Onboarding and early employment experiences in healthcare: Implications for retention

Abstract

Objective

In the United States healthcare system, employee retention is impacted by a range of factors including work environment, culture, remuneration, and managerial relationships. Leaders who understand these dynamics are crucial for enhancing retention and improving patient outcomes. This study aimed to identify key job satisfaction indicators—such as onboarding, comfort, productivity, job expectations, and perceived challenge—across various employment stages within a multi-hospital system in the Midwestern United States.

Theoretical Framework

Guided by Job Embeddedness Theory, this study examined how employees’ links to the organization, sense of fit, and potential sacrifices associated with leaving influenced retention patterns.

Methods

A quantitative descriptive-comparative design was used. MANOVA and one-way ANOVAs were conducted to evaluate differences among new employees at 30, 60, and 90+ days of employment based on five retention-related variables.

Results

Statistically significant differences emerged across all five indicators. Employees at 30 days were more likely to report that their job met expectations, felt productive, and were satisfied with onboarding. However, job satisfaction and comfort declined substantially by 60 and 90+ days, suggesting potential gaps in ongoing support. These patterns provide empirical support for Job Embeddedness Theory by demonstrating how employees’ sense of fit and organizational links initially strengthen retention intentions but weaken without sustained reinforcement, highlighting the importance of continuous integration strategies.

Conclusion

While early onboarding experiences were positive, findings highlight a marked decline in satisfaction over time. Recommendations include enhancing long-term engagement strategies, aligning job expectations with role realities, fostering leadership engagement, and offering continuous professional development tailored to employee tenure. Healthcare leaders who prioritize sustained employee support, clear communication, and adaptive retention strategies may improve workforce stability, organizational performance, and ultimately, patient care outcomes.