Creating Cultures of Belonging: Welcoming and Connecting Newcomers

A recap from the “Creating Cultures of Belonging: Welcoming and Connecting Newcomers to Our Teams” intensive session at the 2013 International Relationship-Based Care Symposium


The importance of retaining nurses

A stable, satisfied nursing staff is the bedrock of a successful health care organization, ensuring quality outcomes and profitability. No organization could or should have zero turnover; childbearing, retirements, spouses’ relocations, and individual and family health issues all need to be factored into an organization’s staffing plan.

Departing nurses take with them knowledge and experience; that loss has a significant impact on staff performance and patient outcomes, but it can be difficult to measure. The financial impact of nurse turnover is more quantitative. According to the final report of the Robert Wood Johnson Retaining Experienced Nurses Research Initiative (available at, estimates of annual turnover rates for RNs range from 8.4% to 13.9%. Depending on methodology and geography, estimates of the cost of replacing one RN range from $22,000 to $64,000. This cost comprises five major elements:

  • The nurse’s departure (e.g. payout for unused vacation)
  • Advertising for and recruiting a replacement nurse
  • Hiring the replacement nurse (e.g. interviewing, background checks)
  • Staffing the vacant position (e.g. overtime pay for current staff, hiring temporary staff)
  • Training and orienting the replacement nurse.

The latter two elements account for 2/3 of the replacement cost.

Other reasons nurses leave

Educational and career advancement. Organizations can retain some employees who wish to advance by providing career laddering.

The stress of work. Relentless advances in the amount and complexity of technology, increased acuity resulting from reduced lengths of stay, and heightened consumer expectations combine to make the work of many nurses more stressful than ever before.

Toxic work environments. Isolation, bullying, and disrespect (interdisciplinary and intradisciplinary) can drive any nurse away, but are especially devastating to new employees. The antidote is a Culture of Belonging in which newly hired nurses are supported and nurtured as they learn to navigate a new work world.

At an international symposium on Relationship-Based Care sponsored by Creative Health Care Management in Sandusky, Ohio in September 2013, a breakout session addressed this important topic of creating welcoming environments for new health care workers to maximize the quality of their work life as well as to optimize retention of these valuable employees. In a Nursing Salon setting, approximately 50 symposium attendees shared thoughts, feelings, and memories about their own onboarding experiences, as well as hopes and concerns for those who are joining the profession now. The confidential nature of Nursing Salons means that the material presented in this article is de-identified, but the passion and wisdom of the participants shines through. Here is some of what they had to say:

 Welcoming begins with the first contact.

Information about the organization and about open positions must be readily available, and the process of applying for a job must be user-friendly. All job applications must be acknowledged quickly, along with information on how the applicant can track the process. To do otherwise alienates applicants and affects the reputation of the organization in the community among a pool of potentially valuable workers. Individuals who are offered positions after a flawed application process already have an impression of the organization as uncaring at worst, and disorganized at best.

 The role of the manager in creating and maintaining a culture of belonging

The manager’s first interview with a potential staff member is crucial in two ways.

  • It plants the seeds of a potential work relationship.
  • It is the manager’s first opportunity to determine the employee’s fit with the unit and the role. Health care is extremely specialized, and the applicant (especially if a new graduate) may not be aware of the importance of proper fit.

The importance of the manager in initiating, facilitating, and supporting formal and informal group morale-building activities, and being seen to do these things, cannot be underestimated. Even more important in welcoming and retaining new employees is public recognition of individuals’ achievements and exemplary performance, and private acknowledgement of their personal stresses and issues when appropriate.

The organization needs to support the manager by providing sufficient time and resources to monitor and encourage individual employees’ career development, including increasing responsibilities, recommending continuing education, and pointing out opportunities for advancement within the organization. Acceptance and successful incorporation of new employees into a unit is closely related to the manager’s effectiveness in addressing bullies, toxic people, and negative leaders, and minimizing their impact on the unit culture.

 The role of the preceptor in creating and maintaining a culture of belonging

The preceptor has even more impact, for good or ill, on a new employee’s joining the group than the manager does. The preceptor must be expert in the tools used to orient new employees and to evaluate their progress, as well as in understanding and applying knowledge of adult learning styles and generational differences. The preceptor has a strong influence on the new employee’s social acceptance into the work group.

 Helping new employees cope with the realities of work life

The state of being a new employee includes the stress of unfamiliarity with new surroundings, new procedures and responsibilities, and the hard emotional work of joining an already established group, which some individuals find extremely difficult because of their personal makeup or previous experiences.

The implications of shift work for all employees, but especially for new employees, are often overlooked. Working while the rest of the world sleeps or plays is inherently alienating and disruptive to family and social life. Scheduling to minimize this disruption is crucial. Organizations need to provide opportunities and quiet environments for rest during breaks. Shift work makes healthy eating more difficult; organizations can do a lot to support employees in maintaining good nutrition.

The presence of cliques on particular shifts is normal and can be a healthy response to the alienation of shift work. But managers and the staff members themselves need to monitor the behavior of these cliques to make sure they are not having a negative impact on the care of patients or the emotional health of staff members – in particular, new staff members.

Organizations need to acknowledge that their employees have lives outside of work. New employees who recently graduated from their educational programs may also be separating from their former jobs, relocating, and making possibly life-changing personal and financial decisions, in addition to orienting to their new jobs. Even new employees with years of experience are often juggling relationships, care of children and/or parents, volunteering, and even additional jobs, along with orientation.

The relevance of generational differences in today’s work force is not confined to learning styles. Many new employees fully expect to change jobs, employers, career paths, and even careers over the course of their working lives. Acknowledging and celebrating this reality rather than regarding it as a destructive trend will help organizations recruit and retain knowledgeable, motivated individuals who will quickly become proficient at the work for which they are hired and will stay with the organization for a tenure that is fulfilling to both the employee and the organization.

Marty Lewis-Hunstiger, BSN, RN, MA, is editor of Creative Nursing: A Journal of Values, Issues, Experience, and Collaboration. 


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