

their team and the companyli. New employees need to be transitioned in a supportive, welcoming

environment in order for them to become confident in their ability to perform their role within an

organization.

By appreciating and utilizing systematically the knowledge and wisdom the newly hired brings,

the organization makes the person feel appreciated and valued in an early phaselii. If there is an

understanding that the organization can increase the quality of organizational thinking and create

significant improvements and new ideas by getting information from new hires, organizations can

create a learning culture where they can embed learning from new hires. Organizations that learn

from the newly hired can empower the individuals to get a jump start on the new job and create a

strong employer brand for the companyliii. Designing the program from the employees perspective

and soliciting input from employees about what information they would have appreciated getting

but didn’t and other suggestions for improvement will help to provide an inclusive environment for

new hiresliv.


19

As newcomers typically have few established relationships with supervisors, co-workers,

work groups, or organization and the desire for positive social relationships is one of the most

fundamental and universal of human needs, individuals experiencing little social inclusion are

motivated to find alternative bonds of affiliation in other organizationslv. Organizations can further

develop relationships by using socialization tactics to create a more welcoming environmentlvi.

Socialization tactics that provide information about the sequence of learning activities and

experiences and about the timing associated with completing each step of socialization should lead

to a positive social exchange relationship with the organization which will increase new hires

commitment and embeddedness in the organization. Providing this information requires the

development of a systematic socialization process and communicating it to new employees to

increase perceptions that the organization is willing to invest in the employees future because they

developed a plan for adaptation and development, as well as increase perceptions that organization

cares about employee’s well-being because such knowledge reduces uncertainty and anxiety and

helps them establish routineslvii. Reducing uncertainty and anxiety about their place in the

organization, specific knowledge about when they will complete official socialization activities

should speed the development of a sense of fit with the organization.

Formal and Informal introductions

Introducing new employees both formally and informally through one-on-one

introductions, group introductions at meetings, and written introductions via newsletters and

website announcements enhance team building and makes the environment more welcoming.

Managers should plan formal introductions and schedule time during formal meetings for the

introduction of the new NPs and their role. Also, informal introductions contribute to an effective

onboarding program as they can meet members of the team that may not have been at meetings. It

may be helpful for new NPs to formulate a short introductory speech that describes their role as a

pre-prepared, semi-rehearsed speech is one way to reduce anxiety and develop confidence about

their role. Also, an effective way to facilitate introductions is for a manager to create a list of people

to meet and review this list with the employee during the first week, as well as setting up meetings

with key people. Making introductions during a tour showing new hires around the building and

introducing them to the team they will be working with directly and other key personnel will aid in

a smoother transition. It is also important to be selective and realistic as it doesn’t help to walk

them around and introduce them to 100 people in other departments.lviii Companies that take

onboarding more seriously make introductions mandatory and having more structured

introductions helps new employees get embedded especially in the o to 6 month framelix. Also, just


20

giving someone a list of people to meet is not enough to cause that person to be acquainted with

anyone, “introduce” means to cause to be acquainted and it is a best practice to formally require

introductionslx.

Provide Ongoing Feedback, Evaluation and Support and Coordinate periodic check-ins

Ongoing feedback and support through monthly meetings with the preceptor, new NP, their

manager, and the collaborating physician will provide an opportunity to discuss the pace of

orientation, concerns, and encouragement, as well as assessments of the NPs progress in clinical

practice competencies, teamwork and communication, and professional behaviors. Regular

interactions between mentor and employee are essential, and should involve open, bidirectional

communication and sharing of constructive feedback. Coordinating periodic check-ins early and

frequently will allow for the reinforcement of practices that are working well and improvement of

the things that are working less well. Checking –in with new employees will make assimilation

easier through milestones such as 30, 60, 90, and 120 days—and up to one year post-organizational

entry to check in on employee progress. Informal manager “check ins” should occur regularly as

well as formal performance reviews at 6 month and 1 year marks. Many employees are on

probation during the onboarding period and are formally evaluated at set intervals and an effective

onboarding program should provide employees tools and support needed to succeed, and identify

new hires that are not a good fit for the organizationlxi. Also, ongoing dialogue and feedback from

the mentor promotes development of self-awareness and discussion for improvements. As the

relationship NPs establish with others in the workplace significantly influences their role

development in the first 6 months of practice, progress during this time depends on how leadership

and other staff support the NPs role. lxii

Get Feedback on the Onboarding process

In addition to individual’s performance, it is also important for organizations to evaluate

how effective the onboarding program has been to determine areas for improvement. The

evaluation can be both operational and strategic, including common measures such as turnover and

retention rates for groups of new hires, retention threshold (ex: threshold of employees leaving in

the first 6 months or within 2 years), performance indicators (performance differential between

employees who participated in different onboarding programs, ex: mentoring); and informal and

formal feedback (focus groups, interviews, one-on one conversations to ask employees about

experience)lxiii. By evaluating and making adjustments to both individual performance and

onboarding process, organizations can create cycles of improvement for the process.


21

Getting feedback on the onboarding process allows for continuous improvement and

leading companies rely on fact-based assessments to improve the new hire experience and better

assimilate employees. Benefits can accrue to newcomers and organizations from the careful and

thoughtful recognition and consideration of each other’s perspectives, and organizations should

more carefully accommodate the perspective of newcomers during the socialization process as a

way to foster a more successful socialization experience and acquire new ideaslxiv. When evaluating

onboarding effectiveness, companies create a measurement framework to identify areas for

improvement and drivers of hiring process effectivenesslxv. Examples of measures include

employee engagement, employee satisfaction, productivity, reduced turnover, and increased

retention. Conducting structured entrance interviews can help organizations identify and address

issues that are affecting new employee’s morale and performance, as well as provide valuable

information on how to continually improve the onboarding processlxvi.

Recognize Current trends and Incorporate Generational Differences into Onboarding

Many recent trends in onboarding are from changes in technology and the entry of

Millennial’s into professional positions. Organizations can cherish the differences by acknowledging

that people born in different generations have different perspectives and needs, and being aware of

the differences will contribute to a more effective onboarding program. There are differences in

onboarding across four generational cohorts: Traditionalists (born 1928–1945), Baby Boomers

(1946–1960), Generation X (1961–1980), and Generation Y (1981–2000).lxvii

Figure 7: The four generational cohorts

TRADITIONALISTS (1928–1945)

BABY BOOMERS (1946–1960)

GENERATION XERS (1961–1980)

GENERATION YERS (1981–2000)

Onboard by showing respect, accommodating their needs, clarifying their roles, responsibilities, performance standards, and decision-making processes.

Onboard by putting them in charge, using give-and-take problem-solving and decision making, encouraging them to compete, and giving them challenging work.

When onboarding Xers, keep in mind their general desire for work-life balance and ready access to interesting and meaningful work choices and development opportunities.

Onboard Yers with fast decision making, stimulating work, continuous feedback, frequent praise, working in teams, support networks, and continuous learning and change.

As Millennial’s need constant feedback due to the amount of feedback they have received in the past

from teachers, friends, parents, and early employers, they want to know exactly, and often, how

they are doing and where they stand.lxviii This further emphasizes the importance of providing

continuous feedback for employees as a Millennial’s are a large sector of the current workforce.

Organizational Planning: Utilize a written onboarding plan, formal document, or roadmap


22

“Often, agencies with decentralized onboarding processes inconsistently execute them”, and

inconsistencies are further magnified by differences in onboarding processes in organizations with

regional and field componentslxix. Using a written onboarding plan, formal document, or roadmap

that outlines the specific timeline, goals, responsibilities and support available to new hires will

help them succeed because it describes what they should do and what assistance they can expect.

The most effective plans are written, communicated to everyone, and consistently applied. lxx Items

to include the written plan include the organizations history and profile, a welcome message from

an organizational leader, employee profiles, policies, procedures, tour, etc. lxxi Because a lack of role

transition results in high turnover and diminished quality and safety in patient care, the response

from leadership must be to provide the nursing workforce with the tools needed to transition new

graduates in an environment that ensures a strong foundation to support professional growth and

quality patient care—tools that guarantee robust transitional training and education for new

graduate nurses are essential if hospitals are to ensure achievement and sustainability of

excellencelxxii

Socialization tactics that provide clear information about the content, sequence, and timing

of socialization activities and expectations, those that provide positive interactions with

experienced organizational members and include well-defined socialization activities are related to

commitment and turnover through perceived organizational support and embeddedness. Research

suggests that even in relatively unstructured situations, organizations would be able to foster more

attitudinal and behavioral commitment to the extent that they are able to provide an overarching

framework for newcomers.lxxiiiThe planning process helps to create an in-depth onboarding process

and can manifest itself in various ways including an organizational checklist, printed orientation

guides, or localized activities to aid in the acclimation processlxxiv. A common tool organizations rely

on to assist with facilitating the onboarding experience for new employees is a checklist, which

usually focuses on three distinct staff members involved in the onboarding process including (1)

the manager; (2) the supervisor; and (3) the employeelxxv. Figure 8 outlines the level of use of

onboarding checklists by the three primary staff members involved in the process.

29%

53%

12%

0102030405060

Managers Supervisor EmployeePe

rce

nta

ge

(%

)

Staff Member

Figure 8. Use of Onboarding Checklist


23

Encouraging early Participation and a Hands-on Approach

Orientations that include co-worker networking sessions, time for new employees to

develop their skills, and encourage employees to participate on their first day and contribute are

using best practices. Encouraging early NP participation in multidisciplinary patient rounds may

give immediate exposure to the NPs’ skill base and underscore the depth of their patient care

experience and system awareness.lxxvi Making sure new employees have meaningful work and

including them in key stakeholder meetings as part of the onboarding program will help make the

onboarding process more effective, and making onboarding more participatory is a best practice.

A Case Study: Practice -Based learning

An analysis of the effectiveness and impact of how Google currently trains its new software

engineers (“Nooglers”) to become productive in the software engineering community revealed

findings that Google offers a state-of-the-art onboarding program and benchmark qualities. Google

empowers programmers to “feel at home” using company coding practices, as well as maximizing

peer-learning and collaborative practices. These practices reduce isolation, enhance collegiality,

and increase employee morale and job satisfactionlxxvii. Experts recommend “conducting

contextualized learning and increasing the effectiveness of learning and efficiency of transfer by

creating a training environment that reflects the work situation as closely as possible”.

The Google onboarding process includes recruiting and pre-start preparation; two-week

face-to-face training and orientation; online training; mentoring program and Noogler support

community; on-the-job training; and practice-based learning. The class, Life of an Engineer, is an

integral part of the onboarding process regarding expectation management and includes helpful

advice such as “learning to find out” by learning who to ask and what inquiry methods lead to

answers rather than memorizing primary information, and “find role models” off a list of the most

influential software engineers on the intranet and copy their behavior. Google also uses check-lists

and one standard list allows Nooglers to explore a multitude of systems, practices, events, and

institutions step-by-step, including the Nooglers’ immersion from week one to week four and

beyond. Also, a training checklist lists advanced orientation tasks to be completed and a developer

handbook outlines practices reference containing explanations and points to other specialized


24

resources. The first meeting between the new hire and mentor takes place at the end of the

introductory lecture on first day, and they show the new hire the office and facilities. Mentors go

through training workshop where they are sensitized to the needs and expectations of new hires

and the mentoring relationship usually extends over a 3 month period.

Google also has a transparent performance management system that ensures co-workers

can review all reports, objectives, team relationships and so on which consist of weekly progress

reports (Snippets) and quarterly objectives, as well as Intergrouplets, which are voluntary

communities for interdepartmental matters that contribute to the socialization of Nooglerslxxviii.

Research shows the onboarding practices are well designed and successful because of the

underlying organizational mindset and practice architecture, which allow for practice-based

learning as peripheral participation and cognitive apprenticeshiplxxix.

Strong leadership and involvement from both organizational and departmental levels

Strong leadership and involvement at both the organizational and departmental levels is

necessary to establish and support an effective onboarding system. Department managers should

establish the standards for onboarding and foster effective mentorship, and the goal of these

initiatives should be to bring structure to the ad hoc guidance and coaching often provided by

senior employees to new hires. From the integrated health care system perspective, onboarding

should provide coordinated, team-based care and share knowledge, experiences, and best practices

routinely across the system to improve performance.lxxx

Helping supervisors and managers do their part well is important and research has

revealed that the employee’s supervisor plays the most significant role in that employee’s

performance, engagement, and morale. Providing supervisors and managers with sufficient

training, guidance, and logistical support for their part in the onboarding process is critical for

holding them accountable for their responsibilities. Investing in management development is a

critical factor in reinforcing other components of the onboarding process. By conducting training

specifically related to the onboarding process and their role in it will help them to execute their

duties and providing them with a straightforward “onboarding to do” list they can follow will make

sure they address all the key components and provide them with a standard operating procedure to

follow.lxxxi Senior leadership participation and buy-in positively impacts new employees and is a

best practice for onboardinglxxxii.

Clearly defined Roles and Responsibilities

Although, many view the HR department as the sole “owner” of employee onboarding, there

are several stakeholders that should be involved with clear accountability in the process. According


25

to Workforce Magazine, only 37 percent of managers are involved in some form of employee’s

onboarding activities, yet an employee’s direct supervisor is vital to helping a new team member

acclimate. Insiders in workgroups and organizations risk losing talent by overlooking or

underestimating the importance of their roles in the socialization processlxxxiii.It is especially

important to define everyone’s roles to avoid duplication of effort and properly orient employees.

It is essential that ownership of the process reside with someone with authority who can direct all

departmental stakeholders in the onboarding process. Onboarding success is reliant on

organizations’ ability to establish a single source to oversee the process and ensure that all other

stakeholders are held accountable for their roles, and make sure the program is consistently

implementedlxxxiv.

However, there is a growing trend in onboarding that positions shared responsibility

between HR, the employee’s manager, and the employee. Research suggests that “following the

introduction phase of the orientation process the responsibility for the new employee’s integration

is transferred to the new employee their supervisor, and their work area peers—here the learning

process turns to the process of socialization”lxxxv. While HR may play a role in recruiting new

employees and ensuring they have received all relevant policies/forms, the managers and

supervisors of new employees should “own” or take the lead on the rest of the process. This

emphasizes the importance of managers’ participation in the onboarding process, especially at an

organization where departments are siloed and act as independent organizations. Research shows

that many organizations are putting more responsibility for onboarding on departments and

supervisors as opposed to HR departments, evidenced by the increase in orientations conducted at

department level and increase in new hire supervisory checklists being usedlxxxvi. Additionally, a

more systematic approach to training supervisors and coworkers in effective socialization practices

could help improve the socialization process for newcomers, so organizations should expand the

scope of socialization programs to include more formal training and education of supervisors and

coworkers.lxxxvii

Clearly defining new employee’s timelines, roles, and responsibilities is critical for

employers to set clear expectations for new hire’s progress in terms of learning their role and

building relationships as ambiguity or confusion in expectations can lead to frustration and

attrition. The majority of onboarding programs fail due to lack of ownership –although HR has held

responsibility, various departments and key stakeholders are involved in the creation,

implementation, and measurement of the program. Although best in class orgs are moving away

from the role of an onboarding manager, they are assigning non-traditional roles to own the


26

onboarding process such as mentors, peers, and individual business leaders—these orgs recognize

that in order for onboarding to become long term, HR and recruiting departments should not be

primary owner and need to collaborate with individual employees and leaderslxxxviii.

A strategic onboarding model

By using the onboarding process strategically, agencies will be able to effectively integrate

their most valuable resource—its people. High performing agencies use a comprehensive strategic

approach to bringing on new employees. The following section outlines the principles, roles, and

key activities that a best practices strategic onboarding manual should include.

The first principle to include is aligning to vision and mission: onboarding programs should

present, explain, and help new employees understand how their role contributes to organizations

mission so they can internalize the missionlxxxix. The second principle is connecting to culture,

strategic goals, and priorities: Onboarding goals should be measurable so performance can be

monitored and so agencies can produce feedback for continuous improvement. Another principle,

identifying and assigning roles and responsibilities is important because “When there are multiple

owners of a process, a common problem is that no one really owns a process”, so three roles

including process owners, process champions, and new employees must be clearly defined and

communicated. It is also essential to integrate across process owners as all process owners must be

held accountable for performance and for meeting shared onboarding goals, and effective

onboarding processes should identify and integrate all process owners and other functional

owners. Process owners must take accountability for the mechanical aspects while coordinating

with others and process champions are responsible for motivating employees and helping them

understand how jobs are critical to the fulfillment of the mission. Figure 9 describes common

process owners and champions and their responsibilities.

Process Owners Process Champions Figure 9: Roles & Responsibilities Human Capital- owns conceptualizing, planning, coordinating of onboarding experience; holding responsible offices accountable Information Technology- supports process with enabling technology and providing employees with technology assets and accounts

Senior leadership- new employees want to meet and hear from senior leadership in first days, weeks, months and should participate in new hire activities Manager/Supervisor- developing and providing tools for managers can help educate managers about importance of roles, enhance capabilities, and encourage desired behaviors. All managers should:

- Welcome new employees - Meet with new employees as soon as possible - Communicate job responsibilities - Explain & set cultural expectations - Review Performance Management system - Discuss career development - Monitor performance and provide formal/informal feedback

Tools for managers can include: - Checklist with timeline of key activities - Links to forms or sample Performance Plans


27

Security – processing clearance requirements, ensuring awareness of procedures, granting access Facilities – arrange for office space to accommodate new employees Training

- Talking points for first discussion with new employees Sponsor- new employees should be assigned someone to help integrate them and help understand culture

- Understand written & unwritten elements - Learn how to navigate organization - Meet colleagues and other essential staff - Answer questions - Identify useful resources

Tools for sponsors can include: - Sponsor training guide, suggested activities, email templates

Human Capital Liaison- bridge gap between human capital office and managers/sponsors; assign sponsor

Employee- responsible for being active participants

Combining Best Practices for Successful Onboarding

Although there are many different onboarding best practices, influences on onboarding are not

distinct entities, and many influences contribute to the basic process toward a fully assimilated

worker. Each influence impacts the overall program in different ways and is interrelated. Also,

successful onboarding results from the coordination of several Human Resource Management

functions outlined in figure 10xc. Excellence in onboarding results in a combination of strategies

and components that enable a smoother transition into the organization from a multidimensional

approach of streamlined onboarding activities and ongoing feedback and support.

Figure 10:

Coordination

of HRM

Functions


28

Methodology

The main focus of this project is the RCT transition from CIP training to their Living Units.

Informational Interviews with UDs, RCS’s, and Job Coaches provide a baseline of the current

onboarding process used by different units and allow identification of current best practices used

by Living Units. Creating a best-practice onboarding program requires an assessment of the

current program and engaging recently hired staff to get feedback on current process.

Recommendations are based both on best practices used within the center and in other leading

organizations based on secondary literature research. Triangulation between Focus Groups,

Interviews, and Surveys was used to gather data from a variety of sources and involvement from all

levels of the workforce.

a) Conduct background research using secondary literary sources to research best practices for

other leading organizations onboarding programs.

b) Informational Interviews with UDs, RCS’s, and Job Coaches to gain an understanding of the

current onboarding process for RCTs. Information on how they currently onboard employees

after CIP training and all materials used when they orient an employee to the unit were

gathered. Each role in the process was interviewed to learn more about the components of

onboarding that are used in each department.

c) Case study of NEO to experience New Employee Orientation. The orientation experience was

documented including observations of the content, process, and environment.

d) Focus Groups with new RCT’s/ Preceptors to gain opinions about the onboarding process and

increase understanding of perceptions of new-to practice RCTs and preceptors. An outline was

used to provide structure for the group sessions, which varied in the number of employees but

on average included 4-5 RCT’s and lasted about a half hour.

e) Survey for new RCTs (>1month, <6months) to evaluate the onboarding process. Survey

questions were developed from key areas identified in focus groups and interviews. The

survey analyzed the effectiveness of various practices and evaluated new RCTs overall comfort

level during the first week and month of the transition.

f) Follow- Up interviews with workforce SMT members to further expand on survey responses

Analysis of the data and information collected and identification of best practices involved key

themes from survey results, focus group findings and interview responses. Onboarding themes

were developed by utilizing thematic content analysis and a table of representative focus group and

interview findings was analyzed by coding and grouping all responses into common themes.

**See Appendix D and F to see data for interviews and focus groups


29

Key Results

Key Result #1: Some living units currently apply some very positive onboarding practices. Supporting Evidence:

a. Focus Group Summary Table of Best Practices used by some units

Figure 11. Best Practices at CWC Summary Table

Pre- Transition Preparation

• Email Unit Directors before transitioning to unit • Unit Director Introductions in NEO and description of Living Unit • Exposed to living unit before transition; trained on unit assigned to

Introduction • Both Formal and Informal introductions • RCS facilitates introductions • meet UD on first day ; job coaches introduce RCTs to UD • meet all team members

Tour • Informal introductions during tour

• UD gives tour

Unit-Based Training

• use scripts • exposed to each shift • many people involved in training so get a variety of views

RCT Role & Expectations

• Each discipline/ team member explains their role and expectations of RCT

• Talk in depth with nurse, psych, etc. • review job expectations • chain of command explained

Socialization &

Assimilation • Use a welcome board

Preceptor Program

• RCS reviews with preceptor what plan is and what was accomplished

• train with different preceptors (but experienced)

Evaluation/Monitoring • check in with new RCTs on daily rounds (twice/shift) • 3-6-9 month reviews • RCS monitors progress and how many residents to work with

RCS, Job Coach, UD role • RCS works side by side with RCTs • job coaches check in in the first few weeks • UD participates in the process

Tools • sheets about conflict resolution • competency checklists

*For more details, please see appendices D and E for Focus group and survey questions and Results.


30

Key Result #2: There is no systematic, structured approach to onboarding across living units.

Supporting Evidence: Assessment of current onboarding program revealed that

(1) Unit Directors had individual styles of onboarding to their Living Units and thus there

were inconsistencies in orientation experiences

(2) The process lacks standardization which results in lack of confidence and competence,

insecurity in delegation/decision-making, and lack of understanding of expectations

Focus group theme that there is a need for increased consistency. RCT comments include:

During an interview, an employee commented that the process is “ad hoc, ill-defined, and

both personality and area- dependent”

During the informational interviews, variation in terminology, perceptions of roles, and

levels of involvement were identified (*See Informational Interview Summary in Appendix B

for more details)

a. Different units used the terms mentor/buddy/preceptor to describe the same role.

b. Interviews showed that forms are not consistently used across units. One person

described they “fill out forms to see if they need additional training” and another person

described that “no forms are used, but they used to have some for preceptors”

c. There is a desire for more information which provides evidence that new hires do not

receive the same information during their experience

“There are different ways of teaching, and it looks chaotic—like we don’t know what we’re doing” “One building is way different than another building—why is every building different?” “Want to be consistent all around the board so you can take skills and apply them in all buildings.” “Different buildings have totally different expectations.” “It’s not consistent center wide—we want consistency.” “Every day there is a different preceptor, I didn’t get to learn the apartment and felt like I was thrown everywhere—some people go above and beyond and others don’t do anything at all”

45% 45%

15% 25% 20% 20%

5%

0%10%20%30%40%50%

Pe

rce

nta

ge

of

Re

spo

nd

an

ts

Topic

Figure 12: Please indicate the topic you would have liked

more information about.


31

b. Survey shows that best practices are used much of the time as all the practices were

in place for over 80%

Correlation analysis revealed that the three top components of onboarding that had the

greatest correlation with confidence performing their job in the first week were “my job

coach as there to answer questions”, “my unit welcomed me”, and “I have had the

opportunity to meet senior leaders”.

The best practices of onboarding that correlate to knowledge perceptions in their first week

include “my job coach was there to answer questions”, “I received all resources”, and

“someone was assigned to help, guide, and support”

The top three practices correlated with confidence their first month on the job are “my job

coach was there to answer questions, “I was given a tour of my unit”, and “skills check-offs

were used”

The top three practices correlated with knowledge in their first month were “assigned

person made me feel welcome”, “someone was assigned to help, guide, and support”, and

“UB training”

0% 20% 40% 60% 80% 100%

job coach was there tour of living unit

my unit welcomed meintroduced to my co-workers

met with supervisor within weekopportunity to meet leaders

clear job duties and expectations resources I needed

someone was assigned assigned person welcoming

unit based training prepared meskills check-offs were used

feedback on my performance

% of Respondants

On

bo

ard

ing

Act

ivit

y

Figure 13: Please answer to following according to your experience: Yes or No


32

Key Result #3: New RCTs experience an information overload during the transition

from CIP training to their assigned living unit.

Supporting Evidence

Focus group comments indicate they need more time to retain information about

individuals preferences and to develop effective behaviors

Research indicates that novice NPs tend to internalize their time constraint issues and

blame themselves for any uncertainty, slowness, and guilt around asking questions.

They have a difficult time accepting outside causes, such as problems with scheduling or

system issues, as possible explanations for some of the issues related to workloadxci

Key Result #4: There is no consistent approach to personal welcoming from key

people.

Survey data shows that “I was introduced to co-workers” was one of the components with a

lower percentage of 87%. This indicates that not everyone is introduced consistently.

0%10%20%30%40%50%60%70%80%90%

100%

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Onboarding Component

Figure 14: Please answer to following according to your experience: Yes or No

“There is lots of information, will probably take me the whole summer to learn” “Already trying to retain a lot of information & DLP is not a small book” “An extra week of working with another RCT would allow more time to absorb information” “We need more time to get to know residents better” “One day with most of the groups is not enough” “Too much information”


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Focus group responses show there is variation in introductions experienced by new RCTs.

Some examples of comments include:

Key Result #5: There is an opportunity to improve the understanding of the

preceptor role and responsibilities for both the new RCT and the RCT preceptor.

Supporting Evidence:

Survey findings indicate there is a desire to learn more information about

roles/expectations as it is one of the most selected choices at 45%

Focus group findings indicate more specifically a need for increased understanding of

preceptor role. Some members of the focus groups didn’t understand that they were

preceptors or what that meant, and some were very knew yet had precepted other

RCTs. Some comments include:

45% 45%

15%

25% 20% 20%

5%

0%

10%

20%

30%

40%

50%

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Topic

Figure 15: Please indicate the topic(s) you would have liked more information about.

“There were no introductions…I came to work and they were like ‘oh you’re working with me today’” “For others they put up a board of photos and it worked because everyone knew who I was” “We received introductions as ‘new RCTs’ and eventually got to know everyone, but some haven’t yet” “The only reason I met my UD was because I ran into them” “They may act welcoming, but sometimes not all that welcoming”

“I have only been working here for about a month, and when I was new I was a preceptor for a couple days even though it was still a learning process for me” “It was kind of scary; I was new and training right away and it was different”


34

There is variation in perceptions of preceptor roles and responsibilities

a. In an interview, someone described that they are “assigned preceptors who help

them learn more” Another comment “there isn’t always preceptors that are available

or willing to train for a specific apartment” and “buddy is their go to person”

Focus group theme that it is seen as an easy day for preceptors. Some comments

include:

Survey shows that the preceptor guiding and supporting them is the activity that

contributes the most to their onboarding experience. This indicates that the center

should focus on improving that area the most.

survey also shows that someone assigned to help guide, support, and make them feel

welcome is moderately correlated with perception of knowledge level first month and

first week

Key Result #6: There is no consistent process owner(s) for the onboarding program

that integrates the activities of stakeholders or holds them accountable.


Different levels of responsibility are associated with different roles across units for

instance, from job coaches just providing reminders to new RCTs to providing a “variety

of roles including coach, parent, and others to deal with behavioral issues, help them relax,

and accommodate needs”

“When working with an RCT, they take 2 people and you take 2 people—and they

aren’t there to watch you taking care of your 2 people”

“RCTs look at it like an ‘easy day’ or ‘rest day’”

52%

13%

48% 30%

4%

0%20%40%60%

Preceptor Introductions Unit-BasedTraining

Feedback Other

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esp

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Onboarding Activity

Figure 16: Which activity contributed the most to your experience starting to work on the unit?


35

Not a consistent person that took ownership of a specific activity, rather comments

were made such as “most of the time this person does it” or “when I am here…this is what

happens—but I don’t know what happens when I’m not here”

Some unit directors are more involved than others. During an interview a Unit Director

commented that there have been times where they haven’t gotten to meet an RCT until

weeks after they started.

Focus group theme that job coaches are not there from comments such as “Job coaches

were nowhere around when started to answer questions- even though they sometimes

checked in” –“maybe we need trainers”

Interview comment “there is no point person for the whole process—who is going to help

them when they get onto the unit?”

Key Result #7: There is an opportunity for better preparing new RCTs for working

with individuals at CWC.


Survey responses show that RCTs would like training to be modified:

Focus group themes support that RCTs do not feel prepared for transitioning into their

role.

Theme: The transition is overwhelming

Theme: Training not realistic

“The most helpful thing would be the unit-based training in all the apartments in building” “Let RCTs train in every apartment of the unit with all residents \Train in Assigned Unit” “During CIP to have more interactions with the type of residents in your assigned building”

“Hectic, shocked, never knew a G-tube existed” “Stressful and felt rushed, behind and frustrated” “Very nervous—people standing over you watching everything you do” “There was a lot of frustration, just kind of thrown out there”


36

Theme: Training isn’t realistic

Survey showed that UB training was the component with the highest correlation to

knowledge in the first week, month (.6367). This indicates the importance of providing

training that prepares RCTs for the realities of their role.

Key Result #8: There is not a performance evaluation system for the onboarding

process.

CWC gathers immediate feedback in orientation but doesn’t measure the long term

impact of onboarding activities

a. During NEO, observation revealed that there were orientation evaluations

distributed but there was no indication of any follow-up after NEO

There is a need to measure activities effect on long term turnover and productivity in

order to monitor the effectiveness of the onboarding program

“Being on the units is different from CWC rules, new people get in trouble for doing what learned” “Once on the units it was different than the way to pass certification” “Confusion because what is done in CIP training is different than for the test” “CIP training is 75% CWC, 25% what is in the CIP program, and become confused” “Should train on each apartment evenly so you get comfortable going to all apartments” “If you work the way they teach you, you won’t get anything done—especially bathing” “Better time management training” “During clinical you only get to work with 1 resident, should rotate residents instead because after the first week you don’t know anyone” “Never had 4 people all at once”; “they teach you to take your time with 1 person but next thing you know you have 4 people” “It’s not healthy, safe, and not consistent”


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Recommendations

Recommendation #1: Apply the best practices used by some units at the center to other units.

Best practices correlate with confidence and knowledge levels first week and first month into jobs.

This supports the importance of applying best practices consistently throughout the center to

provide RCTs with the confidence they need to perform their role.

Action Steps:

(1) Include best practices in the new employee manual as part of the new hire checklist

(2) Set a reoccurring agenda item for a current Unit Director meeting to share best

practices, knowledge, experiences for onboarding in their units

(3) Best practices to be applied to other units (from focus groups/ interviews) and also

from the survey question “which activity contributed the most to your experience?”

are summarized in figure 11 for key result #2.

Recommendation #1: Develop a comprehensive new employee toolkit that includes

checklists and a written onboarding timeline.

Action Steps:

(1) Include logistics information that includes building map, driving/ parking, visitor

process, where key offices are located, bistro, building regulations, resources (reflection

room, fitness center, etc.)

(2) Create a new hire checklist that all supervisors use during unit orientation

a. Should outline the specific onboarding timeline, goals, responsibilities, and

support available

b. Include clear expectations of roles, responsibilities. Focus group comments

indicated that RCTs “don’t know who to go through or who to address” and it

would be helpful to “explain how their role is connected to other roles”. Also, an

RCT commented that “Knowing what to expect takes overwhelmingness away”

(3) Include key skills list & page of quotes/advice from RCTs to help new RCTs adjust

better. Examples of advice and key skills that could be included from focus groups

include:


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(4) Include a section that outlines of the specific onboarding timeline, goals,

responsibilities, and support available

a. Include clear expectations of roles, responsibilities. Focus group comments

indicated that RCTs “don’t know who to go through or who to address” and it

would be helpful to “explain how their role is connected to other roles”. Also, an

RCT commented that “Knowing what to expect takes overwhelmingness away”

(5) Include a general timeline/schedule that explains their expectations and

responsibilities. Focus group comments indicate RCTs would find this helpful.

(6) Include general rules, information, and helpful tips. Focus group comments and survey

responses indicate that certain information would be helpful.

(7) Communicate to all members of the organization that it was created and should be used

consistently

(8) Educate and train managers on using the manual and also the goals/challenges of

employee onboarding as well as best practices

(9) Post the resources electronically

“Don’t rush or get overwhelmed, you have more time than you think” “Observe how other RCTs react to residents because there are a lot of behaviors to learn” “Carefully read DLP otherwise you aren’t going to know how to help” Important skills: Consistency, teamwork, communication, helpful “Get to know people’s names fast”

“A general schedule would be helpful because you can get in your head about what the timeframe is” “Challenging to show routine because constantly getting pulled for meetings—possibly do check-offs at end or all at one time” “How are you going to learn anything if you’re not there? We need to have RCTs with preceptors all day, not just 3 hours” “Every 2 minutes you should know what’s on board”

“Minor things like: can’t close the curtains after 8, can’t have TV on at certain time” Be consistent with everything everywhere-that’s my only advice (Survey) Show us more on reading the DLP's and such because as a rotator, I don't always have the same residents and same apartment. Include the fact that you can take the residents on walks & get them out during leisure activities. RCT rights


39

Recommendation #3: Modify the time period RCTs have to learn unit-based

information so it is longer and more participatory.

Action Steps:

(1) Create a realistic timeline to allow the new hire time to fully adjust and take in all

the information being given to them

a. Increase from 2 to 3 weeks as described in the comment from focus group “if

we could have just one more week”

(2) Increase hands-on experiences RCTs have in unit-based training; Increase RTC

participation in tasks will help with retention

a. Focus group (and survey) theme of increasing participation

(3) Train employees on the unit they are assigned to

(4) Pace the delivery of onboarding information to avoid information overload. “it’s a

marathon not a sprint”

(5) Refresh and remind information over time; review and cover at shift changes

Recommendation#4: Speed the development of important working relationships for new RCTs.

Action Steps: (1) Managers should welcome new employees and meet them on first day on the unit.

(2) Provide a framework for the socialization of new hires by using an assimilation

checklist of key people to meet for first day and first week on unit.

a. Identify relevant people for new RCT to meet

b. Don’t just give them a list; establish accountability for completing the list.

“Long time RCTs have a hard time letting you take over so it’s harder to learn—it’s like a new day

all over again”

“Give more residents during training”

“It would be helpful to have 1 resident in first week, 2 residents in second, 3 the next…”

“Depends on what RCT you’re with on how much they let you do”

“RCTs you’re paired with just let you watch; would prefer hands on approach”

Survey comment to “make them have more than one resident during their training period so that

they can know how to manage their time/scheduling”

“If I would do it again I would have said something about taking on the whole group. Some people

don't give you the whole group”


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c. Include leadership profiles with photos and brief biographies of key leaders

(3) Prepare RCTs and others for meaningful, productive onboarding conversations

a. Clarify objective of meetings

b. Provide a list of talking points for key meetings

(4) Make formal and informal introductions to key people and teams/committees.

(5) Manager should organize meetings, lunches, and events to facilitate face-to-face

meetings

a. Invite new RCTs to key meetings

(6) Develop a required meeting focused on issues of new RCTs.

(7) Conduct consistent check-ins with these relationships to identify any potential

problems early

(8) Create a welcoming environment and culture of inclusion.

a. Incorporate team building activities in unit based training

b. Explain WHY they have to do something or what the purpose is of the task.

Also explaining who “they” is important to RCTs

c. Focus group theme of Explaining WHY

(9) Invite RCTs to key meetings to give them an opportunity to participate in decision-

making

Recommendation #5: Create a more structured preceptor program.

Action Steps:

(1) Educate preceptors about their role and responsibilities

(2) Have consistent preceptors

Preparation

-prepare checklist

-set up meetings

- brief bios, background

Delivery

- formal/informal introductions

Follow-Through

-check in consistently

“90% don’t explain why we do this” “If you want good people to stay and get involved, you have to explain why” “Need more transparency and have to have enough respect to say why” “How are preceptors supposed to train if they don’t even know why?”


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a. Coordinate with scheduling office to make sure preceptor is scheduled on

every shift

(3) Develop and communicate clear expectations for preceptors

a. Create scripts for teaching how to do things

(4) Preceptors should collaborate with the RCS to utilize what’s your plan and what

was accomplished today meetings

(5) The preceptor and new RCT should remain in “married state”

a. The “married state” concept helps address the misconception that it’s not

an “easy day” when new RCTs come onto the unit. Historically, nurses

that are only given certain residents never learn about all the patients on

the unit—only the 2 they were assigned to care for and the married state

approach ensures they identify and address patient challenges together

throughout their shift.xcii

(6) Increase recognition for Preceptors

a. focus group comment “we don’t hear so many positive comments here or

recognition for good things, it’s like they don’t care if we did a really good

job today”

Recommendation #6: Increase accountability for the onboarding process by

establishing an owner of the process as a whole and defining who controls the steps.

Action Steps:

(1) Identify a process leader; someone to take ownership and oversee process as well as ensure

all other departmental stakeholders are being held accountable for roles

(2) Document key roles/responsibilities for all members

(3) Increase leadership involvement in onboarding

a. “I would like to see administration at meetings and be more visible. I don’t think they

know what the RCT day is like and expectations are so high”

b. Survey showed a correlation between

“within 1 week I met with supervisor and knowledge in first month

c. Survey showed that the biggest correlation for confidence in the first week was that

they “had the opportunity to meet senior leaders”

(4) Interview comments about roles & responsibilities


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a. “The RCS should ensure all the check-offs are done but the UD should also have

involvement”

b. “Ultimately, the responsibility for the whole process is with the UD”

c. “The UD needs to follow up with the new RCT, and the RCS should be ready when the

new RCT arrives and should facilitate all the other introduction”

d. “The RCS should meet the RCT during training and learn how they have been doing so

they know what to expect”

(5) Part of the job coach role should be to be there to answer questions consistently during the

first week, because it is correlated with confidence level in first week, first month, as well as

knowledge in the first week and month

Recommendation #7: Expand Unit-Based training to better prepare new RCTs for

working with individuals at CWC.

Action Steps:

(1) Have workforce SMT develop a multidisciplinary team including leadership, Unit Directors,

and other relevant employees

(2) Identify content areas to include in Unit-Based Training

a. Active Treatment

b. Reminder of NEO content

c. Emphasize CWC guidelines and policies

(3) Evaluate the time requirements of new RCTs and how consistent Unit-Based training can be

made across units

(4) Develop an improvement plan to modify Unit-Based Training

Recommendation #8: Seek further feedback on onboarding program from new

employees

Interview comment that “In order to improve and innovate the onboarding process, you will have to

have process measures to support you in managing the onboarding process and outcome

measures/results to indicate how you are doing”

Action Steps:

(1) Identify Process measures

a. Process measures are measures that consistently show you are following the

process (ex: were they introduced, was a checklist used)

(2) Identify Results (outcome) measures


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a. Examples include reduced turnover, increased retention, increased engagement and

satisfaction, increased confidence

(3) Monitor onboarding program effectiveness over time

Table 2: Summary Table Key Results and Recommendations

Key Results Recommendations Key Result #1: Some living units currently apply some very positive onboarding practices

Apply the best practices used by some units

at the center to other units

Key Result # 2: There is no sound, systematic, structured approach to onboarding across living units.

Develop a comprehensive new employee manual that includes checklists and a written onboarding timeline.

Key Result #3: New RCTs experience an information overload during the transition from CIP training to their assigned living unit

Modify the time period RCTs have to learn unit-based information so it is longer and more participatory

Key Result #4: There is no consistent approach to personal welcoming from key people

Speed the development of important working relationships for new RCTs

Key Result #5: There is an opportunity to improve the understanding of the preceptor role and responsibilities for both the new RCT and the RCT preceptor.

Create a more structured preceptor program

Key Result #6: There is no consistent process owner(s) for the onboarding program that integrates the activities of stakeholders or holds them accountable.

Increase accountability for the onboarding process by establishing owner of the process as a whole and defining who controls various steps.

Key Result #7: There is an opportunity for better preparing new RCTs for working with individuals at CWC.

Expand Unit-Based training to better prepare new RCTs for working with individuals at CWC.

Key Result #8: There is not a performance evaluation system for the onboarding process.

Seek further feedback on onboarding program from new employees


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Appendices

A. Organization chart

B. Interview questions

Help me understand the onboarding process for your unit? How does it work after CIP

training when new RCTs come onto the unit? What is your role in the transition?

C. Focus group questions

For New RCTs (>1month, <6months)

(1) Can you tell me about your experience in orientation to the living unit after CIP

training? What was it like in the first 2 weeks?

(2) Who helped you when you came onto the unit? How did that experience go with that

person(s)?

Institution Director

Program & Psych Services

Management Services

Human Resources

Resident & Special Programs

Medical Services Nursing Services Social &

Community Services

Deputy Director

Psychology

Education

Services

Religious Services

Communication

Adult programs: Therapeutic Rec Music Therapy Community Vocational Contracted

Administrative Services Mailroom/Copy Communication Center Business office Fiscal Services Resident Accounts Medical Assistance Stores Food Services Food Production Special Diet & Formula Facility Services Building & Repair Grounds Mechanical Repair Environmental Services Housekeeping Laundry Sewing Service Safety Fire, Health, & Safety Security Safety Risk Manager IT Desktop support Application Development Hardware/Software

Personnel Services Labor Relations Workers Comp Payroll & Benefits

Resident Living Units Volunteer Services Foster Grandparents

Laboratory Services Clinical Lab EEG/EGG Lab Radiology Pediatrics Services Dental Services Genetics Peer Review Services Medical Records Rehab Services Psychiatric Services UW Rehab Services Program Support & Medical Transcription Medical Staff

Short-Term Care Unit Central Supply Outpatient Clinic Center-wide Escorts Onsite GYN Clinic Float Teams (RCT/NC3) Employee Health Admin Charge Office Nursing Practice Quality Improvement Infection Control Nurse Clinician 3 Accident/ Injury Resident Incident Wellness Program Training & Development NEO Certified Instructional Program (CNA) Nursing Orientation CPR/First Aid Training Consultation Community Workshops Professional Dev. Safety Training

Transition to Community Living Clients’ Rights Caregiver Misconduct MSTC DEC STAP


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(3) What was done well and what wasn’t done well? What would have made it easier for

you or made you feel more comfortable?

(4) What are the key skills you need to be successful in your unit?

(5) What would be helpful to include in a manual for new RCTs?

(6) Are there any other recommendations that you have or suggestions for making the experience more welcoming, improving it for future RCTs?

For Preceptor RCTs (1) I want to get an idea of how you have been involved in helping new RCTs transition

to the units. How does precepting work in your area? (Are you assigned/stay with them? Or do people just come to you when they have questions?) Is it different for anybody?

(2) What could help RCTs adjust better? Is there anything that would make it easier for them, make them feel more confident?

(3) So, one of the things they were thinking of doing was creating a written plan/guide for the RCTs for coming onto the unit when they are done with CIP training. What would be helpful to include?

D. Information Interview Summary Chart

UD/ RCS/Job Coach INFORMATIONAL INTERVIEW SUMMARY CHART Component Living Unit

UD Job Coach RCS

Living Unit UD Job Coach RCS



Pre-Transition Preparation

Exposed to unit during CIP training If don’t feel they are giving enough attention, will get more help Job coaches prepare them and get them competent before unit

Gets emails from job coaches before (foreknowledge) Oxygen educational component Assigned unit at end of week 6 Not a best “cookie cutter” way; UDs want things done a particular way Staff training shows all general information- where to find DLPs, etc.

Job coaches there to answer questions on first day Show around unit while waiting to take test (4 clinical days, mock testing) – after clinical, test get to see unit while waiting Show where everything is (OT/PT recs, schedules, DRRs)

No communication when come onto unit No job coaches present on first day when new RCTs come on they get a locker (job coach brings them on; meet and greet)

Introduction RCS facilitates intro Informal intro to UD in rounds Formal in meetings Job coaches bring on group and there is an some sort of initial intro; Rounds- if haven’t met, will try to meet with them & check-in

Job coaches introduce RCTs to UD

Report to AM RCS, intro to staff Introductions to other RCTs

Intro in NEO? Handwritten note? Welcome name on board

Tour Give tour Job coaches bring on units

Review equipment, UD gives tour

Timesheet in middle Show around unit

Who gives tour? Tour- other intros to


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RCTs, UD, RCS, etc.

Unit Based Training

Scripts for NC3 Meet all team members Oriented to all shifts Once through PT/OT they are good to go on own Exposed to each shift Many people involved in training so they get a variety of info/ ideas; all have own way Each discipline/ team member explains their role and expectations of RCT (nursing, SW, RCS, etc.) during orientation (after all classwork training & unit orientation) OT/PT/Bath check offs before on own

Meet UD in gathering room Oxygen Pamphlet Taught a certain way but there is variation between units; encourage to roll with it Let OT/PT know they are ready to get check offs Meet all team members

Meet all team members OT/PT check-offs RCS core competencies Learn about resident, apartment, PT/OT check offs: wait week to get to know residents before check offs- depends on RCT Learn about behavior programs, charts >they receive check offs that show what they will be expected to do in OT/PT check offs >emphasize leisure activities, what residents do and don’t like

Most check-offs don’t happen until last minute When should be training for OT/PT? If OT/PT are there, they will help them with check offs depending on how comfortable they are Talk in depth to nurse/NC3, psych, RCS, SW, etc. Schedule flexible so they can meet with people After week on PM, go to week on night shift, then scheduled on count

RCT Expectations/Role

From RCT & nursing view Review job expectations and need to meet them

Part of unit training Honest about forcing

Review job expectations

Socialization/Assimilation

Optional photos on bulletin board Open door policy/walk through helping them fix things/ ask-don’t tell doing something wrong (learn from them)

Photos on bulletin board “all in the sandbox together” philosophy First names & eye contact Photos on bulletin board Negativity effects retention Supervisors try to make feel more welcomed but day-to-day can get busy Takes at least 6 mo to a year to get routine

There is more repor between the job coaches and RCTs so they feel more comfortable/ it’s welcoming to have them there

Names on bulletin board Welcome names on board( other units have photos)

Preceptor Program

Assigned preceptors who help learn more Preceptors assigned one group Multiple preceptors for about 1 month “all preceptors each day” Form- what accomplished Unit RCT Preceptor Set up with strong RCT who shows routine, schedule, etc. Preceptors given sheet to go over what was done Write down good things & concerns

Buddy depends on experience Scheduling issues First few days w/trusted RCT before others RCTs know residents better Strong mentors on unit; RCTs, used to have mentoring class, have at least one mentor on each unit Fill out forms to see if they need additional training

Assign primary preceptors Go to person, ask questions Work with RCT’s but they can be too busy sometimes to give all info; job coach also mentor

No point person for whole process, who is going to help on unit? Scheduling issues Novice expert philosophy First day, assigned apartment and set up buddy (go-to person, have to “win them over”); some shadow at first and maybe given a resident -following day give 2 residents (depends


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Trainee gets 1 new preceptor per shift

on comfort) - work on unit 1-2 days, some 2-5 days- depends on coach (1 apt, 2 days) Buddy- receptive, skilled, everyone has a different personality Don’t always have preceptors that are available/willing to train for specific apt.

Evaluation/Monitoring

Continual reinforcement Ongoing follow-up Stress level Daily rounds (twice/shift) RCS’s and UD’s needs assessment Submit monthly summaries (strengths & weaknesses) & will re-check areas couple weeks Check if comfortable Job coaches check in periodically 3-6-9 month evaluation- prior to 1 year anniversary (probation period)

Comfort level/need more training? Try to have RCS convo weekly, UD ask in hallway, Ideally RCTs check in daily Within first couple weeks check in, how doing; Check in every month; Pericare sheet Go back and forth between groups /units Try to check in weekly: encourages them, shows tricks Monthly night meeting w/all night staff

Check in more frequently towards end Touch base Make sure confident Quarterly meetings Talk to UD, give feedback how they are doing and if need to remedy Check up to see how they are doing (Pericare) ; follow up for a year depending on needs

Not really anything in place Check in with RCT to see how it is going, if they are comfortable/ help become more comfortable

No forms used (used to have some for preceptors)—online forms??

RCS, Job Coach, UD Role

RCS- supervisor, check- in Job coach- many roles (coach, parent, etc.) & behavioral issues; help relax, accommodate needs Need to think outside of box to show how to do things RCS helps with any follow-up necessary (language barriers- maybe staff training can help)

RCS- hands on person; work side by side with RCTs, liaison between LSO, staff training and unit, and a mentor that helps with scheduling RCS email/ contact about problems Teamwork with PNI’s & help each other out, help RCTs plan & personal critiquing

Make sure doing things correctly; mentor Sometimes RCTs too busy to give all info Encourage to ask RCS and other RCTs questions They are go-between person Correct RCTs if not teaching correctly REMINDING

Usually a job coach there to help along RCS- checks in with RCTs


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E. Survey


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F. Focus Group Themes Summary Table

Focus Group Key Takeaways Themes Examples of comments RCT Experience in first two weeks Overwhelming- RCTs described feelings of stress, frustration, and disorganization Information Overload-RCTs described that they need more time to absorb information More Participation-RCTs described that they would like more opportunities to participate and increased responsibility Training isn’t realistic – RCTs described feelings of confusion regarding training and preparation for their roles Variation- RCTs expressed a lack of consistency in onboarding practices Not Welcoming- RCTs described negative first impressions

Hectic Shocked and didn’t know about some equipment Stressful, tedious job a lot of people can’t handle Rushing, felt behind and frustrated Very nervous- people watching everything you do It was different; change in nature of residents

Lots of information Will probably take entire summer to learn Time consuming looking at DLP Already trying to retain lots of information Need more time to absorb information and get to know residents better Extra week of working with another RCT 1 day with most of groups is not enough

Paired RCTs just let them watch Prefer a hands-on approach Long-time RCTs have hard time letting you take over so its harder to learn; “it’s

like a new day all over again” Give more residents during training Don’t let RCT paired do all work Helpful to progressively increase responsibility

Being on units is different than training New people get in trouble for doing what they learned Once on units its different than way to pass certification Confusing because it’s different for test than CIP training 75% CWC/25% CIP program ;confusion about what to do Teach how to pass state exam and then learn CWC Train on each apartment evenly Only taking care of 2 people isn’t like reality of 4 residents In clinical only get 1 resident; should rotate residents instead Don’t mislead; can’t do it to the book because there is so much going on for

activities

some said it was easygoing, others were stressed job coaches check in sometimes training length a little different (some 2 weeks, others had more time) depends on which RCT you are paired with how much they let you participate

They may act welcoming but not all that welcoming sometimes Higher powers not so nice

Preceptor Experience Easy day for preceptors-RCTs expressed that preceptors don’t understand their responsibility Different preceptors- RCTs described that they receive a variety of preceptors

They take 2 people and new RCTs take 2 people RCTs look at it like an “easy day” or “rest day” They are not there to watch you taking care of your 2 residents They would just take over if you fell behind

Not assigned to anyone specific Jumped around with different RCTs Good to train with others and get to know them: “each have own strengths”


50

Positive experience – RCTs described that they found the experience to be helpful Variation in Introductions- RCTs described different experiences regarding meeting their co-workers

Every RCT was friendly, nice Some were awesome Most instructors know what they are doing Meeting with UD helped a lot ; helpful to know you have support Everyone is good, works well as a team Co-workers get along good Tell them you need help and they are there to help you Primary RCTs are most helpful

No intros: “oh you’re working with me today” For others they put up a board of photos and it worked well Intros as “new RCTs” and eventually got to know everyone but some have not yet Some haven’t met UD yet, others have met with more than twice Only reason they met UD was because they ran into them

Other opportunities for improvement Emphasize importance of DLPs Time management skills Attrition

Keep reading DLPs as they change daily Have RCTs show you how valuable they are (they were told but more

demonstration)

Better time management training; sometimes many residents will be leaving at same time

People leave after CIP training (get paid to get certification)

Onboarding Manual Content Helpful tips/Advice Key skills General rules/info General Schedule Roles/Responsibilities

Importance of getting more advice from others on how to handle residents Don’t rush or get overwhelmed, you have more time than you think Observe how other RCTs react to learn behaviors Socialize- get to know people fast

Consistency, teamwork, communication, helpful

Minor things like: can’t close curtains after 8, can’t have TV on at certain time Show how whirlpool actually runs not just where buttons Explain programming schedule

Get in head about what timeframe is (first 2hrs, next 2 hrs) So you can have time for introductions Get a comfort level

Who UD is; who else you are working with

Other Recommendations Need rule for forcing

Don’t force people after 3 months because they will leave Do something about calling in, create some type of rule (ex: require doctors note)

Precepting Experience Knowledge gap- RCTs indicated a lack of knowledge regarding the Precepting role

Didn’t know they were a preceptor New RCT was a preceptor when it was still a learning process


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Willingness to Precept- RCTs described that some are not supportive of Precepting Scheduling issues- RCTs described barriers to helping new hires learn the routine Training-RCTs described a negative impression of unit-based training Increase Consistency –RCTs described variation between buildings and preceptors

A lot of people don’t like to train Don’t want anyone to throw off your routine Timing, routine issues

Challenging to show routine b/c constantly pulled for meetings Possibly doing check-offs at end or all at one time How are you going to learn anything if you’re not there Need to have new people with preceptor s all day

Same group for different residents; it’s like starting over Some trainers just give you 1 person ( don’t want to work with) Training is lacking It’s not healthy, safe or consistent

Different ways of teaching It looks chaotic—like we don’t know what we’re doing One building is different than another building Why is every building different Want to be consistent all around the board so can apply skills Totally different expectations

Better Adjustment/ Increased Confidence? Reduce inconsistency- described different expectations and a fragmented learning experience Explain WHY- described they want to understand why they do things a certain way Retention issues- described various reasons for attrition Motivation/selection- described that it’s hard to train those who aren’t there to learn Job coaches not there-described that they would like job coaches to be present more in beginning Management- described negative perceptions of management and lacking of leadership skills

Not consistent around the board-where do I go to find…? Everyday a different preceptor—didn’t get to learn apartment Thrown everywhere, some people go above and beyond and others don’t do

anything at all. Not consistent center-wide-we want consistency Training way different than units, expectations totally different

90% don’t explain WHY we do this “if you want good people to stay and be involved, you have to explain why” Need to have enough respect to say why, more transparency Tell me why/who is they?

Can’t remember someone staying longer than a month Forcing, mean people, don’t know what doing It’s like a “revolving door”, just making clones that come and go

Know people are here for paycheck, why are they here Just watch TV; hard to train people you know don’t care Just want to fill holes—not healthy, not good for work ethic

Need trainers Job coaches just give you a bath to do Nowhere around when started Only do so much because stuck in ways

so much negativity in certain buildings-it takes a toll “loved residents, hated management” RCTs vs. management (there is a divide where shouldn’t be) RCS hides in offices; not around when needed/above law Nobody in management communicates with each other RCS vs. RCS rivalry Everyone’s got a different agenda Some care about different things RCS asks how it is supposed to be Everybody wants them to do all these different things Management says something but doesn’t follow through People take shortcuts and managers still say everyone does a good job so


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Lack of Communication-described that there needs to be better communication skills at all levels of the workforce Training- Described a desire to train on assigned building

preceptors think they can do whatever and get away with it

UD wants this done, RCS wants this done All bosses and nobody knows what’s going on Communication is bad-number 1 thing to work on Read DLP- and forget to make changes but nobody tells anyone Still get yelled at for leisure activities already did

Wish we could train on assigned unit—allows you to get a feel Understand why they do it currently so can learn everything but…Maybe spend a

day in other buildings


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i Lee, David. Successful Onboarding, 2008. ii Bauer, Tayla N. Onboarding New Employees: Maximizing Success. SHRM Foundation, 2010. iii Graybill, Jolie O., Employee Onboarding: Identification of Best Practices in ACRL Libraries. 2013 iv Johnson, Maggie, and Max Senges. Learning to Be a Programmer in a Complex Organization: A Case Study on Practice-based Learning during the Onboarding Process at Google.2010 v Bauer, Tayla N. Onboarding New Employees: Maximizing Success. SHRM Foundation, 2010 vi McNeill, Jane. Onboarding and Induction. 2012 vii Lee, David. Successful Onboarding, 2008. viii Lee, David. Successful Onboarding, 2008. ix Graybill, Jolie O., Employee Onboarding: Identification of Best Practices in ACRL Libraries.2013 x Graybill, Jolie O., Employee Onboarding: Identification of Best Practices in ACRL Libraries.2013 xi Aberdeen Group. The onboarding benchmark report. 2006 xii Johnson, Maggie, and Max Senges. Learning to Be a Programmer in a Complex Organization: A Case Study on Practice-based Learning during the Onboarding Process at Google. 2010 xiii Snell, Alice. "Researching Onboarding Best Practice: Using Research to Connect Onboarding Processes with Employee Satisfaction”, 2006 xiv Bauer, Tayla N. Onboarding New Employees: Maximizing Success. SHRM Foundation, 2010. xv Bauer, Tayla N. Onboarding New Employees: Maximizing Success. SHRM Foundation, 2010 xvi Bauer, Tayla N. Onboarding New Employees: Maximizing Success. SHRM Foundation, 2010 xvii Bauer, Tayla N. Onboarding New Employees: Maximizing Success. SHRM Foundation, 2010 xviii Graybill, Jolie O., Employee Onboarding: Identification of Best Practices in ACRL Libraries.", 2013 xix Harmon, Gabriella Grohmann, In what ways does participation in an onboarding process impact the socialization and contribution of employees? 2012. xx Lee, David. Successful Onboarding, 2008. xxi Lee, David. Successful Onboarding, 2008. xxii Lee, David. Successful Onboarding, 2008. xxiii Lee, David. Successful Onboarding, 2008. xxiv Lee, David. Successful Onboarding, 2008. xxv Lee, David. Successful Onboarding, 2008. xxvi Lee, David. Successful Onboarding, 2008. xxvii Lee, David. Successful Onboarding, 2008. xxviii Simone, Shari, Kay Blum, and Mona N. Bahouth. Transitioning Into Hospital-Based Practice: A Guide For Nurse Practitioners And Administrators. 2013 xxix Shinners, Jean, Cherilyn Ashlock, and Yvonne Brooks. "Implementation of a Standardized, Organizational Approach to Transition From Academics to Practice: A Case-Based Discussion."2014 xxx Simone, Shari, Kay Blum, and Mona N. Bahouth. Transitioning Into Hospital-Based Practice: A Guide For Nurse Practitioners And Administrators. 2013 xxxi Simone, Shari, Kay Blum, and Mona N. Bahouth. Transitioning Into Hospital-Based Practice: A Guide For Nurse Practitioners And Administrators. 2013 xxxii Bahouth, M. N., & Esposito-Herr, M. B. Orientation program for Hospital-based nurse practitioners.2009 xxxiii Bahouth, M. N., & Esposito-Herr, M. B. Orientation program for Hospital-based nurse practitioners.2009 xxxiv Graybill, Jolie O., Employee Onboarding: Identification of Best Practices in ACRL Libraries.", 2013 xxxv Graybill, Jolie O., Employee Onboarding: Identification of Best Practices in ACRL Libraries.", 2013 xxxvi Lee, David. Successful Onboarding, 2008. xxxvii Graybill, Jolie O., Employee Onboarding: Identification of Best Practices in ACRL Libraries.", 2013 xxxviii Bradt,George and Vonnegut, Mary. Onboarding: How to Get Your New Employees Up to Speed in Half the Time. 2011 xxxix Lee, David. Successful Onboarding, 2008. xl Simone, Shari, Kay Blum, and Mona N. Bahouth. Transitioning Into Hospital-Based Practice : A Guide For Nurse Practitioners And Administrators. 2013 xli Graybill, Jolie O., Employee Onboarding: Identification of Best Practices in ACRL Libraries.", 2013 xlii Bradt,George and Vonnegut, Mary. Onboarding: How to Get Your New Employees Up to Speed in Half the Time. 2011 xliii Simone, Shari, Kay Blum, and Mona N. Bahouth. Transitioning Into Hospital-Based Practice : A Guide For Nurse Practitioners And Administrators. 2013 xliv Simone, Shari, Kay Blum, and Mona N. Bahouth. Transitioning Into Hospital-Based Practice : A Guide For Nurse Practitioners And Administrators. 2013 xlv Lee, David. Successful Onboarding, 2008. xlvi Simone, Shari, Kay Blum, and Mona N. Bahouth. Transitioning Into Hospital-Based Practice : A Guide For Nurse Practitioners And Administrators. 2013


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xlvii Simone, Shari, Kay Blum, and Mona N. Bahouth. Transitioning Into Hospital-Based Practice : A Guide For Nurse Practitioners And Administrators. 2013 xlviii Simone, Shari, Kay Blum, and Mona N. Bahouth. Transitioning Into Hospital-Based Practice : A Guide For Nurse Practitioners And Administrators. 2013 xlix Harmon, Gabriella Grohmann, In what ways does participation in an onboarding process impact the socialization and contribution of employees? 2012. l Simone, Shari, Kay Blum, and Mona N. Bahouth. Transitioning Into Hospital-Based Practice : A Guide For Nurse Practitioners And Administrators. 2013 li Lee, David. Successful Onboarding, 2008. lii Allen, David G., and Linda Rhoades Shanock. "Perceived Organizational Support and Embeddedness as Key Mechanisms Connecting Socialization Tactics to Commitment and Turnover among New Employees." 2013 liii Weckstrom, Sonja. Onboarding: process plus a broad organizational mindset. 2014 liv Lee, David. Successful Onboarding, 2008. lv Weckstrom, Sonja. Onboarding: process plus a broad organizational mindset. 2014 lvi Weckstrom, Sonja. Onboarding: process plus a broad organizational mindset. 2014 lvii Weckstrom, Sonja. Onboarding: process plus a broad organizational mindset. 2014 lviii Quinley, Kevin. Best (and Worst) Practices for Onboarding Claims Staff.2013 lix Bradt,George and Vonnegut, Mary. Onboarding: How to Get Your New Employees Up to Speed in Half the Time. 2011 lx Bradt,George and Vonnegut, Mary. Onboarding: How to Get Your New Employees Up to Speed in Half the Time. 2011 lxi Graybill, Jolie O., Employee Onboarding: Identification of Best Practices in ACRL Libraries. 2013 lxii Simone, Shari, Kay Blum, and Mona N. Bahouth. Transitioning Into Hospital-Based Practice: A Guide For Nurse Practitioners And Administrators. 2013 lxiii Graybill, Jolie O., Employee Onboarding: Identification of Best Practices in ACRL Libraries. 2013 lxiv Korte, Russell F. The Socialization of Newcomers into Organizations.2007 lxv "Saratoga Waters." The Boston Medical and Surgical Journal. 2008 lxvi Lee, David. Successful Onboarding, 2008 lxvii Bradt,George and Vonnegut, Mary. Onboarding: How to Get Your New Employees Up to Speed in Half the Time. 2011 lxviii Ferri-Reed, Jan. Onboarding Strategies To Supercharge Millennial Employees. 2013 lxix Lavigna, Bob. Getting Onboard: Integrating and Engaging New Employees. 2009 lxx Bauer, Tayla N. Onboarding New Employees: Maximizing Success. SHRM Foundation, 2010. lxxi Graybill, Jolie O., Employee Onboarding: Identification of Best Practices in ACRL Libraries. 2013 lxxii Simone, Shari, Kay Blum, and Mona N. Bahouth. Transitioning Into Hospital-Based Practice : A Guide For Nurse Practitioners And Administrators. 2013. lxxiii Allen, David G., and Linda Rhoades Shanock. Perceived Organizational Support and Embeddedness as Key Mechanisms Connecting Socialization Tactics to Commitment and Turnover among New Employees. 2013 lxxiv Graybill, Jolie O., Employee Onboarding: Identification of Best Practices in ACRL Libraries.2013 lxxv Graybill, Jolie O., Employee Onboarding: Identification of Best Practices in ACRL Libraries.2013 lxxvi Simone, Shari, Kay Blum, and Mona N. Bahouth. Transitioning Into Hospital-Based Practice : A Guide For Nurse Practitioners And Administrators. 2013 lxxvii Johnson, Maggie, and Max Senges. Learning to Be a Programmer in a Complex Organization: A Case Study on Practice-based Learning during the Onboarding Process at Google. 2010 lxxviii Johnson, Maggie, and Max Senges. Learning to Be a Programmer in a Complex Organization: A Case Study on Practice-based Learning during the Onboarding Process at Google. 2010 lxxix Johnson, Maggie, and Max Senges. Learning to Be a Programmer in a Complex Organization: A Case Study on Practice-based Learning during the Onboarding Process at Google.2010 lxxx Simone, Shari, Kay Blum, and Mona N. Bahouth. Transitioning Into Hospital-Based Practice : A Guide For Nurse Practitioners And Administrators. 2013. lxxxi Lee, David. Successful Onboarding, 2008. lxxxii Lavigna, Bob. Getting Onboard: Integrating and Engaging New Employees. 2009 lxxxiii Korte, Russell F. The Socialization of Newcomers into Organizations: Integrating Learning and Social Exchange Processes.2007 lxxxiv Lavigna, Bob. Getting Onboard: Integrating and Engaging New Employees. 2009 lxxxv Korte, Russell F. The Socialization of Newcomers into Organizations: Integrating Learning and Social Exchange Processes.2007 lxxxvi Lavigna, Bob. Getting Onboard: Integrating and Engaging New Employees. 2009 lxxxvii Korte, Russell F. The Socialization of Newcomers into Organizations: Integrating Learning and Social Exchange Processes.2007 lxxxviii Aberdeen Group. A New Look at New Hires. 2013 lxxxix Lavigna, Bob. Getting Onboard: Integrating and Engaging New Employees. 2009


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Final OIP

Documents

Transcript of Final OIP