New Staff Onboarding: A 90-Day Checklist That Works

The first 90 days decide more than you think

A new nurse, technician or receptionist forms a view of the institution quickly. The institution forms a view of them just as fast. Talya Bauer's onboarding guide for the SHRM Foundation notes that "employees get about 90 days to prove themselves in a new job." The reverse is also true. Many people decide within months whether to stay.

In nursing, the cost is well documented. A US panel study of newly licensed registered nurses by Christine Kovner and colleagues found that about 17.5% left their first job within a year. Every early departure means another recruitment, another orientation and more pressure on the colleagues who covered the gap.

One more thing before the checklist. In our own work, the guide a newcomer receives is never final. Coordinators note what works on the floor, and the department's guide is rebuilt from those notes. A newcomer should meet the current version of the job, not last year's.

What research says about onboarding

Adjustment has measurable parts. A meta-analysis by Bauer and colleagues in the Journal of Applied Psychology, covering 70 unique samples of newcomers, tested a simple model. Role clarity, self-efficacy and social acceptance sit between what an organisation does for newcomers and outcomes such as job satisfaction, commitment, performance, intention to remain and turnover. The authors report that "the results generally supported this model." In plain terms: people stay and perform when they know what their job is, believe they can do it, and feel accepted by the team.

The four Cs. Bauer's SHRM Foundation guide turns this into four building blocks. Compliance is "teaching employees basic legal and policy-related rules and regulations." Clarification means people understand their job and what is expected. Culture covers the formal and informal norms. Connection is "the vital interpersonal relationships and information networks" a newcomer must build. The guide estimates that only about 20% of organisations formally address all four. Most stop at compliance and some clarification.

Structure matters, and the kind of structure matters more. The National Council of State Boards of Nursing ran a large randomised study of transition-to-practice programmes involving 105 volunteer hospitals in Illinois, North Carolina and Ohio, published by Nancy Spector and colleagues in 2015. Hospitals with established programmes had about 12% first-year turnover, against nearly 25% in hospitals with limited programmes. Yet the new standardised programme did not significantly reduce turnover against control hospitals in its first year: 15% against 16.7%. The authors suggest a programme may need to run longer than a year to have a major impact. NCSBN's summary lists what the better programmes shared: a formal programme backed by senior leaders, a preceptor educated for the role, a length of 9 to 12 months, and time to learn, apply and reflect with feedback.

We value this study because it flatters no one. Onboarding works when someone owns it and keeps it going well past the first day. A binder is not enough.

A 90-day checklist, stage by stage

Each stage below maps to the four Cs. Adapt the items to your institution. Keep the structure.

Before day one

• Verify licences and registrations with the issuing body, and record mandatory certificates with their expiry dates.
• Prepare access: badge, uniform, system accounts, locker and roster entries for the first two weeks.
• Name a buddy and, for clinical roles, a preceptor. Brief them before the newcomer arrives.
• Send a short welcome with the first-day schedule, who to ask for and where to go.

First week

• Cover compliance: fire safety, infection prevention, emergency response, privacy and incident reporting.
• Give a written role description and the list of competences to be signed off, with target dates.
• Introduce the newcomer to the people they will depend on, not only their own team.
• Hold a short check-in with the manager at the end of the week.

First month

• Work through competence sign-offs in practice, by observation, not by signature alone.
• Meet the buddy at least weekly. Keep these conversations separate from evaluation.
• Hold a 30-day review: what is clear, what is not, and what support is missing.

By 90 days

• Complete the core competence sign-offs, or record openly which remain open and why.
• Hold 60-day and 90-day reviews. Bauer's guide recommends milestones "such as 30, 60, 90 and 120 days on the job."
• Ask the newcomer what nearly made them leave, and fix one thing.
• For newly qualified clinicians, plan support beyond 90 days. The nursing evidence points to programmes of 9 to 12 months.

Buddies, preceptors and competence with evidence

A buddy and a preceptor do different jobs. A buddy is a peer who helps with connection and culture: where things are, who to ask, how work really runs. A preceptor, in clinical settings, teaches and supervises practice. Bauer's guide cites employers that give newcomers a buddy to help them navigate, and the NCSBN study ties better outcomes to preceptors educated for the role. Choose both deliberately, and give them time on the roster to do it.

Competence sign-offs deserve the same care. The Joint Commission separates orientation, "a process used to provide initial training and information," from competence, which it describes as "a combination of observable and measurable knowledge, skills, abilities and personal attributes." It leaves the timing to each organisation, based on the newcomer's starting level and the complexity of the task.

A sign-off should therefore record more than a signature. Note the skill, the date, who observed it, in what situation and with what outcome. If a competence has not yet been observed, show it as not yet assessed rather than ticking it to clear the list. A checklist full of ticks with no evidence protects no one, least of all the patient.

Measure early turnover honestly

Early turnover is the clearest signal of whether onboarding works. It is also easy to measure badly. Kovner and colleagues show that turnover rates change with how they are defined, for example whether every departure counts or only voluntary ones. Decide the definition before you look at the numbers.

• Track by start cohort. Group people by the quarter they started. Report how many in each cohort left within 90 days and within 12 months.
• Separate voluntary from involuntary. In the NCSBN study, first-year voluntary turnover was 16% and involuntary turnover 1%. They mean different things and need different responses.
• Show counts when numbers are small. Two leavers from a cohort of eight is 25%, but it is still two people. Say both.
• Ask why, and record it. A short exit conversation, held by someone outside the reporting line, tells you more than a percentage.
• Do not claim cause. If turnover falls after a new programme, other things may have changed too: pay, staffing levels, the job market. Say what you know and what you do not.

How Refraction handles onboarding

Refraction is Roadyom's people system. Onboarding sits beside staff records, the org chart, time off, rosters and credentials, so a new starter's checklist, licences and first shifts live in one place. Each stage has owners and dates. Competence sign-offs carry their evidence, and items without evidence show as not yet assessed. Checklists are checked against your institution's own framework rules. Refraction does not track activity, and it does not judge people. Managers and preceptors see the same record, and people make the decisions.

Sources

1. Onboarding New Employees: Maximizing Success. SHRM Foundation, 2010.
2. Newcomer adjustment during organizational socialization: A meta-analytic review of antecedents, outcomes, and methods. Journal of Applied Psychology, 2007.
3. Transition to Practice Study in Hospital Settings. Journal of Nursing Regulation, 2015.
4. Transition to Practice Study Results. National Council of State Boards of Nursing, 2026.
5. What Does Nurse Turnover Rate Mean and What Is the Rate?. Policy, Politics, & Nursing Practice, 2014.
6. Competency Assessment vs Orientation. The Joint Commission, 2026.

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