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“My takeaway from my new employee orientation experience is that it is the place where you go to learn how to be fired,” a Vice President said.

Mary Elizabeth’s first day on the job as the new Chief Nursing Executive for a suburban hospital was a disaster. It only went down hill from there.

As soon as she accepted the position, she gave her former employer a 30-day notice and immediately confirmed her start date with her new the boss, the Chief Executive Officer. He told her that his team would follow up, but there was no contact from the hospital until a week before the start date. She received an email from the Chief Human Resource Officer who explained the CEO had been away on vacation and instructed Mary Elizabeth to report to his office at 8:30 AM on her start date. That was it.

When she walked in on that first Monday, the CEO’s surprised executive assistant explained that her boss and his leadership team were in a meeting until noon. She began to feel like no one was expecting her.

The assistant called the facility manager to escort Mary Elizabeth to the newly renovated nursing administration suite that had been relocated from its previous location across the hall from the executive offices. The new offices were very nice – spacious, freshly painted and re-carpeted. There was just one problem: no furniture, no computer, no telephone, and no computer network wall outlets, and no assistant to help her get organized. The previous CNO’s executive assistant had apperently resigned three weeks prior. She was beginning to think that it was her first job and duty to kit out the room she was standing in. Was she soon to meet the CEO and be told “can you take a look at different desks for your staff and find other supplies for this new office, please”

The facility manager said the person in his office who coordinated office logistics was out on maternity leave and was not scheduled to return for two or three weeks. “Welcome to the team,” he said almost perfunctorily, “And good luck with all of this.”

Mary Elizabeth spent most of the first day on her own, filling out paperwork for a new assistant, making a list of office supplies she would need, talking to the telecommunications department about when they could get her on the network – no one had submitted a work order – figuring out where to have lunch, and going to get her new employee badge and parking tags. As she was returning from HR she heard her name paged, dialed the number and was connected with her boss. “I am sorry about the confusion. I thought you were coming in next Monday and have not had time to make the announcement about your first day. Let’s get together on Wednesday for lunch.”

When she arrived on Wednesday she found that her lunch meeting was cancelled – an emergency board meeting on a financial matter – and by the time she finished her new employee orientation the following Tuesday, Mary Elizabeth sadly concluded that being an executive in this organization was all about figuring it out for yourself. Her colleagues on the senior team seemed friendly enough but they were not overly helpful with her transition. With the exception of meetings, everyone seemed to remain in their silos. As she was driving home that night thinking about her initial experiences, Mary Elizabeth was struck by the thought that her new organization seemed so different from the one she saw during the interviews.

Seventy-eight days into her new role, after dealing with repeated surprises – material issues within nursing and the hospital’s financial position that were not disclosed in the recruitment process – she met with her boss to present her letter of resignation.

Now the hospital would have to begin the costly and disruptive process of searching for a new chief nursing executive yet again, the third time in five years.

While Mary Elizabeth’s story fortunately represents the rare and extreme dysfunction in new employee transition, it is clear, based on interviews with dozens new executives that many healthcare organizations have not invested in comprehensive onboarding that can protect against costly employee turnover. Even those healthcare organizations that say they have onboarding programs are missing the point. More often than not, it amounts to little more than online pre-employment administrative functions. This lack of buy-in to good onboarding is surprising on two fronts: first, hospitals and other healthcare organizations are among the most complex human organizations ever created and, second, buy-in can significantly reduce costly employee turnover in the first 24 months at a time when controlling expenses is a strategic imperative.

When you ask many hospital executives about onboarding they immediately revert to describing their employee orientation process. The agendas for these frequently mind-numbing events are packed with completing forms, listening to dull presentations on the policy book – the dos and don’ts – the benefits package, various videos, and individuals promoting other employee-focused programs. “My takeaway from my new employee orientation experiences is that they are the place where you go to learn how to be fired,” a newly appointed hospital vice president said. “Most are the same.”

While most employee engagement and transition consultants agree on the definition of onboarding, very few agree on when it should begin, the scope and contents of what the process should include or even how long the process should last.

For Mary Elizabeth, she was facing a significant challenge – to explain the short tenure and avoid allowing this mistake to derail her career.

Next: Recommendations for Onboarding

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