Healthcare systems are pouring time and resources into recruitment, pulling every lever to bring in the right clinical talent, only to watch many walk out the door within days. Without a plan to support them once they arrive, even the best hires won’t stick around. Some leave within weeks, others just after a few shifts, because nothing about their first days sets them up to succeed.
It’s a preventable failure with far-reaching costs. Clinicians arrive to confusion, lack of structure, mixed communications and unprepared teams – all immediate red flags that shake the confidence in the system they just joined.
These are not one-off, unavoidable incidents. Unfortunately, they happen too frequently and are symptoms of a deeper issue across the United States: the transactional approach to workforce strategies that dismisses the relational nature of our health care workforce.
Most hospitals are focused on hiring as fast and efficiently as possible. However, unless that same focus carries through to the first months on the floor, retention will remain the uphill battle it is today.
Rough Starts Leave Lasting Impressions
When a clinician shows up and their name isn’t on the schedule, or no one knows who’s orienting them, it signals disorganization and devalues their presence. These seemingly small oversights erode trust in the system, particularly in high-stakes environments where every hour matters.
The opening hours of a new assignment set the tone and shape whether they feel a sense of belonging, or lack of it. Without clear communication, structured support and cultural alignment, new hires often feel like outsiders.
In a workforce that is already stretched thin, no one wins when a promising hire walks away.
When Expectations Don’t Match Reality
One of the most common reasons clinicians leave early is a misalignment between what they were told and what they find on the job. Clinicians are promised stability, mentorship, or advanced systems, only to find understaffed units, outdated EHRs that are barely functional, and team members too overwhelmed to help.
Who wouldn’t feel disappointed when there is such a level of mismatched expectations? Even small details can become dealbreakers when they pile up.
The disconnects lead to frustration, which turns into doubt as clinicians question whether they are in the right place. Some may risk sticking around with the hopes that something will change, but eventually, many decide to leave.
Some of that disappointment can be avoided with a better matching strategy on the front end. Agencies that take the time to run a solid intake, such as getting clear on unit expectations, team dynamics, how prepared the facility is to onboard, are in a better position to place the right person. When that prep is matched with a deep knowledge of each clinician’s preferences and continuous feedback, it’s much easier to spot where the fit is good (or not).
What Onboarding Often Misses
In hospitals of all sizes, onboarding still revolves around policy compliance and administrative checklists. But after all that, a clinician might still walk into their first day unsure how to navigate the shift they have just been assigned.
That’s a missed opportunity. Effective onboarding should offer a clear sense of what to expect, not only technically, but also interpersonally. It should answer the questions clinicians are asking:
- Who do I talk to about shift swaps?
- How does communication work in the unit?
- What should I expect when things get hectic?
You won’t find these insights in a policy manual. Clinicians pick them up through real people interactions, or through intentional, well-structured onboarding that is built with their day-to-day experience in mind.
What Better Onboarding Looks Like
Most teams don’t need a massive overhaul. What they need is a better handoff with a few consistent practices that show someone how the first few days are going to unfold. They need clarity on team dynamics, communication protocols, escalation processes and who to turn to when things go wrong.
Some of the most impactful moves are also the simplest:
- Assigning a clear point of contact for the first few shifts
- Providing a short “what to expect” guide tailored to the unit
- Checking in after the first few days
- Orient with physical walk-throughs (real videos or simulations)
These early experiences help build trust and help them quickly get grounded and focused on what they came to do: care for patients. They are low-cost steps but valuable ones because they send the signal that tells them “You matter here.”
Clinicians who walk into a well-prepared environment notice the difference.
Start Retention Where It Actually Begins
Too often, teams don’t think seriously about retention until something goes wrong. By that point, the damage is already done. Once a clinician starts to question whether they’re in the right place, it’s tough to repair that security and broken trust.
The smarter move is to start earlier. That means thinking about fit before the hire is made, being clear about what the role involves, and creating space for clinicians to ask questions and find support early on.
Keeping a clinician in their role comes down to the basics: a clear schedule, a familiar face to check in with, and early signs that their presence is valued. Those are the things that turn a good hire into a lasting one.
Buffy Stultz White
Buffy Stultz White is CEO of PHHI, a healthcare staffing firm dedicated to transforming how hospitals and clinicians work together. She assumed leadership to challenge outdated models that prioritize profit over people and treat clinicians as interchangeable. At PHHI, Buffy focuses on building lasting partnerships with hospitals while ensuring clinicians are supported, respected, and set up for success. She champions sustainable staffing strategies that value both clinician well‑being and hospital performance.
